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4.1. Staff supporting students
       4.1.1. The role of staff as supporters
       4.1.2. Training and staff development
       4.1.3. Mentoring schemes
       4.1.4. Staff consultation with student support services
       4.1.5. Debriefing
       4.1.6. Information sources
       4.1.7. Support outside of normal working hours
       4.1.8. Inclusive institutional mental health policies
4.2. Students supporting other students
       4.2.1. The role of students as supporters or invisible carers
       4.2.2. An example of practical guidelines for students supporting students
       with possible mental health difficulties

• This section is concerned with the support needs of those who find themselves supporting students experiencing mental health difficulties. It is possible for any member of the institutional community to become involved in such a supporting role, whether as an initial point of contact or on a longer term basis. This role is sometimes referred to as that of an 'invisible carer', in recognition that much support for those experiencing mental health difficulties is provided informally, rather than through statutory services.

• As well as some of the measures referred to in this section, the issuing of general practical guidelines (see section 3.2) and effective training and awareness programmes (see section 5) can help to prepare staff and students for such a role.

4.1.1 The role of staff as supporters

• Staff who become involved in the support of students with mental health difficulties may need their own support systems to ensure that they feel confident in their actions and that they have the opportunity for debriefing if appropriate. Staff often find themselves in such supportive roles unexpectedly and may feel out of their depth or concerned about how a situation has been handled.

• A wide range of staff, including personal tutors, departmental secretaries, domestic and security staff and student services staff, may all be the first point of contact for a student who has possible mental health difficulties. Good practice throughout the institution in terms of support networks, well publicised protocols and policies, non-discriminatory practices and training are all critical in creating a climate that provides appropriate levels of assistance for those staff supporting students in such circumstances.

4.1.2 Training and staff development

A programme of mental health awareness training, integrated with general staff development, should give staff sufficient basic awareness to be reasonably confident when encountering issues around mental health. Training that emphasises good practice around referral supplemented with information on local service provision and contacts can be particularly useful (see section 5).

4.1.3 Mentoring schemes

• To spread support more effectively throughout an institution a system of senior tutors, staff mentors, or similar roles, may give staff someone within their own department or academic discipline to refer to in the first instance if concerned about a particular situation. Mentors or senior staff within the same section or department may be relatively easier to access and may also be more aware of the specific implications of a difficulty within that department. Nominated roles for such internal referral helps to spread support responsibility more widely through the institution, reducing over reliance on specific support services.

• Although staff are encouraged to respect a student's desire for confidentiality, staff who are not bound by specific professional codes of confidentiality may need at times to share concerns about an individual if there is serious cause for concern (see section 3.2.6). Moreover, a general discussion of protocol, without identification, may often suffice.

4.1.4 Staff consultation with student support services

Specialist student support services may promote the fact that they are available for staff to consult. Support staff can advise on good practice and referral while still respecting confidentiality and enabling the staff directly involved to maintain front line contact if this seems appropriate. Some specialist student support services instigate regular surgeries or drop-in facilities for staff who wish to consult in this manner.

4.1.5 Debriefing

There may be a need to set up debriefing sessions led by experienced support staff in the wake of a particular incident. If there has been a distressing event around a student with mental health difficulties, staff who were involved may wish to discuss any personal concerns or practical implications that have arisen as a result. Fears that an incident could have been prevented or that the action taken was inappropriate are frequently cited after such events and the availability of debriefing is important to ensure that such fears are addressed.

4.1.6 Information sources

• Guidelines and directories of services concerning supporting students with mental health difficulties need to be widely available in varied formats so that, at the point of need, staff can access them easily. Web based materials are useful and leaflets which are available to all staff can supplement any more detailed materials which may only be given to key personnel. If such literature and resources are given a high profile, this helps to acknowledge that such difficulties do occur and that it is expected that people will need guidance.

• In all guidance materials it is important to stress that there are seldom simple rights and wrongs in supporting individuals and that often personal skills, listening and natural empathy may have the greatest value of all. Too great a sense of strict codes to be followed may be counter productive if it makes staff feel so unsure as to their abilities that they fear to engage with a student in need at all.

4.1.7 Support outside of normal working hours

• Frequently, the most acute incidents relating to supporting students with possible mental health difficulties occur outside normal working hours. Residential and security staff are therefore often the first to be involved and it is important that appropriate access to support is considered. Clear information on external 24 hour services needs to be available to such staff. Some institutions have also created rotas of out of hours contacts (using a pager, for instance) operated by staff who can be used as a first point of referral in such circumstances.

• Even if support out of hours may be limited by resources, there should be adequate follow up as quickly as possible, possibly co-ordinated through student services (see section 4.2.3). Dealing with a crisis, especially at night time, can be particularly distressing for all those involved.

