Integrating Mental Health in Curriculum Design: Reflections from a Case Study in Sport, Exercise, and Health Science

Abstract

The rise of mental health concerns in today’s Higher Education (HE) students is a growing concern. Integrating mental health principles into curricular design can enhance the student experience and improve outcomes such as continuation, completion, and success. This paper aims to integrate mental health guidance into the design of a revalidated curriculum in sport, exercise, and health sciences. A further aim is to provide recommendations for future mentally healthy curricular design. A case study design exploring how mental health does, and might, feature across curricula was undertaken, employing a qualitative methodology. A range of stakeholders, including students, participated in workshops, interviews, and revalidation events over a 4-month period. The analysis and interpretation of the resulting transcripts proposed two main lines of action; ‘building students’ (centring on helping them navigate the nuances of the academic process and developing confidence in their university self, for example, through systematic scaffolding) and ‘building connections’ (focusing on enhancing social connections and psychological safety, for example learning student names). Recommendations proposed by this research highlight that induction should be primarily social, progressing to more fundamental skills, behaviours, and knowledge. Systematic scaffolding and mapping of relevant skills, behaviours, and knowledge throughout the course are fundamental to building students’ confidence. This could reduce both academic staff and students’ frustrations about a lack of ‘know-how’. Staff–student interactions and a focus on micro-behaviours could further enhance a student’s sense of belonging and desire to engage.

1. Introduction

Mental health can impact student satisfaction, engagement, continuation, and completion (Hughes & Spanner, 2019). However, poor mental health amongst students is increasingly reported; 57% of students self-reported a mental health issue, and 24% reported having a diagnosis, according to UK data (Student Minds, 2023). Mental health is the most common driver for dropping out of university, higher than any other factor, beyond financial support or course content (Sanders, 2023). Recent UK data showed that students who feel supported by their university feel better about their wellbeing and are significantly less likely to consider dropping out (Studiosity, 2023). A bi-directional relationship could be at play, where enhanced mental health is related to academic success, deeper learning, and higher student satisfaction, and vice versa (Hughes et al., 2022; Boulton et al., 2019; Houghton & Anderson, 2017).

The Higher Education (HE) curriculum is a guaranteed touchpoint with students and, therefore, is key to enhancing perceptions of student support and mental health (Hughes & Spanner, 2019). Evidence highlights that elements of curricular design, such as scaffolding, authentic assessment, and meaningful classroom tasks, are associated with better mental health (McArthur, 2023; Kirschner & Hendrick, 2020). Interventions taught through the curriculum could enhance student mental health and potentially reduce mental ill health by reaching more students, rather than solely treating those with a declared mental health challenge (Upsher et al., 2022). Wellbeing interventions are often offered as an option within the curriculum or as an additional programme, these include stress management, mindfulness, and positive psychology education (Upsher et al., 2022; Hobbs et al., 2022). These interventions have found mixed findings, with some studies demonstrating improved mental health and others showing no relationship. In part, this variability is explained through heterogeneity of methods and measures implemented across the studies (Upsher et al., 2022). However, these interventions focus explicitly on strategies to enhance mental health, which may limit the impact and only reach those who are interested in developing their mental health. Furthermore, some of these interventions are optional and are not fully integrated into the curricular design and delivery. To further enhance mental health, a consideration of wider curricular design and pedagogy could be beneficial. In the UK, an Education for Mental Health Toolkit (EMH) (Hughes et al., 2022) has been produced, emphasising principles of curricular design.

This EMH toolkit is underpinned by similar principles to those outlined in the University Mental Health Charter (Learn Theme) by Student Minds (Hughes & Spanner, 2019). The principles in the EMH toolkit include social belonging, which focuses on the connections between the students, their tutors and their environment; learning focus, which highlights that developing a mastery learning focus can enhance deep and meaningful learning; scaffolded design, guides students from novice to independent learner and can provide stretch and challenge; learner development highlights how developing students’ academic competencies can develop their self-efficacy, self-attribution and self-management. The principles within the EMH toolkit are produced to inform curricular design. However, the application and integration of these principles across an entire curriculum is yet to be carried out.

The aim of this study is to design a revalidated curriculum informed by EMH guidance and the experiences of students and practitioners on curricula and student mental health. A secondary aim is to produce recommendations on how to integrate mental health principles into curricular design.

2. Methods

A case study design was conducted over a 4-month period from February to June 2023. This design was chosen to enable a deep exploration of a course, allowing rich data collection from multiple sources. This study was conducted at a university in the north of England, focused on a sport, exercise, and health course, and included listening workshops, course development workshops, and stakeholder and revalidation events. This paper reports on the findings from listening workshops and interviews and reflects upon the integration of these findings into the course documents of the revalidated course. Thus, resulting in recommendations as to how to integrate mental health principles into curricular design. An overview of the process can be seen in Figure 1.

