Student Mental Health Policy

(Updated 11 April 2013)

1. Introduction

1.1 The purpose of the Student Mental Health Policy is to help ensure that the University provides a coherent institutional approach when responding to students with mental health problems. It has two specific aims:

1.2 As a collegiate institution, the University aims to provide a supportive environment in which all students, including those with mental health difficulties, have the opportunity to realise their full academic potential and meet the academic requirements of their programmes of study. By providing the opportunity to pursue social, cultural, sporting and spiritual activities alongside academic activities, the University also aims to facilitate and promote positive mental health and well-being amongst its students.

1.3 The University seeks to implement these aims by:

• Providing a range of support services within the college environment including the Senior Tutor and other Student Support officers as well as specialised student support in the form of a Counselling Service and a Disability Service in addition to support services provided through Durham Students' Union;
• Encouraging students with mental health difficulties to make these known to the University and to seek support both pre-arrival and after they have commenced their studies;
• Actively addressing any stigma associated with mental health by ensuring that students are not discriminated against, academically or otherwise, because of their difficulties and treating them in accordance with the University's equal opportunities policy statement;
• Referring students with serious mental health concerns, to the Counselling Service and appropriate mental health services;
• Ensuring that consistent procedures are adopted across the University to support students with mental health problems;
• Engendering a culture in which mental health difficulties are recognised and supported;
• Ensuring that consistent procedures are adopted across the University and its constituent Colleges to support students with mental health problems;
• Providing advice, guidance and support to staff involved in the support and care of students;
• Providing clear guidance on the confidentiality of personal information provided by students.

1.4 Whilst the University is committed to providing a supportive environment, it is important to recognise that it is not a mental health facility nor is it a therapeutic community. There are, of necessity, limits to the extent of the support that can be provided and it is not the responsibility of the University to replicate services that already exist within the wider community and within the NHS. 

2. Meeting commitments to students with disabilities

2.1 The University has specific responsibilities towards those students whose mental health concerns are defined as a disability under the law. This requires the University to ensure that such students are not discriminated against and that reasonable adjustments are put in place to support their learning. To enable the University to meet its legal obligations and to provide access to necessary support services, all students are encouraged to disclose any disability they have prior to and after entry to the University.

2.2 The University has admissions procedures in place for students with additional support needs. These can be found at:

 • http://www.dur.ac.uk/learningandteaching.handbook/1/2/3/ (undergraduates)

 • http://www.dur.ac.uk/learningandteaching.handbook/1/2/4/ (postgraduates)

2.3 The Equality Act 2010 defines a disabled person as someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities. Thus, it is likely to include students with a long-term mental illness. Responsibility for providing support rests with the student's College and Department in partnership with the Durham University Service for Students with Disabilities (DUSSD). DUSSD, in consultation with the academic department concerned, undertake an assessment of the academic support needs and produce a Recommended Reasonable Adjustments Report (RAR) outlining the reasonable adjustments that are required to mitigate the effects of the student’s disability. DUSSD are also able to provide advice and guidance concerning students who need to be re-admitted to the University following a period of withdrawal or suspension from the University on the grounds of mental health (see section 7 below). Further details on the services provided can be found on the intranet through the following link:

 http://www.dur.ac.uk/dussd/aboutus/

3. Support Services for Students

3.1 The University has a well established tradition of providing extensive student support which includes the College network of pastoral care, access to medical care, the Counselling Service, DUSSD and the support services offered by the Students' Union. Responsibility for helping students with difficulties rests, in the first instance, with the Colleges and, in particular, those with responsibility for pastoral care. Staff in Departments and Faculties also have an interest and should liaise with the relevant Senior Tutor or support service if they have concerns about a student, subject to the requirements of confidentiality (see section 5 below). 

3.2 The College based system of pastoral support enables many of the minor problems experienced by students to be addressed and is appropriate for resolving practical or academic problems which give rise to anxiety or stress. However, it is not equipped to deal with more serious emotional and psychological problems which require professional intervention. For these problems the College pastoral support system acts as an early warning system that identifies students in need of professional help, whether that help is provided by a medical professional or the Counselling Service. Advice and guidance for members of University staff dealing with a student presenting with mental health difficulties is given below. 

