Let's Be Honest Report by ARU Students' Union

LET’S BE HONEST A REPORT INTO ARU STUDENTS’ EXPERIENCES OF MENTAL HEALTH

Author and Contributors Hannah Belcher is a PhD student and Associate Lecturer at Anglia Ruskin University (ARU) and The Open University. She is currently conducting research on Autism Spectrum Conditions in females and lectures in Psychology and Mental Health. She has appeared on BBC News and ABC Radio Australia, as well as in the New Scientist and The Psychologist. Hannah is the current President of ARU Students’ Union’s Disabled Students’ Society, and she has established art therapy groups for students facing mental health difficulties at ARU. She was recently awarded the Inclusivity Award 2017 by ARU Students’ Union. Hannah has written this report on behalf of ARU Students’ Union. ARU Students’ Union would also like to recognise the significant contributions by the elected officers and Students’ Union staff from academic years 2016–17 and 2017–18, including the design and delivery of the ‘Let’s Be Honest’ survey, the creation of the recommendations following the survey analysis, and the design and delivery of this report.

Contents Acknowledgements ....................................................................................................................................02 Executive Summary ....................................................................................................................................04 Introduction....................................................................................................................................................06 ‘Let’s Be Honest’ Campaign ...................................................................................................................07 The Survey ......................................................................................................................................................07 Demographics...............................................................................................................................................08 Findings............................................................................................................................................................10 Previous diagnoses of mental health conditions..................................................................10 Mental health concerns whilst at university...........................................................................11 Factors contributing to mental health conditions...............................................................14 Awareness of in-house support centres..................................................................................17 Use of and satisfaction with the Counselling and Wellbeing Service............................19 Preferences for support.............................................................................................................................21 Barriers to accessing support..................................................................................................................22 Discussion.......................................................................................................................................................24 Recommendations.......................................................................................................................................26 References......................................................................................................................................................30

Acknowledgments

Appendix 1.......................................................................................................................................................31

The Students’ Union is grateful to those who took the time to share their thoughts and experiences of mental health at university and contributed to the effectiveness of this research. They include the students of Anglia Ruskin University (ARU), ARU’s Counselling and Wellbeing Service, academic staff who have supported and promoted the campaign, and the National Union of Students.

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Let’s Be Honest

Executive Summary ‘Let’s Be Honest’ originated from Anglia Ruskin University’s (ARU) Students’ Union’s priority campaign in 2016–17, which focused on mental health. Amongst other successes during this period, they surveyed 1,736 students about their experiences of mental health whilst at university. The findings are presented in this report. This report contains a detailed and comprehensive account of student experiences at ARU. Some of the issues raised are part of a national problem; others are specific to ARU. Findings include: ..

less likely to know about all the university services on offer to students. ..

One-third of students reported having a pre-existing mental health condition. Females, students identifying as gay, lesbian, and bisexual, students with a disability, and students from the ALSS faculty were most like to report pre-existing mental health conditions. Over half of students were worried about their own mental health and/or a friend’s, and over a quarter rated their current mental health as bad or very bad. The majority of students taking the survey experienced stress, anxiety, and sleep problems whilst at university. Females, students identifying as gay, lesbian, and bisexual, students with a disability, students from ALSS and FST, undergraduates, and students working parttime alongside their studies were all more likely to experience mental health difficulties during their time at university. Two-thirds of students said that their studies had contributed to their mental health problems. Many students also reported that fees and finance, social isolation, and distance from family and friends were contributing factors towards their mental health difficulties. Students with disabilities were more likely to report that commuting and travelling distance, social pressures, social isolation, and bullying and harassment had been contributing factors towards their mental health difficulties. The majority of students were aware of their personal tutor/supervisor and the Counselling and Wellbeing Service. However, the majority of students did not know about other services, such as the Money Advice Service or Student Advisers. Distance learners were

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The majority of students who had used the Counselling and Wellbeing Service were satisfied with the service. However, those who had to wait a long time to be seen were more likely to rate the service poorly. Waiting times and availability of counsellors in the service were common concerns amongst students. Students prioritised wellbeing support from their family, friends, and doctor over services offered by the University. However, personal tutors and the Counselling and Wellbeing Service were ranked highest as the university services most often used for wellbeing support. Some of the reasons for students not accessing available support for their mental health included anxiety, concern for the confidentiality of support and the effects it may have on their course if others found out, feeling that their issues were not important enough, effectiveness of the support available, the waiting times and availability of that support, having the time and/or transport to go to appointments, and awareness that certain services even existed.

Key Recommendations put forward for ARU by ARU Students’ Union 1. Recommendations for University Policy and Strategy 1.1

Conduct an official university audit on student mental health in order to take active institutional responsibility for pastoral care of students.

1.2 Develop a mental health policy and strategy based on the recommendations of this report. 1.3 Integrate mental health into the widening participation agenda, including access agreements. 1.4 Nominate and support a University Governor to track ARU’s progress on improving mental health support.

2. Recommendations to Strengthen University Services 2.1 Develop a multi-service approach to mental health support and mental health issue prevention (e.g. library staff, security team, residential assistants etc.) and utilise a ‘triage’ system to reduce pressure on the Counselling and Wellbeing Service. 2.2 Protect the Counselling and Wellbeing Service from budget cuts and/or closure and subsequently increase the resources to the Counselling and Wellbeing Service to include the employment of three more counsellors. 2.3 Increase the resources directed to the Counselling and Wellbeing Service, specifically to include the ability to offer different types of intervention. 2.4 Increase the availability/flexibility of support from the Counselling and Wellbeing Service for students who are on placement, who are commuting from afar, or who have more intense course timetables. 2.5 Extend the Counselling and Wellbeing Service’s intervention blocks. 2.6 Explore investment into alternative online support for students. 3. Recommendations for Wider University Support 3.1 Make Mental Health Awareness/Mental Health First Aid Training compulsory for personal tutors/ supervisors and other ARU staff with regular student contact. 3.2 Give up-to-date and clear information to all students about the confidentiality of university mental health support.

3.4 Provide more information to all students before they start university and early on in their university career on the mental health support that is available, as well as targeting information towards vulnerable student groups. 3.5 Collect data through the registration process regarding whether students have pre-existing diagnosed mental health conditions. 3.6 Give students with prior mental health conditions the option to have an earlier induction and the option to move into accommodation earlier. 3.7 Extend the maximum nights that a parent/friend can stay over in student accommodation to two nights in every consecutive seven. 3.8 Ensure that students intermitting from their studies are set up with mental health support during that period if they need it. 3.9 Conduct research into ‘graduate depression’ to gain better understanding of the effects of the transition from university into employment on mental health. 4. Students’ Union and External Support 4.1 Work with ARU Students’ Union to run targeted mental health campaigns over key periods of the academic calendar. 4.2 Review accessibility of reporting sexual assault to Anglia Ruskin University and build links with the local Rape Crisis Centres for men, women, and non-binary individuals. 4.3 Advocate that students be able to register with a general practitioner (GP) both at home and at university.

3.3 Support the creation of peer support groups for vulnerable students with mental health difficulties.

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Let’s Be Honest

Introduction There is a growing body of evidence that higher education students are at an increased risk of mental health difficulties (Stewart-Brown et al, 2000; Roberts et al, 1999; Andrews and Wilding, 2004). A 2013 National Union of Students (NUS) survey reported that 80% of university students reported feeling stressed, 70% a lack of energy or motivation, 66% feeling unhappy, 55% feeling anxious, 50% having trouble sleeping, and 49% feeling depressed (NUS, 2013). A 2016 survey by YouGov further highlights the growing concern of mental health problems in university students. In their report over a quarter of students (27%) reported having a mental health problem; females and LGBT students were particularly vulnerable (YouGov, 2016). Of particular concern is the rate of student suicides, which has steadily been increasing (Office of National Statistics, 2014). A report by The Times (2016) demonstrated a 68% rise in the number of counselling service users at Russell Group universities since 2011 (Sandeman, 2016). Further data from the 2016 YouGov survey found that the majority of students (86%) were aware of mental health services at their university, and 18% of students had made use of these. Generally, satisfaction with these services was high, with 75% overall satisfaction (YouGov, 2016). Whilst running these services may be costly, supporting students with mental health conditions has been shown to improve retention and the associated costs that come with student drop-outs. A 2012 survey looking at the effectiveness of in-house university or college counselling at 65 UK higher and further education institutions found that 81% thought that the counselling they had received had helped them stay in higher education (Wallace, 2012). The 2016 Higher Education Policy Institute (HEPI) Student Academic Experience Survey found that 68% of students knew how to contact these services (Neves and Hillman, 2016). Freedom of Information requests by Young Minds revealed that 75% of mental health trusts, 67% of Clinical Commissioning Groups, and 65% of local authorities froze or cut their mental health budgets between 2013 and 2015, putting further strain on in-house university mental health services (YoungMinds, 2015). Currently the average counsellor to student ratio in UK universities is 1:5,000, which is three to four times lower than it should be (Brown, 2016). Anglia Ruskin University (ARU) has four counsellors, a ratio of 1:4,529. In response to these findings and concerns, HEPI have put forward a number of recommendations to improve the mental wellbeing of students and the management of support services:

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Allowing students to be simultaneously registered with a GP at home and at university.

