Good evening everybody and welcome to this MHPN webinar on treating a health professional with mental health issues. We've had over 4,700 registrations for this webinar and currently already have a thousand people online. So welcome and it's obviously a topic that is really close to the hearts of everyone who's here tonight. MHPN would like to acknowledge the traditional custodians of the land, seas and waterways across Australia upon which our webinar presenters and participants are located. We wish to pay our respects to the elders past, present and future for the memories, the traditions, the culture and hopes of Aboriginal and Torres Strait Islander Australia. My name is Mary Emileus and I will be facilitating tonight's session. I am by background a general practitioner which I did for about 20 years if you include my registrar training and a psychotherapist and I was a regional practitioner for all of my career until a year ago when I moved to the Gold Coast. I'm also now a psychiatry trainee. I'm in the fourth year of my psychiatry training. I would just like to say that some of the content of tonight's message is around health practitioners who might be struggling. So we want to remind you that if any of the content causes you distress, please seek care if you require it, including you could see your GP or contact Beyond Blue or your local mental health provider. Now the panelist bios were circulated before the webinar and you've all had a chance to see them so we won't go through them in depth but I would like to welcome each of them in turn. So I think Roger I'll start with you. So you're a GP in South Australia and you're the chair of the Doctors Health Network. Is that correct? Could you just tell us a little bit about that role and perhaps one thing you've done that you do regularly for your own self-care? Thanks for that. Thanks Mary. Thank you Mary and it's great to be here and welcome everybody. It's great to be part of this very special event. Yes, I run the, of my background this is a rural GP, procedural GP in Adelaide Hills and my interest in Doctors Health grew out of that. I've seen colleagues who are struggling with a whole lot of issues. So in 2010 we started the Doctors Health program here in South Australia and we've since established one in the Northern Territory. A service purely for medical students and doctors and you know we see all the range of issues coming out of that. I'm sure a lot of these problems the doctors have are shared by health professionals across the country. In terms of what I do to help myself, I play the guitar and piano on a muso and my ambition is to have a top 10 record at some stage. Everyone's got to have ambition. So in terms of having some interests of your own, critical in mental health of health professionals. I hope that comes up later on in the discussion. Thanks Mary. Thanks Roger, it's great to have you. And Christina Ciglaris is a clinical psychologist and Christina you're in South Australia as well, I believe. So could you tell us a little bit about your practice and also something about your own self-care? Thanks. Thanks Mary, good to be here. Yes, I'm a clinical psychologist. I'm based in private practice in Adelaide. My interest in health professionals originally stemmed from working with the fellow psychologist and burnout with them and then has expanded over time. So I work with doctors and medical students and I work closely with Roger and the other GPs at the Doctors Health Service in SA. I see a range of professionals, medical students, doctors, nurses, psychologists, paramedics. So I think this webinar is really really important for all health professionals and I hope we have some interesting information tonight. And in terms of my own health and well-being, I try really hard to set limits on not working when not at work and also ensuring that there's time for catching up with friends, family and general relaxation and self-care. Thank you Christina and welcome. And I'd also like to welcome Dr Emma Adams who's a psychiatrist in the ACT. So Emma and I understand you have an interest in treating health professionals as well. Could you just tell a little bit about your practice and also one of your self-care activities? Thanks. Okay. I've returned to private practice after a wonderful sabbatical having adventures around the world. My practice is perinatal and infant but I do see a lot of doctors as well in my practice. To look after myself, I take off to the bush and connect with country whenever I can and that's what keeps me well and I also write. Fantastic. Thank you for being part of the panel tonight and I should also say I am a bit of a meadow as well so I like playing the violin although I would have to say fiddle in a kind of Irish session which I can't access because of COVID and because I left Cairns but my partner and I play a bit of Irish music from time to time and I also am very fortunate to live near the beach which you can see from my bio-photo and I get to walk home along the beach from work so I'm very blessed I think. I would just like to go on to some ground rules and also just where to get technical support if anyone's having any problems. So just remember that we need to behave in the chat box as though we were in a live face-to-face activity so just be respectful of other participants and the panellists. You can talk to each other, the participants, in the chat box but just try and keep your comments on the topic. Now if you have a technical issue you need to go to the technical support FAQ tab and if you can't find the answer to your problem in there you can call a red-back help desk and the number is on your screen now. It's very, very rare but sometimes something can happen that affects the overall delivery of the webinar and if that happens you'll be alerted via an announcement and the other thing is that right at the end there will be a feedback survey and MHPN really value your feedback and it helps inform future webinars so please remember to fill out the feedback survey when the webinar finishes. Just in case you're not familiar with the platform there's a few things, colourful little dots up the top so you'll see the purple thought bubble open the chat box, the blue arrow to access resources so the panellists at MHPN have provided some resources that are relevant to the topic, you can find it. Refresh, sometimes the frequently asked questions technical support will advise you to refresh your platform. There's the exit button and then the feedback survey is the yellow one so we'll remind you again at the end about that. The way our format is going to work is that each panellist is going to introduce their response to the case study just a short response from how they would address it from their discipline and then there'll be a Q&A between the panellists after that. So hopefully, and I'm absolutely confident it's going to be a really engaging conversation the learning outcomes for tonight we're going to hopefully, well definitely address some tips and strategies for providing care to a health professional who's seeking care for their mental health identify ways around the specific issues of privacy, stigma, discrimination about mental health issues and just demonstrating the importance of collaboration and appropriate referrals when supporting a health professional seeking care I would like to acknowledge that many people have also submitted questions when you registered so we have over 300 questions that have been submitted I am confident that a lot of the answers will come from the presentations and