The Handbook of Physician Mental Health
Author: Clare Gerada
Publisher: Routledge
Price: £29.99 (paperback) £99.99 (hardback) £26.99 (eBook)
ISBN: 9781032479866
Doctors ‘have a greater tendency towards mental ill-health’
Given its title, I approached this book somewhat tentatively as I was wary of not being a physician myself. The authors eased my concern promptly and assured it readers that the contents were applicable to all working health professionals, and this proved to be the case.
The book is written by Clare Gerada who is well known within medical circles for being a past president of the Royal College of General Practitioners. Dr Gerada is joined by Sarinda Wijetunge who is described as ‘contributor’ who represents the organisation Doctors in Distress. Both offer introductions to their individual backstories with Dr Gerada’s being a fleeting glimpse into why she chose the medical profession, while Dr Wijetunge shares a raw and honest account of her own experiences of mental illness. This is a powerful start, and the inclusion of lived experience from the perspective of a medical doctor is captivating while lending the book a real sense of relevance and authenticity.
The book begins by immediately dispelling the harmful myth that as health professionals we should be immune from mental ill-health simply because we have greater knowledge about its genesis and how to treat it. In fact, the authors indicate that doctors have a greater tendency towards mental ill-health due to three core factors: the need to display professionalism, their job role and the system in which they work. There is also the trait of the ‘wounded healer’, whereby individuals can be drawn to work in a particular industry, role or specialty based on prior, related trauma or injury they may have experienced themselves. Thus, leading them to be at greater risk of experiencing the same mental ill-health they diagnose and treat in others.
I recommend that all leaders working in the NHS should read this book. Individual clinicians can take solace from the fact that a tendency towards mental ill health is not a reflection of inherent fallibility, instead they are victims of ill-planned workplaces and cultures [Chris Tuckett]
A ‘loss of control’ is crucial
I believe the greatest strength of this book lies beyond the ‘wounded healer’ analogy, in that its pages are dedicated to explaining how factors outside an individual’s locus of control are what contribute most to mental ill-health. This explicit recognition that the individual is not to ‘blame’ for struggling or suffering with mental illness is important.
Too often in today’s society we expect people to battle barriers at work, absorb chronic stress, cope with poor cultures and deflect conflict while remaining resilient and steadfast. And there is a pervasive sense that if one complains of mental ill-health then we can be labelled as lacking fortitude, lacking commitment enough or simply being ‘too weak’. Of course, that is all untrue, and it is systemic factors that heighten the risk of experiencing mental illness.
This book shares the main risks, which are
- socio-political environment
- workplace culture
- blame culture of a culture of fear
- bullying and/or racism
- industrialisation of care
- workplace environment
- workload intensity
- sleep disturbance
- stigma and shame around mental health issues
Incoming Labour government has been a let-down
That is quite a list, but as I alluded to earlier, they are all external factors and are not derived from something being inherently ‘wrong’ with an individual.
I’ll not go through each one, but a handful provoke a need to say a little more about them. Firstly, the socio-political environment is as relevant now as any other time. With the arrival of Labour into government many thought there might be a lessening of the ‘NHS is broken’ rhetoric, and a loosening of the budgetary strings. Sadly, neither arrived. And the former has arguably worsened, with the current health secretary engaging in some frankly harmful leadership behaviours, wielding shame, admonishment and threats of sanction towards leaders as his tools to ‘motivate’ improvements in care delivery. And if this is how the leadership manifests at the top, then we should not be surprised when it trickles down to all other levels within the NHS. With the inevitable detrimental impact on the mental wellbeing of the workforce.
Secondly, workplace culture, the workplace environment, fear of blame and the workload intensity all arise from the type of workplace we deliver care within. Simply, cultures, behaviours and environments in which we work are critical to our mental health and wellbeing. The wellness of its staff is something the NHS still needs to regard as its primary focus.
Thirdly, the industrialisation of care involves a pervasive tendency to try and find ways to make care more ‘efficient’ by introducing standard operating procedures, tick boxes, risk assessments and other forcing processes. All of which disempower the clinician, reduce their sense of professionalism and remove opportunities for connection between patient and clinician. This can lead to a sense of dehumanisation towards patients who simply become another ‘task’ to complete while at the same time reducing the likelihood of any joy being elicited from healthcare work. This industrialisation is both dangerous but exceptionally common.
The authors demonstrate their caring instincts towards their fellow clinicians and have produced The authors demonstrate their caring instincts towards their fellow clinicians and have produced an invaluable resource and guide for any healthcare professional who may be feeling the mental strain of working in our healthcare system
‘Victims of ill-planned workplaces and cultures’
Of course, by explicitly stating the contributing risk factors for mental ill health, the book at the same time offers the recipe to minimise these risks too. The difficulty is that because many of these risks are systemic, healthcare leaders need to be focused on them to be able to rectify them. For this reason, I recommend that all leaders working in the NHS should read this book. Individual clinicians can take solace from the fact that a tendency towards mental ill health is not a reflection of inherent fallibility, instead they are victims of ill-planned workplaces and cultures.
The authors share much more detail about the aetiology of mental ill-health in doctors, how it manifests and what can be done about it, but due to the importance of these topics I do not want to reduce them down here. I simply recommend reading the book to obtain the detail.
The book is well written, conveying a sense of depth while managing to maintain its brevity. The authors demonstrate their caring instincts towards their fellow clinicians and have produced an invaluable resource and guide for any healthcare professional who may be feeling the mental strain of working in our healthcare system. If that is you, then I would recommend reading this book.
Dame Professor Clare Gerada is an international leader in practitioner health and, until recently, has led the largest physician health programme in the world. She is a co-chair of the NHS Assembly and past president of the Royal College of General Practitioners.
Chris Tuckett is a physiotherapist and an NHS director of allied health professions
LinkedIn X: @HealthPhysio
