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‘Physical Health’ and ‘Mental Health’ would seem, on the face of it, to be twins that deserve equal attention and equal resources. Yet in 2014, 67% of clinical commissioning groups in the NHS spent less than 10% of their budgets on mental health services. In some areas this dropped as low as 6.6% of their budgets, despite anxiety and depression statistically taking up 23% of the NHS burden. (1)
In January 2016 the Prime Minister, David Cameron, announced an additional £1 billion for mental health treatment (2), which is clearly welcome. However, to keep the numbers in perspective, it is worth bearing in mind that the overall NHS budget for 2015/16 was £116.4 billion for England. So, in real terms this represents less than 1% of the total.
In addition, in a recent survey (3) by mental health charity stem4, eight out of ten GPs expressed the opinion that the provision of mental health services for young people is inadequate, and almost nine out of every ten had concerns about patients coming to harm while waiting for treatment.
In 1987 there were 67,122 overnight beds available in the mental health sector in the NHS in England. But by the early part of 2016 (figures for January to March 2016 - Excel file) that number had dropped to 19,086 (4). That is a drop of over 70% at a time when the general population of England has risen by over 5 million people (5), and the number of students in higher education has risen by 16% to 2.26 million in 2015. (6)
In fact, out of 215 NHS Trusts listed in the NHS bed data, fully 150 (or over 2/3rds of them) had ZERO AVAILABLE BEDS at all for mental health patients. Despite that, in March 2015 the BBC reported that Mental health trusts in England had seen their mental health budgets fall by more than 8% between 2011 and 2015, at a time when referrals to community health teams had risen by nearly 20% (7).
Paul Farmer, the chief executive of the mental health charity Mind has commented: (7)
It is with this backdrop of challenges that we need to ask ourselves.
There are clearly challenges at all levels when it comes to mental health. There is the need for political will to take action, and the issue of how you fund better mental health treatment, and what do you cut to pay the bill? (Because inevitably choices have to be made in the real-world, where there are not unlimited funds to pay for everything). But at a grass-roots level what more can be done to specifically support students who suffer from mental health challenges?
Here are four practical tips: 1/ Not every crisis is a mental health crisis… But stay open to the possibility – “Hand a man a hammer and everything starts looking like a nail”, as Mark Twain once said. So it is easy to start seeing every student struggle as something that requires medical intervention. In reality, life comes with its challenges for all of us. There is a certain sense in which more than half the battle is to be able to differentiate between ‘normal’ amounts of stress from areas of student life such as relationship issues, family problems and anxiety from course workload, that all students will experience. And the moment when this passes a ‘tipping point’ and becomes a stress that the student no longer feels can be managed alone. This is when ‘challenges’ become ‘problems’, and when all of us can do with some help.
MIND have a good guide to Understanding Mental Health Problems here that discusses some different issues that people commonly experience. Signs of when ‘challenges’ have become ‘problems’ to a student might be:
On their own none of these may be significant. They can equally be caused by not getting enough sleep, being hungover, trying (and failing) to fit into skinny jeans or a short-term slump because you were dumped by your girlfriend! But when a change is perpetuated over time then it becomes more important to stay open and be aware to consistent changes in a students behaviour.
‘Mental health problems’ are far more common in students than most of us would ever realise. In 2013 the National Union of Students surveyed 1200 students and found that 20% of them considered themselves to have a mental health problem. 13% had suicidal thoughts, and almost a third said they were experiencing ‘mental distress’ every week. (8)
So don’t discount the possibility that someone is really suffering.
If you do notice some of these, then be prepared to step in and at least ask some questions.
2/ Talk things through - For many of us the first step with mental health challenges is not to phone our Doctor. It is to phone a friend or a family member, and that is perfectly normal.