Offering alternative appointment times if there is a clash with exams or study leave.

At universities currently spending the least, increasing (at least threefold) funding for counselling and other support services needs.

Encouraging universities to collect data and conduct a self-review of their mental health policies, before creating an action plan detailing what needs to be improved and how.

Ensuring vulnerable students on leave from studying have sufficient mental health care provision in place.

Providing robust support arrangements for students with a history of mental health problems who are studying abroad or on placement.

Providing training on mental health policy and awareness to all university staff.

Signposting reliable sources of information regarding mental health, for example the Expert Self Care (ESC) student app.

Ensuring more funding for mental health research, so that the new Office for Students (OfS) and other relevant bodies have robust data on the prevalence of mental health problems amongst higher education students. (Brown, 2016).

Recently the ARU Students’ Union worked with Alterline Research and eighteen unions as part of a joint venture to inform and enable a proactive response to the new National Student Survey’s Q26: ‘The students’ union (association or guild) effectively represents students’ academic interests’. A quarter of ARU students (25%) reported that they wanted the Students’ Union to campaign on mental health support in order to represent their academic interests. The purpose of this report is to look at the real-life experiences of students at ARU, their mental health and wellbeing, and the in-house services that are available to support them in order to establish and drive forward recommendations for change.

‘Let’s Be Honest’ Campaign The ARU Students’ Union’s strategic plan (2016–19) states that it will: ‘work to understand and improve the wellbeing and mental health of [their] students and propose universitywide actions to improve all aspects of student life’. The ‘Let’s Be Honest’ campaign was developed to address the ongoing challenges that mental health difficulties pose to students. The campaign aims to make ARU a community in which people care about each other by addressing the stigma around mental health, equipping students to support themselves and one another, and increasing the awareness and provision of available support. The campaign has three key objectives:

The ARU community will be educated about mental health issues and the services available to students.

2. Students will feel comfortable talking about mental health issues and will be equipped to support each other, creating a real ethos of care within the community. 3. The university will address, and change if necessary, their provision of services relating to the mental health of our students.

The Survey A survey was devised by ARU Students’ Union as part of their ‘Let’s Be Honest’ mental health campaign. It was emailed to all students at the university, as well as being promoted through social media, and throughout the two largest ARU campuses (Cambridge, Chelmsford). The aim of this report was to identify which groups of students within ARU were most at risk from mental health difficulties whilst at university, and also to identify the difficulties faced by students in accessing support and the effect this has had, as well as other aspects of university life on their mental health and wellbeing. We hope that by identifying these areas of concern we will be better able to put forward recommendations that will better support students whilst at university, and also generally

improve their wellbeing. In particular, the report allows us to better understand: ..

Previous mental health conditions of students.

Mental health concerns of students at university.

Factors contributing to mental health issues.

Awareness of in-house support services.

Use of and satisfaction with the Counselling and Wellbeing Service.

Preferences for support.

Barriers to accessing support.

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Let’s Be Honest

Demographics 1736 students completed the survey. Table 1 illustrates the demographic percentages of the sample. When compared with the whole of ARU’s demographic data, taken from the November 2017 Student Snapshot, the sample obtained for this current survey was fairly representative: ..

Gender: In 2016, 62% of all ARU students were female and 38% were male. The survey sample had 71.6% females and 25.6% males. Although this is a slightly higher number of females than in the general ARU population, females do tend to be more likely to fill in surveys. (Smith, 2008). Sexuality: 84% of students at ARU were registered as ‘heterosexual’, 2% identified as ‘bisexual’, 1% identified as a ‘gay man or woman/lesbian’, 10% preferred not to say, and 3% selected ‘other’. In the current sample, similar numbers of students identified as ‘heterosexual’ or ‘straight’ (80%) or as ‘other’ (3%). However, many more identified as ‘bisexual’ (9.2%) and ‘gay’ or ‘lesbian’ (3.9%). Ethnicity: The current sample was more biased towards students identifying as ‘white’ (74.1% compared to 60% in the general ARU population). Disability: A similar percentage of students in the current sample identified as disabled (11%) when compared to the proportion in the general ARU population (12%). Campus: 63% of all ARU students are currently based in Cambridge, 34% in Chelmsford, and 3% in Peterborough. The current sample had a slightly higher number of students based in Cambridge (68.4%) and a slightly lower number in Chelmsford (28.5%) and Peterborough (1.7%), although these differences are small.

Faculty: A similar percentage of students in the general ARU population and in the current sample are in the ALSS faculty (23% and 26.9%), FMS (10% and 7.1%), FST (28% and 29.6%) and FHSCE (25% and 27.5%). However, the current sample had a lower percentage of students in LAIBS than the general ARU population had (8.2% compared to 14%). Level of study: 71% of students in the general ARU population are studying at undergraduate level, 18% postgraduate, and 11% other. In the current sample, a higher number of students were studying at undergraduate level (87%), and a lower number at postgraduate level (11%) and other (2.1%).

Table 1. Demographics of survey respondents

GENDER

CAMPUS

Female

71.6%

Cambridge campus

66.4%

Male

25.6%

Chelmsford campus

28.5%

Peterborough campus

1.7% 1.4%

SEXUAL ORIENTATION Straight

80.3%

Distance learner

Bisexual

9.2%

FACULTY

Prefer not to say

3.6%

Faculty of Science & Technology

29.6%

Other

27.5%

Gay

Faculty of Health, Social Care & Education

Lesbian

1.9%

Faculty of Arts, Law & Social Sciences

26.9% 8.2%

White

74.1%

Lord Ashcroft International Business School

Black African

7.3%

Faculty of Medical Sciences

7.1%

Mixed

4.7%

Not sure

0.7%

Other

4.3%

Asian Indian

2.3%

Asian other

1.7%

Black Caribbean

1.3%

Asian Pakistani

1.1%

Asian Bangladeshi

Arab

0.7%

Black other

0.6%

Chinese

0.3%

Traveller

0.1%

RACIAL BACKGROUND

DISABILITY Non-disabled

86.4%

Disabled

11%

Prefer not to say

1.4%

CARING RESPONSIBILITY

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YEAR Undergraduate 1st year

43%

Undergraduate 2nd year

23.8%

Undergraduate 3rd year

19%

Postgraduate

11%

Other

2.1%

Undergraduate 4th year

1.2%

WORK STATUS Unemployed

44.9%

Working 11-20 hours a week

22.6%

Working 1-10 hours a week

18%

Working 21-30 hours a week

7.2%

Working 30+ hours a week

7.2%

ACCOMMODATION/DISTANCE In rented/privately owned accommodation

29.7%

No care responsibility

82.4%

In University accommodation

18%

Parent with children at home

12.5%

Commute 20+ miles

27.7%

Care of relative

3.1%

Commute 10+ miles

12.8%

Child at home and care of relative

1.9%

Commute 2+ miles

11.8%

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6) Preferences for support 7) Barriers to accessing support

Yes 33%

A third of students who took the survey reported pre-existing mental health conditions prior to coming to university (see Figure 1). By looking at the demographics which may be contributing factors (gender, sexuality, disability, ethnicity, faculty and level of study), we are able to suggest which students are more likely to come to ARU with pre-existing mental health conditions: ..

Females were 1.96 times more likely to report having a prior mental health condition than males; 35.6% of females reported having a pre-existing mental health condition compared to 21.9% of males, which was found to be a statistically significant difference. 51.9% of individuals identifying as gay, 58.1% of individuals identifying as lesbian, and 51.1% of individuals identifying as bisexual reported having a pre-existing mental health condition, which was statistically significantly higher than the 29% of individuals identifying as straight who reported having a pre-existing mental health condition. Individuals with a disability were 3.39 times more likely to report having a pre-existing mental health condition than those without a disability; 57.6% of individuals with a disability reported having a preexisting mental health condition compared to 28.6% of those without a disability, which was found to be a statistically significant difference.

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No 67%

12.8%

200

These findings suggest students who may be more vulnerable to having pre-existing mental health conditions (such as females, individuals identifying as gay, lesbian or bisexual, those with a disability, those identifying their ethnicity as white, and those from ALSS). It should be noted that these figures only represent those who have received diagnoses and those willing to report them. It may be the case that these students are more likely to seek help and/ or gain clinical diagnoses or feel able to disclose that they have them.

N on e

di so rd e

Ea tin

lin

’

Lo ne

io n/

ur nt ou t

‘b g

lin

Iso lat

sio n D ep re s

pr ob l

17.1% 9.7%

8.7%

When looking at the possible contributing demographic factors of the respondents (gender, sexuality, disability, ethnicity, faculty, level of study and employment), several statistically significant findings were made about which students were more or less likely to experience each of these mental health difficulties whilst at university:

Gender: Really good

Good

Average

Bad

Really bad

Females were 2.1 times more likely to report experiencing stress than males; 74.8% of females reported this compared to 58.6% of males, which was found to be a statistically significant difference.

