A Sustainable Mental Health System: Regards to Financial and Social Sustainability

This is one of a series of blogs the Foundation will be publishing in line with its Standard development on University Mental Health Care and Access to mental health care services.

We invite you to share and comment on our work as it will help inform us on what to look out for, relevant topics/areas of concern and if our recommendations represent the needs of the students across the country.

If you have any recommendation on reports we should read, people we should contact or if you want to participate in our work please email info@graemattafoundation.org.

INTRODUCTION

Universities face a huge demand for student mental health services (SMHS) with long with times and only a few students being able to accesses services (Institute for Public Policy Research (IPPR), 2017). According to The Guardian, many students experience extreme academic struggles which eventually lead to students dropping out when they do not receive the appropriate assistance (Tickle, 2015). Creating sustainable student mental health services that are financially, environmentally, and socially sustainable would ensure that these services are able to meet the level of demand and are able to survive for future generations.

The Grae Matta Foundation hosted a workshop with people interested or involved in the mental health sector and university mental health services to discuss sustainability with regards to university mental health services and what a sustainable university mental health service should entail. The workshop focused on discussions surround what is university mental health services and what does a current student mental health service look like, as well as discussing what an ideal student mental health service would entail, and who should pay for student mental health services.

University Mental Health Sustainability Workshop (February 2018)

This report outlines researching concerning the delivery of the delivery of SMHS in the UK and sustainable programmes. Also outlined are the main ideas discussed in the workshop regarding this topic. This report concludes with recommendations on how universities can be more sustainable and suggests what should be included in the standard scope of sustainable university SMHS.

BACKGROUND

The number of students seeking student mental health services (SMHS) has increased by 210% in the last 10 years (IPPR, 2017) with one in three students experiencing depression or loneliness as well as an increase in student suicides (Brown, 2018) and a 210% increase over 5 years in students who left courses early due to mental distress (Marsh, 2017). The current means of support for students experiencing mental distress is counselling (IPPR), however, the sustainability of such services are brought into question as many students are having to wait up to 43 days to access such services (Marsh, 2017) and counselling sessions are often capped at six session which may not be enough support (IPPR, 2017). Moreover, evidence shows that counselling can be highly effective, but student-to-counsellor ratios are lower than required as universities need to increase funding on student mental health services (Weale, 2016). Universities need to provide high quality, cost-efficient sustainable services that are able to meet the demand for mental health services and provide students with the appropriate support.

Sustainability

According to The Joint Commissioning Panel for Mental Health (JCPMH) (2015) sustainability in regards to healthcare can be broken down into three definitions: Economic or Financial Sustainability; Environmental Sustainability; and Social Sustainability.

• Economic sustainability is concerned with efficient use of economic resources. This includes reducing demand for services, improving value of services, and reducing resource use.
• Environmental sustainability relates to using environmentally friendly resources that has a low carbon cost including switching away from paper materials and reducing any travel and wasted medications.
• Social sustainability is concerned with optimising the use of social resources. This includes staff, students, and non-clinical support such as peer support students.

A completely sustainable university SMHS would encompass low financial costs and low environmental and social costs (JCPMH, 2015). In order for this to be achieved, universities must prioritise preventive interventions to reduce demand on SMHS. Additionally, they must invest in the best-value interventions and clinical resources which will improve value and reduce resource use consequently ensuring these clinical resources and clinical activities have low carbon costs (JCPMH, 2015). They must also utilise social resources which can provide community projects that provides mental health education and encourages self-management (JCPMH, 2015).

Solutions for Financial or Economic Sustainability

Becoming digital is a methodology to ensure for improvements in the monetary aspects, continuity of care, and to ensure access to safe and quality healthcare (NHS European Office, 2017). Telemedicine, services which can provide services from a mobile platform, is more convenient for the clients, GPs, counsellors, and other support providers to access; also, it is economically friendly (NHS England, 2017). According to the Information Age, there have been experiments in integrating mental health services via phone, internet, and mobile apps. These new digital platforms will allow remote therapy and online consultations (Buchanan, 2015). With these changes to the delivery of psychological healthcare, it can reduce pressure on practitioners and counsellors and lower the financial funding required for having a physical location and equipment for every client (Evenstad, 2017).

Additionally, preventative measures can reduce the demand for student mental health services as possible mental health distresses are being dealt with before it reaches the stage where service support is needed (JCPMH, 2015). This would also improve environmental sustainability as appropriate and reduced resource use would be reduced limiting the carbon costs.

Solutions for Social Sustainability

Many employers and universities are recommending stress assessments and health audits. These audits can be on a done bi-weekly or monthly basis, making this an efficient system to keep track of employees’ and students’ mental health (Henderson, et al. 2014). Implementing this evaluation processes would allow employers and universities to gain a new level of understanding on mental health growth, a recorded history, and a technique to anticipate a mental break down before it were to occur (The Sainsbury Centre for Mental Health, 2007). Another solution, given by the Information Age, is to execute a digital mental healthcare system. Going digital through the internet and mobile apps which would empower individuals and make it easier to manage their conditions (Evenstad, 2017). Going electronic allows for more accessibility to resources including educational materials. Digitising healthcare would give clients control and not feel stigmatized (NHS England, 2017).

