Supporting the wider community
It is important at an organisational level for a university to have an awareness of the impact of stigma, social inclusion and access issues associated with mental wellbeing and be proactive in addressing them. ‘No health without mental health’ the cross Government mental health strategy launched early, 2011, is the latest national strategy for mental wellbeing.
Staff Mental Wellbeing: Being in work plays an important role in promoting a persons mental wellbeing. However,work can also have a negative impact on mental health, particularly in the form of stress. This comes at a cost to the individuals health, their productivity and a companies reduced effeciency. The interest in workplace wellbeing has increase over recent years, legislation, guidance and support for universities is available.
Student Mental Wellbeing: While many people can manage mental health difficulties during their time as a student, sometimes mental health problems can be severely disruptive to a student’s capacity to study and learn. There is a wide range of mental health difficulties and universities should aim to offer a range of support and referrals into external agencies in response to this. The development of student mental health policies and procedures is recommended along with staff development and training.
…background information, evidence and links to existing guidance for universities to promote mental wellbeing.
…general information on mental wellbeing as well as separate sections focussing on staff and student issue.
…suggestions on policy/procedures development, areas for consultation, potential internal/external partners to involve.
Get to know your university’s and Students’ union’s range of services related to mental health support, explore potential links and synergies, and signpost to staff and students.
Identify key internal and external partners to work with you in developing action linked to mental wellbeing.
Review awareness of current guidance/recommendations for universities and what strengths and potential gaps your university can identify to take forward.
Promote the Five Ways to Wellbeing – a similar idea to 5-a-day for fruit and vegetables developed by the New Economics Foundation. All activities are research-based and offer practical ways of offering a positive mental wellbeing approach. The Year of Health and Wellbeing is a North West example of work using this approach.
‘Mental wellbeing is a dynamic state in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others and contribute to their community. It is enhanced when an individual is able to fulfil their personal and social goals and achieve a sense of purpose in society.’
Jenkins, R. et al (2008) Foresight Mental Capital and Wellbeing Project: Final Project Report. London: The Government Office for Science.
There is no single definition of mental health or wellbeing, although there is widespread agreement that mental health is more than the absence of mental illness, as with the definition of health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’(WHO, 1948) included in the World Health Organization (WHO) Constitution. The terms ‘mental health’, ‘mental wellbeing’ and ‘wellbeing’ are often used interchangeably. Different sectors will also prefer different terms that communicate and resonate with their stakeholders.
WHO, in its 2001 World Health Report, defined mental health as: ‘a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’ (WHO, 2001). In its Mental Health Action Plan for Europe, WHO has further recognised that:
‘Mental health and wellbeing are fundamental to quality of life, enabling people to experience life as meaningful and to be creative and active citizens. Mental health is an essential component of social cohesion, productivity and peace and stability in the living environment, contributing to social capital and economic development in societies.’ (WHO, 2005, p.1)
Improved mental health and wellbeing is associated with a range of better outcomes for people of all ages and backgrounds. These include improved physical health and life expectancy, better educational achievement, increased skills, reduced health risk behaviours such as smoking and alcohol misuse, reduced risk of mental health problems and suicide, improved employment rates and productivity, reduced anti-social behaviour and criminality, and higher levels of social interaction and participation. (No Health without Mental Health, 2011)
In exploring mental health further, a number of points can be highlighted:
(WHO, 2010)
Each person has a state of mental health just as everyone has a state of physical health.
It can be useful to understand mental health and wellbeing as being along a continuum, naturally fluctuating in response to life events, situation and environments (see Fig. 1). For example, typical staff issues can be change of role, uncertainty of job security and workload; while typical student issues can be homesickness, academic demands, forming relationships and managing family, work and studying. People will respond individually and differently to these issues and it is vital that these typical experiences are not unnecessarily ‘medicalised’.
The majority of staff and students will be able to respond to and cope with the demands of university life. However, mental health difficulties can begin to occur if a person does not have the resilience to deal with daily stresses and becomes unable to function and participate in daily life. For example, they are unable to get out of bed, are unable to concentrate, or become unable to interact with others. In these situations people can typically describe their experience as feeling stressed, low, anxious or depressed.
