FINAL PLENARY DISCUSSION

Chair - Eileen Smith

We have not been able to identify some of the speakers (contributions preceded by ?) but would appreciate being informed by anyone who can.

ES:  This session is a fairly brief one.  We have put the members of the HUCS executive on the platform because HUCS were the people who put on the conference and we see ourselves as having some responsibility to take it forward, but certainly not the only responsibility as this has been a collaborative conference and what we want to take forward are ways of collaborating with other organisations.  We are going to start with very brief feedback from each of the workshops, so we’ll see what’s been going on there and then we’ll throw it open to the floor.  So Elsa, would you like to start?

Elsa Bell:  I was chairing workshop or seminar one. We have two speakers, Dr Mike Hobbs who is a consultant psychiatrist and consultant psychotherapist, the chair of the Royal College’s working party, speaking personally because the paper is not yet published, and Dr Ravi Rana who used to work in student counselling and now works in the NHS as joint head of psychotherapy.  In many ways it was quite a controversial group and lots of us were somewhat perplexed and our eyes were glazed because of the enormity of the task.  Mike set the scene very carefully at the beginning, explaining to us in no uncertain terms the reality of what psychiatric services can and will deal with and are able to deal with in terms of funding and provision and also looking at the appropriateness of that.  He expressed a strong will on behalf of psychiatrists to work with people in the Primary Care setting and included student counselling in that; they deal with nine tenths of people with mental health problems while one tenth will be dealt with by the psychiatric services.  He also came up with a number of ideas for working together and taking things forward, which I’ll try to summarise very quickly at the end.

Ravi’s presentation actually challenged us and maybe, in a way, challenged Mike’s presentation. She was saying that this is all well and good but actually it isn’t going to happen; if we accept that student counselling services alongside our primary care health practitioners are going to be dealing with nine tenths of people with mental health problems, then we need services that are resourced and competent to deal with that.  And she challenged us to think about the kinds of services that we already run and what we might need extra in order to do this task. She didn’t actually use the word there but what she was saying was that we would be taking on the treatment of people with mental health problems and that’s a word that, particularly in student counselling, we have tried very hard not to use for a long time.  So Ravi, congratulations for at least making us think and making some people cross, which actually allowed for the kind of glazed expression and sentiment voiced by one member, “I’ve heard today of all the things that I’m not doing that I’m supposed to be doing and I can’t think how I’m going to do it”.

OK. A quick summary of the suggestions from Mike Hobbs in terms of the way forward, a way we might work well together.  He suggested that NHS staff need educating in the particular issues facing students.  He emphasised counselling services as having a primary mental health care role and the need for developing a collaborative network. An idea about having someone who is familiar with the mental health network within the NHS as well as within universities and in Higher Education. He suggested actually having someone in the NHS whose responsibility it is to know more about HE and to make sure that’s infiltrated, as it were, into the NHS system. Primary care trusts should develop a student mental health strategy and there should be a definite continuity between home and NHS services.  His view was, it’s a nonsense that in a national health service there should be arguments about who is going to pay for the treatment of people.  And that service models should built on existing good practice, but we should argue for the money to evaluate these. He was also advocating within the NHS an extension of what is now the work up to sixteen with adolescent mental health and extending this to those between 15 and 24.  So we had a lot to think about and if we are going to take this forward we’re going to have a huge amount of work.

ES:  The bit I remember from Ravi was that we all in counselling services had to improve our competencies if we were going to do it.

?:   I am speaking for workshop two, which was the one on student services.

We had three presentations and then a discussion at the end and questions.  The first presentation was by Professor Rick Trainor on the Universities UK report into effective approaches to retain students in higher education, the one that Margaret Hodge wasn’t terribly encouraging about this morning.  Basically Rick talked about the background and the factors feeding into the report, the fact that it was produced in a very short timescale; the findings; evaluation criteria; recommendations for government, HEFCE and universities and the further work that was needed.  The main conclusion was that student services need higher priority and a higher profile in terms of planning and funding in all universities. Also, another point that came up was the importance of taking an integrated approach to planning student services.

The second presentation was by Sally Olohan and was on the AMOSSHE guidelines. She talked generally about the report, the breadth of the consultation exercises that were entered into, looked at who had responsibility for what and the stages of the student experience, the student life cycle in a university.  Really, the main thing that came through to me, at any rate, from that was that a whole institutional approach is what is required and a holistic approach or multi disciplinary working were what institutions needed to be thinking of doing.

The final presentation was from Barbara Walters of SKILL and she was talking about DDA part four – issues with regard to students with mental health problems.  She pointed out that the DDA part four will inevitably raise the profile and the importance of student services within all the universities.  We looked at anticipation and anticipatory duties in all aspects of institutional provision and issues affecting adjustment. Disclosure and confidentiality are also two very significant issues in relation to mental health.  She finished by saying we need to think beyond the campus and again looking at working with other institutions and partners and not working in isolation.

