Setting Up and Running Services for Students with Mental Health Issues

NADO ONE DAY CONFERENCE STUDENTS WITH MENTAL HEALTH ISSUESWednesday 9th March 2005Sue Meads; Head of Mentor Service; University of Southampton

Focus of this presentation:

Why have services for Students with Mental Health Issues?

Practical issues involved in setting up and running services

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)

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

Why develop specialist services? Cont…

Existence of HEFCE mainstream and capital allocation funding plus Disabled Students’ Allowances for individually focussed support

Forthcoming variable feesChanging expectations of students

and their parents

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.

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

In less general terms

Due to a condition or to medication students experience individual effects, which may includeGreatly raised anxiety levelsExtreme fatigue Elation, grandiosity and a tenuous

relationship with practical realitySelf criticism and hostilityPhysical pain

In less general terms cont…

Hyper vigilanceAcute self consciousnessUnable to stay in, or function

effectively in, certain environmentsPanic attacks & fear of panic attacksProblems with processing informationSleep deprivationObsessive behaviour

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 InstitutionArrange reasonable adjustments,

special examination arrangementsAdvocate for our students

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

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

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

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

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

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

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

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

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:

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

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

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

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

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

Paying support workers Method 2o 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

Paying support workers Method 3o 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

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

‘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

Illustration : Money costs only

Purpose Salary Salary + 16%

No. hrs per year

Cost per hour

20 hrs academic mentoring per week:

3 x 10 week terms

28000 32400 600 £54.13

20 hrs academic mentoring per wk: 3 x 10 week terms

£24000 £27840 600 £46.40

30 hrs 1:1 support per week: 3 x 10 wk terms

£18500 £13920 900 £23.84

30 hrs note-taking per week: 3 x 10 wk terms

£12000 £13920 900 £15.47

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

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.