If you think of mental health challenges as being a bit like a step-ladder going upwards, then the first few steps up may be managed by simply having someone you already trust holding the base of the ladder to give you support. The higher you climb, the wobblier it may get, but regardless a firm base of support can help you to feel much more secure in exploring the upper echelons of your feelings. If a course tutor noticed any of the above consistently in a student then a ‘normal’ first step would be to take the student to one side, perhaps after a class, express their concerns and see if they can get to the bottom of what is going on. It may be nothing big, or it may be something major, but either way you won’t know unless you ask. At the very least the student will feel cared about, and that is no bad thing. And if they have simply been partying too hard, then it will be a wake-up call to start focusing again.
And the reality is that probably more often than you think students WILL be feeling that they have mental health issues and could do with some help, especially if you consider that based on the NUS Mental Distress Survey (PDF) in 2013 one-in-five students considered themselves to have a mental health problem. (9)
3/ LSBM Can Help - If the student does need help or there are bigger issues that may give cause to think that the student needs more support, then it is worth realising that LSBM already has a structure in place to do exactly that for our staff and students. LSBM prides itself on helping students wherever we can. We have a dedicated member of staff, Dr Nadia Michail, who is the Student Disability, Welfare and Engagement Officer, who can help to assess students and offer advice both to academics and the student, where appropriate. It may be for example, that mental stress can be linked to a specific physical cause, such as difficulty with hearing a lecture, seeing the screen, or feelings of claustrophobia. In which case Nadia can help to assess that, and may be able to provide very practical solutions such as screen readers, audio recorders or possible class adjustments (dependent on relevant assessment and circumstances). She can also provide a knowledgeable and supportive first port of call for someone to talk to in the event that they need it. So, simply letting students know of her existence can also be a good strategy, so that they can choose to talk to her independently if they would prefer to talk to her, rather than a family member or a course tutor. You can read more about our Disability Office here - http://www.lsbm.ac.uk/disability-office You can contact Nadia at firstname.lastname@example.org or call our switchboard on 020 7078 8840 and ask to speak to her if you are one of our students or lecturers who would like advice.
4/ Take advantage of external help that is available – Sometimes mental health problems can be dealt with effectively by talking to family, friends, the course tutor, or a dedicated professional at the college, like Nadia. But sometimes they can’t. Not every mental health issue fits into neat boxes. But it is important to make students aware that there are other ways they can get help if they don’t want to talk about their issues with any of the above. Here are three other sources of mental health help: 1/ The local GP – If problems really feel like they are mounting up, then a GP can really help. They have the medical expertise to be able to flag up more serious issues and also to be able to introduce new treatment options that may otherwise not be available. They can also offer advice as to medications that may help to treat depression for example, or that may assist in lessening the effects. Some Doctors even specialise in mental health issues. The ‘Black Dog Institute’ in Australia have produced a useful fact sheet that offers general guidance (mostly also applicable to the UK) about how to ‘Find a Mental Health Friendly Doctor’, that you may find useful.
The Mental Health Foundation also offer a good guide here, specifically for the UK, about how to talk to your GP about your mental health.
2/ Samaritans – One of the biggest ‘fears’ of people with mental health challenges is that there is an ongoing ‘cost’ to pay if they admit to someone else that they are having mental health problems. All sorts of ‘fears’ run through their minds. They may want to address the ‘problem’. But what happens after the problem is fixed? Even if they feel better, then they may worry about the stigma of being branded as someone with ‘issues’ (however unfounded that may be). This is where a charity like Samaritans can really help. Samaritans was founded in 1953 to do something specific and practical to help people in distress who had no-one else to turn to. Since those early days it has grown into an organisation of over 200 regional branches and 20,000 volunteers who give their time, 24/7, to actively listen to those who want to talk to someone without any fear of repercussions. Three things sets Samaritans apart:
You can phone Samaritans up safe in the knowledge that whatever you say will go no further. You will talk to someone who cares, but who doesn’t judge you. Samaritans don’t offer advice. But they do offer an active listening service that can help to clarify your own feelings about your situation, what is happening to you, or what has happened in the past. Or you can simply vent your feelings, safe in the knowledge that it will go no further and have no repercussions for the future.
For example, if a student felt angry or irritated with a tutor, then a call to Samaritans may be enough to make them feel ‘heard’, but without potentially destroying a student/teacher relationship, that could literally last for years, with an angry or emotional outburst.