This study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Leeds Beckett University, February 2023.

Recruitment

Participants were recruited through communication systems internal to the university. This included advertising the project in staff newsletters, existing email groups, and blackboard for students. All the participants were informed that this study would involve discussions around their experiences of curricula and mental health and explore how mental health principles could be integrated into the curriculum of the revalidated course.

Listening workshops

Three listening workshops took place with a total of 21 participants: six students, eight academics, three wellbeing colleagues, and four colleagues from the Centre for Learning and Teaching (CLT). Workshops lasted three hours and included small group discussions about experiences of mental health principles as outlined in EMH. Discussions were centred on the principles of social belonging, learner focus, scaffolded design, and learner development. Participants were encouraged to share examples of good practice, barriers to best practice, and examples of practice which could impact on students’ mental health, in either a positive or negative manner. The workshops were conducted by the principal researcher and a research assistant. The workshops were audio recorded and transcribed, with all names being altered to pseudonyms.

Interviews

Two interviews were undertaken with experts on student mental health who were external to the university. These interviews were conducted online, recorded, and transcribed, and lasted approximately 60 min. All names were altered to pseudonyms during the transcription process.

Course development workshops

Two course development workshops were conducted with academic colleagues who were developing the course for revalidation. The first workshop introduced the key principles of developing a mentally healthy curriculum to 21 members of the health and exercise course team. The second workshop shared findings from the listening workshops with 25 members of the course team about how to integrate the findings into course design. Activities involved (i) sharing and identifying the academic and learner development skills, behaviours, and knowledge relevant to the course, (ii) mapping the identified skills and behaviours across the levels and modules and (iii) writing the skills and behaviours into the course and module learning outcomes, assessment, and indicative content.

Mapping of skills and behaviours

The mapping process began in course development workshops (see above) where skills and behaviours relevant to the course were identified. Examples of identified skills included academic skills, such as writing, applied skills, such as communication with clients, self-management skills, such as planning and self-regulation, and learner development skills, such as developing group work skills. Module teams discussed if and how any of these skills could be integrated into their module learning outcomes, assessment, and learning activities. Subsequently, JH reviewed each module and systematically mapped the identified skills across all the modules and the course. This highlighted further inclusion of identified skills was necessary to fully integrate principles from the EMH toolkit. Discussions with course directors were conducted, facilitating further alterations.

Stakeholder event

A stakeholder event was part of the revalidation process, which involved discussion with four external stakeholders who work in a relevant field, students, and members of the course team. They discussed and provided feedback on the proposed changes and the integration of mental health principles into the curriculum.

Curriculum Revalidation Event

Revalidation of a curriculum is periodically undertaken for all courses. This process entails a thorough review of a course and considers what content is required at the current time. This involves consultation with senior leadership, academic colleagues, CLT colleagues, current and past students, and external stakeholders. The revalidation event is an essential part of the revalidation process, where the proposed curriculum is assessed by a panel of internal and external stakeholders. The process involved student consultation, a review of the submitted paperwork, a presentation, and a discussion of the proposed course. The course was approved for revalidation and commended for the mentally healthy curriculum design.

Data Analysis

A reflexive thematic analysis (TA) (Braun & Clarke, 2006, 2019) was carried out on all the listening workshops and interview data. An inductive analysis was conducted to allow for wider reflections on how to enhance mental health through curricular design. This involved a bottom-up approach to analysis where themes were generated from the data collected in the listening workshops and interviews, rather than enforcing pre-conceived theory and ideas. The principles from EMH informed the listening workshops and interviews; however, these were not used to guide the analysis, as a wider exploration of mental health curricular design was warranted. However, the principles from EMH were aligned with the generated themes at stage five. Therefore, the themes are structured in a way that reflects the pragmatic nature of course design and builds on the principles outlined in EMH, rather than reflecting the same names and themes. The findings include reflections from staff and students about the complexity of integrating some of the EMH principles. Reflections obtained through the course development workshops are integrated into the discussion of the generated themes. The findings culminate in some recommendations from our learnings.

