Monday, 31 August 2015

Your results do not define you

With A-Level and GCSE results coming out over the past few weeks, lots of people will be processing their results and thinking about what comes next - take a look at Olivia's brilliant blog on getting perspective and remembering that your results do not define you...

- Olivia Niblock

So your results have sunk in and maybe you’re disappointed…

Your results do not define you.

I thought I might just start with that because a) it’s true, b) not a lot of people believe it and c) neither did I until I got my A level results 3 and a bit years ago.

When I was doing my GCSEs, everything went pretty well. I worked really hard and managed to get 13 A*-Bs and I was fairly happy. I convinced myself I wanted to study medicine at university and become a doctor. Trouble was that I didn’t really want to do that at all. I wanted to help people – certainly! I still do. But there are other ways of helping people other than being a doctor and being stressed to the point of implosion.

So I chose my A Levels and unlike many, I chose to carry on with 5 A levels to A2, because I wanted to make my choices for universities and subjects as diverse as possible. I applied to UCAS (I truly feel for you guys that still have to do it!) and I applied to a handful of Medical schools and one course I truly wanted to do – Medical Genetics.

I didn’t do as well in my A level results as I wanted to – and I threw all my toys out of the pram because I thought that was the thing to do. I thought I was a failure. And then Queen Mary, University of London got back to me on Track. I had been happily accepted onto the Medical Genetics course and was expected in September.

It was then that I allowed myself to accept that I didn’t want to study medicine. I wanted to be a researcher - to help people out in a different way. My ‘failure’ in A-Levels turned out to be the biggest success I’ve ever had.

University was great. I had family and medical circumstances that weren’t great, like 6 family deaths and the diagnosis of Generalised Anxiety Disorder (GAD), but university itself was so good, and so supportive. They (the university and my friends) completely embraced the fact that I had GAD, the fact that I may need a bit more time to process things and the fact that I was grieving for 4 close relatives.

I didn’t graduate with a first, but to be honest, I don’t measure my success by the grades anymore – I made it through incredible adversity, and it was like I had won the lottery. I am a proud Medical Genetics graduate, interning at a place that helps people in need.

Just remember: your results do not define you!

Wednesday, 26 August 2015

Don't suffer in silence

- Andrew Read

A guy is walking down the street when he falls down a hole. The walls are so steep he can’t get out. A doctor passes by and the guy shouts up: “Hey you, can you help me out?”
The doctor writes a prescription, and throws it down in the hole and moves on. Then a priest comes along and again the man shouts up: “Father, I’m down in this hole, is there any chance you can help me out?”
The priest gets down on his knees, says a prayer, and moves on. Then a friend walks by: “Hey Joe, its me, can you help me to get outta this hole I’m in”. The friend jumps in the hole and our guy says: “Are you stupid? Now we’re both stuck down here”. The friend says: Yeah, but I’ve been down here before and I know the way out.”

At Student Minds, we believe its okay to talk. In fact, more than okay. This is the first time I’ve talked about my mental health issues in a public setting, but talking to others in depth seemed to be the only reason I got back on my feet and out of the hole, so its important to me to encourage others to do the same.

Until February of this year, I was an undergraduate at the University of Oxford, four months away from sitting my finals. I hadn’t struggled with mental health issues previously, but over the preceding six months I’d been finding it increasingly more difficult to simply be happy, without really realising it. Shortly after Christmas, following advice from my doctors, I found myself sat at home having walked away from my university life, my degree and my friends. It was all very sudden.

Whilst at university, perhaps unlike many, I was quite open and vocal about my problems, purely because I really needed my friends to help me to be happy. However, when isolated at home, I felt so distant from university life and associated Oxford with the cause of my depressive symptoms. I felt I had to distance myself from the entire place. I found it incredibly difficult to go back to the place that I thought had made me so upset; to even think about going back and seeing my friends whilst they were all still there.  I didn’t find I could effectively explain to people how I felt, why I didn’t want to come back to Oxford to visit them all the time, despite the fact some of them were leaving at the end of the year and I might never see them again. I didn’t feel like anyone really understood how difficult it was for me, I didn’t feel like I understood, and shut everyone out.

