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University Calendar

Fitness to Study Appendices

Appendix 1: The Intersection of the Mental Health and Fitness to Study Policies

Appendix 2: Procedure for a Fitness to Study Meeting

(1) A University staff member with concerns about a student must consult with relevant colleagues to establish whether a Meeting is necessary or if an alternative option is available. These colleagues may include, but are not limited to:

  • A senior representative from the Counselling Service;
  • A senior representative from Disability Support;
  • A senior representative of the student's College;
  • A representative of the student's Academic Department/s;
  • The Deputy Academic Registrar and/or the Assistant Registrar.

The Fitness to Study Meeting will be convened by a College Principal, an academic Head of Department or their delegated representatives. The decision to convene a Meeting must be made in consultation with the Deputy Academic Registrar, the relevant Deputy Head of Faculty and a senior representative from the Counselling Service or Disability Support.

(2) The student must be invited to attend. This can be done verbally but, in all cases, a letter must be sent to the student confirming that a Fitness to Study Meeting will take place. It is recommended that the student be verbally informed before receipt of the formal letter. The student will be given at least seven (7) days’ notice that a Meeting will take place, however, where in the reasonable view of the University the severity of an individual case warrants it a shorter notice may be appropriate. This allows time for the student under review to seek independent guidance and support and to familiarise themselves with all documentation under review, unless the meeting is being called as an urgent safety measure for the student or others. A sample letter is presented in Appendix 2 and should:

  • Reiterate that the University still has concerns about the student’s well-being and outline those concerns;
  • Include a copy of the Fitness to Study Policy;
  • Explain the nature, purpose and potential outcomes of the meeting as outlined in the Fitness Study Policy;
  • Be accompanied by any documentary evidence that is to be considered at the Meeting;
  • Allow the student under review the opportunity to be appropriately supported at the meeting by a member of the University community or by a medical practitioner, if appropriate (see below).

(3) Consent and attendance: On occasion a student may not recognise or be willing to accept that they have a difficulty and, as a consequence, are unlikely to be willing to attend a meeting or give their consent to it going ahead in their absence. The Policy allows for a meeting to proceed if the University is reasonably satisfied that it is in the vital interests of the student and/or other students and staff that the meeting goes ahead without the student being present.

If the student is willing but unable to attend the meeting for verifiable reasons, or to participate via teleconferencing, the convener of the meeting has the discretion to delay the meeting or to proceed if the issue is one of urgency, in which case the student will be invited to submit their evidence in response to the evidence contained in the letter of invitation.

(4) Membership of Fitness to Study Meeting. Membership of the meeting will depend on the nature of the case under consideration and will include:

All of;

  • A senior representative of the student's College;
  • A representative of the student's Academic Department(s);
  • The Deputy Academic Registrar and/or the Assistant Registrar - Student Complaints and Appeals, Academic Support Office;

At least one of;

  • A senior representative from the Counselling Service;
  • A senior representative from Disability Support;

And may include;

  • An external health practitioner who is involved in supporting the student, if the practitioner is willing and the student agrees to them being present. The presence of an external health practitioner is not a formal requirement for the Meeting;
  • External stakeholders, who may be invited on case by case basis to attend the meeting or part of the meeting or to submit evidence, with consideration to medical privacy. Any external stakeholder attending the Meeting will be subject to the provisions of the Data Protection Act 1998.

(5) Professional advice and medical evidence:

It is expected that professional advice should be available at the Fitness to Study Meeting from a representative of, at least, the Student Counselling Service and/or Disability Support. If the student has been supported by a University Counsellor or Mental Health Advisor, and if they have contributed to the evidence, the Fitness to Study Meeting must also include a representative of the Counselling Service who has not previously been involved in the student’s support.

Decisions may be informed by contemporaneous medical evidence prepared by an appropriately qualified medical practitioner. Guidance on the preparation of medical evidence for medical practitioners is available in Appendix 4. The responsibility for gathering medical evidence will rest with the student, and any personal data that they share with the University will be held securely and confidentially in line with the Data Protection Act (1998).

It will ultimately be the University’s responsibility to interpret and assess the evidence, taking into consideration the context of University life and the impact on academic progress. There may be occasions where medical evidence is not available or applicable, or it may not be provided by the student. A lack of medical evidence would not necessarily prevent the University from making a judgement about a student’s fitness to study. A meeting may result in a recommendation that the student secure appropriate evidence. Further requests will only ask for evidence that is additional to any evidence already provided to the College or Disability Support, or to provide an update on impact of the condition.