ES:  This morning research was one of the things that we were enjoined to do so if Peter Ross would say what was planned from the research meeting?

Peter Ross:  I suppose two questions lurked behind the research seminar.  One was, “Is there evidence of effectiveness?” and the other is. “Is there evidence of what needs to be done?”

Steve Potter from Manchester University spoke about effectiveness, looking at the way in which he uses CORE in his service.  Some of you will not be familiar with CORE.  It’s a questionnaire, lots of questions, five point scales which clients can fill in before and after counselling.  It gives a very good measure of change or no change. It can also be used for continuous audit which was what Steve was doing.  This has the advantage that you can pick out very quickly those cases that are not going well, indeed perhaps cases that are going backwards, so to speak and quickly sort them out.  Steve’s suggestion with regard to the future is that we set up a practice research network.  In other words a group of universities using CORE PC who in coming together would greatly enhance the normative data and of course bring down the cost of doing that.  That seems to me a very, very good idea indeed, because it would give a major bit of progress in terms of looking at and proving something to do with the effectiveness of university counselling services.  It would also give comparative data with clinical psychology and psychotherapy services within the NHS, which seems to me very important.

Dr. Annie Grant from Leicester University spoke about a very wide ranging research survey she did into second year under graduates at Leicester where she got an 80% response.  A really important cohort of students.  She described some of the interesting things that came out of that.  11.5% of all those students were either concerned or very concerned about their suicidal thinking.  It struck me this morning when people were talking about suicide that we talk widely about suicidal thinking, don’t we?  And yet the suicide rates for students are roughly similar to the suicide rate for comparable groups in the wider population.  Yet in these surveys we find that there is loads of self harm and there is some very interesting research on self harm which shows that lack of problem solving ability is behind a great deal of self harm.  So that if we were teaching social skills, assertiveness and so on, the self harm rate seemed to come down very well and so one of the issues for us is whether we carry on dealing with people individually in our traditional fashion or whether in effect we get into teaching in groups.  But of course, if you were to say, is there any evidence, solid evidence, that teaching in groups works in this context, the answer is no.  So that’s some research that needs doing.  And again from Dr. Annie Grant, very interesting work on ethnic minorities and international students which show that they were less likely to seek help and more likely to have high distress levels, I think in general terms less likely to feel valued by the host community.  We know of course that students who don’t approach help providers, including counsellors, by and large have got lower self esteem and by and large make the assumption that the person they might be going to see is going to be highly critical of them.  In other words these are critical parent issues.  So again it seems to me quite a lot of research that we might be able to do on that front.

ES:  Did you solve the question of who was going to fund the research?

Peter Ross:  Not yet

Nicola Barden:  I don’t think I can summarise everything that went on so what I’ll do is just speak to the points that struck me during the discussions.  I was in the group on Counselling Services in the University.  Colin Lago talked about it from the counselling service perspective and Rachel Tooth from the student user perspective, so it was a really nice balance.  

From Colin what I remembered was that students nowadays need to be much more psychologically robust than ever before. We were thinking about the multiple transitions they go through; even courses can involve many transitions because they are so modularised.  Placements and friendships and reference groups and accommodation, they can go through lots of changes in three years.  He talked about spreading the importance of interpersonal contact, that’s what really matters to whether students’ needs are met in or not is the level of good interpersonal contact they can have.  And he talked about the acceptability and accessibility of counselling services and that contains a huge amount that was really important. 

Rachel spoke really clearly of the need to be able to choose or to have a say in what catches you when you fall.  I thought that was a really neat way of putting it.  And also the social embarrassment of seeking help and the feelings of greed if you need to ask for a lot which can actually prevent you getting what you need and the need to normalise services.  The importance of giving staff access to basic but well informed pieces of information so that they don’t have to trawl a lot of stuff to find out what it might mean if somebody comes with x problem and what they might very simply be expected to do about it.  And we also talked about the need to support the students who are supporting the people with mental health problems. 

We commented that the commitment to change is patchy.  You get some departments and some institutions that are great and some that really don’t want to know.  We did touch on email support with some groans.  A feeling it’s coming “Oh, God. Do we want it?” And also some really lovely examples particularly from the Samaritans of developing e-listening, which were very encouraging.  One last thing was perhaps the difference between visibility and recognition when you are looking for resources.  It’s not impossible to make sure you become visible in terms of attending meetings, being there and so on, but how to make sure that someone takes notice of you is, perhaps, a different question and something which, I think, HUCS and AUCC and BACP can well address.  It’s not just an individual within their institution who can address that.

