|
|
|
Mental health problems are common
in the Australian population, and medical practitioners and students
are in no way immune to them. On the contrary, because of their high
workload and study requirements, they are probably particularly
vulnerable. It is important that doctors and medical students be
encouraged to pay due attention to their own mental health needs,
including those relating to mental health, and to seek assistance when
necessary.
We, the three deans of Medicine in
NSW, endorse the initiative of the NSW Doctors’ Mental Health Program in
producing a set of strategies relating to mental health which will be of
value in our medical schools.
Professor Stephen Leeder
Dean, Faculty of Medicine
University of Sydney
Professor Bruce Dowton
Dean, Faculty of Medicine
University of New South Wales
Professor Rob Sanson-Fisher
Dean, Faculty of Medicine and Health Sciences
University of Newcastle
|
|
|
The aim of the Strategies for
Medical Schools are to
 |
promote the mental health and
well-being of medical students
|
|
assist medical schools with
implementation of the Doctors' Mental Health Policy.
|
|
|
|
The
objectives of the Strategies for Medical Schools are to
| promote a culture within medical
schools which emphasises the importance of personal mental health and
well being during medical school years and throughout the whole
of one’s professional life |
| identify specific personnel for
students requiring personal assistance |
| encourage a culture of ‘caring
for students early’ with the intention of preventing problems
reaching a crisis |
| develop and maintain procedures
that assist and encourage medical students with mental health or
stress related problems to seek appropriate and confidential help. |
|
|
|
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.
|
|
|
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).
|
|
|
Major changes have taken place in
medical schools in NSW in recent years. In particular there has been an
increased emphasis on experiential learning and communication skills.
Medical schools should ensure a
unified and co-ordinated approach to promoting the mental health and well
being of students by establishing and maintaining an environment of positive
support.
Students should be aware of existing
internal and external services that can assist with mental health and stress
related problems. The universities and clinical schools should ensure that a
mechanism exists to coordinate and communicate information about these
services to students and their advisers.
|
|
|
Assistance with mental health
and stress related problems can be obtained from personnel within the
university and teaching hospital campuses.
University campuses
|
University health services
|
|
University counselling services
|
|
Medical Sub-Deans
|
Teaching hospital campuses
|
Heads of Clinical Schools and
other nominated faculty staff
|
|
Individual mentors or
independent student advisors where available
|
|
Staff counselling services and
employee assistance programs
|
|
|
|
All medical students and medical
practitioners should have their own general practitioner. A variety of other
external services are also involved in students' mental health and well
being.
|
The Doctors' Health Advisory
Service (NSW) (DHAS) provides a referral service for medical students
and medical practitioners who are experiencing personal or career
related difficulties. The DHAS is an independent organisation and has
strict rules regarding confidentially. It will arrange specialist
treatment in a discreet and expeditious manner as required. A member of
the ‘first call’ panel is always available on (02) 9437 6552.
|
|
The Medical Benevolent
Association (MBA) of NSW employs a non-medical counsellor and provides a
non-judgmental counselling service and interim financial assistance for
medical students and medical practitioners, and their families in times
of stress. Donation and bequests from the profession fund the MBA. The
contact number for the MBA is (02) 9419 7062.
|
|
Medical defence organisations
provide counselling to students in relation to personal and professional
conduct.
|
|
The NSW Medical Board has a
particular role and function with respect to impaired medical students.
The Board also has a strong commitment to early intervention and the
provision of support and rehabilitation for these students. The
mechanisms to obtain confidential advice and assistance from the NSW
Medical Board should be understood within each medical school. The
contact number for the NSW Medical Board is (02) 9879 6799.
|
|
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.
|
|
Medical Schools are asked to
implement the following strategies.
1.1
|
Ensure a faculty structure is
created that is responsible for the design and maintenance of an
education program that promotes the mental health of students. The
theme of this program should pervade the entire medical school course.
The program should be assessed as with all other components of the
curriculum, but in a manner that is appropriate to the topic.
Participation rather than examination maybe the most suitable form of
assessment for this program. The program should include the following
topics.
a) Communication and
listening skills required for working with patients and their
families, colleagues, administrators, lawyers and journalists.
b) Preparation for a
number of roles, including clinician, consultant, advocate,
educator, supervisor and patient.
c) Identification of the
social and psychological factors that can lead to stress related
problems, recognition of early warning signs and the value of
early intervention. For example, problems such as fatigue,
overwork, irritability and anger can all translate into stress
related problems.
d) Recognition of healthy
lifestyle practices (related to nutrition and exercise and the use
of alcohol, nicotine and other drugs) and the importance of
developing and maintaining interests outside of medicine.
e) Training in the
development of strategies to manage change and stressful events.