4. Guidance for College and Departmental staff dealing with a student presenting with mental health difficulties

4.1 The majority of students with mental health difficulties are very unlikely to cause disruption or risk to themselves or others. However, experience at the University and in other higher education institutions, has shown there may be occasions when mental health difficulties or psychological or emotional disorders have a profound impact on the functioning of individual students and on the well-being of others around them.

4.2 This guidance is intended to support staff responding to students with mental health difficulties;

• in emergency situations;
• in situations that are not an emergency but where they have concerns about a student's behaviour.

4.3 When dealing with students presenting with mental health difficulties it is vital that staff understand that they are not expected to replace the professional care and support that are the responsibility of the NHS. Staff should always seek further professional advice/assistance when dealing with student mental health issues either by referring the student to a specialist service or by calling a case conference (see paragraph 7.4 below). They should never allow a situation to develop where an individual case places personal demands upon them or compromises their privacy, safety or impartiality. In all cases, personal safety overrides confidentiality. Staff who are personally affected by the supporting of a student, can receive advice and guidance from the University’s Occupational Health Service and can be directed to independent sources of support by the Student Counselling Service.

• http://www.dur.ac.uk/healthandsafety/occupationalhealth/
• http://www.dur.ac.uk/counselling.service/staff/counselling/

5. Confidentiality

5.1 All staff within the University have a legal obligation under the Data Protection Act 1998 to treat a student's physical or mental health as sensitive personal data (for further information see: http://www.dur.ac.uk/data.protection/dp_principles/principle1/) . It is important therefore that all staff recognise that they have a duty to maintain strict confidentiality within the University in respect of students and must not disclose information unless it is necessary to do so. Staff at the University who are involved in supporting students with mental health difficulties, should only pass on personal information about individual students when they judge it is in the vital interests of the student and/or the members of the university community. 

5.2 Where consent is not given by the student to disclose information this should be respected and information should not be disclosed. However there are rare exceptions to this rule which should be considered when dealing with students who are experiencing mental health difficulties:

• where the member of staff would be liable to civil or criminal proceedings if the information was not disclosed (for example if a crime had been committed);
• where it is believed the student's mental health has deteriorated to such an extent that they have become a danger either to themselves or to others;
• where a student is so ill that he/she lacks insight into their condition and lacks the mental capacity to give informed consent.

In these instances it is not necessary to ensure the consent of the student before disclosing information about them but it is still good practice to seek it and to inform the student that such a disclosure is going to be made to a mental health professional or similar.

5.3 Staff may find that, when dealing with students experiencing mental health difficulties, they are contacted by concerned parents or other relatives requesting information. Staff can offer a sympathetic ear but in most circumstances personal information about a student must not be disclosed to anyone outside the University, including parents, without the student's permission[1]. Staff can offer to talk to the student and encourage them to get in touch with their relatives or offer to forward a letter to the student concerned and although some relatives are unlikely to be happy with this response, it is important to remember that students have the right to privacy.

6. Dealing with Emergency and Serious Situations

6.1 Very occasionally a student will exhibit behaviour that causes considerable and immediate concern. 

6.2 In emergency cases the need for intervention on behalf of the student will be urgent. If this happens during office hours and the student will accept help then they should be referred to their GP if medical intervention is required. . If medical intervention is not required and the student is a known client of the Counselling Service, it may be appropriate to refer the student there. The Counselling Service’s Duty Senior Counsellor would advise the department how best to meet the students’ urgent needs. The duty senior counsellor is available weekdays from 9am to 5pm on 0191 334 2200.

The Counselling Service can also refer students to specialist mental health support services in most cases the student would need to attend the Counselling Service to facilitate an assessment of their immediate needs. 

If the crisis happens outside of normal office hours then the student will need to be directed to

• their GP and the 'out of hours' number
• NHS Direct (0845 46 47 48) is also available to provide advice and guidance. 
• NHS 111 You can call 111 when medical help is needed fast but it’s not a 999 emergency
• The mental health crisis team
  • Durham 01914415858 (select option 4 when you call)
  • QCS 01642 524714

6.3 If it is believed there is a serious risk of the student harming themselves or others, staff should contact the appropriate emergency services. Having done this, University Security should be informed so that they can provide any additional support required by the emergency services. The University has two emergency numbers which enable staff to liaise with University Security about an incident. These numbers are:

• Durham - 42222
• Stockton - 40080

6.4 If the member of staff dealing with the situation is not the student's Senior Tutor, once they have dealt with the immediate emergency situation they should ensure that the student's College is aware of the situation by informing the Senior Tutor. The Senior Tutor has responsibility for ensuring that the student's academic Department is kept appraised of the situation.

