Holistic mental health strategies for medical schools

I RECENTLY participated in a symposium and consultative forum at Orygen regarding the Australian University Mental Health Framework.

This framework is currently being developed with funding from the Australian Government for universities to help combat poor mental health at university institutions, summarised in the concerning survey finding that 25% of young university students experienced mental ill health in any one year.

During the symposium, one of the standout concepts mentioned was the need for universities to create learning environments that are conducive to good mental health and wellbeing. Universities are forward thinking and diverse institutions that bring to shore the issues of young people within society, and mental health is one of the most important of this generation. Universities need to shift and adapt to its student cohort’s needs and be ready to innovate and implement new strategies to ensure that the issue of mental health is managed.

As a medical student, the need to address mental health at the university and faculty level could not be more important. It is no secret that medical students undergo a demanding curriculum and that the need of medical students for mental health support is burgeoning and great. Some of the most illustrative data around this are from beyondblue’s widely quoted survey in 2013, in which medical students reported higher rates of general distress and specific mental health diagnoses in comparison to the Australian population.

But it doesn’t take a statistic to tell you what is happening. Ask any random selection of medical students and they will tell you that mental health is one of the top few concerns they have for themselves and their peers at university.

Medical schools need a strategic and holistic plan when it comes to approaching the mental health of their students. They need a tailor-made strategy that implements best practice to promote wellbeing and mental health at medical schools.

This brings me to what I want to discuss more closely in this article: a few factors that should be considered when constructing a strategic approach to medical student mental health for medical schools.

The first is codesign. Any holistic strategy that intends to address and solve the mental health of medical students will require codesign with the students. Codesign isn’t tokenistic involvement of students in the process of development; instead, it is an iterative and active involvement of students in the process of development where student concerns are actively sought after and addressed. The value and need for codesign cannot be overstated as medical students encounter a unique set of circumstances while undertaking their degree.

Within this codesign process, solutions can be tested and trialed with students, who can speak on behalf of the student experience and engage peers to provide feedback on potential canvassed initiatives. The codesign process not only includes involving students in constructing the solution and testing it with them but it also includes updating and keeping all students in the conversation regarding progress on the strategy. So often, great ideas and initiatives are marred by poor communication between faculty and student bodies. Any strategy that is deserving of support and is underlined by collaboration with its student body warrants a strong communication strategy that adequately maintains the enthusiasm and belief in the shared vision for healthier medical schools and better mental health among its students.

The second factor is the need to address mental health beyond the crisis point. This comes back to the overarching idea that universities need to become places that cultivate healthy environments, and not just be machines for pushing out the future workforce.

When we look at a cohort of medical students (or students in general), we can separate them into three categories: students that are currently well, students that are currently unwell and students that are currently experiencing a crisis point in their life. Having systems such as crisis response protocols, well promoted and easily accessible crisis support lines, or adequate counselling services are only a small part of the solution. We can’t let mental ill health fester in students and only deal with it at the crisis point. Points at which students are well or are feeling mild to moderately unwell also require recognition in any mental health strategy. In these cases, preventive and supportive solutions are needed to ensure that we are on the front foot when it comes to addressing mental health within the cohort. This may include helping students to find a suitable GP who is willing to see medical students, providing mental health wellness guides and actively participating in Blue Week and R U OK? Day with students.

The third factor to be considered is strengthening the student community and ensuring students are adequately prepared to respond and help peers who are struggling.

The nature of medical training requires students to train and learn off-campus and in various hospitals and general practice environments. This means that students are constantly moved around from one site to another, to experience different patient demographics, working environments, specialties and caseloads. Therefore, the inherent enablers of quality medical education can often come at the detriment of long-lasting, stable communities and learning environments, which are vital for creating strong networks that act as a safety net for students.

All of this implies the need for faculty-backed, student-led initiatives to create the healthy and non-stigmatising community. Further, any strategy by faculty also needs to look at the preparedness of first responders to both mental health concerns and crises – who are most often students. There is a need to equip students with the skills to adequately support the mental health of peers during crisis and during unwellness until further help is sought. Courses such as mental health first aid, offered by some medical schools, go a long way to upskilling student cohorts and strengthening the ability of students to support each other in times of difficulty.

The fourth factor to consider is execution, as a matter of urgency, and ensuring that easy wins are looked at in the early stages of implementation. The conversation around medical student mental health has been raging for a long time. Medical student suicides are a regular occurrence, almost expected and completely unacceptable. Developing strategies, frameworks, standards or any other type of generic document highlighting the direction to be taken is only worth as much as its execution – and only delays us from putting a stop to more medical student ill health.

Real tangible action that is reflected at the grassroots among medical students is what is needed. One of the best ways to kick start the implementation of strategies is to look at picking low-hanging fruit, the easy wins that can see immediate impact. These are plentiful in many medical schools.

For many, a simple review of special consideration procedures for medical students will go a long way in decreasing the stress that students feel during their course. For other medical schools, it may be offering a mental health day off in each rotation to allow students to focus on mental health and manage their personal life. These initiatives are important and will galvanise the roll-out of any mental health strategy.

Ultimately, mental health of medical students is not an issue that can be delayed. Universities and faculty are responsible for cultivating healthy learning environments for students, and for medical schools and faculty, it is no different. Action needs to be taken urgently.

Daniel Zou is the President of the Australian Medical Students’ Association and a 3rd-year medical student at the University of Melbourne.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.