Mental Health in Doctors: Making the Hospital a Safe Space

In the spirit of this year's World Mental Health Day theme, let's make mental healthcare for our doctors a reality. Here is how the hospital can support struggling doctors in their troubled times.

If you’ve been following my thread of articles, you’d see how passionate I am about mental health. Before I share my list of mental health solutions and first aid for the struggling doctors which will include some self-help and a whole lot of self-empowerment, I thought I’d write first on how we can make the hospital a safe space. If you’re the lucky ones who have managed to find a balance in clinical life, here are things you can do to help those struggling with mental health – some everyday things you and I can do, some hard-hitting truths, and in all seriousness, how we can improve support moving forward. 

First Aid and Trinkets of Support

1) Reach out

If you notice something amiss, don’t stop by just acknowledging how awkward the situation is. Oftentimes, people don’t really know how to help, but it is as simple as asking if others are doing alright. Here are some examples you can try: 

Is everything alright?”

I see you’re not okay, would you like to talk about it?” 

RU OKAY? has a conversation algorithm to use when reaching out to someone in need. The Depression Project has listed down 50 ways of reaching out without asking how someone is doing. These are brilliant resources if you’re in a position to offer help. 

Check in over text every other day or send a little midday pick-me-up message. Better still, bring them out for a meal. Pick them up. Walk them to the canteen. Buy that meal for them because you know they won’t, even if you insist. When someone isn’t okay, everything feels like a chore. A depressive slump. This is why you need to go the extra mile to be there for them. Conversation, food, and genuine connection can do wonders. 

Everyone loves receiving gifts. Put together a little care package to brighten their day up. It’s simple and inexpensive. Include something to self pamper, something to snack on, something to read, something that could be useful at the hospital, and a few handwritten notes. Drop it at their doorstep or pop up at their ward and surprise them with or without confetti. You don’t need an occasion. Care packages are hugs in a box.

2) Team work makes the dream work

Cheesy, but works like a charm. There’s nothing more demotivating than feeling like you have the whole world over your shoulders when you’re already on the verge of breaking your back. It is so important to work as a team. That way, your day becomes manageable, you build connections and you hold each other accountable.

As important as it is to be effective on your own, a team that works well together will excite you for another day’s work. If you see a team member down, help them out. Done with your list? Help your team with theirs. In a passive ward and have the rest of the afternoon off? Ask your colleagues if they could use an extra hand. It really doesn’t matter if you’re a house officer, a medical officer, or a specialist. Power gaps should not exist. Patient care is a team effort. 

I’ve been fortunate enough to work in teams where the medical officer says – let’s split the task, we’re on the same team. Where the specialist says – let me insert a branula, it’s been so long since I’ve inserted one. And where the consultant says – you all did great today, let’s go have breakfast. 

Be a leader, know your team, understand the various situations and formulate a mental strategy to help distribute tasks. Keep emotions in check, follow up, and always congratulate your team for the effort. At the end of the shift, say thank you. A high five if spirits are still high. 

3) Every situation is a teachable moment

It’s instinctive to get riled up when inconvenienced. It happens every time rounds are a tad less efficient, when you get a phone call and the point isn’t made immediately, when you have to explain yourself more than once, even to explain something seemingly simple. 

A doctor heals, leads and educates. Every encounter of inconvenience is a teachable opportunity. It’s reckless to be mindless and snap when someone is trying their best. Pause, breathe, and learn how to communicate kindly. It’s a win-win situation when you say things like:

 “I see you’re struggling to get this point across, the way I’d ask is so and so, now you try.

That’s an interesting way of presenting, let me show you have you can improve.”

The next time you call, I’d appreciate it if you’d start with this, and provide so and so information because it helps me decide so and so.

I’m glad you don’t know, you’ve got an opportunity to learn now, let’s go through this case together.”

I understand you’re trying your best but in an urgent situation, here’s how you can calmly and methodically get things done without the expense of time.

Always validate the effort someone has made, propose solutions for improvement, and allow second chances. It’ll do everyone a favour.

Solid Advice

1) Timeouts 

Quiet rooms are quickly becoming more common at workplaces. There are those who resonate with the need for some absolute quiet to calm the senses. As much as the passion to heal led us to the hospital, hospitals can be maddening for those who struggle with sensory overload – sounds, sights, smells, touch, and the pure rush of impulse. 

