Mental health support for doctors—a vital yet fragile lifeline

Even as a doctor myself, it's easy to take other doctors for granted. As a population, we have come to assume that we will be cared for in our hour of need, spoilt by the ready provision of the NHS. But the NHS succeeds because of those who work for it. As an institution it relies on professionals who go above and beyond again and again, who have sacrificed years of their lives to studying and striving to better serve their patients.

A few months ago, a family member became suddenly ill. She was cyanosed and short of breath. She had chest pain radiating down her left arm and described a sense of impending doom. We felt desperate, but we were lucky. She had and still has a brilliant clinical team looking after her. She had an ECHO within an hour of it being sought.

The paediatric cardiologist doing that ECHO has trained for many years. Risk and death are part of their job and should something go wrong the consequences can be devastating. I have never been so grateful to someone for their skill and dedication, for their willingness to take on the challenges of the role.

Being a doctor is hard, and doctors are at increased risk of a whole range of mental health difficulties. On average, in the UK, one doctor dies by suicide every three weeks. The job is stressful, and the regulator holds doctors to high standards, even in their personal lives. When things go wrong the doctor is often a second victim, destroyed by the unintended impact of their actions—or indeed their mere involvement in a sad case.

I have a second job as a medicolegal consultant for Medical Protection Society, helping doctors with a range of matters, including regulatory, disciplinary, and inquest cases, as well as complaints. I spend hours every week comforting those who are distressed and desperate because of an adverse event at work.

I advise doctors who are struggling to seek support from NHS Practitioner Health on a daily basis. I see how valuable their input is. My colleagues agree, with one stating that NHS Practitioner Health has been life saving for some doctors she has worked with. It has helped them recover and thrive as outstanding clinicians. They are empathic and insightful due to their own experience with mental health issues.

Poor mental health can affect individuals and their families, healthcare teams and patient care. This week, hospital colleagues heard the news that NHS Practitioner Health would not be accepting new secondary care registrations, following discussions with NHS England about funding. The decision was swiftly reversed, following passionate outcry from across the profession and concern over comparable alternatives.1

Primary care is overwhelmed, and services are not designed to meet the specific mental health needs of healthcare professionals. Funding for the NHS staff mental health and wellbeing hubs was also recently scaled back, resulting in the demise of most of the hubs.2 The suggestion that hospital doctors in need could seek support from occupational health as an alternative was also confusing, given that NHS Practitioner Health does not provide occupational health services.

All in all, the past few days have exposed the fragility of the mental health support network for NHS staff, and a worrying disconnect between funding decisions in this area, and reality on the ground.

Survey after survey shows a struggling, burnt out workforce, with demand for mental health support growing, not falling. Millions of NHS working days are lost to mental health and wellbeing reasons each year, and many healthcare professionals are on the verge of quitting healthcare due to mental health concerns.

While the medical community breathed a collective sigh of relief when the decision to halt new secondary care referrals to NHS Practitioner Health was reversed, this is a temporary measure. The service has been extended by 12 months for both new and existing patients, while NHS England carries out a wider review into mental health support for all staff groups.

We look forward to hearing more about this review, including the evidence base and who will be consulted. What is clear to us all is that funding for mental health support must be long term and ring fenced. Services like NHS Practitioner Health help to keep doctors at work, caring for their patients, and help those who are sick back to work. They can be a lifeline, and it is critical that all NHS staff—regardless of where they work—have access.