Medical Student Beliefs about Disclosure of Mental Health Issues: A Qualitative Study

An Analysis of Students' Perceptions of Strategies to Improve Well-Being in Dentistry

INTRODUCTION

A number of papers have reported on stressors to students in the dental curriculum. This paper analyses perceptions of strategies to improve well-being among final-year dental students in a dental curriculum.

METHODS

A literature review was performed to create a question guide to explore issues of wellness and stress in a dental curriculum. Final-year dental students were invited to an interview using random sampling and issues related to strategies for well-being were analysed by an inductive-deductive approach.

RESULTS

Fourteen interviews were conducted, yielding three themes under the overarching domain of strategies to improve dental student well-being. Under the theme of well-being management, students wished for training on stress reduction for their personal well-being and guidance on communication, referral and mental health support to manage the well-being of colleagues and patients. The second theme, mentoring, covered peer support in the form of a 'buddy system' and sharing from recent graduates to help students gain practical and career advice about post-graduation challenges. Finally, suggestions for institutional support included providing in-house counsellors in the dental hospital with specialised knowledge about the unique concerns of dental students and clear leave of absence policies that treat mental and physical health equally to encourage help-seeking and reduce the fear of disclosure.

CONCLUSION

The experiences of final-year dental students were sampled to explore potential approaches to improve well-being in the dental school environment. Guided by these student perspectives, specific strategies have been implemented and recommended to improve the wellness support provided by the faculty for dental students.

Developing a Framework for Mental Health Disclosure Decision-Making Among Medical Students: A Qualitative Pilot Study

PurposeAmerican medical students exhibit higher rates of depression, anxiety, and psychological distress than age-matched members of the general population, yet the majority of students do not seek help for these conditions. A necessary precursor to help-seeking is disclosure, or the sharing of one's diagnosis or symptoms with others. This pilot study aims to explore mental health disclosure decision-making among medical students.DesignSemi-structured qualitative interviews.SettingStudents were interviewed virtually using Zoom.Participants20 students enrolled in nine American undergraduate medical education institutions (MD or DO).MethodInterviews were audio-recorded and transcribed. Using Constructivist Grounded Theory (CGT) and iterative cycles of analysis with focused and theoretical coding, a preliminary framework was developed to represent mental health disclosure decision-making among medical students.ResultsThe proposed framework presents three factors that impact students' disclosure decisions: Assessing Anticipated Outcomes, Evaluating Priorities, and Determining Appropriate Recipients. The framework also identifies two moderating variables-Disclosure Goals and Severity and Type of Symptoms-that affect students' perspectives on outcomes and recipients.ConclusionThis pilot study highlights the complexity of student disclosure decision-making. While limited by the small sample size, the results suggest the importance of considering student perspectives on disclosure recipients, communication surrounding disclosure outcomes, and the flexibility of student schedules when pursuing future projects related to medical student well-being and mental health disclosure.

A Qualitative Analysis of Students' Perceptions and Experiences of Stressors and Well-Being in Dentistry

INTRODUCTION

Well-being is increasingly regarded as an integral component of a graduating dentist's professional responsibility, yet studies demonstrate significant levels of stress and poor mental health in the dental student population. The aim of this qualitative study was to explore final-year dental students' perceptions of stressors in dentistry and their experiences of managing their individual well-being and supporting the well-being of their colleagues and patients.

METHODS

A literature search was performed to guide the development of an interview framework which included questions centred around three higher domains based on self, peers and patients. Participants were randomly sampled and the interviews audio recorded and transcribed verbatim. An inductive-deductive approach was adopted for thematic analysis of the results.

RESULTS

Fourteen interviews were conducted, revealing four themes and 15 subthemes. Students were acutely aware of poor well-being symptoms amongst themselves and their peers. Treating dental patients with mental illness was common but some students expressed uncertainties in managing these patients. The key stressors were assessments and clinical stress. Students frequently sought support from peers and half had received professional help. Barriers to approaching faculty staff were identified. The role of stigma in preventing students from openly sharing their well-being experiences was discussed.

