Doctors and mental health
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1708 (Published 30 March 2011) Cite this as: BMJ 2011;342:d1708
Abstract
Attitudes towards mental illness may be improving within the profession, but Sue Learner speaks to several doctors whose experiences are far from positive
Nearly a third of doctors have some kind of mental disorder.1 Yet for many it is a shameful secret, because of the deep prejudice towards mental illness that still exists in the medical profession.
Liz Miller, who has been sectioned three times and has bipolar disorder, says, “I was so ashamed that for years I never told any of my colleagues. I felt so isolated and thought I was the only doctor with a mental health problem.”
Claire Lane, a 35 year old general practitioner, who has had postnatal depression, believes that part of the problem is that “medicine is quite a macho profession, and lots of doctors still don’t understand mental illness. I think they sometimes think people with mental health problems are being pathetic.”
Workload and depression
Many doctors work long hours and have heavy workloads, which can cause severe depression and lead to suicide attempts, says the BMA’s Doctors’ Health Matters, which also claims that doctors are more likely than any other profession to have mental health problems.1
In 2000 the NHS was criticised for systematically failing Daksha Emson, a psychiatric specialist registrar who killed herself and her 3 month old daughter during a psychotic episode. An independent inquiry into her death found a “widespread stigma against mental illness in the NHS.”2
More than 10 years on, little has changed in the NHS, says Dr Miller, who founded the Doctors Support Network (www.dsn.org.uk) for doctors with mental health problems.
“I would like to think things changed with the Disability Discrimination Act in 2005,” she says. “However, they haven’t changed a lot. Employers are now in some circumstances obliged to offer part time work if you have a mental health problem and your doctors say it would be helpful for you.”
GMC investigations
If doctors are found to be working while they have a mental health problem they are often referred by their employer, or are expected to refer themselves, to the General Medical Council (GMC), which investigates to see if they are fit to practise.
Figures from the GMC show that last year a total of 143 doctors were investigated.
Since 2005 health has been investigated under the same procedures as misconduct and poor performance, although health hearings are held in private (see boxes).
Dr Miller calls it a “harrowing experience” and says, “I have lost count of the number of doctors I have had to talk back from suicide because they have been through the GMC process—as if being depressed isn’t hard enough. It is awful that people commit suicide at least partly because they are hounded by their regulatory body. Three friends of mine, who were doctors, have all committed suicide. They were being investigated and had a serious hammering by the GMC.”
One of these was Belinda Brewer, who committed suicide in 2007. In the book Doctors as Patients she is quoted as saying that the GMC investigation process “erodes self-confidence and self-belief” and called it “threatening and isolating.”3
She added, “Staying well and fit for work is a daily battle for someone with serious ongoing illness, without the added struggle of the GMC health procedures.”
She found the process very “frightening” and “formal,” and said “the special delivery of legal-style documents was very threatening.”
Dr Miller believes that the GMC’s investigative process drives doctors with mental health issues underground. She says, “If you apply for a job with a primary care trust you probably won’t get a job interview if you have been investigated by the GMC, even if the GMC claims are found to be groundless. Application forms insist that you declare any involvement with the GMC, but if you do declare it human resources [departments] exclude you from the interview process. If there is one change I would like to see, it is that the GMC removes health from the fitness to practise process.”
GMC procedures help some doctors
Clare Gerada, however, who is chairwoman of the Royal College of General Practitioners and medical director of the Practitioner Health Programme, a London based service for doctors with health problems, believes that the procedures do help some doctors.
Dr Gerada says, “We see a number of doctors who are going through the GMC FtP [fitness to practise] procedures, and for some it works well and they get an awful lot of support. Some doctors are very sick and they do need a lot of monitoring. But we would like to see more support offered, as it can appear to be used as a punitive measure and be rather legalistic.”
Felicity Rothwell, investigations assistant for the GMC, says, “People are only referred if there has been an issue at work. If a doctor has a mental health issue, they are required as part of their registration to notify us. We can then make a decision to see if it is affecting their work.”
In May the GMC is launching Your Health Matters, a new website that gives more support and information to doctors with health conditions going through its fitness to practise procedures.