Furthermore, development of community services such as such as peer support services and self-help materials would create supportive structures for students within the universities (JCPMH, 2015), thus encouraging mental health disclosure and reducing the stigma of mental health, while also reducing demand on more severe SMHS such as counsellors as mental health is addressed and supported earlier.

FINDINGS FROM WORKSHOP

What are University Mental Health Services

The attendees of the workshop discussed positive and negative experiences of SMHS, however, positive experiences were only expressed by one attendee. Positive experiences focused on the university’s promotion of mental health and wellbeing, support for mature students, and appropriate referral to external support services. Negative experiences which were expressed by the majority of the group stated that, there was no education about mental health before or during university studies, and therefore, they were unable to identify warning signs of mental illness or distress. Furthermore, many attendees experienced long waiting periods (with one attendee quoting up to 3 months) to access counselling services, and these sessions were capped at 6 sessions. Attendees also stated there was no safe space for minorities to discuss struggles.

What a current SMHS looks like

The picture of SMHS presented by attendees is one that is underfunded, understaffed, low skilled grouped with long waiting lines. Additionally, they felt there is lack of communication and coordination between departments and services.

One attendee stated that her university had a very good mental health service providing on-site counsellors, a ‘GP like system’ where she could go get assessed and be referred on to appropriate services. Additionally, she stated her university had a holistic approach in the support they provided by dealing with both internal (handled by the university) and external (handled outside university) problems by negotiating with external agencies and partnerships.

Improvements to current SMHS

The group expressed a number of improvements that could be made to current SMHS.

• One would be to have a strong and high quality mental health team including coupled with safeguarding policies that ensures designated safeguarding people are assigned to each place within the university.
• They believe that trainee counsellors could be utilised by providing university student counselling services to fulfil their required training hours. This service is to be provided with supervision from qualified professionals.
• As many students do not sign up to their local GP practice after moving to university (possibly because they would be required to switch from their current GP practice or because they simply do not have the desire to), attendees felt that signing up to GP practices should be a part of student enrolment but universities and the relevant ministries (such as the Ministry of Health and Ministry of Education) need to review this system so to allow students the ability to sign up to two GP practices which at universities.
• Different university departments including professors/personal tutors, counsellors, and support services should be interlinked where they could share relevant knowledge and communication students in accordance to data protection policies.
• A sustainable SMHS is believed by the attendees of the group to be one that is embedded into the framework of universities. A possible vision of this would to be create ‘Mental Health League Tables’, meaning, rates mental health distress experienced by students has an impact on university league tables, and therefore, the tables are not just concerned with the curriculum.
• Another suggestion is to have an Ofsted equivalent system for mental health care in higher education which will evaluate the services provided thus making sure accountability is taken. It would make universities look at what they can do to improve as well as provide guidelines for universities to follow coupled with a timeframe for them to implement the services or any necessary changes to services provided.
• Attendees believed that to make services more sustainable universities must ensure that the number of mental health support staff meets the demand for support services, this means that the number of mental health support staff should increase as do the number of students seeking services.
• They also believed that there should be more education of mental health, with mental health talks during the induction week coupled with more preventative interventions and personal tutors receiving mental health first aid training.
• Attendees believed universities need to create safe spaces for students to discuss mental health as well as developing diverse services and support which are encouraging and accommodating for all ethnicities.

What an ideal SMHS look like

The attendees felt that an ideal SMHS service included the following:

• Improved accessibility — services such as telemedicine allow for increased accessibility.
• Better communication — more communication between universities and their students. If students having been attending lecturers, universities such reach out either via personal tutor or letter, to enquire about them from a well-being perspective rather than disciplinary.
• Preventative interventions
• Option for counsellors to be matched to students’ preferences, achieved by counsellor criteria forms filled out by students. However, there is a concern that this can slow down the process of accessing services, nevertheless, some attendees expressed they themselves would not mind waiting for a more preferable counsellor, and believe other students may feel the same.
• Peer counselling between students where students can listen to each other and talk about mental health.
• Establishment of communication networks between departments in accordance to data protection policies.
• Holistic support — services are able to refer students to other appropriate and accessible services for demands that fall outside of the scope of SMHS.
• Well-being education should be embedded in curriculum and in orientation week.

Who should pay for SMHS

Attendees felt that universities should pay for SMHS where a certain percentage of tuition fees received from students should go on welfare services. The group felt that there should also be a separate budget for physical and mental health care services. This is because, if the budget is to be merged, there is a belief that little to no money will be spent on SMHS with the priority being assigned to physical care (disability). They believed that in every university, budgets given to each university service and department should correlate with the need of that service or department, therefore, the budget given to SMHS should correlate with the need and demand for this service.

