Reviving hope for Doctors battling mental health issues: Dr Achal & Dr. Shailesh explain
M3 India Newsdesk Jul 03, 2018
Dr. Achal Bhagat, a noted Psychiatrist and Chairperson, Saarthak and AADI along with Dr. Shailesh Jha, also an accomplished Psychiatrist highlight the rising mental health issues among the medical fraternity in India and suggest what doctors, policymakers, and professional associations can do to address this.This is a part of the special articles for this week as we continue to celebrate Doctors' day.
Everyone kept whispering, “Why?”, and the whispers remained unanswered. “Why? If only I knew… He never told us…” “How can a doctor do it?” “We are resourceful.” “We are brave!” “Was that the only way to overcome miseries?”
As the crowds stood around, some of us reassured ourselves that we would not ever do ‘it’ and some of us remembered how close we came to ‘it’. Some others wondered about the futility of life. Some were angry about the thanklessness of the jobs we do.
Another untold story of another doctor was lost in the hushed silences of committees and reports. Beyond mourning, the whispers remained unanswered!
We write today about the taboo of suicide amongst doctors, because we too have been whispering witnesses, numbed by our inability to make sense of the loss. We too have cried in silence. We too have mourned our young ones and our friends. We too have been sad. And, unfortunately, we have mourned and then we have moved on without doing much.
How does a medical student learn about suicide? Probably, from descriptions in “forensic medicine” and media coverage of such event. How do you empathise with a person who wants to attempt suicide, when all you know about such a person is how to differentiate the suicidal hanging knot from a murder knot? What happens when the closest you have come to thinking about causes of suicide in your everyday life is the time when you heard the news anchor shout, “is it suicide or is it murder?”
As doctors, we are as ill-informed about the anatomy of suicide as all lay people.
Myths about suicide
Let us first address the myths about suicide. If we introspect, we will recognise when it comes to myths about mental health, mental illness or suicide, there is not much difference in the opinion that we hold as medical professionals and those held by lay people.
Myth 1: First, “suicide is an isolated occurrence which happens rarely amongst doctors”.
Reality: Every month we come across such heart-breaking stories about suicide among doctors. Doctors are not immune to being suicidal. In the last month, there were 5 headlines where doctors or medical students committed suicide. In a recent online survey conducted by Department of Psychiatry at PGIMER Chandigarh, which was published in Indian Journal of Psychiatry, it was reported that 30% doctors are suffering from depression while 17% even thought of committing suicide. This is not any different than other young professionals being depressed or committing suicide. The suicide rates amongst the young are rising in India. The numbers from the National Crime Records Bureau imply that there is a death by suicide every three minutes.
Myth 2: Suicide is an “unwanted, unacceptable and forbidden event” which is resorted to by those who are “emotionally weak, incapable or with low intelligence.”
Reality: Without glamourising suicide, it is important to recognise that it is a considered decision. It is a process wherein a person feels hopeless, and even in the face of this hopelessness, plans and thinks through the act in details. The person weighs the pros and cons, and often, he/she can stop himself/herself because of the insight that the negative impacts of suicide outweigh the possible solution it provides. Some people do lose the battle of hopelessness. However, we need to recognise that suicide is not inevitable.
Myth 3: Talking about suicide may suggest it as a solution to people and may precipitate someone to attempt it.
Reality: On the contrary, talking about suicide and exploring the risk is the obvious first step to decrease the risk of suicide. If you do not explore the risk, you will not have any chance of decreasing it. It is a part of mental health basics to explore suicidal ideas and intent, rather than ignore it.
Myth 4: Suicide is a crime or suicide is a personal choice.
Reality: These two myths are two sides of the same coin. Suicide is neither a crime nor is it a matter of personal choice. Suicide is a public health emergency. It is no more a crime or personal choice than Diabetes, Hypertension or HIV/ AIDS. It requires a public health and aware policy response, as it causes a significant loss of human capital in a society.