CONCLUSION

A range of curricular and clinical stressors, and potential sources of support to manage these stressors, have been explored from the perspectives of final-year dental students. From these experiences, action points have been proposed to address knowledge gaps and enhance faculty-level wellness support for dental students.

The experiences of students with mental health difficulties at medical school: a qualitative interview study

BACKGROUND

High rates of burnout, anxiety, and depression in medical students are widespread, yet we have limited knowledge of the medical school experiences of students with mental health issues. The aim of the study is to understand the impact of mental health issues on students' experience and training at medical school by adopting a qualitative approach.

METHODS

Qualitative study using in-depth semi-structured interviews with 20 students with mental health issues from eight UK medical schools of varying size and location. Students were purposefully sampled to gain variety in the type of mental health issue experienced and demographic characteristics. Reflexive thematic analysis was employed using NVivo software.

RESULTS

Three themes were identified. 1) Culture of medicine: medical culture contributed to causing mental ill-health through study demands, competitiveness with peers, a 'suck it up' mentality where the expectation is that medical school is tough and medical students must push through, and stigma towards mental ill-health. 2) Help-seeking: students feared others discovering their difficulties and thus initially tried to cope alone, hiding symptoms until they were severe. There were multiple barriers to help-seeking including stigma and fear of damage to their career. 3) Impact on academic life: mental health issues had a detrimental impact on academic commitments, with students' unable to keep up with their studies and some needing to take time out from medical school.

CONCLUSION

This study provides insight into how medical culture contributes both to the cause of mental health difficulties and the reluctance of medical students to seek help. Mental health issues had a considerable negative impact on medical students' ability to learn and progress through their degree. Addressing the medical culture factors that contribute to the cause of mental health issues and the barriers to help-seeking must be a priority to ensure a healthier medical workforce.

Barriers and facilitators to help-seeking for common mental disorders among university students: a systematic review

Objectives: Common mental disorders affect high proportions of university students. This systematic review aims to summarize the barriers and facilitators to help-seeking for depression and anxiety among university students and provide evidence to improve mental health services. Methods: EMBASE, MEDLINE, and PsycINFO were searched for eligible papers. Inclusion criteria: (1) published between 1990 and 2021, (2) written in English, (3) had qualitative or quantitative methodology, (4) involved university students, (5) students had depression or anxiety, (6) students were explicitly asked about barriers and facilitators, (7) >60% of study population had mental illness. Results: Ten studies were included into this review. The most common barriers were self-reliance, stigma, and poor mental health literacy. Good mental health literacy and social encouragement were significant facilitators. Conclusions: Universities could encourage help-seeking by targeting stigma and increasing mental health literacy. Future research could explore the role of self-reliance in help-seeking and identify more facilitators.

Exploring access to support services for medical students: recommendations for enhancing wellbeing support

BACKGROUND

Medical students have reported facing unique challenges in their academic journey that can have a significant impact on their mental health and wellbeing; therefore, their access to support services and wellbeing resources has been deemed crucial for dealing effectively with the various challenges they tend to face. While previous research has highlighted certain barriers affecting medical students' help-seeking and access to wellbeing support more generally, there is a pressing need for more in-depth research into the factors that may hinder or facilitate medical students' acceptability and uptake of the wellbeing resources available to them within institutional contexts. The current study aims to explore students' perceptions and utilization of wellbeing interventions and welfare resources within a medical school setting, as well as the factors influencing their help-seeking attitudes or behaviours. Additionally, it seeks to instigate medical students' deeper reflections on potential enhancements that could be applied to wellbeing resources so that they are better suited to address their needs.

METHODS

This study employed a qualitative design, involving semi-structured interviews and a series of focus groups with medical students at the University of Nottingham (UK). Post-interview, focus groups were deemed necessary to gain deeper insights into emerging findings from the interviews regarding students' views on wellbeing support services. Qualitative data from the interviews was subjected to thematic analysis while a hybrid thematic analytic approach was applied for the focus group data in order to allow for both pre-defined themes from the interviews and newly emerging patterns to be identified and analysed in a combined manner.

