Health professionals cautious yet open to proposed revision of mandatory reporting laws

Doug Hendrie

16/04/2018 4:52:22 PM

Australia’s peak health bodies have described a proposed revision of mandatory reporting laws as a good start to necessary reform, but many believe more needs to be done.

Some healthcare professionals have reportedly flown to Western Australia to avoid other states’ mandatory reporting laws.
Some healthcare professionals have reportedly flown to Western Australia to avoid other states’ mandatory reporting laws.

The news came through late on Friday, following the Council of Australian Governments (COAG) Health Council meeting. Australia’s health professionals might soon be able to seek help for mental health issues without worrying that their registration might be at risk.
The move was widely seen as the first step towards reducing the unintended consequences of Australia’s mandatory reporting laws, which were introduced in 2010. However, many feel the changes remain short on detail.
As they stand, Australia’s mandatory reporting laws require a treating health professional to report any health professional coming to them as a patient who discloses they are experiencing drug addiction or mental health issues – any issue, in short, which was ‘placing the public at risk of substantial harm’.
With the proposed change, treating practitioners would be exempt from reporting health professionals with an ‘impairment’.

State health ministers agreed at COAG to retain requirements to report past, present and the risk of future sexual misconduct, as well as a requirement to report current and the risk of future instances of intoxication at work and practice outside of accepted standards.
While the RACGP supports removing the requirement for mandatory reporting of health professionals with an ‘impairment’, it believes the retention of requirements for reporting a health professional ‘practising at a lower standard’ could leave doubt for professionals seeking healthcare.
‘Much of the conduct identified as grounds for mandatory reporting is subjective, open to interpretation by both the health professional and their treating practitioner,’ RACGP President Dr Bastian Seidel told newsGP.
‘If there is room for doubt on what should or shouldn’t be reported, the fundamental issue of there being barriers to healthcare for all health professionals remains.
‘Without collaboration with all stakeholders during the legislation drafting process to address any uncertainty or misunderstanding of the intent or boundaries, the change may not provide sufficient assurance or confidence to health practitioners needing to seek help.’
Many doctors have said they fear discussing their mental health issues might result in their registration suspended, even though the barrier for being reported is quite high. A 2013 beyondblue study of more than 12,000 doctors found that more than a third cited concerns about their medical registration as an obstacle to seeking treatment for a mental health condition. Some doctors have been flying to Perth for treatment, as Western Australia has already moved away from mandatory reporting for health professionals. 

The COAG announcement comes in the wake of a string of doctor and medical student suicides, often linked to stress, isolation and various mental health issues.
As Federal Health Minister Greg Hunt left the meeting in Sydney, he fronted to the media to announce the changes.
‘Until now, there have been significant unintended barriers to doctors and nurses seeking the appropriate mental health treatment because of mandatory reporting requirements,’ he said.
‘What has been agreed is a system that will both protect patients, but critically, remove barriers to doctors and nurses receiving and accessing the mental health treatment that they want.’
But while the RACGP, the Australian Medical Association (AMA), and the Australian Medical Students’ Association (AMSA) have welcomed the broad strokes of the announcement, the organisations had concerns around the detail.
AMA President Dr Michael Gannon said his organisation had concerns regarding the wording around ‘future misconduct’ of health professionals.
‘It is unreasonable and unworkable to expect treating doctors to predict the future behaviour of any patients, including their colleagues,’ he said in a statement.
Ear, nose and throat surgeon Dr Eric Levi told the RACGP last year of his own struggles with mental health due to the stress of the job.  Medical professionals and students are often high-achieving, goal-driven people who feel the need to maintain a high level of performance and are often loathe to admit to difficulties – even at the cost of their mental health, Dr Levi explained.
‘Letting our guard down by allowing other people to know we have mental health conditions is something that may be considered a negative thing,’ he said.
Psychiatrist Dr Helen Schultz told The Citizen that implementation of the mandatory reporting rules has been done in a way that ‘no one really knows what it is, how it is done, and what constituted it’.
Prominent mental health campaigner and cardiologist Dr Geoff Toogood has chronicled his own battle with mental illness and stigma within the healthcare system.
He attributes his recovery in part to the fact that his GP did not report him to the Australian Health Practitioner Regulation Agency (AHPRA).
‘Her understanding and her effort to keep it private was crucial. It was vital she didn’t report me. At that point, I was so sick – I reckon it would have killed me, to be reported,’ he told newsGP.
‘It would have been the final step; to have someone else assessing you, judging you. You already feel judged when you have a mental health issue.’
Dr Toogood said last week’s COAG announcement represents a positive first step, but reiterated that he and many other doctors are waiting for the detail.
Dr Seidel said the RACGP looks forward to the opportunity to work with health ministers on developing the final policy for mandatory reporting.
‘Healthcare professionals are just like any other patient; their needs are complex and cannot be compartmentalised. This is what the RACGP will focus on during the coming months as the legislative provisions for mandatory reporting are redeveloped,’ he said.
‘While the announced change will not address the fundamental issue, there is still opportunity to address it as part of the review.
‘Together, ministers and health professionals can develop a rational approach to ensuring practitioner and patient safety.’

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