Stories of doctors taking their own lives have attracted much media attention in recent years. These stories highlight how pressing and critical the issue of achieving wellbeing at work for doctors has become, and how important it is to undertake research in this area. Current interventions seem to have limited effect given that the issue of mental ill-health in NHS staff is not improving, but, rather, getting worse. Something needs to change. “Care Under Pressure,” a research project synthesising existing interventions and resources to tackle and prevent mental ill health in doctors, aims to help with this need.
Most existing interventions are based on the idea of building up individual resilience to cope with stress. This one dimensional approach is not the best way to deal with a complex issue such as mental ill-health in doctors. Moreover, this approach is not only ineffective, but is also potentially harmful. It ends up assigning all the responsibility to (and potentially isolating and harming) the individual doctor, while the issue needs to be understood and addressed also from organisational, historical, social and cultural perspectives.
A common objection to the idea of developing new and more sophisticated interventions is the lack of funds within an already overstretched NHS. However, there already are initiatives and interventions, sometimes at national level or in specific trusts—but they are either not well publicised, or they are under-utilised.
When I present the “Care Under Pressure” project to a clinical audience, I am often told about a support scheme for doctors (e.g. one offered by occupational health), or about tools to increase staff wellbeing. On questioning, it becomes clear that these initiatives are virtually unknown outside of the group I am speaking to, yet this group complains about the low level of engagement with, or awareness of, such initiatives. More surprisingly, through our discussions, we discover that even in their own trusts, those who are meant to be in the know are not aware of other initiatives in the same organisation (e.g. schemes to encourage staff to recognise positive outcomes in the workplace, to counterbalance negativity and blame culture). Within this hidden world, there are probably “good ideas” which could save lives and/or inform the improvement of effective interventions. This “hiddenness” potentially also means unnecessary replication of efforts or even “reinventing the wheel”— which is counterproductive in a system that is already under pressure.
Developing interventions alone is not enough for them to be used successfully; how they are designed and conveyed is equally important. There are interventions that currently “do not work” because they are not properly communicated to doctors who could benefit from them. In some cases they are not communicated at all, so it is hardly surprising that they are not accessed. Sometimes these interventions are effectively communicated, but they are not accessible to doctors, due for example to rigid shifts and lack of time. If available, they may not be accessed by doctors, due to stigma or fear of career repercussions.
We need to think about the wider context, because of the complexity of the problem of mental ill-health in doctors and because doctors are diverse and have different needs. We need to take a systems-wide perspective which incorporates individual, organisational, professional and broader sociocultural and historical dimensions. This also implies that a “one-size is not fits all” approach is unlikely to be successful, but rather certain interventions and approaches may work well in certain contexts. A “once and for all” approach may also be problematic, as the success of an intervention over time can also depend on a regular review of its effects on the targeted population.
Daniele Carrieri is a research fellow in the University of Exeter Medical School. He is part of the Care Under Pressure team. Twitter: @care_under
Competing interests: I have read and understood BMJ policy on declaration of interests and declare I have no conflicts of interest.
If you are aware of any initiatives, reports, or evaluations of initiatives that have been used within the NHS to tackle and prevent mental-ill health in doctors and would like to share them with the Care Under Pressure project please do so by tweeting them to: @care_under
This project is funded by the NIHR HS&DR (project number 16/53/12) This research discussed is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.