Med Students With Mental Health Issues Feel Unsupported

Liam Davenport

September 10, 2015

The majority of medical students who experience mental health problems do not feel supported by their medical school, the results of a UK survey reveal.

The study of more than 1100 medical students indicated that 3 in 10 reported having experienced some kind of mental health issue while at medical school, but 80% of these did not feel adequately supported.

The results also showed that rates of smoking, binge drinking, and illegal drug use among medical students were relatively high.

Matthew Billingsley, editor of Student BMJ, which commissioned the survey, pointed out that the reasons behind the 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,” he writes. "Stigmatising attitudes to mental health problems are passed down from senior doctors, making it difficult for students to step forward when they need support."

The findings highlight the need for dedicated support for medical students and for academic and pastoral roles to be separated, argues a leading expert.

The article was published online September 1 in Student BMJ.

The online survey was sent as an open invitation to readers of Student BMJ, which gathered information on mental health issues and other aspects of health, including smoking, drinking, and drug use.

In all, 1122 students responded, representing approximately 2% of all medical students in the United Kingdom. Of those, 30% said they had experienced or received treatment for a mental health condition while at medical school, and 15% also reported having considered committing suicide at some point during their studies.

However, 80% of those who reported a medical health condition said that the level of support available was either poor or moderately adequate.

Some respondents reported that the attitudes of senior physicians and tutors exacerbated these feelings. One respondent is quoted as saying, "The stigma with mental health issues especially comes into focus when exposed to consultants and tutors who refer to it as a weakness."

The results also showed that 15.8% of respondents said that they smoked, that 25.0% said they engaged in binge drinking every week, and that 10.9% claimed to have taken illegal drugs more than once.

In addition, 8.3% of the students who took part said they had tried a "legal high"; the same proportion said they had used cognition-enhancing drugs to aid their studies.

Perfectionists

Deborah Cohen, MD, a professor in the Institute of Medical Education and director of student support, School of Medicine at Cardiff University, in Wales, recently conducted a survey in collaboration with Ania Korszun, PhD, MD, FRCPsych, of the Wolfson Institute of Preventive Medicine, in London, of 557 students at Barts and the London School of Medicine and Dentistry and at the University of Cardiff School of Medicine, of whom 15% reported having experienced depression and 57% anxiety.

Speaking to Medscape Medical News, Dr Cohen explained that there are a number of reasons why medical students may develop mental health problems.

"You've got a course that's high demand, with long hours, lots of intense learning; plus, they're exposed to some very difficult life events in their practice," she said.

"They see people dying, with serious illnesses, whether they be physical or mental. They're students, and they have to learn to adapt and understand all that while they're learning."

Dr Cohen added that many of the students recruited into medical schools are perfectionists. "That's what we need in medicine: people who are very attentive to detail. They are very cautious about what they do, and they want to be good at what they do, but we know, though, that there is a tendency that they can become more anxious," she said.

Dr Cohen urged caution in overinterpreting the findings, because mental health problems such as depression and anxiety are common in the general population. The problem is also not solely confined to medical students but is seen in other high-achieving student populations.

She continued: "We also have to be careful about how we report these high levels of anxiety, because it looks like...one of the issues might be that people are self-reporting very high levels of anxiety, due to the pressures of the course, but this may not, in fact, mean they are suffering from clinical levels of anxiety or depression."

"People say they are getting very anxious because they are doing lots of exams; they're doing things that would naturally make people feel anxious."

Nevertheless, Dr Cohen believes that systems tailored to support medical students are needed, because "it's clear that medical students are different."

Recent guidance from the UK General Medical Council (GMC) and the Medical Schools Council emphasizes that teaching and pastoral care roles should be separate.

It states: "Doctors in the medical school 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."

Dr Cohen conducted a systematic review on this issue and made a series of recommendations for the GMC on the separation of teaching and pastoral roles within medical schools.

She said: "What we're seeing is medical students very often don't want to go and tell somebody they're going to meet in front of them in an exam about very personal issues that might have happened to them."

"We have to provide them with safe place to talk about personal issues and feel that it's confidential."

She added that medical school students need to know how they can access support and where their confidential records are kept.

Having separated teaching and pastoral roles in the University of Cardiff, Dr Cohen has seen a fourfold increase in the number of self-referrals from students seeking help.

She concluded: "If we want our medical students to behave appropriately, then we've got to give them the appropriate means to access support and have got the right people who are trained to provide that support."

Matthew Billingsley and Dr Cohen have disclosed no relevant financial relationships.

Student BMJ. Published online September 1, 2015. Full text

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