Transcript The Iceberg Factor

Mentoring for Students
with Mental Health
Difficulties
Sue Meads
Head of Mentor Service, University of Southampton
Friday 28th July 2006
AMOSSHE Conference 2006: Enhancing the Student Experience
Rationale for mentor support
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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
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Rationale continued
Support from specialist services
benefits transition to HE, retention,
achievement, development of
transferable coping strategies, self
esteem, self awareness and health
 Mentoring offers effective and
appropriate specialist help
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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.
 Any student with mental health issues,
disability or chronic medical condition
which affects their ability to study to
their full capacity
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Including
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Depression
Anxiety
PTSD
Schizophrenia
Eating disorders
Self harm
Social phobia
Bi-polar affective
disorder
General anxiety
disorder
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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 with practical reality
 Hyper vigilance
 Acute self consciousness
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Hidden effects continued
Panic attacks and fear of panic attacks
 Sleep deprivation
 Obsessive behaviour
 Intrusive thoughts
 Unable to stay, or function, in certain
environments
 Problems with processing information,
memory, concentration etc
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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
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And …
Liaison with other services including
medical and social services teams
 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
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Mentor Service at
Southampton
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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
75-89% mental health issues, 10-24%
chronic medical, 1-5% temporary
Extent of demand
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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
Funding
Most frequently from Disabled
Students’ Allowances (DSAs):
maximum non medical helper
allowance for UG approx £12000
 Possibly from Access to learning
Funds (ALF)
 Other University or Departmental
Hardship Funds
 Charitable Foundations?
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Mentors need
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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…
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Ability to identify strategies and help adapt
them to the individual
Enjoy working at several levels at the same
time
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Observe and think about student’s manner
and disclosures
Communicate empathy and understanding
Monitor own emotional responses
Assess student’s situation
Choose how to respond
Identify and facilitate useful strategies
Counselling and Mentoring:
the differences
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Complementary forms of help, different with some overlap, not
mutually exclusive
Mentoring is an active, practical role, very ‘hands on’ when the
student is in crisis
Confidentiality is treated slightly differently, mentors will contact
GPs routinely if the student is at risk, and the academic school if
the student is a risk to others
Counselling is a very private relationship with little or no
communication with others outside of it, the emphasis on
facilitating the student’s self understanding and own
resourcefulness
Mentors will contact doctors, academic schools, tutors, other
services, DSA providers to arrange support and adjustments,
for and with the student
Mentors will help identify skills gaps and useful strategies, then
teach and facilitate them
Differences continued
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Counsellors will communicate outside the relationship in
extreme circumstances
Mentors will do so as routine part of the role for
reasonable adjustments, and will be more or less active
in response to student’s current state and needs.
Counsellors will offer supportive counselling, emotional
‘holding’ or interpretation which helps extend, or
challenges, the student’s self understanding, according to
the student’s needs.
Mentors offer emotional support and ‘holding’ as part of a
wide range of skills. They do not offer interpretation or
‘treatment’. They help students manage their courses and
study whilst managing a condition, or whilst having
treatment.
A student who wants to explore their emotional
difficulties, will be referred on by Mentors, mentoring will
not be continued if that is everything they want to do.
Differences continued
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Counselling is a generic service, open to all students
with emotional issues
Funding for Counselling is for a generic service
Mentoring is restricted to those who are eligible on,
essentially, disability grounds
Funding for Mentoring from the Disabled Students‘
Allowances (DSAs) is for non medical helpers. It is for
the individual and cannot be used for generic services
e.g. counselling or generic study skills, or for anything
which should come from the NHS.
Differences continued
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Because the funding is a grant to the individual, mentor
support can be long term, for the whole length of student’s
course, weekly even twice weekly if needed.
Mentoring is an effective way to support students who are
waiting for, or receiving NHS treatment, or managing a
serious long term condition without treatment
HE Counselling Services often need to manage carefully the
amount of counselling available to an individual
HE Counselling Services have increasingly been
responding to the needs of students with more serious mh
conditions to compensate for shortage of NHS provision,
often referred by the NHS
Long term support for students with serious mental health
issues is not usually available in HE Counselling Services,
since it would duplicate NHS responsibility. If it were, there
would also be a risk that they would need so much resource
that others would have less access to counselling.
Choosing mentors: Criteria
for selection
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Relevant qualifications and experience
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Academic level, graduate a minimum with
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 set criteria for selecting
mentors?
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Why not just nice people?
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Working regularly and closely with people
with mental health difficulties, even
depression and anxiety, is a powerful
experience, risks include
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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 set criteria for
selection?
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Many people are attracted to this role, with a
genuine desire to help but …
• Desire to help doesn’t equal ability, being nice isn’t
enough
• How do you screen out people who are attracted
because of their own issues? Is always a bad
thing for the mentor to have their own issues? This
involves questions of degree, training and clinical
supervision.
• Even people with relevant professional training
should have clinical supervision
• Intuition and insight need the discipline of theory,
experience and training
Why set criteria for
selection? continued
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The professional trainings listed all involve
learning
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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?
Usually cost effective
 Attractive because it offers
development opportunities for the
‘mentors’ - something for their cv
 Fraught with the difficulties listed
earlier in relation to selecting mentors
 Impossible to supervise properly
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The issue of responsibility
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Vital issues arise in this work at
whatever level
Duty of care and duty of confidentiality
 Making appropriate referrals to other
services
 Fitness to study and fitness to practice
 Professional boundaries of all kinds,
including academic
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Feedback
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Consistently emphasises that
mentoring enables the student to
stay at University
 complete course
 achieve grades in line with potential
 overcome difficulties
 recover from setbacks
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Feedback example:
Charlie, 3rd year humanities student with General
Anxiety Disorder/Depersonalisation, returned to
University after a breakdown in year 1, achieved
1st class honours
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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!
Charlie’s feedback continued
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What difference has mentoring made to you?
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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
Other Examples
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Amy – bi polar affective disorder
Jenny – Post Traumatic Stress Disorder
Tom – anxiety and depression, non traditional background
Zoe – bi polar affective disorder(?) frequent suicide attempts
Jo – borderline personality disorder
Helen – suicide attempt, 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