REPORT OF THE WORKING PARTY ON STUDENT MENTAL
HEALTH POLICY AND PROCEDURES AT THE UNIVERSITY
OF YORK.
CONTENTS
1
2
3
Introduction. ............................................................................................................................................................ 3
1.1
The working party’s terms of reference. .................................................................................................... 3
1.2
The Guidelines on Student Mental Health Policies and Procedures for Higher Education. ........... 3
1.3
Membership of the working party. ............................................................................................................. 3
1.4
The working party’s approach to the task.................................................................................................. 4
1.5
Definition of mental health. ......................................................................................................................... 4
Student Mental Health. ......................................................................................................................................... 4
2.1
Threats to mental well-being. ...................................................................................................................... 4
2.2
Incidence of mental health difficulties. ..................................................................................................... 5
2.3
Duty of care...................................................................................................................................................... 5
Support for Student Mental Health at the University of York: current policy and procedures. ............. 5
3.1
Policy................................................................................................................................................................. 5
3.2
Support network at York. .............................................................................................................................. 6
3.3
Demand for mental health support services. ............................................................................................ 6
3.4
Provision of information for students and potential applicants concerning support services for
student mental health: overview of existing procedures. ................................................................................... 6
3.4.1
Approach. ................................................................................................................................................. 6
3.4.2
Reference to mental health. .................................................................................................................. 6
3.4.3
Limitations on provision. ...................................................................................................................... 7
3.4.4
Prospective applicants. .......................................................................................................................... 7
3.4.5
Student Support Services handbook. ................................................................................................. 7
3.4.6
Departmental and college handbooks. ............................................................................................... 7
3.4.7
International students. ........................................................................................................................... 8
3.5
Admissions arrangements for applicants with mental health difficulties. ......................................... 8
3.5.1
Applicants declaring a disability. ........................................................................................................ 8
3.5.2
Applicants not declaring a disability. ................................................................................................. 8
3.5.3
Applicants for vocational programmes with specific entry requirements. ................................. 8
3.6
Supporting students with mental health difficulties: overview of existing procedures. ................. 9
3.6.1
First contact with the welfare network. .............................................................................................. 9
3.6.2
The colleges. ............................................................................................................................................ 9
3.6.3
Student Counselling Service. ............................................................................................................. 10
3.6.4
Departments & Supervisors. .............................................................................................................. 10
3.6.5
University Health Centre. ................................................................................................................... 11
3.6.6
Other agencies in the University welfare network. ....................................................................... 12
3.6.7
Special cases: leave of absence and disciplinary procedures. ...................................................... 12
3.6.8
Impact of academic assessment procedures..................................................................................... 13
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3.6.9
4.0
Monitoring of policies and services. ................................................................................................. 13
Recommendations. ........................................................................................................................................... 14
4.1
Information. ................................................................................................................................................... 14
4.1.1
Prospectuses........................................................................................................................................... 14
4.1.2
Departmental handbooks. .................................................................................................................. 14
4.1.3
College handbooks. .............................................................................................................................. 15
4.1.4
Academic staff & supervisors’ handbooks. ..................................................................................... 15
4.1.5
Disability statement and information about health care. ............................................................. 16
4.1.6
International students. ......................................................................................................................... 16
4.2
Confidentiality and Record-keeping. ....................................................................................................... 16
4.2.1
Confidentiality policy. ......................................................................................................................... 16
4.2.2
Records of staff training. ..................................................................................................................... 17
4.3
Training & Support. ..................................................................................................................................... 17
4.3.1
Cleaners and porters. ........................................................................................................................... 17
4.3.2
Academic supervisors. ......................................................................................................................... 17
4.3.3
Secretaries, receptionists and Students’ Union officers. ............................................................... 18
4.3.4
Provosts. ................................................................................................................................................. 18
4.3.5
Support for staff in the welfare network. ........................................................................................ 18
4.4
Monitoring the demand for and effectiveness of mental health support. ......................................... 19
4.4.1
Leave of absence. .................................................................................................................................. 19
4.4.2
Counselling Service. ............................................................................................................................ 19
4.4.3
Student perception of mental health support. ................................................................................ 19
4.4.4
Colleges. ................................................................................................................................................. 20
4.5
Coordination of mental health support. ................................................................................................... 20
4.5.1
Emergency procedures. ........................................................................................................................ 20
4.5.2
Coordination of mental health support and links with external agencies. ............................... 21
4.5.3
Post-incident debriefing. ..................................................................................................................... 21
5.0
Conclusions. ...................................................................................................................................................... 21
6.0
Summary of recommendations. ..................................................................................................................... 23
7.0
Appendices. ....................................................................................................................................................... 25
7.1
Appendix 1: Extracts from Guidelines on student mental health policies and procedures for higher
education. ................................................................................................................................................................... 25
7.2
Appendix 2: Demand for University of York Counselling Service, 1997 - 2001................................ 29
7.2.1
Number of requests for appointments. ............................................................................................ 29
7.2.2
Number of people on the waiting list for appointments. ............................................................. 29
7.2.3
Requests for appointments as a percentage of total FTEs. ............................................................ 30
7.2.4
People on the waiting list for appointments as a percentage of total FTEs. .............................. 30
7.2.5
Mean number of consultations per client. ....................................................................................... 31
7.2.6
Comparison of number of requests for appointments and number of clients seen. ............... 31
7.3
Appendix 3: Analysis of leave of absence cases from 1 October 2000 to 16 March 2001 ................. 32
7.4
Appendix 4: Proposed addition to section on disability advice in the prospectuses. ...................... 33
7.5
Appendix 5: Suggested points to be included in each College Handbook. ...................................... 33
7.6
Appendix 6: Illustrative material from Helping Students in Difficulty. by Annie Grant,
University of Leicester (1999). ................................................................................................................................ 34
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1
INTRODUCTION.
1.1
The working party’s terms of reference.
The working party on student mental health was set up by the Welfare Coordination
Committee (now the Student Welfare Committee) with the following terms of reference:
To consider the implications of the Guidelines on student mental health policies and
procedures for higher education for the university’s policy and procedures by

obtaining information about current policies, procedures and services within the
university in relation to student mental health;

clarifying the university's duty of care and the limits of the university's
responsibility in relation to student mental health;

identifying areas where action is required in order to fulfil the university's
commitment to supporting mental health and assisting students with mental
health difficulties; and

making recommendations in the light of the above.
The working party was intended to make a contribution towards Target 11 of the student
support and welfare strategy: Clarify the institution’s understanding of mental well-being, its
strategy for supporting mental health and assisting students with mental health difficulties.
1.2 The Guidelines on Student Mental Health Policies and Procedures
for Higher Education.
The Guidelines were prepared by members of a working group established by the
Committee of Vice-Chancellors and Principals (now Universities UK), the Association of
Managers of Student Services in Higher Education and the Standing Conference of
Principals.
Their stated purpose is to guide and support higher education institutions in their
strategic planning to ensure that, in relation to teaching and learning, student support,
and staff development, they take full account of the needs of students experiencing mental
health difficulties, and of other students and staff who work and study with students
experiencing such difficulties.
They invite institutions to consider the following issues in the development of policies
and procedures:




1.3
Awareness of relevant legal and duty of care issues.
Access to support and guidance services.
Provision of training and development opportunities.
Liaison between internal and external agencies.
Membership of the working party.
The membership of the working party was as follows:
Dr P Bailey
Department of Psychology (Chair)
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Dr C Hall
Ms S Hardman
Dr J Lethem
Dr S Marshall
Ms W Shaw
Ms E Tate
Ms P Thomas
Head of the Counselling Service
Academic Registrar
University Health Centre
Provost, Goodricke College
Registrar’s Department
Education & Welfare Officer, Students’ Union
University Disability Advisor
The working party (also referred to herein as the group) met for the first time on 15
November 2000, and for the seventh and final time on 22 June 2001.
1.4
The working party’s approach to the task.
A set of questions was derived from the guidelines to facilitate the working party’s
discussions1. We sought to answer these questions for the specific context of the
University of York and its current policies and procedures.
1.5
Definition of mental health.
The Guidelines do not provide a clinical definition of mental health, but draw attention to
potentially useful distinctions between mental illness, mental health difficulties, and
mental well-being. Problems with mental health vary in nature and severity in a manner
that defies easy categorisation, as do problems with physical health, and both mental and
physical health are difficult to define formally2. We noted that there is often no clear
distinction between behaviour indicating mental ill-health and behaviour that is merely
unusual, and not everyone with a mental health problem will recognise their behaviour as
problematic, or feel the need for help.
2
STUDENT MENTAL HEALTH.
Mental well-being is recognised as a major contributor to maximising the benefit that
students derive from their experiences at university, and the contribution that students
make to a university community.
2.1
Threats to mental well-being.
Threats to mental well-being are widely believed to be increasing for young people
generally, and students in higher education are subject to pressures that can lead to or
exacerbate mental health difficulties. Success in making access to higher education
available to a wider range of young people is likely to intensify such pressures. The
guidelines identify several features of embarking on a higher education programme that
may render students vulnerable to mental health difficulties, including, for example,
leaving family and friends, moving to a new location (or even a new country and culture),
and financial concerns.
1
2
See appendix 1.
But see Categorisation of Client Concerns, Association for University and College Counselling, August 2000.
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2.2
Incidence of mental health difficulties.
Accounts of the increasing incidence of mental health difficulties among students and
staff in higher education have been provided by the Association for University and
College Counselling3, and by HEFCE-funded research on mental health issues in
universities4. Some preliminary results are available of an ongoing survey of students’
mental health problems and staff responses to them in progress at the University of
Leicester5.
2.3
Duty of care.
It is generally considered that a contract exists between a student and his or her
institution, and that the institution has a statutory duty to take ‘reasonable care’ of its
students, for example by providing a safe environment, and making reasonable efforts to
ensure that students are not in danger6. The detailed implications of this duty of care are
only likely to emerge in case of a legal claim for negligence in a case where an institution
allegedly failed to comply with its duty of care and this failure led to quantifiable loss that
was reasonably foreseeable by the institution. It would be sensible to assume that the duty
of care will include an obligation to provide support for student mental health 7. Aside
from the constraints imposed by the legal framework, the Guidelines clearly imply that
universities have a responsibility to promote mental health generally, and to provide
support for students with mental health problems8. We hope that this report of the
working party’s discussions will go some way to clarifying how this is done at the
University of York, how the responsibility for mental health support is distributed
between the services provided by the university, and where the limits of the university’s
responsibilities might lie.
3
SUPPORT FOR STUDENT MENTAL HEALTH AT THE
UNIVERSITY OF YORK: CURRENT POLICY AND PROCEDURES.
3.1
Policy.
The University has not articulated a specific policy on support for student mental health,
beyond that implied in general terms by the disability statement. The group did not feel it
was necessary to have a more specific policy statement, but agreed that should one be
required it could be expressed, following the Guidelines, as a commitment to provide mental
health support where necessary through appropriate support services in a discrete and nonjudgemental setting, within the limits imposed by available resources.
3
Degrees Of Disturbance: The New Agenda (1999)
e.g. Supporting Students with Mental Health Difficulties: A Whole Institution Approach (University of Leicester,
1999)
4
5
See http://www.le.ac.uk/edsc/sphp/
6
See Evans, G. R. & Gill, J. Universities & Students. (Kogan Page, 2001) p.39
See AMOSSHE briefing document Responding to student mental health issues: ‘Duty of Care’ responsibilities for
student services in higher education. Autumn 2001
7
8
See Stanley N. & Manthorpe J. Students' Mental Health Needs. (Jessica Kingsley Press, 2002)
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3.2
Support network at York.
Support for student mental health at the University of York is provided through the
network of student support services that includes the supervisory system, the colleges, the
Counselling Service, the Disability Adviser, the Welfare Information Officer, the Health
Centre, the International Office, the Accommodation Office, the Students’ Union and
Graduate Students’ Association, the Chaplaincy, and the undergraduate and graduate
offices of the Registrar’s department.
3.3
Demand for mental health support services.
Overall demand for mental health support services from students is not easily quantified,
but there is clear evidence that demand for student counselling is increasing 9. We noted
that despite an increase in the number of counselling sessions offered, the number of
people on the waiting list for an appointment with a counsellor remained high. Also
noteworthy is the increase in the average number of sessions spent with each student. The
increase in demand is primarily from first and second year undergraduates; demand from
graduate students has remained relatively stable at a time when their numbers in the
university are increasing.
3.4 Provision of information for students and potential applicants
concerning support services for student mental health: overview of
existing procedures.
3.4.1
Approach.
Central to defining the extent of the university’s duty of care are the claims made about
what student support services the university provides in the information given in
prospectuses, booklets, handbooks, videotape and web pages that might be seen by
potential and registering undergraduate and graduate students. In this context support
services were taken to be services relevant to student mental health intended to promote
the university’s main aim of teaching, learning and research.
The working party reviewed the university’s documentation to determine what claims are
made about support for student mental health, and whether they are an accurate
reflection of the services that are in fact provided. The group took the view that it may not
be appropriate yet to assume that information provided only on the university’s web
pages —for example the university’s disability statement — could safely stand alone,
without there also being access to at least an outline of that information from a printed
source.
3.4.2
Reference to mental health.
In most cases the information provided about student support services discusses the
various services available without making specific reference to support for students with
problems arising as a result of mental ill health. This is consistent with the absence of
9
See appendix 2
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references to support for students with specific medical conditions or, in most cases, with
specific disabilities. The disability statement indicates the availability of support
structures as a whole rather than specifically mentioning mental health, in part because
none of the support services provided by the university is designed exclusively for
students with mental health difficulties.
3.4.3
Limitations on provision.
We found no instances of claims to offer support services that are not in fact available.
However, we noted that the published information does not typically reflect any
limitations that might apply in practice to the extent of student support services. We
considered that this was appropriate and probably inevitable in general publicity,
although we suspect that if limitations on the extent of student support services were
made explicit the university would be in a better position to defend itself against legal
challenge in cases of alleged failure to comply with its duty of care.
3.4.4
Prospective applicants.
For prospective applicants we assumed that the primary sources of information are likely
to be the undergraduate or graduate prospectus and, increasingly, the university’s web
pages. We considered whether, given the information therein, a potential applicant who
had experienced mental health problems in the past would be able to get a clear picture of
what support would be available (and by implication what support would not be
available) should problems recur whilst they were studying at the university. A person in
this position might not necessarily assume that the disability statement (which in any case
does not specify practical limitations on available support) applied to them, and it may
not be adequately clear how best to obtain further information about the fit between their
specific circumstances and the support services available through the university or other
local agencies.
3.4.5
Student Support Services handbook.
For registered students we assumed the primary sources of information are likely to be
the student support services handbook, departmental and college handbooks, and
university and department web pages. The student support services handbook provides
an accurate overview of student support services and the relationships between the
different sources of support, and gives succinct guidance on whom to contact in case of
difficulty.
3.4.6
Departmental and college handbooks.
General information on welfare in college handbooks and in those departmental
handbooks we surveyed was variable, not always well organised and, in some cases, out
of date. We considered this noteworthy because although we acknowledged that
providing information about welfare is not a central objective for departmental
handbooks, and welfare information is available elsewhere, we felt that students may look
on their departmental handbook as a primary source of information on a wider range of
issues than those strictly relevant to departmental matters.
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3.4.7
International students.
We acknowledged that international students are a potentially vulnerable group for
which the pressures on mental well-being may be particularly strong. A booklet giving
general information specifically for international students is sent to new international
students prior to their arrival in York; this has a section outlining arrangements for
obtaining medical care but does not make reference to support provided by the
Counselling Service or the Disability Adviser.
3.5 Admissions arrangements for applicants with mental health
difficulties.
3.5.1
Applicants declaring a disability.
For students who declare a disability on their UCAS application form and indicate a need
for support, a well-established procedure is triggered whereby the university’s Disability
Adviser interviews the applicant to explore in detail what support will be required and
whether the support can be provided within available resources. Although they are not
required to do so, departments typically also interview candidates declaring a disability
that requires support. Experience suggests that these procedures work well, and we
believe they would be effective in the case of a disability involving mental ill health. We
noted that because students need not register with the University Health Centre, it was
not possible for the Health Centre to make advance referral for applicants who would be
in need of local NHS services.
3.5.2
Applicants not declaring a disability.
Applicants with disabilities that are not declared on their UCAS application form need to
have available clear guidance on how to obtain further information about the availability
of and limitations on support for their particular circumstances. We believe that the
likelihood of a person with mental health difficulties sufficiently severe that they could
not be supported by existing services in the university making an application without
prior consultation is low. However, we have proposed in section 4.1.1 an addition to the
prospectuses that we hope would further reduce that likelihood.
3.5.3
Applicants for vocational programmes with specific entry requirements.
Applicants for entry to certain programmes that lead to membership of professional
bodies must satisfy specific non-academic entry criteria. At York this applies to students
embarking on health studies programmes, who must satisfy occupational health criteria,
and to applicants for the post-graduate certificate of education leading to qualified teacher
