The Student Lifestyle: Accessing Support

Callum discusses the student lifestyle and accessing support at University

- Callum - Centre for Mental Health

For as long as there have been students, there has been the notion of a ‘Student Lifestyle’. Across all sections of society, including the student body itself, there is an expectation that students must lower their standards for living. Students are meant to be poor, to have low quality housing, and to drink to excess. Moreover, the ‘Student Bubble’ means that students are excluded – and exclude themselves – from the wider community; this absurd way of life is normalised through exclusive exposure.

 
But what is this doing to our students? And how has it changed in recent times? As a student of 7 years (BSc, MSci, PhD), I have lived as part of a shifting student world. I have seen playful conversations about poor housing turn into desperate fears of homelessness. I have seen social drink-and-drug-use descend into chronic dependency. I have seen inadequate support disappear in its entirety, and people left to deal with their struggles.

 
It is well established that insecure housing, poverty, and isolation are risk factors for mental ill health. As much as by biological factors, mental health is dependent on social determinants like these. The student lifestyle is not something that is aspired to. Instead, it is driven by unfair employment laws, insufficient renters’ rights, and a tacit institutional endorsement of harmful cultural norms.

 
These key issues are identified and addressed in the Student Mental Health Manifesto. In this manifesto, Student Minds highlight the societal barriers between students and good mental health. By writing this blog, I hope to echo their sentiment, and explore how these factors have changed during my seven years as a student. Being a student does not exclude you from your right to health; the demands in Student Mind’s manifesto can address these inequalities. A mentally healthier nation for all, must include students too.

When I started university, I found myself in a state of flux. I was, for better or worse, becoming an adult. As for many people, this was a tumultuous time for me. I had moved to a new city - away from my friends and family - to study a subject I knew little about. I was forced into housing with total strangers, for which privilege I had paid more than half my termly loan. I was broke. I was anxious.

This was not my first taste of anxiety. Throughout my A levels, I had been receiving support for persistent mental health difficulties. I was constantly afraid of losing my friends, and of failing my exams. At times, it was debilitating. Without counselling, I would never have been able to go to university in the first place.

This is where the problem lies. Upon starting uni, I was suddenly bereft of such support. It’s not that the university had nothing to offer me. Indeed, I was constantly reminded of the raft of support services which they could provide. The trouble was accessing this support. Both statutory and university services were plagued by massive waiting lists. Moreover, fear of organising my own doctors’ appointments meant that I had been unable to get repeat prescriptions for my antidepressants. With these soon running out, I was plunged into the turmoil of medicinal withdrawal. My emotions were unstable, and my mental health in a spiral.

It took until September of 2022 for me to get on top of my medication. I started university in 2017.

Many students start university with mental ill health. The new environment, and isolation from support networks, can precipitate these difficulties. Moreover, as students transition from paediatric to adult mental health support, the lack of joined-up care can mean that people are lost in the system. This is especially true for students who leave home, and move to a new NHS trust.

This happened to me, and with growing waiting lists, the risks are only rising. There is a false understanding that students are meant to be stressed. That, to learn independence, students must face the challenges of life unsupported. This is a harmful and unsubstantiated assumption; mental health support is important. For people in a new place, and a new stage of life, it is increasingly difficult to access the care they have come to rely on. Accessing talking therapy for the first time can take up to 6 weeks from the point of referral. Between this first contact, and a more comprehensive programme of care, the wait is 62.5 days. That is an unacceptable length of time to wait, especially if the care you have grown accustomed to is suddenly withdrawn.

As outlined in the Student Mental Health Manifesto, more cohesive care is a critical step in addressing this. An intermediary service for young people aged 18-25 could help in the transition to adult services. These services should be equipped to holistically support people with independent living. Moreover, better record sharing between NHS trusts - and proactive outreach to students under new care authorities – will help meet the needs of people in a very vulnerable stage of life.

Like many students, university was my first foray into house sharing. In the summer of second year, I was living in a three-person flat with a tenancy set to renew. The place was a basement, with an overgrown garden and proliferating damp. The rent was rising, and our loans were not. Moreover, we were locked into our contract, and had been since October the previous year. Due to a competitive rental market, and insufficient protections for student renters, we were forced to sign our rental contract a year before it started. This is a fraught environment in which to make housing decisions, and for many people this can backfire. I was one of these people.

At this time, I entered a protracted period of depression. This co-occurred with hostility between myself and one of my flat mates, which created a harmful environment for me. In retrospect, there was no ‘bad guy’ in this situation; we were evidently ill-suited to living together. Unfortunately, because of the way that the housing market worked, finding an alternative living arrangement was near impossible. We could not escape our contract, nor afford to rent twice. We were stuck together, and made each other miserable.

I hear similar reports from other students: stories of people with respiratory disorders, in flats rife with mould; of people who get bullied by housemates, to the point of physical abuse; of people who work for minimum wage, to still fall short of their exorbitant rent. In all these situations, a predatory housing market traps people within harmful environments.

With the cost-of-living crisis, things have gotten worse. Right now, the student maintenance loan is pegged to the predicted rate of inflation from two years ago. Inflation has far outpaced student loans, forcing people to live miles from campus in homes that are barely habitable. Even then, the cost of rent and bills is so high that many must choose between food and heating. Indeed, research from HEPI has shown that, in university accommodation, the average student is left with 50p to live on.

Poor housing is a major risk factor for mental ill health. The ‘student squat’ is not a suitable living environment. As such, it is essential that we build more and better affordable housing, and that existing houses are retrofitted with the kind of provisions that make them safer and cheaper to live in. All renters, including students, should have their rights enforced, and landlords must be held accountable to their tenants’ health and wellbeing. On top of this, for those who must work to support themselves, a real living wage must be implemented as a minimum for adults of all ages. These recommendations, amongst others, are made in the Student Mental Health Manifesto. To achieve equality in mental health, we must act to prevent mental health disorders in all people.

Find out how you can get involved with the Student Minds Blog.

I am enthusiastic neuroscience student (PhD) and policy intern for Center for Mental Health, passionate about using research to change people's lives for the better.  

I am determined to work with researchers to change the mental health conversation, and advocate for fairer and more equitable health policies in the UK.

WELL at Uni?

Michael shares his experience about wellbeing at University.

- Michael 

University is a journey. For me, it has been a really rewarding road; I have learned so many things about myself and achieved things that I never would have imagined possible! But it can be challenging when you first settle in, and it took me a while to learn some tips and tricks to adjust, and get the best out of my time at university. Here is my story.

