Community-Based Intervention on Mental Health

Mental health illness is becoming increasingly common worldwide. It is important to understand its causes and effects and how to create meaningful and affective intervention. Evidence shows exposure to unfavourable social, economic, and environmental circumstances increases vulnerability to mental health conditions. One way to promote positive mental health is to develop and implement mental health promotion programs within the target community. In doing so, according to Regehr et al (2013), it is important to consider cultural, social, environmental and economic influences on mental health, as well as the relationship between social adversity and mental health problems.

A group that is greatly influenced by mental health is UK university students. According to Kaparounaki et al (2020) mental health crisis is a major problem that affects university student’s energy levels, concentration, dependability, mental ability, and optimism whilst hindering performance. Moreover, research by Naser et al (2020) suggests that mental health issues such as depression are associated with lower grade point averages, and that co-occurring depression and anxiety can increase this association.

Mental health crisis among students present in the form of stress from academic pressure, separation from family, work overload and family responsibilities. (Pedrelli, et al., 2015). On the same note, Regehr et al (2013) highlighted an increased rate of anxiety and depression among university students, with only a small percentage receiving treatment from university health services, most of which did not institute effective mental health promotion interventions.

Also, a recent literature and meta-analysis examined the effectiveness of interventions aimed at reducing stress in university students. the reviewed studies represented a variety of intervention approaches with students in a broad range of programs and disciplines. Twenty-four studies, involving 1431 students were included in the meta-analysis. Cognitive, behavioural and mindfulness interventions were associated with decreased symptoms of anxiety. Secondary outcomes included lower levels of depression and cortisol (ddd). This essay explores evidence of mental health promotion can reduce mental health distress among UK university students, as well as how the universities can implement mental health promotion intervention among the students.

Previous Mental Health Promotion Interventions

There are various mental health promotion interventions that have been implemented by universities in the UK and could be used a s a case study to understand the role of mental health promotion and support as an intervention for university students’ mental health and wellbeing. For example, Brunel University London, through its student affairs department, runs a comprehensive mental health promotion and support program that takes advantage of a multidisciplinary team to ensure the students can easily seek help and access mental health services. According to BruNet (n.d), a key element of the university’s mental health promotion and support program is the use of professional counsellors whose main responsibly is to offer support and advice to students on both long-term and new mental health issues during their lives as students. through the counsellors, students at Brunel University London can easily access short-term one on one counselling to solve their immediate problems, thereby helping them to develop effective coping strategies by understanding the underlying issues.

A similar program has been implemented in Manchester University, whereby students can join peer support groups run by trained student facilitators to discuss topics such as anxiety, low moods (University of Manchester, n.d). similarly, through the peer support groups, the students can have access to supportive and safe environment where they can discuss their shared experiences and how to cope with various mental health issues. Through counselling, the two Universities have maned to create a therapeutic environment for students to safely and confidentially share their mental health issues (e.g. anxiety and depression) without fear of judgment.

Apart from counsellors, universities have used mental health advisers as a form of mental health promotion and support to students. for instance, at Brunel University London, the mental health advisors’ work is to work compassionately, collaboratively and honestly with the students to provide them with practical advice and emotional support on various issues affecting their mental well-being (BruNet, n.d). for example, they might help the students to works towards developing a support plan that incorporates various self-help strategies for mental well-being. Similarly, the mental health advisors at Brunel University London have the responsibility of signposting students the existing counselling services or to external mental health support providers.

At University of Manchester, there is a comprehensive disability advisory and support services that provide advice to both disabled students and those with mental health issues on how to make various adjustments to work and studies (University of Manchester, n.d). For instance, the university’s occupational health service delivers confidential services to protect both students and staffs on fitness for work, so that they can effectively work and study while maintaining good physical and mental health. Similarly, through the university student union advisory services, students can access various mental health advisory and support.

Although it is unclear whether these approaches are applicable to other universities, they are widely scalable and cost effective if their efficacy are based on research evidence. However, there is significant evidence (O’Really et al 2018, Uphoff et al 2020, Mehmet et al 2020) that not all mental health promotion and support programs need to be formal. students are young people who prefer to talk to family and friends as well as people they closely know rather than professionals. On this note, Byrom (2018) conducted a study to examine the effectiveness of peer support among 72 students across none university UK universities and found promising evidence of effectiveness. However, these findings were limited by relatively high attrition, with only 285 of the students completing the six session courses of the study. In another study by Gulliver et al (2018), the researchers described how lecturers play the role of first port of call for many students facing mental health issues, 60% of the participant lecturers felt like they did not have the right equipment to provide the necessary mental health support to students. these findings corroborate with findings from other earlier UK-based studies such as Manthorpe & Stanley (2001) and Hughes et al., (2017), suggesting the need for training and other guidance to academic staff on how they can promote and provide mental health support to students.

Mental health promotion and support has also been executed by universities from a policy point of view. For instance, the University of Manchester collaborates and consults with student associations and unions, especially with students with mental health issues when developing and implementing student mental health related procedures and policies as well as when identifying areas for improvement. Moreover, in Brunel University London, the student welfare department works with students to ensure that the students are not overlooked when developing statutory services such as NHS and other external mental health service providers. The university has established clear links between internal voluntary agencies and external statutory mental health providers (e.g. NHS) to ensure easier cross-referrals. More importantly, the university has established robust arrangements for students with a history of mental health difficulties who require a period off campus, including those who work or study abroad.