A quick 10-minute timeout helps reorientate someone who’s so sensory overloaded and needs time to recharge. It’s necessary for doctors, both junior and senior, to have rest lounges that offer food, allow a few good stretches and some quality quick recharge. It is a welcome upgrade for those who tend to resort to a quiet lavatory. 

We can one-up this by starting the conversation on sensory rooms and the little spoken about sensory processing difficulties. Often overlooked, sensory experiences are a normal part of our lives. However, some have a heightened response, which can be very uncomfortable and often provoking if left unattended, especially in environments like hospitals. Often undetected, many may live with this and just adjust to their environments accordingly. Sensory rooms however can help regain a sense of calm and emotional control. Learn more about setting one up here.

2) Mental health first aid

The first week a doctor starts training, we go through the basic life support first aid course, because it’s essential and it saves lives. It is just as compulsory to introduce mental health first aid to incoming doctors. Mental health first aid enables us to be better educated to recognise, understand, and respond to mental illnesses. A mental health first aider will be equipped to respond to subtle signs of a full-blown crisis before professional help arrives. 

Making training compulsory shows commitment towards improving mental health care, eliminating stigma, and improving the information surrounding mental health. It also encourages those struggling to speak up knowing support is everywhere. If you’d like to get ahead, sign up for a mental health first aid course offered by the Malaysian Mental Health Association. The Ministry of Health has a Psychological First Aid Pocket Guide you can have a look at.

Otherwise, explore how you could bring the course to your institution. Mental healthcare is convenient in hospitals with psychiatric departments, making it that much easier to offer compulsory first aid training with expertise and funding. 

3) Debriefing

Debriefing is an important learning and team-building process. It is essentially a dialogue to discuss and reflect on a patient care situation and put forward suggestions for improvement in the future. It encourages learning. Hence, it is so important that debriefing sessions are done in a way that promotes a safe learning space without accusing wrongdoing and without being psychologically damaging. Listen to feedback and accept them as well. Both leaders and team members require them. 

I do not believe in micromanaging. It’s important to empower those who are working with you because you are nothing without a good team. It’s really important to surround yourself with a team whose opinions that you trust, who are not in any way frightened of disagreeing with you and you have to listen – Anna Wintour

Bereavement debriefing is as important. Death is unforgiving. Emotional distress seeing death is a natural human response that doctors are not immune to. It is ill-advised for doctors to carry on their duties with a muted response because of other pressing needs. Health care professionals experience physical, emotional, cognitive, behavioural, and spiritual distress when they are unable to manage grief in response to the death of a patient. This NHS Toolkit can guide in supporting healthcare professionals in the process.

4) Referrals to psychiatry

Getting someone professional help can be a persuasive effort. Those in need may be too debilitated to seek help. There are many concerns as well:

What will people say? My family and friends might find out.” – What they think should not be at the cost of your sanity.

My bosses will find out and treat me differently.” – That is not okay, they should empathise. 

Will I be able to practise? Will I get a full license being under psychiatry?” – Yes you will. The Medical Review Panel will keep an eye on you and will prioritise your well-being.

Will I be able to commit to treatment and find time for appointments? What if medications have side effects?” – You have to make time for your health on top of anything else. There are options. 

Going into medicine changes people, sometimes for the better and sometimes for the worse. It can humble you or harden you to a point of bitterness. Know that it doesn’t have to be that way. Life doesn’t have to be an ultimatum. 

If you know someone who isn’t doing too well, accompany them to speak with leaders or those in charge. Let it be a two-way conversation with a non-negotiable referral to a psychiatrist. Reassure them that there is nothing wrong with seeing one. In fact, everyone needs one as much as they need a primary care physician. Don’t stop there. Offer to walk them to the clinic to secure the appointment. Follow them to their first appointment if that’s alright. Ask them how things are going. Offer to discuss with their doctors how you can make training more accommodating to them to help in the recovery process. 

5) Be interested and involved

You can help by making their schedule more accommodating as a leader. Maybe it’s placing them in a more passive ward for a bit. Consider having someone additional on duty with them. Have the entire team a little bit more aware so that they are mindful to not trigger too strong an emotional response in that process of treatment and recovery. 

Ask how you can take the lead, help by being more involved and formulate a game plan in making sure your teammate in recovery doesn’t fall behind. Understand that no team member is alike. Say things like:

I see you are struggling to cope with this, would you like to discuss this with me? Let me know how I can make this easier for you or let me know how I can help you cope with this better.

