‘Human beings, who are almost unique in having the ability to learn from the experience of others, are also remarkable for their apparent disinclination to do so.’ – Douglas Adams
Recognising mental health
I hope and expect that those in the healthcare professions smoke less, eat better, do more exercise and keep an eye on their weight more often than the general public. This is because we see the effects that lifestyles have on health so often that we know what can happen. We learn and make amends where we can. What we are bad at – as it is so often invisible, intangible or hard to admit – is recognising the issues that affect our mental health.
It’s a strange belief that excessive hours, uncontrolled workload, massive responsibility and chaotic uncertainty will never leave any mark.
Why am I writing this article though? Why me particularly? I am not an expert; I am not a psychologist, a counsellor or psychiatrist. I am just another haematologist, but I am also a supervisor, a teacher, a colleague and a friend to people living and working through extraordinary times. I need to share what I have witnessed in healthcare in my own anniversary of 30 years as a doctor. I have sat with someone whose very physical appearance was altered by depression. I have listened to the trainee who could not face coming to work for fear of doing something wrong. I have seen the overwhelming impact of suicide and unexpected death on a team. I have witnessed and experienced the anxiety that follows a complaint or an error. I have spoken with and seen the fallouts of addiction, gambling and burnout.
It’s never happened to me though – of course not, it never will. It’s a perk of the job, never getting ill.
It’s a strange belief that excessive hours, uncontrolled workload, massive responsibility and chaotic uncertainty will never leave any mark. Maybe, just once, I started to think it could affect me, when a psychologist I worked with gently asked if I would like a counselling session. But that was years ago now.
How to approach mental health issues
I started to learn about managing mental health and the impact of trauma from a keen and talented manager, who is now a chief executive of a big hospital. This was at a time I was taking on responsibility for Foundation doctors in the trust. One of our trainees had been physically assaulted during their placement in general practice. I heard about it from their friend first. I remember thinking how, who, what, why? What this manager did was better. They got a counsellor to the trainee straightaway – someone who knew exactly what to do, what to say and how to help, not the recently qualified haematologist with an MRCPath who thought he could do everything.
There has been a strange culture of machismo in branches of healthcare that celebrate excessive hours at work. There are even those who don’t drink any fluids because they are too busy to pee. Getting a kidney stone was once a badge of honour for some.
We just don’t see the effects of our own mental health; we don’t see it affect others until it’s too late. We just don’t learn. We carry on thinking that what we are doing to ourselves or others is okay.
Am I just starting to impose my beliefs if I start to criticise being at work when you shouldn’t be? Answering emails as you go to bed? Sending emails at the weekend and maybe even reading medical journals rather than playing with your kids? Who decides what is important and how we should work? Why is this haematologist telling you to play with your kids or get out a bit more?
It comes back to that thing about learning. We just don’t see the effects of our own mental health; we don’t see it affect others until it’s too late. We just don’t learn. We carry on thinking that what we are doing to ourselves or others is okay. Until you have really talked with someone whose mental health is suffering, you may never really understand how precious and fragile your own wellbeing and mental health are.
You will be the last person who knows you are burning out.
I remember a colleague I was coaching, upset by being offered a quieter bit of the job for a few months. What this colleague thought was undermining by their boss was actually their wellmeaning supervisor looking after them during a stressful time. Your ability to cope will vary. Things at home will affect your work. Those around you in the office will spot your bad days. They will see your tells and, if they care and feel comfortable doing it, they will help.
...doctors and all .... healthcare staff are at risk for mental health problems and we are not good at recognising, managing or helping reduce the risk of them.
Prejudices and perception
In the 2021 GMC training survey of 40,000 doctors,1 a third of trainees said they felt burnt out to a high or very high degree because of their work – compared with around a quarter in previous years. Three in five trainees said they always or often feel worn out at the end of the working day; 44% felt their work was emotionally exhausting to a high or very high degree.
But of course, it will never be me.
I don’t have any history of mental health problems, just like I don’t have any history of diabetes, asthma or epilepsy. But I bet that is what everyone says just before they get ill. Lots of us do have underlying physical and mental illnesses. These are hard enough to manage without having to experience the stigma or explain the effects of mental illness. In fact, why should anyone actually have to explain what illnesses they have anyway? What we have to do is be understanding, flexible and aware of our own prejudices.
A trainee who is just a little late every morning and you might think is being lazy, could just be commuting 60 miles to see their wife and child every night because they couldn’t get a job together in the region. Maybe that trainee who is really slow on ward rounds isn’t actually slow and instead is someone struggling with depression, dyslexia or disease. And, just maybe, the person who made that serious error you can’t help shouting about was let down by a badly designed system rather than their incompetence.
Every time you feel yourself being the ‘bad cop’, think what your ‘good cop’ might say.
It is often the simplest things that make people feel comfortable enough to talk. We need good listeners as well as people feeling happy enough to open up. Being the ‘good cop’ or being happy to talk comes when we are feeling secure. If you ever want to know how to induce that feeling, just look at some of the oldest psychological models like Maslow’s hierarchy of needs, written in 1943. He described that, at the most basic level, we all need our physiological needs met – food, warmth, shelter, sleep. If we don’t get those most basic things right, then we are never going to achieve anything. Beyond that, we need security and safety – financial, emotional, freedom from fear and our health.
Time to listen and learn
I am, though, very wary of words like ‘resilience’, ‘stress’ and ‘wellbeing’ because they have become buzzwords. They do not describe what we need. This stuff is not new – it is basic, it is common sense. We don’t need to make this a big thing. It just needs to be normal – not special, not requiring a committee, not measured, not mandated. Just day-to-day normal.
You can find tools from the NHS that will get you thinking about the workplace and the simple things you can do to make people feel better.2,3
So why am I writing this as a haematologist, and not some kind of HR or psychology expert? It is because doctors and all other healthcare staff are at risk for mental health problems and we are not good at recognising, managing or helping reduce the risk of them. But we can all learn, because we are humans and have that ability. And we need to do this now more than any other time. Listen to your colleagues, listen to their stories and share your own too. Make sure people eat, sleep and rest with some exercise in between. Listen to their worries and help them or direct them to the help they need.
Professor Dame Claire Gerada, Medical Director of the Practitioner Health Programme, said: ‘If we’re to learn one thing from COVID-19, it must be that all health and care staff should have access to a group to talk about work, to receive and give support, and to normalise rather than catastrophise their distress – and, in time, to reduce the burden of mental illness on those who care for us.’4
It’s just starting to seep into my brain that it could be me next. I need to learn.