the Q&A but as much as possible we'll try and cover as much as we can but I do apologise in advance if your questions don't get specifically answered it's just impossible in the timeframe and you can also type questions into the question manager and I'll keep an eye on that as well and we'll do our best to cover as much as we can just to remind you of the case study which you've seen a little video it's about a young doctor who visits his GP after experiencing a panic attack on the hospital ward round and so he's a young doctor who has buried himself in study and he did really well in med school his mum's a bit of a warrior he lost his father when he was 11 in a road accident and ever since he started working he's found himself feeling more and more anxious especially during ward rounds for anyone that is a junior doctor or a doctor who went through that ward rounds can be quite stressful I think they're stressful with patients too it's another story he says the feelings are getting worse now and that he's starting to avoid people he's not suicidal but everything's in effort he doesn't know what to do and he's come to the doctor to get some help I would like to point out and to give a thank you to the Doctors Health Services Limited which is from the Doctors Health South Australia which is part of a national educational program which can be found on the website Doctors for Doctors so that's one of the resources for any doctors who are watching tonight there's a national website called Doctors for Doctors that links you into all of the local Doctors Health Services so we'd like to thank them for allowing us to use this video for the case study and in our case study our young man has presented first to his general practitioner and so I'm going to invite Roger first of all to respond to this case from the perspective of a GP thanks so much Roger Thanks Mary I found this quite emotional to watch this person as somebody's son a clearly exceptional young man who's struggling with what's becoming incapacitating anxiety disorder he mentions a number of triggers to this to my view he's clearly at a crossroads in his career the high risk that he may leave the professional which would be an absolute tragedy and this I think underpins the importance of our work in treating colleagues the fact he saw help requires a huge effort and I think another point we should discuss later on is the effort it takes for health professionals to ask for help for other health professionals it sometimes takes a long time to pluck up the courage but as I said the stakes here are very very high but the whole case made me think of a number of things that I've seen in treating doctors and firstly the what we bring into our studies is health professionals and if you look at the first slide there are things like our IQ, our EQ the things that motivate us our own life experiences and resilience self-esteem is a great driver for high achievement in health professionals various outside interests particularly two things I think prior health problems their undergraduate studies are healthy they bring in sometimes undiagnosed anxiety disorders, mood disorders undertreaties, depression some of us autoimmune disease, multiple sclerosis these things are all things that we've seen and typically they intensify during the transition through our career so with all health professionals all go through career transitions from undergrad to postgrad to various placements and these are typically associated with considerable increase in anxiety the next point is in my travels I see lots of different doctors with personality types the same across all the health professions and there's three that are particularly common that I see and they're a double-edged sword the obsessional personality traits are common they make for very thorough health professionals like detail, drilling down, perfectionism and along with that comes propensity to anxiety particularly during transitions in our career particularly during transitions we then have the avoidant health professional often who find it hard to refuse to request for patients so they quickly build up a very large following of patients who know that when they go to see that health professional it's very unlikely that their request will be refused so these are people who don't like conflict and these doctors and health professionals quickly build up a large following which can become overwhelming and be rewarded sometimes by the use of acidity by alcohol or substances at night to relax and the third type we see is the dependent health professionals who really enjoy being amongst people they like to contact with patients, people and often share a bit of their own lives with their patients and develop quite close relationships with those patients a mutual sharing of things they're the much loved health professional and the risks here they may get too close to patients and undergo boundary violation the third thing is with this case raises the barriers what barriers are in the way for health professionals to seek help and the mental health condition itself can be the low energy pressure with depression the anxiety symptoms can be a great deterrent to going out and sitting in a waiting room or even putting out the phone to make an appointment there's a lot of embarrassment around the timing of the presentation is this serious enough to ask for help will I look foolish if I admit what I've done or what I've not done to this point previous negative experiences a loss of trust in the skill set of the health professional and mostly in medicine particularly is career jeopardy admission of or disclosure of any illnesses can be a career jeopardising move so these are all things I think have come out in the video the other big fear is mandatory notifications something we can talk about a bit later on essentially I was previously chair of the medical board here in south Australia and familiar with the transition over into ARPRA at this stage you need to hold a reasonable belief that in the course of practicing their profession this particular health professional has placed the public at substantial risk of harm from four things easier to remember, sex, drugs rock and roll and impairment if you can remember those rock and roll is rock and roll and their behaviour or their performance but that essentially sums up the sort of indicators for notification in the case of students it's a little narrow it's just impairment so I think that's important to and I know we've had some questions around mandatory notification but it's always at the limits very significantly misunderstood and I think hopefully we can open that up in the discussion later the other the other barrier is when health professionals go to another health professional is six things that I find interfere with that and may corrupt it is the tendency to give and take a selective history that is you don't want to reveal everything in case you get a diagnosis that you don't want there may be an expectation of special treatment being seen after hours or at special times and being given billing discounts social content intruding into the console at the expense of the clinical content self-treatment coming along to the health professional having done a whole lot of things that they don't want and denying them any chance to offer something new and refreshing and sabotaging the consultation steering the treating practitioner away from the diagnosis you don't want and the consulting style obviously some people just are never going to get on and finally I think just to finish up there