University Mental Health Framework

The framework is a voluntary guide which universities and the mental health sector can use to help identify and prioritise actions and areas for collaboration to support student mental health and wellbeing.

The framework is structured around six principles that support student mental health and wellbeing. Guidance is included for each principle to illustrate what it might look like in practice. Supports for student mental health and wellbeing may range from wellbeing programs, mental health promotion, prevention and early intervention activities, through to mental health care and treatment.

Further information on suggested activities and the evidence base informing the framework is included in the full report. Detailed case studies accompanying the framework highlight some examples of the good practice currently underway to support student mental health and wellbeing.

The framework was developed in response to the Orygen report Under the radar: the mental health of Australian university students, published in 2017.(1) The report noted that more than half of tertiary students aged 16–25 years reported high or very high psychological distress while 35.4 per cent had thoughts of self-harm or suicide. Under the radar also reported that counselling services within Australian universities were finding it difficult to meet the escalating demand for services and the increasing complexity and severity of presentations.

The report suggested that a lack of government policy attention and resources had impacted the capacity of both the university and the mental health sectors to effectively respond to the needs of university students.(1)

In response to the report’s call for national leadership on this issue, the Australian Government Department of Health awarded Orygen funding to develop the Australian University Mental Health Framework.
1. Orygen. Under the radar: the mental health of Australian university students. Melbourne: Orygen; 2017.

Key stakeholders from various student groups, universities and the mental health sector helped to develop the framework. Existing initiatives and literature informed discussion and development. An advisory group guided the framework’s overarching structure and direction and a number of expert working groups provided input to the framework’s content. Orygen retained final editorial approval.

Focus groups with university students were conducted to provide insight into student needs and preferences in relation to mental health and wellbeing. Participants reflected the diversity of the university student population, incorporating a broad range of ages, stages and areas of study; students from metropolitan and regional areas; and groups identified in the literature as being at higher risk of developing mental health issues.

International experts undertaking similar initiatives were engaged to provide insights on their experiences and to share contextual perspectives. Orygen invited project leaders from Universities UK and the Mental Health Commission of Canada to attend a symposium in Melbourne in February 2020 to share their insights on developing similar frameworks in their countries. The symposium brought together many of the key stakeholders engaged in the advisory and expert working groups.

Over 500 stakeholders were engaged via conference presentations and workshops with stakeholder groups to inform development of a draft framework. The draft framework was made available for public consultation in July 2020.

The framework can be used by anyone with a role that supports university students’ mental health and wellbeing. Within universities this could include anyone across the university community, including university leaders prioritising mental health and wellbeing; all staff contributing to reducing stigma and discrimination; as well as counselling and student services staff in roles providing programs and services to support students’ mental health and wellbeing.

Within the mental health sector, the framework can be used by anyone across the broader range of primary and specialist mental health settings, or from organisations and networks within the mental health system that work to support the diverse university student population in collaboration with universities.

Students themselves can use the framework to help facilitate access to supports and build connections within the university community, including student peer-workers, student clubs and associations, student unions and those in student leadership roles.

The framework is focused on supporting student mental health and wellbeing through mentally healthy universities working in collaboration with the mental health sector. The framework was developed in response to research highlighting the increasing mental health and wellbeing needs of university students. Focusing on students as a population group supports the application of the framework across both the mental health sector and universities.

Research informing the development of the framework focused on university students’ mental health and wellbeing. Practices described in the framework focus on the student experience and opportunities for supports to be enacted across universities and the mental health sector.

The framework takes a settings-based approach to embed student mental health and wellbeing responses across the whole university. Student and staff mental health and wellbeing is interconnected within the university setting, however, universities determine their own approaches to workplace mental health. The framework recommends universities align student and staff mental health and wellbeing strategies.

A settings-based approach considers the impact on mental health and wellbeing of the places where people work, study, live and socialise.

