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Many medical organisations and health services are working diligently to reduce the enormous scale of burnout and mental injury in doctors, but further action is required to address its impact on doctors’ families, writes Dr Leanne Rowe in part one of this three-part series.
During Australia’s current mental health crisis, it’s time to confront the impact of the enormous scale of burnout and mental injury in doctors on their families.
At the tip of the iceberg of mental ill health, recent figures show that one in five adults and one in seven young people in the general population experienced a psychiatric disorder in 2021–2022 (here) and 4.7 million people filled a mental health-related prescription, including 5% of children aged five to 11 years, 10% aged 12–17, and 15% aged 18–24 years (here).
The consequences of lockdowns during the coronavirus disease 2019 (COVID-19) pandemic, and other major issues such as climate change, global conflict and economic downturns are continuing to have a big impact on the mental wellbeing of parents and their children (here, here and here). Access to help is limited by serious challenges faced by a health system in chaos, including the shortage of general practitioners and other mental health professionals.
Doctors and their families, of course, are not immune from these universal problems (here).
When I worked as a GP in a youth-specific health clinic for nearly ten years, I researched and wrote extensively about the importance of authoritative parenting and parental mental health in promoting wellbeing in young people. Among my many memories of the clinic are the unwarranted despair, guilt and shame of my specialist colleagues when their adolescent children presented in crisis with depression, eating disorders, drug use and other addictions, self-harming behaviours, or suicidal thinking. Although these reactions were shared by non-doctor parents, my colleagues disproportionately blamed themselves for failing to recognise the impact of their work stress and their own mental health problems on their children.
The uncomfortable truth is that parental mental illness may have a negative impact on young people and children, but this common association should be seen as a catalyst to seek help rather than a cause for parental despair, guilt and shame. During Australia’s current mental health crisis, the Children of Parents with a Mental Illness (COPMI) national initiative and other foundations are providing helpful resources for families, carers and health professionals on this complex topic.
Further action is required to support doctors and their families
Families with a medical parent also require more support, as many doctors have subjected to abnormally demanding and unsafe work environments, long hours, high stress and traumatic situations in the past few years, and are currently at increased risk of mental health problems.
How can we tackle these complex and intractable problems?
Firstly, a united medical profession could scale up its approach to doctors’ mental health by building on the tremendous efforts of the Australian Medical Association (AMA); Drs4Drs; the Doctors’ Health Alliance; colleges including Royal Australian College of General Practitioners, the Royal Australian and New Zealand College of Psychiatrists and the Australasian College for Emergency Medicine; the Black Dog Institute; Beyond Blue; and the Every Doctor, Every Setting National Framework. As a profession, we can do more to ensure all doctors have timely access to evidence-based psychological and/or psychiatric treatment and to cocreate psychologically safe health care workplaces. We can also support the recent advocacy by the AMA to encourage family friendly health workplaces and greater work–life balance, flexible hours and parental leave — not only for our own mental health but for the wellbeing of our families.
At an individual level, doctors can take proactive steps to prioritise advanced psychological protection and to seek early evidence-based treatment for burnout and mental injury.
At a family level, parents who work in highly stressful environments can protect the mental health of their children and adolescents by being proactive. As examples, here are some observations about expressing emotions and attitudes honestly and constructively, improving general mental health literacy, and role modelling early help seeking behaviours.
Expressing emotions and attitudes honestly and constructively
When young people are bombarded by images of a world in turmoil through social and other media, it is a normal response for them to feel overwhelmed, sad, confused and angry. Why then do many adults avoid talking about vulnerability?
In relation to work stress, adults may try to be stoic, but children and adolescents intuitively know when parents are sad, distressed or traumatised. It can help to be aware that when we quietly ruminate about work at home, our children pick up on our emotional detachment. As one of my young patients reflected: “I live in an emotional desert at home and school. I look into people’s eyes to try to find some understanding and there’s nothing there”.
In my experience, young people usually respond positively if parents talk appropriately about navigating work stress in constructive ways, as well as what it means to have a loving family at home for support when external pressures are excessive. It also helps to talk openly to other colleagues about common parenting challenges with understanding — not unwarranted shame.
Unfortunately, the negative stigma surrounding mental illness in the medical community may inadvertently deter children from talking about this “taboo” topic.
“We thought he would diagnose us” was the explanation by my own children about why they had avoided a psychiatrist guest at our family home, which was surprising given my long term interest in mental health. This experience helped me understand the importance of talking to children about the negative attitudes they may absorb from others about psychiatric illness.
Improving mental health literacy for all
Mental health is universal and mental health literacy should not only be the domain of psychiatrists and GPs with a special interest.
With the increasing subspecialisation of medicine, many doctors are at risk of failing to understand the importance of early comprehensive mental health assessment and specific evidence-based psychological treatments for effective recovery.