are some practitioners who do extremely well carry very heavy loads heavy burden in their personal and professional lives and there's probably 10 10 various things which do assist them in getting by carrying these loads and getting through difficult times having their own GP looking after their basic existence needs food, water, sleep, sunlight, exercise having a network of personal and professional supports which often come from unexpected sources having creative interests that we've already spoken about for me it's been music and Mary we should have a jam online one time and fulfilling all their other roles we're all somebody's somebody's daughter we need to remember those other roles that we have and from time to time discussing the burden we carry with our colleagues sitting down to exactly what your working week looks like at the moment and sometimes the stories I hear are horrible having a plan breaks recognising the warning signs in our self and in our colleagues are critical how do you react when you're under pressure do you withdraw, do you become irritable controlling, cranky how do you do it and having a crisis plan so many practitioners I see have never thought about an injury that might take them away from work for 6 months what they would do in that situation so all of these things I hope will come up later in the discussion for me, for Mary, for me that case raised I think all of those issues and plenty more thank you Mary thanks so much Roger and I must say I felt like I personally had all three of those trays of the beginning GP, fortunately I had some really good therapy for a while and managed to get by so I'd really like to welcome Christina now to talk to us about how you might respond to this young man from a psychologist perspective, thank you well I think from a psychology perspective it's really really important to acknowledge what has actually happened so we've got a lot of issues that we need to tease out obviously there's an acute anxiety episode that's happening although it sounds like it's been happening for some time then we've got the potential background information some possible family mental health history with anxiety the mother which may have or may not have contributed to learnt behaviour with anxiety then we've got an early loss with the death so that is also potentially having an impact and then there's what appears to be the fear of failure perhaps or speaking up in ward rounds or getting it wrong so they're all issues that we would need to take note of I guess underlying that we've got this problem with stigma so as Roger mentioned the fear of mandatory reporting for any disclosure of mental health issues or any difficulties is a significant issue as the case study said there was I guess quick to quick to notice that there's issues there but they're not at severe risk so they're not suicidal and I think it's really really important that we acknowledge that despite trying to break down the stigma the misconceptions around mandatory notification continue to worry I see with most people about the uncertainty with the career impact the fear of negative evaluation from both their peers and their supervisors tends to go throughout their career unfortunately there's much misunderstanding about what actually constitutes impairment, what is a substantial risk of harm to public and I'm sure my colleague is going to expand more on that later the thing that I think is really important when seeing any health professional with issues that present whether it be the GP the psychologist or the psychiatrist is to reinforce for them that mental health does not discriminate it can happen to anyone it's not a reflection of their level of resilience, their character or their competence in their profession and I often tell my clients especially the doctors that medicine is hard it's inherently stressful we know this given that it's to me quite understandable that at some point people are going to struggle we know that medical students start off with better health and on par as their non-medical peers and somewhere as they progress that changes so there is something about the professions themselves that is stressful despite knowing that mental health issues are prevalent in medicine psychology nursing and so forth I have lots of clients who struggle with severe shame they feel completely defective as though they're one step away from being found out so to speak their fear of failure is very very high which as Roger said perpetuates anxiety and often perpetuates the depression and it's this balance on the logical side the kind of doctor side of them can provide statistics for me and lets me know that there is a greater risk of mental health and burnout in medicine but this other part feels that's happening to other people that's not them and this perception that everyone else is coping they go to ward rounds and everyone else seems to have it together and they feel that it's just them one of the things I try to do in working with any health professional is help them to understand and recognise that they're a human first and foremost who happens to work as a doctor psychologist, nurse, paramedic other health professional and with treatment any of these professionals can go on to have fulfilling lives successful careers and do well in the job that they're training to do the other thing is that we want to help as people that work in the doctor health field we want to support people we want people to reach out and we hopefully are not punitive so it's a safe environment to do so so like with anyone I think this is really important and Roger touched on it before that we take a comprehensive history it doesn't matter what occupation your client has a comprehensive history is paramount and that includes a risk assessment for doctors which is something that can be tricky at times because doctors may deny or minimise or attribute difficulties to something else they're often very very scared of telling you to have suicidal ideation that they're severely depressed but it's still an important thing to cover I often utilise questionnaires as well as an interview because that can be quite telling in and of itself if they're high symptoms but also they rate very low so it's the discrepancy between the coming for treatment yet according to their measure everything's fine and it informs my treatment plan and our intervention we'll touch more on this later but a collaborative team approach with of course authority to exchange information is paramount for everyone involved in the client's case the GP, the psychiatrist as is gaining collateral information with again the client's permission I often get collateral information from spouses, parents, family friends again imperative in working with health professionals that therapy is a safe space we want to help you it is confidential as Roger said it needs to be a substantial risk to the public and many of the mental health conditions I see do not meet that threshold at all so it's imperative that we help our health professionals know that they can and do get better which is often quite difficult for them as they often feel hopeless and worthless and a little bit stuck as a psychologist I think that therapeutic relationship is key in my experience working with doctors the ability to build trust is really important that it facilitates open disclosure people can become a bit more sharing and you can get some useful information that initially was not given or that they hesitant for again we want to work within the treating team and often really important with