Coming from two years out of education, I always felt that I didn’t belong academically or socially at university. My application to my university had been previously rejected (twice!), and I never shook the feeling of imposter syndrome and that I wasn’t ‘good enough’ to be there. This made me anxious around others, self-critical, and develop some pretty unhealthy working patterns, as I strove to prove to myself and others that I deserved my place on my course.

Unsurprisingly, this unhealthy mindset made it really hard to settle in. I was so fixated on not falling behind with my studies that I never got involved in any clubs or societies where I could meet other people and make friends. In class, I didn’t contribute or talk to other people for fear I would expose myself as being out of my depth. I was constantly fixated with running out of money, and felt that I couldn’t afford the student social lifestyle anyway. And I was also a couple of years older than most people, and after a period of mental health difficulties which had resulted in two years away from education, I felt as if I was coming from a different background, with different experiences, to everyone else.

I found the academic culture and pressure especially difficult to adjust to. I struggled with workload and time management, I stressed about minute details and found it hard to prioritise, and I was constantly preoccupied with ‘failing’ or ‘falling behind’ and the need to be productive. I found the competitive culture and environment at university was not conducive to self-compassion, self-care, and mental wellbeing. I interpreted my whole education as a threat, never contributing to anything in class for fear that it was a test which I would inevitably fail. I worked unhealthy hours and patterns trying to feel comfortable on my course and though I belonged at university. But the harder I worked, the more that I isolated myself, the more unwell I became, and the worse I performed. 

After receiving some support from the counselling service that helped me to understand my feelings, I gradually grew in confidence and started to really enjoy my studies and my time at university. Approaching my studies differently helped to develop my sense of purpose, confidence, and wellbeing. Based on this experience, I started to question whether and how changes to university structure and culture could support better student mental health and wellbeing. And how changes to curriculum, assessment, and teaching and learning could improve student education and wellbeing.  

My experience of university inspired me to launch the WELL @ UNI study, or the Wellbeing and Experiences of Living and Learning at University study, to explore how university policies and practices can impact positively or negatively on student mental health and wellbeing, and how this is experienced by different student groups. I am currently conducting an online survey, open to all undergraduate and postgraduate students in the UK until 11.12.20. It takes approximately 15-20 minutes to complete and participants will have the opportunity to enter a £50 prize draw. Please consider sharing your story, so that we can represent and learn from the diversity of student experiences and, working in collaborative partnership with mental health organisations, make recommendations from the study for healthier policy and practice. Follow me @PriestleyMJ to keep up to date with the project and find out more. 

We know that experiencing mental health difficulties at university can feel overwhelming. Explore the support that is available at your university and further. 

Student Space is here to help you through coronavirus. Explore online resources, access direct support via text, phone, web chat or email and find the support available at your place of study.

Tips on navigating university life/Freshers: Explore tips and resources to help you navigate university life in Student Minds’ Transitions guide.

I’m Michael and I used to be the editor of the Student Minds Blog and a member of the Student Minds Advisory Committee. I am a PhD student at Durham University studying student mental health and wellbeing. I write for Student Minds to share my own experiences of mental health difficulties and to advocate for change to improve the state of student mental health. 

 

 

 

How the University Mental Health Charter Will Support Students

Alyssa writes about how the key provisions of the University Mental Health Charter can make lasting changes to the state of student mental health.

- Alyssa

As a former student who dealt with anxiety throughout university, I know how hard it can be to balance your mental health with your studies, especially when you don’t feel supported by anyone around you. I also know I’m not alone. So many university students today struggle with addressing and supporting their mental health — but that’s changing.

As a nationwide UK initiative to promote mental health support, the University Mental Health Charter wants to recognise and reward institutions that promote and support the well-being of their whole community. Students and educators alike collaborated with university leaders and professional staff in creating the charter. Student Minds recently launched the first stage of the project — one that will change mental health conversations and change the future for university students like us.

What Is the University Mental Health Charter?

Student Minds’ University Mental Health Charter represents a voluntary reward and quality improvement plan designed to recognise universities that prioritise student mental health. In March of 2019, a team from Student Minds brought together 360 students and university leaders from six campuses across all four countries in the UK and surveyed more than 2,000 students and staff members online to develop the content of the charter. It aims to make mental health a university-wide priority while maintaining the unique diversity of each institution. Students experiencing anxiety, depression and other mental health challenges can often feel isolated and unable to talk to their professors and peers, but this charter is here to make sure universities encourage mental health support at the administration level, whilst ensuring on-campus resources are available to help students.

What Are the Key Provisions of the University Mental Health Charter?

How will the University Mental Health Charter work? How can universities achieve recognition — and, more importantly, how can they improve the mental well-being of their students? Here’s why the charter is important and how it will bring about change:

1. Dedicated To Diversity: The charter recognizes that different students have various needs and can face unique barriers to accessing services, and it encourages departments to be more inclusive and supportive with their provisions and policies.

2. Evidence-based: The charter will be underpinned by relevant literature and a robust research base. As such, the charter encourages universities to develop resources based on what’s relevant to student mental health.

3. Collaborative: Students, instructors, university leaders and mental health counselors alike have been involved in developing this crucial charter.

4. Open To All Institutions: The recognition program is designed to let every institution apply for charter status, whether a university is a large, research-based facility or a smaller, private specialty school.

The University Mental Health Charter Will Make Lasting Changes

Mental health awareness is so important — especially for tutors and universities who work to support and advance students. For too long, it’s been hard for students to voice their struggles and find the right level of mental health support. But with expanded services and recognition of those universities that go above and beyond to support student mental health, more individuals will be able to realise their academic dreams without struggling alone. 

Find out more about Student Minds' work and how to get involved here. 

Hi, I'm Alyssa, an education and student life blogger with a passion for connecting with students of all kinds. Making positive self-care choices like these has kept me grounded through school and life — and I hope to help other students succeed, stay healthy and make the most of their university experience. Follow along on my blog, Syllabusy.

Raising the Student Voice on the University Mental Health Charter

Michael writes about how the University Mental Health Charter offers an exciting opportunity got improving student mental health.  

- Michael Priestley

“If universities had the ideal approach to student mental health, what would that look like and how would we know?”

What is the University Mental Health Charter? 

The University Mental Health Charter is a set of principles that outline what universities can do to better support student and staff mental health and wellbeing. Student Minds will launch the content and dimensions of the Charter on the 9th of December 2019 with the pilot phase taking place in 2020. 

