Theme 5: Risk
What does it cover?
- Risk related to suicide
- Risk related to mental health crisis
- Risk to wellbeing from others
Principles of good practice
5.1 Universities have in place effective practice, processes and training for alerting and assessing risk to staff and students, and appropriately referring those at risk to internal or external services.
5.2 Universities ensure staff have access to timely, expert advice and guidance.
5.3 Universities provide interventions for all affected by risk and suicide and provide support for those at risk, when waiting for external interventions.
5.4 Universities plan for prevention, intervention and post-vention activities, including planning for suicide clusters and reporting to the media.
5.5 Universities reduce risk by ensuring they provide a safe physical environment and university culture.
5.6 Universities support students to be able to report concerns.
Why is this theme important and what matters?
ONS data indicates that in the year 2016–2017, 95 students took their own lives (1). A recent international meta–analysis found that 3% of students reported attempting to end their lives and 1 in 4 had experienced suicidal ideation in the previous 12 months (2). Concerns have also been raised about the risk to university staff from suicide and serious mental illness (3).
Evidence from staff in the Charter consultation indicates that university support services are seeing more students with enduring and complex mental health difficulties and a higher level of risk to themselves and/or others. This is supported by research with academics and halls staff who report the same trends (4, 5). While it is clear that students are less likely to end their lives than their matched peers in the general population (1, 6), risk related to mental health is a very real factor within universities. There is, therefore, a clear ethical responsibility for universities to act in this area.
That is not to argue that universities are entirely responsible for the safety of seriously ill students or for treating or keeping safe those who require urgent psychiatric intervention. Nor are they entirely responsible for the safety of staff experiencing serious mental illness. Much of this clearly lies with the NHS and Social Care. However, as much of this risk will be presented within the university environment and have an impact throughout the community, institutions do have a responsibility to plan for prevention, intervention and post–vention activities (7). This includes planning for potential suicide clusters (8). Suicide has understandably attracted a substantial amount of attention nationally. This is a complex issue, made more so by the fact that many students who experience mental illness or go on to take their own life, do not contact support services (9).
In addition to risk from suicide, attention must to be paid to individuals who experience mental health crisis. For instance, an individual experiencing psychosis may engage in behaviours that place them or others at risk, without them fully perceiving, understanding or acknowledging the potential consequences of their actions.
Behaviours caused by mental illness and suicide can have impacts on others connected to the individual. The RaPPS report (7) identified that suicide transmission can be a risk in the student community. Students who have a friend who ends their own life are more vulnerable to dropping out of university, underperforming or developing suicidal ideation or going on to end their own life (8). Staff and students effected by suicide are, therefore, likely to need additional support and interventions. Individuals may also require support if they have supported a mentally ill friend, peer or colleague, or witnessed acts of self–harm or expressions of great distress (11, 12).
Finally, there is a significant mental health impact for individuals who are at risk of harm from others. Students who are experiencing abusive relationships may need specific interventions and support (13). Evidence indicates that hate crime, harassment and discrimination, sexual violence or violence motivated by ethnicity, sexuality, disability or gender, can have a negative impact on mental health (14, 15).
Universities must therefore ensure that they are alert to early warning signs of significant illness, have efficient internal and external referral and signposting, be able to assess risk appropriately, provide interventions for all of those affected by risk and suicide and ensure the safety of the environment (7, 16).
Staff in non–specialist roles who are concerned about potential risk, need to be able to access timely, expert advice and guidance. Students who have concerns about peers, need highly visible routes available to report their concerns and to access support for themselves.
This guidance is best provided by staff who have the clinical expertise and qualifications to assess risk and who have received up to date risk assessment training. It also requires services to have effective triage in place, to ensure that those at risk are seen in an appropriate timeframe.
This requires universities to be able to support individuals to maintain their own safety while waiting for NHS/Social Care interventions. The fact that there will usually be a delay between reporting a concern to statutory services and intervention is inevitable (even if that delay is waiting for an ambulance). Universities should ensure they have prepared for this eventuality and have clear and effective practice and resources in place.
Finally, how suicide and mental health is spoken about and reported publicly can have significant negative effects on others, potentially increases risk and can lead to further deaths (17 – 19). University communication teams should be trained and prepared to communicate with the media in relation to suicide and to adhere to national reporting guidelines (17).
