4. Thrive

Mental harm at work is not inevitable. It reflects governance and system failures that expose clinicians to unmanaged psychosocial hazards, increasing the risk of patient complaints, clinical incidents, and compensable work-related mental injury. It is predictable, preventable and has an excellent prognosis with evidence-based treatment and workplace interventions.

Preventing and managing psychosocial hazards protects health and safety, reduces turnover and absenteeism, and improves performance and clinical workforce retention.

The Work Health and Safety Code of Practice was registered in late 2024. Since then, employers have had a legal duty to implement systems, procedures, and policies to prevent, reduce and manage psychosocial hazards affecting employees, including clinicians in training, contractors such as GPs, and visiting consultants.

These hazards include excessive job demands, low job control, poor support, lack of role clarity, poor organisational change management, inadequate reward and recognition, poor organisational justice, exposure to traumatic events or material, remote or isolated work, poor physical environments, and conflict or poor workplace relationships.

Excessive job demands involve sustained physical, mental, or emotional effort and become hazardous when prolonged. Risks include excessive overtime, heavy workloads, unsafe clinician–patient ratios and being required to work outside scope of training. Controls include realistic staffing, protected breaks, appropriate training and supervision, and timely support following exposure to trauma.

Low job control occurs when autonomy is restricted, such as through rigid rosters or unnecessary approvals. Risk is reduced through flexibility, shared planning and greater control over task timing and priorities.

Poor support includes inadequate resources, poor communication, unavailable supervisors, and toxic cultures. Controls include adequate resourcing, supervisor training, clear escalation pathways, and effective teamwork.

Lack of role clarity arises from unclear expectations, shifting duties or ambiguous reporting lines. Risk is reduced through clear role descriptions, instructions, and accountability structures.

Inadequate reward and recognition become hazardous when effort is persistently unacknowledged. Controls include meaningful feedback, fair evaluation, development opportunities, and respectful management.

Poor organisational justice reflects unfair processes, inconsistent decision-making, lack of transparency or blame cultures. 

These risks are managed through fairness, consistency, privacy, and respectful communication.

Exposure to trauma becomes hazardous when frequent or severe. Controls include limiting exposure, role rotation, protected recovery time, and opportunities for helpful debriefing.

Poor physical environments affect safety and concentration. Risks include unsafe tasks, poor equipment, ill-fitting protective equipment, poor air quality, and inadequate facilities, all of which must be addressed in line with WHS and accreditation standards.

On a positive note, it is possible to protect your mental safety by trying to minimise work stress, damaging interpersonal conflict, unconscious and conscious bias and negative behaviours.

Clinicians work in high-stakes environments - making rapid decisions, managing crises, and being exposed to trauma, grief, and uncertainty. These pressures are amplified by community expectations that clinicians are always competent, caring, and available.

Patient complaints, clinical incident processes, and medicolegal issues also create intense stress, particularly when prolonged, unreasonable, or malicious. 

Clinicians targeted by vexatious complaints require experienced collegial, organisational, and psychological support.

Stress also accumulates from personal life events such as career transitions, relationships, parenting, illness, or loss. 

Together, these pressures compound overall strain.

Helpful strategies include acknowledging concerns, accepting limits, creating mental distance during breaks, and allowing recovery through support and self-compassion.

If rumination about work outside work hours persists, it may be helpful to ask:

· what is the evidence for this belief?

· is there another explanation?

· what is the worst, best and most realistic outcome?

· what would I advise a colleague?

Evidence-based tools including cognitive behavioural techniques, positive psychology, mindfulness, and relaxation may help.

Sleep disruption is common, particularly with shift work. Generic sleep hygiene may be insufficient. Tailored online programs such as The Mindful Way to Healthy Sleep by Dr Giselle Withers may assist.

Respectful disagreement and robust debate are essential for learning, ethical discussion, and patient safety. Conflict becomes harmful when it is ego-driven, unmanaged, or personalised.

When conflict arises, try to remain calm and assertive, clarify facts, listen actively, acknowledge different perspectives, and work towards solutions. Focus on behaviour rather than character and consider professional mediation if required.

Reflect on past conflicts and consider how tone, authority or prior experiences may have influenced outcomes. Aim to remain professional and calm.

Bias refers to the mental shortcuts used to make rapid judgements. While often efficient, in complex healthcare environments these shortcuts can distort recruitment, supervision, performance assessment, complaint handling and incident review.

Conscious bias is deliberate and intentional. Unconscious bias is automatic and outside awareness, shaped by training, culture, and experience.

Examples include interpreting identical behaviour differently based on gender, favouring those similar to oneself, or misjudging quiet clinicians as less capable.

Bias influences whose concerns are taken seriously, who receives support, and who is blamed when system pressures contribute to adverse outcomes.

Both conscious and unconscious bias can undermine psychological safety, contribute to discrimination, distort decision-making and increase the risk of scapegoating individuals for system failures.

Where biased decision-making contributes to unsafe conditions or suppresses speaking up, it may expose organisations and their officers to legal risk.

Practical steps include valuing all voices, challenging stereotypes, and recognising the significant cumulative harm that can be associated with bias.

Workplace hazards such as discrimination, racism, sexual harassment, bullying, and violence are specifically addressed in “Stop abuse” in the main menu.

Poorly managed processes for responding to these behaviours can worsen harm, particularly where inappropriate mediation is used. Early, confidential escalation to a trusted senior person can prompt change and protect others.

A strong speak-up culture, visible leadership and safe reporting mechanisms are critical.

Work-related mental injury and suicidality are common in clinicians, particularly those in training. Mental injury is both preventable and treatable when psychosocial hazards are addressed and clinicians access evidence-based treatment early.

This section is deliberately concise and aims to encourage your early engagement with a trusted treating practitioner – because self-diagnosis and self-management are usually ineffective and may be harmful.