Previous research show that young people who face various forms of resource inadequacy are more likely to experience mental health distress and would therefore benefit from school-based mental health promotion programs and support services (Pumarienga et al, 2005). Furthermore, as per Durlak et al (2011) the school environment and infrastructure can support the implementation of large-scale mental health promotion and support services, including prevention interventions. This supports the implementation of the proposed mental health promotion program within universities and colleges. Moreover, existing evidence show that successful implementation of various mental health support services such as school-based cognitive behavioural therapy is associated with positive outcomes. For example, Skryabina et al (2016) conducted a randomised control trial study on the educational outcome children who received a school-based cognitive behavioural therapy – an intervention that taught children anxiety management, emotional regulation and problem solving. The study found that the intervention group had more experiences of decreased social anxiety and depression compared to the control group.

The proposed mental health promotion program would cover various aspects of mental health including the promotion of early stage assessment, diagnosis and treatment of mental health symptoms as recommended by (NICE, 2021). The other key aspects of the proposed mental health promotion program are to ensure that students have access to external materials that contain a wealth of information on mental health self-help and help seeking. The materials will be sourced from national statutory organizations (e.g. NHS) and voluntary organizations (e.g. Universities UK). The materials will be developed in both soft and hard copies, whereby the latter will be distributed through online platforms while the former will be mounted on university billboards and on-campus public places. Some of these materials will include Mental Health First Aid, Papyrus, and Rethink Mental illness.

The other mental health promotion activity to be implemented is the engagement of university student unions and associations in various mental health campaign programs through their respective websites, so that useful mental health information can be delivered to students in a language they understand, through people their resonate with (Wong et al, 2017). Apart from that, the proposed program will also be implemented in university induction programs. In doing so, new students will receive useful information on how they can refer themselves or their peers, classmates or roommates to mental health services in case they sense any unusual behaviour.

Lastly, the program will also identify student champions within the schools, whose main responsibility will be to promote and raise awareness about the available student services that provide specialised mental health support and guidance. As recommended by Betancourt et al (2020), the champion will typically be someone responsible for student experience (e.g. student dean), and if possible, a member of the university management team.

To create effective change, the mental health promotion program will be implemented using the Lewin’s Change model. According to Hussain et al (2018), the model holds that change can be implemented through three main stages namely: unfreezing, changing and refreezing. During the unfreezing face, various stakeholders within the university will be informed about the reasons behind the proposed mental health promotion program. Informing them about the program will help gain a buy-in form them, thus developing a positive attitude and behaviour in them towards the program (Abd et al, 2019).

During the changing phase, a multidisciplinary team will be called upon to help implement the proposed interventions. The team, including dean of students, student leaders, lecturers and support staff will be involved in implementing various aspects of the program, including educating them on how they can use well-being events to promote mental health and show students how to access available services. This is important because practice interventions must be evidence-based. Furthermore, Hussain et al (2018) emphasised that to facilitate effective change, stakeholders must understand how to implement the proposed changes.

After implementing the proposed mental health promotion programs, all the stakeholders will be asked for their feedback regarding how effective they think the program was. In what is also termed as the refreezing stage, feedback gathering is an important aspect of change implementation because it highlights whether the program was effective enough to achieve the intended outcomes, all which are explored in the section below.

Measuring Mental Health Promotion Impact

Upon successfully implementing the proposed mental health promotion program, it is expected that the student body will have adequate knowledge and literacy about mental health and well-being. As per Uphoff et al (2020), this will be demonstrated by an improved attitude, confidence, motivation, personal skills and behavioural intentions towards various aspects of mental health and well-being such as early help seeking and usage of available mental health services. Typically, after the campaign, students should know where to go or signpost their colleagues to access mental health services.

Also, the program will be considered effective based on the level of social action and influence towards mental health and wellbeing. This can be measured by the level of student participation, student empowerment, positive public opinion and social norms towards mental health (Mehmet et al, 2020). typically, this would be indicated by how student leaders, student unions and associations participate and invite students to participate in various mental health promotion activities. Moreover, the program would be considered successful if the students develop their own positive mental health coping strategies.

The other indicator of a successful mental health promotion is the development of healthy organizational mental health practices and policies. According to Wong et al (2017), the implementation of policy statements, resource allocation, as well as organizational support services towards mental health can be an effective indictor of an engaging and successful health promotion program. In this case, the proposed program would be considered successful of the university management allocates funds towards mental health services or incorporate mental health and well-being services as part of its major agenda in various school activities.

Dig deeper into Communication skills for health and social care management with our selection of articles.

References

Abd El-Shafy, I., Zapke, J., Sargeant, D., Prince, J. M., & Christopherson, N. A. (2019). Decreased pediatric trauma length of stay and improved disposition with implementation of Lewin's change model. Journal of Trauma Nursing| JTN, 26(2), 84-88.

