It’s okay not to be okay
There are lessons to be learned from the experiences of a GP who discusses the escalation of occupational burnout.
It’s a term not yet officially recognised but an experience some clinicians may have encountered during their careers.
Human feelings and behaviours relating to work experiences have become a more common conversation in the past two years, as a global pandemic affects healthcare professionals on a personal level.
Some professionals, however, have had a longer commitment to coping with the workplace phenomenon of burnout and ensuing mental health issues.
Six years ago Dr Owen Harris was working in a busy medical practice.
What started as occupational burnout—‘Honestly, I was just working too much’—escalated to drug use to ‘self-medicate and cope’ and the loss of his job.
Eventually he was diagnosed with depression and anxiety.
‘There was a culmination of factors, including a relationship break-up, family issues, poor physical health and overwork,’ he says about what sparked his initial decline.
‘Work wasn’t the primary factor for my mental health suffering, but it definitely was a big part of it.
Without better ways of coping with my life and the work, I ended up with a significant substance-use issue.
The real problem was that I knew I needed help, but I was too scared to reach out because of my fear of the consequences.
So basically, things just got worse and worse until my business partners realised something was going on and I was forced to come clean to them.’
Owen was reported to the Australian Health Practitioner Regulation Agency (Ahpra), the governing body that sets the standards medical practitioners must meet and manages complaints and concerns (notifications) about their health, conduct or performance.
Ahpra suspended Owen’s licence as a practitioner in 2015.
After that, he says, the ‘roller-coaster really began’, with various treatments, multiple relapses and major depression and psychosis.
Thankfully, he had the support of his family and friends and some excellent care to assist his recovery.
Today, the GP is back at work in Brunswick East in Melbourne’s inner north and is in a ‘really good place’.
If not for a clash of commitments, he would be keen to share his experiences with burnout and struggles with mental health at the Victorian Branch Breakfast scheduled this month.
‘This is certainly an area that’s very close to me, having been through a bit of that myself.
I wasn’t caring; I thought I could manage the issue.
The real problem was I knew I had a problem and I knew that I needed help.
But I was avoiding getting any of the help that I actually needed myself, because I had significant fears around the mandatory reporting legislation.’
That legislation has now changed and the Ahpra guidelines state that a clinician has to have suspicion of significant risk to the public (rather than just any risk) before notifying Ahpra.
‘This is much more supportive of people getting the help they need—they can take time off to recover without fear of a report being made to Ahpra and them having their registration suspended.’
Having support within a workplace, professional association or organisation is important to clinicians coping with burnout and mental health issues, says Ellen Lake, APAM, the national chair of the APA Mental Health Group, adding that there is a clear distinction between the two conditions.
‘Burnout in itself is not defined as a mental illness or medical condition.
People use it colloquially, but when used in terms of occupation and work issues, as an occupational phenomenon, there is an increased risk from developing burnout to developing depression and anxiety, and having health issues related to that.’
She says burnout is included in the 11th revision of the International Classification of Diseases as an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed.
It is characterised by three dimensions: feelings of energy depletion or exhaustion, increased mental distance from one’s job or feelings of negativism or cynicism related to one’s job, and reduced professional efficacy.
To support members, InMotion published ‘Five facts about mental health for practitioners and patients’ in June last year (go to australian.physio/translation for an infographic poster version).
The information is designed to help physiotherapists look after their own mental health in times of stress and uncertainty and to help manage interactions with patients.
Ellen was one of five physiotherapists involved in producing the content.
‘The really big thing for coping with burnout, and then mental health issues, is early intervention, being aware of the importance of self-care and having support networks around you,’ says the Brisbane-based physiotherapist, who works in community and hospital healthcare, which includes people living with mental illness and chronic disease.
In late 2020, research from Mental Health Australia gave insight into how healthcare professionals depend on support from friends and family during the COVID-19 pandemic.
More than 70 per cent of healthcare professionals stated that COVID-19 restrictions affected their mental health and wellbeing in a negative way.
Four out of five said working in healthcare during the pandemic has increased the amount of stress and pressure they experience in the workplace.
According to the research, a social support network of family and friends has had a positive effect on healthcare professionals.
Adds Ellen, ‘Negotiating within your organisational structure is important.
Understandably, this can be particularly challenging if you’re a sole practitioner, but professional organisations can be a support.
Early awareness and intervention are important.’
She offers the following advice to avoid burnout in the workplace:
- setting up a self-care plan in times of low demand, if possible
- not underestimating the importance of routines and strategies that enhance mood and a sense of wellbeing, including exercise
- having an awareness of unhealthy coping strategies
- having a ‘wellbeing buddy’ or mental health support person at work (someone you are willing to share with and look out for)
- having support networks.
Ironically, work has been ‘a big part’ of Owen’s recovery as he continues to enjoy a ‘fresh start’ at a different clinic in Melbourne.
Outside of work, exercise is a priority, including long walks with his dog Benjamin and spending time with friends and family to talk about ‘how he is feeling, not just what is happening’.
‘I talk about when I am going well and not so well, which is important.
I also found a practice where people are supportive and understanding.
The knowledge side of things came back really quickly,’ he says of returning to work.
‘I certainly think I’m a better doctor for everything that I went through.
I now set clear boundaries for myself so I can save enough in the tank to see the next patient, and for myself.
‘My advice to others is that your job is not your life, nor is it your identity.
You need to maintain connections to people or things that reward you outside of work.
And remember that you are not alone.
It’s okay to not be okay and to ask for help.’
He hopes his story inspires fellow clinicians to recognise the early signs that may suggest that a person is not mentally well and is coping with work or personal matters.
‘Clearly, for me, everything would have been much easier to manage if I had reached out earlier, but I was scared about my career, about the mandatory reporting and the stigma around mental health, particularly for clinicians.
‘I am keen to maintain my mental health and I am doing everything I need to do regularly and that includes being kind to myself.
I also know that this is an ongoing challenge for myself and for everyone, particularly for people who work in caring roles.
‘Remember, it’s okay not to be okay.
We spend a lot of time looking after other people; we really need to look after ourselves first.
Recognise when something is not right, but don’t try to diagnose yourself too much.
If you do recognise something, speak with friends and family, your colleagues and your GP.’
© Copyright 2018 by Australian Physiotherapy Association. All rights reserved.