Mental Health and Suicide prevention strategies: a whole university approach

1. Mental Health and Suicide prevention strategies: a whole university approach Ross Renton Pro Vice Chancellor University of Worcester, UK 22 November 2018 Open University Seminar

3. National Context: Youth is peak age of onset for most MH Difficulties Students in HE are a high risk group for Mental Health difficulties based on AGE + other vulnerability factors/stressors (transition, exam and study demands, external factors e.g. parental divorce) Victoria (Aus) Burden of Disease Study: Incident Years Lived with Disability rates per 1000 population by mental disorder

4. 15 – 24yrs is the peak period for the onset of mental disorders (75%); 1 in 4 young people will experience a mental disorder in any 12 month period. • Self harm has peak incidence in young people (females are high risk group with highest rates (APMS 2014) and is a significant, persistent risk factor for future suicide, 50-100x lifetime risk • Suicide 2nd most common cause of death for young people (globally it is the most common for young females) • No. of suicides is low but rises in late teens:30% females; 70% males (National Confidential Inquiry into Suicide 2016) Youth and Student Mental Health Problems, Self Harm and Suicide: A Rising Tide? HE student suicides risen by 50% since 2007 (75-112) (ONS 2011); in 2014 (130) risen by a further 25% for males (ONS 2014) 134 in 2015 (ONS 2015)

5. HEPI latest report

6. Intersectionality

7. According to the Children’s Society, serious mental health problems affect about one in ten children, with only 30 per cent receiving appropriate interventions. Colleges and schools

8. Suicide antecedents: 22% bullying, 13% bereaved by suicide, 15% abuse/neglect • 53% in education at time of death • 15% experiencing academic pressures • 27% exams or exam results at time of death Suicide related internet use: 12% searched for info on suicide method, 9% posted suicidal thoughts, 6% online bullying Over a third had sought medical help for a physical health condition 54% previous self harm 27% expressed thoughts of suicide in past week 41% contact with Mental Health services, 43% no known contact with any services Suicide by Young People in England National Confidential Inquiry into Suicide (May 2016)

9. Zero Suicide (ZS) in Health care: (Hogan and Goldstein Grumet 2016) An aspirational goal, mindset, a specific set of suicide prevention (SP) practices: Core Values - belief/commitment that suicide can be eliminated in a population under care…by improving service access and continuous quality improvement. Q Does HE share these core values? Systems Management - taking systematic steps with bold but achievable goals to eliminate suicide attempts and deaths among members. Q Is suicide prevention a key strategic goal for HE? Evidence-based clinical care practice includingengagement and education of patients, families and health care professionals. Q Is HE following evidence based SP practice? HE is a ‘Community of interest/Practice’ where ZS could potentially be adapted and applied

10. Adapting Zero Suicide approach to a HE setting • Requires adaptation of the ZS model to be 'fit for purpose' in an educational setting where health care delivery is not its primary function. • Requires a 'hearts and minds' shift from anxieties about reputation, recruitment, 'duty of care' and corporate responsibility when there is an overt focus on 'student suicide' How many more publicly profiled student suicides are required for HE institutions to prioritise student suicide prevention as a core responsibility of HE?

11. What might ZS look like within a HE setting? (Adapted from Zero Suicide Key Elements identified by Hogan and Goldstein Grumet 2016) Leadership: Commitment to and a culture emphasizing suicide prevention as a critical student safety issue, goal setting and action planning using evidence-based approaches to suicide prevention, support for staff who may be in a role supporting students. Training A competent, confident, caring trained HE workforce with training and intervention skills appropriate to staff roles. Staff who interact with students are aware of signs of suicidality and know the steps they should take.

12. What is the potential contribution of HE to a wider suicide prevention agenda? Huge youth mental health literacy/ emotional resilience opportunity where 50% of young people currently attend HE institutions in the UK Embedding knowledge and skills in the HE curriculum could future proof the next workforce generation and support longer term suicide prevention across the lifespan Research evidence and knowledge contribution through systematic review and robust evaluation of suicide prevention interventions, including Zero Suicide

13. Suicide Prevention Planning: Why are partnerships with HE important? Access to a large cohort of young people at a key life stage Collaborative working opportunities across health and education sector interface for young people facing health issues while in education Education, training, resource development, consultation, involvement opportunities Evidence appraisal and evaluation

14. What is happening in HE about student suicide? Limited epidemiological evidence or incidence data on HE student suicide (Hawton suicide research group University of Oxford, NCI into suicide May 2016) Few research studies with a specific focus on student suicide or its antecedents Many mental health and wellbeing initiatives in Universities supported by national NGOs (eg Nightline, Student Minds, Students Against Depression, Charlie Waller Memorial Trust, Samaritans, MWBHE, UUK) Interventions with high risk student groups: medical/veterinary students (eg. Universities of Birmingham, Bristol, Leicester, BMA students) Few whole university suicide prevention initiatives (eg. Universities of Worcester, Wolverhampton, York)

