Developing and Evaluating a Clinical Student Mental Health Service at the School of Clinical Medicine, University of Cambridge: Planning to Practice
Type of Research:
Mixed method evaluation
Background & Scientific Rationale:
There is a growing awareness of an increase in mental distress and illness in higher education students, both in the UK and indeed internationally (Karp J et al, 2018).Whilst this phenomenon encompasses all academic disciplines, data shows that mental health problems are at least as common amongst medical students, with some studies suggesting the prevalence may be significantly higher amongst medical students than the general population, particularly with respect to depression, anxiety and stress (Quince et al 2012, Dahlin et al. 2005) This may be related to the demands of the course itself, financial worries, compromised sleep patterns and exposure to patients distress, suffering and even death. Additionally there is evidence that emotional difficulties, relate to the medical course as students entering medicine have similar or even better scores on mental health rating scales than students of other college disciplines ( Karp J et al 2018). Worryingly data from the General Medical Council shows that medical students are less likely to access help possibly as a result of the perceived stigma associated with psychiatric disorders, concerns regarding career progression and a medical culture that emphasises the invulnerability of doctors (GMC 2013, Fox et al. 2011) The learning environment, during clinical training in particular, creates added stress in the context of frequent relocation and separation from their usual support networks, exposure to workplace attitudes beyond the control of the medical school and self-imposed pressure by medical students themselves (GMC 2013). Additionally, during clinical years, the long working days with an expectation of full student engagement and attendance also makes access to health and university counselling/ support services more difficult. There are therefore both cultural and logistical impediments for medical students receiving the appropriate care.
The GMC document ‘Supporting medical students with mental health conditions’ highlights the importance of medical schools ensuring access to appropriate mental health services for student doctors. Provision of support for students in distress is challenging and clearly requires a network of services which are flexible, easily accessible and acceptable to students. The GMC suggests that ‘provision will need to include staff who recognise when a student’s issues need more expert support then they can themselves provide and a network of support into which the student can be referred, which itself has clear rules about what can be provided and on what conditions’ (GMC 2013). Cambridge University student doctors have access to a wide range of options for support in times of crisis; from their colleges; from the University student services; from their GPs; and for clinical students from their pastoral advisor and the deanery team. The gap in the service is in access to specialist psychiatric assessment for those students with more serious mental health problems.
In this context the School of Clinical Medicine, University of Cambridge, have funded a clinical service for medical students with mental health difficulties, which is delivered by a newly developed Clinical Student Mental Health Service (CSMHS). This service is delivered by the local NHS mental health provider CPFT; the funding allowing the appointment of a part-time psychologist and a consultant psychiatrist. Each patient is assessed initially by a psychiatrist and has psychological input, either within the service or sometimes with NHS or University Counselling services. Rating scales assess progress from the outset and at discharge from our care.
- To describe the setting up and service delivery using the research design ‘service improvement project’.
- To evaluate the service delivery focusing on both quantitative and qualitative data. The former will study the number of patients seen, the improvements in pre and post outcome measures and numbers completing course. The latter consider qualitative feedback by patients using the service
Expected Output of Research / Impact and added value:
- CLAHRC East of England are supporting the CSMHS to describe and evaluate the service development, publish and disseminate our findings and consider methods of improving and even broadening the scope of our project.
- Given the research literature suggesting a significant rise in mental health issues for students in Higher Education, our aim is to highlight the growing issue for this vulnerable patient group and share good practice. This will also provide universities and colleges an understanding of the perils, pitfalls and potential benefits of setting up a dedicated service for medical students in distress.
For further information on this project, please contact Rebecca Jacob Rebecca.Jacob@cpft.nhs.uk
Karp J, Levine A Mental Health Services for Medical Students -Time to Act: N Engl J Med 2018379;13.
Chew-Graham C, Rogers A, Yassin N ‘’I wouldn’t want it on my CV or their record’: medical students’ experiences of help-seeking for mental health problems’ Medical Education 2003;37:873-880
Dahlin M, Joneborg N, Runeson B ‘Stress and depression among medical students: a cross-sectional study’ Medical Education 2005; 39:594-604
Fox F, Rodham K, Taylor G, Harris M and O’Connor M. ‘Junior doctors’ experiences of personal illness: a qualitative study’ Medical Education 2011; 45:1251-1261
Givens J, Tija J ‘Depressed Medical Students’ Use of Mental Health Services and Barriers to Use’ Academic Medicine September 2002;77:9:918-921
GMC. ‘Supporting medical students with mental health conditions. General Medical Council, 3 Hardman Street, Manchester M3 3AW. Published July 2013General dical Council, 3 Hardman Street,
Quince T, Wood D, Parker R, Benson J ‘Prevalence and persistence of depression among undergraduate medical students: a longitudinal study at one UK medical school’ BMJ Open 2012; 00:e001519. doi:10.1136/bmjopen-2012-001519