7. Treat mental injury

There are high levels of work-related mental injury and suicidality within the medical profession. The good news is that mental injury is both preventable and treatable when workplaces identify, assess and control psychosocial hazards and risks, and when doctors have early access to evidence-based mental health care.

The sections below aim to improve the mental health literacy of non-psychiatrists. They are deliberately concise and are not a substitute for independent professional assessment and treatment. The Medical Board advises against self-diagnosis and self-management, which are potentially harmful and usually ineffective.

The ICD-11 diagnostic criteria for the following conditions are referred to below:

1. Burnout
2. Adjustment disorder
3. Dysthymia
4. Depression
5. Seasonal affective disorder
6. Anxiety disorders
7. Panic disorder
8. Acute stress disorder
9. Post-traumatic stress disorder
10. Substance use disorders
11. Suicidality

How work-related mental injury develops in doctors

While workplace stressors may exacerbate pre-existing mental illness, more commonly a previously healthy doctor develops mental injury following prolonged exposure to unmanaged psychosocial hazards and risks. These include repeated exposure to trauma, chronic mental fatigue, excessive workloads, unsafe hours, bullying, discrimination, occupational violence, and sustained moral distress.

Medical rosters often lack redundancy or flexibility, making it difficult to take time off to recover or to access leave when unwell. As a result, doctors with emerging mental injury frequently continue to work despite symptoms such as low mood, irritability, loss of energy, impaired concentration and difficulty with decision-making.

Many doctors cope by burying themselves in work, prioritising patient care at significant personal cost. Other common features include withdrawal from family and friends, loss of interest outside work, excessive guilt, taking disproportionate responsibility for adverse outcomes, defensiveness, uncharacteristic anger, frustration or pervasive cynicism.

Because these behaviours are often normalised in overstretched medical environments, colleagues and workplaces may fail to recognise mental injury early. When doctors disclose distress or request time off, responses may be dismissive (“everyone is burnt out”) or, at times, discriminatory.

Delayed recognition and treatment worsen prognosis

Early treatment - and why timing matters

Optimal management of work-related mental injury involves early, comprehensive psychiatric or psychological assessment, followed by evidence-based treatment. Depending on diagnosis and severity, effective interventions include:

• cognitive behavioural therapy (CBT)
• interpersonal therapy
• mindfulness-based cognitive therapy (MBCT)
• pharmacological treatment where indicated

Evidence-based treatment guidelines are available at:
https://psychology.org.au/for-the-public/psychology-topics/evidence-based-psychological-interventions
https://www.ranzcp.org/clinical-guidelines-publications

When treatment is delayed, symptoms may escalate, insight may diminish, and functional impairment increases - raising the risk of crisis, prolonged absence from work, or suicide.

Workplace intervention is essential for recovery

Clinical treatment alone is not sufficient. Recovery from work-related mental injury often requires workplace interventions to address hostile cultures.

Employers must identify and control the psychosocial hazards and risks that contributed to the injury and plan early for a safe, flexible and supported return to work. Graduated return to duties, reduced hours, predictable rosters, protected leave and trauma-informed supervision are often critical.

Where doctors return to the same psychologically unsafe environment - with unchanged hazards, unrealistic expectations, or unresolved trauma - relapse is likely.

Sadly, many medical workplaces still fail to recognise the benefits of supporting doctors to remain at work or return safely, despite workforce shortages. When mental injury is unrecognised, untreated or undertreated, doctors may deteriorate rapidly and leave work abruptly, often with little organisational support.

This harms not only the affected doctor, but also colleagues who observe the consequences and quietly resolve not to disclose their own distress.

These outcomes are preventable.

Mental injury can be prevented and effectively treated when workplaces address psychosocial hazards and risks and doctors have timely access to evidence-based care.

Common mental illnesses (ICD-11 aligned)

1. Burnout

Burnout is a syndrome resulting from chronic workplace stress that has not been successfully managed. It is characterised by:

• feelings of energy depletion or exhaustion
• increased mental distance from work, negativism or cynicism
• reduced professional efficacy

2. Adjustment disorder

Adjustment disorder is a maladaptive reaction to identifiable psychosocial stressors, emerging usually within one month. It is characterised by preoccupation with the stressor and impaired adaptation causing significant functional impairment.

Symptoms may include persistent worry, rumination, sadness, sleep disturbance, poor concentration, increased alcohol use, hopelessness, social withdrawal and suicidal thoughts or behaviours. Adjustment disorder often resolves within six months unless the stressor persists.

3. Dysthymia

Dysthymic disorder involves a persistent depressive mood lasting two years or more, with associated symptoms such as low energy, poor concentration, low self-worth, guilt, sleep and appetite disturbance, and hopelessness.

4. Major depression

Major depressive disorder involves depressed mood or loss of interest most of the day, nearly every day for at least two weeks, with associated cognitive, emotional and physical symptoms.

Antenatal and postnatal depression can occur during pregnancy or in the year following childbirth and affect not only the mother but also infant development and family relationships.

5. Seasonal affective disorder (SAD)

SAD is a mood disorder with a seasonal pattern related to light exposure. Doctors working night shifts or in low-light environments may also be at risk. Light therapy can be effective.

6. Anxiety and fear-related disorders

Anxiety disorders involve excessive fear or anxiety causing significant impairment. Symptoms may include restlessness, muscle tension, palpitations, hyperventilation, sweating, tremor, fatigue, poor concentration, gastrointestinal symptoms, dizziness or faintness.

Types include generalised anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, phobias and panic disorder.

7. Panic disorder

Panic disorder is characterised by recurrent, unexpected panic attacks with persistent concern about recurrence and associated avoidance behaviours.

8. Acute stress disorder

Acute stress disorder is a short-term response to trauma, lasting from two days to four weeks. Emotional cycling, intrusive memories and avoidance are common early reactions.

9. Post-traumatic stress disorder (PTSD)

PTSD may develop after exposure to extremely threatening or horrific events and involves re-experiencing, avoidance and persistent heightened threat, causing significant functional impairment.

Complex PTSD involves additional disturbances in affect regulation, self-concept and relationships, usually following prolonged or repeated trauma.

Doctors are particularly vulnerable due to repeated exposure to trauma, death, adverse outcomes and vicarious trauma. Rural and remote doctors may face additional risks due to isolation, limited resources, personal relationships with victims and community scrutiny.

10. Disorders due to substance use

Substance use disorders arise from repeated use of psychoactive substances, including prescription medications. Alcohol dependence involves impaired control, prioritisation of use, persistence despite harm, tolerance and withdrawal.

11. Suicidality

Suicidal thoughts or behaviours are psychiatric emergencies.

If you are at risk, contact your GP, mental health professional or the Doctors’ Health Line (24/7):
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.

Serious mental illnesses (such as bipolar disorder, schizophrenia, substance use disorders) and cognitive decline carry increased suicide risk and reduced insight. Early, proactive treatment is essential. Doctors can seek care, take time off work and obtain confidential medical certificates without mandatory reporting when engaged in treatment.

If you are concerned about a colleague, intervene sensitively as a trusted friend and assist them to access urgent professional help.

For support pathways, refer to Topic 9.

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