Six stages of reflexive TA (Braun & Clarke, 2006, 2019) were implemented. Stage one involved familiarisation with the dataset and involved being immersed in the data by reading and re-reading the transcripts and noting initial observations. NVivo 14 was used at stages two and three to help generate initial codes and themes. The entire dataset was coded, followed by collating codes into broader patterns of meaning of potential themes. Thematic maps were generated and refined, culminating in the naming of the themes. This encompassed stages four and five of Braun & Clarke’s TA, which was iterative and was continually refined until the authors were content that the story being told reflected the participant’s experience. At this stage, principles of the EMH were aligned with the named themes. Finally, stage six of writing up was completed through the writing of this paper and entailed weaving together the analytic narrative with quotes from the data. At this stage, reflections from the course development workshops and mapping activities were woven into the discussion. This was further contextualised in the discussion of this paper by integrating the findings with the literature. The analysis was predominantly undertaken by the principal investigator. To ensure rigour in the process, two critical friends (a research assistant and a fellow author) supported the analysis at stages four, five, and six of the TA. This involved discussing the thematic maps and respective data extracts to ensure that the quotes and themes (a) represented the participants’ initial data and (b) provided further depth and understanding to the data. Furthermore, to ensure fidelity to programme aims, referral to the aim was continuously undertaken.

Table 1. Overview of key findings: building students and building connections.

Theme	Sub-Theme	Principle from EMH
Building students	Academic and student frustrations - Clarity of information - Systematic scaffolding of skills - Teaching and assessing the learning process - In class feedback - Meaningful assessment - Integrating learner development skills into the curriculum Normalise emotions	Learning focussed Scaffolded design Learner development Learning focussed Learning focussed Learning focussed Learner development
Building connections	Induction Psychological Safety - Academic micro-behaviours - Boundaries	Social belonging Social belonging Social belonging Social belonging

(as seen in the results) shows the final thematic map and represents the experiences of mental health within curricula and reflections of integrating the EMH principles into a revalidated course. Further to this, Figure 2 was established to include the recommendations based upon the participants’ data. This figure can be seen at the end of the results and represents the findings from the TA but is organized into pragmatic ‘how-to’ recommendations.

3. Results

Two main themes, building students and building connections, were generated, which represent the experiences of mental health across curricula from the participants within the listening workshops and interviews. Reflections on how these informed the design of the curriculum revalidation are discussed within the themes and shared in the green boxes. Challenges of integrating the findings into the curricular design are also discussed. The principles from EMH are outlined in the table to demonstrate how these link to the generated themes. Table 1 demonstrates the main themes and sub-themes and highlights where the principles from EMH are integrated.

3.1. Building Students

‘Building students’ addresses how we can support students to develop themselves and their commitment to learning. This integrates principles of scaffolded design, learning focussed and learner development from EMH. The workshops highlighted those activities which recur across the curriculum, provided opportunities for repetition, progressive development, and enhanced confidence. This included developing subject-specific knowledge, but importantly also developing skills and behaviours associated with being a university student. Skills for development were associated with traditional academic skills as well as those associated with well-being. These skills are labelled learner development skills to align with the EMH. Development of learner development skills included searching and reading academic literature, note-taking and writing, group work, oracy, and reflection. It also includes the development of skills such as attention control, procrastination control, schedule planning, and resting.

Academic and student frustrations

In developing the overarching theme of ‘building students’, tensions were identified between what students need and are prepared to invest in and what the institute provides and expects. These tensions were highlighted as a result of discussions in the workshops about scaffolded design and learner development. A key frustration between academic staff and students was the expectation of staff that students should ‘know’ things. Throughout the ‘building students’ theme, we discuss what we have learnt about frustrations for staff and students, and we aim to prevent this through systematic planning of the course revalidation with a key goal to enhance student confidence. This is discussed through the following sub-themes.

The workshops highlighted that academic staff presumed that students would have more knowledge about key information, such as assignments and how to access basic information. This aligns with the concept of the ‘hidden curriculum’ (i.e., the rules and norms of the university which are not always explicitly taught and are often assumed), which was discussed in some of the workshops. For example, students were unsure how to address their tutors, how to balance asking for help with developing independence, and were even unsure about ‘rules’ for waiting before entering a teaching space. Participants from CLT discussed the hidden curriculum and highlighted how the first year should be developing student skills, which become a habit.

‘This first year is about making sure that if nothing else, you transition into a different way of learning and next step up, which will take some time. That’s one of the reasons why it doesn’t actually count. But you will be learning and we will expect you to engage. And we will expect you to come to us with questions. So we can help you make that transition. It’s almost like seen as a transition year. And I don’t see any reason why that could should be a harmful way to talk about that first year as a way of building relationships, transitioning into a new environment and learning how things operate so that when you go into the second year, you’ve turned those routines into more functional habits’.

(Becca, CLT)

However, students often are not taught how ‘to be’ a student, nor where to find potential key information. Sometimes, accessing this information can be problematic and a source of frustration for both students and academics. Academics were frustrated that their usual approach to signposting was only sometimes effective.