RESULTS

Twenty-five participants took part in the semi-structured interviews and twenty-two participants were recruited in a total of seven focus groups. Thematic analysis findings identified several key barriers to medical students' accessing wellbeing resources, including difficulties in finding relevant information, lengthy processes and difficulties receiving prompt help in urgent situations, learning environment issues, confidentiality concerns, and stigma around mental health. Student suggestions for the enhancement of wellbeing provision were centered around proposed improvements in the format that the relevant information was presented and in the structure underlying the delivery of support services.

CONCLUSION

The study findings shed light on multi-faceted factors contributing to medical students' challenges in accessing support services; and provided a deeper understanding of medical students' wellbeing needs through a consolidation of their recommendations for the implementation of practical steps to address these needs. These steps can potentially inform key medical education stakeholders so that they can actively and proactively foster more supportive environments that may help improve medical students' help-seeking, as well as their acceptability and uptake of wellbeing services.

Barriers to help-seeking, accessing and providing mental health support for medical students: a mixed methods study using the candidacy framework

BACKGROUND

The mental health of medical students is a national and international problem increasing in both demand and acuity. Medical students face barriers to accessing mental health support that is clinically effective, timely and appropriate for their needs. This mixed methods study aimed to explore experiences of these barriers and the challenges to health service delivery aligned to the Candidacy Framework.

METHODS

One hundred three medical students studying at The University of Sheffield completed an online survey comprising the CCAPS-34 and follow-up questions about service access and use. Semi-structured interviews with a nested sample of 20 medical students and 10 healthcare professionals explored barriers to service access and provision. A stakeholder panel of medical students and professionals met quarterly to co-produce research materials, interpret research data and identify touchpoints by pinpointing specific areas and moments of interaction between a medical student as a service user and a mental health service.

RESULTS

Medical students who experienced barriers to help-seeking and accessing support scored significantly higher for psychological symptoms on the CCAPS-34. Uncertainty and fear of fitness to practice processes were important barriers present across all seven stages of candidacy. The fragmented structure of local services, along with individual factors such as perceived stigma and confidentiality concerns, limited the progression of medical students through the Candidacy Framework (a framework for understanding the different stages of a person's journey to healthcare).

CONCLUSION

This study outlines important areas of consideration for mental health service provision and policy development to improve access to and the quality of care for medical students.

Assessing the Mental Well-Being and Help-Seeking Behaviors of Pre-Veterinary Undergraduates at a Land-Grant Institution

Recent research conducted within the veterinary profession has reported higher rates of depression and stress than the general US population. While this decline in mental well-being has been documented in Doctor of Veterinary Medicine (DVM) students and veterinary professionals, there is a lack of research on the mental well-being of the pre-veterinary population. This gap led us to conduct a survey in the fall of 2021 utilizing the DASS-21 and ATSPPH-sf inventories to assess the levels of depression, anxiety, stress, and help-seeking stigma in pre-veterinary students to better understand when the decline in veterinary mental well-being begins. A pre-test survey was completed by 233 pre-veterinary students in September, and an identical post-test survey was completed by 184 pre-veterinary students in November. From the pre- and post-test data, depression, anxiety, and stress scores increased as students advanced in academic status during their undergraduate degree. Juniors reported the highest averages of depression, anxiety, and stress compared with their peers. In the post-test, sophomores and juniors exhibited higher rates of depression than freshmen, and juniors and seniors exhibited higher rates of stress than freshmen. Current VMCAS applicants exhibited higher levels of stress than non-VMCAS applicants in the pre-test and lower levels of stress in the post-test. In both the pre-test and post-test data, respondents averaged a neutral attitude toward help-seeking. Based on these results, a decline in pre-veterinary mental well-being occurs as students' progress in their undergraduate career and should be further studied to assess its impact on Doctor of Veterinary Medicine and veterinary professional well-being.

