This is a deeply personal issue for me directly and indirectly. I understand Dr Toogood's desire to translate the deep and important lessons from his personal journey into a positive impact on the issue of mental health of doctors (and other health professionals). It is noble and brave. I am concerned, however, that increased awareness will not have the desired impact unless it is part of a more multi-faceted approach that deals not only with the sick health professional but medical culture, system responses, health regulation and governmental oversight.
I believe there are few degrees of separation between medical practitioners and colleague suicide. This implies there is awareness within the medical community (if unacknowledged) of this tragedy and its profound and lasting consequences on the friends, family and colleagues. Awareness amongst the general community may increase and no doubt this awareness will elicit kind, compassionate and supportive commentaries. It may inspire fund raising for needed research and support services for sick health professionals.
There is evidence (including from Australia) that the prevalence and incidence of suicide amongst health professionals is higher than the expected rate for the general population. This begs the question what are the risk factors for suicide. Of course, health professionals are not immune to mental health issues. However, solely focusing on the sick doctor/nurse or other health professional misses an opportunity. #crazysocks4docs has the potential to focus on "crazy doctors" (socks4crazydocs). Of course getting sick health professionals to help is important. However, we need to understand what are the barriers to seeking care. I do not believe the sole issue is awareness and I sadly do not believe increasing awareness will necessarily translate into reduced barriers and improved outcomes. It is unlikely that the sympathetic reception by kind compassionate people will lead to any improvement unless it changes medical culture and health regulation. There are risks, in fact, to vulnerable people exposing themselves to a system that remains punitive rather than therapeutic. The balance between the public interest and the individual health practioner interest is complex and highly non-trivial. However, in my direct and indirect experience, medical culture, medical administration and health regulation are weighted against the practitioner and contribute to inhibition of vulnerable people seeking help.
I applaud the initiative in so far that it is stimulating discussion and hope that people of good will with power and means will fund research, fund support services, advocate for efforts to deal with medical bullying, advocate for health regulation reform that gets the balance right and engages government for a comprehensive approach.
I reiterate this is a deeply personal issue for me. Of course, it is easy to be a naysayer spectator from sidelines. However, I have skin in the game. What do I do? I advocate culture change at my little level. I try within my limitations to create a "safe space" for my colleagues (particularly my junior colleagues). I try to have uppermost in my mind the humanity of my colleagues. I try to anticipate when a colleague may or has experienced undue stress and actively discuss what they are feeling and help them process the difficult times. I encourage my younger colleagues to take time for themselves and develop strong support structures. I thank them for their efforts and acknowledge they are valued. I try to follow my own advice for my own health.
Perhaps, everyone does this and we still have a problem. This was not my direct and indirect experience and I admit to being part of a culture that I believe fails to support and promote the health of colleagues.
Research is needed. We need to understand remediable factors that contribute to suicide and mental illness among health professionals.
On June 1, I worked a busy full day. I wore plain matching socks but I applaud those #crazysocks4docs for their thoughtfulness and compassion. I just think it is not enough. I took a moment to remember those who have been lost (particularly those I knew) and to give thanks to those kind souls who have been my support.