Where available the meeting will take into account any professional guidance on the specific issue to be considered, for example national guidelines and protocols from the National Health Service, the National Institute for Clinical Evidence or Higher Education Occupational Physicians/Practitioners guidance, for example ‘Fitness to Study for Students with Severe Eating Disorders’.

(6) The outcomes of a Fitness to Study Meeting may be:

  • No further action;
  • A recommendation of a further specific support arrangement, formal monitoring of the student’s condition, the specification of evidence required and a date set to reconsider the situation;
  • An assessment of Fitness to Study that leads to the student’s collaborative agreement to a Grace Period of up to five (5) weeks or a suspension of studies concession or a withdrawal from studies.

If the assessment reached in the meeting is that the student is not fit to continue their studies at this time, and the student is not in agreement with this assessment, the meeting may recommend a suspension from the University under General Regulations.

(7) Note-taking: The Fitness to Study Meeting will be formally minuted and circulated to all attendees. The convener of the meeting is responsible for ensuring that any follow-up actions are undertaken.

Note: A supportive member of the University Community is defined a student currently registered at the University, a current, substantive or honorary member of staff of the University, or a Support/ Sabbatical Officer of the University Students’ Union. The student may also invite a medical practitioner who is engaged in the current support of the student to fulfil this role. The role of this person is to provide support to the student through their presence. They will not be expected to contribute to the meeting, nor to speak on behalf of the student unless the need for such a role arises from the condition of the student, at the discretion of the convener of the meeting.

Appendix 3: Sample Invitation Letter

Dear Xxx

Re: Fitness to Study Meeting, Date, Time, Location

As you are aware from our recent meetings, the University has reasonable concerns about your well-being and is particularly concerned that these have had an adverse impact on your studies/ behaviour/other students/ placement employer(delete as appropriate).

EITHER: A number of supportive measures have been in place:

  • List, if appropriate

These measures have not in our reasonable opinion resolved our concerns.

OR We have in our opinion serious and urgent concerns for your safety and wellbeing/ the safety and wellbeing of others.

Consequently I am writing to invite you to attend a meeting in accordance with the University’s Fitness to Study Policy, a copy of which is enclosed for your information. This meeting will:

  • Consider the background to our concerns;
  • Determine what action is necessary to try to ensure your health and wellbeing;
  • Determine what action is necessary to protect any other students/staff who may be affected by your behaviour.

The outcome of this Meeting may be:

  • No further action;
  • A recommendation of a further specific support arrangement, formal monitoring of your condition, the specification of evidence required and a date set to reconsider the situation;
  • An assessment of your Fitness to Study that leads to your agreement to a Grace Period of up to five (5) weeks or a suspension of studies concession or withdrawal.

If the assessment reached in the meeting is that you are not fit to continue your studies at this time, and if you are not in agreement with this assessment, the meeting may recommend a suspension from the University under General Regulations.

The following people have also been invited to the meeting (insert as appropriate) and we will be considering the enclosed documentation as well as our discussion with you (list documentation to be considered here) OR insert request for evidence if required.

We recognise that this may be a difficult process for you and you are, therefore, entitled to bring along someone from the Durham University community to support you in a personal capacity. This support might be another student, member of the University or a medical practitioner. In addition, you may wish to receive independent advice and guidance in relation to your current position and this can be provided through the Advice Centre located within Durham Students’ Union. The Advice Centre can be contacted on 0191 334 1781 and they are located in Dunelm House.

Please let us know by (insert as appropriate) if the proposed date and time for this meeting is suitable for you and if you will be able to attend. [State if the meeting needs to proceed on this date or by a certain date, whether or not the student is able to attend]

If you have any questions about this process please do not hesitate to contact me.

Yours sincerely,

Appendix 4: Guidance on Medical Evidence

Medical evidence for some conditions is straightforward. Chronic medical conditions characterised by a pattern of relapsing-remitting have a more subjective and fluctuating impact upon a student’s capacity to engage with their academic study. It is important that the medical evidence meets the need of the University, as reasonably determined by the University and in its sole discretion, to make appropriate decisions with regards to student support.

