RCPsych Wales - Dr Anita Naik, Maintaining Wellbeing in Psychiatrists
Wellbeing is paramount for any individual to function. Wellbeing includes both psychological and physical wellbeing. Maintaining wellbeing is vital for both doctors and patient’s health.
Growing pressures and demands on the NHS, ever-increasing patient lists, low staffing levels, increasing expectations of patients and complaints can make stress unavoidable. Added to this, if one has a physical illness or family related issue or any other stressful event happening in their life, wellbeing could easily dwindle. Physical and psychological wellbeing can be seen as the two wheels of a bike and if one of the wheels doesn’t work properly, one can expect to have a bumpy ride or a crash.
As Psychiatrists, the patients and the varying risks that we encounter can be very challenging. Some patient contacts can be emotionally very draining and can take a toll on us. Regular Balint groups, peer supervision and reflective practice help us understand some of these underlying dynamics and we emerge as better risk assessors and risk managers for patients.
We hesitate to heed to the same advice
As doctors, we are very good in advising our patients about how to maintain wellbeing and look after themselves. However, when it dawns upon us, we hesitate to heed to the same advice. Recently published results from a survey [1] carried out by BMA in 2018 (British Medical Association) with over 4300 UK respondents including both doctors and medical students showed that 80% were at high/ very high risk of burnout; 40% reported currently suffering with emotional difficulties and about 90% stated this to be contributed by their current work/ study environment.
I can remember the days of being a core trainee where keeping up with my training, on-calls, the pressure of exams, maintaining a family life and being a new mum all a bit too much! The feeling of psychological exhaustion and overwhelm made me question my choice of this profession. However, my decision to reduce hours by becoming a less than full time trainee which came eventually was a huge factor, and the support of my peers/ supervisors and family helped a great deal in easing some of the pressures. In my case, being able to recognise the problem and taking the step towards resolving it came about by giving myself the headspace to reflect, understand my own expectations and from discussions with colleagues, family members and friends.
We all know that too much stress is bad and especially chronic stress can lead to health problems like poor sleep, impaired attention, irritability, anxiety, depression and also problem drinking and drug misuse as unhealthy coping strategies. It can also lead to physical health problems like heart disease, diabetes and memory problems. An individual’s functioning and performance can diminish in turn causing more stress and unless recognised early, the person may feel stuck in this vicious cycle. Suicidal thoughts and attempts to take their life are also common amongst health professionals. Figures from Office for National Statistics [2] showed that between 2011 and 2015, 430 health professionals committed suicide. Female doctors have four times the risk of suicide than the general population.
So what makes it so hard for us to seek timely help?
There could be some intrinsic and extrinsic factors at play. As health professionals, we are considered as the hard working, intelligent and the ones that strive for the best even in the most stressful situations. Given all this, it does not come naturally to us to voice that “I am feeling stressed and I need help!” We fear that it may be seen as an inadequacy or as being incompetent!!
The fear of losing career and its implications like financial, reputation or disciplinary action if patient safety is compromised or if drugs and alcohol are involved. Then, there is the fear of stigma associated with all this making the individual hesitate or even reluctant to accept that there is a problem. Suffering in secret begins! We are humans after all and not machines!! We experience the same emotions as the population that we treat, but individual tolerance and resilience may differ. Some fortunate or insightful ones may start their remedial process either by themselves or with support from colleagues, family and friends.
A lot of work is being done to improve the wellbeing of health professionals at all grades. It is being recognised that healthy doctors can keep patients healthy.
How can one maintain wellbeing?
- First and foremost is for the individual to look after oneself.
- Maintain good physical health
- Do not compare yourself to others. Instead analyse your problem
- Seek help early if you feel you are at that verge.
- Understand your limitations and resilience.
- Indulge in activities/ hobbies to keep your mind off work.
- Maintain a healthy support network of people you trust
- Keep a work life balance that best suits you.
- Review your job plan
Alongside help from GP and Occupational health, there are several other agencies that are offering help and support for health professionals:
Psychiatrists Support Service from RCPsych
Free, confidential advice and support via telephone helpline for psychiatrists at all stages of their career. High quality peer support is delivered by fully trained Doctor Advisor, College members.
There support service provides 24/7 confidential support and advice which is free to all doctors. No need of being member to avail this service.
It’s a confidential peer support network for doctors and medical students with concerns about their mental health. No subscription required but it involves a suggested voluntary donation.
Provide confidential, not for profit, psychotherapeutic consultation service for all doctors. It is a joint initiative between the Royal Medical Benevolent Fund and BMA.
NHS Practitioner Health Programme NPHP
It is based in London and offer free, confidential NHS services to doctors in London. For doctors from other areas of UK, telephone advice and signposting to local areas provided.
Health for Health Professionals
It’s a confidential, face-face counselling service for all doctors in Wales, fully funded by Welsh Government and administered by Cardiff University. It provides with access to a BABCP accredited therapists (British Association of Behavioural and Cognitive Psychotherapies) in local area.
Professional Support Unit in HEIW
It provides advice and support to all doctors in training Welsh training schemes.
It’s a service commissioned by GMC and provided by BMA to doctors facing GMC investigation. It is recognised that being subject to GMC complaints can be extremely stressful. Free, confidential support and emotional help is provided by fellow doctors and this service functions independently of GMC.
Available 24/7 and provide free phone support when someone is feeling suicidal or going through a difficult time. Number to call 116 123.
Other initiatives like StartWell from RCPsych is a consultant-led initiative which focuses on supporting new consultants in their first 5 years of the consultant role. Mentoring schemes are being developed by RCPsych for supporting psychiatrists and help them achieve their full potential.
Mentoring for doctors of all grades is also available for free from the Faculty of Medical Leadership and Management (FMLM) to members. HEIW is also looking at developing its own mentoring programme for Higher trainees and New Consultants in Wales.
References
Caring for the mental health of the medical workforce report, BMA survey from 2018
Office for National Statistics: Suicide by Occupation, 2011-2-15;
Dr Anita Naik is a policy and public affairs attachment at RCPsych Wales. She is currently training to be a Child and Adolescent psychiatrist and is currently based at the Ty Llydiard inpatient unit in Bridgend. This article first appeared in the RCPsych Wales Summer Newsletter.