Why is the University Mental Health Charter Important? 

As a student with lived experience of mental health difficulties, I believe the University Mental Health Charter can offer the following exciting opportunities to benefit student mental health. 

1. It supports universities to adopt a ‘whole university approach’ to mental health. It can provide a framework to help universities to think beyond the provision of services to develop a joined-up transformative approach that embeds mental health initiatives across all policies, cultures, curricula and practices to try and prevent difficulties from occurring. This represents a shift towards stimulating structural and cultural change to reduce risk factors and increase protective factors that support the wellbeing of the whole university population. For us as students, this offers the benefit of our mental health and wellbeing incorporated holistically into the design of all areas of university policy such as accommodation, teaching and learning, support services, environment, and culture. 

2. It is grounded in diverse student voices and experience to ensure that it will be responsive to the challenges and issues we face at university on a daily basis. Moreover, Student Minds have worked tirelessly to involve underrepresented student voices so that the Charter recognises and responds to the diversity of the student body. After all, different students have different needs and can face different barriers to good mental health. 

3. It encourages universities and university leaders to really prioritise student and staff mental health and wellbeing. It aims to be challenging, ambitious, and create radical transformative and long-term change; it will not simply be another box ticking exercise for universities to compete with one and other for our fees! 

4. It allows us as students to see and understand how, and how well, our universities are working to support mental health and wellbeing.

Going Forward

We all have mental health and better mental health benefits all of us. There is still a long way to go, but the launch of the University Mental Health Charter represents a positive step towards improving the mental health of the whole university community. As students, lets continue to engage with its development and ensure that our voices are heard so that universities take action to change the state of student mental health. 

You can find information on how to get involved with Student Minds here. 

I’m Michael and I’m the editor of the Student Minds Blog. I’m a PhD student at Durham University studying student mental health and wellbeing. I write for Student Minds to share my own experiences of mental health difficulties, and tackle the stigma around mental health. 

Funding Support for Students with Mental Health Difficulties

- Nicola Byrom; @nicolabyrom

A report has been produced for the Higher Education Funding Council for England (HEFCE): Understanding provision for students with mental health problems and intensive support needs. It considers the recent dramatic increase in demand for mental health services among university students and how these services are currently funded and provided. The report comes at a time of imminent changes to government funding for disabled students. The government is instigating changes that will mean that Higher Education Institutions (HEIs) will be expected to provide a greater level of support to students, in line with reasonable adjustment expected under the Equality Act, while government funding (through the Disabled Students Allowance, DSA) will focus on support provision for those with greater needs. This may provide an opportunity to improve how support for students experiencing mental health difficulties is provided and funded. However, the report suggests that no one really seems to know what implications these changes will actually have, either in the short or longer term.

I have summarised this report, to provide a concise overview, available here (http://www.studentminds.org.uk/dsa-consultation). In this blog I would like to share some personal reflections and concerns about the future of funding for student support. Through the blog I consider the challenge that linking funding for student support to long-term conditions creates for provision of responsive mental health services and reflect on the implications of limited NHS mental health provision for students and HEIs. 

Mental health exists on a continuum; we all have mental health and our mental health can fluctuate. However, the current structure of DSA funding cannot accommodate this fluctuation. While the report encourages HEIs to be proactive in their support for student mental health (through developing inclusive curricula and proactive measures, such as wellbeing and resilience initiatives), interviewees for the report reflect a combination of hope that the changes to DSA funding will help HEIs adopt a more social model of mental health and fears that it will push HEIs further towards a medical model of mental health. The social model of mental health proposes that individual mental health problems may have their root in social circumstances and experiences of trauma. The model recognises that anyone can suffer distress and repositions mental health as a social construct, not a purely individual concern. Currently however, even when informed by a social model, student services are “typically delivered on the basis of individual models… of mental health”.

As mental health fluctuates, I am concerned about the current situation of funding being linked to long-term problems. As one interviewee for the report highlights, mental health difficulties can be acute and require a rapid response “… it may be fine to wait 12/15 weeks under certain circumstances, but if you’re working with someone who is a young person who doesn’t have a lot of life skills, is away from home for the first time, that can be calamitous.” In the university environment, mental health can decline dramatically and have a substantive, negative impact on a student’s ability to study; “taking vulnerable people away from their personal support networks and then giving them a massive amount of academic pressure is ‘a potent cocktail’.’’

I arrived at university with a track record of mental health difficulties. I had experienced an eating disorder for years. I was however, very much in recovery. For me, I was doing very well. I did struggle. There were periods of time at university when I was self-harming to manage my anxiety levels. In my second year I started having panic attacks and developed an acute case of agoraphobia. I was fortunate to have a family who could support me and I left university early in the run up to a vacation to visit my family GP and take time at home to “unwind” and reset. Out of the university environment my anxiety subsided rapidly.

I did not hide my mental health difficulties. My friends and housemates knew that at times I was struggling and this in itself was helpful. I did not talk about my anxiety with tutors as it never seemed relevant, nonetheless, my tutors were incredibly supportive and intensive academic encouragement through my final year of studies had a very positive impact on my mental health. Could I have benefited from counselling or mentoring? Yes. I’m sure it would have helped. But for the university to have provided me with a mentor, I would have had to apply for the DSA. In my eyes, I was not disabled. Even in the depths of my eating disorder I would have found it difficult identifying as disabled. At university I would have said that I was simply adjusting and learning to manage my mental health.

Funding to support students with mental health difficulties is currently linked to the DSA and the Equality Act, which requires reasonable adjustments to be made to ensure that individuals with a disability have equal access to education. I understand that disability is defined as an enduring condition, spanning years. However, from my own experience, I am fundamentally uncomfortable with conceptualising mental health difficulties as disabilities. Tying mental health to the framework of disability seems to suggest that mental health difficulties are long-term, if not permanent. This is in direct contrast with recovery models that focus on change.

According to the report demand for mental health support has increased. However, by linking mental health difficulties and disability, capturing this demand is challenging[1]. Across all institutions, the portion of students who have declared a mental health problem is 1.4%. This is a dramatic under-representation of the number of students experiencing mental health difficulties and there is an awareness that more needs to be done to encourage students to disclose. 1.4% needs to be viewed in context; within a year 25% of British adults will experience at least one diagnosable mental health difficulty and at some universities, counselling services are seeing nearly 10% of the student population.

