Gateways guidance: 15.8 Support and reasonable adjustments in the case of mental illness
The following account of a trainee with mental illness diagnosed during postgraduate training suggests a number of possible reasonable adjustments and support measures that might be useful:
- ‘The consultant I worked for at the time of my diagnosis was great. We used most of the weekly supervisions to discuss my diagnosis and possible consequences including the risk of relapse, the possible impact of mental illness on performance and fitness to practise, and the importance of insight. He managed to reduce some of my fear and anxiety about being stigmatised and discriminated against for the rest of my professional (and private) life.
- ‘We agreed that I would continue to work full time but stop night on-calls for the time being to reduce some of the pressure and to allow a regular sleeping pattern. My psychiatrist later referred me to occupational health to get more advice on possible work arrangements.
- ‘The next year was difficult due to being off sick for months in a row and feeling very guilty about that, coming back to work and trying to sit the exam in between aiming for the right combination of medication, and relapsing due to sleep deprivation when trying to re-commence on-call work. I worked nine to five and had a reduced workload. At one point, it seemed that we had reached the limit of how much adjustment to a job is possible. But my clinical tutor suggested that the deanery would find me a staff grade post within the Trust and that my place on the rotation would be kept open for me to come back. However, we decided against this option. Eventually, I was offered a six months extension of my rotation and passed the Part 2 Exam.
- ‘After that I had very useful meetings with my clinical tutor, occupational health consultant and my educational supervisor to discuss my strengths and weaknesses due to suffering from a mental illness, the choice of a sub speciality and different locations/Trusts to work as an SpR.
- ‘I have started my full time post as an SpR. Occupational health has agreed to allow me to try night on-calls again. The condition being that I will have backup by a consultant who knows about my illness so that I could ring the backup consultant any time if things get too much and he/she would take over.
- ‘When I wasn’t so well earlier this year my consultant agreed on flexible working hours. These sorts of adjustments are very helpful, I needed it only for two weeks, but I’m sure it played a part in not further relapsing.
- ‘I made sure that the Program Director of the SpR Rotation is aware of my illness and our agreement is that I apply for/attend the programmes as everybody else; however, should I feel it becomes too much I could discuss it with him etc. He also reassured me that he would always be available in the background.
- ‘There are several aspects which have to be considered in order to ensure as much mental stability as possible and ongoing fitness to practise:
- be aware of warning signs for possible relapse and alert for changes
- involve people around you and work together with the support system available
- my safety net consists of my psychiatrist, my occupational health consultant, the consultant I work for and myself
- I also always encourage my educational supervisor to tell me if he/she thinks something isn’t quite right
- in my experience it is helpful to be open with colleagues I work with closely as they usually appreciate to know what is going and therefore find it easier to help if needed.’
- ‘It did take a lot of determination from myself and everybody else involved to finally get me where I am now. It took a lot of emotional support as well. I needed a lot of support from my psychiatrist, consultants and occupational health consultant. We talked for hours, wrote endless emails, and probably repeated ourselves a million times but it helped to restore a lot of my self confidence. It also restored my belief that I am able to have a career in psychiatry.’
- Disabled trainee