Figure 1: Mental Health as a Continuum
Mental wellness is generally viewed as a positive attribute, such that a person can reach enhanced levels of mental health, even if the person does not have any diagnosed mental health condition. This definition of mental health highlights emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life’s inevitable challenges.
The Mind organisation suggests that good mental health isn’t something you have, but something you do. To be mentally healthy you must value and accept yourself. This means that:
Mental illness is very common. About one in four people in Britain has this diagnosis, but there is a great deal of controversy about what it is, what causes it, and how people can be helped to recover. People with a mental illness can experience problems in the way they think, feel or behave. This can significantly affect their relationships, their work, and their quality of life. Having a mental illness is difficult, not only for the person concerned, but also for their family and friends. Mental illnesses are some of the least understood conditions in society. Because of this, many people face prejudice and discrimination in their everyday lives. It’s important to remember that having a mental illness is not someone’s fault, it’s not a sign of weakness, and it’s not something to be ashamed of. (Mind)
People may have a diagnosed mental illness or disorder, such as bi-polar, schizophrenia or depression. People will experience a range of symptoms which can vary in their severity. For example, they may experience anxiety – but this may be mild or so severe that the person affected finds it impossible to concentrate on their work, watch TV, or leave their home for months on end. Other examples of symptoms are difficulty sleeping, feeling hopelessness or guilt, or believing that other people are plotting against you – but as with anxiety, the extent to which different individuals are affected by these symptoms can vary enormously.
People with different illnesses or disorders will have different illness experiences, including;
For many people with such mental health difficulties, it is not a single factor or type of factor that has led to the development of their problems. It is often the case that a series of events have occurred, eventually triggering mental illness.
(Rethink, n.d.)
With regard to appropriate responses, the importance of early intervention is widely recognised, alongside improved access to psychological therapies.
‘There is no health without mental health. Mental health is central to the human, social and economic capital of nations and should therefore be considered as an integral and essential part of other public policy areas such as human rights, social care, education and employment.’
WHO (2005) European Declaration on Mental Health. Copenhagen: WHO Regional Office for Europe.
Mental wellbeing at work is determined by the interaction between the working environment, the nature of the work and the individual. Work has an important role in promoting mental wellbeing. It is an important determinant of self-esteem and identity. It can provide a sense of fulfilment and opportunities for social interaction. For most people, work provides their main source of income.
Work can also have negative effects on mental health, particularly in the form of stress. Work-related stress is defined by the Health and Safety Executive (HSE) as ‘the adverse reaction people have to excessive pressure or other types of demand placed upon them’ (HSE, 2007, p.7.). Universities can be subject to external ‘stress audits’ conducted by the HSE. The HSE website has a range of useful information and tools to support workplaces tackle and prevent stress, including Working Together to Reduce Stress at Work: A Guide for Employees.
Although pressure can motivate employees and encourage enhanced performance, when pressure exceeds an employee’s ability to cope, it becomes a negative force in the form of stress. Working environments that pose risks for mental wellbeing:
Stress is not a medical condition, but research shows that prolonged stress is linked to psychological conditions such as anxiety and depression as well as physical conditions such as heart disease, back pain and headache. Promoting the mental wellbeing of employees can yield economic benefits for the business or organisation, in terms of increased commitment and job satisfaction, staff retention, improved productivity and performance, and reduced staff absenteeism – as explored further in the 2008 PriceWaterHouse Coopers report, Building the Case for Wellness and the Guidance Package on Leading and Implementing a Healthy Universities Approach to Enhance Staff Experience and Performance.
The costs associated with employees’ mental health problems are significant for businesses and other organisations. These costs are associated with loss in productivity because of sickness absence, early retirement, and increased staff turnover, recruitment and training. Evidence also shows that productivity can be reduced through the lower level of performance of employees who are at work but experiencing stress or mental health problems. This is known as ‘presenteeism’. A recent report estimated that impaired work efficiency associated with mental heath problems costs £15.1 billion a year, which is almost twice the estimated annual cost of absenteeism (£8.4 billion)
Source: Sainsbury Centre for Mental Health (2007) Mental Health at Work: Developing the Business Case. Policy Paper 8. London: Sainsbury Centre for Mental Health
‘There is evidence that the number of higher education students presenting with symptoms of mental ill health has increased in recent years. Mental health problems can be severely disruptive to the student’s capacity to study and learn.’
