Barriers to students opting-in to universities notifying emergency contacts when serious mental health concerns emerge: A UK mixed methods analysis of policy preferences

Background: When students experience serious mental health difficulties, universities face the dilemma of deciding whether to notify trusted others such as parents. This study investigates the key factors underpinning students’ decisions not to opt-in to ‘consent to contact’, which would allow their university to notify an emergency contact of their choice in the event of serious mental health difficulties.Methods: An online survey was administered to university students in a UK institution with an active consent to contact policy. Students self-reported: (1) whether they had opted-in or opted-out of the policy, (2) socio-demographics, and (3) mental health outcomes including depression (PHQ-9) and anxiety (GAD-7). Students who recalled not opting-in were invited to explain their decision via qualitatively analysed free-text responses.Results: 2637 students responded, 648 (24.57%) recalled opting-in, 463 (17.56%) recalled not opting-in and 1432 (54.30%) were unsure how they opted. Students currently experiencing moderate/severe anxiety and depression demonstrated lower rates of opting-in than students not experiencing these difficulties. The most common reasons for not opting-in were ‘not wanting emergency contacts to worry’ and ‘preferring to tell emergency contacts themselves’. These policy decisions were underpinned by four qualitative themes: ‘unhelpful anticipated outcomes’, ‘seriousness of student difficulties experienced’, ‘quality of relationship with their emergency contact’ and ‘situational appropriateness’.Limitations: This study focussed on students at a single university.Conclusions: Students who are at greater risk of mental health difficulties may be resistant to wider support networks being contacted. Future research is required to address barriers to opting-in for students most at-risk.