Stress, anxiety and depression in the NHS, hidden in plain sight?
So, for all the right reasons, you wanted to be a Doctor, Nurse, or maybe an NHS Psychologist……
A few years ago a doctor working in a hospital nearby to the practice I ran, called me and asked if I had any free space for an initial appointment, they were a little nervous about seeing a counsellor or therapist. They asked a few questions, one of which was 'Have you ever treated a doctor before?'. My reply was that I was treating three at that time, I got the impression that they where a little taken aback.
Even though I was already aware that doctors and other NHS professionals have a 'Be Strong' element to the way they are, the unconscious assumption that I may not previously have treated a doctor surprised me. There is an expectation within the profession, it seems, that medical personnel will have endless reserves of resilience and stamina, and seeing a counsellor or therapist would be unusual.
What Factors Can Exacerbate Stress, Anxiety or Depression?
Factors that contribute to the title question, at least in my experience from talking with clients, are long hours, mixed with impossibly high self-expectations and a constant drive to provide an excellence of service with often limited resources. Combined with a relentless need from inside and outside for perfectionism, these factors can have a detrimental effect on emotional and physical wellbeing. Impostor Syndrome is sometimes present, and the hierarchical system can add to this so even quite senior staff can feel reduced or unqualified.
My clients tell me that these demands often result in stress and anxiety type symptoms or sometimes low morale. As with all workplaces, the usual suspects of challenging colleagues and personal conflicts are present in the NHS. This blog though is more about the additional, and sometimes unique challenges of working for the NHS in the UK, training rotations, repeatedly having to get used to new people and systems are examples of workplace conditions that rarely exist in other jobs.
As a note, I can't remember a time when I WASN'T treating at least one NHS doctor, as I write this, I am assisting five. Although I do very much enjoy working with NHS personnel, I am but one practitioner of many, so I wonder how many NHS personnel seek help without sharing it.
Interestingly I have on occasion treated colleagues working within the same department, with each one believing they are the 'Snowflake' of that department and the only one struggling to manage. While support within the NHS is often better than in other places of work, I am struck by the juxtaposition of how hard-working NHS staff promote wellbeing, while sometimes at least, hiding personal suffering. It is easy to form the impression that no one else is struggling, and that one should be dealing with 'your problems' better, this can sometimes lead to feelings of inadequacy, isolation and depression.
There is a, sometimes Media led, general attitude that doctors should do ever more and more for the patients they see, to be a ministering Angel with all the answers each time with every patient. Mixed with a juxtaposition, again often media-led, of 'Those doctors they don't know what they are doing', this creates a tension of expectation, passive and sometimes overt aggression that many doctors, especially those in critical areas, have sometimes to navigate.
Personal Factors in Choosing a Medical Career.
It seems that there is an underlying drivenness, and a desire to help others, mixed with a lack of compassion for self that plays a part in some peoples choice of a caring career path. For medical personnel who are reflectors, are carrying unhealed wounds from the past or are more sensitive to external events than the average, this can lead to a tough journey through training and career.
Workplace and external pressures and how they are met and supported with, are only part of the picture, though. Medical personnel choose their career for many reasons, and I have spoken with many a doctor who is the proverbial 'square peg in a square hole' and very content with their work. So it is important to acknowledge here that there are, of course, many doctors and others within the organisation who deal with personal challenges, the stresses and requirements of the job in their own ways, which is excellent for them. Of course, they seldom need to come into my office.
Doctors Are People!
While they tend to be high functioning individuals, there are NHS staff who are sometimes dealing with complex personal histories, the minor to moderate to severe psychological conditions from which people often suffer, complicated personal relationships or recovering from the same. It has been noted, there is no cure for being human, so I aim to assist people in making their journey through life one of as much quality as possible.
CBT based treatments for anxiety, 'irrational' thoughts, depression and dealing with organisational stresses and negotiating colleagues idiosyncrasies, is often useful and effective. For treatment that is about the whole person, or for ongoing and continued health and improved relationships, or when CBT or focused treatments don't work or appeal, then other forms of treatment can be considered.
Seeking Help.
As NHS professionals, you have the needs, desires and baggage that the rest of us carry, and you will sometimes need counselling, occasionally therapy and of course workplace and social support just the same. There are different routes to support an NHS professional can take, and there are options of peer support or access to in-house psychological services. My impression is the NHS support network is pretty good when it fits the need, and one feels it is ok to reach out for it in house.
With deeper-seated troubles, reoccurring 'Hamster Wheel' experiences or dealing with problematic self/other relationships, then longer-term or experienced supportive/psychodynamic treatment can also be beneficial.
Doctors and other NHS staff tend to work long hours and have shift patterns that can change at short notice, finding an appointment with a counsellor, at least a well-regarded one, can be difficult. As I work with doctors often and do not overburden myself with high client numbers at this stage in my career, I can reasonably comfortably accommodate shift patterns.
Conclusion.
I put forward the question, are stress, anxiety and depression a problem hidden in plain sight within the NHS, my conclusion, and I appreciate others may differ in their views, is that it is not so hidden as it would seem. For various reasons, including the public's anxieties about putting our health in another's all too human hands, and constant departmental demands, I believe the public and sometimes the medical profession often see but don't always want to acknowledge the problem. The NHS has to carry on regardless no matter what pressures they face, as we are currently, very starkly, experiencing.
Footnote.
I appreciate this is a snapshot view and so does not reflect many of the areas where the NHS runs very well indeed. I am most definitely living on extra time and would not be alive now if it wasn't for the skill, dedication and proactiveness of quite a few NHS Doctors, Nurses and Support Staff. To you, especially those in Clatterbridge, Arrowe Park and Guy's Hospitals I express my gratitude that you were there, like ships in the night, passing by to keep me off some potentially fatal rocks. Partially because of that, I am passionate about playing my part in return in helping with the wellbeing of Medical Practitioners, who sometimes pay a high price for their dedication.
About Peter:
Peter Banczyk is a professional Counsellor and Psychotherapist, having been the Director of The Liverpool Centre for Counselling and Psychotherapy for 22 years. Relocating in 2018, he is now living on the small island of Westray in Orkney, continuing to provide treatment to clients from around the world via video-link.
Website: https://www.my-onlinepsychotherapy.com/blog
© Peter Banczyk January 2020