Whilst students as a population are not at increased risk of suicide, research suggests periods of transition and instability increase the risk of suicide. Some subgroups of the student population may be more vulnerable; a review of literature suggests that young males are at increased risk of suicidal ideation and behaviour. Students with multiple risk factors, such as mental health difficulties, alcohol and substance misuse, relationship problems, perfectionism and academic difficulties may be a high risk for suicide and should be offered intensive support, particularly in periods of transition. National studies have demonstrated that students – in part because of the age structure of the traditional student body – are a vulnerable group in terms of mental health difficulties, for example:
Source: Student Mental Health, Planning, Guidance and Training, Lancaster University.
While many students with mental health difficulties manage university life well there will be some students who find their mental health difficulties affect their academic work, ability to settle into university life, make friends and have a positive experience. For this reason, it is appropriate for higher education institutions (HEIs), primary health care services, secondary mental health care providers and other relevant agencies to address the issue of student mental health. One key aim of this must be to tackle the stigma and social exclusion experienced by many students, by working to challenge and change the contextual and attitudinal factors impacting on them. It is also important to prioritise approaches that are empowering rather than paternalistic and to review the extent to which courses comply with anticipatory duties in terms of design and assessment methods required by the Equality Act and suggested by the QAA code of Practice. (Royal Society of Psychiatrists, 2003)
HEFCE have identified low levels of disclosure of disability and uptake of the Disabled Students’ Allowance as key factors impacting on the progress of disabled students (including students with mental health difficulties – in 2008, the proportion of accepted applicants who disclosed mental health difficulties on their UCAS form was 0.3% nationally. (www.umhan.com)
The following sections offer guidance for practical action to develop supportive environments, challenge stigma associated with mental health difficulties and work to reduce barriers towards inclusion.
‘The social and financial costs of mental health problems are immense. The burden on individuals, families, communities and society as a whole includes the psychological distress, the impact on physical health, the social consequences of mental health problems, and the financial and economic costs. Recent estimates put the full cost at around £77 billion, mostly due to lost productivity.’
Department of Health (2009) New Horizons A Shared Vision for Mental Health. London: DH.
There are a number of legislative acts, national strategies and guidance documents that provide the wider context for HEIs in relation to mental health and wellbeing, informing them with regard to their responsibilities and duty of care. In addition, they influence the development and content of local implementation and action plans led by local partnerships, within which universities are key players.
Management Standards for Work-Related Stress
Building on the legislative requirement under the Health and Safety at Work Act 1974 and Management of Health and Safety at Work Regulations 1999 for employers to ensure the health safety and welfare at work of their employees, the HSE have developed Management Standards. These cover the primary sources of stress at work, structured around six key areas of work design that, if not properly managed, are associated with poor health and well-being, lower productivity and increased sickness absence. The six areas are:
The Equality Act came into force from October 2010 providing a modern, single legal framework with clear steamlined law to more effectively tackle disadvantage and discrimination. The Equality Duty replaces the three previous public sector equality duties – for race, disabiltiy and gender.
The Equality Duty has three aims. It requires public bodies to have due regard to the need to:
The Equality and Human Rights Commission has information aimed at disabled student and learnings in post 16yrs education.
The Quality Assurance Agency for Higher Education has a code of practice on disability.
In 2007, the University Mental Health Advisors Network(UMHAN) developed a policy position with regards to the use of examinations as an assessment method and students with mental health difficulties.
Preventing Suicide in England (2012)
This strategy aims to:
Action on Stigma: Promoting Mental Health Ending Discrimination at Work (2006)
This guidance supports the implementation of employment laws regarding equality, anti discrimination, health and safety, maternity and parental leave and flexible working. Its workplace focus relates to a number of subsequent national publications, including:
No Health Without Mental Health (2011)
The strategy’s theme is that mental health is everyone’s business, whether employers, education, third sector or criminal justice and it takes a life course approach covering children and young people, adults to older people, in order to:
This mental health outcomes strategy sets out how actions across government will help to deliver better mental health outcomes. It is more than a service improvement plan; it seeks to promote a transformation in public attitudes towards mental health.
