Improving student mental health through partnerships

The Improving student mental health through partnerships project aimed to develop a student-focused, innovative best practice model for collaboration and liaison between university and NHS mental health services.

The University of Liverpool (UoL) was the leading partner for a Liverpool-based project working with regional partners to develop an integrated model of support for student mental health.

Partners of the project include:

• Liverpool John Moores University (LJMU)
• Mersey Care NHS Foundation Trust (MCT)
• Brownlow Health (a GP practice)
• Innovation Agency (the Academic Health Science Network for the North West Coast).

The project aimed to develop a sustainable framework for an integrated approach between universities and the NHS, offering seamless referral pathways and shared protocols supported by a clear risk management strategy which clearly specifies the responsibilities of partner agencies.

Through increased collaborative working and the development of mechanisms for shared learning, this allows for more effective planning and delivery of services to meet the varying and escalating needs of students.

This project is funded through the OfS mental health Challenge Competition. A further case study, 'U-COPE: targeted interventions for students in crisis', looks in more detail at how the project has provided interventions for students who may be at risk of suicide and includes further information on the U-COPE service.

At The University of Liverpool and Liverpool John Moores University, demand for student welfare and advice services, and counselling and mental health advisory services is increasing year on year. More students are presenting with mild to moderate wellbeing issues, alongside increasing numbers of students presenting in crisis.

Large numbers of students are known to engage with both university and NHS services. However, prior to the introduction of the project there was no streamlined communication between universities and the NHS. It was based instead around professional relationships, reliant on individual people and their network of contacts.

The project aim was to improve partnership approaches to student care by developing a standard operating procedure to ensure that students in crisis are supported in a joined-up and systematic way. 

Following a strategic review of local student population need, considering feedback from the Mersey Care NHS Mental Health trust (MCT), Liverpool public health departments and coroners, the priority focus was on improving pathways to support students experiencing mental health crisis and emotional dysregulation, which was a rising concern for both universities.

To address these needs, the project developed The Liverpool Model, comprising the following two services:

• U-COPE (University – Community Outpatient Psychotherapy Education)
• The Student Liaison Service.

The project also introduced clinical partnership meetings to facilitate more joined up approaches to care.

U-COPE

U-COPE service delivers therapeutic interventions to students who self-harm. It is a campus based therapy which offers a six-session blended model of Psychodynamic Interpersonal Therapy (PIT) and Cognitive Analytical Therapy (CAT). All students are able to access the U-COPE Service whether or not they are registered with a GP in Liverpool.

Selecting U-COPE as the most appropriate approach acknowledges clinical evidence that self-harm is linked to the risk of suicide (see further case study on suicide prevention).

It also tests the innovative psychological intervention already being locally used by MCT in hospital and community outpatient settings, to treat a student population presenting with self-harming behaviours.

The Student Liaison Service

The Student Liaison Service has developed essential links between university and NHS services, closing the feedback loop more effectively and enhancing partnership approaches to risk management of students in crisis.

For example, students who contact the Mersey Care NHS Foundation Trust (MCT) crisis support phone line or present at A&E in crisis are asked for their consent for the Student Liaison Service to contact them.

A student data field has also been added to NHS systems which allows the team to ascertain need more effectively for the student population.

Practitioners are then able to follow up with these students after a crisis situation, and signpost to support, refer into appropriate services or ensure the students are supported via a brief intervention.

Students from across the Liverpool City region can access this service and to date over 400 students have been supported.

Initially a pilot activity, the feedback and impact have been promising so far and led to a development of service standard operating procedures and integration into current MCT pathways. 

Both key project activities have been rapidly embedded into university and MCT practice.

Clinical partnership meetings

The final jigsaw piece was the early introduction of clinical partnership meetings which were designed to facilitate more joined up approaches to care and effective risk management of students thought to be at risk of harm.

The meetings are attended by:

• university service managers and practitioners
• project MCT clinicians
• Brownlow Health GPs.

The meetings have allowed greater development of the liaison approach, enabling clear processes for the information which is now more easily shared between organisations. They provide a transparent approach to which service is identified as most appropriate to continue to deliver the integrated support to the student.

The addition of student as a data field is a significant result of the project as a student journey through NHS services can now be tracked.

By June 2022, 526 students (higher education and further education) had been seen by the Mersey Care Urgent Care Team (student status has been recorded since February 2021).

The project has confirmed that more effective tracking of students between health and higher education services would be beneficial. Processes are in place to obtain student consent to share data but system incompatibility means this currently requires manual intervention.  

Project qualitative evaluations of the U-COPE service have been extremely positive. In particular the accessibility of the service and speed of referral has been very well received by students and practitioners.

'The ‘Working in partnership to improve student mental health’ project has enabled Mersey Care and our university colleagues to collaborate and develop a successful partnership, using shared processes to ensure students can access the right support and psychological interventions, which will allow them access to a safer, improved mental health provision.'

Donna Robinson, Director of Mental Health/Divisional Director of Mental Health Care, Mersey Care NHS Foundation Trust

Practitioners have also noted that the links between the universities and the NHS have facilitated better signposting and availability of care at the right time for each individual.

Early indications from the evaluation of project data indicate a significant improvement in clinical outcome measures for participants in U-COPE therapy. Participants complete CORE-34 at sessions one and six and CORE-10 for sessions two to five. Data indicates significant improvement in scores between sessions one and six and sessions two and five. Full quantitative and qualitative evaluation of the project are underway and aim to be completed towards the end of 2022.

Headline outcomes to date (25 May 2022) have been:

• All students from partner higher education providers are able to access the U-COPE service whether or not they are registered with a GP in Liverpool.
• 299 students have been referred for U-COPE therapy.
• 429 students have interacted with the Student Liaison service, receiving advice and guidance for next steps following a crisis. 100 of these students have been referred on to appropriate NHS services.

Next steps

The project team have secured an additional year of funding for The Liverpool Model, with a new extended partnership between The University of Liverpool, Liverpool John Moores University, Liverpool Hope University, Liverpool Institute of Performing Arts, Liverpool School of Tropical Medicine, Liverpool International College and Mersey Care NHS Foundation Trust. The partners are working together to fund the initial one-year expansion, with plans to develop a long-term funding plan.

Challenges which remain beyond the project are:

1. Development of systems for information sharing which comply with consent and data protection requirements. Linked to national issues, this requires NHS England systems and data collection practice changes and is part of a wider piece of work with Universities UK.
2. Implementation of more effective data collection and reporting of student usage of MCT and university services, would allow for real time service evaluation and population needs. Vital to this is clear identification of higher education students and the different services with which they interact.

The project team are planning a national online learning event in early September 2022 to share the successes of the project and disseminate learning. If you are interested in attending this event please contact [email protected] to be added to the event list.