DOCTORS
MENTAL HEALTH POLICY
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CONTENTS
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Recently,
awareness of the mental health needs of the medical profession has been
heightened. Vulnerability to stress, mental disorders such as
depression and, tragically, suicide is of concern to the NSW Government
and the medical profession. In an ongoing effort to promote the
mental health of doctors, the NSW Doctors' Mental Health Implementation
Committee was formed in 1997.
The Doctors
Mental Health Policy is the work of this Committee which has had wide
ranging contributions from all sectors of the medical profession.
The policy
emphasises that stress management and promotion of mental health should be
taught as an essential part of being a doctor. It strongly
recommends that doctors care for themselves and that the medical
profession take responsibility for its members. It is recommended
that all doctors have their own general practitioner. The Doctors
Health Advisory Service is endorsed as a confidential service for advice
on mental health and stress related problems. Awareness of the
early symptoms of mental disorders and the effectiveness of early
intervention is emphasised.
Strategies to
implement this policy are being developed for health services, medical
schools and learned colleges.
I am pleased
to endorse the Doctors' Mental Health Policy.
Deputy
Premier
Minister for
Health
Minister for Aboriginal Affairs
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The purpose
of the Doctors' Mental Health Policy is to provide a framework for the
implementation of strategies aimed at promoting the mental health and well
being of doctors and medical students. Implementation of the
strategies requires the commitment of both individuals (medical students
and doctors) and organisations (Area Health Services, medical colleges,
medical schools and other medical organisations).
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There have
been several recent developments that may have impacted on doctors' mental
health and well being. These include the rapid pace of change in the
health care system, growth in medical knowledge and technology and
accompanying ethical dilemmas, the political and economic uncertainty
affecting practice location and remuneration and the needs and
expectations of an increasingly informed public.
Day to day
occupational stresses may include heavy workloads, frequent on-call
responsibilities, management of private practices and concerns about
litigation. The ability to cope with day to day occupational
stresses differs from person to person. It is important to
acknowledge that some stress factors are controllable or can be modified
while others are outside the control of the individual.
A certain
level of stress, in a well supported environment, contributes to the
learning of new skills. However, stress can become overwhelming and
can lead to emotional or behavioural problems if it is not managed
properly. Similarly some personality attributes common among
doctors, such as commitment, competitiveness and perfectionism, can have
both positive and negative effects on mental health and well being.
Doctors, like the rest of the population, are also vulnerable to common
mental illnesses such as depression.
Achieving a
balance between professional and private lives is seen as a critical
factor in the maintenance of doctors' mental health and well being.
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A Doctors'
Mental Health Working Group was established in 1996 in response to an
apparent increase in medical practitioner suicides and growing concerns
about the levels of unrecognised and untreated stress and mental health
problems in NSW doctors. It was a joint initiative of the NSW Health
Department and the Australian Medical Association (NSW Branch).
Professor Beverley Raphael, Director, Centre for Mental Health, NSW Health
Department, convened the Working Group and its membership was drawn from
key medical organisations. The Working Group produced an important
report that was presented to members of the medical profession by Dr
Andrew Refshauge, NSW Minister for Health, in October 1997.
The Working
Group consulted widely and reviewed services offered to doctors and
medical students for mental health and related problems. The
subsequent report contained more than 80 recommendations covering the
following areas:
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Data
collection and research
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Promotion
of mental health and well being
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Early
detection and intervention
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Management
of mental health problems
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Follow
up.
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Central to
the recommendations in the report was the formation of the NSW Doctors'
Mental Health Implementation Committee. This committee,
established at the request of the NSW Minister for Health, comprises
representatives from all areas of the profession. A list of the
organisations represented appears at the end of this document.
The purpose
of the implementation Committee is to ensure the recommendations in the
Doctors' Mental Health Working Group report are implemented and to report
its progress to the NSW Minister for Health and the NSW Health Department.
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The
Implementation Committee endorses a broad definition of mental health
problems, which includes stress related problems, mental illnesses, and
alcohol and other drug abuse. It was further agreed that the work of
the committee should emphasise the promotion of mental health and well
being among doctors.
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The promotion
of the mental health and well being of medical students and doctors is not
only important for the well being of individuals and their families, it is
critical for the provision of quality health care.
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A healthy
medical workforce involves all doctors acknowledging their right to be a
patient and to receive timely and high quality medical care free from the
threat of negative consequences. It is important for all doctors to
have their own general practitioner and refrain from self-prescription of
drugs and 'corridor consultations' with colleagues.
The
management of doctors as patients requires special attention by treating
doctors to ensure normal doctor- patient relationships are maintained.
The workloads
and on call responsibilities of some doctors are excessive and need to be
self monitored to ensure clinical performance is not adversely
affected. Developing expertise in stress management techniques,
learning how to manage conflicting needs and maintaining contact with peer
medical groups for professional and social support will assist doctors to
monitor their work practices.
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The long and
intensive education and study required by medical schools and
uncertainties about career opportunities may contribute to mental health
and stress related problems among medical students. Medical schools
should support and promote the mental health and well being of students by
emphasising the importance of career guidance and a balanced and healthy
lifestyle. Stress management and the promotion of mental health
should be taught as 'part of being a doctor', not as an extracurricular
activity. In particular the stress related to role transition, such
as from medical student to intern, should be acknowledged.
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Both
employers and employees have a responsibility to ensure the workplace
provides a safe and healthy environment. Reasonable working
hours and reasonable breaks between shifts are important for both the
health of doctors and the quality of patient care. It is
acknowledged that doctors who have inadequate sleep and excessive
workloads may be putting the health of their patients at risk. The
principle that employers must ensure doctors in their employ have the
opportunity for adequate rest may soon be established in law.
