Contents

1. Introduction.

  • What is meant by the term“mental health difficulties”?
  • Indicators of possible difficulties

2. Legal responsibilities of the staff within the university

  • Duty of care
  • Confidentiality & data protection
  • Disability Legislation

3. Cultural Issues

4. Identification of mental health difficulties

  • Declaration of need prior to entry
  • Identification of need post entry
  • Supporting a student in crisis

5. Taking time out

6. Supporting a student in crisis

7. Key internal referral contacts within the University

8. Responsibility

1. Introduction

Lancaster University’s mission statement includes the commitment to ‘provide the best support and facilities and to foster teaching, learning and research of the highest quality’.The university aims to provide a supportive environment that will help all students realise their academic potential and to successfully complete their course. In accordance with this, this document is intended to be a resource for all members of the university, on the basis that everyone both staff and students are involved either directly or indirectly in student mental health. It is hoped that in being accessible to students and staff it might encourage a co-operative approach between staff and students. This involves:

  • Recognition of boundaries and knowing where and when to refer on to other services
  • Treating each student as an individual
  • Empowering students with mental health difficulties to enable them to participate fully and successfully
  • Working towards a non-stigmatising community

What is meant by the term 'mental health difficulties'?

Within this document the term 'mental health difficulties' is used to cover a wide range of experiences which may affect anyone at anytime. When supporting a student with mental health difficulties the focus is best placed on how these difficulties impacton their ability to enjoy a full and successful student life, rather than on diagnostic criteria.

Students arriving at university have to learn to manage many changes including living away from home for the first time, managing on a budget, balancing academic study with social activities and for international students living in a different country and adjusting to a different culture. For most students these changes are challenging but exciting and are seen as part of the attraction of going to university. However, problems can occur which can give rise to anxiety.

Most problems can be solved quickly by talking to friends, family, tutors or other advisors and as such it is important not to label a normal emotional reaction as a mental health difficulty. However, a small number of students may experience difficulties which are more persistent and which impact on their ability to participate fully in higher education without appropriate professional support. Some students arrive at university with a preexisting mental health condition, either declared or undeclared, others develop a long term difficulty or a temporary but debilitating condition whilst they are here.

The Royal College of Psychiatrists Report 2011 states that students in Higher Education represent a unique group in the challenges that they face, for example:

  • an internet based survey of mental distress in students in four higher education institutions found that 29% described clinical levels of psychological distress
  • thetypical age of students is 18-25 years which is also the age associated with theonset of severe mental health difficulties such as schizophrenia and bi polar disorder.
  • 56% of young men who attempt suicide have employment or study problems (The Samaritans, 2008)

The onset of mental health difficulties may be associated with added specific stressors, such as;

  • Age related issues
  • Being away from home
  • Financial pressures
  • Study pressures
  • Sexual identity
  • Cultural differences
  • Work placements
  • Language difficulties
  • Increased consumption of drugs and alcohol

Indicators of possible mental health difficulties

  • change in work pattern, working longer hours or less hours
  • deterioration in relationships with fellow students
  • decrease in concentration
  • increased absence
  • increased lateness
  • risk taking behavior
  • increased drug/alcohol use
  • unexpected poor assignment/exam results
  • perfectionism
  • physical health problems
  • decline in physical appearance
  • weight loss
  • aggression/violence

2. Legal responsibilities of the staff within the university

As a member of staff either with formal pastoral responsibility for students or with direct contact with students during the course of your work, you may well encounter students who are suffering anxiety and depression, who are self-harming, have an eating disorder or who are experiencing suicidal thoughts. You could be the first person that the student has spoken to about how their experiences or you may yourself recognize that a student may require help. In these circumstances your input is vital in the student accessing the help that they need.

There are also a number of regulatory and legal reasons for mental health issues to be an important consideration for institutions. They are critical issues relating to access and retention which make it a concern for institutions to widen the range of students with disabilities/special needs who can attend and succeed. They include:

2.1. Duty of Care

The university may potentially owe a duty of care to students with mental health difficulties. This covers such areas as breach of contract, liability for negligence, standard of care and breach of statutory duty under such acts as the Human Rights Act, Data Protection Act, Disability Discrimination Act and Special Educational Needs and Disability Act.

