Feature, Report

Let’s talk about mental health

Eyecare professionals are often high achievers who manage businesses, patients and staff all at once. The stress and pressure can lead to psychological issues. With COVID-19 presenting new problems, Insight checks in on the sector’s mental health.

Six years ago, the issue of mental health forced its way into the consciousness of the eye health sector unlike ever before when two Australian optometrists were lost to suicide.

Both men, who were middle-aged and practised in New South Wales, took their own lives within a six-week period. It was an unprecedented tragedy for the sector and served as a stark reminder that optometrists and other professionals within the ophthalmic workforce weren’t immune to the devastating effects of anxiety and depression.

“They were guys I had talked to on a number of occasions and they would have been well known among the sector. It was shocking because on the surface there didn’t appear to be any underlying issues, their worlds seemed much like yours and mine,” Optometry NSW/ACT CEO Mr Andrew McKinnon says, reflecting on that period.

“They came in very quick succession and it made us sit up and think this is an issue that really needs exploring, not just as a personal issue for members, their colleagues and family but from the patient viewpoint as well.”

In recent months, mental health has again worked its way to the top of the agenda for bodies like Optometry Australia (OA) and RANZCO as eyecare professionals deal with a multitude of new clinical, employment, financial and personal health issues brought on by COVID-19.

In perhaps the most comprehensive data on the psychological impact so far, OA surveyed 3,290 optometrists during the month of April – arguably the worst month of the crisis in a nationwide context – to provide a snapshot of optometrists’ mental state.

The survey indicated in April 88% of optometrists were ‘travelling ok’, which OA says is an indication of the sector’s resilience. While it’s positive to have a large proportion feeling this way, it’s important to note that 12% were struggling.

Other stark findings revealed 46% of members were anxious about their future, with 61% believing it would become increasingly difficult to find employment as an optometrist, and 76% suspecting that salaries will be compromised due to over-supply.

Although sentiment may have improved in some states since the survey, the fact that 96% of practice owners or self-employed optometrists such as locums saw their revenue decrease indicates the financial strain that’s been imposed on the sector. Furthermore, 25% of those had their income decrease by 75% or more, 34% saw a decrease of 50-74%, and 30% experienced a 30-49% drop.

In August, another poll of optometrists revealed an estimated 50% of optometrists were still working fewer hours than they were pre-COVID-19.

In the medical field, which includes ophthalmologists, mental health organisation Beyond Blue conducted the country’s first ever National Mental Health Survey of Doctors and Medical Students in 2013 and found doctors and medical students are burnt-out and are more likely to experience psychological distress and suicidal thoughts than the general community.

In total, 27% of doctors and 36% of young doctors are highly likely to have a minor psychiatric disorder.

Medical students and young or female doctors are most at risk, with significant levels of stigma directed towards people with mental health problems.

Further evidence of this was highlighted in Australia’s inaugural national Medical Training Survey this year where one in eight trainees were found to be working at least 60 hours on average per week.

“This is particularly worrying given the clear recent Australian research showing that doctors in training who work more than 55 hours each week have double the risk of developing mental health problems and suicidal ideation,” Australian Medical Association president Dr Tony Bartone said at the time.

“One in five doctors in training felt they had personally experienced bullying, harassment, and/or discrimination in their workplace in the last 12 months.”

Andrew McKinnon.

Optometry NSW/ACT CEO Mr Andrew McKinnon says he has seen optometrists at opposite ends of the career scale struggle with their mental health during the pandemic.

Building resilience

In light of these statistics, member bodies within the ophthalmic sector have taken note and have swiftly mobilised to support professionals that are doing it tough.

When Optometry NSW/ACT was confronted with the loss of two optometrists six years ago, it enlisted the help of organisational psychologist Ms Rachel Clements who is now helping the organisation through the COVID-19 pandemic.

Her previous work with the organisation has focussed on managing the mental health of optometrists who are often ‘high achievers’ focused on balancing their business and patient load. Her work has also guided optometrists in dealing with mentally unwell support staff, as well as management of patients who appear at risk of suicide.

In her latest initiative with Optometry NSW/ACT, Clements, who is director of psychological services at the Centre for Corporate Health in Sydney, has introduced the Resilience Box. The resource will soon be rolled out nationally to OA members, and features alongside OA webinars and podcasts she has done in recent months.

“Rachel developed the Resilience Box for a major bank and she thought it would be great for our members,” McKinnon, CEO of Optometry NSW/ACT, says. “It is designed specifically to provide people with online tools that will help them with their mental resilience.”

McKinnon says the resource comprises a series of video clips and talks through the body’s natural responses to stress. Users can also select different modules that pertain to them, such as dealing with grief, positive mental health, the importance of nutrition, the role or neurotransmitters, reducing stress and much more.

“It largely reinforces that what you’re feeling is normal and that there are ways to cope and here’s the tools to help. If you’ve been through this and it’s not helped, there’s further contact details for mental health support organisations and counselling if you want to go to the stage. The member will cover the cost of counselling individually, but they get it at a better rate than they would normally.”

In his role, McKinnon says he is currently seeing mental health issues at both ends of the career scale in optometry.

He says optometry has been one of the last remaining professions that offered guaranteed job prospects for graduates, however that wasn’t necessarily the case in the current climate.

“Many graduates have been affected and that’s simply because they were the last to be hired and first to be let go in some cases, so the uncertainty and reality of job curtailment is very real for them – and it’s not a situation that has ever arisen before,” McKinnon explains.

“On the other hand, we’re seeing quite a number of older optometrists who are facing two dilemmas. The first is that their practices have been affected like everybody else’s. Secondly, a number of them have their own health issues and optometry is a very close contact profession, so there’s been a lot of concern about how close they need to get to their patients.

