What’s next for the future of student mental health?

We take a deep-dive into current student mental health trends, the latest thinking in the student support sector, and what this means for the future of student mental health.

Content warning: This episode contains discussion of sensitive topics including suicide, eating disorders and domestic violence. If you need support with the topics discussed in this episode, there are organisations such as Mind (0300 123 3393), Samaritans (116 123) or Student Minds that can help you in complete confidence.

Episode talking points include the legacy of Covid-19 on student mental health, how universities and accommodation providers are collaborating on matters of student support, student suicide prevention, and the future of student mental health provision.

Host Jenny Shaw is joined by an expert sector panel made up of:

• Professor Jo Smith, Professor of Early Intervention and Psychosis at University of Worcester
• David Malpas, Director of Student Affairs at Middlesex University
• Becca Hayhurst, Head of Student Support at Unite Students

Listen to the episode now on your preferred podcast platform, or you can download the episode below from Podbean. Links to resources mentioned over the course of the episode are available in the episode show notes.

Episode transcript: The future of student mental health

Jenny Shaw: Hello, and welcome to Accommodation Matters, where we talk about the topics that really matter for student accommodation. Student mental health is, of course, one of those topics; it’s been at the forefront of our minds for many years now.

I’m your host, Jenny Shaw, Higher Education External Engagement Director at Unite Students. Now, before we start, I do want to give a content warning because in this episode, we’re going to talk about a range of mental health issues, including eating disorders and suicide.

Today, as usual, I’ve got an expert panel with me – I’m going to ask them each to introduce themselves.

Jo Smith: Hi, my name is Professor Jo Smith. I’m a clinical psychologist by profession. I’ve worked for 34 years in the NHS, in serious mental health problems in young people, and then moved across to work as Professor of Early Intervention and Psychosis at University of Worcester, and was the Suicide Safer Project Lead for six years there.

David Malpas: Hi, I’m David Malpas. I’m Director of Student Affairs at Middlesex University based in Hendon, North London. My background initially was as an academic at Middlesex before I moved into Professional Services, and now I’m Director of Student Affairs.

Becca Hayhurst: Hi, I’m Becca Hayhurst, Head of Student Support at Unite Students, and my background is in University Student Services. I spent over 15 years working within a university, and now, I’m bringing that knowledge through to the accommodation sector working at Unite Students.

Jenny: That’s great, thank you. Now, last time we recorded an episode on student mental health, we were still right in the middle of COVID. Lockdown, social restrictions, in some cases, bereavement, were all having a huge and immediate effect on students.

Things have changed now, things are opening up, but there are still some legacy effects, and new pressures as well because, of course, society didn’t stand still over the last two years – things have moved on. Jo, can I come to you first? Which mental health issues came to the fore during the pandemic, and are these things that are still affecting students?

Jo: I think what we’ve seen generally if we look within the general population, we’ve seen an increase in mental health presentation and referrals. We’ve seen that with child adolescent and youth services. That has all also been reflected within Student Services within the university sector and Higher Education sector, that we’ve seen more presentations for mental health problems.

I also think it’s important to say that eating disorders referrals have gone sky high within the NHS. It’s probably one of the biggest areas where referrals, and again, there’s been a push to towards early intervention. What we’ve seen, certainly at Worcester, is an increase in referrals, and in fact we have partnered with an eating disorder service because there’s an early intervention initiative there. So we’ve actually been having that service coming onsite to run groups for students.

Jenny: David, can I come to you? What kind of issues are your students presenting with at the moment at Middlesex University?

David: It’s a complete range, Jenny. We have, within our counselling team who are trying to support students, a variety of mental health issues. We also have something called our Care and Concern Process, where we hold our at-risk students. We probably have, at any one time, anything between 5 and 10 students that we are particularly concerned about in terms of suicide.

What we’ve found since the pandemic and the approach we now have in terms of blended working and blended learning is the complexity that has caused in terms of responding to student needs and the student issues.

Jenny: Is that a complexity in terms of the service end of things, or is that a complexity for students themselves?

