Impact case study database
The impact of resilience-based training for populations at an inflated risk of mental ill health.
1. Summary of the impact
This programme of research sought to identify the prevalence and risk factors for mental ill-health and severe mental illness within members of the UK university student population. Investigation into the help-seeking behaviours of those at risk resulted in the identification of ‘hard-to-reach' groups that would benefit from alternative means of engagement. A programme of resilience-based training was developed spanning the public, private and third sector. Institutionally, new educational practices were adopted, and practitioners within the counselling service noted a direct and positive impact on waiting lists. Private and third sector organisations reported a positive impact on working practices and wellbeing.
2. Underpinning research
Research continues to highlight the continued growth of mental ill-health within the student population. Less attention is placed on identifying those groups who are at-risk of mental ill-health compared to those who are at risk of severe mental illness. Delineating these groups would serve two purposes. Firstly, it would allow resources to be directed appropriately, and secondly, it could serve to prevent mental ill-health developing into severe mental illness. Research has suggested that preventative programmes focusing on resilience would equip students with the skills to manage their mental health and “would benefit from promoting help-seeking behaviour to encourage students to seek help before their mental health needs are severe” (Broglia, Millings, & Barkham, 2018, p.449).
Broglia, E., Millings, A. & Barkham, M. (2018) Challenges to addressing student mental health in embedded counselling services: a survey of UK higher and further education institutions. British Journal of Guidance & Counselling, 46(4), 441-455. DOI: 10.1080/03069885.2017.1370695
Nature of the research insights:
Consistent with previous studies, Reference 1 reported more than one third of university students (in a HE institution in the North of England) experienced mild to moderate psychological distress and just over one in five experiencing serious psychological distress indicative of severe mental illness. Only 30% of those experiencing mild-moderate distress had sought professional help within the previous 12 months compared with 58% of those experiencing severe psychological distress. This highlights a considerable unmet need for those not engaging with formal professional help. In contrast to previous research, levels of social support were not found to be related to help-seeking behaviours. Interestingly, when focusing specifically on depressive symptomology and quality of life within the same sample, Reference 2 found social support from family and friends to be a significant predictor of depressive symptoms (which can constitute severe mental illness) and to increase quality of life within the psychological domain. At a minimum, institutional strategies would benefit from promoting social support as a positive help-seeking strategy to facilitate avenues of engagement. This would serve to prevent mental ill-health developing into severe mental illness, particularly for students transitioning into university as well as directing resources more appropriately and effectively.
Research has previously linked childhood adversity to severe mental illness, to the extent that it can increase the risk of psychosis threefold. Reference 3 found 89% of university students reporting low levels of childhood adversity and 11% high adversity. Childhood adversity was related to three types of prodromal symptoms (hallucinations, perceptual abnormalities negative symptoms). Interestingly, a novel relationship was found between childhood imaginary companions and hallucinations/perceptual experiences, with the former partially mediating the latter. This, coupled with the fact that stressful experiences further trigger the primary onset of severe mental illnesses such as psychosis, highlights the need for identification of at-risk groups and allowing for targeted early intervention support to prevent the onset of severe mental illness.
3. References to the research
Reference 1: Wadman, R., Webster, L., & Stain, H. (2017). Help-seeking and psychological distress in university students: Findings from a cross-sectional online survey in the UK. European Psychiatry, 41(S1), S184-S185. doi:10.1016/j.eurpsy.2017.01.2101
42% of students experiencing high psychological distress indicative of severe mental illness did not seek help
In contrast to previous research, social support was found not to be related to help-seeking behaviours
A more targeted approach is warranted for students with a focus on relational barriers to help-seeking
An over-reliance on anti-stigma campaigns ubiquitous in UK universities may reflect a misunderstanding of their impact and as a consequence result in a misdirection of attention and resources.
Reference 1 Reach:
The above output has been referenced across a range of domains including counselling and cross-cultural psychology as well as spanning a range of demographics including the public (50%), scientists (38%) and practitioners (13%). With an Altrmitic attention score of 7 it lies in the top 25% of all research outputs tracked by Altmetrics. Overall usage equals 189 via EBSCO and link-outs numbering 36. An E-poster was presented at the 25th European Congress of Psychiatry 2017, Florence, Italy.
Reference 2: Alsubaie, M. M., Stain, H. J., Webster, L. A. D. & Wadman, R. (2019). The role of sources of social support on depression and quality of life for university students. International Journal of Adolescence and Youth, 24(1), 484-496. doi: 10.1080/02673843.2019.1568887
Social support from family and friends play a significant role in decreasing the risk of depressive symptoms and increasing quality of life in university students
Social support from significant others and friends was shown to have a significant role in improving the quality of life in social relationships for university students.
Interventions to protect the social and emotional wellbeing of university students should utilise the role of social support.
Reference 2 Reach:
The above output has an Altrmitic attention score of 8 and is in the top 25% of all research outputs tracked by Altmetrics. Scopus preview report 18 citations spanning the domains of Psychology, Psychiatry and Law, and Environmental Research across a range of countries including Chile, Ethiopia, Ghana, Thailand and Vietnam. Demographic reach equates 75% to members of the public and 25% to scientists.
