Referring Back To CR166 (And A Note For Journalists)

Blind Men And The Elephant
During the past few months, there have been articles about the mental health of students in the Guardian (here, here, here, here, and here), the Independent (here and here), Times Higher Education (here, here, and here), and now the BBC (here). It’s great to see the issue being covered, even if it’s because of tragic statistics and stories.

If there’s one issue with the coverage it’s that it tends to focus a lot on problems and not much on solutions. It’s important that those covering the subject don’t ignore the work that’s already been done to provide us with answers.

The Royal College of Psychiatrists’ report doesn’t have all the answers. It doesn’t even have all the questions. (It makes it clear that more research and data is needed – some of which has since become available thanks to the work of organisations such as NUS and the Equality Challenge Unit). But the report does give us a few clear guidelines and recommendations that can be acted on immediately. More than that, it’s the most comprehensive report on student mental health we have, with input from organisations across the higher education and mental health sectors. It gets us on the same page. We should all be referring to it.

When I get phone calls from journalists looking to cover student mental health, it’s usually immediately apparent that they are full of compassion and sensitivity for the subject. I enjoy talking with them. But I don’t think I’ve had a single journalist start by asking me what needs to be done. The focus has always been on what’s wrong, and why. I suppose that’s the nature of journalism, but hopefully it can begin to shift a little.

I wrote a review of the Royal College of Psychiatrists’ report after it’s publication, summarising key points and adding a few things that were omitted. I’ve now updated this paper, adding data and developments from the past 18 months. If you’re a journalist or policymaker looking to do something around the mental health of students, take a look.

Is It ‘Wellbeing’ Or ‘Well-being’? (And Why It Matters)

Who cares, right? Quite a few people apparently. According to Google Keywords, 450,000 people a month are unsure whether to go with well-being or wellbeing.

For those working in the area, it’s mostly just a minor niggle. The internet makes it more important, though. Get it wrong, and a particular webpage won’t show up in search results. For those looking for information about support services, it could be crucial.

Some of us – the geeky ones, perhaps – have also thought about why there are two words that seem to describe the same thing, and what it means to use one over the other.

The short answer: Should I use ‘well-being’ or ‘wellbeing’?
It’s up to you – just be consistent. Generally, well-being and wellbeing are used to refer to the same thing. While ‘wellbeing’ is becoming more popular, ‘well-being’ is probably still used more. If that’s all you wanted to check, thanks for reading.

If you want to read the analysis, and to know why I suggest using ‘wellbeing’, read on.

What do the dictionaries tell us?
Oxford and Cambridge dictionaries go with ‘well-being’. accepts them both equally.
Princeton, based in the USA, favours ‘wellbeing’, although Merriam Webster, also USA based, goes with ‘well-being’.

On balance then, ‘well-being’ seems to be the linguist’s favourite.

What about general usage?
The media, as you’ve probably gathered, uses both words. In the realm of politics, we find that the British government is not set on ‘well-being’ either. Actually the government seems a bit confused about which to use. While the Office of National Statistics uses ‘well-being’, the number 10 website and parliamentary reports went with ‘wellbeing’.

In the voluntary sector, there’s also a mix of usages. While the New Economics Foundation opts for ‘well-being’, the Young Foundation has gone with ‘wellbeing’.

So, it seems that there’s no agreement on whether to use ‘well-being’ or ‘wellbeing’. The words are used interchangeably, and it’s a matter of personal preference. But things seem to be changing.

What’s the trend?
Here’s where it gets interesting. (Well, about as interesting as a discussion about hyphens can get.) To date, Google search results indicate that ‘well-being’ is more popular than ‘wellbeing’. However, Google Trends indicates that since 2004, searches for ‘well-being’ have been on decline, while searches for wellbeing have significantly increased.

To understand why this is, it’s useful to know the role of the hyphen.

Oxford Dictionaries says that “the hyphen is used to link words and parts of words”. In our case, the words are (obviously) ‘well’ and ‘being’, which, like ‘well-known’, come together to form what is technically known as a compound adjective.

