DSN blog

(Un)reasonable adjustments? - difficulty in accessing reasonable adjustments for mental ill health

Mon, 23 Nov 2020 18:25:41 GMT

In the past, medics experiencing mental ill health have often encountered difficulties in accessing 'reasonable adjustments' to their work or study.

Dr Louise Freeman, co-chair of DSN, discusses whether there are any signs of improvement to the situation.

A summary version of this blog has been published on the British Medical Association website here as part of a focus on access and invisible disability for UK Disability History Month 2020.

'Once reasonable adjustments are advised, it's normally straightforwards' - from a recent medical meeting on medics with disabilities and getting back to or staying in work.

That wasn't my experience. I encountered difficulty in agreeing suitable adjustments to my work in returning to my consultant role after sick leave with a bereavement reaction. I was asked by my employer 'What did you say to occupational health that they made this recommendation? ' regarding initial advice that night-time on-call should be avoided for the first three months of my return. This exchange developed into a lengthy and acrimonious discussion with predictable effects on my mental health. I was initially advised that the recommended adjustments would not fall within the remit of the (then applicable) Disability Discrimination Act 1995 or DDA - when returning to work after ten months off with a mental health diagnosis. The return to work process eventually resulted in my contract being terminated. At the time, I felt as if my symptoms were dismissed and seen as being 'self-reported' due to mental illness being an 'invisible' disability.

Was it just me?

Medics replying to the recent BMA disability survey echoed my own experience in that respondents reported difficulty in having recommended 'reasonable adjustments' implemented.

What are reasonable adjustments?

Medics experiencing mental ill health may find themselves considered to be a 'disabled person' under the Equality Act 2010 (which superceded the DDA) if their mental illness (considered as if without treatment) has a substantial negative long-term effect on their ability to undertake normal day to day activities. There is no requirement for the disability to be consequent to a medical diagnosis although some conditions such as addiction are specifically excluded from the Act. The definition still applies if you would have met the definition of disabled in the past and have now recovered. Subsequent reasonable adjustments - to remove substantial disadvantages to their work or study that a disabled person would otherwise experience - may be recommended by an occupational health specialist.

There is no over-arching legal definition of what is considered 'reasonable' regarding adjustments to a specific work or study environment as there is wide variation in employers' resources to consider changes and they are not obliged to follow recommendations.

Rethink Mental Illness provides examples of reasonable adjustments for mental health disabilities including changes to working hours or allowing time off for treatment, assessment or rehabilitation. [FR1]

Any improvements in 2020?

My own experience took place a decade ago - surely medics' recent experiences would be better? I asked over seven hundred DSN members of about their experiences of needing reasonable adjustments to their work or study due to mental ill health. Survey respondents were asked basic career information and to categorise their experience of reasonable adjustments as positive, neutral or negative with an option to comment with more detail if they wished. (The online survey was anonymous and confidential - with no identifying information collected.) I divided their anonymous responses into 2015 and before or 2016 and after to see if there was any change in recent years.

From the figures above, the more recent experiences may be marginally better but not markedly so. N.B. Four of the respondents from 2015 and before volunteered that they had lost their jobs as a result of their mental ill health.

Demographics for the survey respondents included a full range of ages and seniority varying from medical student to career grades from a wide variety of specialities. We might expect either junior doctors to have more difficulty in accessing reasonable adjustments or, conversely senior, career grade doctors to be more susceptible to the willingness of a single employer to make changes. However, in this small survey, there was no apparent correlation between career stage, specificity or age ass to whether medics had a positive or negative experience of reasonable adjustments. Several respondents reported mixed experiences: positive in one work / study environment but negative in another.

Commonly recommended adjustments included:

working less than full time (LTFT)
not working on-call / night shifts
reducing home visits
reducing clinical sessions
amending pattern of the working week.

Problems cited with implementing adjustments included:

employers not understanding their duty to consider adjustments under the Equality Act 2010
speciality return to work policy not followed
occupational health dismissive of concerns due to the doctor coping at work to that point
refusal to consider longer appointments
being placed in a more stressful work situation (instead of less)

Anonymous comments from respondents:

'Reasonable adjustments are often seen by those in authority as a sign of weakness and inability to cope.'
On occupational health 'They don't know what to offer mental illness.'
On asking to reduce working hours 'my colleagues only agreed to me reducing my hours once they realised that I was under psychiatric care .' and 'I was told to get a job somewhere else .'

On the impact of poorly handled adjustments ''I do not feel valued as a team member. I feel a burden and am compared to colleagues who are doing more than me. This can have a direct impact on my mental well-being.'
On a positive experience ' Felt supported by team. Flexibility worked both ways - if able,I helped out when a need and had time off when needed. I was able to accommodate medical appointments around days off or at either end of shifts.'
On why adjustments seem so difficult to achieve 'There was a lack of guidance to myself and the colleagues with whom I was working. Everyone is so busy and stressed themselves there perhaps isn't any slack in the system to allow support for a colleague who is in need of some.'
On being offered a training post with appropriate reasonable adjustments in place 'I was really grateful that occupational health and the training scheme agreed that it was important to prioritise my health.' (after a previous less positive experience)
On how having LTFT training agreed is not necessarily the end of the matter 'LTFT is still quite a mixed bag, working better in certain speciality training programmes than others. Also translating LTFT/reasonable adjustments agreed “on paper” into something that works in reality can be a never-ending battle.'
'Things that I mentioned would be helpful were ignored. Basically, you either work in the full horror of conditions as junior doc, or you take time off. No middle ground.'

Why does this matter?

One would hope that healthcare might be eager to promote best practice in enabling skilled employees to stay at or return to work after mental ill health - unfortunately this is still not the experience of many medics as shown by the results of this small survey.

Pro-actively addressing any potential barriers to work for medics with mental health related disabilities makes obvious economic sense. When medical school costs £250,000 - with far more expenditure to train a doctor to career grade level - failure to address mental health related reasonable adjustments is not in the long-term interests of the National Health Service (NHS). In addition, there is no reason why suitable adjustments to work or study should not be considered before the Equality Act disability definition is met - requiring fewer resources rather than waiting to treat a more serious problem when the threshold is eventually reached.

Access to reasonable adjustments should not be a 'postcode' lottery dependent on the variable practices of local organisations. The stigma of having had a mental illness, as well as being seen as demanding or needy, can create further barriers for individual medics. By raising awareness, we can (as a profession) improve support and challenge organisations to do better without relying on individuals to effectively advocate their own adjustments, often at a time when they feel particularly vulnerable during recovery.

I hope that the spotlight on healthcare professionals' mental health and wellbeing during the pandemic will result in substantial improvement in how we support each other in returning to work after mental ill health.

N.B. I completely accept that doctors with physical health issues (as well as other health professionals / other NHS employees) can often struggle to access reasonable adjustments. This article focuses on medics experiencing mental ill health because this area is DSN's specific charitable remit.

Dr Louise Freeman - reflecting on why NOT volunteering is the right decision for me

Thu, 09 Apr 2020 16:18:09 GMT

Dr Louise Freeman is the co-chair of the Doctors' Support Network. Here, she talks about why prioritising your own health can feel difficult in times of crisis such as the coronavirus pandemic.

'...if I am not fit to return to the NHS under normal conditions (I am not), then I am definitely not fit to do so now.'

'I know that I am not the only doctor feeling uncomfortable about not volunteering in the coronavirus pandemic. I have a long -standing interest in physician health – in particular our own mental health – and, in this context, I’ve noted similar concerns from other doctors who aren’t currently working in the NHS.

My background is that I previously worked as a consultant in emergency medicine in the NHS (and have anaesthetics experience albeit from many years ago). I no longer work in this role after the handling of my return to work from a bereavement reaction resulted in a major depressive episode after which my NHS contract was terminated. I currently work in a non-clinical part-time role outside the NHS.

What would I need in order to consider returning to the NHS?

If I was to consider returning to the NHS, much planning and discussion would be required to achieve a suitable phased return and update of my clinical skills. Mentoring and specific occupational health support would be required, as well as close liaison with my own doctor and psychiatrist, in order for my return to have any chance of succeeding without unduly jeopardising my own health.

The bottom line however regarding whether I should consider returning to acute medicine during the pandemic is that, if I am not fit to return to the NHS under normal conditions (I am not), then I am definitely not fit to do so now. The current pandemic situation with approximately a quarter of the medical work force off sick or self-isolating, my own doctors fully occupied and occupational health currently inundated with enquiries (I hear) is not likely to fulfil my needs for a safe return.

This is a summary of my cognitive, rational thinking.

Emotionally however is another story

I currently feel thoroughly conflicted. The root of my discomfort is probably a long-standing and dysfunctional belief that my own well-being is secondary to that of patients and indeed everyone else’s. This is a common belief among health professionals and is intrinsically unhealthy. Dr. Clare Gerada of the NHS Practitioner Health Programme has a great saying ‘pull down your own oxygen mask first’ – I applaud and fully endorse this. If you’re not well yourself, you won’t be in any position to help anyone else. Another senior doctor explained to me that the bible commandment ‘love your neighbour as yourself’ does NOT say ‘love your neighbour INSTEAD of yourself’ yet the latter interpretation is how many health professionals end up feeling.

I am also aware that I would be likely to be able to work effectively for several weeks / a few months in the pandemic before becoming unwell – in my own recognisable pattern with poor sleep, low mood and increasing somatic symptoms of anxiety and depression. This really doesn't help when I'm feeling as if I 'should' be volunteering to help.

How to counter the uncomfortable emotional thinking?

I have done a lot of reflecting over the last several years since I was first unwell, and I am now much clearer about the importance of putting my own well-being first. I am still as likely to be caught out by instinctive thought patterns as anyone else, but I am now more likely to recognise and counteract them with logical reasoning.

I have found that I need to somewhat emotionally distance myself from the coronavirus pandemic and its impact on all of us but on the health service in particular – as opposed to reading and watching every news story and opinion.

I always find it very helpful to talk to sensible friends and family as is considering what advice I would offer to someone else in a similar situation. Many of us find it far easier to advise others than to treat ourselves with an appropriate level of compassion.

Offering praise and support to those currently working in the NHS

So, my role in the pandemic response is to applaud everyone working in the front-line NHS – all doing an amazing job in the most challenging health situation in a century. Not just doctors, of course, but all of the vital roles involved in keeping the health service show on the road. And I will continue to work in the voluntary sector as the co-chair of the Doctors’ Support Network.

I hope that this article is not read as advice on how anyone else should think or feel but merely as my reflection on the various pushes and pulls which any health professional in a similar position might be experiencing at the moment.

&me is our joint campaign, with the Royal College of Veterinary Surgeons' Mind Matters Initiative, to encourage senior, currently well healthcare professionals including doctors, vets, dentists and pharmacists to informally self identify as having experienced a mental health condition in order to reduce the stigma of mental health in the healthcare professions.

Find out more about our campaign and how you might get involved here

Dr Serena Haywood - &me anti stigma campaign

Thu, 10 Oct 2019 16:22:29 GMT

Dr Serena Haywood MBBS BSc FRCPCH MSc MA

Consultant Paediatrician, Guardian of Safe Working Hours, GMC Associate Assessor, BMA Doctor Supporter, London Women’s Leadership Network Mentor, Trust Health & Wellbeing Champion, Resilience blogger (Recalibr8), theatre producer and playwright.

'When your bio is longer than your story there’s probably a thing going on….

My story is that I have depression (including post natal), anxiety, post-traumatic stress disorder (PTSD) and a LOT of jobs. In my very doctory way, I work through my mental distress by doing more and more. Which means I’ve gathered a lot of titles along the way. On the surface then, I’m a mental health success story. Still a doctor. Climbing my way up the physician pole without overly frightening the horses.

But working harder and harder might not always be the healthy option. Workaholism is not unusual in doctors. I like to think that I take it to the next level. When I’m feeling low, I start another degree. I’ve had to be wrestled to the ground recently from starting a PhD. Why do this? I am terrified of stopping. I am a deceptively functional individual, successful by most measures, cheerful and good company. My friends say I make everything more fun and also ‘things/drama’ tend to happen around me. I love drama in all senses which is why I am a playwright and theatre professional as well as a doctor but this reflects my beginnings as the daughter of an alcoholic. Our collective behaviour is often one of cheerful calm, conflict avoidance and control at the expense of our own wellbeing whilst craving a maelstrom of emotions around us in order for things to make sense. I am a supporter and giver from childhood, absorbing others’ distress but that has not always been a healthy position and my familial tendency to maladaptive behaviours has taken the form of working sometimes to the point of exhaustion.