6.5 A student whose behaviour is causing significant concern may refuse to accept help. In emergency situations action can still be taken by staff as set out in section 6.3 above. If the situation is not an immediate emergency but remains a cause for concern, staff can seek advice in writing (which may be in the form of an email) from: the student's Senior Tutor, a senior member of staff in the Student Counselling Service and other specialist mental health partners involved in providing care for the student concerned (for example the student’s psychologist, psychiatrist, GP, eating disorders specialist etc).

7. Dealing with serious concerns about a student's behaviour

7.1 Identifying serious concerns

7.1.1 In some cases, the behaviour of a student may not present an immediate crisis but still causes concern. College and Departmental staff may become aware of students who they consider to be in slow decline and it is important to address this situation to avoid the possibility of it escalating into a crisis. College and Departmental staff may become aware that there is a problem when a student persistently misses lectures, fails to meet coursework deadlines or their academic performance deteriorates markedly. Fellow students may also bring concerns that they have about another student to the attention of College and/or Departmental staff. 

There are also other warning signs that may be apparent to anyone who comes into contact with a student, including:

• behaviour that indicates that a student is persistently tense, sad or miserable;
• loud, agitated or aggressive behaviour;
• very withdrawn or unusually quiet behaviour;
• erratic or unpredictable behaviour;
• unusual uncharacteristic behaviour;
• unkempt personal appearance;
• signs of fatigue, exhaustion and lack of energy;
• limited concentration and inability to make decisions;
• problems maintaining academic and social relationships;
• visible bruising, cuts or recent scarring.

Appendix I appended to this policy provides a general guide to some of the most commonly used mental health terms produced by the Counselling Service.

7.1.2 Most students are likely to be forthcoming if they are experiencing difficulties and concern is expressed, others may be more reticent so their difficulties may be more difficult to detect. Many students may feel embarrassed about the problems that they are facing and hope that, by doing nothing, the difficulties will go away. 

7.1.3 If staff have particular concerns about a student it may be appropriate to ask colleagues if they share concerns about the student's wellbeing. Staff can also seek advice from the University Counselling Service whose staff, while they will not be able to breach confidentiality, are happy to talk in general terms to anyone with worries about a student.

7.2 How should staff respond?

7.2.1 The first step would normally be for the member of staff who has identified a cause for concern to speak to the student to try and find out more about their situation. Staff may discover that the student is already accessing appropriate support by seeing a counsellor, a doctor or other healthcare professional. Expressing concern for the welfare of the student in this way may reassure them and allay concerns staff may have had. However, if the conversation with the student does not provide this reassurance and the student is reluctant to talk, a judgement needs to be reached with regard to the best way to proceed. There are two main courses of action open: to signpost the student to an appropriate source of help or to seek further advice and guidance with regard to the best way to manage the situation.

 Appendix II appended to this policy provides a flowchart for staff to follow when supporting a student with mental health difficulties.

7.3 Signposting: identifying sources of help and advice

7.3.1 The University has a number of specialist student support services with different areas of expertise. If staff talk to the student about their concerns and are aware of the range of provision they should be able to guide them to the appropriate service. Appendix III appended to this policy provides advice and guidance with regard to the services to which a student could be directed to enable staff to respond appropriately.

7.3.2 Any student who believes they are experiencing mental health difficulties should be encouraged to seek help offered within the University (as outlined above) or to seek professional help from the range of services offered within the City and Region. The Counselling Service maintains a comprehensive index of external agencies and helplines that are well placed to support students experiencing particular difficulties. The index can be accessed via the University's website by using the following URL: http://www.dur.ac.uk/counselling.service/further/.

Alongside this, the Counselling Service can provide university staff with a contact list of the University’s mental health partners who regularly treat student mental health concerns. The partners have all agreed that they can be contacted directly about student mental health concerns.

