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GPs go forth

Top GP issues mental health warning as 400 doctors die by suicide

Professor Clare Gerada has called on the Government to improve support available to doctors, amid data showing over 400 doctors died by suicide in just four years.

According to the BBC, the leader of the national GP mental health support service believes that the rate of suicide within the medical profession may be rising, and she called for the NHS Practitioner Health Programme (PHP) to be expanded to help more people.

The Victoria Derbyshire programme, due to air this morning, will focus on Office for National Statistics data showing that between 2011 and 2015, 430 doctors died by suicide.

Professor Gerada warned that doctors, especially female doctors, are at a higher risk of suicide than the rest of the population, and she linked this in part to the pressure related to receiving patient complaints.

Former RCGP chair Professor Gerada is medical director of PHP, which has offered mental health support to doctors since 2008. But she told the BBC that the programme should be expanded, as currently only London-based practitioners can anonymously self-refer to the service.

PHP is also the provider of the more far-ranging GP mental health service, which was launched in January 2017, and to which GPs from all over the country are free to self refer, anonymously and free of charge.

According to NHS England, some 1,500 GPs have now gone through the programme, but Professor Gerada will say on the BBC programme that doctors with mental health problems remain ‘the last taboo in the NHS’.

She will say: ‘Doctors are at an incredibly high risk for mental illness. Female doctors have up to four times the risk of suicide in comparison to people in the [general] population.’

She will add that of the 5,000 doctors the service has seen over the last decade over two-thirds were women, with the average age dropping from 51.6 years to 38.9 over the course of 10 years.

Complaints from the public have the biggest impact on doctor mental health, Dr Gerada will add, as they can 'shatter their sense of self'.

In 2015, it was revealed that 13 doctors had died while under investigation by the GMC.

Since then, the doctors’ regulator has moved to improve its process, and it revealed in May this year that it had since halted seven fitness-to-practise investigations to spare doctors with mental health concerns.

The GMC’s assistant director of fitness to practice Anna Rowland said: ‘We're committed to continuing this work, and we're also keen to influence the way wellbeing is approached by other healthcare leaders through independent research… Health organisations must come together to tackle these important issues.’

Asked about her comments to the BBC, Professor Gerada told Pulse: 'I am not sure we know whether the rate of suicides is increasing. We do know that the rate of mental illness is - which is of course a risk for suicide.

'I think PHP should expand across England for all doctors, not just GPs. Other doctors are in desperate straights and have very poor access to effective care.'

An NHS England spokesperson said: ‘We launched the NHS GP Health service in 2017, a world-first, nationally funded confidential service which specialises in supporting GPs and trainee GPs experiencing mental ill health and which has already helped more than 1,500 GPs.

‘NHS Trusts and clinical commissioning groups may offer additional support for professionals in their area, for example CCGs in London have commissioned the NHS practitioner health programme for their staff.’

The state of GP mental health

The news comes after a recent survey revealed that two in five GPs have experienced mental health problems, including conditions like depression, anxiety, bipolar disorder and post-traumatic stress disorder.

The launch of the GP mental health service followed lobbying from the profession - and Pulse’s Battling Burnout campaign - for a comprehensive support service for GPs struggling with mental health concerns related to stress and burnout.

The RCGP reported this year that one in four GPs in the UK's devolved nations are so stressed that they feel unable to cope at least once a week. 

And last year Pulse revealed that one in nine GPs has turned to alcohol because of work pressures, while 6% have turned to prescription drugs.

Readers' comments (42)

  • Guess what everyone. The demand and stress will only worsen:

    "The impact of an aging population on palliative care."

    https://www.ncbi.nlm.nih.gov/pubmed/24303834

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  • Thanks Alan. I am exhausted. But oh joy of joys today. Started batting my way through the open surgery when there was the usual ominous knock on my door.

    "Dr Merlin a locum has just turned up that we weren't expecting"

    Marvellous! Give her my patients so that I can make a start on the Admin. OK 800 quid out the window--but I honestly don't care. Today I can breath.

    OK folks--I'm off to put the kettle on.

