The Lunatics Have Taken Over the Asylum - Mental Health in Healthcare
Writing: Surabhi Kumar
Illustration: Hazel Laing
CW: this piece discusses issues surrounding mental health, particularly in students, experiences with healthcare professionals, and touches on suicidal ideation and actions.
Mental Health is a hot topic right now. You’ll probably have noticed a push to talk about your wellbeing, whether from the university, from the students association, from celebrities, and across social media. The message is usually to check in with your friends, and to get help if you need it. And don’t get me wrong – this is a great message. But what happens when you go to seek help? If you go to your personal tutor they’ll tell you to go to student counselling for four sessions. You wait 12 weeks for a counsellor to tell you to see your doctor. And you see your doctor and they… well really, this depends on who you see. Speak to anyone who has tried to see a GP for their mental health problems and they’ll tell you who’s a good doctor and who to avoid. The good ones are the ones that listen, treat you like a grown up, and realise you really are suffering. The bad ones, those are the ones who give you their ‘solutions’.
You’re having panic attacks every time you go to uni? Try yoga.
You haven’t slept properly in weeks? Spend less time on your phone.
You feel so sad you don’t see the point in going on? Join a gym.
I’m not saying these solutions can’t be helpful - there’s plenty of research that says these things can be helpful - but when you’ve reached the end of your tether and you’re finally asking for help, these aren’t feasible options.
These beliefs are routed in a mass-scale misunderstanding of a severely under-taught subject. One in three GP appointments have a mental health component,(1) but the teaching medical students receive doesn’t even make up a tenth of the course. In fact, in Edinburgh the medical students only get around three hours of teaching on mental health before they are let loose on patients in their fourth year of university.
It’s unsurprising, then, that there’s a huge stigma with medical students surrounding mental health and illness. In fact, studies show that while they might go into their degrees with population-level prejudice, their negative views are further strengthened throughout the course.(2) And why wouldn’t they be? We inherently fear what we don’t know, and mental illness is definitely something we do not know.
The prejudice that exists within medical students means that they are less likely to talk to their friends about their problems, fearing judgement. In such a competitive course, mental illness is a weakness. We all get stressed – so what’s your excuse for being the one who can’t cope with the course?
The next option is going to the university to ask for help, or even just a little break. Student support tries to put out a friendly face, but practically, there’s not much that can be done. Having a breakdown and needing to take a week off means coming back in the holidays to catch up. There is no opportunity to take a planned break, because once you’ve missed a couple of weeks you may as well retake the full year. And with this new policy from the university that forces mentally unwell students to take time off, asking for help is even scarier.
So you try to see a doctor. You figure out who are the good ones – but a referral to psychiatry means a fear of seeing someone you know. And believe me, there is nothing worse than being treated by your tutor. Imagine how embarrassing it is to spend the day as someone’s student and then be treated by them in your worst moments. Or worse still – seeing one of your classmates when you go for your appointment.
Almost 30% of medical students experience depressive symptoms, and one in ten experience suicidal thoughts.(3) There are so many barriers to care that make it so unlikely that we will ask for help. This may be why doctors have the highest suicide rates of any profession – in fact, female doctors are four times as likely to die by suicide than the general population.(4)
Prejudiced medical students make prejudiced doctors, and prejudiced doctors make prejudiced teachers. The cycle continues to repeat. No one talks about it, no one gets the help they need. Our patients suffer as a result.
1. London Strategic Clinical Network for Mental Health. A commissioner’s guide to primary care mental health. 2014.
2. Curtis-Barton MT, Eagles JM. Factors that discourage medical students from pursuing a career in psychiatry. Psychiatrist. 2011;35(11):425–9.
3. Munn F. Medical students and suicide [Internet]. Student BMJ. 2017 [cited 2019 Mar 14]. Available from: (http://student.bmj.com/student/view-article.html? id=sbmj.j1460)
4. Hurley Group. Suicide in doctors and other health professionals [Internet]. NHS Practitioner Health Programme. 2017 [cited 2019 Mar 14]. Available from: (https://php.nhs.uk/resources/suicide-in-doctors/)