The musings of a final year medical student

Saturday, 24 October 2015

Medicine and Mental Health

This is a topic I have wanted to discuss for a long time, but sometimes it's hard to know where to start. 

First of all, I will show you the results of the Student BMJ's survey on 1122 UK medical students:

15% (167) of the survey’s respondents revealed that they had considered committing suicide at some point during their studies

30% (343) declared they had experienced or received treatment for a mental health condition while at medical school
From this group, 80% (276) thought the level of support available to them was either poor or only moderately adequate

I find this data both shocking and unsurprising. Almost one in three medical students receive treatment for a mental health condition. When we think of doctors we like to think they are wise and stoic members of society: robots even. We trust our doctors with information we may not even tell our partners or our family. Not just health problems, but love problems, money worries, housing issues. And sadly, there is something jolting and unnerving about thinking that your GP, your physician, your surgeon, has a mental health problem.

Why do we think less of people with mental health problems? I suppose in the past if times were tough you were told not to grumble and to have a 'stiff upper lip'. If someone appears unable to get out of bed, it is and has often been assumed that it is caused by laziness, not disease. In fact, it's easier to assume someone is lazy or selfish than having a true disease - it can be easier to cure sloth than a complex psychological problem. 

The combination of both ingrained negative heresay about mental health diseases and the tall order of being in the medical profession silences the many unhappy, stressed medics. Whilst a career in medicine is a great privilege and to pursue arguably the most satisfying job in both academic and altruistic perspectives, that doesn't make it any easier. In fact, it can worsen the burden. How do you explain to a colleague at hospital that you had to take a couple of days off because your anxiety was becoming unbearable without feeling guilty and inadequate? How does a medical student fill in an absence form and simply write 'depression' as the cause of absence? Are these problems really going to be accepted by the working professionals? They should be accepted, but currently they often are not. 

On top of this, there's the looming head of the quasi-legal GMC guidelines. Due to some of its ambiguity, many students and doctors fret that admitting they are struggling with a mental health problem means they'll be booted out. That is simply not the case. The NHS or the medical school does not need to be notified by your doctor until it reaches a point where the disease(s) spirals out of control, reaching into dangerous behaviour and unable to care for oneself. 

However, the truth is medical students should be precisely the ones admitting that they need support. Sometimes lovely friends and family are not enough. By engaging with the various therapies out there for mental health problems, ranging from medications to talking therapies, the student can accept they have a problem and be 'proactive' about it. Sometimes it can take years for someone to admit they have OCD/anxiety/depression/an eating disorder/etc.. I'm not saying it's simply a case of nipping the problem in the bud, but by making the time to take stock of whether they're coping or not will fundamentally improve their outlook. I have several friends studying medicine that have resisted medications and talking therapies like counselling/CBT for a long time, and once they tried it they kicked themselves for being so hesitant. 

It is worth noting that most medical schools do not do nearly enough to help their students. Most medical schools do have some contacts with counselling and such but often it is not advertised clearly to the students who want or need it. Instead of medical schools glossing over the problem or failing to address it, the  taboo of mental health problems needs to be obliterated and tackled head on. Doctors will always be around, and you can't change the fact doctors and medics will unfortunately develop mental health issues that are only exacerbated by their chosen profession. 

It is often said that doctors make the worst patients. However, medical students and doctors need to accept that by being attentive to any mental health issues they may have it will only help benefit themselves and help them to be better doctors. 

Here are some links I thought might be helpful if you are a medic (or not) with a mental health issue:

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