‘Lots of students will talk about the fact that they don’t know what’s required of them. And I always find that surprising, because I say, “Well, have you read your module handbook? Because it’ll tell you in there”, and often that there’s a bit of confusion around what a module handbook is, or, you know, stuff that like that. I find it surprising, because I think, why is this not being explained to you’

(Jane, Academic)

Clarity of information

The quote above highlights the surprise academics can feel when students do not seem to know where and how to access seemingly obvious information. Furthermore, academics were often frustrated by what they saw as ‘handholding’ and having to repeat information:

‘ambiguously worded assignments that students haven’t been properly prepared to talk about. When then students ask perfectly legitimate questions about “how should I go about this?” are then being told, “well, it’s pretty easy to figure that out, you’re at university”. And that’s a classic one we come across actually, They’re thinking that “well, if I help you, then that’s dumbing down or, you know, I’m not stretching you”. But actually, if you don’t know how to go about starting to do something, then you’re just lost. That’s not stretching somebody that’s just abandoning’

(James, Academic)

It became clear through the discussions that some of the frustrations for academic staff are students not engaging with already prepared information. Often, it seems, academic staff can overlook that students are new to this information and way of working, where academics may be familiar after sharing and using the same information for many years. For instance, some information is only shared once at the beginning of a level or module. Therefore, it is recommended that information is coherently and consistently shared; one way to ensure this is to include students in the development of the course and module material.

What we did: Students and stakeholders were involved with the design of the new curriculum. Students will be involved with new material developed for the new validated course.

Systematic scaffolding of learner development skills

A further source of tension was students not knowing how to do certain academic skills, which academics believed they should have mastered. Academic skills have been labelled under ‘learner development skills’ as this aligns with the theme from the EMH guidance. While many students progressed perfectly well, for others, discrepancies arose from assumptions made on all sides; students were not universally exposed to, and/or did not engage in, deliberate, systematic use of essential skill areas either before or through their courses. Academic writing skills were discussed the most frequently, with it being a source of frustration for staff and students alike. Academic colleagues often felt disappointed in the quality of the writing within assignments. At the same time, students often felt they remained unequipped, especially so with the concept of ‘critical’ writing as the degree progressed. An academic participant underlined the importance of creating opportunities to apply the skills that underpin writing critically in supervised sessions:

‘I’ve heard that be raised multiple times, over recent years, that they’re not prepared when they get to that higher level, that kind of writing is nowhere we expect it to be… Literally, because there hasn’t been enough opportunity to do it’.

(David, Academic)

Systematic scaffolding throughout the entire curriculum could alleviate frustrations for both students and academics. As a key principle from EMH, scaffolding was frequently discussed, with many examples of good practice highlighted. However, few practices were consistently repeated and developed. Instead, the focus tended to be on scaffolding knowledge across disciplines, rather than on developing learning-focused curricula and fostering learner development skills and behaviours across the entire curriculum.

Since many tutors teach across multiple modules and often in different discipline teams, students miss out on the satisfaction of making sequential improvements. This lack of systematic scaffolding meant that students did not experience the progression that comes from building on previously acquired skills. Academic staff often assumed that fundamental skills were being covered in other modules, leading to an overestimation of students’ abilities in these areas. It was suggested that only when these fundamental skills are mastered can deeper learning take place. Thus, highlighting a need to develop student skills from the beginning of their university career, beginning with aspects of the hidden curriculum.

What we did: We identified learner development skills for the course and shared these with the course team responsible for developing the course and associated modules. Academic staff were asked to consider where these skills could be developed in their modules and embedded into learning outcomes, assignments or classroom tasks. These skills were then mapped across the entire course to show how they developed. These tasks were conducted within the course development workshops

Teaching and assessing the learning process

Not only were academics frustrated at some students’ low levels of competence, but their frustration was also amplified by some students’ apparent indifference to this. Yet, students told us they have often had no opportunity—nor had they ever been required—to learn and/or develop some basic competencies. Furthermore, the step-by-step process of developing the skill was often never begun.

An idea shared by both academic and CLT staff, to address learner development, skill development, and confidence, was to log and review skills in a portfolio maintained by both the student and their personal tutor/academic advisor. It became clear that this should also include reflections of the process of developing these skills, and the process should also be assessed. This suggestion would aid scaffolded design and learner development principles of EMH.

‘This is about the process and what you learned on the process. I say that a lot. Okay, what happens in your job if you don’t work well together as a team, and you try and make it relevant…It’s always been a hard sell—group work—but maybe the answer is, we evaluate the process. So how well they’re working together as a group, rather than what the end product is purely. So the end product is what the presentation or a written piece of work. Okay, that’s 30%, but actually, we’re going to evaluate on how you work together as a group’

(Felicity, CLT)

Teaching and assessing the processes underpinning group work, making presentations, writing short sections of essays, and using reflective questioning to review study designs were found to support students. Equally, students appreciated the value of specific session content when they see how it contributes to wider ‘Why?’ questions, like ‘Why do I need to know this to do?’.