David: I think it’s both. The pandemic has caused things like isolation, students unable to go home, accommodation issues, and so the knock-on effect of that has been more complex for universities to be able to support these students and then put effective action plans in place.

Jenny: Did anything pop up during the pandemic that surprised you, in terms of presenting issues?

David: I’m not quite sure whether ‘surprise’ is the right word because we saw it as the national situation, but the increase in domestic violence and how we could support students in those situations.

One of the things we did at Middlesex was to really open up our halls of residence and provide free accommodation as a safe haven for our students that were affected by domestic violence because, what we were experiencing at the time, was that the private rental accommodation sector just closed down, so students could not get accommodation.

Jenny: Thank you. Just looking forward now, Becca, you’ve said that you’ve got the experience from both the university sector and now, in PBSA, you’ve got a national role now. Given that perspective that you’ve got, what are you seeing as some of the emerging issues in student wellbeing and mental health?

Becca: I think one of the biggest observations that we’ve made within the student support team is that those transitions that students go through are now more important than ever for us to pay attention to. For example, the transition into university, the transition during the course of your student journey, onto placements, or into a graduate career have suddenly become more of a concern for us, and more of a concern for students because the way in which they’ve been taught, and the way in which they’ve been learning over the last few years, is so different to previous cohorts of students.

It’s been more behind closed doors, less social contact, so there’s more social anxiety coming through. We have a duty to make sure that we’re aware of that – that transitional process and that experience that students are having, and working with them to help them through it. We’ve certainly seen that.

Social anxiety, in particular, is a hot topic for us. There’s an increasing demand for emotional assistance animals to be brought through to university, and things like that. As a sector, it’s something that we have to be responsive to.

Jenny: Yes, absolutely. What’s new in the Student Services world? What are some of the emerging trends in terms of the way in which you might respond to students?

Becca: The emotional assistance animals is a big area in which we need to respond to the trend. The demand is there – so as a sector, both accommodation and universities, we need to work together to establish how we want to support students, and how we might make reasonable adjustments for students to accommodate those requests. That’s particularly where they are acutely aware of how they’ve managed and coped over the last couple of years before coming to university, we need to try and accommodate that where we can – but it’s not without its challenges. That’s one of the areas that we’re looking at.

The other is around collaborative work. Those of us on this podcast, we’re looking at suicide postvention – but there’s also broader work happening around general student behaviours, sexual violence, drugs use, so all of those key topics that affect the age group with which we are working. We need to now work collaboratively so that whatever we do is reflected both in a university setting, but also in our accommodation settings as well; really setting some best practice, and making sure that what we’re doing is in the best interests of the students, and is being rolled out nationally.

That’s certainly an area of work that I’m particularly interested in. As a team at the moment, we’re developing something called ‘Support to Stay’, which is a framework which will complement university processes. University processes are around supporting students to study, so, working with them to maximise the chance of success no matter what barriers crop up along the way. From our accommodation perspective, it’s a complementary approach. It’s supporting them within their accommodation and working with university partners to make sure that students have that best chance of success.

Jenny: Yes, I think it’s really interesting how that sort of parallel process is developed – or the recognition of the importance of what happens in accommodation, as well as what happens in the academic space. I think going alongside the structural changes in the accommodation sector, with a huge amount now provided by private providers, drives that need for collaboration as well. We might come back to that later.

One of the things that I did want to ask is really about students’ own awareness of mental health conditions. That’s something that I’ve certainly noticed, that young people themselves are very knowledgeable often, about conditions that they’ve either had diagnosed, or something that they maybe haven’t had diagnosed but that they recognise in themselves. I’m wondering how this affects the way that students are approaching services. Is that a change that’s been seen over the last few years? Can I come to you on this first, Jo?

Jo: We have seen an increased mental health awareness, again, in students and in the general population. I think that’s been aided by access to the internet, and the ease with which we can get information. Certainly, we’ve seen that in students and staff being able to access information from the internet, but also through social media, we can access information more easily from peers. We don’t necessarily have to wait to see a professional. We don’t necessarily have to wait till we see someone. We can just text or use social media in order to do that.

