The task force survey found that one in four MBBS students has a mental disorder, while one in three postgraduate medical students experiences suicidal thoughts.
Published Aug 16, 2024 | 7:00 AM ⚊ Updated Aug 16, 2024 | 10:40 AM
Representative image.
The National Task Force for Mental Health and Well-being of Medical Students, established by the National Health Commission (NMC) in February this year, submitted its report in June, making recommendations aimed at addressing the problem of depression and suicide among medical students in the country.
The task force recommended the creation of an e-complaint portal, and putting in place policy adjustments related to bonds that students must serve as part of their course; also regulation of duty hours, and increasing the number of postgraduate and super-specialty seats.
The NMC set up this National Task Force (NTF) under its Anti-Ragging Committee. From April 26 to May 6 this year, the task force conducted an online survey of 25,590 undergraduate students, 5,337 postgraduate students, and 7,035 faculty members. Using survey results and drawing on related literature, the task force put forward several recommendations.
The task force survey found that one in four MBBS students has a mental disorder, while one in three postgraduate medical students experiences suicidal thoughts. “Online survey results were consistent with the global literature. An alarmingly high 27.8 percent of UG students and 15.3 percent of PG students voluntarily reported having a diagnosed mental health disorder,” the report stated.
Furthermore, 16.2 percent of UG students and 31.2 percent of PG students reported experiencing suicidal ideation. Additionally, 564 PG students (10.57 percent) indicated making plans to attempt suicide within the last year, and 237 PG students (4.44 percent) admitted to attempting suicide in the past year.
“This level of mental health disorders and suicidal ideation, combined with students’ risk factors, demands urgent and aggressive implementation of intervention programmes,” the report emphasised.
Regarding faculty perspectives, the survey revealed a divide. As much as 51.76 percent of the faculty respondents believe students might use mental stress as an excuse, while 48.17 percent consider these issues genuine.
“Given the individualised nature of mental health issues and suicidality, a one-size-fits-all solution for suicide prevention is impractical. Addressing this complex challenge requires a sophisticated, multi-faceted approach tailored to meet the unique needs and circumstances of medical students in India,” the report stated.
One of the key recommendations is the establishment of an e-complaint portal under the NMC for grievance redressal, which would enable secure and efficient handling of student complaints. The task force suggested that a dedicated grievance redressal cell within the NMC should manage the workflow and ensure timely resolutions.
The task force also emphasised the need to increase the number of postgraduate and super-specialty seats. “Expanding postgraduate medical seats addresses healthcare needs, enhances specialist care, and reduces student migration,” the task force noted.
Moreover, the task force recommended the abolition of seat-leaving fees and bonds, as well as the compulsory rural service bond. In terms of duty hours, the NTF recommended that residents should work no more than 74 hours per week, with no more than 24 hours at a stretch. This is a significant reduction from the current practice, where students often work more than 36 hours in a single shift. The recommendations also include one day off per week, a 24-hour duty cap, and 10-hour shifts for the remaining five days of the week.
“Ensuring 7-8 hours of daily sleep for medical students is crucial for their mental and physical health. Collaborative planning of duty hours by HODs, faculty, senior residents, and residents is essential. It’s imperative to recognize that postgraduates and interns primarily serve educational purposes rather than merely filling gaps in healthcare staffing,” stated the NTF.
Medical colleges could consider granting a ten-day vacation at least once a year to both undergraduate and postgraduate medical students on a rotational basis. This vacation would allow students to meet their family and foster protective family ties. The task force also recommends employing adequate number of senior residents, so medical colleges are better equipped to handle workload and patient care.
The task force also recommended abolishing fees for repeating semesters to reduce economic burdens and stress. They emphasised the need for transparent and standardised grading systems, along with an independent appeals process, to ensure fairness. The task force suggested that supplementary exams be introduced to reduce academic pressure and anxiety, and provide a fairer assessment system that supports student well-being.
The task force proposed aligning medical students and faculty pay scales with those of AIIMS, New Delhi. They suggested that a uniform AIIMS, New Delhi pay scale for interns, postgraduate students, super-specialty students, and medical college teachers would ensure equity and fairness, promote job satisfaction, and attract high-quality faculty and students.
The task force recommended that reporting of suicide attempts and deaths by suicide be made mandatory, so that data collection is accurate and accountability can be established; also, this would aid the development of targeted mental health interventions.