While workplace stress can exacerbate pre-existing mental illness, mental injury more commonly develops in previously healthy clinicians following prolonged exposure to unmanaged hazards such as trauma, fatigue, excessive workloads, unsafe hours, bullying, discrimination, occupational violence, and moral distress.

Rigid rosters and lack of flexibility often prevent timely leave or access to care. 

Many clinicians continue working despite symptoms including low mood, irritability, fatigue, impaired concentration, and poor decision-making.

Other common symptoms of mental health problems include withdrawal, loss of interest, excessive guilt, over-responsibility for adverse outcomes, defensiveness, anger, or pervasive cynicism. These behaviours are often normalised in health care workplaces because “many people feel this way”, leading to delayed recognition and inadequate responses.

Delayed treatment increases the risk of deterioration, functional impairment, prolonged absence, and suicidality.

Optimal management requires early psychiatric or psychological assessment and evidence-based treatment tailored to conditions such as burnout, adjustment disorder, dysthymia, depression, anxiety disorders, panic disorder, acute stress disorder, post-traumatic stress disorder, and substance use disorders. 

Effective treatments include cognitive behavioural therapy, interpersonal therapy, mindfulness-based cognitive therapy, and pharmacological treatment where indicated. But clinical care alone is insufficient. Recovery often requires workplace intervention to address contributing hazards and support a safe return to work, including graduated duties, reduced hours, predictable rosters, and protected leave. If clinicians return to unchanged unsafe environments, relapse is likely – which is why it is so important to have a continuing relationship with a trusted treating GP who can help you ensure a workplace is safe before your return to work plan is implemented. 

Other serious mental illnesses, such as bipolar disorder, schizophrenia and substance use disorders, as well as cognitive decline, carry increased suicide risk and reduced insight - a dangerous combination. Clinical colleagues may be in a position to identify uncharacteristic behaviours and help facilitate urgent proactive treatment through skilled mental health professionals outside the workplace. 

Many clinicians fail to acknowledge their own cumulative exposure to trauma. Most are expertly trained to manage physical trauma. We intubate on roadsides, lead resuscitations in chaotic emergency departments, and support families through sudden loss.

The psychological trauma that most effects clinicians is different. it is quieter, cumulative, and frequently unrecognised - or dismissed as “just burnout”.

It is the moral distress when a patient dies because there are no beds or staff.

It is reporting threats or stalking and hearing nothing in response from management.

It is a child disclosing abuse when you know the system is overwhelmed.

These are not isolated events. They are repeated exposures to ethically distressing situations in overstretched systems, often without time, support or permission to recover.

When psychosocial hazards such as excessive workloads, unsafe staffing, bullying, discrimination, racism, sexual harassment or violence are present, the initial event is often only the first injury. Minimisation, disbelief or silence can create a second, deeper harm.

Too often, this pattern is misunderstood. Symptoms such as hypervigilance, sleep disturbance, emotional exhaustion, irritability and withdrawal are labelled as poor coping or simply “burnout”. In reality, many clinicians are experiencing cumulative psychological trauma or moral injury. This does not necessarily mean there is a psychiatric condition such as post-traumatic stress disorder or complex post-traumatic stress disorder. 

Generic wellbeing strategies and resilience training may help with everyday stress, but they are insufficient in the face of repeated trauma. 

Common responses, even when well-intended, can deepen experiences of trauma such as:

“That’s just how it is.”

“Everyone goes through this.” or

“You need to toughen up.”

Encouraging clinicians to “be more resilient” in unsafe environments shifts responsibility away from the system and can compound harm. These inappropriate responses reinforce silence. 

Under new WHS laws, exposure to trauma is a recognised psychosocial hazard that must be identified and managed. Trauma cannot be eliminated from healthcare, but the response to it must change. Protection does not come from endurance alone. It comes from simple human responses: being believed, having experiences acknowledged without judgement, being treated with respect, restoring some choice and control, and having timely access to support within psychologically safe teams.

The greatest risk in clinical environments is not exposure to trauma itself - it is the expectation that clinicians should absorb it without support. We must move from silence to safe speaking up, from stoicism to supported professionalism, and from individual blame to system accountability.

For more information and links to helpful websites, please see the links below. 

Please consider sharing the SafeDr website link with your colleagues and workplaces.

More information:

Safe Work Australia – Model Code of Practice: Managing Psychosocial Hazards at Work
https://www.safeworkaustralia.gov.au/sites/default/files/2022-08/model_code_of_practice_-_managing_psychosocial_hazards_at_work_25082022_0.pdf

https://www.safeworkaustralia.gov.au/safety-topic/managing-health-and-safety/mental-health/psychosocial-hazards

Evidence-based guidelines for treatment of psychological injury:

https://psychology.org.au/for-the-public/psychology-topics/evidence-based-psychological-interventions

https://www.ranzcp.org/clinical-guidelines-publications

Helpful references:

https://www.mentalhealthcommission.gov.au/projects/mentally-healthy-work/national-workplace-initiative

https://www.safeworkaustralia.gov.au/workers-compensation/workers-compensation-psychological-injuries

https://www.safeworkaustralia.gov.au/safety-topic/managing-health-and-safety/mental-health/resources

If you wish to seek help or advice, please refer to 2. Help now on the main menu of this site. 

Contact your GP, or mental health professional.

In addition medical practitioners may contact the Doctors’ Health Line, available 24/7: 

T: 1800 006 888

State services:

NSW & ACT: 02 9437 6552
NT & SA: 08 8366 0250
QLD: 07 3833 4352
TAS & ACT: 1300 374 377
VIC: 1300 330 543
WA: 08 9321 3098

Lifeline: 13 11 14

Recovery is possible. You are not alone.