Previously, we examined student mental health at British universities from the student’s perspective. This time, it is the turn of the universities.
British universities find themselves suffering criticism for a lack of investment in their mental health services: broadly student support, but more specifically, counselling or wellbeing services.
As demand for the services has grown in the last five years or so, universities found themselves reacting, often too late. 24 higher education institutions (HEIs) reported an average of 845 applications to services in 2011/12. By 2015/16, 45 HEIs reported an average of 1,385 applications. It is not uncommon to see applications at individual universities rise by 20-40% year-on-year. Meanwhile, funding has risen much more slowly. At Cardiff, applications rose by 138% from 2011/12 to 2015/6, while funding increased by… 26%. Similar stories are all too common.
Yet for British universities, there is a great deal to say in response to these figures. They don’t represent the entire picture. Funding does not need to increase in a linear relationship with applications to serve the needs of those applying. They are being adversely impacted by cuts to the NHS, pushing greater responsibility onto the institutions’ duty of care. Care delivered is not the same as care paid for.
Students may be waitlisted for months at a time
The goal of wellbeing and counselling services at British universities is simple: to look after as many students and staff as possible. The university, like the NHS, also wants to keep costs down where possible, while maintaining services that are free to use. As such, services don’t exist like private practices, where immediacy and quality of care is prized above all else. Universities triage applicants, then prioritise them according to their need. This means students may be waitlisted for months at a time. In 2015/16, the average waiting time at Glasgow for an appointment after an assessment session was 83 days. Universities typically manage much shorter waiting times than that, but comprehensive data is unavailable.
Regardless of how long the wait is, there is a tension there. Here are private institutions, sustained by students who are paying thousands of pounds a year to attend them, delivering care on a public healthcare model. Yet that model does makes sense. While demand across the year is somewhat predictable, spiking prior to and around exams, the spikes from year to year are new. In order to serve as many students as possible, services need to hire more staff, particularly counsellors. Maintaining additional capacity to serve those spikes is expensive, particularly when an institution isn’t sure that the rise in applications is here to stay.
Uncertainty surrounding mental health care extends to a national level
Part of the reason for that is the uncertainty surrounding mental health care at the national level. As the NHS has come under strain, fewer hospital beds are available to those who need them. As such, more high priority cases are pushed onto the lower intensity care systems, like out-patient services. This ‘cascade effect’ means that GPs will frequently direct students to their university counselling service, rather than to the NHS, as it means the student in question will get some help sooner. This pattern has been sustained over multiple years, despite political rhetoric to the contrary.
Hypothetically, the strain transferred to university wellbeing services means that universities have less desire to do outreach and properly communicate the availability of those services, as doing so will likely increase applications. However, it does give universities an incentive to explore other models of care delivery, as we see high-quality e-health solutions emerge, alongside a shift away from traditional models of counselling services, towards wellbeing services. While this article won’t explore the weeds of policy, as that is to come in the next article, the problem has led to full-university responses emerging.
A university is, in large part, its students
While reactive initially, universities are now fully aware of the scale of the problem, both in terms of what it means for individuals’ health, but also what it means for the university as a whole. The narrative of a student mental health crisis and the criticism it lays at the feet of universities often forgets that a university is, in large part, its students. The fewer lectures and tutorials students miss, the better. The fewer dropouts, the better. The more successful the students, the more successful the university. Universities want their students to succeed, and properly funded university healthcare systems are a key part of that.