Theme 4: Support services

What does it cover?

• Services to respond to students experiencing mental health problems*
• Support for long term mental illness
• Services to support students with issues that may impact on mental health and wellbeing e.g. finance, disability, faith etc.

*Staff support is discussed in the Staff Wellbeing section.

Principles of good practice

4.1 Universities ensure that support services are appropriately resourced.

4.2 Universities ensure that support services are safe.

4.3 Universities ensure that support services are effective.

4.4 Universities ensure that support services are responsive to current and future need and to local context.

4.5 Universities ensure that support services are equally accessible to all students.

4.6 Universities ensure that support services are well governed.

Why is this theme important and what matters?

University support services have long been at the forefront of responding to student mental health and remain a key element in a whole university approach^[1]. While counselling services are the most often referenced type of support, the Charter consultations revealed that universities provide a wide variety of services that have a dedicated role in relation to student mental health and wellbeing^[2]. These services vary according to size and type of provider, but often include some combination of mental health teams, counselling, inclusivity teams, disability teams, wellbeing teams, nursing teams, chaplaincy, residential life teams and financial advice services. This demonstrates that many universities are devoting considerable resource and effort into supporting student wellbeing.

Research exploring student experiences of support services suggests that there are a number of key principles that must be met for services to meet student need^[3, 4, 5]. In particular, services must be safe, effective, accessible to all, appropriately resourced, relevant to local context and well governed.

While there are significant gaps in evidence demonstrating the effectiveness of support services, what evidence there is clearly shows that traditional services, such as counselling and therapy, can be effective responses to poor student mental health^[6, 7]. However, this does not mean that it can be assumed that all such services are effective. There can be significant variations in outcomes between counsellors/therapists and between services^[8, 9]. Counselling/therapy also has the potential to cause harm^[10]. It is therefore important that counselling/therapy services are taking steps to ensure quality, safety and effectiveness. Although opinions differ on how best to do this, research suggests that triangulating clinical data, outcome data and student feedback may provide an appropriate method^[11].

There is less agreement on how to measure the effectiveness of other services – such as mental health teams^[11]. Participants in the consultations highlighted a range of measures being used, such as gathering formal and informal feedback, holding student advisory groups, using university level data and measuring the impact of individual interventions. However, given the nature of the work undertaken by many mental health teams, there is an equal need to develop robust measures of safety and effectiveness for these areas^[12, 13]. Support services staff in focus groups and surveys identified that mental health teams are supporting increasing levels of risk and complexity. Given this, it is vital that staff in these roles are properly equipped, qualified, registered and supervised. This need for quality assurance extends to other interventions, such as the provision of digitally based services.

Equally important is that support services are accessible to all students. This includes physical accessibility, i.e. ensuring that all students, including those with physical disabilities, can access the buildings and rooms where services are provided. Consideration should also be given to how mode of study or the geographical spread of a campus may affect accessibility, and how decisions about location, opening hours and mode of provision of services (online, digital applications and by telephone) can help to alleviate this.

The need for accessibility requires services to be culturally competent. Recent reports have raised concerns that some services may not understand the experiences and needs of particular student groups e.g. BAME students, LGBTQ+ students, international students and post–graduate students^{[3, 16, 17]}. National data and students in the Charter consultation indicated that a lack of informed cultural understanding, from support staff, can result in students not accessing support or not returning after a first appointment^[14, 15] (see Inclusivity and Intersectional mental health).

Waiting lists are also an accessibility issue. If students in need have to wait several months or if service lists are closed down all together, then a service is no longer genuinely accessible. Recent research has raised concerns about the length and ubiquity of long waiting times for support services and the impact on students and other staff^[5, 18]. It should be recognised that there are a number of reasons waiting lists can grow, including unpredictable rises in demand, management and triage practices. However, appropriate resourcing can be a factor. It is therefore incumbent upon universities to ensure that they are providing sufficient resources, recruiting the right staff and managing services effectively and efficiently.

All of which emphasises the importance of effective governance of support services. As evidence gathered through the Charter consultation demonstrated, services dedicated to student mental health manage risk on a regular basis and frequently encounter complex ethical challenges.

Services such as counselling and mental health teams require appropriate clinical governance to ensure services remain safe, ethical and effective and make efficient use of resources^[19].

This includes ensuring that staff in specific mental health roles are appropriately qualified, clinically supervised and registered with a professional body.

Finally, services are most effective when designed to meet the needs of their local community. The consultation revealed a variety of models of services shaped to respond to local context. These included partnerships with NHS/Social Care or third sector organisations, and shared services provided across a number of small institutions. There is no one–size–fits–all model that would meet the needs of students in every university. However, there are a number of principles that emerge from the research and our consultations.

First, effective services are those that understand the context of student life and of the relationship between academic learning and wellbeing, as these are such influential factors in the experiences of students^[20, 21]. Second, services should understand their local community and establish mechanisms for the student and staff voice to influence service development^[22] (see Student Voice and Participation). Finally, services should be responsive to changes in need among their population– for instance, some universities identified specific issues among their student cohorts that had led to the provision of specialist services (e.g. for eating disorders or addiction).

Suggested resources

Research from the Charter consultation – E. Cage, E. Jones, G. Ryan, G. Hughes & L. Spanner (2021) Student mental health and transitions into, through and out of university: student and staff perspectives

BABCP – Improving Access to Psychological Therapies (IAPT) Black, Asian and Minority Ethnic Service User Positive Practice Guide

Book – Student Mental Health and Wellbeing in Higher Education: A practical guide

References