Christopher Butler: The final workshop was on academics supporting students and the support that academics need to help them give that support.

We had two excellent presentations.  The first from Nicky Stanley which focused on research at Hull about academics supporting students and about what they had found helpful and found enabled them to perform their task better and what they had found unhelpful.  The research contained, I think, some plaudits for counselling services and described things that underlined the usefulness of the service and the usefulness of coordination with the academic staff. But it also raised some difficult questions that we looked at later.  Things that I really felt the meeting seemed to feel we needed to be clearer on and move forward on.

Ros Crouch then gave a very interesting insight into setting up a tutorial system, personal tutorial system, for large groups of students and the work that one could do with them in their first year. One particularly interesting thing that I felt that emerged from her research, was the academic staff’s ability to quite quickly spot what students might have ongoing difficulties and what other students, although they may have temporary difficulties, seemed more likely to remain within the institution. So that could maybe give us some insight for improving retention. 

We drew out of this four things that we felt needed looking at.  The first was the whole area of confidentiality.  Firstly, it just seems that it needed simplifying; a lot of people there were just unsure about confidentiality issues and have been given conflicting advice. But it seemed beyond that, that we as counsellors maybe have to think a little deeper about precisely how we can help our academic colleagues and making sure that confidentiality is not a bar to that. 

The second issue that we looked at in some detail was the issue of role conflict. The different roles that the academics have to perform in relation to the students and how, quite often, the caring role and supporting role can be in conflict with the assessing role. I think there was a fairly strong feeling in the room that actually academics are now struggling to perform a large number of roles that do not fit together particularly well.  There may be a sense that the Minister had glossed over those difficulties this morning. 

The third area we thought was important was the awareness of mental health issues amongst academics, though we accepted that they were pushed for time in this. There was a general feeling that actually we need to carry forward a feeling of more involvement and more discussion of the issues in raising the whole institution’s awareness if universities are genuinely to become communities that foster mental health across the wide range of the population. And then we devoted a few minutes to the question of what reasonable adjustments are and got involved in complex philosophical points about the nature of learning at which point we called a halt.

ES:   Well it would appear that everyone has been working very hard and we’re making notes.  We will digest them.  We have 10-15 minutes left of the formal proceedings for people to make further comments or suggestions of ways to take things forward from the floor.

Keith Sylvester: My name is Keith Sylvester, Central School of Speech and Drama.  I think the most disappointing bit of the day for me was the Minister and I wanted to urge the HUCS committee to really take seriously that she didn’t think it was that important to target help towards student services and student counselling, but to leave it to institutions which I think was a great misjudgement.  I particularly want to support something that I think Alan Percy said this morning about “at least the old QAA system meant that institutions could drop an all too valuable point if they didn’t provide student services properly” and I think we have lost that safeguard.  I think I would really like HUCS to take on board that there has to be some way of safeguarding that money does get to student service and doesn’t get eaten up in other parts of institutions.  I don’t know how you go about doing that.

ES  Well, I did notice that the Minister had someone with her who was writing down the point about QAA as she left.  Also, I can’t see her at the moment, but there is a member of the House of Lords who has been with us who has asked if she could put a question.  She’s not back yet, but we will follow that one up.

Alan Percy: Just very briefly, I spoke with Alan Jamieson and we’re going to be arranging a meeting to speak with a consultant who is working with the new QAA, so that’s just for information.

ES  Excellent

Sam Fisher: I’m Sam Fisher from Goldsmiths.  I thought it was outrageous the assumption that the Minister made in suggesting that there was a deflection from priorities from research towards pastoral care.  I mean it’s precisely because the government has targeted research that an awful lot of our anxieties are directed towards this conflict and if they are going to fund it in any other way I’d be glad to know that they are actually going to do this and maybe we could then address some of the issues she was suggesting we were ignoring.

David Owens, Chair of AMOSSHE:  As we’re reaching the end I really would like to thank the HUCS committee for putting this day on.  It’s had a very clear counselling focus but quite honestly the issues that you’ve raised have been widespread and I think there are a wide variety of people here and we have had a kind of discussion which has benefited from the various disciplines.  I think what the Minister said this morning actually took me by surprise. I hadn’t expected some of the things, but one of them that she said I think we all have to counter and that is that we need to take these things on at institutional level.  To be sure, we have to.  But I think one of the valuable things about the conference today is that it shows that these issues are generic and that if organisations like AMOSSHE and HUCS and whoever else actually addresses them collectively we might actually get something done at the central level, which, frankly, is essential for some of the issues that we face.  I’d like to thank you again.

ES:  Well, thank you for that.  Because I think one of the things we hope to do is to take things forward, to set up some kind of standing committee of all the organisations who have got something to contribute in this.  That’s one of the things we’ll be following up after the conference, because just like in our institutions we need a whole institutional approach. I think we need a whole services approach.