‘One thing I thought was pointless coming out of a seminar, you know, the ones where they’re like, it’s practical and …we’ll do tests that might be interesting… but you just put it all on a sheet and then you put it in your bag, and you’re probably never going to look for that. Yeah. And I’d rather just spend it getting to know the assessment’.

(Simon, student)

This student reflects a sentiment that academics frequently hear and adds frustrations among students. However, integrating the development and process of skill development in class and assessment could enhance the meaning of the work for students and academic staff. This could be further promoted by reinforcing to the students why this skill is important for their course, any future career, and their current life and lifestyle.

Developing progressive practices in these areas was seen to build confidence and competence; this positive attention could also displace the many frustrations of both students and academics. Academic staff also felt a sense of satisfaction from seeing students develop as people as well as developing their academic skills. University staff who worked collaboratively with library colleagues, who have expertise in academic skills, stated further confidence and development of these skills among students.

What we did: Replaced some knowledge oriented learning outcomes with process oriented learning outcomes. It was also recommended that academic staff include skill process development within the indicative content of the module specifications and assessments. It is recommended that this is developed across the entire course and not the focus of specific modules.

Meaningful assessment

Participants highlighted that designing a meaningful and authentic assessment, which integrates the process, could help students engage with the development of skills as well as the assignment itself.

They may do like a podcast on it. Or they may do something a bit more creative, something that might be for the public, or for a professional view. So yeah, they do lots and lots of creative type assessments, which, that that to me is authentic assessments what you’re going to actually use in your next job, or how could you use them? Rather than just sitting an exam? Or, you know, writing an essay on something that’s quite abstract?

(Pam, CLT)

Meaningful assessments included replicating activities and developing skills required in the workplace. However, it also included developing assessments with appropriate challenges and opportunities for growth.

However, several barriers hindered the implementation of authentic assessment across the entire curriculum. Meetings with course directors revealed that the marking burden significantly impacts the mental health of academic staff. Consequently, ‘more efficient’ assignments, such as exams, were sometimes adopted. Additionally, the size of modules and the need for marking consistency posed challenges to implementing more applied, authentic assessments. Shared modules across different courses, each with distinct learning outcomes, further complicated the integration of authentic assessment across the curriculum.

What we did: Where possible assessments were designed which were authentic. Furthermore, more detail of assessment type was written into revalidation documents to ensure that authentic assessment is implemented as planned.

Integration of learner development skills into the curriculum

Developing learner development skills, such as self-regulation, self-management, and self-attribution, was regarded as an asset to any course. However, it was also clear that these skills should not be an additional or optional aspect of the course but should be integrated into modules and include credit.

‘We typically will get your 18 year old who’s just coming out of college … if they don’t hand the homework in then there’s a consequence to that they’re held to account. And now coming in, they’re having 12 hours contact time a week. It’s free time. And actually, it’s on there, automatically taking responsibility for their own learning in a new environment, where they’ve never been before. So, it’s finding that balance between holding them accountable in the first week for certain things that they need to do, because that sets up engagement moving forward. But also learning that they do have to… there is that level of independence. And it’s a really hard place’

(Felicity, CLT)

Normalising negative emotions

Learner development skills included managing and discussing emotions, specifically, anxiety and nerves. Responsive examples included discussing how speaking aloud and doing presentations can be anxiety-inducing and exploring options for handling that anxiety. It was suggested that academic staff might share examples where they have also felt nervous and how they have managed these nerves.

‘And just knowing that feeling anxious is normal…and stress and worry will pass and you’ll be alright, it’s gonna be okay. But you just need to practice. If you practice with your peers… I hate doing presentations. But now I’ve learned to love it. Because it’s what I have to do. But it doesn’t mean you don’t worry. You just have to use it to your advantage, being able to teach kids that you can pick up on like, if you’re hot, you’re sweaty, you’re a little bit out of breath, how to manage that with really basic techniques, but then how to use that to your advantage. Because you can use that to your advantage and do well in presentations’

(Claire, Well-being)

Academics highlighted that some may need training to enable them to have these conversations with students to help with their own confidence in talking about emotions and being clear on boundaries in order to determine when a student might identify with more serious mental health problems and need referral to wellbeing services.

What we did: Wrote learner development skills into the course documents including learning outcomes and indicative content. It is also recommended that academic staff are supported in discussing emotions associated with assessments with students.

3.2. Building Connections

‘Building Connections’ relates to meeting the developmental needs of young people to feel welcome and, then, to feel belonging. This is underpinned by the social belonging theme from the EMH guidelines and relates to enabling students to feel comfortable in their surroundings. The workshops delved deeper into social belonging and explored how and where in the curriculum this can be developed for student mental health.

