Truly supportive services

Institutions must focus closely on their duty of care for students with mental health difficulties, say Alastair Wilson and Richard Brunner

November 4, 2010

Credit: Jason Raish

A student arrives at university at the start of a new academic year. They may have no contacts or friends in the area, or even in the UK. They have been assigned university accommodation and have an initial point of contact. But essentially, the student is entering a completely new social situation.

What are the institution's responsibilities regarding this student's well-being? Will the university recognise if he or she became anxious or depressed and, if so, how should it respond? These are questions that are not easily answered by higher education institutions in Britain, and this state of affairs poses risks to both students and institutions.

The death last month, apparently by suicide, of a University of Cambridge student distraught at the death of a fellow student and still mourning the death of his mother five months earlier, is a reminder of the contingent responsibilities of institutions and staff.

Universities largely rely on student counselling services to take responsibility for issues related to student well-being and mental health. What, however, are the roles of teaching staff, disability support teams, student accommodation teams, library staff and ancillary staff? In our research, we interviewed individual academics who have had serious concerns about a student's well-being, but were uncertain how to respond. Staff were at times constrained by issues of student confidentiality that prevented them contacting parents or even support staff.

When addressing prospective students, universities sometimes explicitly assure parents of their commitment to offering safety and care. Yet one accommodation officer spoke to us of the "terror" that something should happen to a student living in university accommodation under their "watch".

Staff members' sense of responsibility varies, as do departmental and institutional responses. At one institution we found a department so focused on student well-being that it would contact a student who had not been to successive tutorials to check that all was well. Other departments argued that this was neither the role of an individual academic nor the responsibility of the university.

Young adulthood is a particularly crucial time for emergent mental health difficulties, and they can have an immediate impact on a student's academic performance. A typical response to a student with such difficulties may be to recommend that they suspend their studies until they feel better. However, this may not always be helpful, as engagement with the university and its routines can sometimes be crucial in managing their difficulties.

There is a need for a more careful, tailored response involving academic and support staff and, where appropriate, the NHS. Further research is required, and would inform, for example, on the benefits of dedicated NHS services for students.

Small changes can help make a significant difference. Some universities have addressed student mental health in careful and creative ways. These include appointing mental health officers to work closely with individual students alongside strategic interventions to increase institutional awareness of student well-being and ways of addressing the impact of mental illness on teaching and learning.

Still, these innovations are the exception. We often speak of universities' "duty of care", but this has done little to effect change. Also, the Disability Discrimination Act 1995 and its successor, the Equality Act 2010, have not transformed the position. It is not clear from where leadership for change will come.

An added complication is that universities are now striving to reduce costs. There are already examples of student counselling services being reduced or withdrawn, and student health services are similarly at risk. Perhaps the increasingly contractual relationships between universities and families will help to drive change. As tuition fees rise in England now, and perhaps elsewhere later, students and families will compare institutions more rigorously to minimise risk in their educational investment.

To adapt to this consumerist model, universities may need to adhere more closely to their duty of care and ensure that reasonable steps are taken to support the health and well-being of all students. This will enable them not only to compete in this changing market, but also to reduce risks of litigation.

Whatever the eventual driver of change, the evolving relationships between universities, students and their families require institutions not only to make clear statements about student care and support, but also to put in place the procedures, practices and staff that back up those statements.

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