Females were also 2.3 times more likely to report experiencing anxiety than males; 69.9% reported this compared to 50.2% of males, which was found to be a statistically significant difference.

Perceived Quality of Mental Health

Summary:

11.9%

200

19.8%

300

100

Figure 1. Percentage of students with and without a pre-existing mental health diagnosis

400

Figure 3. Number of students reporting different types of mental health difficulties whilst at university

500 400

39.1%

600

Mental Health Difficulties

44.7%

700

Previous diagnoses of mental health conditions

40.6%

800 700

46.9%

800

Fe e

5) Use and satisfaction with the Counselling and Wellbeing Service

51.4%

xie t

4) Awareness of in-house support services

39.1% of students studying in the ALSS faculty reported having a pre-existing mental health condition, which was statistically significantly higher than the 25.5% of FMS students, 34.7% of FST students, 29.5% of FHSCE students, and 21.8% of LAIBS students who reported having a pre-existing mental health condition.

1000

Sl e

3) Factors contributing to mental health difficulties

55%

2) Mental health concerns whilst at university

When asked if they were concerned about their own or a friend’s mental health, 28.6% of students said they were concerned about their own, 7.3% said they were concerned about a friend’s, and 22.5% said they were concerned about both. When asked to rate how their own mental health had been in the last month, on a scale from ‘really good’ to ‘really bad’, the majority of students rated their mental health as ‘average’ (44.7%); 8.7% rated their mental health as ‘really good’ and 19.8% rated it as ‘good’; 17.1% rated it as ‘bad’ and 9.7% as ‘really bad’ (see Figure 2).

70.1%

1200

St re s

1) Previous diagnoses of mental health conditions

37.7% of individuals identifying their ethnicity as white reported having a pre-existing mental health condition, which was statistically significantly higher than the 17.3% of those of Asian ethnicity and the 10% of those of black ethnicity who reported having a preexisting mental health condition.

1400

Number of students

The following findings are summaries of the significant statistical results produced by the ‘Let’s Be Honest’ survey (see Appendix 1). Findings have been grouped into seven categories:

Mental health concerns whilst at university

Findings

Figure 2. Students’ mental health ratings in the month preceding the survey

Only 11.9% of students reported suffering from no mental health difficulties at all (see Figure 3). A large percentage reported suffering from stress (70.1%), anxiety (65%), sleep problems (51.4%), depression (46.9%), feeling ‘burnt out’ (40.6%), and isolation/loneliness (39.1%). When given the option to specify ‘other’, students also reported problems with panic attacks, PTSD, OCD, bipolar disorder, suicidal ideation, self-harming, grief, psychosis, personality disorder, and depersonalisation.

Sexuality: ..

84.3% of students identifying as bisexual and 84.4% of students identifying as lesbian reported experiencing stress, which was statistically significantly higher than the 68.8% of students identifying as straight and 76.5% of students identifying as gay who reported experiencing stress.

81.1% of students identifying as bisexual and 81.2% of students identifying as lesbian reported experiencing anxiety, which was statistically significantly higher than the 62% of students identifying as straight and 73.5% of students identifying as gay who reported experiencing anxiety. Visit www.angliastudent.com

Let’s Be Honest

52.2% of students identifying as bisexual and 55.9% of students identifying as gay reported feeling ‘burnt out’, which is statistically significantly higher than the 38.1% of students identifying as straight and 40.6% of students identifying as lesbian who reported feeling ‘burnt out’. 71.7% of students identifying as bisexual and 67.6% of students identifying as gay reported feeling depressed, which was statistically significantly higher than the 41.9% of students identifying as straight and 59.4% of students identifying as lesbian who reported feeling depressed. 67.3% of students identifying as bisexual and 67.6% of students identifying as gay reported experiencing sleep problems, which was statistically significantly higher than the 48.6% of students identifying as straight and 62.5% of students identifying as lesbian who reported sleep problems. 56.6% of students identifying as bisexual and 56.2% of students identifying as lesbian reported experiencing isolation/ loneliness, which was statistically significantly higher than the 35.1% of students identifying as straight and 52.9% of students identifying as gay who reported experiencing isolation/loneliness. 23.9% of students identifying as bisexual and 35.3% of students identifying as gay reported experiencing eating disorders, which was statistically significantly higher than the 18.8% of students identifying as lesbian and 10.4% of students identifying as straight who reported experiencing eating disorders.

compared to 38.7% of non-disabled students, which was found to be a statistically significant difference. ..

Students with a disability were 2.42 times more likely to experience sleep problems than those with no disability; 70% of disabled students reported this compared to 49.1% of non-disabled students, which was found to be a statistically significant difference.

Students with a disability were 2.05 times more likely to experience isolation/loneliness than those with no disability; 54.7% of disabled students reported this compared to 37% of non-disabled students, which was found to be a statistically significant difference.

Students with a disability were 3.04 times more likely to report experiencing stress than those with no disability; 86.8% of disabled students reported this compared to 68.5% of non-disabled students, which was found to be a statistically significant difference.

Students with a disability were 1.69 times more likely to report experiencing anxiety than those with no disability; 74.7% of disabled students reported this compared to 52.6% of non-disabled students, which was found to be a statistically significant difference.

Students with a disability were 1.76 times more likely to experience feeling ‘burnt out’ than those with no disability; 52.6% of disabled students reported this

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Students with a disability were 1.65 times more likely to experience eating disorders than those with no disability; 18.4% of disabled students reported this compared to 12% of non-disabled students, which was found to be a statistically significant difference.

21.5% of students identifying their ethnicity as mixed reported experiencing eating disorders, which was statistically significantly higher than the 12.5% of students of Asian ethnicity, 6.3% of students of black ethnicity, and 13.1% of students of white ethnicity, which was found to be a statistically significant difference.

Generally, students identifying their ethnicity as black were significantly less likely to report experiencing stress, anxiety, feeling ‘burnt out’, depression, sleep problems, or eating disorders.

No other statistically significant differences were found.

Faculty: ..

71.6% of students in ALSS and 70.1% of students in FST reported experiencing anxiety, which was statistically significantly higher than the 50% of students from LAIBS, 50% of students from FHSCE, and 57.4% of students from FMS who reported experiencing anxiety.

55.2% of students from ALSS and 54.9% of students from FST reported experiencing depression, which was statistically significantly higher than the 31.8% of students from FMS, 36.6% of students from FHSCE, and 39.4% of students of LAIBS who reported experiencing depression.

57.8% of students from ALSS and 58.6% of students from FST reported experiencing sleep problems, which was statistically significantly higher than the 43.3% of students from FHSCE, 41% of students from FMS, and 42.3% of students from LAIBS who reported experiencing sleep problems.

45% of students from ALSS and 48.6% of students from FST reported experiencing isolation/loneliness, which was statistically significantly higher than the 27.9% of students from FHSCE, 29.5% of students from FMS, and 31.4% of students from LAIBS who reported experiencing isolation/loneliness.

Ethnicity:

Disability: ..

Students with a disability were 1.91 times more likely to experience feeling depressed than those with no disability; 60.5% of disabled students reported this compared to 44.6% of non-disabled students, which was found to be a statistically significant difference.

16.8% of students from ALSS reported experiencing eating disorders, which was statistically significantly higher than the 5.7% of students from FMS, 14.1% of students from FST, 9.7% of students from FHSCE, and 12.7% of students from LAIBS who reported experiencing eating disorders.

Level of study: ..

Undergraduate students were 1.74 times more likely to experience feeling stress than postgraduate students; 72.3% of undergraduates reported this compared to 60% of postgraduates, which was found to be a statistically significant difference.

Undergraduate students were 1.55 times more likely to experience feeling ‘burnt out’ than postgraduate students; 41.6% of undergraduates reported this compared to 31.6% of postgraduates, which was found to be a statistically significant difference.

Undergraduate students were 1.89 times more likely to experience isolation/loneliness than postgraduate students; 41% of undergraduates reported this compared to 26.8% of postgraduates, which was found to be a statistically significant difference.

Employment: ..

44% of students working part-time and 43.8% of students working full-time reported feeling ‘burnt out’, which was statistically significantly higher than the 36.2% of students who were unemployed who reported feeling ‘burnt out’.

42.9% of students working part-time and 40.1% of students who were unemployed reported experiencing isolation/loneliness, which was statistically significantly higher than the 26.1% of students employed full-time who reported experiencing isolation/loneliness.

Summary: A high percentage of students reported being worried about their own mental health and/or that of a friend. The majority of students reported feeling stressed and/ or anxious whilst at university, and a large percentage also reported feeling ‘burnt out’, depressed, isolated/ lonely, and/or having had sleep problems. Certain students were found to be more likely to experience these difficulties whilst at university: females were found to be more likely than males to experience mental health difficulties whilst at university, as were individuals who identified as either gay, bisexual, or lesbian, those with a disability, those studying in ALSS and FST, undergraduates, and those working part-time alongside their studies. However, it should be noted that whilst these groups were more likely to experience mental health difficulties, a large proportion of all students reported experiencing these problems.