15. Local Context “We aim to make a truly transformative contribution to the lives of our students, our staff and the people of our region and to make a very positive impact in society more broadly” University of Worcester Strategic Plan (2013-18) First UK university to sign the International ‘Charter for Compassion’ 11,000 students and over 1,000 staff The Hive – Europe’s first University and public library University Arena – Inclusivity Worcestershire County Council Mental Wellbeing and Suicide Prevention plan 2014-2017 WSCB CYP Suicide Prevention Guidance launched December 2013

16. Project Impetus Interest in support of University students with mental health problems by the former High Sheriff of Worcestershire, Nicholas Wentworth-Stanley Appointment of Professor Jo Smith to Institute of Health and Society (clinical and research interests include suicide and mental health problems in young people) Top down support: Vice Chancellor initiated a ‘suicide safer’ project Consistent with the ‘Compassionate University’ pledge as a signatory to the European ‘Charter for Compassion’ Aligned with other University health and wellbeing initiatives

17. Leadership, Context and Scope Dedicated project leadership supported by a project group University and partner agencies (PHE, WCC, health and NGOs) chaired by Pro Vice Chancellor Students Expertise/experience within the University and local community University: low suicide incidence but consistent with explicit organisational values and aligned with other University health and wellbeing and disability/inclusion initiatives Existing work around protecting mental health and well being and targeted support to high risk groups Community outreach opportunity to work with local partners to: Raise awareness and take small actions share and develop existing good practice initiatives develop collaborative working to impact positively on young people in relation to self harm and suicide

18. Intended Outcomes To support the mental health and wellbeing of young people attending the University and living in Worcester City and County  To reduce suicide rates (attempts and incidence) in young people attending University of Worcester, and living in Worcester City and Worcestershire County To develop, evaluate and promote an intervention model and identify key components contributing to the development of a suicide safe University, City and County

19. Key Values and Principles Promoting mental wellbeing and inclusion Creating ‘compassionate communities’ mobilising peer support to support others Prevention and early intervention to reduce the need for higher level more complex interventions and crisis services Education and mental health awareness/sensitivity/support with a workforce that can deliver focused early support and intervention to those who require it Partnership with other stakeholders to create joined up services in response to crisis and sharing resources/expertise Targeting vulnerable groups Targeting vulnerable times

20. Three Project Strands Strand 1: Education of students and future graduate workforce (embedding MH knowledge and skills into the curriculum), University staff, local partner organisations in relation to skills, understanding, empathy, contributing to “suicide safer” environments. Strand 2: Support for students (and parents) and staff to maintain wellbeing, awareness and availability of early support services, risk identification and support to reduce risk, crisis support services, support for those affected by suicide and suicide survivors. Strand 3:Researchlocal audit and data collection, evaluation of project elements and a contribution to the understanding of student suicide and suicide prevention in HE through a programme of research ( VRA, Phd studentships, ESRC grant bid).

21. Phased Implementation Programme Phase 1: Building a ‘Suicide Safer’ University: Mental health awareness events Peer support initiatives Mental health ‘Inspire and Share’ events for academic staff Awareness: information and skills training, resources and support for students/parents/staff Phase 2: Contributing to a ‘Suicide Safer’ City: Support to local partners through sharing info,rmation, resources, training, consultation, events participation Schools and CAMHS mental health awareness training outreach Public Lectures on Mental Wellbeing Phase 3: Contributing to a ‘Suicide Safer’ County: Suicide audit group Research evidence, training, information, resources Contributions to local suicide prevention action planning Public awareness through media releases, radio interviews, public lectures Skilling graduate professional health, education and social care workforce

22. Building on Existing Good Practice Listening Ear drop in run by UW Mental health counselling service for students and parents during first 3 weeks of term Existing support for potentially vulnerable groups eg International, LGBT and DSA students UW Counselling and Mental Health Services: ‘Looking after mental health and wellbeing training’ for ASD students, students on DSA, any educational department that request this ‘Exam anxiety’ workshops Procrastination workshops Mindfulness training (weekly sessions) Wellbeing group for International Students Training for UW security staff, domestic and student support staff to spot students who may be of concern and daily concerns log to alert Mental Health counselling who will proactively follow this up Fresher’s week mental health and awareness event

23. Stakeholder Engagement Student Union: President, CEO and sabbatical staff Strategic Director for Health and Wellbeing Head of Student Support Services ‘Compassionate University’ lead Mental Health and Counselling Service Personnel University Chaplain University staff and students Local Community: WCC Public Health, Samaritans, Community First, WHAC NHS Trust, Worcester Warriors, Chamber of Commerce National/International links: The Alliance of Suicide Charities (TASC: core member), Alliance for Student Led Wellbeing (ASLW: core member), Nightline, Grassroots (Brighton), IMHL international Suicide prevention exchange meeting in Oxford and ‘Zero Suicide’ Collaborative

