Doctors and mental health

Staff working in the National Health Service (NHS) experience significant work-related mental health distress, as discussed in a major report by the Royal College of Physicians on health and work in the NHS 2013 [1]. This is being played out through high levels of bullying, complaints, sickness absence, rates of burnout, early retirement and emigration. The reasons for the distress are complex and multifactorial and most easily thought of as a combination of the doctors’ vulnerabilities (including their own past traumas and recent life events) interacting with occupational factors (long hours, unpredictable shifts) and/or wider socio-environmental issues (such as increasing culture of litigation, lack of resources and so on) [2]. It might appear, given the explosion of resilience training courses and creeping mandatory training in this area that the problem with the increase in distress among younger doctors is due to some general lack of resilience, that somehow, they lack the ‘right moral fibre’ to survive a lifetime in health care. The General Medical Council (GMC) publication, Be Prepared: Are New Doctors Safe to Practise (2014) [3], contained reports of concerns from postgraduate deans about the resilience of new doctors, their preparedness to work in busy areas and generalized anxiety they have about working with acutely ill patients. However, health professionals past and present are some of the most resilient human beings in our society, necessary if they are to survive a lifetime exposed to disease, distress and disability. Of course, individuals bring their own predisposing experiences (early losses, dysfunctional parenting and personality problems) and precipitating factors (divorce, moving home, illness, bereavements). But while there might be some changes across the generations, moving home more often nowadays for training purposes, for example, these are not sufficient to be causal factors for the rise in mental illness to individual adversity or vulnerabilities. Far more likely is that the levels of distress are linked to larger societal and geo-political changes, as well as the more parochial such as workload, working conditions and rotas.

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