Tackling mental health risks among GPs – what works?

It will come as no surprise to GPs that doctors experience higher rates of psychological distress compared to people in other professions and the general population.
 
Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine, believes GPs tend to have certain personality traits that may make them more vulnerable.
 
‘We need to let go of overworking to compensate for a broken health system,’ she told newsGP.
 
‘As high achieving carers, we tend to perfectionism, rescuing behaviours with challenging patients and a high sense of responsibility which puts us at risk of feeling that we failed when we haven’t been able to change a patient’s problem.
 
‘GPs are also autonomous thinkers who find it hard to accept support and help from others, in part because of our perfectionism, but also from a fear of being exposed as vulnerable human beings who don’t always get it right.’
 
These traits, in addition to intense daily workloads, administrative burdens, and challenges around sustaining a work-life balance are all contributing factors to one’s mental state.
 
But what can be done about it?
 
A new global systemic review and meta-analysis, led by the University of New South Wales (UNSW) and the Black Dog Institute, looked into the effectiveness of various mental health interventions for reducing or preventing symptoms of common mental disorders and suicidality among doctors.
 
Analysing 24 international studies, involving 2336 practising doctors, it found approaches that help build doctors’ skills – such as cognitive behavioural therapy (CBT), stress management, and peer support – to be the most effective.   
 
Similarly, other skills-based approaches like mindfulness and meditation were also found to be helpful.
 
However, programs that provided educational information about mental health without teaching practical skills were found to have no meaningful benefit. 
 
Dr Andronis says this is not surprising, as skill building ‘is the essence of healthy self-esteem’.
 
‘Words are not enough, especially for people prone to intellectualising,’ she explains.
 
‘We need to practice what we preach and that means practicing on ourselves, and it means learning strategies and practical techniques that sooth and emotionally regulate us. But we also need the mindfulness to notice when we are feeling emotionally dysregulated.’
 
Meanwhile, despite strong evidence linking poor working conditions to psychological distress among doctors, the researchers sought to review studies on mental health interventions at an organisational level – only to discover a lack of high-quality research in this area.
 
Dr Mark Deady, study co-author and Workplace Mental Health Research Lead at the Black Dog Institute, said this is worrying given the major impact working conditions are known to have on doctors’ mental health.
 
‘Yet not one study examined organisational-level interventions that aimed to improve physician mental health through modifications to the work environment, such as modifying working hours or rescheduling rosters,’ he said.
 
‘This gap is now too wide to ignore. Workplaces have real potential to be part of the solution. The evidence shows that multi-level approaches are essential for creating mentally healthy workplaces.’
 
Lead author Dr Katherine Petrie, Postdoctoral Research Fellow at UNSW and the Black Dog Institute, agrees and fears the lack of research at an organisational level is a missed opportunity to implement solutions that meet doctors where they are.
 
‘If organisations do not address the stressors and hazards present in the working environment, it is unlikely that skills-based interventions alone will have a meaningful or sustained effect,’ she said.
 
In terms of personal steps GPs can take in the interim however, Dr Andronis says it is important to try and develop better boundaries, which can be uncomfortable initially.
 
‘It can be difficult to say “no” even when that’s what we need to do,’ she said.
 
‘Practicing with others is an excellent way to learn while supporting each other at the same time.’
 
Meanwhile, despite doctors having an increased risk of suicide, the review also noted a lack of research into suicide prevention for the cohort, with only two studies examining interventions that targeted suicidal ideation among doctors.
 
Dr Petrie said this finding is ‘particularly alarming’.
 
‘This must be treated as a critical research priority,’ she said. 
 
But Dr Andronis says suicide can be difficult to predict and believes the best that can be done to protect doctors is to put in the preventive care work ‘as early as possible’.
 
‘See it as a continuous, lifelong process of development,’ she advised.
 
The Melbourne-based GP says developing skills, such as mindfulness, can enable doctors to differentiate between their personal responsibilities and those of the system in which they work.
 
‘It is a grave mistake to blame ourselves for issues out of our control,’ Dr Andronis said.
 
‘When we see problems in our health system, it is empowerment through advocacy and speaking out that can lead to positive outcomes for us and for our patients.
 
‘We can’t expect an impersonal system to care for us. We need to care for ourselves while recognising the limitations of our work environment in particular the Medicare system, which tries to be everything for everyone.’
 
While the authors note that further research is needed to confirm the most effective delivery formats and strategies for mental health interventions among doctors, in the meantime the authors hope the findings will provide ‘important guidance’ for workplaces.
 
Dr Andronis also pointed to a number of support programs, including the RACGP’s GP support program, Hand-n-Hand Peer Support, as well as The Essential Network created by the Black Dog Institute for health professionals.
 
‘They are extremely helpful, the challenge is for doctors to be aware of them and to use them,’ she said.
 
‘But probably the most important support comes from having your own trusted GP.
 
‘It takes courage to seek help because doctors score poorly on ‘accepting compassion from others’ questionnaires. Embracing our vulnerability not only makes us safer, it also makes us better doctors.’
 
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