Show Hide image

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

Show Hide image

Jeremy Corbyn supporters should stop excusing Labour’s anti-immigration drift

The Labour leader is a passionate defender of migrants’ rights – Brexit shouldn’t distract the new left movement from that.

Something strange is happening on the British left – a kind of deliberate collective amnesia. During the EU referendum, the overwhelming majority of the left backed Remain.

Contrary to a common myth, both Jeremy Corbyn and the movement behind him put their weight into a campaign that argued forcefully for internationalism, migrants’ rights and regulatory protections.

And yet now, as Labour’s policy on Brexit hardens, swathes of the left appear to be embracing Lexit, and a set of arguments which they would have laughed off stage barely a year ago.

The example of free movement is glaring and obvious, but worth rehashing. When Labour went into the 2017 general election promising to end free movement with the EU, it did so with a wider election campaign whose tone was more pro-migrant than any before it.

Nonetheless, the policy itself, along with restricting migrants’ access to public funds, stood in a long tradition of Labour triangulating to the right on immigration for electorally calculated reasons. When Ed Miliband promised “tough controls on immigration”, the left rightly attacked him.  

The result of this contradiction is that those on the left who want to agree unequivocally with the leadership must find left-wing reasons for doing so. And so, activists who have spent years declaring their solidarity with migrants and calling for a borderless world can now be found contemplating ways for the biggest expansion of border controls in recent British history – which is what the end of free movement would mean – to seem progressive, or like an opportunity.

The idea that giving ground to migrant-bashing narratives or being harsher on Poles might make life easier for non-EU migrants was rightly dismissed by most left-wing activists during the referendum.

Now, some are going quiet or altering course.

On the Single Market, too, neo-Lexit is making a comeback. Having argued passionately in favour of membership, both the Labour leadership and a wider layer of its supporters now argue – to some extent or another – that only by leaving the Single Market could Labour implement a manifesto.

This is simply wrong: there is very little in Labour’s manifesto that does not have an already-existing precedent in continental Europe. In fact, the levers of the EU are a key tool for clamping down on the power of big capital.

In recent speeches, Corbyn has spoken about the Posted Workers’ Directive – but this accounts for about 0.17 per cent of the workforce, and is about to be radically reformed by the European Parliament.

The dangers of this position are serious. If Labour’s leadership takes the path of least resistance on immigration policy and international integration, and its support base rationalises these compromises uncritically, then the logic of the Brexit vote – its borders, its affirmation of anti-migrant narratives, its rising nationalist sentiment – will be mainlined into Labour Party policy.

Socialism in One Country and a return to the nation state cannot work for the left, but they are being championed by the neo-Lexiteers. In one widely shared blogpost on Novara Media, one commentator even goes as far as alluding to Britain’s Road to Socialism – the official programme of the orthodox Communist Party.

The muted and supportive reaction of Labour’s left to the leadership’s compromises on migration and Brexit owes much to the inept positioning of the Labour right. Centrists may gain personal profile and factional capital when the weaponising the issue, but the consequences have been dire.

Around 80 per cent of Labour members still want a second referendum, and making himself the “stop Brexit” candidate could in a parallel universe have been Owen Smith’s path to victory in the second leadership election.

But it meant that in the summer of 2016, when the mass base of Corbynism hardened its factional resolve, it did so under siege not just from rebelling MPs, but from the “Remoaners” as well.

At every juncture, the strategy of the centrist Labour and media establishment has made Brexit more likely. Every time a veteran of the New Labour era – many of whom have appalling records on, for instance, migrants’ rights – tells Labour members to fight Brexit, party members run a mile.

If Tony Blair’s messiah complex was accurate, he would have saved us all a long time ago – by shutting up and going away. The atmosphere of subterfuge and siege from MPs and the liberal press has, by necessity, created a culture of loyalty and intellectual conformity on the left.

But with its position in the party unassailable, and a radical Labour government within touching distance of Downing Street, the last thing the Labour leadership now needs is a wave of Corbynite loyalty-hipsters hailing its every word.

As the history of every attempt to form a radical government shows, what we desperately need is a movement with its own internal democratic life, and an activist army that can push its leaders as well as deliver leaflets for them.

Lexit is no more possible now than it was during the EU referendum, and the support base of the Labour left and the wider party is overwhelmingly in favour of free movement and EU membership.

Jeremy Corbyn, John McDonnell and Diane Abbott are passionate, principled advocates for migrants’ rights and internationalism. By showing leadership, Labour can once again change what is electorally possible.