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Factors contributing to mental health difficulties

Gender:

When asked to what extent they thought studying at university contributed to their mental health problems, the majority (43%) said it had done so ‘sometimes’; 15% said ‘seldomly’; 17.8% said ‘not at all’; 15.3% said ‘frequently’; and 8.8% said ‘a lot’ (see Figure 4). When looking at what those issues might be, the most common contributing factor was fees and finance, with 45.5% of students indicating that this had contributed to their mental health problem. This was followed by social isolation (28.1%), distance from family and friends (26%), accommodation (23.6%), social pressure (23.5%), and commuting/travelling to university (20.1%). All of the issues and the corresponding percentages can be seen in Table 2.

Females were 1.43 times more likely to say that fees and finance were a contributing factor to their mental health difficulties than males; 47.4% of females reported this compared to 38.6% of males, which was found to be a statistically significant difference.

Females were 1.46 times more likely to say that distance from family and friends contributed to their mental health difficulties than males; 28.1% of females reported this compared to 21.2%, which was found to be a statistically significant difference.

Females were 1.43 times more likely to say that commuting/travelling to university contributed to their mental health difficulties than males; 21.6% of females reported this compared to 16.1% of males, which was found to be a statistically significant difference.

Females were 2.71 times more likely to say that social media had contributed to their mental health difficulties than males; 6.5% of females reported this compared to 2.5% of males, which was found to be a statistically significant difference.

Ethnicity:

Number of students

800 43.02%

700 600 500

400 300 200

15.31%

17.81%

15.05%

8.81%

100 0

A lot

Frequently

Sometimes

Seldomly

Not at all

Sexuality:

Rating

Figure 4. The extent to which students’ studies contributed to their mental health difficulties

Yes

Fees and finances

45.5%

54.6%

Social isolation

28.1%

71.9%

Distance from family and friends

26%

74%

Accommodation

23.6%

76.4%

Social pressure

23.5%

76.5%

Commuting/travelling to university

20.1%

79.9%

Cultural barriers

4.6%

95.4%

Social media

5.4%

94.6%

Bullying/harassment

4.4%

95.6%

Table 2. Percentage of students who found each factor had contributed to their mental health difficulty

When looking at the possible contributing demographic factors of the respondents (gender, sexuality, disability, ethnicity, employment, and commuting distance), several statistically significant findings were made about which factors contributed more to mental health difficulties.

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44.1% of students identifying as gay and 43.5% of students identifying as bisexual reported social isolation as a contributing factor to their mental health difficulties, which was statistically significantly higher than the 25% of students identifying as straight and 25% of students identifying as lesbian who reported social isolation as a contributing factor. 38.2% of students identifying as gay, 37.5% of students identifying as lesbian, and 30.2% of students identifying as bisexual reported social pressures as a contributing factor to their mental health difficulties, which was statistically significantly higher than the 20.7% of students identifying as straight who reported social pressures as a contributing factor.

Disability: ..

Students with a disability were 1.60 times more likely to report that social isolation was a contributing factor to their mental health difficulties than those with no disability; 36.8% of disabled students reported this compared to 26.7% of non-disabled students, which was found to be a statistically significant difference.

Students with a disability were 1.76 times more likely to report that social pressure was a contributing factor to their mental health difficulties than those with no disability; 33.2% of disabled students reported this compared to 21.9% of non-disabled students, which was found to be a statistically significant difference. Students with a disability were 1.64 times more likely to say that commuting was a contributing factor to their mental health difficulties than students with no disability; 27.4% of disabled students reported this compared to 18.7% of non-disabled students, which was found to be a statistically significant difference. Students with a disability were 3.46 times more likely to say that bullying or harassment was a contributing factor to their mental health difficulties than those with no disability; 10.5% of disabled students reported this compared to 3.3% of non-disabled students, which was found to be a statistically significant difference.

34.8% of students identifying their ethnicity as Asian reported that distance from family and friends was a contributing factor to their mental health difficulties, which was statistically significantly higher than the 16.4% of students identifying as black, 21.5% identifying as mixed ethnicity, and 26.5% identifying as white who also reported this as a contributing factor. 25.1% of students identifying as white and 26.7% of students identifying as Asian reported that social pressures were a contributing factor to their mental health difficulties, which was statistically significantly higher than the 8.2% of students identifying as black and 19% identifying as mixed who also reported this as a contributing factor. 15.2% of students identifying as Asian reported that cultural barriers were a contributing factor to their mental health difficulties, which was statistically significantly higher than the 5.7% of students identifying as black, 2.5% identifying as mixed, and 3.4% of students identifying as white who also reported this as a contributing factor.

Employment: ..

30.3% of students who were unemployed reported that distance from family and friends was a contributing factor to their mental health difficulties, which was statistically significantly higher than the 25.1% of those working part-time and 15.7% of those working full-time who also reported this as a contributing factor.

31.2% of students who were unemployed reported that social isolation was a contributing factor to their mental health difficulties, which was statistically significantly higher than the 27.8% of those working part-time and 19.7% of those working full-time who also reported this as a contributing factor.

23.9% of students who were employed part-time reported that commuting/travelling was a contributing factor to their mental health difficulties, which was statistically significantly higher than the 19.3% of students employed full-time and 16.8% of students unemployed who also reported this as a contributing factor.

Commuting distance: ..

51.1% of students living in university accommodation with no commute, 51.7% of students living in privately owned/rented accommodation with no commute, and 51% of students with a 2–9 mile commute reported that fees and finance were a contributing factor to their mental health difficulties, which was statistically significantly higher than the 38.4% of students living 20+ miles from campus and 35% of students with a 10–19 mile commute who also reported this as a contributing factor.

33.8% of students living in university accommodation with no commute and 36.4% of students living in privately owned/rented accommodation with no commute reported that accommodation was a contributing factor to their mental health difficulties, which was statistically significantly more than the 11.3% of students living 20+ miles from campus, 5% of students commuting 10–19 miles, and 26% of students commuting 2–9 miles who also reported this as a contributing factor.

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46.9% of students living in university accommodation with no commute and 34.1% of students living in privately owned/rented accommodation with no commute reported that distance from family and friends was a contributing factor to their mental health difficulties, which was statistically significantly higher than the 12.6% of students living 20+ miles from campus, 8.2% of students commuting 10–19 miles, and 25.5% of students commuting 2–9 miles who also reported this as a contributing factor. 36.2% of students living in privately owned/rented accommodation with no commute reported that social isolation was a contributing factor to their mental health difficulties, which was statistically significantly higher than the 31.8% of students living in university accommodation with no commute, 19.9% of students living 20+ miles from campus, 19.1% of students commuting 10–19 miles, and 30.9% of students commuting 2–9 miles who also reported this as a contributing factor. 30.1% of students living in privately owned/rented accommodation with no commute reported that social pressures were a contributing factor to their mental health difficulties, which was statistically significantly higher than the 28.3% of students living in university accommodation with no commute, 15.3% of students living 20+ miles from campus, 15% of students commuting 10–19 miles, and 28.4% of students commuting 2–9 miles who also reported this as a contributing factor. 8.2% of students living in privately owned/rented accommodation with no commute reported that social media contributed to their mental health difficulties, which was statistically significantly more than the 2.6% of students living in university accommodation with no commute, 5% of students living 20+ miles from campus, 2.7% of students commuting 10–19 miles, and 6.4% of students commuting 2–9 miles who also reported this as a contributing factor.

39.8% of students living 20+ miles from campus and 32.7% of students commuting 10–19 miles reported that commuting/travelling to university was a contributing factor to their mental health difficulties, which was significantly more than the 18.1% of students commuting 2–9 miles, 5.1% of students living in university accommodation with no commute, and 6.5% of students in privately owned/rented accommodation with no commute who also reported this as a contributing factor.

Awareness of in-house support services The most well-known support service within the University was personal tutors/supervisors (77%), followed by the Counselling and Wellbeing Service (59.2%), the Students’ Union Advice Service (49.3%), and the Student Money Advice Service (45.8%). The Student Advice Service was less well-known (32.6%), followed by the International Student Advice Service (15.9%).

Yes

International Student Advice Service

15.9%

84.1%

The most common factors contributing to students’ mental health problems are fees and finance, social isolation, distance from family and friends, accommodation, social pressure, and commuting/travelling to university. Those identifying as disabled, gay, lesbian and/or bisexual were more likely to find social pressures and isolation to be factors contributing to mental health issues. Worryingly, those students with a disability were also much more likely to say that bullying/harassment had contributed to their mental health difficulties. Students identifying as Asian were more likely to find distance away from family and friends, as well as cultural barriers, to be factors contributing to mental health problems.

