Mental Health and Supporting StudentsDr Niamh Farrelly

Consultant Psychiatrist TCD

An Integrated Approach

How Disability Services can communicate with college-based and external health services and ensure best use of resources?

Overview

• 75% of mental health problems emerge before the age of 25

• 25% of 18-25 year olds experience MH problems each year : ¼ of whom access help

Estimate 20,000 students25% = 5,000 students have MH problems = 1,250 (25%) Actively access help (6% all stds)

Changing student profile

• more college students meet criteria for some form of learning disability.

• Lifestyle habits— eating patterns, sexual activity, sleeping and drinking—we also see evidence of markedly increasing maladaptive patterns.

More students, more complex needs…

Models of Support

Authoritarian

Autonomous: Age / maturity /Separation / individuation

Collaborative Care:blend of

‘authority’ (training, knowledge, experience) and ‘autonomy’ (knowledge , preference, experience)

Autonomy

• Do we hide behind autonomy (right to refuse recommendation) rather than attempt to recognise the clinical problem that lies at the root of the refusal

• Autonomy can be made an acceptable way of passing burdensome problem or decisions over to the student

• Abdication of responsibility for decisions from the college to the student

Collaborative Care

• blending of professional cultures: achieved though sharing skills and knowledge to improve the quality of patient care

• There are important characteristics that determine team effectiveness, including members seeing their roles as important to the team, open communication, the existence of autonomy, collaborative education

Collaborative Care

• Individual becomes active partner • Takes appropriate responsibility• Agree joint decision

– At times balance between authority and collaboration may need to shift

– Emergencies trump collaboration but true collaboration plans for these exigencies

Student

Student Service

supports

Self help resource

s

Academic supports

External

Family supports

Friends

Collaborative Care Planning

• Student at the helm, support etc. crew• Concordance on destination• Concordance on route• Concordance on contingency planning– Advance directives/ planning if temporary absence

of captain• e.g. discussion re ‘what do you want me to do

if you DNA?’

Outcome of collaborative care?

– Greater treatment concordance– Better mental health outcomes– Reduced hospitalisation– Reduced time to relapse– Reduced frequency of relapse

– Greater student retention

Consider perspective of all agencies

• Student *• Disability officer *• Tutor• Academic supports• Counselling supports• Friends • Doctor*• OT• Family*

What is competing with what?

• Student : academic / finances / relationship/• Academic: funding / placement integrity• Family: domestic issues / concerns/ isolation• Friends : social life / formation of friendships• Student Services: how is service shared/ how

efficiently is this done

• Doctor

Medical role

• On site medical service– Advantages: experienced in age group– Disadvantages: lack 24/7 care access model

• Off site medical service• May be most appropriate care setting especially if

enduring difficulties likely to persist beyond college • Provide continuity of care• Broader scope to access service• Emergency treatment provisions 24/7

Off site care

• Ability to be fully aware of demands and environmental challenges student faces?

• Day care facility– notional structure and routine– Inappropriate expectations of pastoral care– Lack of awareness of financial implications of failure– Assumptions made wrt. intellect and comparisons made with

different core cohort of patients– Educational experience of external provider– Confidentiality– Access to speak to somebody

External Care Provider

• How do you identify yourself?

• Most people do not know what a disability officer is?

• Concerns wrt confidentiality

• Speaking to somebody who knows individual

• Difficulties with continuity of care

CMHT

• 450 points• Articulate• Likely higher SEG

– Behavioural activation strategy– Development of goal– ? Full consideration of range of skills required to

function as student who is unwell

Family

• Expectation to continue• Assumptions to return• ? Understanding of options

• Often– left out in the cold– Misinformed– Lacking in knowledge of what is really going on

• Collaborative Care

– Sharing the same vision– Aiming for the same destination– Recognition of crew and their roles– Contingency planning in event of a storm

COMMUNICATION

Communication

• Not just with student but with each other

• Attempting to understand different perspectives

• Development of relationships with core personnel / working out best person to speak with

• Meeting regularly / forming relationships

• Relationship with family

• Remember who you are dealing with!

• Pick up the phone!

• Networking

• Go and visit service