What factors facilitate partnerships between higher education and local mental health services for students? A case study collective

Theme 1: building blocks for developing partnerships

Partnership building blocks were identified as early intentions and activities that laid the foundation for partnership working. Staff emphasised the importance of having dedicated individuals with existing links to other services rather than recruiting a specific role to foster relationships:

Communication can be dependent on having consistent relationships between dedicated staff rather than a well-established pathway or role (ID 72).

Regular communication between different teams played a vital role in building partnerships, and institutions employed various approaches:

We have informal case management meetings between the campus GP and student services (ID 23). There is a monthly practice liaison forum that brings together NHS and university counselling services (ID 24).

Effective communication between services was a crucial cross-cutting factor that necessitated a shared understanding of their purpose and staff roles. It also involved joint discussions among professionals from different sectors to reach a consensus on the best course of action:

Meeting with key people in the NHS and university aids discussion on what university services can and can’t do to contain the work (ID 82). Managers come together to discuss complex cases and clarify a course of action, which helps to debunk false assumptions of either service (ID 36).

Identifying primary contacts within the university, across academic faculties, and with external services was crucial. These primary contacts highlight another cross-cutting factor that facilitated partnership working by providing a supportive network and connected staff who would otherwise be isolated. Examples of potentially isolating roles included a sole mental health advisor embedded into an academic department or a clinical psychiatrist within student support services. This network extended from frontline service providers to senior leaders involved in service development and policy:

We have staff based across the institution who are informed, supported, and connected to services and are not isolated (ID 82).

Theme 2: barriers to developing pathways and partnership working

Barriers hindered the development of service pathways and created gaps between services, especially during student transitions. Information sharing was a prominent cross-cutting factor that provided challenges to partnership working both internally and externally with local services:

Different people [within the university] involved in the student’s care open a new case each time and the information is unlikely to be linked (ID 61). Information is not always shared with university services when students are discharged from NHS services and local hospitals (ID 29).

Infrastructure issues and data compatibility problems hindered access to relevant data, limiting the ability to inform referral decisions and evaluate important service outcomes such as effectiveness and impact. Staff explained that the determinants of successful service outcomes tended to focus on the number of students seen, and how soon, with little support for them to use the data collected routinely by their service to demonstrate their effectiveness and contribute to the evidence base:

Different systems are used across the university, making data requests and outcomes evaluation time-consuming and difficult (ID 73).

Incompatible datasets and limited communication across sectors were substantial cross-cutting factors that prevented service development and hindered insights into students’ unique needs. Differences in service structures and provision across sectors further caused delays in students accessing NHS services:

It’s difficult to get NHS services to collect data that acknowledges clients are students, and there is little to no data collected that captures students’ characteristics (ID 58). Students referred to specialist external services experience long waiting lists, while the university counselling service maintains contact without providing immediate support (ID 59).

High staff turnover, service restructuring and reliance on temporary contracts significantly hindered relationship building and contributed to service gaps. Having unclear roles for risk management and the lack of discussion among service leads led to uncertainties and defensive work practices, which could create tension between teams:

Changing staff roles in HE and NHS, especially during partnership development or when a key staff member leaves, weakens or delays partnerships (ID 39). Not all staff doing the triage have an extensive mental health background, resulting in inaccurate referrals or holding onto students with risk instead of appropriate referrals through a fear of getting it wrong (ID 29).

Theme 3: achieving positive outcomes from partnerships

Staff described several tangible achievements that resulted from partnership working and provided positive cross-cutting developments that enabled services to be more responsive and ‘joined-up’. Benefits of partnership working included cross-cutting factors such as building formal long-term relationships with local GP surgeries, new streamlined referrals into partner services, quicker assessments and shared decision-making between different services and professions:

Having good relationships with the GP service means that we have direct referrals and same-day mental health assessments (ID 43).

