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

2. Focus of this presentation: Why have services for Students with Mental Health Issues? Practical issues involved in setting up and running services

3. Background to the Mentor Service at Southampton 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)

4. 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

5. 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

6. Underlying rationale In general terms 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.

7. Underlying rationale cont… This affects performance, achievement, self- esteem, 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

8. In less general terms 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

9. 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

10. Purpose of Specialist Services A student centred approach to helping the student to access their course effectively We need to be able to: Liaise with tutors, academic and other departments in the Institution Arrange reasonable adjustments, special examination arrangements Advocate for our students

11. Purpose of Specialist Services cont… 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

12. Who does what? 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: Role clarity and focus Managing expectations of Institution, staff and students Effective case management Effective service management

13. For example: our service The Mentor Service provides all the functions, but 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

14. Role Clarity, Focus and Managing Expectations 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

15. 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

16. 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

17. Finding and training the right people 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

18. Relevant qualifications and experience 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

19. Training 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:

20. Training cont… 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

21. Monitoring and evaluation 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

22. Financial management 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

23. Myths about money 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

24. Paying support workers Method 1 Introduce student to self employed support workers and leave them to it. 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

25. Paying support workers Method 2 o Self employed support workers 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

26. Paying support workers Method 3 o Hourly paid support workers with a contract to pay for hours worked plus holiday pay. 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

27. Paying support workers Method 4 Support workers employed on permanent contract 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

28. ‘Cost recovery’ 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% 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

29. Illustration : Money costs only PurposeSalarySalary + 16% No. hrs per year Cost per hour 20 hrs academic mentoring per week: 3 x 10 week terms 2800032400600£54.13 20 hrs academic mentoring per wk: 3 x 10 week terms £24000£27840600£46.40 30 hrs 1:1 support per week: 3 x 10 wk terms £18500£13920900£23.84 30 hrs note-taking per week: 3 x 10 wk terms £12000£13920900£15.47

30. Charging Charge should be in line with level of qualifications and expertise required for the work Work with the Funding providers Contact before first invoice Provide clear information for their audit purposes Take responsibility for the quality of invoices All relevant information Accurate

31. Keeping Financial Records Your service will be audited one day! Keep: 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.