This brief discusses issues relating to mental health. If you are affected by any of the issues raised, you can contact:
The OfS cannot deal with individual cases from students relating to mental health or wellbeing. Students should be able to get help from their university or college through its student support services. Further information about support available through other organisations and services is listed at the end of this briefing note.
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The coronavirus pandemic has dramatically changed students’ day-to-day lives. Teaching is moving online, there are significant changes to assessment, and many students are no longer living in their term-time housing.
While the physical health and safety of students is critical at this time, looking after their mental health and wellbeing is also crucial in helping students to succeed and benefit from their higher education. In regulatory guidance published at the beginning of April 2020, we noted that ‘all students are likely to require increased pastoral support and resources to support their wellbeing’ during this period, and made clear our expectation that universities and colleges should take ‘reasonable steps to put in place equivalent alternative arrangements for such support for all students’.1
Staff in many universities and colleges have responded quickly to the need to deliver mental health support in different ways, and students and students’ unions are showing resourcefulness and resilience in helping their peers.
This briefing note looks at some of these ideas and practices. It does not stipulate particular approaches or endorse the actions of specific institutions, and it does not supplement or constitute regulatory guidance. Its purpose, rather, is to highlight the practical steps universities and colleges are taking to support their students’ mental health and wellbeing in challenging circumstances. In doing so, it considers how they are supporting the mental health and wellbeing of the general student population, students with a declared mental health condition and others who may be particularly vulnerable during this time.
Supporting the mental wellbeing of the general student population
Clear, easy-to-access and timely communications
All students will be facing additional challenges during the pandemic. They may contract the virus or have caring responsibilities for friends and family who fall ill. They may struggle to learn remotely or have financial problems. Some of them may be contributing to the frontline effort in hospitals across the country. Those who are still in purpose-built student accommodation may be concerned about the risk to their health of sharing communal areas. Students in their final year may be facing the most challenging graduate jobs market for a generation. Postgraduate students may have had to make significant changes to their programme or to pause research activity.
Supporting student wellbeing can start with the provision of clear, accessible and timely communications – about new arrangements for learning and teaching, changes to assessment, adjustments to accommodation costs (for students living in university or college accommodation), and financial aid. Universities and colleges are working with their student communities and students’ unions to understand what questions students want answered and to ensure that their communications are relevant, appropriate and accessible to the whole student population. For example, the Royal College of Art is carrying out engagement through established staff/student relationships, particularly where this has been requested by individual students. To enable non-specialist staff to provide appropriate support, additional mental health guidance has been issued to academic and other staff.
Adapting delivery of mental health and wellbeing support
Many universities and colleges are adapting their existing mental health and wellbeing support services to meet the needs of their students during the pandemic. This has included moving face-to-face services online or via phone, expanding existing digital or phone services or procuring new services. Although these changes have needed to be implemented quickly, it has been crucial for universities and colleges to continue to ensure the quality of their service through evidence-informed practice and clinical validation wherever they can, and to evaluate responses to understand impact.
As with the broader shift to online learning and teaching, sudden changes in modes of delivery could affect different groups of students in different ways. For example, some students may not have access to a computer or reliable internet connection – this may make it difficult for them to receive online support. Disabled students who receive additional support on campus may not be able to run specific software programmes if they are no longer on campus, and some may have additional needs which cannot easily be supported through digital delivery. International students who have returned to their home countries may find it difficult to access mental health and wellbeing services that are being promoted through social media platforms.
Adapting existing early intervention systems
Changes to the delivery of academic and pastoral support mean that universities and colleges can no longer rely on their established systems and processes. Student engagement analytics based on lecture attendance or library usage – which can be early indicators of student disengagement and mental health issues – cannot be applied as they were previously. However, subject to addressing security and privacy concerns, virtual attendance and engagement can still be monitored. Universities and colleges are thinking about how they can adapt their systems so that they can continue to identify early warning signs that a student may be struggling with their mental health.
