Commentary on “Medical School: A Mental Battle”

The transition from high school to higher education (and, in the United Kingdom, to medical school) can be challenging for many students; many are moving out of their family home for the first time. Students’ often-romanticized expectations of how university life will be tend to conflict with the reality of its inherent hardships. At university, students face academic, personal, social, and financial challenges, as illustrated in “Medical School: A Mental Battle.” In 2016, the World Health Organization found that one-fifth (20.3%) of college students in the United States had mental health disorders.1 A similar YouGov survey highlighted the extent of this issue in the United Kingdom, where over a quarter (27%) of students reported having a mental health problem of one type or another.2 These figures suggest that the prevalence of mental health problems amongst students is increasing to almost epidemic levels. As medical students at UK universities (Cambridge and Imperial), we have witnessed firsthand the impact of mental health issues amongst our colleagues. We have seen peers relish their exhaustion, flaunting it as a trophy of hard work. We have seen students develop eating disorders and isolate themselves to cope with the workload and the competitive pressure to succeed. Students who feel lonely are at a greater risk of developing mental health problems, such as anxiety and depression.3 In September 2017, Sodexo released its biennial International University Lifestyle Survey.4 They collated research on the student experience from over 4,000 students in six countries. They reported that 32% of students globally admit to loneliness while studying at university, and 42% have considered dropping out because of physical or mental health issues.4 The report highlights how, paradoxically, loneliness as a significant mental health problem unites students across the globe. The potentially harmful effects of loneliness and social isolation on mental health and longevity are well established,5 yet loneliness itself can be rather subjective, as it is synonymous with perceived, rather than objective, social isolation. Further, the sense of social isolation associated with the stigma of mental illness exacerbates loneliness,6 and the perceived stigma causes students to be unwilling to seek help.7 Exacerbating the problem is the reality that many universities are not adequately equipped to deal with this major issue7 and need to increase spending on support.8 We note, however, some positive changes. One report indicated that, compared with 10 years ago, nearly five times as many students disclosed a mental health condition to their university.9 Furthermore, the majority of students (84%) now accept that mental illness is as serious as physical illness, suggesting that the stigma around mental health is beginning to diminish.10 Social enterprises, such as Student Minds in the United Kingdom, are mounting campaigns and hosting promotional events to raise awareness of mental health and to work toward removing the stigma attached to poor mental health and help-seeking. They are advocating student mental health as a priority, embedded across all university activities. Students must feel they are supported throughout their university tenure in a holistic way, including having greater, more transparent information about and access to mental health services, including therapy. A collaborative approach between the academic and student well-being units of universities is crucial to expanding and improving services to meet the growing need and to help ensure the mental health of students. We wanted to contribute to this transformation, to promote access to mental health services, and to improve the perception of help-seeking. Students at Cambridge cofounded the Cambridge Students for Mental Health Society and held workshops on destigmatization, during which students learned about using poetry as an outlet to express powerful yet abstract emotions and feelings. We authored “Medical School: A Mental Battle” during one of the society-organized workshops to provide insight into mental health issues from the perspective of a first-year medical student—drawing both on our own and on others’ experiences during this turbulent period. For us, the process of writing was therapeutic and cathartic; it has allowed us to communicate the feelings we have either faced or witnessed and enabled us to develop potential solutions. Students in the society realize they are not alone. Poetry workshops not only give members a sense of belonging and acceptance but also allow the unburdening of shared struggles. The society welcomes members at different stages, and providing a forum for people who are coping with and openly expressing their mental health issues gives hope to those at the beginning of the process.

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