Veterinarian burnout demographics and organizational impacts: a narrative review

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

A systematic review of mental health interventions to reduce self-stigma in medical students and doctors

Background

A growing body of literature has revealed that many medical students and doctors do not seek professional help for their mental health due to fear of stigma (both public- and self-stigma) and questioning of their clinical competency. The aim of this systematic review was to identify and evaluate direct and indirect interventions that address mental health stigma in medical students and/or doctors. We focused explicitly on studies that measured the impact on self-stigma outcomes.

Method

A systematic search of the following electronic databases was undertaken from inception to 13 July 2022: PubMed, Embase, PsycINFO, and CINAHL, together with manual searching of reference lists. Screening of titles, abstracts, and full texts of eligible studies, plus quality appraisal using the Mixed Methods Appraisal Tool, were independently conducted by multiple reviewers with disagreements resolved via discussion.

Results

From 4,018 citations, five publications met the inclusion criteria. None of the studies explicitly aimed to reduce self-stigmatisation, with the majority focusing on medical students. Most of the identified interventions focused on reducing professional stigma (i.e., stigma toward patients with mental illness) and measurement of self-stigma was incidentally collected via a subscale of the general stigma measure selected. Three studies found significant reductions in self-stigma following the delivered intervention. These studies were of moderate quality, had medical student samples, employed combined education and contact interventions, and used the same outcome measure.

Discussion

Intentional development and evaluation of interventions specifically designed to decrease self-stigma among doctors and medical students are needed, with further research required on the optimal components, format, length, and delivery of such interventions. Researchers delivering public/professional stigma reduction interventions should strongly consider measuring the impact of such interventions on self-stigma outcomes, using fit-for-purpose, psychometrically sound instruments.

-Barriers faced by medical students in seeking mental healthcare: A scoping review

Background: Medical students commonly exhibit mental health issues. Despite the availability of professionals on medical campuses, seeking help continues to be a challenge for some students. Our review aimed to identify the barriers medical students face when seeking professional mental healthcare. Methods: A Medical Subject Headings (MeSH) search was created for articles using PubMed, Embase, and PsychINFO databases to identify articles specifically about medical students and their barriers to professional mental healthcare. Inclusion criteria included articles in which barriers to mental healthcare were either the primary variable or one of multiple study results. No date limits were imposed. Reviews, pilot projects, or articles that did not address barriers to mental healthcare faced by medical students or focused on veterinary or dental students were excluded. A total of 454 articles were identified and screened by title/abstract and then full text. Data were extracted from 33 articles using an independent framework. Barriers identified were compiled and reported.  Results: From a total of 33 articles, the most identified barriers were fear of negative effect on residency/career opportunities, fear of confidentiality breach, stigma and fear of shaming from peers, lack of perceived seriousness/normalization of symptoms, lack of time, and fear of documentation on academic record. Students also preferred to seek care outside of their institution from fear of their provider being an academic preceptor.  Conclusions: Many of the barriers to mental healthcare faced by medical students relate to a fear of academic and career reprisal, and fear of confidentiality breach. It appears that despite recent efforts to decrease stigma surrounding mental illness, many medical students struggle to seek appropriate support. Access to mental healthcare can be improved by increasing transparency regarding what information will be displayed on academic records, dispelling common myths about mental healthcare, and increasing awareness about resources available for medical students.

