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A few minutes wisely invested in an internet search of ‘student mental health’ results in access to a very wide range of resources. Some are student friendly, for example the website http://www.studentsagainstdepression.org. Some are focused on policy-makers and practitioners in higher education, an example being the guidance provided at Lancaster University on mental health planning, guidance and support. In a previous editorial the establishment and contribution of the ‘Mental Well-being in Higher Education’ (MWBHE) group was noted. This group has representation from the British Association for Counselling and Psychotherapy (BACP), Association of Managers of Student Services in HE (AMOSSHE), Student Health Association (SHA), Heads of University Counselling Services (HUCS), the Higher Education Academy (HEA), the Royal College of Psychiatrists (RCP), Universities UK (UUK), University Mental Health Advisors Network (UMHAN) and the National Union of Students (NUS). Thus there are a plethora of organisations engaged with this vital area of mental health policy and practice.
An important premise underpinning of much policy and practice on student mental health is that such work will be planned and undertaken through a series of partnerships. One tenet of effective partnership working is the need for some shared goals. Another is the need for mutually respectful relationships between all parties. A third is the extent of investment both financial and in other resource terms, that are committed to mental health services. More widely, adult, adolescent and child mental health services have each been deemed so-called Cinderella services in terms of the comparatively low resources and prestige allocated and attributed to them. Putting aside such traditions in healthcare, it is also worth considering the extent to which higher education institutions have responded to the challenge of student mental health needs. There have undoubtedly been improvements across the sector, nonetheless the nomenclature of higher education has as its focus a normative notion of the ‘student experience’. There is a danger that there will be much more interest in student satisfaction ratings on scales such as the National Student Survey (NSS) than concern about the actual experience of the individual student, and in particular their mental health.
One often unspoken challenge is the extent to which students are treated as any other adult and the extent to which they are infantilised. Such tensions manifest themselves in the ways in which relevant policies and practices are enacted. It would be anticipated that university staff would respect confidentiality in relation to the disclosure of mental health problems and not be willing to discuss such matters with a concerned parent without the informed consent of the student in question. However, one major change in higher education institutions has been the significantly increased involvement of parents in the selection of a university with many arriving on ‘open days’ to give the benefit of their advice to their offspring. Such activities although not without their merits may contribute not just to how a university is selected for a particular student, but also how university staff may come to view students. At some level there is a danger of seeing students not as young adults but as those still within the care of their parents despite their chronological and legal age suggesting otherwise.
The apparently widely accepted mantra within student support services both in health and higher education services seems to suggest the need for specialist services—and that may well be right. There remains a challenge that this can, sublimally and symbolically, actually undermine the self-efficacy of students and thereby negatively impact on their mental health. We need to tread carefully and sensitively in the development of such specialist services if we are not to undermine the very feelings of self-efficacy that are vital for mental health. Indeed one compassionate test of our assessments and interventions may well be; what impact have I had on the patients sense (of self- esteem) and self-efficacy? And the important point is that this is not simply about the clinical interactions with the patient but also about how the service is structured and all staff involved in its delivery. Such services need to be informed by the need to support and build the resilience of the individual patient.
What are the general lessons for student mental health services? Organisational arrangements can service to improve or make worse our interventions, however well evidenced at the level of the particular therapeutic intervention. We cannot sensibly look at evidence-based practice in an organisational and cultural vacuum. Future commissioning arrangements need to ensure that services aimed at students are better integrated with mainstream services and that such services are better equipped to engage with this students in making the transition to adult life.
Competing interests None.
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