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Interview with Liz Brewster

Liz Brewster is a Senior Lecturer in Medical Education at Lancaster University and has written extensively about student wellbeing and bibliotherapy. She gained her PhD from the Information School at the University of Sheffield in 2012, and has previously worked in public and academic libraries, before taking up research and teaching positions in health sciences at the University of Sheffield and University of Leicester. 

In June, Emma Fitzpatrick and Pete Williams from the Wellbeing Task and Finish Group caught up with Liz over Microsoft Teams to talk about how library collections can promote good mental health and what academic libraries can do to support student wellbeing.  

We started by asking Liz about the sort of things librarians should consider as they begin planning a wellbeing collection. For Liz, thinking through exactly what aspect of wellbeing you are seeking to address is crucial, and partnering with other services is key: 

I would like libraries to think about who they need to partner with in selecting the titles they put in their collection. And that can vary. So, if you’re thinking about bibliotherapy in the more traditional ‘books on prescription’ sense, focusing on different conditions and wellbeing techniques, then I would expect people to think about whether they’re working with their university counselling service or wellbeing service. 

But when we talk about mental health and wellbeing, there are diagnosed mental health conditions and then there are things that worry students, that cause anxiety. You could say that these are more at the wellbeing end’ of the spectrum. And there are resources that the library could provide in these areas as well. So, if students are worried about money, for example, we can’t necessarily help them to get more money, but we can point them to supportive services in the university, and we can also highlight books about budgeting or other practical skills that can help to manage these aspects of wellbeing. 

But in addition to these kinds of functional books, you can also think about bibliotherapy in terms of its capacity for emotional connection or even escapism. So, fictional texts might be suitable. But as an academic at a university, although I can tell you what books I find helpful or interesting, or go back to in times of stress, I‘m not eighteen anymore and I don’t know other people have found helpful or what’s been published recently. So here, you need to think about how to get students involved in recommending texts to each other, thinking of students themselves as partners. 

Liz also identified another type of book that is often forgotten: 

The kind of texts that are sometimes underused in bibliotherapy are ones about people’s real-life experiences – their stories of depression or anxiety and so on. There are lots of these books available now, written from various perspectives, and sometimes it seems as if bibliotherapy has firmly placed itself in the information category or firmly placed itself in the fiction category and actually there are these books in in the middle which can be the most helpful.” 

Another consideration is where to physically locate your wellbeing collection, which isn’t always straightforward: 

“You’ve got this tension between wanting to promote the collection and draw attention to it but also ensuring people feel comfortable accessing it. At my university’s library at the moment, they’ve got a big display at the front, it’s very open and very visual, and you could say that it’s helping to break down stigma and show people that these books are there, but you never see people actually going over to it! So, you need to think about where to put your collection to make it accessibleOne approach is for some books, particularly ones on mental health conditions, to be sort of woven into the collection as a whole, so that you can go to the ‘scholarly mental health and psychology section and also find ‘how to cope’ books as well. Obviously, you need multiple copies to be able to do this but, if you can, you’ll have the glossy ‘here we are’ promotion of the collection but will also be providing a route for people to feel comfortable accessing it. 

We spent some time discussing with Liz how to measure the effectiveness of wellbeing collections. This will depend on the purpose of the collection and, once again, partnering is important. 

I’d start by thinking about what outcomes you want to achieveIf the ultimate aim is to actually improve people’s mental health and wellbeing, or to increase their knowledge of certain conditions, then I would expect you to be working with your counselling service and asking: are fewer people using the services, are there shorter waiting times, or are people coming in better informed – those kind of things. 

However, often wellbeing collections are more about trying to open up conversations about mental health and reducing the stigma around it. In these cases, it can be difficult to assess impact. 

Even if you do something like monitor book issuesyou don’t really know if that book has helped someone  you don’t even know if they’ve read it! And a lot of the time people struggle to articulate what it is about a particular text that they’ve found helpful, particularly when they’re in the middle of struggling with something. It might only be later, when they’re looking back, that they can say: “actually, this book really helped me.” Often, the evaluation we do is often quite short term, so thinking more longitudinally and measuring over a period of time might be more useful. 

My background is as a qualitative researcher and I’m interested in what people think and feel about various aspects of mental health but sometimes when we try to measure bibliotherapy it can be quite reductive and we do it because it’s easy, or because it’s the only thing that’s possible. So, saving some of that resource and effort and putting it into something that might be a bit more complex or difficult to facilitate, is worth considering. Working in partnership with counselling and support services, who might be more trained in eliciting things from students, could give libraries richer data to help them analyse what’s going well and what’s going badly, and whether the collection is actually helpful for students.” 

We asked Liz whether she felt that libraries and librarians were equipped to partner successfully with other services. She believes it is well within the remit and the skillset of librarians but that, sometimes, true integration is missing.  

I’ve seen some wellbeing collections that almost seem to be led and driven by the counselling service and just hosted by the library, and some that are led and driven by the library and they’re trying to bring the supportive services on board. I think there would be a real strength in working to bring those together. Sofor example, in every book, you could have a bookmark that gave the number of the counselling service or the university nightline, that says something like “you’ve picked up this book, we understand you might be struggling with various things, you’re trying to work through them yourself, here are some other people who might help you.” 

One of the things that has come out of the research that I’ve done into public libraries is that people really like the autonomy of being able to just go and pick up a book themselves and think about it themselves. They can find too much attempt to put a structure around it unhelpful because this is one of the ways they are trying to deal with it themselves. 

