Why are GPs having to beg for appointments to get their patients treated in hospitals?

Ever wondered why it sometimes takes ages for you to have an ailment treated? Mavis is wondering. She has been waiting for weeks to have an infected scar checked, after the removal of a cancer, but was referred back to the wrong hospital much too late, even though her GP had begged for an appointment asap. And Rosemary’s GP asked for investigations into a worrying ailment last April, but her request was returned twice, with a demand for more information, but no explanation about exactly what information, confusing and enraging the poor GP.

Could these hold-ups be caused by third-party scrutiny by a clinical commissioning group (CCG)? Your GPs or consultants can’t just refer you for surgery themselves any more. They must first beg a CCG for your procedure, explaining why you, in particular, need treatment, especially if it’s some minor thing, no longer routinely NHS funded: a knee/hip replacement, hernia, varicose veins, cataracts, or a chalzion cyst on your eyelid, because after all you won’t die without treatment, even if your cyst is like a big boil, eye “out like you’ve done a couple of rounds with Mike Tyson”, as one man put it on Radio 4’s Inside Health, even if you can barely see, and it hurts. You’ll live. So the CCG (32% privately run) may say no, or send you somewhere for a “holding test”, or back to outpatients, or ask more questions, which all often costs more than the procedure would have done if they had just got on with it straight away.

This is all getting a bit scary now that my peers and I are going physically down the pan. If the CCG’s weren’t that fussed about Rosemary’s worrying mystery ailment and Mavis’ cancer, what hope for hips or eyelids? We’ll have to all limp around blindly and in horrible discomfort until we are nearly dead. And I have rather worrying pains in my hips. Should I join the replacements queue now? It is rather long already. I have a friend who has been in it for months, after years of waiting for permission to see the consultant who could tell him he ought to be on it. Is there even a queue to join any more?

Why are GPs having to beg for appointments to get their patients treated in hospitals?

I treated Sam for minor complaints. I didn"t see the domestic violence victim

Sam* started attending my GP practice at the same time I joined. She had no extensive list of medical conditions yet she had frequent doctors’ appointments for minor complaints – in summer she would come with a cold, in winter with hay fever and all year round with tiredness.

She startled easily if someone spoke too loudly or the telephone rang. When she once arrived five minutes late for an appointment, she had volunteered that there were no clocks in her flat, since they were a reminder of time spent away from loved ones.

Sometimes Sam would roll her fingertips on the old scars that spanned her wrists. I asked about those scars (and traced their criss-crossed pattern with my eyes) but Sam would shake her head and hide her arms.

We went on in this fashion for some years. I was no longer the new doctor. I stopped looking for things that probably did not exist. Then one year a medical student came to us on a placement. He was in first year and this was his initial encounter with patients. He was given the task of researching and writing about a patient’s journey. He spent the day with me: we saw people with heart disease, diabetes, headaches, depression and dementia. Somewhere between these 10-minute appointments, there had also been Sam, who had come in with “not a particularly memorable” sore throat. To my surprise the student chose Sam.

Sam was taken aback that the young student doctor wanted to write about her but bit by bit she told him her story and with her permission he wrote it down. A while later Sam and I read it together.

Samia was brought up in a small village in the Indian subcontinent. Her life was busy yet carefree. She wished that time could stop there – she was happy. But her parents felt she had crossed a marriageable age and were worried – perhaps even more so because they had other children and dowries to provide for.

By a quirk of fate, in the nearby village a man had come from the UK in search of a bride. Samia’s parents hoped their daughter might be considered because she was beautiful and they belonged to the same caste as this man.

Samia was chosen and the date was fixed for the marriage – a few days before the groom was to fly back. Forms for her passport and visa were secured to start the process of her leaving for Britain. The procession came and the marriage ceremony was performed, with Samia’s father spending a substantial part of his savings on the wedding.

The groom returned to Britain and Samia to her parents. She was happy because she would travel by plane for the first time. She dreamt of a beautiful place where lambs grazed on lush green hills. Her only sadness was that she would move so far away from her family, friends and even her animals.

