Minimum Waiting Times for Mental Health

– Nicola Byron, Founding Director of Student Minds
Minimum Waiting Times for Mental Health
Speaking at the Liberal Democrats conference in Glasgow, Nick Clegg announced waiting time targets for mental health would be introduced by April next year. We are absolutely thrilled – this is one more step towards parity of esteem between physical and mental health.
Tracking and reporting waiting times and holding organisations to targets is absolutely vital for student mental health, where waiting times are the difference between successfully continuing with education and having to take time out. Students’ transient lifestyle, spending around 25 weeks of the year at home, away from University and their registered GP, creates real problems for accessing specialist mental health services and receiving good continuity of care. These problems are exacerbated by long waiting times. Due to high demand for psychological therapies, it can currently take months to progress up a waiting list to receive care.
Our transitions report, University Challenge, identified that it is not uncommon for students to reach the top of the waiting list in their university locality when they are back at home during the holidays or when they are about to sit university exams. If patients cannot attend the sessions assigned to them, they are usually dropped off the waiting list and required to go through the referral process again. A quarter of the students with experience of eating disorders surveyed in the University Challenge study waited more than 6 months for an appointment with a specialist service and on average students were waiting 20 weeks for an appointment. These waiting periods are particularly problematic, leaving students doubting whether they need treatment; as they wait, people lose the self-motivation that they need to fight towards recovery. The challenge of waiting times is not only felt by students. Over half of professionals we surveyed in the University Challenge project identified that they did not find it easy to refer students to specialist services and 96% felt that students do not get see by specialist care quickly enough.
It is imperative that we do not let students fall through the gaps. “Because the majority of serious mental illnesses present themselves by the age of 25, students are a particularly vulnerable group and are most in need of reliable, accessible mental health care,” says Seb Baird, Student Minds Volunteer.
To decrease waiting times, the government is going to have increase the availability of mental health interventions. The Health Foundation argues that this can be done effectively by changing the relationships between health services and those with mental health difficulties. A pilot peer support project at Nottingham NHS Trust resulted in a 14% reduction in inpatient stays, saving the trust around £260,000. Innovative steps like this can, and must, be used to help increase provision of mental health services, decrease demand for high intensity interventions, and cut waiting times.
Student Minds has been advocating the power of peer support for years. If you are interested in finding out more about the support that our programmes offer for students, please visit – http://www.studentminds.org.uk/find-support.html
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#StudentTransitions Campaign Success: Changing the shape of support for students

~ Dr Nicola Byrom, Student Minds Founding Director

I can remember moving to Nottingham as an undergraduate student. It was an exciting time, but it was also a nerve-wracking time. The move provided an enormous opportunity: a new beginning with new peers in a new city. That opportunity came with a pressure to make the most of it. This is a transition that thousands of young adults make every year and it is not an easy one. Today almost 50% of UK young adults enter higher education and 80% of them move away from home to do so. This move offers these amazing new opportunities, but means leaving behind all existing support networks.

A proportion of students will be experiencing mental health problems when they move to university and may be receiving support from mental health services. Despite being national our NHS cannot cope with an individual living in one area of the country and receiving support from a service in a different area of the country. Though there are fantastic examples of what can be achieved using modern technology (e.g. SHaRON in Berkshire), for the majority of students, as they register with a new GP in their university city, their support will need to be provided by a new mental health service in the new city.

The transition to university isn’t easy and so it would seem to be a time in a young adult’s life when they could really do with as much support as possible. When the care system in our country works, young adults experiencing mental health problems receive the support they need as they make this transition. Home mental health services can contact mental health services in the university town to formally hand over care and ensure that a care plan is in place so that continuity of care is achieved. This doesn’t always happen. I have heard so many stories of students who have been discharged from mental health services at home shortly before making the move to university, who are left struggling to get support at university. In worst case scenarios it can take the better part of an academic year before a student is able to be seen by the mental health services, by which stage the difficulties of transitioning to university are well past and a student will either have begun to settle into university or have dropped out.

I believe it is completely unacceptable for students to be systematically let down by health services at such a crucial time in their lives. At Student Minds we have been looking into this problem for some time now, trying to understand exactly why this gap in care arises. This research has been written up into our Transitions Report. We can identify two factors; it is often quite difficult for home mental health services to find and make contact with university mental health services and the mental health services in a university town may not be aware of the needs of students in their area. On the 24th of February 2014, we launched a petition calling on the Department of Health to ensure that mental health services meet the specific needs of students.