That’s helpful, but one of the things is about quality checking some of the information that people are accessing, to ensure that it is appropriate and helpful. I think that’s one of the concerns – that sometimes there aren’t quality checks, and that can take people up routes which may not be helpful. Again, in terms of peer support, I think there’s mixed feelings about social media. It can be extremely helpful, and particularly in the context of COVID, has been helpful to connect people, but it can lead to unhelpful conversations too.

It’s much harder to control that. Certainly, universities may well signpost people to information that has been evidence-checked. We have things like Ripple now, which also identifies when students are perhaps searching for unhelpful sites and gives popups to more helpful signposting. The difficulty is people can use mobile phones or personal PCs – they don’t use necessarily university systems. We have no real control over knowing what people are looking at, what information they’re getting, and whether that information has been tested, and whether it is evidence-based.

That’s the concern about it, but we have a much more informed, much more aware group. I think more expectations as well, comes along with that, in terms of what people are expecting. People are less passive and much more active in terms of wanting to take control to learn for themselves.

Jenny: Yes. Thank you, Jo. I do want to pick up on that theme about students being more knowledgeable and the expectations that that may bring. I’m wondering, David or Becca, if you want to comment on how students are presenting themselves for support with that knowledge behind them.

David: Could I actually think about this from an international student perspective? There is evidence that students come to the UK with mental health issues because they and their families know that the NHS and related services – and we, the support services at universities – will help them. I think when the pandemic hit, students who couldn’t get home and were left in halls of residence or in private accommodation, are then very much isolated because of how we all had to stay at home, et cetera.

The other was really students that actually went home and were still expecting support from specialists at universities in the UK, and the concern around how we could continue to do that when there wasn’t the access in some other countries to the secondary support services that we have in the UK, that would provide the mechanisms to support students.

Jenny: Is this a growing trend, David?

David: I don’t know whether it’s a growing issue, but I know it was an issue right across the sector.

Jenny: Becca, have you got any comment on this area at all?

Becca: I think, in regard to expectation management, there is a big shift for accommodation providers to make sure that we align better with the way that universities are operating. For example, universities are very open and transparent about all of their policies. Students can read those before they’ve arrived. They understand what to expect from the university in terms of support, adjustments, all of that sort of information.

As an accommodation provider, that’s the direction that I would like to see the sector moving, so that we are actually being equally transparent with students about what to expect, what support they can get because, as we said, they are knowledgeable. If they already have established needs, they’re going to know what support they’re going to need, what they’re worried about, what we might be able to help them with. We almost need to be in a position where we’re pre-empting that and reassuring people before they arrive.

I think a lot of that will boil down to collaboration with our partners, in particular, and being really aware of who our audience are, and how we might need to support them. It’s also being aware that those expectations are quite high, and sometimes we might need to work with our students to actually hear what they’re saying to us and to navigate that area with them.

We need to increase collaboration with our current students so that we actually understand those trends that are coming through and how we might respond to them moving forward. Yes, expectation management is quite a challenging area because we can’t always offer everything that everybody wants, but what we would do is do our best to make sure that what we are doing is reasonable. It’s fair, it’s transparent, and it’s consistent in terms of approach.

I think there’s a lot that we can learn from our university partners, but likewise, there’s a lot that our university partners can probably learn from us given the number of students that we work with and that national picture of student trends.

Jenny: Thanks, Becca. I’m really interested in where this might go. It’s been such a growing trend all the time that I’ve worked in student accommodation, that idea of collaboration between private providers and universities, and also with students themselves. You mentioned that as well. What’s the art of the possible here? Where do you think we could get to in say, five years’ time?

Becca: That’s a really big question. I think there is a lot that’s possible. As a business, we would quite like to put a finger in every pie if we can because actually, the work that we would like to do will make a difference to students. If we take some of the key themes that universities are responding to, such as sexual violence, domestic violence, drugs, and alcohol misuse, and how we can support students, the role that we can play in making a positive impact is huge as long as we collaborate.

We’re members of AMOSSHE – that’s the student services organisation. We’re doing a workshop at their conference this summer, for example, about this collaborative approach. What is the role that we, as an accommodation provider, can play in student success?