4.1.8 Inclusive institutional mental health policies

Institutions may consider having inclusive policies in terms of student and staff mental health, particularly in terms of mental health awareness campaigns. Such inclusive policies which acknowledge that staff too experience mental health difficulties can make it easier for staff to feel they can share concerns regarding their supporting role and may also encourage more empathy with students. If the culture is that only students have mental health difficulties, it may make staff more reluctant to support students when they feel that their own needs are not going to be recognised or supported. Mental health awareness training which targets the whole institutional community, with literature and events which relate to staff and students, may help to break down such barriers (see section 5).

4.2 Students supporting other students

4.2.1 The role of students as supporters or invisible carers

• Students are often the first to notice that a fellow student may be experiencing mental health difficulties. Students may therefore find themselves in the role of invisible carers, providing a considerable level of informal support to a fellow student.

• Where students are in shared accommodation this support may extend to a full-time role and, in the event of crisis situations relating to mental health difficulties, these often happen in accommodation out of hours, so that students may often be the first to respond to any such incident or emergency.

• Debriefing sessions are especially important in the wake of any serious incident and should be offered both immediately after the event and on an ongoing basis as long as such support may be required. If an incident happens that affects a group of students, for instance in a student residence, it may be worth arranging for the group to stay together immediately after the event so that there is an opportunity to implement debriefing as well as to give time for peer support.

• It is important that all students have access to guidelines concerning supporting a friend or fellow student with possible mental health difficulties. These guidelines can be made accessible through leaflets included in general student support literature, on an institutional website (where applicable) and through involving students fully in training and mental health awareness events. Co-ordination with Students' Unions and student run welfare services (e.g. nightline services) in disseminating such guidelines is also essential (see also section 3.4). An example of a basic set of practical guidelines for students supporting other students with possible mental health problems follows (section 4.2.2). It could be adapted to suit the particular structure of individual institutions, including clear directories for accessing further support and where to go for appropriate debriefing.

4.2.2 An example of practical guidelines for students supporting students
with possible mental health difficulties

• If you are worried about a friend or fellow student, it may be helpful first to consider the causes for your concern:

  - Have they told you they have a problem?

  - Have there been any dramatic changes in your friend's appearance? (e.g. weight loss/gain, decline in personal hygiene)

  - Have you noticed that your friend is drinking more alcohol or using drugs?

  - Do they smell any different? (e.g. can you smell alcohol or cannabis on them frequently)

  - Has their mood recently changed a lot? (e.g. miserable, sad, hyperactive)

  - Have other friends, relatives or tutors expressed concern about your friend?

  - Have there been recent changes in their behaviour, college work and/or sociability? (e.g. doing too much work, not socialising as much as usual, withdrawn, not attending lectures or meeting deadlines)

  - How long has your friend been feeling or behaving like this?

• Having established your causes for concern, the following practical guidelines may be useful:

  - Try not to avoid the situation or pretend nothing is wrong. This could make the problem worse or persist for longer.

  - Try to talk to your friend and tell them you are concerned about them. This may give your friend an opportunity to discuss their problems with you. However, try not to ask insensitive or intrusive questions and respect the privacy of your friend if they do not want to discuss their problems.

  - Be prepared to listen. The situation may only require sympathetic listening. But do consider your time and other commitments. Avoid using unhelpful comments like 'pull yourself together'.

  - Try not to take responsibility for your friend's problems, but rather listen to them. Try not to give advice but encourage them to seek help (see directory of services). Sometimes it is not always clear which service/person would be appropriate, it is important here to suggest a service or person which is acceptable to your friend. Help them to help themselves.

  - Express concern but remember you are not a therapist. It is not your responsibility to solve the problem and, if you feel you are unable to suggest the way forward at present do not feel that you have let your friend down.

  - If you feel you need to tell someone else, always try to gain your friend's consent beforehand. Explain to them why you feel you need to tell someone else and what the likely consequences of telling someone else would be. It is vital to gain your friend's trust and being open and honest with them can help cultivate trust.

  - If your friend refuses help and you are still concerned, then speak to one of your college tutors, personal tutor, someone in a specialist support service or someone you can trust. If your friend has not given you consent to talk to anyone, you do not need to mention their name when asking for advice; in this way you are not breaking your friend's confidence.

  - However, there may be EXCEPTIONAL circumstances where there is a need to act without your friend's consent, e.g. if their mental health has deteriorated to the extent of threatening their personal safety or that of others.

• It can be extremely emotional and time consuming helping a friend and that is why it is important to remember to look after yourself and seek appropriate support and help from others.

• A flow chart summarising these practical guidelines for students supporting other students can be found in the appendix to this manual (section 7).