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Awareness of the mental health
needs of the medical profession has been raised by the work of the NSW
Doctors Mental Health Implementation Committee. The committee has produced
the Doctors' Mental Health Policy, a framework for addressing the mental
health needs of doctors.
This report Strategies for Area
Health Services was developed in the context of the policy. The Strategies
will assist Area Health Services to implement the policy.
The thrust of the Strategies is
the creation of a positive work environment that promotes the well-being of
medical staff and facilitates access to support, counselling and treatment
where required. The emphasis remains on the promotion of good mental
health whilst acknowledging the importance of receiving rapid,
confidential treatment for mental disorders.
I am pleased to endorse the
Strategies for Area Health Services as part of the NSW Doctors Mental
Health Program.
Deputy
Premier
Minister for
Health
Minister for Aboriginal Affairs
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The aim of the Strategies
for Area Health Services is to assist Area Health Services to implement
the Doctors' Mental Health Policy.
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The objectives of the Strategies
for Area Health Services are to:
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create a positive work
environment that promotes the well being of medical staff.
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encourage a responsive work
culture that promotes openness by acknowledging problems or mistakes
and provides appropriate support.
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encourage medical staff to
create a balance between their professional and personal lives and to
encourage organisational acknowledgment of this.
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In determining appropriate
procedures and programs for the implementation of strategies each Area
Health Service should examine existing procedures and programs and ensure
that all sections of the organisation are working towards the common
objective of a positive and supportive environment.
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Some of the existing resources
that may be mobilised to assist with issues related to the mental health
of doctors include:
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Directors of Clinical Training
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Directors of Postgraduate
Training for each specialty
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Staff counselling services and
Employee Assistance Programs
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Department Heads and Medical
Directors
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Medical Staff Council
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Individual mentors or
appropriate clinical colleagues with an interest in the health and
professional concerns of junior doctors
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Human resources staff with
knowledge of Equal Employment Opportunity, anti-discrimination and
affirmative action
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Occupational health and safety
and risk management units
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Quality improvement programs
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In most Area Health Services there
are mechanisms by which these various people come together but, because of
the very nature of hospitals and health services, it is not usually a
single structure. In implementing the strategies, Area Health Services
should ensure that there is a mechanism by which the roles of the above
services are communicated to medical staff. An orientation program for
newly appointed medical staff would be one such mechanism.
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All doctors should be encouraged
to have their own general practitioner. A variety of other external
services are also involved in issues related to doctors' mental health and
well being:
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The NSW Postgraduate Medical
Council addresses specific issues regarding training and supervision
of interns and residents in hospital settings. A core objective of the
Council is to create a positive culture for junior medical staff.
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The Doctors' Health Advisory
Service (NSW) (DHAS) provides assistance to colleagues who are
experiencing personal or professional difficulties. The DHAS is an
independent organisation and has strict rules regarding
confidentiality. The DHAS will arrange specialist treatment in a
discreet and expeditious manner if required. A member of the first
call panel is always available on (02) 9437 6552.
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The Medical Benevolent
Association (MBA) of NSW employs a non-medical counsellor to provide
non-judgemental counselling and interim financial assistance for
doctors and their families in times of stress. The MBA is funded by
donations and bequests from the profession. The contact number for the
MBA is (02) 9419 7062.
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Medical defence organisations
provide support for doctors facing medical litigation or disciplinary
inquiries. There is an increasing focus on the emotional and
professional impact of these stressful circumstances.
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and HREA] provide advice and
support to members about working conditions and occupational health
and safety issues.
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Private sector organisations
or individuals provide a range of personal and work related advice or
support and their value should not be underestimated. Services include
personal health care, financial advice and practice management advice.
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The NSW Medical Board has a
particular role and function with respect to impaired medical
practitioners. The Board has a strong commitment to early intervention
and the provision of support and rehabilitation. The mechanisms to
obtain this confidential advice and assistance should be understood by
all doctors.
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1. Promotion of doctors’ mental
health and well being
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1.1 Supportive working environment
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Area Health Services are asked to:
1.1.1
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provide resources for
doctors, such as common rooms, which encourage a supportive and
convivial working environment.
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1.1.2
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assist with normalising the
seeking of help by doctors. Junior doctors, in particular, need to
be assured that seeking help will not jeopardise their career
prospects.
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1.13
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provide opportunities for
training in communication and conflict resolution skills with the
aim of enhancing relationships with patients and colleagues of all
disciplines. These sessions should stress the importance of doctors
working in collaboration with their colleagues.
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1.1.4
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develop procedures which
encourage doctors to discuss mistakes in an open and supportive
environment. The review of work practices with a view to improvement
should be an integral component of doctors' professional lives.
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1.1.5
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develop procedures that
ensure junior doctors are only responsible for tasks for which they
are qualified. Junior doctors should not be left with difficult
situations without adequate support, such as talking to families
about the death of a patient or talking to patients about major
issues related to their health.
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1.1.6
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develop communication
procedures that ensure relevant information reaches all medical
staff and establish mechanisms to receive and deal with responses.
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1.1.7
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provide an effective
complaints procedure for assisting with the resolution of grievances
by doctors.
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1.1.8
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provide job descriptions
that clearly define each doctor's clinical and administrative lines
of responsibility.
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1.1.9
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provide formalised
mechanisms for the review of doctors in a supportive environment.
These may include supervision programs, mentor programs, peer review
programs and staff appraisals.
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1.1.10
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ensure supervisors and
mentors are trained to adequately respond to mental health and
stress related problems among doctors'.