I was reading up on your situation and I found some resources that can help you. Why don’t you have a look at them and we can discuss which works best.” 

I see you’ve been working hard, I’d like you to know that you’re doing incredibly well. Here is how you can improve to be more efficient. If it were me, here is how I’d prioritise. This is why this works and why that does not.”

Remember, leave no man behind. Understand every team member. It’s important that your team is not afraid of communicating with you.

6) Advocate

I’ve said it before and I’ll say it again. Advocate. Be a strong voice to mental health. Educate yourself and join platforms like the Malaysian Medical Association, Malaysian Medics International, and Medic Footprints Malaysia that continuously speak up on the welfare of doctors. 

You may have been equipped with good coping strategies and have found a way to maintain good physical, emotional, and mental stability throughout your time in medicine. Maybe you were strong enough to bite the bullet and power through. But that doesn’t mean everyone has that privilege or isn’t resilient enough. It’s incredibly resilient to be trying hard despite disabilities. It just makes them different. In medicine, we celebrate that difference. You are responsible for the well being of the people you work with.

This doesn’t have to be just another unfortunate situation for the files. 

Hard Hitting Truths

1) Hear me make my case

It’s true that medicine may not be for everyone, and if that’s the case, people are free to leave for something that serves them better. However, it is a well-known fact that the less than perfect environment and the lack of effective leadership in Malaysia, where I write this, hugely contributes to the lack of morale, motivation, loss of passion, and burnout. 

It breaks my heart to get messages from medical students and junior doctors who tell me they’re scared, who tell me they don’t know if they can go on anymore. They tell me they’re suicidal. I know many go back home and then right back to work without life and vital energy. I hear them say they hate their jobs and their lives. Why should this be okay?

While it’s true that many have support and good coping mechanisms to survive and enjoy this profession, that shouldn’t be the reason we tell those who are suffering to buck up or leave. That shouldn’t be the way we build and sustain our health system. Our patients don’t deserve care that’s built upon the suffering or the undermining of their medical practitioners.

2) Leadership matters

You cannot advance your career in medicine, leaving a colleague behind. In a profession that promises to be the hand in need, it is hypocrisy to leave one of your own behind, struggling. You don’t get to choose to help your patients but not your teammate. What is success in medicine when it’s at the expense of those struggling under your watch?

You can be a talented doctor but pray, be a leader as well. Good leadership is a learned and required skill to be employable. In a system that only favours medical acumen, we don’t hire the best. We weed out the struggling with no safety net but keep those who turn a blind eye to struggle with no assessment on leadership.

A doctor heals, educates and leads. You see, you don’t get to choose who you care for as a doctor. A doctor cannot be told to leave if they can’t cope mentally and emotionally.

How can we take this one step forward?

Effective leadership and improved work cultures are equally as important as awareness and psychiatric help.  One person affected mentally by the job is one too many. It doesn’t take hundreds to fit into a study before it’s acknowledged as a problem that requires intervention. Call mental illness on the job an occupational hazard if that prompts faster action. 

It’s not just about preparing medical students for the realities of the job or keeping only those immune to the stresses of the job. It’s about improving work cultures and making sure we have the leadership to see it through. This is justice to the many healthcare professionals who have lost years of their lives battling mental illness brought upon by the job they were dedicated to.

Employees’ mental health and emotional well being are not too much to ask for, it’s non-negotiable. There should be safety nets and alternative pathways for doctors, even junior doctors in training so that talent is not lost, so that they’re well taken care of when they fall while on duty. 

Emphasise leadership with team-building efforts. Let there be designated support and intervention apart from a mere referral to a psychiatrist. There may be no space for this in policy right now, but there could be if there is will on the part of healthcare professionals and decision-makers who feel deeply that no man should be left behind, especially a man on your team, a man committed to the oath to protect others.

Interested in finding out more about alternative careers for doctors? Check out our career guides and find inspiration from our case studies. For those based in Malaysia, you can sign up for updates here, and follow our MF Malaysia Instagram and Facebook pages to stay updated on our events, webinars, job vacancies and more.

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Victoria Navina

Victoria Navina is driven towards policy and practice-changing public health interventions, and is a strong advocate for mental health, aiming to make the conversation surrounding it louder and unrestrained.

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