24 May 2019

What doctors can learn from firefighters

Clinical Mental Health

The Black Dog Institute is adapting its first responders training program to teach senior doctors how to respond to mental health problems in the workplace.

A pilot program will be launched in the next few months in partnership with the Royal Australasian College of Physicians.

“One of the things that we know from first responders and the military is that having managers who are trained to respond appropriately to mental health issues when they arise is a hugely important factor in determining the mental health outcomes of a workforce,” Associate Professor Sam Harvey, the chief psychiatrist at the Black Dog Institute who leads the workplace mental health research program at the University of NSW, said.

The Black Dog Institute tested a similar training program for managers at Fire and Rescue NSW in 2014.

Around 80 managers, who were responsible for 4,000 staff, were randomly assigned to the four-hour RESPECT mental health training program, or to a control group.

After six weeks, work-related sick leave dropped 18% among staff whose managers had been trained to handle mental health issues, while sick leave increased 10% among the staff with an untrained manager.

“We are now working with a couple of the royal colleges to develop a similar training for senior doctors so they can feel confident in knowing how to respond to these issues when they see them or hear about them amongst the junior doctors that they are helping to train,” Professor Harvey said.

Speaking at the Royal Australian and New Zealand College of Psychiatrists’ annual congress in mid-May, Professor Harvey updated his colleagues on the Shift app, which the Black Dog Institute is developing to help junior doctors get more mental health support.

“We are working in partnership with NSW Health to develop an app for junior doctors. In the next month we are going to start piloting that among junior doctors and then early next year we hope to be doing a large-scale trial,” Professor Harvey said.

“The app is based on another app called HeadGear, which is already available. That’s an app design for male-dominated industries – first responders, construction workers, transport workers – and it provides a confidential space in which people can monitor their mental health and can be linked into health services if they want.

“It guides them through a 30-day program where they learn mindfulness skills and some behavioural activation and some cognitive skills, which hopefully they find useful in some situations. 

“We’ve had about 10,000 people download and use the HeadGear App and we are just in the process of finalising the evaluation.”

One of the reasons that junior doctors were at increased risk of suicide compared with the general population was that there were real and perceived barriers to treatment, Professor Harvey said.

Junior doctors often feared being reported to the regulator if they sought mental health support, even though mandatory reporting only applied in cases of more severe illnesses.

“There are a variety of different ways this is being handled around the world,” he said. “Within the UK, they developed The NHS Practitioner Health Program, which was a confidential health service just for doctors.”

The health records for this program were kept separate from mainstream health records. “And so, people were able to be confident that their records were not going to appear on any of the more easily accessed health records part of the health service,” Professor Harvey said.

“In the end, these things come down to reputation. They quickly established the right kind of reputation for confidentiality, which helped enormously.”