CONCLUSION

Currently, universities are faced with a huge demand for SMHS which they cannot meet (IPPR, 2017). Universities must create sustainable university SMHS that would ensure services are ‘future proof’ and are financially, environmentally and socially sustainable service which are able to meet demand and can be maintained for a long time. With the implementation of telemedicine services such as Slivercloud and services such as peer support networks and self-management workshops available at some universities, it seems that there are some efforts to improve the sustainability of SMHS, however, more needs to be done to tackle the raising demand and create a ‘future proof’ SMHS.

Recommendations:

• Focus on preventative measures which would reduce demand and use of SMHS.
• Invest in best-value interventions and clinical resources which will ensure that students are receiving high quality care provided at the right time, thus ensuring care is delivered efficiently at a minimum possible cost and the correct use of resources.
• Develop community services such as peer support networks and self-care materials thus encouraging students to develop healthy independent lifestyles, consequently easing demand on more specialised SMHS.
• Telemedicine services improves accessibility and encourages disclosure as well as presents as a low-cost service for universities to provide. Furthermore, remote services eliminate travel for services thus reducing environmental costs.
• Departments should be interlinked with regards to SMHS which would increase communication between departments allowing for relevant and necessary knowledge of students to be shared in accordance to the data protection act which would allow for better tracking of a student’s wellbeing.
• Universities must provide a holistic support with accurate signposting, as well as engage with external agencies.
• Universities must increase spending on SMHS that is equivalent to demand.

REFERENCES

Brown, P. (2018) The Invisible Problem? Improving Students’ mental health. Higher Education Policy Institute. [Online] Available at: http://www.hepi.ac.uk/2016/09/22/many-universities-need-triple-spending-mental-health-support-urgent-call-action-new-hepi-paper/ (Accessed 21 Mar 2018).

Buchanan, M. (2015) ‘Mental Health Services Budgets Cut by 8%’, BBC News, 20 Mar 2015. [Online] Available at: http://www.bbc.co.uk/news/health-31970871 (Accessed 21 Mar 2018).

Evenstad, L. (2017, 01 10) ‘Theresa May announces £67m fund for digital mental health services’, 10 Jan 2017, ComputerWeekly.com. [Online] Available at: http://www.computerweekly.com/news/450410687/Theresa-May-announces-67m-fund-for-digital-mental-health-services (Accessed 21 Mar 2018).

Henderson, M., Madan, I., & Hotopf, M. (2014) ‘Work and Mental Health in the UK: A case of could do better’, BMJ (online) March 2014. DOI: 10.1136/bmj.g2256

Institute for Public Policy Research (2017) ‘Not by degrees: Improving student mental health in the UK’s universities [online]. Available at: https://www.ippr.org/research/publications/not-by-degrees (Accessed 21 Mar 2018)

Joint Commissioning Panel for Mental Health [JCPMH] (2015) Guidance for commissions of financially, environmentally, and socially sustainable mental health services. [Online] Available at: https://www.rcpsych.ac.uk/pdf/JCP%20Sustainable%20Mental%20Health%20Guidance.pdf (Accessed 21 Mar 2018).

Marsh, S. (2017) ‘Number of university dropouts due to mental health problems trebles’, The Guardian, 23 May 2017 [Online]. Available at: https://www.theguardian.com/society/2017/may/23/number-university-dropouts-due-to-mental-health-problems-trebles (Accessed 22 Mar 2018).

NHS England (2017) Mental health patients set to benefit from pioneering new digital services. (12 April 2017). Available at: https://www.england.nhs.uk/2017/04/mental-health-patients-set-to-benefit-from-pioneering-new-digital-services/ (Accessed 22 Mar 2018).

NHS European Office (2017) Telemedicine and eHealth. [Online] Available at: http://www.nhsconfed.org/regions-and-eu/nhs-european-office/influencing-eu-policy/more-eu-issues/telemedicine-and-ehealth (Accessed 22 Mar 2018).

Tickle, L. (2015) ‘How universities are using data to stop students dropping out’, The Guardian, 30 June 2015. [Online] Available at: https://www.theguardian.com/guardian-professional/2015/jun/30/how-universities-are-using-data-to-stop-students-dropping-out (Accessed 22 Mar 2018).

The Sainsbury Centre for Mental Health (2007) Policy Paper 8. Mental Health at Work: developing the business case. [Online] Available at: http://www.mentalhealthpromotion.net/resources/mental_health_at_work_developing_the_business_case.pdf (Accessed 22 Mar 2018).

Weale, S. (2016) ‘Some universities need to triple mental health services funding, says report’ The Guardian, 22 Sep 2016. [Online] Available at: https://www.theguardian.com/education/2016/sep/22/universities-triple-mental-health-services-funding-report (Accessed 22 Mar 2018).

Edited 10th April 2018