Barriers to mental health help-seeking in veterinary professionals working in Australia and New Zealand: A preliminary cross-sectional analysis

Despite higher reported rates of mental ill-health than the general population, professionals working in the animal care industry have low reported rates of help-seeking behavior. Potential factors involved in veterinary professionals' reluctance to seek help include stigma toward mental ill-health, practical barriers to accessing supports, and a cultural normalization of symptoms in the industry. This preliminary study sought to explore these factors in a sample of veterinarians, veterinary nurses, and veterinary technicians and examine effects of gender, years' experience, and practice location. A total of 408 veterinary professionals working in Australia and New Zealand completed an online survey between June and December 2021 measuring perceived stigma, practical barriers to mental health help-seeking, perceptions of normalized psychopathology and sickness presenteeism. Results indicated moderate levels of both perceived stigma and barriers to mental health help-seeking. Interestingly, psycho/pathology (e.g., burnout, fatigue, and sickness presenteeism) was perceived to be a normalized aspect of the profession by majority of respondents. Although no effect of gender or geographic location were observed, stage of career did have an effect on findings. Early career veterinary professionals were identified as more vulnerable to perceived stigma and barriers to care. The practical and research implications of the findings are discussed and include the need for mental health to be more centrally incorporated into the veterinary curriculum and professional development. Also discussed is an agenda for future research aimed at improving the mental health and wellbeing of professionals working in the animal care industry.

"Obligated to Keep Things Under Control": Sociocultural Barriers to Seeking Mental Health Services Among Veterinary Medical Students

Research reveals veterinary medical students and professionals are at increased risk for mental health problems such as depression, anxiety, and suicidality, yet many individuals in distress do not seek professional mental health services. Although some barriers to accessing services have been identified, other factors, including how professional culture influences service underutilization, are poorly understood. In this study, we used a mixed-methods approach to investigate 573 veterinary students' perceptions of barriers to seeking mental health services and potential mechanisms to lessen them. We identified four barrier themes: stigma, veterinary medical culture and identities, services, and personal factors. Participants' suggestions for reducing barriers to seeking help related to three themes: culture, services, and programmatic factors. We compared perceptions of barriers based on the severity of participants' self-reported symptoms of depression and anxiety and found that participants with severe depression, compared with participants with mild depression, were more likely to perceive barriers related to veterinary medical culture. The results of this study provide a deeper understanding of veterinary students' barriers to seeking mental health services and, in particular, how these barriers, as both individual and sociocultural phenomena, are often interrelated and mutually reinforcing.

Application of Sandplay Therapy in the Mental Health Education of Vocational College Students

Objective

To analyze the application and effect of sandplay therapy in higher vocational students' mental health.

Method

350 sophomores of 2019 in a higher vocational college were randomly selected, and 72 subjects of depressed students (SAS ≥ 50) were selected from 350 sophomores and randomly divided into the intervention group and the control group, each group 9, preparing one set of chamber equipment, adopting the same group before and after test experiment design. The intervention group was, respectively, given 8 individual box court game tutoring, once a week for each person. The control group did not intervene. By comparing the intervention group with the control group, the intervention effect of sandplay therapy on anxiety of experimental group members was investigated.

Results

Among 350 respondents, 72 had SAS scores ≥ 50, and the incidence of anxiety symptoms was 20.57%. Since there was only 1 case with SAS score ≥ 70, it was incorporated into the group with SAS score ranging from 60 to 59. After treatment, SAS scores of students with mild to moderate anxiety in the intervention group decreased, and the difference was statistically significant. The difference before and after control group was not statistically significant. After sandplay therapy, the differences in SAS scores between the intervention group and the control group were found to be statistically significant for both mild and moderate anxiety.

Conclusion

Sandplay therapy in the higher vocational college students' mental health education could promote the mental health of students, and it effectively improves students' psychological quality.

Seeking support for an eating disorder: a qualitative analysis of the university student experience-accessibility of support for students

BACKGROUND

While there is increased concern around mental health problems in universities, the experience of students with eating disorders (EDs) has received less attention. This is problematic as the detrimental consequences of a lack of adequate support are profound.

METHODS

A qualitative study was adopted to investigate students' perspectives of the availability, accessibility and suitability of support services. One hundred university students with experience of EDs completed an online survey. A further 18 students completed semi-structured interviews. Descriptive data are reported alongside analysis of qualitative data.