What happened

I had depressive symptoms from late adolescence triggered by my parents’ abusive domestic situation, which continued through medical school, culminating in my first significant depressive episode. Seeking help was not always easy and the support I received was often patchy and sometimes very peculiar; being told by a general practitioner (GP) to treat myself with plentiful relationship-less sex was a colleague low point. My trainee peers were fantastic but the oddness of responses over the years from bosses continued, with responses ranging from curtness, being patronised and, frankly, fear. The Iesson that I therefore learned, was that doctors did not let the side down (particularly as a woman, heaven forfend) and the rules were: don’t blub, be super profesh and ‘just get on with it’. When I experienced an extremely traumatic experience in paediatrics twenty years ago and was essentially left to deal with the emotional fall-out on my own (‘You’re fine are you? Good’), I did just that and more. My response was to keep my head down, shut down and emotionally blunt. This resulted in the insomnia, intrusive thoughts, hyper-vigilance and self-blame that I was later told were classic signs of PTSD. I came close to taking my own life. It was only in finding peers in Australia who told me this wasn’t ‘normal’ that I looked outside of the hard shell I had built up around myself and started my psychotherapy journey (via MedNet, now the Practitioner Health Programme in the UK) that I continue today. This hasn’t always been easy and, in part, I continue to make life challenging for myself by refusing medication and time off. This changed when another awful event four years ago triggered me into an emotional black hole and I conceded that I needed two weeks off. The fear and isolation of this event led me to take the risky decision to start talking about my mental health as much as I could to as many people as would listen. I was advised not to but did it anyway. And my life changed from there.

The benefits of speaking out

My colleagues have been universally accepting, my Trust (employer) has been supportive both in occupational health and managers and I have felt better. I have been supported in talking with junior doctors about resilience and that has led me to talking with other healthcare professionals, doctors returning to work, GP trainees, IT workers and on one notable occasion, Her Majesty’s Treasury Office. I support doctors dealing with the GMC via BMA Wellbeing and they in turn support me to be a better listener and learn more about the mental health of others. I blog as recalibr8 as part of my mental health journey and teach the skill of writing to support others to develop resilience using amazing actors in workshops. Doctors asked to do improvised comedy are hilarious! I also write plays which are performed in fringe theatres around London, Manchester and the Edinburgh Fringe Festival.

Why I am volunteering for AndMe

My wish is that if only one person can read this and take the exceptionally brave step to seek support from other professionals as a result that is job done. If it also helps reduce the stigma of health care workers coping every day with mental health difficulties, even betterer (job done plus…yes, OK, always the extra step!). I rely on my friends, my family and exceptional kids, my colleagues and, importantly myself, to notice when my depression comes back. I know it will, it always does. But I’m learning to be kind to myself, to know when to stop if I need time out so I can give the best to my patients and actually and literally say no. I tell myself that I do recover from the dark moments and to know that my sense of failure that sets that off is often misplaced. I am on a sobriety journey now which is tougher than I thought but I am hoping to use that experience in my next writing project. Do come, tickets available soon (always the shameless plug!). '

Seeking help?

Our wonderful &Me ambassadors share their inspiring stories to provide general encouragement and to help breakdown stigma, but if you need support, please seek it from your healthcare provider or a specialist service, rather than contacting our ambassadors in person. See our 'Support for Doctors' page for listings of various services and organisations specialising in supporting medics with mental ill health.

To disclose or not to disclose your own history of mental ill health as a healthcare practitioner - Caroline Elton

Thu, 15 Aug 2019 21:00:01 GMT

Caroline Elton is an occupational psychologist specialising in supporting doctors and dentists. Caroline has a best selling book about her experiences in this field - Also Human. Here, she talks about the thorny question of disclosing one's own experience with mental ill health.

'I’m an occupational psychologist who specialises in supporting doctors. I’m also a woman who has experienced a number of periods of depression at different times in my life. I’ve taken anti-depressants, had psychiatric treatment, and benefitted hugely from a long period of psychotherapy. When a doctor comes to see me and talks about their depression, do I share my own psychiatric history? Probably not.

‘But why not?’ you may ask – and that’s certainly a valid question. My reticence is partly due to my training, which discourages telling clients too much about one’s own personal stuff. And partly because people have come to talk to me about the difficulties they have been experiencing, and there’s always the danger that by adding in your own history, the focus can shift from them to you.

But the fact that I typically refrain from talking to a client about my own experience of depression doesn’t mean that I have to remain silent. In my book ‘ Also Human: the inner lives of doctors’ there’s a chapter which looks at the stigma doctors can face if it is known that they have suffered from a mental illness. When writing the chapter, it struck me as deeply hypocritical to, on the one hand, be arguing that there needed to be a culture of openness so that doctors could talk about their own mental health issues - and on the other hand, keeping shtum about my own experience of depression. It wasn’t exactly the bravest of self-disclosures, or the loudest, but if you read that chapter carefully, I mention that I too, like some of the doctors who come to see me, have had struggles with depression.

Perhaps it’s a symptom of the stigma that still surrounds mental health issues in the medical profession – but in the hundreds of emails that I’ve received from doctors all over the world since my book was published – very few have commented on my self-disclosure. But Dr Louise Freeman – Co-Chair of DSN picked it up – and she asked me to write this brief piece.

So #&Me. And whilst I don’t typically talk about it to the doctors who come to see me – I don’t want to collude with the fantasy that depression, or any other mental illness, only happens to other people. It has certainly happened to me. '

Buy Caroline's book 'Also Human' via the link here (a small percentage of the price will go to DSN without any extra cost to you)

DSN's patron Dr Phil Hammond defines health at the DSN 2019 conference

Fri, 14 Jun 2019 19:59:00 GMT

CLANGERS, keeping well for medics, specialist support and creativity were all on the programme at our recent conference in Bristol.

Our first AGM and conference in South West England was held in Bristol on Saturday 8th June 2019 at the New Room chapel.

AGM
We elected our officers and committee for 2019-20 as below:

Co-chairs: Dr. Louise Freeman and Dr. Angelika Luehrs
Vice chair: Dr. Malcolm Kinnear
Treasurer: Dr. Rebecca Lawrence
Secretary: Dr. Matthew Christie
Membership secretary: Dr. Susan Atcheson
New committee member: Dr. Cathy Wield

Chair's report available here
Treasurer's report available here

Discussion took place around face to face DSN meetings, manning DSN stands at events, our London Marathon silver bond place, and donations to DSN.

After lunch, we welcomed non members of DSN to join our conference for the afternoon session. This was very well attended with an engaged and enthusiastic audience responding to our fantastic speakers.

The Meaning of Health
Speaker: Dr. Phil Hammond is a doctor, journalist, campaigner, comedian and DSN's long-standing patron. He qualified as a GP in 1991 and currently works in a specialist NHS centre for children and adolescents with chronic fatigue syndrome/ myalgic encephalomyelitis (ME). The General Medical Council has said of Phil 'A comedian trapped in a doctor’s body.’
Twitter: @drphilhammond

Phil started his talk by noting that neither the NHS nor NICE has a definition of health! He introduced his own definition of health as 'Freedom to live a life that we have reason to value' later adding the caveat 'that also values others while taking as much responsibility as we reasonably can'. He told us that health is from the Old English 'hǣlth' meaning oneness in mind, body and spirit.

Phil talked about his own family history, noting that both his father's and mother's families had a history of mental ill health and suicide. He has previously spoken about his father's death during his own childhood. He said that he could 'remember feeling proud at the age of seven that I was crying less than my brother' when he found out that his father had died of a heart attack. Phil said that he had felt under pressure to get a lot done as a young man - campaigning as a junior doctor, writing for Private Eye, founding the comedy duo 'Struck off and Die' because he thought that he might die early like his father. In his thirties, Phil finally discovered that his father had actually died by suicide - as had his great grandfather and great uncle.

Phil then introduced Dr Phil's CLANGERS - his acronym for daily habits which promote good health for everyone:

C onnect
L earn
(be) A ctive
N otice
G ive back
E at well
R elax
S leep

Phil pulled together his thoughts about health and wellbeing and his own family history. He said that he thinks he's okay, despite the early tragedy of his father's suicide, because he has never experienced cruelty and has otherwise been surrounded by kindness. Phil felt that work-related stress or bullying could be experienced as cruelty.

Phil concluded his talk by declaring his intention to stand for election as Health Secretary on the grounds that he couldn't be worse than the last three!

Keeping on Keeping Well for Medics
Speaker: Leona Walsh , Professional Support Unit, Health Education & Improvement Wales (HEIW). Leona has been working in Postgraduate Medical Education, Wales Deanery since 2004 in roles ranging from International Medical Graduates, Specialty Training Recruitment and Professional Support to doctors and dentists in training.
Twitter: @LeonaAWalsh

Leona started her presentation by explaining the role of Professional Support Units whose remit is to provide support to trainee doctors in every region of the UK - the structure of the support provided varies between regions. The support provided includes regarding mental health problems, psychosocial stresses, exam pressures and training demands. Leona explained that her own unit currently provides support for 11% of trainees in Wales and is able to refer onwards to a coach or therapist for up to twelve meetings. Leona reported an increasing number of self referrals to the unit - showing that trainees are developing confidence in the service. The unit hopes to increase its remit to all doctors in Wales in the future.

Echoing Dr Phil's CLANGERS, Leona spoke about the importance of sleep, exercise and relationships as well as being organised, planning and identifying stressors and distractions in trainee's lives. She showed us the HEIW 'Game of Training' - demonstrating that careers do not proceed smoothly (for anyone) from medical school to Certificate of Completion of Training. Leona reminded us that events such as getting married and having children can bring their own stressors to be negotiated.

Finally, Leona reminded us that promoting trainee wellbeing did not need to be complex or expensive - giving the example of trainee medics reporting that the most effective interventions regarding their wellbeing were for seniors to 'know my name' and 'say thank you'.

Practitioner Health Programme Update
Speaker: Richard Jones RMN MSc BSc . Richard is the Clinical Director for both the NHS Practitioner Health Programme (PHP) and the GP Health Service (GPH) . He manages the largest caseload in both services, helping practitioner patients to recover from a wide variety of health problems and addictions.

Richard firstly explained how his role covers the Practitioner Health Programme PHP (currently commissioned for London based doctors and dentists - and all docs in England via GP referral) the GP Health Service GPH (all GPs including trainees in England) as well as a trainee support service for London.

Regarding PHP - the first specialist mental health service for UK medics - Richard told us that the programme has an active caseload of 840 practitioners with 30 new patients per month and most being discharged from the service within one year. GPH has 1600 active patients with 112 new referrals per month. Richard explained that both services see new patients within two to seven days and they aim not to operate a 'wait list'. He mentioned that the service will expand significantly in late 2019 when all doctors and dentists in England (175,000) will be able to self refer to PHP or GPH.

Discussing precipitating factors leading to mental ill health, Richard said that the newer GP service sees cases falling into four main categories:

'Practice meltdown'
'Too much, too soon'
'The straw that breaks the camel's back'
'Sad leading to bad'

Richard then covered how the case mix had changed since PHP started in 2008 when the average age of medics presenting was 50 and the gender mix was 50/50 to the current situation where the average age is 30 and the gender mix is 70% female. Regulator involvement has also decreased from 30% of cases in 2008 to 8% now.

Link to Practitioner Health Service 10 year report here

Creativity & Wellness for Doctors
Speaker: Dr. Jo Bowen ‘I am a retired London psychiatrist now running a private stress and anxiety/trauma management clinic in Devon and online, specialising in helping doctors, dentists and vets. I include use of conflict reduction creativity tools to aid wellness and fulfilment.’
Twitter: @jotalbotbowen

The area of creativity can be a confusing one.

What makes people’s creative juices flow?

What does it mean to say that someone is ‘getting creative’?

Why does creativity matter to a doctor feeling well?

To take a pragmatic viewpoint of what it means to be a well human being, creativity is not only for those with special ability- it is for everyone. It is therefore important that doctors can access a range of creativity tools for everyday life and work, especially whenever they need to process experiences or memories which can lead to anxiety and other frequently experienced emotional issues.

Dr Jo Bowen’s talk at the DSN Conference concentrated on the sort of tools that can be developed by doctors themselves to allow them to make the most of their essential creativity. When creativity can be accepted and nourished there is plenty of evidence to suggest that better self-development can lead to more empowered lives for doctors. This helps doctors deal with their conflict and fatigue issues, which are current urgent concerns for many in the medical profession.

Some of the problems, relating to how creativity can all too easily be dismissed by doctors, are explored. Some experiential tools were offered to ask doctors to reflect on their own creativity and how they might choose to access their imagination and sensory perceptions and even to change their living spaces to feel better in themselves.

Feedback from attendees!

'All the speakers and talks were very good. Phil's family story was very moving, and CLANGERS is something I will take away for my own self care'

'Stimulating and interesting speakers!'

'The range of presentations, their content and delivery, all of which were excellent.'

'Excellent'

Sponsors
DSN is extremely grateful to the British Medical Association , Chase de Vere Medical and the Medical Defence Union for their generous sponsorship of our 2019 conference.

Find out more about DSN:

JOINING DSN
If you're interested in physician health and haven't come across DSN before, any UK doctor or medical student, with mental health concerns, is warmly invited to consider joining (it's free with a suggested donation) and taking part in our anonymous, confidential support forum. Anyone not included in the above category who supports the aims of DSN in improving physician health is invited to consider becoming an associate member. Find out more on our JOIN page.

PUBLICITY
DSN leaflets and posters can be downloaded and printed out from our PUBLICITY page.

Dr Cathy Wield - Shall we talk about our recovery?

Wed, 05 Jun 2019 12:13:55 GMT

DSN member, Dr Cathy Wield, successfully returned to work in emergency medicine in the UK after two bouts of major depression, which included hospital admissions and brain surgery. Here Cathy reflects on talking about recovery.

