Mental Healthcare Services for Medical Students: An Approach From the University of Pittsburgh

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Medical students experience a significantly elevated risk for depression, suicidality, and burnout during their education, even if they matriculate in relatively good health.
Medical students experience a significantly elevated risk for depression, suicidality, and burnout during their education, even if they matriculate in relatively good health.

Medical students experience a significantly elevated risk for depression, suicidality, and burnout during their education, even if they are in relatively good health when they enroll in medical school.1 In a perspective article published in the New England Journal of Medicine, investigators described their success in implementing mental health services for enrollees.2

Jordan F. Karp, MD, and Arthur S. Levine, MD, of the University of Pittsburgh Department of Psychiatry, shared details of the University's “dedicated medical student mental health care team.” The team is financially supported by the medical school to provide mental health care for all students: 560 medical students and 360 graduate students. The budget provides the staff psychiatrist with 30% salary support and the psychologist with 100% salary support. Care is provided free of charge, and students' insurance is never billed for mental health care received at the school. This approach eliminates any financial concerns for students seeking help and minimizes the stigma associated with billing mental health services to an insurance plan that may be shared with family members.

The mental health services team is further supplemented by the Student Health Advocacy Resource Program (SHARP), a confidential peer-counseling referral and advocacy service sponsored by the student affairs office. The SHARP team comprises 10 peer counselors equipped to provide assistance on a breadth of mental health topics, including “life transitions, family stress, depression and anxiety, academic concerns, relationship difficulties, leaves of absence, and substance abuse.” SHARP is supervised by faculty from the departments of medicine and psychiatry to ensure the quality and safety of services provided.

First-year medical students at the school are introduced to the availability of mental health care during orientation, and teaching faculty and advisory deans are educated regularly on the services available so that they can provide information to students. During the 2016 and 2017 academic year, 16% of students consulted the staff psychologist. Of these, 20% sought help for problems with concentration and/or academic performance. For these students specifically, the mental health care team works closely with the medical school's academic support specialist. If a student fails an educational block during the first 2 years of medical school and there are “concerns [of] attention-deficit disorder or a learning disability that may [require] accommodation,” the school finances any subsequent neuropsychological testing.

A total of 850 appointments were scheduled with the psychologist during this academic year for 150 total students seen. Among this cohort, 35 were diagnosed with depressive disorder, 35 with anxiety disorder, 25 with adjustment disorder, 20 with attention-deficit disorder, and 5 each with eating disorder or substance use disorder. These data highlight the prevalence and diversity of mental health issues encountered by medical students, particularly those who have recently begun medical school: 60% of students seen by the psychologist were in their first or second year of schooling.

The authors underscored the current inability of medical schools to meet students' mental health needs, even though approximately half of medical students report burnout and 10% report suicidal ideation.3 In an article published by JAMA, one medical student wrote that “depression and its vestiges are everywhere.”4 The suicide of a fourth-year medical student in New York “rocked [the school] with anguish, anger, and frustration” regarding the lack of support offered by student services and the stigma surrounding mental illness.5

“It's time to act,” Drs Karp and Levine wrote, urging other medical institutions to adopt inclusive mental health services. The team at the University of Pittsburgh may serve as a blueprint for other initiatives. Other schools, including the University of California, San Diego — which offers an online educational counseling system — have developed their own approach. Medical institutions must leverage available physician-services resources to provide students the support they need.

References

  1. Brazeau CM, Shanafelt T, Durning SJ, et al. Distress among matriculating medical students relative to the general population. Acad Med. 2014;89:1520-1525.
  2. Karp JF, Levine AS. Mental health services for medical students – time to act. N Engl J Med. 2018;379:1196-1198.
  3. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334-341.
  4. Gupta R. I solemnly share. JAMA. 2018;319:549-550.
  5. Muller D. Kathryn. N Engl J Med. 2017;376:1101-1103.
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