Mental health of students in higher education

Pathways to psychiatric careand is potentially precarious. There is a risk that the expertise in dealing withmental health difficulties that has been developed in some practices will bediminished or lost.Collaborative working between health and highereducation institution servicesThere is overlap in the problems that people present with to NHS psychiatricteams and higher education institution services (e.g. Connell et al, 2007).It seems self-evident that care could be improved if these two sectorsworked in closer collaboration with each other. For some students, integratedcollaborative working is well established; some examples of these aredescribed in Appendix 1.A possible option would be to create a single pathway of care in whichNHS and the relevant higher education institution staff work together in afully integrated service. This would allow all who are involved to see studentswho are most appropriate to their skills and training. It would also alloweasy referral of students from one professional to another. However, suchintegration may be difficult to achieve when there is separate managementof the different elements of mental health provision. There are often otherbarriers to joint working.One of these is the existing configuration of psychiatric services. Anintegrated service could probably only arise if there was a designated CMHTwhich took all referrals from the student population of each higher educationinstitution. In most psychiatric services, provision of care is sectorised bygeographical location or GP population. The establishment of dedicatedstudent psychiatric services would require considerable reorganisationof services. It might also cut across important working relationships thatpsychiatric services have with GPs and social work departments.A second problem arises from constraints on exchange of clinicalinformation. National Health Service clinical records are created and retainedin well-established organisational and legal frameworks. Administrationand monitoring of case notes is undertaken by trained clinical recordsprofessionals. There are clear standards in relation to retention, storageand disposal of case notes. Case records are covered by data protectionlegislation which sets out criteria and procedures for patient access. Thereare restrictions on the extent to which confidential clinical information canbe disseminated outwith the health service. Any clinician who does conveysuch information to a non-NHS provider of care will remain accountable forany breach of confidentiality that might arise from this. Similarly, counsellorsand mental health advisors maintain case notes and confidentiality in linewith professional guidelines and data protection legislation. Service-levelagreements could be negotiated between services and disclosure formsdesigned and agreed by university/college and NHS staff to enable liaisonand information exchange where appropriate. This would require the explicit,written consent of the student.If higher education institutions had contracts with the NHS for theprovision of counselling and mental health support rather than being directproviders themselves, it might be possible to bring counselling, mentalhealth advisors and NHS services under a single organisational umbrella. Thedownside of this is the risk that the level of understanding of the structuresand cultures of higher education institutions, the context-specific training,Royal College of Psychiatrists55