When is evidence needed?

Medical evidence will be required to declare any condition as a disability with the Disability Support Service. Once registered with the Disability Support Service a student will not be required to provide further evidence of the underlying condition, but the University reserves the right to make a request for additional evidence of the current impact of that condition upon their capacity to engage with their studies and University life, if concerns are raised.

Medical evidence may be requested, but is not a formal requirement, for formal Support Meetings under the Mental Health Policy and for formal proceedings under the Fitness to Study Policy. It may be requested if there are concerns that a student is unwell and has not yet engaged with health services. The role of evidence is explained in each of these policy frameworks.

Medical evidence may be requested as a follow-up to Occupational Health forms completed in advance of participation in year abroad or off-site activities, such as field trips or work placements. It will also be routinely required as part of professional Fitness to Practice frameworks before registration on courses in Education and Social Work that include professional placements.

Medical evidence may be required at the point of a return to study from a concession on mental health grounds to evidence a fitness to return, possibly to demonstrate engagement with medical treatment during the out of residence period and to outline any need for ongoing engagement with medical treatment if necessary. It will also be necessary if a student has previously withdrawn on mental health grounds but has re-applied through UCAS to register for a new course.

Who can provide medical evidence?

Medical evidence can be provided by the student’s General Practitioner or other Registered Medical Practitioner involved in the student’s recent care. Evidence solely from qualified counsellors and psychotherapists or other allied health professionals may not be sufficient but will be taken into account. This position will be kept under review, as there may be changes in the status of professions and their responsibility/ authority to produce medical evidence.

The University recognises that waiting times for assessments and treatment may be significant. Waiting times and service provision will differ by region. Students are advised to inform themselves of timings well in advance of any date by which evidence may be required. A medical practitioner may wish to charge a fee for the production of medical evidence.

There are likely to be particular international differences in services. It remains the responsibility of the student / their supporters to identify the appropriate equivalent service to provide evidence of wellbeing. Students are responsible for the provision of a verified translation into English of any medical evidence. The University Mental Health Advisors can help students to identify and access a UK-based provision for mental health conditions.

What evidence is needed?

Given the individual nature of health conditions and the particular circumstances of a request for evidence, the University cannot produce standardised guidance on what constitutes medical evidence. Students will be informed at the point of request of the particular evidence required.

Evidence for Mental Health Conditions

Guidance is needed particularly in the area of mental health evidence, as these conditions are often chronic, with a relapsing-remitting pattern and diagnosis and evidence of wellbeing often relies on self-report rather than objective measures. Higher education study and independent living may present additional challenges for students with these conditions, and medical evidence will form the basis for both assessment of capacity to engage in study and for ongoing support within the University context.

The University’s Mental Health Advisors are available throughout the year to provide assistance and advice on individual requirements. A pro-forma Wellbeing Questionnaire accompanies this guidance in Appendix 5.

Return to Study

There are particular requirements for the evidence to return to study after a concession on mental health grounds. This will be made clear within the concession. A pro-forma Return to Study Questionnaire is presented in Appendix 6 along with a Pro-Forma Personal Statement in Appendix 7. The following list illustrates potential examples of evidence required:

  • Evidence of a period of sustained mental health stability, often stated as three (3) or six (6) months in duration;
  • Evidence of engagement with treatment (duration, frequency, attendance and nature of treatment);
  • Evidence of improved mental health symptoms;
  • Evidence of an ongoing treatment and support plan on return to study;
  • Evidence of relapse and crisis-planning for return to study (along with information on how this was drawn up and details on who it is appropriate/ consented to be shared with).

As part of the Return to Study process, the student must make an appointment to meet with a University Mental Health Advisor, or make an appointment for a consultation over Skype. In advance of that appointment the student is required to complete a Personal Statement detailing their understanding of the difficulties they faced that led to the concession and detailing how they feel their condition has improved such that they are confident to reengage with their studies at that time. The Mental Health Advisor will

  1. Assess the quality of the personal statement and medical evidence, drawing upon the Mental Health Advisor’s knowledge and experience of mental health and the particular context of Durham University, and
  2. Draw up an appropriate support plan with the student to facilitate the most effective return to study. This will include details of the support provision (educational, pastoral or medical) that the student will access upon return either as a preventative measure, if appropriate, or at the earliest signs of relapse.

