IN THE PUBLIC perception there is still, perhaps, a hint of decadence about the student lifestyle. The image of the beer swilling, drug taking and, probably, fornicating student has died hard. The reality is that today's students are under more pressure than their predecessors.

Today there are increased student numbers. There is greater competition for jobs. And there is a range of issues affecting students' physical and psychological well being, including sexual health, drugs, alcohol and smoking.

Students may also be at an increased risk of suicide because of underlying depression, difficulties in integrating into the college environment, unrealistic parental expectations and financial or family pressures.

Dr David Thomas has seen over two decades of students pass through Trinity College, Dublin, first as medical officer and, since 1986, as director of the student health service. In the late 1970s, he imported condoms so they could he supplied to the students, marking TCD as the most enlightened college in the country.

Other colleges have followed suit since then, although it was only two years ago that USI's former welfare officer, Noeleen Hartigan, noted that some college doctors would still not prescribe the Pill.

"I suppose the introduction of the Pill has changed sexual attitudes and has caused a shift towards a much more liberal outlook," says Thomas, "but I would say that there is a responsible attitude among most students to sexual activity. They have become aware, particularly over the past 10 years, of safe sex. We are very fortunate in this country that HIV has not so far become an issue in the student body and I think we're missing it."

TCD operates a sexual health clinic and, while it does see conditions associated with sexual activity, Thomas says there is no major problem with sexually transmitted diseases. "A lot of the students are in fairly stable relationships and I don't think there is a high level of promiscuity, as people sometimes think with students."

MOST STUDENTS appear to combine condoms with the Pill and there is a general awareness of the need for safe sex. As Thomas puts it, "it's not sex that causes AIDS in students, it's alcohol". A sheaf of forms for post coital contraception, the "morning after pill", is testament to the fact that accidents still happen.

"If they came in for things like the morning after pill they would certainly tend to tell you, yes, we didn't use contraception and it's generally when they have been drinking that they haven't used them," he says. At such times, the health service operates what the doctor terms an opportunistic" approach, advising students on contraception and the risks they are taking with their health.

"We keep reinforcing it and when somebody comes in for the morning after pill we certainly take that as an opportunistic time to discuss the issues of drugs and alcohol. That I would do regularly: anyone who comes in for post coital contraception is asked when it happened and were drugs or alcohol involved."

Substance abuse, whether alcohol smoking or drugs, remains an area of concern. About 32-34 per cent of female students in TCD smoke, compared to 25 per cent of male students, a disparity which is difficult to explain. "We try to get the message across about smoking but in youth we tend not to worry about what will happen when we are 45," says Thomas.

Students who smoke have their medical files tagged with a bright, red `smoker' sticker: "It does irritate them," says Thomas, "but I tell them I want to be able to take it off."

There is some concern about other drugs too. "There certainly has been quite a bit of smoking of hash and there has been some experimentation with Ecstasy," according to Thomas, but he believes there has recently been a decline in the use of these drugs.

"Unfortunately I see the other side of it. I see people who become basically hooked on Ecstasy and that's very sad. Occasionally I see people who have problems with hash, who have overindulged and both of these cause major academic problems. There's a little bit of acid still being used but I think students as a whole tend to stay away from the other harder drugs."

STUDENT STRESS is an increasing problem. "We tend to see stress in first years and final years in particular," says Thomas. "In final years, there may be concerns about the future - what does it hold and what have I done this for? Then we get other people with bereavement problems and, over the past couple of years, parents separating. We're seeing a surge, where it seems that people say they'll stay together until the kids grow up and the kids are seen as grown up at 18."

Between one and two per cent of students will suffer major psychiatric illness and another 10-20 per cent will need some form of ongoing support from counsellors or doctors. Another 20 per cent experience transient problems which need little more than a little reassurance.

In a small number of cases, there is a risk of suicide. According to a submission made by Dr Thomas to the Task Force on Suicide, the estimated level of suicide for the student age group 15-24 is 14 per 100,000, or around one in five of all suicides.

Young males are particularly at risk. Research presented earlier this month by Dr Moya O'Brien and Ms Myra Barry, senior clinical psychiatrists with the Eastern Health Board, concluded that the rate of young male suicide had risen dramatically between 1980 and 1994. In 1980 19 suicides were recorded in the 19-24 age group. By 1994 this had increased to 55.

The rate of female suicide remained relatively stable during this period of the 83 young people aged 12-24 who committed suicide in 1994, only 11-12 were female.

TCD's health centre has 10,000 consultations each year for 3,500 students and non-emergency cases may have to wait five or six days for an appointment. While 50 per cent of the college's students come from Dublin City and County, they account for only 20 per cent of patients. This may be due in part to the use of local GPs but it also reflects the fact that those living away from home tend to feel more vulnerable when something goes wrong and may be more inclined to seek assistance from health and support services.

FEWER than 10 per cent of students have medical cards and David Thomas believes the removal of medical card entitlements from students in the early 1980s was a major step backwards. Last year a USI survey revealed that almost 30 per cent of students surveyed could not afford to visit a doctor in the previous twelve months.

"We should never not give medical advice because of financial problems," says Thomas. "For that reason I think it's important that we have student health services which are student friendly and are available at a minimal cost."

He believes that if medical card entitlements were returned to students and those students were registered with college health services then the scheme could fund good health care within the colleges. TCD's health service runs at a cost of £25 per student but, with medical cards and other medical schemes, the net cost is reduced to £18. With proper funding, the service could be improved and younger GPs, currently excluded for the General Medical Scheme, could used to expand the service.

In the end, despite the difficulties, Thomas is undeniably happy in his work. "I've got the best medical job in Dublin," he says, "except I'm under enormous pressure. I think working with young people keeps you young.