University student counselling and mental health services in the UK are under increasing pressure to adopt Routine Outcome Monitoring (ROM) as a standard practice, according to a new review published in Counselling and Psychotherapy Research. The study, conducted by Michael Barkham and Emma Broglia, highlights the potential benefits and challenges of integrating ROM into student counselling services, a practice that has gained significant traction in clinical settings but remains underutilised in higher education.
The review underscores the importance of evidence-based practices in the context of student mental health, where the stakes are particularly high. University students face unique challenges, including academic pressure, social anxiety, and the transition from adolescence to adulthood. These factors contribute to a complex mental health landscape that requires targeted interventions.
Despite the well-documented benefits of ROM, which include improved therapy outcomes and enhanced clinical decision-making, its adoption in university settings has been slow. Barkham and Broglia attribute this reluctance to several factors, including concerns about the burden of data collection on both students and practitioners, as well as the potential impact on the therapeutic alliance.
ROM involves the regular collection of data on a client’s progress throughout therapy, typically through standardised measures administered at each session. This data is then used to inform clinical decisions, ensuring that therapy is responsive to the client’s needs and making adjustments as necessary. ROM has been shown to improve client outcomes by approximately 8% compared to standard therapeutic practices, making it a powerful tool for enhancing the effectiveness of mental health interventions.
In the NHS, session-by-session measurement is a hallmark of the Talking Therapies for Anxiety and Depression programme. But similar practices are not yet widespread in university counselling services. According to the review, only a small percentage of higher education institutions in the UK administer measures at every session, with many relying solely on pre- and post-therapy assessments. This approach, while useful, is seen as insufficient for capturing the full picture of a student’s mental health journey.
The review identifies several challenges that have hindered the widespread adoption of ROM in university settings. One of the primary concerns is the administrative burden associated with session-by-session data collection. Practitioners worry that the time required to administer and analyse these measures could detract from the therapeutic process and overwhelm both staff and students.
Additionally, there is concern that ROM could interfere with the therapeutic relationship, which is a critical component of effective counselling. Some therapists fear that the focus on data collection might disrupt the natural flow of sessions and create a more clinical, less personal atmosphere.
But the review argues that these concerns can be mitigated through careful implementation and the integration of ROM into the therapeutic process. For instance, practitioners are encouraged to use ROM data as a tool for facilitating deeper conversations with clients, rather than viewing it as an external requirement. By making data collection a collaborative part of therapy, practitioners can strengthen the therapeutic alliance rather than weaken it.
Barkham and Broglia make a compelling case for the adoption of ROM in university student counselling services. They argue that the benefits of ROM—namely, improved client outcomes and more responsive therapy – far outweigh the potential drawbacks. Also, as universities face increasing scrutiny over the effectiveness of their mental health services, the ability to provide data-driven evidence of success will be crucial.
The review also highlights the broader implications of adopting ROM, suggesting that it could play a significant role in securing the future of in-house university mental health services. As higher education institutions grapple with rising student mental health needs, the ability to demonstrate the effectiveness of their services through robust data will be key to justifying continued investment.
