Mental health of students in higher education

College Report CR166All students should register with a GP when they first come to auniversity or college and, in fact, most do so in the first weeks followingmatriculation. Most university health practices make active efforts to havenew students fully registered in the first few days following enrolmentand screen for pre-existing medical conditions, including mental illnesses.Sometimes students register with a university GP only when they firstdevelop a medical problem, which may be a mental disorder. Generalpractitioners are usually involved in the care of patients with the fullspectrum of mental illnesses, whether this is at first presentation or withongoing care. In the vast majority of cases, higher education institutionservices will involve the student’s GP as the primary link with NHS services.Furthermore, in crisis situations the GP is often the first port of call eitherby the student or the higher education institution (or even the student’sparents). Practices used to dealing with students and higher educationinstitutions are well aware of the particular issues related to the studentgroup and have systems in place to cater for their specialist requirements.In the past, many universities were direct providers of primary carehealth services to students. Although these services were funded by theNHS, the university employed clinical staff such as doctors and nurses. Thismodel has now been largely abandoned and primary care services are nearlyalways provided by mainstream general practices. In some cases these areformer student health services which retain links to the higher educationinstitution and the majority of whose patients are current or former students,university/college staff and their families. They may also, for example,have contracts to provide non-NHS services such as medical certificatesand opinions on fitness to study abroad. In other cases, practices attractlarge student populations because they are located in close proximity to auniversity or college campus. Such practices may have no formal link withthe higher education institution and primary care services for students areprovided as for non-students.This diversity of provision was confirmed by a recent survey carriedout by AMOSSHE (L. Foley, 2010, personal communication). Of the 57institutions which responded to the survey, only 2 were direct providersof medical services. Thirty had a service-level agreement with a generalpractice on or near to the campus for provision of services to students.Twenty-three stated that they had a local practice that provided treatmentto the majority of students but that there was no formal contract withthe practice. In the other two institutions there was no arrangement orunderstanding of any sort with a primary care provider.One intention of the current GP contract was to achieve improvedassessment and management of chronic diseases such as coronary heartdisease, kidney disease and diabetes. This was taken forward under theauspices of the Quality and Outcomes Framework (QOF). A substantialproportion of the income of GPs is now achieved by attaining adequateperformance against a range of targets for specific diseases. The diseasestargeted by the QOF have a low prevalence in young people in generaland in students in particular. As a result, practices with a high number ofstudents and few patients over the age of 25 have been unable to attainincome levels that are comparable to that of the average GP. This couldlead to disincentives to GPs becoming involved in the care of students. Atthe very least what is likely to happen is fewer and fewer trained clinicalstaff being available to provide primary care services including supportand treatment for mental illnesses to more and more students. Unless thissituation is remedied the future of student health services will be uncertain54 http://www.rcpsych.ac.uk