7.3.3 It is important to remember that Durham's students come from a wide range of backgrounds and experiences and their reactions to difficulties may not be predictable. They may also feel less or more comfortable about seeking help from particular people or services. For example, some international students may be uncomfortable about the idea of counselling and reluctant to seek help from the Counselling Service, even if it seems the most appropriate place to which to refer them. If a student has already established a good relationship with any of the key services, this might provide the most appropriate initial referral point as the services are experienced in cross-referral if this becomes necessary. 

7.3.4 It is important that students are encouraged to access services that are acceptable to them. They should be encouraged to take the initiative and contact the relevant service themselves as they are more likely to derive benefit if they do this independently rather than being pushed into it. 

7.3.5 There may, however, be times when a student finds it difficult to make the first move especially if they are depressed or so ill that they lack insight into their mental wellbeing. On these occasions it may be helpful for staff to take a more active role by contacting the service on the student's behalf and making an appointment, preferably when the student is present in the room. Afterwards, staff can check whether the student attended and, if they felt unable to do so, offer further encouragement and/or advice about any alternative steps that might be helpful. If the student is agreeable it is helpful to ensure that a note of his or her concerns are recorded and filed confidentially.

7.4 Seeking further advice and guidance: Case Conferences

7.4.1 In some cases, a student will present with difficulties that, whilst not an acute emergency, cause significant concern and require advice and input from more than one of the University's support services. In other cases, a pattern of behaviour may be displayed over time which may indicate that a student is in slow decline and there is potential for a crisis situation to develop. In these situations it is likely that staff will have sought to resolve matters informally through discussion with the student concerned and through interaction with the student support services set out in Appendix III. However, despite attempts at informal resolution, there may be occasions when the student's situation remains a cause for concern and, in such a scenario, it may be advisable for those members of staff who are actively involved in supporting the student to convene a case conference.

7.4.2 A case conference is a small ad hoc group convened to address the needs and monitor the progress of particularly complex or higher profile cases. The use of a case conference can help to contain difficult situations, calibrate support and protect the interests of both the individual concerned, and equally importantly, those in the surrounding environment who may be seriously affected by disruption. By using this approach, members of staff are supported and protected when dealing with more complex cases by drawing upon the knowledge and expertise of others within the University and also by the sharing of responsibility through consensus decision making. If staff have any concerns about whether or not a case conference is the next appropriate next step, they can discuss the case with the Deputy Academic Registrar and/or the Director of the Counselling Service.

7.4.3 The case conference would have the following objectives:

• to consider the background to the case;
• to determine what action is necessary to try and ensure the health and wellbeing of the individual concerned;
• to determine what action is necessary to protect any other students/staff who may be affected by the behaviour of the individual concerned;
• to consider any impact upon the individual's academic studies and whether these can be mitigated in any way.

7.4.4 To convene a case conference the staff member concerned should follow the case conference protocol set out in Appendix IV. The student whose situation is under review should be invited to attend the case conference and offered the opportunity to be appropriately supported at the meeting by a friend[2]. The student should be informed in writing in advance of the meeting of the purpose of the case conference and should be provided with any documentary evidence that is to be considered; Appendix V provides a sample letter that can be sent to the student. If the student has not already declared that they are happy for a case conference to go ahead (for example by signing disability disclosure documentation) and they do not wish to attend then written consent should be sought to enable it to go ahead. On occasion a student may not recognise or be willing to accept that they have a difficulty and, as a consequence, are unlikely to be willing to attend a case conference or give their consent to it going ahead in their absence. If this scenario occurs then the case conference can take place if the University is satisfied that it is in the vital interests of the student and/or other students affected by the behaviour(s) of the student with mental health difficulties[3]. If there is any doubt about whether or not it is in the vital interests of the University to convene a case conference, a conference can still go ahead but the identity of the student should be protected from those who have not been given direct permission to know about the case. If staff have any concerns about whether or not a case conference can go ahead given the confidentiality issues involved they are advised to take advice from the Deputy Academic Registrar and/or the University's Information and Data Protection Manager.

7.4.5 The membership of the case conference will depend upon the nature of the case under consideration. Consequently it is difficult to be prescriptive regarding the person who should Chair the case conference however, in most cases, it is likely to be The Deputy Academic Registrar, The Director of Counselling, the appropriate Senior Tutor or Head of College. It is also not possible to be prescriptive with regard to the membership of the case conference but the student and his or her friend should be asked to attend and serious consideration should be given to including some, or all, of the following.

