PARTNERSHIPS FOR STUDENT

MENTAL HEALTH:

THE STATE OF PLAYDr Ron Alcorn,

Consultant Psychiatrist and

Royal College of Psychiatrists representative for

student mental health

Student Mental Wellbeing: Policy, Practice and Future Directions

February 13th 2015

Background – the HE student group

• Increased access to and participation in HE

• Research shows higher levels of stress and symptoms in HE populations compared with matched controls

• Widespread perception of an increasing range and severity of problems amongst students in HE

• New influences on mental wellbeing; impacts of social networking (positive and negative), information from the internet (eg; self-diagnosis), drug and alcohol patterns/access

• HE mental health epidemiological and survey information is often dated and limited

• Rapidly changing context calls for new and more sophisticated partnerships

Background – HE Support Services

• Pressure of numbers

• Greater complexity (and risk)

• Rising expectations

• Reduced resources

• Moves to shorter interventions (similar to trends in services generally)

• Broader range of interventions (alongside face-to-face, 1:1 work); information / bibliotherapy / internet-based interventions / groups / call-lines / remote (“Skype”) sessions

• On-campus Mental Health Advisors / Coordinators / Mentors / peer-led or mutual-aid services

• Wide variety of joint arrangements with other providers (eg;NHS)

Ideal service for HE students (or what would optimised partnerships look like?)

• Prompt, accessible, flexible, effective

• Accounts for adjustment and developmental processes (resists

“over-medicalisation”)

• Young person centred but working towards adult integration

• Flexible around the academic year and academic priorities

• Allows for diagnostic, therapeutic and prognostic uncertainties

Ideal service for HE students

• Targeted interventions for vulnerable groups such as international

students , those with pre-existing problems and possibly those with

strong family histories of mental health or addiction problems

• Offers treatments that don’t have a negative impact on learning or

performance

• Offers continuity throughout the period of being a student

• Handles transitions from “home” adolescent settings and into adult,

“real world” settings

and services that address ….

• Crisis interventions

• Autism spectrum disorders (Aspergers syndrome)

• Eating disorders

• Adult ADHD

• Emerging personality difficulties (emotionally unstable / borderline patterns and self-harm)

• Emerging major mental illness (bipolar affective disorders and schizophrenia)

• Anxiety disorders that affect study (OCD/social phobia)

and….

• Co-occurrence with specific learning problems

and…

• Use sensitive, “early intervention” methodologies

Services in the Local NHS

Services ‘at Home’

Services in the

Voluntary Sector/ Charitable Sector

Services in the

Local Authority/ Public Health

STUDENT IN HIGHER

EDUCATION

Partnerships with “home” services

• Adolescence into early adulthood is when many mental health problems first emerge, come in to “focus” and affect functioning

• Potential discontinuities for existing physical and mental health care in the move to HE

• Adult services may question existing diagnoses, have reduced access to effective treatments and medications and employ less assertive engagement models

• Transitions can be coupled with the student’s desire to “leave it all behind”, make a fresh start or exploit the “gaps”

• Transitions from other countries come with all the issues mentioned above along with stresses of acclimatisation/acculturation

Key priorities

• Timely flow of information / health records / liaison with key informants

• Information and preparation for the student and the family

• Introduction and orientation to the HE locality services (pre-entry “bridging”)

• Crisis and contingency plans

• Continuity across holidays / breaks

• Managing expectations

NHS - strategic context

• Health and Social Care Act 2012

• Clinical Commissioning Groups (CCGs) – led by GPs

• GP-leads for specific areas (mental health / young people), enhanced service arrangements for targeted conditions

• Creation of Public Health England (PHE)

• Allowing healthcare market competition / bidding and tendering for all services

• New combinations of agencies in new types of partnerships (many now non-NHS)

• New regulatory bodies (Monitor / CQC)

NHS – services context• Development of Primary Care for the local context / more creative responses

• Move to Primary Care Psychiatry (less emphasis on secondary care / improving access / reducing stigma)

• IAPT (Improving Access to Psychological Therapies) – stepped care models / other than face-to-face options

• Psychological Medicine / Liaison teams in acute hospitals (“RAID” models)

• Emphasis on recovery models / peer-led and mutual aid / service-user involvement / outcomes

• Retraction of some specialist functions/teams - absorbed back into the Community Mental Health Team (CMHT)

• Cuts to funding year on year

• Waiting lists / ever more stringent criteria / shorter packages of care

Local Authority - strategic context

• LAs now commission and administer Public Health functions

• Director of Public Health sits in the local authority

• Local responses to local needs

• Joint Strategic Needs Assessment (JSNA) – sets out priorities for funding and targets

• Health and Wellbeing Boards (multi-agency)

• Cuts to local authority and social care budgets

• Ring-fence taken off some budgets

Local Authority – services context

• Competitive bidding-tendering

• New combinations of agencies in new types of partnerships

• Services such as alcohol and drug / sexual health / smoking cessation / health campaigns have moved out of the NHS into the local authority

• These services vary in their knowledge of and preparedness for student health / mental health issues

• Opportunities exist for joint working / developing student-specific information / participation in Pubic Health-led campaigns (prevention, reducing stigma, health promotion)

3rd sector ,charities, student-led

organisations, independent sector • Expanding sector

• Innovative and responsive options and interventions

• Can be more flexible and responsive to student needs / feedback / co-production

• Ideally complementary but sometimes competitive

• Fears about short-term funding streams / impact of market economics on existing services / “following the money”

• In-house vs out-sourcing

• Specific local vs national focus

New Challenges / Opportunities

• Redefining CAMHS – increasing the age limit into the twenties (“adolescence is the puberty of the body, the twenties is the puberty of the mind”)

• Integrated Young People’s commissioning

• GP Choice agenda

• Portable / personal clinical records

• Personalised budgets / support for carers (Care Act 2014)

• New technologies

• Confidentiality-information sharing protocols / “network” protocols

New Challenges / Opportunities

• Time and trust to build collaborations, networks, joint protocols, pathways

• Mapping and keeping abreast of local services and mental health provision / avoiding duplications of service

• Fielding the frequent questions….“what to you expect us to do that you can’t?” / “don’t you have that in-house?” / “wouldn’t it be quicker if you saw them?”

• Jointly funded or shared posts / in-reach services

• New models (DBT / MBT – AMBIT) adapted for HE populations

• Regular network / liaison meetings / joint-training

New Challenges / Opportunities

• Developing new skills – lobbying, writing business cases

• Understanding other sectors’ priorities, language, funding

streams, funding timetables, opinion leaders

• Using research and grants to get new services and /or

improve the evidence base

• HE institutions sharing experience and practice models

Student Mental Wellbeing: Policy, Practice and Future Directions

February 13th 2015

• Reference

Royal College of Psychiatrists position paper

“Report on the Mental Health of Students in Higher

Education” – CR112 (2003), revised CR116 (2011)

and thanks to my colleagues at QMUL and in the London

Student Mental Health Psychiatry Network

ron.alcorn@eastlondon.nhs.uk