Induction

In the initial stages of HE induction, students were keen to avoid ‘being bombarded’ with information and detailed processes. In terms of adapting to university life, foundational information was often found to compete with other types of information. Both staff and students highlighted that a more considerate form of induction would last longer than the conventional one week. Several examples of longer inductions were discussed: from six weeks to a year. The consensus was to focus the first week of induction on social processes—learning students’ names (and vice versa), doing shared activities, and connecting with others—progressing, in subsequent weeks, to building their knowledge and skills relevant to the course.

‘Getting people just having fun doing something fun together. Once people can feel at ease with each other and with you guys as the staff team, I think that reduces that that level of distress that a lot of students are probably feeling when they first land. And you can’t learn when you’re in that state, when you’re just a bit overwhelmed by everything. Whereas once you know who your mates are and you can feel safe around people, that’s when the learning can start taking place.’

(Helen, CLT)

Examples of positive inductions included residential programmes, walks, and sharing a coffee and/or lunch, and were seen as strengthening social bonds with coursemates and with academic staff. This supported students to feel like they belong in university life and affiliate with their courses.

Steph: That walk was good.

Melissa: Yeah. That was like to share ideas with the younger people and the older people to share ideas. And that was nice and different.

Laura: It was a relaxed setting and not the pressure of like getting something right.

The example above refers to a walk on a local trail for a cohort of students from different levels of the same degree. It was optional, with mixed attendance from the different levels. However, those who engaged found it beneficial to engage in relaxed conversation rather than the forced conversation that is often required in classrooms. Organized social activities are not always well attended, and this is a source of frustration for staff who understand the benefits. Therefore, a recommendation is to build social skills into course learning outcomes; these could also be included in module learning outcomes and be central to an academic advisor programme.

What we did: Recommended that induction is social focussed. Information on the course and wider university policies to be shared after the initial getting to know you phase. This information should be shared frequently.

Psychological Safety

Creating a space where students feel psychologically safe was seen as paramount to self-efficacy and involvement in class activities. Classes were described as spaces where students should feel able to ask questions and share their thoughts and ideas, even contentious ones. They also presented an opportunity for students to be reassured about their progress. Staff micro-behaviours appear to be paramount in developing psychological safety.

Academic micro-behaviours

Staff micro-behaviours can impact the engagement and mental health of students, often unknowingly. Micro-behaviours include how quickly an academic speaks (or the overall academic ‘level’ of their vocabulary), how they enforce rules, and how they communicate. Micro-behaviours include smiling, making eye contact, holding an open stance during conversations, using students’ first names, sharing personal interests and experiences (hobbies, children, etc.), and encouraging peer-to-peer (one-to-one, one-to-some, some-to-some, one-to-many, some-to-many) interactions, rather than enforcing them.

Melissa: Yeah. I think it’s nice when they talk to you about other stuff than just Uni.. You actually think, Oh, they’re actually interested in something than their bit. …

Sophie: When they tell you about the dogs. Yeah. It’s nice to know about them and they know about you so it’s nice to do back.

Laura: Yeah. It’s nice. Like even yesterday in that nutrition and we were on about their marathon.

Melissa: It makes you want to go more if you can be chatty with them rather than sit and listen.

Sharing a little bit about ourselves helps students to feel safe and to share a bit of themselves. This enabled students to feel more comfortable and confident in responding to in-class discussions and asking relevant questions, seeming to enhance engagement in the classroom.

Boundaries

Micro-behaviours also relate to how boundaries are formed within the classroom. However, this often appears to be determined on an individual level, rather than agreed upon by a course team. For instance, one member of staff shared how he would invite latecomers into classes, whereas others have a strict policy of not allowing students to enter classes after an agreed time frame.

‘example being someone turns up late. It might be because they’ve not been, organized. And that’s immediately we look at when they’ve turned up late. But it is not like they haven’t turned up. So, I congratulated and commended someone for coming in half an hour later to the session. The reason for that was, they had made what I feel was an incredibly brave decision at the start of a new semester. So, knowing the context there, I knew that they would probably not know everyone there. And I said, Thank you so much, you know, I don’t need to know the reasons why you’ve decided to come. It’s not disruptive anything, let’s get on. That person came up to me at the end and said ‘so thank you very much for just making me feel like I can make that call. And I was incredibly nervous and embarrassed coming on’.