The Mental Health Advisor will then produce a summary report and recommendation for the Fitness to Study Standing Group of the student’s fitness to return to study. The Mental Health Advisor may request the student to provide further information or evidence if required, and will ensure the student is ready to engage with local practitioners if necessary

  • The Fitness to Study Standing Group will meet in mid-September and at least once per term, to review the recommendation and make a decision on fitness to study
  • A decision that a student is not fit to return to study will be reviewed and ratified by the Academic Registrar.

How will the evidence be considered?

Medical evidence will be submitted to and assessed by one or more of the following;

  • Occupational Health, for fitness assessments for years abroad or off-site activities;
  • Disability Support, for assessment for disability support and the design/implementation of any additional support required;
  • College Support Offices, for applicable concessions;
  • Academic Departments/ Faculty Offices;
  • The Fitness to Study Standing Group, for return to study requests following Fitness to Study proceedings or for complex evidence assessment in other cases.

Specialist advice on the interpretation of medical evidence for the context of the University and for the case in question may be sought from Occupational Health practitioners, the University Mental Health Advisors and the Counselling Service.

The University will consider evidence in line with local and national guidelines and protocols from the National Health Service, the National Institute for Clinical Evidence or Higher Education Occupational Physicians/Practitioners guidance, for example ‘Fitness to Study for Students with Severe Eating Disorders.’

Guidance for Medical Practitioners for Fitness to Study

If you have been invited to submit medical evidence as part of a student’s application to return to study, we are looking for a clear opinion on whether the student is fit to live independently and engage in higher education study. We have prepared the following guidance to help you understand the context of the University.

With the exception of a minority of students aged under 18, students at Durham University are autonomous adults living either in College communities or living externally in private accommodation.

Colleges provide a stimulating academic community with an element of pastoral support, but this living situation is not comparable to living in the care of appropriate adults. A student will need the capacity to manage communal living, possibly with shared kitchens or bathrooms, but it is not necessarily the case that other adults will be available to support the student. College staff are available only within working hours as listed on each College’s website. The College may or may not offer catered accommodation. Your patient may be living independently or in a shared house with other students. You may need to check your patient’s particular situation.

Undergraduate and postgraduate study is by its nature demanding. The University provides academic support through departments and through the provision of specialist support services, but these services cannot replicate the provisions more appropriately offered by health services. Students are often keen to resume their studies as soon as possible, but we encourage medical practitioners to consider the scale of the investment that students are making in their higher education when assessing their fitness to return at this time.

‘Fitness’ in the context of the University’s Fitness to Study Policy refers to:

  • Fitness to engage in academic studies or a work placement without compromising the academic potential or ordinary activities of themselves, their peers or their employer;
  • Fitness to maintain an appropriate level of health and wellbeing, such that they are not a risk to themselves, their peers and University staff;
  • Fitness to be resident in a College community, noting the impact of their residence upon both students and staff.

If your recommendation that a student is fit to return to study is based upon the assumption of support, it is important that you specify the form of educational support you consider necessary. The University will then assess the support request.

It would be helpful if you could detail:

  • A diagnosis;
  • Whether the condition is long-term; a prognosis would be helpful if the condition is only recently acquired or identified;
  • When was the last episode of ill-health and did the condition improve with treatment;
  • If there is a pattern of relapse-remittance to their illness – and if so, what are the triggers and how well-informed is your patient about them;
  • How well your patient participates in the understanding and management of their condition, seeking help from appropriate sources and engaging in self-care;
  • The effect the condition will have upon learning/ attendance at University;
  • The impact upon day-to-day activities and relationships.

If your patient has received treatment for the condition, and is seeking to demonstrate a fitness to return to their studies we also require information on:

  • The form and length of treatment;
  • Evidence of the patient’s engagement with the treatment;
  • An assessment of the outcomes of the treatment.

If the patient will require ongoing care during their studies at Durham University can you also indicate:

  • if you have made a referral to the relevant local service; or
  • if the patient has been informed of the service/care to secure in Durham via their Durham-based GP; and
  • if the patient has a relapse plan or a crisis plan in place.

When completing your evidence can you provide details of your professional qualifications and accrediting body.

