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| British Journal of Psychiatry | Advances in Psychiatric Treatment | All RCPsych Journals |
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Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2QZ, email: alfred.white{at}bsmht.nhs.uk
Queen Elizabeth Psychiatric Hospital, Birmingham
Newbridge House, Birmingham
Division of Health in the Community, Warwick Medical School, Coventry
Queen Elizabeth Psychiatric Hospital, Birmingham
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Abstract |
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 Top Abstract IntroductionMethodResultsDiscussionReferences |
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To determine the opinions of psychiatrists on mental illness among themselves and their colleagues a postal survey was conducted across the West Midlands.
RESULTS
Most psychiatrists (319/370, 86.2%) would be reluctant to disclose mental illness to colleagues or professional organisations (323/370, 87.3%). Their choices regarding disclosure and treatment would be influenced by issues of confidentiality (n=245, 66%), stigma (n=83, 22%) and career implications (n=128, 35%) rather than quality of care (n=60, 16%).
CLINICAL IMPLICATIONS
The stigma associated with mental illness remains prevalent among the psychiatric profession and may prevent those affected from seeking adequate treatment and support. Appropriate, confidential specialist psychiatric services should be provided for this vulnerable group, and for doctors as a whole, to ensure that their needs, and by extension those of their patients, are met.
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Introduction |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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There has been less interest in the impact of stigma on the accessing of mental healthcare by medical professionals in general and psychiatrists in particular, despite the fact that this may be a particularly vulnerable group. It is well-recognised that doctors have high rates of mental illness (Caplan, 1994) but are often reluctant to seek help, which may explain the high rate of suicide among the profession (Richings et al, 1986). According to the General Medical Council, psychiatrists have one of the highest rates of psychiatric morbidity among hospital doctors and there is concern that this is not adequately recognised and managed. The British Medical Association (2005) estimates that 1 in 15 doctors, at some point in their lives, will have some kind of problem with alcohol or drugs.
Mental illness may be particularly stigmatising for those working in a stressful profession where vulnerabilities are not readily tolerated. There is evidence that avoidance of appropriate help-seeking behaviour by doctors starts as early as medical school and is linked to perceived norms, which dictate that a mental health problem may be viewed as a form of weakness with implications for subsequent successful career progression (Chew-Graham et al, 2003).
The aim of this study was to investigate the views of psychiatrists on the prevalence of mental illness among their colleagues, their own experiences of mental illness and their preferences for disclosure and treatment should they develop mental illness.
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Method |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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The questionnaire sought information on the respondents’ perceptions of the prevalence of mental illness among psychiatrists compared with the general population and other medical professionals. Respondents were asked whether they had ever experienced mental illness, what their disclosure and treatment preferences would be should they develop mental health problems and what factors would influence these decisions. A freetext box was included for any additional comments.
The 
2 test was used to determine whether there was an
association between having experienced mental illness and the responses to the
other questions. P
0.05 was considered significant. The associated
effect sizes of these tests (
or Cramer’s ) were also
computed. The significant two-sample 2 associations are
reported.
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Results |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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Roughly a third (124) of respondents considered that psychiatrists have a higher incidence of mental illness than the general population. Over a third (135) considered that they had a higher incidence of mental illness than other medical professionals (Table 1).
Disclosure of mental illness
In the event of developing a mental illness most respondents
(n=240, 64.9%) would choose to disclose this to family and friends
rather than to colleagues (n=51, 13.8%) or professional institutions
(n=47, 12.6%); 32 (8.7%) would disclose this to no one. Career
implications were the most frequent reason for failure to disclose mental
illness (n=128, 34.7%), followed by professional integrity
(n=102, 27.5%) and stigma (n=83, 22.4%).
Treatment preferences
As a first treatment preference for a moderate depressive disorder, less
than half (n=162, 43.9%) would seek formal professional advice; 114
(30.9%) would choose informal professional advice, 73 (19.8%) self-medication
and 20 (5.4%) no treatment. If they were to require inpatient treatment, 171
(46.2%) would choose a local private facility, with only 15 (4.1%) choosing a
local National Health Service (NHS) facility. Overwhelmingly the most
influential factor governing this choice was confidentiality, which was cited
by 245 respondents (66.2%). Only 60 (16.3%) would make the decision based on
the best quality of care.
Experience of mental illness
Eighty-one respondents (22%) indicated that they had, at some time,
experienced a mental illness which had affected their personal, social and
working life.
Those who had experienced mental illness were more likely to disclose
future mental illness to no one (2=10.719, d.f.=3,
P=0.013; Cramer’s =0.174) and were more likely to cite
stigma, and less likely to cite career implications and professional
integrity, as the most important reason for this decision than those who had
not experienced mental illness (2=8.395, d.f.=3,
P=0.039, Cramer’s =0.154).