(David, Academic)

A further consideration of providing clear and consistent boundaries is around referral to wellbeing services. This links to the previous discussion of ‘normalising negative emotions’. The quote below highlights the fact that academic staff do not need to fix the tutees’ problems, highlighting that staff often show compassion, and that this can be enough, but that they should be referred to wellbeing services when it is appropriate:

‘They can show care and support by saying, this is something that I’ll be honest, isn’t something that I’m in the best position to help you with. However, there are support mechanisms available. I think that’s the training, I’m thinking of’

(Debbie, Well-being)

However, this discussion of referral to wellbeing services also resulted in conversations around academic staff training and knowing where the boundary is between healthy mental health and mental ill health. This may require intervention and referral.

What we did: Developing social learning outcomes and indicative content focussed on social connections were promoted. Further academic staff training is required for discussions on emotions and well-being.

3.3. Recommendations

The findings have culminated in recommendations about how to integrate principles outlined in EMH. These recommendations have been discussed in the findings and summarised within Figure 2.

Figure 2 focuses on ‘building’ and on bricks, which fits with our emphasis on development occurring over time. Bricks represent discrete processes for wholesale adoption. We emphasize routines since these are small, ordinary actions, meaning they are more likely to be implemented. People affected by time-pressures and/or fatigue are often forgetful; this is another reason to favour routines—they are often activated by the inevitability of contexts, people, and/or other systems. Finally, we also encourage others to develop their own bricks in order to build bespoke approaches to curricular design.

4. Discussion

The aim of this study was to integrate EMH guidance into the curricular design of a revalidated course in sport, exercise, and health sciences. A secondary aim was to produce recommendations on how to integrate EMH guidance into curriculum design. The process of integrating mental health guidance into curricular design has highlighted the importance of both ‘building students’ (helping students solidify satisfaction with their ‘university self’) and ‘Building Connections’ (making links and finding people who will help one another).

‘Building students’ highlighted how there is a need to develop students’ confidence in their self as students through skill development within the curricula. However, one of the key findings was academic staff and students’ frustrations about what staff believe students should be able to do and know, and what students actually have the confidence and ability to do well. This supports the work of Kirschner and Hendrick (2020), who discuss that learning processes can seem clear to the experienced academic, but, for students, these same processes can be confusing, leading to feelings of anxiety and discontent. Therefore, a full curriculum underpinned with a scaffolded design was written into the revalidated course. Our study found that scaffolding is evident in some places on existing courses, but rarely systematically throughout an entire course. Barriers to full implementation of scaffolded design across courses included academic staff often working in silos or in small teams to develop modules rather than as a whole course team, learning outcomes focussing on knowledge development, rather than learner development or mastery development, and assumptions that these skills are developed in other modules or before the onset of their degree. The findings of this study highlighted that providing clear and consistent information from the very beginning of the course and a gradual development of learner development skills could support scaffolded design. As scaffolded design is known to reduce anxiety and enhance confidence (Hughes et al., 2022), learner development skills were identified and systematically mapped across the whole degree. Thus, ensuring that the student’s skills will be gradually built, creating strong foundations and confidence in the student’s university sense of self. These successes are important for revitalising commitments to learning (and dealing with setbacks) and for creating a new identity as a fully-fledged university student (Kirschner & Hendrick, 2020). Success rates of around 85% have recently been identified as optimizing the acquisition of learning routines (Koedinger et al., 2023) and supporting academic persistence (Eskreis-Winkler & Fishbach, 2022). Once these routines are formed, they can continue to be refined across the university career and across lifelong learning. Furthermore, these skills can be developed and documented in class, which can enhance students’ perception of their learning as meaningful, avoiding a constant focus on assessment (Hughes & Spanner, 2019)—a further frustration for academic staff. Developing a portfolio of skills across an entire course was highlighted in our findings as a promising means of supporting learner development skills and confidence. Embedding skills, such as critical writing and stress management, within curricula has been found to enhance mental health (Worsley et al., 2022). Systematically mapping and tracking the learner development skills could enhance student confidence and prevent staff frustrations. However, further research and evaluation are required to explore how this impacts students’ mental health and evaluate how this is integrated into the delivery of curricula. Further research could also explore how students construct a university identity and how curricular design can support this process.

Learning outcomes were developed to include learner development skills, well-being, and process-based learning, rather than the dominance of knowledge learning outcomes. The development of these learning outcomes meant some creativity and deviation from Bloom’s taxonomy of learning outcomes (Bloom, 1956), which still dominates the language used in UK universities. However, these learning outcomes were generally well received by the course team, CLT, and Quality Assurance. Further research could explore the development of learning outcomes with mental health at the forefront. Integrating learner development skills into modules and learning outcomes will confirm our collective commitment to these features because they are so fundamental to the learning process (Stallman & King, 2016). Furthermore, developing confidence in these skills enables further and deeper learning (Hughes et al., 2022). Wellbeing interventions or psychoeducation embedded into curricular design have had mixed success, with some having a positive impact on student mental health (Upsher et al., 2022). However, these courses are often optional and solely address wellbeing. In the current study, learner development skills, such as self-regulation skills, were integrated into the learning outcomes and curricular design. Including these skills and the process of developing these skills in learning outcomes will make them front-and-centre commitments and prioritize them in everyday delivery and in management capabilities.