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Area Health Services, through the
Directors of Clinical Training are asked to:
1.2.1
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develop an orientation
program for junior medical staff that assists them in preparing for
the expectations required of them when they begin work in hospitals.
The orientation program should include 'making the most of
supervision from senior medical staff '.
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1.2.2
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provide training sessions in
stress management and healthy lifestyles in association with others
responsible for educational programs. Opportunities for interns and
residents to discuss the stresses they experience, and strategies
for dealing with those stresses, is an important component of such
training. This training should also include the:
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importance of having
your own general practitioner
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dangers of self
prescribing
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risk of substance abuse
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ability to recognise,
acknowledge and deal with mental health and stress related
problems
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importance of developing
and maintaining interests outside medicine
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need for adequate
exercise and nutrition
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importance of regular
holidays
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stress related to role
transition and increasing levels of responsibility.
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1.2.3
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facilitate meetings of
interns and residents aimed at fostering peer support and providing
a forum for presentations from senior colleagues. Local medical
organisations such as the Division of General Practice could be
invited to such meetings.
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1.2.4
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facilitate seminars on
career guidance and planning.
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Area Health Services, through the
Directors of Postgraduate Training for each specialty, are asked to:
1.3.1
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make adequate provision for
registrar training and examination preparation in consultation with
the medical colleges.
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1.3.2
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ensure medical
administrators, supervisors and mentors are aware of the pressures
associated with vocational postgraduate training and assessment and
provide adequate support.
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1.3.3
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provide career guidance for
those who change their career choice or fail to progress in the
training program.
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Career Medical Officers,
unstreamed residents and registrars in non-accredited positions are likely
to increase in number in the near future and are at risk of failing
between existing training structures.
Area Health Services are asked to
appoint Professional Support Directors, with roles similar to that of
Directors of Clinical Training, to:
1.4.1
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provide career guidance for
these groups of doctors.
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1.4.2
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provide training sessions in
stress management and healthy lifestyles in association with others
responsible for educational programs. Opportunities for these groups
of doctors to discuss the stresses they experience, and strategies
for dealing with those stresses, is an important component of such
training. This training should also include the:
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importance of having
your own general practitioner
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dangers of self
prescribing
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risk of substance abuse
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ability to recognise,
acknowledge and deal with mental health and stress related
problems
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importance of developing
and maintaining interests outside medicine
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need for adequate
exercise and nutrition
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importance of regular
holidays
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stress related to role
transition and increasing levels of responsibility.
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Area Health Services are asked to:
1.5.1
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ensure senior medical staff
participate in programs that improve awareness of personal health
issues.
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1.5.2
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provide opportunities for
senior medical staff to learn teaching and supervision skills.
While
a number of supervision programs currently exist these need to be
further developed and evaluated.
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1.5.3
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ensure that senior medical
staff are aware of their responsibilities towards junior medical
staff with respect to teaching and supervision.
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Area Health Services are asked to:
2.1
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provide education programs
for all doctors about the importance of recognition of early warning
signs and the value of early intervention for mental health and
stress related problems.
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2.2
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provide education programs
about stigma and discrimination in relation to mental health
problems. Psychiatry should be promoted as a discipline possessing
effective tools for the treatment of mental health problems.
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2.3
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provide education programs
about doctors' responsibility to monitor their own emotions and
behaviour and to seek help if they suspect mental health or stress
related problems.
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2.4
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provide education programs
about doctors' role in 'looking out for colleagues' and encouraging
them to seek treatment if required. The responsibility of the
medical profession to its member colleagues is addressed further in
the Strategies for Medical Colleges
of the NSW Doctors' Mental Health Program.
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2.5
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develop procedures for
investigating identified and suspected mental health problems and
inappropriate behaviour among doctors. Referral for assessment
should be made to external services that ensure confidentiality and
privacy is safeguarded. These services may include a doctor's
general practitioner or the Doctors' Health Advisory
Service.
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Area Health Services are asked to:
3.1
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develop procedures that
ensure the confidentiality of matters related to a doctor's mental
health or stress related problems.
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3.2
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encourage doctors to seek
treatment from services that are not associated with their
employment or training.
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3.3
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develop procedures for the
referral of doctors displaying impairment (as defined in the NSW
Medical Practice Act, 1992) to the NSW Medical
Board. All doctors
should have received information about the NSW Medical Board's non-punitive approach to impaired doctors and its emphasis on support
and rehabilitation.
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3.4
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ensure counselling and
support for families, colleagues and patients of doctors who are
impaired or have suicided.
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Area Health Services are asked to:
4.1
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work collaboratively with
medical colleges and other Area Health Services to develop a state
wide program for the provision of supervised re-skilling and
rehabilitation posts for doctors returning to the workforce.
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Area Health Services are asked to:
5. 1
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support research into
factors affecting the mental health of doctors and effective health
promotion and treatment programs.
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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 website address is www.dmh.org.au.
All NSW Doctors’
Mental Health Program documents are available on the website.
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Contacts for Health Care Services
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For
hard copies of any of the NSW Doctors’
Mental Health Program documents, contact:
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2nd Edition: November 1999
Unchanged since 1st Edition (October 1998),
except for acknowledgements, website address and contacts for health care
services.
Copyright
© 1998-2004.
Medical Benevolent Association of New South Wales. All rights reserved.
Citation suggestion:
Medical Benevolent Association of NSW, Doctors Mental Health Strategies for
Area Health Services (http://www.dmh.org.au/dmh/strat_ahs.htm) [date
accessed]
Last revised: 20 April 2004 16:05
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