1. Mental Health and Supporting Students Dr Niamh Farrelly Consultant Psychiatrist TCD

2. An Integrated Approach
How Disability Services can communicate with college-based and external health services and ensure best use of resources?

3. Overview 75% of mental health problems emerge before the age of 25
25% of year olds experience MH problems each year : ¼ of whom access help
Estimate 20,000 students
25% = 5,000 students have MH problems
= 1,250 (25%) Actively access help (6% all stds)
Mental health and substance use disorders account for 60-70% of the burden of disease among year olds

4. Changing student profile
more college students meet criteria for some form of learning disability.
Lifestyle habits— eating patterns, sexual activity, sleeping and drinking—we also see evidence of markedly increasing maladaptive patterns.

5. More students, more complex needs…

6. Models of Support
Authoritarian Autonomous: Age / maturity /Separation / individuation Collaborative Care: blend of ‘authority’ (training, knowledge, experience) and ‘autonomy’ (knowledge , preference, experience)

7. Autonomy
Do we hide behind autonomy (right to refuse recommendation) rather than attempt to recognise the clinical problem that lies at the root of the refusal
Autonomy can be made an acceptable way of passing burdensome problem or decisions over to the student
Abdication of responsibility for decisions from the college to the student

8. Collaborative Care
blending of professional cultures: achieved though sharing skills and knowledge to improve the quality of patient care
There are important characteristics that determine team effectiveness, including members seeing their roles as important to the team, open communication, the existence of autonomy, collaborative education

9. Collaborative Care Individual becomes active partner
Takes appropriate responsibility
Agree joint decision
At times balance between authority and collaboration may need to shift
Emergencies trump collaboration but
true collaboration plans for these exigencies

11. Student Service supports
Self help resources
Academic supports
External
Family supports
Friends

12. Collaborative Care Planning
Student at the helm, support etc. crew
Concordance on destination
Concordance on route
Concordance on contingency planning
Advance directives/ planning if temporary absence of captain
e.g. discussion re ‘what do you want me to do if you DNA?’

13. Outcome of collaborative care?
Greater treatment concordance
Better mental health outcomes
Reduced hospitalisation
Reduced time to relapse
Reduced frequency of relapse
Greater student retention

14. Consider perspective of all agencies
Student *
Disability officer *
Tutor
Academic supports
Counselling supports
Friends
Doctor* OT
Family*

15. What is competing with what?
Student : academic / finances / relationship/
Academic: funding / placement integrity
Family: domestic issues / concerns/ isolation
Friends : social life / formation of friendships
Student Services: how is service shared/ how efficiently is this done
Doctor

16. Medical role On site medical service Off site medical service
Advantages: experienced in age group
Disadvantages: lack 24/7 care access model
Off site medical service
May be most appropriate care setting especially if enduring difficulties likely to persist beyond college
Provide continuity of care
Broader scope to access service
Emergency treatment provisions 24/7

17. Off site care
Ability to be fully aware of demands and environmental challenges student faces?
Day care facility
notional structure and routine
Inappropriate expectations of pastoral care
Lack of awareness of financial implications of failure
Assumptions made wrt. intellect and comparisons made with different core cohort of patients
Educational experience of external provider
Confidentiality
Access to speak to somebody

18. External Care Provider
How do you identify yourself?
Most people do not know what a disability officer is?
Concerns wrt confidentiality
Speaking to somebody who knows individual
Difficulties with continuity of care

19. CMHT 450 points Articulate Likely higher SEG
Behavioural activation strategy
Development of goal
? Full consideration of range of skills required to function as student who is unwell

20. Family Expectation to continue Assumptions to return
? Understanding of options
Often
left out in the cold
Misinformed
Lacking in knowledge of what is really going on

21. Collaborative Care Sharing the same vision
Aiming for the same destination
Recognition of crew and their roles
Contingency planning in event of a storm
COMMUNICATION

22. Communication Not just with student but with each other
Attempting to understand different perspectives
Development of relationships with core personnel / working out best person to speak with
Meeting regularly / forming relationships
Relationship with family

23. Remember who you are dealing with!
Pick up the phone!
Networking
Go and visit service