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The Student Room were recently joined by UMHAN in a question and answer session for University Mental Health Awareness Day. Here's the result:

<h3>To what extent are universities responsible for the mental health of their students Should students be taking more responsibility for themselves over their health issues?</h3>

Dan Doran, Mental Health Coordinator at Loughborough University and UMHAN Secretary:
<br>Education – especially Higher Education - is a joint effort; responsibility is therefore shared: On one hand, the provision of learning environments/communities that promote analytical, creative, critical thinking, developing skills for the future; and on the other, students have a responsibility to engage with this, learn, become a more academic thinker, and so on.

We all have a “mental health condition” and in terms of maintaining mental health generally in the student population, it makes sense to consider the nature of and impact of Higher Education on our well-being; this responsibility is shared by individuals and the institution. For example, workloads are set by Universities, so there is a strong business case in setting a pace and balance of workload to enable students to adopt a healthy work-life balance. Similarly, students have a responsibility to adapt their work-life balance to meet their academic commitments. Responsibility – over well-being – is therefore a joint effort as well. Students take personal responsibility and Universities take responsibility for the conditions of study. At the same time, students will be adapting, growing and changing as people. Universities, Student Unions, and/or local communities provide a range of mechanisms (formal and informal) that enable this process of discovery. Life, sometimes involving distressing events from childhood, teenage years or the continual personal development during the Higher Education years, means that some people will be recovering during their Higher Education years, and this can make engagement with the joint effort of Higher Education difficult.

Recovery from mental health difficulties involves compassion, hope, identity, meaning, and empowerment. I think this question is touching upon the issue of empowerment from different angles and personal responsibility is of vital importance to this. The peak age of onset of mental health difficulties coincides with the age range of many people studying at undergraduate level and mental health difficulties are the learning cause of disability amongst young people. Concurrently, the attitudes and actions (and responsibilities) of organisations, businesses, education-providers, communities and personal support networks can help or potentially hinder recovery and engagement in civic life by being psychologically accessible or inaccessible.

In my experience, many students do take responsibility for their recovery and over their health issues, and have done so for some time. The responsibilities of organisations and individuals towards mental health are different and it is difficult to be prescriptive about what actions and attitudes demonstrate an “organisational responsibility”, but institutions do have legal obligations under the Equality Act as well as business-case and moral reasons for being responsible.
<h3>Is there sufficient sense of community between students, lecturers and others at universities in general, or is it all too easy for someone to become isolated as a result or cause of mental health issues?</h3>
Dan Doran, Mental Health Coordinator at Loughborough University and UMHAN Secretary:
<br>Wherever we live, we have a need to belong, and we can find this in all sorts of different ways – friends, the Union, social groups, a sense of identity from being in a particular department with lecturers, colleagues, etc. Also, the sources that fulfil our need to belong changes over time; for example, full-time undergraduate students may seek out different ways of belonging than, say, a part-time post-graduate research student with children. So I’m not too sure what “sufficient” may mean here! Nevertheless, Student Unions and Universities provide a range of opportunities to develop a sense of community and joint identity – from accommodation with other students to social groups - and many students do develop a sense of belonging. There are also opportunities to try new things.

The education (ie. learning and teaching) environment is of course the consistent factor in all this. There is often talk of a distance between teaching staff and students; this probably reflects the increase in numbers of students on courses generally. However, some courses are small, so the learning and teaching environment may be more intimate. Some institutions are in rural areas, and this may promote a more intimate sense of community or, equally, feeling isolated. Some people prefer anonymity while studying, and place a greater sense of community in their personal/social networks. Universities do have mechanisms to pick up “non-engagement” of individuals, and often have strategies and committees that aim to consider promoting integration for a range of different groups. However, an overall sense of community is created by a range of people, including the student- and local-community. Opportunities are created, but, you’re right, may not be taken up - becoming isolated may reflect what’s going on for a person, rather than an isolating situation. Some mechanisms in place at each University would pick up on this at different times of year, and some will make efforts to find out what’s happening and what could be done to help.

