Mental Health: Who doctors the Doctor?
by Mary McFadden
In our fast paced society, with the tolls and troubles of work (or the lack of it) it is no wonder people experience depression in their life. According to Aware, an organisation that assists those directly affected by mental illness, it is estimated that at any one time 280,000 people in Ireland suffer from depression. Judging by this information, anti-depressants could become an ever more common thing to see in medicine cabinets.
What is mental health anyway? How do we define it? The HSE states that mental health describes how we think and feel about ourselves and others and how we interpret events and activities in everyday life. It relates to our ability to deal with change, important events and the stresses of life. It refers to the emotional resilience to be able to enjoy life and the ability to survive through adversary. It covers pain, disappointment, sadness and it involves the level of belief in your own and others’ worth.
There are many helpful websites for those seeking treatment for mental health issues and in most cases they are effective for those that are brave enough to begin to tackle the problem. However, there is a group of people in our lives who we visit yearly, people who we wouldn’t think twice about and those who, for some reason, are viewed to be in perfect health just because of their profession. This group of people are doctors.
For many doctors, there are some who take the dangerous route of self-diagnosis. The majority of those with depression either don’t recognise the symptoms to figure out what they have, or they don’t want to accept it.
Medical Independent writer Dr. Anthony O’Connor has said, “It’s really important to talk about mental health in general, but because of the culture of innocence, if you’re a doctor then you’re seen as a healer and you don’t want to be seen as weak.”
Junior hospital doctors, otherwise known as NCHDs, have claimed they are working under such pressure that it is affecting the quality of care for their patients. These professionals say they could have shifts as long as 36 hours and they sometimes work 71 hours a week or more.
Dr. O’Connor taught two undergraduate medical students who subsequently ended their lives. He said, “Suicide is rarely down to just one thing so I can’t say for definite what their reasons were. What I can say is that junior doctors in particular are not known for having good mental health. There are barriers to getting help for them as they could be working thirteen hours a day and wouldn’t have the time to go and see a GP for help. So I wouldn’t say that suicide is due to any one factor or work or stress that a person doesn’t see a way out of, it can be a number of factors. However, I don’t think the way that doctors work breeds good mental health, and it’s important to acknowledge that.”
The effects of these working conditions have been logged as stress, extreme exhaustion, depression and suicide. A 2004 EU directive said that workers in the EU should work ‘no more than 48 hours per week’. However there is evidence that this is largely being ignored.
NCHD Dr Niall Kelly said, “There’s been times I was driving home, felt fairly tired and had to pull in at the side of the road and nap so I didn’t crash, and this has happened a couple of times. I could even fall asleep before I get out to the hospital car park from just working flat out shifts.”
The Irish Medical Organisation (IMO) has a role to represent doctors in Ireland and to provide them with all relevant services. It is committed to the development of a caring, efficient and effective Health Service.
Shirley Coulter, representing the IMO said, “The key objectives of the current junior doctors campaign, a campaign borne out of NCHD’s absolute despair at the soul destroying hours they are required to work to the detriment of patient care, are to limit the maximum shift length to 24 hours, limit the weekly average to EWTD compliant 48 hours while protecting training time and the removal of NCHD-inappropriate tasks.”
Trying to research mental health among doctors with a quick Google search is quite fruitless as there is very little information on it. This was surprising as there are so many facilities and organisations that promote mental health in teenagers, single parents and the elderly. They are also easy to find. On the contrary, the lack of information on services for doctors could make it difficult for them to find help.
Although Ireland has only recently started to notice the problem, Canada was among the first to acknowledge the constraints that stop doctors from seeking help for themselves. They set up aconfidential help service in 1987 and in 1994 Norway invested $1.3 million in programmes to improve physicians’ health and working conditions. Hopefully Ireland is not far behind.
Mental health issues have never been more recognised than they are today. In the past, citizens with these problems could be forcibly admitted to psychiatric units and were generally stigmatised by their communities as people simply didn’t understand their condition.
The Sick Doctors Scheme is accessible to all doctors from any medical discipline who may have a problem or are concerned about a substance misuse issue. The SDS provides medical assessment, appropriate referral, on-going monitoring and general support in the event of a problem being diagnosed. This is one of the few schemes of its kind that has the sole aim of helping doctors.
According to consultant psychiatrist Dr. Tony Sharkey, “I’ve seen quite a few sick doctors over my time. Doctors are harder to manage than the general population as there is a great deal of denial. A lot of the time problems arise due to the stress of not being able to deal with death. Personally, I was a clinical director for some time and the most difficult part of my job was to actually manage the doctors who became unwell, to approach my colleagues and get them to understand that they’re not coping. That was the hardest part for me.”
Doctors have to deal with a lot of very difficult issues that arise on a daily basis. These can include stress, exhaustion and the inability to accept death and all can lead to mental health problems. The EU directive has made an improvement but it may be a long time yet before it is implemented correctly, and many doctors could suffer in the process.
Doctors can be as vulnerable as the rest of us, if not more so, in their difficult jobs. They are remarkable people but they are not invincible, and it is important that this is acknowledged.
Junior doctors protesting outside Mercy Hospital in Cork:
Are you feeling depressed? Call the Samaritans, the 24 hour listening service, to talk to someone now if there’s something on your mind. Call 1850 60 90 90.