Dr John Smyth is one of the Assistant Directors in the General Medical Council’s (GMC) fitness to practise department. For World Mental Health Day, John, a former GP, answers questions about doctors’ mental health and the role of the regulator.
What mental health challenges might doctors’ face?
Doctors aren’t immune to mental health problems, we’re as vulnerable and susceptible as anyone else. The fact that a doctor has a mental health condition isn’t what’s important to the GMC and it’s unusual for a purely mental health related matter to be opened as an investigation. It’s whether the condition affects a doctors ability to work safely, how they handle their condition and how they look after themselves.
For example, if a doctor is moderately depressed, anxious, or struggling with stress at work, then this need not stop them from doing their job. However, these conditions shouldn’t be taken lightly, and doctors should recognise when they are struggling and get help if they need it from their own GP or an occupational health advisor. If there is no risk to patients then there is no need for doctors with these symptoms to involve the regulator.
It’s no different if a doctor is suffering from a serious chronic, relapsing mental health problem. If a doctor is insightful, their condition is stable and they follow advice such as stopping work when particularly unwell or having a phased reintroduction, there is no reason for the regulator to be involved.
We are more likely to be concerned if a doctor shows a lack of insight around their condition, if they are in denial, their condition isn’t stable and it’s affecting the safety of patients.
How does mental health generally get presented to fitness to practise?
Most concerns about mental health come alongside something else, for example, misconduct or a performance issue. Occasionally, mental health conditions become apparent in the context of a criminal incident, such as drink driving or possession of drugs, when it is our statutory duty to investigate.
In these situations, a mental health condition may be declared, and we may do an assessment to see if this explained or contributed to the incident under investigation. We do need to consider if the mental health condition had an impact, but this doesn’t always mean we’ll need to take action in relation to the mental health condition itself.
Where possible, we would agree restrictions with the doctor that allowed them to continue working, usually with the engagement of a medical supervisor. Medical supervisors keep an eye on a doctor’s mental health, monitor progress and this arrangement can guide the doctor back to unrestricted practice.
What advice would you give to a doctor struggling with mental health?
The same that I would give to anybody who might be suffering from a mental health problem. Seek professional advice and support early. This could be via your GP, occupational health, or go to an organisation like Practitioner Health – who specialise in confidential support and advice for healthcare professionals.
Can you see why doctors might be nervous around disclosing their mental health problem?
Yes, of course I can, I completely understand why doctors feel that there is peril involved in disclosure. They might be worried about stigma, confidentiality, their reputation, and professional advancement. Doctors also fear it will lead to involvement with the GMC and potentially affect their career. But this is rarely the case.
Has the GMC improved its support for doctors with mental health problems who are under investigation?
Yes. Since I started at the GMC, 15 years ago, I have seen big improvements in support for doctors. One big step was appointing psychiatrist Professor Louis Appleby, an independent expert, to advise us on reducing the stress of an investigation in 2015.
We implemented all of Professor Appleby’s recommendations and tried to put ourselves in the shoes of doctors under investigation. We looked at ways of acting more compassionately and provided training to all our staff, to help them recognise when a doctor might be vulnerable. We changed how we communicated with doctors under investigation and introduced a specific team to deal with doctors thought to be vulnerable. We assessed the impact each step of the investigation process could have.
There was also a gap in the emotional support available for doctors. So, we commissioned the BMA to create the independent Doctor Support Service. This service is separate to the GMC, is confidential, staffed by fellow medics, and supports doctors going through fitness to practise procedures. You don’t have to be a BMA member to access this service.
What is the regulator aiming for with a doctor who has mental health problems?
As a regulator we’re certainly not here to ‘punish’ doctors for being unwell or to make the situation worse – we only act in relation to mental health where there is a risk to public confidence or patient safety. We are fully aware that being under investigation doesn’t help someone already in distress.
When a doctor is under investigation, and there are concerns about their mental health, we are aiming to understand if the mental health problem affects the doctor’s fitness to practise. This doesn’t mean we’ll need to act in all mental health cases. If action is required we aim is to agree restrictions, including period of medical supervision as part of the undertakings.
Most doctors are more insightful, having engaged with treatment and their mental health problem is stable. Our hope is that the work restrictions are eventually removed, and the doctor returns to unrestricted practise.
What would you say to a doctor who is too worried to do anything about their mental health?
If you think that you need help with your mental health – show yourself the same care you would anyone else. Make a proper appointment. Like any patient you are entitled to confidentiality. Get any help you need at an early stage.
Also, according to Good medical practice, the GMC’s guide to being a good doctor, doctors must support colleagues who have problems with their performance or health. Keep an eye out for colleagues. We aren’t always aware when we are becoming ill with mental health.