RESULTS

Three overarching themes were identified; awareness of support, confidence in asking for help and early experiences with services. Most students were aware of support through their GP and university counselling services. Few identified ED-specific sources of support. Barriers to help-seeking included self-stigma and gaps in service availability. Early experiences with services were often negative, problems included; difficulty accessing services, a lack of ED specific support and continuity of care between home and university.

CONCLUSIONS

There is substantive progress to be made in ensuring that students with EDs receive the support they need to thrive at university. While it is important that good treatments exist, the pathway to accessing these treatments equally important. As universities increasingly recognise the need for action around student mental health attention must also be directed towards EDs and the provision of specific services.

'I think it does just opens it up and … you're not hiding it anymore': Trainee clinical psychologists' experiences of self-disclosing mental health difficulties

Self-disclosure of experiences of mental health difficulties is a complex process, particularly within the workplace. Research shows that a significant number of trainee clinical psychologists have lived experience of mental health difficulties and thus face the dilemma of whether to disclose and how to manage self-disclosure during doctoral training. Grounded theory methodology was used to explore trainee experiences of self-disclosure of mental health difficulties during training. Twelve trainee clinical psychologists from accredited doctoral programmes in the United Kingdom participated in semi-structured interviews about their experiences of disclosure. Six core categories emerged relating to 'motivations', 'enablers', 'barriers', 'features of disclosure', 'responses' and 'impact', each of which were comprised of several further sub-categories. The model that emerged is largely consistent with research on disclosure in healthcare professions and has implications for training programmes, supervisors and trainees when engaging in conversations about lived experience.

Medical student knowledge and concern regarding mental health disclosure requirements in medical licensing

OBJECTIVE

Two-thirds of United States medical boards require disclosure of mental health treatment or diagnosis during licensure, with negative influence on physician well-being but unknown impact on medical students. This study sought to understand whether medical students perceive mental health treatment to be a threat to their future medical license.

METHOD

Students at an American medical school in a state without disclosure questions completed an anonymous fourteen question survey. Analysis with univariate and multivariate statistics explored knowledge, opinion, and impact of disclosure questions.

RESULTS

Data was obtained from 327 medical students, a 53% response rate. The majority-91% (299)-were unsure or incorrect as to whether their state licensing board requires mental health disclosure. 33% (86) reported disclosure questions substantially discourage them from seeking mental health treatment. Of the 32% (105) who accessed mental health treatment during medical school, half-52% (74)-would not disclose during licensing. Those who believe that disclosure could impact their license were more likely to be discouraged from seeking care (OR, 5.23 [95% CI, 1.97-15.99]; P = 0.002). Most students-75% (245)-opposed mandatory disclosure.

CONCLUSIONS

Concern about mandatory mental health disclosure discourages medical students from seeking care, despite uncertainty about disclosure questions.

Grief in Response to Uncertainty Distress Among Veterinary Students During the Early Stages of the COVID-19 Pandemic

The abrupt and life-altering shifts brought on by the COVID-19 pandemic have stimulated research in fields ranging from social sciences to virology. This study explored perceptions and experiences of COVID-19's impact on students at Lincoln Memorial University–College of Veterinary Medicine (LMU-CVM) and considered how to respond to these. Semistructured interviews were conducted with 20 students from LMU-CVM. Thematic analysis elucidated five subthemes that were combined into two main themes based on Bertuccio's framework of grief in response to uncertainty distress. Uncertainty and disruption of routine were subthemes of ambiguous loss, while lost opportunities, milestones missed, and risk concern came under anticipatory grief. There was overlap and fluidity within these themes, with frustration, stress, and unexpected benefits pervading all categories. Differences were noted between classes, with clinical students expressing concern over graduation and lack of preparedness, and preclinical students with online assessment, lost opportunities for clinical experiences, and the loss of social connections. These results point to mitigation strategies for the adverse effects of COVID-19-related stressors specific to this population that encompass academic, physical, and mental well-being concerns. Clear communication, assurance of quality education, flexibility for meeting family needs, financial assistance, and mental health support are the areas evident from the interviews where successful responses might be targeted. This study also highlights areas for future research, including follow-up interviews, given the prolonged timeline of COVID-19, surveys of beliefs and practices across a larger university population, and exploration of the long-term impact on academic and practice success of the affected cohorts.