Although books can have a positive impact on people’s wellbeing and mental health, this is not always the case. In fact, some books might have a negative impact. We asked Liz whether wellbeing collections should come with health warnings. 

“There needs to be an awareness of risk and an awareness of that duty of care that we have to students. If we accept that literature can be powerful and if we accept that there are different therapeutic approaches and some people take well to some and some people take well to others …  there’s always the danger of negative effects. If anything has power, or if anything is useful or potentially useful, then it’s also potentially not, so yes, we definitely do need to bear this in mind 

I get a little annoyed when people say, “books are a really good thing and will make you feel better,” when, actually, they won’t – not always. Sometimes they might make you feel worse; sometimes there might be a scene in a fiction text which upsets you. I’m thinking particularly about working with younger children and teenagers and books with scenes of suicide and things like that – it’s a sensitive subject for a lot of people and I think we have to accept the fact that books might not always have a positive impact. 

Last year, Liz co-authored with Andrew Cox an article in the New Review of Academic Librarianship (link) which asks critical questions that academic libraries’ need to think about when planning wellbeing activities. The article argued that often librarians fail to define the problem they are seeking to address when they undertake wellbeing interventions and that, while well-meant, their impact is often not formally evaluated. We observed that it was quite unusual in our profession for an article to be so provocative, and asked Liz if she had faced any criticism herself for writing it. 

“I keep waiting for the negative feedback! We really meant it in a ‘critical friend’ way, not to undermine all the hard work that people have done and the very good intentions they have to support wellbeing. But we both felt – and I don’t think this is just a problem in libraries but it’s a problem in a lot of sectors at the moment – that people weren’t really thinking about what the genuine causes of poor wellbeing were. We think that there are lots of things a library can do to have an impact but sometimes people were going for the things that were popular, or showy, or made them look good. To be honestpeople have been quite supportive about what we’ve written, and quite interested to think a little bit differently about it and to have some of their thinking challenged.” 

So, what are the real causes of the wellbeing problem in universities and what can libraries do to help? In her article, Liz talks about the marketisation of higher education and even ‘neoliberalism’ as being explanations. But there are other factors too and each one offers a possible role for librarians. The digital world, for example: 

I work quite closely with people in mental health services and studentbased services and they do see people coming forward with things that they feel might be a symptom of a mental health problem that a lot of us would just see as a normal reaction to somethingThere is this idea of the medicalization of everyday life, pathologizing things like sadness or grief, or people splitting up with their boyfriend … I do think there’s a definite argument around that. 

But alongside that I do think that young people face different challenges now that do affect their mental health more. The digital world can be both a positive and a negative. It helps people to become connected but it’s also putting increased pressure on them by portraying a version of other people’s lives that seems perfect or is curated in a way that makes it look like everyone else is having a wonderful time. And if they’re not having a wonderful time – is there something wrong with them?  

“For me, that aspect of the digital is something the library could do something aboutThat idea of digital skills, digital life skills, I think is really something that is within the librarian’s remit. With information literacy you already talk about fake news and the way it’s created and the way myths get perpetuated … so bringing that approach into the context of everyday life and what you see when you are on the internet, or on your phone, could be incredibly helpful. And I’m not sure there is very much of it in the library world at the moment. 

The marketisation of HE and changes in student expectations about university life remains a huge problem: 

“That drive towards students seeing the university as a means to an end … you go to university now to try to get a better job and to earn more money and we talk about graduate outcomes and the value of going to university. This means that students put a lot more pressure on themselves to achieve, and every poor grade, or piece of work they haven’t done as well as they could have done, feels like something that’s really going to affect them. 

I’ve done some work around student failure at Lancaster and I’ve also done some work with Student Minds for the University Mental Health Charterand what has come out very strongly is that there such a big fear of failure amongst students partly because of this idea that if you don’t get a really good grade, you’re not going to get that job that you want.  

Again, I think that this is something that the library can help with both in terms of managing expectations and through their support for students. You could argue that some of the things that libraries do as their core business, such as helping students with skills development, has a positive impact on their mental health because, if they feel prepared for their assignments and have them in perspective, perhaps that will mean they worry less and it will stop that spiralling of anxiety around “I got a bad grade and I’m never going to get the job that I want.

Liz also believes that libraries can have a positive impact on student wellbeing by contributing to discussions about the academic calendar: 

“We know that the library gets much heavier use at exam times and can almost become a source of stress in a way because you’ve got fights for space, all that kind of stuffand when you start to unpick that you realise it’s not just a library problem – it’s a university problem. It’s the bunching of assessments, it’s students having lots of exams within confined period of time, when we could do things differently in terms of when we assess, how we assess, the ways in which we put pressure on at particular points in the year. And I think the library has got a role to play in being part of those conversations because you’re the ones that have this mass of students arriving at exam time and working ridiculously long hours and not taking breaks and being worried about space and resources, and so on.” 

What these suggestions for how academic libraries can support student wellbeing have in common is that they all sit within the remit of our core business anyway. Liz warns against diversifying into wellbeing activities for their own sake and, instead, says libraries should draw upon their existing professional knowledge base to support student mental health. 

“Actually, the core offer of the library is still ridiculously strong. Every time anyone asks, “why do we need the library anymore, everything’s online these days,” there are so many arguments you can make without even having to break a sweat … I don’t think it’s necessary to radically diversify to demonstrate that. 

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