Student Advice Service

32.6%

67.4%

Student Money Advice Service

45.8%

54.2%

Students’ Union Advice Service

49.3%

50.7%

Counselling and Wellbeing Service

59.2%

40.8%

Personal tutor/supervisor

77%

23%

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Females were 1.42 times more likely to know about the Counselling and Wellbeing Service than males; 61.5% of females knew about this service compared to 53% of males, which was found to be a statistically significant difference.

Males were 1.45 times more likely to know about the Student Advice Service than females; 39.1% of males knew about this service compared to 30.75% of females, which was found to be a statistically significant difference.

Males were 1.39 times more likely to know about the International Student Advice Service than females; 19.1% of males knew about this service compared to 14.5% of females, which was found to be a statistically significant difference.

When looking at the possibly contributing demographics of respondents (prior mental health condition, gender, level of study, faculty, and campus), several statistically significant findings were made about which students were more or less likely to know about each of these services.

Level of study:

Prior mental health condition:

Postgraduate students were 1.57 times more likely to know about the Student Advice Service than undergraduates; 41.6% of postgraduates knew about this service compared to 31.2% of undergraduates, which was found to be a statistically significant difference.

Postgraduate students were 2.63 times more likely to know about the International Student Advice Service than undergraduates; 30% of postgraduates knew about this service compared to 12% of undergraduates, which was found to be a statistically significant difference.

Gender:

Table 3. Percentage of students aware of in-house support services

Summary:

Commuting and travelling distance was found to be a problem for those with a disability, students working part-time, and those commuting 10+ miles. Those not commuting had more difficulties with fees and finance, accommodation, social pressures, social media, and distance from family and friends. Employment was also found to play a role, with those unemployed experiencing more problems with distance from family and friends and social isolation.

mental health condition knew about this service compared to 29.2% of those with a pre-existing mental health condition, which was found to be a statistically significant difference.

Students with pre-existing mental health conditions were 1.83 times more likely to know about the Counselling and Wellbeing Service; 68.3% of students with a pre-existing mental health condition knew about this service compared to 54.1% of students without a pre-existing mental health condition, which was found to be a statistically significant difference. Students with no pre-existing mental health condition were 1.36 times more likely to know about their personal tutor/supervisor than those with a preexisting mental health condition; 79% of those without a pre-existing mental health condition knew about this service compared to 73.5% of those with a preexisting mental health condition, which was found to be a statistically significant difference. Students with no pre-existing mental health condition were 1.31 times more likely to know about the Student Advice Service than those with a pre-existing mental health condition; 35% of those with no pre-existing

Faculty: ..

65.1% of students from FST, 61.4% of students from FHSCE, 55.4% of students from FMS, and 56.8% of students from ALSS knew about the Counselling and Wellbeing Service, which was statistically significantly higher than the 43.2% of students from LAIBS who knew about the service.

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41.1% of students from FST knew about the Faculty Student Advisors, which was significantly higher than the 31% of students from ALSS, 22.3% of students from FMS, 27.1% of students from FHSCE, and 36.7% of students from LAIBS who knew about the Faculty Student Advisors.

23.7% of students from LAIBS knew about the International Student Advice Service, which was statistically significantly more than the 14.4% of students from ALSS, 16.5% of students from FMS, 18.1% of students from FST, and 11% of students from FHSCE who knew about the International Student Advice Service.

Campus: ..

60.7% of students from Cambridge campus, 57.9% of students from Chelmsford campus, and 50% of students from Peterborough campus knew about the Counselling and Wellbeing Service, which was statistically significantly higher than the 33.3% of distance learners who knew about the service. 34.4% of students from Cambridge campus knew about the Student Advice Service, which was statistically significantly higher than the 30% of students from Chelmsford campus, 23.3% of students from Peterborough campus, and 20.8% of distance learners who knew about the service. 77% of students from Cambridge campus, 78.2% of students from Chelmsford campus, and 76.7% of students from Peterborough campus knew about their personal tutor/supervisor, which was statistically significantly higher than the 45.8% of distance learners who knew about them.

55.7% of students from Chelmsford campus, 46.7% of students from Cambridge campus, and 50% of students from Peterborough campus knew about the Students’ Union Advice Service, which was statistically significantly higher than the 29.2% of distance learners who knew about the service. 46.7% of students from Cambridge campus, 46.3% of students from Chelmsford campus, and 30% of students from Peterborough campus knew about the Student Money Advice Service, which was statistically significantly higher than the 4.2% of distance learners who knew about the service.

Summary: Whilst the majority of students were aware that their personal tutor/supervisor existed, and over half were aware that the Counselling and Wellbeing Service existed, a worryingly high number of students were not aware of these services or others. As we would expect, those with a prior mental health condition were more likely to be aware of the Counselling and Wellbeing Service, whereas those without such a condition were more likely to be aware of their personal tutor/supervisor and the Student Advice Service. We could make the assumption that many of those with prior mental health conditions may be in receipt of a mental health mentor through the Disabled Students’ Allowance, which would automatically link them into the Counselling and Wellbeing Service as soon as they begin their studies. Females were also more likely to know about this service, although this could reflect the findings that females were more likely to disclose prior mental health conditions and to be affected by certain mental health difficulties whilst at university. Students from LAIBS were less likely to know about this service, although this might reflect the significantly lower numbers of students from LAIBS reporting prior mental health conditions and/or mental health difficulties experienced whilst at university. Distance learners were less likely to know about this service and others.

Use of and satisfaction with the Counselling and Wellbeing Service The Counselling and Wellbeing Service collect their own service user data and have reported an increase of 137% in the number of students registering with them between 2010/11 and 2015/16, demonstrating an increasingly high demand on the service. Student satisfaction is reportedly high for the service. 98.5% of respondents in 2015/16 said they were satisfied with the support they received, and feedback indicates that the support received directly contributed to retention. The ‘Let’s Be Honest’ survey investigated perceptions of the Counselling and Wellbeing Service further, looking in particular at waiting times and overall satisfaction. The majority of students (45.6%) had a very short wait of between 1–2 weeks for an appointment, whilst 13% had a very long wait of over 6 weeks. No differences were found in the waiting times between the Cambridge and Chelmsford campuses. (see Figure5). The majority of students rated their experience with the service as ‘good’ (62.7%), although 14.5% rated their experience as ‘poor’ (see Figure 6), which is higher than the service’s own report, in which only 1.5% rated their experience as not being satisfactory. However, it should be noted that the Counselling and Wellbeing Service only send out their satisfaction survey to students who are currently in receipt, or who have been in receipt, of intervention and/or support. Our survey was sent to all students, meaning that those who had contacted the service but who had not gone on to receive any intervention or support were also able to rate their satisfaction. 120

45.6%

100

160 140

62.7%

120

Number of students

84.4% of students from FHSCE and 80.8% of students from FST knew about their personal tutor/supervisor, which was significantly higher than the 73% of students from ALSS, 71.9% of students from FMS, and 57.6% of students from LAIBS who knew about their personal tutor/supervisor.

Number of students

100 80 60

22.7% 14.5%

40 20 0

Good

Average

Poor

Rating

Figure 6. Overall satisfaction with the Counselling and Wellbeing Service

A significant correlation was found between the length of waiting time and overall satisfaction with the service, with those reporting that they had to wait a very long time to be seen (over 6 weeks) being far more likely to rate the service as ‘poor’. This is 8.68 times more likely than students with a very short wait (1–2 weeks), 13.04 times more likely that students with a fairly short wait (2–4 weeks), and 3.97 times more likely than students with a fairly long wait (4–6 weeks). It is probable that these students who had a very long wait may never have received intervention or support from the service or may still have been in the process of waiting at the time of the survey, which could have impacted the scores. Furthermore, the qualitative data gathered highlighted that waiting times, availability, and awareness were contributing factors to stopping students accessing the support. However, it should also be noted that many students described their experiences with the Counselling and Wellbeing Service as being fairly positive when asked how well they felt supported at ARU. Box 1 on the following page illustrates several examples of the feedback students gave in relation to the service.

23.8%

17.6% 40

13%

Very short (1-2 weeks)

Fairly short (2-3 weeks)

Fairly long (4-6 weeks)

Very long (over 6 weeks)

Length of wait

Figure 5. Length of waiting time for an appointment with the Counselling and Wellbeing Service

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‘What might stop you accessing the support?’ ‘Time scales to wait, limited appointments and sessions’ ‘Time between referral and appointment. Only 6 sessions offered…’ ‘If you are having issues with your studies and are discontinued from your course, you immediately lose access to the Counselling and Wellbeing service (at a time when you need it the most!)’ ‘I never heard about mental health support at ARU’ ‘Not sure where to go. E.g. for the counselling service’

Summary: Fewer students reported overall satisfaction with the Counselling and Wellbeing Service in this survey than in the service’s own reports. However, general levels of satisfaction with the service were high. Waiting times were found to be a contributing factor to poor satisfaction, with those waiting longer rating it more poorly. Feedback from students also highlighted this as an issue, as well as raising concerns over the service’s limitations in terms of the number of sessions which could be offered and their availability. Despite this, many reported feeling well supported by the staff they saw within the service.

