Medical students with mental health problems do not feel adequately supported

Survey provides a snapshot of mental health problems among medical students in the UK

Over 80% of medical students with mental health issues feel they receive poor or only moderately adequate support from their medical schools, finds a small online survey published in Student BMJ today.

Of the 1,122 UK respondents, 30% (343) said they had experienced or received treatment for a mental health condition, and almost 15% (167) revealed that they had considered committing suicide while studying at medical school.

"The number of students reporting mental illness or considering suicide is shocking," says Twishaa Sheth, chair of the BMA’s student’s welfare committee, adding that "what is more concerning is the lack of independent support available for students."

Student BMJ invited its readers to take part in a survey on the health of medical students. The number of respondents represents around 2% of medical students.

The survey also asked questions about smoking, drinking and alcohol use. In total, 15.8% (177) of respondents claimed they smoked, one quarter reported binge drinking each week, and 10.9% (123) said they had taken illegal drugs more than once.

Furthermore, 8.3% (94) claimed to have tried a legal high, and the same number had used cognitive enhancing drugs to help with revision.

Reasons behind the high rates of mental health problems among medical students are "complex", writes Matthew Billingsley, Editor of the Student BMJ.

"Students often have a relentless timetable of exams as well as having to balance the emotional strain of seeing sick patients and uphold high professional standards," he says, adding that "the demands of the course can cause an over competitive environment that can have a detrimental effect on the health of students."

Deborah Cohen, senior medical research fellow at the University of Cardiff, describes Student BMJ’s results as "concerning," but that they are in line with previous research.

A study she carried out found that 15% of 557 respondents from two large UK medical schools had substantial levels of depression and 52% reported substantial levels of anxiety.

Earlier this year, Student BMJ reported that there was not a clear separation between medical school staff with pastoral roles and those who rule on fitness to practice disciplinary issues. This raised concerns about students being able to report a problem without it affecting their final result.

In July, the General Medical Council and the Medical Schools Council issued new guidelines to clarify that teaching and pastoral roles should be separate.

Iain Cameron, chair of the MSC, says "Medical schools take the mental wellbeing of their students seriously. The Student BMJ survey highlights key issues and similar concerns have been raised previously."

"It is crucial that students who have concerns about their health are able to make this known so that they can be provided with the necessary advice and support."

He adds that the MSC would like to work with Student BMJ and colleagues across the sector to promote the new guidelines and other initiatives on student mental health.

Link to research

Concern over inappropriate use of psychotropic drugs in people with intellectual disability

Over 70% of prescriptions are given to those without a record of mental illness

The proportion of people with intellectual disability in the UK who have been treated with psychotropic drugs far exceeds the proportion with recorded mental illness, finds a study published by The BMJ today.

This suggests that, in some cases, these drugs are being used to manage challenging behaviour rather than for mental illness, say the researchers. They call for changes in the prescribing of psychotropic drugs for people with intellectual disability as well as more evidence on their safety in this group.

People with intellectual disability develop severe mental illness at higher rates than do the general population and may show challenging behaviour.

Concern has existed for many years that psychotropic drugs in general - and antipsychotics in particular (mainly used to treat schizophrenia and bipolar disorder) - are overused in people with intellectual disability, but accurate estimates have been difficult to obtain.

So a team of researchers based at University College London set out to describe rates of recorded mental illness, challenging behaviour, and use of psychotropic drugs in people with intellectual disability in UK primary care.

They analysed data from 571 UK general practices using the The Health Improvement Network (THIN), a large database of electronic health records, and identified 33,016 people with a record of intellectual disability. Average age at study entry was 36 years and average follow-up was five and a half years.

Of 9,135 participants treated with antipsychotic drugs by the end of the study period, 6,503 (71%) did not have a record of severe mental illness.

Of the 11,915 with a record of challenging behaviour, 5,562 (47%) had received antipsychotic drugs, whereas only 1,421 (12%) had a record of severe mental illness.

And of those with a record of prescription of antipsychotics, 26% did not have a record of severe mental illness or challenging behaviour.

New prescriptions for antipsychotics were significantly more common in older people and in those with a record of challenging behaviour, severe mental illness, depression, anxiety, autism, dementia, and epilepsy.

People with a record of challenging behaviour were more than twice as likely to receive a prescription for antipsychotics compared with those without a record of challenging behaviour, say the authors.

Prescription of antipsychotic drugs is disproportionate to the level of recorded severe mental illness and is associated with the presence of challenging behaviour, older age, and diagnoses of autism and dementia, they add.

"Inappropriate use of drug treatment has implications for the individual and for healthcare systems," they warn. "These findings highlight the need for an improved evidence base for use of drugs and optimisation of drug treatment in people with intellectual disability."

Link to article