more_vert
IT has been a little over 1 year since I penned an MJA InSight article on mandatory reporting of health practitioners. What inspired me to write a follow-up article was the suicide of Dr Chloe Abbott, which has been widely reported in the Australian media in recent months. Her story bore some similarities with SJ, the nurse in my original article.
The difference is that SJ survived and is now on the path to recovery.
SJ was admitted to hospital under the NSW Mental Health Act for psychiatric reasons. She was reported by her treating doctor to the professional state health council as is required under Section 151 of the Health Practitioner Regulation National Law (NSW). To be clear, this is a NSW-only law.
Chloe is dead, SJ is not. Let’s examine potential reasons why the outcomes were different.
SJ sought psychiatric care interstate as she initially found it difficult to trust treating doctors in NSW, due to the Section 151 mandatory reporting requirement. Local NSW mental health services actually discharged her from their care, despite her vulnerability after her recent suicide attempt, and conditions were placed on her nursing licence as a result of the mandatory reporting and assessment by the nursing council.
In severe financial stress, a single mother of two young children and in utter shame due to the mandatory reporting, SJ endured prolonged periods of suicidal ideation, racked in a state of existential despair and hopelessness. Slowly, day by day, with the help of an interstate psychiatrist and novel ketamine-based depression therapy, SJ started on a gradual path to recovery.
She is now back to nursing work, having passed further psychiatric assessments by the nursing council. She has found a local psychiatrist to manage her treatment, but still requires ongoing ketamine from the interstate specialist.
She survived. Why? Pure luck? The system worked? No. She survived because she went outside the mental health system of her state of NSW, and reached out for help from interstate.
The mandatory reporting law almost killed her by putting her into a state of hopelessness and shame. She could have had the same psychiatric treatment locally if not for the mandatory reporting laws creating a state of fear for her and her treating doctors.
What I can safely say is that a law that requires a treating doctor to report a mentally unwell doctor or nurse to a state and national authority – which will jeopardise their career and professional record – will absolutely not help their mental state, nor their recovery.
Medicine is built on trust. It’s called the therapeutic relationship or alliance. If you cannot trust your treating doctor to have your best health interests in mind, then you may as well not bother.
A year on from my original article calling for a change to the NSW mandatory reporting law, I am glad to report that SJ is on a good recovery path, but it required extraordinary measures.
It saddens me to hear of the tragic suicides of young doctors like Chloe Abbott. I hope that in a year from now, I am not writing another article about the same thing and lamenting that, indeed, the cure is deadlier than the illness.
Footnote: Newly appointed NSW Minister for Health Brad Hazzard has called for an action plan to deal with young doctor suicides and is convening a forum in June 2017 in Sydney. Now is the time to petition him for a change to the NSW law Section 151. You can tweet him @BradHazzard.
Dr Minh Le Cong works for the Royal Flying Doctor Service in Queensland and is the chief editor of the PHARM (Prehospital and Retrieval Medicine) blog site and podcast, the FOAM4GP blog site and the Ketamine Leadership Academy blog site.
If this article has raised issues for you, help is available at Lifeline on 13 11 14, and beyondblue on 1300 224 636.
To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.
Loading ...
With the aid of fictional evidence from a vindictive wife, I was wrongly labelled and appallingly treated for a mental illness that has since been shown not to exist. However, as a result of my complaints to the system over my inhumane treatment, I was then subjected to the humiliation of having my registration suspended by AHPRA and the Board. At the time I felt that I had no way of defeating corruption and dishonesty and decided to take my own life.
Whilst I still regret not dying, it has made me more resolute in my quest to rid the world of as much dishonesty and corruption as I possibly can.
It is my belief that AHPRA and the Medical Board do not have any doctor’s welfare in their hearts and indeed must be shown to exert power, whether rightfully or not, to justify their own existence. I encourage everyone to question any of AHPRA or the Medical Board’s decisions and ensure that these bureaucracies must verify their information and justify their decisions before proceeding to ruin innocent doctor’s lives.
Mandatory reporting is just a small part of an overall larger problem. Training doctors are often in situations where they are not actually receiving much training. But they will be working excessive hours, encounter high stress and then later have to face exams. Essentially the registrars cover the majority of after hours work. The colleges do very little to control the quality of education within the training programs and even less when there are complaints of bullying (they offload this to the hospital). I’ve seen a site where training was so bad that all of the registrars complained as a group and the college did not step in until the AMA and the media were involved. Even then, that specialist college did not check with the registrars at any point if things had improved. That site had a temporary bad rating but returned to business as usual the next year. 1 reg failed out and 3 went interstate. The fact is that training doctors are literally powerless when they encounter problems such as this. The only solution is to attempt to find another job. However, sometimes that is not possible and that process is stressful in itself. Anxiety, stress, PTSD are likely to result in such scenarios. Sure, counseling can help and mandatory reporting is an issue. However, shouldn’t we identify and fix the parts of the system that are causing the mental health problems to start out?
