AHPRA moves to douse mandatory reporting fears – but RACGP yet to be convinced

Doug Hendrie

4/12/2019 3:12:03 PM

Mandatory reporting thresholds are set to be raised, but concerns linger regarding the deterrent effect for mental illness.

Medical practitioner talking to a patient.
AHPRA says doctors should not fear seeking help for mental health issues.

‘We know many health practitioners have crippling fears about what [AHPRA] will do if we receive a mandatory report about health impairment, and we hear very distressing stories about health practitioners who are too afraid to seek help because they’re worried about being de-registered.
‘These are the unintended consequences of mandatory reporting and this is a challenge for all of us, because all of us want to make sure health practitioners can get [the] care they need when they need it.’
That is Martin Fletcher, the CEO of the Australian Health Practitioner Regulation Agency (AHPRA), speaking on a new video.
The video is part of a new AHPRA campaign aimed at reducing fears of the mandatory reporting regime among Australia’s 740,000 health practitioners.
New laws set to come into effect in every state and territory (except Western Australia) early next year will raise the threshold of mandatory reporting for treating practitioners for impairment, intoxication or breach of professional standards – but not for sexual misconduct.
Once the laws are in place, mandatory reporting will only be required when the public is deemed at substantial risk of harm, a higher threshold than the old requirement of a risk of harm.
This, AHPRA believes, will make mandatory reporting even rarer than it currently is.
But the RACGP has warned that fears will not dissipate entirely, even with the higher threshold.
Many GPs are concerned that the existing laws act as a deterrent to seeking help for legitimate mental health concerns, with fears that mental health crises might constitute an impairment, which could threaten their careers.
Fears grew in the wake of a spate of suicides within the profession and calls for much greater attention to the mental health of doctors.
RACGP President Dr Harry Nespolon does not believe the new laws will solve the problem for mental health issues in particular, and has called once more for the Western Australian model – which exempts treating practitioners from having to report doctors in their care – to be adopted nationally.
‘[D]octors are still going to be faced with that dilemma when they’re unwell – should they be going to see someone?’ Dr Nespolon told the ABC.
‘What we would like to see is go back to the West Australian model, where there is no requirement of mandatory reporting. As far as we’re aware, there’s been no issue with regards to patient safety.’
Mr Fletcher confirmed in a press conference on Monday that there is no indication the Western Australian model has put the public at greater risk.
‘There’s no evidence to suggest that,’ he said.
‘There are variations in mandatory reporting rates across states and territories … [but there’s] not an obvious pattern. There’s no specific difference for Western Australia.’  
But AHPRA and the National Boards are confident the new legislated changes will address the concerns of the nation’s health practitioners.
Medical Board of Australia board member Dr Andrew Mulcahy said the changes will ‘address this specific fear’.
‘There are growing concerns in the medical community that there are indeed barriers [to seeking care]. That’s not what regulators are looking for,’ he said in a press conference on Monday.
‘I believe these changes will address that issue … and provide high-level reassurance to not only doctors, but treating practitioners.’
Psychiatrist Dr Kym Jenkins said the changes should make it ‘a lot easier’ for treating practitioners like her.
‘[For] somebody who’s depressed but really caring and conscientious … a mandatory notification wouldn’t be appropriate,’ she said. ‘If you’re a seeing a patient who’s acutely psychotic … with their own patients at risk, that’s a big risk of harm.’
The RACGP has frequently expressed its unease over mandatory reporting, with the Australian Medical Association similarly concerned. Once the laws were passed in February, the RACGP called for amendments to further limit the circumstances in which mandatory reporting was required, leading to further tightening of the laws.

