Mental health of students in higher education

Pathways to psychiatric careNHS pathwayThe standard route into NHS psychiatric care is by referral by a GP. In somecases general practices within the UK employ counsellors or psychologists.Only a minority of practices have any formal arrangements for the deliveryof more intensive psychological therapies such as CBT, although this shouldchange with the IAPT initiative in England and Wales and comparable effortsin Scotland such as Doing Well by People with Depression (2003–2006).If the GP feels that a student’s mental disorder cannot be effectivelymanaged within primary care, the student will sometimes be directed tothe counselling service within their academic institution. Arrangementsfor referral and communication between medical practices and counsellingservices vary from institution to institution. Where higher educationinstitutions have a university medical service (see pp. 53–55) this isfar more effective and straightforward than in those institutions that donot have this close relationship with a single primary care provider. Insuch cases there may be no facility for GPs to make formal referrals tocounselling services and no reporting back to GPs in the course of, or atthe end of, counselling. It is helpful if clear channels of communicationare established and relevant information is shared. Students are generallyhappy to consent to this.The GP may also make a referral to the local secondary care CMHT.These teams are multidisciplinary and can provide a range of interventionssuch as psychiatric assessment, expert pharmacological management,occupational therapy and more formal treatments, for example CBT. In thecase of a student who has acute psychosis or is acutely disturbed there mayother options such as referral to early intervention for psychosis teams orintensive home treatment teams.Where appropriate, individuals can be referred by CMHTs to specialisedtertiary services such as psychotherapy, drug and alcohol services andeating disorder services. The provision of these services varies widely fromone area to another.In general, there is limited access to NHS secondary care directlyto potential patients or to non-NHS referrers such as counsellors andother university staff, and there are good reasons why this should not beoverridden. The first is that the GP can coordinate and provide continuityof care for patients as they proceed through the system. The GP remainsresponsible for prescribing rather than this responsibility being dispersedacross a range of specialist services. This means that there is less risk ofdrugs being prescribed that have adverse interactions. Finally, GP referral isa major factor in promoting efficient use of secondary and tertiary services.52 http://www.rcpsych.ac.uk