Samaritans – ‘Step by Step’ Samaritans Post–vention support service
StayingSafe.net – Staying safe from suicidal thoughts
Universities UK – Suicide Safer
|1. Office for National Statistics. (2018). Estimating suicide among higher education students, England and Wales: Experimental Statistics. London: ONS. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsand marriages/deaths/articles/estimatingsuicideamong highereducationstudentsenglandandwalesexperimental statistics/2018–06–25. [Accessed: 4/9/19]|
|2. Mortier, P., Cuijpers, P., Kiekens, G., Auerbach, R., Demyttenaere, K., et al. (2018). The prevalence of suicidal thoughts and behaviours among college students: a meta–analysis. Psychological Medicine, 48 (4), pp. 554–565|
Morrish, Liz. (2019). Pressure Vessels: The epidemic of poor mental health among higher education staff. London: HEPI.. https://www.hepi.ac.uk/wp–content/uploads/2019/05/HEPI–Pressure–Vessels–Occasional–Paper–20.pdf. [Accessed: 30/9/19]
|4. Piper, R. (2016). Student living: collaborating to support mental health in university accommodation. Oxford: Student Minds. https://www.studentminds.org.uk/studentliving.html|
|5. Hughes, G., Panjwani, M., Tulcidas, P., Byrom, N. (2018). Student mental health: The role and responsibilities of academics Oxford: Student Minds.|
|6. Gunnell, D., Caul, S., Appleby, L., John, A. & Hawton, K. (2020). The incidence of suicide in University students in England and Wales 2000/2001–2016/2017: Record linkage study. Journal of Affective Disorders. 261, pp 113–120.. https://doi.org/10.1016/j.jad.2019.09.079.|
|7. Stanley, N., Mallon, S., Bell, J., Hilton, S. & Manthorpe, J. (2007). Response and Prevention In Student Suicide (Rep). Preston: University of Central Lancashire.|
|8. Public Health England (2019). Identifying and responding to suicide clusters: A practice resource. London: PHE. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/839621/PHE_Suicide_Cluster_Guide.pdf. [Accessed: 8/11/19]|
|9. McLafferty M, Lapsley CR, Ennis E, Armour C, Murphy S, et al. (2017) Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland. PLOS ONE 12(12): e0188785.. https://doi.org/10.1371/journal.pone.0188785|
|10. Pitman, A.L., Osborn, D.P.J., Rantell, K., et al (2016) Bereavement by suicide as a risk factor for suicide attempt: a cross–sectional national UK–wide study of 3432 young bereaved adults. BMJ Open; 6. DOI: 10.1136/bmjopen–2015–009948|
|11. Byrom, N.C. Supporting a friend, housemate or partner with mental health difficulties: The student experience. Early Intervention in Psychiatry. 2019; 13: 202– 207.. DOI: https://doi.org/10.1111/eip.12462|
|12. Byrom, N. & Warren, A (2016) Look After Your Mate. Oxford: Student Minds|
|13. Clements, C., Ogle, R. & Sabourin, C. (2005). Perceived control and emotional status in abusive college student relationships: an exploration of gender differences. Journal Of Interpersonal Violence, 20(9), pp. 1058–1077.|
|14. McDevitt, J., Balboni, J., Garcia, L. & Gu, J. (2001). Consequences for victims: A comparison of bias and non–bias motivated assaults. American Behavioral Scientist, 45, pp. 697–713.|
|15. Iganski, P. & Lagou, S. (2015). Hate Crimes Hurt Some More Than Others: Implications for the Just Sentencing of Offenders. Journal of Interpersonal Violence, 30(10), 1696–1718.. https://doi–org.ezproxy.derby.ac.uk/10.1177/0886260514548584|
|16. UUK, (2018). Suicide Safe Universities. London: UUK.. https://www.universitiesuk.ac.uk/policy–and–analysis/reports/Documents/2018/guidance–for–sector–practitioners–on–preventing–student–suicides.PDF|
|17. The Samaritans, (2013). Media Guidelines for reporting suicide. Surrey: The Samaritans.. https://www.samaritans.org/about–samaritans/media–guidelines/best–practice–suicide–reporting–tips/. [Accessed: 8/11/19]|
|18. Etzerdorfer, E. & Sonneck, G. (1998). Preventing suicide by influencing mass–media reporting. The Viennese experience 1980–1996. Archives of Suicide Research. 4(1) pp 67–74|
|19. Sinyor, M. Schaffer, A. Nishikawa, Y. Redelmeier, D.A. Niederkrotenthaler, T. Sareen, J. Levitt, A.J. Kiss, A. & Pirkis, J. (2018) The association between suicide deaths and putatively harmful and protective factors in media reports|