More Than 80% Of Med Students With Mental Health Issues Feel Under-Supported

Student BMJ surveyed 1122 medical students about their health. Matthew Billingsley looks at the results and the reactions to them

Most medical students who experience mental ill health feel under-supported by their medical schools, a small online survey by the Student BMJ has found. Of the 1122 UK based respondents, 30% (343) declared they had experienced or received treatment for a mental health condition while at medical school. From this group, 80% (276) thought the level of support available to them was either poor or only moderately adequate. Just under 15% (167) of the survey’s respondents also revealed that they had considered committing suicide at some point during their studies.

“The number of students reporting mental illness or considering suicide is shocking,” Twishaa Sheth, chair of the BMA student’s welfare committee, said.

Debbie Cohen, senior medical research fellow at the University of Cardiff added: “whether a representative sample or not these figures are concerning. What is most concerning is that over 80% who have experienced mental distress have found the support they received only moderate or [they] received none at all.”

The survey was sent as an open invitation to Student BMJ readers and the respondents represent around 2% of UK medical students. In comparison, a survey of the general population in 2007 of 7403 adults found that 23% of adults met the criteria for at least one psychiatric condition and 16.7% of people had thought about committing suicide at some point in their life.

This snapshot from the Student BMJ survey adds to the small evidence base about the prevalence of medical students’ mental ill health.

Cohen added that the results of the survey correlate with similar research she and her team presented at the International Conference on Physician Health in London in September 2014. Their research analysed the mental health of medical students at Barts and the London and the University of Cardiff medical schools. The medical schools’ offices sent students an email containing a link to the survey, and a printed version of the survey was given to students after lectures. Of the total number of medical students across both institutions, 17% (557) completed the survey, which showed that 15% of students experienced substantial levels of depression and 52% reported substantial levels of anxiety.

Medicine has a reputation for being one of the most intensive degrees. Only six in 10 applicants manage to get a place at medical school, and students often have a relentless timetable of exams as well as having to balance the emotional strain of seeing sick patients and uphold high professional standards.

The Student BMJ survey also asked students about other aspects of their health, including smoking, drinking, and drug use. Only 15.8% of respondents claimed they smoked (national average is 18.7%),one quarter binge drink each week (the national average is 18% for 16-24 year olds), and 10.9% said they have taken illegal (class A, B, or C) drugs more than once. A survey published on theguardian.com found that 31% of the population have taken drugs at some point in their lives.The Student BMJ survey found that 8.3% of respondents had tried a legal high, and the same number 8.3% (94) had used cognitive enhancing drugs to help them revise.

The reasons behind the apparently high rates of mental health problems are complex. The demands of the course can cause an over-competitive environment that can have a detrimental effect on the health of students.

One respondent to the survey said, “As a postgraduate student studying undergraduate medicine I worry for my younger colleagues. I know many of them suffer with depression, self esteem issues, and various other problems and I am stunned by the amount who take prescription medication during exam time.”

And it’s not just the intensity of the course. Stigmatising attitudes to mental health problems are passed down from senior doctors, making it difficult for students to step forward when they need support.

A second respondent said, “The stigma with mental health issues especially comes into focus when exposed to consultants and tutors who refer to it as a weakness.” The same respondent had worked with several consultants who had stated that depression “isn’t a real illness.”

These attitudes seem to contradict some of the efforts being made by some medical schools in stamping out stigma. The second respondent also added: “When this is rhetoric we are exposed to from senior consultants on the wards—many of whom we look up to and aspire to be—is it any wonder that students struggle to come forward?”

And fellow students also play a role in perpetuating a negative environment for people who experience mental ill health.

A third respondent, who has had mental health problems and who has been close to committing suicide, added, “I was recently told by someone I regard highly on the course that one person in particular had commented that I should just ‘get on with it and put a positive spin on things.’”

Although the existence of mental ill health, and particularly suicidal thoughts, among students seems worrying, Sheth thinks that what is more concerning is the lack of independent support available for students.

