Webinar resources DATE: Self-care for mental health professionals November 12, 2008 Broadcast date: Thursday, 23 rd August 2018 Supported by The Royal Australian College of General Practitioners, the Australian Psychological Society, the Australian College of Mental Health Nurses and The Royal Australian and New Zealand College of Psychiatrists
PAGE 2 GP’s perspective Taking care of BASICs As Caroline’s GP I am concerned by the multiple stresses that she is currently facing, including: • Work-related stress and burnout • Potential relationship with her husband who is likely to have his own significant issues • Guilt relating to her ability to spend time with her children • Financial stresses • Physical stresses • Lack of meaning and purpose Hopefully as her GP we already have an established rapport and a degree of trust. Simon Willcock
PAGE 3 GP’s perspective Physical stresses • Poor sleep – associated fatigue • ? Adequate diet • ? Time for physical exercise • ? Any reliance on substances or medication for coping “You can’t run the machine when the battery is flat” Simon Willcock
PAGE 4 GP’s perspective Emotional (affective) stresses • Mood – low mood/depression is to be expected in these circumstances • Anxiety – how has she coped in the past? • Relationship and intimacy – husband is dealing with his own issues • Guilt and Financial stress – counterproductive in her current circumstances – how can Caroline ameliorate them? Simon Willcock
PAGE 5 GP’s perspective Social health • Does Caroline have a support network / safety net – friends, family etc. • Is Caroline isolated from a potentially supportive community? • Is it possible to organise some “pleasant event scheduling”? Is Caroline comfortable in the role of “client” Simon Willcock
PAGE 6 GP’s perspective Spiritual stress • Lack of meaning and purpose • What has helped Caroline in the past? • What are the foundations of her belief system? • Are there shared things that she and Nick share that help them to regain their spiritual health? Can this time be an opportunity to grow and re-evaluate priorities? Simon Willcock
PAGE 7 Mental Health Nurse’s perspective How to assist Caroline: 1. List all current stressors she is experiencing. Also important to identify her strengths and normalise her experience. • Discuss fight, flight, freeze responses • Discuss with Caroline the impact of chronic stress on the body • Discuss the terms burnout, compassion fatigue, vicarious traumatisation: their characteristics and implications for Caroline. • Challenges, tips and strategies for self-care to reduce stress & maintain wellbeing 2. Complex emotional work especially with people experiencing trauma, mental illness and substance use, requires and demands self-care • Organisational demands • Self stigma Katherine Fairest
PAGE 8 Mental Health Nurse’s perspective What is self-care? Domains of self-care include: • Professional: clinical supervision, continuing professional development, ethical & professional accountability, maintaining boundaries • Psychological: challenging negative thoughts, being reflective, setting limits, maintaining boundaries, help-seeking • Physical/Health: diet and exercise • Social: family and friends • Spiritual: mindfulness and meditation Complete self-care assessment: • How organisations encourage self-care • Barriers that impact organisations and workplace culture Katherine Fairest
PAGE 9 Mental Health Nurse’s perspective Katherine Fairest
PAGE 10 Psychologist’s perspective What is burnout? State of emotional, mental and physical exhaustion caused by excessive & prolonged stress Symptoms: • Feeling overwhelmed • Physically and emotionally exhausted • Isolating self from others • Loss of motivation; forgetting why you do your job • Questioning one’s professional competence and effectiveness; self-doubt • Increase in illnesses and/or pains • Increasingly cynical and negative outlook Ann Evans
PAGE 11 Psychologist’s perspective What is self-care? More than just having a hot bath or using smelly candles Two aspects: 1. Managing emotional reactions to stressors in our work/life 2. Proactively enhancing ongoing overall well-being To implement these, you need good self-awareness Ann Evans
