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No Monash doctor will struggle in silence

A report from Monash Health’s Chief Medical Officer, Professor Erwin Loh, and Director Medical Services, Dr Anjali Dhulia.

This article was published in the February edition of vicdoc

The compelling case for action

The National Mental Health Survey of Australian Doctors and Medical Students conducted by beyondblue in 2013 found that doctors and medical students reported substantially higher rates of psychological distress and attempted suicide compared to both the Australian population and other Australian professionals. Doctors, especially junior doctors, now work in a challenging environment of increasing demand, increasing expectations and finite resources. Work conditions including excessive workload, lack of autonomy and control, lack of professional support and training particularly in the areas of communication, leadership and management can be stressors in the workplace for doctors. Personal, career and health issues may add to the stress and the medical culture of infallibility makes doctors increasingly vulnerable to distress and burnout.

Monash Health is the largest public health service in Victoria and employs over 2000 doctors. At Monash Health there is a high awareness of the need to support the mental health and wellbeing of our doctors. We firmly believe that a mentally healthy workplace leads to better patient outcomes.

Monash Care - the Mental Health and Wellbeing Strategy for Monash Doctors (the Strategy) is a new initiative that has been developed to create an actively caring work environment to support our doctors to thrive in their
careers and personal lives. The Strategy has the support of the Monash Health Board of Directors, the Executive and the Senior Medical Staff Association.

Planning and raising awareness

The Strategy was developed by a working party that was convened in early 2014 following the release of the findings of the National Mental Health Survey. The working party comprised of senior and junior medical staff, including directors of clinical training, medical students, medical administration, workforce and education representatives as well as human resource and university representatives. The working party undertook wide consultation and organised workshops and surveys, obtaining feedback from key stakeholders to identify key focus areas and specific initiatives.

The Strategy was formally endorsed by the Monash Health Board of Directors and was officially launched on 22 October 2014 by the Honourable Jeff Kennett AC, Chairman of beyondblue.

Recognising effective communication is the key to success of any change or intervention, particularly in a large and complex organisation, the launch was a widely promoted major event which also included keynote speaker Dr Steve Ellen, a well-known psychiatrist and a radio show host who explored the importance of work-life balance. The launch also featured a poignant two minute video with de-identified stories of doctors who had experienced mental illness to give the audience real-life examples of the vulnerability of doctors and their ability to ask for help and recover.

Monash Health’s Public Affairs department helped design a professional quality brochure. Doctors were informed of the launch by email, newsletters, internet posters, SMS and through word of mouth. Local champions were used to spread the word at every opportunity. Senior medical staff support for the Strategy was strongly communicated at the launch.

Over 200 doctors attended the launch, indicating that the awareness raising campaign was successful. A post launch survey found 90% of attendees reported the launch had helped to raise awareness about the findings of the National Mental Health Survey.

Further, 66% reported the launch raised awareness about where to go for help or refer a colleague for help when experiencing psychological distress, and 78% reported that after the launch they would be or might be more inclined to seek help. 52% of respondents stated that after the launch they would be more inclined to help a colleague or junior staff member in psychological distress. These results are very encouraging and the launch gave the Strategy the kickstart it needed.

The Strategy

The Strategy provides a roadmap for Monash Health to address this important matter. Its compelling purpose is that “No Monash doctor will struggle in silence” and it has five key goals which are:

1. Creating widespread awareness of mental health and wellbeing amongst medical staff;
2. Creating a caring and supportive culture that prevents psychological distress in the workplace;
3. Identifying and supporting doctors with mental illness;
4. Building strategic partnerships to achieve workplace wellbeing; and
5. Supporting research to improve our understanding of workplace wellbeing.

Projects are being developed for each goal based on needs identified through the workshop and surveys, and targeting high risk groups identified in the National Mental Health Survey.

Some of the key projects include:

1. Junior Medical Staff Peer Support Program - evidence from educational institutions shows that students are more likely to seek support from a peer if feeling worried or under stress, and that effective peer relationships can act as a buffer to the stresses of daily academic life. We know that doctors do not seek help from their seniors or from management when they experience psychological distress for fear of jeopardising their career prospects. The Peer Support Program is designed to offer psychological first aid by trained peers in a confidential and safe environment. A peer will be available to discuss a range of issues including career guidance, dealing with exam pressures, workplace interactions/conflicts, navigating work environment, and provide advice when something goes wrong. They will also be able to provide information on services and supports available.

2. Perinatal Support Program - this program will raise awareness about perinatal emotional and mental health, and provide support to male and female doctors to manage the demands of work and life during the
perinatal period.

3. Workplace Wellbeing Officer - a dedicated part-time position has been created to support the Strategy. The Wellbeing Officer is a point of contact for junior doctors experiencing workplace stress and will support them to resolve the situation or refer them appropriately.

4. Optimising the use of the Employee Assist Program - Employee Assist Programs are available in most workplaces but are underutilised by doctors. There is a drive to raise awareness of the resource amongst doctors, and understanding and addressing the barriers to its use.

There will be projects to engage the support and expertise of partners like beyondblue, the Australian Medical Association, the Victorian Doctors Health Program and Monash University, to support the Strategy.

A base line wellbeing survey is being planned for March 2015 and will be repeated every six months to evaluate the change. We are committed to Monash Care for the long-term and Monash Health is proud to be a pioneer in this field. The focus now is to build on the initial good-will and optimism the launch has generated, and deliver on the projects that have been planned.

However, the Workplace Mental Health and Wellbeing Strategy can only partially address the problem. Creating a happy and mentally healthy workplace is a shared responsibility of both the employer and the employee.

Jeff Kennett put this aptly at his speech at the launch: “These programs that you are setting up are terribly important but they are not going to address the fundamental issue which is how you approach your own life and deal with stress and anxiety. It is therefore very important that what you are doing in the hospital network continues to be advanced and we can measure change but don’t believe it is all up to them who are showing leadership and implementing these programs to provide you with the totality of opportunity of getting your yins and yangs right. We have to be better at looking after ourselves; we have to accept more responsibility for our own lives. Dealing with those things that cause us stress and anxiety. Reaching out for help when we can’t resolve those.”

We are extremely excited about this new initiative and look forward to working with Monash doctors to implement the Strategy and create a mentally healthy workplace where employees can thrive. We sincerely thank the Monash Health Board, Executive and the Senior Medical Staff Association for their endorsement, and the Australian Medical Association for their support.

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