Also referred to as a ‘healthy settings’ or ‘whole of university’ approach, a settings-based approach recognises the role all members of the university community play in supporting students’ mental health and wellbeing. It emphasises the importance of effective collaboration across the whole university community.

Within universities, a settings-based approach may be reflected through the integration of a range of promotion and prevention initiatives, stigma reduction and education activities, programs and supports provided by counselling services, and support for those experiencing or recovering from mental ill-health to engage with education.

Evidence from other settings-based approaches reinforces that the most effective approaches target multiple factors simultaneously through aligned programs and initiatives rather than single-component programs.(1)

1. Martin A, Shann C, LaMontagne A. What works to promote workplace wellbeing? A rapid review of recent policy developments and intervention research. Melbourne: Victorian Workplace Mental Wellbeing Collaboration; 2017.

The framework provides universities with adaptable guidance, which recognise autonomy and enables institutions to determine their own course of action in addressing student mental health and wellbeing.

Each university will be at a different point in their journey and will be responding to varying student needs within diverse populations and contexts. The framework enables multiple entry points to suit individual contexts, enabling institutions to meet the unique needs of their student population while supporting ongoing cross-sector collaboration, improvement and innovation through a coordinated national approach.

The framework is informed by a socio-ecological model which considers the influence and interaction of individual, interpersonal, institutional, community and structural factors on mental health and wellbeing.(1, 2) The socio-ecological model acknowledges that these factors overlap and interact with each other, and can have a cumulative effect on mental health and wellbeing.

The framework provides guidance to support action in six key areas (the principles) oriented around: a student-centred approach; teaching and learning environments; the role of the whole university community; coordination and collaboration; student services and supports; and continuous improvement and innovation. Actions taken across these six areas address different influences of mental health and wellbeing aligned with the socio-ecological model.

1. Canadian Standards Association Group, Mental Health Commission of Canada. National Standard of Canada: CSA Z2003:20 Mental health and wellbeing for post-secondary students. Ottawa (ON): CSA Group, Mental Health Commission of Canada; 2020.
2. Golden SD, Earp JAL. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39(3):364-72.

Mental health and wellbeing is a shared responsibility both within and external to the university. It does not sit neatly within the responsibility of any one organisation or sector. A multi-faceted, coordinated approach is needed across a broad range of programs, environments and policies.

The boundaries for the provision of mental health and wellbeing services are often blurred given that there is no standard definition for ‘mental health-related service’,(1) and that there is a complex mix of roles and responsibilities across federal, state and territory governments, and private and non-government organisations.(2) Important supports and services are also provided outside of the mental health sector, such as social and community services, disability programs, and housing assistance programs.

Universities are settings which can have a positive or negative effect on the health of students and staff.(3) Universities typically offer a range of mental health promotion, prevention and student wellbeing services and supports. All universities offer counselling services to students, with each university determining which services it will provide.

Emphasis on strict boundaries for the provision of mental health and wellbeing supports and services may not reflect the complexities of mental health and wellbeing and the often overlapping influences both within and outside the university setting. Focusing on rigid roles and responsibilities for mental health and wellbeing may contribute to stigma and discrimination, and may result in inaction.

The framework is focused on the student experience. Practices described in the framework focus on supporting student mental health and wellbeing, whether delivered by a university or mental health sector organisation. The framework provides multiple opportunities to begin making changes with a focus on enhancing students’ experiences. Other settings such as schools and workplaces, as well as some universities, have shown the importance and the benefits of taking action to enhance mental health and wellbeing.(4-6)

1. Australian Institute of Health and Welfare. Mental health services in Australia [Internet]. Canberra: Australian Institute of Health and Welfare; 2020 [cited 2020 Aug 25]. Available from: https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia.
2. Cook L. Mental health in Australia: a quick guide. Canberra: Department of Parliamentary Services; 2019.
3. Universities UK. Stepchange: mentally healthy universities. London: Universities UK; 2020.
4. Beyond Blue. Be You evidence summary. Melbourne: Beyond Blue; 2018.
5. Universities UK. Whole university approach London: Universities UK; [cited 2020 Jan 20]. Available from: https://www.universitiesuk.ac.uk/policy-and-analysis/stepchange/Pages/whole-university-approach.aspx#ref_1.
6. Harvey S, Joyce S, Tan L, Johnson A, Nguyen H, Modini M, et al. Developing a mentally healthy workplace: a review of the literature. Sydney: National Mental Health Commission; 2014.

