Suicide amongst doctors: Fears more health professionals could be lost as strain on hospitals continues

Warning: This article is about suicide and may be distressing for some readers.

Fears loom that more doctors could be lost to suicide as distress among the medical profession increases due to hospitals struggling with a surge in patient demand.

Today, the New Zealand Medical Journal (NZMJ) published an editorial detailing why suicide rates among doctors tend to be higher than the general population, and concern over increased mental distress within the profession.

This year, there have been multiple reports of patients dying after leaving emergency departments (EDs) due to long waits. By the time they got care, it was too late.

Frontline health staff have also been pleading for the Government to take urgent action to address the growing health crisis, with ambulances queuing outside stretched EDs due to lack of beds.

Psychiatrist Roger Mulder, who co-authored the article with NZMJ's editor in chief and surgeon Frank Frizelle, said when doctors feel unable to deliver care they can suffer guilt for events beyond their control.

"Good doctoring" could also be linked to perfectionism, obsessiveness and competitiveness which could act against them when stressed, Mulder - who is also a professor in psychiatry at the University of Otago - said.

"They are more likely to blame themselves for their illnesses and feel they have failed by becoming mentally unwell," he said.

Muller said suicide among doctors has been linked to long working hours, lack of support and dealing with death.

"Complaints and disciplinary processes are increasingly recognised burdens that weigh heavily on doctors, adding to their risk."

He said doctors may avoid treatment, as they fear sanctions from their employer and professional regulator, such as the Medical Council of New Zealand.

"Their fears are not irrational, with examples of doctors who have spoken publicly about their mental health problems being disciplined," he said.

While there had been some improvements, this culture of doctors feeling like they couldn't speak up needed to change, Mulder said.

Medical Council of New Zealand's chief executive officer Joan Simeon said in a statement that while public health and safety was paramount, the council understood that fitness to practise, which included the mental health of the doctor, must be addressed in an empathetic, informed and supportive way.

"Wherever possible, the objective is getting the doctor well, safe to practise again and back to work."

Association of Salaried Medical Specialists (ASMS) executive director Sarah Dalton said the NZMJ article echoed what she was hearing within the sector.

The senior doctors' union leader said with increased strain on health services of course there was worry that suicides among doctors could escalate.

"I've dealt with a couple of members who unfortunately committed suicide... it's unbelievably awful," Dalton said.

"If a doctor is really serious about committing suicide then they are far more likely to succeed because they know how to do it. They are also more likely to have access to drugs so that's one of the really tragic parts of it."

She said there was heaps of work to be done but it came with a price tag.

"It doesn't matter what structure we put across the health system, if we continue to make do with the smell of an oily rag and we don't invest in the people who are running the system then we are always going to fall short," Dalton said.

The NZMJ article said the most effective intervention was reducing workloads and improving teamwork.

"However, changing organisations is complex, time-consuming and costly, and almost impossible in the present time given the difficulty in bringing in staff from overseas."

As a result, organisations prefer introducing initiatives that help individuals enhance their "stress management skills" including mindfulness and psycho-education modules, the article said.

"Meta analyses suggest that these produce only minor benefits, and only in those motivated and interested in them.

"The responsibility for protecting one's health is firmly placed upon that person, with the organisation erroneously believing that these methods are sufficient to tackle what could be a pathogenic work environment," the editorial said.

Mulder said interventions were more likely to be effective if there was good data and New Zealand didn't have this, which was a huge problem.

The Medical Council boss said they didn't have any way to collect data about doctors who have died by suicide.

"However, we do request the coroner's report when we are aware that a doctor may have died by suicide. This allows us to consider if there is anything that we could learn," the Medical Council's Simeon said.

Earlier this week, deputy chief Coroner Anna Tutton released the provisional suicide statistics for the 2021-22 financial year.

The number of New Zealanders lost to suicide dropped significantly, with the latest statistics showing the rate to be the lowest seen in the past three years.

In the year to June 30, the number of people who died by suspected suicide was 538, compared to 607 last year and 628 two years ago.

A doctor lost

Brave widow Kate Harding shares her heartbreak of losing her husband Richard who was a Northland doctor to suicide. Photo / Supplied

Kate Harding will never forget finding the love of her life dead in their family home five years ago, on Labour Weekend.

"I still miss him desperately," Harding told the Herald.

Her husband, Richard Harding, was an anaesthetist at Whangārei Hospital. He took his last breath on October 23, 2017 at their Tamaterau home.

"I know that Richard thought he was going to be lifting a burden for me and the kids which obviously is a joke, I mean I am burdened by feelings of loss, regret and guilt for the rest of my life... he would never have wanted that for me had he been able to think straight."

She spoke out to urge whānau to confront suicide in the hope of preventing more deaths.

"Despite my work as a GP and hospice doctor for over 20 years, it was inconceivable to me that my own husband might ever do something like this," Kate said.

He was 47 when he died and had spent 25 years working in the health sector after growing up and training in England.

Having moved from England to New Zealand under the cloud of a complaint - from which he was eventually fully exonerated - Richard's stress levels peaked, to the point where he started taking antidepressants.

"Like many doctors, Richard was all about getting the job done well. He held himself to a very high standard... that complaint really shook his sense of self both personally and professionally which was hard to witness," Harding said.

"He changed as a person, he was a lot more anxious and questioned his decisions a lot more at work. He was less confident."

With the help of medication, Richard slowly recovered and no longer relied on the pills. However, after a battle with insomnia, Richard went back onto medication in the winter of 2017.

This time, his medication did little to improve his mood and in the weeks before his death, his illness took a serious hold - despite his best efforts to exercise, eat well and maintain his health.

He was booked in for an urgent psychiatrist appointment but tragically never made it.

"I feel that had he made it to that psychiatrist appointment, he would have felt in safe hands and I'm sure his medication would have changed...but of course, you can't torture yourself with 'what ifs'," Harding said.

Her message to doctors who were struggling was: "please, share those struggles with someone you trust.

"In Richard's case he struggled to a great extent alone. He knew he was ill and he talked to me about being ill but he was sketchy on the detail and found it difficult to articulate how he felt... so my message is to get help early and to be as open as you feel you can be, particularly any suicidal thoughts."

WHERE TO GET HELP:

If you are worried about your or someone else's mental health, the best place to get help is your GP or local mental health provider. However, if you or someone else is in danger or endangering others, call police immediately on 111.

OR IF YOU NEED TO TALK TO SOMEONE ELSE:

• LIFELINE: 0800 543 354 or 09 5222 999 within Auckland (available 24/7) • SUICIDE CRISIS HELPLINE: 0508 828 865 (0508 TAUTOKO) (available 24/7) • YOUTHLINE: 0800 376 633 ,free text 234 or email talk@youthline.co.nz or online chat. • NEED TO TALK? Free call or text 1737 (available 24/7) • KIDSLINE: 0800 543 754 (available 24/7) • WHATSUP: 0800 942 8787 (1pm to 11pm) • DEPRESSION HELPLINE: 0800 111 757 • SAMARITANS – 0800 726 666.