Cropped Photo with Norman Lamb

On the 13th of March I was able to meet with the government care minister, Norman Lamb, to discuss the needs of students. We asked Mr Lamb what could be done to ensure that mental health services had specific guidance about the needs of students. Today, services across the country are commissioned locally by Clinical Commissioning Groups, CCGs. While NHS England provides guidance to CCGs about the needs of many community and patient groups to help them commission appropriate services, no such guidance exists for students.

Our meeting with Norman Lamb felt very successful. Mr Lamb agreed to have brief put together by the end of April about the possible options for improving care delivered to students. We also set the wheels in motion for a meeting with NHS England to ask for this specific guidance to be written on the needs of students. While I’m optimistic about the possibility that improvements will be made for the provision of mental health services for students, we are continuing to call for support from students across the country. The challenges for student mental health provision have been raised before; this is not a new complaint! Though many professional organisations have discussed the challenges students face when transitioning to university many times, real improvements have not materialised.

Students need to get behind this call for mental health services that meet their needs. Today it is estimated that around 28% of students are experiencing clinically significant levels of psychological distress, but if students remain silent about limited services, services will never be tailored to their needs.

If you agree that students with mental health problems should be able to access support as they transition to university, please get behind our campaign. You can sign our petition at www.change.org/en-GB/petitions/doh-address-the-gap-in-student-mental-health-support. But please don’t stop there. Ask your friends, family and peers to sign the petition; your involvement can turn one signature into many. You can find out how to get more involved in this campaign on our website at www.studentminds.org.uk/transitions-campaign or by emailing campaigns@studentminds.org.uk.

#StudentTransitions: Improving support for student mental health

Later today Student Minds Founding Director, Nicola Byrom, and trustee, Eleanor Hambly, will be meeting with Norman Lamb to present our University Challenge report and petition. We’d like to thank all of you for your ongoing support, from taking part in the research surveys to responding to our consultation or signing the petition. In just over two weeks we have collected almost 1,500 signatures and we’ve been inspired to read all of your comments about why the campaign is so important to you.

With over a million students spending half the year at home and half the year at university each year, it is clear that we need to start responding more flexibly to the needs of a transient student population. We’re hoping that today’s meeting will mark the beginning of a series of changes to improve access to care for students across the country. Whether you’re a current or future student, a university or NHS professional, a parent concerned about your child or a member of the public who wants to help make a change, please join us by calling for this important issue to be addressed.

What’s the issue?

A postcode lottery for student support exists. Whilst there are some great examples of best practice in a number of larger university cities, in many parts of the country students are facing particular problems accessing support services. Of the professionals we surveyed, 92% felt that a student’s treatment is negatively affected by moving between home and university and 96% felt that students do not get specialist care as quickly as they would like. There are a number of issues at play, but a key problem is that NHS commissioners often aren’t aware of how many students are in their area and where they are at different times of the year, so many do not take this into consideration when funding services.

Cropped Inforgraphic

What are we asking for?

We’re calling on the Department of Health to support the development of best practice guidelines for all Clinical Commissioning Groups (CCGs) on how to support transient student populations. We have spoken to a number of CCGs that welcome further input in this area and are enthusiastic about improving student access to support, but central action from the Department of Health is necessary to help commissioners access the resources they need to make changes.

“My daughter is in her first semester of her first year at university… our experience is a disjointed, complicated, stressful and timely one, with my observation that I have provided the role of case worker to help join up the dots, communicate and facilitate her best use of the help that’s out there. I can see how a sufferer can very easily slip through the net without this support and motivation. Any change to address this would be helpful.”

Why students?

Today, 49% of young people enter higher education. According to NUS, 20% of these individuals are experiencing a mental health problem. In 2011, The Royal College of Psychiatrists called for NHS providers to ‘recognise and respond to the particular mental health needs of the student population and the difficulties that many experience in gaining equal access to services’. Our research has shown that this isn’t happening fast enough. Too many students are falling through the gaps between home and university support services, with their care being compromised by a lack of continuity and the need to go through a new assessment process and build up a new therapeutic relationship each time they move to a new service and see a different professional.

