While university occupational health includes classical, formal environmental health problems such as laboratory safety, radiation and so on, its central concern, I believe, should be with the main function of the University as an institution, namely, teaching and learning. The aim of a University Health Service in this context is to minimize failure and under-achievement among students. To achieve this aim involves an extension of the doctor’s role beyond the detection and treatment of illness, and beyond a concern with formal psychiatric illness, to a concern with what I call the ‘irrational transaction’ between the student and his teacher at the University. To develop a Health Service, which can work along these lines, one must follow certain stages. Firstly, one must create a satisfactory clinical service, because upon this depend the basic attitudes of the students and the University to the doctors. Secondly, the doctors will intervene, on behalf of student patients, with their tutors where illness or disability has interfered with their functioning. Thirdly, partly through such intervention, the doctor can begin to extend the general understanding of his role to include a recognition of the part he can play in understanding the tutor–student interaction. If he is accepted in this role, then a fourth stage becomes possible in which the Health Service is formally involved in policy making, in teaching of tutors and so on. When the doctor in his occupational role is faced with a student who is a psychiatric or an academic casualty, I think he should ask himself two kinds of question. Firstly, he must ask what, in the history and the personality of this student, predisposed to psychological or academic breakdown. Secondly, what in the institution may have promoted, and what could have prevented or may limit his breakdown.
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