This quote by Dr Vikram Patel, a prominent psychiatrist and researcher, sums up the role of non-psychiatrists in promoting “mental health for all by involving all’:
“Mental health is too precious to be left to psychiatrists alone. We believe that mental health is everybody’s business. And there is no health without mental health.”
Although self-diagnosis and self-management of mental illness is inappropriate and inadequate, everyone can benefit from improving their mental health literacy and knowing where to access high quality mental health resources (here, here, here, here, here) and mental health services for their families and themselves.
Role modelling early help seeking
There are many attitudinal barriers deterring mental health care access for doctors and their families. At one extreme, doctors may fail to seek medical or psychological help for their children for fear being misjudged by their colleagues as overanxious. In contrast, they may bypass the wisdom of an independent GP to consult a specialist family friend, but this can prevent an adolescent from engaging with the chosen professional for fear parents will intrude when sensitive matters are discussed.
Family members of doctors seeking help also face the usual structural barriers that the general public face in accessing mental health care.
GPs, psychologists, psychiatrists, and initiatives such as the Better Access Program and Headspace, and other youth mental health services, are currently swamped by the enormous unmet community need and waiting lists are excessive.
One of the most damaging experiences for young patients is to finally muster the courage to seek help, only to find there is a long wait or to be turned away by a GP, psychiatrist, mental health service or accident and emergency department (here).
To overcome these structural and attitudinal barriers, parents can role model early help seeking behaviours and build trusting relationships with independent GPs (not a friend or doctor in the same practice) for routine health matters, including preventive health screening, and informal mental health screening when appropriate. The AMA has recently launched an important initiative to encourage all doctors to have a GP for these reasons. When there is continuity of general health care by a GP, it is easier for adults and young people to seek early help and appropriate referral for any mental health concern.
A clarion call for further action
As acknowledged above, many medical and other organisations are continuing to do a huge amount of important work to promote and protect psychological wellbeing in doctors. Despite these initiatives, unacceptably high levels of work-related mental health problems. persist in the medical profession for complex reasons, including the compromised psychological safety of health care workplaces.
Further action is also required to address this impact on doctors and their families. There are solutions.
InSight+ will publish Part 2 and Part 3 of this series in the coming weeks to challenge further discussion on these topics across all specialties of the profession:
- Part 2: Every doctor can recover from work-related mental injury – to be published on 25 September 2023
- Part 3: Every doctor can cocreate a psychologically safe health workplace – to be published on 2 October 2023
If this opinion piece has triggered any discomfort or if a family member needs support, please make a long consultation with your independent and trusted GP. The AMA’s Drs4Drs program and the Doctors’ Health Alliance also provide confidential support and resources to doctors and medical students across Australia.
Clinical Professor Leanne Rowe AM is a rural GP and co-author of Every doctor: healthier doctors = healthier patients. Her Doctor of Medicine thesis is on the topic of GP mental health training, and she was a past Chairman of the Royal Australian College of General Practitioners and Deputy Chancellor of Monash University.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
Lets talk about Dr’s prescribing and referring their children. This happens a LOT and it has to stop.
As a rural GP in a big country town, I see lots of Doctors and their families in my practice. I make it very clear to all medical professionals and their family members who consult with me, that I do not support self prescribing or self referring. I seek an agreement with them that this will not happen when seeing any medical patients for the first time. I work hard to care for my fellow medical colleagues and their children in a confidential and supportive manner. It is extremely difficult working with Doctors who then prescribe or refer their children (or themselves!) directly to psychiatrists or other specialists with out involving me, the long term GP. It is detrimental to the children, to their relationship with me, their trusted GP, unethical and frankly insulting. Unfortunately, this is so common that I have experienced this with over 90% of my medical colleagues as patients. I am seriously thinking of writing a contract down for each Dr re this issue, and getting them to co sign the agreement. I have exited several doctors off my books for doing just this..(and yes, there are other dr’s in my town so no, I didn’t leave them in the lurch) If you do it, stop it, it is not helpful for you, or your children’s welfare and mental health. No exceptions, don’t kid yourself, my practice has several appointments available every day of the year. And no, I DON’T refer or prescribe for myself, or my family. They all have their own GP. Stop being “fools”
This is such an important topic and not spoken about enough. As healthcare workers we become desensitized to the daily “micro-traumas” we experience in the workplace. Unfortunately, it can be our loved ones who bear the brunt of the effects on our mental health and wellbeing. The vicarious trauma experienced by the families and loved ones of doctors and healthcare workers must no longer be overlooked, rather brought to the forefront of our minds and acted upon. Thank you Dr Rowe for highlighting the importance of looking after ourselves and each other!
This is an excellent article Prof Leanne Rowe, and so relevant to all health professionals! Thank you!