If we work collaboratively nationally, with our university partners and with AMOSSHE, then what we can do is provide data, we can provide insight, we can do trials. There’s lots of developmental and research work that we can work with. I know, Jenny, you’ve done lots of that previously. In relation to student support, if we get it right, and we work with the right partners, and we do things in the right way, actually, we should start to see some positive results.

I don’t necessarily mean a reduction in the number of students presenting with mental health concerns. Actually, it might be an increase in the number of students presenting because they feel able to ask for help, to trust us as a partner to refer into their university services, or even make disclosures to members of staff because they feel safe and supported in doing so.

Those are the sorts of trends that we would expect to see so that we know that we’re moving in the right direction. Then we can build on it, we can learn from it, and we can do more, which is why it’s really exciting to be in a position to be able to work with David, and Jo, and other colleagues on such important topics as the suicide postvention work. Actually learning lessons from things that happen so that we can do better, ultimately.

Jenny: Thanks, Becca. Of course, you’ve seen it from both sides of the fence, having recently jumped the fence into a private PBSA. I’m really keen to come to you, David, from a university’s perspective. What are your thoughts on this? Because you’ve seen it from within a university, working with private providers who are doing more and doing different things in this space – where do you think this is going to go?

David: I think from my perspective, it’s really all about partnerships and relationships. If we think about when we are dealing with a student incident that may be happening in one of our outsourced halls of residence, it’s absolutely crucial that we have the relationships in place already between the accommodation provider and staff at the university so that we can work together from the outset as a team. It’s one of the things that I’ve noticed in the number of years I’ve been working with colleagues in Unite and other accommodation providers, that there is very much a willingness to do that, but I think we can all do more with that regard.

I think it’s really about how we can be proactive and do the pre-planning and the preparation to think about what scenarios might happen, and how we can work together in those scenarios, and also understanding the impact of other agencies such as police, ambulance services, et cetera, that might be involved as well.

Jenny: Thanks, David. Jo, is this something you want to come in on?

Jo: Yes. I was thinking, as we were talking – I’ve been involved in national roles in trying to get links between different elements of the system and developing joint protocols for working together, and then actually evaluating those protocols against real cases to see how it’s working and how we can improve it. Addressing issues, and problem-solving as they come up. I think that would lend itself to this, where you’ve got different systems contributing, but they need to work together.

I think one of the difficulties is often how external providers are seen, that they’re not seen as part of the system, and yet, are integral to provision. Part of it is a mindset about seeing this is part of a wider system. We need to think about how that system is able to converse, communicate, link, and equally, the responsibility on the university to also link, and it’s one of the issues we’ve been talking about, which is if an incident occurs, making sure that accommodation providers are aware there’s been an incident.

Equally, if an incident occurs in accommodation, how do they get access? Who do they call? Is there some kind of either, daily report system, or some kind of triaging process and some information communication system that is clearly identified, so that someone takes responsibility to actually act on that information and to work collaboratively? I think it’s these kind of processes which actually make things work well for a student.

Some of the work that David and Becca were talking about is that when you start looking at real student issues and thinking between organisations about how would we work together to best address this, it’s thinking about: what are the kind of issues that this presents, and how can we problem-solve those issues and come up with a solution? Which we’ll try, but we’ll also review so that we continue to improve and work better in a proper partnership together.

Jenny: Thanks, Jo, I think that’s quite a good segue into our next topic, which is a very sensitive topic, but very important – and one that we’ve touched on already – which is student suicide. Fortunately, very rare, but of course, with huge, huge impacts for parents and also for the whole student and university community.

We have said that all of you are involved in Suicide Safer and postvention work. What’s the latest thinking in this area, and can we ever get to a place of zero student suicides? Jo, can I start with you?

Jo: In terms of suicide, it’s interesting. There was data recently presented by Louis Appleby about the impact of COVID on suicide rates, and actually showing, in the general population, that there doesn’t appear to have been an impact, or at least it’s not been revealed yet.