status, who require medical clearance. This is flagged clearly in the disability statement,
and described in the relevant programme prospectuses. These programme-specific criteria
would apply to an applicant with a mental health problem, who would have the usual
opportunities to discuss the problem with the university’s disability or health adviser.
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3.6 Supporting students with mental health difficulties: overview of
existing procedures.
3.6.1
First contact with the welfare network.
First contact with the welfare network for students with mental health problems can arise
in several ways. In many instances such students will present at the Health Centre or
Counselling Service and be seen by professionally-experienced people whose job is to talk
with, advise or treat their clients, or refer them to other experts. But in some cases support
will be provided, initially at least, by fellow students, cleaners, porters, supervisors,
provosts and other non-specialists who happen to be in the orbit of the student
experiencing the problem. Recognising this is an important part of forming a realistic
picture of university-wide support for student mental health, and providing appropriate
training and support for the people who provide it.
3.6.2
The colleges.
The role of colleges in the welfare structure has been raised in the report of the working
party on student supervision, and will be considered further by the working party on
welfare and security in colleges set up by the Policy and Resources Committee. We noted
that only full-time students are automatically assigned to a college; part-time students are
informed through the registration arrangements handbook that they may choose to join a
college if they wish.
Our impression is that college procedures relating to welfare generally work well, but
that, as with the information in college handbooks discussed above, arrangements are
variable and not always clearly articulated. It was reported that Junior Common Room
welfare representatives were not always aware of which college personnel were
responsible for welfare matters, and it appeared from some college handbooks that
provosts had delegated responsibility for welfare to another post, for example to a dean,
which was a voluntary position.
Procedures in case of emergency for provosts were believed to be generally unwritten,
although we recognised that most provosts have the necessary experience to deal
appropriately with emergencies. Emergency procedures for porters are written and clear.
College staff such as cleaners and porters, who have no formal welfare role, may well
encounter students with mental health difficulties; these categories of staff are informed
during their job induction programme that concerns about a student’s behaviour should
be reported to the staff member’s immediate supervisor or manager, who passes the
information via the college secretary or bursar to the provost. A similar reporting chain
operates for students in Fairfax House and other housing services properties, but in the
latter case it was less clear how effective was the mechanism for discovering need and
ensuring action was taken if necessary.
We noted that arrangements for training of college staff are currently the responsibility of
individual provosts, who themselves receive no training specific to their role. No formal
mechanism exists for monitoring the effectiveness of student welfare support in colleges.
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3.6.3 Student Counselling Service.
The scope of the support provided by the Counselling Service is described in the annual
report submitted to the Student Welfare Committee by the Senior Counsellor. The
primary role of the Counselling Service is to help students with personal and emotional
problems that are interfering with their life and work at the university. A significant
proportion of the problems students present with are associated with mental health
difficulties for which counselling as a talking therapy is an appropriate treatment choice10.
An important part of the Counselling Service’s work is also to help students gain access to
NHS mental health services where appropriate. Students make appointments with the
Counselling Service of their own volition, although they may be strongly encouraged to
do so by other people in the welfare network. Informal advice is provided on request for
academic supervisors and others who have responsibility for students with mental health
difficulties.
In cases of emergency, well-articulated procedures exist describing actions to be taken by
counsellors. The confidential basis on which counselling is undertaken, and the
circumstances in which confidentiality is limited are described clearly in a leaflet given to
students when they attend for their first appointment. Confidential records of
consultations are kept within the Counselling Service. The opinions of service users on
their experiences with the Counselling Service are sought occasionally by questionnaire.
The Counselling Service has been evaluating a monitoring system which could be used to
evaluate clinical outcomes more systematically than is possible at present, but currently
lacks resources of time to put the system in place.
The division of responsibilities between local NHS primary care and the Counselling
Service in providing support for students with mental health problems is not formally
defined. Communication with local agencies concerning individual students, which is
typically through the Senior Counsellor, works well. The service has general links with
groups concerned with mental health support in the York area, but there is scope, again
constrained by limited resources of time, for elaborating and extending these partnerships
and opportunities for information exchange.
Counsellors are supervised in their work by external practitioners, and records are
maintained of this supervision and other training. The Senior Counsellor is a member of a
Heads of Counselling Services discussion group, and of the Association for University and
College Counselling, the local section of which meets regularly.
3.6.4
Departments & Supervisors.
The general responsibilities of academic supervisors are laid down in a section of the
Academic and Related Staff Handbook (although that section is not yet available from the
university’s web service). It states that ‘...the supervisor is intended to be the person to
whom the student may turn for advice or help in relation to academic, developmental or
personal matters...’, and asks supervisors to inform the undergraduate office if there is
any sign that a student’s mental health is deteriorating. The limits of the supervisor’s
responsibilities in cases where a supervisee’s behaviour gives cause for concern are not
specified. In practice this will typically involve directing such students to the appropriate
Treatment Choice in Psychological Therapies and Counselling: Evidence Based Clinical Practice Guideline.
Department of Health, Feb 2001
10
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agencies within the university’s welfare network, and acting as an occasional monitor of
the student’s welfare.
The role of the supervisor in welfare matters was specifically addressed by the joint
working party on student supervision, which identified a need for better information and
training for supervisors, including refresher training for established staff. Supervisors
now receive current copies of the student support services handbook, in which a map of
the university welfare network is provided. A list of external agencies relevant to welfare
support is provided to departments for inclusion in the departmental supervisors’
handbook. All new junior academic staff attend an induction programme which includes
training on student welfare and the university’s student support network; academic staff
appointed at a higher level are encouraged (but not required) to attend this induction
programme.
Responsibility for maintaining records of supervisor training lies with departmental
training officers. The report of the joint working party on student supervision emphasised
the importance of keeping records of supervisory meetings within departments, however
the policy on confidentiality for such records, particularly in cases where students are
experiencing significant personal problems, has not been articulated. We noted that
departmental secretaries, who come into direct and often regular contact with students
and as a result can come to know individual students well, can be an important contact
point for students with mental health difficulties. As far as we are aware, no formal
mechanism exists for monitoring the effectiveness of the supervisory system in dealing
with cases of students with mental health difficulties.
3.6.5
University Health Centre.
The University Health Centre provides primary medical care for those members of the
university and their families who register with the practice. Students are required to
register with a local GP, and most choose to do so with one of the GPs at the Health
Centre. Information about the Health Centre is provided in a leaflet given to all new
students, and is to be provided via the university’s web service. In addition to a range of
other health-related services, the Health Centre run regular clinical psychology sessions.
The number of students presenting with disorders of mental health is not easily estimated.
Preliminary data provided by Dr. Lethem showed that in the previous six months 92
patients had been diagnosed with conditions that might loosely be described as mental
health disorders, and 160 patients had been prescribed anti-depressant medication. We
agreed that the collection and analysis of data on the incidence of mental health problems
and their change over time would be helpful in guiding strategy for mental health
support. We noted that the Health Centre was now logging episodes of deliberate self
harm and attempted suicide.
The label University Health Centre has led some students to the mistaken belief that
information held about them at the Health Centre may be passed to the university
without their consent. Effective links do exist between the Health Centre and other aspects
of the university welfare network; coordination of care for students with mental health
problems who are registered with the practice operates primarily at the level of personal
contact between individual GPs, the Academic Registrar and the Senior Counsellor, and is
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subject to the usual constraints of confidentiality. These arrangements may be less
effective for students not registered with the Health Centre practice.
Links with NHS agencies providing secondary and tertiary care are well developed and
effective. The Health Centre provides the primary channel of communication with the
community psychiatric nurse service. Patients would not often be referred to voluntary
sector services, but links with local voluntary agencies providing support for mental
health could be developed further. Information exchange with Health Centres in other
institutions is maintained through the British Association of Health Services in Higher
Education, of which Dr. Letham is currently the chairman.
3.6.6
Other agencies in the University welfare network.
The potential role of the University Disability Adviser in supporting individual students
with mental health difficulties has been referred to above. In our discussions we
acknowledged the contribution to mental health support of a number of other elements in
welfare network. These included the Students’ Union Education & Welfare Officer, the
Welfare Information Officer, college JCR welfare officers, the GSA and its welfare officers,
Nightline, and the Chaplains.
We also recognised that underpinning much of the coordination of the support network
for mental health, for both students and staff, are the services provided by the Registrar’s
department. The Academic Registrar is a channel for information about best practice
through her membership of the Association of Managers of Student Services in Higher
Education, and she and her staff in the graduate and undergraduate offices play a key role
in providing information and guidance about the practical interpretation of the
university’s ordinances and regulations, and about the university’s legal responsibilities.
3.6.7
Special cases: leave of absence and disciplinary procedures.
Procedures for students who need to apply for leave of absence on compassionate or
medical grounds are clearly articulated and well understood. Such applications
necessarily involve discussions between the student and his or her supervisor, as the
formal application to the special cases committee must be accompanied by supporting
comments from the student’s supervisor.
In cases where leave of absence is granted on medical or compassionate grounds, the
special cases committee would typically require evidence that the precipitating problem
was resolved before a programme of study could be resumed. We recognised that this
evidence may be difficult to obtain in cases where leave is granted on grounds of mental
ill health.
The number of students seeking leave of absence because of mental health difficulties and
the effectiveness of leave of absence as a means to ameliorate the circumstances of
students with mental health difficulties has not been monitored. Data collated specifically
for the group11 suggest that of the 71 applications for leave of absence in the period
October 2000 to March 2001, 31% mentioned mental health problems. Overall, only about
one third of all students granted leave of absence return to their programme of study.
11
See appendix 3
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We noted that the university was not in a position to force students to seek medical advice
or counselling, but we believe that the welfare network is typically able to address
problems, including problems arising from mental health difficulties, to the mutual