'Sometimes there is negative comment towards those who talk about their recovery from mental health conditions. But I know that we have no desire to negate the suffering of those who are still in the throes of illness. I don’t think we would say the same thing about those speaking about their recovery from cancer.

It is true that many suffer for life with mental illness with cycles of relapse & remission, whilst others go from exacerbation to exacerbation. Yet the medical world has little to offer. I believe this is precisely why de-stigmatising of these conditions is so vital. We urgently need to recognise that at least 25% of us do understand this because we have suffered something similar, even if we are presently in remission or have recovered. Empathy, compassion and comfort for each other helps our health and therefore the health of our patients.

But there is a proviso and I think we do well to understand that none of us must relinquish our right to confidentiality. We need to be wise about who we trust and who we open our lives to, as in any circumstance. Revealing personal information to the public arena can have far reaching consequences.

It can be tempting to speak too soon. Timing is everything. I know that when my book came out, five years following my recovery and I subsequently suffered a relapse, I felt terrible. I felt as though I had ‘let the world down’. I had spoken on radio and television, been featured in articles and suddenly, there I was depressed once again. The downward spiral was driven by feelings of failure and I didn’t recognise it – nor did those who were caring for me! It was in fact short lived and not nearly as severe, but my confidence took a big hit.

How much worse it could be, if an unwise tweet or a Facebook post gets into the wrong hands. It’s happened and the unintended consequences can be difficult to reverse. My advice is to check with a trusted friend or loved one when it comes to instant social media.

But there is no such thing as never and it is clear is that we have solidarity and safety in numbers; those of us who can speak out, will speak out so that we can confidently tackle discrimination and help our patients to get the best care possible. '

Cathy tweets about her experiences as doctor and patient, using the handle @cathywield1 and blogs here She has written two books about her experiences: Life After Darkness: a doctor’s journey through severe depression 2006 and A Thorn In My Mind: mental illness, stigma and the church 2012

&me is our joint campaign, with the Royal College of Veterinary Surgeons' Mind Matters Initiative, to encourage senior, currently well healthcare professionals including doctors, vets, dentists and pharmacists to informally self identify as having experienced a mental health condition in order to reduce the stigma of mental health in the healthcare professions. Cathy is one of our amazing volunteers for this campaign. Read her blog piece for the campaign here

Find out more about our campaign and how you might get involved here

In our Own Words: UK doctors talking about our own mental health

Mon, 20 May 2019 14:07:08 GMT

Doctors' Support Network (DSN) co-chairs, Dr Louise Freeman and Dr Angelika Luehrs, presented at the 2019 European Association for Physician Health conference in Oslo about speaking openly about our own mental health as doctors and how this has changed since DSN was founded in 1996.

Doctors' Support Network background

Dr Louise Freeman first explained how DSN had started and developed over the last twenty years.

'The Doctors’ Support Network is a confidential peer support network for UK based doctors and medical students with concerns about their mental health.

Early years The organisation was founded in 1996. GP Dr Soames Michelson had published an advert in the British Medical Journal asking if there were any other doctors with mental health problems and Dr Lizzie Miller, the first female trainee neurosurgeon in the UK, was one of the thirty doctors who replied. The group approached leading UK medical organisations for support. These included the General Medical Council, the British Medical Association and the Royal College of Psychiatrists. They were told ‘I think you’ll find that you’re the only ones’! At this stage, there were only two peer support organisations in the UK – both for doctors with addiction - and little formal physician health. Early group activities included face to face meetings and a newsletter.

The network started an online, confidential support forum in 2001. Membership of the forum was restricted to doctor members of DSN. The forum allowed doctors to informally support each other while navigating being unwell with mental illness. Adding medical students to the forum was considered at one point and rejected by a majority of members partly due to worries around confidentiality. At this time, the committee only published their first names on the website and did not have their photographs either – photos were only added in 2013.

DSN Stigma Survey In 2014, DSN surveyed our members about their experiences of stigma - find out more here . A typical example of the type of experience recorded was ‘I experienced two years of pretty florid physical symptoms of anxiety/ depression (weight loss, early morning wakening, panic attacks) before attending my GP for help, mainly because I really wanted to be able to cope, and everyone around me seemed to be coping fine. I didn't want to admit to failing.’

In the UK in general, very few doctors spoke openly about having had mental ill health due to a combination of felt and enacted stigma. The stigma of mental ill health is well known to lead to delays in seeking treatment as well as poor responses from colleagues and others to mental ill health.

Unfortunately, my own experience of becoming sick while working as a consultant in emergency medicine involved experiencing much felt and enacted stigma including being told that a colleague had 'always thought that I was a mental health problem waiting to happen!'. I joined DSN in 2011 and became vice chair in 2012 and I've been co-chair with Angelika since 2018. I have gained so much from volunteering with DSN and connecting with other medics with similar experiences as I got better having definitely felt as if I was the only one while I lost my job.'

Louise then handed over to Angelika to talk about her experience of working as a consultant psychiatrist while having a diagnosis of Bipolar Affective Disorder.

It’s ok not to be ok and the art of speaking up.

Dr Angelika Luehrs said:

'It is ok not to be ok was the title of a piece on my Trust’s website about my experience of being a doctor with mental illness. It is ok to be a doctor and suffer from a mental illness and it should be ok but not always is as yet, to be open about it. Therefore, awareness raising is for me an essential activity. Raising awareness of course doesn’t mean wearing a sticker stating ‘I suffer from bipolar Illness’ – it would be counterproductive and irritate people more than being helpful. There is a time and place for awareness raising. But that’s not always easy and we (DSN) thought it would be interesting to reflect on the choice of activities to raise awareness and the impact of being open about having a mental illness as a doctor. The following points are my own experience and considerations although I have discussed them with others and found that people in similar situations and also friends/family and professionals mostly agree. All of the examples are my own as well.

About me I work as a consultant psychiatrist in Wiltshire, UK since 2010 and as a specialist advisor for complex mental health cases with the NHS GP Health service since 2017. I suffer from Bipolar Affective Disorder and was diagnosed in 2004 during my training. This was somewhat unexpected and caused significant disruption to my training. I was initially hesitant to get help and scared whether or not I would be able to continue with my career. I had never heard of a doctor with bipolar illness. I wasn’t really worried about medication, side effects, prognosis – all the questions my patients ask me. Of course, my illness caused major disruption to me training but overall the key issues have been medication and significant side effects. For example, I have photosensitivity as a side effect of one of my mood stabilisers which on occasions causes more problems than my illness. It is amazing how much emphasis we put on our role as doctor.

I wondered if there were any other medics out there and was signposted to DSN. I have been involved with the organisation since 2005. I realised that I am not the only doctor with mental illness and that there is more stigma attached than I had realised. In addition, I heard the negative experiences of colleagues and found that I have been very lucky with the support I received from professionals and my Trust as an employer. I decided that I was in a good position to speak up, personally and due to my support. Speaking up is a great thing to do but needs to be carefully considered. Once it is out there you can’t take it back.

So I would like to share with you some of the insights I’ve gained over the last fourteen years.

Factors to consider:

Support system This includes for me friends, family and professionals – people I would contact when I become mentally unwell. They need to be aware of any activity such as interviews etc and support it. My psychiatrist has been crucial with his advice about how and when to speak up and when not to.

Own mental health It is important to be mentally reasonably stable (that is of course very individual) when undertaking these activities. Raising awareness brings up memories, emotions and therefore almost always leaves me feeling somewhat vulnerable and raw. It makes me more self-conscious and worried about what people think for a while until this settles again.

It is also important to have considered all factors prior to deciding about awareness raising activity such as your frame of mind, support, possible consequences and what to say. For example, being elated in mood is not the time to agree to an interview and go ahead with it. This leads to another key point – how much do you feel comfortable to disclose: diagnosis? Related problems? Symptoms? How much detail of symptoms? I for example don’t mind talking about my diagnosis, symptoms in general but not in detail. Why not? Because I don’t think it is important and I wouldn’t feel comfortable about it.

The other important factors for me are around work:

Employer I have always included my employer in any decisions around awareness raising on national and international level. This usually includes a conversation with my line manager or, for example for the television show, with my medical directorate and communication department. I was keen to ensure that the Trust is supportive of my activity and would be happy to intervene in case of any problems. Also I had to make sure that the Trust is happy to be in the press/social media. If my Trust hadn't agreed and been supportive, I wouldn’t have done some of the activities. I have been very lucky with the support and responses from my Trust. They have been very supportive and are actively promoting our activities on their social media and local radio.

Medical and non-medical colleagues This is a very interesting aspect as you would think that it is not a major issue as the whole idea is about speaking up and raising awareness. However it is a lot easier to disclose my diagnosis and challenges to strangers rather than locally. Some of the most nerve-racking moments were a talk to my team, the Trust Board and also knowing that my team was watching the television show on which I appeared. How would my junior doctor feel about his consultant with a mental illness? How would I feel in the next Leadership Forum knowing that all senior managers know? These are the questions you need to feel confident to answer prior to agreeing to any awareness raising activity.

And last but certainly not least:

My patients Last but not least, I need to maintain a professional therapeutic relationship with my patients. There is a lot of talk about disclosing own experience of illness (physical and mental) and how this impacts on the patient-doctor relationship. There clearly are advantages to it such as own experience and, in some professionals' and patients' opinion, better understanding. I don’t think that the understanding is ‘better’ as such but rather different. Every illness and the perception of it is individual depending on factors such as symptoms, nature of illness, culture, personality, up-bringing and many more. The way I experience depression will be different to others but my overall understanding of it will differ from somebody who has never suffered from depression at all. It doesn’t make it necessarily better though.

What to do if a patient asks about my mental illness I have of course been faced with the situation of a patient reading about my mental illness as a result of looking me up online. Therefore you do need to prepare for this and what you would say in the threatened scenario of somebody challenging you ‘how do I know you are not unwell’ or simply asking you for more details?

Managing information I also consider how my patients and families/carers might feel reading for example in the newspaper about their consultant having a mental illness. I personally don’t think that that’s a good way of finding out and therefore would not consent to a piece about me in the local paper. This is very different to something posted on Twitter by my Trust, DSN or another professional organisation. This is also somewhat protective as it implies that they are aware and don’t have an issue with it.

There are clear positives though which for me outweigh the potential challenges by far:

There is an element of safety in disclosing one’s illness rather than keeping it a secret and being worried it might cause problems. It makes it easier for an employer and I am thinking in particular about local colleagues to act and to support if they are aware of a problem in the first place for example on-calls.
In general, of course the more we talk about having a mental illness the ‘safer’ it gets until having a mental illness as a doctor turns into something acceptable, something that needs managing but nothing else.
There is positive feedback which makes it worth-while from colleagues and other doctors with mental health problems.

At medical school I was confident that I would never choose psychiatry as a subject. I was going to do emergency medicine or general practice (GP) and be a ‘proper ‘doctor’. I then had to do psychiatry as part of a GP rotation and loved it. Not because it helped me to understand myself – I actually thought I knew myself pretty well but clearly didn’t as well as I had thought! Apart from realising that I find psychiatry exciting and interesting as a field of medicine I also found patients and staff inspiring and have met some fantastic human beings. I never saw mental illness as anything other than something we can learn to manage and control. It would have never occurred to me to perceive anyone I met as weak and unable to do the things they would like to do simply as a result of having a mental illness. Obviously, there are limitations externally and as a result of illness, but this is not the place to discuss these.

The greater good And finally, for me the key point is being part of something good, something important and bigger. As I said at the beginning, I was very lucky with the support I received both from professionals and employer feeding into and strengthen this attitude. I was therefore open about having a mental illness from the beginning and developed the drive to take this further. '

AndMe anti stigma campaign

And finally, Dr Louise Freeman introduced our AndMe campaign:
' A turning point for DSN as an organisation was our participation in the Royal College of Veterinary Surgeon’s cross professional Medical Minds Matter event in 2015. I represented DSN at this event and spoke about my own experience of low mood and depression after a bereavement reaction. The reason that I spoke at the event was because no vets would speak openly about their own mental health. I realised that doctors seemed to have more of a problem with our own mental health than vets, pharmacists or dentists and I thought that this should change but we then had to work out how to enable people to do this as safely as possible.

So in 2017, we started our AndMe campaign with the Royal College of Veterinary Surgeons' Mind Matters initiative in order to create a group of senior health professionals with lived experience of mental ill health who could show that a psychiatric diagnosis had not meant the end of their career. An AndMe volunteer writes their own text and supplies a photo for online use. We are very careful in selection of our volunteers to make sure that people are sufficiently well and in a robust career situation. For example, we ask our volunteers to check with their employers / work partners as well as their close family to make sure that those around a volunteer are positive about their proposed involvement in the campaign.

There have been some amazing responses including this from a trainee paediatrician who tweets as bipolar doc:

And her response to our And Me campaign:

Around the AndMe campaign, DSN also collaborated with a German group 'Selbst betroffene Profis' in presenting a symposium at the 2017 World Psychiatry Association Congress in Berlin about the value of peer support for health professionals (while owning our own history of mental ill health).