Reference 3: Davis, P., Webster, L., Fernyhough, C., Ralston, K., Kola-Palmer, S. & Stain, H. (2019). Adult Report of Imaginary Companion Play and Adversity in Childhood: Relations to Concurrent Prodromal Symptom Report. Psychiatry Research, 150-152. Doi: 10.1016/j.psychres.2018.11.046
The presence of imaginary companions in childhood can predict the subsequent development of prodromal hallucinations in adulthood and is mediated by childhood adversity.
The impact childhood adversity in university students is crucial to consider since prodromal symptoms present within the typical university age range, thus forming an at-risk sub-population needing targeted support.
Reference 3 Reach:
The above output has an Altrmitic attention score of 57 and is in the top 5% of all research outputs tracked by Altmetrics. One citation in Schizophrenia Research (October 2020) reflects the recency of the output. Attention reached news sources in the United Kingdom (The Conversation) and in the United States (Foreign Affairs).
4. Details of the impact
The ‘SoWise Vision Day’, a research innovation and knowledge exchange event led by Webster brought together researchers and key local and national stakeholders in student mental health that included representatives from Student Minds, Together Women and YoungMinds. The event aimed to create collaborative working partnerships across sectors to enhance the understanding, learning and participation of stakeholders. YoungMinds delivered an interactive workshop that focused on the importance of resilience to young people. Feedback suggested staff from all sectors would benefit from resilience-based training. Higher Education staff expressed a need for tailored training to enable them to engage students at risk of mental ill-health and signpost students to appropriate resources. As a result of the event and based on evidence from References 1 to 3, Webster designed and delivered bespoke resilience-based training workshops reaching the public, private and third sectors.
Impact within the public sector:
Resilience-based training was delivered to staff within all departments across the institution. Student facing materials were developed and incorporated into all levels via specific modules and personal tutoring. An institution wide initiative called Learning to Be was developed allowing students access to a six-week programme designed to develop resilience, increase awareness of mental ill-health and promote positive coping strategies and help-seeking behaviours. Feedback from students included the following:
“Feel like I’ve got a strategy/confidence going into the next semester which is amazing for me”
“Changed my perspective, dealt with anxieties and given reassurance”
“All students should do this – they would have benefitted from it”
Subsequently, the institution’s student mental health and wellbeing service delivered sessions to students prior to commencing placement. The service manager states that “initial audits indicate a reduction in presentation to the Student Mental Health & Wellbeing Service during the usually high-level periods following placement weeks.” Following the first COVID-19 lockdown, the service designed an online course for students including resilience-based training. Over 200 students participated with the service reporting a positive impact on waiting lists as evidenced in Source 1:
“..less than 10 of these Students subsequently refer themselves for further support indicating that the research has contributed to Students being empowered to manage their own mental health and release capacity for Students less able to do so by reduction of our waiting lists.”
Impact within the private sector:
Ad:Venture requested Webster to deliver bespoke resilience-based training for small business owners. Two-day workshops provided strategies to foster resilience and encourage positive coping strategies. Twenty-one regional businesses attended. Source 2 reports that the information on stress and coping strategies was useful, with particular reference to the emotional aspects of running a business that impact on quality of life and wellbeing:
“Practical resilience topics which I will use as well as strategies to find time for self and to cope / deal with day to day stress”
“Helped find long term preventative measures to help stress getting too much”
Based on feedback and demand and in the context of the current COVID-19 pandemic, Ad:Venture have requested these workshops be delivered again in May 2021:
“With Covid-19 most businesses owners were required to be more adaptive and flexible .., this workshop certainly helped me grow my mindset to support me in this”
Impact within the third sector:
As a consequence of participating in the SoWise Vision Day, Together Women requested the expertise of Webster to design and deliver resilience-based training for their staff who work with young women with multiple complex needs. The aim was to foster positive coping strategies for the staff and provide techniques that could be used within their practice. Source 3 indicates the training had a positive impact on the wellbeing of staff including a request for further delivery:
“It was so well-received and had a really uplifting positive impact on all the staff”
“We agreed that having workshops like this on a regular basis would encourage staff engagement and improve their emotional wellbeing”
International reach:
The underpinning research is evidenced at an international level with collaborators in Italy. Webster was invited to the International Cognitive Sciences Arena in Italy to act as Senior Scientific Advisor. Based on her expertise, Webster was further invited to deliver ‘in-depth seminars’ to students at the University of Bozen-Bolzano on topics including student mental health and adolescent resilience (https://ceslab.unibz.it/events/misc/seminars2020.html\). This collaboration led to the development and launch of a multi-site international study investigating the impact of isolation on student mental health, resilience and connectedness to learning (Source 4). A derivative of the study will commence in April 2021 in Australia (Source 5).
5. Sources to corroborate the impact
Source 1: Toby Chelms (Leeds Trinity University Mental Health & Wellbeing Service Manager)
Source 2: Sarah Carling (Ad:Venture Programme Manager)
Source 3: Rokaiya Kahn (CEO, Together Women)
Source 4: Dr Demis Basso (Collaborator Italy)
Source 5: Professor Helen Stain (Collaborator Australia)