satisfaction of student and university. However, we recognised that in rare cases a student
may have behavioural problems that they do not recognise but which are of a magnitude
that leads to chronic adverse consequences for the student’s academic progress or for
others in the university community. In these circumstances it may be necessary as a last
resort to fall back on disciplinary procedures.
Disciplinary powers in the university are held by council and delegated to the ViceChancellor, provosts, heads of departments and the Registrar & Secretary. The Guidelines
raise the question of whether unusual behaviour by a student experiencing mental health
problems could lead to arbitrary and inappropriate application of the university’s
disciplinary procedures. The group agreed that procedures were in place — primarily by
means of the Disciplinary Advisory Committee — to minimise the risk of inappropriate
action being taken by those who discipline students.
3.6.8
Impact of academic assessment procedures.
The Guidelines raise the question of whether the university makes adequate efforts to
ensure that course assessment methods do not exacerbate mental health vulnerabilities
amongst the general student population. We noted that it would be difficult to envisage
assessment methods which were both effective and certain not to exacerbate mental health
vulnerabilities. In a few individual cases the particular health problem faced by a student
may prove to be inseparable either from academic study, for example when academic
study aggravated the condition, or from assessment, for example when a student was
unable to hand in work. However, we recognised that students with mental health
problems did successfully complete degree programmes.
One way in which the university attempts to meet the needs of its diverse student
population is through the use of a range of assessment techniques. Specific modifications
to assessment methods in individual cases were possible but were not generally needed,
and we believe Boards of Studies and Boards of Examiners would be properly resistant to
the idea that this should be common practice. However various specific practical
arrangements were routinely made to assist individual students, for example by allowing
an examination to be taken in isolation from other candidates.
We noted that as a result of modularisation, examination stress tended to occur at an early
stage in the programme, and students returning from leave of absence were often
required to sit examinations immediately on their return. The Counselling Service was in
a position to monitor serious difficulties arising from this kind of pressure, and has in the
past picked up on and discussed with the relevant department distinctive patterns of
difficulty with assessment methods. We believe that departments are generally sensitive
to these issues, and Boards of Studies have the power to modify assessments where
necessary.
3.6.9
Monitoring of policies and services.
Monitoring of the welfare network, including services relating to support of student
mental health is the responsibility of the Student Welfare Committee. Some specialist
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welfare services sought direct student feedback — for example the Counselling Service —
and others currently did not — for example welfare information and disability advice.
Valuable feedback on the effectiveness of welfare support is provided to the Student
Welfare Committee through the input of student representatives on the committee. The
Students’ Union has in the past undertaken surveys relating to welfare services. Subject
reviews carried out by the Quality Assurance Agency have given favourable evaluations
of the Student Support and Guidance aspect of the review. We acknowledged that there was
a difference between eliciting opinions on satisfaction with services and the monitoring of
their effectiveness. Regular appraisal of the welfare strategy by the Student Welfare
Committee provided for some monitoring. We were satisfied that feedback on services for
those with mental health problems was part of the monitoring process as it stands, but
acknowledged that this feedback might be obtained more reliably if welfare services as a
whole were monitored. There is no university-wide end-of-programme questionnaire for
graduating students, although some departments collect feedback from their students by
this means.
4.0
RECOMMENDATIONS.
4.1
Information.
4.1.1
Prospectuses.
The group felt that it was appropriate for the prospectuses not to focus in detail on
support for specific potentially problematic conditions — including mental ill-health —
that individual applicants might present with. However, we felt it was important that the
prospectus give clear guidance to potential applicants on how to obtain further
information about support for health issues relating to their particular circumstances.
We recommend that a statement should be included in the prospectus giving a contact
point for people seeking, for example, clarification of current practice in student support,
or detailed information about what support the university could offer for a specific
condition. The proposed statement12 should clarify the procedure by which potential
applicants with specific health problems or disabilities can make an informed choice about
whether the support available from the university and from local NHS services would be
likely to be adequate for their needs.
Personal contact between potential applicants and the university’s disability or medical
advisers is important because it would provide a focussed opportunity to discuss any
practical limitations on the support that could be made available for a specific condition. It
should also facilitate setting up special support arrangements in cases when an applicant
with a potential health problem becomes a registered student.
4.1.2
Departmental handbooks.
Although a comprehensive outline of the range of welfare services available to students is
provided in the student support services handbook, the group took the view that some
12
See appendix 4 for a proposed addition to the Student Support Services section of the prospectus.
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redundancy was desirable in the availability of welfare information for students. One way
we recommend to achieve this in a consistent and up-to-date form is to encourage all
departments to include a section on university-wide welfare support services in their
departmental handbooks, based on the centrally-provided core of information, which
could be elaborated at a department’s discretion.
4.1.3
College handbooks.
The group felt that similar but stronger arguments could be made for providing welfare
support information, including that relevant to mental health, in college handbooks.
College handbooks are currently variable in the amount and quality of welfare
information they contain, both about support services provided by the university, and
about the welfare structures within the colleges themselves.
We felt that it was important that college handbooks should provide clear and consistent
information about both these aspects of welfare support, and that the sense of the college
as a community with welfare responsibilities should be conveyed to both resident and
non-resident members of a college. This is consistent with the recommendations of the
joint working party on student supervision relating to the development of pastoral
support services in colleges.13 Accordingly, we recommend that a section entitled Welfare
should be included in all college handbooks, based on a core list of points14, and
elaborated by individual colleges as required.
4.1.4
Academic staff & supervisors’ handbooks.
The operation of the supervisory system has had recent close scrutiny by the joint
working party on student supervision, and we endorse the recommendations outlined in
its report15. Our discussions gave rise to some additional recommendations that we
believe could enhance the support supervisors provide for students with mental health
difficulties.
We recommend that the section of the academic staff handbook that defines the role of the
supervisor should be more specific than it is at present, for example about the limits of the
supervisors’ responsibilities, about how supervisors should use other elements of the
university’s welfare network, and about what records supervisors should keep about their
interactions with supervisees.16
Greater specificity in the academic staff handbook should be accompanied by an
elaboration of specific guidance available for academic staff and others about approaches
to helping students with mental health difficulties. We recommend that the Student
Welfare Committee should seek resources to make possible the creation of a Guide to
13
http://www.york.ac.uk/admin/aso/docs.yrk/stusupervision_report2001.htm
See appendix 5 for an outline of the proposed core content of the Welfare section to be included in college
handbooks
14
15
http://www.york.ac.uk/admin/aso/docs.yrk/stusupervision_report2001.htm#10%20Recommendations
We noted that recommendation 10.11 of the joint working party on student supervision refers to a
Guidebook on Supervision, copies of which were to be made available to departments. This was to have been a
private initiative of the Senior Counsellor, which has not yet been realised.
16
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helping students with mental health difficulties, for which a useful model might be the guide
produced for personal tutors and other staff at the University of Leicester17.
4.1.5
Disability statement and information about health care.
The group recognised that the disability statement was intended to be a general statement
about the availability of support services for students with disabilities, and does not go
into detail about provision for individual disabilities. However, we felt that it might be
helpful if the statement did refer specifically to mental health, as it may not always be
understood that a diagnosis of mental ill health can qualify as a disability. We support
continued development of the information about disability support provided on the
university’s web service, and welcome the opportunities for raising awareness of support
for mental health afforded by the forthcoming University Health Centre web pages.
4.1.6
International students.
We recommend that the section on health care in the booklet giving general information
for international students should be extended to include a reference to the student support
services handbook, and some brief details about the availability and purpose of the
Counselling Service.
We recognised that the particular pressures on international students could tend to
increase their susceptibility to mental ill health, and felt that it might be helpful to monitor
the incidence of mental health difficulties amongst international students so that the
magnitude of this potential problem could be assessed. However, the benefits of this
monitoring exercise would probably be outweighed by the practical difficulties of
identifying students in this category and the resource implications of effective acquisition
of the relevant data.
4.2
Confidentiality and Record-keeping.
4.2.1
Confidentiality policy.
We noted that many elements in the welfare support network have clear and clearly
understood policies concerning confidentiality and disclosure of information about
individual students. However, there are aspects of the welfare network where
confidentiality and disclosure policies are not clearly articulated, for example in relation to
records held in departments and by supervisors. We are not aware of any problems that
may have arisen as a result of this, but we believe it would be desirable for explicit
guidance on record-keeping and confidentiality to be formulated for everyone who has
dealings in any context with students or with keeping records about them, and
particularly so in cases of students with specific problems such as mental health
difficulties. This guidance, once formulated, should be conveyed to staff and students so
that both have a clear understanding of the confidentiality of records and its limits in
Helping Students in Difficulty: a guide for personal tutors and other staff. University of Leicester Educational
Development and Support Centre (Author: Annie Grant). See appendix 6 for illustrative extracts from this
guide. A similar guide – Guidelines on Supporting Students Experiencing Mental Health Difficulties – has been
produced by Student Services at the Manchester Metropolitan University.
17
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specific circumstances. The Data Protection Act (1998) provides a means for students to
gain access to records held about them by the university or by departments, but we regard
this as a last resort which, if used, would indicate that the university’s internal procedures
were not working optimally.
4.2.2
Records of staff training.
Records of training are not held centrally; for example training records are maintained by
the Staff Development Office for administrative staff within the Registrar’s department,
and by individual training officers for staff in the Directorate of Facilities Management,
the finance department and in academic departments. Thus while we believe the general
level of record-keeping concerning staff training is appropriate, the disparate nature of the
records limits their use as a means to monitor the provision of training and its
effectiveness and currency for the institution as a whole. As a result, it is difficult to assess
the university’s overall success in meeting the training demands of a particular issue.
Specifically for our current purposes, in the absence of a central record of training carried
out in the university, we found it difficult to assess whether the full range of opportunities
was being exploited to raise awareness of student mental health issues. We recommend
