Introduction to the wellbeing committee
The last few years have been extremely challenging for all healthcare professionals, the importance of good well-being has never been more of a priority for the NHS workforce.
Good well-being is multi-faceted and involves things such as:
- Access to support services
- Positive and productive senior support with investment in well-being
- Active involvement of the workforce in feedback, service and hospital development
- Access to basic necessities 24/7
- Fatigue friendly rotas
- Access to flexible working opportunities
- Induction processes in place, access to IT
- Support attending teaching opportunities, uninterrupted breaks
We are keen to support any projects across London working to improve well-being for psychiatry trainees. Below are some of the things we have been working on as well as how to access support If you need to.
Please get in touch with your ideas, projects and experiences. We are also looking for keen people who might want to work on and update our webpage.
Wellbeing days/conference
By Mary Thornton (ST5 general adult trainee)
2022 saw the return of face-to-face meetings and we took the opportunity to organise a well-being day in July, during the peak of the summer heatwave! We had sessions on mindful-self compassion run by Dr Biswas, trainee health by Dr Ahmed and the importance of balancing training with other activities by Dr Ashby (who came with her little new born as honorary guest).
We had a session on becoming a writer, including an exciting reading from his new book ‘You don’t have to be mad to work here’ by Dr Waterhouse. The morning was then rounded off by Dr Rupal with the utilisation of yoga in well-being and psychiatry.
The afternoon included some brilliant trainee presentations and we then all took part in three workshops on blackout poetry run by Daniel Regan, writing music by Raw Sounds and grounding photography and drawing by Fern Denyer. We finished the day with a picnic in Russel Square.
The feedback from trainees was more, more more…… So with this in mind we are planning a half day in February 2023 and then a full day of well-being in September so watch this space!
London Wellbeing committee for Psychiatry Chair:
Dr Rowena Carter, ST7 Dual General and Old age psychiatry
Neurodiversity
By Dr. Anna Sri (ST2 Psychiatry core trainee)
A survey had identified that 1% of general practitioners and 1.1% of psychiatrists identified as autistic. Alongside general UK population figures of 1.1%, at least 3000 UK doctors may be autistic. Attention deficit hyperactivity disorder (ADHD) affects 2% of UK adults, and is often not diagnosed until adulthood. Overall, there are more neurodiverse doctors in the UK, but they are not recognised due to challenges once they come forward about their diagnoses.
We are aware that by increasing diversity in medical education and in recruitments of doctors, it would equate to substantially improved outcomes for patients. However, there is limited evidence on the support and understanding of neurodiverse doctors in their training, as well as educating the trainers of these doctors with challenges.
As a result, a lot of neurodiverse doctors are faced with having to leave training programmes (whether by choice or failing ARCP) and are trapped in a mental crossroad on whether they should leave medicine altogether. There are doctors who are afraid to enquire about diagnosis or are afraid to be open about their neurodiverse challenges, due to fear of being singled out as “doctor in difficulty…despite adequate support”.
The support given might not have been adequate at all if the trainers are not equipped with the understanding and support to train neurodiverse doctors.
The Gold Standards that are used to create the curriculums of the training programmes were possibly created without the input of those with knowledge of neurodiverse characteristics. Therefore, the measurements to achieve these standards may not be suitable and fair if neurodiverse doctors are being measured against standards of non-neurodiverse doctors.
It is to be considered how the learning environment can be improved to not only help neurodiverse doctors reach their potential but retain neurodiverse doctors in the training programmes that are suitable for them. This includes increasing the diversity of senior role models, using a cognitive apprenticeship model, employing teaching strategies which allow neurodiverse doctors to elaborate their individual thought processes during clinical practice, and providing timely feedback.
Neurodiverse doctors can seek assurance and guidance through established groups tailored for neurodiversity in medicine:
1. Autistic Doctors International (Twitter: @DoctorsAutistic)
2. AND – Association of Neurodiverse Doctors ( Twitter: @Divergent_Docs)
3. Neurodivergent Doctor (https://neurodivergentdoctor.com/ )
4. Bridging the Divide – Tigger Pritchard, Neurodivergent Mentor, Consultant, Advocate and Trainer (https://www.tiggertraining.com/ )
Current support for diagnosis, treatment and therapy for neurodiverse doctors requires 4 -6 years waiting list under NHS, which could be impacting on the doctors’ current training. Therefore, neurodiverse doctors seeking help are resorting to seek help privately, but only a few are so fortunate to do so.
For managing mental distress, neurodiverse doctors are seeking support under Occupational Health, NHS Practitioner Health and BMA Wellbeing. This will only solve managing mental health crises, whilst awaiting diagnoses and treatment.
