Co-creation to develop culturally competent mental health support for students

This case study explores how London South Bank University (LSBU) is using co-creation to develop proactive and preventative interventions with Black students, for Black students.

Through the Black Students Mental Health Project (BSMHP), LSBU works with the Black student community to document their perspectives and experiences of support services, mental health, education, wellbeing and disability, and to develop culturally competent resources. 

The project has been funded through the Office for Students' mental health funding competition. It began in 2020 and is set to finish in June 2023. Partners on the project include:

• Student Services at LSBU  
• Healthy London Partnership, Good Thinking NHS London
• South Bank Students' Union
• South Bank colleges
• Univarisity, YouPlus+ app
• Stephen Rudder, Quiet Voice, Black River.

The purpose of the BSMHP is to:

• promote early access to support services
• promote good mental health practices
• prevent mental health deterioration in the Black student community.

Through the evaluation of current support services and co-production of new culturally competent resources, the project aims to initiate institutional change, complementing work on ensuring the curriculum is relevant and reflective of all students.

Analysis of OfS access and participation data indicates that, nationally, there is a large gap between the attainment rates of Black students and white students in higher education. In addition, the OfS's 2019 mental health Insight brief found the attainment gap between Black and white students with a declared mental health condition to be extremely high.

In the 2021 academic year, Black LSBU students were seen by university mental health services proportionate to the student population (25 per cent). However, Black students were less likely to self-refer for support and are overrepresented within the university's crisis referral pathways, including fitness to study. 

University data indicates that there are several contributing factors to the widening gap between service awareness and service use by LSBU Black students. Research in the first year of the project gave an insight into the challenges that Black students face, which suggested that:

• students experience a lack of representation and culturally competent services with culturally relevant resources
• there is a sense of isolation amongst students and stigma about help seeking behaviours and mental health difficulties
• academic staff do not significantly contribute to students’ mental health and their wellbeing support journey
• there is lack of awareness of the support services on offer.

The challenge was to find ways to make services become, and feel, more inclusive to help change the narrative around mental health difficulties and attitudes to help seeking behaviours within the Black student community.

LSBU took a whole institution approach to this project, with departments from across the university committing time and expertise. This included colleagues from employability, sports and recreation, mental health and wellbeing, disability support, academic experts, communications and alumni, as well as committed time at director level. The university executive were fully supportive of the proposal.

Once the project officer was in role, they were able to continue to cultivate relationships and connect different parts of the project, raising the profile of the work and its purpose at LSBU. For example, they worked with the students’ union and academic staff to engage student societies, run student led events and embed the project across the student body.

There were two key elements to the project's approach: co-creation and student engagement.

Co-creation

Student voice has been embedded in the project from the start. Paying student collaborators removed financial barriers to participation. 

This has resulted in a student-led approach at every stage, with input from a wide range of intersectional groups of Black students including a mix of gender, sexuality, age ranges, cultural backgrounds and courses.

Using virtual and in-person focus groups and workshops, the project team worked with students to develop materials, including: 

• project branding
• discussion guides
• questionnaires
• events
• resources to support specific needs directed by students.

Through this process students identified areas for improvement, particularly in the way information about support is shared with them, enabling them to make meaningful changes to welcome materials for 2022-23 academic year.   

Other outputs co-created by students included blogs, vlogs, tutorials, podcasts, a YouTube series and clinical source material.  

Student engagement

Highly engaged Black students recruited other Black students virtually and on campus, via course group chats, sports clubs, and other communities they belong to.

The project team also ran a series of student-led pop-up events across the university, in the library, in halls, at Varsity, in local colleges, at national conferences. They were also invited to host a wellbeing stage at UK Black Pride 2022.

Students were hired to help facilitate focus groups, in roles such as note taking, co-ordinating their peers and presenting at university conferences and events.

Hear from students involved in the project in the video below.

There is a genuine excitement about the project, the materials that have been co-created, partnerships formed and the upskilling of students through their contributions.

By listening to the student voice, the project has led to the rebranding of services. The language and imagery used to advertise student services has changed, facilitating a better understanding among students. 

The project team believe that their findings support the importance of appropriate remuneration in co-production and that this has encouraged students to work as true collaborators, contributing to the project's success. 

Student feedback

Students that have engaged so far have reported an important connection and sense of belonging, which has been highlighted by testimonials:

'Thank you again for the opportunity today, it was my first experience interacting with Black LSBU students outside of my course group and a great way to build on my confidence with public speaking.' 

'I liked taking part in the focus group, it is good to see this kind of work being done at LSBU it goes to show that progress is being made.'

'Loved the experience! I found it very uplifting. I am excited to be part of this project and I have put everything I have done with you so far on my CV.' 

'Thank you very much for the opportunity! This is amazing work, and it feels great to see the things I have worked on being used on campus.' 

Evaluation

The evaluation of the project has developed key metrics in conjunction with students to measure perceptions, trust in services and staff, satisfaction, graduate outcomes, and perceptions of wellness and belonging.

Additionally, the project team will use available metrics on Black students to assess improvements, such as: 

• an increase in self-referrals to support services including mental health and wellbeing
• an increase in mental health and wellbeing appointments attended
• a decrease in crisis referrals to mental health and wellbeing services by Black students, including safety concern response meetings and fitness to study referrals
• an increase in students disclosing a mental health condition and accessing disability support
• a decrease in the percentage of students interrupting their studies and/or withdrawing
• an increase in the percentage of students progressing at first attempt
• improved National Student Survey (NSS) and Postgraduate Taught Experience survey student experience/satisfaction scores.

Next steps

The next phase of the project will establish a peer mentoring programme that develops a network of student support. This programme aims to build a community of Black students that engage with culturally relevant co-created wellbeing resources.

Project Officer Andy Owusu also joined The Unite Students Commission ‘Living Black at University’ project as a commissioner providing mental health and wellbeing expertise. This platform allows the BSMHP to contribute to a programme that has national impact, further demonstrating commitment to both university and sector equality and intersectionality.