Based on these learning outcomes, some process-oriented and authentic assessments have been written into the revalidated course. This is recommended by EMH, with evidence outlining that assessments can be beneficial for mental health if they have an appropriately scaffolded challenge (Upsher et al., 2023). However, implementing authentic assessment throughout the course was difficult. A paradox was highlighted, where academic staff chose knowledge-based assessments, such as exams, over authentic assessments, to protect the mental health of colleagues, as a result of the perceived marking burden associated with authentic assessment. To alter this perception, it is recommended that confidence-building for academic staff be provided, in terms of implementing authentic assessment, and that education about the potential mutual benefits of both staff and student mental health could be provided. This study further highlighted that any changes to academic staff practices and behaviours need to be seen as easy, with limited impact on their often-stretched workload. This is reflected in the ‘what staff can do easily’ statement in Figure 2 and includes developing meaningful in-class tasks, which relate to learner development skills and preparedness for assessment tasks. Furthermore, assessments that are meaningful for students and time-efficient for academics could be created. Examples within this study highlighted Vivas and process-oriented group work; however, further research could explore this paradox of meaningful yet time-efficient assessments. The use of behavioural science to educate staff about curricular design and mental health could also be explored.

Just as we need to build students, in their turn, students want and need to ‘feel known’ to others (Schroeder & Fishbach, 2024). Embodying this idea, ‘Building Connections’ relates to meeting the developmental needs of young people to feel welcome and then to feel belonging. A recent belonging-based RCT intervention increased students’ attendance and grades in two large college science courses (Binning et al., 2020). These needs prioritize respect and involvement with others.

Seen in this way, it also involves social belonging and creating psychologically safe spaces where students feel comfortable in their surroundings. Crucially, interconnectedness is increasingly recognised as being a public health priority in its own right (Kubzansky et al., 2023) and central to many of the mental health problems affecting the HE community.

The routine micro-behaviours of academics can foster a more engaging and psychologically safe space in which students feel more confident to make active contributions and be willing to return to the classroom. Central to this is to emphasise support that moves each learner forward. To further strengthen positive social interactions with peers, administrators, and tutors, a ‘whole course approach’ is justified, beginning in induction and continuing through to graduation. The ‘overwhelm’ of the initial experience may persist for many weeks, as has been identified in workplace inductions for 18-year-olds into PriceWaterhouseCooper (Price Waterhouse Coopers, 2023). Therefore, it is proposed that inductions are ongoing and focus on social connections and activities. Any information that is provided during induction needs to be clear and consistently shared with students.

Strengths and limitations

A range of stakeholders were included in this study, offering a wide range of perspectives on the curriculum design. However, the academic staff were mainly from sport, exercise, and health sciences; therefore, wider academic insight could be beneficial. Furthermore, this study is limited to one specific course; further exploration outside of this course and the university could further the recommendations.

The integration of EMH guidance was, at times, curtailed due to constraints within the system, such as shared modules on other courses and staff perception of workload. Therefore, a longer development time before the revalidation could have aided the integration of the principles from the EMH toolkit. Further education and time spent with course directors with shared modules could have aided the integration of the guidance.

The workshops promoted insightful and meaningful conversation, and participants reported how they valued their inclusion and the opportunity to support important work.

5. Conclusions

This study reports on the integration of EMH guidance into a revalidated course design and provides recommendations for future practice. The findings and recommendations were generated through workshops about curricular design and the experiences of student mental health. Key findings centred around ‘building students’ into confident learners and ‘building connections’ between their peers, university staff, and the university itself. To enable the building process, key learner development skills were identified and systematically scaffolded across a revalidated curriculum. Learning outcomes within the curriculum design reflected these skills; the development of learner development skills (such as well-being, self-regulation, and planning) and process-oriented skills (such as reflection of academic skills, e.g., group work), and the development of social skills, was advocated. Further recommendations include developing a portfolio of learner development skills and providing consistent and coherent information, beginning in induction with concepts of the hidden curriculum. Systematically mapping these skills and embedding them into learning outcomes was implemented to enhance students’ capabilities and confidence, and reduce anxiety, thus preventing the frustrations felt by academic staff and students alike. Furthermore, enhancing social connections was proposed through longer social inductions and through promoting the micro-behaviours of university staff, such as learning names and sharing a bit about themselves. This could facilitate an environment where students feel welcome and confident to share their ideas with others. Future research should evaluate the delivery of mentally healthy curricular design and how this relates to student success and wellbeing.