One of the hardest things about depression is that you can often feel alone.  It’s a very personal battle: only you can really understand how it affects you, but that doesn’t mean others can’t help. Whilst spending time at home by myself, I convinced myself that everyone at university just thought I had taken the easy way out. I didn’t think they would understand why I had to do what I had to do. It wasn’t until I went back to university for the first time after my friends had finished their exams, and sat down with one of my friends in a park and tried to explain how hard it was to be back, that I began to realise that it doesn’t necessarily matter if people don’t understand what you are going through, as that doesn’t mean they can’t be there to help.

Very few of us understand the molecular basis of cancer, arguably none of us can cure it, but that doesn’t mean if a friend has it we don’t want to help support them through it. Mental illness is another illness, and although nobody can understand what each person goes through personally, that doesn’t mean your friends don’t want to help you through it. Talk to them.

Personally, I feel like a lot of my mental health issues were exacerbated because I shut out my friends and didn’t feel like I could talk to anyone about them. I suffered in silence. When you finally realise that friends don’t have to understand the ins and outs of your struggle, that simply spending time in the company of someone when you are feeling down, and providing messages of support can be as effective as medication and therapy, life can become more manageable. I began by talking to someone who I didn’t even know about my problems as I felt like that would be easier for me. Below are just a few of the multiple lines of support open to us:

HOPELineUK - T:0800 068 41 41, SMS: 07786 209 697, E: pat@papyrus-uk.org (Mon-Fri 10am-10pm, or weekends 2pm-10pm)
NHS 111 - T: 111
Samaritans - T: 08457 90 90 90, E: jo@samaritans.org (24 hours)

When you feel strong enough, take a step and trust in your friends; open up to them. When you feel even stronger, encourage someone who suffers from similar issues to do the same. The only way to make people understand mental health, and a very effective way of dealing with mental health issues, is to talk.


Don’t suffer in silence.

Thursday, 13 August 2015

Funding Support for Students with Mental Health Difficulties

- Nicola Byrom; @nicolabyrom

A report has been produced for the Higher Education Funding Council for England (HEFCE): Understanding provision for students with mental health problems and intensive support needs. It considers the recent dramatic increase in demand for mental health services among university students and how these services are currently funded and provided. The report comes at a time of imminent changes to government funding for disabled students. The government is instigating changes that will mean that Higher Education Institutions (HEIs) will be expected to provide a greater level of support to students, in line with reasonable adjustment expected under the Equality Act, while government funding (through the Disabled Students Allowance, DSA) will focus on support provision for those with greater needs. This may provide an opportunity to improve how support for students experiencing mental health difficulties is provided and funded. However, the report suggests that no one really seems to know what implications these changes will actually have, either in the short or longer term.

I have summarised this report, to provide a concise overview, available here (http://www.studentminds.org.uk/dsa-consultation). In this blog I would like to share some personal reflections and concerns about the future of funding for student support. Through the blog I consider the challenge that linking funding for student support to long-term conditions creates for provision of responsive mental health services and reflect on the implications of limited NHS mental health provision for students and HEIs. 

Mental health exists on a continuum; we all have mental health and our mental health can fluctuate. However, the current structure of DSA funding cannot accommodate this fluctuation. While the report encourages HEIs to be proactive in their support for student mental health (through developing inclusive curricula and proactive measures, such as wellbeing and resilience initiatives), interviewees for the report reflect a combination of hope that the changes to DSA funding will help HEIs adopt a more social model of mental health and fears that it will push HEIs further towards a medical model of mental health. The social model of mental health proposes that individual mental health problems may have their root in social circumstances and experiences of trauma. The model recognises that anyone can suffer distress and repositions mental health as a social construct, not a purely individual concern. Currently however, even when informed by a social model, student services are “typically delivered on the basis of individual models… of mental health”.

