Fitness to Study Procedure

Student Health - Procedure for Assessment of Fitness to Study on the Grounds of Health and Safety

What does this document do?

The purpose of this document is to set out the procedures which the College follows when there are concerns about the fitness to study of one of its students. It applies to both undergraduates and postgraduates. It outlines the steps to be taken by the College when there is concern that a student’s behaviour or health has the potential to disrupt or threaten the welfare or academic progress of the student himself or herself or of others in the academic community. Decisions made concerning a student’s fitness to study are made through a collective supportive process, after appropriate consultation and after consideration of the student's ability to study, learn effectively and complete his/her course successfully. The procedures described below do not take precedence over the relevant provisions of the College’s Statutes and College Rules or, where applicable, the University's Statutes and Ordinances. As a general rule this procedure is only intended for use in cases in which the behaviour, disruption or risk presented by the student is perceived to be of a serious or potentially serious nature. Where possible the tutorial system and other student support services should be used as the first port of call, prior to taking any formal action 

What are the benefits?

Having this procedure set out enables students to have a document they can consult, and provides them with a clear understanding of their full responsibilities and expectations related to their commitment to study and their lives within the College community. If and when a problem arises, those steps taken are limited – and are seen to be limited -- to those necessary to protect the best interests of the student and other members of the College community, and to ensure a consistent and sensitive approach to managing challenging situations. Tutorial, academic or support staff can initiate the procedure when concerns for a student are raised by staff or students, thus allowing for issues to be detected and addressed in a structured manner as early as possible. Shared concerns articulated by different sections of the College and the University community can be formally collated by the use of this process. The problem-solving approach is objective-oriented, allowing a student to focus on agreed actions geared to achievable aims, which are clearly documented and come from a supportive perspective rather than a disciplinary one.

Background Knowledge

In advance of this procedure being initiated, there are other support services in the College and the University to which students may be directed by Tutors or other support staff. For students with a mental or physical health difficulty the first port of call should be their Tutor. They are also strongly advised to consult all relevant support services available in the College and University, and in particular the College Nurse, the University Counselling Service, the University Mental Health Adviser, their General Practitioner, the Disability Resource Centre. Early intervention and recommendations for support in cases of student ill-health or distress or inappropriate behaviour can prevent a crisis. (For crisis situations see appendix.) Advice available from Tutors and in the self-help leaflets from the University Counselling Service will be useful, as well as advice from one or more of the following:

• University Mental Health Advisor
• University Counselling Service
• College Nurse
• Cambridge University Students Union
• Graduate Union
• Access and Disability Services
• Occupational Health
• Student Advice Service
• Drinksense
• Alcoholics Anonymous
• Cocaine Anonymous

Fitness to Study Procedure

1. Purpose and scope of the procedure

1.1 Whilst at University, all students should be able to study and perform to the best of their ability in a safe and comfortable environment. The reality of College and University life means that students not only work but also live in close proximity to each other, and whilst many students find studying and living in such an environment easy and enjoyable, others can find it more challenging. The term 'fitness to study' as used in this document relates to the entire student experience, and not just a student's ability to engage with their studies. For example, the College expects its students to be able to live in harmony with others, and not conduct themselves in ways which have an adverse impact on those around them. This procedure is not designed to address academic performance issues (which should be dealt with under the normal academic assessment and monitoring procedures) except where poor academic performance results from a `fitness to study’ issue.

1.2 In order to maintain and enhance harmony within the College community, students need to conform to certain standards of behaviour. However, it is recognised that the cause of concern regarding fitness to study may include issues relating to a student's health and general well being, where disciplinary action may not be appropriate. The College and University have disciplinary mechanisms in place to deal with students whose behaviour falls outside acceptable standards, see University Regulations and the College Rules.

1.3 A student's fitness to study may be brought into question if health problems are disrupting his / her own studies or the studies of others, or are resulting in unreasonable demands being placed on staff or other students. The College has a duty of care to its community and is bound by health and safety legislation and the Equality Act, which means that it is obliged to take action if a student presents a risk to themselves or to others.