Similarly, recommendations for building and sustaining good mental wellbeing through exercise or socialising with friends cannot now be facilitated in the same way following the closure of university and college sports and social facilities. Many universities and colleges are working with their students’ unions to offer alternative forms of wellbeing support.
University of Sussex: Wellbeing ‘What’s On’
‘Caring for You’ has been created on the university’s student webpages as a ‘go to’ place for students on wellbeing matters. It includes videos and curated articles to support psychological, physical and spiritual wellbeing. A page with links to activities and advice for self-help during the coronavirus lockdown and self-isolation has been developed.
A timetable of activity provides a snapshot of the Wellbeing ‘What’s On’ offer. The wellbeing offer runs alongside online teaching and learning activities, and care has been taken to ensure students are not overwhelmed by a plethora of activities and opportunities.
Website usage statistics for the mental health pages show continued uptake by students, with noticeable peaks on Mondays and Fridays.
The university is collaborating with its students’ union to support students still resident on campus, including through a buddy scheme, a virtual language café for international students, and a forum to exchange recipe ideas.
Support for bereaved students
Some students may lose a family member or friend during this period or become a victim of coronavirus themselves. Universities and colleges are needing to be ready to respond to bereavement and student death, for example by:
- ensuring their bereavement and student death policies are up-to-date and capable of responding to the exceptional circumstances of the pandemic
- having appropriate grief support in place for bereaved students, including through signposting to external support. During this time, there are further considerations to ensure that support is responsive to the additional challenges of suffering bereavement during the pandemic, for example social isolation, and restrictions on hospital visits and funeral attendance
- considering the administrative burden of their policies on bereaved students during the exceptional circumstances of the pandemic, for example requests for a GP's letter or a death certificate as evidence of mitigating circumstances
- being attentive to international students whose home countries may be at different stages of pandemic outbreak and response.
Supporting students on campus
Universities and colleges may still have relatively high numbers of students remaining on campus and using student services. Many have been carrying out assessments to understand what services they can continue to provide in the circumstances, and the specific needs of those students remaining on campus. In doing so, they have had to be mindful of the health and safety and basic access needs of staff and students when delivering support.
The OfS has produced a briefing note on student accommodation during the pandemic2 which includes case studies showing how universities and colleges are working to address issues such as safety and wellbeing for students still living on or near campus.
Cardiff University: Student Check-In Service
The Student Check-In Service is proactive in contacting and staying in touch with students during social distancing, to prevent feelings of loneliness and detachment from the university. Students use online forms to explain their circumstances and where they are, and those remaining in Cardiff are prioritised. Volunteer staff call students using Skype, phones and Microsoft Teams to engage students from home; they work from scripts and have the option to refer students to professional support services.
The scheme was set up on 18 March – within two weeks of being conceived – and had reached over 8,000 students at time of publication. With its own reporting framework, management information, risk assessment, data protection processes, reports and monitoring, it allows the university to monitor and respond to trends in student issues and needs.
Supporting the mental health and wellbeing of students most vulnerable to the impact of the pandemic
Some groups of students may be particularly exposed to mental health and wellbeing problems during this period, both during the coronavirus pandemic and beyond. These groups include:
- Black and minority ethnic students: Early research indicates that minority ethnic groups are at greater risk from coronavirus and its impact3 and there have been reports of race-based hate incidents which are linked to coronavirus.4
- Care experienced students and students estranged from their families: These students may have less support than their peers and face greater financial difficulties. They are also more likely to be in student accommodation, with no alternative options, and face uncertainty about accommodation over the summer months.
- Carers (longstanding, and those with caring responsibilities during the pandemic): Students may have taken on additional caring responsibilities for family members or friends – for example, those who are self-isolating because of existing health conditions or possible exposure to the virus. Students with children are likely to have less time to study as a result of school and nursery closures and reduced childcare support from family and friends.
