403 - Mental health at university | Scoins.net | DJS

403 - Mental health at university


The darling daughter and I had an exchange of views this morning. I've taken out the few names. For those who don't know us, I spent decades in secondary teaching and she has spent decades in university administration and teaching. Black and numbered paragraphs (only in the order I thought of them) are me and the blue is herself. No, we had no agreement I'd post this; yes, we really do normally write like this to each other. The interleaved habit has built up across many years and exchanges can run for weeks, with bits of conversation cut out as a topic is somehow exhausted (i.e. we've begun to repeat). We occasionally have more than one set of threads on the go.

Dear Dad,

On 02/06/2023 06:43, David Scoins wrote:


A poor article. It points to there being an issue but makes no attempt made to explain it or to understand it. That is the observed (Ha! Sunday) current reporting process  and, in the case of the Guardian, proper (considered, reasoned, detailed) reporting only occurs in The Long Read.

Which means that the press (single data point) is (yet again) simply baying. 

As my sister used to say, “I demand a protest”.

Yes, and I'll also add that it is very unclear who is meant by 'universities'. On whom would the statutory duty fall? Wellbeing/student health services, which in HE are chronically small and underfunded? Academic staff, who don't have the time or the training? Admin staff, who also don't have the time or the training? It's also incredibly unclear what HEIs are even being asked to do here. What would success/failure look like?

Points for discussion:

1. Over-18, tertiary education is ‘adult’, so 

2. Parents are not the university customer and one could argue that they are third parties. Indeed, one can question whether they have any interest in what passes for a time at university. One can further question whether parenting has been done well - if students have poor mental health, should they be doing this thing, and what is the message to all concerned when they don’t do well? I say that this means they’ve been badly prepared for what university actually is.

This is the natural and inevitable consequence of a) fees, which means in some sense that parents feel they are the customer (which indeed they are - but not in the way that they think); and b) the message that university is something one has to/ought to do aged 18. If we remove fees, then we also remove parents; if we remove the stigma about going to university at more or less any time, then we also allow students to say "look, I'm not ready" or "I need a load of therapy first". A final point is that, for students with poor mental health *whose mental health is made worse by school and/or their parents* (I'm thinking of queer kids, but there are loads of other obvious examples), university needs to be a place where you can go *with* your mental health problems and get them attended to if university is likely to be a safe(r) space for you compared to home/school. So, there needs to be balance: university cannot become a place in which mentally unwell people simply aren't welcome, but (as you suggest) it also can't and shouldn't be seen as a therapeutic space, because emotional and intellectual robustness are vital precursors to study.

3. What is the statutory requirement and how is that different from what is perceived as being available? Is it really true that a supermarket shelf-stacker is better looked after and, if so, is that to do with employment? A student is definitely not an employee.

HEIs would be somehow required to provide mental health support to our students, but nobody has thought this through. Firstly, many students who are mentally ill are (understandably) reluctant and slow to reach out for help. How, then, are we to divine who needs support and who doesn't, if they don't actually tell us they are struggling? Denial, isolation and poor communication are all markers of poor mental health. Secondly, the comparison between an employee and a student is an invidious one, since a) students are not employees, as you say; b) when a person doesn't show up to work, that is seen as them failing to fulfil their duty to the company, and so it would be recorded and acted upon swiftly, whereas students understand that their attendance at classes is their choice. We take a register (centrally, electronically, so that we can measure 'engagement'), but in my experience very little happens when students miss a lot of class beyond them receiving an email that basically says "r u ok hon"; and c) most mentally unwell employees are not actually 'looked after' by their employers in any real sense - the response to (a close friend) telling his employer that he has been diagnosed with depression was a demand that he 'act cheerful', for example. HEIs in particular have an appalling track record of looking after their staff, so again I'm not sure what is really being sought or compared here. Thirdly, to actually intervene meaningfully in the life of a student who is struggling with their mental health, one has to physically be in a room with them - sending concerned emails (which, as I say, is what would happen, at least in the first instance) does very little, especially if the student has disengaged to the point at which they are simply not checking their email or similar. In other words, it is very unclear what an intervention would look like, who would do it, when they would do it and how students in need of such a thing would be identified. 

4. I suspect that the issue here is that the student is supposed to be (and assumed to be) independent, self-sustaining and capable. Clearly many are not; clearly we have a push to US levels of support. Clearly support at such a level would have to be funded and, if done, merely kicks the responsibility can down the road.

Yes, because they are adults. We assume that they are basically fine when they arrive, because what else can we do?

5. So what is it that a young adult is supposed to be able to do for which they are provably not competent? Given that there might well be a list of such competencies (say three lists: assumed, to be learned, and possibly achieved), whose responsibility might it have been (in a blame culture) to have provided these competencies?

Well quite. It's all very well to say "I sent my mentally fragile child to university and the university didn't look after them", but we aren't boarding schools. We don't have matrons. Who exactly did you think would be 'looking after' your child? Also, if you don't think your vulnerable child can cope with university, maybe they aren't ready for it and you shouldn't be sending them off in that state.