As mental health fluctuates, I am concerned about the current situation of funding being linked to long-term problems. As one interviewee for the report highlights, mental health difficulties can be acute and require a rapid response “… it may be fine to wait 12/15 weeks under certain circumstances, but if you’re working with someone who is a young person who doesn’t have a lot of life skills, is away from home for the first time, that can be calamitous.” In the university environment, mental health can decline dramatically and have a substantive, negative impact on a student’s ability to study; “taking vulnerable people away from their personal support networks and then giving them a massive amount of academic pressure is ‘a potent cocktail’.’’

I arrived at university with a track record of mental health difficulties. I had experienced an eating disorder for years. I was however, very much in recovery. For me, I was doing very well. I did struggle. There were periods of time at university when I was self-harming to manage my anxiety levels. In my second year I started having panic attacks and developed an acute case of agoraphobia. I was fortunate to have a family who could support me and I left university early in the run up to a vacation to visit my family GP and take time at home to “unwind” and reset. Out of the university environment my anxiety subsided rapidly.

I did not hide my mental health difficulties. My friends and housemates knew that at times I was struggling and this in itself was helpful. I did not talk about my anxiety with tutors as it never seemed relevant, nonetheless, my tutors were incredibly supportive and intensive academic encouragement through my final year of studies had a very positive impact on my mental health. Could I have benefited from counselling or mentoring? Yes. I’m sure it would have helped. But for the university to have provided me with a mentor, I would have had to apply for the DSA. In my eyes, I was not disabled. Even in the depths of my eating disorder I would have found it difficult identifying as disabled. At university I would have said that I was simply adjusting and learning to manage my mental health.

Funding to support students with mental health difficulties is currently linked to the DSA and the Equality Act, which requires reasonable adjustments to be made to ensure that individuals with a disability have equal access to education. I understand that disability is defined as an enduring condition, spanning years. However, from my own experience, I am fundamentally uncomfortable with conceptualising mental health difficulties as disabilities. Tying mental health to the framework of disability seems to suggest that mental health difficulties are long-term, if not permanent. This is in direct contrast with recovery models that focus on change.

According to the report demand for mental health support has increased. However, by linking mental health difficulties and disability, capturing this demand is challenging[1]. Across all institutions, the portion of students who have declared a mental health problem is 1.4%. This is a dramatic under-representation of the number of students experiencing mental health difficulties and there is an awareness that more needs to be done to encourage students to disclose. 1.4% needs to be viewed in context; within a year 25% of British adults will experience at least one diagnosable mental health difficulty and at some universities, counselling services are seeing nearly 10% of the student population.

The discrepancy in these numbers is important because the funding that a university receives to support students is linked directly to the number of students receiving the DSA. There is a huge gap between the number of students experiencing mental health difficulties and the number receiving support through the DSA. To receive the DSA, a student experiencing mental health difficulties has to recognise and accept this. They then have to identify themselves as disabled and choose to disclose their mental health difficulties as a disability. This is challenging enough. However to claim the DSA a student’s mental health difficulty has to have a long-term adverse effect on his or her ability to carry out normal day-to-day activities or study. Long-term here is defined as a problem that has persisted for over a year. As such, of the small proportion of students who have declared a mental health difficulty, only 33% receive the DSA.

So the question to ask is how are universities funding support services for student mental health? Student Services, including counselling services, are funded by core university funding, including student fees and funding from HEFCE in the form of the Student Opportunity disability allowance (a non-ring-fenced allocation of funding linked to the number of students claiming DSA). The report identifies that institutions are topping up funding from the SO disability allowance by £2 to £5 for every £1 received.

It could be argued that as HEIs are institutions for education and not health care, they should not be expected to provide any form of counselling or support beyond that provided for students in receipt of the DSA. After all, students should be able to access support for mental health difficulties through the National Health Service.

