Universities outsource mental health services despite soaring demand

Critics say shifting counselling resources into ‘wellbeing’ is perverse and dangerous when depression and suicide among students are at worrying levels

Amid mounting concern over student suicides, some universities have found a surprising solution to their long mental health waiting lists – they are reducing or outsourcing their counselling services in a move apparently designed to shift the burden on to the NHS.

Unable to keep up with rising demand, they are rebranding their mental health student support as “wellbeing” services. Some universities plan to maintain a reduced number of counsellors, but others are sending students to local NHS services. Professional counsellors are being told to reapply for jobs as wellbeing practitioners, or face redundancy.

Hull, Wolverhampton and Essex are among the universities outsourcing some or all of their counselling. They say that they are boosting and expanding their services, but campaigners fear students with the most serious mental health issues could lose out. “Wellbeing” is a broader approach to mental health that includes healthy eating, mindfulness and stress-relieving activities such as yoga, meditation and campus walks.

There is concern over the loss of trained, experienced counsellors on campus, a move described as “perverse and dangerous” by the British Association for Counselling and Psychotherapy. “The fact that some universities are considering downgrading or reducing counselling services within their institutions is a huge cause for concern, particularly seeing as mental health needs among students are often complex,” says Andrew Reeves, BACP chair.

The switch to wellbeing could be a smokescreen for cutting costs, warns Alan Percy, chair of BACP interest group Heads of University Counselling Services, and head of counselling at the University of Oxford. “We have always supported an institution-wide wellbeing approach to student mental health, but reducing or outsourcing inhouse, embedded professional counselling services at a time when there is so much concern about student mental health and suicide rates is not only perverse but institutionally irresponsible,” he says.

Ninety-five university students killed themselves in the 2016-17 academic year, and Sam Gyimah, the universities minister, last month issued an ultimatum to vice-chancellors to tackle the mental health of students. “There are some vice-chancellors who think that university is about training the mind and that they don’t have to deal with these extra things. They can’t do that … It can’t be something that belongs to the wellbeing department of the university. This requires sustained and serious leadership from the top,” he said. One of his proposals is for an opt-in system authorising universities to contact the parents or guardians of students with a mental health crisis.

The University of Wolverhampton disagrees: “Our core function is as an educational institution and not a specialist mental health service,” it states in a consultation document on planned changes to student support services from September. “The current counselling model is not able to respond to the demand from students for support, with resulting waiting lists of up to six weeks.”

Figures from the Office for National Statistics last month showed the annual suicide rate among students rose slightly over the last decade to 4.7 suicides for each 100,000 students. The ONS said this was below the rate for the general population. However, a recent study of UK suicides by age group and education carried out by the Centre for Suicide Research and Prevention at the University of Hong Kong said the student suicide rate was higher than that for non-students, rising from 6.6 to 10.3 (56%) per 100,000 between 2007 and 2016.

David Mair, the former head of the counselling service at the University of Birmingham, which has retained its professional, accredited counselling staff, says there is a lot of sloppy language around mental health. “You often hear things such as 66% of students say they had a mental health problem in the past year – but this can range from feeling anxious about exams to depression, which makes it hard to get out of bed in the morning,” he says. Universities could become overwhelmed by demand for counselling if the people who see students initially lack the training to distinguish those who need the most help.

But shutting down counselling because of demand is wrong, he says, because accessible support on campus is important for students with significant mental health issues. “You need a wellbeing service, but the distinction between wellbeing and counselling needs to be understood. That understanding seems to disappear when counselling is subsumed within wellbeing.”

Anonymous student in counselling
One of the concerns is that students will not be offered face-to-face meetings with counsellors. Photograph: Fabio De Paolo

The University of Wolverhampton says its new model of student support will refocus services around prevention. “To increase the number of counsellors misses the opportunity to implement new approaches,” says its consultation document. “A new team of mental health and wellbeing practitioners will provide a range of interventions, including counselling and preventive student and staff programmes.”

Its 12 mental health workers and counsellors have been told to show how they match the requirements for five new positions of mental health and wellbeing practitioners.

A spokesman told the Guardian: “The model of support from September 2018 is to refocus the team towards a prevention, intervention and referral model, providing for greater capacity where this is needed most. This will result in the formation of a multidisciplinary team made up of staff with a range of clinical and wellbeing backgrounds, including counsellors and specialist mentors with the ability to provide a single point of contact for students in distress and staff seeking advice to support students in distress.”

The University of Essex is also overhauling its mental health services. For the past 20 years it has had four counsellors on its main site and outside provision for its two satellite campuses, but the service is being outsourced from mid-October.

Essex’s consultation report says there has been a substantial growth in demand and a “sector-wide shift towards seeing wellness as part of a much broader and more complex matter than simply mental health”. Instead of being provided by university employees, counselling will be provided by “partnership arrangements” with an outside body, yet to be decided.

An advertisement for three university wellbeing assessors last month did not ask for counselling qualifications. It stated: “The successful candidate will hold a minimum of two A-levels or equivalent and will have experience of working with people with mental and emotional health difficulties, as well as experience of student-facing delivery in this area. You will understand the practise [sic] of assessing student risk, working to empower and enable clients and working with stakeholders to ensure effective referral.”

Essex says its plans will “increase the number of staff working for our student wellbeing service and increase the availability of student counselling at Colchester campus by 30%”. The spokeswoman adds: “The restructure will increase significantly the volume of counselling we can offer as well as create roles dedicated to launching new activities and working with academic colleagues in departments to improve inclusivity and support students.” The spokeswoman adds: “The restructure will increase significantly the volume of counselling we can offer as well as create roles dedicated to launching new activities.”

The University of Hull says its scheme has helped provide extra support for students. In 2015, Hull outsourced its counselling to Let’s Talk, a free, local NHS-commissioned service. It has bases across the city and now on campus as well, says a spokesman. “The university’s wellbeing team, together with Let’s Talk, allows us to provide a more in-depth intervention for those students in need, allowing us to broaden the available support. This partnership has provided more directed and specific help to students who need it,” he added.

However, Percy remains sceptical: “If, after a ‘wellbeing’ review a university is employing fewer trained and qualified counsellors, than previously then that is a cut. If, after a review of support services, students have to get counselling from an external provider not embedded into the university, that is a cut. If students have to get counselling from the already overstretched and underfunded NHS services, that is a cut. And if students are offered telephone or online counselling without the option of a face-to-face meeting with a counsellor, then that is yet another cut.”

• In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.


Liz Lightfoot

The GuardianTramp

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