Theme 10: Proactive interventions and a mentally healthy environment

What does it cover?

• Ensuring a culture and environment that supports good mental health
• Proactive interventions to improve the mental health of the whole community
• Proactive interventions targeted at the mental health of specific groups of students
• Awareness raising

Principles of good practice

10.1 Universities promote the mental health of all members of the community through education, actively encouraging healthy behaviours and community– building and providing proactive interventions to improve wellbeing.

10.2 Universities take steps to create an environment and culture that supports positive mental health and wellbeing.

10.3 Universities take steps to create an environment that facilitates and makes it easy for individuals and groups to adopt healthy behaviours, offering multiple and varied options and interventions.

10.4 Universities take steps to create a culture that prioritises mental health as important and are open and highly visible in doing so.

10.5 Universities take steps to create a culture in which individuals feel safe and supported to disclose when they are experiencing poor mental health.

Why is this theme important and what matters?

Research has consistently shown that most students and staff who experience poor mental health do not access formal support ^[1, 2]. We also know that there is no single approach to mental health support that works for everyone ^[3, 4, 5]. While medication, therapy/counselling and behavioural interventions can be effective for many, for each of these approaches there is a proportion of the population that experiences no improvement ^[4, 5, 6].

It is therefore important that students and staff have access to a range of interventions, so that each individual is able to find the thing that works for them.

Human beings have a complex relationship with social context^[7]. Our environment and surrounding culture has a significant effect on our behaviour, wellbeing and mental health ^[7, 8]. Research in psychology and economics has shown that our behaviours are heavily influenced by environmental cues (7–9). Emotional states can be contagious^[10] – a culture which heightens stress for some will ripple out to impact on the people around them. Conversely, a culture in which people are happy, fulfilled and motivated, will have positive impacts on the wellbeing of the whole population. Recognising the impact of social context can help to avoid a deficit approach to mental health, address the issues within university communities that hinder mental health and create an environment that supports good wellbeing ^[8, 9, 11].

Many universities are already taking proactive approaches to improving mental health and preventing mental illness in their communities^[10] . Awareness raising activities and forms of health promotion and psycho–education have been a staple part of university life for many years. It is important to note, however, that education and awareness raising alone does not tend to alter health behaviours or significantly improve wellbeing ^[9]. The environment has been shown to be a much stronger influence on health related behaviours than knowledge by itself^[8, 9]. A mentally healthy university, therefore, requires an environment that is itself good for wellbeing and which supports healthy behaviour and the development of habits that are good for mental health ^[11, 12].

At an individual level, knowledge and understanding of healthy behaviours must be supplemented by environmental cues and support to develop motivation for change ^[9]. That is not to say that awareness raising interventions are not important; the presence of regular, highly visible awareness raising can be an important part of establishing an open culture which supports positive change and can help individuals identify the most appropriate ways forward for them.

Interventions to improve physical health and wellbeing have been repeatedly shown to have positive impacts on mental health. Exercise, diet, engaging with nature and good sleep can all help to improve or maintain mental health ^{[13, 14, 15, 16]}. Importantly, these behaviours can have a deep and long lasting ‘pooled effect’^[15]. In other words, the positive gains are maintained beyond the time someone is engaged in the activity. For some individuals, improving physical health will be their best route to mental health. A university environment that promotes physical health and makes it easy for staff and students to eat healthily, exercise, engage with nature and sleep well, will therefore have a positive impact on both mental health and wellbeing. The Behavioural Insights Team argue that for such interventions to be successful they should be Easy, Attractive, Social and Timely ^[17]

Universities have provided a range of proactive interventions that have been shown to have significant positive impacts on wellbeing, such as yoga, mindfulness and peer support ^[18, 19]. Again, such interventions can provide the most effective path to good mental health for some people. However, interventions can be a risk to mental health if delivered poorly ^[3, 4, 5]. Adopting evidence informed practice, testing the impact of interventions in context and ensuring staff are qualified and appropriately trained are important steps in guarding against harm, as well as ensuring that resource is being used efficiently and effectively.

Finally, universities have implemented interventions that are targeted at specific student groups, either because they have particular needs or because they are less likely to access traditional services ^[20]. These include interventions for disabled students, particular nationalities of international students, BAME students, male students and LGBTQ+ students. The mere presence of these interventions can help to make the university feel a more welcoming and supportive environment. However, it should be noted that to ensure relevance and effectiveness, such interventions are often better if they are co–created with those with lived experience (see Student Voice and Participation on page 65) ^[21].

For interventions to be effective, they must be underpinned by a cohesive environment and culture that is open about mental health and supports the wellbeing of the whole community.

Visible messaging from leadership, role modelling, day to day practices and behaviours, a sense of community and evaluated ‘nudges’ are all key to this ^[22]. It is important that staff and students encounter a culture in which it feels safe to disclose, if they are experiencing poor mental health and in which they receive effective, appropriate support.

Suggested resources

Canadian Health Promoting Campuses – Okanagan Charter

Website – Healthy Universities Network

References