Mental health of students in higher education

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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
College Report CR166or to graduate. Psychiatrists and other health professionals who contributeto the assessment of a student’s fitness to study should not also take onthe role of responsible clinician. This especially applies when psychiatristsare looking after undergraduate medical students or postgraduate doctorsregistered for degrees at the same university where the doctor is employedeither as a staff member or in an honorary capacity.A further conflict of interest can arise when a psychiatrist, counsellor orother practitioner is providing treatment to a healthcare student and thereis concern about the impact of a mental disorder on the student’s ability topractise. The usual requirement to respect patient confidentiality may haveto be balanced against the duty of care to third parties such as the patientsthat this person may be responsible for in the future. The permission ofthe student should always be sought before any disclosure is made. If thispermission is not granted, the clinician will have to decide whether risk topatients overrides the obligation of confidentiality. Guidance for doctors ondisclosure of confidential information in the public interest is available in theGMC document Confidentiality (General Medical Council, 2009b: par. 36–39).66 http://www.rcpsych.ac.uk
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Mental healthof studentsin higher e
Page 3 and 4:
DisclaimerThis guidance (as updated
Page 5 and 6:
Working groupPrincipal contributors
Page 7 and 8:
AcronymsAMOSSHE, Association of Man
Page 9 and 10:
College Report CR166Epidemiological
Page 11 and 12:
College Report CR166Care pathwayThe
Page 13 and 14:
College Report CR166Psychiatrists w
Page 15 and 16: College Report CR166Promotion of Me
Page 17 and 18: IntroductionThe purpose of this doc
Page 19 and 20: College Report CR166managing mental
Page 21 and 22: College Report CR166Students who ex
Page 23 and 24: College Report CR166Students must a
Page 25 and 26: College Report CR166of postgraduate
Page 27 and 28: College Report CR166alcohol use. Fo
Page 29 and 30: College Report CR166driving, unsafe
Page 31 and 32: College Report CR166the first, the
Page 33 and 34: College Report CR166ConclusionsWhen
Page 35 and 36: College Report CR166undergraduates
Page 37 and 38: College Report CR166and the Institu
Page 39 and 40: College Report CR166body. The EHRC
Page 41 and 42: College Report CR166and provision o
Page 43: College Report CR166consultation to
Page 46 and 47: Higher education contextConclusions
Page 48 and 49: Higher education contextMental heal
Page 50 and 51: Higher education contextHealthy Uni
Page 52 and 53: Higher education contextImproving h
Page 54 and 55: Pathways to psychiatric careIn coun
Page 56 and 57: Pathways to psychiatric careand is
Page 58 and 59: What to do if a psychiatric patient
Page 60 and 61: What to do if a psychiatric patient
Page 62 and 63: Mental health issues facedby intern
Page 64 and 65: Mental health issues faced by inter
Page 68 and 69: ReferencesAdams, T. & Moore, M. (20
Page 70 and 71: ReferencesJumaian, A. (2001) Preval
Page 72 and 73: ReferencesSocial Exclusion Unit (20
Page 74 and 75: Appendix 1understanding of, student
Page 76 and 77: Appendix 2Internal liaison within h
Page 78 and 79: Appendix 3Different models of psych
Page 80 and 81: Appendix 3see this as a step forwar
Page 82 and 83: Appendix 4I have also been involved
Page 84 and 85: Appendix 5University general practi
Page 86 and 87: Appendix 6Initiatives from counsell
Page 88 and 89: Appendix 6The Westminster mentoring
Page 90 and 91: Appendix 6to the volunteer and then
Page 92 and 93: Northampton Assessment CentreUniver
Page 94 and 95: Appendix 8AimsThe aims of the MWBHE
Page 96 and 97: Appendix 8Current projectsThe group
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Mental health of students in higher education

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