As reported in the Student BMJ earlier in 2015, part of the confusion lies in there not being a clear demarcation between medical school staff with pastoral roles and those who rule on fitness to practise disciplinary issues.Students are often scared that if they disclose a problem it will have a detrimental effect on their exam marks and progression through the course. Often it is not clear to students who the right person to go to is, and if their confidentiality can be assured.

The General Medical Council and the Medical Schools Council updated their guidance on supporting medical students with mental health conditions in July. They make it clear that teaching and pastoral roles should be separate. The guidance states that medical schools “must not be responsible for the clinical care of individual students, and any treatment that students receive must be managed separately from the medical school.”

Iain Cameron, chair of the Medical Schools Council, said, “Medical schools take the mental wellbeing of their students seriously. The Student BMJ survey highlights key issues and similar concerns have been raised previously.”

“It is crucial that students who have concerns about their health are able to make this known so that they can be provided with the necessary advice and support.”

He added that the Medical Schools Council is keen to work with Student BMJ and colleagues across the sector to promote the newly issued guidance and engage in new initiatives relating to student mental health.

In terms of making genuine cultural change, Cohen said that “medical schools need to work harder at providing open access to support, with sign posts to safe and confidential support structures that have clear boundaries around them.” Since the University of Cardiff launched a dedicated system of support that allows students to self-refer safely if they are experiencing mental health problems referrals have increased fourfold. Cohen also called for medical schools to introduce more teaching on “managing your own health and building resilience” into their curriculums.

Sheth concludes that “support systems are available in the forms of formal and informal pastoral support from universities, peer support, your GP, and the BMA’s counselling service. They are all there for us, but it is important to ask for this help.”

Myth busting—medical students and mental health

• “Mental health conditions are rare in medical students”—This is not the case. In fact, research shows that medical students may have higher instances of mental health conditions than those in similar areas of study
• “If I have a mental health condition, it will damage my career prospects”—Mental health conditions are common in the general population and affect many doctors. Legally, employers can’t discriminate against you if you have a mental health condition
• “If I tell my medical school that I have a mental health condition, I will automatically be referred to a fitness to practise committee”—This should not be the case. If you engage with your medical school and ask for support and follow the advice given, there will be no need for a fitness to practise committee to be involved
• “Seeking help is seen as a sign of weakness”—Seeking help is the strong thing to do. It is also the right thing to do. Your medical school has systems in place to support you and it wants you to do well
• “The GMC will refuse to grant me provisional registration if I have a mental health condition”—This is not true. The GMC refuses registration only if it believes your condition would put patients at risk. When applicants understand their condition and ask for appropriate help and support, the GMC will grant registration

Matthew Billingsley, editor, Student BMJ

References

1. Health and Social Care Information Centre, Social Care Statistics. Adult psychiatric morbidity in England, 2007 Results of a household survey. 2009. www.hscic.gov.uk/catalogue/PUB02931/adul-psyc-morb-res-hou-sur-eng-2007-rep.pdf.
2. Office for National Statistics. Integrated Household Survey, January to December 2013: Experimental Statistics. www.ons.gov.uk/ons/dcp171778_379565.pdf.
3. Health and Social Care Information Centre, Lifestyle Statistics, Health and Social Care Information Centre. Statistics on Alcohol: England 2013. www.hscic.gov.uk/catalogue/PUB10932/alc-eng-2013-rep.pdf
4. Mann J. British drugs survey 2014: drug use is rising in the UK—but we’re not addicted. Guardian 2014. www.theguardian.com/society/2014/oct/05/-sp-drug-use-is-rising-in-the-uk-but-were-not-addicted
5. Sayburn A. Why medical students’ mental health is a taboo subject. Student BMJ 2015;23:h722.
6. General Medical Council and Medical Schools Council. Supporting medical students with mental health conditions. 2015. www.gmc-uk.org/Supporting_students_with_mental_health_conditions_0715.pdf_53047904.pdf.

Source