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Choosing to disclose…but then what?

  • 19 March 2024
  • By Anna Matthews
  • This HEPI blog was kindly authored by Dr Anna Matthews, Founder and CEO of UMO.
  • University Mental Health Day took place last Thursday, 14th March. You can read our blog commemorating the occasion, from Rachel Spacey and Sam Gamblin, here.

When students choose to talk about themselves and the struggles they may be facing—whether mental health, neurodiversity, disability or wellbeing—it is done with trust. They trust that information will be safely shared and that their needs will be understood and the right support offered. Indeed, the recent ruling of the High Court, regarding the death of Natasha Abrahart, has highlighted not just a requirement under the Equality Act (2010) but also the need to have a joined up, student-centred approach.

Although the High Court chose not to rule on whether universities have a statutory duty of care for their students, it is clear from it that once a student discloses their disability the university does have a duty to ensure that the student is not discriminated against either directly or indirectly. The EHRC welcomed the judgement stating that ‘We hope that current and prospective students will feel empowered by this judgement which provides them with clarity on what they should expect from their university.’ Hence there is an expectation that academic institutions must have joined up working with departments passing on key information on students with disclosed disabilities and putting in place appropriate support.

The solicitor for the bereaved family stated. The solicitor for the bereaved family stated:

So far as we are aware this is the first time the High Court has considered arguments that disability discrimination has contributed to a person’s death. Upholding the finding that Natasha’s death was linked to this kind of unlawful treatment therefore establishes a powerful legal precedent (Silverman, G, 2024).

Campaigns to encourage students to disclose, such as #IChoseToDisclose as a former theme for Uni Mental Health Day, run by UMHAN and Student Minds, rightly offers advice and support for students to come forward and let the appropriate authorities at universities know they may be struggling, highlighting available support, usually within Wellbeing Services, and what that support may look like — e.g. specialist mental health or neurodiversity mentoring, counselling, specialist learning differences support, etc. Importantly, they can also manage expectations of students by making referrals or signposting students if beyond their role boundaries. For example, directing students to the excellent Student Minds Hub – Student Space, the Students Against Depression, or via phone line support such as Nightline, Papyrus, Shout and Samaritans, which all offer direct text or phone support.

UCAS has also done a fantastic job of encouraging students to disclose mental health, neurodiversity or disability on their UCAS form before entering university, which has resulted in a 34% increase in 2023 and a staggering 78% increase from 2022 (UCAS, 2023). However, with only 17.3% students disclosing and with 25.4% the general population having a registered disability, there is still significant under disclosure amongst the student population (OfS, 2021). Quite properly UCAS links to the DSA encouraging UK students with a diagnosis to apply for government support. This is with the hope and expectation that the university will be able to identify the student and act swiftly to support them; they were upfront, trusting and prepared to say they need help. There is, however, an ethical problem, which needs highlighting.

There is an underlying assumption with encouraging disclosure:  the whole university approach to supporting students. By the student admitting they have a problem (something not necessarily easy to declare), puts some responsibility on those organisations that encouraged disclosure in the first place  — UCAS, the government and the university — to recognise the need for support and how that support will be actioned for the student. The implication is that the student will be picked up and supported as soon as they set foot on campus grounds, with efficient information sharing . But this does not always happen in practice. UCAS is running an excellent study, supported by TASO, tracking those students who disclose at point of entry and what happens as a consequence.

Clearly, each HEP is different, some have greater resources than others, which will be reflected in the individual experience of the student after disclosure. It is unfortunately not smooth, with long waiting lists, underfunded wellbeing and disability teams, (cuts in the NHS), and, importantly, the student themselves often not knowing what or where to access support,especially as each HEP’s student support services may be set up differently. However, This is not to underplay the huge efforts made by wellbeing and disability teams.

In UMO’s experience, many students are unaware of how to  get support as they transition to university. UMO (a not for profit specialist mental health and neurodiversity service for students and staff in the Higher Education sector) works with thousands of UK and international students with mental health and/or neurodivergent challenges from over 100 UK universities across the country, researching and analysing every step of the way. It is evident a new system is required so universities have a clear understanding of a student’s needs as soon as they arrive and how this might change over time, and the student has a clear understanding of their needs and what works for them.

To this end UMO has developed a Mental Health, Neurodiversity, Disability and Wellbeing Passport, which is already backed by Student Minds, UMHAN, Nightline, Thrive LDN and Good Thinking. We hope that it can be implemented across the sector to not only support the School/College transition into university, a particularly vulnerable period for students, but for the whole student lifecycle and the move into the working world. By recording their key information as well as storing vital documents (assessments, reports, letters), the passport ensures both the individual student and the university have a shared understanding of how best to provide support.

By asking key questions via an AI personal assistant, the passport forms a unique record about the student and what works for them —strategies, techniques, their triggers, signs and symptoms, support network, trusted contacts, and  services they can link with if needed, such as Shout. Assessments and reports can also be stored securely within a vault. This approach ensures the student is always an active participant, allowing them to manage their information and take responsibility.

The passport gives the students agency, something advocated by Student Minds (Tressler, R. 2021). It gives students control of what they choose to share and with whom. But it goes further, as it recognises the need for support after disclosure,creating an ethical approach to disclosure. Each student can access a level of support from a Higher Educational clinical professional, giving the student sound guidance and support via a chat system, in case support services are delayed or not yet joined-up.

The Passport, aka OneSpace, aims to promote psychologically safe environments for students at university whilst working on reducing the stigma of having a need and requiring help for that need. Its importance has already been advocated by Professor Edward Peck and The Higher Education Mental Health Implementation Taskforce. Indeed, it also corresponds to a wider initiative of an NHS app, which holds patient records thus promoting transparency, agency and patient centredness. Crucially,  at the Higher Education level,it aims to join the dots, supporting a Whole University Approach by bringing key information together, so everything is within One Space and can be shared easily. It gives students much needed agency, yet recognises the need for support post-disclosure for all students, but especially for those students who may not turn up to services or know how to ask for help.

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