- Disabled students: Some disabled students may have to self-isolate for the duration of the pandemic and may struggle to meet their medical or everyday needs. Those with existing mental health conditions may find their conditions exacerbated by the pandemic. Some students may not have previously declared their disability, including mental health conditions, but may now be experiencing barriers specific to their impairment(s) and coronavirus.
- International students: Some international students may have intended or want still to return to their home countries, but have been prevented by borders being closed or a lack of flights. Whether they have remained in the UK or have returned to their home country, they may experience heightened isolation, financial difficulties and worry about the safety and health of their family and friends. Some may also be more likely to experience race-based hate incidents during the pandemic.5
- Students experiencing domestic violence and abuse: The domestic violence support charity Refuge has seen an increase of 25 per cent in calls and contacts to its helpline since the UK entered lockdown measures.6 It may be difficult for these students to access a safe study space; those who are self-isolating may struggle to access support or escape abuse.
Regent College London: Student co-development of mental health resources
The college’s student body consists mainly of mature learners with significant responsibilities and other pressures. Through a coronavirus strategy group, and with collaboration with students, the college created an evaluation form for online learning after the first week of implementation. Students were able to give feedback on any additional support needed, such as academic and IT help, and suggest topics for COVID-19 information in the college’s ‘Mind Connect’ wellbeing app. This content, including signposts to useful resources, is co-developed with student focus groups and representatives. The feedback has also resulted in a weekly online mindfulness session for students and staff.
Students who have caring responsibilities or are key workers are offered reasonable adjustments, including extra hours with academics and wellbeing check-ins offering emotional support. The approach is continually adapted and enhanced based on student and staff feedback.
Tailoring mental health support to the most vulnerable students
While universities and colleges will already be engaging with students who are particularly exposed to mental health and wellbeing problems during the pandemic, others may not be known to them, for example students experiencing domestic violence and abuse or those with additional caring responsibilities. These students may be more difficult to identify due to lack of face-to-face contact because of new learning and teaching and residential arrangements. In these circumstances, making all students aware of support available to them and providing information about local or national support services or helplines becomes even more important.
Universities and colleges are considering how mental health and wellbeing support can respond effectively to the needs of students from different communities. This includes tailored support based on social, cultural and linguistic need. By engaging with students in vulnerable groups and relevant specialist organisations, universities and colleges can ensure that provision is appropriate and supports students with diverse values, beliefs and needs.
Bath Spa University: Supporting vulnerable students
Student wellbeing service advisers at Bath Spa University have contacted groups of students who may be considered vulnerable, including care experienced students, young adult carers and those estranged from their family. Key workers were assigned to determine where students would be staying and to maintain contact with them for the duration of the pandemic. All ‘students of concern’ have been contacted by their mental health practitioner or key worker to ensure any safety and action plans are updated to reflect the current situation.
Supporting the mental health and wellbeing of healthcare students moving into clinical practice
Some final year healthcare students may be moving into clinical practice earlier than anticipated to support the NHS. Other healthcare students, particularly student nurses, will spend more time in clinical placements than previously expected. Some healthcare students may not be taking up placements as they are at increased risk of developing complications from the coronavirus infection.
Working in clinical settings during a pandemic may have a negative impact on a student’s mental health. The reasons for this might include concerns about how they will be supervised, personal protective equipment, fear of catching coronavirus, trauma from dealing with death, stress, and post-traumatic stress.
Universities and colleges are identifying what additional and tailored wellbeing and mental health support is required for those carrying out extra clinical placements as part of their study. The NHS has also announced dedicated mental health support for all NHS staff. This includes online therapy and group counselling sessions.7 Practical and financial assistance, specialist bereavement counselling, and help with disturbed sleep will also be offered.
Keele University and Staffordshire University: Students on healthcare placements
Keele and Staffordshire Universities are collaborating on a project funded through the OfS Mental Health Challenge Competition, which includes refining referral pathways and strengthening relationships between higher education and the NHS.