1.4 The level of risk to himself / herself, other students or others posed by a student will be measured by the use of a risk assessment process, which should be used throughout the procedure to provide a consistent means of assessing the risk to the student, other individuals and the institution. This process will be led by the Senior Tutor in close collaboration with health professionals. Even when no risk is involved, the fact that a student has a problem does not in itself justify or excuse inappropriate behaviour.

1.5 Once this procedure has been used (at any of the three stages) the behaviour observed will normally be considered under this procedure rather than under a disciplinary procedure.

1.6 If concerns are raised whilst a student is on authorised study away from Cambridge (e.g. is on a Year Abroad, has leave to Work Away, or is on a placement) the College will discuss with the other institution and the University Department, where appropriate, alternative arrangements to address such concerns.

2. Circumstances under which a student's fitness to study may be brought into question

2.1 A student’s fitness to study may be brought into question as a result of a wide range of circumstances. These include (but are not restricted to) the following:

• Serious concerns about the student which have emerged from a third party (e.g. friend, other student, department, placement provider, member of the public, medical professional etc) and which indicate that there is a need to address their fitness to study.
• The student has told a member of the College that he/she has a problem, and/or has provided information which indicates that there is a need to address his / her fitness to study.
• The student’s affect is such that it indicates that there may be a need to address an underlying problem because his / her behaviour is causing problems to himself / herself or others, for example if he / she has demonstrated mood swings, shown signs of depression or become withdrawn.
• Behaviour that would otherwise be dealt with as a disciplinary matter, but is considered to be the symptom of an underlying physical or mental health problem.

The student’s academic performance or persistent behaviour is unacceptable and this is thought to be the consequence of an underlying physical or mental health problem. If Tutorial, Academic or Support Staff have concerns regarding a student’s fitness to study they should discuss this with the Senior Tutor and with support services (such as in the University Mental Health Advisor) as a first point of contact if appropriate, and consider implementing Stage 1 of the Procedure.

This Fitness to Study Procedure has three stages depending on the perceived level of risk, the severity of the problem and the student’s engagement with efforts to respond to it. When a member of College raises concerns, the relevant member of College staff (usually the Tutor) has a duty to investigate and initiate this policy as part of their larger duty of care to College members.

3. Stage 1- Informal action by the College

3.1 Should preliminary action in terms of support and guidance be unsuccessful, the designated member of College staff should contact the student and explain to him or her in person, in a supportive and understanding manner, that concerns about their fitness to study have emerged. This would ordinarily be their Tutor but might be the College Nurse or another member of the pastoral support team. Should the Tutor or other member of staff require advice or guidance on this they should contact the Senior Tutor.

3.2 The student should be made aware of the precise nature of the behaviour that has caused these concerns to be raised. Normally the Tutor, but on occasions the Director of Studies or other staff member will attempt to resolve the matter by informal discussions with the student. The student should be given the opportunity to explain their own views on the matter, and be encouraged to think about using one or more of the support services offered by the University. It may also be appropriate to look into the possibility of applying for special academic arrangements or support to enable the student to study effectively.

3.3 It is hoped that in most cases issues can be resolved at this level, and that the student will respond positively, co-operating fully with the process and taking advantage of the support available. It may be necessary to obtain independent corroboration as to whether the support offered is being taken up. The responsibility for providing this will lie with the student.

3.4 A review period should be determined by agreement between the Tutor, Director of Studies (if applicable) and the student to allow the student to consider his / her own behaviour and seek advice from the support services available. At the end of this period a meeting should be held to discuss any steps taken by the student to address the concerns. If the concerns have been addressed satisfactorily, this will be noted. Further meetings may be scheduled to continue to monitor the situation/progress and help ensure that continued support is provided to the student to enable them to study effectively. If, however, the concerns have not been addressed, a further review period may be agreed, or the case will move to the next stage of the policy.

3.5 The informal discussions, advice and any undertakings made by the College or University and/or the student should be documented for the benefit of the College, the University and the student, but should be kept confidential. Copies of documents are to be kept by the Tutor and the student. A letter setting out what has been agreed should be given to the student.