Reports by treating practitioners should only be required to be made when there is a real risk to the public. in that regard, a report should only be made if the unwell person has no insight and continues to work – putting the public in danger. If the ill person is responsible, seeks help and makes sure they work when their treating practitioners are happy for them to do so – where is the need for any intervention by any body?
Agreed, but this is what is required with Mandatory Reporting.
Mandatory Reporting with respect to Psychiatric or physical illness does NOT require reporting of all those with a diagnosis.
(This is different to Boundary Violations)
Mandatory reporting does not make health care safer!
Reports by treating practitioners should only be required to be made when there is a real risk to the public. in that regard, a report should only be made if the unwell person has no insight and continues to work – putting the public in danger. If the ill person is responsible, seeks help and makes sure they work when their treating practitioners are happy for them to do so – where is the need for any intervention by any body?
Mandatory reporting fails to recognise that not all people who are ill lack insight. Further, doctors who have been patients – make better doctors.
We should support doctors to be the healthiest version of themselves and that includes providing real access to health care.
Couldn’t agree more with Randal. I sent myself to a top specialist in the field who does work for the MBA, thinking this would be protective. I obviously wasn’t thinking straight at the time. He reported me immediately. Now I can’t even trust him and refuse to tell him anything else which may self-implicate further.
I think if the unwell doctor or nurse is prepared to put themselves medically in the hands of a senior specialist in the field of their illness/problem then it should be left to the discretion of the specialist whether reporting to AHPRA is necessary. I don’t like mandatory reporting on the basis of set criteria; It undoubtedly will be a deterrent to seeking medical help. It also puts those reporting in the ‘villain’ category and in the case of a colleague, undoubtedly would destroy any ongoing relationship
It is not the Mandatory Reporting Law itself that is the problem, but the clumsy, naive, inappropriate and at times unprofessional manner in which it is being interpreted and implemented. Then the grinding bureaucracy that follows, with limited care of the individual.
Properly interpreted , as per the Chair of the MBA, this does replicate the moral and professional duty that has always existed – to remove oneself from practice at times when one is not adequately equipped to do so. This includes but is not exclusive to mental illness. Tiredness for example.
The fact that this is unpleasant does not mean this is a punishment. This is a conclusion not worthy of reasonable people.
The reason that a practitioner may not be able to work is a consequence of their condition, not merely the law. This is also unpleasant, but could hardly reasonably be regarded as the condition ‘punishing’ them. That conclusion would be ridiculous.
A major complication is that the individual affected is not, for many reasons, best placed to assess their ability to practice. As an analogous situation, there would otherwise be no requirement for breath testing drivers.
History has demonstrated many examples of patients being harmed by practitioners who, at the time, were not sufficiently equipped for the task, and who had not acted on their professional obligation to remove themselves from practice until they were.
The suffering from this extra complication of having an illness, including a psychiatric illness, is real, substantial, important and common. In addition to the illness itself, proper professional management by the treating practitioner should assist the individual to manage this well. Too often the medication alone is provided, and the help for the human suffering not.
But that is about standards of professional practice rather than blaming the law for acting to protect the public.
A major problem that gives rise to unnecessary distress, and harm, is the unskilful, clumsy use of the law, at times to solve difficult interpersonal problems in a very inappropriate manner.
Again, this should not be regarded as a problem of the law, but of how it is used (misused).
The Chair of the MBA has made a statement to the effect that a treating doctor should use discretion in deciding to report a doctor with mental illness, but the situation is such that if the doctor decides not to report a doctor who has a mental illness because he or she decides the sick doctor is not a risk and that doctor is is the subject of a notification and the fact of the therapeutic relationship is discovered, the treating doctor will be potentially liable for not reporting his or her patient.
This makes the treating doctor potentially at risk of sanction because of the actions of their patient. We are familiar with patients who commit suicide having been discharged from mental health units having been found to be not at risk of suicide, which suggests that the assessment of behavioural risk is very difficult. This fact makes mandatory reporting the default option, and puts the treating doctor in peril if he or she decides not to make a mandatory report. This seems to be most unjust.