Her husband did not ring her, but Samia and her parents assumed he was busy in his job. Eventually, she got a plane ticket and all of the family arranged a van to go to the airport to see her off.

Her husband’s parents received Samia when she arrived in the UK – he was not there. Her father-in-law told her that he was at work. The days passed, with her seeing her husband rarely. It was a big family. Eventually she learned he was living with someone else.

She was soon introduced to the work she was to do, which included cooking and cleaning. Her life back home was tough, but here it was hundred times worse. When she complained it was decided that she should be sent back but Samia could not go back. She would not be the cause of pain and disgrace to her beloved family, no matter how much she needed them in her despair.

Her refusal made the situation worse. The hatred became visible. Her husband hit her sporadically. On one or two occasions other family members slapped her too. She was humiliated repeatedly with bitter remarks. Samia’s father-in-law had incurred business losses since her arrival and she was blamed for that too. In the end when there seemed to be no way out, Samia attempted suicide.

Someone took her to the local hospital. From there she had gone to a women’s refuge, and then moved from city to city, refuge to refuge until she had come to us.

Samia tried to put her life back together. She got a divorce, found a job, a place to live and even made a few friends. But home was still several thousand miles away. She longed to be with her family but lacked the courage to turn up alone, divorced and with nothing to show for her parents’ efforts.

Samia and I both finished reading. That is how the story would have ended – except that it didn’t.

Our student left but Samia had started talking and healing. She told me about her scars, her childhood, her siblings, her parents and even her pet goat. She told me of her aspirations for a better life when she had come here and her disappointment when her hopes had come to nothing. But after despair had come fortitude and courage. Then I did not see Samia for a while – she had gone to see her family. That had been her happy ending.

Samia had needed space and time to open up and heal. At the beginning I had asked the questions but she had been too traumatised to talk. I then focused on her medical problems and fixing only what was apparent. Samia’s story made me realise that sometimes we all need a fresh perspective on the same problem, perhaps even more so when some time has passed. It can occasionally lead us to question our initial diagnoses.

*Sam is a composite of this GP’s experiences of patient care

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more about issues like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

I treated Sam for minor complaints. I didn"t see the domestic violence victim

Revealed: dozens of children still treated on adult psychiatric wards

Dozens of children and young people with mental health problems are still being treated on wards containing adults with sometimes severe psychiatric problems despite ministers having supposedly outlawed the practice in 2010, the Guardian can reveal.

Mental health campaigners condemned the persistence of the problem and said it was “completely unacceptable” for vulnerable minors to be subjected to what many find a “terrifying” experience. The Liberal Democrat health spokesman Norman Lamb, who was the minister for care, including mental health care, in the coalition government, said putting children on adult wards was “scandalous” and must be ended at once.

Official figures from mental health hospitals collated by NHS Digital, the health service’s statistical arm, show that in July 47 children and young people aged 17 or under were treated on adult psychiatric wards. Of those 21 were aged 17, another 18 were 16-year-olds and the other eight were aged 15 or under. There is particular anxiety that under-16s are still receiving treatment in adult settings as the government made clear six years ago that this should never happen.

Gordon Brown’s Labour administration placed the “age-appropriate environment duty” on NHS mental heath trusts in April 2010 in a bid to end a practice that parents, charities, MPs and the children’s commissioner for England had criticised as unpleasant and traumatising for children.

“The simple truth is that this has to end completely. It’s scandalous that the practice continues. It is unsafe and wrong. There must be a clear and unequivocal commitment from this government to eradicate the practice completely without delay”, said Lamb.

The duty legally obliges managers of mental health units, under section 131A of the Mental Health Act 1983, to ensure that “the patient’s environment in the hospital is suitable having regard to his age (subject to his needs)”. While it allows 16- and 17-year-olds to still be looked after on adult wards occasionally in “exceptional circumstances”, such as if they need to be admitted as an emergency, it forbids totally under-16s ever being treated there.