The framework is relevant for all students. Student experiences of mental health and wellbeing have been at the forefront of development of the framework. However, this has been somewhat constrained by the limited research and evidence specific to university students.

As a youth mental health organisation, the research that informed Orygen’s Under the radar report emerged from a focus on young people. The report noted that more than half of tertiary students aged 16–25 years reported high or very high psychological distress, while 35 per cent had thoughts of self-harm or suicide.(1) Young people are at increased risk for mental ill-health with 75 per cent of mental illness emerging before the age of 25.(2)

The student population, however, extends beyond young people, with around 40 per cent of domestic university students in Australia aged over 25.(3) In the general population the annual prevalence rate for mental ill-health is one in five people.(4) There are also a number of other cohorts of students who are increased risk of mental ill-health. The framework draws on the evidence base in youth mental health, available evidence related to other at-risk groups of students, and mental health and wellbeing initiatives in other settings, to provide guidance that is adaptable to meet the needs of all university students.

Universities and the mental health sector are encouraged to review, evolve and strengthen their understanding of the mental health and wellbeing needs of university students and tailor their approaches to meet the specific needs of the students they serve.

1. Orygen. Under the radar: the mental health of Australian university students. Melbourne: Orygen; 2017.
2. McGorry P. Building the momentum and blueprint for reform in youth mental health. Lancet Psychiatry. 2019;6(6):459-61.
3. Universities Australia. Data snapshot 2019. Canberra: Universities Australia; 2019.
4. Australian Bureau of Statistics. National survey of mental health and wellbeing: summary of results, 2007 (cat. no. 4326.0) [Internet]. Canberra: ABS; 2008 [cited 2020 Feb 24]. Available from: https://www.abs.gov.au/ausstats/[email protected]/mf/4326.0.

Yes, it does. Some student cohorts have been identified as being at increased risk of mental ill-health, including young people (aged up to 25 years),(1, 2) international students,(3) rural/regional students,(4) law and medicine students,(5-8) students from low socio-economic backgrounds,(9) PhD students,(10) and students with physical disabilities.(11) Other student groups may also benefit from differentiated strategies to support mental health and wellbeing including students who are the first in their family to attend university,(12) Aboriginal and Torres Strait Islander students,(13) students who identify as LGBTIQ+,(14) and students with existing mental health conditions.(15,16)

The framework emphasises the importance of tailoring approaches to meet students’ needs and the full report provides further information on strategies to support those students at increased risk of mental ill-health.