doctors is to help them understand that therapy unlike other aspects of medicine per se can take a little bit more time than what we're expecting doctors as Roger said are very driven so they often come expecting a strategy to fix all their problems it would be lovely but it's not so simple unfortunately obviously there are a wide range of treatments and this differs by professional and also tailored to the client treatments I utilise in working with health professionals and the doctors and students in particular I utilise schema therapy cognitive behaviour therapy and find EMDR very effective in treating trauma so that's been useful again we're reiterating that message that with treatment things can get better you can have successful careers and life can be good I mentioned before collaboration is essential an important part of that is educating the client in front of you that they can still get help by people that understand their needs for example the doctors health service is an excellent example of being tailored to meet the needs of GPs and other doctors and medical students so often the doctors I see are uncertain about where to get help and they tend to be somewhat avoidant of that so encouraging them and helping them access supports and other experts in the areas are really important also telepsychology is really important it's something I've been offering for several years now it's especially important for perhaps doctors in the state or those that work gruelly and remotely in a small community where there are other colleagues with the other trading professionals or they know them and it's not appropriate for them to see them for their own therapy and care so telepsychology has been a big advantage there so I hope that persists another thing that is important when working with health professionals to help them and encourage them to remain engaged with the trading team some of my clients were really good at initially seeing the GP and perhaps the psychiatrist and over time they have attended these to let those go or have less regular appointments so I try and encourage them that monitoring needs to happen from all professionals collaboratively and like Roger said we want to be quite upfront with discouraging self-prescription discouraging self-treatment and helping them see that it's okay to struggle and there is help available and we want them to get better Thanks Christina I'm just going to acknowledge a couple of questions that have come in through the chat box firstly if you're having problems with volume, check your own computer volume and if you are still struggling go to the number or the frequently asked questions that you can't find the answer then call the 1800 number and Redback will talk you through fixing the volume there's a question also around what question is Christina might use in her initial assessment so we'll put that on hold and we'll come back to that in the Q&A and I'd like to welcome Emma to talk about the case thank you okay thank you and thanks to Christina and Roger for covering everything I wanted to talk about too I just wanted to say there we go thinking about it my first question is with everyone but in doctors in particular is to listen to what is not said as well as what is said everybody's mentioned avoidance and shame and doctors are really good at hiding things you know in very good at deflecting and in medicine doctors learn the stiff upper lip in medical school you're not supposed to complain and if you complain you are the faulty unit so if we think about this man's early life he said his mother was anxious and you know it's pretty understandable when a husband gets killed when her child is 11 but get a load of what he said he said it's okay and he reassured that doctor so much about his dad dying but she didn't ask him anymore I'm assuming I'm going to take liberties with this history so he took control and she didn't ask any more questions about that so we could talk about the psychodynamics of this particular case you know he's likely learnt not to rock the boat and not to communicate his own feelings in order to protect his mum and we also might wonder is this way entered medicine and if we're writing a sitcom we have the storyline of repairing the guilt that he felt about the death of his father or something and that's it could be this is a made up patient so we can say what we want about him in thinking about what is not said one of the first things is and what was not taken in the history was a drug and alcohol history and this is pretty significant doctors have a higher rate of substance abuse than the rest of the population and a significant rate of problematic alcohol abuse and coming to work when intoxicated is a mandatory notification so I will talk about opera a bit later but substance abuse really is a significant problem and with an avoidant person asking about drug and alcohol it's something I would come back to again and again and again because not that I think anybody's lying or anything like that it is quite a shameful thing and people know that they're not supposed to be doing it but can't feel that they can't help her anyway so that's the first thing I would really make sure is really make sure you tick off that you have inquired about drug and alcohol use the next thing is suicide she didn't really I mean he told her about suicide she didn't ask about suicide he headed her off at the pass yet again like I really think that as the clinician you need to ask the question and also those kind of that gut feeling those senses that you think something just goes to when you're thinking about that it's really important like I feel like if I'm talking to a bunch of mental health professionals about asking about suicide I think I'll just go over it just to be sure it's got to be in the right sitting you've got to create the right space in order to ask the question and the question is suicide it's not if you've been feeling so bad have you felt harm because self-harm is actually something different to suicide and to be direct you are more likely to get a more direct answer and we're trying to model this kind of communication because otherwise it's just dangerous the other thing I can't see my slides I've forgotten what the other point you had cultural issues oh yes and the Africans that you've mentioned so one of the things that was a bit of a deflection was this case study was of a white man so I'm going to talk about a few things that we might not notice in seeing this patient that certainly affects a lot of doctors the issue of sexual harassment sexual assault and rape occurring in the workplace is significance and it is also important to know that it just doesn't happen just to women it also can happen to men and opening up some part of the conversation and history which will focus on workplace issues so as well as asking about burnout and things like that is asking about feeling uncomfortable at work and asking about any sexual harassment or sexual traumas at work another huge problem that we're not seeing with this maybe not seeing with this case is the issue of racism and any doctor who is a person of colour has an accent is a recent immigrant is indigenous is going to face racism likely every day in their working lives and it's a huge problem and not only is it the bigotry by patients and you're on your own with those because no one's going to help you there's also the issues if some patient is being so obnoxious what do you do do you refuse to see them because they're racist and a colleague of mine who's another indigenous psychiatrist