Change and courage needed to tackle mental illness in medicine
Author: Dr Kunal Luthra, President, DiTs subdivision
This article features in the June/July 2017 edition of Vicdoc.
Let us begin with a straightforward proposition: that it is unacceptable for the demands of work and training to be contributing to the suicides of junior doctors.
Of course, every individual scenario is complex. It is not our place to pry further into the personal lives of those in our profession who have so tragically taken their own lives this year. Work as a doctor may not always be the sole or even the dominant contributor. But we would be naïve to think that the reality of medical training does not play any role at all in exacerbating mental illness.
Because sadly, the news that doctors and medical students suffer a comparatively higher burden of mental illness is not new. The 2013 beyondblue National Mental Health Survey of Doctors and Medical Students reported 12.3% of interns and 12.4% of trainees surveyed had suicidal thoughts in the previous year.
That is one of every 10 interns you see scurrying around a hospital attending to patients while managing seemingly endless administrative tasks. One of every 10 physician trainees working regular unpaid overtime and then using their remaining waking hours studying for looming exams. One of every 10 unaccredited surgical registrars working even longer hours with the suffocating knowledge that they swim amidst a tsunami of graduates who the training system was unprepared to support.
As members of the medical profession, it is very much our place to deeply contemplate the way in which the demands of employment as a junior doctor can drive bright and capable young women and men to end their lives. It is our place to call out the unreasonable rostering, the lack of flexibility and the training bottleneck. It is our place to identify the contributory factors, and to raise them at all levels from hospital administration to Federal Government, as a matter of urgency.
Because it is unacceptable that lives have already been lost.
We must begin to ask frank and sometimes difficult questions. How do some workplaces and training programs sink vulnerable individuals into the depths of mental illness? What support services exist to pull those who suffer from mental illness back into good health? And what barriers may prevent people from accessing these services when they need them the most?
It could be a misallocation of resources that results in some units being unmanageably understaffed while others are overstaffed. It could be inflexible rosters that force doctors to sacrifice and neglect their personal lives on a regular basis. It could be a lack of investment into training places that leave intelligent, conscientious doctors feeling like there may not be any light at the end of their training tunnel. It could be the fear of accessing support services in case confidentiality is breached, or in case one’s registration comes into question.
There is not enough space here to explore all the possible answers. Individually, each point is complex. Training must be difficult to ensure the quality of trainees. Some training positions may be scarce because community need is not high enough. Hospital budgets are tight, and sometimes reinforcements simply cannot be found for understaffed units. And reporting doctors with mental illness is ultimately aimed at maintaining public safety.
But rather than succumbing to such counterarguments, perhaps we ought to dig deeper to find more nuanced solutions. There are certainly examples of healthy workplace policies in many hospitals – we should champion and emulate these. It is our duty to our colleagues to do so. Because it is unacceptable for the demands of working in this profession to be a contributing factor to the suicide of any junior doctor. Change is needed, and we must demonstrate the courage to make difficult changes for a far more noble cause than the tightness of hospital budgets: the lives of this country’s medical trainees.
The AMA has a crucial role to play in this space. In January 2015 we, as a community, had a discussion on mental health in medicine in sadly similar circumstances. Let us hope that we are not discussing this same issue again in a year or two years’ time without having seen tangible change.
Support services for doctors
AMA Victoria provides peer support for doctors by doctors. For anonymous and confidential support call the AMA Victoria Peer Support Service on 1300 853 338 (for the cost of a local call). It’s available 365 days of the year from 8am to 10pm.
The Victorian Doctors’ Health Program (VDHP) is a confidential service for doctors and medical students who have health concerns such as stress, mental health problems, substance use, or any other health issues. Sensitive to the needs of doctors and medical students, it’s a non-judgmental service dedicated to improving the health and wellbeing of those within the profession. Call (03) 9495 6011.
First Response is a free, confidential telephone support service for all Victorian doctors who may be facing workplace bullying, discrimination or harassment. First Response is part of AMA Victoria’s strategy – Setting the Standard. For support, counsel or advice on your rights and options, call First Response on 1300 AMA DOC (1300 262 362).