Mental health - barriers to doctors' own care
Work-related mental illness, for example, puts doctors at the top of the UK incidence table alongside armed forces personnel (from figures reported by psychiatrists and published here by the Occupational Health Statistics Bulletin).
But what care is there for doctors themselves and how do they access it - whether the mental morbidity be mild, moderate or severe? It is a question that the Department of Health has sought to give practical guidance on in its 2008 report, 'Mental health and illness in doctors', key points of which are:
Current state of care for doctors
•Doctors often use informal pathways for mental health advice and treatment.
•Few areas have agreed formal pathways for specialist mental healthcare for doctors.
•There are few specialist services for doctors with mental illness.
•Doctors accessing help need explicit assurances of independence, confidentiality and privacy.
•Doctors have practical concerns that should be accommodated, such as not being put at risk of being seen by their own patients or colleagues when attending clinics and so on - out-of-area care should be routine.
•Ill doctors should be treated as patients first, not colleagues, since their expert knowledge may not extend to their own mental health condition - and the fact that the patient is a doctor should have no bearing on clinical decisions.
•Those doctors responsible for care should be senior, have an interest and experience in the treatment of doctors and lack any close professional or personal contact.
•The NHS as an employer should take a model role in tackling stigma and discrimination (the report cites five principles for doing this).
•The NHS should also exercise healthy working practices and reduce workplace stressors (citing the Health and Safety Executive's six points under demands, control, support, relationships, roles and change).
•On the support of staff with mental illness, the report recommends the guidance of mental health and employment in the NHS.
BACKGROUND TO THE REPORT
The Department of Health's document looks at a broad spectrum of need, although it took an extreme and tragic case to prompt the work behind it, the case of psychiatrist Dr Daksha Emson.
During a relapse of her long-standing bipolar disorder in 2000, Dr Emson killed her baby and herself. The DoH report includes a moving tribute from the late doctor's husband that outlines the story of a previously well-managed illness and successful medical career.
The broader theme of the document is to point out that, adding to the high rate of psychiatric morbidity in the profession, 'doctors may fear that acknowledging the need for help will damage their career prospects or lead to scrutiny of their fitness to practise'.
The report's foreword by national mental health tsar Professor Louis Appleby cites many factors - including high personal standards, a culture of always coping, that fear of damage to job prospects, and uncertainty about who to tell - lying in the profession's background, to such cases as Dr Emson's.
Prof Appleby's foreword also includes the view that doctors often find it 'difficult to admit that their work is stressful, that they have a drink or drug problem or that they need help.'
The Department of Health report - Mental health and illness in doctors
The Practitioner Health Programme (PHP) -which is being piloted in London, in response to the Department of Health report
If you are responsible for a colleague who has a mental illness, this may be useful: Line manager's guide