in Canada she had this huge issue do you just suck it up and push on and see people who are not faintly actively abusive to you or do you feel like you're a quitter or do you risk having a complaint made against you by a regulatory board because you refuse to see somebody being so obnoxious is it the bigotry by staff and colleagues and you know it may not be those big things but it shows micro well sometimes it is the big things actually let's be honest and it's often really hard if you are the only person in a group in a workplace for my personal experience you know for a while there was only two of us Aboriginal psychiatrists in Australia and being single you'd say something and you'd be labelled she's the angry Aboriginal woman and I'm sure that everybody in every group who feels like they're isolated has that and do you fight every fight do you take everything on or do you suck it up do you oh my goodness I forgot the word cortisol takeover you know these microaggressions are particularly severe so the next thing is I think the last thing is about I just wanted to talk about because I think a lot of people are very very anxious about this is about mandatory notifications there are four reasons that mandatory notifications are made they are intoxication when practicing a significant departure from professional standards sexual misconduct and impairment and as a treating psychiatrist and a member of a medical board that impairment has to be not just a degree of severity that would affect safety of patients but in a situation where the practitioner isn't taking responsibility for it so you can have a psychosis and just say okay I'm not going to be at work until I'm better and signed off by my doctor and that wouldn't with the current rules that wouldn't trigger a notification at all you can be if you're away at home you can be as mad as you like but if you take it to work then that that becomes the problem and so it's often those severe illnesses that really lack insight that do cause problems but if you're sad or feeling suicidal that's not a reason to avoid getting the treatment that you would benefit from okay thank you Thanks so much Emma I just learned a lot from what you just said and I it's just really helpful for us all to remember that these really severe things can happen to health practitioners as well and the thought of having to practice every day with racism directed at you in your practice in addition to dealing with everything else is pretty full on so I really appreciated what you had to say and I'd like to welcome us all back into the chat so there's been a couple of things that have come up from the audience that I think we might start with Kristina I did give you a little bit of warning someone has asked I actually can't tell whether the questions are just coming to me or everybody but somebody asked what is EMDR so that's eye movement desensitization re-processing therapy it's a particular evidence based therapy for trauma there was also a question what is schema therapy and that's really looking at underlying core beliefs that people have about themselves and I recommend that you just look those things up because you can find really good information but Emma just as a sorry Kristina as a practical tip what kinds of questionnaires might you use in an initial session with someone presenting with kind of anxiety a question is a health professional thank you for that I would use obviously the same health professionals don't have separate questionnaires for themselves so we obviously use a standardised questionnaires that we would use for any other presenting client I also tend to do this once I'm with the client as I've noticed with doctors in particular and you'll get a questionnaire that just isn't representative nor of much clinical value at all so I think we need to have the understanding about misconceptions and how freely they can actually speak before we give them questionnaires otherwise it's not very representative questionnaires that I like tend to be the PHQ9 for depression the GAD7 for generalising anxiety the DAS is okay but if you see GPs then they're very typically used to scoring those so sometimes using something that they don't necessarily use themselves can be useful and there's a whole range of others it depends obviously what the presenting problem is thanks Kristina um yeah okay I'm just collecting my thoughts here now Roger I would like to come to a question for you there was in the registration questions and also in the chat just now a question around how to just to answer an audience question we are talking about all health professionals here a lot of our comments are around doctors because they're particularly tricky but all of the information is relevant to all the health professionals that you're treating Roger how do we go about thinking about like a kind of when is somebody ready to return to work so Emma's beautifully said that you could be as mad as you like as long as you're at home and not placing patients at risk of harm how do we make decisions around knowing when people are ready to return to work is there any kind of guidance this is a really a really good question and I think to understand that it's good to start with how were they working at the time they were unwell and what's been their work history over the years it's always amazed me how people often in health professional circles ask are you working full time this can be a question that pops up in a social setting but also at other times what is full time for health professionals and I think if you're sitting down with patients all week doing 9 or 10 sessions of consulting that is not full time that is about 1.5 FTE everyone listening knows when you see people you have to document you're often maybe doing a case notes at home on the weekends or late in the evenings so the actual work associated with clinical care really extends well beyond so what people define as their full time is often very firstly very interesting to explore so you wouldn't want to send somebody back into that again and of course one of the new workplace health and safety hazards of the modern era is the ability to remotely log in from home it's the worst thing because that extends your working week or FTE from 1 up to about 1.5 because it's just so tempting to go in another nice and tidy up your case notes or work from home or log in that we're seeing this enormous amount with particularly younger obsessional professionals who are very worried about making a mistake and making an error so understanding their prior work environment is very important and the triggers that built up to this for example you may have an obsessional person who is working in a very very uncertain environment there may be a very unpredictable rapidly changing rapidly moving clinical environment which is completely unsuited to their personal top you may have an avoidant health professional with a very large case load long complex consultations very demanding patients who expect you to sort out everything and don't necessarily want to get better by the way it's very unfair to send that patient back into that same working environment if you have a dependent health professional who's again got a large case load and their patients will wait weeks or even months for them to come back to work and when they do they've got weeks and months of problems they're going to dump on their health professional and expect them to sit there for an hour when they've got a half hour appointment for example so understanding their prior work environment is very