In 2022, the World Health Organization released the World Mental Health Report: Transforming Mental Health for All, which recognizes the critical importance of mental health to everyone, everywhere – including doctors and their families.
The consequences of the coronavirus disease 2019 (COVID-19) pandemic and other major issues such as climate change, global conflict, and economic downturns are continuing to have a big impact on the mental well-being of many parents and their children. Access to help is limited by serious challenges faced by our chaotic health systems, including the shortage of general practitioners (GPs) and other mental health professionals.
Doctors and their families, of course, are not immune from these universal problems.
When I worked as a GP in a youth-specific health clinic for nearly ten years, I researched and wrote extensively about the importance of authoritative parenting and parental mental health in promoting well-being in young people. Among my many memories of the clinic are the unwarranted despair, guilt, and shame of my medical colleagues when their adolescent children presented in crisis with depression, eating disorders, drug use and other addictions, self-harming behaviors, or suicidal thinking. Although these reactions were shared by non-doctor parents, my colleagues disproportionately blamed themselves for failing to recognize the impact of their work stress and their own mental health problems on their children.
The uncomfortable truth is that parental mental illness may have a negative impact on young people and children, but this common association should be seen as a catalyst to seek help rather than a cause for parental despair, guilt, and shame.
Further action is required to support doctors and their families.
Families with a medical parent also require more support, as many doctors have been subjected to abnormally demanding and unsafe work environments, long hours, high stress, and traumatic situations in the past few years and are currently at increased risk of mental health problems.
How can we tackle these complex and intractable problems?
As a profession, we can do more to ensure all doctors have timely access to evidence-based psychological and/or psychiatric treatment and to create psychologically safe health care workplaces. We can also ramp up our advocacy to encourage family-friendly health workplaces and greater work–life balance, flexible hours, and parental leave — not only for our own mental health but for the well-being of our families.
At an individual level, doctors can take proactive steps to prioritize advanced psychological protection and to seek early evidence-based treatment for burnout and mental injury.
At a family level, parents who work in highly stressful environments can protect the mental health of their children and adolescents by being proactive. As examples, here are some observations about expressing emotions and attitudes honestly and constructively, improving general mental health literacy, and role modeling early help-seeking behaviors.
Expressing emotions and attitudes honestly and constructively.
When young people are bombarded by images of a world in turmoil through social and other media, it is a normal response for them to feel overwhelmed, sad, confused, and angry. Why then do many adults avoid talking about vulnerability?
In relation to work stress, adults may try to be stoic, but children and adolescents intuitively know when parents are sad, distressed or traumatized. It can help to be aware that when we quietly ruminate about work at home, our children pick up on our emotional detachment. As one of my young patients reflected: “I live in an emotional desert at home and school. I look into people’s eyes to try to find some understanding and there’s nothing there.”
In my experience, young people usually respond positively if parents talk appropriately about navigating work stress in constructive ways, as well as what it means to have a loving family at home for support when external pressures are excessive. It also helps to talk openly to other colleagues about common parenting challenges with understanding — not unwarranted shame.
Unfortunately, the negative stigma surrounding mental illness in the medical community may inadvertently deter children from talking about this “taboo” topic.
“We thought he would diagnose us” was the explanation by my own children about why they had avoided a psychiatrist guest at our family home, which was surprising given my long-term interest in mental health. This experience helped me understand the importance of talking to children about the negative attitudes they may absorb from others about psychiatric illness.
Improving mental health literacy for all.
Mental health is universal and mental health literacy should not only be the domain of psychiatrists and GPs with a special interest.
With the increasing sub-specialisation of medicine, many doctors are at risk of failing to understand the importance of early comprehensive mental health assessment and specific evidence-based psychological treatments for effective recovery.
This quote by Dr. Vikram Patel, a prominent psychiatrist, and researcher, sums up the role of non-psychiatrists in promoting mental health for all by involving all: “Mental health is too precious to be left to psychiatrists alone. We believe that mental health is everybody’s business. And there is no health without mental health.”
Although self-diagnosis and self-management of mental illness are inappropriate and inadequate, everyone can benefit from improving their mental health literacy and knowing where to access high-quality mental health resources and mental health services for their families and themselves.
Role modeling early help-seeking.
There are many attitudinal barriers deterring mental health care access for doctors and their families. At one extreme, doctors may fail to seek medical or psychological help for their children for fear of being misjudged by their colleagues as overanxious. In contrast, they may bypass the wisdom of an independent GP to consult a specialist family friend, but this can prevent an adolescent from engaging with the chosen professional for fear parents will intrude when sensitive matters are discussed.
Family members of doctors seeking help also face the usual structural barriers that the general public faces in accessing mental health care.
Mental health services are currently swamped by the enormous unmet community need and waiting lists are excessive.
One of the most damaging experiences for young patients is to finally muster the courage to seek help, only to find there is a long wait or to be turned away by a GP, psychiatrist, mental health service, or emergency department.
To overcome these structural and attitudinal barriers, parents can role model early help-seeking behaviors and build trusting relationships with independent GPs (not friends or doctors in the same practice) for routine health matters, including preventive health screening and informal mental health screening when appropriate. When there is continuity of general health care by a GP, it is easier for adults and young people to seek early help and appropriate referral for any mental health concern.
A clarion call for further action
Unacceptably high levels of work-related mental health problems. persist in the medical profession for complex reasons, including the compromised psychological safety of health care workplaces.
Further action is also required to address this impact on doctors and their families. There are solutions.
If this opinion piece has triggered any discomfort or if a family member needs support, please make a long consultation with your independent and trusted GP or other mental health professional.
Leanne Rowe is a physician in Australia and is the co-author of Every Doctor.