The figures, which the Guardian requested from NHS Digital, cover January to July this year. A total of 39 under-18s were treated on adult wards in that time, though some may have shown up in the figure for more than one month, NHS Digital said. One hundred and thirty 17-year-olds and 90 children aged 16 were also treated during that time. If the same trend is maintained in the rest of the year that would result in a total of 446 under-18s being treated there, which would the highest for many years. A total of 391 children were treated in such wards in 2014-15.

Under-18s spent 1,938 days on adult mental health wards between them during April and June, almost double the 1,102 days they spent there from January to March. Most of those occurred in the north of England, which saw such bed days soar from 35 in the first three months of the year to a massive 1,405 in the second quarter. In that same period there were 225 such bed days in the Midlands and East of England (down 650 the previous quarter), 185 in London (down from 220) and 125 in the south of England (down from 195), NHS Digital’s data show.

Responding to the figures, the health secretary, Jeremy Hunt, said the number of children in psychiatric wards had fallen by 60% since 2010 and such places should be used rarely. He is set to make a major speech on children’s mental health care on Tuesday, weeks after condemning adolescent and child mental health services as the NHS’s most glaring area of failure to meet need.

“However, this type of care should be an absolute last resort, once all other avenues have been exhausted,” Hunt said. “But to help ease demand, we recently opened 50 new beds, increasing the total number to the highest there has ever been.” Those 50 took the NHS’s supply of beds in children and young people’s mental health services up to 1,442, though the continued use of adult wards suggests that is not enough.

Sarah Brennan, the chief executive of the charity Young Minds, said: “It’s completely unacceptable that vulnerable children are still being treated on adult mental health wards, six years after the government changed the law to stop this from happening. Young people often find it terrifying to be placed alongside much older patients, and say that it adds to their distress rather than helping them.”

Meanwhile, new research to be released on Monday reveals huge frustration among parents of children and young people with mental health conditions at the difficulty of obtaining help for them.

Two-thirds (66%) of such parents surveyed by Young Minds complained that their child had to wait a long time to get treatment, and almost half (49%) said no one believed them when they first raised concerns about their offspring’s mental welfare.

Two in five (41%) of the 316 parents said thresholds for accessing treatment were too high, which meant their child was deemed not ill enough to warrant NHS care, while 36% had paid a private counsellor, psychologist or other therapist to help their child because NHS care was unavailable.

“Not only are many thousands of young people suffering with mental health problems but their parents are suffering too. They feel helpless, unheard and are desperate to help their young people but don’t have the knowledge or tools”, said Emma Rigby, chief executive of the Association for Young People’s Health.

Revealed: dozens of children still treated on adult psychiatric wards

My ‘insane’ Uncle Ed tried to kill Queen Victoria – he was treated with kindness | Penny Pepper

A young Queen Victoria rides out of the palace with her dashing husband. It’s June, and she is happy as the open carriage moves down Constitution Hill. Waiting on a grassy verge is a young man. Scarcely that – he’s a boy, just 18, with dark eyes and a baby face, short of stature and wearing a high top hat, as was fashionable in 1840. As the Queen draws closer he raises two pistols, determined to fire on the pregnant Victoria.

The young man is Edward Oxford, and he’s about to fulfil his dream of becoming notorious. Edward: my great, great, great uncle, who I fondly call Uncle Ed.

As ITV’s Victoria came to the season finale, I was relieved his story played out relatively true to what is known. Edward is described as “one of Cumberland’s creature’s”, part of the supposed Hanoverian plot against Victoria. But it is quickly revealed he is as a “half-witted pot boy from south of the river”, and that “the would-be assassin is completely insane”. Victoria wanted to hang him high, naturally.

Since unearthing this skeleton in my family closet, I feel a deep protectiveness – and relief that Edward’s attempted regicide came at a time when “lunatics” and the “criminally insane” were beginning to be treated more humanely.