Doctors experience unique and different stresses to other health professionals. Running a medical practice and keeping up with the changes expected of us can be so stressful. Unfortunately, we often bring those stressors home. I have found ways to help reduce that stress before I go home such as listening to relaxing music in my car and deep breathing but sometimes that can be hard.
It is further challenging for us when our children are not coping or doing mentally well, despite our attempts of protecting them and being the best parent possible. Our children are also experiencing enormous pressures and stress through competitive education at schools, social media, bullying, etc etc.
We should be grateful when our children decide to speak out and seek help, and not feel embarrassed or harbor negative feelings such as guilt, despair or shame. We too need the support and help.
I personally found chatting with medical colleagues/friends very helpful.
A great article Prof Rowe with useful strategies, thank you!
Listening to young people at the youth specific clinic gave me great insights into parenting, and some of their poignant observations have stayed with me. For example, here is a great piece of advice for parents from an 18 year old who had recovered from depression with the support of her mother:
“When I look back on my school years, the most important thing that helped was that my mum really listened to me. I just wanted her to understand but not to worry, or overreact, or do anything, or give me advice. She would sometimes stop the car and give me her full attention, or stay up late with me just talking on my bed. Most of all she would listen with her kind eyes. She did not even have to tell me. I knew when she did this, she really loved me.”
There are so many additional issues for doctors’ children in rural areas where it is difficult to maintain boundaries between work and home, and difficult to find time to debrief or seek support from an independent GP. In my past rural practice and like many rural GPs, I sometimes had to stop as the first responder to motor vehicle accidents on our drive home from school, a number where my patients (their families known to our family) were seriously injured or dead. Now that that my sons are well adjusted adults, I can conclude that growing up in a connected country town was an overall positive, but during their adolescence, I often worried about the impact of vicarious trauma on them. I will explore this further in parts 2 and 3 of this series in the next 2 weeks.
The first 5 years are vitally important for a child. Most doctors lead unhealthy work lifestyles- they work too much. They don’t spend enough time with their children – that is the truth. You want normal kids- probably working 60-100 hours a week during the younger years – isn’t going to make them ‘normal’. Let’s be honest – it’s not ‘not bringing them to a GP’ it’s not ‘not seeking help’ – it is a direct consequence of all the hours doctors work and don’t put in the effort at home with their own children. It is not rocket science. We teach others to have correct attachment 0-5yrs and the majority of doctors do the exact opposite. Daycare is not a substitution for correct attachment.
Q: What do doctors‘ children want to be when they grow up?
A: Patients
This is from the suicide note of the son of a very eminent psychiatrist
Our profession, and probably the pathologies which make us choose it, is/are very destructive of family life, for all of the reasons which you elaborate – brutal hours, chronic unreliability etc. . We are still inclined to look askance, albeit more subtly these days, at somebody who says „I can‘t do that shift/those extra hours because of family priorities/personal needs“. It is also all too easy to fall in to the trap of getting the relatively easy interpersonal gratification we can get in our professional role than to do the hard yards of earning it in a close personal relationship.
This gives the message that our patients/work are more important to us than our family. It can be a cruel bind sitting in it oneself, being torn both ways, but from the point of view of the partner or child it can feel as if one is only being drawn one way.
I am lucky in having a tolerant and forgiving family, but this should not be necessary. We really do need to do better as a profession in caring for our colleagues, ourselves and our/their families
Great article – thank you!
There is no doubt that the health (both physical and mental) of parents has consequences on their children and you have shown doctors are no exceptions.
I notice there is no mention of the causes of the injuries that doctors (as parents) experience that are detrimental to their and their children’s health: the fear and abuse of administrators, lawyers, and of course, the non-medical government agency that is responsible for more mental injuries in doctors that anyone else, AHPRA.
Sometimes the cure is to be had in treating the cause and not bandaiding the symptoms. What can be done to minimise the harm caused (possibly deliberately and maliciously) by the perpetrators named above?
It is difficult in rural practice for doctors to access an independent GP in the town in which they practice. The smaller the town, the greater the problem. A solution may be to access a GP in the closest bigger centre, but this presents logistical problems both for the doctor and their family. Telehealth can help overcome some of the challenges but not the initial assessment. When I worked in rural general practice it was sometimes felt to be disloyal to the local medical community to seek help elsewhere. It is good to promote the attitude that it is not. However, when the next bigger centre is 2-3 hours away, or more, inevitably one relied on one’s colleagues for medical advice, especially in emergencies. The
—-Unfortunately, the negative stigma surrounding mental illness in the medical community may inadvertently deter children from talking …
Editors:
There is no doubt we are bombarded with requests to direct a stigma at mental health issues, and from so many directions that we come to participate in that prejudice. Of course our children hear us, just as we as children heard that same message.
Harold A Maio