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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

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Why Angela Merkel's comments about the UK and US shouldn't be given too much weight

The Chancellor's comments are aimed at a domestic and European audience, and she won't be abandoning Anglo-German relationships just yet.

Angela Merkel’s latest remarks do not seem well-judged but should not be given undue significance. Speaking as part of a rally in Munich for her sister party, the CSU, the German Chancellor claimed “we Europeans must really take our own fate into our hands”.

The comments should be read in the context of September's German elections and Merkel’s determination to restrain the fortune of her main political rival, Martin Schulz – obviously a strong Europhile and a committed Trump critic. Sigmar Gabriel - previously seen as a candidate to lead the left-wing SPD - has for some time been pressing for Germany and Europe to have “enough self-confidence” to stand up to Trump. He called for a “self-confident position, not just on behalf of us Germans but all Europeans”. Merkel is in part responding to this pressure.

Her words were well received by her audience. The beer hall crowd erupted into sustained applause. But taking an implicit pop at Donald Trump is hardly likely to be a divisive tactic at such a gathering. Criticising the UK post-Brexit and the US under Trump is the sort of virtue signalling guaranteed to ensure a good clap.

It’s not clear that the comments represent that much of a new departure, as she herself has since claimed. She said something similar earlier this year. In January, after the publication of Donald Trump’s interview with The Times and Bild, she said that “we Europeans have our fate in our own hands”.

At one level what Merkel said is something of a truism: in two year’s time Britain will no longer be directly deciding the fate of the EU. In future no British Prime Minister will attend the European Council, and British MEPs will leave the Parliament at the next round of European elections in 2019. Yet Merkel’s words “we Europeans”, conflate Europe and the EU, something she has previously rejected. Back in July last year, at a joint press conference with Theresa May, she said: “the UK after all remains part of Europe, if not of the Union”.

At the same press conference, Merkel also confirmed that the EU and the UK would need to continue to work together. At that time she even used the first person plural to include Britain, saying “we have certain missions also to fulfil with the rest of the world” – there the ‘we’ meant Britain and the EU, now the 'we' excludes Britain.

Her comments surely also mark a frustration born of difficulties at the G7 summit over climate change, but Britain and Germany agreed at the meeting in Sicily on the Paris Accord. More broadly, the next few months will be crucial for determining the future relationship between Britain and the EU. There will be many difficult negotiations ahead.

Merkel is widely expected to remain the German Chancellor after this autumn’s election. As the single most powerful individual in the EU27, she is the most crucial person in determining future relations between the UK and the EU. Indeed, to some extent, it was her intransigence during Cameron’s ‘renegotiation’ which precipitated Brexit itself. She also needs to watch with care growing irritation across the EU at the (perceived) extent of German influence and control over the institutions and direction of the European project. Recent reports in the Frankfurter Allgemeine Zeitung which suggested a Merkel plan for Jens Weidmann of the Bundesbank to succeed Mario Draghi at the ECB have not gone down well across southern Europe. For those critics, the hands controlling the fate of Europe are Merkel’s.

Brexit remains a crucial challenge for the EU. How the issue is handled will shape the future of the Union. Many across Europe’s capitals are worried that Brussels risks driving Britain further away than Brexit will require; they are worried lest the Channel becomes metaphorically wider and Britain turns its back on the continent. On the UK side, Theresa May has accepted the EU, and particularly Merkel’s, insistence, that there can be no cherry picking, and therefore she has committed to leaving the single market as well as the EU. May has offered a “deep and special” partnership and a comprehensive free trading arrangement. Merkel should welcome Britain’s clarity. She must work with new French President Emmanuel Macron and others to lead the EU towards a new relationship with Britain – a close partnership which protects free trade, security and the other forms of cooperation which benefit all Europeans.

Henry Newman is the director of Open Europe. He tweets @henrynewman.

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