AHPRA Chief Executive Martin Fletcher.
The circumstances in which a treating practitioner will need to report include when the public is placed at substantial risk of harm due to an impairment, intoxication at work, or professional practice that departs significantly from accepted standards.
However, sexual misconduct will retain a lower threshold for reporting.
Mr Fletcher said that any concern about past, present or future risk of sexual misconduct should be the subject of a mandatory report.
Psychiatrist Dr Jenkins said she has treated many health practitioners with health issues or substance dependencies.
‘Illness is not impairment,’ she said. ‘Having concerns around your mental health and wanting to do something about it is not a condition for mandatory reporting.
‘For all of us working in the mental health area, there are many barriers to getting help. There’s stigma, self-stigma, getting time off work, which can delay [seeking help].
‘Mandatory reporting fear shouldn’t be one of the barriers stopping people getting help when [they] need it.
‘Many overestimate the likelihood of getting a mandatory notification. There’s an unnecessary fear of it. People are avoiding seeking health treatment, which can lead to mental health issues or burnout.’
In order to give clarity on what would constitute a mandatory report, Dr Jenkins gave several examples in the AHPRA video.
‘The first example is a doctor that I saw recently,’ she said. ‘He felt that all his career he’d been a fraud, that he was a fake, and had a bit of difficulty in concentrating at work.
‘He’d already taken a couple of days off because he couldn’t face going into work.
‘He’d not put any patients at risk. He’d already had a couple of days off. And we were able to sit and talk about what was the best treatment plan for him.
‘He started on some antidepressant medication and embarked on a course of psychotherapy and had a few more weeks off work in order to get better. There was no question at all about putting in a mandatory report for this doctor.’
In this situation, there was no mandatory report required.
‘My second example is a nurse that I saw a couple of years ago,’ Dr Jenkins said.
‘She had a psychotic illness and she believed that the doctors on the ward that she was working on were poisoning the patients, that the medications were contaminated. And therefore [she felt] it was her responsibility, her duty, to tell all the patients not to take their medication.
‘Now, she was clearly putting patients at risk of substantial harm and she actually did trigger mandatory reporting.’
A mandatory report was made in this situation. 
Mr Fletcher said AHPRA wants to ensure treating practitioners are aware they only have to notify the agency when a practitioner is putting the public at substantial risk of harm.
‘Healthy practitioners are good for patient safety,’ he said. ‘We want all registered practitioners to know what the changes mean for them and to seek advice and support for their own health and wellbeing, without fear of an unnecessary mandatory notification.’
Dr Mulcahy said the changes to the law will clarify to health professionals and treating practitioners that they are free, and encouraged, to seek treatment and look after their own health and wellbeing. 
‘We don’t need to know if a doctor is taking antidepressants or seeing a psychiatrist,’ he said. ‘It’s only when there is substantial risk of harm.’
Associate Professor Lynette Cusack, Chair of the Nursing and Midwifery Board of Australia, urged health practitioners to seek help without worrying unnecessarily about mandatory reporting. 
‘Make your health a priority – take care of yourself so you can take care of others,’ she said.
Mandatory notifications made to AHPRA accounted for 11% (1807) of the 15,858 notifications made in 2018–19.
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Dr Felicity Jane Heale   5/12/2019 8:06:00 AM

It would be helpful if the focus was not just on doctors seeking help so that they can be functional enough to continue to be of service to others. We have worth as people separate from our caring professional role. Maybe the stress on doctors seeking help primarily in order to continue at the coalface devalues us, and that is part of what leads into the anxiety and depression in the first place. We don't do that to other people. For example, we don't treat an accountant's depression so that he or she can continue to be the best accountant they can be, but because that person has worth as a human.

Dr Keith Andrew McArthur   5/12/2019 8:14:51 AM

The fact that AHPRA have been so heavy handed in the past, do not really listen to the GPs voice and essentially have treated us with considerable disrespect remains a problem. The current guidelines are still wrong and will not fix the monster they have created.

Dr Gregory Norman   5/12/2019 9:09:36 AM

I self reported in 2012 due to PTSD related to my previous ADF service.I was not complying with admin requirements for DDU for 2 opiate patients. I had already discussed my issues with a colleague who was more than happy to keep an eye out for me.
I was already under a psychiatrist. DDU and I had a plan in place to manage my patients. I suggested a 12 month restriction (with DDU support) to opiate prescribing while I got myself back up to speed.
When it came time to remove the restriction it became incredibly difficult . I had a clinical report from my treating psychiatrist, a forensic report form an independent psychiatrist and a report and letter of support from the DDU.
None of that was good enough. Not only were AHPRA insisting on extending my restriction indefinitely. I posed an immediate and urgent risk to patient care. 12 months later. None of their own protocols or regulations were followed.
I fought and eventually won.
We are afraid for a reason. It is not paranoia.

Dr Peter James Strickland   5/12/2019 12:25:33 PM

I empathise with Dr Greg Norman as an ex-ADF officer myself. AHPRA are a bureaucratic, impractical organization who have run their usefulness. Bring ALL registration and problems of registration back locally to the States in my opinion ---cheaper for all registrants, less expensive to administer, much fairer and aware of local issues. AHPRA are exactly the same as any government bureaucracy, and that means NO responsibility is taken for bungles, suicides and mental illness caused by their obvious slow and often unfair decisions to practitioners who are later proven to be innocent. There should be obligatory reparation payments made to ALL practitioners who are cleared of wrongdoing, and who go through months or years of psychological trauma caused by this organization. Doctors in all States re-form your own State Registration Boards, and simply tell AHPRA there will no more exorbitant payments made to them. Come on AMA and RACGP etc. --the WA AMA President has legal qualifications!

Dr David Zhi Qiang Yu   8/12/2019 10:47:41 AM

I support West Australian model.