The discrepancy in these numbers is important because the funding that a university receives to support students is linked directly to the number of students receiving the DSA. There is a huge gap between the number of students experiencing mental health difficulties and the number receiving support through the DSA. To receive the DSA, a student experiencing mental health difficulties has to recognise and accept this. They then have to identify themselves as disabled and choose to disclose their mental health difficulties as a disability. This is challenging enough. However to claim the DSA a student’s mental health difficulty has to have a long-term adverse effect on his or her ability to carry out normal day-to-day activities or study. Long-term here is defined as a problem that has persisted for over a year. As such, of the small proportion of students who have declared a mental health difficulty, only 33% receive the DSA.

So the question to ask is how are universities funding support services for student mental health? Student Services, including counselling services, are funded by core university funding, including student fees and funding from HEFCE in the form of the Student Opportunity disability allowance (a non-ring-fenced allocation of funding linked to the number of students claiming DSA). The report identifies that institutions are topping up funding from the SO disability allowance by £2 to £5 for every £1 received.

It could be argued that as HEIs are institutions for education and not health care, they should not be expected to provide any form of counselling or support beyond that provided for students in receipt of the DSA. After all, students should be able to access support for mental health difficulties through the National Health Service.

However, mental health has an effect on ability to study. A recent study found that, of the students attending one university counselling service, 92% identified themselves as having problems with their academic work. Of those students, interviewed on conclusion of counselling, 67% considered that it had been important in enabling them to address those issues. Further, acute mental health difficulties, if not addressed quickly, can have a substantive impact on a student’s ability to study, having a direct influence on the HEI’s ability to meet its responsibility regarding education. One GP points out that if a young adult loses three or four weeks of their academic year, they will struggle not to slip back a whole year if they have problems. Students usually have to wait 12 to 14 weeks for mental health support through the NHS.

The report identifies that HEIs see their responsibility around mental health as helping with academic management, offering short-term support around managing the impact that a student’s condition has on their studies (or longer-term support supported by DSA funding). HEIs rightly state that they are not a ‘therapeutic community’ or the ‘5th emergency service’. While they are not a medical service and cannot provide medical support to students, they are often left providing ‘holding support to students.’ Extensive waiting lists within the NHS are leading some GPs to “refer individuals back to their HEIs for support.”

This echoes concerns that Student Minds has been raising through the Transitions Campaign regarding health inequality experienced by students, due to a lack of recognition in the NHS about the needs and circumstances of students regarding mental health. The NHS mental health provision is predicated on people living with their family and having support at home. “There is somehow the belief that we’re a therapeutic community and one of the discussions I’ve had repeatedly over the years with psychiatric units, with psychiatric teams is, would you have discharged this individual to a bedsit in the centre of the city? And if their answer is no, then why have they discharged them in exactly the same way to the university?”

In 2014 the government published a policy paper, “Closing the Gap: Priorities for essential change in mental health” and the then Deputy Prime Minister hosted a conference. This gave me the opportunity to ask why students, as a population at high risk of developing mental health difficulties, did not feature once in the paper. In reply, the Deputy Prime Minister asked “surely the provision of support for students is the Universities’ responsibility?”

It seems, from the recent report for HEFCE, that universities are picking up this responsibility, holding and supporting students who should be seen by the NHS, despite the universities’ firm belief that they are not a medical service. Universities seem to be providing this relief to the NHS without any related government funding, and a recent study demonstrates that University support services really are masking a substantive gap in primary care provision. The study compared students attending counselling services at 11 universities with a similar non-student population receiving primary care services. The study found that university counselling services deliver a service to people who closely resemble NHS primary care service users in terms of severity and the risks that they pose to themselves. They concluded that, student counselling services are “providing considerable relief from a potential additional burden on primary health care.”

The report reflects considerable frustration on the part of GPs. The Student Health Association, the national  body representing health professionals that work with students, are currently working with NHS England to try to find a better way to fund young people’s health through a national approach. In a climate when the NHS and universities are under more pressure than ever and the government is making decisions about the resourcing of mental health services, it’s crucially important that students are fully represented in the discussion. In recent restructuring of Student Services, some universities, including the Universities of Leeds and Southampton, have bought mental health services (IAPT) onto the university campus, creating explicit links between services provided by the University and by the NHS. This seems to be an interesting way forward.

I would like to side with the hopeful; staying optimistic that changes in funding will help HEIs adopt a more social model of mental health, creating more space to support the fluctuations of health. I hope that the fantastic work that Mental Health Advisers have done over the recent years will continue to be developed and built upon and that HEIs can support those with long-term conditions to thrive, whether they identify as disabled or not, while also increasing capacity to reach out to those experiencing acute difficulties.

Student Minds are interested in hearing your views on the findings of this report and want to better understand the direction that various stakeholders in the sector believe support for students should be heading. Today we’ve launched a consultation and invite any students, staff, health professionals or other concerned parties to share your views: www.studentminds.org.uk/dsa-consultation

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[1] The report acknowledges that mental health, as a subset of disability, has received limited research attention leading to a general lack of data and understanding.

Increasing hospital admissions for eating disorders

- Nicola Byrom, @nicolabyrom

This morning I work up to news that made my heart sink. The BBC report that in the last 3 years the number of hospital admissions for young people with eating disorders has nearly doubled. This means that the prevalence of eating disorders must be on the increase. The BBC is dutifully asking whether social media, the curse of our generation, is to blame. The pressure from the online world to be fit and healthy must be getting to young people. I don’t doubt that it is. And we still haven’t worked out how to teach young people to be confident about their bodies – though there has been some fantastic work by @NatashaDevonSET and www.bodygossip.org. But, though eating disorders feed off of a desire to be fit and healthy, they are rooted in much deeper set of insecurities: uncertainty about life, low self-esteem, and stress. 

We need to ask about the increasing pressure that we are putting young people under. As @AnthonySeldon voiced in March – exam pressure today is putting children under “vile, cruel pressure” .

I'm very worried about the possible increase in prevalence of eating disorders among young people. It's a horrific illness, devastating to the sufferer, their friends and their family. However, the dramatic increase in hospital admissions for eating disorders raises concerns about how we are treating eating disorders. Hospital admission for mental distress in young people should be an absolute last resort. We should never have to get to the point where a young person needs to be admitted to hospital. At times of great emotional and mental distress people need safety and security. They need to trust the world around them. Except in the rarest of circumstance, this is best provided by the home environment. 

