Transcript Slide 1

Setting Up and
Running Services for
Students with Mental
Health Issues
NADO ONE DAY CONFERENCE
STUDENTS WITH MENTAL HEALTH ISSUES
Wednesday 9th March 2005
Sue Meads; Head of Mentor Service;
University of Southampton
Focus of this presentation:
Why have services for Students with
Mental Health Issues?
 Practical issues involved in setting up
and running services
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Background to the Mentor
Service at Southampton
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Started by ‘accident’ rather than design in 1999
80% students with mental health issues, 20%
chronic medical conditions
Rapid growth to 300 students by the end of
2003-4
Began within Disability Service and ‘promoted’
to sister service in May 2004
Now 3.5 FTE Mentors and 7 self employed
Mentors – 1:1 ‘tutorial’ type work
Plus 2FTE higher level LSAs 1:1 support for
several hours per week
(Not the only effective model)
Why develop specialist
services?
Increasing awareness of needs of
students with mental health issues
 Inter-related developments amongst
the professionals engaged in Student
Support, Legislation, Charities and
Non Governmental bodies
 Growing professionalism in Student
Support
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Why develop specialist
services? Cont…
Existence of HEFCE mainstream and
capital allocation funding plus
Disabled Students’ Allowances for
individually focussed support
 Forthcoming variable fees
 Changing expectations of students
and their parents
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Underlying rationale
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In general terms
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Studying whilst managing the impact of
mental health issues places severe strain on
the student’s organisational and study
strategies, their emotional and physical
resources
Students with mental health issues 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.
Underlying rationale cont…
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This affects performance, achievement, selfesteem, health, financial resources whilst
studying and future earnings
The introduction of variable fees will
increase the negative effects because the
opportunity cost of ‘failures’ will increase
Support from specialist services benefits
achievement, development of transferable
coping strategies, self esteem, self
awareness and health
In less general terms
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Due to a condition or to medication
students experience individual effects,
which may include
Greatly raised anxiety levels
 Extreme fatigue
 Elation, grandiosity and a tenuous
relationship with practical reality
 Self criticism and hostility
 Physical pain
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In less general terms cont…
Hyper vigilance
 Acute self consciousness
 Unable to stay in, or function
effectively in, certain environments
 Panic attacks & fear of panic attacks
 Problems with processing information
 Sleep deprivation
 Obsessive behaviour
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Purpose of Specialist
Services
A student centred approach to helping
the student to access their course
effectively
 We need to be able to:
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Liaise with tutors, academic and other
departments in the Institution
 Arrange reasonable adjustments,
special examination arrangements
 Advocate for our students
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Purpose of Specialist
Services cont…
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Help with applications for Disabled Students
Allowances and/or other funding
Provide help with organisation and planning,
solving problems, developing and tailoring
life and study skills and strategies to
individual needs
Support motivation and morale
Liaise with other services, including medical
and support services within the Institution
Provide Ancillary Learning Support
Who does what?
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There is no single formula; the different
functions can be met by more than one
service, working closely and effectively
together, or by one. Success depends on:
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Role clarity and focus
Managing expectations of Institution, staff
and students
Effective case management
Effective service management
For example: our service
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The Mentor Service provides all the functions,
but
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Members of the employed team are case
managers, coordinate 1-3 Self Employed
Mentors and carry their own caseload
Self Employed Mentors focus on the 1:1 support
Team LSAs do the 1:1 support with students with
more disabling conditions
Ancillary Learning Support is arranged through
the University Tempbank at present, but a
dedicated service is planned for 2005-6
Role Clarity, Focus and
Managing Expectations
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Clarity about levels of qualification and experience
required, matched to role, pay levels and the rates
charged to DSAs providers
Clear boundaries
 Institutional role – do not blur roles
 personal - what contact, when and how, issues
disclosure
 academic – facilitating processes not doing the work
 health and safety policies
Supervision for staff to maintain professional focus and
staff well being
Written guidelines for support workers and students
Clear confidentiality agreements and understanding
about Duty of Care
Effective Case Management
Keeping in touch with student’s
changing needs
 Flexibility
 Working in ‘partnership’ with student
 Effective liaison with all departments,
services and organisations involved
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Effective Service
Management
Finding and training the right people
 Monitoring and evaluation of work
 Dealing with the financial
management
 Providing for 3 levels of support
worker – professional, intermediate
and ancillary
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Finding and training the right
people
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Advertising or word of mouth, partly
depending whether post is ‘formal’
Take up references and phone referee too,
read references before interviewing
Question motivation for the work, people
are sometimes attracted to this work in
order to try to ease their own pain
Criminal Records Bureau checking
Relevant qualifications and
experience
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appropriate academic level, graduate a minimum
standard
teaching qualifications if study skills and strategies
involved in role
experience of FE or HE
appropriate professional qualifications and experience
 related qualifications for higher level work –
counsellors, mental health nurses, mental health
social workers, mental health occupational therapists,
counselling and health psychologists
 graduate with additional training for intermediate level
e.g. counselling skills, PGCE
Don’t be afraid to test for basic level of practical skills
required
Training
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Be clear what you need to get as part of the
package and what you can realistically train
in. This is a new field of work, practically
every recruit will have a lot to learn even
when they are adapting existing
professional and practical knowledge and
skills.
