By Sumaiyah Al-Aidarous
A survey by the Student BMJ found that 80% of medical students with mental health problems feel under-supported . Medical schools are failing their students when it comes to mental health. The welfare and mental health of medical students is as important as ever, especially due to the increasing demand put upon newly qualified doctors in the NHS today, and after the new junior doctor contracts are set to go through.
Being trusted by the sick to care for them and cure them is one of the most noble privileges doctors and nurses hold, which is why medical school is not designed to be easy. The personal development during the years of a medicine degree is huge. It transforms someone who has just left school into a mature adult that is capable of handling the responsibility and demand of caring for the sick whilst being able to understand and cater to their desires and needs. Arguably, this personal growth is more important than the facts and knowledge of the human body which are gained during these years; no one wants a doctor who knows everything but doesn’t empathise with them. However, where there is pressure, there also needs to be coping mechanisms. Usually, coping mechanisms need not go further than discussing the demands with peers and supporting each other. However, this is not always enough, and medical schools need to fully institutionalise the support. Discussions on mental health between teachers and students must become a normal part of the welfare system at every medical school around the world.
The negative stigma that mental health problems are due to one not being able to look after themselves or handle stress is not prevalent amongst medical students, as you’d expect. However, there can sometimes be another stigma, that as medics we will be looking after others and therefore should be able to look after ourselves. This is heightened by the level of professionalism that medics must exhibit, especially those in hospital placements who are interacting with the sick, dying and bereaved from as young as the age of 18. It can take months, years, or a whole career to develop the mind set and ability to be able to correctly process the emotionally unsettling situations faced by medical professionals on a daily basis, and therefore if not managed correctly, can have a lasting impact on students.
On top of the professionalism, medicine is known to be an intensive course across all universities. The schedule of a medic is typically 9-5, 5 days a week which can leave little time for socialisation. Compared to courses which are not as time-table heavy and involve more self-directed study, medics can feel isolated and frustrated by the lack of autonomy they have over their time. Furthermore, the constant examination and assessment puts medics under the pressure of having to constantly maintain their highest standards. No flower blooms all year round and it is not difficult to see why this constant pressure can lead to feeling of self-depreciation, undervalue, and incompetence that can potentially develop into an anxiety or mood disorder.
The best way for anything to become accepted within society is to foster open and frank discussions on the topic. As it stands, too few medical schools are openly speaking about mental health. It is often mostly talked about by student societies in and amongst themselves. Lecturers, tutors, and those leading the teaching must mention these issues so that students know that they can receive support from the authorities they are being taught by. With time, if things continue the way they are, it is hoped that the discussion of mental health will not be considered a taboo topic at all.
There have been huge developments in reduction of mental health stigma over the past few decades, for reasons including our greater scientific understanding of it, but also through movements and projects which aim to destigmatise, along with the rise of open discussions via blogs, forums and the social media. Therefore, the generation gap is a contributing factor for the lack of support from medical schools. The current generation of students now are fighting to drop the ‘stiff upper lip’ mentality, which many people in the above generation (including senior medical teachers and consultants) have grown up with. Leaders of medical schools must have a comprehensive understanding of the demands of students today and realise that it is unacceptable to expect anyone to ‘grin and bear’ mental pain, just as it is unacceptable not to administer analgesics to those who need it. The openness of discussion amongst our generation and its contrasts to how mental health problems have previously been perceived can really become a cause of friction and slow down the process by which a student is receiving the proper support required.
Further to combatting this problem, medical schools must have proper protocols in place to support students with a mental health problems and ensure that it will not have a detrimental impact on their academic life. The difficulty is that each and every case must be individually considered, but in the same way that there is extra support provided for a student who fractures their arm, that extra support must be there for a student with social anxiety. Although many institutions will claim that they are more than happy to provide this, the lack of communication means that students are often not willing, or simply unaware that they can receive help from their academic institution. It all comes back to fostering an open discussion and by making students aware that if they come forward because they require academic support due to their mental health, it will definitely be worth the time and courage, and they will be treated seriously and properly.
Specifically, fostering an open discussion can be done by a few simple changes. Firstly, a talk at the beginning of the academic year from a psychiatrist or counsellor aimed to inform students on how to care for themselves and know where support can be found is necessary. This will not only reflect to students that their institution recognises mental health problems, but educate students to be able to identify them and know when to seek help. This is already happening at some medical schools such as Queens University, Belfast where students say the talk helps them feel more supported. The ‘somebody else’s problem’ mentality when approaching mental health is extremely problematic and there must be more acceptance that medics can be patients for this too. This can be combatted by having trigger warning or content notes before lectures where neuropathology or psychiatric disorders are discussed. This will, not only eliminate feelings of discomfort and isolation during teaching when a sensitive topic is covered, but will also regularise the concept that the people suffering from those mental health problems may be amongst us.
Everything that I’ve discussed applies not only to medical students, but students of any discipline. However, the heightened pressure on medics and doctors in the UK today and the emotional upheaval that can come from working with the sick means that medics can be at a higher risk. Academic institutions and medical schools must recognise that making provision for pastoral and welfare support will ultimately increase the quality and effectiveness of their teaching and create doctors who are in the best mind set to pursue their career and treat patients in the best way possible.
By Sumaiyah Al-Aidarous
Sumaiyah is a third year Medical student at St Anne’s college, Oxford, and she enjoys photography.