The Universities UK Framework has been developed to support higher education senior teams to adopt a whole university approach to mental health. Every institution will want to adapt it to context, building on strong engagement with students and staff and a robust evaluation of need.
The cultural and structural changes needed to improve mental health in higher education require strong and engaged leadership at all levels, starting with the vice-chancellor and the board of governors. There are examples of this already happening in leading corporations (City Mental Health Alliance - case studies). Mental health needs to be included in strategy development and planning rounds – with mental health embedded across activities and behaviours – to allow ambitious, long-term goals and shared aims. This provides a framework and a process for improvement as well as ensuring the financial sustainability required to meet this aim.
University leadership should set the character and tone of the whole institution’s approach to mental health, characterising it as a strategic priority, vital to the reputation and future success of the university. Their support should be visible and visionary, enabling other people within the institution to know what the goal is, and to know what change could and should look like. Leadership for a whole university approach to wellbeing and mental health should be reflected in all policies, processes, procedures and guidance documents. These should set out what teams and individuals should be doing on mental health and will build on much of the good work that is already taking place.
The scale of present and future challenges cannot be addressed by siloed services: the whole organisation approach is needed to address system and structural barriers and to reach more groups earlier.
Leadership is required at all levels with engagement from all members of staff, including heads of departments and faculties, deans, and other senior management team members. This encourages wider understanding, engagement and participation to ensure that barriers are identified and removed.
Everyone engaged in higher education and in the organisation – students, academic staff, tutors, students' unions, security and accommodation as well as professional services – has a role to play to contribute to the change and improve the outcomes.
Individual institutions should commit to fund services in line with an open and robust evaluation of current student need, existing provision, and reasonable future projections.
Innovative service redesign will be important, ensuring a mixed access of support available, as well as interventions supporting prevention and early intervention.
To sustain pace and focus, robust evaluation should be carried out with regular reviews of progress at senior level. It is essential to involve students and staff at all stages of this journey including the evaluation and review.
A mental health needs assessment is central to strategy development and the whole university response.
It should look wider than mental health difficulties and clinical prevalences to encompass environments, relationships and measures of wellbeing.
Universities UK will be developing and validating a mental health audit tool, as below, which will include recommendations for baseline evaluation.
A robust and systematic review of current practices is essential, to identify and address any gaps in provision, to ensure the effectiveness of current care/support, and to inform evidence based-decision making. Elements of the review should include waiting times, seeking feedback, and provision by the statutory and voluntary services in the local area.
Interventions – whole population prevention, early interventions to promote awareness or encourage disclosure as well as support, care and triage mechanisms – should at all times be based on the best available evidence.
Greater account should be given to susceptible or at risk groups, with characteristics defined by discipline, demography, or culture. Targeting and personalising interventions to these characteristics ensures that these are more impactful.
Universities UK will be developing a good practice exchange to promote and sustain a learning community on this issue.
Progress should be monitored year-on-year, to indicate trends between years and cohorts, and effectiveness of policies and interventions.
This audit process should be transparent and allow the identification of successful interventions, interventions that can be improved further, and interventions that are not working.
Universities UK will be developing and validating a mental health audit tool.
Institutions are encouraged to align learning analytics to the mental health agenda to identify change in students’ behaviours and to address risks and target support.
Additional professional training will need to take place to ensure professional development in mental health ‘essentials’ and to better understand the importance of mental health and wellbeing in relation to curriculum and teaching practices.
Training will also aid the development of an organisation-wide understanding of mental health and wellbeing.
Senior managers should make adjustments to the workload of staff related to supporting student mental health to ensure that they have the right skills and resources to provide that support and that such work does not impinge on staff wellbeing and their own stress levels.
There should be an explicit allocation of resources for the delivery of services and programmes for staff to support student mental health. It is important to ensure that there are print and digital resources available for staff to support their own wellbeing. Also, any activities developed to support staff mental health should be delivered in partnership with mental health experts.
Mental health support for staff should be aligned with the support that is available for students. This should be reflected in strategic planning and operational delivery.
Current evaluation of performance against objectives, behaviours and leadership might also include health and health promotion. This recognises staff and student health as assets to be supported and enhanced to underpin delivery.
Social, physical and digital environments determine every student’s social and educational journey and contribute to mental health and wellbeing.
These environments should be inclusive and diverse, promoting respectful interactions and relationships. To achieve this, it will be important to audit and enhance physical spaces and student facilities, ensuring access to appropriate study, social and quiet spaces, healthy food options and sporting facilities such as bicycle storage.
Promotion of healthy behaviours can have a significant impact on mental health (World Health Organisation, Promoting Mental Health, 2005). Examples of healthy behaviours include healthy nutrition, being physically active and reducing sedentary behaviour, not using tobacco, alcohol or drugs, safe sexual health practices, getting sufficient sleep and rest, balance in use of screen time, and volunteering.
Higher education institutions should create programmes, policies, and messages to encourage such behaviours.
Promotion of diverse, inclusive and compassionate culture increases the sense of belonging and connectedness that students have. This can be achieved through creation of a variety of social networks, the right accommodation, and peer support.
Some universities will have the opportunities to work with local, third-sector organisations, helping to foster a sense of belonging to the broader community and supporting wellbeing through connectedness and purpose.
