Clare Gerada: Doctors’ mental health and stigma—the tide is turning

I’ve recently been unwell. Thankfully, nothing too serious—a broken bone in my foot and some dental surgery. Both resulted in visible manifestations of illness: an orthopaedic boot for my foot, and heavy swelling and bruising to my face. The overwhelming response from medical colleagues and friends was sympathetic, with a constant chatter of advice, suggestions for healing, and tales of their own injuries and operations.

It set me wondering what my experience would have been if, instead of obvious physical injuries, I’d admitted to hidden psychological ones. Would the sympathy have been as free flowing, or—as the literature on sick doctors would suggest—would I have been shunned and left feeling ashamed?1 Even a half decade ago I might have been, but I think that the tide against the stigma of mental illness generally, and mental illness among doctors, is finally turning.

This was evident at the recent BMA annual representative meeting, which I attended as a BMA Council member. Many motions focused on issues relating to doctor burnout and psychiatric illness, the need to support doctors and medical students, and the need to tackle the impact of inspection and regulation on doctors’ mental health. My own motion, on having to deal with the psychological burden of complaints, also received a sensitive hearing. Speaker after speaker—including medical students, junior doctors, seasoned doctors, and the chair and president—talked poignantly from their various professional and personal perspectives about mental illness in doctors and NHS staff.

Some recent reports highlight this problem and how to tackle it. Earlier this year Health Education England undertook a major review of NHS staff’s mental health and wellbeing, making sensible recommendations.2 The NHS Long Term Plan,3 published in 2019, also looked at staff wellbeing. It prioritised reducing discrimination, violence, bullying, and harassment (all causes of psychological distress), and Prerana Issar was appointed to take this work forward as the NHS’s chief people officer.

More recently, independent reports commissioned by the General Medical Council (its gross negligence manslaughter review4 and Fair to Refer?5) have made recommendations that should substantially tackle some causes of mental illness in doctors. The gross negligence manslaughter review made recommendations to help employers reduce the stress of serious complaints against staff and bring in fairer, more consistent processes for serious incidents. Fair to Refer? focused on improving inclusivity for all staff, but especially those who experience the most isolation and discrimination, such as doctors who have trained overseas or those from BME groups.

There’s still much to do to stop needless morbidity and mortality of doctors due to mental illness, but at least the issue is now in the open. Maybe someday discussing mental illness, and suggesting solutions, will be as normal as talking about a broken metatarsal.