PAGE 12 Psychologist’s perspective Caroline has not been proactively looking after her wellbeing, and now appears ‘burnt out’ • She needs someone she can talk to who won’t judge her • When someone burns out, they will generally need a true break from work/stress to recharge (this could be challenging for Caroline, but is important) • She needs to implement both aspects of self-care – processing her emotional reactions and acknowledging their impact on her physical and emotional wellbeing; and proactively taking care of herself. Ann Evans
PAGE 13 Psychologist’s perspective Managing and processing emotional reactions • Acknowledge and accept any reactions • Understand how these are impacting her – thoughts, feelings, behaviours • Reflective practice and journaling may be useful • Practice relaxation exercises: e.g. deep breathing, meditation, mindfulness, music • Take breaks where she doesn’t multi -task • Debriefing and supervision Ann Evans
PAGE 14 Psychologist’s perspective The importance of happiness • Not to distract herself from emotional reactions (these need to be processed) • To give her brain a break from processing traumatic material • To nurture her relationships with others • To help her to cope with the hard times, and gain a sense of meaning • Understand what works for her – what/who gives her energy – and add more of this in her life Ann Evans
PAGE 15 Psychiatrist’s perspective Below is the literature relating to Psychiatric Morbidity in Doctors Factors associated with psychiatric morbidity in doctors from the international literature • Long hours of work • Poor sleep • Overload between work life and home life • Personality type • Family history of mental illness And additional findings from my research with Australian doctors*: • Not taking a holiday in the past 12 months • Having a current medico-legal matter • Personality traits of neuroticism and introversion *Nash L, Daly M, Kelly P, van Ekert E, Walter G, Walton M, Willcock S and Tennant C. Factors associated with psychiatric morbidity and hazardous alcohol use in Australian doctors. Medical Journal of Australia 2010; 193 (3): 161-166. Louise Nash
PAGE 16 Psychiatrist’s perspective Psychiatric morbidity & hazardous alcohol use in 2999 Australian doctors – medico-legal and gender comparison (Nash et al 2009) Measure Total cohort Current Total Total medico-legal females males matter number 2999 426 877 2122 39 *** % GHQ > 4 28% 31% 26% ** %AUDIT >=8 15% 20*** 8% 18% *** Chi-square **p<=0.01, ***p<=0.001 Louise Nash
PAGE 17 Psychiatrist’s perspective Psychiatric Morbidity and Error • 123 paed residents (50% rr) • 20% met criterion for depression • 74% met criterion for burnout • 6 weeks of medication charts reviewed objectively • 0.7% error rate • Depressed doctors accounted for 6.2 times as many med errors as non-depressed doctors. Fahrenkopf 2008 et al Louise Nash
PAGE 18 Psychiatrist’s perspective The Mental Health of Doctors • Difficult working environment • Personality traits eg conscientiousness and obsessiveness risk burnout and stress, or depression/anxiety • Stigma associated with mental health disorders • Concerns around confidentiality and career impact – may lead to self-diagnosis and self-medication. Beyond Blue Systematic Lit. Review - 2010 Louise Nash
PAGE 19 Psychiatrist’s perspective beyondblue key points • Thoughts of suicide are significantly higher in doctors • Stigmatising attitudes regarding mental ill health and impact on practice and progression persist • Most common source of work stress: balancing work and personal responsibilities • Younger doctors more vulnerable • Student morbidity and attitudes – Similar to doctors – Indigenous students higher morbidity • Barriers to seeking treatment: – Fear of lack of confidentiality 53% – Embarrassment 37% – Concern over registration 34% Louise Nash
PAGE 20 Psychiatrist’s perspective Recommendations in the literature • Training to maintain good mental wellbeing, awareness of early warning signs and stress management ( beyondblue , 2013, RACP 2013) • Nurture a culture of self-care and wellbeing in the profession to promote resilient medical workforce (Nguyen, 2011) • Take a holiday every year (Nash et al) • Consider reduction in hours of work at stressful times (Nash et al) • Address stigmatising attitudes early in career: – remove barriers to treatment – provide high standards of care for those with mental illness – influence attitudes towards mental illness within the community ( beyondblue 2013) Louise Nash
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