Identify training needs at individual and
team level, hold regular training events and
be prepared to cover:
Training cont…
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At professional and intermediate level
 Academic policies, structure and processes
 Service policies, processes and procedures
 Local services, institutional, social services, NHS and
voluntary
 Disability awareness and legislation
 Understanding of psychiatric conditions
At Ancillary Learning Support level, we should be
prepared to train for
 Note-taking, library systems
 Interpersonal skills
 Disability and mental health awareness
 Service policies, processes and procedures
Monitoring and evaluation
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Systems
 Support worker; timesheets, notes of work and
monthly summaries of work with each student
Management
 Clear targets, issues arising dealt with openly and
quickly, reflective practice encouraged
‘Clinical’ Supervision
 Support worker has opportunity to discuss concerns
out of line management system, source of technical
and skills input, help to maintain professional focus
and monitoring of support worker’s fitness to practice.
Student feedback
 Forms and questionnaires
Financial management
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Fundamentally important but least liked
aspect of providing Support Services
Myths about money
How we pay support workers
Record keeping and systems for financial
administration
Charging funding providers e.g. of DSAs
Myths about money
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That Finance Departments can or will do it
all for us
Phrases like ‘income generation’ and ‘self
funding’ are misleading, services for
students with mental health issues are
involved in ‘cost recovery’. We invoice for
a ‘contribution to costs’.
That somehow, dealing with the money is
‘not nice’.
That ‘they’ should fund all support without
requiring cost recovery
Paying support workers
Method 1
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Introduce student to self employed support
workers and leave them to it.
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Can choose degree of involvement in vetting and
quality assuring work,
No financial processes to deal with
Student bears burden of financial management, not
currently seen as good practice
Support worker bears all risks and provides for own
holiday, sick and retirement pay, plus training and
development.
Less likely to get space and equipment from
Institution
Paying support workers
Method 2
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Self employed support workers
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Support workers need to be paid a rate which reflects
professional standing, costs and risks
Less resource to carry burden of service
responsibilities, self employed support workers
concentrate on the 1:1 support
Support workers bear all the financial risk, need to
fund own sick pay, holiday pay, pension, equipment,
materials, training and professional development etc
Easiest way to start service at professional and
intermediate level, but not ancillary level
Paying support workers
Method 3
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Hourly paid support workers with a contract to
pay for hours worked plus holiday pay.
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Essentially support worker is still carrying much of the
risk – little or no security, no sick pay, no pension
Some institutions reluctant to pay appropriate rate
Very economical for Service, only paid for hours
worked
Little contribution to administration or development of
Service
Can be very seasonal - advantage and disadvantage
Only practical approach for Ancillary Support ?
Service bears more training and development costs
Paying support workers
Method 4
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Support workers employed on permanent
contract
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Staff who contribute to the running and development
of the service
Work together as a team to support each other and
provide cover and continuity for students
The most expensive staffing option because staff
have whole year contracts, holiday, sick and
retirement pay
Provide basis for strong service identity within
organisation
Service bears more training and development costs
‘Cost recovery’
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Fees we charge are a contribution to costs.
Costs can be divided into:
 direct money costs of employing the support worker
• Salary plus Employers National Insurance Contributions
and Employer’s Contribution to Pension usually approx
salary plus 16%
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indirect costs including
• use of room, furniture, telephone, computer hardware
and software and maintenance etc
• paper, photocopying, telephone, books
• training costs, meetings
• other people’s time - recruitment, induction, training,
supervision, administration and management
Illustration : Money costs
only
Purpose
Salary
Salary + No. hrs
16%
per year
Cost
per hour
20 hrs academic
mentoring per week:
3 x 10 week terms
28000
32400
600
£54.13
20 hrs academic
mentoring per wk: 3 x
10 week terms
£24000
£27840
600
£46.40
30 hrs 1:1 support per
week: 3 x 10 wk terms
£18500
£13920
900
£23.84
30 hrs note-taking per
week: 3 x 10 wk terms
£12000
£13920
900
£15.47
Charging
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Charge should be in line with level of
qualifications and expertise required for the
work
Work with the Funding providers
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Contact before first invoice
Provide clear information for their audit
purposes
Take responsibility for the quality of invoices
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All relevant information
Accurate
Keeping Financial Records
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Your service will be audited one day!
Keep:
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all financial records for 6 years (Statute of Limitations)
a full set of copies of all
• orders,
• invoices and other payments you have made
• invoices and other requests for payments you
have sent out
a clear record of all transactions for each student, with
copies of all paperwork in the student’s file
Analyse costs and ‘income generation’. These
can be used to back up requests for staff.