  • AMOSSHE Guide to Good Practice Duty of Care document,

2.2. Confidentiality and Data Protection

The rationale for confidentiality is to encourage students to have the confidence and trust to seek appropriate help and to assist in identifying needs. Students need to know that any information they give will be treated with respect and that it will be passed on to only those who need to know. It is important that where consent is given by the student, it is informed consent. Therefore it is necessary to tell the student concerned why there is a need to disclose information, who will have access to that information and the likely consequences of giving or withholding consent e.g. explaining why academic work might be delayed. Once consent has been obtained, it is the responsibility of the person passing on the information to ensure that this is carried out only on the terms agreed with the student.

The basic principles of sharing information are:

  • Where information is recorded or shared, the terminology used must be agreed with the student and reflect needs as opposed to diagnosis.
  • If information is required by outside agencies (via phone, letter etc.), for example by social workers, psychiatrists or GPs, the rights of the student should be protected. Information cannot be disclosed to any third party unless the student has given consent for information to be passed to outside agencies. It is essential to clarify why the agency requires this information before imparting it, and whether it is pertinent and relevant to that student's care and treatment, or their safety or the safety of others.
  • It is not uncommon for some staff to be contacted by concerned parents or relatives. While it may be useful to provide a sympathetic ear, the institution’s normal position would be that personal information cannot be disclosed to parents/relatives without the consent of the student.
  • Disclosure of information can take place not only verbally or in writing but also as a result of papers left on a desk or through a computer screen left on in a public area. Under the 1998 Data Protection Act, all data relating to a person's physical or mental health is regarded as sensitive personal data.
  • The only exceptions to sharing information without consent are when there is a threat to personal or other’s safety or under legal requirements.

2.3. Disability Legislation

As everyone has a state of mental health, mental health issues, in the widest sense, are relevant to all sectors of society. Moreover, there have been several recent government initiatives in this field (e.g. National Service Framework for Mental Health) which apply to the whole of society of which the student body is a part. Legislation under the Disability Discrimination Act (1995) and Special Educational Needs and Disability Act (2001).

  • Disability Rights
  • SKILL,
  • QAA Code of Practice on Students with Disabilities,www.qaa.ac.uk

3. Cultural Issues.

Just as there is stigma attached to mental health difficulties in the UK, so in other cultures there are associated beliefs and values. The way that stress manifests itself is culturally acquired and we may not understand or be understood by someone from a different culture. International students may experience a period of cultural disorientation when they first arrive, the symptoms of which can appear to be very similar to mental health difficulties. As a consequence any suggestion to seek help from a mental health professional may be received as baffling or even insulting, if the person sees their problem in a different way. It is therefore important to avoid assumptions regarding someone else’s experience of their problem.

However, cultural disorientation may precipitate a previously undetected mental health problem and for this reason great care is required when assessing the student’s difficulties.

4. Identification of mental health difficulties

The identification of need is the starting point in the process of supporting students with mental health difficulties. This identification may come from a declaration prior to entry or may often arise post-entry.A detailed assessment of such needs would normally be carried out by a member of specialist student services staff with appropriate training and experience.

4.1. Declaration of difficulties prior to entry

  • Some students may have approached the university on their own initiative to discuss their needs or someone may have done so on the student's behalf (e.g. tutor, mental health service provider etc.) with the student's knowledge and permission. A declaration of a mental health difficulty may also be made on an application form.
  • It should not be assumed that, if a mental health difficulty is declared, there will always be needs relevant to student life or to the institution. A student may not wish any special arrangements to be made or even discussed.They may have their own support network through a Community Psychiatric Nurse, for instance, and wish to keep this separate from their student life.However, it may be possible to discuss with the student whether these links are in their view sufficient or whether they wish to have any additional support from within the institution. The student may wish to give their external support service (e.g. Community Psychiatric Nurse) some information from the institution about its structure, nature of course, support services etc in order for them to discuss strategies for student life. Where a student's external support has come from a different region, there may be issues around ensuring continuity with provision in the institution's locality, including effective referral in vacation periods.