According to ‘The Grammar Curmudgeon‘, “The trend in English is for frequently used word combinations to “grow together” from two words to one, sometimes passing through a hyphenated stage.” But this “hyphenated stage” is, apparently, becoming less and less used, at least partly because of the internet. (A hyphen is often recognised by computer software as a space, which can make things confusing.)

In this way, ‘well being’ has become ‘well-being’, and is gradually becoming ‘wellbeing’. If we accept this it’s only a matter of time before all dictionaries recognise ‘wellbeing’, after which the continuing survival of the hyphenated ‘well-being’ will probably depend upon people finding some need to regress back from ‘wellbeing’ into the broader notion of ‘being well’.

So is there a difference in meaning between ‘wellbeing’ and ‘well-being’?
Yes, kind of.

Most of the time the two words are used interchangeably, but in removing the hyphen, ‘wellbeing’ implies a standalone meaning beyond merely ‘being well’. So, if we mean ‘being well’ then use of the word ‘well-being’ might be most appropriate. But if we want to express more than this, such as psychological interpretations of the term (which are increasingly common), then ‘wellbeing’ might be better.

As interest in measuring well[-]being continues to grow, independent meanings for the word will continue to develop. There will inevitably be more debate around the meaning of the word, but widespread use of the word ‘welfare’, which is also a coming together of two words (‘faring’ and ‘well’), suggests that the ambiguity of the word will not be enough to stop ‘wellbeing’ from becoming more prominent than ‘well-being’. In short, ‘wellbeing’ is here to stay.

Why might it be better to use ‘wellbeing’?
There are two reasons why I (usually*) use ‘wellbeing’ over ‘well-being’.

  1. When I use the word ‘wellbeing’ I am referring to more than just ‘being well’. Academic accounts of well[-]being (such as this one from Ryff and Keyes) consistently refer to well[-]being as a dynamic and active state of flourishing, which conflicts with the sense of mild satisfaction and inertia implied by the term ‘being well’.
  2. If my earlier analysis is correct then, despite dictionary definitions, the word ‘wellbeing’ will become more widely used than ‘well-being’. By adopting ‘wellbeing’ now, we accelerate the transition and minimise the period in which inconsistency over use of the words causes webpages to be missed by those searching for information about services and resources.

So that’s my analysis of the wellbeing / well-being issue. Dispute anything I’ve said? Got something to add? Let me know!

* The exception would of course be when referring to a specific article that uses ‘well-being’, where the use of ‘wellbeing’ would then cause confusion.

University Mental Health Policies: Better Communication = Better Mental Health

In March I was part of an online discussion about the role of mental health policies in promoting students’ mental health – a subject brought to prominence by the Royal College of Psychiatrists. The starting point for the discussion was simple: should all universities have a mental health policy?

At first there seemed to be unanimous agreement from panelists: yes, all universities should have a mental health policy. Since all of the panelists were (to some degree) involved in supporting students’ mental health, this probably wasn’t surprising. Why would anyone not want to make it easier for students to access support, right? But the discussion grew more complex, and an opposing point was raised that I hadn’t anticipated. After reflection it became clear though that the disagreement was not based on a difference of views, but on an ambiguity found in the RPsych’s recommendations – one that I hope to clear up here.

The argument put forward by one of the panellists was that, whilst all universities should have mental health policy, it should not necessarily be based in a single ‘mental health policy’ document. The wider point that they alluded to was that, since the mental health of students is interrelated with other subject areas (such as disability issues and student services), it cannot be looked at in isolation; to expect universities to be able to extricate mental health policy from related policy areas and present it in a single uniform document risks oversimplifying the issues.

In some ways, this view aligns with the principles of the Healthy Universities project (based on the World Health Organisation’s settings-based approach), which recognizes that health and wellbeing is not a standalone issue but one that necessarily involves wider environmental factors. We know that social factors have a profound influence on mental health, therefore for universities to modernize and adopt settings-based approaches they need to recognize the links between mental health and wider campus issues – even those issues traditionally considered to be academic (as alien as this idea may be to certain VCs). The panellist was surely right, then: mental health policy must be embedded into wider institutional policy. And yet, the content of policy and the presentation of policy are not necessarily the same thing.

