Overstretched NHS services are sending suicidal students back to universities for helpBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m814 (Published 04 March 2020) Cite this as: BMJ 2020;368:m814
All rapid responses
Taylor paints a sobering picture of mental health amongst university students(1). Medical students especially are at an increased risk of deteriorating mental health due to the pressures of the course. A recent survey of more than 4,300 doctors and medical students found that 27% had at some point been diagnosed with a mental health condition, with 90% of respondents stating the reasons for this were significantly or partly due to their work or study environment(2). This is a worrying statistic that is likely to worsen as pressure on the NHS increases.
The following experiences are from the perspective of students at one UK medical school. Students are expected to attend clinical placements daily, simultaneously revise for exams, whilst maintaining a healthy work-life balance. The first point of call for students struggling with their mental health is often the university or the course specific well-being team. This service is part of a wider team that includes members of staff overseeing students’ fitness to practice. Although one may argue a student’s deteriorating mental health may eventually effect their competency as a doctor, the joint service discourages students from accessing help.
Many medical students feel that sharing their mental health concerns with course specific well-being services may have a direct impact on their degree. For example, it’s not unheard of for students struggling with the stresses of final year to repeat clinical placements or to be encouraged to sit their exempting exams at a later date. This in turn causes extreme anxiety amongst students already struggling. The same scenario is observed in the context of academic advisors whom are intended to be student’s pastoral support, but also mark the student’s academic portfolio, passing which is a mandatory part of the degree. They are another potential source of support effectively taken away from the student, as the relationship resembles that of an examiner.
The position of the medical school seems reactive rather than proactive. Students experiencing mental health difficulties are pushed into the same cruel system concerning absences and resits rather than one which should embody support and flexibility.
1. Taylor A. Overstretched NHS services are sending suicidal students back to universities for help. Vol. 368, The BMJ. BMJ Publishing Group; 2020.
2. Sykes C, Borthwick C, Baker E. Mental Health & wellbeing in the medical profession. Br Med Assoc [Internet]. 2019;1–77. Available from: https://archive.bma.org.uk/collective-voice/policy-and-research/educatio...
Competing interests: No competing interests
It is noteworthy that this timely article mentions the parental role but once, and then in their capacity to fund private mental health care. Parental commitment of duty of care and concern for their children far exceeds that of healthcare and educational services and joined up services should seek to include this invaluable resource.
Whilst there may be a danger of overmedicalising the issues with which most students are presenting, deaths from despair are irreversible endpoints and all possible resources should be utilised to address and reverse the causes of distress.
The deaths of Averil Hart and Caera Thacker are two recent well documented cases where parental interests were conspicuously sidelined. In a 2019 National Union of Student survey of 14000 undergraduates, 81% said that they would be happy for their university to share information concerning their mental health with their next of kin should such circumstances arise. These results challenge the preconception that students are adults who would not want their parents included in discussions concerning mental health difficulties that they experience whilst at university.
Data Protection Laws that mitigate against the sharing of confidential information about students aged 18 and over without their express permission might therefore valuably be revisited. This would provide more effective joined up care of the soaring number of the university population who experience mental health difficulties during their studies and those who end their lives.
Perhaps Sokol might discuss this in his current ABC of Confidentiality series of articles?
Competing interests: No competing interests