1. Mokdad AH, Forouzanfar MH, Daoud F, Mokdad AA, El Bcheraoui C, Moradi-Lakeh M, et al. Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2016;387(10036):2383-401.
2. Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. 2016;387(10036):2423-78.
3. Forbes-Mewett H, Sawyer A-M. Mental health issues amongst international students in Australia: perspectives from professionals at the coal-face. The Australian Sociological Association Conference Local Lives/Global Networks; Nov 29 - Dec 2; University of Newcastle2011. p. 19.
4. Mulder AM, Cashin A. Health and wellbeing in students with very high psychological distress from a regional Australian university. Adv Ment Health. 2015;13(1):72-83.
5. Leahy CM, Peterson RF, Wilson IG, Newbury JW, Tonkin AL, Turnbull D. Distress levels and self-reported treatment rates for medicine, law, psychology and mechanical engineering tertiary students: cross-sectional study. Aust N Z J Psychiatry. 2010;44(7):608-15.
6. Australian Medical Students' Association Student Mental Health and Wellbeing Committee. Australian university student mental health: a snapshot. Barton: Australian Medical Students' Association; 2013.
7. Beyond Blue. National mental health survey of doctors and medical students. Melbourne: Beyond Blue; 2013.
8. Kelk N, Luscombe G, Medlow S, Hickie I. Courting the blues: attitudes towards depression in Australian law students and lawyers. In BMRI Monograph 2009-1. Sydney: Brain & Mind Research Institute; 2009.
9. Eisenberg D, Hunt J, Speer N. Mental health in American colleges and universities: variation across student subgroups and across campuses. J Nerv Ment Dis. 2013;201(1):60-7.
10. Woolston C. PhDs: the tortuous truth. Nature. 2019;575(7782):403-6.
11. Australian Bureau of Statistics. National survey of mental health and wellbeing: summary of results, 2007 (cat. no. 4326.0) [Internet]. Canberra: ABS; 2008 [cited 2020 Feb 24]. Available from: https://www.abs.gov.au/ausstats/[email protected]/mf/4326.0.
12. Scevak J, Southgate E, Rubin M, Macqueen S, Douglas H, Williams P. Equity groups and predictors of academic success in higher education. A 2014 student equity in higher education research grants project. Report submitted to the National Centre for Student Equity in Higher Education. Perth: Curtin University; 2015.
13. Toombs M, Gorman D. Mental health and Indigenous university students. Aborig Isl Health Work J. 2011;35(4):22.
14. Rosenstreich G. LGBTI people mental health and suicide, briefing paper (revised 2nd edition). Sydney: National LGBTI Health Alliance; 2013.
15. Soydan AS. Supported education: a portrait of a psychiatric rehabilitation intervention. Am J Psychiatr Rehabil. 2004;7(3):227-48.
16. Mowbray CT, Collins ME, Bellamy CD, Megivern DA, Bybee D, Szilvagyi S. Supported education for adults with psychiatric disabilities: an innovation for social work and psychosocial rehabilitation practice. Soc Work. 2005;50(1):7-20.

Mental ill-health has been identified as a barrier to educational achievement and employment.(1) Investing in improved mental health outcomes for university students has the potential to provide a better return on investment for universities though increased course completions, academic achievement at university and opportunities for workforce engagement.(2)

Students today experience different pressures than their previous counterparts, with job security and career pathways being less straightforward and more choice available in the job market.(3)

This may create uncertainty around future financial independence and increased vulnerability, particularly for younger university students, who may be in a period of transition to independence.(4) For young people impacted by mental ill-health, the human and economic impact can last for decades, through what should be the prime years of productivity and economic participation.

Mental health interventions delivered in other settings, including workplaces and US colleges, have shown promising findings regarding the potential return on investment of improving mental health and wellbeing.(5, 6)

University students make up a significant portion of the community, with most universities being the size of large towns. As such, it is important for the mental health sector to invest in effectively planning to meet the needs of this diverse population and work in collaboration with universities.

1. Beyond Blue. Submission: mental health and workforce participation. Melbourne: Beyond Blue; 2011.
2. Browne V, Fava N. Safeguarding the ‘mental wealth’ of Australian university students. In J Marychurch & A Sifris (Eds), Wellness in Law: Making Wellness Core Business. 1 ed. Chatswood: LexisNexis Butterworths; 2019.
3. Walter M. ‘Going it alone’ adds to tertiary students’ high mental health risk. The Conversation [Internet]. 2015 [cited 2020 July 29]. Available from: https://theconversation.com/going-it-alone-adds-to-tertiary-students-high-mental-health-risk-41362.
4. Cleary M, Walter G, Jackson D. “Not always smooth sailing”: mental health issues associated with the transition from high school to college. Issues Ment Health Nurs. 2011;32(4):250-4.
5. Ashwood JS, Stein BD, Briscombe B, Sontag-Padilla L, Woodbridge M, May E, et al. Payoffs for California college students and taxpayers from investing in student mental health. Santa Monica (CA): Rand Corporation; 2015.
6. Gorringe J, Hughes D, Kidy F, Kesner C, Sale J, Sabouni A. ROI the return on the individual: time to invest in mental health. Speak Your Mind and United For Global Mental Health; 2020.