f) Identification of
specific mental health problems (for example, eating disorders,
anxiety, depression and substance abuse) common among medical
students and medical practitioners.
g) Recognition of the
stigma and discrimination associated with mental health and stress
related problems and promotion of psychiatry as a discipline
possessing effective tools for the treatment of mental disorders.
h) Recognition of the
importance of medical students and medical practitioners having
their own general practitioner, the importance of regular medical
check-ups and the dangers of self-diagnosing and prescribing.
i) Recognition of mental
health and stress related problems in fellow medical students and
the importance of supporting and assisting fellow students.
j) Recognition of the
impact of medico-political, legal and ethical issues and the
rationing of health budgets on medical practitioners’
professional lives.
|
1.2
|
Promote good study habits,
exam techniques and other coping skills such as stress management.
This will also benefit students during post-graduate examinations.
|
1.3
|
Assist students requesting or
requiring a general practitioner by facilitating contact with local
general practitioners or general practitioner organisations.
|
1.4
|
Develop a mentor or peer
support program for students. This could include a ‘buddy’ system.
These programs require considerable care in their establishment and
maintenance. They should ensure confidentiality and be co-ordinated by
the clinical schools.
|
1.5
|
Ensure a mechanism exists for
the preparation and supervision of mentors or peer support personnel.
These people should be volunteers and student feedback should guide
the selection and matching process.
|
1.6
|
Provide education for
potential medical school applicants which realistically describes the
responsibilities and lifestyles of medical practitioners. For example,
the need for physical and mental stamina, and good coping and
communication skills should be emphasised.
|
|
Medical Schools are asked to
implement the following strategies.
2.1
|
Appoint a faculty Student
Coordinator whose role includes the identification of a ‘key staff
member’ and/or an independent student advisor at each university and
clinical school to whom students can go for confidential assistance.
Any person nominated for such a role should be accessible to and
respected by students, and independent of decisions related to
students' academic progress. Consideration of gender and the
needs of minority groups should influence selection. ‘Key staff
members’ and independent student advisors should be offered
education about mental health and stress related problems.
|
2.2
|
Reinforce the concept that all
academics, while being primarily responsible for the development of
clinical skills, should assist with the identification of students
with mental health or stress related conditions. If a problem is
suspected the academic has a responsibility to contact the Student Co-ordinator (in 2.1 above).
|
2.3
|
Facilitate referral of
students for assistance, where required, away from the university or
clinical schools to ensure their confidentiality is safeguarded and
future career paths are not compromised. Medical students should be
advised to seek assistance from their general practitioner or the
Doctors' Health Advisory Service.
|
|
Medical schools are asked to
implement the following strategies.
3.1
|
Develop or identify existing
procedures that ensure confidentiality of matters related to medical
students’ mental health or stress related problems.
|
3.2
|
Educate students and staff
about the confidential service provided by the Doctors' Health
Advisory Service for medical students and medical practitioners.
|
3.3
|
Educate students about the
counselling and financial support services provided by the Medical
Benevolent Association of NSW.
|
3.4
|
Educate students about the NSW
Medical Board's non-punitive approach to impaired medical students and
medical practitioners and its emphasis on support and rehabilitation.
|
3.5
|
Develop or identify existing
procedures for the referral of medical students displaying impaired
judgement (as defined in the 1992 NSW Medical Practice Act) to the NSW
Medical Board.
|
3.6
|
Ensure information is
available about post suicide and para-suicide support for the families
and friends of students involved in these incidents.
|
3.7
|
Identify mechanisms to
facilitate sensitive group support and debriefing for students (and
involved staff) following serious mental health incidents such as
suicide attempts.
|
|
Medical schools are asked to
implement the following strategies.
4.1
|
Develop or identify mechanisms
for close supervision of clinical studies for students returning to
their studies. This would occur in consultation with students’
carers.
|
4.2
|
Ensure counselling is
available for students requiring or considering a career change.
|
|
Medical schools are asked to
implement the following strategy.
5.1
|
Support research into factors
affecting the mental health of medical students and the development of
effective health promotion and treatment programs.
|
|
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.
|
|
Organisations
represented on the NSW Doctors’ Mental Health Implementation Committee
|
Other NSW Doctors’
Mental Health Program documents
|
Consultant to NSW
Doctors’ Mental Health Program
|
Susan Johnston
Susan Johnston Consultancy Services
|
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.
|
Contacts for Health Care Services
|
For
hard copies of any of the NSW Doctors’
Mental Health Program documents, contact:
|
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 Schools (http://www.dmh.org.au/dmh/strat_medsch.htm) [date accessed]
Last revised: 20 April 2004 16:04
|
