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Why doctors' mental health should be a concern for us all

When medical students enter university, their mental health is no different from that of the rest of the population. By the end of their first year, however, it is significantly worse.

When medical students enter university, their mental health is no different from that of the rest of the population. By the end of their first year, however, it is significantly worse. Stress accumulates throughout their training and, for many, things do not improve. A new study demonstrates what a problem this has become – especially for the doctors involved.

Debbie Cohen and colleagues at Cardiff University carried out a survey of almost 2,000 British doctors at various stages of their career. Of these, 60 per cent had experienced mental illness (the figure is 82 per cent in England) but most had not sought help.

Even the doctors don’t see it coming. In the survey, most medical professionals who have never experienced mental health problems say that they would disclose any problem that arose. But attitudes change when it actually happens. “You don’t do what you think you would do,” Cohen says.

The figures differ according to stage of career. Trainees and junior doctors are less likely to admit to having a problem – perhaps unsurprisingly, given the perception that it may damage their future. Disclosure rates also differ by career track. Among GPs, 84 per cent say that they would disclose; 39 per cent do so. Trainees disclose at the same rate as GPs but are more aware that they won’t: only 62 per cent say that they would disclose a mental illness. Locums and specialist staff are the least deluded and the least open: they acknowledge the lowest likelihood of disclosure (60 per cent) and they follow through, with 38 per cent making a disclosure of an issue.

The reasons for not disclosing vary widely. There is certainly a lack of understanding about the support available. There are also concerns about being labelled and about confidentiality. Cohen and her colleagues are now designing an online tool to make disclosure easier. “We have considerable interest from all stakeholders and we aim for it to be disseminated widely across NHS organisations, deaneries and medical schools eventually,” she says.

Britain’s NHS reforms should make this an urgent priority, because the alternative is what the Cohen report calls “maladaptive coping strategies”. Research indicates that doctors learn these behaviours early on. The best known – because of its high prevalence even among trainee doctors – is alcohol and substance abuse, including misuse of prescription drugs. These coping strategies are not sustainable in the long term, leading to high levels of burnout and breakdown.

In many ways, much of these findings is not news. We have known for a long time that doctors have a higher rate of mental illness than the general population. We have not, however, considered the consequences. Some of the more alarming outcomes of having stressed and depressed doctors are pathological cynicism, an unwillingness to care for the chronically ill and decreased empathy. It is clear that no one benefits when doctors begin to go under.

Combing through the literature, one phrase stands out time and again: “particularly female doctors”. This group experiences a higher degree of anxiety than male doctors. Perhaps that is because, as a large Canadian study showed, female doctors are twice as likely to be depressed as their male counterparts. That becomes even more likely if they have children (no such relationship has been recorded for male colleagues who have children). Though more likely to disclose mental health problems, female doctors are less likely to turn to colleagues for help. The reasons are not uniform but reluctance to show weakness in the workplace, especially if there is an atmosphere of prejudice, is likely to play a significant role. Because of long shifts – often into the night – many have to endure journeys home in the dark, and feel vulnerable to attack. Once home, women suffer more, too, adjusting between children and work.

In the UK, the situation is about to get worse. The government’s assessment of the contract it has just imposed on junior doctors includes an admission that it will have an “indirect adverse effect on women”. This is justified as “a proportionate means of achieving a legitimate aim”.

Everything we know about doctors’ mental health indicates that the quality of care provision goes down as doctors get more stressed. The risk of suicide is higher than in many occupations (the rate among women doctors exceeds that of the general female population). It is also now clear that it won’t only be patients who die as a result. 

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

This article first appeared in the 08 April 2016 issue of the New Statesman, The Tories at war

Jeremy Corbyn. Photo: Getty
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Jeremy Corbyn: “wholesale” EU immigration has destroyed conditions for British workers

The Labour leader has told Andrew Marr that his party wants to leave the single market.

Mass immigration from the European Union has been used to "destroy" the conditions of British workers, Jeremy Corbyn said today. 

The Labour leader was pressed on his party's attitude to immigration on the Andrew Marr programme. He reiterated his belief that Britain should leave the Single Market, claiming that "the single market is dependent on membership of the EU . . . the two things are inextricably linked."

Corbyn said that Labour would argue for "tarriff-free trade access" instead. However, other countries which enjoy this kind of deal, such as Norway, do so by accepting the "four freedoms" of the single market, which include freedom of movement for people. Labour MP Chuka Umunna has led a parliamentary attempt to keep Britain in the single market, arguing that 66 per cent of Labour members want to stay. The SNP's Nicola Sturgeon said that "Labour's failure to stand up for common sense on single market will make them as culpable as Tories for Brexit disaster".

Laying out the case for leaving the single market, Corbyn used language we have rarely heard from him - blaming immigration for harming the lives of British workers.

The Labour leader said that after leaving the EU, there would still be European workers in Britain and vice versa. He added: "What there wouldn't be is the wholesale importation of underpaid workers from central Europe in order to destroy conditions, particularly in the construction industry." 

Corbyn said he would prevent agencies from advertising jobs in central Europe - asking them to "advertise in the locality first". This idea draws on the "Preston model" adopted by that local authority, of trying to prioritise local suppliers for public sector contracts. The rules of the EU prevent this approach, seeing it as discrimination. 

In the future, foreign workers would "come here on the basis of the jobs available and their skill sets to go with it. What we wouldn't allow is this practice by agencies, who are quite disgraceful they way they do it - recruit a workforce, low paid - and bring them here in order to dismiss an existing workforce in the construction industry, then pay them low wages. It's appalling. And the only people who benefit are the companies."

Corbyn also said that a government led by him "would guarantee the right of EU nationals to remain here, including a right of family reunion" and would hope for a reciprocal arrangement from the EU for British citizens abroad. 

Matt Holehouse, the UK/EU correspondent for MLex, said Corbyn's phrasing was "Ukippy". 

Asked by Andrew Marr if he had sympathy with Eurosceptics - having voted against previous EU treaties such as Maastricht - Corbyn clarified his stance on the EU. He was against a "deregulated free market across Europe", he said, but supported the "social" aspects of the EU, such as workers' rights. However, he did not like its opposition to state subsidy of industry.

On student fees, Corbyn was asked "What did you mean by 'I will deal with it'?". He said "recognised" that graduates faced a huge burden from paying off their fees but did not make a manifesto commitment to forgive the debt from previous years. However, Labour would abolish student debt from the time it was elected. Had it won the 2017 election, students in the 2017/18 intake would not pay fees (or these would be refunded). 

The interview also covered the BBC gender pay gap. Corbyn said that Labour would look at a gender pay audit in every company, and a pay ratio - no one could receive more than 20 times the salary of the lowest paid employee. "The BBC needs to look at itself . . . the pay gap is astronomical," he added. 

He added that he did not think it was "sustainable" for the government to give the DUP £1.5bn and was looking forward to another election.

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.