More than half (55%) of doctors currently suffer from mental health problems such as depression, stress, burnout and emotional distress due to their work, a recent BMA survey found, with many reporting a deterioration in their health since the start of the Covid-19 pandemic.
Healthcare bodies have called for the Government and NHS to increase access to specialist support services for healthcare workers, to prevent people suffering in silence or even leaving the profession.
Healthcare Leader spoke to Dame Clare Gerada, Doctors in Distress chair and NHS Practitioner Health medical director, about how best to tackle this rising tide of mental health issues among the workforce, and why health professionals themselves have been reluctant to reach out for help.
While she would welcome additional support services, Dr Gerada says the primary goal for the system should be to improve the ‘mental wellbeing’ of healthcare professionals, because ‘if we wait until somebody is mentally ill, it is too late’.
Impact of second wave
As the second wave of Covid-19 rolls in, healthcare professionals are suffering ‘exhaustion, despondency and dissolution’, she explains, as they have to contend with a massively increasing workload and the backlog of treatment.
‘Many healthcare staff have themselves been bereaved, whether that’s grieving the loss of a person, or their job or training, or not being able to see their grandparents,’ she says.
‘Just because you’re a health professional that does not make you exempt from the normal difficulties that the general population have faced, and if anything, they’ve had more. We’re all human, and though we are incredibly resilient, we all have our tipping point.’
Support available
Dr Gerada says pre-pandemic, NHS Practitioner Health would typically see around 60 new patients attend the service each week, but now that number has doubled – a direction that is ‘worrying’. The peak age bracket is 30-39, she adds, with an increasing number of international medical graduates also reaching out.
‘My concern is for the hidden groups. If you’re an intensive care specialist in a large teaching hospital, you’re probably well supported, but that [might not be the case] if you’re an overseas-trained GP locum working from your bedroom.’
Suffering in silence
Dr Gerada believes doctors are generally reluctant to seek support for their mental health and suggests there are a number of complex reasons for this – but one is the fear of being exposed to the regulator. She recalls hearing about a doctor who had a recurrence of her alcohol problem and took her own life because ‘she was so fearful that she would lose her job’.
‘She’s not unique – there are fears that your peers might find out, and there are problems in accessing health, as some doctors are registered with friends and family, especially in small areas.’
Doctors are selected in their field for personality traits such as ‘denying vulnerability’, and are trained to follow the rules and customs of medicine, which includes not taking time off and self-sacrificing, Dr Gerada explains.
These expectations develop the psychological defences needed to do the job that the public expects, and see death or cut people open, she adds, but when this stops working it can lead to mental illness.
‘We have to harden ourselves against our own mortality, but of course, we are mortal. Where the system treats you well, you can have this balance, but where the system doesn’t – when you have nowhere even to hang your coat, let alone sit down and rest your head – then, of course, the balance shifts, and you fall over in a sense.’
‘The illnesses we get are no different from the illnesses that everybody else gets and our depression is the same depression. What’s different is that we don’t seek help, and we’d rather suffer in silence than actually admit that we might have problems.’
Healthcare leaders must act
As the pressure on services continues to mount, Dr Gerada says there is now ‘a moral imperative to provide not only physical PPE for healthcare staff, but also psychological PPE’.
This is what the charity, Doctors in Distress, focuses on, but the NHS itself also needs to put welfare of the workforce ‘at the heart’ of every single primary care organisation and NHS trust, she says – and this has to be done at board level and determined locally.
‘For example, if you have a high number of international medical graduates, you might need to focus on those doctors.’
‘I also think there needs to be de facto access to confidential services for every health professional, and a fundamental review of what needs to be disclosed to the workplace, and who needs to know about a person’s mental illness.’
Healthcare leaders also need to review long shifts, which are affecting staff and ‘contribute to fatigue and accidents’, Dr Gerada says, as well as ensuring people are paid for their break times and can visit peer groups during working hours if needed.
But the main thing leading to burnout and depression, she suggests, is the ‘intensity’ of the work and ‘what we are expecting people to do within those hours’.
‘When I was training, even though it was busy, you still had time for lunch and some downtime, and when on call, time to sleep. Now, you start your work, and you don’t stop – and it’s that intensity that’s destroying people’s lives.’
Dame Clare Gerada is chair of registered charity Doctors in Distress and medical director of NHS Practitioner Health. Her new book Beneath the White Coat: Doctors, their minds and mental health is out now, published by Routledge, £22.99 (paperback). All royalties will be donated to Doctors in Distress.
