Presentation on theme: "Mental Health Problems Student Support & Fitness to Practise"— Presentation transcript:
1Mental Health Problems Student Support & Fitness to Practise UCL MEDICAL SCHOOLMental Health Problems Student Support & Fitness to PractiseDr Peter RavenFaculty Tutor, Medical Sciences, UCLHon Consultant Psychiatrist, C&I
2An increasing problem? UCL Student Psychological Services 137% increase in students registered over 5 years to 20122,482 students registered in 2012“More than any other UK university”Bad news: UCL students have more mental health problemsOrGood news: breaking down barriers so that seeking help is OK
3The scale of the problem UCL has over 14,000 full time undergraduate studentsMBBS has >2,100 on a 6 year programmeAbout 1 in 6 of all UCL full time undergraduate students on a single programmeCommon mental health problems are commonRecurrent depressive disorder, anxiety disorders including OCD, eating disorders, Personality Disorder (self-harm)
4At 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 knownOn average, 2-3 students leave the course each year due to mental health problemsOn average, 1-2 students go to full FtP panel each year for mental health problems
5Pathways to support - disclosure CommonStudent declares on admission – anxiety disorders eg OCDStudent discloses at the time – anyAcademic issue, reveals underlying problem - depression
7Pathways to support - disclosure Personal TutorTeachers – university academicTeachers – NHS doctor (esp GP or psych)Teachers – Clinical Skills TutorTeachers – Communication Skills TutorAdministratorsOther eg chaplainAll need to know how to refer on and who to
8Principles of support A responsible student needs to Recognise the problemSeek helpAccept treatmentBe aware if clinical interactions are impaired
9Principles of support A responsible support service needs to Support the student not the medical schoolAim for the long term by establishing a positive relationshipBe aware that we are not the students’ doctors
10Support structures Support Tutors (or Personal Tutors) Occupational Health – liaise with GP or treating DrUCL Student Psychological ServicesUCL Disability OfficeClose SupervisionStudent Support Card
11Support precedes FtP Inform student that protected by disclosing Advise student to go to Disability OfficeReassure student that done the right thing in seeking help – GMC expects us to look after our own healthReassure student that MH problems no barrier to successful careerRefer student to Occupational Health
12Support precedes FtP Advise student to d/w GP if not already Advise student to see Student Psychological ServiceReassure student re confidentiality (except FtP)Clarify responsibilities of support service and responsibilities of studentNot FtP at first discussion!
13Ongoing support - toolkit See the same Support Tutor each timeNegotiate reduced workload, eg deadlinesChange placementGive student permission to take time outUse interruption as last resortMentor support, learning supportStudent Support Card
14Student Support CardOriginally 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 issuesProved very useful for students with mental health problems and regular therapy appointmentsSupporting students with disabilities using a ‘student support card’ scheme Raven, Griffin & Hinson (2008) Med Educ 42:.
15Sample card UCL 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 appointmentsand 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 2014Signed:Any queries regarding this should be directed to: Dr Peter Raven, Faculty Tutor.
16Benefits of Student Support Card Wording agreed with the studentStudent can choose whether and when to use itFlexible and allows for individual needs90% of students felt they benefitted from possessing the cardStudents felt empoweredBut.... Hard to publicise to all teachersSupporting students with disability and health issues: lowering the social barriers Cook, Griffin, Hayden, Hinson & Raven (2012) Med Educ 46:564-74
17This 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 useful6th year student
18Problems 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
19Problems with support - toolkit Occupational HealthRead GMC advice on MH and FtPLearning agreementInterruption of studyLast resort - FtP
20Fitness to PractiseAbout one quarter of all UCL FtP referrals are due to mental healthMental health issues + academic problemsMental health issues + interruption of studyRecurrent or enduring mental health problems2 stage processInitial FtP less formalCan make requirementsFull FtP panelRarely used (8 cases in 5 years: eating disorder, OCD, PD, substance misuse)More commonly, student unable to continue on course
21Support during FtP FtP is stressful Clear separation of support from “prosecution” of caseTo provide pastoral support, within limitsNot to be the student’s “friend” at hearingNot to provide references
22Support after FtPMay be requirement for monitoring – this is not pastoral support and should be separateSupport when returning from interruption with MH problemsOccupational Health review – fit to return?Close supervision for year after returnReasonable adjustments
23Difficult issuesBoundaries Between support and FtP process Communication 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