Students chatting

Steve West, Vice Chancellor of the University of the West of England and Chair of the West of England AHSN, outlines the challenges facing universities around student mental health, and how harnessing the expertise of the AHSN is helping to develop solutions.

In my day job leading a university, I see the mental health and wellbeing of students as one of the biggest issues facing higher education today. The demand for services amongst students is increasing year on year, just as it is in the general population. We shouldn’t be surprised by that – one in four adults experience poor mental health. Half of those people will be identified as having mental health issues by the time they are 14, and by the time they are 24 that will have risen to 75%. So the demands on my institution, other universities and the NHS continue to grow.

Working with students also presents a particular set of challenges. Firstly, they are transient. They move between home, university accommodation and onwards, but our health system wants them to have a single GP to act as a gatekeeper to services. Secondly, we know they access services and support in a fairly random way.

Students can access acute services directly, enrol in cognitive behavioural therapy (CBT), use apps to support their health or access services from third sector groups. This is all in addition to any services they may access through a GP. There is also a lack of evaluation of many of the apps and pathways they using. The result of this increasing demand and complexity of pathways could be a perfect storm – you can see why universities are concerned.

This sort of complexity is something I’ve encountered before working with the AHSN. The work we’ve done leading the spread and implementation of tools like NEWS and NEWS2 could provide some valuable insights here. So I wondered if it would be possible to bring the AHSN’s ability to navigate complex pathways and find innovative solutions to bear on this knotty issue.

One of the first issues we have is defining the challenges we are trying to overcome. For instance, the tendency of students to move between locations and services means data sharing is a real challenge. Through the AHSN I can see that there is some great work being done around Local Health and Care Records, but the complexity around this issue is undeniable.

Another issue occurs around handovers of care. Currently we don’t have a universally accepted assessment tool. So when a patient is referred from one service or clinician to another, the receiving service don’t necessarily accept or trust the assessment they have been given. Again my work with the AHSN has shown me this can be overcome with innovations like NEWS2, where universal acceptance of the NEWS score and a shared understanding of how to use this to track deterioration have led to really significant improvements in patient safety.

We don’t yet know what the solutions will look like, but are starting to explore some of the possibilities. For example, one idea of a way to deal with complexity of data sharing has been learned from another of the AHSN’s key areas of experience – maternal and neonatal care. The traditional, simple solution to sharing infants’ notes is that they are kept by the mother, the old red or green book.

So we are wondering, can we come up with a way that students can take control of their own records? Smartphones are near universal amongst students, so could we develop an app or portal that allows them to carry around a record of their interaction with services? Many already use health and lifestyle apps to track activity or screen use, so it may be possible to integrate elements that encourage students to make lifestyle choices that protect their mental health.

If we can start to apply our learnings and put all this together the possibilities become really exciting. There is undoubted complexity in bringing all the service providers together here, but collaboration is what the AHSN does best. If we harness the power of collaboration and work with designers, clinicians, developers, students and many others, we have the chance to co-design something that could be revolutionary.

The sort of solutions we are looking at will also help move interventions upstream, hopefully enabling students to manage their risk factors and take action at an earlier stage, in line with healthcare interventions more widely. If we get this right we will also be looking to work with schools and colleges and think about how it could provide support to adolescents and children.

It’s a huge project, massively exciting and a little bit scary. It will draw on some of what we have learnt from past projects and take us to places where we will learn plenty more. And if we get this right it could have a huge impact on workforces and communities and end up with a replicable and scalable solution.

We’re already engaging with other universities on this work, and there is a huge appetite out there. In addition, through the AHSN Network we have one of the most effective adoption and spread mechanisms of any healthcare system in the world, so there is real potential to create a system wide solution, one that could benefit millions of students ■


Funding from the Office for Students

The University of the West of England, in partnership with other institutions and supported by the AHSN has won funding for a project to understand and advance the impact of partnership to improve mental health support for students.

The scheme is part of a major collaborative programme launched by the Office for Students to find innovative ways to combat a sharp rise in student mental health issues and spark a step-change in student support across the country.

The project aims to improve care for students in need of mental health support through the development and evaluation of local partnerships between universities, the NHS and student unions connected together through a National Learning Collaborative.

Read more in our Innovating Together magazine – a look back at the work of the West of England AHSN in the year 2018-19, and a look ahead to some the work we have planned. Download it here as a PDF or read it below via Issuu