4.2. Identification of needs post-entry

  • It is common for students not to have declared any mental health difficulties at application or prior to entry. This situation may be due to continuing problems over stigma and mental health in society.
  • The first time that a possible mental health difficulty or history of previous mental ill-health is identified is often in a chance conversation after entry or in the wake of a particular 'crisis' or time of stress, for example, at examination time. There are also often cases when fellow students, friends, housemates, family members or other members of staff detect a problem, which they may bring to your attention.
  • If you are concerned about the mental health of a student, you need to talk to him or her. Tell them clearly and straightforwardly that you are concerned and why, for example, they look sad all the time, they are missing lectures, etc. The student has the right not to discuss their experience but it is crucial that they are given the opportunity to do so if they wish. This may be much easier in the pretext of a regular meeting, with someone they trust, for example, with a personal tutor. Sometimes a simple question, such as "how are things going?" may be all that is needed to give a student the confidence to identify needs.
  • If you would like to seek advice or discuss the student’s situation with the service discuss confidentiality and seek consent from the student before you pass on information.
  • Suggest that help is available throughtheir General Practitioner (GP) and by contacting the counselling and mental healthservice via self-referral through the services web site at
  • A student may be anxious about making an appointment with a specialist service, so it may be appropriate for you to do it on their behalf if they are willing. Sometimes it may be appropriate to accompany them to their appointment if you can.
  • Acknowledge your personal feelings regarding mental illness and remember that most mental illness is by definition common, mild and treatable.
  • Know the limits of your expertise. It is not necessary to know what is wrong, only that something is wrong.

When a student does not want to talk

  • It may be extremely difficult to help someone with a mental health difficulty unless they are ready to acknowledge that they might have one. If the student is not ready to accept help or talk about their problem, do not ask insensitive or intrusive questions. Always respect the right of the student if they do not wish to discuss things. Offer an open invitation to the student to come back and talk to you in the future. Continue to ask how they are and reiterate that they can talk to you, when you see them again.
  • However, if you are still very concerned about a student who has refused help, contactthe Counselling & Mental Health Service for advice at or 01524 592690. A specialist perspective on the problem may be useful and it may enable you to better assess the situation. It is important to acknowledge that supporting a student with mental health difficulties can be extremely stressful and time consuming, which is why it is important to remember to look after yourself and seek appropriate support and help from others.

5. Taking time out

Although the university makes every effort to assist students with difficulties, they also have a duty of care to other students and to staff. When a student’s behavior causes significant distress to others the university may request the student takes time out for a suitable period of time to gain treatment and make a full recovery. This eventuality is covered in more depth within the Safeguarding and Fitness to Study Policies.

Students resuming their studies will only be allowed to do so when they have provided suitable medical evidence which demonstrates that they are well enough to return.

6. Supporting a student in crisis

Occasionally, a student may reach a point of crisis, and this section has been included to raise awareness and provoke thought about what to do in such a situation. However, it is important to emphasise that people experiencing mental health problems are very rarely violent towards others and crisis situations are also extremely rare and can usually be prevented. This highlights the importance of adopting a pro-active rather than reactive approach in the area of student mental health.

A crisis situation occurs when a student’s feelings have become outside their control. These emotions might express themselves in a number of ways, for example self-harming, talking about suicide or having persistent suicidal thoughts, having no sense of reality and exhibiting behaviour which is out of character. However, many crises occur in private rather than in public.These guidance notes may help you:

  • In all crisis situations, assuring your safety and that of others, including the person involved, is paramount.
  • Know the limits of your expertise
  • Try to remain calm and adopt a non-threatening approach (in most cases calm behaviour by others is all that is required). Do not approach the student from behind without warning, nor stare at them, as this could be interpreted as threatening.
  • If there are other students about, calmly ask them to leave the area.
  • Some situations can be very frightening and distressing. If you do not feel confident to approach the student, then go and get help.
  • If you stay with the student, give them personal space and do not touch them, unless you are sure that they do not feel threatened by you.
  • Explain your actions before you act and continue to reassure the student, without being patronising, about what is happening.
  • Take threats of suicide seriously - do not ignore them - it is a myth that 'those who talk about it don't do it'. Attempted suicide is far more common than most of us realise. The circumstances leading to a suicide attempt or a suicide can never be fully explained or understood. Quite often suicidal thoughts occur when a person is depressed and experiencing stressful events. For some people there is no apparent reason. Although most people who attempt suicide survive, a few remain at high risk of taking their own life for some time afterwards. Therefore, any suicide attempt, however, minor should be taken seriously.
  • Ensure appropriate people are contacted. If a student becomes severely disorientated or dangerous to themselves or others it may be necessary to call a GP, the local accident and emergency service, your institution's security or, if necessary, the police.

In all situations, whether they are crises or not, each case must be treated individually. A person’s mental health problems may fluctuate from week to week or even from hour to hour and the level of support needed will vary from person to person.

Usual boundaries regarding confidentiality may need to be broken. DO NOT promise to keep information confidential; instead discuss the need to involve other services. Do not contact friends and family unless specifically asked to do so by him or her.

Supporting students in distress