EXECUTIVE SUMMARY
Who heals the healer? How might we equip and support Junior Doctors to start conversations about their mental health and not feel alone? Aim: To empower Junior Doctors to track, vocalise and feel supported in their mental health
(BMA, 2019)
80%
• Junior Doctors do not know where to access mental health and of doctors reported being well-being support. Support varies greatly across NHS Hospital Trusts at risk of burnout and Insight: 1, 3 Insight: 2,3,4,5,6 Insight: 1,2,5,6 Junior Doctors were the • Fear of reflecting honestly and speaking up. Juniors said they had ‘played down’ Insight: 1, 3 Insight: 2,3,4,5,6 Insight: 1,2,5,6 their feelings when talking about their mental health to supervisors out of fear of most vulnerable Persona Persona 2: Jenny Persona 3: Melissa Insight: 1, 31: Guy Insight: 2,3,4,5,6 Insight: 1,2,5,6 being labelled as not resilient or incompetent
(Copeland, 2019)
Psychiatry Trainee, 29
25%
O&G Trainee, 31
F1 placement in A&E, 25
Persona 1: Guy Persona 2: Jenny Persona 3: Melissa Persona 1: Guy Persona 2: Jenny Persona Melissa • Female Doctors are particularly susceptible to negative mental health. Guy, a Junior Doctor whose Jenny, a Junior Doctor from Melissa, a 3: Junior Doctor Psychiatry Trainee, 29 O&G Trainee, 31 F1 placement in A&E, 25from
Trainee, 29 the O&G Trainee, F1 placement inmust A&E,urgently 25 training rotation forced him London. Normally outgoing Birmingham. qualified As profession moves to a31 higher proportion of women, weRecently of all NHS sick leave is Psychiatry Guy, a Junior Doctor whose Jenny, a Junior DoctorJenny from has Melissa, a Junior Doctor from to move to Basildon for a new and bubbly, recently and finding her job in a hospital address this reality caused by stress, anxiety Guy, a Junior Doctor whose Jenny, a Junior Doctor from Melissa, Junior Doctor training rotation forced him London. Normally outgoing Birmingham. Recently qualifi ed placement, far removed from become anxious and stressed can be aoverwhelming atfrom times. and depression training forced London. Normally outgoing Birmingham. Recently ed to moverotation to Basildon forhim a new and bubbly, recently Jenny has and fifeels ndingher her job negatively in qualifi a hospital friends and family. When he due to back to back night shifts She work • Healthy deliver better patient outcomes. Data shows staff to move to work Basildon fornew afrom newDoctors and recently has and fibe nding her job inhealth awell-being placement, far removed become anxious andJenny can overwhelming athospital times. goes into at this andbubbly, being involved instressed a patient impacts her mental as a key indicator for high quality patient care outcomes placement, far removed from become anxious and stressed can be overwhelming at times. friends and family. When he due to back to back night shifts She feels her work negatively
3,000,000
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This places them at a significant disadvantage for seeking help and advice
Junior Doctors may have limited into their own mental Junior Doctorsinsight are increasingly or forced well-being due to the isolated whenhealth they are fast paced, high stress move job every six months. Junior Doctors often feel to they Junior Doctors often feel they environment they work in. Mental Close relationships, support are the only one not coping. are the only one not coping. health and well-being ebbs and rapport with seniors and They are less likely to speak up, They are less likely to speak up, ows over time. It is hard to cultivate for fear of being labelledpeers as are hardand for fear of being labelled as to keep track of mental health weak or not resilient. Many do weak or not resilient. Many do over a period of time in this not know where to accessThis helpplaces them at a significant not know where to access help disadvantage environment for seeking help and advice A private first step to vocalise A private first step to vocalise It is crucial to have an appreciation their own feelings is crucial to their own feelings is crucial to of when you are so down that you building the confidence to start a building the confidence to start a need to speak up conversation with someone else conversation with someone else
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Junior Doctors may have limited insight into their own mental health or well-being due to the fast paced, high stress environment they work in. Mental health and well-being ebbs and ows over time. It is hard to keep track of mental health over a period of time in this environment
