Implementing a whole-institution approach to mental health and wellbeing

In 2017 and 2018, there were several tragic student suicides at the University of Bristol. In response, the university, led by the Vice-Chancellor, committed to taking a whole-institution approach to mental health, wellbeing and suicide prevention. 

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What followed was the publication of comprehensive student mental health and wellbeing strategy, a suicide prevention sub-strategy and the overhaul of existing support services.

While there has been significant progress since the publication of these strategies, the university is clear that a process of continuous improvement is required to ensure services meet the needs of users.

A 2018 institution-wide survey of Bristol students found one in three had experienced a diagnosed mental health problem at some point in their lives. One in four students also said they didn’t have someone to talk to about their day-to-day problems.

That same year, Bristol’s Vice-Chancellor-led Mental Health and Wellbeing Taskforce conducted a comprehensive review of its existing support services and set about developing new dedicated strategies. This work culminated in the publication of the university’s new mental health and wellbeing strategy for students and an associated suicide prevention sub-strategy.

Importantly, the student mental health and wellbeing strategy was co-developed with input from staff and students who, as 'experts from experience', shared honest feedback, insightful comments, and many supportive and innovative ideas. The aims of the strategy included:

  • supporting students at key transition points
  • promoting healthy behaviour and positive mental health
  • delivering effective, wide-ranging and easy-to-access student support services
  • fostering strong partnerships with external organisations to support mental health and wellbeing
  • reducing the risk of student suicide.

What took place, what worked well and why?

The university initiated a total overhaul of the mental health and wellbeing support, including the introduction of 24/7 Residential Life and Student Wellbeing services to complement existing on-site student counselling and Primary Care services. These services are proactively supporting student wellbeing through transitions, inclusive community building and personal skills development, as well as providing individual support for students with additional needs.

Other initiatives included:

  • supporting key transitions: including providing students with: the option of disclosing mental health conditions prior to enrolment, online induction resources on how to stay well at University, community building and the introduction of a consent to contact policy (see below)
  • prevention: access to a Science of Happiness course, a harm reduction approach to drugs and alcohol and proactive work with groups at higher risk of mental health issues
  • early intervention: reducing the stigma around mental health, including convening a network of staff mental health champions, peer-to-peer support and thought leadership from the senior team
  • additional support: investing in its Students’ Health Service to provide extended same-day GP mental health appointments and specialist support for students who have complex mental health conditions that require longer term psychological intervention, plus investing in staff training to help colleagues recognise and respond to mental health problems and suicide risk
  • partnerships: working more closely with the NHS, other universities and relevant organisations across the local area
  • data and research: introducing an annual wellbeing survey to monitor and evaluate the impact of the initiatives as well as identify emerging issues, and funded research in student and young people’s mental health.
  • learning: reviewing any deaths or serious suicide attempts to understand if there is anything that could be done differently, or where good practice has been demonstrated. This requires the implementation of a robust monitoring and review system and involves capturing essential information and demographic, personal, academic or other pertinent information. This monitoring and review process is used by senior colleagues to develop recommendations to reduce future risk. By collating this and other sector data, the university also aims to help build a profile of vulnerability within higher education students, with a view to establishing mechanisms for identification, targeting support and developing appropriate support resources.

The commitment and leadership provided by the university’s senior team has been vital in driving the process of actively learning from past experience and in taking proactive and collaborative steps to further address this most pressing of issues.

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The consent to contact policy

When a student registers for their studies at the University of Bristol, and then at the start of each academic year, they can opt in or opt out of allowing the university to contact a designated parent, guardian or friend if it has serious concerns about their wellbeing.

Every student is an individual and their personal circumstances at the time are taken into consideration by professional wellbeing staff before the university uses the emergency contact details provided. Circumstances in which the university might inform the emergency contact include:

  • A student has attended or been admitted to hospital in an emergency
  • A student has suffered a serious physical injury, including self-harm
  • A student ceases to engage with their studies and the university has been unable to contact them
  • A student has not recently been seen in their hall of residence and the university has been unable to contact them
  • A student has an ongoing illness and they appear to be deteriorating
  • A student is experiencing a mental health crisis.

The university would normally tell the student that it intends to alert their emergency contact unless it is not possible to do so, or doing so would cause delay. Students are free to withdraw their consent at any time. However, the university may still decide to inform their emergency contact if it considers it to be in the student’s vital interests to do so.

The university’s Student Emergency Contact Procedure explains the situations when the university would get in contact.

What have been the barriers or challenges?

During the COVID-19 pandemic, the university was able to move many of its services online. However, the student wellbeing survey and other engagements have highlighted concerns about high levels of isolation and loneliness, the need to socially distance and isolate and the impact on social and extracurricular activities.

In response to these new challenges, the university has an additional focus of work on building community across the university and students’ union.  

Other challenges relate to potential confusion about the services on offer (e.g. wellbeing and counselling) and communication across a number of different support services which can result in a student needing to repeat their story several times. In response, the university has simplified access to services using a single point of access and moved to a shared computerised record.

The university’s significant investment in services has strengthened support for students in accommodation, in academic schools and through central support services. This has been evidenced in recurrent student wellbeing survey results, with increasing levels of satisfaction reported, increasing numbers of students coming forward for support and reduced waiting times for counselling services.

Unfortunately, students from marginalised groups, including ethnic minority, LGBTQ+, first-generation university students and those with a mental health diagnosis, still describe higher levels of anxiety and depression than their peers.

In response, the University of Bristol is working to further strengthen its Student Inclusion Service to ensure services are equally accessible and effective in supporting these groups. For example, it has supported students to create Black Men Talk, a peer support group for black male students and work is progressing to start a black women’s group. These groups are supported by staff at the university to help ensure students know when and how to seek specialist support. The university is also working with external partners, such as Nilaari, to provide culturally appropriate therapies for students for whom this may be more helpful.

The university is now in the process of refreshing its strategies and action plans. Importantly, this work will be informed by the findings of its student mental health and wellbeing survey, delivered in partnership with Bristol students' union.

This survey provides students with an opportunity to have a confidential and frank discussion about what the university offers and how it can continue to improve.

Could the approach be replicated?

  • The approach taken by the University of Bristol has informed national work in this area, including the Suicide-Safer Universities work, and has also been adapted by other institutions.
  • The active involvement and oversight of senior leaders within the university has been crucial, including the appointment of a Pro Vice-Chancellor for Student Experience and the ongoing engagement and collaboration with students and staff to constantly improve services.

Authors

Professor Sarah Purdy, Pro Vice-Chancellor Student Experience, University of Bristol

Professor David Gunnell, Professor of Epidemiology, University of Bristol

Further information

University of Bristol - policies and approach 

Suicide-Safer Universities guidance

Published 10 September 2021

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