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Revealed: York's crisis of mental healthcare

Open Door is popular but delivered mixed results. Better, and more widespread academic mental health training is needed.

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Image Credit: Joseph Silke

An investigation by *Nouse *has uncovered a crisis of mental healthcare at the University. Following interviews with dozens of students and staff, Nouse found that although York has instituted a training programme to enable its employees to pick up on issues and signpost services, that training is controversial and not universally implemented. Students inevitably get funnelled to Open Door, the standard counselling service, which can deliver mixed results. The University has denied that rising mental health numbers indicate it is not doing enough to support students.

Most students develop mental health issues in the first year, in spite of excellent support and entertainment throughout Freshers' week. The wide variety of activities for Freshers’ Week and the weeks that followed were intense and offered little downtime. Transitioning from that hectic pace to the relative calm of regular university life presents the first challenge for incoming students, and issues can develop after a “honeymoon period” once students have settled into their work-life balance.

Jack, now in his third year, found himself with depression for the first time in his life at the end of their first term, as deadline mounted and socialisation became less “structured”. For Jack, problems with mental health began developing after the second term. “If you'd said to me at the start of first year the situation I’d be in during third year, I would not have believed you.”

Whether due to academic, financial, or social worries, one in nine students at York will visit Open Door at some point in their university career, and those mental health problems are often not diagnosed early enough. Like many students before him, Jack had trouble identifying his condition early on. Another student said that it “never occurred” to them to label their suicidal thoughts as depression. As a result, neither immediately thought to apply for mitigating circumstances on the basis of mental health difficulties: a relatively common solution that *Nouse *found the university has offered over 1 000 students over the last five years.

Mitigating circumstances present new problems for students who believe they may be suffering, not least because of the complicated process of talking through problems in-depth with academics. The University does not maintain full-time mental health staff in departments, which is a problem considering its stigma, and other issues associated with the condition. Many students interviewed by Nouse spoke negatively about the perception of mental health at university. Jack described the pressure he felt to “not be crazy”, and deal with depression privately. Despite valuable campus awareness campaigns, mental health is still stigmatised in the UK as weakness or failure. This helps explain why mental health often goes undiagnosed, and many students make the tough decision to not raise

York’s solution
The poor state of York's mental health services first came under fire in 2016, when the University ranked dead last in The Tab’s rankings for student satisfaction with mental health. The survey also found that the University spent £174 per applicant to its service, well under the national average for British universities. At the time, the University responded by pledging half a million pounds to mental healthcare over the next five years.

York's management at the time were highly critical of The Tab’s research, arguing that it focused on counselling services instead of the “investment in a variety of University-wide activities”. Two years later, an anonymous YUSU source told Nouse that the University had nevertheless funnelled much of the funding increase into hiring more staff at Open Door: a fact a University spokesperson has now confirmed to Nouse, saying that the funding “accounted for an increase of staffing for the Open Door Team, this included two Open Door Practitioners, an Operations Manager, as well as [a] Link Practitioner to work across the University and Unity Health.”

Open Door’s budget has, as a result, increased by around 30 per cent annually over the last two years, to £566 000, and the majority of the students interviewed by Nouse reported positive experiences there. A report released to *Nouse *by a Union official showed that referrals get a response “fairly quickly”, and have their initial meeting within two weeks. Grace, who contacted Open Door after stress with her academic work, commented that Open Door was a helpful way to “get out of the house and talk to people” to combat the isolation and lack of motivation she’d been feeling for weeks.

Most meetings at Open Door are weekly, and allow students time to open up about their problems. Grace found that her initial “scepticism” broke down after the first few meetings at Open Door, that offered practical advice on topics like academic assistance, or medical diagnosis through the NHS. This is particularly important because the team are not clinically trained psychologists, but counsellors.

Open Door is not without its flaws, and it isn't a solution to all conditions: 40 per cent who use the service only attend one session. Its status as the most well-known system on campus for mental health issues often means it is used as a catch-all for many different difficulties, although students with more serious conditions can get left behind. When Jess’ boyfriend self-harmed over their relationship, they were both referred by a member of their college team. She later found herself re-assigned to another counsellor after the first seemed “out of her depth”. Jess was eventually dismissed after that member of staff deemed her to have a “pretty good handle on things”.

Another student stopped using the service after he felt Open Door were failing to take his alcohol addiction seriously, adding that it took him “years” to seek help again. In these two cases, NHS referrals would provide an eventual solution, but Open Door's well-known status prevented immediate action.

The Universit's support for increasing the Open Door budget shows a positive attitude, but the University has been criticised for not supporting or publicising other services sufficiently. Steph Hayle, the YUSU Officer for Community and Wellbeing, noted that there were alternative support services in York, but that many of them were “under-utilised”. She found in her conversations with students that once they had a bad experience at Open Door, attendees would not appreciate being “bounced around” the system, and would be unlikely to return.

