Strategies for NSW Medical Colleges - final
release
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I am pleased to present this
strategic document to each of the NSW Medical Colleges. The document is
intended as a resource for Colleges addressing the recommendations
included in the NSW Doctors' Mental Health Policy. That Policy was
developed in response to the Report of the Doctors Mental Health Working
Party, published in October 1997.
These strategies are intended as a
guide for each of the Medical Colleges, and are intended as a resource
whereby each College can look to implement the recommendations made in the
Doctors' Mental Health Policy. Medical Colleges are expected to take
responsibility for promoting and maintaining the mental health of their
members, including those training for College Fellowship. You will find
listed in this document a comprehensive range of resources currently
available to support your College in implementing the Doctors' Mental
Health Policy, along with recommendations relating to the promotion and
maintenance of good mental health among your members. Additionally, there
are strategies designed to support College members affected by mental
health problems, including assistance and rehabilitation strategies.
I wish to commend this document to
each of the Medical Colleges. Each College should ensure that there are
mechanisms in place to support the mental health of members. Programs that
emphasise the need for good mental health should be a part of ongoing
professional development. Please ensure that your state organisation
addresses the recommendations contained in the Doctors Mental Health
Policy and ensures that appropriate strategies are in place.
Sincerely,
David Storey
Chairman
NSW Committee of College Chairmen
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The aims of the Strategies for
NSW Branches of Medical Colleges are to:
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promote and maintain the mental
health and well being of vocational trainees and members of medical
colleges
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assist medical colleges with the
implementation of the Doctors’ Mental Health Policy.
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The objectives of the Strategies
for NSW Branches of Medical Colleges are to:
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confirm the role of colleges
in supporting members and affiliated trainees
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create a positive training
environment that promotes the well being of trainees and provides
support for trainees seeking assistance for mental health or stress
related problems
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encourage and support a mode
of professional practice that promotes openness and acknowledges
problems associated with professional decision making;
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encourage trainees and college
members to create a balance between their professional and personal
lives, and provide acknowledgement of the need for a balanced life
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encourage a culture of ‘caring
for colleagues early’ with the intention of preventing problems
reaching a crisis
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ensure confidential assistance
and support for trainees and members with identified or suspected
mental health or stress related problems.
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The NSW Doctors’ Mental Health
Program endorses a broad definition of mental health problems which
includes stress related problems, mental disorders (most commonly
depression and anxiety), and alcohol and other drug abuse. The Program
emphasises the promotion of mental health and well being among doctors.
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Stress is defined as the physical,
emotional and mental strain which results from a three way relationship
between demands on a person, that person’s response to those demands and
their ability to cope with those demands (Bynoe G., 1994). This definition
captures the essence of stress in medical practice as being a dynamic
process that changes in quality and quantity in response to internal and
external factors (RCGP, 1998).
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Medical colleges have a
responsibility for members and affiliated trainees. This includes trainees
who for some reason do not progress through to completion of the college
training program.
Some medical colleges already have
programs or committees that are specifically concerned with the mental
health and related needs of their members and affiliated trainees. However, this is by no means universal and the specific needs of
affiliated trainees are often not addressed. If a suitable committee is
not already in place, medical colleges should consider the establishment
of a committee to oversee the implementation of the strategies listed in
this document.
In determining programs and
procedures for the implementation of strategies, each medical college
should examine existing programs and procedures and ensure that all
sections of the college are working towards the above objectives.
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Other resources that may be
mobilised to assist with issues related to the mental health of doctors
include:
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College Directors of
Postgraduate Training and college appointed supervisors
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‘Training Advisors’ and
‘Mentors’ (see 1.2 and 1.3 below) or other clinical colleagues
with an interest in the health and professional concerns of junior
doctors
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Medical college quality
improvement programs
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Continuing education programs
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Committee of Chairmen of NSW
Branches of Medical Colleges
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Committee of Presidents of
Medical Colleges
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In addition, the independent
organisations listed below are concerned with the mental health of
doctors:
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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. It will arrange specialist treatment in a discreet
and expeditious manner as required. A member of the first call panel
can be contacted on (02) 9437 6552.
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The Medical Benevolent
Association (MBA) of NSW employs a non-medical counsellor to provide a
non-judgmental counselling service and interim financial assistance
for doctors and their families in times of stress. Donations and
bequests from the profession fund the MBA. The contact number for the
MBA is (02) 9419 7062 and website www.mbansw.org.au.
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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 and risk
management.
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Unions and professional
organisations 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. 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
college members and affiliated trainees. The contact number for the
NSW Medical Board is (02) 9879 6799.
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With respect to vocational
trainees (registrars) medical colleges are asked to implement the
following strategies:
1.1
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Encourage all trainees to
have a general practitioner.
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1.2
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Develop formal systems of
support for trainees, preferably involving respected clinicians who
act as ‘Training Advisors’. Individual colleges may have
different titles for these positions but certain general principles
should apply. These ‘Training Advisors’ should not be directly
involved in the assessment of an individual’s progress through
training. These positions are in addition to clinical supervisors
who have defined supervision and assessment responsibilities. Each
"Training Advisor" would have responsibility for a number
of trainees over the period of their training and would liaise with
each trainee on a regular basis. At these meetings training goals,
career decisions and continuing personal and professional
development should be addressed. College Directors of Clinical
Training or Training Coordinators should allocate ‘Training
Advisors’. Both ‘Training Advisors’ and Training Coordinators
require continuing professional development to assist them in these
roles.