Lydia Pell, UMHAN Chair and Mental Health Coordinator at City University London explains:
<br>Some students who have mental health difficulties may need to attend appointments or have days they struggle to attend lectures. This may be difficult to explain to friends and so they may find themselves being more left out of activities. However, as peers, other students can consider that when someone is unwell they need the sense of belonging or community even more and so friends, course mates and housemates can make a big difference. Some students may also find this sense of community in other places such as through online support or through peer support programs.
<h3>How can we as students help ourselves and each other to promote good mental health and understanding of mental health issues?</h3>
There are things we can all put in place for ourselves to promote good mental health, for example the New Economics Foundation suggest 5 ways to well-being which we can all incorporate into our daily lives. The team at Student Minds also suggest thinking about your own well-being toolbox; what does a good week look like and how can you make it happen?
Dan Doran, Mental Health Coordinator at Loughborough University and UMHAN Secretary:
<br>Get informed and – importantly - get active! There is a lot of information freely available; stay in touch with reputable organisations; join your local StudentMinds or student-led mental health group. Ask about what happens for University Mental Health and Well-being Day at your institution; get involved, or start something new! Some people may be really enthusiastic and perhaps see the benefits, others may find it difficult to initially think or talk about mental health generally, or may not have an interest - so be prepared for differing responses. For me, a good understanding doesn't mean adhering to one way of looking at mental health either; the more we look into student mental health, the more opportunities for maintaining good mental health and promoting recovery and inclusion, we create.

Lydia Pell, Mental Health Coordinator at City University London and UMHAN chair:
<br>There are often courses run by counselling departments and mental health advisors that focus on prevention, such as managing stress, sleep hygiene and developing resilience. These are for all students to learn about how to stay mentally healthy and can help you learn life long skills around well-being. The more we all understand what's keeps us well the more we can support those around us too.
<h3>If a student approaches a member of staff, e.g. personal tutor or lecturer, but feels unsupported in terms of their mental health, who should they turn to? Should all staff be equipped to deal with such circumstances, or should they refer elsewhere? What if a student feels that the whole climate of a university or college is negative towards mental health issues?</h3>
The provision of mental health and wellbeing services tends to vary for each University but usually includes Student Support/Welfare services which are staffed by mental health professionals. This may include Mental Health Advisers, Disability Advisers, Mental Health Mentors, Wellbeing Advisers and Counsellors. The role of a Mental Health Adviser is to support students who may be experiencing emotional or psychological distress or personal difficulties. Whilst the job title and remit of their role may differ across each University, typically, a Mental Health Adviser will be able to co-ordinate support for students with mental health difficulties and act as a point of contact for the duration of your studies.

Some universities will have a dedicated member of academic staff who is the Disability rep for the department, so they should be more approachable and hopefully sympathetic to disclosure of mental health difficulties. An alternative approach would be to contact the Students Union and speak either to one of the Sabbatical Officers, as usually there is one with either a Welfare or Disability role. As a student, you may find it easier to talk to someone within the Union, and the Union may also be able to direct you to a supportive member of academic staff or the appropriate services.
<h3>Is stress an inevitable part of university life? What are the warning signs that someone is struggling more than the average person? Do some degree courses, e.g. medicine, place too much pressure on their students?</h3>
Lydia Pell,Mental Health Coordinator at City University London and UMHAN chair:
<br>Some students thrive more in courses that have many hours of contact time, regular deadlines and high expectations and find holiday periods more demanding. Some students really struggle with being in university for more than two days a week. This is why it is important to know what type of situations you thrive in, what type of pressure you can manage and what is more likely to make you feel so stressed you can't keep up. This is part of developing into an adult and thinking about what your skills are and also part of learning about yourself. This information can then be applied to think about what course and career you are suited too. Understanding and recognising stress symptoms and learning how to relax are critical skills that we are realising don't come naturally to everyone.

Some of the pressure of university stems from internal or external pressure to succeed, to be perfect and to get a job. This is far from the actual university experience which should in my view be based around a desire to learn, to question and to want to think in depth about a specific subject. The more students are able to stay in the moment of enjoying learning and enjoying the different aspects of learning, whether in a lecture, reading journals or writing an essay, the more they will be able to put the other pressures into perspective.