And in the last year, DSN has appeared on BBC television’s Victoria Derbyshire programme in a film about physician suicide and provided senior doctor volunteers willing to openly talk about their mental health for BBC radio discussions.

So from not having our family names or photographs on the DSN website, we have graduated to frequently contributing to broadcast articles about physician health under our own names - in fact it might seem as if we now never shut up about it!

Key messages for doctors considering talking openly about their mental ill health include

Is it the right time for YOU?- health / career / personal life considerations?
What are you trying to say? Generalisable positive messages are good!
Talking about your own health experience has a cost to you - it's not like doing a normal presentation at work
Recognise and acknowledge that other medics' experience may be quite different to your own

Read presentations from the EAPH conference here

Doctors' Support Network

DSN is a confidential peer support network for UK based doctors and medical students with concerns about their mental health. As a registered charity, we aim to raise awareness, reduce stigma and influence the agenda regarding physician health.

DSN facilitates informal peer support via an online, confidential, anonymous forum, face to face meetings and an AGM and conference. The photo above is from our most recent conference in Edinburgh in 2018. DSN is free to join with a suggested donation.

Find out more on our main website here

Dr Cathy Wield - Physician health = physician mental health?

Sun, 12 May 2019 18:16:06 GMT

DSN member, Dr Cathy Wield, successfully returned to work in emergency medicine in the UK after two bouts of major depression, which included hospital admissions and brain surgery. Here Cathy reflects on how we are still reluctant to talk about physician mental health.

'Talking about physician health is talking about physician mental health, but we can’t quite bring ourselves to come out with that. The question is why?

I am the first to say that our mental health is totally linked to every other aspect of ourselves, that we are whole people – physical, mental & spiritual – by that not meaning religion but our sense of self within the world we live in. But we still don’t really believe that mental and physical are inextricably linked or that to have a primarily mental condition is on a par with the physical.

We hide this with our inability to talk about a diagnosed condition that is termed ‘psychiatric’. Of course this is nothing new and, for decades, we have hidden our distress in such ways that are acceptable to others. The term stress is more acceptable than di-stress! But some of us have braved it and accepted a diagnosis such as depression, anxiety disorder or bipolar……but even amongst psychiatric illness there is a level of acceptability. Few talk about addiction or personality disorder, let alone schizophrenia.

But we are also in a vulnerable position because there is an increasing concern that physician health is all about what we can do to prevent ‘burnout’. We are encouraged to exercise, do mindfulness have a healthy work:life balance etc. The onus is on the individual to keep themselves healthy. But if systemic stress and pressure continue unabated it misses the point completely and once again, stigma comes in through the back door. It is an easy pathway to blame and that is something we need to avoid at all costs.

I was invited to speak at the Emergency Medicine Continuing Education Forum (EMCEF) in Birmingham on May 8th 2019. I am lucky that I managed to survive severe depression and have been well for over a decade; being able to talk to colleagues in emergency medicine about my experience is a privilege that is not easy to come by. I want to make this a subject that is interesting and compelling even for those who believe it’s ‘not their thing’ or they ‘don’t get it’. Stigma is at the heart of it, because let’s face it, if we fail to recognise that there is no such thing as a purely ‘physical’ condition, then we cannot do our jobs well. ‘So what about a fractured femur?’, some may say. But our response to any physical insult involves emotion and pain is a brain event as much as sadness or anxiety!

My talk: ‘what doesn’t kill us makes us stronger’ will, I hope, encourage emergency medicine doctors to seek support, without the worry of being alone or unusual for doing so. (Doctors' Support Network leaflets and information were available at the event. )'

&me is our joint campaign, with the Royal College of Veterinary Surgeons' Mind Matters Initiative, to encourage senior, currently well healthcare professionals including doctors, vets, dentists and pharmacists to informally self identify as having experienced a mental health condition in order to reduce the stigma of mental health in the healthcare professions. Cathy is one of our amazing volunteers for this campaign. Read her blog piece for the campaign here

Find out more about our campaign and how you might get involved here

Prof. Steve Robson on having felt suicidal as a trainee doctor: 'We need to support each other'

Wed, 08 May 2019 16:26:35 GMT

DSN contributed to a live discussion on physician health BBC Radio Five Live on 26th November 2019.

The original inspiration for the interviews was this article written by Prof. Steve Robson in MJA Insight about his experience of attempting suicide as a junior doctor many years ago as well as the further discussions about his disclosure including comment by Dr. Kate Tree - one of his colleagues at the time.

Prof. Steve Robson was first interviewed by Anna Foster from BBC Radio Five Live. Steve described having felt very much affected by the death of a particular patient during his first year at work as a doctor. He talked about how he felt as if he was dangerous as a doctor and as if there wasn't anything that he could do to make it any better. Steve then related how, having assembled preparations for killing himself, he was interrupted by loud knocking at his door from one of his colleagues. The interruption prompted him to get help - although he was told, by the doctor that he saw, not to tell anyone about the episode otherwise his career would be ruined. Steve now has a successful career in women's health and is the immediate past president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. He described having been moved by hearing stories of other doctors' experiences and feeling obliged to talk about his experience ' I have to say something - it's okay to seek help. '

Dr. Kate Tree was also interviewed about her experience being a fellow trainee doctor with Steve at the time. She told how she and her fellow trainees had observed him becoming unwell before their ' desperately staged intervention ' - knocking on his door having seen his preparations to kill himself. Steve described how he now felt as if we all needed to ' to try to reset the conversation ' about doctors' mental health

Emergency medicine consultant, Dr Laura McGregor, then talked about her experience of suffering Post Traumatic Stress Disorder related to her work with an air ambulance service. She described attending two train related fatalities on consecutive days in the same place and remembering thinking ' don't show that you're upset '. Laura then told how she had looked after someone with a myocardial infarction with the family looking on and feeling a ' huge sense of hopelessness ' and as if the person had been ' failed by me '. She went on to say that she felt as if ' her head broke ' and ' her brain was exiting the building '. She said that she couldn't concentrate and felt very ' on edge ' - with a heightened sense that something wasn't right. Laura went on to explain how a friend who was a psychiatrist had thankfully guided her in the direction of MedNet (formerly a dedicated psychotherapy service for doctors). Laura described how she was told ' You shouldn't be working ' but that she would get better - which she did and is now a substantive consultant in emergency medicine in Scotland after a supported phased return to work. Laura pointed out that the extra susceptibility of female doctors to mental ill health is well known - so why is there not more input! and that she had been ' at the top of my game' and still became unwell - it can happen to any of us.

Dr. Louise Freeman, co-chair of DSN was then interviewed about the pressure on medics not to disclose mental ill health. Louise confirmed that stigma related barriers are much the same for medics around the world and the importance of seeking early support to achieve the best outcomes for doctors and their patients.

Link to DSN's Support for Doctors page here

DSN is FREE to join and has an online, anonymous support forum for UK doctor and medical student members only.

Find out more here .

New 24 hour text based crisis support for doctors in England - BBC Radio 5 live discussion about physician health

Wed, 24 Apr 2019 12:56:20 GMT

DSN took part in a BBC Radio 5 live discussion about the announcement of a new 24 hour mental health crisis text service for doctors in England as well as the publication of a new survey on physician health from the British Medical Association.

On 24th April 2019, the British Medical Association published the results of a survey on physician health as well as a narrative study with Swansea University Medical School around trainee doctors' mental health - see link here.

In addition, the Practitioner Health Service announced the opening of its new 24 hour mental health crisis text service for doctors in England - see link here .

Firstly, there was an interview with Gurdas Singh, co-chair of the BMA medical students' committee, who rightly said ' we need to care for the carers'.

Clare Gerada: ' We can't keep photographing the problem (physician health) - we need to do something about it.'

Presenter, Rachel Burden, then interviewed Dr. Clare Gerada , the medical director of the Practitioner Health Programme . Clare described the one in four statistic (of docs responding to the survey who had been affected by mental ill health in the last year) as worrying and added that the figures would be much the same for nurses. She went on to talk about how personality traits selected for in medicine - such as perfectionism and martyrdom - can lead to burnout for medics. Clare also described major problems associated with the current environment in which doctors are practising, including a lack of time to reflect on the emotional aspect of the job.

Clare recommended that we need a senior level body to oversee NHS staff wellbeing. She explained about the new 24 hour mental health crisis text service for doctors in England which has just been started by the Practitioner Health Programme but that what we really need is an NHS confidential face to face service for doctors. Such a service will be in place by the end of 2019 for doctors in England.

Clare described how we should be supporting staff to help them to give the emotional support which is routinely required of healthcare professionals. Nicky then asked ' How worried should we be about the impact on patients? ' and Clare responded that patients shouldn't worry that their GP will burst into tears in front of them. She said that it's not patients who should be worried about staff mental health but doctors and that we should all, as patients, be worried about the mental health of the NHS workforce. Clare also pointed out that the other UK nations will have their own issues and that the current situation was only planning for extending the service to doctors in England.

Dr. Rebecca Lawrence, consultant psychiatrist and DSN committee member, was then interviewed. She described her own experience of mental ill health. Rebecca talked about how the work situation for trainee doctors is different today compared to when she was training with the potential stressors including shift work, more technology to negotiate, increased pressure to avoid complaints and the absence of the old team structures. Rebecca said that she was pleased to hear about the new text crisis support system as well as the roll out of the face to face support but that issues regarding the system in which doctors are working also needed to be addressed in order to reduce the likelihood of burnout and serious mental illness. She talked about training can be very hard in the early stages and people who struggle can be thought to be 'not up to medicine' as well as how medics are afraid that they may be reported to the GMC which she described as the 'ultimate horror for doctors' . (Rebecca blogs about her experiences as doctor and patient here and also tweets as @Rebecca99LT .)

Ella, a third year medical student then described her experience of mental ill health while at medical school and how she had received fantastic support but that she was aware that this was not the case for everyone. Ella talked about how mental ill health for medics can be viewed as a ' fatalistic failing ' or the individual's own fault. She said that doctors are human and are allowed to be ill but that we don't like to acknowledge this. Ella concluded by saying that she was still keen to work in the NHS.

During the on-air discussion, a listening nurse tweeted about how disappointing it was that the focus on mental health support was again about doctors. Rebecca agreed that all health professionals needed appropriate support and how a very large service would be needed to cover everyone.

Finally, Dr. Louise Freeman, co-chair of DSN, explained about the work of DSN in facilitating informal peer support for UK based doctors and medical students as well as campaigning to improve care and there was a brief discussion about the needs of doctors with addiction including mention of the Sick Doctors' Trust and the British Doctors and Dentists Group .

The programme will be available to listen again online until 23rd May 2019. (Clare Gerada's interview is at 7 minutes into the programme with Rebecca and Ella's slot at 1 hour and 5 minutes.) Link here .

Specialist sources of support for UK medics are listed here on the DSN website.

DSN is FREE to join and has an online, anonymous support forum for UK doctor and medical student members only.

Find out more here .

Get involved with running DSN!

Wed, 17 Apr 2019 10:38:13 GMT

Ever thought about helping to run DSN? DSN was initially set up and is entirely run by its members, all of whom are medics with a mental health concern or people who support the aims of the organisation.

Why volunteer with DSN? Because it is interesting, fulfilling and good for your own wellbeing! In addition, representing DSN at physician health meetings and events is also an excellent opportunity to connect with all the major organisations in UK physician health.

N.B. There is no expectation that DSN committee members will support other unwell medics one to one. Committee members may, of course, choose to anonymously support other members in the protected environment of the DSN Support Forum.

Why are we (current committee) involved in running DSN?

Dr Louise Freeman, co-chair: ‘ Because, when I was sick, I felt as if I was the ‘only one’ and it was a very lonely experience. Physician health is a quickly developing area in the UK and I think that it is important that we contribute an informed user opinion.’

Dr Susan Atcheson, membership secretary: 'I joined DSN when I was recovering from depression. My first contact was by pitching up at the AGM but I could not have been made to feel more welcome. For me finding doctors who have experienced mental illness and who are willing to speak out about it has been the most helpful aspect of DSN. I feel empowered to speak out myself and I take strength from the experiences and stories of my DSN colleagues'

Dr Matt Christie, general secretary: 'DSN provided me with a safe space for support at a time when I needed it most and reassurance that I was not alone in my experiences of mental ill-health as a doctor. It’s since been my privilege to continue DSN’s good work and its advocacy of physician health as part of the committee.'

Dr Malcolm Kinnear, vice chair: ' I joined DSN in 1999 when I was myself severely depressed, & found myself organising its Scottish meetings from 2003, joining the DSN Committee after some years of advocating for better mental healthcare for doctors in Scotland. DSN played an important role in my own recovery & return to work, & as a consultant general adult psychiatrist, I feel that it is important that I use my life experience, skills & contacts to help doctors & students to access appropriate healthcare & support, in which context a peer support charity such as DSN has special relevance & credibility due to doctors' widespread mistrust of official bodies on the grounds that their purpose seems more to protect patients than support doctors. '

Dr Rebecca Lawrence, committee member: 'I joined because DSN provided me with support some years ago, & this was the first time I had received any peer support in a long history of illness. I also have years of experience as a trainer and educator, peer supporter and GMC supervisor. Recently I have written about my own experiences, and have started a blog. I hope that sharing this will provide hope and support to others.' Link to Rebecca's blog here

Do you need to be an expert on physician health to be on the DSN committee? Definitely not – you merely need to be enthusiastic and happy to contribute some of your time.