Preferences for support When students were asked to rank nine options of support in order of priority, family or a partner were both most commonly ranked as the highest. Friends were most commonly ranked second to this, followed by doctor, and personal tutor/ supervisor and the Counselling and Wellbeing Service were both ranked at a similar level. Counselling outside of the university, the Student Advice Service, and the Chaplaincy were the least favoured.

Family or Partner Friends

‘It is difficult to fit in appointments with the counselling service due to my course requirement of 100% attendance and living 55 miles from Cambridge’

Doctor Personal Tutor or ARU Counselling and Wellbeing

‘Counselling service require a GP and I won’t be able to get with a GP for months. Mental health can’t wait that long’

Counselling outside of University Faculty Student Adviser

‘How well supported do you feel at Anglia Ruskin?’

Chaplaincy

‘Somewhat, my tutor and counsellor were brilliant’ ‘Really well, had 6 weeks of counselling with the CWS. It was really helpful’ ‘Quite well supported but everyone is busy. I hate the fact you only get 6 sessions with a counsellor and are told this right from the start’ ‘The counselling and wellbeing service is excellent, but they should have more power to liaise with student advisers, e.g. when a student’s mental health issues are affecting their studies’ ‘I think the counselling service is great, but feel as though other university departments funnel people there when the problem has already escalated too far, rather than taking preventative measures. So I feel that Anglia Ruskin as a whole is not supportive, but the counselling service is’

Figure 7. Hierarchy of how students ranked wellbeing support options

Summary: This hierarchy of support demonstrates that the services on offer at the University are often prioritised after options more familiar to students (e.g. people that the students know personally), and that the highest ranked University services were personal tutors/supervisors and the Counselling and Wellbeing Service.

‘I wish the counselling service was quicker in responding to me especially when there is a crisis’ Box 1. Feedback on barriers to accessing support and how students feel supported at ARU in relation to the Counselling and Wellbeing Service

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Barriers to accessing support A thematic analysis was conducted in order to explore freetext comments in relation to what might stop students accessing the different types of support available. The comments were initially coded before being analysed for broader themes and sub-themes (with several different codes going into each theme). The themes identified are described below with examples from the data.

Theme A: Being too anxious to seek support Many students spoke of being too shy, worried, anxious, nervous, afraid, and fearful to seek the help they needed, for example: ‘Too nervous to talk to anyone’ and ‘My anxiety of actually getting in touch’. Many said that they did not feel confident enough to speak to others about their difficulties, for example: ‘Confidence issues’ and ‘Lack of confidence’. Whilst this was recognised as a theme in itself, several further sub-themes were born from this. Subtheme A1: Reluctance to discuss personal problems with strangers/others Many students reported that they did not feel comfortable telling a stranger about their personal problems, for example: ‘Talking to someone new and opening up about issues I am facing’ and ‘The fact I would have to talk to somebody I don’t know about my problems’. Many wanted to keep their difficulties private and described how they did not like sharing these with others, for example: ‘I’m very private’ and ‘I don’t talk about my problems’. Subtheme A2: Stigmatisation around mental health Many students described being too embarrassed or ashamed to discuss their difficulties with others or seek help, for example: ‘The embarrassment of admitting something is wrong with me’ and ‘Embarrassed about my mental health’. Many also specifically mentioned fear of being judged and the stigma around having mental health difficulties, for example: ‘I would not go to my personal tutor or anyone in my field due to past experiences of being judged’, ‘Fear of being labelled and judged’, and ‘Fear of stigma attached to male mental health issues’. Others described being too proud to seek help for a mental health issue, for example: ‘My proud and stubborn nature’ and ‘pride’. Subtheme A3: Concern for confidentiality and the effect seeking support may have on their course or for their future career Many students reported worries that if they shared their difficulties these would not be kept confidential, for example: ‘As a nursing student, I may feel reluctant to access

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outside support due to worries of confidentiality across services in relation to placements and fellow students finding out’ and ‘Worries things not remaining confidential’. In addition, many feared that it might negatively impact their course or future career, for example: ‘It might look bad on my record’, ‘Worried it might affect my career later in life’, and ‘Thinking I might be chucked off my course if they knew I had mental health problems’. Subtheme A4: Feeling that difficulties were not severe enough or valid Many students were worried that their problems were not severe or worthwhile enough to seek support, and they feared that they would waste other people’s time and be a burden, for example: ‘I don’t know if I have a serious issue or if I’m just stressed. I don’t want to waste people’s time’, ‘Worry that what I was feeling wasn’t worth their time, and that was hindering someone who needs help more than me’, and ‘I would think that personal tutors, new friends etc. would have too much to worry about before I show up asking for help’. Many students reported that they did not like to admit they had difficulties or were struggling, or struggled to recognise when problems were severe enough to seek help, for example: ‘Being afraid to admit I have an issue’ and ‘Denial of issues, fear of being told something I don’t want to hear’.

Theme B: Effectiveness of support available Many students reported that they did not trust the support available, that the people involved were or might be unprofessional or lack experience, or that it could be ineffective, for example: ‘Personal Tutor never replies with anything useful anyway, I’ve also talked to many faculty members about issues and they say it’s not their job’, ‘Unprofessionalism’, ‘The ineffectiveness’, ‘References from other people – friends with mental health concerns were rejected’, and ‘I feel like it may not make a difference, or help me’. A further subtheme was identified from this theme: Subtheme B1: Waiting times and availability of support Many students said that the long waiting times to receive support put them off, for example: ‘Extreme wait times for doctors appointments and counselling service’, ‘No appointments/waiting list for ARU counselling and then never contacted about it’, and ‘Waiting too long to be seen’. Also, many complained that the availability of the support meant longer waiting times or missing out on being able to access that support altogether, for example: ‘Found it really hard to make the appointment they set for me. They cancelled my engagement with them after I missed an appointment. Couldn’t

go through reapplying and explaining everything all over again’ and ‘Time scales to wait, limited appointments and sessions’.

Theme C: Having the resources necessary to seek support Many students said that they did not have the time to seek help for their difficulties and that their schedules were too full, for example: ‘Not having enough time’ and ‘The lack o time I have to myself due to workload and working outside of uni too’. Many also lived too far away to seek the support, for example: ‘Living away from family and partner’ and ‘The distance as have an hour commute so time is restricted whilst on campus as I am now in my second year of studying’. Many also said they were concerned about the cost of the support, for example: ‘Finances and charges’ and ‘The fact I will have to pay at some stage to continue to have psychological care’.

Theme D: Solving problems by themselves Many students felt that they could solve their problems by themselves, rather than seeking external support, for example: ‘Trying to overcome it myself’ and ‘I can manage it by myself’.

Theme E: Awareness of how to access the support Many students said that they did not know the support was available, or where or how they could find it or access it, for example: ‘Lack of knowledge of the support’, barrier, ‘Where to go’ and ‘Not knowing how to contact these support services. I don’t know where they are in the building or any number to call and am currently struggling’.

and this would make me feel even more isolated and depressed. Almost as if any attempt at expressing or communicating my problems are far too limited to describe what I am going through’.

Summary: This qualitative analysis of the reasons why some students do not seek support for their mental health difficulties suggests a wide range of concerns. The majority of these are anxiety-based; students fearing repercussions if they share a concern, worrying about telling a stranger their problems, and also fear that they will be a burden or that their problems are not severe enough amongst others. Other concerns suggest problems with the visibility of the services available, and also confidence that the support available would be effective. As well as these issues, problems with waiting times and availability were raised, and many students reported not having the free time necessary to use the services and support available to them. There also appears to be a vicious circle, whereby mental health problems in themselves can lead students to isolate themselves and therefore lack motivation to seek the support they may need.