I was diagnosed with anorexia about 15 years ago. As I became increasingly unwell, I withdrew and shut out the world around me. To recover, I had to start opening the doors again and engaging in real life and the world around. As we put young people in hospital we remove them from the friends and family who they trust and can ultimately keep them safe and well. We remove young people from the world they need to engage with to recover. We need to be able to treat the mental distress of young people at home. We need to support friends and family to support young people to remain at home. We need better and more intensive early intervention. 

Hospitalisation is devastating for friends and family who care. The separation is painful. The distance for family can be unbearable. A few years ago someone very close to me was admitted to general hospital. She had Anorexia Nervosa. Her condition had deteriorated to a stage where her body was no longer functioning properly. Physically, her health was too unstable to allow her to be admitted to a mental health unit. So, in deep mental distress she remained for weeks on a general hospital ward, which was more familiar with caring for elderly individuals. This place might have had the equipment to monitor her physical health, but it was not a positive place for her to be. 

In our time of “economising the NHS,” we must ask why we are not investing in early intervention. Supporting young people at home is more economical than keeping someone in a general hospital bed for weeks. That's before you even begin to factor in the cost to that person’s mental wellbeing. Our team at Student Minds summarised some of the financial arguments for better and more joined up early intervention for eating disorders in our University Challenge Report.

So, what is currently stopping early intervention? I don’t have a complete answer. However, in anecdotal reports, I still get the impression, far too often, that the experts that we turn to for eating disorder interventions are still struggling to work out how to help. From counsellors to GPs, I still hear too much focus on food and eating. This has got to change. 

Yes, to recover from an eating disorder you have to normalise eating patterns. You may have to gain weight. But for most, the disrupted eating patterns are a solution to the problem. Behind the disrupted eating patterns, there are many psychological challenges that need to be addressed. 

Through years of work, the Institute of Psychiatry and Maudsley have mapped out a psychological intervention for eating disorders that focuses on understanding the costs and benefits of the psychological traits that maintain eating disorders. This approach looks to build motivation for recovery, encouraging young people to develop their own drive to recover. This understanding, this focus on psychology, urgently needs to be disseminated nationally. Early intervention that young people can engage with rather than be afraid of, exist and should be common place. 

To learn more about the ideas discussed here, see:

• Student Minds' resources on Understanding Eating Disorders
• Getting Better Bite by Bite: A Survival Kit for Sufferers of Bulimia Nervosa and Binge Eating Disorders, by Ulrike Schmidt, Janet Treasure, June Alexander 
• And for a more positive view in light of today’s news, check out Inspiration for Recovery, five stories of young people’s recovery from eating difficulties 

Reasons to Stay a Student

- Sheffield Mental Health Matters Society

Things people say to students affected by mental health that they don’t say in other life-threatening situations:

“Yes, I understand that your face is on fire, but do you have a letter from your doctor to prove it?”

“I wish I had cancer so that I could get an extension on my essay”

“Are you sure you’ve got meningitis? Because these days there’s a culture where everyone thinks they do”

“Your neck may be broken but I’m sure you could just make a bit more of an effort to get out of bed”

“Okay. Yes. I get it. Your parachute has failed. Don’t forget you have seminars next week that I expect to see you at”

Reasons to Stay Alive by Matt Haig recently became the only thing that kept me from having a panic attack on public transport. London underground is a bad one in particular; the entrapment of privileged people in Moss Bros suits and polished shoes, the masses of shopping bags suddenly pressed against you when you go through Oxford Circus, the general feeling that there simply can’t be enough air to keep all of these people alive. And yet, they’re all there, breathing fine, looking (mostly) perfectly calm, if a little (…very) grumpy. And you’re the only one feeling like your throat’s about to close and the tips of your fingers are on fire. Or so you think.

Matt Haig made me realise it wasn’t just me. He kept me calm, he gave me hope. He helped me suppress the nauseating tickle of fear up your neck and realise that anxiety doesn’t mean you can’t live your normal life. That’s part of the reason I’m so completely and utterly frustrated by the stigma faced by students affected by mental health at university. The notion that it is perfectly normal not to eat or sleep to complete deadlines ridiculously placed within a few days of each other is just a small part of the lack of care for students’ mental health at university. This comes alongside a first year experience where nightclub advertising is thrust at you from every angle, you’re suddenly miles away from home in an intense prison-block flat with a hoard of people you don’t know, and you absolutely have to join every society and sports club possible to consider yourself as having “a great uni experience”. To be frank, there are many ways in which university is absolutely terrible for your mental health.

This is not to say that there aren’t people and services out there to help. I know many people that have had fantastic experiences. I’ve recently become president of an amazing society that works to reduce the stigma faced by students at university. I’ve met amazing people who don’t look at me like I just walked off a spaceship from Mars when I tell them I felt like my spine had turned to jelly and my head was about to fall off during a recent panic attack. My current counsellor cheers me up weekly with philosophical, political, existentialism and ‘what even is the point?’ discussions. I also recently spoke with a seminar tutor who actually asked me how he could help and proceeded to moan with me about how deficient the treatment for mental health is. My family are amazing, my boyfriend buys me the books that my counsellor recommends (Reasons to Stay Alive) and I know many inspiring people I know I can really talk to.

However, it remains the case that all of those things said to students affected by mental health at the beginning of this blog are my own experiences. I was never asked for any proof when I needed an extension because I’d sprained my wrist, and yet extensive evidence was needed when I was dizzy with panic attacks. I genuinely got told by a counsellor at a first appointment that there had been a shift in today’s culture and everyone should just realise that they’re actually fine! The blunt emails informing me of my absences at seminars during periods of intense anxiety were of little comfort at an already hard time. Friends occasionally do find it hard to understand why I’m not more cheery and fun and… well… out of bed before midday. And it is a frequent occurrence to hear course mates complain about wanting an extension, when I desperately want to feel well enough to get that essay in on time.

It is for all of these reasons, and many more, that it is crucial that we continue to talk about mental health and fight for an end to the stigma that prevents it from being treated with an equal priority to physical health. That we continue to add to the reasons to stay a student, when staying at university can often feel so impossible. The panic attacks I face daily at the moment are often in toilets, in my bedroom or by myself somewhere. To many I continue to appear my usual politics-obsessed self, singing along to Taylor Swift and maintaining a well blow-dried fringe every morning. The invisibility of mental ill-health often leads to the perception that people are simply lazy, selfish or weak for struggling. Matt Haig, and I in my altered version, chose to compare mental health to life-threatening situations because it absolutely is a life-threatening situation. Suicide is the second most common cause of death in young adults. The stigma of mental health absolutely needs to be combatted. 

