Opinion Piece: Student Minds contributes to the conversation about mental wellbeing measures

By Rachel Piper 
​Student Minds’ Policy Manager responds to some of the arguments set out in HEPI’s recent  paper contributing some of our understanding from what we have learnt from the sector, on the issue and implications of measuring student mental health and wellbeing.

HEPI’s Policy Note ‘Measuring well-being in higher education’ makes a case for increasing the consistency and coverage of measuring mental well-being in HE. It argues that we must clearly distinguish between ‘mental health’ and ‘mental wellbeing’ in order to both understand and respond to concerns in HEIs. The paper states that the conflation of the two terms has led to an “inaccurate funding” of student support services, specifically focusing on a reduction of counselling services. It concludes that further measurement into wellbeing will help us better understand the wellbeing of our university communities, and subsequently address gaps in provision.

At Student Minds we welcome discussion about effective approaches to create healthy university communities. Whilst we appreciate the value of measuring wellbeing focussed on here, we would like to acknowledge areas raised in this article which may benefit from deeper study and caution - through looking to wider developments such as the role of The Student Mental Health Research Network (SMARTEN), which is looking into the complexities of measuring student’s mental health and wellbeing. 

In this opinion piece, I focus on 4 key areas:

• Why might we say ‘Mental Health and Wellbeing’? - Understanding the use of models
• Why does advocating for counselling alone miss the bigger picture? - The necessity for a whole university approach & wide range of provision
• Why do we need to exercise caution in using mental wellbeing measures as a metric? - The power of encouraging excellent practice
• How can a university understand the mental wellbeing of its community? - The tools at our disposal

Why might we say ‘Mental Health and Wellbeing’? - Understanding the use of models

The HEPI paper recommends that “We should be consistent in our terminology and clearly distinguish between mental health and personal well-being.” and argues that the conflation of mental health and well-being is not helpful for tackling either low levels of well-being or supporting those suffering mental ill-health.

• At Student Minds, we recognise in this discussion that we must remember the importance of context, and meet each student according to their own needs regardless of the language they use - All models of mental health and/or wellbeing are contextual and limited.  Definitions of mental health and wellbeing, such as  in our Transitions guide, are important guideposts to informing our understanding of how to meet students’ needs. Equally, studies have shown that different students and staff may use varied language in varied contexts to navigate their experiences,. Meeting a student where they are at, and initially understanding their experience of distress on their terms, is empowering in terms of management, treatment and recovery.
• People have mental wellbeing and mental health at the same time, they are related - Wellbeing support and health promotion programming should not “replace” services for those with mental health conditions. In fact, they work well in tandem, and one can’t exist without the other.  Appropriate wellbeing support can help to prevent more severe mental health difficulties and reduce the numbers of students needing to access one to one mental health support both at the university and at the NHS. It is also worth noting that “Wellbeing” teams in universities are often made up of qualified mental health professionals. We believe that anyone who is involved in mental health staff roles should be a qualified professional, an example of this is recent reform to the provision of disability advisors to ensure that they are professionally trained. 
• We agree that increased mental health literacy is important - it can enable staff and students to signpost to, and access, appropriate support for their needs. It is essential that any mental health training is tailored to the role of those attending, and is supplemented by sufficient resource in Student Support Services, in order for signposting to be effective and informal support to be a safe part of the picture. (See our research on the Role of Academic Tutors) 

Why does advocating for counselling alone miss the bigger picture? - The necessity for a whole university approach & wide range of provision

The HEPI paper near exclusively focuses on the role of counselling, and expresses a concern that counselling services are reducing in capacity due to the conflation of terminology and a lack of data. 

• We need to protect funding for a range of effective and good quality provision - We share the concerns about the Review of Post-18 Education and Funding reducing funding for mental health and wellbeing services, but are more broadly also concerned about the protection of funding for whole university approaches that we are beginning to see in light of Step Change. 
• Consider both a whole university approach & a tailored response - When making decisions about how to fund and distribute university support services, HEIs can benefit from first, taking a whole university approach that considers a. How to support the health of all university students, b. How to support those who are exposed to greater risk factors such as those who are experiencing early signs of distress, or specific groups that are more vulnerable such as LGBTQ+ students and c. how to support those with greater support needs and those in crisis.
• Understand that a range of support is needed - The focus in the HEPI paper on the concern regarding the reduction of counselling services is too narrow, as students should be able to access support for mental health difficulties, from a range of practitioners and sources.  This is because we know that counselling, as with any form of support or treatment, whilst effective for some, is not 100% effective or appropriate for all.  Furthermore, “Counselling” is often used by students as shorthand to mean any services for mental health, but in fact, most universities offer a range of different services (such as Cognitive Behavioural Therapists, Mental Health Advisors, Mental health nurses and Counsellors) to meet a range of varied needs - all of these need resourcing. 

Why do we need to exercise caution in using mental well being measures as a metric? - The power of encouraging excellent practice

The HEPI paper suggests that the collection of wellbeing data will enable universities to compare one another, potentially through both metrics and regulatory frameworks. Whilst we would support the need for collection of data on a national level through surveying the student and staff body,  in order to understand what the sector needs, we would advise caution about using mental wellbeing data as a metric, or a proxy for measuring the standard of a university: 

• Remember that every university is different - Using a single wellbeing measure, or even a vast set of wellbeing measures can be rendered redundant, and will have bad outcomes, if it is does not take into account contextual factors. Each university must take into account its own unique setting and university community demographics (such as populations that may have greater exposure to risk factors)  to design a strategic whole university approach. 
• Recognise and reward excellent practice - The University Mental Health Charter will recognise and reward excellent practice in student mental health and wellbeing. It will acknowledge the complexity of this issue and work with the sector to co-produce a nuanced response to the issue.  

How can a university understand the mental wellbeing of its community? - The tools at our disposal

Whilst there is value in collecting national data to support the sector to improve, we would extend this conversation to encouraging universities to collect data that supports them to make the best strategic decisions for their specific expression of need. 

• Share learning across the sector - The Student Mental Health Research Network, SMARTEN is looking into measuring student mental health, and held a ‘sandpit’ on this topic,  the event discussed the challenge of developing a set of core outcome measures for student mental health and well-being, and creating a common language.
• Use the best measures, not the easiest measures - In order to best understand wellbeing, we need to use the best measures. SMARTEN is looking into this, and we look forward to sharing further insights in the future. 
• Use In-house research expertise - One effective strategy to understanding the wellbeing of a student population, and thus the changes that may need to be made, is to design a research strategy (that includes co-creation with students) in order to make informed decisions to support the student population.
• Find out what is already known - universities are currently measuring wellbeing in a range of ways across a variety of surveys. It is essential that universities audit the measures of wellbeing that are taking place in University, SU and 3rd party surveys; and to co-produce any new measures in consultation with students. 
• Advocate for ‘student’ as a category on national data collection - Currently, Student mental health is often understood through looking to data on youth mental health, we need local CCGs and other data collection bodies to capture respondents’ student status. 

We hope to further respond to a number of areas in further depth, such as commenting the role of the NHS and third sector organisations in collecting and responding to wellbeing data. We hope to see these discussions continue - and we will share the results of SMARTEN’s rich discussions and findings in this area, as they come to light.