There is a wealth of evidence relating to mental wellbeing and the value of adopting a whole organisation response. Two key sources are introduced below:
An evidence review prepared by the New Economics Foundation for the Foresight Mental Capital and Wellbeing Project suggests that building the following five actions into people’s day-to-day lives is important for well-being:
In 2008, the National Institute for Health and Clinical Excellence (NICE) published Workplace Interventions that are Effective for Promoting Mental Wellbeing: Synopsis of the Evidence of Effectiveness and Cost-Effectiveness. This review highlighted the lack of consistency in definition and use of terms to describe a healthy individual’s emotional experience at work (in contrast to the clinically defined mental disorders or psychological ill-health), but goes someway towards identifying which workplace-based interventions are effective in improving mental wellbeing. The following year, it published Guidance for Employers on Promoting Mental Wellbeing at Work, also available as a Quick Reference Guide. This guidance makes a number of recommendations for employers concerned to promote mental wellbeing. Within the context of the whole system Healthy Universities approach, it is relevant that the guidance urges employers to:
‘Adopt an organisation-wide approach to promoting the mental wellbeing of all employees, working in partnership with them. This approach should integrate the promotion of mental wellbeing into all policies and practices concerned with managing people, including those related to employment rights and working conditions.’ (NICE, 2009b)
It also recommends that employers ‘promote a culture of participation, equality and fairness that is based on open communication and inclusion’ and ‘create an awareness and understanding of mental wellbeing and reduce the potential for discrimination and stigma related to mental health problems.’(NICE, 2009b)
Universities are challenging environments in which to work and learn. They are increasingly competitive and target driven, subject to the impacts of national-level policy, and are often characterised by organisational change and restructuring .
An HEI is often the largest employer in an area with a workforce that encompasses a huge variety of roles in a wide range of contrasting environments. Unlike smaller organisations, universities generally have human resources departments, occupational health services and staff counselling provision. In terms of staff mental wellbeing, workplace-related stress is understood to be a particular problem for the higher education sector. For example, a report from the University and College Union Tackling Stress in Higher Education concluded that, on all stressors apart from control, HEIs on average reported lower well-being than the levels recorded in the HSE report Psychosocial Working Conditions in Britain in 2008. Taking a broader approach, the HEFCE funded project Improving Performance through Wellbeing and Engagement is concerned to create an environment where staff are supported to perform to the best of their abilities.
Alongside this, student mental health has become a major policy focus. In 2000, the Committee of Vice-Chancellors and Principals (now Universities UK) published Universities UK Good Practice Guide, intended to support HEIs in their strategic planning to ensure that they take full account of the needs of students experiencing mental health difficulties and those who work and study alongside such students. The guidelines present an overview of:
In 2002, a management guidance document was published Reducing the Risk of Student Suicide: Issues and Responses for Higher Education Institutions which aimed to raise awareness of the risk of suicide and attempted suicide amongst students and help organisations to take appropriate steps to minimise those risks. This endorsed the Healthy Universities approach with its focus on the creation of environments that seek to create positive health.
In 2003, the Royal College of Psychiatrists published a report on The Mental Health of Students in Higher Education, which has recently been updated in 2011.
‘Since the publication of the previous report in 2003, the concerns highlighted there have shown no sign of abating and in many respects have become more pressing. The demand for counselling and mental health advisor services continues to rise as the percentage of school leavers entering higher education increase.’
It includes the nature, prevalence and causes of mental health problems amongst higher education students, suggesting that higher education is associated with significant stressors and that students report increased symptoms of mental ill health compared with age-matched controls. This report aims to be of practical help to universities wanting to improve the care and treatment of students and assist in developing policies and procedures.
‘There has been a general increase in liaison between higher education counselling services, primary care health services and locality mental health teams, although the extent and success of such partnerships has been widely variable. There is a continued need to build bridges between higher education and mental health services, at a locality level but also with commissioning bodies, primarily the primary care trusts in England and Wales and NHS boards in Scotland.’
