Standards are still required for university mental health practices

Starting university can be challenging – students are stressed by high expectations – their own and those of others – yet there are students must adjust to a new way of life: new leaning methods,  living in halls yet often without any friends – it’s is easy for some to just hide away.

Ceara Thacker, 19, committed suicide in her halls of residence at the University of Liverpool in May 2018. She had previously attempted to kill herself by taking an overdose. Her family were not told of the earlier suicide attempt. Iain Thacker, Ceara’a father, insisted it would have “made a difference” if they had known about an overdose just three months earlier. Some universities are trialling an opt-in scheme, whereby students allow the authorities to tell their parents if they develop problems, to help ensure their families know and can help to support them… yet not all.

It seems that there is little monitoring of the wellbeing of students – and not way to catch any sudden deterioration.  Surely our universities could recognise that families can provide significant support to students experiencing difficulties – the impact of  preventing such support can be devastating.  Why is it not already mandatory, that as part of enrolling at a college, a student must register a family member to be notified of [specified] serious health issues?

The problem of student mental health issues is rising – and quickly . A survey of 2,573 first-years, conducted by Unite Students, found that 17 per cent of respondents reported suffering from anxiety, depression or another mental health condition – up from 12 per cent in 2016. Yet only 23 per cent said they trusted their university to provide them with the right level of support.

This week, Sir Norman Lamb, the ex-health minister, published the results of his research to show that students with mental health problems are being forced to wait up to 12 weeks for help from their university…  prompting fears that some may take their own lives during the delay – as reported in The Guardian: https://www.theguardian.com/society/2019/sep/16/uk-students-waiting-up-to-three-months-for-mental-health-care

Undergraduates at the Royal College of Music in London had to wait the longest to start counselling last year, with the worst case being 84 days. “Twelve-week delays to start counselling are scandalous, particularly when we know that so many students are taking their own lives,” said Sir Norma. “That’s longer than a university term. It’s extraordinary that some universities are subjecting students to such long waits and failing their student populations so badly. Universities with these long waiting times need to remember that students suffering from mental health conditions very often need help as a matter of real urgency. The risk is that their mental welfare will decline even further while they wait and wait for care and support.”

That average delay of seven-and-a-half weeks was seen at the University of Bristol despite its mental health support for undergraduates coming under scrutiny as a result of the suicide or suspected suicide of 12 students there in the last three years.

The Guardian reports:  “Universities have been heavily criticised for the mental health provision they offer undergraduates, as the number of them seeking help has soared in recent years. Students’ struggles can lead to them dropping out, doing poorly academically or killing themselves. An estimated 95 students in higher education took their own lives in the 12 months to July 2017 in England and Wales… Reported student mental ill-health has increased fivefold since 2010. Research has found that one in five (22%) students has been diagnosed with a mental ailment and that even more (34%) have struggled with a psychological issue with which they felt they needed professional help. In addition, 45% use drink or drugs to help them cope with problems, 43% worry often or all the time and 9% think about self-harming often or all the time.”

Tom Madders, campaigns director at the charity YoungMinds, was quoted by The Guardian: “It is very worrying that there is considerable variation in the level of mental health support offered at universities around the country. Counselling for students should not be a postcode lottery. Many young people start university expecting to have the time of their lives. But for some it can be a stressful experience: moving away from home, financial difficulties, problems with your course, making new friends and changes to your support network can all pile on the pressure.”

So when is the Department of Education,  perhaps through its the Office for Students, going to impose safeguards and minimum standards to be delivered by universities – insisting on  disclosure to a nominated contact and establishing minimum referral times?

The BBC quoted a spokesman for Universities UK – some kind of grouping of Universities –  said: “Funding to support mental health services at universities will vary depending on the needs of each student population. Universities cannot address these challenges alone. The NHS must provide effective mental health care to students, and Universities UK is working closely with NHS England to ensure that commitments in the NHS long-term plan are implemented.”

Hmmm… it sounds like they are passing the buck. I wrote about this before… back in july 2018: Student mental health must be top priority – Universities Minister Sam Gyimah says issue requires serious leadership from vice-chancellors .  The then Universities Minster, Sam Gyimah, was calling for  the universities to introduce as schemes to notify the families of students experiencing problems – and yes, he seemed to be suggesting that the universities were not accepting a leadership role in sorting things out.  Worryingly, the quote from the universities (in the form of “Universities UK mental health in higher education advisory group”)  suggested the that they were passing the buck even then.  Yet how many more suicides will it take before the universities to step up?

High Stakes Decision Making

I wrote recently about how the US Special Forces have adopted training in mindfulness to help soldiers make better decisions in chaotic situations… to be able to focus and avoid distraction.  (See “Focus in the midst of chaos- US Special Ops” https://carinasciences.com/2019/07/04/focus-in-the-midst-of-chaos-us-special-ops/ )

This set me thinking about how to help people make better decisions when the stakes are high.

I’m talking about “crisis management”… coping with disaster scenarios… or having make significant calls: stop, go, invest, expand, closedown, buy, sell or hold.

Clearly mindfulness is part of the solution… together with a few other techniques that can help also:

So the first thing: you must be able to focus and to avoid distraction.