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1.3
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Offer mentorship programs.
Whereas ‘Training Advisors’ should have a defined role and
should be allocated by the College, ‘Mentors’ should be offered
as respected and experienced clinicians who are happy to advise
trainees on a range of personal and professional development issues.
Trainees should be encouraged to access one or more ‘Mentors’,
and should understand that contact is informal and not monitored by
the relevant College Training Program.
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1.4
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Assist with normalising the
seeking of help by trainees. Trainees need to be assured that
seeking help will not jeopardise their examination or career
prospects.
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1.5
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Provide education sessions
that promote acceptance of stress management as a necessary personal
skill.
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1.6
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Provide training sessions on
communication and conflict resolution skills to help trainees deal
with the range of roles they will encounter in their professional
career, including relationships with patients, and colleagues of all
disciplines.
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1.7
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Develop procedures which
encourage doctors to discuss mistakes in an open and supportive
environment. It is important that mistakes are not discussed
publicly and when emotions are heightened. Regular reviews of work
practices should be an integral component of doctors’ professional
lives.
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1.8
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Promote discussion of mental
health and stress related problems among doctors as a core issue for
registrar associations, where they exist.
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1.9
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Ensure entry and exit
criteria to training programs are transparent and non-discriminatory
(see Brennan report "Trainee Selection in Australian Medical
Colleges", 1998).
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1.10
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Review the philosophy
underlying college training and examination, with a view to
minimising unnecessary stress associated with current procedures.
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1.11
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Establish programs for
counselling trainees who fail their examinations.
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1.12
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Review the failure rate of
trainees and identify any defects in examination preparation or
procedures that may be contributing to unnecessary stress and
examination failure.
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With respect to college members, medical colleges are asked to
implement the following strategies:
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1.13
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Encourage all college
members to have a general practitioner.
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1.14
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Encourage college members to
participate in programs that improve awareness of personal health
issues. This could be included in Continuing Medical Education (CME)
programs.
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1.15
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Develop mechanisms to ensure
members working in rural areas are not isolated from their medical
colleagues. This may include encouraging rural members to
participate in CME programs and other college related activities.
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1.16
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Provide opportunities for
college members to learn the skills required for teaching and
supervision and for these skills to be assessed.
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1.17
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Provide seminars on
communication and conflict resolution skills to enhance college
members’ 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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Medical colleges are asked to work
collaboratively with Area Health Services in a coordinated fashion to
implement the following strategies:
2.1
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Develop procedures for
responding to identified and suspected mental health problems and
inappropriate behaviour among college members and affiliated
trainees. If an assessment is required, referral should be made to
services external to the doctor’s employment and training to
ensure that confidentiality and privacy are safeguarded. These
services may include the doctor’s general practitioner or the
Doctors’ Health Advisory Service.
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2.2
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Provide educational programs
for all doctors about the importance of recognising early warning
signs and the value of early intervention for mental health and
stress related problems.
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2.3
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Provide educational 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 educational programs
about doctors’ role in ‘looking out for colleagues’ and
encouraging them to seek treatment if required.
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2.5
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Provide educational programs
about stigma and discrimination in relation to mental health
problems and promote psychiatry as a discipline possessing effective
tools for the treatment of mental health problems. Doctors with
mental health and stress related problems should be supported, not
penalised or discriminated against.
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Medical colleges are asked to work
collaboratively with the Doctors’ Health Advisory Service and the
NSW
Medical Board to implement the following strategies:
3.1
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Develop procedures that
ensure the confidentiality of all matters related to a doctor’s
mental health or stress related problem.
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3.2
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Encourage doctors to seek
treatment when required. To ensure confidentiality it is advisable
that doctors access services that are not associated with their
employment or training.
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3.3
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Consider the development of
an advisory service for college members and affiliated trainees.
For
example, the Royal Australasian College of Surgeons has a Health
Advisory Bureau with a toll free number. The caller is referred to a
panel member (a surgeon) for ‘first aid and triage’. The panel
member may also provide ongoing support to the person seeking
assistance.
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3.4
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Develop procedures for the
confidential referral of doctors displaying impairment (as defined
in the NSW Medical Practice Act, 1992) to the NSW Medical
Board. Ensue all doctors 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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3.5
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Ensure follow up and support
for families, friends and colleagues of college members and
affiliated trainees who are impaired or have suicided.
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Medical colleges are asked to work
collaboratively with Area Health Services and the NSW Medical Board to
implement the following strategy:
4.1
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Develop a statewide program
for the provision of supervised re-skilling and rehabilitation posts
for doctors returning to the workforce. The Department of Health has
advised that it is possible for the NSW public sector health system
to provide supervised posts for medical practitioners in private
practice. However, it would not be possible to guarantee
remuneration to the practitioner by the Area Health Service. Each
case would depend on the nature of the work undertaken during
supervision and the needs of the Area Health Service.
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Medical colleges are asked to
implement the following strategy:
5.1
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Support research into
factors affecting the mental health of doctors and the development
of effective health promotion and treatment programs.
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Bynoe G. (1994) Stress in Women
Doctors, British Journal of Hospital Medicine, 51 (6): 170-173.
Stress and General Practice (1998)
RCGP Information Sheet No. 22.
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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 web site.
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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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First edition: November 1999
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
Medical Colleges (http://www.dmh.org.au/dmh/strat_medcoll.htm) [date
accessed]
Last revised: 20 April 2004 16:05
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