The assertion that students might simply be lazy, or looking to excuse poor or incomplete work, is not supported by the evidence and adds to the stigma and discrimination faced by students who experience mental ill-health.(1)

Students with ‘invisible disabilities’, such as mental ill-health, report feeling disbelieved or having the reality of their condition not understood by some staff. Students have specifically said that they wish some staff would better understand that they are not lazy or faking in order to gain special consideration.(35) Students have also highlighted feeling hesitant to disclose due to concern that other students may perceive any adjustments they receive due to their mental ill-health as unfair.(1)

This perception adds to the stigma and discrimination surrounding mental ill-health and impacts students’ confidence to disclose or ask for help early, often not until a crisis has been reached. For individuals, stigma and discrimination associated with mental health and wellbeing may mean that they hide their condition and under-report issues.(2) Poor mental health literacy, or a lack of knowledge about mental health, can increase stigma and discrimination.(3)

Effective communication approaches can help to break down stigma and increase understanding of mental health. Increasing the mental health literacy of staff can improve understanding about mental health, thereby reducing stigma and discrimination, and provides staff with the knowledge and skills to recognise, manage, prevent and reduce the impact of mental health issues.

1. Osborne T. Not lazy, not faking: teaching and learning experiences of university students with disabilities. Disabil Soc. 2019;34(2):228-52.
2. Corrigan PW, Druss BG, Perlick DA. The impact of mental illness stigma on seeking and participating in mental health care. Psychol Sci Public Interest. 2014;15(2):37-70.
3. Mental Health Foundation. Mental health literacy [Internet]. London: Mental Health Foundation; 2019 [cited 2019 Jul 22]. Available from: https://www.mentalhealth.org.uk/a-to-z/m/mental-health-literacy.

Yes, it does. Since the release of Orygen’s Under the radar report in 2017, there has been increased visibility of a range of initiatives occurring in universities in response to the mental health and wellbeing needs of students. However, universities are at various stages in their work to support student mental health and wellbeing.

The visibility and accessibility of university strategies and approaches to student mental health and wellbeing is still quite variable. This has made it difficult to accurately review the scope of practices already occurring in universities and to identify exemplary practices aligned with the framework. Regardless of the stage, all stakeholders consulted to inform development of this framework indicated that they would like to see more examples of best-practice shared across the sector.

Throughout the consultation period many stakeholders referenced current practices occurring in universities. Where possible, these have been reflected in the supporting information contained in the framework full report. Detailed case studies highlighting examples of good practice aligned with the framework are included in the suite of materials to support the framework.

Existing initiatives and literature informed discussion and development of the framework. Early themes focusing on a settings-based approach and emphasising the contribution of the whole university community were drawn from the World Health Organization’s Ottawa Charter for Health Promotion(1) and the Okanagan Charter.(2)

Similar frameworks developed internationally also focus on the creation of mentally healthy university settings, for example, the Universities UK Stepchange: mentally healthy universities framework; (3) and the National standard of Canada for mental health and well-being for post-secondary students.(4) Both these frameworks also utilise the dual continuum of mental health and wellbeing,(5) a perspective that was also well-supported by Australian universities.

Along with the health promotion focus of similar frameworks, the importance of incorporating mental health and wellbeing service provision is important in the Australian context. This is also reflected in Australian initiatives, such as the Framework for enhancing student mental wellbeing,(6) and the Guidelines for tertiary education institutions to facilitate improved educational outcomes for students with a mental illness.(7)

Examples of current practices are highlighted in eight case studies which accompany the framework and illustrate the framework principles. Where possible, examples of Australian practices were also referenced throughout the practices and supporting information in the full report.