Despite its reputation, Open Door is ill-equipped to deal with certain issues, and can have negative impacts on others. The solution, then, seems to be to better signpost students that are appropriate for them, and that means better training for academic supervisors so they can identify problems when they develop. Mental health, according to research by advocacy group Student Minds, is an “inevitable part of the academic role”, and therefore an element of University support that deserves better attention.

The current mental health training scheme for academics has been criticised privately by staff across the University. It takes one to two days, and is not compulsory (by necessity: training every supervisor would likely run costs into the millions.) Most departments have at least a few staff members with training, but this prompts concerns about the consistency of care to students: good mental health advice from academic supervisors can be a lottery. Student Minds commented that many academics had to draw “entirely from their own experiences”, and Jack made the point that it’s “extremely hard to feel empathy” for people struggling with mental health, if you have never experienced the problems yourself, and are not equipped with the correct training.

Nouse found inconsistencies with regard to mental health across University departments, due to the fact that most have substantial freedom in squaring their academic rigour with duty of care. Phil Lightfoot, a Senior Lecturer in the Physics Department, described Physics’ highly effective system. Although there is no expectation that academic staff act like “medical professionals”, 95 per cent of academic supervisors in Physics have undertaken mental health first aid training, and aim to be “sensitive” to student concerns.

The model Physics use was praised across the University by the staff and students that had used its services. Steph Hayle agrees. “More needs to be done by the University to train their staff on the wide variety of support services available”.

To pick up on issues even easier in the department, a tool called MarkBase tracks attendance, and students that show a dip are encouraged to meet with their supervisor to discuss issues and potential solutions. This ensures that leaves of absences are not used as a 'catch-all', and that students are obligated to keep in touch with their department. Finally, students that have pre-existing mental health conditions are specially assigned to supervisors that have “greater experience of students with those personal circumstances." Students can then ensure that their concerns are taken seriously when they arise.

Other departments are concerningly inconsistent. York’s Law school was highlighted by interviewees as having a particularly insensitive approach. The department demanded the submission of several similar module assignments over the same week, and one module leader is well-known for actively discouraging worried students from consulting academics on assessed work. This presented a clear barrier to allowing supervisors to recognise mental health issues, and made students feel “anxious, inadequate, and over-worked.”

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Changes needed?
For mental health signposting, it looks like better support is on the way. Steph Hayle is currently collaborating with the University on an online Mental Health Hub to educate students expected to arrive over the summer. Hayle explained that “the aim is to provide more streamlined access to services, and give students a better understanding of what services are available.”

All of the students interviewed by Nouse agreed that the University could do better to educate students on the symptoms of mental health, and on the services that York provides, from student-led services like Nightline to professional college tutors. Many suggested Freshers’ week mental health education sessions should be hosted similar to the ones provided for fire safety and sexual consent.

The University has defended criticisms in a statement to Nouse. “It is important to acknowledge that there is an increasing demand for support in relation to mental health nationally... The University is working closely with the Vale of York CCG and the NHS Secondary care provider”.

Another area for improvement concerns how students access support on the Heslington East campus. Langwith College President, Sally Marlow, spoke about “significant concerns” regarding provision of care to students there. The Open Door building is further away, which means crucial services, like the on-call duty practitioner, are harder to access. 350 students used this service last year: a mark of its importance.

Heslington East Chairs have also noted that the University's reforms have included abolishing the practise of using 24/7 receptionists for each college. This lack of dedicated support for the twin campus, mental health-related or otherwise, is extremely concerning in the light of rumours that new colleges will be added there in the near future, putting further strain on the existing service, which is currently centralised to one location in the Ron Cooke Hub.

By the University’s admission, college infrastructures are another crucial part of mental health provision. The investigation here revealed more inconsistencies: some students said that their concerns were not taken seriously enough by college staff. Furthermore, JCRs receive no formal mental health training. James College Chair Jack Edwards has noted that his college is changing that. One member of each of the college sport teams is now trained to be an “effective listener” for their peers; a programme that has received “excellent feedback”, and is now being rolled out in other colleges. James is also recruiting a graduate tutor next year with more specialist mental health training.

The general picture of mental health at York is one of optimism, but inconsistency. While some departments and colleges prioritise mental health support, others are clearly lacking. Beyond that, better signposting and education efforts could go a long way to improve the ability of students to get the support they need, and to ensure the University experience is as fulfilling as possible for all the students who attend.

Names have been changed, and quotes have been condensed and edited for clarity.
*If you have been affected by any of the issues raised in this piece, please seek help. Advice is available on the University’s signposting page at *york.ac.uk/students/health/help

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