6. Might it be appropriate to suggest that some people are not fit to join a university? If there is evidence that university should be open to all, then quite clearly the provision is inadequate. You have touched upon such points yourself.

It's completely reasonable to expect there to be *some* support. However, expecting a university to have the staff and funds to offer wraparound, specialist mental health provision is unrealistic. Everyone should be able to access mental health support through the NHS, regardless of whether they are studying or not - why on earth would you expect universities to reinvent the wheel here? We are not healthcare providers. What often happens to students who become too ill to continue their studies is that leaving university *also* removes all their support systems, including both accommodation and healthcare. That's not an improvement in their situation. If they were getting mental health support from the NHS, that could continue uninterrupted and thus leaving university might even be a positive move. As it is, lots of very ill students cling on, because they know they won't cope if those things are stripped away from them when they cease to be students.

7. There is a crying demand for mental health support across the nation. So a relevant question would be to ask whether universities are different; I suspect they might actually be better served than the general population.

Yes, I'd agree that in many cases this is true. My students have three hours a week in which I am available to them, in a quiet, private space for (minimum) 20 mins of tea and chat. That makes me (in my role as a university tutor) considerably easier to speak to than many GPs, for example. I'm not a therapist or a medic, so I'm not saying this is ideal, but it's certainly measurably better in at the sense of accessibility, at least. [Jess has on several occasions asked for specific training from her employer so as to be able to cope better with these sessions that amount to therapy]

8. I agree with the criticisms of performance by universities; mental health provision is slow, inadequate, underfunded and is not recognised as of importance by the university authorities. But we are not hearing any counter argument at all, not even “if you want it you’ll have to pay for it”, or “we’re doing more than the statutory minimum” or “That’s none of our business”.

The media likes the narrative that universities don't care about students, because their readership is angry parents worried that their child will kill themselves and they won't be able to blame someone for it. So the media don't consult universities, and if they did, they would consults VCs, who would say a load of bland stuff like "we support our students through x services; any suicide is one suicide too many; get off my lawn". The mental health provision in both the NHS and HEIs *is* slow, inadequate, underfunded and neglected. It has been for years. Fixing that would be very, very expensive and again, all the murky areas we have identified would need to be de-murkified.

9. There is an assumption that university is more School. This assumption is perpetrated by press when that is the very first response I’d expect to hear from a university representative. I am surprised that this is (the counter-attitude) is not also being reported.

Not just more school - specifically, it's more boarding school. Students are adults. They're old enough to get married or get a job, and instead they've decided to do more study. Good for them. That's their choice. They come to lectures, or they don't, just as they like/feel able; they get home whatever time they like; they cook, clean and shag however and whenever they like. They're adults. We can't and shouldn't interfere with any of that. If we treated them like employees, the consequence would be that after missing two weeks of class (say), we'd simply chuck 'em out - you wouldn't continue to employ someone who simply didn't turn up, after all. I'm really, really sorry for the guy in the article whose daughter died from suicide while at Bristol, but speaking about 'responsibility' as if someone *must* be to blame for that death isn't helpful. We can't know why an individual takes their own life. Nobody would dream of making a school or a parent legally obliged to prevent (or legally liable for) the deaths of kids in their care, so why on earth would you suggest it for university? And, were such a thing to be enacted, universities would (naturally, and quite sensibly) respond by simply not admitting anyone with even a sniff of a pre-existing mental health problem, in order to avoid being slapped with a legal duty that they couldn't possibly fulfil, thus effectively shutting all those vulnerable kids out of HE altogether. Well done, everyone. One can't have it both ways: if your child is sufficiently unwell that their need for support is blindingly obvious, then they are probably too ill for university; if they are not that ill, then you can't be surprised that the university doesn't realise they require support until it's too late. Kids come to us from school, and from their families. They don't arrive at university and spontaneously develop depression in Week 0, I suggest.

10. It would be quite easy to generate a metric for this. We have Student Satisfaction Surveys (which I criticise because I don’t see how a student compares where they are with anything other than their own expectations). It would be easy to add in some questions about provision supplied and used. 

God yes - the student satisfaction surveys are bullshit.

It would be, I think, quite easy to produce some evidence of the access to and provision of mental health (or other health, other support services) and to measure this in a way that indicates, say, how much support a student might expect to receive across a year, or what the U spends per student, or the time delay to professional attention. But I refer back to the statutory requirements - this is where every U will start any internal discussion. Is there any understanding/explanation of what the student is expected to be able to do? 

Not really. We have university agreements/contracts, which say things that you'd think would be obvious, like "you will speak to the other students and the staff with respect" (I've had to read it recently because I have a student in my care who speaks to the female staff as though they are beneath him), but there is no enforceable duty on students to attend every single class. Why would there need to be? They have chosen to be there in the first place, after all.

