{"id":50250,"date":"2021-05-12T09:20:44","date_gmt":"2021-05-12T08:20:44","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50250"},"modified":"2021-05-18T10:21:28","modified_gmt":"2021-05-18T09:21:28","slug":"students-with-a-mental-illness-should-be-welcomed-into-the-ranks-of-medicine","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/12\/students-with-a-mental-illness-should-be-welcomed-into-the-ranks-of-medicine\/","title":{"rendered":"Students with a mental illness should be welcomed into the ranks of medicine"},"content":{"rendered":"

Isobel Walker considers how we can dispel the notion that those with a mental illness aren’t “cut out” for the medical profession
\n<\/span><\/p>\n

My medical school experience has definitely not been \u201ctypical\u201d\u2014I\u2019ve spent most of it under some level of psychiatric care. Being a patient as a medical student affects every aspect of my university life. When I\u2019m attending a clinic as a patient, I\u2019ll anxiously try to work out whether any medical students will be observing the session, and I\u2019ve found myself calling the receptionist to hide all evidence of me being there so students can\u2019t accidentally stumble upon my notes. In the past, I have been so distressed<\/span> that I would take anyone (even someone who may recognise me) listening<\/span> to me<\/span> at that moment in time, only for worry and embarrassment to creep in afterwards<\/span>.<\/span>\u00a0<\/span><\/p>\n

When<\/span> friends are applying for their next placement locations, I already know mine; it has been planned for months<\/span> because I need to be within easy access of my consultant, or <\/span>psychotherapy <\/span>session, or whatever treatment it is for what my mental health next decides to throw at me.\u00a0<\/span><\/p>\n

I\u2019ve been diagnosed with some form of mental health condition since I was 11,<\/span> and have tried both pharmacological and psychological interventions. Naturally, my ability to cope with medical school<\/span> was questioned before I had even started my first year. I still clearly remember an occupational health appointment where I felt like a list of diagnoses\u2014a \u201cliability.\u201d I resolved then that I would always fight to prove that I was \u201cgood enough.\u201d However, this led me to succumb to the self-stigmatisation that<\/span> so many people in my situation are subject to\u2014unfortunately, it causes many medical students, who would be incredible doctors, to decide that they aren\u2019t cut out for the profession.<\/span><\/p>\n

The obstacles to seeking support that medical students with serious mental illnesses face only add to the stigma. Some are true obstacles: for example,<\/span> the geographic instability of clinical placements<\/a> and, more recently, the restrictions placed upon students by the covid-19 pandemic<\/a>.<\/span> Others, however, are perceived obstacles. The nature of medicine\u2019s admissions process, and its aim to positively select<\/span> candidates who demonstrate traits such as \u201cresilience,\u201d produces<\/span> cohorts full of students who appear mentally robust and strong\u2014making<\/span> a confession of not coping even harder. T<\/span>his emphasis continues beyond medical school into life as a qualified doctor, where a preconceived professional culture<\/span> of invincibility is rife.<\/span> \u201cWe\u2019re supposed to treat the sick, not be sick ourselves\u201d is a common ideation among students<\/a> when considering their role<\/span>.\u00a0<\/span><\/p>\n

It\u2019s frequently assumed that medical students will be \u201cfit and healthy\u201d when, all too often, this isn\u2019t the case. I once had a clinician remark to me how they<\/span> couldn\u2019t imagine how awful it would be to need medication to not feel \u201cmiserable,\u201d assuming I would share this view. I implore clinicians, medical educators, and fellow students to consider their words before they make statements like this, which may add to stigm<\/span>a. <\/span>Medical students are certainly not exempt from invisible illnesses and hidden disabilities. If anything, with <\/span>over two fifths of doctors reporting that covid-19 has worsened their mental health<\/span><\/a>, these issues are likely to affect an even greater number of doctors and students during and beyond the pandemic.\u00a0<\/span><\/p>\n

One further contributor<\/span> to stigmatisation is students\u2019<\/span> fear that confidentiality will not be upheld, and that seeking care for their mental health will harm their career progression<\/a><\/span> or prevent graduation due to<\/span> fitness to practise<\/span> processes. It\u2019s a misconception that disclosure of any mental health problem, no matter how small, will automatically result in fitness to practise<\/span>\u00a0proceedings. The GMC clearly states<\/span> that this is only in \u201cexceptional\u201d cases where it is \u201cimpossible\u201d for a<\/span> student to meet required outcomes. The GMC also requires medical schools<\/a><\/span> \u201cto show the support, interventions, and reasonable adjustments\u201d it has made for a struggling student before a fitness to practise<\/span> process can even be started.<\/span>\u00a0<\/span><\/p>\n

Early preventative measures by medical schools are advised and outlined in the same guidance, ranging from reassurance that some degree of stress and anxiety is normal, to peer schemes and confidential support. <\/span>The normalisation of preventative action, advocacy of students\u2019 welfare and wellbeing, and promotion of<\/span> looking out for one another and seeking help are positive steps towards reducing stigmatisation.\u00a0<\/span><\/p>\n

However, mental illnesses can range from mild to severe, just as physical health conditions can. The GMC specifically admits that people with severe mental health conditions like mine are more likely to be discriminated against. I desperately just wanted to be seen for me, and the abilities that got me into medical school.<\/span> Al<\/span>though it was by no means an easy thing to open up about, I found that the way to <\/span>do t<\/span>his and access the support I so needed to achieve what I was capable of was to be brave, open, and honest as to how I was feeling\u2014three key qualities of a doctor. This support is individualised: for me, it\u2019s knowing doctors\u2019 offices where I can hide away if need be or<\/span> people I can drop a quick email to.\u00a0<\/span><\/p>\n

I\u2019ve now achieved<\/span> more than I ever imagined was possible: I was recognised for services to welfare, have graduated with my BMedSci, and was awarded for an outstanding personal and professional development record in terms of difficulties overcome. I\u2019m also beginning to seriously aspire to my future for the very first time: I absolutely loved my paediatrics placement.\u00a0<\/span><\/p>\n

Realistically, it is likely that I\u2019ll slip downhill again. I\u2019ll probably need to read my own advice <\/span>back to myself, but that\u2019s why it\u2019s there: to remind people<\/span> that you don\u2019t need to \u201cdisappear\u201d from the medical world just because you have a mental illness.<\/span><\/p>\n

Isobel Walker<\/strong> is a fourth year medical student at the University of Nottingham and is also a member of the Sharp Scratch panel. Outside of medicine, she can either be found in a boat (of any sort!) or creating pieces of artwork.<\/span><\/i><\/p>\n

Listen to Isobel discuss her experiences of being a mental health patient as a medical student in this Sharp Scratch episode on<\/span><\/i> Spotify<\/span><\/i><\/a> and <\/span><\/i>Apple pods<\/span><\/i><\/a>.\u00a0<\/span><\/i><\/p>\n

Competing interests<\/strong>: none declared.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Isobel Walker considers how we can dispel the notion that those with a mental illness aren’t “cut out” for the medical profession […]<\/p>\n

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