Medical students’ attitudes towards mental health disclosure: a qualitative study

Purpose

In 2013, the General Medical Council conducted research into best practice for supporting medical students with mental health concerns, producing a document outlining University’s duty of care. It also outlined reasons as to why medical students are susceptible to mental illness. The purpose of this paper is to explore what factors affected medical students' disclosure of mental health problems and their help-seeking behaviour today and if these differed from the GMC’s findings from 2013.

Design/methodology/approach

A questionnaire was issued to all University of Glasgow medical student year groups. In total, 72 people responded. All responses were then analysed by the primary researcher using Mayring’s six-step approach of systematic, rule guided qualitative text analysis.

Findings

Four main barriers to disclosure were revealed: fear of repercussions, medical student “expectations”, judgement and lack of support. Respondents feared being deemed unfit to practise, displaying “weakness” or being treated differently. They believed support provided was inadequate or inaccessible. Less than half felt the Medical School made mental health support easily available and only 11% were even aware of the GMC document. Respondents believed medical students were psychologically vulnerable due to Medical School environment, work load, “expectations” and course content. They perceived the Medical School was “a pressure cooker” for mental health problems and yet student well-being was not prioritised.

Originality/value

The research highlighted some key areas that universities should address, such as promoting support services available, recognising the unique stresses of the medical curriculum and the need for provision of resources that can be accessed without fear, stigmatisation or uncertainty.

Trainee doctors' views on mental illness among their peers and access to support services

The mental health of doctors in training raises two major concerns, first that they are reluctant to, and have difficulty accessing, treatment, and second that undiagnosed and untreated doctors expose patients to unacceptable risks. Four 1-h focus groups were held, with participants' views explored on their observations about mental health as an issue amongst doctors, their personal knowledge of, and preferences for, sources of support, and other related factors. Transcripts were analysed using a thematic framework approach.

'If you're crying this much you shouldn't be a consultant': the lived experience of UK doctors in training with mental illness

There is some disagreement in the literature whether doctors in training suffer more from mental illness than an age-matched population. However, mental illness among doctors in training is a cause for concern because of the dual problems of reticence about accessing help and the clinical risk of doctors practising while mentally ill. The belief that is widely held among doctors in training is that to disclose a mental illness would be seen as weakness and may damage their career. A biographical narrative interview technique was used that enables the informant to tell the story of a painful episode in their lives in their own way and in their own words. Interviews were transcribed, and a thematic framework developed by consensus and then used to analyse all of the narrative interview data. Four major themes were detected: (1) Doing the job while ill, (2) Sick leave (initiating, being on, returning from), (3) Interaction with the employer; and (4) Sources of support. Practising while mentally ill caused significant challenges. Interviewees did the minimum, hated having to make decisions, and failed to study for postgraduate exams. All interviewees took sick leave at some stage. However, most were reluctant to do so. Being on sick leave meant being absent from the career that identified them and running the risk of being perceived as weak. Returning to work from sick leave was often difficult. Back to work interviews and occupational health support did not always happen. This study demonstrates the suffering encountered by doctors in training with mental illness. The job becomes much more difficult to do safely when mentally unwell. A great deal of presenteeism exists, which inhibits doctors in training from getting the medical care they need. It is imperative that confidential medical care is made available to doctors in training, which is sufficiently distanced from their place of work.

State Nursing Licensure Questions About Mental Illness and Compliance With the Americans With Disabilities Act

The current article describes a review of U.S. states and the District of Columbia boards of nursing pre-licensure applications, which were collected, summarized, and evaluated to assess compliance with the Americans With Disabilities Act (ADA). Less than one half (n = 21) of RN licensing boards do not ask questions about mental illness on pre-licensure applications. Of the 30 boards that ask questions about mental illness, eight focus on current disability, which is legal under the ADA. The remaining 22 boards ask non-ADA-compliant questions by targeting specific diagnoses, focusing on historical data in the absence of current impairment, and/or requiring a prediction of future impairment. Nursing boards are urged to join colleagues in law, psychology, and medicine in using ADA-acceptable applications by eliminating mental health questions or limiting them to current impairment queries. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 17-22.].

