Collaborative approaches between higher education and the NHS to support student mental health

The Student Mental Health Partnerships project established partnerships between higher education providers and the NHS in five cities to improve support for students. A toolkit has been developed with practical advice for other regions looking to develop similar partnerships.

UWE Bristol led a partnership across five English cities to improve care for students in need of mental health support through the development and evaluation of local partnerships between universities, the NHS and students’ unions. This project was funded through the OfS mental health Challenge Competition. 

Eight universities were involved (The University of Bristol, UWE Bristol, Liverpool John Moores University, The University of Liverpool, University College London (UCL), Imperial College London, The University of Manchester and The University of Sheffield), as well as NHS organisations.

The design and delivery of care was co-produced with students, with support from Student Minds.

Universities UK led a National Learning Collaborative to share learning across the partnerships.

The project was inspired by Universities UK’s Minding Our Future report (2018) which found that students experience great variation in mental health care, and suggested that there is an urgent need to better co-ordinate care between universities and local NHS services.

Difficulties with co-ordination and sharing information across services mean that students can fall between the gaps. It can be frustrating for students needing to repeat their stories to different services. Some students move to a different part of the country for their education or during the academic year, and information about their care rarely travels with them. Students are also going through an important transition time, taking on new financial and domestic responsibilities, developing new relationships, and learning more independently.

It can be difficult for mental health practitioners working in university or NHS services to understand and navigate the different systems and make appropriate referrals.

The project created and tested four approaches to collaboration between universities and the NHS across five regional hubs, with different levels of integration and connection.

1. Integrated regional student mental health service (Greater Manchester)
   The pilot Greater Manchester Universities Student Mental Health Service was launched in September 2019, offering a single designated mental health care pathway for students across the region, with access routes through existing university services.
   
   The service enables students with significant difficulties and complex needs to receive specialist interventions as part of a single pathway that extends through university-based services directly into the specialist service.
   
   The project carried out an evaluation, co-produced with student partners, that explored the journeys and experiences of students using the service in order to assess the effectiveness of the service and inform future development.
2. Broader clinical pilots: Student Liaison Service (Liverpool)
   The Student Liaison Service in Liverpool was designed to pick up issues of students being discharged from secondary NHS services into universities with no named contact and no clear plan, and ensure that the universities know what has happened with students who present in crisis.
   
   The service acts as an interface between NHS and the university, taking referrals from A&E, urgent care teams, GPs and university services, offering a brief intervention and signposting or referring to relevant services.
   
   A multi-disciplinary team, including NHS, university and student representation oversees progress and ensures practitioners can share best practice and receive the latest information.
   
   For further details please see the case study from the University of Liverpool.
3. Targeted clinical pilots: University Research Clinic (North London and Sheffield)
   The University Research Clinic model involves academic clinical psychology departments working in partnership with NHS services to improve outcomes for students and reduce pressures on universities.
   
   The service brings together clinical academic staff and NHS-funded trainee clinical psychologists, enabling students to access evidence-based treatment within a university setting. This streamlines referrals while providing clinical trainees with a high-quality placement experience.
   
   This has created a new care pathway for NHS treatment which is more easily accessible to students.
4. Structures for connectivity and collaboration (Bristol)
   The Bristol Hub brought together professionals from universities and from NHS primary and secondary mental health services to focus on solving structural and operational issues such as liaison and collaboration between services, referral pathways, and sharing knowledge and research to co-create a better understanding of local students’ needs. 

Further information about the four approaches and additional case studies are available on UWE Bristol’s website.

Student co-production

Students played an important role in the project and each of the hubs, supporting partnerships to better align services to student need.

Engaging students in practical activities such as peer-led research and evaluation projects was particularly effective. This approach gave students a space to work together meaningfully and provided good insights into the needs of the student population, as student service users were more likely to speak openly.

'By building strong cross-sector partnerships and a co-funded model for the service, we have for the first time created a shared approach for all students by listening to their stories and their need and are already seeing a significant reduction in crisis presentations to A&E.'

Professor Sandeep Ranote, Executive Medical Lead Mental Health, NHS Greater Manchester Integrated Care

The project has demonstrated that students are a unique population with particular needs and challenges and a unique pattern of support. It is only through collaboration between higher education providers and the NHS that students will receive the support they need and deserve.

The project evaluation provided some key findings related to the development of partnerships between higher education providers and NHS. Further detail will be available through the programme evaluation report to be published later in 2022.

Key findings

• Higher education and health care are both complex systems. There are many interconnecting parts which undergo constant change, making them difficult to map or fully understand. The systems are unlikely to significantly change in the short term – but the collaboration generated through the project has helped people to understand and to navigate this complexity and opened up opportunities for more integrated ways of working.
• Managing risk effectively is critical. There is no common risk management framework across different services, which presents many challenges. Different languages and terminology are used, affecting communication and trust between services. Developing a culture of evaluation and research helps to build clarity on outcome measures, and collaboration helps to build trust and understanding of different roles.
• Context matters. There is no single solution to developing partnerships – providers will need to understand the funding, organisational and political priorities in their regions, and what stage of the journey they are at. For example, the universities and NHS partners in Bristol are now developing an integrated Student Liaison Service, similar to the Liverpool model. This development is now possible because of the collaboration generated by the Bristol Hub over the previous two years.
• People and relationships matter. Professional identities and cultures underpin decision making. The roles of professionals within organisations who have an understanding of and can reach across different professional communities and the leaders who enable and can legitimise network activities are hugely important and need to be recognised. It is important to build trust – networks and practical opportunities can help create shared ways of doing things.

Toolkit to develop partnerships

The Student Services Partnerships Evaluation and Quality Standards (SPEQS) toolkit is a practical toolkit for service managers and practitioners striving to develop partnerships to respond to diverse student mental health needs.

It has been developed from the pathways and outcomes evaluation work led by UCL and the University of Sheffield.

The toolkit has been co-produced, with student researchers involved in reviewing the themes and developing recommendations. It covers five domains, with practical advice and guidance, suggested measures, and case studies for each:

1. Developing services with student voice and co-production.
2. Collecting and sharing data between services.
3. Managing risk across partnerships.
4. Measuring student mental health and wellbeing outcomes.
5. Developing and evaluating services and partnerships.

Next steps

All five of the regional hubs have secured support to sustain the partnerships developed through the project and are working to embed these models within their core practice.

There is an opportunity through the development of new NHS Integrated Care Systems to ensure that higher education providers are engaged with these structures at a local level, and that care for students is embedded in a way that is integrated and sustainable.