Student mental health action plan: child rights and wellbeing impact assessment

Introduction

1. Brief Summary and Type of proposal:

Decision of a strategic nature relating to the rights and wellbeing of children.

Student Mental Health Action Plan

The Student Mental Health Action Plan (the “Action Plan”) builds on the broader Mental Health and Wellbeing Strategy (June 2023) and its companion documents, the Mental Health and Wellbeing Workforce Action Plan and the Mental Health and Wellbeing Delivery Plan (November 2023). These overarching documents explicitly emphasise the significance of supporting student mental health and wellbeing, in a trauma-informed way, and the role of those who work with students.

The Action Plan recognises the critical importance of early intervention and prevention, ensuring effective access to a diverse range of community-based clinical and non-clinical services, and providing timely clinical acute care for those who require it.

To achieve these objectives, the Action Plan emphasises the need for strengthening partnerships between institutions, student bodies, local NHS Boards, and Health and Social Care Partnerships. This collaborative approach builds upon existing successful partnerships and the effective student-institutional collaborations already in place through NUS Think Positive's Student Mental Health Agreements.

To address the many and differing needs of students, the plan focuses on five key areas, for action:

• Promoting Mental Health and Wellbeing: Enhancing student awareness of mental health, raising awareness of available resources which support mental wellbeing. Fostering a supportive and inclusive, trauma informed, campus culture to reduce levels of mental health stigma and encourage a whole institution approach to supporting students.
• Early Intervention and Prevention: Helping students and institutions to develop early intervention strategies, identifying potential mental health concerns, and providing timely support to address emerging issues. Drawing on the significantly expanded range of evidence based digital interventions and community based services and supports now available.
• Access to Services: Improving access to mental health services, both clinical and non-clinical, to ensure students have convenient and accessible options for support. Institutions and NHS Boards should work together to ensure that students with more complex mental health needs can access the services they need.
• Partnerships and Collaboration: Strengthening partnerships between institutions, student bodies, healthcare providers, and community organisations to create a comprehensive network of support for students.
• Data Collection and Evaluation: Regularly collecting and analysing data to monitor progress, identify areas for improvement, and inform future interventions.

Start date of proposal’s development: May 2022

Start date of CRWIA process: May 2022

1. With reference given to the requirements of the UNCRC (Incorporation) (Scotland) Act 2024, which aspects of the proposal are relevant to children’s rights?

All the measures in the policy will have a direct impact on children and young people who study at college and university and who are under the age of 18 in that it aims to improve the preventative and clinical services offered to them and how they can access them.

The relevant articles are: 2,3,12,19,23,24,28,29 and 42.

2. Summary of the evidence gathered which will be used to inform your decision-making and the content of the proposal.

Children and Young People and Mental Health and Inequalities

Mental Health and children and Young People

Adolescence and young adulthood is a sensitive time for a person’s mental health. Most mental health conditions in adults have their onset by this stage of life. People aged between 16 and 24 are particularly vulnerable to mental health concerns, with 75% of mental health conditions being established by the age of 24 (Mental Health Foundation Statistics).

We also know that social inequalities are associated with increased risk of many common mental disorders (World Health Organisation, 2014). Research in Scotland showed that economic inequality at a societal level underpins and acts as a driver for all other relationships, impacting on family affluence/poverty, social stratification and inequalities leading to stressors in the home resulting among other things in an increased risk of development of mental health disorders (Mowat, 2019). Children and young people living in more deprived areas in Scotland have lower mental health and wellbeing according to SDQ, WEMWBS^[1], and the life satisfaction measurements. (Scottish Government, 2023)

Accessing support

International evidence suggests that mental health stigma, lack of signposting and access to information, long waiting times and geographical inequalities in access (such as affordability of transport) contribute to inequalities experienced in accessing support and services (Knapp et al 2006).

The Thriving Learners research also underscores the necessity of addressing student mental health concerns. Although that research was conducted during the pandemic, its implications remain relevant given the ongoing effects of Covid-19 and the ongoing cost of living issues.

The Student Mental Health Action Plan outlines key areas for collaborative action to address these recognised challenges, and the need to support students to effectively manage their own mental health and wellbeing, with a focus on early intervention and prevention.

Consultation with Stakeholders

Verbal Consultation Meetings February and March 2024

The underlying principles of the Action Plan and action points were positively received with stakeholders, including NUS Scotland and NUS Think Positive. An summary of the key issues for consideration is outlined below:

• Review clinical language to ensure consistency with other agencies such as NHS, and Public Health Scotland.
• Include an overview of the on-campus support that institutions already provide, and make clear the distinction between institutional support and that provided by the NHS.
• Acknowledge challenges faced by particular groups of students, e.g. international, Postgraduate Research, and part-time students.
• Signpost to where students can view and access the resources available to them (e.g. NUS Think Positive Hub).
• Review language around Action 4 which references a ‘campaign’ to raise awareness of resources available to staff.
• Consider the need to establish minimum standards of service provision.
• Consider how progress against the actions will be monitored and measured, including the role of the SFC, and any corresponding reporting burden on institutions.