Indicted for treason, he stood trial at the Old Bailey on 6 July 1840. If found guilty, he would hang, and his defence rested heavily on the ideas of being “innocent by reason of insanity”. The Old Bailey records of the trial are as full of intrigue and early Victorian melodrama as one could wish for, including the reading out of his notebooks, which exposed Uncle Ed’s pseudo-military fantasy society, Young England.

Reading through the statements and the endless legal ramblings, I find nuggets that allow me to unravel a sense of young Uncle Ed’s wayward personality. I follow a repeating echo, as I realise the case for his defence depends on making sure that he is insane. The records swiftly become a sensational feast of detail, especially where Edward’s father and grandfather are concerned. Both were known alcoholics. His grandad, John Oxford, described in one press report as a “black sailor of obscure origin”, died in Greenwich Naval hospital. At various times he believed he was the pope and other times St Peter.

Part of the Bedlam Exhibition held at the Wellcome Collection 2016. Photograph: Thomas SG Farnetti/Wellcome/Courtesy The Vacuum Cleaner and Hannah Hull

Edward’s father, George Oxford, is described as a “mulatto” and “the Tawny Beau” in press coverage. A keen indulger in laudanum, he was given to odd and violent outbursts, most often inflicted on his long-suffering wife, Edward’s mother, Hannah. There was also the time he brought the horse into the parlour for dinner …

It’s hard to know now if Edward shared this family “madness”, assuming you share the still-controversial belief in inherited mental ill-health. Endless witnesses reported his strange behaviour and mood swings. But Edward’s family and friends would have known that any exaggeration could only strengthen his claim to innocence.

Uncle Ed was found “innocent by reason of insanity”, suffering “a lesion of the will”. He was sentenced to be detained indefinitely at Bethlem Royal hospital – better known as Bedlam – in its latest home in Southwark. This was a time when pressure was growing for the proper care for the mentally ill, with supporters committed to the genuine idea of asylum and a removal of those individuals from prisons and the workhouse. This began with the County Asylums Act 1808.

Those with mental health issues are demonised, despised and disbelieved. They are too expensive for the welfare state

Edward flourished in this environment, and responded to regimes aiming for genuine care of the patient – “patient” at last replacing the earlier terms “lunatic”, “imbecile” and plain “inmate” – through the Lunacy Act of 1845. Edward’s frustrated intellect grasped all opportunities – he became a model patient, learning several languages fluently, finding skills as a painter, and becoming an unbeatable chess player. He thrived in that environment, when – as Mike Jay, co-curator of the Wellcome exhibition, Bedlam: The Asylum and Beyond – says in his recent Guardian piece: “The asylum became an emblem of social progress: a therapeutic community in which patients were to be treated with kindness.”

It’s tragic that there is very little sense of true asylum, of sanctuary, within today’s mental healthcare system. In the 20th century, care in the community made much of individuals’ rights to be looked after in their own homes (which, conveniently in the Thatcher era, was likely to be cheaper). Yet many within the mental health system – myself included – feel that the baby might have been thrown out with the bathwater. These days, those with mental health issues are demonised, despised and disbelieved. They are too expensive for the welfare state.

John O’Donoghue, author of the award-winning memoir Sectioned, is a veteran patient of the remnants of those old hospitals. As he says: “The closure of the old Victorian asylums has yielded mixed results … Yes, they could be places of neglect and abuse, patients left to rot … but they also afforded sanctuary, the kind of open-ended humane treatment modern practice seems to have great difficulty in providing.”

Since my own teenage years I’ve experienced ongoing mental distress, uneasily wearing many labels given and changed. Clinical depression. Anxiety disorder. Manic depression. Emotionally unstable disorder. When I read the details of Uncle Ed in all the literature, I wonder what his label would be now. Would it help him any more than “lesion of the will”? That he was troubled, unhappy and in emotional pain is clear, and yes, I sat tight-lipped ready in his defence as this final episode of Victoria unfolded. But this is a royal soap opera. Edward is the pot boy working-class “lunatic”.

