Self-care for mental health professionals November 12, 2008 - - PowerPoint PPT Presentation

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

DATE:

November 12, 2008 Webinar resources Broadcast date: Thursday, 23rd August 2018

Self-care for mental health professionals

GP’s perspective

Simon Willcock

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
• wn 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.

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GP’s perspective

Simon Willcock

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”

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GP’s perspective

Simon Willcock

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?

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GP’s perspective

Simon Willcock

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”

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GP’s perspective

Simon Willcock

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?

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Mental Health Nurse’s perspective

Katherine Fairest

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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

Mental Health Nurse’s perspective

Katherine Fairest

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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

Mental Health Nurse’s perspective

Katherine Fairest

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Psychologist’s perspective

Ann Evans

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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

Psychologist’s perspective

Ann Evans

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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

Psychologist’s perspective

Ann Evans

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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.

Psychologist’s perspective

Ann Evans

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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

Psychologist’s perspective

Ann Evans

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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

Psychiatrist’s perspective

Louise Nash

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.

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Measure Total cohort Current medico-legal matter Total females Total males number 2999 426 877 2122 % GHQ > 4 28% 39*** 31% 26% ** %AUDIT >=8 15% 20*** 8% 18% ***

Chi-square **p<=0.01, ***p<=0.001

Psychiatric morbidity & hazardous alcohol use in 2999 Australian doctors – medico-legal and gender comparison

(Nash et al 2009)

Psychiatrist’s perspective

Louise Nash

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Psychiatrist’s perspective

Louise Nash

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

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Psychiatrist’s perspective

Louise Nash

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

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Psychiatrist’s perspective

Louise Nash

beyondblue key points

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• 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%

Psychiatrist’s perspective

Louise Nash

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)

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Psychiatrist’s perspective

Louise Nash

What builds resilience?

• 1. Attitude: maintain interests, develop self-awareness, accept personal limitations
• 2. Balance and prioritisation: setting limits, professional development
• 3. Management style: good staff and effective practice arrangements
• 4. Supportive relations: personal and professional relationships and good communication
• 5. Seek help – medical, psychological, legal
• 6. Self care – sleep, holidays, nutrition, exercise and,
• 7. Continue to be amazed and inspired by the wonder of life – spirituality and the beauty

– of the world – a wave or a mountain, research, new life, a concert, a gallery etc

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Psychiatrist’s perspective

Louise Nash

Advice for the next 50 years for you and your patients:

Work, love, rest and play

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Are you interested in joining an MHPN network in your local area? View a list of MHPN’s networks here. Join one today! For more information about MHPN networks and online activities, visit www.mhpn.org.au

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