What the Royal College of Psychiatrists’ report fails to do is recognise the dual roles of a mental health policy. If we explore the definition of ‘policy’, we’re confronted by two interpretations. Whilst on the one hand policy exists to provide standards and guidelines for policy-makers and those policing policy, on the other hand, it exists as a public statement of intent – a contract between those with the power to implement policy, and those whom the policy affects. The former, we can think of as ‘policy‘ (or a number of related policies), the latter as ‘a policy‘ – which is about communicating ‘policy’ to stakeholders through a single document.

The reason I first got involved in mental health campaigning was not to address gaps in support, but gaps in communication. The Mind Matters Society was launched to ‘bring mental health out of the shadows on campus’ – by challenging stigma around mental health issues, but also by making information about mental health more available to students so that they could make their own choices. The latter of these goals (although not as topical as the former) is just as crucial. The sharing of good information necessarily reduces discrimination, but a reduction in discrimination does not necessarily lead to useful information being shared. As long as information about a university’s mental health and support provision remains impenetrable to students, mental health will be a subject difficult to grapple with. It’s for this reason that a formal statement outlining the university’s commitment to student mental health is so important.

The task for universities,therefore, is to provide a policy document on the subject of mental health that is accessible to those it affects, whilst also ensuring that policy on mental health remains embedded within its wider system. The dozens of university mental health policies already in place suggest that this is achievable.

If universities need to provide multiple policy documents then so be it, as long as there’s one starting document that sets out the university’s commitment to the mental health of students. As Chris Brill, the ECU’s policy advisor suggested during the discussion, irrespective of the complexity of policy, universities can offer a reference document that outlines the university’s position on mental health. It’s this that I believe the RPsych’s report is referring to it when it speaks of a ‘mental health policy’, and it’s this that I am campaigning around. Whether the title of this policy document contains the term ‘mental health’ is up to them, but  when ‘mental health’ is the universally used term to capture psychological issues and treatments, why complicate matters further by calling it anything else?

How We Can All Make A Difference on University Mental Health & Wellbeing Day

Note: This article was originally published on, here.

It seems like almost every day is an awareness day for something or other. There are a handful of awareness days, weeks, and months that get global attention and raise funds for vital causes. But then there are more obscure awareness days, not necessarily any less vital, perhaps, yet not quite managing to gain the same attention. There is, apparently, a National Pig Day, a Potato Awareness Week, and even a National Toilet Tank Repair Month – which, coincidentally, falls in the same month as National Pickled Peppers Month.

So it was with some trepidation that the idea of a University Mental Health & Wellbeing Day was put to me. Would it get lost in a sea of awareness days? Would the creation of yet another awareness day cause eyes to roll? I was unsure. But after thinking about it, I realised that an awareness day isn’t just about trying to squeeze a date into the diaries of those who would otherwise be uninterested. It’s also about aggregating the resources of those who are already involved with a cause – to get stuff done.

There are many people with an interest in university mental health; including university support staff, student unions, charities, and a growing number of student campaigners. But it’s hard to unite everyone. The issues are complex, and we have our own narrow remits and institutional issues to deal with. This is where University Mental Health & Wellbeing Day comes in. For one day of the year we can try and take a step back from the individual problems we’re working on, focus our resources on addressing the issues that exist across institutions, and know that there are others, all around the UK, who will be doing exactly the same.

Tomorrow is the second annual University Mental Health & Wellbeing Day, led by the University Mental Health Advisors Network (UMHAN). Amidst the campus events and activities aiming to raise awareness of mental health, there will be an opportunity to work towards accomplishing specific, shared goals. Goals that are unambiguous and worthy of broad support.

The most comprehensive guidance paper for university mental health is the Royal College of Psychiatrists’2011 report, which outlines a series of recommendations for how universities can improve the mental health of their members. In its recommendations, there is one that stands out for being relatively straightforward and achievable, and it’s this in particular that, in 2013, campaigners have an opportunity to push for. The recommendation reads as follows:

It is recommended that all higher education institutions have a formal mental health policy. This should ensure that they meet statutory obligations under disability legislation. It should also cover areas such as health promotion, the provision of advice and counselling services, student support and mentoring, and special arrangements for examinations (Universities UK/GuildHE Working Group for the Promotion of Mental Well-Being in Higher Education, 2006).”