important and I think setting their expectations that a graded return to work is often the best way takes a while to negotiate not only with employer but sometimes with the person themselves if you're self-employed it's probably a bit easier but the boundaries between home and work can sometimes be difficult so I think there's many factors to consider I'm sure all of those people listening who may have had an injury or time away from work returning work can be a very stress it's a transition from not working back into work and with that comes a lot of unanswered emails and clinical notes and letters and requests it can be hell going back to work so a graded return is important and creating a work environment which they feel safe they feel valued and they feel listened to the three key ingredients for a safe workplace safe, valued and listened to and I think that's important we advocate for our patients in that return to work and make sure that the workplace is safe the work practices are reasonable they're not being flogged and their workload and their working week matches their personality type I'll leave it at that Yeah that's really helpful Emma I'd like to ask you so we've just heard from Roger about returning to work but we didn't really think about how do we know when someone needs to take time off work and how do we go about helping someone make that decision is it something that as a psychiatrist you might just say this is my clinical opinion that you need to stop working now, what do you do if you're not a psychiatrist can you talk around that a little bit Well it depends on what it is what the condition is I often just talk about the effects of long term stress that's been allowed to fester and how that can make mental health disorders substance abuse disorders strains in relationships and even medical conditions a lot worse so I'd probably indicate that there are negative effects in continuing at work and also provide the positive things of if you have a break it's really really helpful and sometimes if it's just a little bit having a few breaks earlier is probably better than falling in a heap and having a longer break necessary break later on so it's also giving commission and I think we can all play a part in this perhaps in changing the culture that it's okay to have a break it's okay to do something in your life for a while in a lot of colleges you know it's been acknowledged through the medical boards if you want to have a break for a while and do some non-clinical work around your area that's equally valid and I think I'm talking about doctors here but for all health practitioners doing something else for a while is also useful Thanks Emma Christina I'm just going to ask you perhaps a slightly tangential question but if someone comes to see you they might come on a mental health treatment plan that their GP has prepared for them is there concerns about having a mental health treatment plan item number on your My Health Record is that something a health practitioner should worry about? Whether or not it's something they should worry about it's something they do worry about I I mean the mental health care plans as far as I see them with my clients the worry is often difficulty getting indemnity insurance which some people refuse to go on a mental health care plan and just offer to pay privately but I do see several predominantly doctors and medical students but also psychologists and nurses who come under a mental health care plan I'm wondering if Roger might be able to speak a bit more about his experience because he would be the one and or ever about what they see because they would be the referring doctors Yeah Roger would you be able to comment on that concern about a mental health treatment plan? Yes it gets fake to this point about stigma and nobody wants to have that label in my experience but there's a movement there's a shift towards more acceptance of this but really in all health professionals we're brought up to be those who manage these problems we don't suffer from them and there's a culture there that we're a little bit above it we're a little bit immune from those things they're training to some extent and our resilience and our ability to manage these things really builds over time through our undergraduate years and through our work and we see so much of it that we feel we can handle it so it's an important thing to acknowledge that there's a great reluctance to but my personal experience is those who do come and seek for help like that are very keen to have a mental health plan the issue of confidentiality always comes up and it's the whole thing that perhaps is to lay the my health records spread across the nation is there been concerns about is it confidential how is that information going to be used and particularly it's particularly so with life insurance I think it's probably even more of a concern having life insurance a record of that often excludes that as a thing that can be ensured for so that certainly is a concern amongst doctors I know particularly that their life insurance eligibility can be jeopardised and Roger there is I believe that there is some advocacy around that and trying to get that thought about and changed if possible because there was some questions in the registration about you know once we know about these things do we have some duty to try and change the system to make it you know more health professional friendly for us to get care so I do I think there is some energy around that perhaps Roger just do you know about that? Yes yes there is there's a softening of that the processes of complaints for example are very harsh and I do have a negative impact on all health professionals being notified and it's a barrier you know if you've got to think what are the things that stop health professionals seeking independent health care for themselves rather managing the problems themselves and you know doctors are no different to anybody else if you've got the skill and the ability to manage things you tend to do so as far as you can go yourself you think what our patients do they might talk to their partner they might talk to they get some phone advice and they go to the pharmacist to get some advice and I go to the doctor and they might go back to to get a prescription for something there's many steps in the process to seeking help and a lot of that can be bypassed as a health professional and you know if you can do that why wouldn't you because it's very inconvenient attending for an appointment during the day and having to go and get a prescription and you may be able to write for yourself or have a some sort of management that you know can do yourself so it's very tempting for health professionals to treat themselves a little bit too far sometimes and maybe their illness may progress to the point where even they don't realise it's gone to that extent so the barriers that exist are really there to be overcome it's about having a clear pathway of having somebody you know and trust who can see you in a timely way who is confidential and I think who can advocate for you in the health system and these are very important things I think that may get easier for health professionals to seek independent care for themselves Thanks Roger for that and Emma you may want to add something to that and I also wanted to ask you about sometimes people need inpatient care and they might have particular concerns around privacy and confidentiality and also when someone's offered an extended period of time the employer might start asking lots of questions so are you able