Promoting good mental health for university students is a priority. In the UK, 50% of young people now go to university but anxiety, depression and self-harm are rapidly increasing. University mental health services report demand beyond their capacity. Effective ways to prevent student mental difficulties are urgently needed. Further, university should be a positive life experience that promotes students’ wellbeing and ability to thrive.

Research and student feedback recommend changing university culture, environment and teaching to promote wellbeing, by adopting a “whole university” approach in which all aspects of the university support positive mental health

In parallel, a “Stepped care” approach, in which students move through different steps based on need, is suggested to improve student wellbeing and service capacity. Stepped care starts with wellbeing promotion and prevention for all students, steps up to self-help for those with mild symptoms and then to professional support for those with elevated symptoms. However, these approaches have not been rigorously tested in universities. We don't know which elements best promote good student mental health. We don't know what approaches work best for the diverse student body across gender, ethnicity, sexuality, and sociodemographic background.

We will test initiatives within the university environment and at each of the steps, see which initiatives students use, how well they work, and identify which work best for which students across diverse groups. Students will be active partners in shaping, delivering, and evaluating all research.

This breakthrough research programme will have multiple workstreams. The key workstreams involve the following state-of-the-art initiatives:

Understanding student mental health needs

Repeated twice-yearly online surveys across the 6 universities (will give students their say, assess student wellbeing and mental health, and understand what helps or hinders students seeking and getting help. This survey has been adapted from the U-Flourish project led by Professor Anne Duffy and Professor Kate Saunders at the University of Oxford and Queen’s University, Canada.A novel digital self-monitoring tool will map how students actually use different levels of support over time. It will pilot the first use of a student -controlled electronic personal wellbeing record in which all students can track their wellbeing and stress make wellbeing plans and be signposted to relevant sources of help. We hope that this tool will empower students’ self-care and improve the continuity of care between universities and the NHS.

Embedding compassion into education

We will pilot the first practical implementation of a universal compassionate campus to ask if it radically transforms the university environment. Building a compassionate campus will include (a) making changes to the wider curriculum including adding teaching about diversity and mental health, and about practising kindness and understanding for self and others; (b)making assessment more flexible and responsive to students; (c) making the university culture more inclusive and caring and considerate; (d) testing ways to better connect people. Focus groups and interviews will explore how students and staff experience this approach. This workstream is led by Professor Louise Lawrence with Dr Felicity Thomas.  Work on this workstream started at the recent Festival of Compassion at the University of Exeter. 

Dr Polly Card is a visual researcher for the Compassionate Campus initiative. She created a video summarising Festival of Compassion 2021. 

Student mental health literacy course

Building from prior co-design with students, we will adapt and evaluate a comprehensive online mental health literacy course to improve knowledge about what influences mental health, how to promote wellbeing and how to seek help, reduce stigma, and promote healthy lifestyles. Surveys before and after the course will test if it increases students' knowledge, healthy behaviours, helps-seeking and wellbeing.

Guided versus unguided self-help cognitive behavioural therapy 

Most universities now offer self-help to students as part of a stepped care approach. To better understand how to make self-help work for students, three different randomised trials will test different versions of guided and unguided self-help. One trial will test a book-based guided self-help to build personal strengths in students so that they can bounce back better from difficulties. We know that over 40% of students report high levels of worry and worry can predict the development of anxiety and depression. Thus, a second trial will test if unguided digital self-help that targets worry and builds confidence in high-worrying students can prevent future depression and anxiety. A third trial will compare supported versus unsupported digital cognitive-behavioural therapy because unsupported self-help can reach vastly more people and there is uncertainty about whether and for whom supported self-help is more effective. We will use state-of-the-art machine learning to examine what works for whom to develop personalised treatment and direct students to the treatment that will work best for them. 

Enhanced care pathway for students seeking help for common mental health conditions 

To improve the efficiency of student mental health services, we will test if adding an innovative digital self-monitoring tool shared between student and clinician improves the student experience and time to recovery by enabling care to be more proactive, efficient, and responsive (e.g., more frequent meetings if symptoms rise). 

From this research, we will develop an evidence-based integrated model of inclusive and acceptable student wellbeing and mental health support. In partnership with students and university leaders, this model will inform policy recommendations.

We will develop tangible evidence-based digital self-help tools, guides for developing a compassionate campus, and curriculum courses – all of which are easily adapted and added to existing systems, scalable, low-cost, and of benefit to all higher education institutions and their students. 

Students will be central to our ongoing plans for engagement, analysis, and communication. Our project engagement officer, Dr Jemima Dooley, will work with our paid Student Advisory Group who will be involved in joint decision-making and oversight for the project, co-production of policy and dissemination, and joint development of content and design for the various interventions. The Student Advisory Group will be involved in university-specific student-led engagement campaigns and student-driven dissemination, including student-led content such as booklets, website content, video blogs, podcasts and social media posts to ensure that key messages are communicated in an engaging and accessible student voice to other students.