The loss of young doctors like Chloe, and others of my friends who have taken their lives is a tragedy which Professional Colleges, hospital’s and governments have ignored for far too long. But for every one of them they’re are hundreds more, often senior experienced doctors, including me, who struggle on doing their jobs, terrified to seek help because of the stigma of mandatory reporting. When I became very ill not long ago due to severe bullying and the complete indifference of the General Manager where I work, I was reported by her to the state Health Council. After nearly thirty years in the profession, having completed medical school, surgical training, deployment to a war zone, and being chosen to run a department, all after being diagnosed with chronic depression in my twenties, suddenly I became a danger to the public. And it should be noted that the report was made after I had taken leave to deal with the severe exacerbation of my depression. I was not even treating the public. To make matters worse the GM incorrectly alleged that I had been involuntarily admitted under the Mental Health Act. Then finally, undoubtedly to cover herself, she noted that I knew nothing of the report, and that it may cause me more distress. No prizes for guessing that she showed no duty of care by contacting me to let me know. Nor was there any offer of help or support. So, nearly two months later, when I was making a good recovery, I received the letter from the Board. Minh you are so right when you say it leads to humiliation and shame. I felt hopeless, and deeply ashamed of myself for being so weak that I couldn’t cope. It set me back many weeks and led to further suicidal ideation. I believed they would take my job away and I had nothing else. In all the years that I have had regular review and management by my treating specialists not one of them ever felt the need to report me. Mandatory reporting will lead to more deaths. We must demand that it is rescinded. We don’t punish doctors who have diabetes or Chrohn’s or any other chronic disease that may make them unwell. Stop doing it to those who suffer from issues of mental health.
i have said before, seek help outside, “New Zealand sounds nice this time of the year”. take leave without pay if must, call on a family urgent matter, do what must.
in the meantime, we should mandate that politicians are reported and taken away from their duties at “no pay and no superannuation”.
that should bring immediate changes to AHPRA; health professionals have been singled out. Prince Harry could go into a warzone with “mental health issues” which were not treated at the time, as he tries to tell the world. we are to be congratulated to have an insight to seek help and treatment – it should be upto our doctors to say to us that we are not well to work; and only if we do not follow therapeutic advice, report us to the hospital board etc. we need to stand united with all the other health professionals and say – no to mandatory reporting, and/or we stop working! maybe a National approach will help.
We had to seek clarification on this from our Director of Medical Services. We are in Victoria and were told reporting is not mandatory. I would be horrified to think it was as it would greatly reduce the likelihood of our vulnerable colleagues sharing their woes with us. Our moral duty is to keep abreast of the potential risk unwell colleagues pose to their patients and we can make this clear to our colleagues in need without compromising their welfare.
I am glad this is being discussed openly. I despaired at the thought of reporting a depressed colleague recently – and if it was mandatory I would not have done so (conscientious objection) as I am sure his recovery would have been compromised and he shows great insight. If he had been abusing drugs, shows signs of psychosis or inappropriate behaviour I would have felt compelled to ask him/her to take time off and stop seeing patients.
Great article and I wholeheartedly agree. Mandatory reporting is discriminatory, in that doctors are not afforded the same rights of confidentiality and trust that all our other patients are entitled to. It is time we started treating ourselves and each other with the care we all deserve, equally so. I know colleagues who are self-treating and really struggling because they are afraid they will lose their right to practice, and this is causing delays in seeking treatment, and ironically, putting doctors and their patients at greater risk. If the system were supportive and understanding, rather than judgemental and punitive, we would be far more likely to seek help early on, before any harm is done.
3 % of trained medical practioners agree with the policy……………………….
I agree wholeheartedly with this article. Doctors with depression, PTSD or other mental illnesses are suffering enough, without having their ability to work and earn a living threatened by being reported. For many doctors in this situation, being able to go to work is part of the healing process, as work is a place of sanctuary for them. I cannot condone a process whereby doctors who are performing perfectly adequately in their professional roles are penalised and marginalised by their own profession.
Yes. Absolutely yes. There exists a body of evidence that I believe proves, beyond reasonalble doubt, that the actions of AHPRA during Mandatory reporting would be reasonable anticipated to cause psychological distress that in a known vulnerable person would unreasonable increase the risk of suicide. Or to put it more simply, their conduct is a significant departure form accepted clinical practice and the conduct knowingly puts a member of the public at risk of harm.
It is quite clear that a disciplinary system for dealing with mental illness is not appropriate for anyone outside the health professions. Such treatment was abandoned whit the closure of lunatic asylums. The problem is that doctors face sanctions if they do not report doctors and others with mental illness, so although there is some degree of discretion about reporting, it is easier and safer to comply. The process of verifying, gaining further opinions and deciding what to do, during which time the doctor is not allowed to work, are in themselves the punishment for being sick. It is damaging to individuals and families and should be regarded as being repugnant in this day and age.