Summary of Written Consultations

Written submissions were received from a range of stakeholders including Colleges Scotland, Universities Scotland, SAMH, Unite the Union, University of Edinburgh, NUS Think Positive (reflecting student views) and SeeMe. Consultees were generally positive toward the underlying principles and actions but raised a number of issues. These included:

• An agreed minimum level of care to be stipulated.
• Concern over the lack of dedicated resources to support the Plan.
• A need to reference the challenges faced by international students.
• The need to underscore the importance of a whole institutional approach to tackling mental health issues.
• Strengthening governance arrangements around the Plan.
• An acknowledgement of the different starting position for colleges.
• A wish to see a greater focus on enhancement and improvement especially around prevention.
• Institutions should develop early intervention strategies.
• Funding should be put in place to support pathway development work.
• Further references and greater emphasis should be made to tackling stigma in further and higher education.
• The importance of sport in student mental health and wellbeing should be further highlighted.
• There needs to be a clearer articulation of what the responsibility of Higher Education institutions are and what is the responsibility of NHS Scotland.
• Include a commitment by NHS Scotland to start to record data on student presentations.
• Better sharing of best practice across the sectors.
• A concern that local services may not meet the needs of students and students may place additional burdens on local services.
• Maintaining a continuity of services between term time and home addresses.
• Some of the initiatives for students should be replicated for staff.

3. Further to the evidence described at ‘3’ have you identified any 'gaps' in evidence which may prevent determination of impact? If yes, please provide an explanation of how they will be addressed

No gaps had been identified. The evidence gathered and views sought enabled officials to determine the impact of the measure.

4. Analysis of Evidence

Children and Young People in Further and Higher Education

The Student Population

Scotland's student population comprises over half a million full-time and part-time students enrolled in colleges and universities. In 2021/22, there were just over 96,000 persons between under 20 years old studying in colleges and universities in Scotland – almost 32 (HESA Data, Scottish Government Analysis). The Thriving Learners research highlighted that 42% of survey respondents were under 20 in colleges and 35.7% of respondents in universities were under the age of 20.

In 2021/22, there were over 15,500 students aged 18 years and under living in university halls of residence and Purpose Built Student Accommodation. The Scottish Government does not hold data on the number of students aged 18 years and under in college halls of residence, however this number is understood to be substantially lower.

The Thriving Leaners research also set out the significant impact of mental health challenges on students. Nearly three-quarters of university students reported low wellbeing, over a third experienced moderately severe or severe symptoms of depression, and nearly half felt the need for professional help due to a serious psychological issue. A similar trend was observed in a 2022 Mental Health Foundation survey of college students. Which showed this as a key area of focus and has the potential to positively impact article 24, children’s right to health.

Children and Young People and Mental Health and Inequalities

Adolescence and young adulthood is a sensitive time for a person’s mental health. Most mental health conditions in adults have their onset by this stage of life. People aged between 16 and 24 are particularly vulnerable to mental health concerns, with 75% of mental health conditions being established by the age of 24.

We also know that social inequalities are associated with increased risk of many common mental disorders (World Health Organisation, 2014). Research in Scotland showed that economic inequality at a societal level underpins and acts as a driver for all other relationships, impacting on family affluence/poverty, social stratification and inequalities leading to stressors in the home, resulting among other things in an increased risk of development of mental health disorders (Mowat, 2019). Children and young people living in more deprived areas in Scotland have lower mental health and wellbeing according to SDQ, WEMWBS, and the life satisfaction measurements (Scottish Government, 2023). Therefore, by ensuring access to mental health services, for all students regardless of their socio-economic background, we consider this will also positively impact article 2 non-discrimination.

Accessing support

International evidence suggests that mental health stigma, lack of signposting and access to information, long waiting times and geographical inequalities in access (such as affordability of transport) contribute to inequalities experienced in accessing support and services (Knapp et al 2006).

The Thriving Learners research also underscores the necessity of addressing student mental health concerns. Although that research was conducted during the pandemic, its implications remain relevant given the lingering effects of Covid-19 and the ongoing cost of living crisis.

The Student Mental Health Action Plan outlines key areas for collaborative action to address these recognised challenges, and the need to support students to effectively manage their own mental health and wellbeing, with a focus on early intervention and prevention.

5. What changes (if any) have been made to the proposal as a result of this assessment?

None have been made. At the outset officials proceeded on the basis that there were young people under 18 in the college and university system. Consideration of evidence led officials to include all aspects set out in Question 1 into the Action Plan. Therefore, there were no changes to the proposal as the evidence reinforced initial thoughts on the Action Plan.