Doctors look after our mental health but who looks after theirs?

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When medical students enter university, their mental health is no different from that of the rest of the population. Doctors learn early in their training to mask their pain, to hold the line, to come across as stoic, to turn up ready for work come what may, and never to admit to their vulnerabilities. By the end of their first year, however, it is significantly worse. Stress accumulates throughout their training and, for many, things do not improve as they progress through their careers.

Despite the fact that 10-20% of them have suffered from depression, and suicide rates are reported to be much higher than among other professional groups or the general population, doctors have poor access to mental health care and often don’t get the help that’s needed.

This failure to seek help is not a phenomenon that is confined purely to the medical profession, with a survey showing nearly half of psychological professionals report being depressed, along with admitting feelings of being a failure.

The common factor here was that the nature of their work was the culprit, with 70% of those who responded saying that they were finding their jobs stressful.

A 2016 study from Cardiff University, "Understanding doctors’ attitudes towards self-disclosure of mental ill health", has revealed that nearly 60% of doctors have experienced some form of mental illness and psychological problems at various stages in their career.

Across the caring professions 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.

The Cardiff study found that female doctors were particularly at risk of burnout. This group experiences a higher degree of anxiety than male doctors. A large Canadian study showed that female doctors are twice as likely to be depressed as their male counterparts. Though more likely to disclose mental health problems, female doctors were less likely to turn to colleagues for help. The reasons are not uniform but reluctance to show weakness in the workplace, especially if there is an atmosphere of prejudice, is likely to play a significant role.

The role of stigma in preventing people from seeking help

While there is more awareness and discussion around mental health issues like anxiety and depression, and suicide prevention initiatives such as RUOK, the stigma surrounding mental illness still stubbornly persists among healthcare professionals. Worryingly, very few of those 2,000 surveyed in the Cardiff study said that they had actually sought help. Stigma is one of the main reasons why.

A meta analysis of 144 studies involving more than 90,000 people "What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies", supported the notion that mental illness stigma was behind the reluctance to seek. The global report showed that clinicians were not alone in being reluctant to ask for help. One in four people in Europe and the USA, both inside and outside the healthcare profession, have a mental health problem, and as many as 75% of people do not receive treatment.

People throughout society, and particularly clinicians, are afraid of disclosing that they are having problems because they fear the repercussions and possible effects that disclosure may have on their careers. Patients and the public sometimes find it difficult to accept that doctors can also be sick. Doctors sometimes suffer because of patients’ need to place them on a pedestal. They are idealised as quasi-divine healers, without the same vulnerabilities or disabilities as the rest of us.

In many ways, much of this is not news. We have known for a long time that doctors have a higher rate of mental illness than the general population. Everything we know about doctors’ mental health indicates that the quality of care provision goes down as doctors get more stressed. Some of the more alarming outcomes of stress and depression are pathological cynicism, apathy and decreased empathy – something patient care cannot afford to. It is clear that no one benefits when doctors begin to go under.

While there have been moves towards a more open mental health culture within the health professions, fundamentally 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.

Some of CKN’s mental health resources