Supporting students with mental health difficulties Kirsty Wayland kw226@cam.ac.uk

1. Supporting students with mental health difficulties Kirsty Wayland kw226@cam.ac.uk Lisa Halpern lh358@cam.ac.uk

2. Objectives • To discuss the impact that studying for a PhD can have on mental health • To consider the barriers in a PhD for students with mental health conditions • To update on support available for students with mental health conditions • To develop interpersonal skills which can help manage such situations

3. Services available – Disability Resource Centre Advice, Guidance, Assessment and Support for disabled students and those staff supporting them Training: Bespoke and with PPD Disability Equality related advice and guidance Advise on institutional policy for disabled students Resources and Equipment Events

4. Services available - UCS Spectrum from well-being to severe conditions • Well-being - Self-help info and topic-specific workshops/groups • Mild to moderate mental health difficulties - Counselling, CBT & groups (self-referral) • Acute crises; more severe/ongoingMH conditions - MHAs can be contacted directly by staff for advice & support, or to arrange an assessment, including fitness to study procedures

5. Services available – locally (part 1) • Extent to which individuals are involved with the local MH services will vary considerably; shortfalls in service provision are almost inevitable • Access to specialist services is extremely limited for all students, due to systemic cuts/high triage threshold when compared to local population • GPs usually the central contact, both in a crisis and ongoing (along with out-of-hours teams) • Visa/immigration status may mean limited or curtailed services for some international postgrads

6. Services available – locally (part 2) • Addenbrooke's Accident and Emergency (A & E) • Cambridge GP • Urgent Care Cambridge (out of hours GP service) • CAMEO early intervention service for psychosis • Samaritans- email, telephone or in person (local and national)

7. PhDs- an ordinary risk to mental health? • ‘A long and lonely business’ • Postgrads also engaged in the activities of adult life- may have partners, children, aging or ill parents, debts, issues with health… and all the rest! • Imposter syndrome, perfectionism- setting oneself an impossible standard to achieve, never feeling good enough • Sci PhDs completed more quickly & in greater numbers than SocSci and Arts & Hums PhDs because isolation, involvement with supervisors, more regulated work ethos/lab routines…… but this also brings its own challenges…..

8. Studying for PhD with a Mental Health Condition • Long periods of isolated study can increase obsessive rumination or paralysed procrastination… leading to avoidance/absenteeism • Depression can  tendency to focus in the negative, thereby increasing depressive and anxious symptoms • Lab gossip and difficulties with colleagues can  social anxiety and mistrust, even paranoia • Side-effects of psychotropic meds: may impair concentration and memory, cause drowsiness, lethargy, dry mouth etc • Some MH conditions include a risk of relapse, and may require time off or hospital admission. Relapse risk may be  by deadlines, vivas

9. Additional considerations for international students? • Pressure to succeed- PhD is not just for self but for family and community (and possibly one’s employer) • Financial pressures- economy at home may be unstable, grant money or living expenses may be shared with relatives • Different health systems & medications; different remedies • Cultural norms/attitudes re disclosing MH difficulties or seeking professional help • Lack of former support network, social isolation, hostile or unfriendly attitudes/encounters with people in UK

10. Strategies for supporting PhD students • Adjustments for studs with MH difficulties benefit all students • ‘Better’ may not be the goal for all students, rather ‘living with’ • Level of support needed may fluctuate. Most illness are episodic, and many students will have extended periods where they do not need or want any special consideration. • Be guided by each student’s ability to cope with the academic requirements, not by the diagnosis. • Anticipate potential relapse triggers- the ‘stress vulnerability model’

11. Supporting PhD students • Regular scheduled contact • Information about who to contact, when, and why • Liaising with other relevant people to ensure consistent support • Review of support on a regular basis • Consideration of ways to manage sensory overload • Clarity around rules, regulations, deadlines and all expectations, and where there can be flexibility • Time to access scheduled support • Access arrangements for vivas

12. What are ‘Reasonable Adjustments’? The Equality Act continues the existing duty upon universities to make reasonable adjustments for staff, students and service users in relation to: • a provision, criteria or practice • physical features • auxiliary aids Education providers have a duty to make reasonable adjustments to ensure disabled people do not face ‘substantial disadvantage’ in comparison with non-disabled people. The duty remains anticipatory.

13. Examples of reasonable adjustments • Flexible booking policy for equipment • Non-Medical Assistants (e.g. mentors) • Access arrangements for assessments • Working hour adjustments • Adjustments around attendance at meetings • Adjustments around participating in presentations

14. Considering reasonableness • Competence standards • The costs of reasonable adjustments cannot be passed onto the disabled person • The provisions of the Equality Act apply equally to international students • Efficacy • Practice across the HE sector • Relevant OIA and court cases

15. Scenarios Aaron has disclosed depression via email after several weeks of poor attendance and some irritability with his peers. He comes to see you to discuss this. How do you start the conversation? What would you want to tell him and what would you want to know?

16. Scenarios Bella is a committed competent student who is quiet in group settings and friendly but not friends with anyone in the group. She puts in more hours than anyone else. She is clearly underweight and does not engage with you about any personal matters. What do you do?

17. Scenarios Kim is an international student who has disclosed PTSD. He describes concern about speaking in front of or in groups and dealing with pressure. How might you support Kim in your group?

18. Scenarios Clarissa is an American postgrad in physics, who has submitted the first chapter of her thesis after a series of delays. She plans to make a visit home in a few days. Two-thirds of the way into the draft, there is a passing reference to her research being of interest to the US government because it has implications for matters of international security. Five pages later she repeats this, implying she may attempt to speak with President Obama about it in the near future. What do you do?

19. Interpersonal skills – helper dynamics • Crisis or a drama? What’s going on and why? Should you intervene? Who else can help? • Inappropriate/ odd behaviours- can feel confusing, disturbing, unsettling • That sixth sense- what does your instinct/intuition say? Is this normal distress/social engagement? • The ‘ripple effect’- lack of boundaries/boundaried behaviour, “Institutional anxiety.”

20. Helper dynamics- some thoughts • What goes on with students? What happens in the relationships around the student? What happens for us as helpers? • Boundaries: what is it appropriate to do? What is not appropriate to do? Over-responsibility vs under-engagement and inflexibility • Victim, Rescuer and Persecutor- ‘the drama triangle’ • Staff members helping a student with a PD or a MH condition need support & a sounding board • Involving others, clarifying where others fit in- the larger picture