It is crucial to have an appreciation of when you are so down that you need to speak up
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Abolish Resilience Training and Remove the Culture of Blame Resilience culture perpetuates the cycle of shame and secrecy surrounding a doctors mental health. It shifts the blame on to the shoulders of the Junior Doctor and leads Junior Doctors to feel unworthy if they cannot cope
•
Focus on Prevention and Monitoring not Intervention Junior Doctors need a continuous support tool. Ongoing, active mental health support is crucial, to acknowledge, track and signpost to support before doctors present with serious mental health issues. We must pre-emptively support doctors before they burn out or are forced to take sick leave
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Prepare Doctors at Medical School – Mental Health and Well-being Curriculum is a must Many Junior doctors described arriving at their first post and feeling overwhelmed and unprepared for the realities of being a doctor. By preparing them, we can equip and empower them
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Create spaces for Junior Doctors to come together at work Hospitals must provide physical spaces for Juniors to come together to build commeraderie, support eachother and combat social isolation.
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“Medicine would be transformed if doctors were able to admit freely to vulnerabilities, fears and failings. Yet no one does, despite the terrible costs. If even one of my peers had taken me aside and encouraged me to seek help, or even just let me know they were concerned and cared for me, I might have been able to halt the march of my depression before it became utterly devastating.�
Senior colleagues sharing their experiences is a key factor prompting Doctors to seek help
The Proposed Design Intervention Nancy, Junior Doctor
“The ďŹ nal straw came when I worked 17 days in a row including ďŹ ve 25-hour shifts. [‌] Never had I experienced such darkness and hopelessness. I found myself angry at the patients for being sick, and another night wishing that a sick patient would die so I could close my eyes for 10 minutes because I was so desperately tired. ‘I did not feel like myself on the inside anymore.â€?
The Junior Doctor Circle
An app for Junior Doctors to share ‘I’ve seen Junior Doctors their stories with a community of other Junior desperate to tell these stories. Doctors. They are unable to identify you and And it’s completely eating them Doctor to your employer areGreta, not Junior affiliated By realising you are not alone you learn Junior Doctor, 27 “Medicine would be transformed if doctors and support others were able to admit freely to vulnerabilities, fears and failings. Yet no one does, despite the terrible costs. If even one of my peers had taken me aside and encouraged me to seek help, or even just let me know they were concerned and cared for me, I might have been able to halt the march of my depression before it became utterly devastating.�
Key Insights
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DEPRESSION by Clem, Junior Doctor, 29
The Junior Doctor Circle
The Specialty Today, this Traineehappened... Circle Depression
Stress
Has this story resonated with you?
a story of life on the wards
Disclosing privately and safely with professional peers motivated Junior Doctors to seek support more than talking to friends and family. Resonating with people who ‘really understood’ or ‘had been there’ facilated opening up. The knowledge that another in the community could relate to your disclosure provides an emotionally safe space to be vulnerable.
•
You are not alone
Nancy, Junior Doctor
This story resonated with 32 others in the community
One of my F1 colleagues turned to me and said ‘you literally always look so happy, is there ever a day where you aren’t happy?!’
Inspiration & Success
Why I love being a doctor
“Inside it was so far from what I had been feeling.�
On one of the days when I was feeling the lowest, if anyone asked me a question I would go red and get really flustered. I couldn’t get home without stopping on the way home and crying.
“The ďŹ nal straw came when I worked 17 days in a row including ďŹ ve 25-hour shifts. [‌] Never had I experienced such darkness and hopelessness. I found myself angry at the patients for being sick, and another night wishing that a sick patient would die so I could close my eyes for 10 minutes because I was so desperately tired. ‘I did not feel like myself on the inside anymore.â€?