• a senior representative of the Student Counselling Service;
• an external mental health practitioner who is involved in supporting the student; (if the student agrees to them being present);
• a senior representative of the University's Service for Students with Disabilities
• a senior representative of the student's college (this will, in most cases, be the Senior Tutor);
• a representative of the student's academic department;
• the Deputy Academic Registrar and/or the Assistant Registrar - Student Complaints and Appeals, Academic Support Office.

It is expected that professional advice should always be available at the case conference from a representative of at least, the Student Counselling Service and/or DUSSD and a mental health professional.

7.4.6 Due to the nature of the difficulties they are experiencing, students who are suffering from mental health problems may, or may not, be receiving professional healthcare support. As noted in section 7.4.4 above, some may also not accept that they have a difficulty or may refuse to engage with the support services available to them both within the University and externally. Therefore whilst supporting medical evidence will always be helpful when attempting to reach a decision in terms of the action to be taken in relation to a particular case it may not be possible to obtain this. Decisions can still be made via a case conference even if it is not possible to ascertain a professional, certified medical opinion on the health of the student provided their behaviour is of sufficient cause for concern. Any decision regarding a student that does not include certified medical evidence should be backed up by appropriate professional advice and guidance provided, for example, by the Director of the Counselling Service and/or external agencies including GPs, the police and social services.

However, if a student is given time out from the University on the basis of a concession or is suspended on the grounds of their mental health difficulties then they must provide certified medical evidence before they are permitted to return to their studies (see sections 8 & 9 below).

7.4.7 The member of staff convening the meeting will arrange the time and location for the meeting(s) and ensure that any relevant background information is provided. They will also arrange for an agreed note of the meeting(s) to be kept and to oversee any follow-up actions ensuring that these are undertaken. It is likely that a single meeting will be sufficient to address the issues underlying a particular case but it is at the discretion of the case conference whether they wish to meet again to review progress.

7.4.8 Possible outcomes of the case conference might include, but are not restricted to:

• offering to request a ''grace'' period or a concession to take time out of their studies as defined in the Learning and Teaching handbook (it should be noted that the outcome of any request for a ''grace'' period or concession cannot be prejudged prior to its consideration by an appropriate senior Faculty Officer);
• asking the student to give an undertaking with regard to their future conduct;
• where no viable alternatives exist, suspending the student on the grounds of ill health, or other appropriate grounds, as set out in the University's General Regulations (see section 9 below).

8. Taking time out from the University: concessions

8.1 Permission may be sought for students to suspend their studies in relation to mental health and this is done via the concession process. The concession process is normally initiated by the student concerned, and the University endeavours to respond flexibly to requests by students to suspend their studies on the grounds of mental health difficulties in order to provide the student with sufficient time to rest and recover. Any students considering such a concession on these grounds should contact their Senior Tutor or a member of staff in their academic department to discuss the options, and that if it is decided to proceed down this route the person the student has contacted will raise a concession on the student’s behalf. All requests for the suspension of study via a concession will be considered in line with University policy on the consideration of concessions. An appropriate time will be agreed for the concession, in negotiation with the student's College and Department taking account of medical evidence provided by the student. The outcome of any concession request cannot be assumed and all involved should wait until the decision is communicated to them before acting on the basis of the concession request. Students who are granted a concession to suspend their studies on the grounds of mental health difficulties will normally be required to leave their accommodation for the duration of their suspension if they are resident in College at the time the concession is granted. Such a concession will require the student to demonstrate that they are fit to return to their studies once the suspension period is nearing completion and this will require a report from suitably qualified medical professionals such as the student’s GP and/or other medical personnel involved in the student's care. Further information on examination concessions can be found in the Learning and Teaching handbook which is available on the intranet through the following link: http://www.dur.ac.uk/learningandteaching.handbook/2/3/

8.2 In some cases, a need for a concession is indicated, but it is inappropriate or unhelpful to require the student to initiate the process and assemble the necessary supporting documentation (including medical evidence) because of the nature of their condition. In this instance a case conference should be convened as set out in section 7 above. This process provides for professional advice to be taken and for appropriate consideration of the situation by college and department. The outcome of the case conference in this circumstance would be a recommendation to the Head of Faculty or his/her representative that a concession be granted. Students who are granted a concession to interrupt their studies on the grounds of their mental health without providing original medical evidence will need to demonstrate that they are fit to return to their studies once the suspension period is nearing completion as set out in 8.1 above.

