Mental health of students in higher education

Pathways to psychiatric careIn countries in which there is direct access to specialist services, healthcarecosts are generally much higher and resource utilisation less efficient.There are nevertheless some specific situations in which direct accessto secondary care can be of enormous help to troubled students. In manyinstitutions mental health advisors and counsellors have developed goodlinks with early intervention and crisis assessment and treatment teams anddirect referrals to these have proved very beneficial to students.In rare cases, students will require care within in-patient psychiatricsettings either on a voluntary basis or as a consequence of being detainedunder the Mental Health Act. In recent years there has been a trend awayfrom in-patient treatment towards community-based treatment within thenewly developed services such as crisis resolution teams, home treatmentteams and early intervention for psychosis teams.It is important that services are tailored to the time constraints of studentlife. Because a student may not be staying in the area for a long periodof time there is a temptation by local services to avoid involvement as theymay fear, rightly or wrongly, that little can be achieved within a short timeframe.There are often long waiting lists, especially for services such as clinicalpsychology. A student may come to the top of the waiting list towards the endof an academic year. He or she will usually then return to their home area orgo elsewhere for the summer vacation and be unable to attend. Appointmentletters or questionnaires may go astray as a result of changes of mailingaddress. The consequence is that the student may be dropped from thewaiting list and then has to be re-referred and start the whole process again.It is important that higher education institution personnel have someinsight into how the NHS services work and the pressures and constraintsthat exist in the health service. It is equally important that NHS personnelhave a better understanding of the systems and structures of highereducation. In recent years NHS psychiatric services have come underincreasing pressure to focus their resources on patients with severe andenduring mental illnesses such as schizophrenia and bipolar disorder. Insome cases, there has been a corresponding decline in the availability ofservices to those with less severe conditions such as mild to moderatedepression, and the burden of caring for students with these conditions mayfall on counsellors and mental health advisors.General medical care of studentsIt is very important to emphasise the major role that primary care playsin the management of mental disorders in the general population. Mostmental disorders are managed at the level of primary care without referral tospecialist services. This role is reflected in the NICE guidelines for diagnosisand management of depression (for example, in the stepped-care modelof care; NICE, 2009a) and the monitoring of patients on antipsychoticmedications (NICE, 2009b).In GP practices with a significant cohort of students on their patientlists, there is an involvement and experience in the management of mentaldisorders which is considerably greater than that provided in routine GPsettings. In such cases, GPs often liaise directly with student counsellingservices, disability services, mental health advisors, academic staff andsupport services. The general practice often exercises a pastoral andadvocacy role as well as the core clinical role.Royal College of Psychiatrists53