to sorry that was a bit of a double question I'll just imagine a patient who's in hospital who will be there for a while so I was a VMO at a private psychiatry hospital and we had a lot of health professionals cared for a lot of health professionals it is quite tricky in the public system and I think usually what happens is people unfortunately have to go out of area which can provide quite a burden to families so in a psychiatry ward the private ones I've worked in confidentiality has been paramount and that's a big factor that everybody is aware of from the top down so in terms of treating people in hospital I think it's important to note that we will have those privacy things in train and what I found is the nursing staff and allied health staff and everybody in the hospital when it's one of our own another healthcare provider we're all very concerned about privacy anyway so there's the extra step being taken it's important when we have a mental health professional who is now a patient thinking about the things they've said about making them a special I really try and I know that they've got medical or other training but they're a patient and when you're really really stressed you kind of need to have things spelled out the same as anyone else because you might not remember that lecture back in third year or something like that you hear now and you need to be looked after by everybody like anybody else so then imagine this patient has been in the ward for quite a long time and they're getting hassled by work saying when are you coming when you're coming back and why aren't you coming back and things like that first it depends on the setting but you know we've got to remember people's rights here and what rights the workplace have to information about somebody and how far they can go into their rights and what's actually required so you know as we're working as advocates for our patients health and getting better so I will do what I need to do in communicating with the employer and it's often better to be pre-emptive and get a letter in first and something with not too much information rather than the process to drag out and people to get really worried about what's going on unfortunately you know when the letter signed by me and you know I've got to say who I am it's just a chitra so you know games over but you know shouldn't we all be about normalising these things I know it's hard with insurance it's hard can I just give a little aside I got my work getting sick insurance whatever that is like life insurance knocks back because they asked for my GP records and on it the GP had written perinatal psychiatrists and whoever the company looked at saw my job title I thought it was my diagnosis and knocked back my insurance so they will do anything they can and I think there's two levels I suppose of discrimination but workplace if you kind of cooperate with them unless it's really really difficult you know HR often wants to no they don't I don't know you have to pay it case by case actually thank you look I'm sorry it was a bit of a tricky question I do you know it's something that people are understandably concerned about and my observation I'm working in a facility that has it's private and we have many health professionals as inpatients and something that often happens is that they just are absorbed into the patient group which is all kinds of people and that's actually a great relief for them and they actually find that they have a lot of stuff in common with these people so they feel more actually a part of things than separate in my observation Christina a question's been coming in and was also in the registration questions around treating the children of health professionals so it's a little bit tangential but it's also relevant and I'm sure it's something that you've thought about are there any particular sort of issues or things we need to think about in that situation thanks for that well I actually just provide adult psychology so I don't see younger people however having experience and listening to the stories of health professionals themselves the themes of perfectionism fear of failure a big need to please fear of getting it wrong I mean these I guess traits that can be seen from very early in kind of very scholastic children so although they might not be a problem they can escalate so it's probably a good idea to keep a BDI on them and also I always spend fair amount of time looking at the early life experiences did they feel connected how they see themselves and so on so they're important things but just as there are services to help adults there are many to help children so I encourage everyone that needs help to reach out and make that step yeah and I guess what I mean I would have myself treated quite a few health professionals children and one of the big things is just making it clear about communication and confidentiality and boundaries so the young person feels comfortable to speak with you as their practitioner and to be clear about what you're going to share with their health professional parent Roger there's been a question again a number of times so we talked about helping health professionals children health professionals are also often concerned about their co-workers so when we see someone who's struggling or we think they might really benefit from support we're worried about them but they say everything's fine do you have any any advice for us for how we look after each other yes great question Mayor can I just make a point about treating children it's very common for a number of health professionals who never actually had a consultation say with a doctor certainly doctors children have actually never gone to the doctor and don't have to do it they may have been treated at home for a whole range of things so that's just one other thing to overcome so in terms of colleagues this is a really I'm sure everybody listening probably knows somebody they are working with or have worked with probably troubled by something but as we know health professionals can be very good actors if you put a a dash 21 in front of a health professional so I'm just going to I just want you to feel like this form they know exactly the right answers to write that will steer you off the diagnosis they don't want so you've got to be really quite inquisitive and persistent but my experience is health professionals do give out little clues they desperately want help but they want to treat this themselves often privately avoiding disclosure being away from the gaze in eye of a potential notify and they are very reluctant to admit something's wrong they're trying to meet the expectations of themselves of their families of the colleagues around them of patients and they feel that sometimes by just working harder working longer working more persistently they will overcome it in their own time and in their own way so that the clues coming out are often very subtle and one I think area of behaviour that is important to watch for this before we what to do is health professionals who take risks risk taking behaviour is particularly an indicator of depression and it's a recklessness around a whole range of things such as their appearance arriving at work a little disheveled obviously having alcohol on their breath taking risks with their notation taking risks in the case of doctors with prescribing taking risks with billing taking risks with their social media profile a lot of health professionals aren't aware that ARPRA access your social media profile and look at it and say your honour let me show an example of