The project is supporting a Student Mental Health Project Officer who, during the pandemic, has been working with student support services and academic schools within the universities, as well as NHS partners, to support students joining NHS frontline staff as nurses and paramedics.
The universities have been working to support these students to deal with some of the traumatic and challenging issues they may be encountering. Resources have been created with input from Keele University’s occupational health department for students preparing to go on placement. Information toolkits on the support available to students (from their university and other sources) have been developed for personal tutors. The toolkits also give advice on how tutors should be engaging with students.
The universities have also identified the importance of timely support. Many students are working 12-hour shifts outside of typical working hours. Additional support will be delivered by the universities for this purpose.
Supporting the mental health of students with declared mental health conditions
Equality Act 2010
Under the Equality Act 2010, universities and colleges have a legal requirement to make ‘reasonable adjustments’ for disabled students, including those with a mental health condition. The Equality Act stipulates that a mental health condition is considered a disability if it has a substantial, adverse and long-term effect on a person’s normal day-to-day activity. ‘Long-term’ is defined as the condition lasting, or being likely to last, for 12 months. Working with the affected students, universities and colleges will need to consider how these ‘reasonable adjustments’ may need to be adapted during the pandemic, and what new adjustments they may need to be put in place in order to fulfil their duties under the Act.
Changes to NHS support for students with mental health conditions
For students with existing mental health conditions, many of the approaches described above apply. However, they may be facing additional challenges in accessing NHS care for their conditions.
The NHS is trying to ensure continuity of care for those with mental health conditions. However, it is possible that some students may have had their NHS support changed or reduced because of resource pressures. Some may be experiencing longer waiting times for referrals and treatment. Many students who live away from their family home during term time receive care in their university or college location, but those who have now returned to their family homes will no longer be close to it.
In these circumstances, and taking account of the possibility of reduced capacity within the NHS, it is more important than ever for universities and colleges to work with NHS partners to ensure coherent and co-ordinated support for students with a mental health condition.
Continuity of care for students with mental health conditions
Universities and colleges may themselves be providing mental health support for students with declared mental health conditions, for example mentoring support, counselling or cognitive behavioural therapy (CBT), which they will now be delivering online or through a phone service. In doing so, they are focusing on:
- ensuring appropriate confidentiality in new, remote systems and processes
- ensuring staff are appropriately trained to provide emotional support online or by phone
- confirming with students whether they have a safe space to participate in counselling or therapy. This is of particular importance for students in vulnerable situations, for example students experiencing domestic abuse or violence, care leavers and estranged students, and LGBT+ students who may not be ‘out’ to others in their household
- considering alternative modes of support for students who may feel unable to participate in video or phone calls
- considering any legal implications in providing counselling or therapy to overseas students. For example, in the USA there are additional regulations for practising therapy in different states or overseas.
Looking ahead
The current focus for universities and colleges is, rightly, on the urgent and immediate needs of their students during the pandemic. They are also, though, beginning to consider what the return to study post-pandemic might look like and how it will be managed.
Some students may have experienced bereavement, serious illness or other traumatic events which trigger anxiety, depression or a condition such as post-traumatic stress disorder (PTSD). Different student groups will be impacted in different ways, depending on where they are in their higher education journey:
- New students: the transition from school to higher education in the 2020-21 academic year will be very different from the usual pathway. The closure of schools from March 2020 and the cancellation of GCSE, A-level and BTEC exams means that students entering higher education over the coming years may have missed out on key aspects of their academic and personal development. Some may struggle academically in their first term or beyond. This may be a particular issue for students from underrepresented groups, as much of their outreach activity will have been delivered in different ways during this period.8
- Current students: depending on how a university or college’s learning and teaching arrangements are running during the lockdown period, students may have missed out on academic learning or other student experiences. This broad group includes:
- Students returning from planned placement years, or years abroad, may have missed key elements of their courses.
