As a psychologist for NHS staff I saw how hospital work takes its toll

I was struck by their terrible experiences – the doctor who kept seeing a dead child and the person with an alcohol problem

When I began working as a psychologist at a large London teaching hospital I was fascinated and – a little overwhelmed – by the challenge of developing a new psychology service. I was employed solely for the 5,000 staff working in the hospital. Absolutely anyone could come and see me for psychological support, from the porters to the medical consultants. And they did. Over a 12-year period I saw many NHS staff.

Sometimes they were sent by managers who were worried about them. About their behaviour or their distress or the impact of a very traumatic event they had witnessed, for example. Others referred themselves in secret and hoped that no one would know they were coming. When they left they were always polite and thanked me but usually said that they hoped they would never see me again.

It sometimes felt like there was hope that staff could disappear for a bit and emerge intact and ready to work

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Doctors and nurses must find compassion for themselves, not just their patients | Ranjana Srivastava

Changing the culture of medicine needs many actions but one that each individual can control is the need for self-care

It’s still dark outside and I am wide awake, unintentionally. A vice-like grip encircles my abdomen, travelling up to my chest. The heaviness is a reminder of a new morning and with it, a host of new responsibilities. Yesterday was a difficult day, but no different to the week or the month before. Come to think of it, most of the past 20 years have been crammed with difficult deliberations, near-misses, moral dilemmas, organisational decrees, formal complaints, frustrated colleagues, upset trainees, demanding people and needy patients. It’s only the permutation that changes.

But these days my head swirls with fatigue and resentment mingling contradictorily with satisfaction and meaning. There is a lot in daily practice that call for debriefing but there is rarely the time for it or the company of doctors who aren’t engaged in more “consequential” things. Crowded thoughts must be repressed or hustled out to make room for another day.

Related: Medical training is a tragedy waiting to happen. We shouldn’t be silent about it | Georgina Dent

The worse the burnout, the greater the risk of medical error.

Related: To stop doctors ending their lives, we need to hear from those suffering | Ranjana Srivastava

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I worried about working in psychiatry but one patient taught me how to listen

It took ages to earn Sandra’s trust – she showed me how people’s lives can be consumed by the cruel fate of mental health problems

In medicine, psychiatry isn’t seen as glamorous. As a student and while training, you fight with your colleagues for the sexy jobs in cardiology, intensive care or on the frontline. When the crash call goes off, it’s dramatic; chest compressions, ventilation, trying to be the hero you see depicted on television. A job in psychiatry wasn’t my first choice, if there was a crisis, what would I do? Come running with my pen and notebook? Not exactly Oscar-winning stuff.

I had my reservations as I was about to embark on 91 days as a doctor in an adult inpatient psychiatric unit.

Related: The patient who showed me how to be a better doctor and person

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As a GP I feel powerless to help elderly people struggling to survive

I can refer people to mental health services and social care but they are overloaded and don’t provide much help

Recently a patient brought home to me how inadequate the help I can provide my elderly patients as a GP can be. Among more than 50 phone calls I fielded one day as one of the GPs dealing with urgent requests, there were two from a patient in her 80s who is the main carer for her husband who has dementia. She also has health issues and he is unaware of the problems they face. The receptionist learned far more about the difficulties they were having from the woman’s phone calls to the surgery and from observing them in the waiting room, than I did from my snatched telephone conversations and the scrawled note left for me. I found out later that the only way she could get to the surgery to bring the sample I requested was by locking her husband in the car outside. I knew that things were difficult, but this was a new low.

Over the last year I have been increasingly involved in the care of a man who is in his 80s and moved into my practice area to be nearer to his family. He enjoys telling me about his past when he gets the opportunity and I recall how his eyes sparkled as he told me that adopting his daughter was the best decision he and his late wife ever made. He knows his dementia is worsening and was the one who recognised the initial symptoms, well before these signs were noticed by others around him. He looks crestfallen as he recounts to me how he sees the frustration and sorrow in his daughter’s eyes when he asks the same question another time. He is annoyed by his failing health and memory and feels he is a burden to those around him. At times he is too proud to ask for help.

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Medical training is a tragedy waiting to happen. We shouldn’t be silent about it | Georgina Dent

I don’t want to write about being married to a doctor but complicity in the silence around the pressures of practising medicine isn’t a victory for anyone

My stomach lurched when I learned that Andrew Bryant, a husband, son, father of four and gastroenterologist took his life last week. My heart sank when I read the eloquent and succinct letter his wife wrote to his friends and colleagues about it.

