Supporting medical students with mental health conditions

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1 Supportig medical studets with metal health coditios

2 Supportig medical studets with metal health coditios Cotets 02 Geeral Medical Coucil

3 Supportig medical studets with metal health coditios Published July 2013 Geeral Medical Coucil 01

4 Supportig medical studets with metal health coditios Cotets Paragraph(s) Page The resposibilities of medical schools to 04 support studets with metal health coditios Itroductio Who is this guidace for? Medical schools Medical studets People ad orgaisatios ivolved i postgraduate medical educatio ad traiig Defiig metal health Stress Mild-to-moderate metal health coditios Severe metal illesses Eatig disorders Substace misuse (icludig alcohol) Prevetio Etry to medical school Promotig well-beig Opeess ad trasparecy Cofidetiality Occupatioal health services Idetificatio Staff developmet Persoal tutors ad pastoral support Peer support Studet fitess to practise ad moitorig professioalism Geeral practitioers Geeral Medical Coucil

5 Supportig medical studets with metal health coditios Paragraph(s) Page Referral Maagig ad supportig medical studets with metal health coditios The case maagemet model Substace misuse (icludig alcohol) Reasoable adjustmets Takig time away from the course Returig to a course Trasitio to the first year of the foudatio programme Studet fitess to practise Appedix the legal positio Refereces 69 Ackowledgemets 71 Further readig 72 Geeral Medical Coucil 03

6 Supportig medical studets with metal health coditios The resposibilities of medical schools to support studets with metal health coditios Medical schools should create a eviromet where metal health is opely discussed to try to reduce the stigma aroud it. Medical schools should put prevetive measures i place to promote good metal health ad well-beig i their studets. Medical schools should explai that metal health coditios are commo i medical studets ad that support is available. I almost every case, a metal health coditio does ot prevet a studet from completig his or her course ad cotiuig a career i medicie. Medical schools must uderstad the boudaries i which they work whe supportig studets. Medical schools must ot treat studets themselves or maage the treatmet that studets receive. This meas that doctors i the medical school must ot be resposible for the cliical care of idividual studets, ad ay treatmet that studets receive must be maaged separately from the medical school. Medical schools should make sure that their policies about studet cofidetiality are clear ad based aroud GMC guidace. These policies should be made available to studets. Medical schools must ecourage their studets to seek appropriate support from their geeral practitioer (GP) or support services available withi the medical school or uiversity. They should make sure that they are able to refer studets to a experieced occupatioal health service. 04 Geeral Medical Coucil

7 Supportig medical studets with metal health coditios Medical schools should trai staff to recogise the early sigs of metal health coditios ad to idetify whe studets are strugglig. This is so they ca advise them o what support is available withi the medical school or uiversity. The most appropriate way of hadlig a studet with a metal health coditio is through supportive measures, which do ot eed to be put i place through fitess to practise processes. Where a studet is behavig uprofessioally ad also has a metal health coditio, the their behaviour may eed to be addressed by fitess to practise processes i tadem with support. If a medical school believes that a studet will ot be able to cope with a career i medicie, the relevat staff members should talk to the studet about the cocers. The medical school should also seek idepedet medical advice about the studet s coditio. If this does ot resolve the situatio, the medical school should cosider usig fitess to practise processes to get a idepedet decisio o the studet s future. This guidace cocetrates o providig advice o supportig studets with metal health cocers but much of the guidace applies equally to studets who have a physical disability. Geeral Medical Coucil 05

8 Supportig medical studets with metal health coditios Itroductio 1 This guidace has bee produced joitly by the Geeral Medical Coucil (GMC) ad the Medical Schools Coucil. It is desiged to help medical schools support studets who have metal health coditios. It gives examples of good practice ad advice for medical schools o how to provide the best possible help to studets. It is desiged to be flexible, so that medical schools ca improve their existig processes rather tha havig to make radical chages. 2 Studyig medicie at uiversity is a itese experiece ad the course is a demadig oe. It is atural that, at times, studets feel stressed or occasioally overwhelmed by the pressure of exams or the experiece of observig very sick patiets for the first time. This guidace looks at how medical schools ca support studets with metal health coditios, ad what medical schools ca do to promote good metal health ad well-beig i their studets. 3 I society, ad the medical professio i particular, there are still lots of miscoceptios about metal health. Medical studets are ofte reluctat to ask for help we believe this has to chage. As a professio, doctors ad medical schools eed to de-stigmatise metal illess ad we all eed to be more ope about the issue. The GMC also has its part to play. We eed to be clear to the professio that havig a metal health coditio does ot ecessarily mea that a doctor s fitess to practise is impaired. If a doctor recogises that they have a problem, has a uderstadig of their coditio ad asks for help, the i most cases we will ot get ivolved. This applies equally to medical studets throughout their traiig, icludig their postgraduate traiig. 4 The metal health of medical studets has bee widely discussed over the past few years. The fidigs of several studies have raised 06 Geeral Medical Coucil

9 Supportig medical studets with metal health coditios cocers about the prevalece of some metal health coditios i medical studets. 1 Medical schools report that oe of the most complex situatios they face is whe a studet has a metal health coditio ad is strugglig with the course. 5 Medical studets are the doctors of tomorrow ad it is importat they are give the right support at this early stage i their traiig. We believe this guidace will beefit future doctors ad their patiets. 6 Thak you to the idividuals ad orgaisatios who helped us produce this guidace we hope it will be a useful resource for medical schools, studets ad all those ivolved i medical educatio ad traiig. I particular, we thak the members of the group who oversaw the developmet of this guidace for providig their isights ad expertise. 7 Throughout this guidace, we use the terms must ad should i the followig ways. Must is used for a overridig duty or priciple. Should is used whe we are providig a explaatio of how a medical school ca meet the overridig duty. Should is also used where the duty or priciple will ot apply i all situatios or circumstaces, or where there are factors that are outside the cotrol of the medical school or that affect whether a medical school ca follow the guidace. Geeral Medical Coucil 07

10 Supportig medical studets with metal health coditios Who is this guidace for? Medical schools 8 This guidace is primarily aimed at medical schools, because they are resposible for coordiatig support for their studets with metal health coditios. 9 The GMC s guidace, Tomorrow s Doctors, cotais stadards for udergraduate medical educatio, which medical schools must follow. Tomorrow s Doctors says that medical schools eed to give appropriate support to their studets. It also says that studets should feel cofidet to ask for support ad treatmet i a cofidetial ad supportive eviromet This guidace gives advice to medical schools o how they ca give the best possible support to their studets who have metal health coditios. Some of the most commo coditios that medical schools will ecouter iclude: depressio axiety disorders substace misuse (icludig alcohol) eatig disorders. 08 Geeral Medical Coucil

11 Supportig medical studets with metal health coditios 11 Some of the advice will apply equally to studets with physical disabilities or other health coditios medical schools should bear this i mid whe cosiderig this guidace. We kow that medical schools have support services i place ad this guidace is desiged to work with ad improve those services. 12 Medical schools should also make sure that cliical supervisors follow the cotets of this guidace ad that all staff who sped a cosiderable amout of time with medical studets are aware of what the medical school or uiversity provides for studets i terms of support. Medical studets 13 This guidace is also for medical studets. While the support they receive is always goig to be specific to their ow medical school, it is also useful for studets to uderstad the atioal framework for all schools, so they kow what support they ca expect from their medical school. 14 Medical schools should publish examples of the reasoable adjustmets they are willig to make for studets with metal health coditios. This will help studets feel comfortable about askig their medical school to make reasoable adjustmets for them. Geeral Medical Coucil 09

12 Supportig medical studets with metal health coditios 15 We kow that studets are ofte reluctat to ask for support whe they are strugglig, especially if their problems relate to a metal health coditio. This ca ofte be because they are worried that highlightig a metal health coditio could put their career at risk (see the myth busters sectio o pages 11 13, which is desiged to address these fears). People ad orgaisatios ivolved i postgraduate medical educatio ad traiig 16 This guidace is also aimed at those resposible for doctors i postgraduate medical educatio ad traiig such as traiig programme directors, ad educatioal ad cliical supervisors. They should uderstad the support systems that medical schools use, to better uderstad the eviromet their traiees come from. 17 This guidace covers importat issues about the trasitio from medical school to postgraduate traiig, icludig the volutary trasfer of iformatio betwee medical schools ad the UK Foudatio Programme. 10 Geeral Medical Coucil

13 Supportig medical studets with metal health coditios Myth busters Some commo miscoceptios studets have about metal health. If I have a metal health coditio, it will damage my career prospects. Metal health coditios are commo i the geeral populatio ad commoly occur i doctors. Legally, employers ca t discrimiate agaist you if you have a metal health coditio. Staff will treat me differetly if they kow I have a metal health coditio. Most staff will ot kow that you have a metal health coditio. Those who do have a duty to support you. If I tell my medical school that I have a metal health coditio, I will automatically be referred to a fitess to practise committee. This should ot be the case. If you egage with your medical school ad ask for support ad follow the advice give, the there will be o eed for a fitess to practise committee to be ivolved. Oce I m a doctor, if I have a metal health coditio, the GMC will automatically put me i their fitess to practise procedures. The GMC is oly iterested whe a doctor s metal illess puts patiets at risk. The vast majority of doctors with metal health coditios are ot a risk to patiets. If a doctor uderstads their coditio ad seeks appropriate support, the GMC does ot get ivolved. The GMC ever removes doctors from the register solely because they have a metal health coditio. Geeral Medical Coucil 11

14 Supportig medical studets with metal health coditios Seekig help is see as a sig of weakess. Seekig help is the strog thig to do. It is also the right thig to do. Your medical school has systems i place to support you ad they wat you to do well. Psychiatric treatmets are usually ieffective. This is ot true. Treatmets for metal health coditios show high cliical effectiveess ad compare favourably to treatmets for commo physical health coditios. If I see my GP, I will just be prescribed atidepressats. There is a wide rage of effective treatmets for metal health problems, icludig talkig therapies. Your GP should ivolve you i decisios about your care. Medical studets, like doctors, must be perfect ad idestructible we should ot eed prescriptio medicatio for our metal health. At ay oe time, 15 25% of the geeral populatio experiece mild-to-moderate metal health coditios. This icludes doctors, may of whom will take medicatio for their coditios. This is perfectly ormal ad acceptable. I ca ever take time out from my studies. Medical studets ca ad do take time out from their studies. If you are cocered, you should ask your medical school for advice. 12 Geeral Medical Coucil

15 Supportig medical studets with metal health coditios Metal health coditios are rare i medical studets. This is ot the case. I fact, research shows that medical studets may have higher istaces of metal health coditios compared to those i similar areas of study. Metal health coditios are persoal ad do ot cocer the medical school. Your medical school eeds to kow if you have a coditio that may affect your performace. It will be able to support you ad make adjustmets to help you study. Oce you have a metal health coditio you ca ever fully recover. This is ot true. There are may differet types of metal health coditios ad may people make a full recovery from them. There will be o beefit to me if I tell my medical school about my metal health coditio. This is ot true. Your medical school will be able to put i place processes to support you with the course ad will be able to put you i cotact with services that ca help you. The GMC will refuse to grat me provisioal registratio if I have a metal health coditio. This is ot true. The GMC oly refuses registratio if it believes your coditio would put patiets at risk. Where a applicat uderstads their coditio ad asks for appropriate help ad support, the GMC will grat registratio. Geeral Medical Coucil 13

16 Supportig medical studets with metal health coditios Defiig metal health 18 Lots of differet terms are used to describe people with metal health coditios, which ca cause cofusio ad prevet medical studets from gettig the right support. 19 I this guidace, we refer to three levels of severity of metal health coditios: stress mild-to-moderate metal health coditios severe metal illesses. We will also refer to eatig disorders ad substace misuse, which we will defie separately. We have icluded these coditios i this guidace because they are quite commo amog medical studets. Medical schools should be able to give appropriate support for all levels of difficulty rather tha focusig o just oe type of problem. Other types of coditio, such as cogitive impairmet ad autistic spectrum disorders, are rare i medical studets, but this guidace would also apply to medical studets experiecig these coditios. 14 Geeral Medical Coucil

17 Supportig medical studets with metal health coditios Stress 20 Stress is extremely commo ad affects most studets at some time. I fact, studyig medicie ca itself be a source of stress for studets. Feelig stressed is ot the same as havig a metal health coditio or illess, although repeated stressful experieces ca be a risk factor for developig physical ad metal health problems. 21 May symptoms of metal health coditios, such as axiety, are also ormal experieces ad ofte occur whe people are uder stress. I this guidace, we use the term stress to describe the ormal experieces that happe to may medical studets. 22 Eve though this is a ormal part of beig a studet, medical schools eed to thik about ways to support studets who experiece stress both to alleviate ay immediate discomfort ad to prevet more serious problems from emergig. We make some suggestios o ways to support studets later i this guidace (see pages 22 27). Mild-to-moderate metal health coditios 23 Mild-to-moderate metal health coditios are commo ad ca affect 15 25% of the geeral populatio at ay oe time. They iclude: depressio geeralised axiety disorder Geeral Medical Coucil 15

18 Supportig medical studets with metal health coditios paic disorder social axiety disorder obsessive compulsive disorder post-traumatic stress disorder. 24 Commo metal health coditios ca usually be treated i primary care rather tha secodary care settigs. I geeral, these commo coditios carry less stigma tha severe coditios, so those with a mild or moderate health coditio are less likely to face discrimiatio. However, medical studets have a higher prevalece of depressio ad axiety tha the geeral populatio, so it is importat for medical schools to idetify these studets ad support them i the right way, although they must ot treat studets themselves. Some studets may eed adjustmets to their traiig to support them while they are uwell. Severe metal illesses 25 Severe metal illesses iclude: schizophreia severe depressio bipolar affective disorder (maic depressio). 16 Geeral Medical Coucil

19 Supportig medical studets with metal health coditios These coditios are relatively ucommo. Treatig them will usually ivolve local commuity metal health services as well as primary care services. Medical studets who have these severe illesses will eed help from the medical school to make sure they are give the most appropriate support. Where ecessary, adjustmets will eed to be made to support them. Eatig disorders 26 Eatig disorders are characterised by a abormal attitude towards food that causes someoe to chage their eatig habits ad behaviour. People with eatig disorders typically eat too little or too much, or use harmful ways to get rid of calories. 27 The two most commo forms of eatig disorder are: aorexia ervosa where the perso restricts their calorie itake ad ca iclude usig excessive exercise to bur calories bulimia ervosa where the perso tries to cotrol their weight by bige eatig ad the deliberately beig sick or usig laxatives. Geeral Medical Coucil 17

20 Supportig medical studets with metal health coditios Substace misuse (icludig alcohol) 28 The use of alcohol or other cotrolled substaces is defied as substace misuse whe it starts to have a egative impact o the way a perso fuctios. People with substace misuse problems ofte have a patter of use that results i social, psychological or physical harm. Patters of use that ca cause harm iclude: itoxicatio bigeig regular use with physical or psychological depedece. 29 The use of cotrolled substaces that are illegal is always a fitess to practise issue medical schools must make this clear to studets. However, they should also offer support to studets who are addicted to cotrolled substaces. Later i this guidace, we explai about how to maage ad moitor studets with substace misuse issues (see pages 53 54). 18 Geeral Medical Coucil

21 Supportig medical studets with metal health coditios Prevetio 30 This sectio explais what medical schools ca do to create a supportive eviromet for their studets. Medicie is a itesive course ad some stress is ievitable. But medical schools should try to reduce the pressure put o their studets ad help them to strike a balace betwee beig committed ad beig overworked. 31 Whe explaiig that metal health coditios are a ormal part of life, medical schools should be ope about the fact that some studets will struggle with uiversity life. They should highlight the support services available to studets. 32 Metal health coditios are ormal, i the sese that they are: commo i fact they are more prevalet amog medical studets tha amog the geeral populatio expected to happe plaed for with flexibilities i educatio ad traiig. 33 This message eeds to be give ad reiforced at every stage of a medical studet s career particularly durig high-pressure assessmets ad whe movig to the ext stage of their educatio ad traiig. Geeral Medical Coucil 19

22 Supportig medical studets with metal health coditios Etry to medical school 34 From the first cotact with a studet, medical schools should explai that metal health coditios are commo. Schools should make it clear that they do get applicatios from potetial studets who have metal health coditios ad that this is ormal ad expected. 35 The start of a studet s medical course is a importat poit at which to provide support. There will be studets who have had metal health coditios i the past. It is importat that the medical school s occupatioal health or disability support service ca check whether these studets will eed extra support while they are at medical school. 36 Medical schools should clearly explai why it is importat for studets to tell the occupatioal health service about ay health coditio they have at the poit of etry to the course. Studets should do so for three key reasos. Medical schools have a duty to support their studets, but studets have to help the school to do this by beig ope ad hoest about their health. Beig ope ad trustworthy is a importat part of beig a doctor patiets ad the GMC expect this of practisig doctors. Failure by a doctor o the medical register to disclose a health matter that could potetially impact o patiet safety is a breach of this duty Geeral Medical Coucil

23 Supportig medical studets with metal health coditios A studet should uderstad that their ill health could put their ability to study at risk. Where a studet has this uderstadig ad shows this by gettig help ad support their health coditio rarely prevets them from completig the course. Oe way to demostrate uderstadig from the start is for a studet to declare whether they will eed additioal support whe they begi their course. 37 Medical schools should emphasise the importace of studets beig hoest ad ope about their health, ad make clear that support is available, i the iformatio they give to their studets. Schools should also raise the eed to declare coditios i perso with potetial studets, such as at iterviews or ope days. 38 Medical schools should make it clear to applicats that declarig a metal health coditio will ot be held agaist them i the applicatio process. Issues relatig to a applicat s health are dealt with separately from the formal admissios process, ad decisio-makig bodies, such as iterview paels, will ot kow that the applicat has declared a health coditio Medical schools may wat to give the applicat access to a occupatioal health service to talk about their coditio whe they apply. They will be able to advise the applicat o what types of adjustmet might be available to them should their applicatio be successful. Geeral Medical Coucil 21

24 Supportig medical studets with metal health coditios 40 Oce the decisio has bee made to offer a studet a place, they ca be referred to the occupatioal health service if appropriate. The occupatioal health service ca give the medical school advice o whether the applicat will be able to meet the outcomes set out i Tomorrow s Doctors ad the adjustmets they might eed durig their course. They ca also advise o the applicat s suitability for a career i medicie. Promotig well-beig 41 As well as supportig studets who have metal health coditios, medical schools should also promote well-beig amog all of their studets. 42 Some of the ways that medical schools ca do this iclude: deliverig group learig exercises focusig o how to deal with stress providig ad promotig olie resources o keepig healthy, icludig advice o healthy lifestyles providig sessios o techiques such as midfuless ad meditatio, ad providig opportuities for physical exercise ad yoga, which some people fid useful to help them maage their stress levels. Some of these services may be provided by the medical school s paret uiversity. Where this is the case, the medical school should let its studets kow this. 22 Geeral Medical Coucil

25 Supportig medical studets with metal health coditios Promotig good metal health ad well-beig at Birmigham Medical School The Feel Bright campaig was set up i as a joit iitiative betwee studet represetatives ad seior welfare staff to promote good metal health ad well-beig, reduce the stigma associated with metal illess, ad raise awareess that medical studets: ca develop metal health coditios ca recover from metal health coditios ca cotiue with their medical degree, ad practise medicie, despite declarig that they have a metal health coditio will be supported by the medical school. The MBChB studet welfare represetative is resposible for coordiatig the campaig. Feel Bright s message is spread i three key ways. Iteractive sessios First-year studets take part i a iteractive lecture, which focuses o uderstadig stress, axiety ad depressio. The studet welfare represetative, seior welfare tutors ad a local cosultat psychiatrist speak about: Geeral Medical Coucil 23

26 Supportig medical studets with metal health coditios commo causes of stress i medical studets how studets ca recogise the differece betwee stress ad depressio or axiety the prevalece of depressio or axiety i medical studets ad doctors sources of help ad treatmets available. Throughout the lecture, studets are ivited to use aoymous audiece respose clickers to aswer questios. Aswers to the questios are the discussed to bust commo myths, for example If I tell the medical school am depressed, they will throw me out, ad I ca t be a good doctor if I have a metal illess. Medical studet voluteers from years three to five lead a iteractive discussio sessio with small groups of secod-year studets. The sessio focuses o promotig good metal health for example, studets are ecouraged to ask questios ad discuss cocers about startig hospital placemets. Each group is asked to come up with the top-te tips for maagig stress ad axiety, ad the group with the best tips is awarded a prize. The best tips are the circulated to studets i years oe ad two via . Website The medical school website has a dedicated area for Feel Bright, which gives: 24 Geeral Medical Coucil

27 Supportig medical studets with metal health coditios a brief overview of the campaig a wealth of resources about metal health coditios iformatio o how studets ca access metal health advice ad support services both withi ad outside the medical school. The website hosts key documets, such as a poigat reflectio writte by a ex-medical studet who developed depressio at medical school ad is ow successfully workig as a doctor. The Feel Bright booklet, which was writte by two studets, cotais codesed user-friedly iformatio about metal health coditios, ad tips for maagig stress ad axiety, especially at revisio time, ad clearly describes how to access help ad support. The studet welfare represetative seds regular s to studets i all years of the MBChB course to: remid studets of the resources available o the Feel Bright website iform studets about special evets takig part o campus for example, World Metal Health Day sessios ru by the wider uiversity. Geeral Medical Coucil 25

28 Supportig medical studets with metal health coditios 43 Medical schools should also have supportive programmes, or access to equivalet uiversity programmes, i place to help studets deal with stress. There is a rage of support services that schools could offer. Peer support studets are traied ad supported by the medical school to support their peers i dealig with stress. Near peer support, where a studet or doctor who has already bee through the course gives the support, ca also be effective. Group sessios o stress maagemet studets are give the chace to discuss their problems with their peers ad are give strategies to cope with stress. Metorig or buddyig schemes studets are paired with seior colleagues or juior doctors to fid ways to reduce stress. Specific learig support courses to help studets idetify their ow learig style ad develop skills for studyig ca help them to work more effectively ad reduce stress. 44 Medical schools should highlight the importace of the work-life balace ad should promote opportuities for studets to get ivolved with extra-curricular activities. Medical schools must allow time for studets to take part i extra-curricular activities ad should make sure that this time is protected. 26 Geeral Medical Coucil

29 Supportig medical studets with metal health coditios What medical studets say about work-life balace The oly bad thig about med school so far i phase 1 is that it does take up a lot of your time. I ca still fit i activities, but the I will be tired durig lectures ad uable to cocetrate. I feel I have to sacrifice oe or the other each week. People do t realise it is ot ecessarily the time but the exhaustio from cocetratig ad workig hard that stops you from doig leisure activities ad keepig i touch with o-medics. My medical school allows time for leisure activities, but geerally you do t have the eergy both to ejoy leisure activities i time off ad to keep up to date with work, as the work ad lectures are itellectually challegig. I am too tired to do aythig at the ed of the day you commit yourself to the course. Before exams, we revise up to te hours a day. I feel too tired ad guilty to do aythig else. Opeess ad trasparecy 45 It is importat to create a atmosphere that is ope about metal health ad well-beig. Medical schools should reduce the stigma aroud metal health by discussig it as part of learig about metal health withi the curriculum. Geeral Medical Coucil 27

30 Supportig medical studets with metal health coditios 46 As part of this policy of opeess, medical schools must tell their studets about their record-keepig policies. Schools should tell studets what iformatio they keep about their health ad performace, where they keep it ad who has access to these records. Studets should also be told the ame of the staff member resposible for iformatio security ad compliace with the Data Protectio Act. 47 Early traiig i commuicatio skills ca also beefit studets by helpig them to develop their skills i talkig about their ow health. 48 It is importat for medical schools to teach studets about beig both a doctor ad a patiet. They should cosider teachig studets about the Health for Health Professioals iitiative. * Studets should kow that they eed to get the right help for their ow ill health ad should ot self-treat, self-refer or have corridor coversatios about their ow health-related issues or the health issues of others. Addressig this issue early o ca be of great beefit for future doctors. 49 Medical schools must explai how they offer support to their studets. This should form a importat part of the iductio to the course ad should be repeated throughout the time they are at medical school. * This is a joit iitiative ru by the Faculty of Occupatioal Medicie, the Royal College of Geeral Practitioers ad the Royal College of Psychiatrists. Go to: 28 Geeral Medical Coucil

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