Mental Health Awareness Week is an important reminder that poor mental health affects a large proportion of the population every year. Just take the headline statistics from MIND’s website: one in four of us (that’s approaching 14 million adults) will experience poor mental in any one year and one in 15 of us attempt suicide (between three and four million people).
MIND’s website makes it clear that these are likely to be under-estimates and that traumatic experiences are likely to trigger depression, anxiety and stress. I suspect that the figures for 2020 and 2021 must be worse as we have all had to cope with the challenges of the disruption to our daily lives caused by the pandemic.
The Authority sees a lot of cases where there are concerns about the way in which health professionals deal with people who have poor mental health. Many of these are serious, where major action is needed to address the professional’s behaviour to protect the public. We also accredit registers of practitioners who may be able to help people suffering from poor mental health.
The mental health fall-out for health professionals from the pandemic is likely to be significant
In this blog, however, I wanted to think about the health professionals who suffer from poor mental health themselves. This is particularly relevant now when many doctors, nurses and paramedics have been on the front line of dealing with a deadly new disease which stretched the resources available to the limit and beyond. They had the distress of watching formerly healthy people succumb, of making agonising decisions about treatment, together with the knowledge that they were at hugely increased risk of contracting it themselves. There have been reports of professionals suffering PTSD-like symptoms and this isn’t surprising.
This is likely to cause real problems for our healthcare system. First there will be the fact that professionals with these difficulties are likely, quite rightly, to be off work which means that resources will be stretched. Even more seriously, those who try to soldier on may well be at risk of providing less safe care for patients. We frequently see cases of medication errors or other poor practice from otherwise good, caring professionals who were suffering from stressful life events which affected their mental health and, therefore, their performance at work. Sadly, in a very few cases, it is a feature of the condition that the professional does not recognise that they are likely to put patients at risk.
How regulators deal with registrants suffering with their mental health
In our experience, regulators are usually sympathetic to these cases and take the view that the important thing is to ensure that the registrant is able to cope with their condition in a way that protects patients. We regularly see fitness to practise panels take the health condition appropriately into account when looking at the right outcome for the case before them. Most healthcare professionals, with advice from their doctors, can recognise what they need to do to manage the condition and find ways of working safely. In the light of this, regulators may rightly feel that they need to take no action or that undertakings agreed with the registrant will ensure public protection and, as importantly, support the registrant in their recovery. We hope that the Government’s proposed reforms will ensure that all regulators will have the flexibility to deal with these cases sensitively and in a way that assists recovery, while ensuring also that, in the rare cases where the registrant is not able to manage their condition, action can be taken for public protection.
Can regulators do more?
More recently, however, we’ve been thinking about how far regulators should take a more pro-active role in addressing mental health problems among their registrants. This is a difficult question. The regulator cannot control the life events that trigger many cases of stress, anxiety and depression, let alone the neurological causes of the most serious conditions. However, a number of those events are undoubtedly linked to the environments in which registrants work, whether it is simply the stress of a very busy workplace, not recognising that a professional may be suffering from mental difficulties or more serious problems around bullying or inappropriate behaviours. In many cases, the employer will be best placed to recognise a problem and take the right action to support the registrant and protect patients.
One of the principles of right-touch regulation is that problems should be addressed at the closest possible level. In many cases it will be possible for employers to provide the support that is needed without adding to registrant’s stress and exacerbating the condition that will happen if a regulator has to be involved. Doing so will save the regulator’s time and resources as well.
It’s easy to say “this is the employer’s problem” and point out that the regulator usually has no effective control over what an employer does and can pick up the pieces at a later stage. I don’t think that’s a good enough answer. We’ve seen some great examples of regulators working with employers to address individual cases and educate them about the sorts of cases that they need to refer to their fitness to practise processes: the Nursing and Midwifery Council and the General Medical Council (and possibly others) are developing these relationships. But there may well be scope to build on this.
For example, should regulators provide greater guidance for employers about their expectations around the treatment of registrants and, particularly, practices they should adopt? Should there be greater guidance or rules for registrants who have managerial roles around the wellbeing of their colleagues? Is the current liaison enough?
As I’ve suggested, all the information that we have about the impact of the pandemic suggests that we will face more registrants suffering from poor mental health. The involvement of the regulator adds further stress, even where it’s necessary. There must be scope to change things so that regulators, working with employers, can create the conditions where their involvement is minimised. That must assist registrants and it will lead to better outcomes for patients too.
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