‘Care Under Pressure’: developing interventions to tackle doctors’ mental ill-health

Dr Jason Hancock Consultant Liaison Psychiatrist with Devon Partnership NHS Trust said: ”In the challenging times of the COVID-19 pandemic, understanding and developing interventions, both at the level of the individual and the wider workplace, that can support doctors wellbeing is absolutely crucial if we are to ensure that we have a functioning and sustainable workforce”.  

The growing pressures, demands and challenges of a doctor’s work environment can lead to high levels of stress, anxiety, depression, suicidal feelings and other mental illnesses. This can have an impact on both doctors and patients with doctors choosing to leave the profession or continuing to work while unwell. The Care Under Pressure project team undertook a review of the large body of existing literature on interventions, support and advice on treatment for doctors and synthesised it to take in to account factors such as individual, organisational, social and cultural; an approach not considered in existing interventions and initiatives. The team also drew on the perspectives of a range of stakeholders such as patient representatives, clinicians, doctors in training, medical educators and academics to gain a rounded view on how to develop strategies to effectively tackle mental ill-health and its impacts.

Professor Ian Fussell, of the University of Exeter Medical School, said: “This is such important work and now more than ever as doctor's work has changed beyond recognition in so many ways impacting on physical and mental wellbeing. The extension of the project to include other health care professionals is a fantastic development and captures the spirit of inter professional learning and working which we strongly believe in, the University of Exeter Medical School is essential to achieve healthy outcomes for all health professionals and the public.”

Feelings of isolation and ill-preparedness for difficult situations were key causes of mental ill-health amongst doctors. A sense of belonging to a team and to a profession and receiving and giving mutual support were key to promoting well-being at work. Experiencing feelings of trust in work colleagues and individuals’ organisations alongside the support of balanced feedback were also found to be key aspects of positive work cultures. These findings were used to produce a report offering guidance and recommendations to policy makers and organisation leaders involved in the design of interventions as well as contributing to the development of new approaches to the research of doctors’ mental health.

The project, part of an interdisciplinary programme of research aimed at understanding the causes of mental ill-health in doctors is funded by the NIHR, the nation’s largest funder of health and social care research. The Care Under Pressure programme has resulted in a number of outputs. A full report: Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care under Pressure Realist review published in the NIHR journal Health Services Delivery Research.  A related paper Optimising strategies to address mental ill-health in doctors and medical students: ‘Care Under Pressure’ realist review and implementation guidance, is published in the peer-reviewed journal, BMC Medicine.

The team have also worked with GP and comics artist Ian Williams to produce a series of graphic illustrations, and worked with patient representatives to produce a video which asks, ‘Why is the health of your doctor important to you?’, to support and bring to life the findings and recommendations of the project.

Further research will be undertaken with a follow-on project involving nurses, midwives and paramedics starting in July. A further project in the pipeline aims to help NHS Trusts to put the Care Under Pressure and other relevant guidance into practice to improve their workplace interventions and support doctors’ wellbeing. In addition there is related research taking place within the College of Medicine & Health into the impact of other factors endemic to the practice of medicine, such as ability to tolerate ambiguity, on a clinician’s psychological wellbeing. This is particularly relevant in the current COVID-19 pandemic where ambiguity and uncertainty have greatly increased.