Supporting students with mental health conditions

Defining mental health

  1. Lots of different terms are used to describe people with mental health conditions, which can cause confusion and prevent medical students from getting the right support.
  2. In this guidance, we refer to three levels of severity of mental health conditions:
    • stress
    • mild-to-moderate mental health conditions
    • severe mental health conditions.

We will also refer to eating disorders and substance use disorder, which we will define separately. We have included these conditions in this guidance because they are quite common among medical students.

Medical schools should be able to give appropriate support for all levels of difficulty rather than focusing on just one type of health condition. Other types of condition, such as cognitive impairment and autistic spectrum disorders, are rare in medical students, but this guidance would also apply to medical students experiencing these conditions.

Stress

  1. Stress is extremely common and affects most students at some time. In fact, studying medicine can itself be a source of stress for students. Feeling stressed is not the same as having a mental health condition, although repeated stressful experiences can be a risk factor for developing physical and mental health conditions.
  2. Many symptoms of mental health conditions, such as anxiety, are also normal experiences and often occur when people are under stress. In this guidance, we use the term 'stress' to describe the normal experiences that happen to many medical students.
  3. Even though this is a normal part of being a student, medical schools need to think about ways to support students who experience stress - both to alleviate any immediate discomfort and to prevent more serious health conditions from emerging. We make some suggestions on ways to support students later in this guidance (see Promoting wellbeing).

Mild-to-moderate mental health conditions

  1. Mild-to-moderate mental health conditions are common and can affect 15-25% of the general population at any one time. They include:
    • depression
    • generalised anxiety disorder
    • panic disorder
    • social anxiety disorder
    • obsessive compulsive disorder
    • post-traumatic stress disorder.
  1. Common mental health conditions can usually be treated in primary care rather than secondary care settings. In general, these common conditions carry less stigma than severe conditions, so those with a mild or moderate health condition are less likely to face discrimination. However, medical students have a higher prevalence of depression and anxiety than the general population, so it is important for medical schools to identify these students and support them in the right way, although they must not treat students themselves. Some students may need adjustments to their training to support them while they are unwell.

Severe mental health conditions

  1. Severe mental health conditions include:
    • schizophrenia
    • severe depression
    • bipolar affective disorder (manic depression).

These conditions are relatively uncommon. Treating them will usually involve local community mental health services as well as primary care services. Medical students who have these severe health conditions will need help from the medical school to make sure they are given the most appropriate support. Where necessary, adjustments will need to be made to support them.

Eating disorders

  1. Eating disorders are characterised by an abnormal attitude towards food that causes someone to change their eating habits and behaviour. People with eating disorders typically eat too little or too much, or use harmful ways to get rid of calories.
  2. The two most common forms of eating disorder are:
    • anorexia nervosa - where the person restricts their calorie intake and can include using excessive exercise to burn calories
    • bulimia nervosa - where the person tries to control their weight by binge eating and then deliberately being sick or using laxatives.

Substance use disorder (including alcohol)

  1. The use of alcohol or other controlled substances is defined as substance use disorder when it starts to have a negative impact on the way a person functions. People with substance use disorder often have a pattern of use that results in social, psychological or physical harm. Patterns of use that can cause harm include:
    • intoxication
    • bingeing
    • regular use with physical or psychological dependence.
  1. The use of controlled substances that are illegal is always a fitness to practise issue - medical schools must make this clear to students. However, they should also offer support to students who are addicted to controlled substances. Later in this guidance, we explain about how to manage and monitor students with substance use disorder (see Substance use disorder (including alcohol)).