The development of mental health services specifically for doctors is a contentious area. After all, why should doctors have a special service when others don’t? And, if this were allowed, why not extend it to other health professionals? The sad answer to this latter question is that the numbers are simply too great, and there is very little money. None of this feels fair.
However I think the main reason that it is viewed with such suspicion is quite simply down to the idea of doctors getting a better service, and all that that implies. It is far less about a different service. And that, unfortunately, is not an unreasonable assumption when mental health services across the country are struggling to offer care due to lack of staff, resources and morale. Those of us working out there know that we are unable to provide what we want to, and what we think is best. The problem of recruitment and retention of staff sounds a hollow lament, with increasing numbers returning to work in unfilled jobs post-retirement. As a consultant psychiatrist, I know the pressure to deflect patients from services, to avoid offering follow-up. It is the only way to keep waiting lists down, but it can be soul destroying. Of course, not everyone requires assessment, or ongoing care; but it would be nice to base that decision on clinical need alone. Our mental health services are limping into a future with ever increasing demands and expectations, for which we are simply not equipped.
So, back to sick doctors, and let’s pretend that mental health services for the general public are timely, appropriate and with minimal waiting times. People are supported by community nurses, provided with therapy when they need it, and all the other things required. Plus you can always get a bed in a well-staffed unit, in your home town, when you need it. All a bit fantastical, I know, but let’s go with it for now. I have to say that a separate service for doctors might be less necessary in this utopia, but I think it would still be of value. My own experience, over many years, is a case in point (I live in Scotland, where there is as yet no separate service). I have always had the advantage of good access to doctors, and I do believe that this is because I am one. I am grateful for this. However the surrounding support is missing, perhaps partly to protect me from getting involved with local services, where I work. When I have been unwell I have sometimes felt fairly desperate, and input from a psychiatric nurse, or the home treatment team, would have been a huge support, to me and my family. I have twice been admitted out of area, because I am a doctor, and I found that very difficult. I live in some terror of ever being admitted again – I never want to be “sent away” again, but local is also fairly unthinkable.
Staff find it hard treating doctors, and they can end up getting worse treatment – either being ignored, or, more disturbingly, being allowed to lead their own treatment. Doctors have a huge knowledge of medicine, including psychiatry, that can be detrimental when they are the patient, and can lead to manipulation of the system, both unintentionally and otherwise. It is my view that you need to be reasonably experienced to deal with doctors. When I was a trainee psychiatrist – and even a new consultant – I found them quite difficult, and would be very nervous. They can easily become so-called special patients, something which is almost never to their advantage. But their knowledge also instils fear into them – of what might be wrong, of treatment, and of the consequences. I hope that one day mental illness ceases to be stigmatising, but we aren’t there yet, and this can be particularly acute for students and young doctors, who fear for their dignity, their self-esteem and their livelihood. And even if staff at every level are tolerant and understanding, the hours and conditions some doctors work are uniquely challenging, never mind all the exams with their punishingly low pass rates.
However, whatever you think of individual doctors, the problem is that we don’t actually have enough of them, so, being brutal, we need to keep them working. Providing a service for them is likely to be cost neutral in that it will reduce sick days, and this is all very much in the interest of the general public. Doctors can and do access normal NHS services – except when they don’t. Some doctors (not all young) are acutely afraid of potential stigma. This may be less than they think, but it is still there. I have experienced it, and I know others who have. Health care professionals can talk casually and cruelly about their own, more so when certain diagnoses are attached. I lived in horrible fear of being diagnosed with a personality disorder – not because of what this actually meant, but because I knew the views of some – not all – professionals, and I think this can be magnified when the patient is a doctor. I also believed I would never work again, and it was a terrible struggle, with which few supported me. I have never really lost the feeling of having to prove myself twice as much as others.
A doctor-specific, confidential service might allay some of these fears, and get people into services before they reach crisis. It might teach us all more about stigma, which can only be good, and it might keep happier doctors working well for patients. Some doctors prefer to be seen out-of-area, and some, like me, feel that being seen locally is better (and more stigma-dispelling). But I think doctors need to be given that choice, for both out and in-patient treatment.
I feel like I’m arguing in favour of something far more verboten – private medicine or lavish drug lunches, for example – but I’m not. This will help everyone.
5 thoughts on “Mental health services for doctors”
I struggle with this too. I can understand a desire not to be treated on your own inpatient ward. But otherwise, doesn’t having separate services for doctors either create an impression that doctors matter more (when of course society needs teachers, police officers, cleaners, shop assistants too) – “what’s good enough for the general public isn’t good enough for doctors” – or reinforce stigma about mental illness in the medical profession, it should be normal for a doctor to see a GP +/- psychiatrist as needed for a mental health issue just as they would (I hope) see GP for a physical issue. Why does it need to be elsewhere and “secret”?
For me, I’m comfortable with being seen locally, and I think actually helps dispel stigma. But I know there are doctors who are terrified of being seen locally – eg that their records will be seen be others, even just that people will know they’re seeing a psychiatrist. People aren’t always kind. They need to engage with services (from a purely economical point of view we need to keep doctors working; from a wellbeing point of view, they are humans, and it can be harder for them to engage being doctors themselves) and if that has to be out of area, it’s better than not at all. My own hope is that they could then be persuaded to move to more local services, but does depend on individual situations
Yes. I think out of area cases in selected cases is different from a whole other service though. And I’d imagine the % of doctors who know their local psychiatrists as colleagues is fairly small (I’m a cardiologist, I have met a couple who have reviewed my medical inpatients but certainly don’t know them well).
And if we don’t offer out of area care for physical illness (where confidentiality also important) why for mental? I don’t know – I understand your points that we have to be pragmatic and get these doctors treated. But I worry that it only increases stigma.
I fully agree regarding stigma.
The need, if there, is one, may be for some doctors more than others. I know all my local psychiatrists as I’m a psychiatrist, and I think many GPS know a lot. And trainees particularly.
I think local is best, but it’s just not quite working for all.
There are also other issues around managing substance misuse (even more stigmatised and not uncommon) and occ health and GMC stuff.
I also take your point about physical illnesses, but on the whole mental illnesses are more stigmatising, esp substance misuse. Although I acknowledge not always.
It’s certainly difficult. I’m not convinced that things like the practitioner health programme – where as far as I understand it doctors of any specialty can self refer – are the best solution. I think the GP should be the first port of call in most circumstances as for anyone else.
I appreciate that i’m also being somewhat idealistic in that I don’t think there should be any more stigma associated with mental illness than with physical – hopefully one day this will be true. But in the meantime your pragmatic approach is probably right.