Revealed:The Mental Health Crisis Facing Junior Doctors
Stephen Colegrave reports on worrying research from the University of Birmingham, that surveyed 465 junior doctors about their mental health
Nearly three-quarters (70%) of junior doctors report experiencing severe anxiety and depression, with nearly half of that 70% having contemplated suicide, new research reveals today.
A large study of 465 respondents, alongside in-depth interviews with 36 junior doctors, reveal the true extent of the challenges experienced by junior, frontline NHS staff. Participants were specifically asked about the mental health challenges of working in the NHS.
The research began before the start of the Coronavirus pandemic, although it continued throughout the public health crisis that has seen high numbers of NHS staff reporting post-traumatic stress disorder (PTSD). The impact of the pandemic can only have exacerbated the mental health challenges junior doctors face.
The level of poor mental health experienced by doctors has serious implications not only for the doctors themselves, but for the wider NHS and its patients. It also puts into perspective the sacrifice that junior doctors have made on the frontline of the NHS and begs the question about the mental health of other NHS frontline workers.
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Toxic Work Culture
The research identified numerous causal factors of poor mental health in junior doctors.
This included staffing pressures leading to an increased workload, understaffing and a lack of resources.
However, many junior doctors identified a “toxic work culture” where staff vulnerability and illness has become unacceptable. The interviews revealed widespread bullying and negative relationships with colleagues, as well as incidents of sexism and racism from colleagues and patients.
The experiences of misogynistic and racist attitudes may explain why women and minority ethnic groups were more likely to report mental health challenges.
Fifteen of the respondents who indicated they had severe depression of anxiety or high suicidality were recruited to qualitative research to discuss specifically their working experience during the COVID-19 pandemic. They talked about the personal challenges of helplessness and the trauma of seeing patients dying – as well as fears about their own safety. The intensity of working on the frontline during the pandemic meant the respondents felt powerless to switch off.
Alongside the trauma of the period, increased workloads, decreased staff numbers and negative impacts on relationships with colleagues and patients added to the pressures.
The Coronavirus Crisis
Charlotte is a junior doctor who took part in the study and featured in a documentary created by Institute of Applied Health Research at Birmingham University. She worked at a GP surgery during the first wave of the pandemic. She recalled how there were shortages of personal protective equipment (PPE), a lack of testing and staff shortages due to sickness and isolation. But, she told Byline Times, “at least all of us – staff and patients – were on the same side”.
During the second wave, Charlotte was posted to work in an Accident and Emergency department, an experience that, she explained, was “much tougher”.
“People seemed less on our side and were understandably fed up,” she told Byline Times. “We were all worn out from the first wave and there just weren’t enough resources to give patients the time they needed. Sometimes you worried you couldn’t focus on the patients in front of you because you worried about the people waiting in the queue”.
Charlotte and her colleagues were “working longer hours than we should”. She explained how, pre-pandemic, there might have been “30 minutes of unrecorded time, but it was now more like an hour”. When her shift ended, she would have to spend time removing her PPE and washing everything she had with her that day – such as pens and lanyards – making a long shift even longer.
“We worked far more late shifts,” she said. “This meant regularly not getting home until after 10pm or midnight. There was barely time to eat before falling asleep.”
Severe Anxiety and Exhaustion
The long shifts, late nights and stress of the pandemic left Charlotte struggling to sleep, worsening her anxiety.
“I would lie awake at night going over what I had done in the day,” she told Byline Times. “Wondering if I had made any mistakes because I was so tired and had so little time. If I watched some mindless TV I could take my mind off it. But when I lay there trying to sleep, these thoughts just kept going round and round my head, even in my dreams.”
Despite her exhaustion and anxiety, Charlotte kept dragging herself into work because she didn’t want to let her colleagues down. She eventually opened up to her supervisor who, thankfully, was supportive and understanding.
“When she rang me up I burst into tears,” Charlotte said. “I told her everything. She told me I was not well enough to go to work. The main thing was her explaining that I could not be a safe doctor to my patients if I was unwell and if I kept going I could make a mistake and never forgive myself.”
Charlotte took her advice and signed herself off work. With the help of her GP and therapy, she is back at work and can now see a future as a doctor.
The research shows that Charlotte’s experience was common. And while her supervisor provided the support Charlotte urgently needed, many junior doctors find that older and more senior colleagues are less sympathetic. There can be an attitude that they themselves went through a tough time and survived and that the next generation should do the same.
The study invited junior doctors to suggest ways to improve their working conditions in order to tackle mental health challenges. These included better training and teamwork, as well as making support accessible for doctors who are struggling.
They also recommended a more transparent mental health culture.
A film produced by Emily Kay Stoker based on this research work by Dr Ruth Riley at the University of Birmingham is available to watch here