the sort of health professional that we're talking about discuss the character of the person in front of you in the doc so risk taking can come in subtle forms and it's very important that we all look out for subtle changes in behaviour in our colleagues because a small change in behaviour can be often the only sign we've had many clues and they'll be reluctant when approached they'll be embarrassed and they'll be wondering is this going to be the end of my career they'll often have a catastrophic view about being discovered so it's very important to be gentle to be inquisitive, to be persistent to be caring and to choose your moment to call a meeting and have three or four colleagues with you can be particularly confronting and a quiet one to one approach but you may need the help of a colleague a more senior colleague to assist you with it and it's always couched in the fact that look, we're here to help and we've all gone through periods like this you seem to be really troubled what can we do to help and it may be a single issue a difficult patient maybe a colleague to colleague issue maybe domestic or home issue or private issue but once you've identified then you need to be able to send them somewhere it's probably not the best idea to treat them yourself, I think you should preserve your role as a caring colleague and an advocate for them but having a clear pathway of care for that person do they have their own GP always a great start because they can connect with the wider health system is there an EAP associated with the workplace is there an independent colleague who may be able to come in and assist dealing with people who are right on the end of a long difficult period they're hanging on by the fingernails and there's a fine line between you're not doing something and watching them go down and that maybe they, patients will notice and they'll have a complaint which is often the common thing to see an unwell health professional coming before they're bored with a health condition which is triggered a complaint and they're going down this disciplinary pathway which is so sad so be on the lookout, be watchful be inquisitive, caring but persistent Thank you very much, Roger really helpful so we actually have whipped through our time, we're nearly there so I'm just going to give you 30 seconds each to give us your final closing message that you'd like people to go away thinking about and Emma, people have really appreciated your honesty and your just reflecting on your practice as you're speaking so thank you so much for that and I just wondered if there's anything that you would like to sort of leave us all with as we close Yeah We are health providers and health practitioners and when we're seeing a health practitioner we're seeing our brother or sister and that can be very confronting, it can be like a mirror held in front of ourselves so when I was a junior doctor running to an arrest the first thing we'd say is check your own pulse first and I think it's really important that we look to see where we're standing, how we're doing and what our stance is with regards to our patients and be mindful of our own that we're treating somebody very close to us Thank you Kristina, I wondered if you'd like to say anything to finish up Thank you Yes, I would I think it's important that people know your mental health, that is important confidential help is available, we want to help you, we've helped others, they've gone on to overcome the issues and had enjoyable lives, successful careers, a lot of those fears are unfounded so please don't suffer alone and also please don't wait till it's too bad in medicine in particular there always seems to be something more important because it's not quite that bad yet if we can get people coming in when they're stressed, overwhelmed that's really useful especially for people that have had years perhaps of fluctuating anxiety or depression or feel hopeless or worthless or feel a fear failure I guess the most pertinent thing that I see in working with health professionals but in particular doctors is that many of them say if only they had sought help sooner so there are lots of barriers to seeking help but the relief that comes when we actually make progress and they get better is lovely and makes the job thoroughly enjoyable. Thank you that's really helpful to be able to say to many people reflect they wish they had thought help sooner and Roger I just wondered if you have a very brief word that you'd like to say to finish Yes I think our own health is a professional obligation it just has to happen it's easier, we're like sponges we can absorb a lot of stress over many years and not show but eventually we start to drip so there's a certain amount we can absorb but eventually it shows to ourselves and to others having a break, having a gap year discussion what a great idea we don't have enough breaks in our work we don't plan to get out of the consulting room and out of professional life a little while to be creative we're all working very constrained professions very constrained by evidence and the regulator we need to get out and be creative a very important antidote and the third thing I'd say is you may be in the wrong job if your work is stressful you may be in the wrong job so it's good to think about that am I in the wrong job and where do I do my best work is it one to one with patients or is it a teacher as a researcher, as an administrator is my roles at a state level or national level or even internationally where do I do my best work good to think about that because you know a lot of stressed health professionals are actually in the wrong job Thanks Roger it's really helpful to finish with and look it's just been a pleasure talking to all three of you and I know that the audience has got so much out of it tonight so I'd like to thank you all very much just to remind the audience that we would really appreciate you completing the exit survey before you log out and it'll appear on your screen after the session closes or you can see it up there now you will receive a statement of attendance from MHPN within four weeks each participant will also be sent a link to the online resources within a couple of weeks I just bring your attention to the upcoming webinars that MHPN will be hosting the next one is a partnership with Emerging Minds looking at introducing child and family practice to parents that's on the 22nd of September and working collaboratively to address the mental health of people experiencing chronic pain on the 20th of October Lifeline is always there for us and there's lots of resources for health professionals I would like to mention the Black Dog the essential network app which has only recently been launched and has links to lots of other things and also there are many local networks that you can join and you might like to continue this discussion on the local level of joining a local network or you might like to look at the MHPN podcast which is a new activity that's just starting and you can see the links of that with regard to the local networks just keeping in mind I'll just pop it over to here that many of them are on Zoom at the moment due to COVID and before I go I would like to acknowledge the lived experience of people who have lived with mental illness in the past and those who continue to live with mental illness in the present and I would like to thank everybody for your participation this evening including all of our attendees who've been very lively in the chat box and I hope you've got a lot out of it so thanks all and good night