3.6 If a student is unable or unwilling to co-operate with the above process or modify their behaviour, they should be informed that more formal action under Stage 2 of this procedure may be considered appropriate.

4. Stage 2- Case Review Group

4.1 If the action taken under Stage 1 has not been successful, or it is felt that the case is too serious to be dealt with informally, Stage 2 of the procedure can be invoked. A meeting of a Case Review Group shall be convened by the Senior Tutor, made up of the student's Tutor and the Senior Tutor and to include if appropriate: the Director of Studies; Supervisor in the case of Graduate Students or Course Director if there is no Supervisor; College Nurse or another member of the College support services. The student may be accompanied to this meeting by a student or other friend or advisor if they so wish. Representatives such as the University Mental Health Advisor or a member of the Disability Resource Centre may also attend to provide information and advice if felt appropriate by the Senior Tutor. In both stage 2 and stage 3 processes the student’s Tutor should be the point of contact with the student and should ensure that the Senior Tutor is kept informed of all communications. The Senior Tutor should be the main point of contact with all other agencies and individuals and should keep records of the whole process. The Senior Tutor should appoint a deputy if unavailable or has become aware of a conflict of interest to act at any stage.

4.2 Before the meeting, a medical assessment may be sought- the student will be encouraged to consent to this, as it will ultimately enable the College to address the student’s difficulties in the most effective manner possible and make an accurate assessment of risk. In most cases this assessment will be that of an occupational health practitioner (e.g. the University Occupational Health Service) but another qualified medical practitioner familiar with the Cambridge University system and the spectrum of student difficulties (e.g. local general practitioner) may be an appropriate alternative in some cases. The College will offer to reimburse the student any charge made by a general practitioner for preparing such a report. It is the purpose of the medical assessment to make a determination of any underlying medical problem. In preparing their medical assessment, the practitioner will be asked to comment specifically on the following questions:

• Is the student suffering from a medical condition that may reasonably be expected to affect
  his/her fitness to study?
  If so;
• To what extent is his/her fitness to study affected?
• What is the prognosis?
• What impact may it have / what risks may it pose to others?
• Is the student receiving / will the student be receiving ongoing and appropriate medical treatment or support?
• For pre-existing conditions, is there evidence that the student has engaged with appropriate
  treatment or support?
• Are there additional steps that the college could reasonably take to mitigate against any medical condition and so enable the student (and those around him/her as appropriate) to study effectively?

It is for the practitioner performing the assessment, not the College, to determine the likely impact of any medical condition on fitness to practice. To this end, the assessment must address the above questions specifically. Sensitive medical information including (but not limited to) medical diagnoses, examination findings, details of treatments should not be included in this report.

4.3 The student will be asked to authorise full disclosure to the College of the results of any fitness to study medical assessment. The College recognises that any such information disclosed may constitute “sensitive data” for the purposes of the Data Protection Act 1998 and will be handled, processed and stored accordingly. Should the student refuse to undertake a medical assessment, or disclose the report, the College may continue this procedure based on the information already in its possession.

4.4 The student will normally be given at least 7 working days’ notice of the convening of a Case Review Group and informed of the purpose of the meeting. This period may be shortened in an emergency on the advice of the Senior Tutor. The student will also be provided with any documents that will be considered by the Group, and asked to provide any documentation they may wish the Group to consider, in good time for the meeting.

4.5 The student may be accompanied at the meeting by a Students' Union representative, a fellow student, or other advisor. A support worker, if required, may also accompany disabled students. The student should notify the Senior Tutor at least 24 hours in advance of the meeting if he / she is to be accompanied and by whom.

4.6 The purpose of the meeting will be to ensure that:

• the student is made fully aware of the nature of the concerns that have been raised;
• the student’s views are heard and taken account of and the best way to proceed is agreed upon by all parties present;
• the student is fully aware of the possible outcomes if the situation is not resolved within a specified period of time.

