Identification
- A supportive environment in which medical schools openly discuss mental health conditions will help students feel happy to ask for support. However, not all students will recognise that they have a mental health condition, so schools need processes to identify students who are struggling with the course and might need support.
- For example, students showing a drop in academic performance or with low-level fitness to practise issues, such as non-attendance at lectures or seminars, might need additional support and may have a mental health condition. Medical schools should also encourage students to come forward if they feel they might need additional learning support.
Staff development
- All medical school staff should be aware of the support services available to medical students in their school and university. They should be trained in recognising the common signs and symptoms of mental health conditions, including substance use disorder and eating disorders. They should also know how to raise concerns about a student's mental health condition.
- It could also be useful for all staff to have training on how to communicate effectively with students who have a mental health condition.
For example, the mental health charity Mind runs courses designed to improve awareness of mental health conditions. Alternatively, medical schools could ask local psychiatrists or community mental health teams to provide training.
Personal tutors and pastoral support
- Medical students should be offered pastoral support throughout the course. Pastoral support works best when it is a valued part of the course and students are able to build up a good relationship with the person providing it.
- Personal tutors can provide either pastoral or academic support for students. It is important that those providing pastoral support are not in a position to make decisions on academic progression. This separation of function allows students to have a safe environment in which they can raise concerns without worrying that there will be any impact on their academic progression.
- Where tutors provide purely academic support, they should be aware that students may want to discuss personal matters with them, including matters relating to their mental health. Therefore, those giving only academic support need to be aware of the other support services available so that they can give appropriate advice.
- People providing pastoral support must have had the right training for the role. It is likely that the personal tutor will be, in many cases, the member of medical school staff who students are most likely to reveal a mental health condition to.
- If a student reveals a mental health condition, the personal tutor should encourage them to seek help from their GP. The tutor might also want to refer them to the occupational health service as this removes the need to share any of the student's sensitive or personal information with other members of medical school staff.
- Those who give pastoral support must be aware of the boundaries of this role. They should not try to treat the student themselves or insist that they share detailed or sensitive personal information, unless the student asks to do so.
Best practice for pastoral support
- Staff members who provide pastoral support should be selected based on the skills and personal qualities that the role requires.
- Staff who give pastoral support should have their role clearly defined and should be given training for the role.
- Medical students should be strongly encouraged to go to pastoral support sessions.
- Time for pastoral support sessions should be timetabled into the course.
- Appointments should follow a clear format with a record that is completed after each session.
Peer support
- Some medical schools have introduced peer support, which is where students support other students. Peer support gives students the chance to share experiences and listen to the concerns of others outside the clinical environment.
- It must be made clear to all students involved that peer supporters are providing friendship and support - they are not acting in a clinical role.
- Evidence suggests that training volunteers helps them to better support others and also has a positive impact on the personal resilience of those trained*. Therefore, medical schools should consider giving all students training in basic recognition, initial support and signposting. This could be part of a professional development course and could cover:
- the range and prevalence of mental health conditions encountered by medical students
- the reluctance of medical students to seek help
- sources of help and support
- staying within the boundaries of being a supportive friend.
- Where medical schools want to put a formal peer support programme in place, they must make sure that those who provide the service are properly trained for and supported in this role. They must understand how formal support services work within the medical school and must be aware of issues such as confidentiality and boundaries.
* (Hillis J, Morrison S, Alberici F, Reinholz F, Shun M, Jenkins K (2012) ‘Care Factor’: Engaging medical students with their wellbeing Med Educ 46(5): 509–10)
Student fitness to practise and monitoring professionalism
- In the context of this guidance, student fitness to practise covers the behaviour and health of students and the processes by which medical schools manage and monitor such behaviour and health to assess a students' fitness to practise as a doctor. Medical schools refer to this differently, but for ease of reference in this guidance it is referred to as 'fitness to practise'.
- Medical schools should also have a more formal fitness to practise procedure, where a student's actions and behaviour are investigated and a panel may be set up to consider the case and make a decision on the student's future. In the case of a student with a mental health condition, this formal process should only be used when the mental health condition significantly affects their ability to study and practise.