Be a part of that fight – campaign for better services, email your MP, protest, share, question things. But most of all, talk to people. It’s the people that send you a message because you looked a little stressed in the corner of that big event, those that call you to check whether you made it to the lecture and if you need the notes, that person you barely knew before that opens up to you that they get it too – it’s those people that get you through. Be the person that gets someone through. In the same way you might visit a friend bed-ridden with the flu, you can absolutely do the same for a friend living with mental illness. You have no idea how much it might mean to them.

“Your mind is a galaxy. More dark than light. But the light makes it worthwhile. Which is to say, don’t kill yourself. Even when the darkness is total. Always know that life is not still. Time is space. You are moving through that galaxy. Wait for the stars.”

- Matt Haig, ‘The Humans’

“You will one day experience joy that matches this pain. You will cry euphoric tears at the Beach Boys, you will stare down at a baby’s face as she lies asleep in your lap, you will make great friends, you will eat delicious foods you haven’t tried yet, you will be able to look at a view from a high place and not assess the likelihood of dying from falling. There are books you haven’t read yet that will enrich you, films you will watch while eating extra-large buckets of popcorn, and you will dance and laugh and have sex and go for runs by the river and have late-night conversations and laugh until it hurts. Life is waiting for you. You might be stuck here for a while, but the world isn’t going anywhere. Hang on in there if you can. Life is always worth it.”

- Matt Haig, ‘Reasons to Stay Alive’

Minimum Waiting Times for Mental Health

- Nicola Byron, Founding Director of Student Minds

Minimum Waiting Times for Mental Health

Speaking at the Liberal Democrats conference in Glasgow, Nick Clegg announced waiting time targets for mental health would be introduced by April next year. We are absolutely thrilled - this is one more step towards parity of esteem between physical and mental health.

Tracking and reporting waiting times and holding organisations to targets is absolutely vital for student mental health, where waiting times are the difference between successfully continuing with education and having to take time out. Students' transient lifestyle, spending around 25 weeks of the year at home, away from University and their registered GP, creates real problems for accessing specialist mental health services and receiving good continuity of care. These problems are exacerbated by long waiting times. Due to high demand for psychological therapies, it can currently take months to progress up a waiting list to receive care.

Our transitions report, University Challenge, identified that it is not uncommon for students to reach the top of the waiting list in their university locality when they are back at home during the holidays or when they are about to sit university exams. If patients cannot attend the sessions assigned to them, they are usually dropped off the waiting list and required to go through the referral process again. A quarter of the students with experience of eating disorders surveyed in the University Challenge study waited more than 6 months for an appointment with a specialist service and on average students were waiting 20 weeks for an appointment. These waiting periods are particularly problematic, leaving students doubting whether they need treatment; as they wait, people lose the self-motivation that they need to fight towards recovery. The challenge of waiting times is not only felt by students. Over half of professionals we surveyed in the University Challenge project identified that they did not find it easy to refer students to specialist services and 96% felt that students do not get see by specialist care quickly enough.

It is imperative that we do not let students fall through the gaps. "Because the majority of serious mental illnesses present themselves by the age of 25, students are a particularly vulnerable group and are most in need of reliable, accessible mental health care," says Seb Baird, Student Minds Volunteer.

To decrease waiting times, the government is going to have increase the availability of mental health interventions. The Health Foundation argues that this can be done effectively by changing the relationships between health services and those with mental health difficulties. A pilot peer support project at Nottingham NHS Trust resulted in a 14% reduction in inpatient stays, saving the trust around £260,000. Innovative steps like this can, and must, be used to help increase provision of mental health services, decrease demand for high intensity interventions, and cut waiting times.

Student Minds has been advocating the power of peer support for years. If you are interested in finding out more about the support that our programmes offer for students, please visit - http://www.studentminds.org.uk/find-support.html

#StudentTransitions Campaign Success: Changing the shape of support forstudents

~ Dr Nicola Byrom, Student Minds Founding Director

I can remember moving to Nottingham as an undergraduate student. It was an exciting time, but it was also a nerve-wracking time. The move provided an enormous opportunity: a new beginning with new peers in a new city. That opportunity came with a pressure to make the most of it. This is a transition that thousands of young adults make every year and it is not an easy one. Today almost 50% of UK young adults enter higher education and 80% of them move away from home to do so. This move offers these amazing new opportunities, but means leaving behind all existing support networks.

A proportion of students will be experiencing mental health problems when they move to university and may be receiving support from mental health services. Despite being national our NHS cannot cope with an individual living in one area of the country and receiving support from a service in a different area of the country. Though there are fantastic examples of what can be achieved using modern technology (e.g. SHaRON in Berkshire), for the majority of students, as they register with a new GP in their university city, their support will need to be provided by a new mental health service in the new city.

The transition to university isn’t easy and so it would seem to be a time in a young adult’s life when they could really do with as much support as possible. When the care system in our country works, young adults experiencing mental health problems receive the support they need as they make this transition. Home mental health services can contact mental health services in the university town to formally hand over care and ensure that a care plan is in place so that continuity of care is achieved. This doesn’t always happen. I have heard so many stories of students who have been discharged from mental health services at home shortly before making the move to university, who are left struggling to get support at university. In worst case scenarios it can take the better part of an academic year before a student is able to be seen by the mental health services, by which stage the difficulties of transitioning to university are well past and a student will either have begun to settle into university or have dropped out.

I believe it is completely unacceptable for students to be systematically let down by health services at such a crucial time in their lives. At Student Minds we have been looking into this problem for some time now, trying to understand exactly why this gap in care arises. This research has been written up into our Transitions Report. We can identify two factors; it is often quite difficult for home mental health services to find and make contact with university mental health services and the mental health services in a university town may not be aware of the needs of students in their area. On the 24^th of February 2014, we launched a petition calling on the Department of Health to ensure that mental health services meet the specific needs of students.

On the 13^th of March I was able to meet with the government care minister, Norman Lamb, to discuss the needs of students. We asked Mr Lamb what could be done to ensure that mental health services had specific guidance about the needs of students. Today, services across the country are commissioned locally by Clinical Commissioning Groups, CCGs. While NHS England provides guidance to CCGs about the needs of many community and patient groups to help them commission appropriate services, no such guidance exists for students.