Mental Health Adviser from Loughborough University and the University of Cumbria suggest that stress is inevitable but how you manage it is what is important. If you have a sudden change in appetite, sleep patterns (can’t get to sleep, can’t stay asleep), excessive worry or even panic, these may suggest you need additional help.
<h3>Do you think it would significantly help mentally ill students (both in being encouraged to disclose, and their recovery rate) if all uni tutors in a welfare position had mandatory training? If so, do you think the training should be standardised across all universities, or do some universities need more training than others?</h3>
UMHAN Committee:
<br>I believe students experiencing mental illness would be more inclined to disclose, get the most out of their time at University, and utilise all relevant forms of support that will help recovery, if it was more apparent how the institution (not just individuals) actively supported their students’ mental health, and how they accommodate fluctuations in this in the education context. There may therefore be training needs with regards to making inclusive environments. For example, how is anxiety accommodated in the design and delivery of the curriculum, or in other procedures of the University? Variation exists between and within Universities here (different departments may take a different view, sometimes for academic reasons). Nevertheless, an institution that could state it provides an inclusive environment would be a great selling point, and would promote declarations amongst those who want to or have already chosen that University as a place to study.

With regards to people in welfare positions, there may be widely different views and conceptualisations of mental health difficulties (and responsibilities towards people experiencing them), differing levels of confidence, different concerns, etc. Training would be required to facilitate a consistent response to declarations or difficulties at any stage; The Mental Health First Aid training recognises the need for this type of training more generally in society, and there is a specific version being developed for use in Further Education/Higher Education which the University Mental Health Advisers Network are involved with. In fact, one of the Mental Health Advisers at Loughborough University has been nominated for an award for their training. This training is standard and nationally recognised. Knowing that key individuals have undertaken this training may provide re-assurance and improve declaration rates. At the moment, the provision of a Mental Health Adviser and other forms of support such as counselling, residential wardens, provides some of this type of re-assurance.
<h3>As young people newly leaving home, are some students especially at risk of developing mental health problems in comparison with the rest of the population? How can we anticipate the issues caused by being in such a new environment, both on the part of students and universities?</h3>
University is a new time and a new experience for everybody, whilst there may be some things that make us more at risk, we should all put things in place to help look after our well-being.

Lydia Pell, Mental Health Coordinator at City University London and UMHAN chair:
<br>Research suggests that there are some age groups more at risk of developing mental health problems and so they are more at risk than other age groups. Being away from home may mean things can escalate more quickly, however universities often have much more responsive services that in the wider community and so problems may get picked up earlier by counsellors, mental health advisors, welfare officers in residences and so students may have more opportunity to get linked to NHS services in the early stages of mental health problems. The pressures of university depend person to person, and so financial responsibility, transitioning to a new environment, making new social groups for some may increase their risk and for others may enable them to develop their independence and increase their feelings of well-being.

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<h3>Are university counselling and other mental health services sufficiently promoted? Is there still a stigma attached to using them?</h3>
Dan Doran, UMHAN Secretary and Mental Health Coordinator at Loughborough University:

<br>Everyone faces serious challenges at some stage in their life, and to work out what needs to be done to help address their present difficulties, and so continue living as full and meaningful a life as possible, may take time or a range of different conversations/actions with people. With the help of other people working with the person, differences or changes may be made. This may involve contact with different services at different times.

There can be a stigma attached to using any service; culturally, “needing help” is something we hide away because it is viewed as something shameful in itself, and this may add to the shame that someone is already feeling because of their difficulties in the first place. We do need to change our attitudes culturally; given that so many of us, or the people we know and love, will make use of mental health-related services, perhaps we ought to change how we perceive accessing them? Also, some people won’t make use of services because of pre-conceptions as to what services are trying to do. (e.g. Some people may decline to access medical services because they do not wish their difficulties to be medicalised; others may see practical support being of little relevance out of a pre-conceived idea that ). I believe attitudes are changing and people are becoming aware of a range of ways of managing or recovering from mental health difficulties.

I think there is a general question of getting the right information to the person at the right time, and this is the same for counselling and mental health services provided by Universities. The same goes for services provided externally; there are plenty of services available to students for a range of personal and mental health-related concerns – healthcare (such as GPs, consultants, nurses), psychological therapies (IAPT and counselling services), practical support (such as social work, occupational therapy, mental health advisers) and a range of voluntary and charitable services (for example, in Leicestershire, the LAMP Direct website provides a lot of information about community-run and charitable organisations on a range of topics and a range of ways of coping and managing such as local support or art groups).
Involvement of any of these requires a personal decision and possibly a discussion. You are likely to find that University-provided services are more familiar with the concerns students have, as well as the steps that could be taken to support you, by virtue of being a student – other services may not be as familiar with these and therefore are unable to assess your needs. Just because you’re a student, you should not limit your consideration over sources of help (including that from services) from those you immediately know about. Do a bit of research, and you may feel more confident about who to approach, then talk about it with them.