What contributes to suicide?
Suicide has many social determinants, including poverty, substance use, gender roles, discrimination, but most of these determinants are operationalised into the stark reality of suicide through the impact on a person’s mental health. Let us return to the rising incidence of medical professionals attempting and completing suicide. What contributes to it?
Rising stress
There is no denying that doctors are stressed. We all know that there is huge pressure and mounting expectations, especially among the young medical professionals. We join this profession where we are meant to ignore our needs, work selflessly for the society, and at the same time climb the ladder of material success, drive the same cars, send children to the same schools, wear the same clothes, and even the same perfumes as others at our age.
We are confused about our identities and worried about loss of our dignity most of the time. We are also not immune to other life crises like familial, marital, financial and own physical health issues like anyone else. The added personal life stressors coupled with our professional context and commitments sometime makes life unbearable.
This unbearable situation is sometimes the breaking point for some of us. This ‘breakdown’ is understood and handled differently by individuals. Sometimes it can lead to serious mental health issues and suicide is one of the most significant outcomes of unrecognised and untreated mental health problems.
The stigma and invisibilities of Mental Health
If you see the launch advertisements of new hospitals, you will find that many a time these do not even list the Department of Psychiatry as a service.
While it is well known that mental health problems form nearly 40% of a physician’s client load, medical education programs in India only offer a 15-day optional posting in Psychiatry.
When we meet someone with a mental health problem, we discriminate and isolate the person at worst, and at best we pity or sympathise. When a colleague gets diagnosed with cancer we stand by him/her as rocks of support. When the same person is depressed we block them on our phones!
Lack of access to mental health services and untreated psychiatric disorders
The decaying public health system does not attract investment from the state, and hence, cannot provide employment to most professionals. The burgeoning private sector is competitive and labelled ‘corrupt’.
It is difficult for medical professionals to access confidential mental health services. Services which cater specifically to medical professionals simply do not exist, not even in tertiary institutes. If a doctor accesses the mental health service provided by his/her own work place there is a risk of being labelled, which stops most people from seeking help.
What are the solutions?
Is it possible for a society to reach out to people who are thinking about suicide before they attempt it with a fatal or a non-fatal end? Is it possible for a person to be offered support? Is it possible to help a person step back and see at least a speck of hope to explore alternatives and choices one more time? The answer is a clear ‘yes’.
What can we do?
Are we aware? Are we sensitive? Are we skilled enough to provide support to our friends and colleagues in distress?
We often fail to prevent suicide within our own professional circles. We find it difficult to discuss mental health issues or risk of suicide due to the fear of hurting someone, being misunderstood, getting marginalised or being stigmatised for offering help. Our “friend at risk” remains silently suffering and invisible. We cannot wait for changes in the law or development of a policy. We all must try and inform and skill ourselves to respond to people experiencing psychological distress.
Here are a few things one can do:
- Start by creating space for conversations in your relationships. Do not judge people or force your opinions on them. Just listen and validate the person’s experiences.
- Learn to recognise symptoms of psychological distress and illness. If someone tells you that they are sad or feeling hopeless, do take them seriously. If they have lost interest, if they are not able to enjoy anything, if they have become withdrawn or if they are extremely anxious, recognise these as features of depression, which if treated early, will prevent suicidal thoughts.
- Do not just ask a depressed person to ‘pull up their socks’ and live. It is the last thing the person wants to hear. Listen, reassure them that you will support them, and then you must explore if they have had thoughts of harming themselves. Have they attempted self-harm in the past? If they have, it increases the likelihood that they might attempt it again. Also, remember, if the person is intoxicated, it is more likely that he/she would attempt suicide.
- Do not patronise. Do not make the person feel guilty. Be with the person. Sometimes you do not have to do anything except patiently being with person while he/she is able to gradually overcome the overwhelming thoughts. Your words have power; do not use them in a trivial manner. Sometimes sensitive silence is better than goading. Help people navigate their problems without imposing a solution on them.
