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Naming Mental Health as the Cause for Disaster means a Reversal of Gains to Reduce Stigma

I am almost at a loss for words when I see the headlines in relation to Andreas Lubitz and the tragedy of Germanwings 4U9525. The horror is unbearable, but the press coverage surrounding the story has been abhorrent. I am scared to write this post as I do not want my words to detract from the pain that the families involved must be feeling…and I am sure I will not cover this issue as well as @MentalHealthCop or @BlurtAlerts… but I must share my thoughts.

Relating this story back to my own PhD research in supporting health professionals in psychological distress, this story should remind us all that high profile jobs in high pressure environments placed in the public eye can produce adverse health problems. Many people have been questioning what ‘Burnout’ actually is. For clarity I will define this as follows:

Burnout is a syndrome of emotional exhaustion. Burnout has been defined by Maslach as a syndrome consisting of emotional exhaustion, depersonalization, negative thinking towards others and a reduced sense of personal accomplishment (Maslach, 1986, Maslach, 1996).

Moving on to depression:

“Depression is a common, disabling disorder characterized by a period of at least two weeks in which a person loses pleasure in nearly all activities and/or exhibits a depressed mood“(Stewart et al, 2004;19).

Symptoms of major depression include feelings of sadness and hopelessness, diminished pleasure, changes in weight, changes in sleep patterns, lack of interest in life, chronic fatigue, a sense of worthlessness or guilt, muddled thinking and poor decision making (APA, 2013).

Sadly depression can affect all areas of a persons life, and yes some of those with depression will die by suicide. However, the headlines seemingly suggest that depression is the cause of this ‘Murder’. It will not be the only cause of this tragedy, and nothing is confirmed as yet. It frightens me to think that these assumptions are coming up so thick and fast before the facts are known. This highlights to me the stigma still apparent and surfacing in the wake of fear.

We do not know all of the facts, perhaps Andreas dissociated from everything around him and any decisions he may have been making, perhaps this is something completely unrelated. Whatever happened, the headlines of this story are damaging and risk the reversal of any progress we have made in reducing stigma.

Some news companies are scaremongering and stating that nobody with depression should be allowed to fly a plane. This at least makes a change from them saying that all those with depression are ‘fit to work and lazy’ – but I digress.

This idea is ridiculous as those with mental health issues can achieve great things… remember 1 in 4??? Do we get rid of 1/4 of our pilots?

What if our pilots have a headache? what if they have a brain tumor? what if they have a seizure whilst in flight? – the ridiculous parodies may continue…

I was hoping this would get people talking about what can be done to support those in *potential* psychological distress in order to improve overall services, instead it has led to an immediate reaction of fear. I am hoping the long term story will be a different one.

American Psychological Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders (V) American Psychiatric Association, Washington, DC (2013)

Maslach C, Jackson SE. Maslach Burnout Inventory Manual, 2nd edn. Palo Alto (CA): Consulting Psychologists Press Inc; 1986.

Maslach, C Jackson, S Leiter, M, Schaufeli, W, Schwab, R (1996) MBI: The Maslach Burnout Inventory: Manual. Consulting Psychologists Press, Palo Alto (1996)

Stewart Donna ; Gucciardi Enza ; Grace Sherry (2004) Depression BMC Women’s Health, 2004, Vol.4(Suppl+1), p.S19

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Health Professionals who Die by Suicide – 5 Tips for Change


If the content of this post has affected you in any way, please visit the support page of this blog….

Yesterday was #NHSChangeDay, and I pledged to #StartTheConversation and raise awareness about health professionals who are in psychological distress. As it happens, @WeDocs conveniently hosted a  #WeDocs Tweetchat on preventing suicide in health care professional populations. It was great to see an issue I feel so passionate about being discussed, shared and given some much needed attention. This kind of innovative Twitter usage is one of the things I love about our NHS radicals!