May we show you coping strategies that others in the community are using who have resonnated with this story?
Anxiety
SUPPORT SERVICES EXTERNAL T H E PAT I E N T I C A N T FORGET by Lesley, O&G Consultant, 63
Taking it home most Most resonated resonnated
T H E PAT I E N T I C A N T FORGET
T H E PAT I E N T I C A N T FORGET
by Lesley, O&G Consultant, 63
by Lesley, O&G Consultant, 63
“I can still see her face... and it’s thirty years ago.� a story of remembering and questioning
ou become an F1 and like shit hits the fan�
56
a story of feeling out of control
“Its been thirty years and I can still see her face� a story of remembering and questioning
ot he rs re s on n at e d
INTERNAL
T HE BRIT ISH M E D ICAL ASSOCIAT ION
Very, very poorly educated and extremely bright. She came to me in Cambridge and I tried to stop her coming because I knew I was leaving for London, but
“Actually no, this has gone a bit too far, I need to speak to someone about this.� a story of developing clinical ability to acknowledge my mental health
“I didn’t want to let my guard down. I guess for anyone to know that I felt I wasn’t competent at my job.� a story of bottling it up
32
ot he rs re s on n at e d
28
ot he rs re s on n at e d
WE BSIT E LIN K
The BMA wellbeing services are available to all doctors and their spouses and chilldren, 24/7 and free of charge
P E E R SUP P OR T / COUNSE LLI NG / P SYCH OTH E R A P Y / GMC I NVE STI GATI ON SUP P OR T /
I had these two patients who had followed me from Cambridge, where I had been a senior registrar and one was a trapeze artist and she was the most extraordinary character. She really was.
you go throughout your entire you know, from like secondary school, you’re the best in your class and you always get A’s in your GCSEs. You study, you get your A levels you study, get your A’s and get into university, you go through medical school, you pass every exam, you’ve done really well. You’re on sports teams, you’re just doing you know, you are acing life. You
I had these two patients who had followed me from Cambridge, where I had been a senior registrar and one was a trapeze artist and she was the most extraordinary character. She really was. Very, very poorly educated and extremely bright. She came to me in Cambridge and I tried to stop her coming because I knew I was leaving for London, but
A DVI CE FOR YOUR SLE F OR A COLLE AGUE
T HE PRACT ICION E R HE ALT H PROG RAM M E
Practitioner Health is a free, confidential NHS service for doctors and dentists across England with mental illness and addiction problems, who are working or looking to return to clinical practice. The service can help with issues relating to a mental health concern, including stress or depression or an addiction problem.
Greta, Junior Doctor
COUNSE LLI NG / P SYCH OTH E R A P Y / A DDI CTI ON TR E ATME NT/ CBT /
I NDI VI DA ULI SE D CLI NI CI A N LE D CASE MA NAGE E NT / GR OUP SUP P OR T
“It’s incredibly distressing and when things go wrong you do take it very personally.� a story of remembering and questioning
ACAD E MY OF M E D ICAL ROYAL COLLE G E S
19
ot he rs re s on n at e d
The Junior Doctor Circle is an app for Junior Doctors to share their stories with a community of other Junior Doctors. No one using the app can be identified and the app is not affiliated in any way to your employer
up inside.’
•
An online community gives Juniors the space to take a first step to track and understand their mental health and well-being privately, without fear of judgement.
 �
Â? Â? Â? Â? Â?
DEPRESSION
by Clem, Junior Doctor, 29
The Junior Doctor Circle
The Specialty Today, this Traineehappened... Circle
Stress
You are not alone
This story resonated with 32 others in the community
One of my F1 colleagues turned to me and said ‘you literally always look so happy, is there ever a day where you aren’t happy?!’
Inspiration & Success
By realising you are not alone you learn and support others
Has this story resonated with you?
a story of life on the wards
On one of the days when I was feeling the lowest, if anyone asked me a question I would go red and get really flustered. I couldn’t get home without stopping on the way home and crying.
