Normalising Mental Health - Stigma is the Enemy, Not Depression or Anxiety

Doctors are human

As doctors and medical students, we find it very easy to talk about pathology and disease with colleagues and friends. Sometimes, almost like a second nature, idle social chatter can easily turn to stories of interesting cases we have come across, usually to the ire of our non-medical friends and family. Discussions about mental health and psychiatric pathology can be equally as interesting and intriguing – when it doesn’t apply to us.  

We, as a profession, do not like to discuss our own vulnerabilities. Perhaps we are egotistical superhumans. Perhaps we feel that, as the carers, we should not show signs of weakness or illness. Perhaps with our increased burden of knowledge and superior understanding of medicine, we somehow escape the clutches of the pathologies we see and treat daily. Perhaps we are scared.

One thing is for certain – doctors are humans and get affected by disease just like any other human. It doesn’t have to be a disease that can be cut out by a surgeon’s knife or corrected by a physician’s pills, but it's also the diseases of the mind that need to be talked through.

National Mental Health Survey of Doctors and Medical Students

In early 2013, beyondblue released the National Mental Health Survey of Doctors and Medical Students. We now know that doctors suffer much higher levels of psychological distress and depression compared to other professionals. Also those who are younger, female or practice remotely are worst affected. Students have double the proportion of psychiatric disorders, psychological distress and burnout exhaustion as junior doctors, and over 20% of students report harmful levels of alcohol use.

An expert opinion

I recently had the pleasure of catching up with Prof Haikerwal, Chair of the the beyondblue Advisory Committee which conducted this survey to seek his thoughts on the stigma and taboo surrounding mental health within our profession.

He sees two major steps in addressing this issue as a profession: “The first thing we need to do is to actually expose that as an issue. The second thing is to normalise it like we do with our patients who have mental illnesses.”

“As a profession we are not good at seeking treatment. We need to seek treatment early from professionals (not ourselves) and ensure that we are all supportive of that process.”

Doctors as patients

I was interested to know why we treat ourselves differently from the “rest” of our patients. Prof Haikerwal states emphatically that “we are very poor patients” and “we often think that we should be invincible and there is no reason for that. We are just as susceptible to mental illness as anybody else.”

It raises an interesting concept of a double standard – one management for us and one for our patients. Should we not be guided by the same management principles we apply to our patients and the community?

Barriers to seeking help

When we look at the reasons why medical students are not seeking help, around half of respondents to the beyondblue survey reported the following reasons:

• embarrassment (50.3%)
• fear of lack of privacy/confidentiality (49.9%)
• reliance on self and not wanting help from others (47.7%)
• lack of time (40.6%)
• concerns about career progression/development (37%)

Medical students seeking treatment

13.2% of students surveyed (1,800) were taking antidepressants and 8.2% were on medication for anxiety. Half of the respondents believe that depression or anxiety is a sign of personal weakness and over 40% think a history of illness will lead to worse job prospects. Whether the stigma is real or not, the potential consequences mean over 40% of those with illness would advise others not to divulge their illness.

Over 20% of students surveyed had suicidal ideations in the last 12 months prior to the survey. Prof Haikerwal is an advocate for a “near miss register” where people can leave details so they can be reviewed in an anonymous manner in order to learn from the drivers to professionals’ suicidality.

He believes we need to make sure people feel supported so that suicide doesn’t become an option.

Thinking differently

There are many projects and initiatives – international, national, state and local – looking at ways of tackling the problems and issues raised in this survey. However, unless we – that’s you and me – as a profession begin to think and act differently about our own mental health, we are doing a massive disservice to ourselves, our future profession and our patients.

Resources and help

If you are suffering a mental health issue or would like to talk to someone for confidential advice and support, contact beyondblue’s support line 1300 22 4636 or Lifeline on 13 11 14.

Keeping Your Grass Greener is an excellent guide for medical students in maintaining their health and wellbeing throughout their time at medical school. It has been updated in 2014.