‘The Invisible Patient’ a report published by The Department of Health earlier this year highlighted the issue of the ‘health of health professionals’ and how both the service and the individual tend to overlook the health of doctors, nurses and other professionals.
The report also highlighted the high levels of drug, alcohol and mental health problems experienced by health care professionals. It estimated that 7% of doctors develop some form of drug or alcohol dependence in their career, and that health care professionals experience higher rates of depression and anxiety compared to other groups of workers.
George Williams talks to Dr Michelle Zandvoort from the Bayberry Clinic in Oxfordshire, a specialist residential service specifically for healthcare Professionals, about the causes, how it affects their work, and what special difficulties they have finding help.
Bayberry Clinic- ill Healthcare Professionals also deserve good quality care!
Dr Michelle Zandvoort- HPC Registered Psychologist and BPS Chartered Psychologist
In the recent paper by the Department of Health (March 2010- Invisible Patients) it was identified that there are higher rates of depression, stress, anxiety and substance misuse in health professionals than in any other groups of workers. NHS staff have very high rates of sickness and such absence can affect the delivery of services to patients. The cost of absence due to mental illness in the NHS costs £1.3 billion each year and stress related disorders alone cost £300-400 million a year. However, due to an overstretched NHS system illness in healthcare professionals may be overlooked and they often ignore their own illness.
In terms of drug and alcohol misuse the British Medical Association has estimated that 1 in 15 doctors (7%) could have some form of drug/alcohol dependence in their career suggesting 400-500 new cases every year. This is similar to the general population, however due to reluctance of Healthcare Professionals admitting illness and presenting to mainstream services the rate can be higher. Healthcare Professionals also seem to have a higher rate of prescription drug dependence due to access and knowledge of the effects (Hughes et al 1999). However, illicit drug use and alcohol abuse are increasing: A postal survey of hospital consultants reported 17% of respondents, more likely male, were drinking hazardous quantities of alcohol (Taylor, Graham, Potts, Candy, Richards, & Ramirez, 2007). A further survey of 18 NHS Trust hospitals found that over 60% of male and female junior house officers exceeding the recommended safe limits for alcohol, and 10% were drinking at hazardous levels (Birch, Ashton, & Kamali 2009). In terms of substance misuse a survey of junior doctors identified an increasing rate of illicit drug use (24% cannabis use, 8% other illicit drugs) (Newbury-Birch et al, 2001). Furthermore, about half of Healthcare Professionals that are alcohol or drug dependent also have a mental health difficulty such as depression and suicide rates are higher than in any other group of workers (Hawton et al, 2001; Meltzer et al, 2008).
A range of factors lead to the development of mental ill health and substance misuse among healthcare professionals and of these work-related stresses play a significant role. The Department of Health identified factors such as shift work, dysfunctional teams, low levels of support, excessive workload, staff shortages, funding cuts, an undue emphasis on budget and targets, low levels of support and the feelings of being poorly managed can increase vulnerability to mental health problems and substance misuse and dependency.
Despite the high level of mental ill health and substance misuse/dependency among Healthcare professionals they are generally very reluctant to access mainstream services due to a range of factors. These include factors such as stigma and fear of losing their occupation, difficulty recognizing and accepting illness within themselves, feelings of guilt for letting down patients, family and themselves, confidentiality concerns, and inappropriate treatment (National Clinical Assessment Service (NCAS) 2007, Department of Health 2010). Furthermore, seeking help is often viewed by healthcare professionals as weak and incompatible with their occupational identity and are thus mostly restricted to ‘corridor consultations’ and self-treatment. Colleagues are generally reluctant to intervene based on similar factors, wanting to help but not knowing how, and fear of being seen as a ‘whistle-blower’ and victimising the Healthcare Professional. However, it must not be forgotten that Healthcare Professionals are human first and foremost and in order for them to continue to function and ensure patient safety they also need good quality care and early intervention.
More specifically in terms of addiction, the rehabilitation of addicted Healthcare Professionals has better outcomes than punishment in most cases and is more cost-effective. It costs approximately between £100,000 and £250,000 to train a Healthcare Professional and up to £188,000 to suspend (National Audit Office, 2003). In contrast, specialist treatment costs an average of £10000-£21000, depending on need and length of residential treatment. Furthermore, outcomes from Healthcare Professional Treatment Programmes from North America have shown that 78% of treated Healthcare Professionals were in recovery and back in work (McLellan, et al. 2008). This is a significant outcome in comparison to 30% long term recovery rates in some UK mainstream services (Gross et al 2009).
Therefore providing similar specialist, confidential and quality care is essential to enable ill Healthcare Professionals to regain and maintain their well-being, return to work and in turn be able to continue to provide high quality care to their patients and ensure patient safety. Strengthening a caring, compassionate and rehabilitative approach to the vital members of our Health Care Service is crucial to their well-being and patient safety. Unhelpful attitudes towards ill Healthcare Professionals will only worsen the problem. The Department of Health specifically recommends the need for more specialist assessment and treatment services for Healthcare Professionals, particularly Mental Health and Addiction Services.
A confidential, specialist assessment and treatment service is what Bayberry Clinic provides; staffed by an expert clinical and medical team specialising in the issues specific to Healthcare Professionals and experienced in the treatment of addiction and mental health issues. The programme provides evidence-based treatment incorporating 12-Step Facilitation, Cognitive-Behavioural Therapy and Mindfulness training within a therapeutic community framework with five years aftercare. Bayberry Clinic opened its doors in April 2010 after receiving registration with the Care Quality Commission in February 2010. The team has since been raising awareness of the service to NHS Occupational Health Departments, Medical, Dentistry and Nursing Schools and Private Healthcare Services on how to identify and intervene effectively and compassionately with healthcare professionals struggling with substance misuse and co-occurring mental health difficulties.
For further information visit www.bayberryclinic.org.uk or contact a staff member on: 01869 32 1717 or 07880735256 or email firstname.lastname@example.org
All calls are dealt with in a confidential manner. Bayberry staff can provide advice and support to colleagues and family members of ill healthcare professionals.