Lydia Pell, Mental Health Coordinator at City University London and UMHAN chair:
<br>UMHAN has developed its information for students online and is working with organisations such as students against depression and student minds to ensure students are aware of what support is available. Most services do promote themselves during welcome weeks and freshers fairs however for many students this doesn't feel relevant to the, at the start of their new study experience.

Students who disclose Mental Health diagnosis on their university application/UCAS will be contacted directly by their MH advisor or disability advisor. This is a good first step for students who may have more support needs to find out what their institution can offer. Students do also need to be proactive in finding out what support is available at the university they are applying for as many MH advisors are willing to meet with students in advance of starting their course. #IChoseToDisclose campaign is addressing this by encouraging students who have disclosed to share positive stories about this.
<h3>Some people fear seeing their doctor about mental health issues because of being labelled as 'crazy' or even being sectioned. How can we reassure such people about what action will be taken?</h3>
You could make use of the DocReady app and website even before you go and see the GP. This may help you feel more confident about what to say. You may like to ask if there is a GP with a specialism in mental health too.
Issues like self-harm, thoughts of suicide, finding it difficult to cope with daily life, will be taken seriously, and a range of treatment options should be considered by the GP with you. You will also need to be prepared that it will take time for these options to become available and – hopefully – have a positive outcome. GPs will be making an informed decision about treatment options, but even with the best will in the world, sometimes it can be a case of trial-and-error for a number of reasons.

Commonly, GPs and other services (like community mental health teams) view treatment as something best done in the setting where the person lives. Admission to hospital is usually considered if the presenting issues cannot be managed in this way at that point in time. About three quarters of people who go to hospital for mental health difficulties admit themselves voluntarily; compulsory admission is a decision made very, very carefully, and not by one person. Ultimately, you are responsible for the care you receive and the GP will present you with options. Your mental health advisor at the university, or counselling service, may also be able to talk through these worries with you. Many universities have an onsite GP practice or links with a local GP practice and so can talk to you about what to expect. These GPs are often more experienced at student related issues and will take time to listen to your concerns about things like medication or treatment options.
<h3>Is there sufficient support for friends and family members of those affected by severe mental health issues? Ought there to be more services available to them too? What action should we take if we suspect/know someone is at risk? </h3>
Support a friend or family member is a great thing to do and is likely to have a positive impact on someone, but it can be challenging. There are, however, resources available to help you support someone, for example: Student Minds - Look after your mate guide and Papyrus helpline for anyone concerned about a young person.
Lydia Pell, Mental Health Coordinator at City University London and UMHAN chair:
<br><br>Universities will often provide counselling to students who are finding they are impacted on by their friends or family members mental health difficulties. However uni is designed to be an adult environment and so they do not tend to provide support to family members due to confidentiality and the extent to which this is their role. This is where many charities do a great job as they often have support groups for carers and phone lines. organisations like MIND are good for a first port of call as they usually have directories for local mental health services that family members can access too.
<h3>What are the risks and benefits of honesty with Occupational Health? Are there some people who at this stage in their lives just aren't suitable for such courses? Where can worried students find information about the likelihood of being suspended or having action taken as a consequence of disclosure about mental health issues?</h3>
Most universities will have policies, which may be known as fitness to study but they are there to protect individuals. Honesty is the best policy when it comes to your own difficulties as support can be put in place to help you… There is guidance for medical students. If you feel that you've not been sufficiently supported then there are steps you can take to combat this, which may be through your university students union.
Lydia Pell, Mental Health Coordinator at City University London and UMHAN chair:
<br>Fitness to practice links to being able to have insight into your own mental well-being and behaviour. This isn't just relevant for students with Mental Health issues but also those who engage in a range of socially negative behaviours. Students who disclose their mental health tend to be better able to think about what their support needs might be and can demonstrate a willingness to access support to prevent getting unwell. Mental Health advisors can talk through pros and cons in advance of applying to any professional course that involves fitness to practice or clinical responsibility. They can also talk through aspects of the course that may be difficult to students with specific disabilities and consider what reasonable adjustments are possible and which are not depending on the courses competency requirements.

