Published: 26 April 2016 at 09:00
VIEWPOINT: Anglia Ruskin expert on why stigma is stopping our doctors from looking after themselves
by Professor Jamie Hacker Hughes, Anglia Ruskin University
A new study from Cardiff University has revealed that nearly 60% of doctors have experienced mental illness and psychological problems at various stages in their career. That is bad enough in itself, but what is much worse is that very few of the 2,000 surveyed said that they had sought help.
A number of health and professionals from other industries have been studied in recent years and many, not unsurprisingly, also show high levels of stress. Sadly, however, it seems that this failure to seek help is not a phenomenon that is confined purely to the medical profession.
Findings from the British Psychological Society and New Savoy, for example – reporting on their 2015 staff well-being survey – showed that nearly half of psychological professionals report being depressed, along with admitting feelings of being a failure.
Work again was a culprit, with 70% of those who responded saying that they were finding their jobs stressful. For both medical doctors and psychological doctors, therefore, the current climate in the NHS is not, sadly, a healthy one. Workers on the front line of care are becoming governed more and more by contracts and targets rather than by the imperative of caring for people. The threat of cuts, often presented as efficiency savings and the imposition of contracts on junior doctors are just two of many current examples.
Across the caring professions – medical, psychological, nursing, professions allied to medicine, and caring – there is, overall, a picture of worrying levels of depression and stress leading to low morale and burnout.
Burnout is something experienced by people who have been working on the front line of human services in a context where they are caring for, and committed to providing services to, others. Its features are a combination of high levels of depersonalisation – where a person no longer sees themselves or others as valuable – and emotional exhaustion together with low levels of feelings of personal accomplishment. This is exactly what we are seeing reported here in the Cardiff study.
The Cardiff study found that the likelihood of doctors reporting mental health problems differed between different stages of their careers: young doctors and trainees were least likely to disclose any problems. Female doctors were found to be particularly at risk of burnout, as were GPs and trainee and junior doctors.
Almost certainly, the reason why is stigma. People throughout society – particularly frontline professionals – are afraid of disclosing that they are having problems because they fear the repercussions and possible effects that disclosure may have on their careers.
This was also recently demonstrated in a wider paper by Sarah Clements of Kings College London who, with colleague Graham Thornicroft, carried out a meta analysis of 144 studies involving more than 90,000 people. Their resulting global report showed that although one in four people – both inside and outside the healthcare profession – in Europe and the USA have a mental health problem, as many as 75% of people do not receive treatment.
What – if anything – can be done about this situation? Do we really want to consult with professionals who are less able to confront their own difficulties than we are? How can we help them confront their own issues to help others in society overcome the stigma?
There have been moves towards a more open mental health culture within the health professions, with some senior members of staff sharing their experiences. Retired GP Chris Manning, for example, has been greatly involved in the promotion of doctors’ psychological health and self-care after experiencing depression and burnout.
Clare Gerarda, former chair of the Council of the Royal College of General Practitioners, has also been a long-time advocate for doctors’ health and is the medical director of the practitioner health programme – a free and confidential NHS service for doctors and dentists who are experiencing psychological or physical health concerns. Additionally, Dr Gerarda established the Founders Group and Founders Network, a coalition working together to promote psychologically healthy environments within the NHS.
A new Charter on Psychological Staff Wellbeing and Resilience was also launched recently by the British Psychological Society and New Savoy. Building on this, a collaborative learning network of employers in health and social care has been established and will have its first meeting on June 21 in order to begin working together to establish and maintain psychologically healthy working environments.
Fundamentally, though, there has to be a change in culture. People need to be able to speak freely about their feelings of stress and psychological needs – and be supported to seek help. I have tried, personally, to model this as the president of the British Psychological Society over this past year and have talked openly about my own experiences of burnout, stress, depression and bipolar disorder while working as a clinical psychologist.
It is my belief that this culture change could begin to be enabled for doctors, both medical and psychological, nurses, allied health professionals and all in the caring professions too, if senior additions and managers begin to talk openly about their own psychological health.
To do so is a sign of strength and humility.
This article does not reflect the views of any research councils the author has been funded by, nor the societies and groups he is a member of.
Jamie Hacker Hughes, Professor of Military Psychology (Visiting), Anglia Ruskin University