As a psychiatrist I am not so sure about public disclosures of mental illness.
Today is #RUOK day. It’s also a week where two of the top headlines in media have some sort of personal and professional significance to me. A famous AFL player asks for leave because of ‘mental health concerns’. And the Royal Australasian College of Surgeons (RACS) admits to widespread bullying and harassment of its members by members.
Why do both these topics hit a sweet spot? Well, both highlight the point that society functions better when we adopt the approach ‘do as I say not as I do’. In both instances, the message is the same. Don’t tolerate what is bad behaviour, don’t tolerate stigma, and practice open disclosure if you are struggling.
As a psychiatrist who works with patients with psychiatric illness every day, I know more than many the personal impact of mental illness on the lives of those experiencing it. That’s why I strive so hard to manage my patients and advocate for their rights and wellbeing. Why I focus on recovery. Why I care. Because I know that mental illness is common and treatable.
So what has got me feeling like I live in a parallel universe? It’s the imbalance of the strong public health messages such as asking ‘R U Ok?’, and the real life situation for many victims and patients who feel they have no voice or no audience. Because they have practical, tangible reasons to keep silent.
So, this week Lance Franklin has been given leave from his professional career as an AFL footballer as he is struggling with something. As he should. What I disagree with is the notion that one is brave only because they speak up and ask for help in a very public way.
I have seen many patients who have disclosed to their employers that they have a mental illness. Patients who need to see me and need a medical certificate to substantiate their whereabouts away from the office. Patients who are actively managing their mental illness and getting better. I have seen the same patients become victims to harassment in the workplace, and I have been placed in the untenable position of providing reports to validate that my patients are ‘safe’ to be at work. When I am not the employer but the treating doctor and confidante. Some of these patients actually work for organisations that donate large sums of money to organisations that work to reduce the stigma of mental illness. Hence the parallel universe.
In one tragic example, an organisation knew an employee was seeing me because my name and contact details were on a medical certificate I provided. They contacted me ‘as a courtesy’ prior to sacking the employee to ensure that they made attempts to keep the employee safe after breaking bad news. Without the employee, my patient, knowing anything about it. I knew the patient was to be sacked before they did. I was placed in an impossible situation, and was furious at the way the matter was handled. On numerous occasions I have been asked to be involved in workplace assessments if a patient of mine is recovering from an episode of mental illness and returning to work in a graduated manner. Very quickly, reports turn into assessments of competency and performance. My role shifts between keeping my patient from relapsing or suffering untoward as a result of these behaviours and explaining to employers why I will not compromise patient confidentiality. In some difficult cases, my notes are subpoenaed and confidentiality is broken anyway.
So, see why the public health message does not add up to the real life experience? Although everybody knows what is the correct way to act. That is, ask for help if you need it. Of course I agree because I know help is available and is lifesaving. I just really implore people to be careful who they are telling.
This year has also shone light on the impact of mandatory reporting of impaired doctors and doctors asking for help. New AHPRA guidelines outline that doctors must be reported to our regulatory body if one suspects they are practicing whilst impaired, thus placing the public at risk. Doctors are under intense scrutiny to prove they are competent to work, as they should be as health professionals. Yet they endure monitoring from both their employers and the regulatory body, AHPRA. There is data emerging that this will only serve to drive doctors who are suffering underground, away from care that will help them. As a doctor that treats doctors I know this is a defining factor in whether or not to tell anybody you are struggling.
And now RACS have been shown up to harbour bullies within their ranks, at a rate that would close down any other organisation overnight. We doctors are not surprised. We all have scars from the misuse of power whilst training whether it be from surgeons or senior members of other disciplines. Hopefully RACS will choose to ‘do what it does not what it says’ and out the bullies, rather than asking trainees to speak up. They have enough knowledge and information now after all, and can no longer pretend to be ignorant of these cases.
I know if had done the ‘right thing’ during my psychiatry training and spoken up about bullying, I would not be a psychiatrist today. The bullies do determine your fate.
So, how do I feel about campaigns such as #RUOK in the light of recent events? It would be lovely to believe that we exist in a world where stigma about mental illness can be overcome. That we can move from choosing celebrities as role models to accepting that 1 in 5 people go through an episode of mental illness. That it is just as much of society as is the common cold. That bullies can be exposed and dealt with by organisations with more power than an individual. That people can speak up about having a mental illness or being bullied without retribution but instead complete compassion. I will continue to try and traverse both universes, yes I will continue to ask my patients, colleagues and friends if they’re OK beyond today.
But I will offer the sage advice based on experience and my own journey;
Ask for help because you deserve it and it is waiting for you. Ask because you only have one crack at a rich fulfilling life. Just seek out the right people to tell. They are waiting. And ask in a way so you feel empowered, safe and above all, cared for.
Dr Helen Schultz is a psychiatrist in Richmond, Melbourne, Australia, and author of “How Shrinks Think”.