Caring for the Carer: Maintaining Doctors Mental Health Dr Naomi P Harris Melbourne, Australia
Thank You Prof Amanda Howe Prof Michael Kidd Prof Gustavo Gusso Prof Nabil Kirashi Dr Kym Jenkins Mr Nick Arvanitis Every medical student (>2000 medical schools) and graduate (10-15 million doctors), worldwide
Personal Thank You s My partner Brad My mum, dad and sister who struggle to understand but always try to be supportive My friends, new and old, but especially those who stood by me through the worst year of my life My two fur-babies who give me nothing but simple, genuine love Each of you for recognising the importance of todays topic and being here to learn, discuss and educate
If you know someone who s depressed please resolve never to ask them why. Depression isn t a straightforward response to a bad situation, depression just is, like the weather. Try to understand the blackness, lethargy, hopelesness and loneliness they re going through. Be there for them when they come through the otherside. It s hard to be a friend to someone who s depressed, but it is one of the kindest, noblest and best things you will ever do. - Stephen Fry
There was a time I didn t want to be alive.
But I am so very thankful that I am. I m kind of addicted to living now.
Depression in American Residents Systematic review and meta-analysis of 31 cross sectional studies (9447) and 23 longitudinal studies (8113) (conducted between 1963-2015) demonstrated an incidence of depression of 28.8% (4969/17560, 95% CI, 25.3% - 32.5%)
Dr Aaron Carroll from the US states that depressed doctors are not only a danger to themselves, they are also a danger to their patients in extreme cases Doctors more commonly misuse prescription medication to self treat; afterall, we have much easier access than the community Carroll concludes his commentary with a worrying statement too many physicians, especially trainees, suffer in silence afraid to ask for help, for fear they will be punished professionally, if not personally
The U.K. 27%+ UK doctors show significant stress 7% substance misuse lifetime prevalence Doctors have a higher suicide rate than the general population Sickness absence costs the NHS 1.7 billion a year High rates of addiction and non-psychotic mental health problems compared to other professions e.g. law / teaching Different patterns in men and women
Recognition of doctors with problems Presentation Behavioural changes Absenteeism / less reliability Third party concerns Self presentation Police / legal concern Medical intervention signed off sick Barriers to presentation Fear of / culture of stigma Ability to deny / minimise extent Access to drugs self or colleagues Lack of / loss of insight Lack of access to services Loss of confidentiality
Burnout in Brazil A small study done in Curitiba demonstrated, by using the universally applied Maslach Burnout Inventory, that there were high levels of emotional exhaustion and feelings of depersonalisation amongst graduates
beyondblue Established in October 2000 Initially focused on raising awareness of depression and reducing the associated stigma. As knowledge and impact on people's lives broadened, through research and community engagement, they added the key issue of anxiety conditions in 2011 and, more recently, suicide prevention.
beyondblue Doctors Mental Health Program (bbdmhp) In 2013, the bbdmhp commenced to look at the current mental health of our medical students and doctors. A Project Advisory Group was established to provide advice to beyondblue and the beyondblue Doctors Mental Health Program Advisory Committee regarding the planning, development, implementation and evaluation of a National survey.
Australia The National Mental Health Survey of Doctors and Medical Students was conducted with the aims of: Understanding issues associated with the mental health of Australian medical students and doctors Increasing awareness across the medical profession and broader community of issues associated with the mental health of medical students and doctors, and Informing the development of mental health services and supports for the medical profession.
The sample comprised 42,942 doctors and 6,658 medical students. The final response rate was approximately 27% for both doctors and medical students, which resulted in 12,252 and 1,811 respondents respectively.
Approximately 21% of doctors reported having ever been diagnosed with, or treated for, depression and 6% had a current diagnosis. Current levels of depression were similar in doctors in comparison to the general population, but higher than other Australian professionals Approximately a quarter of doctors reported having thoughts of suicide prior to the last 12 months (24.8%), and 10.4% reported having thoughts of suicide in the previous 12 months. Approximately 2% of doctors reported that they had attempted suicide.
Main source of stress is attempting to balance work and personal responsibilities (26.8%). Other sources of work related stress include too much to do at work (25.0%), responsibility at work (20.8%), long work hours (19.5%) and fear of making mistakes (18.7%)
Stigmatising attitudes regarding the competence of doctors with mental health conditions, and their opportunities for career progression, persist in the medical community. Approximately 40% of doctors felt that medical professionals with a history of mental health disorders were perceived as less competent than their peers 48% felt that these doctors were less likely to be appointed compared to doctors without a history of mental health problems. Approximately 59% of doctors felt that being a patient causes embarrassment for a doctor
Barriers Barriers to seeking treatment and support for a mental health condition were identified fear of a lack of confidentiality or privacy (52.5%), embarrassment (37.4%), impact on registration and right to practice (34.3%), preference to rely on self or not seek help (30.5%), lack of time (28.5%), and concerns about career development or progress (27.5%)
Who Is Guilty of This? VIP treatment. When a physician comes to a colleague for help with a (mental health issue), both parties might underestimate the severity of the crisis.
VDHP Established in 2001 as a not-for-profit organsiation and fully independent entity. Initially separate from the Medical Practitioners Board of Victoria (MPBV - now AHPRA) and AMA Victoria It is believed to have been the first Doctors' Health Program of its kind, outside North America (the Federation of State Physician Health Programs was established in December 1990 however ten years previous all but 3 of the 54 US Medical Societies of all states and jurisdictions had authorised of implemented impaired physician programs).
VDHP now (DrHS) The same care, a different model confidential health-related triage, advice and referral services for registered medical practitioners and medical students; follow up services for medical practitioners and medical students who need it, including support and advocacy in returning to work; education, awareness-raising and advice about health issues for medical practitioners and medical students; a physical office from which to provide services, or an alternative service arrangement training to support doctors to treat other doctors; and facilitation of support groups for medical practitioners and students with significant health problems.
Advice is also provided to anyone who is concerned about a doctor or medical student. This includes family, friends, colleagues, university staff and clinical staff.
Our staff are very aware of the many reasons that make it difficult for those in the medical profession to seek help. We are most sensitive to the need for confidentiality. Our office is situated in the basement of AMA House, so doctors and medical students could have any number of reasons for being in the building. We also have our own private waiting room. We know how hard it can be to change from the accustomed role of caregiver to being a care receiver.
2015 Data
Doctors 117, Students 29
Ages accessing service < 20 21-30 31-40 41-50 51-60 61-70 >70
Reason for contacting service Mental Health Substance Use Axis IV
Diagnostic Axis Axis I Axis II Axis III Axis IV
Axis IV Workplace Financial Relationship Legal Education Cultural Other
FEELING ANXIETY? DO A GROUNDING TOOL. Look around you. Find 5 things you can see. 4 things you can touch. 3 things you can hear. 2 things you can smell. And 1 thing you can taste. This is called grounding. It s helpful to do whenever you feel anxious.
The bravest thing I have ever done was continuing to live when I wanted to die