Appendix 5: Pro-forma Wellbeing Questionnaire

Appendix 6: Pro-Forma Return to Study Questionnaire

Appendix 7: Personal Statement for Return to Study

This Pro-Forma Personal Statement is for use in cases where student is intending to return to study

  • after a period out of residence following Fitness to Study procedures, or
  • If a Return to Study assessment was specified as part of the concession

You are invited to submit a Personal Statement as part of the evidence for your fitness to Return to Study following an academic concession. The contents will be held securely and protected under the Data Protection Act (1998).

You are submitting this personal data to the University Mental Health Advisor, based in the Counselling Service of Durham University. This data will be used as part of the assessment process of your fitness to return and will also be used as part of the support planning to ensure that appropriate medical, pastoral and academic support provisions are in place to give you the greatest chance of a successful re-engagement with your studies. As with other personal data in the University, it will be held for a period of six (6) years beyond the end of your years of study at the University at which point it will be securely destroyed. It may be shared with other staff members of the University involved in the decision of your fitness to study.

Any support plan that results from this Personal Statement and the appointment with the Mental Health Advisor will only be shared with appropriate parties with your prior consent.

In returning this Personal Statement you are consenting to the University holding and processing your personal data in this way. Your Personal Statement needs to address the following:

Your understanding of the mental health (and any other) difficulties you faced during your most recent period of study at Durham University;

If relevant, your understanding of the impact of these difficulties upon your peers or members of University staff;

Your understanding of your current mental health. Please detail any symptoms you experience at the present time and how you manage these symptoms;

How you have spent the intervening time between leaving University and writing this Personal Statement, and how this has contributed to your mental health;

Your engagement in any mental health treatment (medication or psychological therapy). Please specify and provide medical evidence to support this where possible/ available;

The basis upon which you believe that you will be able to successfully engage with your studies in the coming academic year, outlining what has changed;

Your anticipated support needs to most successfully re-engage with your studies (medical, pastoral, academic); and

Your insight into how you might know if your mental health is relapsing and your plan for managing any relapse. (The Mental Health Advisor will be able to assist you in the preparation of your plan but will be interested in your own early thoughts in this regard.)

Appendix 8: Fitness to Study Standing Group

Standing Orders

(Sub-Committee of the Education Committee)

These Standing Orders should be read in conjunction with the General Committee section of Standing Orders available on the University's website.

Membership

  • Deputy Academic Registrar, or their delegated nominee (Chair)
  • The Head of the Counselling Service
  • The Head of the Disability Support
  • The Head of Occupational Health
  • The Lead Mental Health Advisor
  • The Assistant Registrar – Academic Support Office
  • A representative from each faculty to be nominated by the Faculty PVC (or nominated alternatives if those members of staff are unable to attend)
  • The Assistant Head of Colleges (Student Experience)
  • A representative from the International Office, for issues relating to fitness to engage in years abroad
  • Up to three (3) co-opted members, at least two (2) of which will be from College Student Support Offices. Co-opted members will serve for a period of up to three (3) years.
  • A representative from Equality and Diversity, in a non-decision-making, advisory capacity on developments in policy and procedure.
  • Students' Union Community Officer and a representative of postgraduate students nominated by Durham Students' Union. Student representatives will be present only for policy discussion agenda items and not for individual case reviews.

Invitation to attend meetings

Other members of the University will be invited to attend the Standing Group for relevant agenda items, for example, the Head of Student Immigration & Financial Support Office or representatives from Health & Safety. Local medical practitioners may also be invited to attend meetings for policy planning or review discussions.

Secretariat

The Secretary of the Fitness to Study Standing will normally be a member of the Academic Support Office.

Meetings

The Group shall normally meet three (3) times a year; in mid-September and at the end of Michaelmas and Epiphany terms, and on an exceptional basis if required to review an individual student case.

Terms of reference

The Standing Group shall:

(a) develop, monitor and assess the implementation of the Fitness to Study Policy;

(b) develop and monitor the training and guidance given to Colleges and Faculty offices regarding statement of concession and the assessment of medical evidence;

(c) consider and develop the frameworks necessary to assess students’ capacity to engage in off-site activity;

(d) review the evidence for students returning to study after a concession if

  • Specified as part of the Concession; or
  • At the request of a College or Faculty Office, in the event of receipt of partial or ambiguous evidence of fitness to return.

(e) act as a channel of communication and consultation between Education Committee, Colleges Board and specialist services on issues of Fitness to Study.