“It is hard for people with mental health needs to ask for help, even without the increased stress of being split between two locations, frequent changes of address and learning to do things for yourself (maybe for the first time in your life). Whether it is dealt with rightly or wrongly will impact the rest of their lives. Let’s give students the chance they deserve!!”

At the same time, students are particularly vulnerable to developing mental health problems and university can be an intense environment with significant academic pressures and expectations combined with the challenges of leaving home for the first time and living independently. If we can ensure that students have access to appropriate support early on then we can help prevent the development of longer term mental health problems.

Why now?

Over the past few months Clinical Commissioning Groups have been developing their local strategies. Their five-year plans will be signed off from April 2014, so this is a great opportunity for us to ensure that the particular needs of students are taken into account.

Transitions Campaign

What next?

Later today we will be meeting with Norman Lamb, the Minister of State for Care and Support, to present our research report and petition. We are hoping to secure a commitment to produce best practice guidance for supporting students in collaboration with Clinical Commissioning Groups, and to ensure that student needs are represented on CCG panels. After the meeting we will have a clearer sense of what action we can expect from the Department of Health on this issue. If the project goes ahead as planned, the next stage of the campaign will involve lobbying to ensure that local changes are being made, adopting a collaborative approach to benefit students across the UK.

Please show your support by signing the petition: www.change.org/en-GB/petitions/doh-address-the-gap-in-student-mental-health-support

You can find out more about the #StudentTransitions campaign on our website: www.studentminds.org.uk/transitions-campaign.

We all hate waiting…

~ Hannah Morpeth

People don’t like to wait at the best of times: whether it’s for Christmas, payday or the ever-growing queue at the Primark till, never mind when they are poorly. Waiting is rubbish, and yet with the increasing demand for mental health services, you may well find yourself on a waiting list for support.

Fear not though, here are a few tips to help you through the waiting period:

University can be as difficult a time as any to develop a mental health problem and if you are living away from home you may find that this makes it more difficult to access health care services. Nobody can give you the answer as to whether you should register with a GP surgery at home or at university – this depends on your particular circumstances, but remember that whichever you choose, you should still be able to access all of the same services as a temporary patient at the other location. Whatever your choice, I encourage you to be persistent with accessing mental health treatment. Get the ball rolling as soon as you notice you are having difficulties – it’s always good to be able to access support early on and there may be a bit of a wait to get active treatment and support.

University can prove to be really useful when it comes to this waiting period with help from student support and wellbeing. Have a look on your university’s website for information on what kind of support they provide. Most universities have some form of in-house counselling team which can offer forms of talking therapy and psychological interventions with relatively short waiting lists. Usually you are required to do some form of self-referral – lots of these are now done online – and you will be asked a series of questions about what you are struggling with and how this is currently affecting your day-to-day living. This will usually be followed up by an initial appointment in which the worker will discuss what they can offer you in terms of support: be it a group session, skills training, counselling or something such as cognitive behavioural therapy. In addition to this the university will have funds set aside for supporting students, which can be in the form of methods of recording lectures, a support for in your lecture, providing equipment and occupational support such as appropriate chairs etc. You are usually assessed for these to be put into place and may be required to provide medical information. Not many people are aware of how much a university can support you in this sense so it’s all about making students aware of their entitlements.

Use your personal tutor – yes that person who you see once in freshers week and then forget they exist for the next three years – personal tutors can be very useful if you are having a hard time, don’t be worried about ‘bothering them’, they have time set aside for supporting students. If your mental health problem is interfering with your studies it is definitely worth arranging a meeting with your personal tutor, as they can provide extra tutorial support in these circumstances, as well as pointing you in the direction of other entitlements. In terms of extra support, applications can be put in for personal extenuating circumstances. This can be when your mental health needs are affecting your performance, which could entitle you to extensions on written work or rearranging examinations. It is worth keeping your personal tutor up to date with the current situation/treatment you are receiving but do not feel like you have to tell them all of the ins and outs if this is going to prevent you from accessing support.

Remember that whilst many support services involve some form of initial assessment of needs, this is to help you identify what support would be most useful so please don’t let this put you off. It is always worth getting help early on and university support services are set up to see you as quickly as possible, so it’s a great first step to accessing support!

10 Ways To Get Involved…

1. Train to run a group or course:

Eating Disorder Support Groups: our eating disorder groups provide support and encouragement to students with eating disorders. The groups maintain a positive, pro-recovery focus and offer a confidential space to talk about life, university and whatever helps you keep your life on track.

