Mental health of students in higher education

Medical and other healthcare students with mental disorderunnecessary suffering to the student and posing significant risk to patientsin the longer term.Medical students are also enjoined to take steps (e.g. informing asenior member of medical staff) to prevent harm to patients that mightarise from the behaviour or ill health of a colleague. They are expectedto demonstrate maturity, respect for others and the ability to work as amember of a team.The GMC expects that medical schools will have in place systemsof pastoral care, mentoring and support. The hope is that this will allowproblems to be detected and dealt with, at least in some cases, before thequestion of fitness to practise is raised. These systems should allow studentsto express concerns in an atmosphere that is supportive and confidential.However, students should be made aware from the start that the obligationto confidentiality is constrained by the need to protect patients from anyharm that might arise from the problems of students. In such circumstances,a mentor or tutor may be obliged to inform the medical school of any matterof concern.If fitness to practise becomes an issue, the student should be givenopportunities to correct the underlying problems. Any doctor who is involvedwith the student in a supportive or mentoring role should not also beinvolved in the formal investigation of concerns about fitness to practise orin decisions that might affect the student’s professional future. If it is foundthat impaired fitness to practise is arising from ill health, the medical schoolmay impose conditions on the student that include appropriate medicalsupervision.There are a number of issues that can arise when students of medicineand nursing or other healthcare professions become mentally unwell. Themost important are maintenance of confidentiality and avoidance of conflictof interest. Medical students and others face a risk of loss of confidentiality ifthey are treated by a psychiatric service which is associated with their placeof study such as medical school or school of nursing. There is a risk that thestudent/patient will encounter fellow students who are in the hospital in thecourse of their teaching. This can create considerable embarrassment forthe student and also for his/her peers and can delay the process of recoveryand social reintegration. Some psychiatric services have set up reciprocalarrangements with neighbouring services to accommodate patients suchas this and this is often the ideal outcome. Where this is not possible forgeographical or other reasons, every effort should be made to maintainconfidentiality. If a medical or healthcare student is being seen as an outpatient,he/she should be seen whenever possible in an off-site clinic suchas a GP health centre. If in-patient care is required, efforts should be madeto avoid contact with other students and to avoid discussion of the student’ssymptoms and problems in the presence of his/her peers. Another measurethat has been used to maintain confidentiality is to set up a ‘safe haven’or ‘hidden patient’ arrangement by which access to the psychiatric recordsof healthcare students is restricted. This can apply both to cases that areopen and to those that have been closed. The disadvantage of this is thatsuch records may not be accessible out of hours and this could lead todetriment of care. Some NHS psychiatric services have removed safe havenarrangements for this reason.Conflict of interest can arise when healthcare students experiencemental disorders which raise questions about their fitness to practise intheir chosen profession. A psychiatrist may be called upon to assist with thedecision about whether a student should be allowed to continue on a courseRoyal College of Psychiatrists65