Students and staff should be confident in recognising the signs of being unwell (for example disturbed sleep patterns, lack of energy, being indecisive, not wanting social contact) and having the strategies to cope and recover quickly. They need to feel confident that they have the right tools to support lower-level issues, self-care and recovery from the ups and downs of life.
Positive education promotes meaning, relationships, positive emotion, accomplishment and engagement.
Evaluations of mindfulness interventions in schools and universities have produced a strong correlation with stress management, healthy sleeping patterns and wellbeing.
Students and staff should be trained in recognising the signs and knowing the coping strategies.
Higher education institutions should engage every faculty, department and team of the university in understanding the importance of mental health, to reduce stigma and encourage disclosure and appropriate seeking of help. This should be reflected in the regulations, policies and procedures within the institution.
It is likely that increased awareness about mental health will lead to an increase in the demand for support services.
Universities UK will be working with Time to Change to support universities to campaign against stigma.
Higher education institutions should provide a broad array of information and appropriate professional training for students and staff to increase mental health understanding, awareness, literacy, and compassion.
These actions should reshape the conversation around mental health, focusing on mental health promotion for everyone and early intervention, rather than solely the support required when people have a problem.
Universities UK will be working with Mental Health First Aid and Connecting with People to promote community wide approaches to mental health awareness.
Mandatory or strongly recommended communities of learning have been shown to improve outcomes among at risk groups of community college and university students in the United States.
Peer support initiatives build on students’ networks of peers. They should be integrated with mental health and wider support services.
Members of the higher education community should be encouraged to lead by example and have an open conversation about mental health, to encourage active listening and help-seeking, when needed.
Universities should configure and resource a range of support services responding to the assessment of need. Services should be effective and accessible, and be based on the best available evidence. They should be integrated within wider student support and advice – students who need support on mental health issues may often require advice on other issues such as academic, housing, finance – and integrated with learning and teaching practice.
There is no definitive service offer. Interventions might include mental health support or counselling, digital apps and online psychological therapies, telephone/online appointments, after hours’ services, helplines and peer-to-peer support.
Clear signposting to the appropriate support services and peer-to-peer initiatives should be in place. This will require effective staff training, including academic staff.
A voluntary or involuntary leave of absence due to a mental health problem should be a viable option for students. It will be important to ensure there are effective and easily accessible policies and procedures in place, providing information on the available leave and the re-entry process.
Universities should review curricula and teaching practice to ensure that they are not creating unnecessary stress – for example multiple simultaneous evaluations – and that they are inclusive. Flexibility in programme structure supports better mental health, allowing a student to change the mode of study, as an option while maintaining academic progress.
Re-entry processes are relevant not only in case of a leave of absence, but also when a student is returning from time abroad or placement, or for other reasons.
Every higher education institution should have a documented approach to a crisis (for example, the death or suicide of a staff member or student), which will require clear lines of accountability, a single point of contact, risk management and integrated support.
A comprehensive post-vention plan, which includes identifying and offering support to all those impacted by the crisis, will need to be in place.
Students transition from home, from school or college and onwards into seeking employment. Working with schools on the issue of mental health including supporting or continuing training in resilience or mindfulness ensures that they receive the best induction, training and support at an early stage. Parents also need to be informed about the support available at university and in the coordination of care around students who are in difficulties.
Intrusive support should be enhanced for students who are at-risk.
Intrusive support can entail outreach programmes, providing advice on issues concerning learning practice or student life. Mandatory learning communities are found to produce better outcomes for these at-risk groups.
Certain groups and demographics are more susceptible to mental health difficulties or to conditions that may impact on their wellbeing. Examples of such groups include international students and refugees, students on the spectrum of neurodiversity, disabled students, black, Asian, and minority ethnic students, lesbian, gay, bisexual, trans, queer/questioning and others.
During transition periods, these susceptible groups and demographics should be considered and targeted initiatives and outreach programmes should be developed.
Working with employers could help universities ensure that their students are ‘work ready’ and help them to manage their expectations, while looking for a job and securing and starting their first graduate position. It could also inform employers about the support systems that need to be in place for graduates with a mental health condition.
It is essential to establish links with NHS commissioners and services to support access into care and better coordination of care.
Partnerships need to be sustained at strategic and operational levels. In respect of the latter, to avoid duplication or inappropriate referrals being made, a member of staff should be responsible for the co-ordination of those referrals.
Universities UK is working with the NHS and clinical experts to develop service and clinical frameworks.
The establishment of strong links and connections with local authorities and with third-sector organisations, can support the institution by providing extra resources, improving current provision, and providing a safe platform for students and staff, who are less willing to disclose.
The development of local strategies and action plans based on population and place is to be encouraged. These should involve all stakeholders including students. Effective links with local police forces and residents are essential.
It is important to work collaboratively with local GPs and mental health services, to support students to access low-intensity services and primary health care professionals rather than accident and emergency departments. Strong messaging about registration with a university practice should be a key component of induction.
These services should be well signposted and alert to the specific vulnerabilities and characteristics of student populations. This is especially true for international students.
Universities UK is considering a kite marking scheme for student friendly services to give users the confidence to use them and to increase awareness amongst university staff of services available.