Addressing Confidentiality and Privacy Barrier to Mental Health Help- Seeking amongst University Students: An Experience.

Dear sir,

A recent article by Arun et al. reported that amongst medical students, preference for informal consultations and concerns about confidentiality were amongst the most common barriers to help-seeking for mental health issues. These findings corroborate with previous Indian research amongst medical students.[1,2] In their concluding remarks, Arun et al. suggested that mental health services should be established taking into account the perceived barriers to help-seeking.

To elaborate on the suggestion made by Arun et al., we share our experience in addressing confidentiality and privacy barriers while developing a “Distress and Suicide Prevention Help” (DASH) program for students from medicine and allied faculties. The university caters to about 1,300 students from 57 different courses. The Department of Psychiatry at our university has been steadfast in helping students in distress. In our practice with students, it was observed that the act of consulting a mental health professional was often associated with apprehension of loss of confidentiality and preference about the location of consultation. We faced two major challenges. Students were apprehensive to come to the psychiatry clinic as they feared that the interns or residents posted in the department would judge them or tell others about their consultation. The university uses an electronic medical record (EMR); many students taking consultation felt that their record could be seen by residents or interns posted in the department. In a qualitative study done amongst medical students, aptly titled “I wouldn’t want it on my CV or their records,” Chew-Graham et al. found that students felt inhibited about sharing their experience with anyone associated with the university. Similarly, another qualitative study by Winter et al. reported fear of stigmatization from the medical school amongst the barriers to help-seeking among medical students.

To overcome the first issue of the location of consultation, students were provided consultations at a place convenient to them—either psychiatry clinic, academic block, student support block, or alumni office in the college building or elsewhere when required, with the kind support of the Dean, student support group, and Alumni Association. In our view, doing so blends “informal” with “formal” consultation and makes the student feel at ease while seeking help. The department is equipped with three senior and two junior consultants and one clinical psychologist. Junior consultants look after the other clinical work when a call is received, allowing the senior consultants flexibility in the location of the consultation. A small number of flexible consultations are arranged after office hours, in a gender-matched manner, or if required, in the presence of a chaperone.

To overcome the second issue, our management team generously supported us in creating a separate module for DASH in the Shree Krishna Hospital Online Application for Clinical Excellence (SOLACE EMR). The record generated in this module is accessible to the four consultants from the Department of Psychiatry only. This was done to create a sense of trust in our students who approach us in distress. However, any medications prescribed could still be reconciled by a clinician from another department simultaneously providing medical care to the student.

All students are given a health card at the time of enrolment. It usually happens in our setting that students come to us in distress. We hear them out and convince them to enlist with the DASH clinic. A mental health practitioner from the department would place a phone call to the reception to register the student under the DASH clinic using his health card number. The service is provided to students free of cost. On request, the students are also provided mobile numbers by their clinicians for emergency contact.

The DASH module was activated in May 2019. Till December 2019, we provided 93 in-person consultations for both undergraduate and postgraduate students. Key program indicators are listed in Table 1. Subsequently, the lockdown was enforced; hence, the number of consultations between January 2020 and July 2020 reduced to 36. During the lockdown, we trained assigned faculty mentors to provide “Psychological First Aid” to all the students. Students who were identified in distress were provided teleconsultations.

Table 1.

DASH Program Data from May–December 2019

Variable	n (%)
Number of students	20
Number of consultations	93
Undergraduate	15 (75%)
Post-graduate	5 (25%)
Number of students with suicidal risk	5 (25%)

DASH: Distress and Suicide Prevention Help.

Several Western countries provide dedicated “student clinics and mental health services,” which may levy significant infrastructure and human resource costs. Our model provides evidence that approachable mental health services can be set up for students on Indian university campuses. Our experience also provides prima facie evidence that mental health services can be established considering the perceived barriers to help-seeking amongst university students.