We have known and recognised for many years that there are specific vulnerabilities and challenges faced by all doctors in their working lives. The provision of confidential and specialist services, to support wellbeing, that can be easily accessed by all medical practitioners has widely been considered to be long overdue.
In October the International Practitioner Health Summit, The Wounded Healer, was held in London, and the NHS Chief Executive Mr Simon Stevens announced national funding for a new scheme to support all NHS doctors in England.
This new funding will help all NHS doctors by providing a safe, confidential non-stigmatising service to turn to when they are struggling and need help. It means the NHS will now have the most comprehensive national mental health support offer to doctors of any country’s health system in the world. Ultimately it will be patients and not just their doctors who will benefit.
This initiative would be an extension of a Practitioner Health Programme (PHP) that was established in London and launched last year to support mental health problems and addiction issues for GPs and their trainees. The announcement (PDF) came as a response to alarming findings reported in a study by the Society of Occupational Medicine and The Louise Tebboth Foundation, which indicated that doctors in the NHS are at greater risk of mental ill health and work-related stress, burnout, suicide, depression, anxiety and addiction than is the general population.
Marking World Mental Health Day, also in October, the BMA (British Medical Association) launched its own report on doctors’ mental health. They promised to monitor the impact of the new provision by NHS England with a survey of junior doctors and medical students, asking in greater detail about their experience of coping with the pressures of practice – and whether they are getting the support they need. The BMA stressed that the NHS needs to work harder to ensure doctors know how to access mental health support services.
The survey is to be overseen by the BMA President, Professor Bhugra, Professor of Mental Health at King's College London. He said:
It is clear that doctors’ mental health is being affected by the ever-increasing demands of their work – morale is low, stress levels have increased, burnout is an all too real risk. The same goes for medical students, who have to deal with stress, sleep deprivation, academic rigour, exposure to traumatic clinical situations and debt. This is a global issue... But equally, we know that mental health issues are still hugely stigmatised and not just in the medical profession – and if we are to address this we need a huge cultural shift... We must create an open culture, whereby leaders recognise wellbeing as a vital issue and empower all levels of their organisations to make it a priority.
In support, BMA Junior Doctors Committee Chair, Dr Wijesuriya added:
Meeting rising demand in an under-resourced system in which you are fearful of being blamed for mistakes is physically and emotionally exhausting and we know the effects on doctors’ health and wellbeing can be significant.
The GMC (General Medical Council) has also announced that they will ensure that their teams receive additional training in understanding ‘Human Factors' in patient care while investigating complaints.
Lack of awareness, taboo status, denial, fear of sanctions, lack of confidentiality and stigma around mental ill health have mitigated against any real success of initiatives that require practitioners to seek help. Individual practitioners and organisations would need to better understand factors that influence wellbeing and resilience in general and specifically in the NHS, and begin to articulate a proactive strategy whereby problems are addressed before they affect patient or practitioner safety and wellbeing. Our RCPCH webinar, Enhancing our wellbeing and resilience, provides a background to this approach.
It will be increasingly important to cascade training and teaching materials in order to meet the needs of individuals and organisations. Health Education England has now announced a workstream to look at this agenda and disseminate good practice across England. We will also require a four-nations approach so that services are also available in Scotland, Wales and Northern Ireland. The RCPCH will be playing a central role in future initiatives that relate to practitioners working in paediatrics.