Mental health in medical students: time to act

BACKGROUND

Mental health problems are prevalent amongst medical students. However, many students delay seeking medical help or support from the medical school for a variety of reasons, including a fear of facing fitness to practice proceedings. Tackling this problem of awareness and delayed presentation will need a strong and dedicated focus at all stages, with prevention being of great importance.

METHODS

A conference dedicated to mental health and well-being was organised for students of all years. The first part of the conference centred on well-being dilemmas and the second part focused on discussing important issues in small group sessions.

RESULTS

Students were divided into eight groups and each group suggested improvements to the course that they felt would improve mental health and well-being. The main suggestions raised were: reassurance that the disclosure of mental health problems would not automatically result in fitness to practice proceedings; separate academic and pastoral roles of tutors; open up the topic of mental health and well-being more frequently during the programme; improve knowledge about the availability of support services; and have mentors who are at an earlier stage in postgraduate training (e.g. junior doctors).

DISCUSSION

It is necessary to tackle the prevalent myths about this topic. Many students are unaware of the support services available. This conference has therefore sought to increase awareness of the topic. An approach is also now needed to identify those who need extra help. The authors strongly advocate opening up this topic throughout the course in the context of a dedicated conference, for example. Many students are unaware of the support services available The authors strongly advocate opening up this topic throughout the course in the context of a dedicated conference ….

Mental Health Stigma and Veterinary Medical Students' Attitudes Toward Seeking Professional Psychological Help

Veterinary medical students may be at increased risk for a variety of mental health problems. However, research with student samples suggests that students in distress may not seek professional help, even when mental health services are available. The purpose of this study was to explore veterinary students' willingness to seek mental health services for several common presenting concerns, as well as their perceptions of their peers' willingness to seek help for the same concerns. We also sought to explore the roles of public stigma, self-stigma, and attitudes toward seeking professional psychological help in explaining students' willingness to seek services using a serial mediation analysis. Study participants were 573 veterinary medical students currently enrolled in accredited programs in the United States. Participants reported being most willing to seek mental health services for issues regarding substance abuse, traumatic experiences, and anxiety. They also tended to perceive other students were less willing to seek mental health services for most presenting issues than they actually were. As expected, self-stigma and attitudes toward seeking professional psychological help serially mediated the relationship between public stigma and willingness to seek mental health services. Public stigma was positively related to self-stigma, self-stigma was negatively related to attitudes toward seeking professional psychological help, and attitudes toward seeking help were positively related to willingness to seek mental health services. Implications for outreach, research, and education are discussed.

Cross-sectional analysis of veterinary student coping strategies and stigma in seeking psychological help

Veterinary education can result in high levels of academic stressors for students. Students are also susceptible to non-academic stressors, including relationship issues and financial concerns. These can all result in mental ill health, which may impair the student's ability to complete their studies and go on to a successful professional career. Finding and using strategies early on to help alleviate mental health problems is critical to successful management of these problems, but seeking help may be impeded by the stigma associated with mental health problems. Using a cross-sectional online survey of a sample of Australian veterinary students, the aim of the current study was to investigate the type and frequency of their coping strategies as well as to explore relationships between self-stigma and coping strategies. Female veterinary students reported more use of instrumental and emotional support as coping strategies, while male veterinary students demonstrated more use of humour. Self-stigma was related to less instrumental support, greater self-blame and gender, while males who employed more humour as a coping strategy reported more self-stigma. Improving the coping strategies of veterinary students and reducing the self-stigma surrounding mental ill health is important to improve the wellbeing and resilience of the veterinary profession.