Or if it is a bigger issue, such as feeling suicidal. Then they can talk it through while remaining in control of their own destiny.
Samaritans gives you the space to be yourself. They have a vision of fewer people dying from suicide. But this is NEVER at the expense of confidentiality. They recognise that people call because they feel safe that their destiny ALWAYS lies in their own hands. Their values are the epitome of how human-to-human contact has always been, and will continue to be so vital in addressing mental health issues: The Five Samaritan Values:
You can call Samaritans in 100% confidence on 116 123 (the call is free).
(Visit their website here for more ways you can contact them, which also includes email, letter and SMS)
If you don’t have the answer, then realise that it’s fine to point a student in the direction of Samaritans. Samaritans even offer a teaching resource pack called DEAL (‘Developing Emotional Awareness and Listening’) that has been developed in consultation with young people and schools across the UK, which has the following aims:
You can find out more about DEAL here.
Remember, it is never a weakness to ask for help, or offer it with a helping heart.
3/ Mind – Whereas Samaritans is more like the ‘Police Fast-Action Response’ team, that jumps in and handles an immediate problem. The charity ‘Mind’ is more like the Bobby on the beat that can help you to take a longer term view on mental health, and give you directions as to where to go when you feel a bit lost. You can find them at www.mind.org.uk Mind also operates a helpline on 0300 123 3393. This is open from 9am to 6pm on weekdays (except for bank holidays) and is primarily tasked with providing information about:
In other words, this isn’t a ‘talking service’. It is more of an advice service that can help you to pin down what the next logical step is for you to get help. They have a useful FAQ section here that provides some great insights as to the kinds of help they can offer. MIND also offers a Guide to Seeking Help for a Mental Health Problem 32-page PDF that is a practical guide for those who are experiencing mental health issues and who want an informed guide as to what steps they can take to help themselves.
Above all else, don’t suffer in silence, and don’t treat others who you think may be suffering with silence.
The American Psychiatric Association has reported that: “One half of all mental illness begins by age 14 and 75% begins by age 24.” (10) So students in higher education are a key demographic for mental health challenges. It is easy to appreciate why when you consider that students are already under stress from their studies, being away from home, and perhaps trying to cope on their own for the first time.
There is a famous psychology study from Latane and Darley where an actor was charged with playing the part of a man having an epileptic fit on a public street in New York. When only one person was present the odds of that man being given assistance were 85%. But when four or more people were present that number dropped to only 31%. (11)
It seems that when we assume we are the ‘last man standing’, that most of us ‘step up’ and take responsibility. But that when we are in a crowd, we assume (usually wrongly) that someone else will help.
It is all too easy as educators to assume that someone else will help. Be that the student’s friends, family, other students, the Government or someone else. But most likely, as in Latane and Durley, that will lead to students who are suffering from mental health issues slipping through the cracks and not getting the help they need.
Don't turn your back.
Remember, a voice in the wilderness carries further.
Step up. Take responsibility. Ask caring questions.
Be that voice.
Stuart Brown Media and Content Manager
1 - http://www.theguardian.com/society/2014/jul/24/nhs-mental-health-second-class-service 2 - https://www.gov.uk/government/news/prime-minister-pledges-a-revolution-in-mental-health-treatment 3 – http://schoolsimprovement.net/time-bomb-waiting-explode-survey-reveals-gps-concerns-mental-health-services-young-people/ 4 - https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/bed-data-overnight/ 5 - https://en.wikipedia.org/wiki/Demography_of_England 6 - https://www.hesa.ac.uk/stats 7 – http://www.bbc.co.uk/news/health-31970871 8 - http://www.nus.org.uk/en/news/20-per-cent-of-students-consider-themselves-to-have-a-mental-health-problem/ 9 - http://www.nus.org.uk/Global/Campaigns/20130517%20Mental%20Distress%20Survey%20%20Overview.pdf 10 - https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness 11 - http://www.appsychology.com/IB%20Psych/IBcontent/Studies/Latane%20and%20Darley.htm
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