Staff felt that partnerships between services enabled universities to better respond to students’ mental health needs, offering a wide range of support options that promote choice, empower students and minimise resource duplication:

[We] work actively with NHS mental health services [to] either offer the help or work out how else they might get help to ensure continuity of care and to avoid duplication of service provision (ID 29).

Developing partnerships also benefitted staff by improving their knowledge and communication across services, developing shared approaches to managing risk, and understanding what different services can offer:

Regular case conferences [enable] joined-up thinking about risk and learning from incidents together… working with NHS staff brings this knowledge into university services and NHS services become more attuned to student need (ID 39).

Staff viewed partnerships as a long-term commitment with the potential to shape new policies to improve mental health provision for students. University services committed to partnership working have been paving the way for coordinated student care and have been preparing for this vision:

[We’re] working with CCGs to recognise that students are a distinct population. For the first time these partnerships have brought together commissioners and service leads (ID 66). [There is] dedicated student mental health liaison in the NHS to support risk management and provide a point of contact for university services (ID 43).

Theme 4: factors that shape student services

Factors that shape service provision encompass the unique characteristics of university services and how they respond to students’ mental health needs within the HE context. University services stand out for their ability to implement cross-cutting activities that enable integration with wider structures that affect student mental health by working with faculties and residences. By recognising students’ distinct needs, staff explained how these services strive to be flexible, responsive and accommodating, offering various support options. Timely access to support was prioritised through cross-cutting initiatives like daily drop-in appointments, free counselling with local charities, paid private counselling, single-session counselling, psychoeducational workshops and pathways to local psychological services:

We are well integrated into wider structures—we liaise actively with schools, faculties, and residences—and so the wider university has direct experience of working well in partnership with the service (ID 64)

Managing risk was a key driver for partnership formation, with protocols and strategies in place such as:

GPs and mental health nurses based in the University Health Service offer daily mental health sessions for students”(ID 43). An at-risk register is held with the GP and reviewed during practice liaison meetings… the onsite GP facilitates risk management (ID 66)

These collaborative approaches fostered staff expertise in student mental health and enabled comprehensive and cross-cutting risk management protocols. Staff also explained how consent procedures play a pivotal role in shaping services, with institutions implementing varied procedures to facilitate partnerships:

Broad consent procedures mean that services can share essential risk information more easily [which allows staff to] discuss concerns with the GP that are covered by consent (ID 36). It’s important that services are transparent about what data is being collected and who it is being shared with to build trust with students (ID 70)

Theme 5: towards coordinated care for students

University staff described a long-term vision for student mental health services, encompassing cross-cutting factors specific to regions and guided by national enablers. These enablers primarily included improving data collection and reporting standards for student services and implementing medium-term activities to achieve this goal. The vision involved simplified pathways into local Improving Access to Psychological Therapies services, now rebadged as NHS Talking Therapies for Anxiety and Depression, that align with academic timescales, increased integration between services within institutions to manage the full student journey, and collaborative efforts with the NHS to improve transitions between services. Staff highlighted the importance of these initiatives:

So that being registered at one GP wouldn’t prohibit students from going to another GP at university (ID 24). To create a shared discharge plan so that universities can support students once they have been discharged from an NHS service (ID 70).

Data collection and sharing policies were crucial cross-cutting requirements of new risk management protocols and informing clinical decisions. The vision emphasised the need for:

Shared and trusted assessments with IAPT (ID 21). More flexibility and support from the NHS surrounding data sharing (ID 59). NHS services to consistently collect student status and institution [to prevent] confusion when discharging students from inpatient care. (ID 78).

The vision centred around supporting students and empowering them to access services responsibly, with data-sharing policies driven by student consent. Integrated systems and tracking the student journey were identified as priorities:

Track the student journey to allow services to respond more quickly [and] improve the flow through of students from schools to services (ID 70).

In addition to data sharing and communication, staff outlined plans for developing new pathways into the NHS to offer specialised support beyond university services:

A DBT pathway at primary care level that the GP can refer into (ID 66). A clear referral pathway for students waiting for NHS services to ensure they are supported whilst on the waiting list (ID 58).