Mental Health Problems
Student Support &
Fitness to Practise
Dr Peter Raven
Faculty Tutor, Medical Sciences, UCL
Hon Consultant Psychiatrist, C&I
An increasing problem?
UCL Student Psychological Services
• 137% increase in students registered over 5 years to 2012
• 2,482 students registered in 2012
• “More than any other UK university”
Bad news: UCL students have more mental health problems
Good news: breaking down barriers so that seeking help is OK
The scale of the problem
• UCL has over 14,000 full time undergraduate students
• MBBS has >2,100 on a 6 year programme
• About 1 in 6 of all UCL full time undergraduate students
on a single programme
• Common mental health problems are common
– Recurrent depressive disorder, anxiety disorders
including OCD, eating disorders, Personality Disorder
At any one time in the Medical School
• ~ 60 students on Close Supervision for mental health problems
• ~ 120 other students with mental health problems known to us
• ~ 120 more students with mental health issues not known
• On average, 2-3 students leave the course each year due to
mental health problems
• On average, 1-2 students go to full FtP panel each year for
mental health problems
Pathways to support - disclosure
• Student declares on admission – anxiety disorders eg
• Student discloses at the time – any
• Academic issue, reveals underlying problem depression
Pathways to support - disclosure
Less common
• Extenuating circumstances (unintentional disclosure)
– depression/ anxiety
• Peers raise concern – eating disorders
• Hospital admission: MHA - psychosis/ bipolar; suicide
attempt – borderline PD/ depression
• Conviction/ caution – substance misuse
Pathways to support - disclosure
• Personal Tutor
• Teachers – university academic
• Teachers – NHS doctor (esp GP or psych)
• Teachers – Clinical Skills Tutor
• Teachers – Communication Skills Tutor
• Administrators
• Other eg chaplain
All need to know how to refer on and who to
Principles of support
A responsible student needs to
• Recognise the problem
• Seek help
• Accept treatment
• Be aware if clinical interactions are impaired
Principles of support
A responsible support service needs to
• Support the student not the medical school
• Aim for the long term by establishing a positive
• Be aware that we are not the students’ doctors
Support structures
Support Tutors (or Personal Tutors)
Occupational Health – liaise with GP or treating Dr
UCL Student Psychological Services
UCL Disability Office
• Close Supervision
• Student Support Card
Support precedes FtP
• Inform student that protected by disclosing
• Advise student to go to Disability Office
• Reassure student that done the right thing in seeking
help – GMC expects us to look after our own health
• Reassure student that MH problems no barrier to
successful career
• Refer student to Occupational Health
Support precedes FtP
Advise student to d/w GP if not already
Advise student to see Student Psychological Service
Reassure student re confidentiality (except FtP)
Clarify responsibilities of support service and
responsibilities of student
• Not FtP at first discussion!
Ongoing support - toolkit
See the same Support Tutor each time
Negotiate reduced workload, eg deadlines
Change placement
Give student permission to take time out
Use interruption as last resort
Mentor support, learning support
Student Support Card
Student Support Card
• Originally a way of communicating reasonable adjustments in a
durable, portable format (credit-card sized)
• Especially useful for clinical placements: range of teachers,
frequent changes, confidentiality issues
• Proved very useful for students with mental health problems and
regular therapy appointments
• Supporting students with disabilities using a ‘student support
card’ scheme Raven, Griffin & Hinson (2008) Med Educ 42:
Sample card
UCL Medical School Student Support Card
This is to certify that Student Name has the following special circumstances:
This student has a medical condition which requires regular appointments
and I would be grateful for your understanding.
Please contact me if you have any questions about this.
This Card is valid: From: 1st September 2012 until 15th July 2014
Any queries regarding this should be directed to: Dr Peter Raven, Faculty Tutor.
Benefits of Student Support Card
Wording agreed with the student
Student can choose whether and when to use it
Flexible and allows for individual needs
90% of students felt they benefitted from possessing the card
Students felt empowered
But.... Hard to publicise to all teachers
• Supporting students with disability and health issues: lowering
the social barriers Cook, Griffin, Hayden, Hinson & Raven
(2012) Med Educ 46:564-74
This card really gave me official credibility for leaving placements earlier as specified
on my card. Without it, I would have to answer many questions and face some
criticism. This card protected my interests, and allowed me to leave earlier without
having to explain my full medical history to various staff, thus protecting my
boundaries. There was a period of time before receiving my card that I had to
explain everything to consultants and tutors, and the response was far more
negative. The card was very, very useful
6th year student
Problems with support
Recognise problem
Student lacks insight (not just psychosis)
Seek help
Student does not disclose on admission
Student presents with conviction or hospital admission
Student in denial about nature of problem
Accept treatment
Student disregards advice
Be aware of impairment
Inappropriate behaviour in clinical setting
Problems with support - toolkit
Occupational Health
Read GMC advice on MH and FtP
Learning agreement
Interruption of study
• Last resort - FtP
Fitness to Practise
• About one quarter of all UCL FtP referrals are due to mental health
– Mental health issues + academic problems
– Mental health issues + interruption of study
– Recurrent or enduring mental health problems
• 2 stage process
• Initial FtP less formal
– Can make requirements
• Full FtP panel
– Rarely used (8 cases in 5 years: eating disorder, OCD, PD,
substance misuse)
• More commonly, student unable to continue on course
Support during FtP
• FtP is stressful
• Clear separation of support from “prosecution” of case
• To provide pastoral support, within limits
– Not to be the student’s “friend” at hearing
– Not to provide references
Support after FtP
• May be requirement for monitoring – this is not
pastoral support and should be separate
• Support when returning from interruption with MH
• Occupational Health review – fit to return?
• Close supervision for year after return
• Reasonable adjustments
Difficult issues
Between support and FtP process
Between support and FtP process
Students and staff need to know who to talk to
Mixed messages from GMC
Take more students with MH problems and look
after them better
I&I much more interested in students with MH

Dr Peter Raven – SFtP and the role of student support