Theme F: Mental health difficulties creating a barrier Finally, many students suggested that their mental health difficulties prevented them seeking the support they need, for example: ‘My own mental health’ and ‘My mental health issues causing me to isolate myself’. Many students reported feeling too low or demotivated to seek help, for example: ‘Sometimes I feel so bad I don’t want to get out of bed’, ‘If I had no motivation’ and ‘Inability to leave the house and lack of accessible methods of consistent communication and support outside of that’. Many also reported finding it too difficult to communicate their difficulties, for example: ‘Social anxiety, communication barriers because of Asperger’s Syndrome’ and ‘I feel as if my problems would be deeply misunderstood

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Discussion The findings outlined in this report reflect those reported in the previous literature, and highlight the growing concern that is student mental health and the availability of services to support those in need. The current survey revealed a similar percentage of students struggling with mental health conditions at ARU (33%) as those found by YouGov (2016) (27%). Furthermore, 26% of students in the current survey said their mental health was ‘bad’ or ‘really bad’. This suggests that at least a quarter of students at ARU are currently struggling with mental health difficulties. Whilst looking more specifically at the types of mental health difficulties students were having, the majority of students were found to be struggling with stress, anxiety, depression, and sleep problems; similar percentages again to those found in the YouGov (2016) survey. Several vulnerable groups of students were identified in the current report. As found in the previous literature, females and those identifying their sexuality as gay, lesbian, or bisexual (LGBT) were more likely to have mental health difficulties. The current survey also identified those with disabilities and those in the ALSS faculty and FST as being more vulnerable. Whilst it is possible that the type of students attracted to the subjects available within the ALSS faculty and FST are more vulnerable to mental health difficulties, or that these faculties are over-represented by vulnerable groups of students (e.g. female, LGBT, and disabled students), it is also possible that the support available to these students (for example, personal tutors and supervisors), or the stress of the courses being studied, may be contributing factors to poorer mental health. For students from the faculty of ALSS, there appeared to be less of an awareness of personal tutors and/or supervisors and Faculty Student Advisers than there were for other faculties. However, it should be noted that students from LAIBS were less aware of the majority of services available and disclosed fewer mental health issues in the survey. We are unable to determine differences in the quality of the support each faculty offers its students, but it is likely that the personal tutor/supervisor systems and the mental health knowledge of these members of staff vary greatly. The qualitative data asking students what would stop them accessing ARU support and also how well supported they felt at ARU revealed a discrepancy between some students who found their personal tutors very helpful, and others who either did not know they existed, or were turned away and not given any support. These findings indicate a need for

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better mental health awareness amongst personal tutors and supervisors, as well as a more standardised method of supervision training for these staff members across the faculties. This seems imperative given that personal tutors/ supervisors were rated in the current survey as the most important method of support provided by the University (equally ranked with the Counselling and Wellbeing Service). Fees and finance, social isolation, distance from family and friends, accommodation, social pressure, and commuting/travelling to university were all identified as factors contributing to mental health difficulties in a large percentage of students. Those vulnerable groups identified previously (e.g. females, LGBT, and disabled students) were significantly more likely to find social pressures and isolation affected their mental health. Most worryingly, of all those, students with disabilities were over three times more likely to report bullying/harassment as a contributing factor to their mental health. These findings demonstrate a clear need for better social and peer support for vulnerable students. Looking at the mental health support services available to students, the current report revealed a slightly lower number of ARU students aware of the Counselling and Wellbeing Service (59%) when compared to those reported by HEPI (68%) (Neves and Hillman, 2016) and those by YouGov (2016) (86%). However, this may reflect the large number of students from ARU who are distance learners, who were also found to be significantly less likely to know about the service.

reveal some issues with the ARU Counselling and Wellbeing Service. Students reported that the long waiting times to be seen were off putting, and this was found to directly link to overall satisfaction with the service. Students also reported problems with the limited availability of the service and the shortness of the interventions offered (typically 6 weeks). Given that the service was rated in the current survey as the most important University-provided method of support for students (equally ranked with the personal tutor), it seems imperative that these concerns be addressed. Most importantly, the service should have more provisions to be able to offer support to those unable to attend campus regularly, and offer more flexibility and options for students. There are several limitations with the current survey that should be taken into consideration when interpreting these findings. The design of the survey had several errors and omissions; for example, it would have been useful to know the age of students and whether they were national or international students, etc. Furthermore, the survey was only distributed to current students, thus issues of concern raised to ARU Students’ Union about ‘graduate depression’ would require further research using a sample of recent graduates. It would also have been useful to obtain less subjective results from students, for example, by using a standardised measure of mental health/wellbeing. Despite these limitations, the survey was still able to produce rich and useful data, highlighting areas of concern within Anglia Ruskin University with regards to the mental health of its students.

Looking at the Counselling and Wellbeing Service’s own statistics, there has been a huge increase in the number of students registering with the service since 2011 – over double that reported in the previous external study, which found a 68% rise in the number of in-house counselling service users at universities across the UK (Sandeman, 2016). Similar to what has been reported in the previous literature, the Counselling and Wellbeing Service’s own reports suggest that the intervention that students receive from them helped them to stay in university and continue with their studies. In addition, the current survey found that 85.5% of students were satisfied with the service they received from Counselling and Wellbeing, which is higher than the percentage of satisfied students reported in the previous literature (75%) (YouGov, 2016). These findings demonstrate the vital and wide-impacting role which in-house counselling services can have in supporting students with mental health difficulties in university. However, the current survey did

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Recommendations The recommendations outlined here are put forward by Anglia Ruskin University Students’ Union to Anglia Ruskin University. These recommendations have been made based on a combination of the findings presented in this report from the ‘Let’s Be Honest’ survey, feedback from students, and recommendations made in previous reports from other higher education institutions and organisations (Elliot, 2009; Brown, 2016; UUK, 2016). 1. Recommendations for University Policy and Strategy 1.1

Conduct an official university audit on student mental health in order to take active institutional responsibility for pastoral care of students. As suggested by the HEPI report, each university should conduct its own audit regularly to gain better awareness of the mental health difficulties their students face. This should particularly include examining the impact of the University’s Academic Regulations and other policies on student mental health and the effectiveness and accessibility of our referral system. Many bodies, including Universities UK (UUK), believe that universities are ‘intellectual, not therapeutic, communities’. Creating this divide does not contribute to a solution to the growing crisis of student mental health problems. The university experience encourages students to move away from their comfort zone, whether through going to a new city or trying new things. If universities wish to promote this they should be equipped to give the pastoral support, particularly concerning mental health, that comes with these changes in circumstances.

1.2 Develop a mental health policy and strategy based on the recommendations of this report. Poor mental health in the student community can no longer be ignored. If we want to improve the student experience, this will be the first step. We cannot expect students to fully engage with any of our practices if their mental health is not one of our priorities. Committing to a policy of mental health support will be the key to ARU putting across this message, supported by the creation of a strategy to address the concerns raised by such a large number of students.

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1.3 Integrate mental health into the widening participation agenda, including access agreements. Mental illness is addressed in the Equalities Act 2010. Making this a part of our access agreement would cement ARU’s commitment to bettering student mental health. 1.4 Nominate and support a University Governor to track ARU’s progress on improving mental health support. This would show ARU’s commitment at all levels to bettering the mental health of our students and ensuring that the strategy created is a priority. 2. Recommendations to Strengthen University Services 2.1 Develop a multi-service approach to mental health support and mental health issue prevention (e.g. library staff, security team, residential assistants etc.) and utilise a ‘triage’ system to reduce pressure on the Counselling and Wellbeing Service. This should look at the role of these services in the context of the work currently done by the Counselling and Wellbeing Service and how they can appropriately support students’ mental health in a proactive way as a network. This would also establish support for staff who have dealt with stressful situations. 2.2 Protect the Counselling and Wellbeing Service from budget cuts and/or closure and subsequently increase the resources to the Counselling and Wellbeing Service to include the employment of three more counsellors. The ability to action many of the recommendations in this report and to maintain the current high standard of service delivery simply cannot exist without consistent funding and assurance that the Counselling and Wellbeing Service does not face closure. ARU currently has a counsellor:student ratio in line with the national average. However, the national average is much lower than recommended. HEPI recommends a ratio of 1:1291, and NUS recommends a ratio of 1:2500. Increasing resources to employ three more counsellors would be in line with HEPI’s recommended ratio. This would free up the time of the service to do

more preventative work, establish relationships in the community, and provide a more specialised service. This would help more students to access this service and would reduce the typical waiting time, which at the date of publication is six weeks. 2.3 Increase the resources directed to the Counselling and Wellbeing Service, specifically to include the ability to offer different types of intervention. Currently the only intervention available to students is counselling and mental health advice/ mentoring. Considering national widespread cuts on mental health services, it would be beneficial to offer a wider variety of support to students, for example Cognitive Behavioural Therapy (CBT) and more group-based therapy interventions and wellbeing group sessions. We also recommend introducing more activities which help students build ‘emotional resilience’. These activities should be promoted appropriately in order to lessen the impact of pressures on student mental health, but ensuring that the message of emotional resilience is not used to claim students are not resilient enough or overreacting to pressures they are experiencing. 2.4 Increase the availability/flexibility of support from the Counselling and Wellbeing Service for students who are on placement, who are commuting from afar, or who have more intense course timetables. This would ensure that different types of support could fit into students’ busy schedules, and that these students would not have to go without access to the Counselling and Wellbeing Service. An example of this could be telephone appointments. 2.5 Extend the Counselling and Wellbeing Service’s intervention blocks. Currently students are offered up to six sessions with a counsellor. This is not ideal for students who have more complex mental health difficulties or who find it difficult to communicate their problems and familiarise themselves with counsellors they have not met before, and who therefore may take longer to build up trust and become comfortable in the sessions.