Betancourt, T. S., Berent, J. M., Freeman, J., Frounfelker, R. L., Brennan, R. T., Abdi, S., ... & Beardslee, W. R. (2020). Family-based mental health promotion for Somali bantu and Bhutanese refugees: feasibility and acceptability trial. Journal of Adolescent Health, 66(3), 336-344.

BruNet (n.d) Mental Wellbeing Services. https://students.brunel.ac.uk/support/mental-wellbeing-services Retrieved on 7/22/2021

Byrom N. (2018). An evaluation of a peer support intervention for student mental health. J Ment Health, DOI: 10.1080/09638237.

Cavioni, V., Grazzani, I., & Ornaghi, V. (2020). Mental health promotion in schools: A comprehensive theoretical framework.

Duffy, A., Saunders, K.E., Malhi, G.S., Patten, S., Cipriani, A., McNevin, S.H., MacDonald, E. and Geddes, J., 2019. Mental health care for university students: a way forward?. The Lancet Psychiatry, 6(11), pp.885-887.

Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta‐analysis of school‐based universal interventions. Child development, 82(1), 405-432.

Giannakopoulos, G., Solantaus, T., Tzavara, C., & Kolaitis, G. (2021). Mental health promotion and prevention interventions in families with parental depression: A randomized controlled trial. Journal of Affective Disorders, 278, 114-121.

Gulliver A, Farrer L, Bennett K, et al. (2018). University staff experiences of students with mental health problems and their Health, 10, 41–52.

Hughes G, Panjwani M, Tulcidas P, Byrom N. (2017). Student mental health: The role and experiences of academics. Available from: http:// hdl.handle.net/10545/622114.

Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin's change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127.

Kaparounaki, C. K., Patsali, M. E., Mousa, D. P. V., Papadopoulou, E. V., Papadopoulou, K. K., & Fountoulakis, K. N. (2020). University students’ mental health amidst the COVID-19 quarantine in Greece. Psychiatry research, 290, 113111.

Manthorpe J, Stanley N. (2001). Responding to students’ mental health needs: Impermeable systems and diverse users. J Ment

Mehmet, M., Roberts, R., & Nayeem, T. (2020). Using digital and social media for health promotion: A social marketing approach for addressing co‐morbid physical and mental health. Australian Journal of Rural Health, 28(2), 149-158.

Mohindra, R., Ravaki, R., Suri, V., Bhalla, A., & Singh, S. M. (2020). Issues relevant to mental health promotion in frontline health care providers managing quarantined/isolated COVID19 patients. Asian J Psychiatr, 51(3), 102084.

Naser, A. Y., Dahmash, E. Z., Al‐Rousan, R., Alwafi, H., Alrawashdeh, H. M., Ghoul, I., ... & Alyami, H. S. (2020). Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak in Jordan: A cross‐sectional study. Brain and behavior, 10(8), e01730.

National Institute for Health and Care Excellence 2021. Social and Emotional wellbeing for Children and young people overview.

National Institute of Mental Health (US). (1970). The National Institute of Mental Health (No. 5027). US Department of Health, Education, and Welfare, Public Health Service, Health Services and Mental Health Administration, National Institute of Mental Health.

O’Reilly, M., Svirydzenka, N., Adams, S., & Dogra, N. (2018). Review of mental health promotion interventions in schools. Social psychiatry and psychiatric epidemiology, 53(7), 647-662.

Pedrelli, P., Nyer, M., Yeung, A., Zulauf, C., & Wilens, T. (2015). College students: mental health problems and treatment considerations. Academic Psychiatry, 39(5), 503-511.

Pumariega, A. J., Rogers, K., & Rothe, E. (2005). Culturally competent systems of care for children’s mental health: Advances and challenges. Community Mental Health Journal, 41(5), 539-555.

Regehr, C., Glancy, D., & Pitts, A. (2013). Interventions to reduce stress in university students: A review and meta-analysis. Journal of affective disorders, 148(1), 1-11.

Skryabina, E., Taylor, G., & Stallard, P. (2016). Effect of a universal anxiety prevention programme (FRIENDS) on children's academic performance: results from a randomised controlled trial. Journal of child psychology and psychiatry, 57(11), 1297-1307.

Thomas, K., & Bendtsen, M. (2019). Mental health promotion among university students using text messaging: protocol for a randomized controlled trial of a mobile phone–based intervention. JMIR research protocols, 8(8), e12396.

University of Manchester (n.d) Mental Health Support. http://www.dso.manchester.ac.uk/what-support-can-i-get/mental-health-support/ Retrieved on 7/22/2021.

Uphoff, E., Robertson, L., Cabieses, B., Villalón, F. J., Purgato, M., Churchill, R., & Barbui, C. (2020). An overview of systematic reviews on mental health promotion, prevention, and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons. Cochrane Database of Systematic Reviews, (9).

Wong, D. F. K., Cheng, C. W., Zhuang, X. Y., Ng, T. K., Pan, S. M., He, X., & Poon, A. (2017). Comparing the mental health literacy of Chinese people in Australia, China, Hong Kong and Taiwan: Implications for mental health promotion. Psychiatry research, 256, 258-266.