The GMC is also currently reviewing the procedures, and its review is out to consultation. The consultation document doesn’t mention mental health, however, and it looks as though health will continue to be seen in the same light as performance and conduct.
Fiona Donnelly, chairwoman of the Doctors Support Network, is “cautiously optimistic” about the reform of the fitness to practise procedures. She would like to see the GMC offering more support for doctors with mental health problems. “They need to ensure that doctors are well enough to undergo the investigative process, especially if the procedures are because of mental illness,” she says.
Case study: Rohen Kapur, 43, psychiatrist
Rohen Kapur graduated in 1994 and started working as a psychiatrist. Shortly after this he began to have mental health problems.
“I was put on medication and went to see a psychiatrist. I also took some time off work. I then went back to work and carried on working as before. In 2007 I exploded at work and was sacked, and the hospital reported me to the GMC. I now have 15 [working] conditions stipulating what I can and can’t do. I have to inform the GMC of any post I take, and they have to approve it. I can’t do any work as a locum, as it just won’t work as hospitals need locums as cover and they can’t wait for the GMC to approve it. When you have all these conditions put on you, it is the kiss of death to your career.
“I wanted to appeal against the conditions, but my defence organisation said it wouldn’t support an appeal. I am on benefits now, and my father gives me some money as well. Being poor is not much fun.”
Case study: Lois Lamb, 42, doctor working in emergency services
“I got sick because of a family problem. The first time I showed that I was ill was when I went into a planning meeting and burst into tears. I realised then I wasn’t well, so I took a month off work. I went back for a month and felt even worse, so I took sick leave and was off work for 14 months. I went to see my GP who diagnosed me as ‘low mood’ instead of depressed, which made me feel even worse. I was later diagnosed by a psychiatrist as having moderate to severe depression.
“The problem came when I decided to go back to work. I wanted a phased return, but they wanted me to work out of hours—on weekends and evenings. I got the BMA involved and they were fantastic, but my employers ended up sacking me.
“I feel like I have died professionally. It has broken my heart. I am so angry at the trust as it showed no flexibility to me over the hours I could do. All I wanted was to do less hours and not to do the weekends on my own on the ward. They said because I worked in emergency services they couldn’t. I feel absolutely betrayed by the NHS. I have been a doctor for 20 years. Before all of this the longest I had been off work was for six weeks for a broken wrist in 2001.”
Case study: Katie Field, 36, trainee doctor
Katie Field was referred to the GMC by her general practitioner after an episode of “acute confusion.” She believes that it was caused by an infection, but at the time her GP suspected she had taken an overdose.
Her GP decided to report her to the GMC “for support” because of her “long history of depression” and assured Ms Field the process would be very supportive and that the GMC would be like “a senior occupational health service.”
“Despite my telling her this was not true and begging her to contact my employers with her concerns, she remained adamant the GMC would provide me with support and refused to discuss her concerns with my employers. The letter she sent to the GMC was inaccurate and misleading and essentially compelled them to investigate me.
“She did not mention any concern about my fitness to practise or about there being any concerns about my ability to work safely but instead focused on my history of depression and provided sensational descriptions of my history and of events the night I was admitted to hospital with delirium,” says Ms Field.
Once the GMC opened its investigation Ms Field was called before an interim orders panel and had conditions imposed on her registration while the panel conducted its investigation.
She underwent health assessments by two GMC appointed psychiatrists, which were “gruelling and very stressful.” The GMC investigation took six months, and eventually the case examiners said that the case should be closed and Ms Field was advised “to remain compliant with Good Medical Practice.”
The conditions were lifted from her registration soon after.
She calls the fitness to practise procedures “soul destroying, formal, and intimidating,” as the hearing is akin to a court case, with a panel, a legal adviser, a GMC barrister, and the defendant with a barrister and a solicitor. She believes that she will always carry the stigma of being investigated. She says, “I will always have to declare this investigation and that my registration was restricted for a period every time I apply for medical posts, even though the case was closed and conditions are no longer published online.”
Footnotes
Competing interests: None declared.
Some of the doctors’ names have been changed to protect their identity.