Depression
Why I love being a doctor
“Inside it was so far from what I had been feeling.�
May we show you coping strategies that others in the community are using who have resonnated with this story?
Anxiety
•
The Junior Doctor Circle can help Junior Doctors to develop the confidence and vocabulary needed to start a conversation in real life. SUPPORT SERVICES
EXTERNAL
T H E PAT I E N T I C A N T FORGET by Lesley, O&G Consultant, 63
T H E PAT I E N T I C A N T FORGET
Taking it home
most resonated Most resonnated
by Lesley, O&G Consultant, 63
“I can still see her face... and it’s thirty years ago.� a story of remembering and questioning
ou become an F1 and like shit hits the fan�
56
a story of feeling out of control
o thers reso n n a ted
INTERNAL
T H E PAT I E N T I C A N T FORGET by Lesley, O&G Consultant, 63
“Its been thirty years and I can still see her face�
a story of remembering and questioning
T H E B R I T I S H M E D I CA L ASS O C I AT I O N
WEBSITE LINK
The BMA wellbeing services are available to all doctors and their spouses and chilldren, 24/7 and free of charge
P EER S UP P O R T / CO UN S ELLI N G / P SYCHO THER A P Y / GM C I N V ESTI GATI O N S UP P O R T /
I had these two patients who had followed me from Cambridge, where I had been a senior registrar and one was a trapeze artist and she was the most extraordinary character. She really was. Very, very poorly educated and extremely bright. She came to me in Cambridge and I tried to stop her coming because I knew I was leaving for London, but
“Actually no, this has gone a bit too far, I need to speak to someone about this.� a story of developing clinical ability to acknowledge my mental health
“I didn’t want to let my guard down. I guess for anyone to know that I felt I wasn’t competent at my job.� a story of bottling it up
32
o thers reso n n a ted
28
o thers reso n n a ted
you go throughout your entire you know, from like secondary school, you’re the best in your class and you always get A’s in your GCSEs. You study, you get your A levels you study, get your A’s and get into university, you go through medical school, you pass every exam, you’ve done really well. You’re on sports teams, you’re just doing you know, you are acing life. You
I had these two patients who had followed me from Cambridge, where I had been a senior registrar and one was a trapeze artist and she was the most extraordinary character. She really was.
Very, very poorly educated and extremely bright. She came to me in Cambridge and I tried to stop her coming because I knew I was leaving for London, but
A D V I CE FO R YO UR S LEF O R A CO LLEAGUE
T H E P R AC T I C I O N E R H E A LT H P R O G R A M M E
Practitioner Health is a free, confidential NHS service for doctors and dentists across England with mental illness and addiction problems, who are working or looking to return to clinical practice. The service can help with issues relating to a mental health concern, including stress or depression or an addiction problem.
CO UN S ELLI N G / P SYCHO THER A P Y / A D D I CTI O N TR EATM EN T/ CBT /
I N D I V I DA ULI S ED CLI N I CI A N LED CAS E M A N AGEEN T / GR O UP S UP P O R T
“It’s incredibly distressing and when things go wrong you do take it very personally.� a story of remembering and questioning
ACA D E MY OF M E D I CA L R OYA L CO L L E G E S
19
o thers reso n n a ted
excited
Today I feel
feeling the lowest, if anyone asked turned to Eme DEPR S and S I Osaid N ‘you literally
Rg N Si O NT ,A oCA oE R d ET eLYYvOeRUEnR nSg SEH OTREYD
it might be the key to helping someone else
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Key Recommendations
HOW ARE YOU FEELING ABOUT GOING TO WORK TODAY?
By sharing and relating to others, you can find the words to ask for help.
The Junior Doctor Circle is an app for Junior Doctors to share their stories with a community of other Junior Doctors. No one using the app can be identified and the app is not affiliated in any way to your employer By realising you are not alone you learn and support others