However, mental health has an effect on ability to study. A recent study found that, of the students attending one university counselling service, 92% identified themselves as having problems with their academic work. Of those students, interviewed on conclusion of counselling, 67% considered that it had been important in enabling them to address those issues. Further, acute mental health difficulties, if not addressed quickly, can have a substantive impact on a student’s ability to study, having a direct influence on the HEI’s ability to meet its responsibility regarding education. One GP points out that if a young adult loses three or four weeks of their academic year, they will struggle not to slip back a whole year if they have problems. Students usually have to wait 12 to 14 weeks for mental health support through the NHS.

The report identifies that HEIs see their responsibility around mental health as helping with academic management, offering short-term support around managing the impact that a student’s condition has on their studies (or longer-term support supported by DSA funding). HEIs rightly state that they are not a ‘therapeutic community’ or the ‘5th emergency service’. While they are not a medical service and cannot provide medical support to students, they are often left providing ‘holding support to students.’ Extensive waiting lists within the NHS are leading some GPs to “refer individuals back to their HEIs for support.”

This echoes concerns that Student Minds has been raising through the Transitions Campaign regarding health inequality experienced by students, due to a lack of recognition in the NHS about the needs and circumstances of students regarding mental health. The NHS mental health provision is predicated on people living with their family and having support at home. “There is somehow the belief that we’re a therapeutic community and one of the discussions I’ve had repeatedly over the years with psychiatric units, with psychiatric teams is, would you have discharged this individual to a bedsit in the centre of the city? And if their answer is no, then why have they discharged them in exactly the same way to the university?”

In 2014 the government published a policy paper, “Closing the Gap: Priorities for essential change in mental health” and the then Deputy Prime Minister hosted a conference. This gave me the opportunity to ask why students, as a population at high risk of developing mental health difficulties, did not feature once in the paper. In reply, the Deputy Prime Minister asked “surely the provision of support for students is the Universities’ responsibility?”

It seems, from the recent report for HEFCE, that universities are picking up this responsibility, holding and supporting students who should be seen by the NHS, despite the universities’ firm belief that they are not a medical service. Universities seem to be providing this relief to the NHS without any related government funding, and a recent study demonstrates that University support services really are masking a substantive gap in primary care provision. The study compared students attending counselling services at 11 universities with a similar non-student population receiving primary care services. The study found that university counselling services deliver a service to people who closely resemble NHS primary care service users in terms of severity and the risks that they pose to themselves. They concluded that, student counselling services are “providing considerable relief from a potential additional burden on primary health care.”

The report reflects considerable frustration on the part of GPs. The Student Health Association, the national  body representing health professionals that work with students, are currently working with NHS England to try to find a better way to fund young people’s health through a national approach. In a climate when the NHS and universities are under more pressure than ever and the government is making decisions about the resourcing of mental health services, it’s crucially important that students are fully represented in the discussion. In recent restructuring of Student Services, some universities, including the Universities of Leeds and Southampton, have bought mental health services (IAPT) onto the university campus, creating explicit links between services provided by the University and by the NHS. This seems to be an interesting way forward.

I would like to side with the hopeful; staying optimistic that changes in funding will help HEIs adopt a more social model of mental health, creating more space to support the fluctuations of health. I hope that the fantastic work that Mental Health Advisers have done over the recent years will continue to be developed and built upon and that HEIs can support those with long-term conditions to thrive, whether they identify as disabled or not, while also increasing capacity to reach out to those experiencing acute difficulties.

Student Minds are interested in hearing your views on the findings of this report and want to better understand the direction that various stakeholders in the sector believe support for students should be heading. Today we’ve launched a consultation and invite any students, staff, health professionals or other concerned parties to share your views: www.studentminds.org.uk/dsa-consultation





[1] The report acknowledges that mental health, as a subset of disability, has received limited research attention leading to a general lack of data and understanding.