The report suggested that measures be taken to reduce the possibility of self-harm by reducing access. High-risk areas must be identified and security measures there enhanced.
The task force report proposes that students be encouraged to explore diverse areas and develop multidisciplinary skills – this could be done through introducing optional courses for medical students. These courses could be credited or non-credited and may be accredited by medical colleges, universities, State Medical Councils, or the NMC, New Delhi. This approach aligns with the principles of the New Education Policy and aims to enhance both the academic and professional growth of medical students.
The task force suggested involving the kin of students during their induction programme, and even periodically during the duration of the course, to help family members understand the situation of students so they can support them better. The report also suggested that regular awareness campaigns be undertaken to educate students and faculty about mental health issues and available resources. Mental health education should be integrated into the undergraduate (UG) and postgraduate (PG) curricula through lectures, workshops, and seminars, the report stated.
The task force suggested that medical teachers, students, and administration undergo regular training in mental health, either through periodic in-person sessions or online via the Swayam portal. Training modules for such sessions could dwell on aspects of mental health, stress management, coping mechanisms, prevention of substance abuse, gatekeeper training, and basic counseling techniques. Those attending should also be taught the importance of maintaining confidentiality when it concerns individuals with mental illness.
Implementing a 24/7 support system, such as the TeleMANAS helpline by the Union Ministry of Health & Family Welfare, is highly advisable, the report suggests. Medical colleges should have comprehensive plans for the referral, evaluation, management, and follow-up of students with mental health issues.
Confidential and accessible counseling services must be widely promoted, and medical colleges must ideally appoint at least two counselors for every 500 students, the report suggested. These counselors could directly report to the dean, so measures that promote mental health and prevent depression could be actively implemented. Psychiatric referrals should only be made when the counselors determine that a student requires psychiatric care.
Medical colleges should also provide free diagnostics and treatment, including medication, for both physical and mental health issues within the campus. Establishing separate wards, clinics, and investigation facilities for students will ensure easy and dedicated access to healthcare services.
Proper infrastructure and amenities are essential for maintaining the physical health and safety of medical students. “This includes well maintained hostels, clean washrooms, safe drinking water, quality food, security measures, recreational facilities, and reasonable fees. To accommodate diverse cultural, religious, and dietary preferences, hostel messes should involve students in menu planning and quality control,” the report stated.
Clear grievance redressal systems should address harassment and psychological stress. Training faculty and administrators on mentorship, accountability, and anti-harassment policies is essential. A feedback and complaint box should be available in the offices of the director, dean and warden.
A gatekeeper training programme in medical colleges should establish a proactive network for identifying at-risk individuals and connecting them with professional help. “This programme involves comprehensive training for participants to recognise warning signs, so such students can be referred to mental health services. With the support of the Department of Psychiatry, local protocols should be developed, and the gatekeeper training program should be initiated across the campus, involving all stakeholders. This initiative is crucial for fostering a supportive environment and enhancing mental health awareness within the medical college community,” the report stated.
The report suggested that technology be integrated into medical education, so that Virtual Reality (VR), Augmented Reality (AR), Artificial Intelligence (AI), and Machine Learning (ML) enhance the learning experience of students and prepares them for technological advancements in healthcare. Expanded career counseling should be available on campus so medical students are well-prepared for various career paths.
The task force has recommended the setting up of dedicated health universities or departments within general universities to ensure the effective implementation of National Medical Commission (NMC) regulations, and addressing the unique needs of medical education. A strategic and comprehensive approach is essential, the report noted, as universities struggle to keep pace with medical college rules and regulations.
The task force was chaired by Dr Suresh Bada Math, professor of psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, and comprised 15 members.
An article in the journal Archives of Medicine and Health Sciences in June 2024, through an analysis of online news reports on suicide deaths among medical students and professionals in India between January 2020 and December 2022 found 118 suicides; more than half of these were by people less than 30 years of age. The most common method was hanging, and mental illness was found among 12 percent of those dying by suicide – the commonest predictor of suicide among medical students and professionals was the presence of mental illness.
The task force was studying only the problems of students already admitted to medical education – the problems of students studying to enter these institutions has not been considered. In August 2023, Hindustan Times carried a report that showed that 23 students had died by suicide that year in Kota, Rajasthan, a hub of coaching for medical and engineering entrance examinations; more than half of these students were minors, and 12 died by suicide within six months of arriving in the town.
(Edited by Rosamma Thomas).
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