The human cost of stress, pressure and an unsustainable
workload in the UK’s NHS has been laid bare by a survey conducted by the
British Medical Association (BMA). It found that eight out of 10 doctors are at
a substantial risk of burnout.

More than a quarter of the 4300 respondents to the survey
said they had received previous, formal diagnoses of mental conditions, and
four out of 10 said they were suffering from psychological or emotional
distress, which affected their work, training or study.

Younger and junior doctors, medical students and those
working longer hours are more likely to suffer from mental ill health, the
survey found.

It also pinpoints a strong relationship between the use of
alcohol, drugs and self-medications by doctors with current or previous mental
health diagnoses – with 62 per cent using them as a coping mechanism. Alcohol,
drug use and self-medication were more common in consultants, those working
shorter weeks, doctors aged 64 and above, and men.

The survey uncovered worrying evidence of inadequate or no
support for doctors when sought. Medical students were most likely to find help
unacceptable while older, staff, associate specialist and specialty doctors,
and overseas-qualified doctors were most likely to say support was not there
when requested.

The survey is part of a larger project led by BMA president
Dinesh Bhugra to find ways to improve the mental health of the medical
workforce and so improve patient care.

Prof Bhugra says that while stress is in the nature of
medical practice it could affect doctors differently, depending on whether they
are trainees, consultants, GPs, or SAS doctors.

‘Medical students are surprisingly stressed, which is a bad
sign, as these are some of the most energetic, enthusiastic people who want to
help people by going into medicine.

‘Informally, I’ve heard that some of these stresses come
from financial problems and debt. They are also feeling that as they learn on
simulators, on dolls and with actors that they do not develop the same empathy
with patients.’

He is concerned about the lack of support in some medical
schools, calling for more research to pinpoint any geographical differences in
stress rates and support levels.

‘As the only organisation that looks after doctors in all
specialties and across the UK, we should examine how terms and conditions in
which people learn and practise could be improved. That’s my challenge to the
BMA and I hope it takes this on board.’

He hopes that the BMA will repeat the survey of doctors’
mental health regularly. ‘The longer people struggle on without support, the
more chronic their conditions become, the more difficult it is to treat.’

Also published this month are the findings of a separate
study by Cardiff University of junior doctors’ experience of mental illness,
the stigma they face, their struggle for support and the effect it has on their
professional lives.

‘It got to the point where I was almost catatonic in my room
all the time,’ one doctor told researchers. ‘I was making it to work, just
doing what was required, then coming back. But I wasn’t making any

The Cardiff study found the trainees were reluctant to
disclose their illnesses for fear of the effects on their careers and struggled
to access support, especially in rural areas. Some also found it difficult to
return to work after time off sick.

The Cardiff report recommends special provision for doctors
in training with mental ill health and for employers to take steps to tackle
the stigma of mental illness in the medical profession.

Professor Bhugra says more is needed to be done to address
the stigma of mental health and to improve the support to doctors.