CYPE(6)-20-22 - Papur 5
Senedd Cymru Children, Young People and Education Committee’s into Mental Health support in Higher Education: RCGP Cymru Wales Response
The Children, Young People and Education Committee has requested written evidence regarding mental heath support in higher education. The Committee has asked for comment regarding the extent of need, how universities can identify need and provide mental health solutions and how policy can assist in this provision.
Extent of need
RCGP Cymru Wales members are accustomed to dealing with mental health issues that present in patients from the local community. The nature of higher education means that it presents unique challenges. Mental health charity, Mind, illustrates that there are several potential sources of poor mental health for students in higher education:
· meeting and working with new people
· the pressure of exams, deadlines for written work or presentations
· managing their own finances for the first time
· homesickness
· balancing the demands of studying with other commitments, such as caring responsibilities or work
· maintaining relationships with family and old friends
· leaving home, finding new housing, and living with new people. [1]
A news article, published in June 2022, stated that 94% of universities reported an increased demand for counselling following COVID-19 as the above factors were exacerbated by the isolation, uncertainty and health anxiety that has come with the pandemic.[2]
Identification and Provision
These challenges are potential sources of stress which mean cause poor mental health. However, the circumstances above can also create barriers for accessing support or treatment for mental health. Students are often many miles away from family members, established friendship groups and will not yet have a relationship with the GP in their new location.
Universities encourage students to register with the GP on site, however this can present a problem as many students spend the extensive breaks in the academic year in their 'home town’, meaning that continuity of care is not possible. It is not practical to register with the closest GP each term and holiday period, meaning that students will spend some of their time without access to a health care professional, other than out of hours services.
It is not just the practicality of students moving between locations which cause issues for the provision of mental health care. If a student wishes to see their GP regarding a mental health issue there will usually be a substantial waiting time, after which time the student have moved locations again.
Due to this practical problem, universities provide onsite counselling services and wellbeing provision[3] , however there have been anecdotal complaints of these services in Wales[4] and research into the effectiveness of these services is in its infancy.
An article in the British Journal of Guidance and Counselling found great differences between the amount of treatment sessions and their frequency, however the study reported that students broadly found the service effective.[5] However the article acknowledged that the data was somewhat unreliable.[6] The study, which considered over 5,500 students from UK universities only involved one Welsh university, and therefore much research is needed to test the efficacy of the counselling services available in Welsh Universities.[7]
There is also some evidence to suggest that even if students could practically access support from a GP that they would not choose to, as there is a perception that they will be dismissed as being 'too sensitive' or will be given medication as a 'quick fix' without any further support.[8] Indeed this may be the course of action taken by university GPs, due the practical issues with referrals for students, described above.
However, the pandemic may have brought a potential solution. As was reported in June 2022, Cardiff University has introduced NHS mental health nurses following the pandemic to cope the increased demand for services. These nurses from the NHS have been funded by the Mental Health University Liaison Service and the pilot is expected to run until December 2022. Cardiff university described the initiative as bridging the gap between NHS mental health services and what can be practically accessed by University Students given their unique circumstances, however RCGP Cymru Wales feels that this 'gap' should be bridged on a permanent basis not simply for one university term.
Policy and recommendations
As in RCGP's 2021 report, Fit the Future: Relationship Based Care, it is clear that a strong relationship between a patient and their GP practice is conducive to improved outcomes including for mental health.[9] Patients who know and trust their GP are more likely to seek help sooner and to disclose more information about their symptoms.[10] This enables the GP to work with the patient to find an appropriate solution. As above, students who feel that they will not be listened to must not have a foundation of trust with their GP. This is understandable given the practicalities of moving from one place to another which is a common part of student life. Therefore, Welsh Government, Universities and Health Boards must provide for that relationship to be created.
This is especially the case for more serious instances of mental illness such as those resulting in self harm. Mughal et al, writing in the British Journal of General Practice note that GPs can be integral in noticing where instances of self-harm occur due to the existing relationship with the patient and the resultant ability to identify changes in demeanour, the same is true of general mental health. [11]
Professor Ed Watkins, Professor of Experimental and Applied Clinical Psychology at the University of Exeter, writing for the National Institute of Care and Research, advocates for a 'whole university' approach. [12]He states that this would involve ' all aspects of the university including culture, curriculum, assessment, and formal services to contribute to improved wellbeing. [This model would involve] universities [being] responsible for promoting good mental health and flourishing in students.'
This would remove the onus for safeguarding of the students away from health services and towards the university itself. It would address the fact that students often miss the community of home however, as above, university lead services often miss the high standard of care that patients are used to receiving from their family doctor.
RCGP Cymru Wales feels that the solution, would be something akin to the pilot currently underway at Cardiff University, whereby NHS professional work closely with the University to provide quality care, strong relationships and a sense of community.
This approach echoes that of Duffy et al, writing in the Lancet in 2019. [13] They suggest that a multidisciplinary NHS team working in tandem with academic advisors and university staff would provide a solution that brings students and community NHS services together.[14]
Duffy suggests that access to self-help resources is the first point of call and these should be supplied by the University. If the student then requires additional support, they can be triaged by an onsite specialist team who can refer to local community services. [15]
This is a potential solution however work is still needed to allow for a student to be able to access support wherever they may be located at various points during the academic year. Also, more work needs to be done in the safeguarding of vulnerable students to encourage them to access support before they reach crisis point.