UCL MEDICAL SCHOOL

Mental Health ProblemsStudent Support &Fitness to Practise

Dr Peter RavenFaculty Tutor, Medical Sciences, UCL

Hon Consultant Psychiatrist, C&I

An increasing problem?

UCL Student Psychological Services • 137% increase in students registered over 5 years to 2012• 2,482 students registered in 2012• “More than any other UK university”

Bad news: UCL students have more mental health problems

Or

Good news: breaking down barriers so that seeking help is OK

The scale of the problem

• UCL has over 14,000 full time undergraduate students

• MBBS has >2,100 on a 6 year programme• About 1 in 6 of all UCL full time undergraduate students

on a single programme

• Common mental health problems are common– Recurrent depressive disorder, anxiety disorders

including OCD, eating disorders, Personality Disorder (self-harm)

At any one time in the Medical School

• ~ 60 students on Close Supervision for mental health problems• ~ 120 other students with mental health problems known to us• ~ 120 more students with mental health issues not known

• On average, 2-3 students leave the course each year due to mental health problems

• On average, 1-2 students go to full FtP panel each year for mental health problems

Pathways to support - disclosure

Common• Student declares on admission – anxiety disorders eg

OCD• Student discloses at the time – any• Academic issue, reveals underlying problem -

depression

Pathways to support - disclosure

Less common• Extenuating circumstances (unintentional disclosure)

– depression/ anxiety• Peers raise concern – eating disorders• Hospital admission: MHA - psychosis/ bipolar; suicide

attempt – borderline PD/ depression• Conviction/ caution – substance misuse

Pathways to support - disclosure

• Personal Tutor• Teachers – university academic• Teachers – NHS doctor (esp GP or psych)• Teachers – Clinical Skills Tutor• Teachers – Communication Skills Tutor• Administrators• Other eg chaplain

All need to know how to refer on and who to

Principles of support

A responsible student needs to • Recognise the problem• Seek help• Accept treatment• Be aware if clinical interactions are impaired

Principles of support

A responsible support service needs to• Support the student not the medical school• Aim for the long term by establishing a positive

relationship• Be aware that we are not the students’ doctors

Support structures

• Support Tutors (or Personal Tutors)• Occupational Health – liaise with GP or treating Dr• UCL Student Psychological Services• UCL Disability Office

• Close Supervision• Student Support Card

Support precedes FtP

• Inform student that protected by disclosing• Advise student to go to Disability Office• Reassure student that done the right thing in seeking

help – GMC expects us to look after our own health• Reassure student that MH problems no barrier to

successful career• Refer student to Occupational Health

Support precedes FtP

• Advise student to d/w GP if not already• Advise student to see Student Psychological Service• Reassure student re confidentiality (except FtP)• Clarify responsibilities of support service and

responsibilities of student

• Not FtP at first discussion!

Ongoing support - toolkit

• See the same Support Tutor each time • Negotiate reduced workload, eg deadlines• Change placement• Give student permission to take time out• Use interruption as last resort • Mentor support, learning support• Student Support Card

Student Support Card

• Originally a way of communicating reasonable adjustments in a durable, portable format (credit-card sized)

• Especially useful for clinical placements: range of teachers, frequent changes, confidentiality issues

• Proved very useful for students with mental health problems and regular therapy appointments

• Supporting students with disabilities using a ‘student support card’ scheme Raven, Griffin & Hinson (2008) Med Educ 42: 1142-3

.

Sample cardUCL Medical School Student Support Card

 

This is to certify that Student Name has the following special circumstances:

 

This student has a medical condition which requires regular appointments

and I would be grateful for your understanding.

Please contact me if you have any questions about this.

 

This Card is valid: From: 1st September 2012 until 15th July 2014

 

Signed:

 

Any queries regarding this should be directed to: Dr Peter Raven, Faculty Tutor.

Benefits of Student Support Card• Wording agreed with the student• Student can choose whether and when to use it• Flexible and allows for individual needs• 90% of students felt they benefitted from possessing the card• Students felt empowered• But.... Hard to publicise to all teachers

• Supporting students with disability and health issues: lowering the social barriers Cook, Griffin, Hayden, Hinson & Raven (2012) Med Educ 46:564-74

This card really gave me official credibility for leaving placements earlier as specified on my card. Without it, I would have to answer many questions and face some criticism. This card protected my interests, and allowed me to leave earlier without having to explain my full medical history to various staff, thus protecting my boundaries. There was a period of time before receiving my card that I had to explain everything to consultants and tutors, and the response was far more negative. The card was very, very useful 

6th year student

Problems with supportRecognise problem

Student lacks insight (not just psychosis)

Seek help

Student does not disclose on admission

Student presents with conviction or hospital admission

Student in denial about nature of problem

Accept treatment

Student disregards advice

Be aware of impairment

Inappropriate behaviour in clinical setting

Problems with support - toolkit

• Occupational Health• Read GMC advice on MH and FtP• Learning agreement• Interruption of study

• Last resort - FtP

Fitness to Practise• About one quarter of all UCL FtP referrals are due to mental health

– Mental health issues + academic problems– Mental health issues + interruption of study– Recurrent or enduring mental health problems

• 2 stage process• Initial FtP less formal

– Can make requirements• Full FtP panel

– Rarely used (8 cases in 5 years: eating disorder, OCD, PD, substance misuse)

• More commonly, student unable to continue on course

Support during FtP

• FtP is stressful• Clear separation of support from “prosecution” of case• To provide pastoral support, within limits

– Not to be the student’s “friend” at hearing– Not to provide references

Support after FtP

• May be requirement for monitoring – this is not pastoral support and should be separate

• Support when returning from interruption with MH problems

• Occupational Health review – fit to return?• Close supervision for year after return • Reasonable adjustments

Difficult issuesBoundaries

Between support and FtP process

Communication

Between support and FtP process

Students and staff need to know who to talk to

Mixed messages from GMC

Take more students with MH problems and look after them better

I&I much more interested in students with MH problems