Education for Mental Health Toolkit - Effective signposting

However, it is clear from research that signposting is a more complex task than it may first appear (1). Simply telling students about the existence of services does not guarantee they will access that support. This is consistent with studies in the general population that demonstrate people often do not engage in healthy behaviours, even when they are aware of their apparent benefits of doing so (2-3). Some authors have identified a range of reasons as to why students do not access support (4) – these include stigma, accepting the possible need for support, not believing support will help, being concerned about the time commitment of receiving support and not believing they need or deserve support for the problems they are experiencing.  

In effect, for students to choose to access support, three elements must be in place. 

1. They must identify that they are experiencing a difficulty which would potentially benefit from support. 

2. They must be able to identify appropriate support, know how to access it and be able to access it in a timely manner. 

3. They must believe that this support will help them and be motivated to access it. (1) 

Behavioural science suggests that whether or not someone engages in healthy behaviours, such as help seeking, can also be dependent on how easy and speedy the process is likely to be (5).  

Academics also identify problems that they experience in signposting students. These include knowing and understanding what support is available and is most appropriate to an individual student and managing the feeling that they are rejecting the student by sending them elsewhere (1, 6). 

There are a number of steps academics can take to make the process of signposting easier and more effective. This begins in laying solid groundwork in advance. Academics can do this by: 

1. clearly explaining how student – lecturer/tutor relationships work at the beginning of the academic year and occasionally recapping this to maintain common understanding. This includes what the boundaries of the relationship are and what the academic can do and cannot do or help with. 

2. ensuring students are aware of the support that is available and how it can help. 

3. including information about support services in class slides as standard, so the information is being relayed to students on an ongoing basis, not just at the beginning of the year. 

4. reminding students verbally of the support available and normalising the use of this support. This can be done by highlighting that many students access such support and find it helpful and that doing so often results in students being more able to engage in academic work. 

If a student discloses a mental health problem, there are then a number of steps that may be appropriate and helpful for an academic to take – this may need to be adapted to individual circumstances.  

1. Be clear that you have heard what the student has told you, that you care and that you want their situation to improve. 

2. Explain that because you care, you want them to get the best support possible for their issue and explain what you cannot do or are not best placed to do. 

3. Ask the student what they think might help. Act on this if feasible. 

4. Identify for the student the support that is available – it may help to provide some options such as student services, chaplaincy, their GP etc. 

5. State your confidence in the support that is available and, if possible, provide details of how the service can help. 

6. It may help to provide a narrative to encourage the student to access support. This is known as a My Friend John story, in which you explain how students in a similar position accessed support and found it helped – any such story should, of course, be changed and anonymised, so it does not relate to a specific student. 

7. In some circumstances it may help if you can make it easy for the student to access support there and then by, for instance, offering to let them use your office telephone or suggesting they use an online contact form, while they are with you. 

8. Set out what you can do to help (e.g., helping them get an extension to a deadline). 

These steps will make it more likely that a student will access support but remember it must remain their choice. People cannot be compelled to engage in support – even if pushed to make initial contact they can disengage later. It is important that academics maintain their boundaries, actively encourage students to access support when appropriate but leave them with their own autonomy and control. 

Key lessons 

• Effective signposting is key to maintaining boundaries and appropriately supporting students. 
• Academics can increase the effectiveness of signposting by laying groundwork in advance – this includes clarifying boundaries, normalising the use of support and ensuring students are aware of the support available. 
• Effective signposting will motivate students to access support by increasing their belief that the support on offer is likely to help them. 

Top Tips 

• Include details of support services on all slides as standard and on the VLE so this information can be accessed at any point during the year. 
• Ensure academics know and understand the support that is available to students. 
• When signposting, academics should express their confidence in the support available and provide illustrative examples of how other students have been helped. 

References 

1. Hughes G, Panjawni M, Tulcidas P, Byrom N. Student mental health: The role and experiences of academics. Oxford: Student Minds; 2018

2. Marteau T, Kelly M, Hollands G. Changing population behavior and reducing health disparities: Exploring the potential of “choice architecture” interventions. In: Kaplan RM, Spittel M, David DH. Emerging behavioral and social science perspectives on population health. Bethesda, MD: National Institutes of Health/Agency for Healthcare Research and Quality. 2015.

3. Kelly MP, Barker M. Why is changing health-related behaviour so difficult?. Public health. 2016 Jul 1;136:109-16. Available from: doi: 136. 10.1016/j.puhe.2016.03.030

4. Broglia E, Millings A, Barkham M. Student mental health profiles and barriers to help seeking: When and why students seek help for a mental health concern. Counselling and Psychotherapy Research. 2021 Dec 31. Available from: doi: https://doi.org/10.1002/capr.12462

5. Sunstein CR, Thaler RH. Libertarian paternalism is not an oxymoron. The University of Chicago Law Review. 2003 Oct 1:1159-202. Available from: doi: https://doi.org/10.2307/1600573.

6. Hughes GJ, Byrom NC. Managing student mental health: The challenges faced by academics on professional healthcare courses. Journal of advanced nursing. 2019 Jul;75(7):1539-48. Available from: doi: 75. 10.1111/jan.