9. Taking time out from the University: suspension

9.1 Whilst every effort is made to support students experiencing difficulties, the duty of care owed by the University to the wider student body and to staff takes priority where a student is exhibiting behaviour that is disruptive to the academic, social or business life of the University community. In such instances efforts will be made to resolve such problems through discussion with the individual concerned and in particular to point out the negative effect that their behaviour is having on others. However, if these efforts are unsuccessful, alternative strategies will be considered including, if necessary, recommending that the student withdraw voluntarily from the University for a suitable period to help facilitate their recovery using the concession route set out in 8.1 above. If a student is suffering from a serious mental health problem, withdrawing from the University may offer them the best chance of making a full recovery, particularly if they receive support from their family. Withdrawal will also be necessary if the student's mental condition is such that they are unable to meet course requirements, notwithstanding the support of the collegiate University and local medical services. 

9.2 However, if a student refuses to withdraw voluntarily it will be necessary to consider suspension. The University's General Regulations provide for the suspension of students on the grounds of health difficulties. Suspension may be recommended as the outcome of a case conference. A student may also be suspended as an emergency measure without prior need for a case conference. Details of the regulations can be found in General Regulation VI, Suspension. Students who are suspended under these regulations and who are resident in College will normally be required to leave their accommodation for the duration of their suspension. Students do have a right of appeal against any decision to suspend.

9.3 Students who are suspended on the grounds of their mental health will only be allowed to resume their studies once the University is satisfied that they are medically fit to do so, as certified by an appropriate mental health practitioner i.e. the student’s psychiatrist, psychologist or GP and that there is appropriate educational and pastoral provision to support them. The University's General Regulations require a comprehensive report to be compiled for the consideration by the Deputy Warden when deciding whether or not to allow a student suspended on the grounds of their mental health to return to the University. 

10. Other University Regulations

In accepting an offer of a place at the University, students agree to be bound by the University's regulations and codes of practice including General Regulation IV, discipline and the respect at work and study policy. These regulations/codes of practice apply to all students and a diagnosis of mental illness will not automatically mitigate the imposition of penalties for breaches of them. However, it is recognised that certain behaviours may result from undiagnosed mental health difficulties in which case, whilst due penalty for any offence will be imposed, the student will also be referred to the relevant support services for assessment. This will enable on-going support to be put in place if appropriate. 

In cases where a disciplinary or harassment case highlights concern that a student is unfit to continue with their studies, or is exhibiting behaviour that is disruptive to the academic, social or business life of the University community, then they may be advised to temporarily withdraw from the University or if necessary, be suspended.

11. Examination Arrangements

11.1 Students whose condition may impact upon their examination performance may be eligible to apply for a concession. There are a range of examination concessions potentially available, including but not limited to allowing a student additional time, allowing them to take examinations in a separate room and providing them with a scribe. 

11.2 DUSSD is authorised to initiate examination concessions for students with disabilities and these are forwarded directly to the Student Planning and Assessment Office. DUSSD require relevant supporting evidence and will copy the request for a concession to the student's College and to the academic Departments concerned. Further guidance is available on the intranet through the following link:

 http://www.dur.ac.uk/learningandteaching.handbook/6/3/11/

12. Advice and Guidance

The University offers a session, run by the Counselling Service, as part of its equality and diversity training programme on how to support students with mental health difficulties. In addition, a series of training programmes are also available for staff working with disabled students. Further details can be found under 'Diversity and Equality' on the intranet through the following link: http://www.dur.ac.uk/training.course/

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[1] A student's permission should be sought in writing. If permission is given verbally by the student this should be followed up with written correspondence confirming that permission has been given and the date.

[2] The friend may be a student currently registered at the University, a current, substantive or honorary member of staff of the University, or a current Sabbatical Officer of the University.

[3] If it is believed that a student's mental health has deteriorated to such an extent that they have become a danger either to themselves or others then this overrides concerns regarding confidentiality (see section 5.2 above).