Explicitly connecting staff and student wellbeing, Guidelines for Mental Health Promotion in Higher Education were prepared by the Universities UK/GuildHE Committee for the Promotion of Mental Well-Being in Higher Education. Offering a framework to guide the development of policies, procedures and initiatives, these argue that effective mental health promotion involves not only addressing the needs of those with mental health difficulties, but also promoting the general mental wellbeing of all staff and students, which will in itself bring significant benefits to the HEI in terms of reputation, staff and student recruitment and retention, performance and community relations. Endorsing the Healthy Universities approach, they suggest that mental health promotion can be seen as involving:
‘the establishment of an environment at all levels of the institution to promote mental wellbeing.’
The publications summarised in this and the previous section recommend that organisations have policies and procedures in place related to mental wellbeing. Within a university context, it may be appropriate to develop separate but co-ordinated staff and student procedures. It will be important to map and forge links to existing policies (e.g. flexible working, diversity and equality, dignity at work, alcohol and drugs) – as discussed in the Guidance Package on Integrating a Commitment to Health and Wellbeing within a University’s Policy and Planning Process – and to clarify potential benefits and links and ensure consistency between university and students’ union procedures:
Developing policies and procedures on mental wellbeing
Benefits of policy and procedures on mental wellbeing:
Links between promoting mental wellbeing and core university agendas:
Ensuring consistency between the university and students’ union:
‘ Mental health includes a sense of wellbeing, self-esteem, optimism, sense of mastery, ability to initiate, develop and sustain mutually satisfying relationships and the ability to cope with adversity (resilience). Good mental health is fundamental in avoiding risk taking behaviours.’
Moodie,R. and Jenkins, R. (2005) I’m from the government and you want me to invest in mental health promotion. Well why should I?, Promotion & Education Journal, Supplement 2
An holistic and joined-up approach to mental wellbeing can be developed by using a whole system approach that recognises and explores the interconnections between different health-related issues, different groups of the population and different components of the university system. The processes and thinking behind this approach are described in the
Guidance Package Leading and Developing the Whole System Healthy Universities Approach. As discussed and illustrated in this (see Fig. 2), there are a number of key steps that a university can take in planning and implementing a whole system approach to mental wellbeing:
Figure 2: Healthy Universities – Operational Planning, Implementation and Management
Source: Adapted from Doherty, S. and Dooris, M. (2006) The healthy settings approach: the growing interest within colleges and universities. Education and Health 24(3): 42-43.
Whilst it is important to appreciate the connections between staff and student wellbeing and to ensure that work focused on both groups is integrated within a co-ordinated and coherent whole system approach, it will also be important to consider the specific planning and implementation requirements for each.
Student mental health promotion can be actively addressed in higher education institutions by using a whole system approach and working in the following areas:
Source: Adapted from Royal Society of Psychiatrists (2003) The Mental Health of Students in Higher Education. Council Report CR112. London: RCP.
It is possible to distil a number of recommendations for employers on how to promote mental wellbeing in the workplace:
Source: Promoting Mental Wellbeing through Productive and Healthy Working Conditions: Guidance for Employers: NICE Public Health Guidance 22 (2009)
Source: Quick Reference Guide: Promoting Mental Wellbeing at Work
Source: Foresight Mental Capital and Wellbeing Project (2008) Final project report. London: The Government Office for Science
As discussed in the Guidance Package Leading and Developing the Whole System Healthy Universities Approach, a whole system approach to mental wellbeing necessitates the engagement and active involvement of all the different parts of an HEI. To enable this to happen, it will be important to put in place effective communication and consultation mechanisms and to invest time and energy in building and nurturing internal and external partnerships. The Healthy Universities model tends to use informal networking to engage and connect people across boundaries and harness their energy, enthusiasm and resources. However, alongside this, it engages with more formal institutional structures and processes in order to ensure alignment with strategic planning and organisational change.
When addressing mental wellbeing issues, a wide range of professionals will be involved, often from different disciplines and services. Through partnership working, greater understanding of roles, responsibilities and links can be identified (e.g. clarifying the role of personal tutors in providing information and support to students and knowing when to refer to mentoring, counselling and health services).
| University | Students’ Union | External |
| Disability Advice Service Health Centre Health, Safety & Environment Human Resources Mental Health Adviser Occupational Health Personal Tutors Staff Counselling Student Services Student Counselling | Advice Centre Executive Officers (e.g. Campaigns Officers) Clubs and Societies Participation Officers | Local Voluntary Groups Service User Forums Primary Care Trusts NHS Mental Health Services |
Using a whole system approach encourages universities to consider the range of wellbeing issues and the types of appropriate intervention. Understanding mental wellbeing as a continuum will encourage partnership working and prevent too strong a focus on only one area. Universities should aim to work towards providing a range of services, information and support for staff and students that can, at one end of the continuum promote wellbeing and, at the other end of the continuum, be able to refer to specialist diagnostic and treatment services.
