We must tackle the ‘prevention gap’ to combat mental health crisis

Quick wins are important in the UK’s efforts to improve student mental health, says Richard Black, but paybacks from long-term projects will create the sea change needed, he argues

July 16, 2018
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About 20 years ago, at a university I was previously working at, a student took her own life. It was – and remains – a shock. She was bright, articulate and appeared to have many friends.

There were signs, it turned out, that not all was well. Her friends had been worried about her well-being. So, too, had her family. None of this had been shared with me as her programme convenor. And everyone around her, it seems, felt that she was getting better. The world lost a promising young researcher and a wonderful individual.

Student mental health has received a lot of focus in recent weeks, in the wake of a series of student deaths at the University of Bristol, with calls for universities in general, and Bristol in particular, to do more. A new charter is to be worked on, and the universities minister says that mental health support should be “a top priority for the leadership of all our universities”. Yet what exactly should be done is less clear. 

For example, while much is made in popular analysis of the challenges of adaptation to university life for teenagers as they transition from school, the most recent figures from the Office for National Statistics show that suicide among university students, although rising, is actually lower than for the population as a whole, controlling for age. The evidence also shows that suicide rates are higher for older students. It is, in short, a policy minefield, full of starting assumptions that are wrong.

One response is the report of the University of Birmingham’s Mental Health Policy Commission, called Investing in a Resilient Generation. It is a much-needed call to action, that addresses suicide among the young in general, not just students. The report highlights how poor mental health costs the UK economy £70 billion to £100 billion each year. And although there is growing awareness of the problem, there is variability of provision of mental health services and a “prevention gap” that allows poor mental health to take root in communities, with devastating consequences for individuals, families and the wider economy. 

The report’s recommendations span from expanding debt advice services to challenging bullying in schools, and stress prevention and well-being in the workplace. There is a need for “quick wins”, but this is also a long-term project, with some recommendations having a payback that will take a generation to materialise.

At the same time, as university leaders step up to this mental health challenge, it is important to remember that mental ill health affects staff as well as students.

And for both staff and students, there are things that can be done. As a start, at Birmingham, we are already embarking on the training of mental health first-aiders. The idea is not that we are all trained to resolve mental health crises – any more than we would expect a first-aider to fix a broken arm or resolve a medical emergency – but we should all know what we can do to make a situation better, and where we can go to get further help. I have asked all the leadership team in social sciences at Birmingham to attend at least a half-day basic course.

We can also think about the things that contribute to poor mental health and try to do something about them. It is hard to avoid the email culture entrenched in higher education that sees academics emailing junior colleagues well into the evening, or at weekends, without considering whether that might increase stress and decrease well-being. Whether the expectation of a reply is implicit or not, the pressure it causes is very real.

University leaders and managers could also think about their style of management. Yes, we want our teaching to be excellent, for academic work to have impact and for us to be active citizens. But we need to recognise the pressures that come with high expectations and uphold our responsibility to provide staff with the support and development that they need.

Universities UK has developed a “whole university” approach to mental health, so that prevention and early intervention strategies are at the heart of student mental health provision. This at least should be embedded in every university. It would, as the University of Birmingham Mental Health Policy Commission notes, represent a “step change” in the way that we address mental health and have tangible benefits for future generations. It should cover staff as well as students. And the more people who advocate for it, the more likely it is to happen.

If we don’t address this issue, lives will continue to be wrecked, and lost, needlessly in many cases, simply because we are not prepared to face up to the challenge. It is time to do that, and to start making a difference.

Richard Black is pro vice-chancellor and head of the College of Social Sciences at the University of Birmingham.

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