Appendix F - SAMPLE REPORT

Summary

A need to support students with mild mental health complexities was identified at the University of Hertfordshire, to reduce the strain on student support services. Previous literature has suggested that physical activity is a key strategy to manage mental health issues and increase wellbeing. The current project provided students with a free 12 week physical activity programme for these students. Students were referred in through student support services and could access a timetable of activities such as Tai Chi, Yoga, Badminton and Archery. A total of 53 students completed the 12 week intervention out of the 60 that were referred in. Following the intervention, there was an improvement in physical activity levels and wellbeing scores, suggesting that the bespoke physical activity sessions improved the wellbeing and activity levels of students. This pilot project has shown promising findings for the benefits of exercise on wellbeing for students at the University of Hertfordshire with mild mental health complexities.

Background and Context

During 2016, Higher Education Funding Council for England (HEFCE)reported that undergraduate students had a lower sense of personal wellbeing than the rest of the population (Neves & Hillman, 2016). Findings from their 2017 report has shown that this has further decreased by 2-3% in the past year (Neves & Hillman, 2017). It is suggested that as many as 27% of University students in the UK suffer from mental health issues (YouGov poll, 2016). This in turn has a substantial impact on student support services in the UK, with a 50% increase in appointments over the past 5 years (Guardian research, 2016).

It has been suggested that people with mental health complexities are more likely to have lower levels of wellbeing, additional health conditions, and reduced life expectancy than the general population (Robson & Gray, 2007). Additional therapies have been used alongside traditional medical therapies to improve wellbeing (including physical activity, counselling and befriending etc). Physical activity has been shown to be beneficial in the management of mild mental health problems, with research indicating that physical activity can significantly reduce depression and anxiety (Paluska & Schwenk, 2000). There may also be additional benefits associated with exercise such as improvements in self- esteem, life satisfaction and mood and may even have a protective effect against depression (Peluso and Andrade, 2005).

During a consultation with the Hertfordshire Students’ Union, approximately 800 students expressed an interest in becoming more physically active at University. It was reported that many didn’t feel able to filtrate in to existing activities due to perceived barriers in relation to their mental health. Discussions with a range of university student-facing services, including Student Wellbeing, Counselling and Disability Services and the Advice and Support Centre support the findings above and reported a rise in students presenting with mental health conditions. Common conditions include stress, anxiety, depression, loneliness, fear of judgement and struggling to integrate – all of all of which have been shown to be helped by partaking in physical activity.

Project Outline

The project aimed to support students with mild mental health issues to engage in physical activity. Students were referred into the scheme through a number of channels. The majority of referrals were processed through counselling services, but referrals were also welcome from Housing, Students Union and academic lecturers. Referrals were made by a member of staff completing the referral form with the student.

A timetable of free activities were made available to referred students on campus. Activities were selected that did not include a team element, such that students could participate individually but with the opportunity to be social. Feedback from student support services had suggested that activities with team elements may be intimidating for this client group. Activities that were included in the programme:

  • Badminton
  • Table Tennis
  • Rock Climbing
  • Archery
  • Yoga
  • Tai Chi
  • Gym

Students completed the post evaluation questionnaire after 12 weeks of physical activity.

Aims

At least 75% of participants to report an increase in physical activity levels by week 12.

  • Evaluated using the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS; Tennant et al, 2007). Scoring for this outcome is between 0 and 35, with 0 indicating the lowest level of wellbeing and 35 indicating max level of emotional wellbeing.

At least 75% of participants to report increased feelings of overall mental wellbeing by week 12.

  • To increase levels of physical activity. Measured by a single item measure of physical activity (Wanner et al, 2013). This outcome measures how many days of the week did the participant complete physical activity to get them out of breathe for half an hour or more.

Results

Outputs

There were 60 referrals received onto the project, of these 53 students completed the 12 week programme (88.3% participation rate). From these 53 students, 24 were female and 28 male. The average age of the students was 20.4 years, with the youngest participant aged 18 and the oldest 29 years. The students were recruited from a number of different academic schools from the University.

Figure 1. Academic School of participants

Of the 53 participants completing the programme, 41 disclosed a previously diagnosed mental health condition (Depression, Anxiety and/or OCD). There were 10 participants with no mental health diagnosis and 2 participants refused to answer.

Ethnicity figures can be seen below:

Table.1. Ethnicity figures for participants completing the intervention

Ethnicity / Frequency / Percentage
White / 4 / 45.3%
Mixed / 5 / 9.4%
Asian/Asian British / 11 / 20.8%
Black/Black British / 6 / 11.3%
Chinese / 3 / 5.7%
Other / 4 / 7.5%

Outcomes

Physical activity levels were measured using the single item measure of physical activity (Wanner et al, 2011). This question identifies how many times a week participants did enough exercise to increase their heart rate enough to breathe heavily for 30 minutes or longer. At the start of the project the average score of the group was 2.12 days. After 12 weeks this increased to 3.56 days. This suggests that the project increased number of days participants engaged in physical activity, with participants having an average improvement of 1.44 days.

  • 88% of students had an increase in number of days they participated in activity
  • 12% of students had stable levels of physical activity

Changes in wellbeing (as captured by the SWEMWBS) were captured when participants started the sessions and again after 12 weeks. The scores for this tool were transformed in accordance with scoring protocol, with the mean (average) score before the students started the sessions was 26.42. After the 12 weeks, the mean score of the group had increased to 31.55. This improvement in scores suggests that the students had an improvement in subjective wellbeing after completing the 12 weeks of exercise. The majority of the students had improved SWEMWBS scores following the sessions:

  • 81% of students had an increase in SWEMWBS score
  • 13% of students SWEMWBS scores stayed the same
  • 6% of students had a reduction in SWEMWBS score

In comparison to national figures, wellbeing scores at the start of the intervention went from average (M=26.42) to excellent (M=31.55).

