Mental health problems are estimated to be experienced by 1 in 4 of the UK population (House of Commons Library, 2018). Although these range from mild to severe, it is concerning that there are 4500 suicides in England each year; this is the leading cause of death in young people, as highlighted when the first cross-government suicide prevention plan was launched in January (Department of Health and Social Care (DHSC), 2019a). Mental health and wellbeing are of particular interest to those involved with pre-registration nurse education because of increasing levels of mental ill-health in student populations generally (Universities UK, 2015; 2019) and in healthcare students in particular. The NHS Staff and Learners' Mental Wellbeing Commission has just published a comprehensive report that makes recommendations to better support undergraduate healthcare students (Health Education England (HEE), 2019).
Going to university is a great achievement and potentially full of exciting opportunities. However, it can also be a time of significant stress as personal circumstances change—leaving home, financial pressures, and personal and family pressure to succeed. Added to this are specific challenges faced by healthcare students: high workloads associated with the placement experience, long and unsocial hours, balancing demands of academic and placement assessment deadlines, emotional distress and ethical conflicts associated with the role. Research shows that compared with other university students, nursing students experience higher levels of stress (HEE, 2019).
These factors can impact on mental wellbeing. Although the stigma attached to mental illness is reducing, it may still influence students' decisions whether to report mental health issues at university and placement settings and therefore delay access to support (Universities UK, 2019).
The Commission (HEE, 2019) gathered evidence from a wide range of stakeholders, to build a comprehensive picture of mental wellbeing in NHS staff and learners, highlighting best practice as well as areas of need. It made 33 recommendations; the first was to appoint NHS wellbeing guardians in healthcare provider organisations to lead wellbeing initiatives at board level. Although not mentioned, a parallel role in healthcare university departments might also be beneficial.
Six specific recommendations focused on reducing healthcare student stress. The first is managing the impact of transitioning into undergraduate education and indeed into healthcare work; they recommend training in self-care and stress awareness as well as clearer signposting support. Specific support for anticipated transition stress is further recommended. Most universities and care providers have counselling and occupational health systems in place but may need to work on making these more accessible. Reviewing the undergraduate curriculum to more explicitly incorporate mental wellbeing self-help in each year of the programme would also be helpful. Related to this is a recommendation concerning access to support in university and placement, specifically incorporating a formal wellbeing ‘check-in’, 2 weeks into placement. Nurse students normally have personal tutors in the university who have a pastoral role, although this is often undertaken in a variety of ways; placing a duty of care in effect to require tutor–student contact after 2 weeks on placement may well be beneficial, even better if this role is undertaken by a practice-based educator, independent of the assessment system. This links to another recommendation concerning staff space in NHS organisations away from the public to meet colleagues and informally reflect on daily work practice. This is a frequently underplayed infrastructure issue.
The remaining recommendations concern strengthening education for practice-based and university educators around student stress. It is easy to forget how much change and pressure students face; educator training could be a very beneficial collaborative activity that leads to action planning to review and improve local services. The last recommendation is to review financial and other costs related to distant placement areas and the stress these create. This is a complex issue, given the shortage of placement capacity. The provision of funds to support student travel to placements seems to vary across universities but needs to be addressed centrally.
The Commission's report raises some excellent points but the focus is the NHS, whereas many nurses work in the independent and social care sectors. I hope recipients of this report, including the Minister for Mental Health, will factor this in to future policy directives, as has been suggested (DHSC, 2019b). Nonetheless, the focus on mental wellbeing is very timely. We owe it to those who care for others to care for them also. Caring colleague relationships, where team members value each other, cost nothing but the benefits are priceless. Some interventions have cost implications, which in times of austerity can be challenging, but doing nothing will ultimately cost more.