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Discussion |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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The stigma associated with mental illness is well-recognised and remains prevalent. The Royal College of Psychiatrists has recognised the deleterious effect of discrimination and prejudice against people with mental illnesses and has attempted to address this with its Changing Minds campaign (Crisp et al, 2004). Psychiatrists should therefore be aware of the devastating effects of stigmatising those with mental illness, but that does not prevent them from suffering its consequences when coping with mental illness themselves (Hausman, 2002).
Mental illness is a broad term covering a variety of illnesses which differ from each other in many significant ways, not least in how they are perceived by others. As such they attract a variety of different reactions from the public and professionals and carry differing implications for the professional competence of those affected. The methodology of our study did not allow us to distinguish between different types of mental illness, but our findings suggest that psychiatrists recognise that such illnesses are not uncommon among the profession.
Psychiatrists will be well aware of the profound impact that such illnesses can have on both their personal lives and their professional competency. It is therefore particularly worrying that, in the event of developing such illnesses, the majority of psychiatrists would be reluctant to seek help. Moreover, in the event that they did seek help, treatment choice would be influenced by concerns over loss of confidentiality and stigma rather than perceived quality of care. This is consistent with the findings of a survey in the USA (Lehmann, 2001) which showed that half of all psychiatrists with a depressive illness would self-medicate rather than risk having mental illness recorded in their medical notes.
Stigma was cited more frequently as a factor influencing choice of future treatment by those who had personal experience of mental illness than by those who had not. This may reflect past experiences of those who had been mentally ill. There is some evidence (Hausman, 2002) that psychiatrists who suffer from mental illness experience isolation, a lack of compassion and discrimination by their own professional colleagues. It is recognised that psychiatrists often hold stigmatising and discriminatory attitudes towards their patients (Corker, 2001) and it is not surprising that these attitudes extend to their colleagues who experience mental illness. The Royal College of Psychiatrists (2001) acknowledges that doctors, including psychiatrists, are sometimes found to be prejudiced by patients and that it is likely that doctors’ attitudes towards people with mental illnesses mirror those of the general population.
Failure to seek appropriate help when ill is prevalent among the wider medical profession (Forsythe et al, 1999). Again, issues of trust and concerns about confidentiality may act as barriers to medical practitioners seeking help for psychiatric illness (Thompson et al, 2001; Davidson & Schattner, 2003). Such attitudes are already prevalent among junior doctors (Shadbolt, 2002) and medical students (Hooper et al, 2005).
The culture of medicine may be a barrier to doctors seeking healthcare as it encourages an image of invincibility and denial of vulnerability (Thompson et al, 2001; Davidson & Schattner, 2003), and accords low priority to the mental health of its practitioners (Center et al, 2003). One of the authors (A.C.W.) runs specialist psychiatric clinics for doctors of all specialties and the views expressed by its attenders appear to be similar.
Recommendations
Our findings suggest that some psychiatrists, and presumably by extension
other doctors, experience mental illness while practising without obtaining
good and appropriate treatment, thus putting themselves and their patients at
risk. Strategies aimed at challenging the culture of doctors’
self-reliance should start in medical school and a ‘no blame’
culture in which doctors who are mentally ill are accepted and supported
rather than stigmatised and punished should be encouraged. All doctors should
be appropriately trained for consultations in which the patient is also a
doctor.
We would advocate the provision of confidential specialist psychiatric services for doctors. These should be recognised and funded posts rather than simply being tagged on to existing clinical services. The provision of well-advertised but confidential referral pathways would be essential. There is some evidence that such a ‘doctor’s doctor’ would be welcomed by senior NHS staff (Forsythe et al, 1999). We believe that there should also be specialised in-patient facilities available, either regionally or nationally and there is some evidence that out-of-area specialist care for psychiatric illness would be welcomed by medical practitioners (Forsythe et al, 1999).
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References |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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CAPLAN, R. P. (1994) Stress, anxiety and depression in
hospital consultants, general practitioners and senior health service
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CENTER, C., DAVIS, M., DETRE, T., et al
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CHEW-GRAHAM, C. A., ROGERS, A. & YASSIN, N. (2003) ‘I wouldn’t want it on my CV or their records’: medical students’ experiences of help-seeking for mental health problems. Medical Education, 37, 873 –880.[CrossRef][Medline]
CORKER, E. (2001) Stigma caused by psychiatrists. British Journal of Psychiatry, 178, 379.[CrossRef][Medline]
CRISP, A. H., COWAN, L. & HART, D. (2004) The
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ROYAL COLLEGE OF PSYCHIATRISTS, ROYAL COLLEGE OF PHYSICIANS OF LONDON & BRITISH MEDICAL ASSOCIATION (2001) Mental Illness: Stigmatisation and Discrimination Within the Medical Profession (Council Report CR91). London: Royal College of Psychiatrists, Royal College of Physicians of London & British Medical Association.
SHADBOLT, N. (2002) Attitudes to healthcare and self-care among junior medical officers: a preliminary report. Medical Journal of Australia, 177, S19 –S20.[Medline]
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