Conclusion

The project has served as a pilot to explore the effectiveness of physical activity and peer mentoring for students with mild mental health issues. The project has had a number of successes as well as lessons learnt. As discussed in the previous section, there was a benefit for students with mild mental health issues in increasing levels of physical activity and wellbeing.

Lessons Learnt

Although this was a pilot project, in future it would also be beneficial to open referrals out to all subject departments and allow self – referrals. This would give the opportunity to lecturers that identify students that require further support and signpost them to the scheme. There is likely to be a proportion of students that are struggling to integrate with University that never present themselves to one of the referring departments to which this scheme could have a beneficial effect.

The rationale of the project was sound with all stakeholders aware of the purpose of the project, where this tended to break down was with referrers. The referrers were enthusiastic and keen to be involved in the project, however referral numbers were low at the beginning of the project. One of the reasons for this was feedback to be some confusion as to the criteria for students being referred on to the scheme. Working with Student Wellbeing services, referrer guidance was created to ensure that all staff were fully aware of the capacity of project and what mentors were trained to deal with. A copy of referrer guidance can be seen in appendix A. This was implemented towards the end of the project and was well received by referrers. In future, this should be in place from the start of the project to minimise confusion and ensure students are correctly referred onto the project. Leaflets promoting the scheme and regular reminders to referrers should also be built in to the project from early to ensure a steady stream of referrals into the project.

Before the start of the project, there was consultation with referring departments as to the structure and development of the project. There wasn’t however, any consultation with the target group of students to shape what the programme should look like. This would have been beneficial in deciding on activities, timings and the referral process to reduce attrition rate of students and create the most beneficial intervention. Going forward a consultation event with students would be beneficial to add to participant feedback gained from students as part of this evaluation.

The students fed back that they sometimes felt intimidated attending the physical activity sessions alone and this was a barrier to attendance. In order to remove this barrier, a peer mentor scheme would be beneficial to provide additional support to students. The mentor would be trained appropriately and would provide light touch emotional support as well as attend activities together.

Recommendations

There have been a number of learnings from this pilot project. In order to run this project effectively on a larger scale, below are our recommendations:

  • Engage both referrers and students in planning consultation
  • Start the project at the beginning of the academic year. Referrers are more likely to buy in to the project at the start of term rather than half way through the year.
  • Schedule activities daytime/evening and weekends. Also include activities that are flexible for students (e.g. the gym)
  • Include activities that can be done alone but with social interaction (e.g. climbing) but also include team sports for students that are more confident or coming toward the end of the programme.
  • Publicise the project to create as many referral points as possible including self- referrals.
  • Include some one off activity sessions (such as the lambing session) that students can get involved in. Students fed back that they really enjoyed engaging with the animals.
  • It can be difficult to get post questionnaires from students after the intervention. A prize draw can provide a useful incentive for completion and return of questionnaires.
  • Ensure the intervention starts at the beginning of the academic year to maximise referrals and support students effectively when they need it.


References

Neves, J. & Hillman, N (2016). The 2016 Student Academic Experience Survey. Higher Education Policy Institute.

Neves, J. & Hillman, N (2017). The 2017 Student Academic Experience Survey. Higher Education Policy Institute.

Paluska, S. A., & Schwenk, T. L. (2000). Physical activity and mental health.Sports medicine,29(3), 167-180.

Peluso, M. A. M., & Andrade, L. H. S. G. D. (2005). Physical activity and mental health: the association between exercise and mood.Clinics,60(1), 61-70.

Robson, D., & Gray, R. (2007). Serious mental illness and physical health problems: a discussion paper.International journal of nursing studies,44(3), 457-466.

Stallman, H. M. (2010). Psychological distress in university students: A comparison with general population data.Australian Psychologist,45(4), 249-257.

Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, & Stewart-Brown, S. (2007). The Warwick-Edinburgh mental well-being scale (WEMWBS): development and UK validation.Health and Quality of life Outcomes,5(1), 1.

Wanner, M., Probst-Hensch, N., Kriemler, S., Meier, F., Bauman, A., & Martin, B. W. (2013). What physical activity surveillance needs: validity of a single-item questionnaire.British journal of sports medicine, bjsports-2012.

Appendix A – Referrer guidance

WE ARE NOT TRAINED TO SUPPORT
Stuents with diagnosed moderate to severe mental health issues.
Students that pose a risk to themselves or others.
Examples of Diagnosis :
  • Schizophrenia
  • Personality Disorder
  • Bipolar disorder
  • PTSD multiple trauma
  • Eating disorders with BMI <18
/ WE LOOK FORWARD TO SUPPORTING
Students with diagnosed mild mental health issues.
We will also accept students that have no mental health diagnosis but are ‘at risk’ of developing mental health issues (struggling to integrate, withdrawing from University, lonely).
Students will also be accepted if they have a more complex mental health diagnosis that is being managed well where this is support by student wellbeing or other referrer.
Examples of Diagnosis:
  • Comorbid physical health problem
  • Mild to moderate anxiety
  • Social isolation
  • Stress
  • Work related stress
  • Panic
  • Phobia
  • Bereavement
  • Low Mood
  • Depression
  • Anger Management
  • Eating disorders with BMI>18