Addressing mental health problems in doctors’ children  

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.