Module 5, Topic 2
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Theme 15: Student voice and participation

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What does it cover?

  • Student involvement in the development of mental health strategies
  • Student voice and participation in shaping key university strategies that affect mental health (e.g. teaching and learning strategies)
  • Student voice, participation and co–creation of services and responses to mental health
  • Processes for students to raise concerns and highlight issues which may positively or negatively impact on their mental health

Principles of good practice

15.1 Universities work in partnership with students to develop mental health related strategy and policy.

15.2 Universities work in partnership with students to shape the ongoing development and oversight of support services.

15.3 Universities work in partnership with students and staff to create a culture that supports good wellbeing.

15.4 Universities provide clear structure for participation and co–creation, support staff and students to develop the necessary skills to collaborate and ensure approaches to co–creation are safe and inclusive.

15.5 Universities take proactive steps to ensure that a diverse range of student and staff voices are considered in developing responses to mental health.

15.6 Universities ensure that student–led or peer support interventions are safe, appropriately resourced and well–managed.

Why is this theme important and what matters?

One of four key components of empowering people with mental health problems, as set out by the World Health Organisation, is “participation in decisions.”[1] Listening to those who experience mental illness is vital, if services and interventions are to be effective and avoid harm [234].

Historically, those receiving mental health care have often been denied their agency and their right to have a say in how they are supported. This has led to delays in responding to adverse effects of interventions, persisting with responses that were ineffective and potentially harmful and missing opportunities for improvements in care [135].

A genuine whole university approach to mental health must learn from these experiences and seek to understand the beliefs, insights, needs and experiences of the whole population.

In responding to mental health problems, different approaches work for different people, and recovery and well supported mental health is often context dependent [6]. To support good mental health in students, it is therefore necessary to understand the context and the direct experiences of current students [7]. Interventions, strategies and services that are developed without fully understanding the experiences and views of students are likely to be less effective and less responsive to actual need.

This is not to say that the views and expertise of clinical professionals are not important. Rather, that the student voice is a vital element in the evidence base, alongside other forms of research, outcome measurement and clinical expertise. By bringing together and triangulating all of this evidence, interventions and strategies can be more targeted, relevant and effective.

Participation in co–creating responses to mental health needs can be beneficial for the individuals involved, helping them to contextualise their own experiences, gain new skills and develop a sense of empowerment and agency [8].

Recent work on student participation sets out how students can be engaged in developing approaches to mental health with varying levels of involvement, from consultation to co–production.[79]

Working with individuals to develop approaches to mental health is an active, ongoing process of collaboration, operating at multiple levels. Students need to be supported to develop the skills and confidence necessary to participate fully in this process of co–creation. It is also important that considerations of participant safety are embedded into the design and operation of the process, particularly for those with previous lived experience of mental illness.

The process of co–production can be facilitated through effective partnerships e.g. between students’ unions and their university and by carefully ensuring that those participating are representative of the diverse student and/or staff body.

Within a whole university approach to mental health, there are a number of areas in which co–creation and participation are important.

The first is in developing or revising the university’s strategic approach to mental health. Student experiences, views and ideas should be included in the development of strategy from conception[710].

Secondly, the student voice can play an important role in helping to oversee, shape and develop student support services, ensuring they are responding to need and serving as an additional quality assurance mechanism. A number of universities in the Charter consultation identified ways in which this was happening in their institutions, including involving students’ union officers in planning groups, holding regular student advisory panels and gathering regular feedback from service users.

Thirdly, co–creation and participation can highlight any aspects of university life that may be having a detrimental impact on mental health and identify potential actions which may improve wellbeing. Finally, students are a significant part of the everyday culture of any university and will, therefore, play a significant role in creating an environment that is positive for mental health. Students can play a powerful role in carrying positive messages about mental health into the university community and can help shape and support the effectiveness of support services’ communication strategies.

We have already noted how student groups can be effective in supporting social integration and preventing mental illness (see Social integration and belonging on page 57). In addition to this, in many universities, students provide direct support to other students. This can happen through peer mentor programmes, or through specific roles, such as Resident Assistants or Wardens in halls. There is strong evidence that many students turn to their friends when experiencing problems with their mental health and that peer support, when done well, can be an effective form of support [11]. Students can help to provide part of the multiple interventions necessary for a whole university approach. However, it is important that students are not regarded as a low cost option when universities are considering their responses to mental illness. Peer support requires adequate resourcing, training and close supervision [12]. The purpose of each type of peer support should also be clear, with well delineated and maintained boundaries. Without this, there is potential risk for both the peer mentor and mentee.

Suggested resources

Student Minds – Co–producing Mental Health Strategies with Students: A Guide for the Higher Education Sector


1. Baumann, A. (2014). User empowerment in mental health – a statement by the WHO Regional Office for Europe. [Online] World Health Organisation.
2. Adelphi Research UK, (2018). No Voice, No Choice (Rep). London: Rethink Mental Illness. . https://www.–voice–no–choice/ . [Accessed: 09/10/19]
3. Healey, D., Le Noury, J. & Mangin, D. (2019). Post–SSRI sexual dysfunction: Patient experiences of engagement with healthcare professionals. . International Journal of Risk & Safety in Medicine, 30(3), pp. 167–178.. DOI: 10.3233/JRS–191005
4. Israilov, S. & Cho, H.J. (2017). How Co–Creation Helped Address Hierarchy, Overwhelmed Patients, and Conflicts of Interest in Health Care Quality and Safety. AMA J Ethics. 19(11), pp.1139–1145. . DOI: 10.1001/journalofethics.2017.19.11.mhst1–1711.
5. Independent Mental Health Taskforce to the NHS in England, (2016). The five year forward view for mental health.London: NHS. .–content/uploads/2016/02/Mental–Health–Taskforce–FYFV–final.pdf. [Accessed: 09/10/19]
6. Grant, A. M., & Schwartz, B. (2011). Too Much of a Good Thing: The Challenge and Opportunity of the Inverted U. Perspectives on Psychological Science, 6(1), pp. 61–76.. DOI:
7. Piper, R. & Emmanuel, T. (2019). Co–producing Mental Health Strategies with Students: A Guide for the Higher Education Sector. Leeds: Student Minds . [Accessed: 30/9/19]
8. Slay, J. & Stephens, L. (2013). Co–production in mental health: A literature review. London: New Economics Foundation .
9. Healey, M., Flint, A. & Harrington, K. (2014). Engagement through partnership: students as partners in learning and teaching in higher education. [Online] Higher Education Academy. https://www.advance––hub/engagement–through–partnership–students–partners–learning–and–teaching–higher
10. Student Minds, (2017). Student Voices. Oxford: Student Minds
11. Byrom, N. (2018). An evaluation of a peer support intervention for student mental health. . Journal of Mental Health. 27 (3) pp. 240 –246
12. Gulliver, E. & Byrom, N. (n.d.) Peer Support for Student Mental Health. Oxford: Student Minds. . [Accessed: 2/11/19]