Our meeting with Norman Lamb felt very successful. Mr Lamb agreed to have brief put together by the end of April about the possible options for improving care delivered to students. We also set the wheels in motion for a meeting with NHS England to ask for this specific guidance to be written on the needs of students. While I’m optimistic about the possibility that improvements will be made for the provision of mental health services for students, we are continuing to call for support from students across the country. The challenges for student mental health provision have been raised before; this is not a new complaint! Though many professional organisations have discussed the challenges students face when transitioning to university many times, real improvements have not materialised.

Students need to get behind this call for mental health services that meet their needs. Today it is estimated that around 28% of students are experiencing clinically significant levels of psychological distress, but if students remain silent about limited services, services will never be tailored to their needs.

If you agree that students with mental health problems should be able to access support as they transition to university, please get behind our campaign. You can sign our petition at www.change.org/en-GB/petitions/doh-address-the-gap-in-student-mental-health-support. But please don’t stop there. Ask your friends, family and peers to sign the petition; your involvement can turn one signature into many. You can find out how to get more involved in this campaign on our website at www.studentminds.org.uk/transitions-campaign or by emailing campaigns@studentminds.org.uk.

#StudentTransitions: Improving support for student mental health

Later today Student Minds Founding Director, Nicola Byrom, and trustee, Eleanor Hambly, will be meeting with Norman Lamb to present our University Challenge report and petition. We'd like to thank all of you for your ongoing support, from taking part in the research surveys to responding to our consultation or signing the petition. In just over two weeks we have collected almost 1,500 signatures and we've been inspired to read all of your comments about why the campaign is so important to you.

With over a million students spending half the year at home and half the year at university each year, it is clear that we need to start responding more flexibly to the needs of a transient student population. We're hoping that today's meeting will mark the beginning of a series of changes to improve access to care for students across the country. Whether you’re a current or future student, a university or NHS professional, a parent concerned about your child or a member of the public who wants to help make a change, please join us by calling for this important issue to be addressed.

What's the issue?

A postcode lottery for student support exists. Whilst there are some great examples of best practice in a number of larger university cities, in many parts of the country students are facing particular problems accessing support services. Of the professionals we surveyed, 92% felt that a student's treatment is negatively affected by moving between home and university and 96% felt that students do not get specialist care as quickly as they would like. There are a number of issues at play, but a key problem is that NHS commissioners often aren't aware of how many students are in their area and where they are at different times of the year, so many do not take this into consideration when funding services.

What are we asking for?

We're calling on the Department of Health to support the development of best practice guidelines for all Clinical Commissioning Groups (CCGs) on how to support transient student populations. We have spoken to a number of CCGs that welcome further input in this area and are enthusiastic about improving student access to support, but central action from the Department of Health is necessary to help commissioners access the resources they need to make changes.

"My daughter is in her first semester of her first year at university… our experience is a disjointed, complicated, stressful and timely one, with my observation that I have provided the role of case worker to help join up the dots, communicate and facilitate her best use of the help that's out there. I can see how a sufferer can very easily slip through the net without this support and motivation. Any change to address this would be helpful."

Why students?

Today, 49% of young people enter higher education. According to NUS, 20% of these individuals are experiencing a mental health problem. In 2011, The Royal College of Psychiatrists called for NHS providers to ‘recognise and respond to the particular mental health needs of the student population and the difficulties that many experience in gaining equal access to services’. Our research has shown that this isn’t happening fast enough. Too many students are falling through the gaps between home and university support services, with their care being compromised by a lack of continuity and the need to go through a new assessment process and build up a new therapeutic relationship each time they move to a new service and see a different professional.

"It is hard for people with mental health needs to ask for help, even without the increased stress of being split between two locations, frequent changes of address and learning to do things for yourself (maybe for the first time in your life). Whether it is dealt with rightly or wrongly will impact the rest of their lives. Let's give students the chance they deserve!!"

At the same time, students are particularly vulnerable to developing mental health problems and university can be an intense environment with significant academic pressures and expectations combined with the challenges of leaving home for the first time and living independently. If we can ensure that students have access to appropriate support early on then we can help prevent the development of longer term mental health problems.

Why now?

Over the past few months Clinical Commissioning Groups have been developing their local strategies. Their five-year plans will be signed off from April 2014, so this is a great opportunity for us to ensure that the particular needs of students are taken into account.

What next?

Later today we will be meeting with Norman Lamb, the Minister of State for Care and Support, to present our research report and petition. We are hoping to secure a commitment to produce best practice guidance for supporting students in collaboration with Clinical Commissioning Groups, and to ensure that student needs are represented on CCG panels. After the meeting we will have a clearer sense of what action we can expect from the Department of Health on this issue. If the project goes ahead as planned, the next stage of the campaign will involve lobbying to ensure that local changes are being made, adopting a collaborative approach to benefit students across the UK.

Please show your support by signing the petition: www.change.org/en-GB/petitions/doh-address-the-gap-in-student-mental-health-support. 

You can find out more about the #StudentTransitions campaign on our website: www.studentminds.org.uk/transitions-campaign.

We all hate waiting...

~ Hannah Morpeth

People don't like to wait at the best of times: whether it's for Christmas, payday or the ever-growing queue at the Primark till, never mind when they are poorly. Waiting is rubbish, and yet with the increasing demand for mental health services, you may well find yourself on a waiting list for support.

Fear not though, here are a few tips to help you through the waiting period:

University can be as difficult a time as any to develop a mental health problem and if you are living away from home you may find that this makes it more difficult to access health care services. Nobody can give you the answer as to whether you should register with a GP surgery at home or at university - this depends on your particular circumstances, but remember that whichever you choose, you should still be able to access all of the same services as a temporary patient at the other location. Whatever your choice, I encourage you to be persistent with accessing mental health treatment. Get the ball rolling as soon as you notice you are having difficulties - it's always good to be able to access support early on and there may be a bit of a wait to get active treatment and support.

University can prove to be really useful when it comes to this waiting period with help from student support and wellbeing. Have a look on your university's website for information on what kind of support they provide. Most universities have some form of in-house counselling team which can offer forms of talking therapy and psychological interventions with relatively short waiting lists. Usually you are required to do some form of self-referral - lots of these are now done online - and you will be asked a series of questions about what you are struggling with and how this is currently affecting your day-to-day living. This will usually be followed up by an initial appointment in which the worker will discuss what they can offer you in terms of support: be it a group session, skills training, counselling or something such as cognitive behavioural therapy. In addition to this the university will have funds set aside for supporting students, which can be in the form of methods of recording lectures, a support for in your lecture, providing equipment and occupational support such as appropriate chairs etc. You are usually assessed for these to be put into place and may be required to provide medical information. Not many people are aware of how much a university can support you in this sense so it's all about making students aware of their entitlements.