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  • @10:12 - I have now gone through the letter written by this seemingly grossly disturbed teenager a couple of times which batters not only the GP but also mentions '' bums, alcoholics and junkies in the Parliament''

    Bit of a shock, maybe the MP also needs some sympathy. I'll temper my response so the MP doesn't need counselling:)

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  • I blame the culture of enforced reflection induced by Revalidation and Appraisal , which is now blatantly a formative assessment . Doctors are naturally reflective and introspective . Now we are forced to constantly self immolate due to the pressure induced by appraisal .This constant searching for negative aspects of practice and relentless self questioning cannot be good for ones mental health , especially considering the baseline pressures of the job .

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  • Most doctors do not need or want the support. Just improve the working conditions. Scrap the CQC, GMC and the manslaughter laws. I am looking forward to retirement. If I am younger the best decision is to move abroad for better working conditions. There are no CCG meetings, PPGs, patient surveys,child protection etc.You can actually practice medicine.

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  • @Merlin, I think we've all been there. Difficult patients, too many scripts, time draining complaints, safeguarding letters to write, coroner on the phone, lots of extras, Docman inbox bursting at the seams,very sick patients whose ambulance hasn't turned up, late visit requests etc etc

    We try our best in a broken system. I've been there late into the evening - thinking, "what am I doing here"?

    I think most of us can be proud that we try our hardest, we make a big difference to our patients lives and we work hard - for the right reasons.

    At the end of the day it's a job. It sounds like you need a break. I'm inferring that you're a partner in a single handed practice. Do you need to think about handing in your contract?

    Seriously, we all see in our job that life is short. You don't owe other people anything. It sounds like you have done more than your fair share of good for humanity.

    You can always come back, but have a serious think about a long extended break. Your patients will still be there, but you sanity might return.

    Sending you positive thoughts and love.

    PS - I'm currently loving being a GP - I sooke to our practice manager and made some changes. I've got a much better work life balance now and I think I'm more effective when I'm at work. There can be light at the end of the tunnel, but you have to look after yourself too.

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  • Qato.D.M. Ozenburger. M.S. Olfson.M.

    Jama: Original Investigation. 2018.

    "Medications with depression, depressive disorder, suicide, suicidal thoughts,suicidal thoughts,suicidal ideation, or suicidal behaviour listed as common or serious adverse effects were defined as having a potential for depression as an adverse effect".

    "Suicide and suicidal thoughts and suicidal ideation, and suicidal behaviour were further sub-classified as having suicidal symptoms as adverse effect".

    Several classes of prescription drugs cause akathisia which is the common denominator underlying medication induced suicide.

    The increasing and overwhelming agitation, writhing restlessness and emotional blunting which are the dominant features of SSRI/SNRI induced akathisia are vulnerable to misdiagnosis as worsening or "emergent" serious mental Illness/illnesses.

    The prevalence of clinically significant akathisia in those taking these drugs has been reported as 20%.

    We are told that these drugs are used (apparently?)
    prophylactically in some doctors where adverse professional circumstances have caused vulnerability to depression.
    (R.S.M. Podcast).

    As far as I am aware, no meticulous prescription drug history, record of changes of (akathisia inducing) psychotropic medication, dose increase, decrease, or additional psychotropic drug augmentation is routinely made available as a component of the inquest reports on our colleagues who have died by alleged suicide.

    Surely a greater awareness of akathisia, the risk of misdiagnosis and the associated risk of induced suicidality justifies detailed, unbiased, objective investigation.

    If denial, and unwillingness to address the most serious ADR of SSRIs and SNRis predominates, how can it be known whether or not these tragic deaths in our colleagues, are being mis-classified as "suicide"?

    The life-long devastation of their families becoming even more unbearable as a result of a potentially incorrect verdict.


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  • Great pitch. The current contract is only worth 19.5 million pounds.

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  • Clare Gerada is correct to highlight issues and pressures. ReValidation is unhelpful and resources are inadequate and demands escalating.Workforce limitations will force model of care to change.Government must accept resposibility for current demands.As GP turnover and workforce diminishes their will be political accountability.

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  • "Most doctors do not need or want the support. Just improve the working conditions"

    An recently unemployed depressed patient doesn't need anti-depressants, they need a job. A depressed doctor doesn't need support they need a better job.

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