Positive Minds Course: a six-week course for students with mild depression, covering topics such as building a support network, establishing healthy routines and exploring different relaxation techniques.

Supporting Supporters Course: a two-part workshop for those supporting a friend or family member with an eating disorder.

If you would like to set up a support programme on your campus, take a look at our website here.

Training

2. Campaign for change:

Lobby on a cause you’re passionate about and have your voice heard! We support a network of student-led campaign societies at 25 universities across the UK. Take a look at our website to find your nearest group. We offer training and support to all of our campaign groups – here are some clips from this year’s Student Minds campaign training! See below for further information for three upcoming campaigns which you might like to get involved in…

Look After Your Mate: We are developing an interactive online resource to encourage and support students to look out for their friends, covering everything from approaching difficult conversations to self-care. To ensure the campaign is focused on students’ experiences we need your stories! Tell us about how you have looked after a mate, or how a mate has looked out for you: you can share your story or find out about submitting a video blog here.

Eating Disorders Awareness Week: To mark EDAW 2014 we will be publishing a report on the effect of university transitions on access to eating disorder treatment and support. Following on from this, we will be launching a national campaign to call for integrated support for university students both at home and at university. More information coming soon!

Love Your Body: We want to get people talking about the things they love about their bodies, so why not start a conversation with your friends, share the campaign on Twitter or download our ‘love your body’ poster to start your own campaign on campus.

Love Your Body

3. Become a mentor:

Do you have experience that our volunteers could benefit from? Whether this is running a support group, campaigning or leading a team, it is always helpful for our volunteers to have support in developing their skills, problem solving and running a great project. See here to find out more about becoming a mentor for Student Minds.

4. Come along to our conference

We will be holding our fourth annual conference on 7th & 8th March – join us to find out more about the key challenges facing student mental health today. For more info and to register, see here.

5. Run an event or fundraiser:

Take a look at our fundraising pack, which includes lots of tips and advice on running a successful event.

Screen Shot 2014-02-18 at 21.49.02

6. Join our blogging team

Take a look through our blog for articles on university life and mental health. If you would be interested in joining our blogging team, go to our website for more information on how to get involved.

7. Send us your recipes:

Student Minds runs ‘The Kitchen’ recipe blog to provide quick & easy recipes for students and to support individuals in recovery from an eating disorder. We’d love your contributions to the project!

Body Gossip

8. Run your own Body Gossip On Tour event:

Body Gossip challenges common perceptions of body image, promoting the recognition and acceptance of natural bodies. Find out more about taking part in the project here.

9. Stay in the loop:

Sign up to our mailing list and join in the conversation on social media: follow us on Twitter, Facebook & LinkedIn.

10. Start a conversation about mental health:

Take a look at this article on having the confidence to talk.

What do you do for your mental health?

Here are some of our top tips…

  1. Get plenty of sleep (most people need around 7-9 hours). Take a look here for some tips on how to get a good night’s sleep.
  2. Go for a walk in the fresh air or do some relaxing yoga – it’s a great way to lift your mood!
  3. Write in a journal or chat to a friend about how you are feeling. If you’re worried about a friend, start a conversation – your understanding could be just what they need.
  4. Eat well – see here for lots of quick & easy recipe ideas for students.
  5. Meet up with friends or join a club. Take a look at your Student Union website for information on all of the clubs and societies on your campus.
  6. Volunteering is a good opportunity to meet new friends whilst learning new skills – visit your university volunteering centre to discover opportunities on campus and in the local community. You can find out about different ways to get involved with Student Minds here.
  7. Take time for yourself to relax and unwind: have a bath, meditate or sit down with a hot drink and a good book. Take a look at the ‘Be Mindful’ website for information on meditation and free online courses.
  8. Why not plan a short visit home halfway through term? Home comforts and the opportunity to see old friends can really help to leave you feeling relaxed and refreshed.
  9. Take a look here for some tips on managing your workload and studying effectively. Try working in bite-size chunks and take regular breaks.
  10. Don’t be afraid to ask for help. Problems with money, housing, relationships and studying are all common causes of worry, but universities have support services that are there to help you. Don’t forget to register with your local GP and make the most of support services on campus. To find out more about the Student Minds peer support programmes, take a look at our website here.