Use your personal tutor - yes that person who you see once in freshers week and then forget they exist for the next three years - personal tutors can be very useful if you are having a hard time, don't be worried about 'bothering them', they have time set aside for supporting students. If your mental health problem is interfering with your studies it is definitely worth arranging a meeting with your personal tutor, as they can provide extra tutorial support in these circumstances, as well as pointing you in the direction of other entitlements. In terms of extra support, applications can be put in for personal extenuating circumstances. This can be when your mental health needs are affecting your performance, which could entitle you to extensions on written work or rearranging examinations. It is worth keeping your personal tutor up to date with the current situation/treatment you are receiving but do not feel like you have to tell them all of the ins and outs if this is going to prevent you from accessing support.

Remember that whilst many support services involve some form of initial assessment of needs, this is to help you identify what support would be most useful so please don't let this put you off. It is always worth getting help early on and university support services are set up to see you as quickly as possible, so it's a great first step to accessing support!

Closing The Gap

~ Nicola Byrom

I have been passionate about mental health for years. I think our society, today, has the opportunity to see a complete revolutionary shift in attitudes to mental health. The change is vital, but is the motivation there?

Most of our society is familiar with the statistic 1 in 4. 1 in 4 adults will experience a mental health problem this year [1] . 1 in 4 is also the number of people with a mental health problem that get treatment. Yes that is right. At the Deputy Prime Minister’s conference (20^th January 2014) on Closing the Gap: Priorities for essential change in mental health, Nick Clegg set out a strong agenda for reaching parity between mental and physical health. Nick argued that we cannot have a stronger economy and fairer society without tackling attitudes to mental health. The problem still seems to be – how can we achieve this. As Graham Thornicroft [2] explained at the conference, 75% of people with mental health problems do not get treatment. This is despite the fact that we know that average life expectancy is dramatically reduced for men and women living with mental health problems; cut by 20 years for men and 15 years for women [3] . Can anyone even imagine this lack of treatment for a health problem with such an enormous impact on life expectancy?

Parity between mental and physical health needs funding. That funding has to come from somewhere. A medical ethicist at the conference noted that mental health “asylums” have been closed (a good thing, we might all agree) but the transfer of services to the community was less than perfect and the Department of Health is even now continuing to cut the number of beds on mental health wards. She asked Nick Clegg if he would be happy to specify which hospitals and which acute services would be cut to fund better mental health services. Her question was not entirely sincere, but it hits the nail on the head. We need a long hard look at how funding gets shared out within the NHS between services. This perhaps seems unlikely to happen as another individual noted at the conference that in December 2013, NHS England took £150 million out of the mental health budget to cover increased staffing levels in acute services.

There may however be a positive note to this question of funding. A representative from Clinical Commissioning Groups noted that CCGs were entirely on board with the mental health agenda and recognised that better (and more) mental health services needed to be commissioned. She asked for information – noting that her CCG needed to know what services worked. If she is to commission evidence based interventions, she needs the evidence. A short answer to this was provided by Lord Layard: why aren’t we using the NICE guidelines as standard? CCGs should commission services that meet the recommendations of the NICE guidelines. A longer answer should look at how the research is funded (after all, research is the generally accepted way of finding evidence based treatment interventions). In 2008/9 the Medical Research Council in the UK spent £24 million, 3.5% of its budget on mental health research [4] .

Nick Clegg recognised that there is a major problem with the transition between CAMHS (Child & Adolescence Mental Health Services) and AMHS (Adult Mental Health Services). CAMHS usually ends at 18. This is a time of major change for young people. Many will leave home and move to university or leave school and start jobs. With these upheavals in life, young people with mental health problems have enough going on without major changes in their service provision. Nick Clegg promised better support through this transition, but does this go far enough? Young people often can’t simply transition from CAMHS to AMHS because AMHS do not offer the same services for the same mental health problems as CAMHS. It is not surprising that so many young adults fall through the gap. And when the individuals are students and are moving to a new part of the country to study, it is even more likely that they will slip off the radar and be failed by the health service during what is likely to be one of the most stressful and challenging times of their life to date.

This gap needs to be taken seriously, but the agenda set out by Nick Clegg did not mention students once. The Royal College of Psychiatrists (2011) called for National Health Service providers to ‘recognise and respond to the particular mental health needs of the student population and the difficulties that many experience in gaining equal access to services’. I asked Nick Clegg why students did not feature in the new Department of Health priorities for essential change in mental health. Nick shifted responsibility from the Department of Health to universities, noting that universities have a duty of care for their students. Nick suggested that universities should be working closely with local health services to ensure that these services are meeting the needs of students. It seems that Nick Clegg would like me to hand this question over to the Rt Hon David Willetts, Minister for Universities and Science. I agree that pressure must be put on universities to step up to the challenge of mental health, but surely the NHS has some role to play in this transition?

The Rt Hon Norman Lamb however responded to my question later in the conference. He returned to his argument that “This cliff-edge must end – proper transition plans should be put in place, and our ambition is for this to be standard practice across the NHS. There must also be effective co-ordination between CAMHS and adult services, and a commitment to ensuring that the support given is always age-appropriate.” [5] Norman recognises the challenges that students face and suggested at the conference that serious consideration should be given to extending CAMHS to 25. Here here!

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[1] http://www.mentalhealth.org.uk/help-information/mental-health-statistics/UK-worldwide/

[2] https://kclpure.kcl.ac.uk/portal/graham.thornicroft.html

[3] http://www.healthcareconferencesuk.co.uk/news/nhs-england-says-people-with-mental-illness-have-life-expectancies-about-10-years-shorter-than-population-as-a-whole-nhs-leaders-are-therefor-calling-on-those-who-are-commissioning-services-to-help-close-the-shocking-mortality-gap

[4] http://www.mentalhealth.org.uk/content/assets/PDF/campaigns/MHF-Business-case-for-MH-research-Nov2010.pdf

[5] http://www.libdemvoice.org/norman-lamb-writes-mental-health-our-priorities-for-essential-change-37901.html