It’s a precise recommendation, and when combined with guidelines on developing a mental health policy, available for download from the website for the Working Group for Promotion of Mental Well-being in Higher Education, there seems little room for ambiguity.

At its most basic, a mental health policy represents an institution’s commitment to supporting the mental health of its members. With it, staff and students can be familiar with the rights and opportunities offered to them, they can hold the institution accountable to its policy, and they can seek improvements to it when they deem it necessary. But it’s more than this. It provides a shared starting point from which the institution and its members can collectively identify and explore broader issues that go beyond the scope of the institution, such as cultural and political factors affecting the Higher Education sector at large.

For the policy to be meaningful it needs to be actively monitored, and reviewed and updated to reflect the needs of students and staff, as well as ongoing changes that affect universities. This is why each university should be encouraged to make their mental health policy publicly available through their website.

In December I wrote an article asking, ‘whose responsibility is student mental health?’ There was no easy answer to it. But on University Mental Health & Wellbeing Day, there is something we can all do. We can give our support to the range of activities taking place. We can champion great work by students, staff, and institutions. And we can push for each institution to have in place a formal, up to date, and publicly available mental health policy. It might not fix everything, but it’s a start.

Visit here to sign a petition urging the CEO of Universities UK – the representative body for 134 institutions – to encourage and support all of its member institutions in developing a mental health policy.

Student suicide data, and what needs to be done

(Note: The issues discussed in this article may be distressing for those affected by suicide. You can find out more information about suicide at the Mental Health Foundation’s website, here. If anyone has been affected by the issues discussed in this post and needs to talk to someone immediately, you can call the Samaritans helpline and speak to someone confidentially, 24 hours a day, on this number: 08457 90 90 90.)

A report published by the Royal College of Psychiatrists last year warned that there was a “pressing need” to do more around student mental health. New figures released last week show what’s at stake. In 2011, 112 students in England and Wales took their own lives. Every suicide is tragic. But what makes this figure particularly concerning is that it is almost a 50% increase on 2007.

I was sent the data on Wednesday by the Office of National Statistics whilst researching for an article to mark the one year anniversary of the Royal College of Psychiatrists’ report (which I reviewed here). Having failed to find any up to date statistics, I contacted the ONS with a freedom of information request on Monday. The figures have been published to the ONS website here*, and are discussed in a Guardian article here.

Although the ONS officer I worked with urged caution about drawing conclusions due to the numbers involved, the increase corresponds with a BMJ study of the wider population that suggests the financial crisis may have caused a significant rise in suicides. It also corresponds with concerns raised in the Royal College of Psychiatrists’ report about the current pressures facing students: “Social changes such as the withdrawal of financial support, higher rates of family breakdown and, more recently, economic recession are all having an impact on the well-being of students and other young people.”

When I received the figures, I was writing an article about the lack of urgency around student mental health. These figures raise further questions about the higher education sector and about what institutions are doing to ensure their students have adequate support. It’s time for the sector to respond.

The Royal College of Psychiatrists’ report provides clear recommendations for institutions and policy-makers. Currently, it is difficult to know which institutions, if any, are making serious efforts to meet these recommendations. This needs to change;

  1. Institutions should guarantee a certain level of support for their students.
  2. Institutions should put in place an institution-wide mental health policy and make it publicly available through their website; the policy should be reviewed and updated regularly by an institution-wide mental health & wellbeing committee that meets several times a year.
  3. The sector should fund a national committee to recognise and promote good practice in student mental health.

It’s up to students, staff, parents, and all those with an interest in the welfare of young people, to demand that institutions and policy-makers prioritise student support.

*The figures are for students aged 18+. ONS data was only available for England and Wales. The number of students in full-time education has increased by 15% during the same period.
Resources:  Universities UK produced a guidance paper on Reducing the Risk of Student Suicide in 2002, available here.