that staff committee, where necessary in liaison with others involved in training within
the university, should consider ways in which a centrally-held record of training
undertaken by all university members could be established and maintained.
4.3
Training & Support.
4.3.1
Cleaners and porters.
We welcomed a constructive response from the Director of Facilities Management
concerning awareness of student mental health issues for cleaners and porters. We
recognised that it is not realistic or appropriate for cleaners and porters to have a formal
welfare role, defined in their job description. However, we believe that in their day-to-day
contact with students they are likely occasionally to have an informal welfare role, at least
to the extent that they may be among the first to become aware of behaviour that is
consistently unusual, and the notification of this given to their supervisors or managers
may be the first contact point with the welfare network for students with mental health
difficulties. We recommend that the training programmes for portering and cleaning staff
should be developed to raise awareness of how mental health problems might present
and what action to take when such problems become evident, and to raise the general
awareness of student mental health issues.
4.3.2
Academic supervisors.
We support the statements and recommendation in the joint working party on student
supervision concerned with refresher training for academic staff in support of their role as
supervisors. We noted that established academic staff will be strongly encouraged to
attend refresher training sessions on student welfare, including supervision of
undergraduates, but they are not obliged to do so. We believe that training of academic
staff would be found wanting if, as could happen if refresher training is not taken up,
even experienced supervisors found themselves acting as a potential first contact point in
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the welfare structure without having received any recent training updates on
arrangements for welfare support within the university.
4.3.3
Secretaries, receptionists and Students’ Union officers.
We noted that Students’ Union officers may have training needs that could usefully be
met by existing training opportunities within the university, and recommend that this
possibility is explored by the Staff Development Office. We also noted two categories of
staff — secretaries and receptionists — who often had direct contact with students and
sometimes formed close relationships with them, but who we believe may have restricted
opportunities for training involving student mental health issues. We do not propose a
formal welfare role for people in these front-line positions, but recommend that
departments should be encouraged to recognise the informal welfare role they sometimes
fulfil, and that the university should provide training opportunities to raise awareness of
mental health issues for them, and in doing so recognise that such training may be
appropriate for a wider range of staff than has hitherto typically been assumed.
4.3.4
Provosts.
Individual provosts are currently responsible for training and welfare teams within
colleges, and welfare-related training was reported to be uneven across colleges. There is
no specific training for provosts themselves. We recommend that provosts should explore
ways to raise their awareness of mental health issues, for which the case scenarios approach
taken in training at the University of Leicester might prove useful, and could be mounted
by the Staff Development Office.
4.3.5
Support for staff in the welfare network.
It was noted that providing welfare support can put considerable personal pressure on the
individuals involved, and that support for some categories of staff involved in the welfare
networks (for example academic supervisors) was inconsistent. Informal arrangements
exist whereby staff who encounter students with mental health difficulties and feel the
need for specific advice can seek confidential guidance from the Student Counselling
Service. We recommend that academic supervisors should be made aware of this potential
source of informal support, but also that the Senior Counsellor should monitor the level of
support requested, in case providing it has resource implications for the Counselling
Service.
We also believe that there will be occasions when the work of key elements in the welfare
network — the student counsellors, Disability Adviser and Academic Registrar — will be
strengthened by access to professional external consultation services. For example,
student counsellors may benefit from specific advice on management of students’ mental
health problems from a consultant psychiatrist. We recommend that resources should be
available for this when the need arises.
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4.4 Monitoring the demand for and effectiveness of mental health
support.
4.4.1 Leave of absence.
In section 3.6.7 above we noted that the number of students taking leave of absence on
grounds of mental ill-health has not been monitored systematically. The small sample of
data summarised in appendix 3 suggests that approximately one third of all leave of
absence applications may be motivated by mental health difficulties. We recommend that
records be maintained of data relating to applications for leave of absence on grounds of
mental ill-health. We believe it will be relevant to the university’s strategic support for
student mental health to monitor, for applicants seeking leave of absence on grounds of
mental ill-health, the variation over time of, at least, what proportion they constitute of all
applications, what proportion of those return from leave, and what proportion of those
returning from leave complete their programme of study.
4.4.2 Counselling Service.
The Counselling Service is not currently collecting data specifically related to mental
health difficulties. Relevant information on the incidence of mental ill-health could be
drawn from the case categories, on which data are held. The Counselling Service is
considering introducing a more formal monitoring system — CORE (Clinical Outcome
Routine Evaluation) — which, once established, would provide a basis for assessing the
effectiveness of service provision, at a relatively low cost. However, the system is not
likely to be effective in practice unless it is introduced carefully, and counsellors given
appropriate training in its use. We recommend that the Student Welfare Committee
should make resources available for this, so that in due course the committee can receive
the additional information that use of CORE would provide, as part of the annual report
of the Counselling Service.
The data summarised in appendix 2 show clear evidence of rising demand for the
Counselling Service. We believe the Counselling Service plays an important role in
university life, and that its continued development should be a high priority in
augmenting support for student mental health. We recognised that a key function of the
Counselling Service in supporting those with mental health difficulties is to complement
NHS services supporting mental health, by providing an easily-accessible service which is
particularly suited to the needs of students. We recommend that resources for the Student
Counselling Service continue to be reviewed on a regular basis, not simply to keep pace
with demand, but to develop the service as a cost-effective means to support mental
health and help students to derive the most from their experience at university.
4.4.3 Student perception of mental health support.
There is currently no formal monitoring of the effectiveness of and satisfaction with
policies and services relating to mental health. We considered whether this could usefully
be achieved in part using an end-of-programme questionnaire given each year to all new
graduates, but decided that whilst it would be useful to receive feedback, there might be
difficulty in obtaining feedback that was not so general as to be unhelpful. Moreover,
obtaining a measure of the level of mental ill health within the university would not
necessarily reveal whether services were effective unless accurate measures of clinical
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10 December 2001
success were used. We recognised that adoption of such methods would have significant
resource implications. We concluded that although the information derived from
additional monitoring of mental health support services would be useful, it did not
provide sufficient motivation for the creation of a formal structure for obtaining student
views, for example by means of an end-of-programme questionnaire. However, we
agreed that questions relating to mental health support services ought to form part of such
a questionnaire should one be used in the future.
4.4.4
Colleges.
The group agreed that it would be useful to have information on the kinds of welfare
problems being dealt with in colleges. We recommend that a pilot study be carried out
within Goodricke and Halifax colleges, consisting of maintaining a daily log of welfare
cases. We suggest that this could form the basis of a report on the nature of welfare needs
within colleges and how they were dealt with, to be presented to the college council for a
response. If the pilot study proved successful a summary of such data provided by college
provosts could be reported to the Student Welfare Committee on a regular basis. We
believe this could be an effective means to monitor the incidence of particular kinds of
mental health difficulties and any change in their prevalence over time, at least for
students resident in college.
4.5
Coordination of mental health support.
4.5.1
Emergency procedures.
We recognised that it is not feasible to have written emergency procedures that cover all
eventualities — most emergencies have unique features — but the procedures need to be
sufficiently well understood that staff and students can have confidence that a call to any
part of the welfare support network would have the desired effect. We believe that
written procedures will be particularly important in passing on experience to new staff,
and when key staff were absent.
Our impression was that although emergency procedures were generally effective, there
were aspects of them that could be made more explicit specifically in relation to student
mental health. We believe it would be desirable to have a written procedure for action to
be taken in the event a student’s behaviour was such that he or she might need to be
‘sectioned’ under the terms of the Mental Health Act. We also believe that the
confidentiality policy should give guidance on how to proceed in a case when, in an
emergency, contact with a student’s designated emergency contact person is indicated by
the circumstances, but the student declines to give permission for the emergency contact
to be used.
We noted that emergency procedures for provosts were largely unwritten, and
accordingly recommend that written emergency procedures should form part of either a
job description or handbook for provosts. We expect that this will be a matter addressed
by the working party on welfare and security in colleges.
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4.5.2
Coordination of mental health support and links with external agencies.
We considered whether it would be beneficial to have a single named individual within
the university who could act as a coordinator for welfare support, and provide a central
point of communication with local mental health services. This could be achieved by
establishing a part-time service co-ordinator post within the Counselling Service. We
noted that these roles are currently filled variously by the Academic Registrar, individuals
within the University Health Centre and the Counselling Service, academic supervisors,
provosts, and the Welfare Information Officer. We took the view that the current primary
issue was that of providing direct support to individual students and that a very strong
case would need to be made for diverting welfare resources from that primary goal into a
co-ordinator post which would overlap with several elements within the existing welfare
network. We believe that the individuals who are likely to be the first point of contact in
the welfare network as it stands are sufficiently well-informed to make appropriate
referrals, and concluded that the case for a welfare coordinator was not strong enough to
merit a recommendation that funds be sought for the post.
However, we acknowledged that such a post might be needed in the future, given the
growing need to co-ordinate the network of support services (including external agencies)
in certain individual cases, a task which currently fell to the Academic Registrar. We
noted the Senior Counsellor’s suggestion that it will be useful to monitor the proposal to
appoint NHS primary care link workers who would undertake a similar role but within
the community. Link workers would be able to take referrals from the university but
would not be dedicated to the Health Centre practice or to the university. Clients would
not be able to refer themselves. This service might work well in terms of channelling
clients to services in the community but less well for receipt of information from the
community.
4.5.3
Post-incident debriefing.
We noted that no formal procedure exists for calling de-briefing meetings following more
difficult student welfare cases where a number of members of the welfare network had
been involved. We recommend that a procedure for debriefing and informing those
involved would be desirable as an effective means to learn from experience. As with case
conferences, it would be the responsibility of the Academic Registrar to judge the need for
de-briefing meetings.
5.0
CONCLUSIONS.
Having reflected on the university’s current policies and procedures concerning support
for student mental health, we found them broadly consistent with the Guidelines.
The general impressions formed by the working party were that:

The university was providing effective support for student mental health, although
the support may not always be optimally coordinated.

The effectiveness of some of the university’s practices may rest too heavily on
particular individuals, but the support network normally worked well.
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10 December 2001

The university provides staff development relevant to support of student mental
health, but there is scope in certain areas for further raising of awareness of student
mental health issues.

Given the concentration of young people under pressure in the student population,
a well co-ordinated and developing Counselling Service was an essential
complement to NHS provision.
The membership of the working party included the key figures in the university’s welfare
and training network relevant to mental health support. We found the experience of
reflecting on the university’s policies and procedures a useful one, with value for those in
the welfare network beyond simply satisfying our terms of reference. We therefore
recommend the establishment of an informal standing Mental Health Group, to be
convened periodically by the Senior Counsellor, and consisting of people with
responsibility for and expertise in mental health, which would carry forward the work of
the working party, and monitor provision for mental health at the university. The
membership of the group should include a representative from the Health Centre, the
Advisor for Disability, the Welfare Information Officer, the administrative assistant in
Student Support Services, and, in due course, a representative from the medical school.
Finally, we believe that it will always be in the university’s interest to maintain a
commitment to promotion of health, including mental health, and its actions should be
consistent with maintaining the health of all the people who work in its community.
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10 December 2001
6.0
SUMMARY OF RECOMMENDATIONS.
[References to the relevant section in this report are given in brackets.]
6.1
There should be a statement in the prospectus giving a contact point for people
seeking information relating to a specific condition of mental ill health. [Section 4.1.1]
Action: Director of Admissions
6.2
There should be a section on university-wide welfare support services in
departmental handbooks. [Section 4.1.2]
Action: Student Welfare Committee to produce core text for departments
6.3
There should be a section entitled Welfare in all college handbooks. [Section 4.1.3]
Action: Student Welfare Committee to produce core text / provosts
6.4
The section in the academic staff handbook that defines the role of the supervisor
should be elaborated. [Section 4.1.4]
Action: Staff Committee
6.5
The Student Welfare Committee should seek resources to make possible the creation
of a Guide to helping students with mental health difficulties. [Section 4.1.4]
Action: Student Welfare Committee
6.6
The disability statement should make explicit reference to mental ill health. [Section
4.1.5]
Action: Disability Adviser
6.7
The section on health care in the booklet giving general information for international
students should be extended. [Section 4.1.6]
Action: Director of the International Office
6.8
Not approved
6.9
There should be an explicit policy on confidentiality, including guidance on recordkeeping. [Section 4.2.1]
Action: Academic Registrar
6.10 A centrally-held record of training undertaken by all university members should be
established and maintained. [Section 4.2.2]
Action: Staff Committee
6.11 Training programmes for porters and cleaning staff should be developed to raise the
general awareness of student mental health issues. [Section 4.3.1]
Action: Training Officer in Directorate of Facilities Management
6.12 The Staff Development Office should explore training opportunities for Students’
Union officers. [Section 4.3.3]
Action: Staff Development Office
6.13 Training opportunities should be provided to raise the general awareness of student
mental health issues for secretarial and reception staff. [Section 4.3.3]
Action: Staff Development Office
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10 December 2001
6.14 Established academic staff should receive refresher training in support of their role
as supervisors. [Section 4.3.2]
Action: Staff Development Office
6.15 The Staff Development Office should explore with provosts ways to raise their
awareness of mental health issues. [Section 4.3.4]
Action: Staff Development Office, Provosts
6.16 The Senior Counsellor should monitor any resource implications of fulfilling
requests from academic supervisors for informal advice. [Section 4.3.5]
Action: Senior Counsellor
6.17 Resources should be made available where necessary to provide access to external
consultation services for senior staff in the welfare network. [Section 4.3.5]
Action: Student Welfare Committee
6.18 Records should be maintained of data relating to applications for leave of absence on
grounds of mental ill heath. [Section 4.4.1]
Action: Secretary to Special Cases Committee
6.19 Resources should be made available for the Student Counselling Service to adopt a
procedure for recording clinical outcomes. [Section 4.4.2]
Action: Student Welfare Committee
6.20 Resources for the Student Counselling Service should continue to be reviewed on a
regular basis. [Section 4.4.2]
Action: Student Welfare Committee
6.21 A pilot study involving a daily log of welfare cases should be carried out within
Goodricke and Halifax Colleges. [Section 4.4.4]
Action: Provosts of Goodricke and Halifax colleges
6.22 Written emergency procedures should form part of either a job description or
handbook for provosts. [Section 4.5.1]
Action: Provosts
6.23 De-briefing meetings should be arranged following more difficult student welfare
cases. [Section 4.5.3]
Action: Academic Registrar
6.24 An informal Mental Health Group, consisting of people within the University with
responsibility for and expertise in mental health, should be established to monitor
support for student mental health. [Section 5]
Action: Senior Counsellor
Report of working party on support for student mental health
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10 December 2001
7.0
APPENDICES.
7.1 Appendix 1: Extracts from Guidelines on student mental health
policies and procedures for higher education.
Questions for the Welfare Coordination Committee working party.
nb.
text in italics is taken (more or less) directly from the guidelines
numbers in brackets refer to paragraph numbers in the guidelines
Key issues