One day I’ll tell his story. Bring him fully to life, track our shared heritage from the mysterious black sailor and take him wholly back into the family embrace – and celebrate his happy ending in Australia.

My ‘insane’ Uncle Ed tried to kill Queen Victoria – he was treated with kindness | Penny Pepper

Women taking pill more likely to be treated for depression, study finds

Women who take the contraceptive pill are more likely to be treated for depression, according to a large new study.

Millions of women worldwide use hormonal contraceptives, and there have long been reports that they can affect mood. A research project was launched in Denmark to look at the scale of the problem, involving the medical records of more than a million women and adolescent girls.

It found that those on the combined pill are 23% more likely to be prescribed an antidepressant by their doctor, most commonly in the first six months after starting on the pill. Women on the progestin-only pills, a synthetic form of the hormone progesterone, were 34% more likely to take antidepressants or get a first diagnosis of depression than those not on hormonal contraception.

The study, published in the Journal of the American Medical Association (JAMA) Psychiatry, found that not only women taking pills but also those with implants, patches and intra-uterine devices were affected.

Adolescent girls appeared to be at highest risk. Those taking combined pills were 80% more likely and those on progestin-only pills more than twice as likely to be prescribed an antidepressant than their peers who were not on the pill.

The researchers, Øjvind Lidegaard of the University of Copenhagen and colleagues, point out that women are twice as likely to suffer from depression in their lifetime as men, though rates are equal before puberty. The fluctuating levels of the two female sex hormones, oestrogen and progesterone, have been implicated. Studies have suggested raised progesterone levels in particular may lower mood.

The impact of low-dose hormonal contraception on mood and possibly depression has not been fully studied, the authors say. They used registry data in Denmark on more than a million women and adolescent girls aged between 15 and 34. They were followed up from 2000 until 2013 with an average follow-up of 6.4 years.

The authors call for more studies to investigate this possible side-effect of the pill.

Other scientists said the research should not put women off using hormonal contraception. Dr Channa Jayasena, a clinical senior lecturer in reproductive endocrinology at Imperial College London, said: “This study raises important questions about the pill. In over a million Danish women, depression was associated with contraceptive pill use. The study does not prove [and does not claim] that the pill plays any role in the development of depression. However, we know hormones play a hugely important role in regulating human behaviour.

“Given the enormous size of this study, further work is needed to see if these results can be repeated in other populations, and to determine possible biological mechanisms which might underlie any possible link between the pill and depression. Until then, women should not be deterred from taking the pill.”

Dr Ali Kubba, a fellow of the faculty of sexual and reproductive healthcare of the Royal College of Obstetricians and Gynaecologists, also said further research was needed.

“There is existing clinical evidence that hormonal contraception can impact some women’s moods, however, from this study there is no way of linking causation, therefore further research is needed to examine depression as a potential adverse effect of hormonal contraceptive use,” he said.

“Women should not be alarmed by this study as all women react differently to different methods of contraception. There are a variety of contraception methods on offer including the pill, implants, injections, intrauterine devices, and vaginal rings and we therefore advise women to discuss their options with a doctor, where they will discuss the possible side-effects and decisions around the most suitable method can be made jointly.”

Women taking pill more likely to be treated for depression, study finds

As a thalidomider, ‘I feel I’m being treated like a scrounger’ | David Brindle and Sue Learner

For Phil Spanswick, who has lived all his life with shortened limbs, three fingers on one hand and four on the other, as a result of the thalidomide scandal, it was galling enough to have his benefits cut after reassessment. But it was doubly so to discover that the assessor had put his condition down as genetic.

“She was 21 and had trained as a paramedic and asked me three times how I had got my disability and what age was I when I got it,” says Spanswick. “She didn’t even know what thalidomide was, that it was manmade and babies were born with it.”