24. Engagement and Awareness Raising Finding Mike: Mental health awareness and suicide prevention event Rethink ‘Stranger on the Bridge' film documentary shown to over 250 students and staff from across the University Panel discussions with the film Producer and Director and an 'expert' panel incl. a suicide survivor and family member bereaved by suicide Mental Health and Wellbeing Fair to raise awareness and provide information to students and staff about local support services available both on campus and locally in the city Leaflet distribution: 'Staying Alive' suicide prevention phone app details (from Grassroots in Brighton) 'Its safe to talk about suicide’ leaflet (from Devon County Council) on talking about suicidal feelings University support services Media Press releases

26. Support for Students (Universal) Student Pocket Guide to Mental Wellbeing Parents guide: support strategies and available University support Nightline soft launch over exam period (full launch September 2015) Residential Student Ambassadors to be trained in Youth MHFA and ‘Safe Talk’ in all University residences Security and Domestic staff Mental Health Awareness and Support training Out of Hours with daily report system when concerned 'Student Mental Health Day’: information and awareness stands on ‘Five Ways to Mental Wellbeing' on main campus.

27. Support for Students (Targeted) Moodmaster training for students struggling with mild mood difficulties (assessed and funded from MH and Counselling Service budget) MH and Counselling Service Listening Ear drop in for Freshers ‘Looking after mental health and wellbeing training’ for ASD students, students on DSA, any educational department ‘Exam anxiety’ workshops Procrastination workshops Mindfulness training (weekly sessions) Wellbeing group for International Students Dedicated support services for potentially vulnerable student groups

28. Support for Staff Student Wellbeing Leads to support Academic tutors (pastoral care role) and other student support staff: ‘Supporting Distressed Students’ booklet for Academic tutors 'Moodmaster' training courses for staff (funded from Personnel training budget) Mental Health First Aid training for academic tutors to spot signs and symptoms of mental illness and how to aid someone experiencing a crisis, including a person who is suicidal. ‘Safe talk’(student well being leads and academic tutors) and ‘ASSIST’ (MH and Counselling staff) training (planned)

29. Community Outreach MHFA training opened up to local NHS and LA staff Adolescent mental health awareness training for trainee teachers in the Institute of Education (further joint training initiatives with CAMH students) Suicide intervention skills (Safe talk and Assist) training included within University Paramedic training curriculum . Collaboration with Worcester Warriors Community Outreach Programme on a schools MH awareness initiative Involvement in a review of mental health and wellbeing training in Higher Education for the Alliance for Student Led wellbeing (ASLW) incl proposal to develop an on line learning platform and resources Included in WCC Mental Well-being and Suicide Prevention Plan

30. Suicide Recording and Audit Epidemiological data on suicide prevalence in University populations is limited University data collection on suicides (completed and attempts) is limited Coroners reports: open verdicts, delays in information Countywide suicide audit group membership (chaired by WCC Public Health): WCC Public Health and Intelligence team, police, fire, health (MH, liaison and A&E), ambulance, University Quarterly review of local suicides based on Coroners report information Intelligence information from key agencies to identify potential prevention opportunities and learning to reduce suicides.

31. Research/Evaluation Vacation Research Assistant studentship: review suicide prevention literature on initiatives targeting college/university students, particularly young males Match funded PhD studentships (n=2): qualitative research projects in partnership with NUS – one on prevention and one on supporting HEI staff Living Works ‘Suicide Safer’ accreditation?: potential UK rural pilot site (led by Grassroots Suicide Prevention in Brighton) UW Suicide Safer Plan: impact/outcome evaluation

32. Issues Project Name: suicide safe(r): limiting and risky? Boundary issues: MH and counselling, student wellbeing, student support Engagement/consultation, involvement, communication Institutional ‘politics’ and ‘pinch points’ (unresolved issues) ‘Quick wins’ and ‘slow burners’ Incentives for involvement and change Pilot initiatives, phased development Capacity issues: academic tutors, project lead and team, University Compassionate University: misconceptions

33. Unique? Not in content but possibly in scope and specific focus on suicide ‘Top down’ Executive support for a ‘bottom up’ initiative Dedicated time and project leadership Membership of national groups (TASC and ASLW) Context specific emphasis on explicit values. community outreach and ‘compassion’

35. Take home messages… HE Students are a high risk group concentrated in most major cities who should be equipped to promote personal/peer mental health and wellbeing, identify mental health problems/self harm early and how to/where to seek help Embedding Mental Health Training in the HE Curriculum offers a ‘critical period’ opportunity for early intervention/prevention of later mental health problems and suicide risk across the lifespan and future proofing the next adult workforce HE needs to be included as a partner to jointly plan and commission ‘fit for purpose’ service access and provision for HE students who may be temporary residents and in transition. HE needs to be vigilant to ensure timely, effective early detection/intervention for emerging mental health problems and self harm/suicide risk in the HE community

36. Ross Renton Pro Vice Chancellor University of Worcester, Worcester, UK @ross_renton pvcstudents@worc.ac.uk