A few months ago I received a text message from my friend asking if I had heard about a former colleague committing suicide: I had not heard.
The news spread fast. He was a much loved character and a good doctor, who I had had the pleasure to work with during my foundation years.
I was shaken and deeply saddened by this news and I asked what everyone who knew him was asking at that time: what he might have been going through, why at that moment he had felt that there was no other option, whether we had failed him as friends and colleagues.
I was troubled by the fact that, within two years of working as a doctor, this was the third suicide I had learnt about – it had not been too long since two doctors with whom I had trained at medical school had taken their own lives. As I spoke to fellow colleagues, it became apparent that almost everyone knew of someone from work or medical school that had committed suicide. These are not new issues.
Mental health statistics state that one in four people will experience some kind of mental health problem in the course of a year, with mixed anxiety and depression being the most common disorder in Britain. Suicide remains the most common cause of death in men under the age of 35 (DOH 2005).1
The medical profession is by no means exempt from these statistics and in the midst of public campaigns, perhaps it is time that we take personal responsibility to reflect upon and address our attitudes towards mental health.
There are support networks and organisational structures to support medical professionals (some linked below), but with 219 physician suicides between 2001 and 2012 this support is not enough.18
Studies demonstrate that the prevalence of depression among medics exceeds that of the general population and other occupational groups and that there is an increase in depressive symptoms during the initial post-graduate years.2, 3, 4, 5
Likewise, there are high rates of alcohol and substance abuse and suicide within the medical profession.6, 7, 8 Data from the GMC health assessments (2007–11) shows that after alcohol and substance misuse, mental health issues comprised the largest proportion of all health assessments. Cited stress factors were work and service pressures, colleague relationships and the demands and nature of the job itself. 9
Numerous blogs, articles and comments by doctors who have suffered from a mental health problem reveal a lack of true support and empathy – underpinned by a macho-type expectation of invincibility.10 Even depression is still stigmatised.11
Dr Jasmine Smith, a GP trainee, explains how her experiences made her feel during her foundation training: ‘Though we are taught to recognise and help treat the signs and symptoms of mental illness in our patients I feel we fail to do so adequately in ourselves or our colleagues. Maybe this is because as doctors we are meant to be the strong and confident caregivers on whom people depend. There is no room to be perceived as “weak”.’
Deaths under investigation
Doctors with a mental health problem can sometimes be referred by their employer or self-referred to the General Medical Council (GMC) for a ‘fitness to practise’ investigation. Surprisingly, physical and mental health problems are bracketed in the same group for investigation as misconduct and poor performance – the GMC use the provisions stated in the Medical Act 1983 (the Act) which stipulates investigation for any ‘impairment’ in practise which is defined as: ‘misconduct, deficient professional performance, adverse physical or mental health, a conviction or a determination by another regulatory body’12. In light of this, the GMC recently launched the ‘Your Health Matters’ and oversaw the development of the BMA ‘Doctors for Doctors’ scheme.13
However, many doctors still find the investigation process demeaning, stressful and gruelling. In an internal review of doctors who committed suicide whilst under investigation, the GMC found that since 2004 at least 96 doctors have died whilst under investigation but it is not yet clear how many of these deaths can be attributed to suicide. More support is required for those undergoing investigations.
As a professional body, when it comes to compassionately responding to colleagues with a mental health problem, we are failing. There is a distinct lack of specialist services for doctors with mental health problems and more genuine and effective support is required.8, 11, 14
Doctors struggle to seek help for many reasons: high personal standards, ‘presenteeism’, a background culture of always coping, fears that seeking help will harm career progression and doubt about who to tell or seek help from.15
It is tragically disappointing that service users and carers report that doctors display negative, unsympathetic attitudes towards people with mental health problems and it has been shown that these attitudes can develop during medical school.16
Research on the effects of the recent ‘Time to Change’ anti-stigma campaign (which aimed to shift negative attitudes towards mental health) showed that there was no significant change in discrimination by mental health professionals.17
Dr Alison Holt describes similar findings from the Doctors’ Support Network (DSN) – a ‘fear of stigma… that having had mental health problems will lead others to judge us as weak, selfish, or unreliable… justified based on our members’ experiences.’
The DSN suggests that ‘through peer support there is hope… Only by breaking the barriers of stigma through proper information and enlightenment can we hope to reduce the risks of these isolating illnesses’.
Dr Seema Pattni is a medical SHO, who plans to train as a GP in 2014. Names of the doctors in this article have been changed to protect their identities.
1 Mental Health Foundation. Statistics.
2 Srijan Sen et al. A Prospective Cohort Study Investigating Factors Associated With Depression During Medical Internship. Arch Gen Psychiatry. 2010;67(6):557-565
3 Firth Cozens J. Emotional distress in junior house officers. Br Med J (Clin Res Ed). 1987 Aug 29;295(6597):533-6.
4 Bellini Lm et al. Variation of mood and empathy during internship. JAMA. 2002 Jun 19;287(23):3143-6.
5 Tyssen R. Factors in medical school that predict postgraduate mental health problems in need of treatment. A nationwide and longitudinal study. Med Educ. 2001 Feb;35(2):110-20
6 Johnson WD. Predisposition to emotional distress and psychiatric illness amongst doctors: the role of unconscious and experiential factors. Br J Med Psychol. 1991 Dec;64 ( Pt 4):317-29.
7 Tyssen R. Mental health problems among young doctors: an updated review of prospective studies. Harv Rev Psychiatry. 2002 May-Jun;10(3):154-65.
8 Tyssen R. The impact of job stress and working conditions on mental health problems among junior house officers. A nationwide Norwegian prospective cohort study. Med Educ. 2000 May;34(5):374-84.
9 GMC. The state of medical education and practice in the UK. 2012.
10 McKevitt C et al. Illness doesn’t belong to us. J R Soc Med. 1997 Sep;90(9):491-5.
12 GMC. The future of adjudication: making changes to our fitness to practise rules and to our constitution of panels and Investigation Committee rules. 2012.
13 GMC. Report of the Fitness to Practise Committee 2011/12’. 18 July 2012.
14 Hawton, K., Clements, A., Sakarovitch, C., Simkin, S., Deeks, J.J. Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979-1995. Journal of Epidemiology and Community Health 2001, 55, 296-300.
15 Department of Health. Mental Health and Ill Health in Doctors. February 2008.
16 Thornicroft G. Discrimination in health care against people with mental illness. International Review of Psychiatry. April 2007; 19(2): 113–122.
17 Henderson C et al. England’s time to change antistigma campaign: one-year outcomes of service user-rated experiences of discrimination. Psychiatr Serv. 2012;63(5):451-7
18 Office for National Statistics. Number of deaths of males and females working as medical practitioners classified as suicide or undetermined intent, aged 23-74. 2001-2012. England and Wales.