You must set aside emotional reactions… and certainly avoid becoming overwhelmed.

And you must set aside thoughts about the “weight” or significance of the current situation… sure, you‘ll need to balance the likelihood and the impacts of success or failure associated with the choices you have…  but this should be approached with  a cool dispassion.

Further, to make the right decisions in the current situation, you should set aside the emotions and reactions from previous situations… good or bad. Every situation is different and you must assess the current issues that you face rather than be influenced by the past.

Mindfulness practice will help you with each of these…. you should try it.

So what else?

In preparation, you should ensure that you are aware of your biases… such as any tendency to take reassurance from “confirmation bias” (that seeks confirm your current understanding but may cause you to ignore evidence that might suggest your understanding may be incorrect) or “cognitive dissonance” (where the presence of evidence that contradicts your understanding causes you to reframe your interpretation of the facts to keep most of your theory intact).

Other biases may cause you to be overly confident in your own ability, or the ability of your team, to carry out necessary tasks.  So you need to talk regularly with colleagues about any biases that you may have (…“sense checking” you opinions).

Build trust… in your systems… indicators… and especially in your colleagues. … in tough times you will need to focus in your task in hand and not start to question things.  Assess the reliability for these regularly… and if you can’t develop that trust then change things now.

And of course you need to trust yourself… all you have to do is achieve this or that; and so focus on doing the things that are required… and visualise moving to a successful outcome.

There are a couple more things that I believe you need to consider:

Don’t feel undo pressure to respond.  When something seismic happens, many organisations look to their leader to make the call – so a leader may see it as their role to jump in and act.  But this is not always the best response especially when a situation is unclear or the corollary of any of the available actions is unclear.  A while ago I wrote how mindful leaders in such situations should set aside ego and emotions and reframe the need to act as curiosity – to investigate what is happening and to reach out for the opinions of others. (See “Transformational change – Leadership … and reframing ambiguity as curiosity!” https://carinasciences.com/2018/07/08/transformational-change-leadership-and-reframing-ambiguity-as-curiosity/ )

You’ll need to manage your own behaviour.  Your reactions, your demeanour and your decisions will be noted by your staff and colleagues who may, rightly or wrongly, believe that the true “you” emerges when you are under pressure.  This may have a lasting impact on their opinion of you; on their loyalty to you and on their willingness to go the extra mile for you.  So, try to remain positive and relaxed. .. not irritable or tense.  Empathise with those working hard and let them know you are trying to limit the impact on them. Sometimes, when I have been in such a situations, all I could do was stay with the team and buy the pizzas.  And be generous… the words “please”, “thank you” and “good job” – they’re free and yet so valuable.

Then there’s the “Moral imperative of leadership”. You should act with integrity and ensure that your decisions and actions are moral… even when a situation is desperate. It is unlikely that staff will remain loyal if they believe your actions are not honest and fair.  I once attended to a talk by Stormin’ Norman Schwarzkopf who was the commander of Desert Storm… the first gulf war.  In that role he was literally asking troops to put their lives on the line.  In such a situation he said it was essential that they were in no doubt that he was doing his best to limit the dangers and that he was taking the best possible care of every one of his troops.  Fortunately most of us do not deal with decisions that can bring life or death… but I am sure the same values are key for all of us.

And finally – don’t choke – easier said than done!  Choking is when a person becomes overwhelmed with the enormity of the situation often causing them to consciously focus on small, trivial actions that have been automated long ago… so that they start to make “novice errors”.  Worse, such emotions can cause the release of brain chemicals that actually reduce your peripheral vision (real and metaphorical) and your ability to notice how the situation is changing.  So simply, set out the steps you have to take and focus on each step, in sequence, one at a time – giving each step your full attention until you have completed all – yet without thinking about weight of the whole situation.

You will get through this.

Stress and mental illness account for 57% of workdays lost in UK

When I talk to people about the impact of building resilience through mindfulness I like to emphasise its value to all – how mindfulness can increase the resilience in all of us to deal with pressure and with change; and make all of us more able to focus and to make better decisions; and to increase our productivity, our open-mindedness, our empathy and our life satisfaction… and there is evidence to show that teams with mindful members are more effective that those without such members.

Yet it is also important to look at how resilience can help people to deal with stress and to avoid becoming anxious or depressed – especially as  my recent work has shown that many people overestimate their reserve of resilience and so that are shocked when they suddenly start to experience problems.  And this happens to many people…

I recently noticed that the HSE (The UK’s Health and Safety Executive) have released figures for 2017/18 that show that work related stress and mental illness (anxiety and depression) accounted for over half of work place absences: 57%. (See here )

So nearly 600,000 employees now suffer from such conditions; and the data shows that the growth such problems has yet to plateau; growing by 13% from the previous year. The cost of this absence is now £8Billion per year.

A spokesperson from HSE commenting on the figures said: “The fact that work-related stress, anxiety and depression is estimated to be responsible for 57 per cent of the working days lost to ill health shows how important it is for employers to take action.”

At Carina Sciences we are working with employers to use our Rezl app to build the resilience of employees – to pre-empt such problems, to reduce the impact on those with such problems… and to enable all employees to boost their performance and life satisfaction.