The provision
of supportive structures and resources contribute to the mental health and
well being of doctors at work. These include adequate provision for
approved leave, clearly defined job descriptions, mentor and peer support
programs and adequate office facilities. Employers have a
responsibility to inform doctors of these supportive structures and
resources and of access to them.
An
environment that promotes a culture of honesty and openness is important
for positive working relationships between medical staff at all
levels. Further, doctors who acknowledge the contribution of other
staff, and work in a collaborative manner with them, also assist in
promoting a positive work environment.
Expectations
placed on junior medical staff should reflect their level of training and
experience. Workplaces should be free from harassment and
discrimination and provide effective procedures for the resolution of
legitimate grievances.
Doctors
should continue to strengthen their communication and listening skills and
understand the social context in which their patients live. A strong
doctor-patient relationship, characterised by honesty, sensitivity, good
communication and mutual respect, contributes to an effective therapeutic
alliance and promotes a less stressful working environment.
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Promotion of
an environment conducive to learning and the acquisition of skills is
critical to the successful training of healthy and competent
doctors. Senior medical staff responsible for junior medical staff
and registrars should be trained to undertake the important role of
clinical supervisor. They will then be in an ideal position to
assist and support doctors during their training. Further, a
positive training environment involves the participation of junior medical
officers and registrars in decisions directly related to their training
and practice.
The provision
of supportive structures and resources, such as examination counselling, a
mentor program and training about stress and mental health issues, will
contribute to doctors' mental health and well being. The privacy of
doctors seeking guidance and support should be protected to ensure that
such approaches are not perceived to, or in fact do not, jeopardise career
opportunities.
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Participation
in continuing medical education is an intrinsic part of professional life
as it provides an opportunity for doctors to keep up to date with current
professional issues and stay in touch with colleagues. The inclusion
of training sessions about mental health and stress related problems would
assist doctors to monitor their own mental health and well
being. Telehealth or video conferencing is supported as a
means of improving access to training for doctors in rural and remote
areas.
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It is vital
that mental health and stress related problems are identified and treated
at the earliest opportunity. Doctors may be particularly at risk of
not having a problem recognised through denial or concealment,
self-diagnosis and treatment or the reluctance of colleagues to suggest a
peer may be unwell.
Promotion of
open and honest discussion about mental health issues and treatment will
encourage doctors and medical students to seek assistance when
necessary. There are often early warning signs such as mood changes,
increased conflict at home or work, or increased use of alcohol or other
drugs. Education programs highlighting the importance of
recognition of early warning signs and the value of early intervention for
mental health and related problems will assist doctors to monitor their
own emotions and behaviour. As well as monitoring their own
behaviour doctors have a responsibility to 'look out for their colleagues'
and to assist with referral where necessary.
Referral for
assessment should be to services that ensure confidentiality is
safeguarded and future employment opportunities are not jeopardised.
The Doctors' Health Advisory Service (NSW) is recognised as an independent
and confidential referral service for doctors and medical students.
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All doctors
and medical students with mental health or stress related problems must be
encouraged to receive treatment and regular monitoring of their mental
health by a suitable health practitioner. Depression is a
common mental illness among doctors and can have debilitating
effects. The treatment for depression is highly effective and should
be commenced as early as possible. Doctors or medical students
requiring treatment, especially inpatient treatment, for mental health
problems should be encouraged to access services that are not associated
with their work or training.
The Medical
Benevolent Association of NSW is recognised as an independent and
confidential service providing counselling and financial assistance for
doctors, medical students and their families.
It should be
acknowledged that a doctor or medical student seeking mental health care
is not necessarily impaired. However, if a doctor does appear to be
impaired notification to the NSW Medical Board should be considered.
Confidential advice about the NSW Medical Board's non-punitive and
rehabilitative approach to impairment is available to all doctors.
The
development of rehabilitation posts for doctors requiring monitoring by
the NSW Medical Board's Impaired Registrants Program are supported.
Further, education and re-skilling programs for doctors returning to the
workforce, after a break for health reasons, should be developed and
supported.
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The standard
of mental health care and follow up for doctors and medical students
should be the same as for any other patient.
The stress on
the families and colleagues of doctors and medical students who have
mental health or stress related problems is acknowledged and appropriate
follow up support for these people should be considered.
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The
collection and collation of data relating to doctors' and medical
students' mental health and stress related problems should be improved and
co-ordinated. Research into factors affecting the mental health of
doctors and medical students, and effective health promotion and treatment
programs, should be supported by funding bodies and all organisations
involved in employment or training.
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Organisations
represented on the NSW Doctors’ Mental Health Implementation Committee
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Other NSW Doctors’
Mental Health Program documents
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Consultant to NSW
Doctors’ Mental Health Program
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Susan Johnston
Susan Johnston Consultancy Services
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The NSW Doctors’ Mental
Health Program web site address is www.dmh.org.au.
All NSW Doctors’
Mental Health Program documents are available on the website.
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For
hard copies of any of the NSW Doctors’
Mental Health Program documents, contact:
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Contacts for Health Care Services
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2nd edition November 1999
The content of the Policy has not
changed since the first edition (October 1998). Only acknowledgements, the web
site address and contacts for health care services have been added.
Copyright
© 1998-2004.
Medical Benevolent Association of New South Wales. All rights reserved.
Citation suggestion:
Medical Benevolent Association of NSW, Doctors Mental Health Policy
(http://www.dmh.org.au/dmh/Policy.html) [date accessed]
Last revised: 20 April 2004 16:05
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