Throughout the conversation, there were seemingly many people concerned and wanting to prevent clinician suicide, but not many solutions to prevention were put forward. -> See the chat summary here

A recent situational analysis into Suicide by clinicians involved in serious incidents in the NHS has identified the current support services available clinical staff, yet there is no consensus on how to effectively support clinical staff, and nobody has yet taken responsibility for the well being of NHS staff (Strobl et al, 2014). This has been further complicated by the fact that Clinicians often have difficulty in recognising symptoms and risk factors associated with their own suicidal behaviour (Goldney et al, 2002). Clinicians are at a higher risk of suicide than the general population, can be misunderstood and left unsupported whilst under immense pressure (Chan et al, 2014). The GMC have recently published a report in regards to a high rate of professionals dying by suicide whilst under investigation. A tragedy for all.

Psychological safety for NHS staff is critical for patient safety and every shiny new white paper will tell you this. But it is also critical for the NHS’s ‘ethical well being’ to care for it’s staff. If the NHS as an organization lets its staff suffer, how will it ever live with itself? The trauma will inevitably become endemic.

So what changes can we make to prevent suicide?

1. We could treat NHS staff as ‘innocent until proven guilty’ & eradicate ‘Name Blame and Shame’ Cultures.

2. Consider that poor behaviour may actually be ‘ill’ behaviour in need of medical treatment before disciplinary action takes place (Brooks et al, 2014).

3. Consider alternatives to discipline & create psychologically safe work cultures.

4.Expose investigation staff to front line clinical practice to understand organizational cultures and pressures.

5. Develop a tailor made national support programme for NHS staff which is confidential, anonymous and provides professional amnesty (The aim of my entire PhD research project)

Also… please keep the conversation going 🙂

Brooks, S, Del Busso, L, Chalder, T, Harvey, S ,Hatch, S, Hotopf, M, MadanHenderson, M (2014) ‘You feel you’ve been bad, not ill’: Sick doctors’ experiences of interactions with the General Medical Council BMJ Open 2014;Vol.4 (7) :e005537 doi:10.1136/bmjopen-2014-005537.

Chan, W., Batterham, P., Christensen, H., Galletly, C (2014) Suicide literacy, suicide stigma and help-seeking intentions in Australian medical students. Australas Psychiatry April 2014 vol. 22 no. 2 132-139

Goldney RD, Fisher LJ, Wilson DH (2002). Mental health literacy of those with major depression and suicidal ideation: an impediment to help seeking. Suicide Life Threat Behav 2002; 32: 394–403.

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Am I too late to the ‘NHS staff wellbeing research’ party?

I began this research journey because I saw an opportunity to make a positive contribution to the healthcare community (and gain a PhD)! I believed that NHS Staff wellbeing was an under researched and undervalued subject (and it is to a large extent). When I began my time at Coventry University, I presented my research proposal to a group of peers at the West Midlands Health Informantics Conference just before Christmas 2014. My ideas were met with enthusiastic conversations and praise for my work, people were excited that it was happening, it was ‘new’.

Then of course I begin to delve into the literature and start to see a plethora of papers and super duper academics who have introduced me to this wondrous world. I see TV snippets, twitter conversations, national and local conferences, action groups and new research on the topic. Am I too late to the party?

What I plan to do has never been done before, but I know that many people have had the same idea. Will it be a race to publish? I hope not. I hope I can find similar minded people to drive forward this positive movement forward, collectively. We should all be in this together, making change happen through collective leadership and a shared passion for the wellbeing of NHS staff. I do worry that I am not really contributing towards new knowledge, but I must keep focussed on the end goal (and beyond the PhD)!

The most refreshing thing is the open discussions being generated through twitter – The next one I will be involved with is on the 11th March, 2015 hosted by WeDocs using #WeDocs – Preventing suicide in NHS staff

This new research is inspiring and I would like to share it:

Wilkinson, M (2015) UK NHS staff: stressed, exhausted, burnt out. The Lancet Volume 385, No. 9971, p841–842, 7 

Sheen, K, Slade, P, Spiby, H (2014) An integrative review of the impact of indirect trauma exposure in health professionals and potential issues of salience for midwives. Journal of Advanced Nursing. Volume 70, Issue 4, pages 729–743, April 2014

Implementing culture change within the NHS: Contributions from Occupational Psychology