Elsa Bell:  I’m maybe going to take my life in my hands no, that’s a bit overdramatic.  But one of the things that really concerns me that the Minister said this morning was the complete dismissal of the notion that FE colleges were struggling in this area and whilst this has been a day for those of us who work in universities and that’s where our expertise and knowledge is, we know that we must speak on behalf of FE as well when we do this.  I notice that the chair of AUCC is being a servant to this by wandering around with the microphone, but John, I think we’ve got to say that we’ve got to work together with AUCC on this and disabuse the Minister of the notion that somehow FE is alright because it has had money thrown at it.

John Cowley:  I would agree with that, I think it is a really important issue.

ES  Anyone else?

?: It was something that came up – I was in the research workshop – and it was something that has made me think which is about how can you do research and get funding for it, if actually the thing you’re researching may come up with results which are uncomfortable for various institutions and/or for the government.  This is a sticky issue, because as various people have said at various times during the day, the universities which are the institutions you have been talking about, get quite anxious if what’s shown to be the case is that there are high levels of stress, or that ethnic minority students are not feeling very welcome in their organisations and I think if you research it there probably is quite a bit of evidence that modular courses are, to put it crudely, bad for the mental health of students, or worse than other courses.  So I think this is a real difficulty, how do you get research funding for sensitive areas which are some of the most important ones?

Steve Potter : One of the benefits of a practice research network would be that a group of people could pool together and that would provide a certain amount of shelter so the data could be aggregated and anonymised and we could make quite detailed reporting on particular themes, but it wouldn’t be clear that it was from any particular university, whilst at the same time we could have another level of access where we could get our own particular reports and keep those for our own particular uses, so I think the value of a practice research network would be great in that respect.

ES   I don’t know if any of my colleagues want to say anything.

Stephen Messinger:  I think it has been a great conference, but one thought about our title, Beautiful Minds?, is that we may  be caught up in one of the dominant pressures, that students face and not just students but that 50% of the population who perhaps never will get to university – the young lads playing football and so on.  And the collusion that we might have unwittingly caught up into, talking about beautiful minds is an idealisation of achievements and I see many students now and many staff at universities for that matter, who are caught in a trap of either be brilliant and succeed or there’s no steps in between to failure and feeling awful.  I think we need to be very aware that we are talking about beautiful and vulnerable minds, as I think Peter Wilson was implying.  Whatever the pressures of debt, which are considerable, and all the other pressures on staff and under-resourcing, we perhaps just have to accept we’re in a society which overvalues achievement and has high, high expectations and creates, therefore, a very critical and demanding voice in all of us.  We need to look in our mental health strategies or counselling strategies to tempering or softening that voice and it may be there regardless of what government is in place or not. So Beautiful Minds? OK.  But perhaps we need to also be looking at diversity of achievements and not an all or nothing approach which I think higher education is caught up in at the moment.

Ann Heyno: Steve, in response to what you are saying.  One of the central things in the film, ‘A Beautiful Mind’ was the fact that someone with a very, very serious mental health problem was enabled by his peers, by his lecturers, by the whole university to actually develop and I think that that needs to be remembered as well. That actually there are lots of things that can be done that aren’t resource intensive, if we can actually accept that mental health, as Peter was saying, is part of all of us really and that we can all do an awful lot to enable students with any kind of difficulties if we can de-stigmatise a bit.  And I think that probably this conference has done quite a lot to at least get Margaret Hodge to sit here and talk with us, which is a bit unusual. To even think about counselling, to get people to think about people with mental health problems and I think that everything has to be done very slowly and there is just a tiny little bit that you can do at a time.  I’ve been very, very struck by the enormity of the task, really.  But actually there is a lot by just being here and talking about it, we’ve done something.

ES:  I think I’m going to let you have that as the last word, Ann. My job now is to begin to thank people. To thank Universities UK, who have made us very comfortable today. To thank all of our speakers and all the people who chaired the seminars this afternoon.  To thank the conference steering committee, there was Ken Ewings and Ravi Rana who had to leave fairly early on, Elsa Bell, Ann Heyno, Chris Butler who was responsible for the publicity and the beautiful website. Charlotte who coordinated everything and made sure that everything ran smoothly - and there were umpteen details to attend to and Zoë who was our conference administrator. I think Charlotte wants to say something particular about Zoë.

Charlotte Halvorsen: I just wanted to say a particular thanks to Zoë who is in the corner there, who has not only done all the administration for the conference but has done that alongside the administration and coordination of our very busy student counselling service.  So thank you, Zoë, for that. And also to thank Eileen who has steered our thinking through the planning and evolving of this conference, kept us to task today and done a great job in chairing.  Thank you Eileen.

ã HUCS 2003