The Iceberg Factor

Mentoring for students with hidden primary and secondary mental health issues in higher education

Sue MeadsHead of Mentor Service, University of SouthamptonMonday 26th June 2006

Rationale

In general terms Studying while attempting to manage the

impact of a disability, chronic medical condition, or severe crisis places severe strain on the student’s organisational and study strategies and their emotional and physical resources

Students with hidden disabilities often have, for much, or part of the time, emotional, psychological and physical symptoms or states which restrict their capacity to study to their full potential

Rationale continued

This affects performance, achievement, self esteem, physical and mental health, social integration, financial resources whilst studying and future earnings

New fee structure may increase negative effects because the opportunity cost of ‘failures’ will increase

Rationale continued

Support from specialist services benefits transition to HE, retention, achievement, development of transferable coping strategies, self esteem, self awareness and health

Mentoring is most appropriate specialist help

For whom?

Students who are more vulnerable to the effects of stress because of disability or health condition. Or the effects of a traumatic event (this would not be DSA)

Any student with mental health issues, disability or chronic medical condition which affects their ability to study to their full capacity

Including

Depression Anxiety PTSD Schizophrenia Eating disorders Self harm Social phobia Bi-polar affective

disorder General anxiety

disorder

Cerebral palsy Epilepsy Brittle diabetes Lupus ME Heart conditions ADD Aspergers syndrome Bereavement Hearing impairment Partial sight

Wide range of hidden effects

Greatly raised anxiety levels Being in a state of fear Extreme fatigue Self criticism and hostility Elation, grandiosity and a tenuous

relationship practical with reality Hyper vigilance Acute self consciousness

Hidden effects continued

Panic attacks and fear of panic attacks Sleep deprivation Obsessive behaviour Intrusive thoughts Unable to stay in, or function in, certain

environments Problems with processing information,

memory, concentration etc

Mentoring can provide

Support for motivation and morale Help with organisation and planning,

solving problems, developing and tailoring life and study skills and strategies to individual needs

Advocacy for student Liaison with tutors, academic and

other departments in the institution

And …

Liaison with others services including medical

Access to reasonable adjustments and examination arrangements

Help with DSAs and/or other funding Access to ancillary learning support

e.g. note-takers, library support

Mentor Service at Southampton Started 1999 with 4 students Numbers approx 360 in 2005-6 Nearly half have regular mentoring Weekly meetings with mentor Supportive relationship to help manage

course, University life and condition/s 75-90% mental health issues, 10-25%

chronic medical, 1-5% temporary

Extent of demand

GPs on campus estimate approx one third consultations involve mental health issues

Estimates vary but 6-10% UK students experience a significant mental health difficulty during period of study

At Southampton that would be 1440-2400 students

Minority of students disclose

Factors which influence individual need

Nature of difficulty, especially if condition or medication is changing

Willingness to believe help is possible Multiple disabilities Social factors affecting potential

academic success

Mentors need

Ability to respond to student – student centredness

Excellent interpersonal skills, ability to establish rapport

Ability to hear distressing experiences and feelings without judging, panicking, ceasing to think, overstepping boundaries or becoming ill

And…

Ability to identify strategies and help adapt them to the individual

Enjoy working at several levels at the same time Observe and think about student’s manner

and disclosures Monitor own emotional responses Assess student’s situation Choose how to respond Identify useful strategies

Choosing mentors

Relevant qualifications and experience Academic level, graduate a minimum

Teaching qualifications and experience if study skills involved

Experience of working in FE or HE Appropriate professional qualifications and

experience in counselling, mental health social work, mental health nursing, occupational therapy, counselling or health psychology

Why?

Why not just nice people? Working regularly and closely with people

with mental health difficulties, even depression and anxiety, is a powerful experience, risks include

• taking on the feelings, even symptoms of the client

• inability to manage feelings• inability to manage boundaries• breaking professional boundaries• Illness• How can we be so sure they are nice?

Why continued

Many people are attracted to this role, with a genuine desire to help but …

• Desire to help doesn’t equal ability• How do you screen out people who are attracted

because of their own issues?• Is having your own issues always bad? • Being nice isn’t enough• Even people with relevant professional training

should have clinical supervision• Intuition and insight need the discipline of theory,

experience and training

Why continued

The professional trainings listed all involve learning

• advanced counselling and communication skills • to manage boundaries • to monitor own responses and behaviour• to work with clinical supervision• how to recognise the emergence of serious

mental illness • and the qualification includes an element of being

fit to practice

What about peer mentoring?

Often popular Usually cost effective Fraught with the difficulties listed

earlier Impossible to supervise properly

The issue of responsibility

Vital issues arise in this work at whatever levelDuty of care and duty of confidentialityMaking appropriate referrals to other

servicesFitness to study and fitness to practiceProfessional boundaries of all kinds,

including academic

Examples

Amy – bi polar affective disorder Charlie – General Anxiety disorder Tom – anxiety and depression, non traditional

background Helen – anger, depression and anxiety Sally – 5 children, husband with serious mental health

issues, poverty, condition of hand affecting writing, low mood and exhaustion

Henry – Aspergers, dyspraxia and mental health issues (with low frustration tolerance)

Frank – paranoid schizophrenia, studying part-time

Feedback

Consistently emphasises that mentoring enabled the student tostay at Universitycomplete courseachieve gradesovercome difficultiesrecover from setbacks

Charlie’s feedback - 3rd year humanities student, General Anxiety Disorder/Depersonalisation 1st class honours

What difference has mentoring made to you? Taken the pressure off Made me feel it is ok to be ill Made me feel less isolated – did not feel I was coping

alone Took pressure off logistical problems Helped fulfil academic potential Eased relations with academic staff Takes away stigma One very important leg of 3 leg support system – GP,

therapist, Mentor Service

Charlie’s feedback continued

What have you found particularly helpful? Accessibility (openness to discuss any

problem) Dynamism (always find a solution) Non-judgemental accepting environment Open meetings – student brings in issues to

discuss The whole package – logistical, emotional,

financial support – this made it possible for me to come back to Uni .. And stay!