Mental health of students in higher education

College Report CR166Care pathwayThe usual route into specialist NHS care is by GP referral. In someinstitutions more direct lines of referral have been established. Forexample, some mental health advisors have established links with NHSearly intervention for psychosis teams that have allowed them to ‘fasttrack’ acutely disturbed students into psychiatric care. Early intervention isespecially important in students to diminish the risk that mental illness willlead to drop-out from university.A major problem is that NHS services are not usually adapted to thetimescales of student life. Waiting times for specialist services such as clinicalpsychology or psychotherapy are often lengthy. This can mean that a studentreceives a first appointment when he/she is fully occupied with examinationsor about to return home or go elsewhere for the summer vacation. It alsomeans that therapies of longer duration are disrupted by vacations. Werecommend that services take account of this disadvantage and try toameliorate it when it comes to managing waiting lists.Primary careIt is very important to emphasise the major role that primary care plays inthe management of mental disorders in the student population. The majorityof patients with mental disorders are treated exclusively in GP clinics withoutreferral to mental health services. Those GP practices with a significantcohort of students on their patient lists have an involvement and experiencein the management of mental disorders which is considerably greater thanthat provided in routine GP settings. In such cases, GPs often liaise directlywith student counselling services, disability services, mental health advisors,academic staff and support services. The general practice often exercises apastoral and advocacy role as well as the core clinical role.General practices with large student populations are facing financialdisadvantage as a result of the current methods by which GPs arereimbursed in the UK. These include payments for the attainment of diseasemanagementtargets in a range of conditions. The student populationis relatively healthy and will therefore generate lower income for thesepractices. The long-term future of practices such as these may be threatenedas a result of diminished remuneration and consequent difficulties inrecruiting staff and funding services.A case for collaborative healthcareIt seems self-evident that mental healthcare would improve if there werecloser collaboration between NHS and higher education providers. There aresome important practical impediments to this. These include restrictions onthe transfer of confidential information between agencies and loss of thedistinctive contributions that can be made by higher education services.Nevertheless, a number of models of collaborative working have beenestablished across the country. Some of these are described in Appendix 1.We hope that these will provide a stimulus to similar developmentselsewhere.10 http://www.rcpsych.ac.uk