Where are the meetings? We hold most of our meetings by telephone conference call. Committee members need to have access to a telephone on which they pay for the call i.e. not a work line. Our AGM takes place face to face in an accessible venue in the UK.

What skills are needed to contribute to DSN? DSN does not have a physical office so ability to use a computer is essential as the committee is dispersed around the UK. We communicate between meetings via the committee email forum.

We are trying to create a system for DSN which is not dependent upon individual skill sets e.g. our website is built on a widely used commercial platform of the ‘drag and drop’ type.

What if I’m not well and can’t take part in a DSN meeting / do the task that I have undertaken? DSN understands that any of us can be unwell and need some time off at any time. DSN committee members are encouraged to communicate with their colleagues if this is the case so that we know what is happening.

Changing the world – or not! It’s easy in the under resourced area of physician health to feel as if DSN ‘should’ have big ideas and projects. From our organisational experience, we now aim for small, achievable goals so that we can keep moving forwards rather than failing to complete bigger projects and becoming discouraged.

The details re. DSN committee

The DSN committee is elected annually at the AGM. DSN Full, Student or Associate members are eligible to be on the DSN committee.

Charity requirements DSN is registered as a charity with the Charity Commission (England & Wales) and the Office of the Scottish Charity Regulator (Scotland). We are required to hold an Annual General Meeting (AGM) and submit an annual return and accounts.

The Charity Commission requires that all committee members are also trustees of the charity. Eligibility criteria for being a charity trustee are detailed in the DSN trustee guidelines here .

DSN roles DSN has officer roles: chair , vice chair, treasurer , general secretary and membership secretary . The main tasks for each of these roles are hyperlinked to the role titles above. In addition, there are other tasks which we need to do, which are not linked to the officer posts.

If you have any questions about the committee, please get in touch via our contact page here

Dr Becky Hirst - &me anti stigma campaign

Tue, 08 Jan 2019 18:19:04 GMT

Dr Becky Hirst is a consultant in Palliative Medicine in South Yorkshire. She has had two episodes of moderate to severe depression, the first as a specialty registrar in 2004, both of which required significant time off work.

In 2007 Becky won the BMA writing competition, writing about her first experience of depression, and was also interviewed on Radio 4’s ‘All in the Mind’ in a programme about doctors’ health. Becky feels strongly that, although the statistics are that one in four people will have an episode of mental illness, in fact one in one of us are vulnerable.

Becky won the 2007 BMA writing competition with this piece:

'What I learnt from that episode of depression

I always hoped that I was a ‘good doctor’ when it came to looking after people with mental illnesses. I’d spent six months working in Psychiatry as part of my GP training scheme. Certainly, it wasn’t always easy – my consultant once accused me of treating her patients like horses, making sure they were fed and watered but not much more – but I did my best. In General Practice it was a standing joke that while the other female partners in the practice did the Well Woman Clinic on a Tuesday morning, I did the Weepy Woman Clinic. I spent a lot of time reassuring people that depression was a real illness; that it was a chemical imbalance in the brain; that antidepressants work by correcting that imbalance; that yes, it was hard because if you’d broken your leg then everyone could see the plaster cast…

And then I got sick. I went from being a relatively competent specialist registrar in Palliative Medicine to nothing in a couple of days. I spent the first couple of weeks asleep. I would manage to have a shower and then I would have to go back to bed. I felt like a shell of my former self, and it surprised me sometimes when I looked at my hands that I didn’t just see straight through them. I had lost everything that made me who I was and I despaired of ever being reunited with my sense of humour. Listening to re-runs of radio 4 comedy programmes at 4am, I could appreciate intellectually why things were funny but it didn’t make me smile. Nothing did (my face hurt if I tried). My concentration was non-existent. I could read, but put the book down briefly and I wouldn’t have clue what the story was or even who any of the characters were (“Losing the plot” said the psychiatrist with a twinkle in his eye). I would be paralysed in the supermarket unable to choose food to eat, struggling not to abandon my trolley and leave. I couldn’t trust myself to judge when it was safe to turn right on to a main road in the car. “If I can’t choose which biscuits to buy,” I said to my GP in despair, “I don’t think I’m well enough to be deciding how much diamorphine to put in a syringe driver”. He laughed nervously and wrote me a medical certificate for another month.

I learned so much - about myself, about how depression distorts your reality and your thinking, about how a lot of people perceive people with depression. I learned that when we tell patients blithely that it will be “two or three weeks” before the antidepressants kick in, that every day of that third week is a lifetime. I was amazed at how physical an illness it was – to begin with the smallest exertion left me breathless and shaking. I had pain all over my body. Verging on the psychotic, I would have terrible, graphic visions of seriously hurting myself. These were frightening as they seemed to come from outside me and I worried I might act upon them as I did not feel in control. More frightening was when I got a little less unwell, so that I was functioning better but still felt dreadful, as I couldn’t see the point of continuing in this robot-like state if this was all life had to offer as suicide seemed a rational outcome. With my poor concentration, I wondered if this was like early dementia – within minutes of taking my tablets, I hadn’t a clue whether I had or not and would have to count how many were left in the packet and how many days until the next GP appointment in an effort to work it out; having ‘Can’t Remember What You’ve Gone Upstairs For’ syndrome so badly that I would get from the kitchen to the end of the hall and not know what I was there for.

So two years, a lot of counselling, antidepressants and a chocolate Labrador puppy later and I have regained most of myself, though I’m not who I was before I got ill. Such an illness is like going through a refiner’s fire – one is definitely changed, I hope for the better. Nevertheless, a bit of me grieves for the old ‘me’, whom my current partner has never met. There have been other bereavements – I still struggle with not working full time; I should have become a consultant a couple of months ago but now it will be 2010 at least. They teach you about Kubler-Ross’s six stages of grief at medical school, but nobody tells you that at times you might be doing three or four of them simultaneously, and I’ve never been so angry. It has helped me appreciate what losses my patients might be facing, and also to empathise with those suffering depression. Sometimes I share a bit of my own experience if I think it might help.

One of the most difficult lessons was learning to be kind to myself, that if I didn’t look after myself there was no way I could care for others. It’s easy to get swamped by the needs of others – patients, team members, family – and to feel guilty if we take time for ourselves. When I was first ill, my psychiatrist friend advised me to do one chore and one nice thing each day. I vividly remember how proud I was the day I washed the kitchen floor for the first time for a year. Depression is a horrible illness. I wouldn’t wish the experience on anyone, but I could not have gained such insights into the world and myself without it. Depression leaves a stain on your soul, even when you fully recover, but that scar serves to remind me of the journey I’ve made and be grateful.'

Find out more about our &me campaign here

Seeking help?

Our wonderful &Me ambassadors share their inspiring stories to provide general encouragement and to help breakdown stigma, but if you need support, please seek it from your healthcare provider or a specialist service, rather than contacting our ambassadors in person.

See our 'Support for Doctors' page for listings of various services and organisations specialising in supporting medics with mental ill health.

DSN 2018 AGM & conference - positive peer support in Edinburgh!

Louise@ffzzz.plus.com (Louise Freeman) — Tue, 13 Nov 2018 11:22:56 GMT

Physician health managed care network, neurodiversity in doctors, talking about our own mental health & equine facilitated psychotherapy!

For the first time in DSN's two decades, we held our AGM and conference in Edinburgh. Scotland has a long standing DSN face to face group and our vice chair Dr. Malcolm Kinnear is a consultant at Tayside.

AGM
We elected our officers and committee for 2018-19 as below:

Co-chairs: Dr. Louise Freeman and Dr. Angelika Luehrs
Vice chair: Dr. Malcolm Kinnear
Co-treasurers: Dr. Wendy Reid and Dr. Caroline Ritchie
Secretary: Dr. Matthew Christie
Membership secretary: Dr. Susan Atcheson
New committee member: Dr. Rebecca Lawrence

Relevant AGM documents and reports are available here

In the afternoon, for the conference part of the day, we heard from engaging speakers on a variety of topics around physician health.

DSN is extremely grateful to BMA Scotland for their sponsorship of our conference.

Proposed Scottish physician health managed care network
As chair of the Royal College of Psychiatry in Scotland from 2013-17, Dr. Alastair Cook chaired a steering group to build a business case for a national network to support doctors' mental health in Scotland.

We were delighted to welcome Alastair to update us on the state of plans around commissioning a managed care, physician health network for Scotland. He first outlined the current situation where informal networks of interested psychiatrists were seeing substantial numbers of doctors and mentioned various unsatisfactory features about this arrangement e.g. difficulty in clearly identifying a psychiatrist with an interest in this area. He described plans for taking this forward involving updating the business case, establishing a hosting arrangements and identifying a clinical lead and team. There was an animated discussion after Alastair's presentation including comments on how postcode medicine would not be acceptable in 'normal' patient care and that rural general practitioners were particularly in need of support. Attendees were impressed with Alastair's obvious commitment to the project.

Neurodiversity in the Medical Profession
DSN member, Dr. Shirley Moore has published an article in Scottish Autism about her own experience of being diagnosed with Autism Spectrum Disorder (ASD).

Shirley first explained what neurodiversity is and how neurodivergence might manifest in doctors. She described how many neurodivergent traits such as having excellent attention to detail and problem solving skills can be helpful to medics while others such as social awkwardness and difficulty with adapting to change can cause problems at times. Shirley then discussed how acquiring a formal diagnosis of neurodivergence can be helpful in identifying necessary support although there is a risk that the condition could be used to harmfully label an affected doctor.

Shirley co-ordinates a Facebook group ‘Square Pegs’ - a group for female (or identifying as female) healthcare professionals or students who are neurodivergent (specifically ASD, ADHD, ADD). Shirley says 'No formal diagnosis is necessary. We welcome members who are self-diagnosed. Our members are predominantly in or from the British Isles, however we will not exclude anyone from elsewhere with an interest in our countries.' Get in touch with Shirley via the info@dsn.org.uk email address to request addition to the 'Square Pegs' group.

‘ Neurodiverse docs UK ’ is another (closed) Facebook group for doctors with neurodiversity.

DISCUSSION - Talking about our own mental health as medics; being real while staying professionally safe
We had an excellent discussion including views from students, trainees, consultants, GPs and therapists. A few points from our discussion were:

Sharing with patients:
' You just know when people have been there themselves .', ' You don't need to actually say (about your own experience) ' and about how telling about an element of your story in the third person can be very useful.

Sharing with colleagues:
' Shame attached (to mental ill health) in healthcare is a big problem .' and ' I disclosed to colleagues since before I started psychiatry - no regrets. '

Equine Facilitated Psychotherapy - an introduction
After 35 years in England as both a Registered Nurse and as a therapist/counsellor in private practice, Mike Delaney has managed to enjoy a sustained career in mental health and addictive behaviours. Until 2015, Mike was Clinical Director and CEO of Bayberry Ltd, a residential treatment facility, which was set up specifically for doctors, dentists and other healthcare professionals who had mental health/addiction issues.
Mike has recently moved back to central Scotland where he plans to introduce the LEAP Equine model.

Mike told us about his initial scepticism regarding equine facilitated psychotherapy (EFP) and his subsequent realisation that this mode of therapy could help a variety of his clients, often in a relatively small number of sessions. For example, he has used equine facilitated psychotherapy with great success for clients with addiction and PTSD, noting that the therapy worked without the client having to verbalise a traumatic experience. Mike described a trial of EFP with troubled teenagers in which they moved from 'It's insane to talk to horses!' to 'It's amazing-it has really made me happy again.'

Watch a short video - 'My day with Dobbin' - about one client's powerful experience of EFP here
Mike's website - click here

We concluded an excellent day by going for a fine dinner in a local restaurant.

JOINING DSN
If you're interested in physician health and haven't come across DSN before, any UK doctor or medical student, with mental health concerns, is warmly invited to consider joining (it's free with a suggested donation) and taking part in our anonymous, confidential support forum. Anyone not included in the above category who supports the aims of DSN in improving physician health is invited to consider becoming an associate member. Find out more on our JOIN page.

PUBLICITY
Our leaflets and posters can be downloaded and printed out from our PUBLICITY page.

The long roots of poor mental health in the medical profession

Thu, 08 Nov 2018 23:48:47 GMT

Is physician health a millennial problem? Prof. Alannah Tomkins doesn't think so...

At the Wounded Healer conference in London recently, Dr Abigail Zuger asked whether the poor mental health afflicting the modern medical profession was new, or whether it had historical antecedents. Her keynote cited the example of Arthur Anderson MD, an eighteenth-century physician who worked at Bellevue Hospital in New York, and diagnosed himself as suffering with depression of spirits. He left medicine, and Dr Zuger drew parallels between Anderson’s experience and her own decision to give up her medical career, but asked how representative she and Anderson were.

I can’t speak to the American medical profession, but English doctors have a long history of suffering poor mental health as a direct result of their working lives. I know this because my research into lunatic asylums, founded chiefly from 1808 onwards, admitted many surgeons, physicians and medical students as patients in the period up to 1890. A survey of just 18 hospital (out of a possible total of 137 English asylums in existence in 1881) found 171 such men admitted to institutions, and a good many of them have surviving case notes to speak to the causes of their distress.