It is almost 60 years since the thalidomide drug was first licensed for use in the UK to counter the effects of morning sickness in pregnancy. By the time it was withdrawn within three years, in 1961, hundreds of babies in Britain and tens of thousands worldwide had been born with limb defects caused, it later transpired, by a component of the drug inhibiting the development of blood vessels and stunting growth.

The scandal became a cause celebre. The drug’s manufacturer in the UK, Distillers (now Diageo), fought a lengthy legal battle with the families affected and it was only after a campaign by the Sunday Times that compensation was settled in 1973 for most of the children, who were by then entering their teens. A long-awaited government apology finally came in 2010 and it was only after half a century in 2012 that the German inventor of the drug, the Grűnenthal Group, issued a statement saying it regretted the consequences.

Remarkably, people are still coming forward with claims for compensation. But as Spanswick’s experience suggests, the thalidomide story is slipping from the consciousness of even health and care professionals and the drug’s survivors – known as “thalidomiders” – are certainly winning no special favours from the reformed benefits system.

Spanswick, 54, has had his lifetime award of disability living allowance (DLA) downgraded under the reassessment process carried out as part of the benefit’s transition into the new personal independence payment (PIP). He is not alone: the Thalidomide Trust, set up as part of the 1973 settlement to administer compensation and represent the interests of survivors, knows of three other cases and suspects there are “quite a few” more.

“The effects of thalidomide are not well understood and the new assessment process can be difficult for individuals to understand and navigate,” says Deborah Jack, the trust’s director. While her team has been able to help other thalidomiders to protect their DLA awards, she explains, it was unaware of Spanswick’s case before it was too late.

Spanswick, who lives with his wife, Rachel, and two grown-up children in Lambourn, Berkshire, has one leg five inches shorter than the other, no left hip, virtually no arms and no thumbs. He is unable to tie his shoelaces, wash his hair and body, or use the oven or washing machine. He needs assistance to get dressed, although he has mastered the art of putting on a sock by using his other foot. 

When he falls, which can be quite often, he cannot put his arms out to break the fall and so tends to hit the ground, injuring his head. He is incapable of getting back up by himself. Yet despite this, he has been assessed under PIP as being entitled to the standard mobility component, worth £21.80 a week, rather than the enhanced rate of £57.45.

Back in the 1980s, Spanswick was awarded higher-rate DLA for what he believed would be the rest of his days. “Up until then I had to keep having medicals, but the doctor said I obviously had a disability that was not going to get better and would only get worse –so they awarded me DLA for life,” he says.

Three years ago, however, the government began to roll out PIP as a replacement for DLA for people with a long-term health condition or disability. The reform meant compulsory testing regardless of previous lifetime DLA.

In December last year, the assessor, working for private contractor Atos, came to Spanswick’s house. “She filled in multiple-choice questions and asked me how far I could walk,” he recalls. “I have one leg shorter than the other, so it all depends. Cobbles are really hard and I can walk further if there are benches along the way so I can sit down and have a rest. These questions cannot be answered with a simple ‘yes’ or ‘no’.”

A few weeks later, on Christmas Eve, he was shocked to receive a letter saying he was eligible only for the standard mobility component. As a consequence, he has lost free car tax worth £515 a year for his vehicle and automatic entitlement to free parking. If he had run a car under the Motability scheme for disabled people, rather than his old, adapted 4×4, he would have had to forfeit that too. He asked for the mobility assessment to be reconsidered. At the end of February, he was informed that the decision had been upheld. He then lodged a formal appeal, but a tribunal has rejected his case.

A Department for Work and Pensions spokeswoman says PIP is a fairer and more objective system than DLA. “Decisions are made after consideration of all the evidence, including an assessment and information provided by the claimant and their GP”.

Spanswick who still gets the higher-rate “daily living” component of PIP, worth £82.30 a week and receives an amount of compensation through the Thalidomide Trust that he prefers not to disclose, says he used to have faith in the system, but now feels “completely let down” and the victim of injustice. “I feel like they are treating me like a scrounger. These assessments try and pigeonhole you, but you can’t pigeonhole disabled people.”