4.7 The Case Review Group will order its proceedings at its own discretion and may call witnesses, including Student Services staff (as in 4.3) working with the student, and/or institute enquiries to assist its deliberations.

4.8 The Case Review Group may decide:

a. that no further action is required;

or

b. to formally monitor the student’s progress for a specified period of time.
In this case an action plan will be agreed with the student, outlining any steps which the student will need to take, and/or any support to be provided to the student, to address the concerns identified. Regular review meetings with the student will need to be arranged with a nominated member of College staff, to ensure that the action plan is being appropriately followed and/or that reasonable support to enable the student to study effectively is being provided. The student will also need to be informed of the consequences of any breaches of the action plan, which will normally involve their fitness to study being considered at Stage 3;

or

c. to recommend that special academic arrangements or support are put in place. Such recommendations should be agreed with the student's department and by the student and approved by the relevant University authority. The student will be informed that unless these arrangements are able to remedy the concerns to the College’s satisfaction, their fitness to study may be considered at Stage 3 of these procedures;

or

d. with the consent of the student, to agree that their studies be suspended for a period of time with appropriate application to the relevant University authority (normally the University’s Applications Committee);

or

e. to refer the case to the appropriate Senior member of the College, to be considered under Stage 3 of this procedure. Action under (e) is likely to be appropriate only in the most serious of cases, where, for example, evidence of a serious risk to either the health and safety of the student or others has been identified, and where it is thought that suspension, exclusion or expulsion of the student may be the appropriate course of action; or where a particular course of action has been recommended but the student does not agree.

4.9 The decision of the Case Review Group, together with a concise record of the meeting, should be sent to the student within seven working days from the date of the meeting, and a copy kept on the student's personal file. A copy of this documentation should be sent to the student's Department where the recommendations reached and any arrangements proposed render this appropriate. 

5. Stage 3 - College Review Panel

5.1 This stage of the procedure will only be implemented following a referral from a Stage 2 Case Review Group, or if in the opinion of the Senior Tutor (having consulted as appropriate), initial concerns are raised which are sufficiently serious as to warrant the consideration of the student's suspension, exclusion or expulsion (e.g. if they pose a potential threat to the health and safety of themselves or others, or are likely to cause disruption to the working of the College).

5.2 As a first step in this stage the Senior Tutor shall consider whether interim suspension of the student pending further action is appropriate, including exclusion from College accommodation.

5.3 The Senior Tutor shall then convene a Review Panel, which shall be chaired by a member of the Review Committee with no previous involvement in the case. The Review Panel will normally comprise the Chair, the student’s Tutor, the Senior Tutor, and another independent member of the Governing Body, in addition to the Chair, who has had no previous connection with the student.

5.4 The Chair will fix a date for a formal meeting of the College Review Panel to hear the case and invite the student to attend to discuss the concerns and all related issues. A member of the College Tutorial Office staff will act as Secretary to the Panel.

5.5 Wherever possible the student will be given at least 7 working days’ notice of the meeting of the College Review Panel. The student will be informed of the purpose of the meeting. The student will also be provided with any documents to be considered at the meeting and asked to provide any documentation he / she may wish the Panel to consider in good time for the meeting. In serious cases the College may temporarily suspend a student, including sending him / her out of residence pending a meeting of the Review Panel.

5.6 The student may be accompanied at the meeting by a CUSU representative, a fellow student or other advisor. Disabled students may also be accompanied by a support worker where required. The student should notify the Senior Tutor at least 24 hours in advance of the meeting if they are to be accompanied and by whom.

5.7 The purpose of the meeting will be to consider the evidence available, including the student’s perception of these concerns and to reach an appropriate decision, action plan or other outcome.

5.8 The Review Panel will order its proceedings at its discretion and may call witnesses and institute enquiries to assist its deliberations, including Student Services staff working with the student, in particular the University Mental Health Advisor and which may include requesting further medical assessments of the student’s fitness to study. It will also consider any previous risk assessments. The Chair of the Review Panel will ensure that all parties have access to all documents.