Men were not drawn predominantly from one part of the profession: a contemporary fear that doctors of the mad were more likely to become disordered themselves is not borne out in my data. Instead the pressures of medicine were pervasive, and expressed by medical patients in the hopes and fears they communicated to their asylum officials. These apprehensions might circle around perception of conspiracy – one man thought his medical peers sought to undermine his character – or of tragic personal circumstances. More than one man was admitted to an asylum after failing to save the life of his own child.

To give two examples:

Owen Arnold was a medical student when he was admitted to the Wonford House asylum in Exeter twice, in 1850 and again in 1857. He believed “that his relatives are always attempting to injure him and that they have been the means of preventing him from following his profession.” He particularly blamed the isolation he felt while living as a student in London. He was dismissed for the second time in 1861 without having become any better.

In contrast Cornelius Suckling was a 43-year-old physician with an established career when he was admitted to the Warwickshire asylum in 1875. His behaviour had become erratic for some time, but for about a month before being taken to hospital he had “a great deal of hard work & for three nights got scarcely any sleep”. He starting “drinking a great deal” and by the time he reached the asylum he was convinced he was the son of Admiral Nelson, and that his wife was Lady Hamilton (sic). He died in the same asylum 26 years later.

The medical professionals admitted to asylums in nineteenth-century England were likely to represent only the worst and most unavoidable cases of poor mental health. How many more experiences went unrecorded in the community, written off as personal idiosyncrasy? But if we can’t know the full extent of doctors’ historic mental-health problems, we can at least give a partial answer to Dr Zuger’s question: she, and Arthur Anderson, have been more representative of a historic phenomenon of depression, distress and disorder in the medical profession than she initially guessed.

Prof. Alannah Tomkins is director of humanities research at Keele University. She is currently researching aspects of the English social history of medicine, including the experiences of doctors who struggled to secure or maintain a professional identity c. 1780-1880.

Buy her book 'Medical misadventure in an age of professionalisation, 1780-1890 (Social Histories of Medicine)' by clicking here (DSN will earn a small percentage of this sale at no extra cost to you).

Doctors' mental health at a 'tipping point'

Louise@ffzzz.plus.com (Louise Freeman) — Tue, 11 Sep 2018 16:29:52 GMT

More specialist support is needed for UK doctors with mental ill health

The Doctors' Support Network recently had the opportunity to contribute to a film about physician suicide in the UK for BBC2's Victoria Derbyshire programme.

Journalist, Chris Hemmings, sensitively interviewed GPs Dr. Laurel Spooner, the mother of Dr Sophie Spooner who died by suicide, and Dr. Kate Harding whose consultant anaesthetist husband, Richard died by suicide on the same day as Sophie. Kate has written movingly about the loss of her husband in this article in the Guardian.

The full 15 minute film about physician suicide in the UK included interviews with Dr. Clare Gerada, medical director of the Practitioner Health Programme - the first specialist doctors' support service in the UK and with DSN’s co-chair Dr. Louise Freeman about her own experience of depression. A studio discussion followed the broadcast of the film on the Victoria Derbyshire programme on 3rd September 2018. DSN's co-chair Dr. Angelika Luehrs took part in the discussion with psychologist Dr. Caroline Elton and Dr. Zaid Al-Najjar of the Practitioner Health Programme around the barriers which often prevent doctors from seeking support for their own mental health. The discussion is from approximately 1 hour 36 mins into the programme . An article summarising the film is available on the BBC News website.

Overall message: more specialist support needed for doctors.

Healthy doctors = healthy patients - good for everyone.

Dr Richard Harding and DSN donations

Louise@ffzzz.plus.com (Louise Freeman) — Mon, 18 Jun 2018 10:04:00 GMT

Dr Richard Harding was a consultant in intensive care medicine and anaesthesia. Richard died in autumn 2017 - his family and many friends have recently held a memorial service for him. DSN was honoured to be nominated as a charity to receive donations made at the service.

Richard took his own life in October 2017 soon after a recurrence of a depression which was, in part, triggered by his first experience of a General Medical Council (GMC) complaint, just as he and his family prepared to emigrate to New Zealand. Although he had excellent support from his colleagues and was confident that he would be exonerated, which is indeed what happened in due course, the terrible timing of the complaint combined with the stress of the move to another country caused him to have his first episode of depression in 23 years. He had had one previous episode of depression in his early 20s, which had responded well to treatment.

Richard was three days away from his first appointment with a psychiatrist when he died. He is survived by his wife, Kate, also a doctor and two children.

Kate has written about her family's experience in an article in the Guardian. Click here to read the article.

Dr Rebecca Lawrence - &me anti stigma campaign

Tue, 13 Mar 2018 00:00:00 GMT

Dr Rebecca Lawrence is a consultant psychiatrist and clinical director.

Rebecca says 'I have had a long career in psychiatry which has been intertwined with my own mental health problems. The latter started relatively abruptly with a puerperal psychosis prior to my psychiatric training, and I have had many episodes over the years, involving hospitalisations and electroconvulsive therapy as well as drug therapies. Talking therapies have been of limited benefit when unwell – and have seemed less relevant when I’m well.

I have a diagnosis of bipolar affective disorder, which I find hard to accept. My psychiatrist tells me that doctors are the most self-stigmatising patients that he comes across, and that he knows I’m becoming unwell when I start to talk more of having a personality disorder. However, I try to follow his advice, and am fortunate that I have had long periods when I have been well.

I have been very lucky with family, friend and colleagues – and those involved in my treatment – and am still surprised by my life and how it has turned out. I have been a consultant psychiatrist in addictions for over ten years now, and have been clinical director since last year. I also work in the chronic pain service, having recently completed a masters in pain management, and do as much teaching as I can. I have a wonderful family, and play music in what spare time I have left.

What advice would I give to others? I am realistic that my illness is unlikely to go away. I used to try to fight it – which was helpful at times – but it does affect my life and will continue to do so. It hasn’t stopped me doing what I want to do, but I do have to adapt at times. It does affect me, like any chronic illness would.

And that, ultimately, is what I would say - adapt if you need to because of the illness, but never because of the stigma of the illness, whether self-stigma or otherwise .'

Rebecca blogs about her experiences as doctor and patient here and tweets as @Rebecca99LT

Updated October 2020: Read Rebecca's recent Guardian Opinion article on her experience here

Seeking help?

DSN AGM & conference 2017

Louise@ffzzz.plus.com (Louise Freeman) — Sat, 02 Dec 2017 22:52:42 GMT

DSN held our 2017 Annual General Meeting and conference at the London Canal Museum today.

Click here to see event details.

A successful year of DSN's activities was reviewed, followed by the election of DSN's officers and committee.

Elected for 2017-18 :

Co-chair: Dr Louise Freeman and Dr Angelika Luehrs
Vice chair: Dr Malcolm Kinnear
Treasurer: Dr Wendy Reid
Secretaries - membership: Dr Susan Atcheson
- general: Dr Matthew Christie:
Committee: Dr Jacqueline Haworth, Dr Clive Morgan and Dr Mahomed Saleh

Documents for AGM are attached below:

Agenda DSN AGM 2017
Minutes DSN AGM 2016

Treasurer report DSN AGM 2017

Chair report DSN AGM 2017

We then took part in a marketing workshop to redefine DSN's key messages.

The workshop was delivered by Andy Ditchburn of Perro . Andy went through his market, message, medium process to help us to identify DSN's core idea and values before finalising our key messages.

We came up with a long list of DSN's key values before weeding them out to the short list below.

supportive
inclusive
unique
informative
respected
confidential
championing
compassion
independent

We then worked on DSN's core idea and key messages with Andy's expert help. Andy has provided a report on his full recommendations, attached here .

Great to meet DSN members today and we all enjoyed working on the organisation's presentation in a supportive and positive environment.

Documents for DSN AGM 2017 and What do we want from services for sick doctors?

Louise@ffzzz.plus.com (Louise Freeman) — Thu, 23 Nov 2017 10:36:54 GMT

Documents for DSN AGM 2017 - please print your own hard copies if you are coming to the AGM in person.

Agenda DSN AGM 2017
Minutes DSN AGM 2016 (unconfirmed)

Treasurer report DSN AGM 2017

Chair report DSN AGM 2017

At last year's DSN conference, we had a discussion about the desirable characteristics of a service to treat sick doctors.

The results of our discussion are listed below:

Confidentiality – unless safety issues -with clear boundaries between treating doctors and doctors who are colleagues.
Location of treatment – not in the same places as your patients
Consistency
Recognising pre agreed plans e.g. treatment plans
Autonomy
Advance directive e.g. doc as patient expressed wishes regarding future treatment if unable to express own view at the time
Shared Decision Making – ICE
Expertise of treating doctor
Power differential • Not your boss!
Minimal waiting list
Specific issues
Doctors present late -like kids – compensate until they fall off a cliff

What do you think? Do you agree?

Definition of sexual harassment

Louise@ffzzz.plus.com (Louise Freeman) — Fri, 10 Nov 2017 19:11:46 GMT

There is much current discussion about the issue of sexual harassment at work. Healthcare environments are as susceptible as any other work place to this potential area of conflict.

The content below is from employment law barrister, Sean Jones QC's Twitter feed (@seanjonesqc) - quoted with his permission.

'What is sexual harassment?

As sexual harassment scandals fill the airwaves the traditional definitional question emerges: but what IS sexual harassment?

There is a legal definition. You’ll find it section 26(2) of the Equality Act 2010. Let me break it down ...

First, there has to be conduct of a “sexual nature”. What counts? Check out Para 7.13 of the Code of Practice on Employment (2011) ...

“verbal, non-verbal or physical conduct including unwelcome sexual advances, touching, forms of sexual assault, sexual jokes ...displaying pornographic photographs or drawings or sending emails with material of a sexual nature” ...

So could it cover feeling a journalist’s knees under the table? Oh yes, absolutely.

Second, the conduct must be *”unwanted”* conduct. If the journo is happy to have her knees touched, it’s not harassment. But there’s more, the conduct must have the purpose OR the effect of: 1. Violating the victim’s dignity; or 2. creating an intimidating, hostile, degrading, humiliating or offensive environment for them .. Note, purpose OR effect. So if you are trying to violate their dignity you don’t need to succeed to be in trouble.

Equally, if you create a hostile environment you don’t escape merely because that was not your purpose.

When considering whether the conduct has had one of the two effects mentioned above, the tribunal must look at 3 things: 1. the victim’s perception; 2. the other circs of the case; and 3. whether it is reasonable for the conduct to have the effect. So if someone is irrationally over-sensitive that will not count but it's the victim’s perception and not the harasser’s that counts

So, for instance, the fact that you can’t see why a journo would object to having their knee squeezed is not important. If it is something a reasonable person could find intimidating or degrading, for eg, that may well do. Also, victim’s perceptions may reasonably differ, so the fact that one finds it trivial does not mean all will.

The standard is not that of the hardiest victim.

Harassment “It was different 15 to 20 years ago”.

I don’t understand this argument. Assume that the statement is true. So what? A lot of social attitudes have changed in the last 15 - 20 years. Have these people been on the moon? Did they not notice the huge social change they claim has occurred? However, I’ve been dealing with sexual harassment in the workplace cases for some 26 years. I don’t think things are radically different now

The current legal definition is an evolution of the one contained in the EU Commission recommendation on sexual harassment from 1991. It was quickly adopted by UK tribunals and applied in harassment cases (which were then treated as a species of direct discrimination). There might be cases that would be unlawful under the present test that would not have been then, but I struggle to think of one. Workplaces were not Carry On fantasies with women giggling uncontrollably at a stream of lewd double entendres.

Being the subject of humiliating or degrading treatment was no less destructive of people’s dignity in 1990 than it is now.

We should not confuse inability effectively to challenge behaviour with tacit approval.'

Sean's Twitter feed is @seanjonesqc

Dr Cathy Wield on stigma and mental illness

Sat, 04 Nov 2017 00:23:17 GMT

Dr Cathy Wield successfully returned to work in emergency medicine in the UK after two bouts of major depression, which included hospital admissions and brain surgery. Here Cathy reflects on the lingering stigma of mental illness.

August 2017

It seems that recovery from mental illness is not enough. Well that’s the impression I get from our stigma filled world. It was really bad when I was suffering from depression – when you have a low self-esteem as a result of your brain chemistry, then often those who you know well, like family & friends unwittingly betray their ignorance with ill thought out advice or banal platitudes. Most of us try to do the right thing and seek advice from our GP and/or various other health professionals. Even then we cannot guarantee that we will be treated with the dignity and respect that we deserve. I was fortunate in that respect most of the time during my illness, with the exception of some of the nursing staff during my inpatient stays and of course the various different specialities that I had the misfortune to come across after bouts of self-harm.

But all that was years ago and I have been well, apart from a less serious relapse which led to me taking antidepressants for life. I have now been completely well for the best part of ten years. That is - well in terms of my mental health.