We have Office for National Statistics data due to be published on May 31st, which will specifically look at the impact on suicide rates in students. We don’t know the impact of COVID yet in terms of suicide rates. but we will have some data on May 31st published, which will take us up to the end of 2019/20.

Jenny: That’s really interesting, thank you. What you’re saying is that so far there doesn’t seem to have been an increase in the suicide rate due to COVID?

Jo: What we know in the general population, from the National Confidential Inquiry data, is that there doesn’t appear to have been the anticipated elevation in suicide rates that we might have anticipated – although where there have been rises, it has been with young people. We might predict that we’ll see the same with students because they will follow what happens in the general population.

Obviously, students are young people, and therefore, follow patterns that we see in the general population. Typically, we know that actually, the rates tend to be slightly lower. That’s one thing we need to be aware of: that although they follow general population rates, they don’t necessarily follow them exactly.

I’ve been involved in work to reduce suicide, generally and internationally. One of the things that I was involved, was an initiative called Early Intervention in Psychosis, where there were quite high suicide rates for young people. I realised that, to some extent, I had been trained in a complacency of expecting a certain rate, and when we challenged that, and actually started looking at how we could build lives that young people would want to be in, and futures that they wanted to be in, we were able to dramatically drive down the suicide rates not only in the UK but also internationally.

That thinking, I suppose, I bought to the university sector, where as you mentioned, it’s a rare event. It reminds me of some of my work with serious mental health problems, where it’s a low-incidence phenomena – but it’s high cost. It’s one of those things where it’s harder to resource because you think, “Well, it doesn’t occur that often, therefore, we’re perhaps taking a sledgehammer to crack a nut.” However, when it does happen, it has high cost, high impact on the whole organization, and long-term consequences, and in fact, can have a ripple effect in terms of contagion clusters, which we see in a number of places.

What I would say, one is, first of all, recognising this happens. Secondly, actually recognising, across the sector, this is an issue, and when it happens it’s a high-cost issue. What resources can we put in place? It always reminds me of a rounders pitch. On a rounders pitch, you want the play to be on the pitch. You want people running around from post to post, but you have to have a backstop in place because when the ball goes behind, it stops play. In a way, suicide prevention is like having a backstop. You need the backstop to prevent the ball going out of play.

A lot of your energy and attention is going to be on the field in terms of maintaining student wellbeing, mental health, addressing early signs of mental distress, and then moving into how we manage more serious mental health problems emerging. We also need a backstop, which is about what we do at times of crisis, or when students are severely distressed. I think I’ve seen a change over the last seven years, where I’ve seen universities recognising this is an issue, and I’ve been involved in working groups with Universities UK and PAPYRUS to produce the Suicide Safer Universities Guidance in 2018.

We’ve seen guidance produced in terms of working better with our NHS partners. In fact, the University of Manchester recently published some workaround information sharing. We’ve seen data now, specifically on student suicide incidence in higher education. There’s a lot of change happening, and with that, what we’re trying to do is work to, rather than individual institutions reinventing the wheel, to pull together that learning within the sector, the understanding, the good initiatives, the good practice so that it can be shared.

Last year, I published a book with contributors from across the sector, on preventing and responding to student suicide, which is the other part of this tripartite picture of prevention, intervention, and postvention.

Jenny: Thank you, Jo. We’ll put links to those books and resources in the show notes as well. So much of what you’re saying really just shows to me how important it is that we do talk about these things. We were quite keen to have this conversation as part of this podcast even though it is quite an uncomfortable one because it is by talking that we do improve these things. David, can I come to you just to talk a bit more about the suicide postvention work?

David: When I looked at the Universities UK’s documentation, I thought it very much talked about the what. What universities needed to do, but not focusing on the how universities might want to go about it. I’ve reached out to Universities UK, who put me in touch with Jo. We then talked it through, initially thought about having a collaborative meeting. What has happened in the end is that we’re producing this document by the sector, for the sector, which will be a very practical guide for people in my position to be able to respond better to sudden death.

One of the things that’s really astounded me from the outset of this is really how universities, accommodation providers such as at Unite Students, bodies such as the Samaritans, Universities UK, AMOSSHE, government departments, how everyone has really come together and said, “Look, this is something that’s absolutely needed for the sector.” It’s really great to be working on something that will be of real practical benefit to universities.