- Healthcare students (non-final year) may experience significant changes to their clinical placements during the pandemic and beyond. Those undertaking placements may have been exposed to challenging and distressing situations.
- Postgraduate research students may have paused their studies, including because it has not been safe to conduct research activities.
- Graduating students are likely to experience high competition for employment, potentially the withdrawal of job offers and potentially delays to the start of postgraduate courses.
Given the disruption to normal study patterns, and potential longer-term changes to higher education as a result of the coronavirus pandemic, it is possible that universities and colleges will see new patterns in their students’ mental health and wellbeing emerge.
Conclusion
This briefing sets out some of the ways universities and colleges are having to change their provision of mental health and wellbeing support for their students. It has particularly focused on students who are most vulnerable during the period of the coronavirus pandemic and those with existing mental health conditions. It is not exhaustive, and student mental health and wellbeing challenges will continue to evolve as the pandemic develops. During and after this time, universities and colleges will no doubt continue to share practice, resources and evaluations within their networks and throughout the sector.
In order to support the sector in responding effectively to this unprecedented situation, we are working with sector bodies and mental health organisations to share practice, including robust evaluation to understand the impact of interventions and responses during this period. There is an impressive range of work being carried out by the sector to respond to the coronavirus pandemic and a wide range of support for students locally and nationally; we have included some links below.
As well as publishing this briefing note, the OfS has been:
- publishing guidance on our approach to the regulation of quality and standards during the coronavirus pandemic,9 including support for student mental health and wellbeing
- making clear how OfS student premium and capital funding can be used during this time, including to support student mental health where needed.10
Mental health and wellbeing resources and support
The NHS has provided guidance on mental wellbeing while staying at home.
The Mental Health Foundation has published guidance for looking after mental health during the coronavirus outbreak.
Mental Health UK has developed information and tips for managing mental health during the coronavirus outbreak.
Mind, the mental health charity, has developed information resources in response to COVID-19.
The Samaritans charity has published support content in response to coronavirus and provides a confidential phone service for those experiencing mental health difficulties.
Refuge provides specialist support to survivors of domestic abuse.
The UK Government has developed guidance for the public on the mental health and wellbeing aspects of coronavirus.
World Health Organization has published mental health and psychosocial considerations during the COVID-19 outbreak.
Student-focused mental health and wellbeing resources and support
Papyrus, the national charity dedicated to the prevention of young suicide. See their website for help and advice.
Student Minds, the UK student mental health charity, has developed information for the higher education community to look after wellbeing during the coronavirus outbreak.
Resources from university and college representative bodies
Association of Colleges, the membership organisation for further education, sixth form, tertiary and specialist colleges in England, has produced a coronavirus resource hub.
Guild HE, a representative body for 50 higher education providers, has developed general advice and guidance for members in response to coronavirus.
Independent HE, the UK membership organisation and national representative body for independent providers of higher education, professional training and pathways, has developed a coronavirus information hub for independent providers.
Universities UK, the representative organisation for 137 UK universities, has developed webpages providing information and resources on coronavirus for universities.
Resources for healthcare students and NHS workers
General Medical Council has published information for medical students, including provisional registration for those in their final year.
Nursing and Midwifery Council has provided a guide on common questions about their role as a regulator when it comes to coronavirus.
Student accommodation: information and resources
Further information and resources can be found in our student accommodation briefing note.
We thank those universities and colleges that provided case studies and interventions described in this briefing note. We are grateful to Student Minds, Universities UK, the National Union of Students, Unite Students, AMOSSHE and the OfS Mental Health Challenge Competition Network for sharing their ideas and insights.
The case studies and interventions described in this note have been developed at pace and have not yet been evaluated for effectiveness. They are offered in the spirit of sharing practice that others may find useful and applicable to their own contexts.