Delay in diagnosis of appendicitis due to mental health history

Unfortunately, physically I haven’t been so lucky. I have needed various surgeries and medical treatment completely unrelated to my previous psychiatric history. Take for example the time when I suffered from an acute appendicitis. So, having had classic crampy abdominal pain for 36 hours, I am then woken suddenly at 03.00 am with severe right sided lower abdominal pain. By morning, I manage to get an emergency appointment with my General Practitioner (GP). Well, I say my GP, but the truth is that he is a GP at the practice where I am registered and I think it’s no coincidence that he is available. He is always available and perhaps here’s why. So, I come in and explain my symptoms and as if by magic, his first thought is “Could this be a touch of Irritable bowel?” Well, I know someone put this diagnosis on my notes nearly thirty years ago when I had diarrhoea for several months. The fact that it all cleared up and I had none of the other symptoms, not have I ever complained of anything similar since, rather suggests to me, that this was an inaccurate diagnosis.

But of course, why consider something physical in a 55 year old who has had a past history of depression? Despite doing my best to avoid having to go to Accident & Emergency (A&E) where I was working, by the time I drove home, I realised that I was not going to be able to drive any more that day. I waited until my husband got home from work, which meant a call to the out-of-hours service. Unfortunately, they wouldn’t see me, so I ended up being admitted from A&E. I was septic by the time I had my appendectomy the following day, but no further mention of my past history had been made or so I thought.

Medical record error correction – or not

I have a scar from a mini abdominoplasty performed several years after the dreadful depression from 1994-2001, when I was in a psychotic state and repeatedly cut myself. The procedure was to remove scar tissue that had become problematic after my self-mutilation. I almost bled to death from one of those episodes, so being the fool that I am, when asked by the surgical Foundation Year 2 doctor why I had the scar, I told the truth. I find out several weeks later that she has requested a CT scan stating I have a ‘self-inflicted wound’. This request is seen by those who I work with on a daily basis and not only is it totally untrue – I have a scar from an abdominoplasty- but it is there, indelible on my record. I tried to get it changed, but it cannot be deleted – a note was put that this was false, eventually, but only after I persisted, having first been threatened with the possibility of disciplinary action for viewing my own CT scan!

Sjögren's syndrome / anxiety – discuss!

I had the misfortune to meet the same GP over a year later, this time when I had been referred to him, from my dentist suspecting Sjögren's syndrome. I have dry eyes, mouth ulcers and sores as a result of the dry mouth and his diagnosis this time is anxiety, because he gets a dry mouth when he’s anxious! I have to instruct him on what blood tests need to be requested. There follows a whole series of consultations with maxillofacial surgery for a biopsy and rheumatology. I also contact the psychiatrist who I was seeing to get him to put in writing that my symptoms are not psychogenic. He also asks if they would please do the decent thing and do proper investigations. It all ended badly, with a doctor being incredibly rude to me. My complaint is dealt with in a similar incompetent manner and seven months later, I receive the answer to it, where the doctor in question has fabricated a story accusing me of forcing her to do the biopsy. Of course, the whole tone of the letter is far from apologetic. Instead, I feel as if I did something wrong by just being a patient. By the time I received this, I am in the USA, having emigrated to Denver, Colorado. Thankfully here no one has questioned the validity of my symptoms and I am receiving appropriate treatment for Sjögren's syndrome, but at a cost!

Practising as a doctor with a mental health history in the USA

Sadly, though the US also takes a dim view of those who have had mental health problems. You can be refused entry to the country if you have self-harmed in the past and are deemed likely to repeat this in the future. While studying for the United States Medical Licensing Exam (USMLE), I found out that if you are suffering from depression and see a doctor when you are working, you have no right of confidentiality and you are not allowed to work, regardless of whether or not you are performing well or have no potential safety issues………………Apparently, in Texas, you will not be able to gain a licence to practice at all, if you have had a history of mental health problems.

Of course, my attempt to get life insurance a few years ago when I was still working in the UK was also thwarted. My GP stated that although I had been well for years, in the past I had self-harmed on multiple occasions – it was true, but that’s it – my life wouldn’t be covered if I committed suicide – well of course not, but in fact my life cannot be covered at all. It was refused and that’s the end of it!

Future plans

This sounds rather depressing, doesn’t it? There is still a long way to go to eliminate not only the stigma of current mental illness, but also of the past. It does fill me with sadness and it also makes me feel angry. But I don’t want to become bitter and unforgiving. While I worked in A&E until August last year, I did my utmost to be open about myself and to educate my colleagues. We are whole people, the mind and body are not separate entities and we all deserve respect and care regardless of our past or present symptoms, or what brought them about. But changing attitudes takes more time than I first thought.

I have not pursued the complaint. It devoured emotional energy and although the head of the complaints department suggested that I enlist the help of a solicitor, it is not such an easy thing to do from here. But I am in two minds. Will the NHS only listen if litigation occurs? If so then maybe it’s worth it, but I don’t want to deprive an already overstretched system of precious resources. At the same time, it does worry me. I am articulate and a doctor and this happens to me, so what about those who are less able to speak for themselves? Sadly, I am increasingly of the mind that I should record consultations, because for some reason, I seem to be the loser when it comes down to who said what. From a legal point of view, a patient is at liberty to do so, even if they do not divulge the information. From a doctor’s stance, I think it would be good if everyone assumed that whatever we say was being recorded. It may just help the vulnerable to not be taken advantage of.

I hate to admit it, but I am still vulnerable as a result of what happened to me in the past. None of it was my fault, I never chose to be ill and I did my best to get free from it. Unfortunately, it follows me, but now, as much as ever, I wish to put the experience to good use to help others. I am far from perfect, but I hope that someone, somewhere will give me a chance. At present, I remain unemployed, hoping, looking and waiting for opportunities here in the USA. Pray or wish me luck, it looks like I need it!

Dr Cathy Wield
Cathy tweets as @wield1 and blogs here

Author of Life After Darkness: a doctor’s journey through severe depression 2006 and A Thorn In My Mind: mental illness, stigma and the church 2012

DSN presents symposium on the role of peer groups in physician health at WPA Berlin 2017

Louise@ffzzz.plus.com (Louise Freeman) — Sat, 14 Oct 2017 22:06:41 GMT

DSN presented a symposium with Selbst betroffene Profis on the role of peer support groups in health professionals' health at the World Psychiatry Association Congress 2017 in Berlin

The initial suggestion for this collaboration came from Dr Astrid Freisen of Selbst betroffene Profis - a group for health professionals with bipolar which is associated with the German bipolar society Deutsche Gesellschaft für Bipolare Störungen . Astrid contacted DSN by email and suggested that we propose a joint symposium for the World Psychiatry Association Congress due to be held in Berlin from 8-12th October 2017. Bearing in mind that our discussion was entirely carried out online and that we did not meet in person until the day before the symposium, our arrangements including agreeing the symposium titles, content and abstract were extremely practical and straightforwards.

We proposed a symposium of three talks with the overall title:

Doctors with mental health disorders – an overview and introduction of UK and German peer support groups for doctors and other health workers

Dr Louise Freeman, DSN vice chair, gave a general background to the topic of physician health : Invisible patients : doctors with mental health problems

Dr Angelika Luehrs, DSN chair, presented a history of the founding of DSN and its activities over the past two decades: The Doctors’ Support Network in the UK : peer support for doctors with mental health problems over two decades

Dr Astrid Freisen explained the history of the Selbst betroffene Profis group in Germany: The German Situation - a short overview about the development of the support and interest group "Selbst betroffene Profis" (self-affected professionals) providing support for doctors with mental health problems

The symposium itself was very well attended by approximately eighty delegates with literally standing room only. The audience listened attentively and contributed to a lengthy debate on physician health which was only terminated by the next occupants of the room arriving. Delegates from Australia, Brazil, South Africa and Switzerland, to mention only a few participants, spoke about the physician health situation in their home countries.

Dr Astrid Freisen - Gedanken zum Weltkongress - see English translation below)

'Der Weltkongress hat mich mit seiner Vielzahl an Themen und seinen mehr als 11.000 internationalen Teilnehmern sehr beeindruckt. Ich fand es toll, dass sich diese Internationalität auch in den Teilnehmern unseres Symposiums widerspiegelte: diese kamen u.a. aus Südafrika, Brasilien, Australien, der Schweiz oder Neuseeland. V.a. in der Abschlussdiskussion wurde noch einmal deutlich, dass es zu wenig Angebote für psychisch kranke Ärzte gibt, egal ob es um Selbsthilfeorganisationen oder strukturierte staatliche Programme geht.

Ein weiterer Höhepunkt war es, Angelika und Louise nach mehr als 12 Monaten Kontakt per Email endlich persönlich kennen zu lernen. Die Zusammenarbeit verlief toll und ich hoffe, dass wir das wiederholen können.'

(English translation : Thoughts about the World Congress

I found the world congress with its variety of topics and over 11,000 international delegates very impressive.

I thought it was great that this was reflected in the delegates attending our symposium: we had attendees for example from South Africa, Brazil, Austria, Switzerland and New Zealand. Particularly the discussion after the presentations highlighted again that there are not enough opportunities, neither self help groups nor structured national programmes, available for doctors with mental health problems. Another highlight was to meet Angelika and Louise in person after more than twelve months of contact via emails. The joint working was great and I hope that we will be able to work jointly together in the future.)

Dr Angelika Luehrs, DSN chair said

'Being invited to talk together with Selbsbetroffene Profis from Germany at the WPA 2017 was both an honour and a great opportunity for DSN.
DSN has always been keen to be open about doctors with mental health problems but so far mainly on a national level and as a lone organisation representing affected doctors. Therefore being able to speak out together with another group representing doctors and across countries has been a unique opportunity. Talking together with Selbstbetroffene Profis created a unique and powerful message. The symposium was very well attended and led to a lively and interesting discussion involving professionals from all over the world. It was an encouraging and inspiring experience.'

DSN is very grateful to the organising committee of the WPA Congress 2017 for giving us this amazing opportunity to forge links with doctors from around the world. The conference facilitated user group participation by charging a nominal delegate fee as well as reimbursing our travel costs.

P.S. Some sightseeing was also done!

The ‘how to guide’ to choosing an Executive Career Coach by Fiona Day

Louise@ffzzz.plus.com (Louise Freeman) — Fri, 29 Sep 2017 22:34:55 GMT

Fiona Day Consulting empowers doctors and professionals to transform their working lives using evidence based psychological theory and behaviour change science.

Fiona is a Consultant in Public Health Medicine with 25 years experience in wellbeing and resilience who is also a fully qualified 'Executive Coach'. Read on to find out how to choose the right coach for you.

Imagine someone who is on your side, walking every step of your career journey alongside you, with no other agenda other than to support you to understand yourself and to make the best decisions you can make, whether you need to make major or minor career changes, improve your wellbeing at work, or develop your skills further. Someone who can challenge you when you contradict yourself in a way which brings out your deeper sense of purpose and helps you to learn and grow in your career and working life, and views you and your career from a perspective of believing in your potential. Sounds too good to be true? Many senior professionals, and most executives, now work with an Executive Career Coach to support them in their career, usually on and off over years or decades, based on adult to adult relationships founded on trust, honesty and integrity.

All Executive Coaches bring some core skills and qualities to their coaching relationships, with nuances according to their own style and their background. It’s important to find the right match for yourself and your own needs – too similar to you and will they challenge you enough? Too different and will they be able to understand your context? This article will help you to find the sweet spot – finding the right Executive Coach to support you in your own career.

1. Is this the right time for you? Coaching can be demanding as well as fun and exciting, it is a journey which will reveal what matters most to you in your life and your career. You become ‘more yourself’ as you learn more about yourself and start to make the changes you need to bring yourself greater meaning and purpose in your life. If you are unwell, check with your healthcare professional first before starting on career coaching – working out the next steps in your career can be key to your recovery and may be positively helpful, or it may not be the right time for you. When working with an Executive Coach, you will have a mixture of session time (face to face or by remote video such as skype) and actions to take away between sessions to implement. This means you need both time for the sessions (these are usually 1.5-2 hours every 4 weeks or so, for 3-4 sessions depending on your needs) and you will need some time between sessions to complete any actions. All actions are always invitations and will be codesigned with you to help you to create space in your life so that you can make the changes you need and to help you to ‘clear the decks’ so that you have more time for what matters most to you.

2. Finding the right coach. There are a growing number of people who call themselves career (and ‘life’) coaches so you might want to check their qualifications and experience. The NHS generally expects their internal coaches to have as a minimum the ILM5 coaching qualification, with more senior staff using Executive Coaches (ILM7). In terms of experience, you might like to check for experience of working with people with the kind of goals you would want to set. You might want to check the coach has the right kind of background for you so that they can understand your context. Other things to look out for: what theoretical model do they use; who is their supervisor and how often do they have supervision; what CPD have they undertaken recently; are they registered as a Data Controller with the Information Commissioner’s Office and how is your information and confidentiality protected? Are they a member of any coaching professional bodies such as the European Mentoring and Coaching Council, and any coaching networks? What has been their own career journey? Some people find it helpful to make a checklist of what they are looking for in a coach before they speak to anyone so they can be clear what they are looking for in advance.