Jenny: Thanks, David. Becca, did you want to add anything to that as well?

Becca: Yes, very briefly. I think this particular topic is something that we all feel very passionately about, and I think you can you can tell that by the way that we’re talking about the work we’re doing. I think we probably should take some comfort in the fact that we are in the luxurious position of being able to make a difference. The group of people that are coming together across the sector, and that partnership work actually can make a positive change here for this particular age group that we work with, which is predominantly 18 to 24, where that might not be happening for other age groups.

We just need to take some comfort in the fact that what we are going to do is make a difference. Any small amount of change we can see on this topic and any small amount of improvement is a positive step forward. I think even the fact that we’re talking about it now so openly, even though it is a difficult topic, actually shows that we’re taking the lid off things a little bit.

Jenny: That’s great, and that’s what it’s all about, isn’t it? Okay, we’re coming towards the end now. I just want to give you each the same question. What do you think is getting better or has got better for students in terms of their mental health? David, do you want to have a go at that one first?

David: We do see increases in students coming forward. I think it’s much easier for students and young people to talk about mental health in a way that it just wasn’t talked about so many years ago. I think there’s been some really helpful documentaries on the television, for example. I’m just thinking about the Roman Kemp one (‘Our Silent Emergency’), where he lost a friend to suicide. The message that really came out of that was that if you ask a man if he’s okay, he’ll say yes. You need to keep on asking him until you get the right answer. You don’t just ask once.

Building on that, and one point I wanted to bring about, was really about trying to be innovative in the way that we approach this. I’m very mindful of one of the things that our students union did before lockdown. Now, they picked up on a piece of research that men were much more likely to talk to their barber about mental health than they were to a clinician. They employed, as a popup for a day, barbers who were also trained counsellors, and gave students free haircuts in the quad at Middlesex as a way of highlighting that.

Jenny: What a great example. Thanks, David. Becca, what are your thoughts?

Becca: Two things that I think are better. I think people in general, but particularly young people, have become more alert to how they’re feeling in terms of mental health and physical health, and are more engaged in both of those topics. In doing that, they’re more likely to ask for help if they need it. That’s the first part of it.

The second part of it is I think that we, as a sector, and by that, I mean education rather than accommodation, but, as a sector, have got better at early intervention. Training people to look for those signs and symptoms, doing things like mental health, first aid. Things like Look After your Mate workshops. By putting in some of that early intervention and coupling that with students being more aware of how they’re feeling, and what they might need, means we’ve kind of met halfway.

I think there’s been huge progress in that area, where if you look back 10 years, we didn’t really talk about early intervention and students were less likely to ask for help – whereas now, we’re making it much more accessible.

Jenny: Thanks, Becca. Jo?

Jo: Yes, it’s interesting. I was just thinking about what I’d observed. One thing that I’ve seen is a move from mental health issues being the role or responsibility of student support to it being everybody’s business. I’ve seen a lot more people getting involved in the discussion debate provision and seeing it as part of their role. I think we’ve seen a lot of players coming into the sector who are bringing, adding value. I’m just thinking the Charlie Waller Trust are about to publish guidance, are the staff talking to students about suicide? They produced mental health modules, training modules.

We’ve seen organizations like PAPYRUS Minds, Student Minds, all bringing in different resources from different angles, whether it be for students, for staff, online, face-to-face. We’ve seen quality checks like standards. I was thinking particularly about the Student Minds Mental Health Charter. We’ve also seen, I think, a bit more policy and government involvement. Perhaps not as much as we’d like to see, but we’ve certainly seen ministerial briefings over the last couple of years, to universities where mental health is central to that.

The other thing that we have seen is better data because, for a long while, we didn’t really know what was happening with students because they were lumped in with children and young people. It was quite hard to work out what’s happening in the sector. I think we’ve seen much better data. All of those things have contributed to better awareness, better response. I have seen definite changes in the last eight years or nine years that I’ve been involved in HE.

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