The cause of low mental health disclosure rates: "Fear of appearing weak" or poor publicity?

Yesterday, The Times Higher Education (THE) published an article suggesting that the low number of students and staff disclosing mental health problems could be explained by “a fear of appearing weak”. I’m not sure that’s a good explanation.

Firstly, the context — The article refers to a report from the Equality Challenge Unit (a charity that, according to its website, “works to further and support equality and diversity for staff and students in higher education”) highlighting that just 0.7% of students and 0.2% of staff are reporting a mental health problem. Even using conservative estimates about the prevalence of mental health problems, there is clearly a very significant number of students and staff that are not disclosing their condition.

The consensus is that stigma prevents disclosure, and that if people feel less stigmatised then the number reporting their conditions will grow. That may be true. But there’s a question in this discussion that needs more attention: Why should they disclose?

If the sector believes that students and staff will benefit from disclosing a mental health problem to their institution then they need to explain how. And it would follow that if the numbers still aren’t increasing then it’s because students and staff don’t think the advantages are significant enough. Or they still know nothing about them.

The ECU’s report states that students with a disability who access Disability Support Allowance don’t only benefit financially, but are also more likely to receive a first class or upper-second class degree. If institutions want more DSA uptake then they need to publicise this, and use it as a way of communicating the benefits of disclosure. They can start by addressing the issue of most students and staff not knowing that they would be entitled to DSA due to confusion around the use of the word ‘disability’. Or by developing, and making available to all staff and students, a university-wide mental health policy – as recommended in the Royal College of Psychiatrists’ report into student mental health.

Stigma is a part of this. But stigma should not be used by policy-makers as a way of shifting responsibility away from their role. If institutions want more of their members to disclose a mental health problem then it’s up to them to give good reasons for doing so. Gary Loke doesn’t seem to understand this:

Gary Loke, head of policy at the Equality Challenge Unit, said the survey showed that many people in the academy with mental illness were suffering in silence.

“If you do not disclose you have a problem, universities cannot help you,” he said. “Institutions are generally very supportive to disabled staff, but people need to feel they can come forward and talk about their mental health problems.”

You may mean well, Gary, but the bigger question to answer is this: how will universities help those that talk about their mental health problems? And what exactly do you mean when you say that institutions are “generally” very supportive? The burden of responsibility for low disclosure rates does not end with those that are not disclosing;  institutions must work on creating settings in which people feel inclined to disclose.

Think Tank Reports Minorities Have Lower Well-being. How valid is the data?

The New Economics Foundation’s Centre for Well-being, a leading think tank for well-being research and policy, expressed concern today about apparent disparities in well-being between ethnic groups. The corresponding report says the following:

“We find that Black, Arab, Bangladeshi, Pakistani, and Indian people experience significantly lower well-being than White people in the UK, even when controlling for individual characteristics”.

The research might have controlled for individual characteristics (I don’t know, I haven’t read through it yet…), but what about cultural characteristics?

The questions that the participants in the study were asked were based on self-perception (i.e. how the participants view themselves and their lives). This raises issues. We know, for instance, that according to the latest research there is good reason to believe that those from North America are more likely to show positivity biases than those from Asia, potentially causing them to inflate their own self-rating for life satisfaction (Kim, Schimmack & Oishi, 2012). Then there are the potential language issues that arise from trying to ask subjective questions of those that don’t necessarily share the same first language (the report doesn’t mention what language(s) the participants speak).

I tweeted the Centre for Wellbeing to ask if they had controlled for cultural interpretation of well-being. They responded: “We didn’t control for cultural interpretation. Could be explanatory factor, needs investigation“.

Maybe it doesn’t matter much at this stage, but due consideration of cultural differences is surely going to be crucial as well-being research becomes increasingly influential in policy-making.

Kim, H.,  Schimmack, U., & Oishi, S. (2012) ‘Cultural Differences in Self- and Other-Evaluations and Well-Being: A Study of European and Asian Canadians’, Journal of Personality and Social Psychology, vol. 102, no. 4, pp. 856–873.