The Lancet Student

Latest blog post:Student mental health

This blog was submitted by ebarrow on 11th August 2014.
Tagged with medical students, university students, Mental health, stress, anxiety, depression, eating disorders

It’s Friday morning, and not just any Friday morning but the last day of term. Before clinic starts I check my email. It's not uncommon for a patient to email me their most recent blood results or with a query about their medication. Today several have emailed to tell me their examination results; it's not all good news. For one, the fact she has passed her first year despite a major depressive episode between Christmas and Easter means a summer off without re-sits. Another is telling me he has failed and will have to consider whether or not to appeal against his mark. His is the opposite end of the student journey, those exams were finals. I can tell from his email that he is tired and the thought of continuing with the process feels like an uphill battle. My instinct is to reply and suggest that I think he is still not yet well and therefore might regret this later if he doesn't complete his degree, but I know that isn't my call to make. I offer an appointment, my support and a written letter to the University should he wish, but the rest has to be up to him.

Working in a community mental health team whose primary population consists of university students brings with it unique challenges. For example, what do you do when your patients realistically have two homes and spend the year journeying back and forth between two opposite ends of the country? You learn to adapt and be flexible, and accept that you will have clinics that are crammed full (e.g. in the run up to exams) and others that are half empty. When young people become unwell it is natural that they would want to seek the care and support of their family. If it's their mental health which is affected then that degree of social and family support is often imperative in getting well. Students form extraordinarily close bonds with peers but there's still stigma against disclosing mental illness. That's not to say they aren't helping each other. I have one patient whose eating disorder has been helped dramatically by the fact that after she confided in her flatmate they began shopping and cooking together. Conversely another is struggling because she is in recovery but recognises illness in one of her close friends and therefore battles every day to keep the eating disordered thoughts at bay in the face of those constant reminders.

An evening on call follows. In A&E I assess another student whose life, as he puts it, is “falling apart”. He’s heavily using drugs, his girlfriend has left him and he’s just found out that a fail in one piece of work means he won’t graduate with the rest of his class. He’ll have to let go of the graduate job he has lined up to start next month and resubmit his work instead. His parents don’t support him and he’s in significant debt. He’s not wrong in his assessment of things. He is anxious and stressed and resorting to heavy substance misuse in order to escape his problems. He reminds me that being a student isn’t easy and nowadays more young people are delaying entry into higher education over concerns as to how to support themselves financially. Once you overcome all the hurdles and gain entrance to the university of your choice, then begins the delicate tightrope of combining enough ‘student-life experience’ with enough ‘time spent in lectures’, a situation which medical students particularly find themselves facing more than most. If you then add in lack of sleep, exposure to drugs and alcohol, graduate job uncertainty and the financial stress of increasing tuition fees year on year it is hardly surprising that student mental health is becoming more of an issue.

As I’m leaving for the day another email pops up from a student who is away travelling. It’s just a few short lines - thanking me for helping him to sort out getting hold of more medication so he could stay abroad for longer than he originally planned. He enthusiastically reports a dramatic reduction in his symptoms, which having watched him struggle through his first year with depression and an eating disorder is really nice to hear. It’s a useful reminder that although the student population is transient, often tricky to track down and only living in your catchment area for roughly half the calendar year, small changes can have a big impact. It might not be the simplest thing to arrange for a prescription to be sent to some far flung part of another continent, but it’s certainly worth it. And one thing students often forget they have got going for them are resourceful, helpful and willing Mums or Dads.