Settings-based

What is it? Settings-based approaches consider the whole student experience and integrate interventions to address challenges in any areas that might make a student’s life difficult. This is sometimes referred to as a ‘whole-system’ approach.

Evidence? Due to a lack of evidence uncovered by our review it is difficult to reliably conclude on the effectiveness of settings-based interventions on student mental health. To develop the evidence base, more UK longitudinal research is needed.

What is the intervention?

Settings-based interventions involve a holistic, ‘whole-system’ approach to implementing changes to improve mental health. This intervention holds at its core the principle that mental health is affected by a combination of environmental, organisational and personal factors. The intervention therefore aims to create a culture and environment that supports good wellbeing, provides effective support when needed and empowers individuals and communities to maintain their wellbeing. For example, this may include financial support interventions to aid financial anxieties, or interventions that improve a sense of security and belonging on campus. The delivery of this intervention involves strategic planning and often the collaboration of multiple departments.

How effective is it?

Due to a lack of evidence uncovered by our review,  it is difficult to reliably conclude on the effectiveness of settings-based interventions. We cannot identify comprehensive evaluations of interventions which qualify as  ‘whole HE provider approaches’ but there have been evaluations of interventions drawing on settings-based principles, see for example Fernandez et al. (2016). This review concluded that “There is inconclusive evidence related to the effectiveness of policies to promote mental health…the current body of evidence is scarce and more research is needed to recommend what are the best strategies.”

How secure is the evidence?

Our evidence review found only one study measuring the impact of settings-based interventions, outside the UK, and this is not of medium/high-quality and is therefore not summarised on this page.

It is important to note that this does not mean that this intervention does not work, nor that it is not being implemented. This style of intervention, requiring whole systems change, will be harder to evaluate. Furthermore, in being an intervention that affects the whole student experience, it may be more difficult to establish a causal link between the intervention and student mental health.

The lack of evidence is a strong indicator that the current research in student mental health does not map exactly across current practices and rapid developments in student mental health. To develop the evidence base on settings-based interventions, more UK longitudinal research is needed.

How do I evaluate this intervention?

Our evidence review uncovered no strong studies which evaluate the impact of settings-based interventions, meaning we cannot highlight any examples of good practice. We also cannot identify common evaluation pitfalls, as we have for other pages in this Toolkit.

Developing better evaluations of setting-based interventions is a key priority for the HE sector, and we are keen to hear from anyone conducting research or evaluation on this topic.

General guidance on evaluating interventions to improve mental health apply to this intervention and can be accessed on the evaluation guidance webpage.

Those looking to evaluate this sort of intervention may also find the TASO resources on quasi-experimental designs and evaluating complex interventions using randomised controlled trials (RCTs) particularly useful.

Where can I find more information and guidance?

• The University of Toronto has developed a suite of mental health support services to widen access to mental health care. As part of their redesign project, they looked at eliminating waiting times, streamlining care and referrals and renovating wellness spaces across their campuses. For more on the redesign project, please click here. A key component of the project was the development of the ‘Navi’ tool, a chat-based virtual assistant that can navigate students to a wide range of support and information such as  admissions, financial aid, careers and mental health.
• For guidance from the Mental Health Charter, please follow the links below:
  • Support services
  • Learning, teaching and assessment
  • Cohesiveness of support across the provider

Where does the evidence come from?

The evidence in the Toolkit was gathered via an evidence review undertaken as part of the Student Mental Health Project. For full details of this review, please see our Methodology document.

It is important to note that our review, and therefore this Toolkit, only relates to student mental health. The review did not cover other populations (e.g. school children, other adult populations) or non-HE settings. The review was also subject to other inclusion/exclusion criteria, outlined in the Methodology document. However, we have flagged some additional links to the wider literature where appropriate and included them under ‘other references’ below.

Please also note that the Toolkit pages only include Type 3 (causal) studies which have been rated as providing medium/high-quality evidence according to our evidence strength ratings. A full list of studies collated via our evidence review, including Type 1/Type 2 studies, and those rated as providing weak/emerging evidence, can be found in our Evidence Review Spreadsheet. A breakdown of these studies by type and strength of evidence is available to download.

Other references

Fernandez, A., Howse, E., Rubio-Valera, M., Thorncraft, K., Noone, J., Luu, X., Veness, B., Leech, M., Llewellyn, G. & Salvador-Carulla, L. (2016) Setting-based interventions to promote mental health at the university: a systematic review. International Journal of Public Health. 61 (7), 797–807. doi:10.1007/s00038-016-0846-4