Suicides among junior doctors in the NHS

Wider problem

Concern about suicides among junior doctors is not unique to the UK. Earlier this year, Australian media labelled a spate of deaths among junior doctors as a “suicide epidemic,” after it emerged that four had taken their lives over five months. The deaths propelled New South Wales’s health minister, Brad Hazzard, to launch an urgent investigation into the problem “so we can start putting evidence based measures in place to help those who help us when we need it.”3

A year after Polge’s death, another junior doctor, Lauren Phillips, also disappeared in England and has not so far been found.4 She too had expressed her concerns about the NHS. Then, in March, Rebecca Ovenden, an accident and emergency doctor who had written about pressures in the NHS on social media, was found dead in her bedroom by her husband.5 She is the third junior doctor known publicly to have gone missing or be found dead in England in just over a year. We are aware of further cases not currently in the public domain.

Distress and alienation

These deaths have occurred at a time when junior doctors in the NHS are reporting alarming levels of stress.6 The 2016 report by the General Medical Council on the state of medical education and practice stated that low morale among junior doctors was potentially putting patients at risk.7 Describing “signals of distress” and a “dangerous level of alienation” among junior doctors, it concluded: “There seems to be a general acceptance that the system cannot simply go on as before.”4 Delegates at the 2017 BMA junior doctors’ conference gave the union a mandate to lobby for all suicides by junior doctors to be investigated formally by their employer, jointly with the GMC, Health Education England, and the BMA.

The UK has not followed Australia’s lead in investigating suicides among junior doctors, so we do not know the scale and nature of the phenomenon. There is no central system for collecting data on the number of suicides among junior doctors, and coroners (and their counterparts in Scotland) are not required to determine whether a suicide was related to conditions at work. Indeed, the law explicitly excludes suicide from the requirement to report work related deaths.8

Transparent approach

Other countries take a different approach. In France, for example, after several suicides linked to employment conditions, “workplace suicides” have been recognised officially and are recorded by the authorities, making them highly visible.9 Any suicide in the workplace is automatically considered work related, with employers required to prove that it is not. Suicides that take place away from the workplace are still investigated as potentially work related if the family can show a causal link to work through, for example, a suicide note.

Arguably, a positive outcome of last year’s dispute is that junior doctors are more open about the potentially harmful effect on their mental and physical health of difficult conditions of work. But unless this transparency is matched by meaningful concerted action by the Department of Health, the GMC, and NHS England, more suicides are likely to be attributed to stressful working conditions.

The junior doctor suicides may simply reflect the fact that people from all walks of life take their own lives, for many reasons. But the combination of increasing concerns about pressures in the NHS and the messages that these young doctors left behind is highly concerning. There should be a means by which all suicides by junior doctors are identified and investigated, including an explicit focus on the role that workplace pressures may have played. In the longer term, in ever more precarious times,10 a strong case could be made for including suicides among work related causes of death, as they are in France. While there may be many reasons why someone takes their own life, when there is evidence of a link to work pressures, a relation should be assumed until proved otherwise.