Do we have proper awareness of relevant legal and duty of care issues?

Do we provide adequate access to support and guidance services?

Do we provide suitable training and development opportunities?

Is there effective liaison between internal and external agencies?
Duty of care (Guidelines pp. 12—15)

Do we have adequate enrolment conditions that clarify the extent of the university’s duties in meeting
mental health support needs? [3.3]

Are the claims we make in our documentation about support facilities accurate and precise, and do they
give a realistic impression of student life? [3.3]

Do we ensure that members of staff whose work may bring them into close contact with students (such as
tutors and college and student support personnel) receive appropriate training to carry out their duties
with reasonable care? [3.7]

Are all staff clear as to when matters should be referred on to specialist services or agencies, whether these are
within or outside the institution? [3.7]

Do we have clear procedures which assign specific responsibilities for ensuring that students are
appropriately supported and referred? [3.8]

Do we keep accurate records of all actions taken (for example training of staff, development of protocols for
referral, details of intervention in particular cases etc.)? [3.9]

Do we have adequate awareness of the legal responsibilities imposed by the following: The Health
and Safety at Work Act (1974), The Occupier’s Liability Act (1957), The Sex Discrimination Act (1975), The
Race Relations Act (1976), The Disability Discrimination Act (1995 et seq.), The Human Rights Act (1998),
The Data Protection Act (1998)? [3.11—3.14]

Are we careful to ensure that our disciplinary procedures are not arbitrarily invoked to take
inappropriate action against students with mental health difficulties? [3.16]

Do we have specific procedures which enable or encourage students to suspend studies if it is clear their
mental health difficulties are affecting their ability to take full advantage of educational opportunities? [3.16]

Do we have effective procedures for responding to students who are reluctant or resistant to acknowledging
that they have mental health difficulties? [3.17]
Report of working party on support for student mental health
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10 December 2001
Institutional policies and practices (Guidelines pp 16—18)
Disability statement

Does the institution's disability statement and other related policy statements indicate clearly the availability
of support structures and systems (and the limitations of these) provided for students with mental health
difficulties? [4.2]
Admissions procedures

Are potential students provided with sufficient information at the pre-application stage to enable them to make
an informed choice? (It should be acknowledged that whilst students are not always going to declare a
disability on the UCAS form, an increasing number are doing so.) [4.3]

Are admissions procedures sufficiently focused to ensure that applicants with specific mental health support
needs are given the opportunity to discuss these in some detail prior to admission? [4.4]

Are there appropriate mechanisms in place to ensure that support/resource implications are fully assessed and
can be met? [4.5]

Where appropriate, has consideration been given to risk assessment in order to inform the admissions process
and subsequent action? [4.6]

Do admissions procedures enable the institution to satisfy specific criteria for programmes leading to entry to
relevant professional bodies and their associated statutory regulatory frameworks (for example, in the areas of
social work, medicine and allied professions, nursing, teaching etc.)? [4.7]

Are admissions procedures, involving specific criteria for entry to professional bodies, clear in stating that the
impact of any mental health problems on each individual student must be the key factor? [4.8]
Confidentiality / disclosure policies

Are policies on confidentiality and disclosure of information articulated clearly to students and staff,
including limitations on confidentiality in particular circumstances (for example, follow-up after a suicide
attempt)? [4.9]

Are students made sufficiently aware that in appropriate instances confidentiality is maintained in order to
assist individuals with problems in coming forward (noting that different levels of confidentiality can be
maintained across the institution)? [4.10]

What policies are in place to ensure that sensitive information about individuals with mental health support
needs is disclosed in an appropriate and responsible manner to individuals within the institution? [4.11]

Are there protocols surrounding the use of emergency contact/ next of kin details and are these transparent?
[4.12]
Emergency procedures

Does the institution have clear procedures/protocols to define the respective roles of, and communication links
between, relevant staff in cases where students show signs of emerging crisis? [4.13]

