Some of you know me; I completed a dual certificate in paediatrics and psychiatry. I am a Child and Adolescent Psychiatrist and the Medical Director of Child and Youth Mental Health Services across CHQ.
Many of you will be aware of the recent tragic suicide of Andrew Bryant, a well-known and respected Brisbane gastroenterologist. I’ve been asked to talk about mental health and wellbeing in the workplace. In particular, dealing with the loss and grief that follow the suicide of a colleague. It is a heavy subject, full of emotion. It’s also a silent epidemic. Andrew Bryant’s death has led to an increased awareness, and in some cases, an open discussion of the risk of suicide for people who work in health. For unless we are able to openly talk about suicide, we will never reduce its stigma. And unless stigma is reduced, we will never truly promote healing.
An often unspoken truth is that at some point in our lives every one of us will be touched by suicide. We will either be at risk of suicide ourselves, know someone who themselves was at risk, or even took their life, or whose life was touched by the loss of a loved one. None of us, regardless of our profession, is immune from this reality.
I myself have lost a brother to suicide and I am all too aware of the unanswered questions, and the grappling sense of grief that comes with the loss of a loved one in such a way.
A person is diagnosed with a life-threatening illness. The medical treadmill begins. Hope is marshalled, rouses, flags and is roused again. For many, there is victory as they survive the dreaded disease. Unfortunately, some do not. And for these victims, we quite rightly say that they have courageously fought the battle, the family proud of their strength and endurance despite hardship and pain.
But what of mental illness? Twenty-five percent of Australians will experience some form of mental illness before the age of 25. For many, it emerges in their teen years. Many also continue to battle mental illness. Some for month after long month. Year after long year.
My brother Ian was one of those 25%. In retrospect, he developed an anxiety disorder at the age of 16, just as I started medical school. Many severe episodes of depression followed throughout his life, interspersed with periods of wellness. It wasn’t all gloom. Hope was marshalled. It was roused, flagged, and roused again. In November 2015, Ian took his life. And there is no stigma in that. For over 30 years, my brother courageously fought his battle.
Others have a different story. An acute trauma, an unexpected life crisis, or an accumulation of overwhelming stress can leave those who have previously been strong and resilient suddenly vulnerable. We who work in medical and health services are at particular risk.
People have asked me if I have felt angry at psychiatry’s inability to keep my brother alive. Or even my own inability to keep Ian alive. The answer is ‘No’. Could the services he accessed have prevented his death? I don’t know. Some of you may be grappling with similar unanswerable questions. On a very personal level, I have learnt to tolerate uncertainty, for at its heart, psychiatry is a specialty about risk and uncertainty. I have no perfect pill, potion, or therapy within which to make someone well. Even someone so close to me as my brother. Ultimately, for Ian it was the precious bonds forged by family and friends kept him alive for 30 years.
It is very important to acknowledge that those of us who work in the health services industry carry stresses which are unique to our professions. Our mandate is to treat the unwell and keep people alive. Often within the constraints of an overburdened system. In spite of our best intentions, our dedicated actions will sometimes fail, and the outcomes fall short of what we expected. This is not necessarily anyone’s fault. But it may lead to profound levels of loss, grief and potential burnout.
While we never may never truly know the reasons behind someone’s decision to take their own life, I believe it is important that we open the discussion as to how we individually, and as a hospital and health service, care for ourselves and each other.
What are the red flags for burn out? How to we recognise when we ourselves or our colleagues are stressed, and those stressors are reaching intolerable levels. This is the conversation that we need to have. How are we to promote self-care within the workforce and encourage each other to practise it? How do we recognise the subtle signs that a colleague may be stressed or depressed? Are we prepared to ask, “Are you ok”? And are we brave enough to do so?
We who work in health care occupy a privileged position. The human condition is one of varying degrees of brokenness. In my therapist wife’s words, “We bear witness to other people’s stories, and ultimately assist our patients to tolerate their own physical and emotional pain.”
A psychotic illness. A relentless and severe depression. A sudden major trauma. A medical emergency. Or even a routine surgical procedure or outpatient appointment. We hold the complex elements of these narratives together in an attempt to help our patients rewrite their own story.
We may use medications, surgery, a therapeutic alliance or a range of investigations or treatments, all of which have their rightful place. But we do something more profound than that. We provide emotional containment for the often unbearable accounts that patients bring. (By the way, this is not just the role of social workers, mental health clinicians, and psychiatrists. Whether we work as doctors or nurses, allied health clinicians or in administration, a management position or in the Executive, we all have a part to play.)
And in providing some sort of emotional containment, we hopefully help them arrive at a different place. A place where they may not necessarily be happier, but where they are living life in a more engaged and functional way. From experience, I know that sometimes this works, sometimes it doesn’t. And sometimes our patients get better and in truth we have no clear idea why.
Whatever your account may be, it is the mystery and the privilege of witnessing another’s story that helps many of us continue to strive to provide and develop effective health treatments and services. Let us not forget that while it is a stressful job that we do, it is also a rewarding one. Within its challenges, our many and varied roles offer us the opportunity to touch the lives of others in ways unimagined. Let us continue this conversation about how we are to care for ourselves so that we can continue this life changing work for many years to come.
Anyone who is potentially distressed, can seek immediate help from the following 24-hour crisis support services:
Lifeline
t: 13 11 14
www.lifeline.org.au
Suicide Call Back Service
t: 1300 659 467
www.suicidecallbackservice.org.au
beyondblue
t: 1300 22 4636
www.beyondblue.org.au