Barriers and facilitators to help-seeking for distressed GPs: a qualitative study

Problem

The English general practice workforce is under pressure, with evidence that general practitioners (GPs) are dealing with increasing demand and decreasing resources. It is perhaps unsurprising that, compared with the general population, doctors - including GPs - experience high levels of stress and burnout, as well as higher rates of mental illness and suicide. When the work of a GP leads them to experience mental distress, they need support. However, it can be hard for doctors to seek help for such difficulties, and a lack of sources of appropriate help has been reported.

Approach

We set out to learn more about the barriers and facilitators to help-seeking for GPs experiencing distress. We employed a qualitative design, conducting in-depth interviews with 47 GP participants recruited via a specialist treatment service, social media, letters to Local Medical Committees and advertisements in professional publications. GPs were asked to classify themselves as: 1) currently living with mental distress (defined as anxiety, depression, stress or burnout), 2) returning to work following treatment for such problems, 3) off sick or retired early as a result of mental distress or 4) with no experience of mental distress. Interviews were recorded with consent, and verbatim transcripts were explored with thematic analysis. This presentation will focus on what helps and hinders GPs as they seek support for mental illness, as well as potential strategies for managing chronic stress and distress.

Findings

We will present three themes which encompass the barriers and facilitators to help-seeking: work related (such as attendance at work and attitude of the medical profession to mental illness) with ‘guilt-induced presenteeism’ (i.e. attending work even whilst sick) commonly described; instances where symptoms themselves worked as barriers or facilitators (such as the inertia of depression versus reaching crisis point as a spur to action); and access to support (such as the relationship with their own GP, concerns about confidentiality and perceived quality and availability of appropriate treatments and specialist services). GPs also talked about survival strategies in an attempt to regain their work/life balance, which included cutting down or varying work content, and asserting boundaries. Although some of these individual coping strategies may be beneficial and necessary for individuals, they may impact significantly on the sustainability of the profession and the NHS.

Consequences

We suggest that systemic changes are needed to challenge the ‘culture of invulnerability’ and combat stigma and its effects regarding mental illness within the medical profession, as well as to support individual GPs and protect the profession from further damage. Further, we support the development of specialist services to support GPs living with distress, such as the new NHS England GP Health Service.