3. Making contact. Most Executive Coaches will offer you a free consultation session to have a confidential but no obligation chat about what you are looking for and whether they can help you at this time. They will be checking that this is going to be right for you as well as for them. This is a great opportunity to find out if the ‘chemistry’ works between you, is this someone you feel you can trust with your deepest hopes and fears with your career? It is similar to finding a therapist, though coaching is not therapy, counselling or advice giving, rather it is focused on the future and on your working life. Check on their fees and whether there are any hidden costs such as VAT.

4. The coaching contract. Coaching works within a contracted relationship. The contract essentially covers ‘this is what you can expect from me and this is what I expect from you’, this is part of it being an adult to adult relationship. The coach helps you to identify your own coaching goals at the start of a coaching relationship and the contract states the boundaries that you work within. You might like to ask for a draft copy of the coaching contract and check it has everything you need in it for you to feel comfortable within the relationship.

5. Getting started. Most of my clients are apprehensive about what to expect especially if they have never been in a coaching relationship before. This is normal and your coach will probably give you some exercises to do before the first session to help you get into a reflective and action planning mode. Coaching is about helping you to work out what you want in the future, and how to move step by step towards that on a daily basis.

We are all going to live longer and spend more of our lives at work. This may or may not be within medicine as our career choice or option. If your career isn’t right for you for whatever reason, take the time to work out who you are and what matters most to you, and set up the next phase of your working life in a way which will bring you meaning, purpose and satisfaction. It’s an investment in yourself and your future that you won’t regret!

Website: Fionadayconsulting.co.uk

Email: Fiona@fionadayconsulting.co.uk

Phone: 07913 917330

Find more articles similar to this on our ' Professional Support' page.

New book - Why Physicians die by Suicide by Dr Michael Myers

Louise@ffzzz.plus.com (Louise Freeman) — Thu, 28 Sep 2017 00:00:00 GMT

Dr Michael Myers is a U.S. psychiatrist who specialises in physician health. His most recent book has just been published Why Physicians die by Suicide.

Dr Myers has kindly provided an extract from the introduction below:

'……. as a practicing clinician treating physicians and their families and as an academician, I have spent my entire career studying the tragedy and enigma of suicide among doctors. Despite substantial research into the personal and workplace stressors, personality traits, psychological vulnerabilities, and psychiatric illnesses among doctors, the published literature is short on information gleaned from those who know physicians best – their family members, medical colleagues, and intimate friends, their teachers and students, as well as those who have lost their physicians to suicide. I have long believed that these are exactly the people who hold information that is key to our quest to make sense of why some doctors make such a desperate decision about their life.

For more than two years I have been talking with those who are willing to share their story and understanding of the physician loved one, colleague/friend, or treating doctor whom they’ve lost. In the pages that follow, you will hear their voices, and I will share what I have learned from them, as well as from another, equally significant population--physicians (including some of my own patients) who have attempted suicide and did not die. They are able to provide unique and invaluable information about the ideas and emotions that led to their decision to kill themselves as well as the ways in which their near-death experience and second chance at living have fundamentally changed them.

Although suicide has been with us since the beginning of time, it remains a very taboo subject in our society. Many people do not want to know about it and when they do they want to push it way, to forget about it, trying hard not to remember. I am only too aware of this. I sense it when I face the resistance to my research or the derision I get from a few of my colleagues about “being obsessed with suicide”. We write about very different subjects but I feel great kinship with the late Elie Wiesel. In accepting the Nobel Peace Prize in 1986, he said, “…I have tried to keep memory alive…I have tried to fight those who would forget. Because, if we forget, we are guilty, we are accomplices.”

As painful as suicide is, we must remember our brothers and sisters in medicine who could not go on, whose lives were so tragically interrupted. Many of the people with whom I spoke in preparation for writing this book have told me that they were sharing their stories because they didn’t want their loved one to have died in vain, and they hoped what they had to say would in some way contribute to saving the life of another despairing physician.

In the words of Dr. Edwin Shneidman who was a Professor of Psychology at UCLA, esteemed researcher, prolific author and giant in the study of suicide: “Postvention is prevention for the next generation.”

Photo Credit: Joe Vericker/Photobureau, Inc.

The new DSN blog

Louise@ffzzz.plus.com (Louise Freeman) — Wed, 27 Sep 2017 00:00:00 GMT

Check out our new blog! A mix of stories about DSN in particular and doctors' health in general.

Why does DSN need a blog?
Our blog page will be a place to collect new stories and articles on our website, which can be linked to social media and elsewhere. Blogs also help to increase recognition of the website by search engines.

What type of story is suitable for the DSN blog?
The blog will contain a mix of stories about DSN's activities and physician health in general.

Can DSN members / friends contribute an article for the blog?
Yes of course. A good blog feature article would be approximately 300 words in length and have a couple of clear (non copyright) photos to illustrate it. If you are not sure whether your idea would fit the DSN blog, then ask us via info@dsn.org.uk. Contributions will be edited to house style and published to fit in with our schedule if the article is deemed to be suitable for DSN.

Dr Cathy Wield - &me anti stigma campaign

Thu, 17 Aug 2017 00:00:00 GMT

Dr Cathy Wield, emergency medicine doctor

Dr Cathy Wield has successfully returned to work in emergency medicine in the UK after two bouts of major depression which included hospital admissions and brain surgery. Cathy is passionate about speaking out and reducing the stigma around mental health. She has written extensively about her experience of being a doctor with depression (her books are Life after Darkness: A Doctor’s Journey through Severe Depression and A Thorn in my Mind: Mental Illness. Stigma and the Church ) and notes that there is still room for improvement in the way that we respond to mental ill health!

Cathy is currently exploring a new medical culture having recently moved to the U.S.

Cathy said 'It seems that recovery from mental illness is not enough. Well that’s the impression I get from our stigma filled world. It was really bad when I was suffering from depression – when you have a low self-esteem as a result of your brain chemistry, then often those who you know well, like family & friends unwittingly betray their ignorance with ill thought out advice or banal platitudes. Most of us try to do the right thing and seek advice from our general practitioner (GP) and/or various other health professionals. Even then we cannot guarantee that we will be treated with the dignity and respect that we deserve.

I was fortunate in that respect most of the time during my illness, with the exception of some of the nursing staff during my inpatient stays and of course the various different specialities that I had the misfortune to come across after bouts of self-harm.

There is still a long way to go to eliminate not only the stigma of current mental illness, but also of the past. While I worked in A&E until August last year, I did my utmost to be open about myself and to educate my colleagues. We are whole people, the mind and body are not separate entities and we all deserve respect and care regardless of our past or present symptoms, or what brought them about. But changing attitudes takes more time than I first thought.'

Cathy tweets as @wield1 and blogs here

Seeking help?

Prof. Jamie Hacker Hughes - &me anti stigma campaign

Mon, 03 Jul 2017 00:00:00 GMT

Prof. Jamie Hacker Hughes, consultant clinical psychologist

Professor Jamie Hacker Hughes is a consultant clinical psychologist, psychotherapist and supervisor currently working in independent practice in central London and leading a religious order as the newly elected Minister Provincial of the Anglican Franciscan Third Order .

Five years after qualifying as a clinical psychologist, Jamie was diagnosed with Type 2 bipolar affective disorder after 20 years experience of anxiety and depression. He has been on Lithium prophylaxis ever since.

After his diagnosis, Jamie gained a consultant post with the Ministry of Defence, becoming head of healthcare psychology and travelling to Bosnia, Kosovo, Afghanistan and Iraq, gained three fellowships and four professorships, established a research institute and has just finished a term of office as President of the British Psychological Society .

He has published and lectured widely and edited two books, the first of which was Battle against Stigma .

Jamie says that it is really important that people at the top of the profession speak openly about the fact that they are human too!

Seeking help?

Dr Susan Atcheson - &me anti stigma campaign

Fri, 02 Jun 2017 00:00:00 GMT

Dr Susan Atcheson is a GP partner and DSN committee member.

'Hi. I am a general practitioner (GP) and I have a recurring mental illness. I’m not alone. Despite a paucity of research addressing mental ill health in health care professionals we know that Doctors are more likely than the general population to suffer burnout, anxiety, depression and addictions. As a group we are shockingly poor at self care. Many Doctors are not registered with a GP and when help is required we are stuck and uncertain where to go next. We are naturally born strivers. We hate to fail. We perceive being mentally ill as somehow not coping with the demands and rigours of the job and as a result we avoid seeking help. The cycle of negativity begins and continues. Meanwhile we turn to maladaptive coping strategies; alcohol, drugs, self medicating.

My story

My own story is of a recurrent psychotic depression which first occurred twenty years ago during the psychiatric phase of my GP training in Scotland. It recurred eight years ago during my first year as a GP Partner in Norfolk and again fifteen months ago when I was actually off sick with a milder depressive illness and burnout following a particularly difficult year at work. I feel I have been particularly lucky. My first hand experience of treatment in the NHS has been on the whole fantastic. The most recent episode of psychosis was diagnosed by an excellent private therapist I was seeing who made a direct referral to the Crisis team in my local area who in turn visited me at home that day. The team consultant visited me at home the next morning and I was given intensive support for the next six weeks. I am now under the care of the Community Mental Health Team and my key worker is an insightful and incredibly helpful Consultant Psychologist. Medication seems to be key for me to get well and remain so but I’ve also been able to access psychological treatment reasonably easily.

Stigma

Successful outcome? Currently for me it is. That’s not to say that over the years I haven’t experienced stigma either from colleagues or self perpetuated. Prior to my last episode I have seen my return to work as “the goal”, my proof that I was better. Once achieved I could put that depression behind me and forget about it. The illness was my failure, my inability to cope. As another episode started to creep in I did my very best to push it away and keep going. I’ve sought solace in a bottle at the end of the day. I’ve experienced shocking behaviour from colleagues which reinforced my internal struggle with failure and acknowledging my illness. I know of colleagues who have experienced similarly harmful behaviour including lapses in confidentiality, lack of support and loss of jobs. When we find ourselves without hope and with nowhere to turn to we are at risk of the ultimate act of desperation.

The stigma surrounding mental health particularly amongst medical professionals has to change. It underpins the reluctance to seek help when it is most appropriate, hinders recovery and a return to wellbeing. It has only been during my last episode of depression that I have learned the value of reaching out to others who are in a similar position. I read blogs, articles and books; as a recommendation do read psychiatrist Linda Gask's excellent book “The other side of silence-a psychiatrist’s memoir of depression” My research was how I found the Doctors’ Support Network.

Things are gradually improving

Accessing help will be easier too. This year sees the national roll out of the NHS GP Health Service. This service which began in London as the Practitioner Health Programme offers free and confidential support to doctors who are unable to access help through the normal channels.

Stigma can be addressed and challenged but this work needs recognition, involvement and reinforcement. We all have to take part. For my part "My name is Susan, I am a senior GP and I have a history of depression".'

This piece was first published on the website GP View.

Seeking help?

Dr Malcolm Kinnear - &me anti stigma campaign

Wed, 10 May 2017 00:00:00 GMT

Dr Malcolm Kinnear - consultant psychiatrist

Malcolm Kinnear graduated in 1990, but had not completed his psychiatric training when he went on long term sick leave with depression in 1997. He joined the Doctors' Support Network in 1999 and became active in organising its Scottish activities from 2004 as his mental health very gradually improved. In 2009 he attempted to return to clinical practice, initially struggling to find a way back as no official route existed, but obtained a specialty doctor post with NHS Fife in open competition on the basis of his work with DSN as well as his independent Continuing Professional Development (CPD).

Malcolm resumed full time practice after a period of shadowing and part time work. He applied successfully to re-enter higher psychiatric training in 2014 and obtained his Certificate of Completion Training in adult psychiatry in February 2017. He was then appointed to a substantive consultant psychiatrist post with a community mental health team in Dundee, with sessions in the Tayside specialist adult autism team.

Malcolm has actively advocated for better healthcare for doctors and is currently involved in a multi-organisation working group to set up a Managed Clinical Network for doctors with mental health problems in Scotland. He has an honorary teaching position with the University of Dundee (twice nominated for a FaME - Faculty of Medical Educators - award) in which capacity he reminds medical students to look after their own health and to remember that doctors can find themselves patients too. He also finds that having taken some of the medications he now prescribes can be rather helpful in terms of understanding their effects!

Seeking help?

Dr Caroline Walker - &me anti stigma campaign

Wed, 29 Mar 2017 00:00:00 GMT

Dr Caroline Walker - psychiatrist and psychotherapist

Caroline Walker is a senior trainee psychiatrist and psychotherapist working in South West London. She had recurrent episodes of depression throughout her twenties and when she experienced periods of high mood in her early thirties she was diagnosed with bipolar disorder. Her mental illness hasn't stopped her from getting her dream job and has fuelled her passion for working in the field of doctors' health. Caroline is involved in running the Facebook 'Tea and Empathy' group facilitating informal peer to peer support for NHS staff.

Caroline says 'The worst stigma I've experienced over the years was the stigma I put on myself. Speaking out about my illness has helped me to feel less ashamed - I now feel incredibly proud of my experiences and the way I manage my mental health. I am open with everyone about my illness - it helps me and it helps them. From individual private conversations to speaking to a room of over 300 trainee doctors.. I'm passionate about encouraging all doctors to talk more openly about our day-to-day struggles. Sharing really does kill stigma .'