Moving through training with a mental health condition
This anonymised account reflects the views of an individual, and not the General Medical Council.
A Foundation Year 2 doctor shares their experience of moving through medical education and training with a mental health condition, and how less than full time training helped with the transition to the Foundation Programme.
Punished for being unwell
I am currently a Foundation Year 2 (FY2) doctor. I qualified from my medical school with Distinction and completed my intercalated degree at another university. I suffered from depression (subclinical) since I was at school, without support from a GP, and have been on antidepressants since my first year of university. I've had multiple mental health problems throughout my education and training, including depression, suicidal thoughts and psychosis, both as a medical student and as a doctor. I have bipolar disorder, but this diagnosis was not made until a few years ago.
I felt that the university were not supportive of my condition. An occupational health doctor informed me that I should not really have considered medicine as a career due to my mental health problems. And they suggested I may wish to consider looking elsewhere for a career, which felt very unhelpful.
The medical school dean held multiple meetings with me. I was asked to have a break in my studies whilst unwell, which I agree was reasonable. However, I think the way it was done was inappropriate. I felt I was being judged as unsafe to practise, and punished for being unwell. I was forced into making a decision that ultimately delayed my qualification by a year, but I felt I had little choice in the matter.
I’ve suffered from psychosis since completing my intercalated degree, but I wasn’t diagnosed until a few years later during my final year of medical school. I commenced antipsychotic treatment which I’ve continued ever since. I’ve also had a few hypomanic/manic episodes and received my diagnosis of bipolar. I’ve been admitted to a ward on three occasions for suicidal thoughts, and attempted suicide.
I had no hesitation in declaring my mental health problems when I entered the Foundation Programme as I’d already been identified as having these issues on a ‘transfer of information’ form. From the start, I was offered the opportunity to engage with the occupational health service (of very high quality) and I was offered less than full time (LTFT) training, which I accepted until I felt I was ready to work nights and weekends.
Following this, I was transferred from one postgraduate training organisation to another. Unfortunately, one forgot about me, and I had to chase them up continuously in order to be transferred, which eventually happened but took too long. I felt this resulted in the postgraduate dean being very unsupportive and that the meetings with Foundation Programme Directors were too intensive and somewhat intimidating, in the guise of appearing supportive. Overall, I think the employer was more supportive than the postgraduate training organisation.
Following my transfer I was allowed to work less than full time (LTFT), but only after I had been off sick for a significant period of time. This should have been offered sooner.
I wanted to work as a locum - my poor financial situation was a significant trigger. However, I was made to feel uncomfortable by postgraduate deans and Foundation Programme Directors about working locum shifts, as whenever they saw me on shift they made comments.
What I would change…
- Offer less than full time (LTFT) training before a crisis happens
- Have a mental health champion doctor available for medical students and doctors in each hospital so that those on placement have a direct named contact.
- Have an external organisation for medical students and doctors to appeal to regarding potential discrimination and bullying.
- Have a charter of rights laid out that makes it clear to deaneries and medical schools what the situation is regarding mental health conditions.
- Make it clear that postgraduate training organisations cannot introduce separate rules to GMC recommendations (I note that mine has introduced a separate locum policy for LTFT), following advice from the GMC that there are ‘no regulatory barriers’ to working them.
- The system should see the doctor as a patient themselves, and there should be the same confidentiality policies applied.
- Encourage an open and honest culture – ask individuals to share stories of their own experiences in medical schools and in training or practice. Educate those speakers on the new Welcomed and valued guidance.