If any doctors are finding themselves in critical situations and are unable to keep themselves safe, please seek support via Mental Health Crisis Helplines:
Maternity provision
Dr Christina Huggins (ST4 Psychiatry of Intellectual Disabilities)
Christina.huggins@swlstg.nhs.uk
I am in the process of setting up a New and Expectant Parents Group in South West London & St. George’s Mental Health NHS Trust. The aim of this group will be to support doctors within the trust who are pregnant, or planning pregnancy, to navigate maternity/parental pay and leave, including liaising with HR. In addition, the group will support doctors with risk assessment and making adjustments to their jobs and on call commitments whilst pregnant, if needed, and provide a support network of doctors going through similar issues. It will raise awareness of resources to support their wellbeing during pregnancy and their return to work after maternity leave. This may include application to Health Education England for funding from SuppoRTT (Supported Return to Training – SuppoRTT | Health Education England (hee.nhs.uk)), for example to enable a period of supernumerary shifts following return from maternity leave. It is my hope that this group will support doctors at what is a potentially stressful and vulnerable time, and make the transitions to parenthood and back to work smoother and more fulfilling.
Please don’t hesitate to get in touch if you have any questions or ideas about this group!
Sexual violence
Joanna Butler (ST2 psychiatry core trainee) and Fiona Huang (ST2 psychiatry core trainee)
Sexual harassment, from both colleagues and patients, is sadly common in the healthcare workplace. A 2021 BMA survey fsound that 91% of women doctors in the UK have experienced sexism at work, with 31% of women respondents experiencing unwanted physical conduct in the workplace, and 56% experiencing unwanted verbal conduct (1). Unfortunately, patients are a common source of gender-based discrimination towards medical trainees (2).
In psychiatry it can be challenging to confront patients displaying prejudiced behaviour or attitudes, due to their vulnerability and the risk of compromising compassionate care. Nonetheless, sexual harassment in the workplace can lead to poor clinician mental health, burnout and stress. This can have a knock-on impact on the individual’s career, as well as patient care (3). Institutional training often overlooks guidance on managing sexual harassment from patients, and formal reporting procedures often do not account for more common forms of discrimination such as inappropriate sexual remarks and gender-based microaggressions (2). I feel strongly that this gap in our training needs to be addressed, and that mental health trusts have a responsibility to provide training on how to recognise and respond to patient initiated-verbal sexual harassment.
To gain an understanding of the scope of the problem at SlaM, a trainee colleague and I adapted and disseminated a survey to staff asking about their experiences of patient-initiated verbal sexual harassment in the workplace. Unsurprisingly, we found that this is a big problem at SlaM with staff reporting many 100’s of incidents of personal and witnessed patient-initiated verbal sexual harassment. In the qualitative responses, respondents raise that there is a culture of passivity and a degree of acceptance that mental health staff will be verbally sexually harassed by patients at work. There appears to be low levels of reporting, due to poor confidence that the report would be actioned.
Using the information collected in the survey, we plan to present our findings to senior management and different clinical teams to raise the awareness of the problem. We then hope to work with the simulation team to develop a new training module which will better equip mental healthcare staff to recognise and respond to patient initiated verbal sexual-harassment. Watch this space!
(If you are interested in find out more about the project or discussing how it might be implemented in your own trust, feel free to get in touch by emailing joanne.butler@slam.nhs.uk ).
If you would like to seek support for the issues raised by this piece, please see the following resources:
- RCPsych Support Services: 020 8618 4020, pss@rcpsych.ac.uk
- BMA free and confidential 24/7 counselling and peer support: 0330 123 1245
- NHS wellbeing hub: https://www.england.nhs.uk/supporting-our-nhs-people/ - Surviving in Scrubs: giving a voice to women and non-binary survivors in healthcare to raise awareness and end sexism, sexual harassment, and sexual assault in healthcare.
- If you are feeling acutely distressed, please contact NHS on 111 or attend A&E
References:
1. BMA Sexism in medicine report, https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/gender-equality-in-medicine/sexism-in-medicine-report
2. Hock, L.E. et al (2021). Tools for Responding to Patient-Initiated Verbal Sexual Harassment: A workshop for Trainees and Faculty. https://doi.org/10.15766/mep_2374-8265.11096
3. One in five doctors have experienced or witnessed sexual harassment in the past three years, survey finds. BMJ 2019;367:l5805. Doi: https://doi.org/10.1136/bmj.l5805
Anti-stigma campaign
Please find a link to an Anti-Stigma Campaign that focuses on health Care professions who live with Mental Illness.
https://www.cnwl.nhs.uk/news/stamp-out-stigma-sos-bring-your-story-work
Getting support:
