Making it to dental school is a great achievement and most students can’t wait to get started on their career journey. But what if the reality is much harder than you expect?

Claire Newey and Lynne Millsopp both work at Liverpool Dental School, where they want students to thrive academically but also see firsthand how the pressures of the course and personal circumstances can affect their mental health. Claire is a clinical lecturer and welfare advisor, and Lynne Millsopp works as a senior clinical lecturer and senior welfare advisor. They spoke to us about how they support students in difficulties, why understanding your own mental health is an important part of professionalism and the inclusion of wellbeing in the GDC’s Standards for Education.

How long have you been involved with student welfare and what attracted you to the role?

Lynne Millsopp: I've always been interested in psychology because I saw it as a way of trying to understand myself, so when I became a lecturer at the University in 2001, I was naturally drawn to the student welfare side of things. I used to have long conversations with the Senior Welfare Advisor at the time, so she asked me if I’d like to shadow her with a view to taking on her role after she retired . I’ve been Senior Welfare Advisor since 2011, alongside my role as Senior Clinical Lecturer in Oral Surgery.

Claire Newey: I did my undergraduate training at Liverpool and returned in 2014 as a Clinical Lecturer in Restorative Dentistry. In 2021 an opportunity came up in the welfare team for someone who understood some of the academic challenges that dental students faced and how that might impact their general wellbeing. I applied because that’s always been an area of interest for me as I want to understand how my brain works. I think just as we can teach students how to acquire new clinical skills, we can also give them the tools to improve their mental health. In some ways being a Welfare Advisor is another form of teaching.

Do you think dental students are under more pressure than other undergraduates?

CN: The nature of the course itself is demanding. It’s longer than most other degrees with fewer breaks because the terms are also longer and it feels more like an 9-5 working day. That makes it harder to have a part-time job alongside their studies or work when they go home so more students can experience financial pressure.

Things like relationship struggles and home sickness are universal, but we’ve noticed more students with home sickness since we’ve increased our international student cohort and we’re looking to provide more support.

Another issue for clinical programmes is that students can get worried about disclosing any mental health challenges because they think it might impact their ability to register with the GDC. We work hard to reassure them that showing insight into your mental health is a good thing but it's hard to dispel that fear. I hope the GDC being more open and inclusive about wellbeing will help.

LM: Clinical programmes can be challenging enough for 18-year-olds who are being supported by their parents but at Liverpool University, our ethos is about widening participation, which means we have people from lots of different backgrounds, including mature students with families and some with caring responsibilities. We might also have students who become unwell or pregnant during the course. At the same time, we find having students from diverse backgrounds really enriches the school as they can teach colleagues all sorts of soft skills such as how to manage your life if you've got a young child or are holding down a job and need to study.

In general, I think people underestimate how much hard work the dental therapy programmes are going to be, even in comparison to medicine. Of course, medical students are on wards and in outpatient settings but they're not actually treating their own patients, whereas our dental students will be allocated patients in their first year and it will be their responsibility to manage their care. That’s useful for their development but it also involves a level of pressure.

Our students take patient care very seriously, almost to the point where they prioritise it over everything else. In fact, one of the sessions in the personal development and well-being component of the course is ensuring you’re physically and mentally fit to practise and recognising when it’s more professional not to treat a patient because of your own health. That insight makes for better practitioners but it certainly is a steep learning curve for some students.

How can wellbeing concerns affect students’ behaviour and academic work – what are the red flags?

CN: One of the early warning signs is if they aren’t attending clinical sessions and lectures. They might not say that they are absent due to mental health difficulties, but we have monitoring systems in place so we can identify patterns of absence and offer support.

Another is how well they're looking after their case load and getting patients booked in for the right treatments at the right time. Sometimes students who are struggling with their mental health can find it difficult to manage more complex administrative tasks and this becomes apparent when we look at the experiential data at various progress checkpoints. One benefit of having welfare team members on panels for making progression decisions is that we’re able to speak up for students who we know are having a challenging time. We don’t go into confidential details, but we might say that a student is receiving support now. That advocacy is an important part of our role.

LM: Another issue that comes up is how students react to feedback in clinic. If they suddenly burst into tears or leave the clinic, staff often worry that it’s down to them, but it might actually be that the student wasn’t able to cope. We always welcome staff raising concerns with us so we can say to the student: “We understand you had a difficult day in clinic yesterday – do you want to talk about it?” They might say that everything’s fine and they were just having a bad day, but it might also prompt a conversation about their wellbeing.

Do students sometimes resort to unhelpful coping strategies?

LM: Unfortunately, healthcare students are notorious for this because these courses are so stressful. We don’t have a huge issue with recreational drugs and this generation don't tend to drink as much alcohol, but we see all sorts of difficulties. For example, I've had students come and speak to me because they've been buying stuff to make themselves feel better and got into financial difficulties. They may be academic high achievers but that doesn't mean that they don't have the same problems as everyone else.

What advice would you give someone who is struggling with their mental wellbeing at their dental school?

CN: I'm quite open about my mental health and, most of the time, people are empathetic or have their own story to share so I’d really encourage you to try and find somebody to speak to about how you’re feeling. It doesn't need to be a professional - you could start a conversation with a family member or friend.

Please don’t be put off from contacting your dental school welfare team, university services or GP because you think they’ll force you to do something you don’t want to do. More often than not, it’s about having the opportunity to chat about how you’re doing and ensuring you have access to support.

LM: We're sometimes not very good at recognising what's going on in our own heads and bodies. While I hope that this generation are better, I advise our students to check-in with yourself each day and ask: “Where am I on a scale of ‘smiley face’ to ‘I just want to put the covers back over my head again’?

If you're at the smiley end of the scale, then great - do whatever you need to do. Equally, if you want to hide under the covers, then think about what you have the capacity to do – your academic, social or compassion battery – so you can achieve some constructive things but be easier on yourself. If we can learn to listen to ourselves more and be ready to ask for help, it can only lead to better outcomes for you, your patients and the people you work with.

Finally, one of the things that I enjoy most about working in healthcare is that you and your colleagues end up being a work-family. In the same way, being at dental school means you’re part of a community so let’s look after each other.

How are you able to help the students who are having difficulties?

CN: When a student emails the welfare team, they can let us know if they want to speak to a particular person or if there is someone they don’t want to speak to- Students sometimes worry about talking to someone who has been supervising them in clinic and although we as staff can separate these roles, we’re a broad team so they can be allocated to another staff member if they wish.

We’ll then reach out to the student and arrange to meet face-to-face or online, depending on their preference. This is usually an information-gathering exercise: we want to find out what’s going on for them and what they’ve already done so we can make useful recommendations. That might include sharing relevant policy documents such as extenuating circumstances for examinations and guiding them through those processes. We can refer them to university services or direct them to the NHS services available in Liverpool, but where students commute to the dental school, we’ll research the support in their own area.

Once we’ve spoken to a student, we’ll arrange a time to follow up with them, if that’s what they want. However, in serious cases we might need to get in touch proactively and put support in place. We decide everything on a case-by-case basis.

LM: Of course, we’re happy for anyone to knock on our door too.

Over the years, I’ve found students appreciate being able to speak to clinicians who have a working knowledge of their course and understand how being unwell might impact on their progress. It sometimes also helps to share my personal experience of being off work and having counselling as I can say: “I’m a qualified dental professional and a senior lecturer so if I can admit I’m not OK, then it’s fine for you to do the same.”

What do you do if a student refuses to admit they need help?

LM: Some people just don't want us to support them, and others feel that they're coping absolutely fine but that's human beings.

As I said earlier, we have a lot of students with caring responsibilities or who are in difficult personal situations and sometimes their attitude can be that they just want to put their blinkers on and get through their clinical programme so they can start earning a reasonable wage for their family.

We don’t intervene if this isn’t affecting their fitness to practise but I always feel sad for these students and think: You need a bit of a hug, but you’re not in a place to accept it now and I hope that changes in the future. I also hope that we’ve been able to plant a little seed in their head, so they know it’s ok to ask for help when they’re ready.

What’s your reaction to the inclusion of wellbeing in the GDC’s revised Standards for Education?

LM: It can only be a good thing that the GDC is recognising that wellbeing is part of being a dental professional. Incorporating it into the education standards hopefully reflects a more empathetic approach and helps us to see the GDC as a supportive body, rather than purely as a regulator. I’m also pleased that they are talking about both students and staff because the health of any institution does depend on all of us.

Mental health and physical health are so intertwined, and this generation are much more educated about wellbeing so it would have been a huge error for the GDC to ignore that. However, it’s still much easier to say: “I can't come to work today because I've got a really bad cold” than “I can't come in because I haven't slept as I’m worried about XYZ.” I hope that the GDC’s move means we can all get a little bit more comfortable in talking about our mental health.

CN: I‘m pleased that dental schools now have the impetus to allocate funding to this important area. It might not have been such a financial priority before but now they need to demonstrate how they are supporting students and staff to meet GDC standards. It means we’ll have more opportunities to prepare our students for all the different professional challenges they might encounter in their working lives, not just the clinical demands.

What student welfare support framework is in place at Liverpool?

LM: We have a personal development and wellbeing component on the dental course and a welfare team which consists of eight academics and members of professional services. There’s a centralised email service so students can request support, but we also encourage staff to raise concerns if they’ve had a difficult interaction and we’ll monitor things like absences. Those issues can prompt the welfare team to reach out to the student concerned.

We make sure that students are aware of the welfare service during their induction and our details are advertised on screens within the dental school too. We also post useful articles on our Teams channel and promote the information and services provided by the University, such as group sessions, anxiety clinics and self-help advice.

CN: Our connection with the central university support services is helpful as they tend to be from social work backgrounds and trained counsellors so they can advise us if there’s something we’ve missed. And at certain points in the year, they hold exam anxiety clinics or drop-in sessions that our students can sign up for.

LM: There’s also an active financial advice team within the university and the sports union will run relaxation and yoga sessions or walking for stress management so we can direct students to those services as well.

What’s the most rewarding aspect of providing welfare support for students?

LM: I’m always very proud of students when I go to their graduation. Their colleagues and tutors may not know the struggles they've had and they don't necessarily bounce up to me to talk about it but I might get a drink at the final’s dinner or a card. The reason I went into healthcare was that I was interested in how people worked and helping them get better so it’s lovely to do that for my students and for them to say, “I feel better, thanks very much.”

CN: It’s lovely when you can see that a student is feeling better from the way they move and interact with the world - even from a brief conversation in clinic - and I’m really pleased for them. That’s their achievement but it feels like I’m doing my bit.

DDU Advice

Most students thrive at dental school but if you recognise any of the challenges discussed in this interview, do reach out to your own school’s wellbeing team or your tutors. The services may differ slightly from Liverpool, but you will still find people who are willing to listen and ensure you get the support you need in difficult times.

You can also find a treasure trove of resources on the DDU student hub health and wellbeing page, including our e-learning course which looks at ways to manage anxiety, details of our free helpline from Health Assured and links to relevant DDU articles and external services. Whether you’re worried about your own mental health or concerned about a friend, it’s important to know that you don’t need to face it alone.

Someone to turn to - mental health at dental school

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