Closing The Gap

~ Nicola Byrom

I have been passionate about mental health for years. I think our society, today, has the opportunity to see a complete revolutionary shift in attitudes to mental health. The change is vital, but is the motivation there?

Most of our society is familiar with the statistic 1 in 4. 1 in 4 adults will experience a mental health problem this year [1] . 1 in 4 is also the number of people with a mental health problem that get treatment. Yes that is right. At the Deputy Prime Minister’s conference (20th January 2014) on Closing the Gap: Priorities for essential change in mental health, Nick Clegg set out a strong agenda for reaching parity between mental and physical health. Nick argued that we cannot have a stronger economy and fairer society without tackling attitudes to mental health. The problem still seems to be – how can we achieve this. As Graham Thornicroft [2] explained at the conference, 75% of people with mental health problems do not get treatment. This is despite the fact that we know that average life expectancy is dramatically reduced for men and women living with mental health problems; cut by 20 years for men and 15 years for women [3] . Can anyone even imagine this lack of treatment for a health problem with such an enormous impact on life expectancy?

Parity between mental and physical health needs funding. That funding has to come from somewhere. A medical ethicist at the conference noted that mental health “asylums” have been closed (a good thing, we might all agree) but the transfer of services to the community was less than perfect and the Department of Health is even now continuing to cut the number of beds on mental health wards. She asked Nick Clegg if he would be happy to specify which hospitals and which acute services would be cut to fund better mental health services. Her question was not entirely sincere, but it hits the nail on the head. We need a long hard look at how funding gets shared out within the NHS between services. This perhaps seems unlikely to happen as another individual noted at the conference that in December 2013, NHS England took £150 million out of the mental health budget to cover increased staffing levels in acute services.

There may however be a positive note to this question of funding. A representative from Clinical Commissioning Groups noted that CCGs were entirely on board with the mental health agenda and recognised that better (and more) mental health services needed to be commissioned. She asked for information – noting that her CCG needed to know what services worked. If she is to commission evidence based interventions, she needs the evidence. A short answer to this was provided by Lord Layard: why aren’t we using the NICE guidelines as standard? CCGs should commission services that meet the recommendations of the NICE guidelines. A longer answer should look at how the research is funded (after all, research is the generally accepted way of finding evidence based treatment interventions). In 2008/9 the Medical Research Council in the UK spent £24 million, 3.5% of its budget on mental health research [4] .

Nick Clegg recognised that there is a major problem with the transition between CAMHS (Child & Adolescence Mental Health Services) and AMHS (Adult Mental Health Services). CAMHS usually ends at 18. This is a time of major change for young people. Many will leave home and move to university or leave school and start jobs. With these upheavals in life, young people with mental health problems have enough going on without major changes in their service provision. Nick Clegg promised better support through this transition, but does this go far enough? Young people often can’t simply transition from CAMHS to AMHS because AMHS do not offer the same services for the same mental health problems as CAMHS. It is not surprising that so many young adults fall through the gap. And when the individuals are students and are moving to a new part of the country to study, it is even more likely that they will slip off the radar and be failed by the health service during what is likely to be one of the most stressful and challenging times of their life to date.

This gap needs to be taken seriously, but the agenda set out by Nick Clegg did not mention students once. The Royal College of Psychiatrists (2011) called for National Health Service providers to ‘recognise and respond to the particular mental health needs of the student population and the difficulties that many experience in gaining equal access to services’. I asked Nick Clegg why students did not feature in the new Department of Health priorities for essential change in mental health. Nick shifted responsibility from the Department of Health to universities, noting that universities have a duty of care for their students. Nick suggested that universities should be working closely with local health services to ensure that these services are meeting the needs of students. It seems that Nick Clegg would like me to hand this question over to the Rt Hon David Willetts, Minister for Universities and Science. I agree that pressure must be put on universities to step up to the challenge of mental health, but surely the NHS has some role to play in this transition?

The Rt Hon Norman Lamb however responded to my question later in the conference. He returned to his argument that “This cliff-edge must end – proper transition plans should be put in place, and our ambition is for this to be standard practice across the NHS. There must also be effective co-ordination between CAMHS and adult services, and a commitment to ensuring that the support given is always age-appropriate.” [5] Norman recognises the challenges that students face and suggested at the conference that serious consideration should be given to extending CAMHS to 25. Here here!