5.9 The collective decision that is reached by members of the Review Panel shall be confirmed by the Chair.

5.10 The student shall be notified in writing of the decision, citing reasons, within 14 working days of the meeting of the College Review Panel. It is advisable that the decision is communicated in such a way that support is available to the student at the time, preferably from the student’s Tutor or Senior Tutor. 

The decision may include one or more of the following actions:

a. formal monitoring of the student’s progress for a specified period of time. In this case the Panel will provide the student with an agreed action plan, outlining any steps which the student will need to take and/or any support to be provided to the student to address the concerns identified. Regular review meetings with the student will need to be arranged with a nominated member of staff (to ensure that the action plan is being appropriately followed and/or that reasonable support to enable the student to study effectively is being provided). The student will also need to be informed of the consequences of any breaches of the action plan.

b. following consultation with the academic department, and subject to the approval of the relevant University authority, the implementation of special academic arrangements - or an interruption of studies. The student will be informed of the consequences should these arrangements fail to remedy
the concerns identified to the College’s satisfaction.

c. the recommendation that the College exercises its statutory power to suspend or exclude the student.

d. any other action considered to be appropriate and proportionate. Any decision regarding suspension or exclusion should be communicated by the Senior Tutor to the University and to any support services who have been involved with the student.

6. Return to Study

6.1 Not less than a month before the end of an agreed break in study, the student may make a request to the College for permission to return to the course. The decision as to whether to seek the University’s permission for the student to be put in standing to return to study will then be made by the Senior Tutor who will request authorization for the student to return from the relevant University authority.

6.2 To this end, the Senior Tutor, in consultation with relevant organisations such as the University Counselling Service, the University Mental Health Advisor, and Disability Resource Centre etc., will identify the issues of concern that the College may have in respect of the student’s fitness to study. The Senior Tutor will also contact the relevant medical professional(s) for an assessment of the student's ability to manage the demands of returning to studying at Cambridge University, drawing attention to the nature and extent of the student's previous problems and the College's concerns about them.

6.3 The student will only be permitted to return if, after receiving medical advice, the College and relevant University authority are each satisfied that the individual is fit to study and able to comply with any conditions imposed on their return.

6.4 In cases where the College has any continuing concerns about the individual’s fitness to study, it may seek a second medical opinion. In this case a student may be asked to submit himself / herself to a medical assessment, at the College’s expense, by doctors / specialists, including the University Mental Health Advisor, nominated by the College, to allow the situation to be properly evaluated.

6.5 In any case where a student returns to study following the implementation of the fitness to study procedure, the College should hold a preliminary meeting with the student to discuss what support measures need to be put into place for the student’s return and to establish a Return to Study plan.

This initial meeting should include the student’s Tutor, the Senior Tutor and the Director of Studies. At this meeting it is recommended that a schedule of regular review meetings with the student be agreed, in order to monitor and support a Return to Study plan. The student must provide their continued cooperation in this respect and such review meetings may continue for part or all of the remainder of his / her course and residency in College. There should be a written record of what is agreed for the Return to Study plan, with a copy given to the student. The Senior Tutor should ensure that, where appropriate, a copy of the plan is sent to any support agencies who have agreed to help implement the plan, and that any necessary support from agencies external to the College is put in place. The Senior Tutor should make arrangements for monitoring the delivery and acceptance of the support plan.

7. Right of Appeal

If the student is not satisfied with any decision made in accordance with the Fitness to Study Procedure, they should follow the College Complaints Procedure within 14 days of the receipt of a letter outlining that decision.

8. General Matters

8.1 The College will take account of relevant legislation such as the Data Protection Act, the Mental Health Act, the Human Rights Act, the Equality Act 2010 and the rights and expectations of a student to the maintenance of confidentiality. In cases where Stages 2 or 3 of the Fitness to Study Procedure have been invoked, the Chair will make a decision about whether the student's emergency contact should be informed, and discuss with the student whether any statutory services should be contacted.

8.2 The College acknowledges that as a result of implementing this procedure it will receive personal sensitive data and data of a confidential nature pertaining to the student and other third parties, and shall ensure that all such data are handled, processed and stored accordingly.