Ms Treasa Fox:

I thank the Chair and members for this opportunity. In its excellent paper on future funding, this committee tellingly devoted a complete chapter to mental health. It stated:

Promoting positive mental health must be of paramount importance in higher education. All HEIs should be designated as places of sanctuary and actively support student health and well-being with a specific focus on vulnerable groups including displaced students seeking refuge in this country.

The Covid-19 pandemic bequeathed many lessons. It cast a spotlight on the inequities within the educational system and instilled a determination to address these. The HEA’s new access plan, which was published in August 2022, extends our notion of enabling entry to a more inclusive and diverse structure to encompass access, participation and success in higher education. The State and its institutions commit not just to widening participation but to supporting all learners through the system. The pivotal role that mental health and wellbeing supports play in sustaining our higher education student population has become increasingly recognised and prioritised. We have welcomed the recommendations that this committee has made in that context. As a professional of long standing, I work with a community of practitioners across higher education and advice based on our direct experience and expertise is key to ensuring that supports are targeted appropriately and effectively.

To give some context, mental health student counselling services are the dedicated mental health support service available across higher education institutions. The work is best described by the comprehensive student counselling service model which identifies four foundational pillars, namely, clinical services; consultation and collaborative services; outreach, prevention and early intervention; and training and education. Evidence points to a dramatic increase in the demand for student counselling services in recent years and also a consistent rise in self-reported self-harm and suicidal ideation among the student population.

In Ireland, in the academic year 2019-20, 12,852 students attended approximately 65,000 counselling appointments. In 2020-21, this rose to 14,386 students attending some 69,000 counselling appointments, a figure which represents attendance at student counselling services of 6% of the total number of students in higher education in those years. What can we expect if student counselling services are not adequately resourced? International evidence shows diluted treatment, limits of eligibility for care and other limitations lead to poor outcomes with less symptom reduction.

This recent research has been examining the clinical load and its impact on counselling service delivery and outcomes. The clinical load index, CLI, is a standardised and comparable score that describes the standardised caseload of a student counselling service. The CLI can be thought of as clients per standardised counsellor per year or, in simple terms, the demand-supply balance or imbalance in a student counselling service. The research shows that working with a high clinical load index means services provided fewer appointments that were scheduled further apart and produced less improvement in symptoms. Additionally, high CLI services require clinicians to absorb clients in their schedules regardless of available openings in an effort to serve more students. The results demonstrate that services with lower annual counsellor caseloads have increased capacity to provide more treatment, on average, to students across all presenting concerns and identities, including those with critical needs, for example, students with suicidality, sexual assault survivors, students with a registered disability and first-generation students. Conversely, services with higher caseloads will likely struggle to offer more care to students with safety concerns and high intensity needs.

Diluted treatment, which includes spreading appointments out, limiting the number of appointments, shortening appointment lengths, limits on eligibility for care and other scope-of-service limitations will be common. Those at the high end of this zone may need to focus almost entirely on rapid access, crisis stabilisation and external referrals. Work stress in this zone will likely be focused on a near constant level of excessive demand for services by students in high levels of distress paired with the inability to provide treatment on site.

This research has particular relevance to the data in the recently published student survey 2022. A new question was introduced to the survey in 2022 which asked, “Have you ever seriously considered withdrawing from your degree programme?” Results indicate that over one in three first year respondents, or 36.6%, have. The rate is particularly high for final-year undergraduate respondents, with more than two in five indicating that they have seriously considered withdrawing from their programme. The most common reason provided was personal or family reasons, which was given by 13.3% of all respondents. This was followed by financial reasons, which was given by 9.8% of respondents. In qualitative responses, 10% specifically called out their mental health as reason for withdrawing. The challenges of balancing personal life, work and study; loneliness and difficulty making friends; and lack of support from the HEI all featured significantly in consideration of withdrawal. Without access to appropriately resourced, timely and adequate counselling services many students, because of personal or mental health reasons, will inevitably withdraw.

On our call to action, we warmly welcome the post-Covid-19 increases in mental health funding, but our advice is that there is a clear need for multi-annual core funding, ring-fenced for student counselling services, to ensure continuity of improved services. This will embed the enhancements arising from the lessons of the pandemic. We also strongly recommend adhering to internationally recommended ratios and the clinical load index. Specifically, we repeat our call for increased multi-annual ring-fenced core funding to support higher education institutions to meet international standards of one counsellor to 1,000 students.

It has become increasingly difficult to recruit qualified and experienced counsellors, psychotherapists and psychologists offering the short-term contracts that have been necessary due to the once-off nature of the recent funding allocations. Student counselling should be identified and promoted as a viable and attractive career path for such professionals and will only be so with guaranteed core funding in order to support long-term, permanent posts which are not possible to offer based on the current ad hocfunding model.