Fear of notification to AHPRA remains a major obstacle to seeking mental health care.
Burnout is a common issue reported among doctors, but mental health difficulties often go beyond burnout.
“Doctors’ mental health is an urgent priority, with direct impacts on patient safety and care,” researchers from the University of Sydney and Western Sydney Local Health District write in Australasian Psychiatry, in one of a pair of new papers on mental health issues facing doctors and the lack of care available.
“While burnout is a common concern, the literature suggests that there are many more mental health issues present in this population.”
Their narrative review finds that the current system leaves healthcare professionals to fall through the gaps.
The authors note that several barriers stand between doctors and good healthcare, including fears that services will be punitive, breach client privacy and, importantly, that services will fail to distinguish between illness and impairment.
But there is hope. In their second paper, the authors describe the first four cases to present to a professional support unit established at a Sydney hospital with a referral base including more than 3000 doctors.
The researchers used those case studies to illustrate how such a service, which was based off a UK prototype designed to care for doctors over their entire career, could help.
The unit launched in early 2021, and it had 50 referrals over the following year and a half.
In one case study, “Agnes”, a senior surgeon, experienced such severe anxiety and panic attacks while working during the covid pandemic that it led to palpitations, diaphoresis and tremor. In fear of the tremor returning during work, she took sick leave.
The surgeon was treated with cognitive behaviour therapy and alprazolam, given a return-to-work plan and referred to a neurologist to investigate her tremor.
Another doctor, “Qi”, had recently escaped domestic violence and was homeless had suicidal thoughts and presented to a local emergency department. She received therapy, short-term financial assistance and a referral for long-term trauma-informed psychotherapy.
“The mix of patients presented here suggest difficulties beyond burnout and highlight the workings of a new service model designed to complement existing services in the Australian context.”
“Consistent with the Australian National Mental Health Survey of Doctors and Medical Students (National Survey), anxiety, depression, suicidal ideation and life stressors were observed.”
The researchers said doctors faced barriers to seeking help, including privacy concerns for 52% of doctors, embarrassment (37%), impact on registration (34%), lack of time (28%) and career concerns (27%), according to the Australian National Mental Health Survey of Doctors and Medical Students.
“Concerns regarding confidentiality frequently prevent doctors’ care-seeking, especially in the public system where medical records are centralised,” the researchers said.
With that in mind, the professional support unit researchers kept medical records and letters in a separate, secure system not otherwise accessible.
There were also antidotes to embarrassment and stigma, the researchers said.
“Normalisation of mental health difficulties and protecting those who disclose mental ill health from external shaming responses are important strategies in shifting cultural stigma, all utilised in initial PSU referral, engagement and triage processes.
“Stigma within medical culture and confidentiality concerns likely limited doctors from accessing a public mental health service; alternatively, the specialised focus on doctors may have improved confidence and expectations of feeling heard and understood. Ambivalence in attending may also have been mitigated by the service being free of charge.”
The researchers said the wellbeing of medical professionals had been brought to the fore by covid pandemic.
But even before the pandemic, doctors have had substantially higher rates of very high psychological distress and suicidal thoughts compared to the general population, they said.
“Burnout, long recognised and commented across the age and specialty range, also remains an issue for doctors, although it is clearly only the ‘tip of the iceberg’.”
The researchers said despite a growth in mental health services in some specialisations and by some organisations, gaps and unmet needs remain.
“In Australia, privacy concerns, including fear of notification to the Australian Health Practitioners Regulatory Agency (AHPRA), remain a major obstacle to seeking care.
“This has led to a raising of the reporting threshold of treating doctors and calls to exempt treating doctors completely from notification obligations, as is already the case in Western Australia.”
Another issue is that personalised assessments and treatments are accessed through GPs, but according to the Doctors Health Advisory Service less than 40% of doctors have an identifiable GP compared to 83% of the general Australian population.
And just like everyone else, doctors also face excessive wait times to access specialist mental health support, they said.
“The reductionistic approach to doctors’ mental health, often with a single-eyed focus on burnout, at JMO stages, and the self-help-based nature of many treatment services is at odds with the cases and treatment needs illustrated here.”
However, a professional support unit can only exist with “buttressed” by broader reach primary prevention services, they said.
“Doctor’s mental ill health has well-recognised translational impacts on patient care and given the substantial capital investment in medical training largely borne by taxpayers, it is in our economic interest to maintain their health and productivity.
“The AMA Codes of Ethics declare that doctors must attend to their own health and wellbeing and that of their colleagues, trainees and students. We need to walk the talk.”
Australasian Psychiatry 2023, online 2 March
Australasian Psychiatry 2023, online 26 March