Do these procedures facilitate prompt and effective support for ‘at risk' students from institutional services,
external health services and other professional agencies? [4.14]
Procedures for suspension of/withdrawal from studies

Are mechanisms in place to support students with severe psychiatric illnesses to temporarily suspend (or in
some cases to completely withdraw from) studies? [4.15]

Are these procedures separated, as appropriate, from academic and disciplinary regulations? [4.16]

Are they appropriately sensitive to the needs of students who may require some encouragement to consider
these options? [4.17]
Report of working party on support for student mental health
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10 December 2001
Course assessment policies and practice

Is adequate effort made to ensure that course assessment methods do not exacerbate mental health
vulnerabilities amongst the general student population? [4.18]

Is due consideration given to adapting assessment requirements for students with identified mental health
difficulties to ensure that they are not unduly disadvantaged? [4.19]
Support and guidance structures. (Guidelines pp. 20—22)

Do we have a commitment to provide mental health support where necessary through appropriate support
services in a discrete and non-judgemental setting? [5.1]

Is the availability of such support communicated widely across the student and staff body? [5.1]

Do we provide clear routes of access to services for those students who decide to seek advice and help for
themselves or for others? [5.2]

Do we have clear and appropriate procedures for handling crisis situations, and do the procedures
provide consistent and sensitive support for students and staff involved during crisis situations? [5.4]

When students withdraw from study programmes as a result of mental health difficulties do we make every
effort to ensure they are able to resume their studies when it is appropriate to do so? [5.5]

Do we have effective coordination between all relevant support services? [5.6]

Is student feedback a key element of the process for monitoring of policies and services?[5.6]

Do we have adequate information about external agencies which can provide support to individuals and
their friends and families? [5.7]

Have we developed effective partnerships with external agencies? [5.8]

How do we communicate with local mental health agencies? [5.9]

Are we deriving proper benefit from the expertise of sector-wide groups (eg. AMOSSHE, AUCC,
BAHSHE)? [5.10]

Do we liase effectively with other local educational institutions? [5.10]
Development and training (Guidelines pp. 24—25)

Do we provide comprehensive information on sources of support for individuals experiencing problems and
for those who might come into contact with such individuals? [6.1]

Do we consult the target audience on the content, format and design of information and training materials?
[6.3]

Do we have a comprehensive directory of the range of internal and external support services available? [6.5]

Do we have training sessions or seminars on the following?
The stigma associated with mental health difficulties.
The emotional effects on people involved.
Professional and personal relationships with individuals who have mental health difficulties.
The range of support services and referral points available (internal and external).
Relevant institutional procedures and guidelines.
Liaison with local agencies (including voluntary bodies and user groups. [6.6]

Do we have specific and detailed training for those who are likely to provide support for individuals
presenting problems? [6.7]

Does this training focus on the different types of staff and the appropriate boundaries regarding their
responsibilities for student welfare? [6.7]

Do we have appropriate training to address the needs of particular groups within the student body,
including international students and non-traditional students? [6.8]
Report of working party on support for student mental health
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10 December 2001

Is training relating to mental health issues embedded in mainstream staff development programmes, including
those for new staff? [6.10]
Recommendations (Guidelines p. 26)

Have the guidelines been given very wide circulation within the University? [7.1]

Do we give priority to incorporating within our annual programme appropriate staff development sessions as
a means of promoting positive attitudes to mental health? [7.3]

Have we circulated the guidelines to our partner institutions and given consideration to the provision of
joint information and training events? [7.4]
Report of working party on support for student mental health
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10 December 2001
7.2 Appendix 2: Demand for University of York Counselling Service,
1997 - 2001.
7.2.1
Number of requests for appointments.
Number of requests for University of York Counselling
Service appointments 1997-2001
450
number of requests
400
By end of Autumn Term
By end of Spring Term
Total
350
300
250
200
150
100
50
0
1997-1998
7.2.2
1998-1999
1999-2000
2000-2001
Number of people on the waiting list for appointments.
Number of people on the waiting list for University of York
Counselling Service appointments
45
number of people
40
35
30
25
20
15
10
5
0
Autumn
Term
Spring
Term
Summer Autumn
Term
Term
1999-2000
Spring
Term
Summer
Term
Week
1
2
3
4
5
6
7
8
9
10
2000-2001
list closed
Report of working party on support for student mental health
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10 December 2001
7.2.3
Requests for appointments as a percentage of total FTEs.
Requests for University of York Counselling Service
appointments 1997-2001 as %age of total FTEs
By end of Autumn Term
requests as % of total FTEs
6
By end of Spring Term
Total
5
4
3
2
1
0
1997-1998
7.2.4
1998-1999
1999-2000
2000-2001
People on the waiting list for appointments as a percentage of total FTEs.
People on waiting list for University of York Counselling
Service appointments as %age of total FTEs
0.6
percentage
0.5
0.4
0.3
0.2
0.1
0
Autumn
Term
Spring
Term
Summer
Term
Autumn
Term
1999-2000
Spring
Term
Summer
Term
Week
1
2
3
4
5
6
7
8
9
10
2000-2001
list closed
Report of working party on support for student mental health
30
10 December 2001
7.2.5
Mean number of consultations per client.
University of York Counselling Service: mean number
of consultations per client 1997-2001
mean number of
consulations/client
6
5
4
3
2
1
0
1997-1998
7.2.6
1998-1999
1999-2000
2000-2001
Comparison of number of requests for appointments and number of clients seen.
University of York Counselling Service: comparison
of number of requests for appointments and number
of clients seen 1997-2001
450
400
Number of requests for
appointments
Number of clients seen
350
300
250
200
1997-1998
1998-1999
Report of working party on support for student mental health
1999-2000
31
2000-2001
10 December 2001
7.3 Appendix 3: Analysis of leave of absence cases from 1 October 2000
to 16 March 2001
Number of Cases
71
Compassionate
13
Medical
33
Motivational
7
Examination Failure
1
Personal
7
Course Transfer
5
Other
5
Of the 33 medical cases, 16 stated mental health problems, in three cases the reason was
unknown and in some cases eg 2 cases of ME it was unclear.
Of the 13 compassionate cases, 6 stated mental health problems.
Of the 16 medical cases stating mental health problems, 4 were first years, 7 were second
years and 5 were third years.
Of the 6 compassionate cases stating mental health problems, 1 was first year, 1 second
and four were third year.
Cases involving mental ill health comprised 31% of cases.
Wendy Shaw
Registrar’s Department
19 March 2001
Report of working party on support for student mental health
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12 February 2016
7.4 Appendix 4: Proposed addition to section on disability advice in the
prospectuses.
The University is committed to responding to the additional support requirements of
students with disabilities. These may relate to disabilities such as sensory or physical
impairment, medical or health conditions or a specific learning disability such as dyslexia.
Advice and information is available from the Disability Adviser. Information on local NHS
services can be obtained by contacting the University Medical Adviser. Include contact details
7.5 Appendix 5: Suggested points to be included in each College
Handbook.
There should be a section entitled Welfare, which should include the following
information.
Reference to:

the College Provost and other staff (to include the College Secretary) with a welfare
brief, to include their contact details*

the SU and JCR Welfare Officers with contact details, and the JCR Welfare Information
Notice Board*

the Student Support Services Handbook

the Counselling Service, the Health Centre, the Welfare Information Officer and the
Chaplains

out-of-hours support eg Nightline, Porters

the departmental supervisory system

concern for other students and their welfare
* to be modified according to the arrangements in individual colleges
Report of working party on support for student mental health
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12 February 2016
7.6 Appendix 6: Illustrative material from Helping Students in Difficulty.
by Annie Grant, University of Leicester (1999).
See also Identifying and Responding to Students in Difficulty by Myra Woolfson, University
of Nottingham.
Reproduced with permission.
Figure 1: How do you know there is a problem?
Report of working party on support for student mental health
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12 February 2016
Figure 3: How should you respond?
Report of working party on support for student mental health
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12 February 2016