- If you feel overwhelmed by the process of supporting someone, do not put on a brave face. Involve other people, share the responsibility of caring. Most large cities have volunteer organisations that provide phone-based support to people in distress. Most medical colleges have departments of psychiatry and most district headquarters have psychiatrists in private practice.
- If you cannot find a mental health professional, approach any system that provides support to people, such as family, the resident doctors’ association, the police, the local medical association etc.
- If you are in a leadership position, help design a process through your local doctors’ association which enables seeking and providing help to those in distress.
What can the policy makers and professional associations do?
Policy on medical education needs to be aware that medical education, the way it is structured today leads to disempowerment and deselection of those who want to be doctors. The lack of parity between mental health and health stigmatises the process of seeking help. The traditional teaching practices and ways of research and ways of learning create a ‘feudal hierarchy’ in the profession.
The healthcare policies and systems need to encourage work life balance, financial support for new entrants in practice and well-defined standards of care so that doctors are not judged arbitrarily. Doctors also need protection from violence by users of health service, mentoring and buddy programs in medical colleges. The policy and professional associations together need to consider starting comprehensive free mental health services for the medical professionals.
Looking after yourself!
How does an individual who is considering suicide as an option help himself/ herself? Let me address you directly and urge you to seek help immediately.
- First, it is important to remember that there are many people who did step back and live and were able to be hopeful one more time. People are resilient, and people do survive. You are resilient, and you can survive!
- Step back for a moment. Talk to someone. It could be a friend, a colleague, a family member, a counsellor, a teacher, a spiritual person, or any other person that you may have access to.
- You have a right to live. Plan the next hour to be with someone or talk to someone. Then with his or her help, plan the next twenty-four hours. Include the step of seeking professional help in the plan. If you are already seeing a mental health professional, reach out to him/her.
- During this time, do not attempt to solve all your problems or even answer the question as to why you should live. Just let someone know how you feel and be with them. No decisions need to be taken. Each passing moment will give you a breather and then you will be able to look at your experiences and problems afresh.
For those of you reading who are not in a crisis, remember, all of us need to look after our mental health! It is imperative. Here is how you can start!
Acknowledging your feelings and thoughts
You need to understand yourself better by learning to recognise the patterns of situations that distress you. Then you can learn to reflect on the patterns of your thinking in these situations.
You could reflect by writing a journal or even a text message to yourself at the end of every day. At the end of every day, ask yourself, “How did I feel through the day? What were my thoughts?”
Over a period of time, you will realise that there is a pattern in your thoughts. Some people generalise, some people think of only catastrophic outcomes, some of us personalise, many of us selectively look at what we cannot do or have not been able to do.
What are your thinking patterns? Are they helpful? If they are not, seek help to challenge and change them. Try the following:
- Create time for physical activity
- Eat well
- Sleep well
- Talk to and be with people whom you love and trust
- Talk not only about your problems, but also about ordinary experiences
- Listen to people
- Do not commit to additional work if you do not have time or resources
- Remind yourself, it is all right to change your mind even if you have committed to something that you cannot do
- Address unhelpful habits like smoking and alcohol
- Question the purpose of your anger and whether it is a helpful strategy
- Experience new things and enjoy
Look out for warning signs
There are a few signs you should never ignore, should you happen to start noticing them on a regular basis. These are:
- You feel sad or worry too much
- You withdraw from every day activities or avoid certain situations
- You are angry and irritable
- Your sleep and appetite are disturbed
- You have lost interest and are not able to enjoy
- You are suspicious
- You do repetitive actions and repetitive thoughts
- You have habits which are likely to harm your health
- You face violence or abuse
If you notice and acknowledge the presence of these signs in yourself; seek help! It is all right and brave to do so. Take Care!
Disclaimer- The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of M3 India.
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