This is also true for many other degree and post grad courses where the pressures or skills needed aren't completely obvious in advance. Course directors, occupational health and mental health advisors should all be able to help students think through what the course demands might be. Universities also have procedures for students to be able to take a break if for some reason their mental health has deteriorated to the point that they need to stop studying or are too unwell to attend placements. students should see these as supportive procedures in place to help them succeed at the right time and not as being a failure because they needed some time out. Each university will have slightly different fitness to study policies and each professional body will have its own guidance about fitness to practice that outline what is expected of trainees in this area.

Claire Gregor, Mental Health Adviser at the University of Reading suggests:
<br>For those studying Social Work, they can always contact the HCPC for advice, or join BASW (British Association of Social Workers) as a Student member if they want to talk things through without fear of their course finding out. Having a declared mental health problem should not preclude anyone from either training or practicing as a Social Worker. What institutions are looking for however, is an awareness of the potential impact of their mental health difficulty on their practice. Students should be able to demonstrate a depth of understanding about their illness, and potentially have a plan in place for times when perhaps they maybe liable to becoming unwell/relapse. For example, students need to be able to demonstrate that if they are unwell, they have sufficient insight to alert others and withdraw temporarily from front-line practice or work that may potentially put service users at risk e.g. knowing that they are becoming manic, and thus stepping back and taking professional advice/accepting treatment. All Professional courses will have a 'Fitness to Practice'policy that students should be able to access via the university's website.

The following questions have been answered by Dan Doran, UMHAN Chair and Mental Health Coordinator at Loughborough University...
<h3>Is there perhaps needed a wider cultural shift towards personal satisfaction with day-to-day studying and life in general (almost a 'mindful' approach), and away from chasing success and perfection? Would this help decrease pressure on students to overachieve and push themselves too hard, having a knock-on effect on their mental health?</h3>
This is quite a profound question! There seems a continual drive for improvement or success in many organisations without “taking stock” of what may be seen as personally satisfying work. People do gain a positive sense of self-worth from having something to do (and do well), but sometimes continual improvement can make some aspects of work seem punishing. The rise of mindfulness as a practice shows something of a resistance to, or trying to cope with, this. We should consider personal responsibility and how our activities may be good enough, without the need for them to be perfect.
<h3>Should schools be educating about mental health issues as part of the national curriculum? Would this be a useful preventative measure against mental health issues emerging at uni?</h3>
A significant proportion of life-time mental illness as present by the age of 14, so targeting younger age-ranges would certainly be important. I think the question suggests educating school-aged children about mental health difficulties, and while there may need to be an educative aspect for the young person themself, I think a holistic approach is needed – one that involves families and potentially wider than that too. This is because the causes of mental health difficulties are varied and looking at the wider context in which young people and their families are living will be important.
<h3>Could those with an interest in preventing or treating mental health issues (such as the government, NHS or charities) be taking greater advantage of having a sort of 'captive audience' in students? What advantages and disadvantages would there be of greater input from such organisations?</h3>
Yes! University Mental Health Day is a really good way of engaging with the student population. Some advantages may include: Healthcare systems that are sensitive to this annually transient population; for charities, they may also become sensitive to the needs of students. It is also important for students to feel part of the wider community and civic life.
<h3>Would there be an argument to be made for having non-compulsory (but taken for credit) modules in mental health self-care and support? Would this be a good way of encouraging but not forcing students to take an interest in such issues?</h3>
Some professional courses do incorporate this into their modules out of necessity (e.g. health, social work, nursing, etc course). Others may touch upon it from a more academic angle (e.g. sociology and psychology). Some Universities may provide training opportunities for students (such as Mental Health First Aid) or other training-days about mental health for which they may receive some form of accreditation, which can then be included on their “employability skills”. So there are already a range of ways in which students participate in compulsory and non-compulsory ways in getting interested in mental health. Having a range is probably preferable than forcing people to get involved.
<h3>What happens when a person with a history of using school support services enters Further Education?</h3>
It is entirely your choice what happens when entering Further Education: nothing will happen unless you choose to declare mental health difficulties or previous experiences of using school support services. Support is only offered even in FE by the student declaring or asking school to share information to the Further Education setting. If you have concerns about what will happen you may want to speak to current school support services before entering Further Education so that you can prepare for this transition.

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