My reaction was visceral. I didn’t know Dr Bryant and I don’t know his family. And yet it felt painfully close to home.

Related: To stop doctors ending their lives, we need to hear from those suffering | Ranjana Srivastava

Related: I wasn’t surprised by Four Corners. Bullying in medicine is as old as the profession | Ranjana Srivastava

Related: How doctors treat doctors may be medicine’s secret shame | Ranjana Srivastava

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Author Joanna Cannon: why I’m going back to the psychiatric wards

The bestselling author of The Trouble with Goats and Sheep talks about how she quit psychiatry to become a writer but can’t stay away from the NHS

Joanna Cannon’s to-do list for next month includes attending the British Book Industry Awards in which her bestselling debut novel has been shortlisted, and pouring tea for people with dementia and their carers in a village hall.

Cannon, author of The Trouble with Goats and Sheep, who quit psychiatry more than two years ago to concentrate on writing, is returning to the NHS as a volunteer with Arts for Health. Its programme, run by South Staffordshire and Shropshire Healthcare NHS foundation trust, brings creative arts to patients. Tea-making aside, she is keen to help patients understand their own life story through “reading for wellbeing” groups and creative writing.

Related: NHS psychiatrist Joanna Cannon has first novel optioned for TV drama

Related: Prince Harry grief revelations draw praise from mental health experts

Related: The Trouble with Goats and Sheep by Joanna Cannon review – a secret history of suburbia

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Antidepressants prescribed far more in deprived English coastal towns

Rate in Blackpool, Sunderland and East Lindsey almost twice the national average, analysis of NHS prescription data shows

Doctors in deprived coastal towns in the north and east of England are prescribing almost twice as many antidepressants as those in the rest of the country, analysis of prescription data shows.

Blackpool, Sunderland and East Lindsey, in Skegness, fill the top three spots for the most prescriptions out of England’s 326 districts.

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What can the UK learn from Finland’s approach to mental health?

An online therapy service for depression, anxiety and substance misuse is cheap and effective and could provide inspiration for the NHS

When Aino Korhonen*, 69, saw an advert for online mental health therapy in a newspaper, she went to her GP and asked if she could be referred to try it.

The lifelong Helsinki resident had been diagnosed with depression and had attended a few sessions with a psychologist but the two didn’t get along. She remembers: “We didn’t [seem to] talk the same language. I went a couple of times and it didn’t help me at all.”

It’s a win-win for patients, for professionals, for [hospital] management and for the taxpayer.

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I thought my career as a doctor was over. It was the arts that saved me

I used to ignore my creative side, but after I was signed off work with depression and anxiety, I made space for the things I loved

As a hospital doctor I am used to working under pressure, and had always felt I thrived on it. But when I took time out of clinical training to pursue a PhD, I found I was intensely unhappy. I suffered a range of physical symptoms: palpitations, early morning waking, nausea, severe headaches, poor appetite, diarrhoea, dizziness, breathlessness and tremors.

My day was constantly interrupted by intrusive negative thoughts; I once walked for 30 minutes with “I hate my life, I hate my life” on a loop of internal monologue that I feared had no end. I listened to podcasts and audiobooks fanatically but could not drown out these thoughts, and no rationalisation of all the wonderful things I had in my life could make them stop.

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To stop doctors ending their lives, we need to hear from those suffering | Ranjana Srivastava

The revelation that four junior doctors have taken their own lives in recent months obliges us to look at why doctors with mental illnesses don’t speak up

The ceilings soar impressively high, the stained-glass windows are exquisite, and the satin-adorned pews stretch majestically to the dignified altar. Amid the silence punctuated by the barest of sobs, I spot doctors whom I have long lost track of. And row upon row of nurses, still tight years later. As we wait for the service to begin, we imagine we are all silently interrogating our memories about each other. Time parted us for decades before we have gathered in such dreadful circumstances.

“I wanted you to hear it from me,” a colleague had said, audibly upset on the phone. I nearly collided with the pavement when I heard.

Related: I wasn’t surprised by Four Corners. Bullying in medicine is as old as the profession | Ranjana Srivastava

Doctors say that the disclosure of mental illness poses a real threat – to license and insurance, career and reputation

Related: How doctors treat doctors may be medicine’s secret shame | Ranjana Srivastava

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