2.6 Explore investment into alternative online support for students. The current software in place, Silvercloud, is recommended for use with a counsellor and takes a high degree of selfmotivation to complete. We would encourage ARU to explore other platforms. We have identified Big White Wall as an effective online platform which does not require a counsellor to use the software with a student. This would effectively engage with students living on campus, students who are commuting, and distance learners. 3. Recommendations for Wider University Support 3.1 Make Mental Health Awareness/Mental Health First Aid Training compulsory for personal tutors/ supervisors and other ARU staff with regular student contact. Whether this training is sourced externally or more staff are trained to deliver this internally, it is important to ensure that personal tutors/supervisors know how to correctly support students who are having mental health difficulties. This would raise awareness of the high rate of student mental health issues and give people the knowledge to address situations appropriately when they first arise and lessen the impact of the long-term academic difficulties students might face due to these issues. This would also help to minimise the need for intervention at a later date. This training should also be compulsory for Residential Assistants and staff working within Student Services. 3.2 Give up-to-date and clear information to all students about the confidentiality of university mental health support. Many students surveyed did not want to seek support for their mental health difficulties because they feared it would not be confidential and it may negatively affect their course and future career. Focusing more on the confidentiality of the service would minimise students’ anxieties around this issue and encourage more to seek help when they need it. 3.3 Support the creation of peer support groups for vulnerable students with mental health difficulties. Based on the findings that ‘friends’ are a preferred method of support, we recommend

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training engaged ‘peers’ to lead peer support groups. These peer support groups would tackle issues such as social isolation, social pressure, and bullying. This would improve the emotional resilience of those attending peer support groups and lessen the impact that these pressures have on their mental health. Creating strong links with adult mental health services could also support this recommendation, as they could support the training of students to facilitate these sessions. 3.4 Provide more information to all students before they start university and early on in their university career on the mental health support that is available, as well as targeting information towards vulnerable student groups. This would prepare students for the difficulties they may face and also give them the tools ready to tackle these when they first occur. The findings showed that groups such as women, LGBT+, international, black & minority ethnic (BME) and disabled students were more likely to experience mental health difficulties at university. Targeting information towards them early on will help ensure that they knew what support is available, which support is specific to the issues they may face as part of a vulnerable group, and where they could go for non-judgemental support. 3.5 Collect data through the registration process regarding whether students have pre-existing diagnosed mental health conditions. This would allow ARU to give targeted support pre-arrival and whilst students are studying with us. It would also enable the Univeristy to explore extra support the students concerned may need with their studies. 3.6 Give students with prior mental health conditions the option to have an earlier induction and the option to move into accommodation earlier. Following wide-ranging discussions with students, this recommendation aims to make earlier support available to students which is clear and accessible, as well as give students time to acclimatise to a new environment. This would prepare vulnerable students and ease the transition into university life and would focus on mental health and other support. Models provided by the report by Action on Access about successful early induction schemes run by other

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higher education institutions can provide ARU with a blueprint to design early induction/moveins for those students who disclose prior mental health issues. 3.7 Extend the maximum nights that a parent/friend can stay over in student accommodation to two nights in every consecutive seven. Being able to have someone stay with a student if they are homesick or having a bad time will improve their mental health and invigorate them. Currently students can have a guest stay over for one night in every consecutive seven. Extending the maximum number of nights by a guest will make visits more worthwhile for those visiting from far away. 3.8 Ensure that students intermitting from their studies are set up with mental health support during that period if they need it. When students intermit their studies, they are unable to access any of the university’s services. Many students with mental health conditions will need to intermit from their studies from time to time. Students may also be intermitting because of other personal circumstances that could contribute to poor mental health. Acknowledging this and ensuring that an adequate support package is in place for them would help students to feel equipped to return to study. 3.9 Conduct research into ‘graduate depression’ to gain better understanding of the effects of the transition from university into employment on mental health. Graduate depression is still under-acknowledged and is often part of the transition from study to work for students. Conversations with students indicated that the University should conduct further research to investigate how ARU’s graduates are managing after leaving university. Before leaving university, the Employability Service should build into their workshops resources to help students to combat these issues, including an awareness of graduate depression, often triggered by being unable to get employment for long periods of time. The Employability Service should also work with Counselling and Wellbeing to promote the positives of healthy emotional resilience.

4. Students’ Union and External Support 4.1 Work with ARU Students’ Union to run targeted mental health campaigns over key periods of the academic calendar. There are key points in the academic year nationally when students are prone to poor mental health and suicide attempts because of the pressure they are facing. Students may also be using self-harm or other unhealthy coping techniques to deal with pressure at these times. Ensuring students are aware of the confidential support available to them during these struggles is very important and can be delivered best through joint campaigns. 4.2 Review accessibility of reporting sexual assault to Anglia Ruskin University and build links with the local Rape Crisis Centres for men, women, and non-binary individuals. This recommendation is led by ongoing conversations between students and the University in relation to sexual assault. The prevalence of sexual assault at university and the high impact of sexual assault on mental health prompts ARU Students’ Union to follow the examples set by UUK’s 2016 report on ‘Changing the Culture’ (Coker, et.al, 2002; Campbell, et. al, 2009; UUK 2016). ARU has recently acknowledged this impact on the student community. Through the now established Sexual Respect Working Group, we recommend a review of how students report sexual assault to the University and establishing partnerships with local, external resources. Ensuring that these students are supported through a transparent and effective process will help show that we want to actively support and validate survivors. 4.3 Advocate that students be able to register with a general practitioner (GP) both at home and at university. Following the HEPI 2016 report recommendations, advocating for dual enrolment would allow more students to be able to seek help immediately from their GP whether they are at home or at university, and would also enable more students to access the Counselling and Wellbeing Service who previously could not do so if they were not registered with a GP in the area.

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References Andrews, B. & Wilding, J.M. (2004). The relation of depression and anxiety to life-stress and achievement in students. British Journal of Psychology, 95, 509-521. Brown, P. (2016). The invisible problem? Improving students’ mental health. Higher Education Policy Institute. Campbell, R., Dworkin, E., & Cabral, G. (2009). An Ecological Model of the Impact of Sexual Assault On Women’s Mental Health. Trauma, Violence, & Abuse, 10(3), 225-246. Field, A. (2013). Discovering Statistics Using IBM SPSS Statistics (4th Edition). Sage Publications: London. McHugh, M.L. (2013). The chi-square test of independence. Biochemia Medica, 23(2), 143-149. National Union of Students. (2013). Mental distress survey overview. Accessed March 2017. https://www.nus.org.uk/global/campaigns/20130517%20mental%20distress%20survey%20%20overview.pdf Neves, J. & Hillman, N. (2016). 2016 HEPI/HEA Student Academic Experience Survey, p. 32. Office for National Statistics (2014). Total number of deaths by suicide of undetermined intent for students aged 18 and above in England and Wales. Accessed March 2017. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/ adhocs/005732totalnumberofdeathsbysuicideorundeterminedintentforstudentsaged18andaboveinenglandandwales2014

Appendix 1 The majority of the data collected was nominal data, therefore Chi Square analyses were employed. This compares frequencies observed in certain categories to frequencies one might expect to get by chance (Field, 2013). It is a non-parametric test, so it is a robust method of analysing data that is not equally distributed (McHugh, 2013). A Friedman test was used to analyse the final quantitative section of the data, which related to students’ rankings of different support options. A Wilcoxin Signed Ranks test was used as a post-hoc test to determine which options were ranked significantly differently to others. The Friedman test is able to determine differences between repeated measure groups where the data is ordinal, and the Wilcoxin Signed Ranks test is able to assess differences between repeated measure groups and determine whether their mean ranks significantly differ. Both these tests are also non-parametric, meaning it did not matter if the data was evenly distributed (Field, 2013). This report only indicates whether or not a result was significant, as well as the associated percentages, frequencies, and odds ratios of those tests; the full statistical test results can be obtained upon request to the author. Finally, students’ answers on what prevented them from seeking support were analysed qualitatively using thematic analysis. Thematic analysis examines patterns (themes) within the data and determines how these patterns describe a phenomenon or research question.

Roberts, R., Golding, J., Towell, T. et al (1999). The effects of economic circumstances on British students’ mental health. Journal of American College Health, 48, 103-109. Sandeman, G. (2016). Surge in students struggling with stress. The Times, 11 July 2016. Accessed March 2017. http://www.thetimes.co.uk/article/surge-in-students-asking-for-counselling-xnvb5p5r2. Smith, G. (2008). Does gender influence online survey participation?: A record-linkage analysis of university faculty online survey response behavior. Dissertation from San Jose State University. Retrieved from https://eric.ed.gov/?id=ED501717. Stewart-Brown, S., Evans, J., Patterson, J. et al (2000). The health of students in institutes of higher education: An important and neglected public health problem. Journal of Public Health Medicine, 22, 492-499. YouGov (2016). One in four students suffer from mental health problems. Accessed March 2017. https://yougov.co.uk/news/2016/08/09/quarter-britains-students-are-afflicted-mental-hea/ YoungMinds (2015). Widespread cuts in children and young people’s mental health services. Accessed March 2017. https://www.youngminds.org.uk/news/blog/2942_widespread_cuts_in_children_and_young_people_s_mental_health_ services. Wallace, P. (2012). The impact of counselling on academic outcomes: the student perspective. British Association of Counselling and Psychotherapy, November 2012.

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