His battle with the DWP has also brought back bad memories for Spanswick’s elderly father. “My father is so upset at this as he feels he had to fight for me when I was young for something that was caused by a drug company. Now I am having to fight all over again.”

Thalidomide: the facts

There are currently 465 thalidomiders on the books of the Thalidomide Trust, but people are still coming forward with potential cases – at an average rate of one a week over the past two years.

Deborah Jack, director of the trust, admits that even she is amazed. But she explains that people who were born with relatively limited physical disorders, and have been able to cope for more than 50 years, may now be struggling.

“One of the most common minor disabilities caused is absence of thumbs, or really tiny thumbs,” Jack says. “While you may have been able to manage with that, after all this time the strain of using your hands unnaturally to compensate starts to tell on your hands.”

By no means all claims for compensation are accepted after investigation. Many similar disabilities have other causes.

The trust administers investments of £130m provided by Diageo and a separate fund set up by the government in 2012, worth £80m in England over 10 years. Payments are made to thalidomiders according to the extent of their impairment.

As a thalidomider, ‘I feel I’m being treated like a scrounger’ | David Brindle and Sue Learner

Survey: 25% of UK architecture students treated for mental health problems

More than a quarter of architecture students in the UK are receiving or have received medical help for mental health problems related to their course. Another quarter feel they may have to seek help in future.

Anxiety over the student debts accrued during the seven-year course, and workloads that frequently require all-nighters, were the primary sources of stress identified by undergraduates.

Poor-value university courses, architectural practices demanding they work for free and sexual and racial discrimination were the other issues highlighted by respondents to the survey carried out by the Architect’s Journal.

More female students reported seeking medical advice for mental health than male students. Nearly one in three women in the survey, 29%, reported receiving mental health treatment over issues directly related to their course, compared with 23% of men.

Nearly 90% of the 447 respondents said they had had to work through the night at some point. Almost one-third said they have to do it regularly.

Related: Six things students can do to boost their mental health

Two-thirds of undergraduates said their debt at the end of their course would be £30,000 or above. Despite that, almost a third said they had been asked to work in practice for free.

Students taking part in the survey reported seeing friends suffering from hair loss as a result of stress. One respondent reported that two course mates had committed suicide, though the Architectural Journal was unable to verify that report. Another student wrote: “I feel so emotionally drained, without any confidence in my ability.” Another said: “A culture of suffering for your art is promoted within education.”

Anthony Seldon, vice-chancellor at the University of Buckingham and a mental-health campaigner, said: “Britain has a near epidemic of mental health problems among its students. Those studying architecture appear to be under added burdens, emanating perhaps from the very length of the course and time taken before earning a proper income.

“Much could be done to rethink the courses so they align with the architectural education needs of the future rather than the dictates of the architectural big cheeses of the past.”

Almost a third of architecture students in the survey said they had been asked to work in practice for free. Photograph: Alamy

University staff, too, are noticing the emotional strain of architecture education on their students. Timothy Smith, architecture course director at Kingston University, said there has been a rise in the number of students applying for “mitigating circumstances or extensions” in recent years, adding that the requirement for many to work part time means there is a “great deal of pressure” on them.

Nam Kha Tran, a student at the Sheffield School of Architecture, said mental health problems are the “disease of our generation”.

Stephen Buckley, head of information at the mental health charity Mind, says university students are not only burdened with the stress of exams and coursework deadlines but also with high student loans and debt. He reports a surge in calls to the charity’s helpline from those struggling with financial problems in the last few years.

Jane Duncan, president of the Royal Institute of British Architecture, is urging architecture students struggling with mental health problems to seek help, stressing that they “are not alone”. She said that long hours, a heavy workload and intense design scrutiny were embedded in the culture of architecture education.

Duncan added: “I am concerned that the combination of tuition fees, rising student debt and the necessity for many students to take on paid work outside study can trigger or exacerbate mental health problems.”

Survey: 25% of UK architecture students treated for mental health problems