Student and staff consultation, involvement and research on mental wellbeing will provide important insights for the university. Potential areas to consider are:
Universities already collect data on students and staff which can be relevant to the mental wellbeing agenda. For example:
Evaluation is a key dimension of a Healthy Universities approach, helping to build evidence of effectiveness and develop understanding of what works and why. It is widely acknowledged that evaluation should be pluralistic, incorporating a focus on both process and impact, and action-focused, informing future policy and planning and contributing to the sharing of good practice (for further information, see the Evaluation Section of the main website). It is important to evaluate both the added value of adopting a whole system approach and the effectiveness of specific interventions and initiatives relating to mental wellbeing.
It is important to make evaluation plans integral to policies, procedures and work programmes – and seeking expertise from the mental health field, public health and academics from within your university will strengthen your evaluation methodology.
Universities and their students’ unions can use existing data sets, conduct their own monitoring and evaluation, and carry out research into wellbeing. There are a number of standardised measures available to assess wellbeing.
Aked, J., Marks, N., Cordon, C. and Thompson, S. (2008) Five Ways to Wellbeing: The Evidence. London, New Economics Foundation
Department of Health (2009) New Horizons A Shared Vision for Mental Health. London: DH.
Doherty, S. and Dooris, M. (2006) The healthy settings approach: the growing interest within colleges and universities. Education and Health 24(3): 42-43.
Health and Safety Executive (2007) Managing the causes of work-related stress. Richmond, HSE.
Jenkins, R. et al (2008) Foresight Mental Capital and Wellbeing Project: Final Project Report. London: The Government Office for Science
Lancaster University (n.d.) Student Mental Health: planning, guidance and training [Internet accessed on 13 August 2014]
Moodie,R. and Jenkins, R. (2005) I’m from the government and you want me to invest in mental health promotion. Well why should I?. Promotion & Education Journal, Supplement 2
NICE (2009a) Promoting Mental Wellbeing through Productive and Healthy Working Conditions: Guidance for Employers: NICE Public Health Guidance 22. London: NICE.
NICE (2009b) Quick Reference Guide: Promoting Mental Wellbeing at Work. London, NICE.
Rethink (n.d.) Rethink [Internet accessed on 13 August 2014]
Royal College of Psychiatrists (2011) Mental Health of Students in Higher Education. Council Report CR166. London: RCP [Internet acessed on
13 August 2014]
Royal Society of Psychiatrists (2003) Mental Health of Students in Higher Education. Council Report CR112. London: RCP
Sainsbury Centre for Mental Health (2007) Mental Health at Work: Developing the Business Case. Policy Paper 8. London: Sainsbury Centre for Mental Health
WHO (1948) World Health Organisation Constitution. Geneva, WHO.
WHO (2001) The world health report 2001 – Mental Health: New Understanding. New Hope, Geneva, Switzerland, WHO.
WHO (2005) WHO European Ministerial Conference on Mental Health Facing the Challenges, Building Solutions. Geneva, Switzerland, WHO.
WHO (2010) Mental health: strengthening our response [Internet accessed on 13 August 2014]
AMOSSHE
AMOSSHE is the UK Student Services Organisation. They inform and support the leaders of student services, and represent, advocate for, and promote the student experience. Around 140 UK higher education institutions are members of AMOSSHE. It has a special interest Healthy Universities Knowledge Community.
Improving Performance through Wellbeing and Engagement
Funded by HEFCE in partnership with the Scottish Funding Council and the Higher Education Funding Council for Wales, this project is led by the Universities of Leeds and Glasgow in partnership with the Universities of Birmingham, Bristol, Chester, Newcastle, Winchester and Queen Mary, London, and Grimsby Institute for Further and Higher Education – and aims to:
Mental Wellbeing in Higher Education
UK/Guild HE Working Group for the Promotion of Mental Wellbeing in Higher Education – links and resources: