Supporting medical students with mental health conditions

Transcription

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

31 Supportig medical studets with metal health coditios Cofidetiality 50 For medical studets to feel comfortable about askig for help if they have a metal health coditio, they must uderstad the extet to which the services they are accessig are cofidetial. 51 Every support service i every medical school should have a cofidetiality policy. This policy should clearly state: who will receive the iformatio provided by the studet how the studet s iformatio will be used istaces where cofidetiality may be breached. Studets should be asked to agree to this policy whe they access support services. 52 It is also importat to make studets aware that, i some circumstaces, they ca decide they do ot wat to share iformatio about their health that they have previously agreed to share. Medical schools should have a process for studets to complai if their cofidetiality has bee breached by medical school staff. 53 Where people providig support feel that it might be ecessary to breach cofidetiality, they should discuss this with the studet before takig ay actio. A studet s right to cofidetiality should be breached oly i very rare circumstaces. Geeral Medical Coucil 29

32 Supportig medical studets with metal health coditios The referral pathway at the Uiversity of Liverpool The Psychological Support Service for Studet Practitioers (PSSSP) bega i Two cliical psychologists give psychological support to medics, detists ad health sciece studets. After a iteral review i 2006, * PSSSP implemeted several chages to make the service more visible, more itegrated with other studet support services withi the uiversity, ad more proactive i researchig ad promotig well-beig activities. For example, PSSSP developed a website to give studets iformatio about the service. PSSSP set up the referral pathway several years ago without ay other models available for guidace. A studet is referred to PSSSP by a desigated tutor i the medical, detal or health sciece school. This meas that the school is aware of the referral ad that the studet has metal health eeds, but the ature of the studet s cocers is cofidetial to PSSSP. The school eeds to kow oly that the studet s eeds are beig met ad whether the studet eeds ay adjustmets. School tutors ad studets have become icreasigly aware that there is support for studets ad that there is a cofidetial referral pathway to readily access this support. * 30 Geeral Medical Coucil

33 Supportig medical studets with metal health coditios 54 A studet s cofidetiality should be breached oly to protect the idividual studet or others from risk of serious harm. 55 Medical schools may also wat to have a overarchig cofidetiality policy that sets out which staff members will have access to iformatio about a studet s health ad what they will use it for. 56 The use of a occupatioal health service ca help medical schools with issues aroud cofidetiality. Occupatioal health practitioers ca give a medical school advice about ay ecessary adjustmets, without the medical school eedig to kow the details of the cliical coditio of the studet. The occupatioal health practitioer will give the medical school a outlie of the coditio ad the suggested adjustmets to support the studet s study. The medical school ca the support the studet without breachig cofidetiality ad maitai appropriate boudaries. 57 Other services withi medical schools ad uiversities will also be able to provide a similar cofidetial service to occupatioal health. Whether a studet eeds to see occupatioal health or ot will deped o the seriousess of the cocer about their health. More complex health problems should be assessed by a occupatioal health practitioer. Geeral Medical Coucil 31

34 Supportig medical studets with metal health coditios The GMC s guidace o cofidetiality The GMC s guidace should form the startig poit for medical schools whe cosiderig cofidetiality. The relevat paragraphs are set out below. Tomorrow s Doctors (2009) 143 Medical studets who are ill have the same rights to cofidetiality as other patiets. Doctors providig medical care for studets must cosider their duties uder the GMC s Cofidetiality guidace. Passig o persoal iformatio without permissio may be justified if failure to do so may result i death or serious harm to the patiet or to others. Doctors should ot pass o iformatio without the studet s permissio, uless the risk to patiets is so serious that it outweighs the studet s rights to privacy. They must remember that studets will be i close cotact with patiets from a early stage of their traiig. Cofidetiality (2009) Priciples 6 Cofidetiality is cetral to trust betwee doctors ad patiets. Without assuraces about cofidetiality, patiets may be reluctat to seek medical attetio or to give doctors the iformatio they eed i order to provide good care. But appropriate iformatio sharig is essetial to the efficiet provisio of safe, effective care, both for the idividual patiet ad for the wider commuity of patiets. 32 Geeral Medical Coucil

35 Supportig medical studets with metal health coditios Disclosures to protect the patiet 51 It may be appropriate to ecourage patiets to coset to disclosures you cosider ecessary for their protectio, ad to war them of the risks of refusig to coset; but you should usually abide by a competet adult patiet s refusal to coset to disclosure, eve if their decisio leaves them, but obody else, at risk of serious harm. Disclosures to protect others 53 Disclosure of persoal iformatio about a patiet without coset may be justified i the public iterest if failure to disclose may expose others to a risk of death or serious harm. You should still seek the patiet s coset to disclosure if practicable ad cosider ay reasos give for refusal. 54 Such a situatio might arise, for example, whe a disclosure would be likely to assist i the prevetio, detectio or prosecutio of serious crime, especially crimes agaist the perso. Whe victims of violece refuse police assistace, disclosure may still be justified if others remai at risk, for example, from someoe who is prepared to use weapos, or from domestic violece whe childre or others may be at risk. 55 If a patiet s refusal to coset to disclosure leaves others exposed to a risk so serious that it outweighs the patiet s ad the public s iterest i maitaiig cofidetiality, or if it is ot practicable or safe to seek the patiet s coset, you should disclose iformatio promptly to a appropriate perso or authority. You should iform the patiet before disclosig the iformatio, if practicable ad safe, eve if you ited to disclose without their coset. Geeral Medical Coucil 33

36 Supportig medical studets with metal health coditios Occupatioal health services 58 Medical schools eed to make sure that they have access to a occupatioal health service. This should be a iteral service provided by, but idepedet from, the uiversity ad medical school. But, i some circumstaces, schools may eed to use a exteral provider. Medical schools must make sure that the service has the right kowledge to treat medical studets ad a good uderstadig of the medical school eviromet. Some occupatioal health practitioers have take extra traiig for workig with doctors, so medical schools should make sure that the service they use has access to staff with these skills. 59 A occupatioal health service should give the medical school advice about the support ad reasoable adjustmets that its studets eed. However, the service does ot eed to tell the medical school about the studet s specific coditio. 60 Medical schools may also wat to cosider whether they could allow studets to self-refer to the occupatioal health service. Self-referral would eed to be doe o a cofidetial basis, allowig a medical studet to ask for advice about their health or disability. Medical schools that allow self-referral should give studets iformatio about how to self-refer ad how the occupatioal health service will assess the adjustmets they might eed. 34 Geeral Medical Coucil

37 Supportig medical studets with metal health coditios The beefits of a occupatioal health service to studets It provides specialist advice about health issues that could egatively affect a studet s studies or career. It ca work with medical schools o health issues without disclosig the details of the studet s health cocer. It s impartial it is there to give advice about studets health ad well-beig. It ca help studets to access other services to support their health ad well-beig while at medical school. Geeral Medical Coucil 35

38 Supportig medical studets with metal health coditios Idetificatio 61 A supportive eviromet i which medical schools opely discuss metal health coditios will help studets feel happy to ask for support. However, ot all studets will recogise that they have a metal health coditio, so schools eed processes to idetify studets who are strugglig with the course ad might eed support. 62 For example, studets showig a drop i academic performace or with low-level fitess to practise issues, such as o-attedace at lectures or semiars, might eed additioal support ad may have a metal health coditio. Medical schools should also ecourage studets to come forward if they feel they might eed additioal learig support. Staff developmet 63 All medical school staff should be aware of the support services available to medical studets i their school ad uiversity. They should be traied i recogisig the commo sigs ad symptoms of metal health coditios, icludig substace abuse ad eatig disorders. They should also kow how to raise cocers about a studet s metal health. 64 It could also be useful for all staff to have traiig o how to commuicate effectively with studets who have a metal health coditio. 36 Geeral Medical Coucil

39 Supportig medical studets with metal health coditios For example, the metal health charity Mid rus courses desiged to improve awareess of metal health issues, icludig a course o metal health first aid. * Alteratively, medical schools could ask local psychiatrists or commuity metal health teams to provide traiig. Persoal tutors ad pastoral support 65 Medical studets should be offered pastoral support throughout the course. Pastoral support works best whe it is a valued part of the course ad studets are able to build up a good relatioship with the perso providig it. 66 Persoal tutors ca provide either pastoral or academic support for studets. It is importat that those providig pastoral support are ot i a positio to make decisios o academic progressio. This separatio of fuctio allows studets to have a safe eviromet i which they ca raise cocers without worryig that there will be ay impact o their academic progressio. 67 Where tutors provide purely academic support, they should be aware that studets may wat to discuss persoal matters with them, icludig matters relatig to their metal health. Therefore, those givig oly academic support eed to be aware of the other support services available so that they ca give appropriate advice. * For a full list of courses ru by Mid, go to: courses_a-z. Geeral Medical Coucil 37

40 Supportig medical studets with metal health coditios 68 People providig pastoral support must have had the right traiig for the role. It is likely that the persoal tutor will be, i may cases, the member of medical school staff who studets are most likely to reveal a metal health coditio to. 69 If a studet reveals a metal health coditio, the persoal tutor should ecourage them to seek help from their GP. The tutor might also wat to refer them to the occupatioal health service as this removes the eed to share ay of the studet s sesitive or persoal iformatio with other members of medical school staff. 70 Those who give pastoral support must be aware of the boudaries of this role. They should ot try to treat the studet themselves or isist that they share detailed or sesitive persoal iformatio, uless the studet asks to do so. 38 Geeral Medical Coucil

41 Supportig medical studets with metal health coditios Best practice for pastoral support Staff members who provide pastoral support should be selected based o the skills ad persoal qualities that the role requires. Staff who give pastoral support should have their role clearly defied ad should be give traiig for the role. Medical studets should be strogly ecouraged to go to pastoral support sessios. Time for pastoral support sessios should be timetabled ito the course. Appoitmets should follow a clear format with a record that is completed after each sessio. Geeral Medical Coucil 39

42 Supportig medical studets with metal health coditios Peer support 71 Some medical schools have itroduced peer support, which is where studets support other studets. Peer support gives studets the chace to share experieces ad liste to the cocers of others outside the cliical eviromet. 72 It must be made clear to all studets ivolved that peer supporters are providig friedship ad support they are ot actig i a cliical role. 73 Evidece suggests that traiig voluteers helps them to better support others ad also has a positive impact o the persoal resiliece of those traied. 5 Therefore, medical schools should cosider givig all studets traiig i basic recogitio, iitial support ad sigpostig. This could be part of a professioal developmet course ad could cover: the rage ad prevalece of metal health issues ecoutered by medical studets the reluctace of medical studets to seek help sources of help ad support stayig withi the boudaries of beig a supportive fried. 74 Where medical schools wat to put a formal peer support programme i place, they must make sure that those who provide the service are properly traied for ad supported i this role. They must uderstad how formal support services work withi the medical school ad must be aware of issues such as cofidetiality ad boudaries. 40 Geeral Medical Coucil

43 Supportig medical studets with metal health coditios Studet fitess to practise ad moitorig professioalism 75 I the cotext of this guidace, studet fitess to practise covers the behaviour ad health of studets ad the processes by which medical schools maage ad moitor such behaviour ad health to assess a studets fitess to practise as a doctor. Medical schools refer to this differetly, but for ease of referece i this guidace it is referred to as fitess to practise. 76 Medical schools should also have a more formal fitess to practise procedure, where a studet s actios ad behaviour are ivestigated ad a pael may be set up to cosider the case ad make a decisio o the studet s future. I the case of a studet with metal health cocers, this formal process should oly be used whe the metal health coditio sigificatly affects their ability to study ad practise. 77 All medical schools should have moitorig i place to detect lowlevel fitess to practise cocers. This is because a studet with several cocers, take collectively, could have impaired fitess to practise. These low-level cocers iclude: lateess or failure to atted teachig sessios hadig i work late lack of egagemet with the course aggressive or o-cooperative behaviour poor commuicatio with staff ad patiets. Geeral Medical Coucil 41

44 Supportig medical studets with metal health coditios 78 Although these are fitess to practise cocers, they could also idicate that a studet is strugglig or has a metal health coditio. Therefore, medical schools should use their processes to deal with mior cocers, to idetify studets with metal health coditios ad to provide support as early as possible. Ecouragig studets to get early support at Uiversity College Lodo (UCL) UCL Medical School proactively moitors studets performace to fid out whether a studet eeds help whe their progress stalls. This has allowed the school to pick up o a sigificat umber of problems, icludig metal health issues, before the studets would have usually told the medical school about them. It has also helped create a eviromet i which studets feel able to get help for problems at a early stage. All studets who have failed a formative or summative assessmet, are offered the opportuity to speak to a member of staff (studet support tutors ad year leads). For formative assessmets, the bottom 10% of studets are see, regardless of the pass mark, ad the ext 10% are offered the chace to opt i to see a member of staff. Studets with poor performace o cliical placemet (for example, D grade) or i the skills laboratory (for example, failure to achieve competecy), or who have failed to submit admiistrative paperwork o time, will also be offered a appoitmet. 42 Geeral Medical Coucil

45 Supportig medical studets with metal health coditios The staff member asks the studet if there are ay uderlyig reasos, ad fills i a form that screes for problems with health, persoal or family life, accommodatio, fiace ad study skills. If ay issues do come to light, the member of staff will idetify what support ca be put i place to help the studet get back o track. At a time whe studet complaits are icreasig, this performace moitorig also provides objective evidece that the medical school tried to idetify ad resolve ay problems that might be cotributig to poor performace. Geeral practitioers 79 Medical schools must ecourage their studets to register with a GP who is local to the school (or the studet health service, if oe exists) so that they ca access idepedet ad objective medical care Studets who have existig metal health coditios may wat to stay registered with a GP who they already have a relatioship of trust with. However, if they have relocated to atted medical school, they should be ecouraged to register with a local GP. Sice GPs play a importat role i idetifyig metal health coditios ad i providig support ad treatmet, all studets should be able to access a GP locally. Uiversity-based GPs will also have a good kowledge of the support services available at the uiversity or medical school. Geeral Medical Coucil 43

46 Supportig medical studets with metal health coditios 81 Medical schools could give studets a list of preferred GP practices if they do ot have access to a uiversity-based GP service. Where a GP has experiece of dealig with medical studets, they are usually better at givig them specific support. 82 Medical schools without a uiversity-based GP service should sed all local GPs a factsheet. This should set out: the support services available at the medical school the school s policies for supportig studets iformatio about the occupatioal health service used by the medical school. 44 Geeral Medical Coucil

47 Supportig medical studets with metal health coditios Liks with exteral services though Newcastle Uiversity s Studet Wellbeig Service The Studet Wellbeig Service (SWS) has liks with several key exteral services. Liks with local GP practices Newcastle Uiversity does ot have a medical cetre o campus, but there are two mai GP practices that studets use. The head of SWS ormally meets with the practice maagers or goes to a staff meetig or traiig evet oce a year. Liks with other services SWS therapy staff have a maagerial lead for each stakeholder service. This allows each service to have a sigle poit of cotact, ad meas there is a local expert withi the team for each service. SWS also has liks with: the local crisis assessmet team to address cocers about a studet s immediate safety the Early Itervetio i Psychosis (EIP) team the Regioal Eatig Disorders Team North East Coucil o Addictios Geeral Medical Coucil 45

48 Supportig medical studets with metal health coditios commuity metal health teams, which SWS liaises with o a idividual studet basis with the studet s permissio. SWS meets with these teams, sometimes shadowig team members, to make sure there are clear lies of commuicatio ad uderstadig about what each of the teams does ad how the referral processes work. If a studet is kow to the SWS service ad is beig see by the EIP team, SWS may arrage for the EIP team member to see the studet o campus to esure the studet is gettig the help they eed easily. Similarly, a umber of members of the team recetly atteded the Regioal Eatig Disorders team meetig to esure clarity regardig the remit ad referral processes for each team ad to allow sigpostig ad joi-up. SWS has also met with represetatives from the NECA (North East Coucil o Addictios). SWS liaises with staff i commuity metal health teams o a idividual studet basis ad with the permissio of the studet. 46 Geeral Medical Coucil

49 Supportig medical studets with metal health coditios Referral 83 Medical schools must ot treat studets themselves or maage the treatmet that studets receive. This meas that idividual doctors i the medical school must ot be resposible for the cliical care of idividual studets. Ay treatmet that studets receive must be maaged separately from the part of the medical school that is resposible for their academic performace ad progress. The role of the medical school is to ecourage the studet to ask for help. 84 I the majority of cases, the most appropriate course of actio is for the medical school to ecourage the studet to seek help from their GP. The studet s GP will be the best source of treatmet for the studet as they ca also refer them to local NHS services, icludig psychiatric services where ecessary. The medical school may also wat to refer the studet to a occupatioal health practitioer who ca advise the medical school o what adjustmets the studet may eed to complete the course. 85 Where differet idividuals ad orgaisatios, icludig studet support services, occupatioal health services ad GPs, are ivolved i treatig the studet, clear pathways eed to be put i place to allow these differet services to commuicate. This is to esure that the studet receives effective care from each separate service. Medical schools should thik about how differet orgaisatios ca be ecouraged to commuicate effectively ad how they ca also esure that they receive appropriate iformatio about the studet. 86 Medical schools eed to be aware of the NHS treatmet services available i their local area for differet metal health coditios. I some places it may be difficult for studets to be treated i the local Geeral Medical Coucil 47

50 Supportig medical studets with metal health coditios NHS system, as cliical placemets for other medical studets may take place withi that system. Where this could potetially be a problem, medical schools should put i place reciprocal agreemets so studets ca be treated outside of the local area. 87 Where good treatmet services are t available, medical schools may wat to fud additioal services for their studets. Referral to these services should come from the studet, the studet s GP or the occupatioal health service. The medical school should ot refer a studet to these services, but it may be appropriate for the service to iform the school that they are treatig the studet. 88 Medical schools ca fud support services for their studets, but they should t be part of the treatmet process. Extra support that medical schools could fud iclude: group cousellig sessios cogitive behavioural therapy support groups for specific problems, such as eatig disorders or substace misuse. These support services could form part of the defied care pathways for studets with commo metal health coditios. It s importat that these services ad care pathways are maaged by a idepedet, suitably qualified healthcare practitioer ad ot by the medical school. 48 Geeral Medical Coucil

51 Supportig medical studets with metal health coditios Maagig ad supportig medical studets with metal health coditios 89 Medical schools should focus o helpig studets who are receivig treatmet to complete the course. They eed to make sure that studets are able to access the right support ad are able to go to support appoitmets. It is ot the medical school s job to treat the studet ad it must ot attempt to do so. Pastoral support for disabled studets at the Uiversity of Southampto The Faculty of Medicie at the Uiversity of Southampto has appoited a part-time cliical pastoral tutor to support disabled studets. The role icludes liaisig with the uiversity disability team, the occupatioal health service ad cliical placemet providers to try to miimise the impact o the studet durig the trasitio from pre-cliical traiig ito the cliical eviromet. The tutor also participates i various meetigs aroud pastoral support, studet progress ad disability discrimiatio. Examples of areas where the tutor s expertise has bee useful iclude: supportig ad eablig disabled studets to do cliical placemets by helpig the local trust uderstad the studets eeds ad carryig out appropriate risk assessmets Geeral Medical Coucil 49

52 Supportig medical studets with metal health coditios supportig studets with metal health issues through the special cosideratios ad reasoable adjustmets process supportig studets who seem to be strugglig with the course by directig them to appropriate help ad decidig if they eed to susped their medical degree util they have recovered actig as a studet advocate liaisig with all parties aroud additioal examiatio requiremets to improve cosistecy ad fairess liaisig with others about updatig ad clarifyig process documets for disabled studets to improve the studet pathway ad experiece. The case maagemet model 90 Medical schools should thik about itroducig the case maagemet model of support. I this model, a amed perso is resposible for coordiatig the support that the studet receives. They do ot eed to be a cliicia because they do ot provide treatmet. Their job is to be a cetral poit of cotact for the studet ad to help coordiate support. They also help to make sure the studet has access to the support services they eed ad that they ca fit appoitmets ito their study schedule. 50 Geeral Medical Coucil

53 Supportig medical studets with metal health coditios Providig cofidetial support to studets at Cardiff Uiversity The Studet Support Uit (SSU) at the School of Medicie, Cardiff Uiversity, was established i 2010 to provide cofidetial support for medical studets strugglig with performace, health, fiacial or persoal issues. Studets are referred to SSU by a tutor or year director, or they self-refer themselves. SSU the refers the studet to the appropriate support services ad moitors their progress. Typical issues leadig to referral iclude: repeatedly failig or early failig examiatios poor attedace behavioural issues absece due to ill health disability fitess to practise issues. All studets referred to SSU are allocated a desigated case maager who supports them. I 2011, the referral process was stregtheed so that all studets who were referred (or who Geeral Medical Coucil 51

54 Supportig medical studets with metal health coditios self-referred) were triaged by a occupatioal psychologist with experiece i health ad performace issues before beig allocated a case maager. Studets would be see for triage withi three weeks of referral. The triage appoitmet would idetify the major uderlyig reasos for the referral ad documet the major issues ad key actios agreed at the meetig with the studet. I September 2012, the medical school itroduced a ew academic metorig scheme ad lauched two services academic metorig ad SSU uder oe umbrella called MEDIC Support. Iformatio about MEDIC Support was dissemiated at the begiig of the academic year, ad members of MEDIC Support atteded lectures for all five-year groups to explai the two services provided ad how to access them. Durig these sessios, a poll was take to try to uderstad studets perceptios of support. About 90% of studets were ot aware where their cofidetial persoal records were held ad who had access to them. After the poll, studets were told about cofidetiality, where cofidetial records are kept, the differet support schemes i place, ad the differeces betwee academic ad persoal support. This iformatio was also set by to all studets at Cardiff. Sice the itroductio of MEDIC Support i September 2012, selfreferrals ito SSU have icreased sigificatly. I the academic year , 19% of all referrals were self-referrals, but this has icreased to 68% sice September The reasos for selfreferral sice 2012 have also shifted from primarily educatioal reasos to the eed for health ad persoal support. 52 Geeral Medical Coucil

55 Supportig medical studets with metal health coditios Substace misuse (icludig alcohol) 91 The use of illegal substaces is ormally a fitess to practise issue. Where a studet is addicted to a cotrolled substace, medical schools should offer support to the studet alogside the fitess to practise process. 92 Substace misuse ofte happes alogside other metal health coditios, meaig that the perso ca face further stigmatisatio. Medical schools should trai their staff to recogise the commo sigs that a studet is misusig alcohol or drugs. Whe they suspect this is the case, they should ecourage the studet to seek help from their GP, uiversity or medical school support services. I some istaces, it will be appropriate to refer the studet to a occupatioal health service. 93 If a studet has a addictio to alcohol or drugs, the medical school should moitor the studet carefully. Whe a studet returs to their course after treatmet, they should be ecouraged to agree to radom testig. This process ca be maaged through the medical school s occupatioal health service or through a specialist cliical service. 94 Testig gives the medical school reassurace that the studet is fit to practise, ad it ca be used as evidece of abstiece whe the studet applies for provisioal registratio with the GMC. Agreeig to testig also shows that the studet has a uderstadig of their coditio ad is prepared to take steps to reassure the medical school. Geeral Medical Coucil 53

56 Supportig medical studets with metal health coditios 95 If a studet refuses to be moitored for substace misuse, the medical school could refer them to a studet fitess to practise pael. Paels ca place coditios o the studet s cotiued participatio o the course. They ca also eforce ad moitor those coditios. Reasoable adjustmets 96 Log-term metal health coditios are cosidered to be disabilities uder the Equality Act * This meas that medical schools have a duty to make reasoable adjustmets for studets with log-term metal health coditios, to help them to study medicie ad meet the outcomes i Tomorrow s Doctors. Eve if a studet s metal health coditio is ot covered by the Act, it is still best practice for schools to make reasoable adjustmets. 97 Occupatioal health services will be able to give advice o the adjustmets that are eeded for a studet to complete their course. The medical school should the cosider whether these adjustmets are reasoable takig ito accout legislatio i this area ad the studet s future practice as a doctor i the NHS. * For further iformatio, see Appedix the legal positio, page Geeral Medical Coucil

57 Supportig medical studets with metal health coditios 98 Some commo adjustmets iclude: time away from studies or placemets to go to support appoitmets time away from the course to get treatmet for more serious metal illesses placemets ear to treatmet providers or support services extra time i writte exams. 99 Our guidace Gateways to the Professios Advisig medical schools: ecouragig disabled studets gives advice o reasoable adjustmets, which medical schools may wish to refer to Medical studets should be aware that they may be etitled to receive Disabled Studets Allowaces to help pay towards the reasoable adjustmets they eed. The uiversity disability service will be able to advise studets o whether they are able to receive these allowaces. * * UK Govermet, Disabled Studets Livig Allowaces. Go to: Geeral Medical Coucil 55

58 Supportig medical studets with metal health coditios Studet support cards at Uiversity College Lodo (UCL) Requestig time off from a cliical placemet or askig for other medical eeds to be accommodated ca be difficult for a studet, particularly if it happes very early i a placemet whe the studet has t met the cosultat resposible for them. Studets ca be very embarrassed if they are asked for details about their coditio ad the adjustmets they eed i frot of other studets ad staff. UCL Medical School addressed this problem by itroducig the studet support card scheme. 8 Studets who have health problems tell a seior course tutor about their coditio ad the adjustmets they eed (for example, goig to a weekly psychotherapy appoitmet). The tutor the issues a wallet-sized lamiated card statig that the studet has a medical coditio ad the reasoable adjustmets they eed. Typical wordig would be: This studet has a health problem which requires regular appoitmets ad I would be grateful for your uderstadig. This meas that the reasoable adjustmet is authorised by the medical school, ad the medical school, ot the studet, is requestig cooperatio with makig the reasoable adjustmet. The ame ad cotact details for the seior tutor are at the bottom of the card should further iformatio be eeded. 56 Geeral Medical Coucil

59 Supportig medical studets with metal health coditios The studet carries the card ad shows it wheever they eed adjustmets, such as time away from a placemet. The scheme has bee well received by studets ad o tutors have bee asked for further iformatio. The scheme has also bee itroduced at Barts ad The Lodo School of Medicie, which carried out a joit assessmet with UCL, showig practical examples of how studet support cards ca be used. 9 Takig time away from the course 101 Medical schools should cosider the amout of time that a studet is allowed to take away from their studies for health reasos before they are asked to retake the full year of the course. 102 Missig a cosiderable amout of teachig time or placemets ca make it impossible for a studet to catch up o their work. However, this eeds to be balaced with the egative effect that retakig a year ca have o the studet, so decisios should be made o a case-by-case basis. 103 Medical schools should thik about ways to build flexibility ito courses, so that studets are able to catch up o the time they have missed. Geeral Medical Coucil 57

60 Supportig medical studets with metal health coditios 104 If a studet eeds to temporarily leave the course to get treatmet ad recover, they could be away for a sigificat time. They may wish to move away from the medical school to where they ca be supported by family ad frieds more effectively. But they should be able to keep i touch with their medical school ad their persoal tutor or other member of staff who provides pastoral care. They should also be able to keep i touch with the occupatioal health service, which will be able to support their retur to medical school. 105 If a medical school thiks that a medical studet should take time away from the course, the school should seek advice from medical practitioers, icludig the occupatioal health service. The medical studet should be ivolved i the process the school should clearly explai to the studet why they should take time away ad what they are expected to do durig that time. At this poit, the school should also start to cosider how to reitegrate the studet ito the course whe they retur ad should discuss this with the studet. Medical schools must keep records of this decisio-makig process. 106 There will be times whe a medical school ad a studet disagree about whether takig time away from the course is the right thig to do. The school should take reasoable steps to uderstad the differece of opiio ad to develop a appropriate pla with the studet. Where this is usuccessful, the medical school may wat to use its fitess to practise procedures to hadle this disagreemet. This is ot to puish the studet, but to make sure that the decisio is made i a fair ad idepedet way. A fitess to practise pael is impartial ad will liste to the poit of view of the school ad the studet before decidig the best course of actio. 58 Geeral Medical Coucil

61 Supportig medical studets with metal health coditios 107 Medical schools must be aware that this will be a difficult time for the studet, so they should provide a high level of pastoral support. Studet support service at Brighto ad Sussex Medical School Brighto ad Sussex Medical School has a dedicated studet support service. Studets who are strugglig to maage their coditio are ecouraged to seek support from a local GP. But, if this support is ot sufficiet i the short term, a studet will be ecouraged to take a period of itermissio ad retur to repeat the full academic year or to pick up where they left the course after a short refresher period. If metal health issues mea that a studet caot cotiue with their medical degree, the school will egotiate a exit route to aother BSc degree at oe of the paret uiversities. Geeral Medical Coucil 59

62 Supportig medical studets with metal health coditios Returig to a course 108 Whe studets take time away from the course, it is very importat that their retur is hadled effectively. It ca be very overwhelmig ad disorietig for a studet to retur to a completely differet cohort of studets. They are ofte worried about beig stigmatised if people fid out why they took time away from the course. 109 Medical schools should have a reitegratio pla i place for each studet, which should be discussed with the idividual. The developmet of this pla should start early well before the studet is due to retur or eve at the poit they leave the course. Settig clear expectatios helps the medical school ad the studet to maage the reitegratio process. 110 Medical schools should cosider whether some studets could complete the course o a part-time basis. This ca be difficult for medical schools to implemet due to the logistics ivolved i allocatig appropriate teachig ad placemet opportuities to large groups of studets. I postgraduate medical traiig (foudatio ad specialty, icludig GP traiig), however, there are some circumstaces i which it is possible to trai less tha full time. * This meas that it may be placig more pressure o studets to expect them to study full time at medical school whe they may ot be expected to trai ad work full time whe they graduate. * The Foudatio Programme Referece Guide 10 ad The Gold Guide Geeral Medical Coucil

63 Supportig medical studets with metal health coditios Studet support team at the Uiversity of Aberdee I additio to the medical school studet welfare officer, Aberdee has a studet support team cosistig of a ear, ose ad throat surgeo with a wealth of medical school experiece ad a cosultat psychiatrist with a backgroud i medical educatio. This team is separate from the year lead ad assessmet teams. The studet support team offers to see studets that year leads are cocered about. The team acts as a high-level scree for metal health ad other problems it does ot treat studets. The team ca liaise with the studet s GP or metal health services to streamlie the studet s access to care. This role is iformed by the Royal College of Psychiatrists report Metal health of studets i higher educatio, * which highlights the barriers to metal healthcare that udergraduate studets face. Whe a year lead is cocered about the academic progress of a studet, a studet support doctor will joi the year lead at a meetig with the studet to idetify whether there is a uderlyig problem. A studet support doctor will also joi year leads for hadover meetigs at the begiig ad ed of academic years to be vigilat for studets who may be gettig ito difficulties. All studets who take time out from the course will be see by the studet support team so they ca pla what the studet ca do to * Royal College of Psychiatrists (2011) Metal health of studets i higher educatio, Lodo, Royal College of Psychiatrists. Geeral Medical Coucil 61

64 Supportig medical studets with metal health coditios address their difficulties while out of the programme. The studets will also be see by a member of the team o their retur to review their progress ad decide what ogoig support is eeded. Aberdee developed this team because some studets with difficulties were idetified at a late stage, eve though the problems had bee there for some time, ad other studets withdrew from the course before their problems became apparet. Furthermore, studets were sometimes returig from periods away from the course after havig achieved little progress with their uderlyig metal health problems. The service has ehaced the care ad support give to studets i Aberdee to make it more proactive. Studets ca speak to a member of the studet support team i cofidece, kowig that the doctor will ot make decisios about their progressio i the course. Year leads have the reassurace of kowig that a metal health doctor is reviewig the studet ad will suggest they cotact their GP for treatmet or referral to specialist services if appropriate. By havig the studet support team, studets ca also ask questios about metal healthcare ad treatmet. This ca help to demystify ad de-stigmatise metal health, which ca ecourage them to pursue treatmet. The studet support doctor ca, if requested by the studet, accompay a studet to ay progress or fitess to practise meetigs to give support ad act as a advocate o their behalf. 62 Geeral Medical Coucil

65 Supportig medical studets with metal health coditios Trasitio to the first year of the foudatio programme 111 The trasitio from medical school to foudatio traiig is crucial for all ew doctors. For those who have had metal health coditios, it ca be particularly importat. Medical schools ca provide a supportive eviromet for studets that they might ot get i postgraduate traiig. However, ay potetial risk to the studet ca be reduced if the trasitio is properly plaed. 112 Medical schools should ecourage studets to be very ope with their foudatio school i their trasfer of iformatio (TOI) form. The studet does ot have to declare specific details about their coditio o the form, but they should give the foudatio school a realistic view of the support they will eed. If a studet does declare a metal health coditio as part of the TOI process, the they should be made aware that oly authorised foudatio school staff members ad the HR departmet of their employer will be able to access this iformatio. 113 Medical schools should meet with studets who have a metal health coditio that could affect the locatio or delivery of the Foudatio Programme. I this meetig, the medical school should: discuss the studet s eeds support the studet to complete their TOI form. Geeral Medical Coucil 63

66 Supportig medical studets with metal health coditios 114 If a studet s eeds could affect a decisio about the locatio of their Foudatio Programme, the medical school should also give advice o applyig through the special circumstaces process. Forms ad guidace for the TOI ad the special circumstaces processes are reviewed every year ad are available at: Completig the TOI form will help make sure doctors get the support they eed for example, foudatio doctors with a disability will be give placemets where the adjustmets they eed ca be made. 116 Medical schools should also tell studets that they will eed to declare to the GMC that they are fit to practise whe they apply for provisioal registratio. They will be asked if they are aware of aythig about their physical or metal health that might raise a questio about their fitess to practise as a doctor i the UK. 117 Medical schools should ecourage studets to declare coditios to the GMC, but they should also emphasise that havig a metal health coditio eve a serious oe should ot prevet them from gettig registratio. 118 The GMC has guidace o applyig for provisioal registratio o our website Medical schools ad studets are welcome to cotact the GMC if they have questios about the registratio process. 64 Geeral Medical Coucil

67 Supportig medical studets with metal health coditios Studet fitess to practise 119 Medical schools must ot allow a studet to graduate if they are ot fit to practise. They must also make sure that every studet has met all the outcomes set out i Tomorrow s Doctors I exceptioal cases, a studet s metal health may make it impossible for them to complete the course ad meet the outcomes. I these circumstaces, the medical school should be ope with the studet about its cocers ad should try to come to a mutual agreemet about the best course of actio. It should offer support to the studet i fidig a career or degree course other tha medicie. 121 Medical schools should give studets who leave their course a appropriate qualificatio that reflects the amout of the course they have successfully completed. If the studet has successfully completed more tha three years of the course, the they should ormally be awarded a alterative hoours degree. 122 If a studet leaves the course because of their metal health, either volutarily or after discussios with the medical school, the school should keep a record of all the discussios it had with the studet. This record should be shared with the studet. 123 I some cases, the medical school ad the studet may ot agree o the best course of actio. Whe this happes, the medical school should use its fitess to practise process to make sure that the decisio about the studet s future is impartial. Geeral Medical Coucil 65

68 Supportig medical studets with metal health coditios 124 This process should ivolve gatherig evidece from medical experts. They will be able to advise the pael o whether they thik the studet is able to meet the outcomes set out i Tomorrow s Doctors, ad whether the studet will be able to work as a doctor i the first year of the Foudatio Programme (F1) i the UK. To help the pael ad medical school make their decisio, they may wat to ask their local foudatio school about what adjustmets ca be made durig F Before startig a studet s fitess to practise process, the medical school must make sure that it is able to show the support, itervetios ad reasoable adjustmets it has made for the studet. It should be able to show that it has made every effort to support the studet to complete the course. 66 Geeral Medical Coucil

69 Supportig medical studets with metal health coditios Appedix the legal positio 126 Whe a metal health coditio meas that a studet is classified as beig disabled uder the Equality Act 2010, their medical school has a duty to make reasoable adjustmets. 127 Metal health coditios may be cosidered to be disabilities uder the Act. The legal defiitio of a disability i the Act is: A perso (P) has a disability if a b P has a physical or metal impairmet, ad the impairmet has a substatial ad log-term adverse effect o P s ability to carry out ormal day-to-day activities. 128 As this is a legal defiitio, it is ultimately for a court or tribual to decide who it applies to. If a school is ot sure whether the defiitio applies to a idividual, it is best practice to assume that it does apply ad to focus o fidig reasoable adjustmets to support them. 129 The Act also defies whe a disability is classed as log-term: The effect of a impairmet is log-term if: a b c it has lasted for at least 12 moths it is likely to last for at least 12 moths, or it is likely to last for the rest of the life of the perso affected. Geeral Medical Coucil 67

70 Supportig medical studets with metal health coditios A substatial adverse effect is defied by the Act as oe that is more tha mior or trivial. 130 Some coditios are ot explicitly covered by the Act such as substace misuse ad addictios. However, medical schools should still support studets with these coditios. 13 Whe the effects of a addictio become a physical or a recogised metal health issue, they may the be covered by the Act ad medical schools would eed to make reasoable adjustmets. 68 Geeral Medical Coucil

71 Supportig medical studets with metal health coditios Refereces 1 Dyrbye LN, Thomas MR, Shaafelt TD (2006) Systematic review of depressio, axiety, ad other idicators of psychological distress amog U.S. ad Caadia medical studets Acad Med 81(4): Geeral Medical Coucil (2009) Tomorrow s Doctors Lodo, GMC, paragraphs 124 ad Geeral Medical Coucil (2013) Good medical practice Lodo, GMC, paragraph 25c 4 Medical Schools Coucil (2010) Guidig Priciples for the Admissio of Medical Studets Lodo, Medical Schools Coucil 5 Hillis J, Morriso S, Alberici F, Reiholz F, Shu M, Jekis K (2012) Care Factor : Egagig medical studets with their well-beig Med Educ 46(5): Geeral Medical Coucil (2009) Medical studets: professioal values ad fitess to practise Lodo, GMC, paragraphs 37 ad 38 7 Geeral Medical Coucil (2010) Gateways to the Professios Advisig medical schools: ecouragig disabled studets Lodo, GMC 8 Rave PW, Griffi AE, Hiso JP (2008) Supportig studets with disabilities usig a studet support card scheme Med Educ 42(11): Geeral Medical Coucil 69

72 Supportig medical studets with metal health coditios 9 Cook V, Griffi A, Hayde J, Hiso J, Rave P (2012) Supportig studets with disability ad health issues: lowerig the social barriers Med Educ 46: The UK Foudatio Programme Office (2012) The Foudatio Programme Referece Guide Cardiff, UKFPO, page NHS Moderisig Medical Careers (2010) The Gold Guide, fourth editio, Lodo, NHS Moderisig Medical Careers 12 Geeral Medical Coucil (2009) Tomorrow s Doctors Lodo, GMC, paragraph Geeral Medical Coucil (2009) Tomorrow s Doctors Lodo, GMC, paragraph Geeral Medical Coucil

73 Supportig medical studets with metal health coditios Ackowledgemets Dr Debbie Cohe, Cardiff Uiversity Professor David Cottrell, Medical Schools Coucil Dr Fioa Doelly, Doctors Support Network Professor Clare Gerada, Practitioer Health Programme Dr Adrew Grat, Cardiff Medical School Dr Fioa Hayes, Uiversity of Bristol Studets Health Service Dr Joa Marti, GMC Coucil ( ) Dr Kare Mattick, Exeter Medical School Mr Adrew Rix, Prepare to Share Ltd Mr Stephe Whittle, GMC Coucil ( ) Geeral Medical Coucil 71

74 Supportig medical studets with metal health coditios Further readig Departmet of Health (2008) Metal health ad ill health i doctors Lodo, DH The Royal College of Psychiatrists (2011) Metal health of studets i higher educatio, Lodo, RCP Chew-Graham C, Rogers A, Yassi N (2003) I would t wat it o my CV or their records : medical studets experieces of help-seekig for metal health problems Med Educ 37(10): Copplestoe R, Thompso T (2011) Uder pressure: Medical studets are at risk of psychological distress Studet BMJ 2011; 19: d3678 Hooper C, Meaki R, Joes M (2005) Where studets go whe they are ill: how medical studets access health care Med Educ 39(6): Ross S, vo Fragstei M, Clelad J (2011) Medical studets illess-related cogitios Med Educ 45(12): Geeral Medical Coucil

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76 Website: Telephoe: Geeral Medical Coucil, 3 Hardma Street, Machester M3 3AW Joi our facebook.com/gmcuk likd.i/gmcuk youtube.com/gmcuktv This iformatio ca be made available i alterative formats or laguages. To request a alterative format, please call us o or us at [email protected]. Published July Geeral Medical Coucil The text of this documet may be reproduced free of charge i ay format or medium providig it is reproduced accurately ad ot i a misleadig cotext. The material must be ackowledged as GMC copyright ad the documet title specified. ISBN: The GMC is a charity registered i Eglad ad Wales ( ) ad Scotlad (SC037750) Cover image: Hybrid Images/Sciece Photo Library Code: GMC/SMSWMHC/0713