news focus: What happens when doctors experience mental illness? Though many manage to get by, national services and help for them are seriously lacking. Daloni Carlisle reports on a new support network

Published: 30/05/2002, Volume II2, No. 5807 Page 16 17

Doctors are a determined bunch - as witnessed in a small-scale study of how they cope after suffering mental illness. Out of 78 doctors surveyed, two-thirds had gone back to work after a breakdown but many said this was in spite of, rather than because of, the help they received from their employers.

The survey was carried out by the doctors' support line, a Department of Health-funded initiative now setting up a peersupport telephone helpline for doctors.

The respondents were members of the Doctors' Support Network, a self-help group for doctors with mental health problems. Of the 78 who took part, 62 per cent were back at work. But only 22 per cent of the 78 said they received help from their employers or, if they were GPs, their work partners.

Project manager Deirdre McLellan says: 'I found the results very surprising because in my experience people who have been off work with mental health problems do not get back into employment, so the fact that twothirds of them did so is astonishing.'

Their comments about the support - or lack of it - show just how difficult this was.While a few were given a high level of support involving a phased return to work, supervision and retraining, this was the exception rather than the rule.Most had to fight to stay in medicine and sometimes for basic rights, such as sick pay.

Take this from an accident and emergency doctor with a bipolar disorder: 'My boss was very unhelpful and tried to get me to change career but the trust agreed to me going flexible and, despite my sorting it out on my own while unwell and depressed, it did happen.'

Many met outright hostility, such as a former consultant obstetrician who is now working his way back through the ranks.

'I was not wanted when I returned to work and was perceived as a drain on the department. They told me so when I left.'

Some found that their mental health issues were ignored. A GP commented: 'My return to work was full time, on call and in a new and stressful job. No allowances were made at all and everyone pretended it hadn't happened.'

The doctors surveyed were clear about the help they needed. Top of their list was information and advice about their rights - legal, employment and financial. They also wanted to know about selfhelp groups and where to get careers advice.

Dr Lizzie Miller is founder of the Doctors' Support Network which, along with the charity Primary Care Mental Health Education (PriMHE), is setting up the Doctors' Support Line.

She says: 'This shows how devastating the effects of mental illness are, even among a group who should be well placed to deal with them. They felt very isolated and few were able to exercise ordinary employment rights or were supported by occupational health.'

She adds: 'Those who did get back to work usually went on to work successfully and reported that the experience made them better doctors and wiser people in the long term. Support needs to be in place so mental health problems do not reach crisis point and become so destructive that there is no chance of returning to work. Doctors are people, too.'

Tim Scott, senior fellow at the British Association of Medical Managers, admits that many managers are not comfortable dealing with mental health problems. 'There are enormous problems of stress across all staff groups and I do not think managers are particularly skilled at dealing with it, ' he says.

But Dr Jolyon Oxley, honorary secretary of the National Counselling Service for Sick Doctors, is wary of blaming managers entirely. Doctors are notorious for failing to take time off when sick and have a traditional mistrust of occupational health departments, he says. 'There are very deep issues around doctors' perceptions of themselves and their needs when they get sick.'

There is a general agreement that more needs to be done to help the growing numbers of doctors with mental health problems, if only on the grounds of workforce issues. A third of doctors who retire early on medical grounds do so for mental health reasons.

Dr Chris Manning, chair of the Depression Alliance and chief executive of PriMHE, says: 'As someone who sits on the mental health task force, I can tell you that capacity issues are a major stumbling block to delivering all the national service frameworks.

Unless we look after our workforce, we can forget it.'

What precisely that something is, depends on who you ask.

BAMM hopes regular appraisal of doctors will provide an opportunity to talk about stress, allowing employers to act earlier and to avoid crises. 'Appraisal is where you pick up early indicators of stress and tackle them. It is the core of good human resources, ' says Mr Scott.

The Royal College of Psychiatrists, meanwhile, argues that doctors need special treatment such as the right to be referred to a consultant outside the geographical area where they work. Though some trusts do offer this already, it is far from routine and the British Medical Association is carrying out a survey to see what sorts of services are being provided.

Dr Susan Robson, chair of the British Medical Association's occupational health committee, says: 'Doctors are very vulnerable to mental health problems and reluctant to see themselves as patients. They are worried about confidentiality and sitting in the same waiting room as their patients. I am not suggesting that doctors with mental health problems should have private healthcare or a fast track into NHS care, but for various reasons they do need a special service.'

Like Dr Manning and Dr Miller, she feels the NHS is letting down doctors and other health professionals when it comes to mental health issues.Much of the help received by doctors in the doctors' support line sample came not from the NHS but from various self-help groups and the BMA's counselling service.

Dr Robson says: 'I think the BMA is doing a wonderful job for the support of its members, but what about the employer? Are they abdicating their legislative responsibility by failing to provide dedicated services?'

Doctors' Support Network: www. dsn. org. uk PriMHE: www. primhe. org

Time bandits: doctors under-report their own bad health A study comparing official levels of sick leave with the doctors'own version of events, published last week, reveals that over 80 per cent of sick doctors are under-reporting the length of their absence by nearly two weeks.

Dr Ian Murphy of Sheffield's occupational health service studied the self-reported sick leave at Royal Berkshire and Battle Hospitals trust, against the officially recorded figures.The set of 304 doctors (83.3 per cent response rate), questioned in March 2001, showed sickness absence was under-recorded by an average of nearly 12 days in those who had been sick in the previous six months.

Dr Murphy said that even the self-reported sickness absences were lower than in other groups in the health service and 89 per cent of doctors reported that their own state of health was either 'excellent'or 'good'.The study results were presented last week at the annual scientific meeting of the Faculty of Occupational Medicine in London.