1. World Health Organization. Health promotion: the Ottawa Charter for health promotion [Internet]. Geneva: World Health Organization; 1986 [cited 2019 Apr 18]. Available from: https://www.who.int/healthpromotion/conferences/previous/ottawa/en/.
2. Okanagan Charter: an international charter for health promoting universities and colleges. Kelowna (BC); 2015.
3. Universities UK. Stepchange: mentally healthy universities. London: Universities UK; 2020.
4. Canadian Standards Association Group, Mental Health Commission of Canada. National Standard of Canada: CSA Z2003:20 Mental health and wellbeing for post-secondary students. Ottawa (ON): CSA Group, Mental Health Commission of Canada; 2020.
5. Keyes CL. Mental illness and/or mental health? Investigating axioms of the complete state model of health. J Consult Clin Psychol. 2005;73(3):539.
6. Enhancing Student Wellbeing. A framework for promoting student mental wellbeing in universities. Melbourne: The University of Melbourne; 2016.
7. The University of Melbourne, Orygen Youth Health Research Centre. Guidelines for tertiary education institutions to facilitate improved educational outcomes for students with a mental illness. Melbourne: The University of Melbourne and Orygen Youth Health Research Centre; 2011.

The term ‘mental health sector’ is used throughout this framework to simplify references to the broad range of public and private organisations and workforces responsible for mental health and wellbeing service delivery. The mental health sector refers to a multidisciplinary mental health workforce in a range of primary and specialist mental health settings, and a broad range of organisations and networks within the Australian mental health system that work to support the diverse university student population. For the purposes of the framework, the term ‘mental health sector’ is not applied to those services and supports provided by universities.

The mental health sector has a role in working together with the university sector to support university students’ mental health and wellbeing. A coordinated, joined-up response, delivered through appropriate partnerships is required to provide effective support for students across the spectrum of mental health interventions.

Staff working within universities also have roles that focus on student mental health and wellbeing. For simplification, staff in universities are not included when referencing the mental health sector. In reality, given the complexities of mental health and wellbeing, roles and boundaries are likely to be blurred. Practices described in the framework focus on supporting student mental health and wellbeing, whether delivered by a university or mental health sector organisation.

The focus of the project has been the development of a framework to provide guidance for action within existing structures and contexts. Implementation of the framework is outside the scope of the project, though consultation related to implementation helped inform the framework’s design.

High level recommendations for taking action are included in the framework. These recommendations seek to provide a focus for universities and the mental health sector as they demonstrate their commitment to implementing the framework.

Sample planning matrices are also included to offer a starting point for reflection and identification of next steps aligned with the framework principles. Self-assessment tools developed for other contexts are referenced to provide examples of structures which may be considered for use in the Australian context.

The framework is a voluntary guide. The Australian Government’s Tertiary Education Quality and Standards Agency (TEQSA) is the regulatory authority for Australian universities. Wellbeing and safety is regulated as part of the Australian Government Higher Education Standards Framework (2015),(1) which encompasses the provision of advice on access to student support services and the promotion of overall wellness and a safe environment on campus and online.

The framework is aligned with current reporting requirements, with flexibility for universities to determine their approach to implementation and reporting.

1. Australian Government: Tertiary Education and Quality Standards Agency. Guidance note: wellbeing and safety. Version 1.2 [Internet]. Canberra: Australian Government: Tertiary Education and Quality Standards Agency; 2018 [cited 2019 Jul 04]. Available from: https://www.teqsa.gov.au/latest-news/publications/guidance-note-wellbeing-and-safety.

The framework is supported by a full report and detailed case studies.

The full report provides further information on suggested activities and the evidence base informing the framework

The case studies highlight examples of good practice currently underway to support student mental health and wellbeing.

Orygen will continue to advocate for additional funding for resource development and support for universities in relation to student mental health and wellbeing.

Visit the Orygen webpage for the Australian University Mental Health Framework.