11. Would it be relevant to ask what provision occurs for anyone of the same age but not going to university? Blackpool has ‘colleges’ and the one at the end of the road seems to be populated with people of IQ 70-90. Blackpool has issues with young people blatantly rejecting the rule of law (motorbikes running through flower beds, no helmets on the public road, no acceptance of any rules at all - and very difficult for the police to catch (and for the population to record, such is the threat level). This is not university but it is a similar age group exhibiting an inability to behave in line with expectations. So is this (mental health provision at university) only symptomatic of a far wider issue?

I'd say this particular article is symptomatic of several wider things, yes. 1. Mental health in the general population is markedly worse than it was (say) 10 or 20 years ago. Covid has hurt everyone, but also it is a feature of late-stage capitalism that everyone feels either pressure to 'be productive', or rejects that pressure and instead does as little as possible. We are a nation of workaholics and layabouts. 2. Medical support for mental health is woeful. The close friend I referred to earlier has had a very good experience, with an excellent GP, swift prescription and very responsive contact after that (i.e. not pills and piss off; the GP has just raised the dosage and it has done wonders), but that's very unusual. Generally, young people wait months to even be assessed. 3. Expectations are thoroughly muddy. Parents expect their child's experience of university to be much like their own, which of course is 25+ years ago. Plus, nobody really knows whether education is supposed to be an end in itself, or a path to employment, or both.

Yours, J

Jess Farr-Cox (she/her) 
The Filthy Comma (www.thefilthycomma.co.uk
Proofreading, copy-editing, indexing, teaching

Okay, so hopefully you've read all that. I went hunting for answers and found, I thought, surprisingly little.

On statutory duty of care (for universities to provide to students) I found a petition. The header says: No general statutory duty of care exists in HE. Yet, a duty of care is owed to students, and the Government should legislate for this. HE providers should know what their duty is. Students must know what they can expect. Parents expect their children to be safe at university. [2]     I found a connected paper whose author took Bristol U to court over the loss of his daughter; the judge ruled that no relevant common law duty of care existed in the case of Abrahart v University of Bristol). [3]. It's well written. Abrahart quotes [4]: In essence, a university has a general duty of care at common law: to deliver its educational and pastoral services to the standard of the ordinarily competent institution, and, in carrying out its services and functions, to act reasonably to protect the health, safety and welfare of its students.

I am not at all convinced that there is a duty for a university to supply and fund the level of support services that parents—not a directly involved party—seem to expect. A small part of the problem is that we changed the age of adulthood from 21 (post-university for those even older than me, so very few current parents) to 18. So expecting that change to be relevant is only historic opinion and largely a red herring.

The situation would, actually, be quite different if students did not pay academic fees and if they were to receive any state allowance they could be considered to be, at least partially, employed. Instantly their 'employer' has a duty of care. Again, we return to what that might entail. It is not the expectations of parents that need to be satisfied, it is the understanding of those that run universities that has to be made clear; only then will there be useful discussions about funding the servicces that 'everyone' seems to think is appropriate. 

We have, post-pandemic—and I am unclear if the pandemic was the cause of that change—recognition that our mental health is something we underfund and only recently have begun to appreciate. That is, we have begun to notice a lack of that health and to make small changes that might improve that. We have not accepted who might be responsible, in terms of care provision, for mental health and its repair; we seem to have agreement that whatever this is it is woefully underfunded. If a university is to be made responsible for this, then so are many more institutions and possibly all employers. If, on the other hand, your mental health is largely your own responsibility, we're going to need support mechanisms in place (more paid sick leave?) and a lot of provision for self-referral. Ideally, we'd be doing small things far earlier that diminished future demand. But, while we can't improve the national diet — and from there we become a nation of fatties ("people with obesity") and a nation with a diabetes problem (and the vast allied costs)  then we cannot expect, whatever the politicians say, that we'll do anything significant to improve this.

Which indicates, I think, that mental health is a problem that you must recognise as your own responsibility. You may be lucky enough to have support mechanisms (immediate family, wonderful froends, rare local support services), but realistically, this is your problem to solve. I feel very much the same about physical health; the swiftest way to bring the NHS toward what we think we want is for Joe Public to take (a lot more) responsibility for his individual health.

DJS 20230606

top pic from Google search, [5]

[1]  https://www.theguardian.com/education/2023/jun/02/parents-survey-mental-health-support-students-universities

[2]   https://petition.parliament.uk/petitions/622847#:~:text=Higher%20Education%20providers%20do%20have,and%20welfare%20of%20their%20students.

[3]    https://www.hepi.ac.uk/2022/11/07/should-there-be-a-new-statutory-legal-duty-of-care-for-students-in-higher-education/   and do read the comment letter from Richie Mack in response.

[4] https://www.amosshe.org.uk/futures-duty-of-care-2015 and see also https://www.amosshe.org.uk/resources/Documents/AMOSSHE_Duty_of_Care_2001.pdf

[5]  https://www.andrewchell.com/studentliving/mental-health-university-infographic  Exactly; infographic(s). With sources linked.

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