- All medical schools should have monitoring in place to detect low- level fitness to practise concerns. This is because a student with several concerns, taken collectively, could have impaired fitness to practise. These low-level concerns include:
- lateness or failure to attend teaching sessions
- handing in work late
- lack of engagement with the course
- aggressive or non-cooperative behaviour
- poor communication with staff and patients.
- Although these are fitness to practise concerns, they could also indicate that a student is struggling or has a mental health condition. Therefore, medical schools should use their processes to deal with minor concerns, to identify students with mental health conditions and to provide support as early as possible.
Encouraging students to get early support at University College London (UCL)
UCL Medical School proactively monitors students' performance to find out whether a student needs help when their progress stalls. This has allowed the school to pick up on a significant number of problems, including mental health conditions, before the students would have usually told the medical school about them. It has also helped create an environment in which students feel able to get help for problems at an early stage.
All students who have failed a formative or summative assessment, are offered the opportunity to speak to a member of staff (student support tutors and year leads). For formative assessments, the bottom 10% of students are seen, regardless of the pass mark, and the next 10% are offered the chance to opt in to see a member of staff. Students with poor performance on clinical placement (for example, D grade) or in the skills laboratory (for example, failure to achieve competency), or who have failed to submit administrative paperwork on time, will also be offered an appointment.
The staff member asks the student if there are any underlying reasons, and fills in a form that screens for health conditions and problems with personal or family life, accommodation, finance and study skills. If any issues do come to light, the member of staff will identify what support can be put in place to help the student get back on track.
At a time when student complaints are increasing, this performance monitoring also provides objective evidence that the medical school tried to identify and resolve any problems that might be contributing to poor performance.
General practitioners
- Medical schools must encourage their students to register with a GP who is local to the school (or the student health service, if one exists) so that they can access independent and objective medical care*.
- Students who have existing mental health conditions may want to stay registered with a GP who they already have a relationship of trust with. However, if they have relocated to attend medical school, they should be encouraged to register with a local GP. Since GPs play an important role in identifying mental health conditions and in providing support and treatment, all students should be able to access a GP locally. University-based GPs will also have a good knowledge of the support services available at the university or medical school.
- Medical schools could give students a list of preferred GP practices if they do not have access to a university-based GP service. Where a GP has experience of dealing with medical students, they are usually better at giving them specific support.
- Medical schools without a university-based GP service should send all local GPs a factsheet. This should set out:
- the support services available at the medical school
- the school's policies for supporting students
- information about the occupational health service used by the medical school.
* General Medical Council/Medical Schools Council (2016) Professional behaviour and fitness to practise: guidance for medical schools and their students, paragraphs 35-36
Links with external services though Newcastle University’s Student Wellbeing Service
The Student Wellbeing Service (SWS) has links with several key external services.
Links with local GP practices
Newcastle University does not have a medical centre on campus, but there are two main GP practices that students use. The head of SWS normally meets with the practice managers or goes to a staff meeting or training event once a year.
Links with other services
SWS therapy staff have a 'managerial lead' for each stakeholder service. This allows each service to have a single point of contact, and means there is a 'local' expert within the team for each service.
SWS also has links with:
- the local crisis assessment team to address concerns about a student's immediate safety
- the Early Intervention in Psychosis (EIP) team
- the Regional Eating Disorders Team
- North East Council on Addictions
- community mental health teams, which SWS liaises with on an individual student basis with the student's permission.
SWS meets with these teams, sometimes shadowing team members, to make sure there are clear lines of communication and understanding about what each of the teams does and how the referral processes work.
If a student is known to the SWS service and is being seen by the EIP team, SWS may arrange for the EIP team member to see the student on campus - to make sure the student is getting the help they need easily.
Similarly, a number of members of the team recently attended the Regional Eating Disorders team meeting to clarify the remit and referral processes for each team and to allow signposting and join-up.
SWS has also met with representatives from the NECA (North East Council on Addictions). SWS liaises with staff in community mental health teams on an individual student basis and with the permission of the student.