“A number of them thought: ‘I’m in my 60s, I was going to retire in five years so should I just do it now?’. But then they are questioning whether they are ready to retire mentally, and then there’s the question of who’s going to buy my practice at this time.”

Luke Arundel.

Mr Luke Arundel, OA’s national chief clinical officer, says the organisation’s Mental Health Support page within its COVID-19 hub to support members through this time has had more than 400 visits during the past few months.

Each of OA’s member support optometrists have undertaken mental health first aid training courses.

“AHPRA notifications, being sued, conflict with employers, employees or patients or needing assistance with helping patients suffering from domestic or child abuse are some of the other non-COVID related areas where we find member’s mental health can be adversely affected,” he says.

“We have been told numerous times that the one-on-one, confidential and professional support provided to members during these incidents has been instrumental in assisting during these very mentally stressful events and I think it is important that optometrists don’t have to tackle these challenges alone.”

Who’s looking out for ophthalmologists?

COVID-19 has also been the catalyst for change at RANZCO when it comes to dealing with the mental health and wellbeing of its Fellows, trainees and associates.

In March, it formally established its first Health and Wellbeing Group which comprises a committee of 14 ophthalmologists at different stages of their careers. Together, they encourage ophthalmologists and their staff to consider health and wellbeing in a proactive manner and it has compiled resources to support them.

Sydney ophthalmologist Dr Nisha Sachdev is one of five co-chairs of the Health and Wellbeing Group. At the beginning of the pandemic as elective surgery was shut down, she says many of her colleagues struggled with a new type of stress they hadn’t encountered before.

“Ophthalmologists are a high achieving professional group. We are so used to working and when that suddenly stopped many found it difficult to deal with,” she explains. “The biggest issue is the uncertainty – as ophthalmologists and doctors we are used to certainty and consistency and so that’s what hit us the hardest.”

This was then followed by increased demand on ophthalmology services after the government lifted elective surgery restrictions, with clinics needing to prioritise the backlog of patients while complying with capacity restrictions.

Dr Nisha Sachdev.

RANZCO Health and Wellbeing Group co-chair Dr Nisha Sachdev says ophthalmologists need to be comfortable and stable to effectively lead a team.

Sachdev runs her own private practice City West Eye Specialists, which she founded seven years ago. She understands firsthand the stresses of being an ophthalmologist in private practice, which extends far beyond managing patients.

“When we shut down this was the first time we’d ever had minimal income with expenses, and it’s very expensive to run a practice with outgoings such as business loans, staff wages and rent on your facility,” she says.

“But in general, financial stress is one thing, along with managing people and keeping them employed and happy. In one of my latest emails to members through the Health and Wellbeing Group, we highlighted one of the biggest issues as ophthalmologists is that, as leaders, we look after people, we lead a team, we look after our staff and patients – but who looks after us? If we are not comfortable, happy and in a stable position how can we look after and lead a team?”

Sachdev believes one underestimated trigger of stress is surgery and operating itself. She knows of several ophthalmologists who have switched to consulting-only for this reason.

As such, Melbourne ophthalmologist Dr Jacqueline Beltz addresses this issue in her podcast series called GenEye where she talks with experts, including psychologists, about the measures eye surgeons can adopt to ensure longevity in their surgical careers.

“She’s done quite a few podcasts on stress and coping with being a surgeon and mindfulness – being a surgeon is one thing when things go right, but it’s quite stressful when they don’t,” Sachdev adds.

Prior to the RANZCO Health and Wellbeing Group, Sachdev says the profession lacked a formal channel to promote mental health and wellbeing. Since its launch, the group has sent monthly emails on topical issues, which are sent to more than 1,200 Fellows and 300 trainees and allied health professionals (orthoptists and practice managers). A lot of the material has been re-published in a newly developed open section of the RANZCO website.

The group also plans to hold workshops at the annual congress, as well as state branch meetings. There are also plans for webinars and online symposium.

“One thing we have highlighted is that there are silver linings for what we have been through and we are getting through it. The Health and Wellbeing Group is making it known to ophthalmologists that it’s OK not to be OK,” she says.

“We also provide guidance for various support groups. RANZCO has an Employee Assistance Program, which is a confidential free service to do with anything in working life. It’s just a phone call away, and you can get advice on a range of issues including financial stress, management of issues within the practice and mental health and counselling advice.

“The Health and Wellbeing Group is a big step for us as a profession.”

New resource an Australian first

Dr Melissa Black is a clinical research fellow and clinical psychologist at the Black Dog Institute, the only research institute in Australia researching mental health for all ages.

She says it’s important to normalise the experience of low mood and anxiety and discuss them amongst peers.

“There’s a really good reason to experience those feelings right now, but in saying that if those feelings are persisting for longer than around two weeks, and more days than not you’re feeling sad, anxious or irritable, then that’s maybe a tell-tale sign that things might be at a point where it would be good to unpack those with someone and seek additional support,” she says.

“The same can be said for those who feel a sense of loneliness even when they’re with other people and don’t feel like you have support, or constant feelings of exhaustion. There’s also those every day routine differences; often people talk about difficulties with sleep, change in their appetite and diet, changes in their relationships, not feeling like they can switch off at the end of the day, or feel a constant need to worry about work.”

The Black Dog Institute has just unveiled the country’s first multifaceted e-health hub called the TEN (The Essential Network), which was developed by health professionals for health professionals out of the Australian Government’s $1.4 million package to support the mental health and wellbeing of the health workforce during the pandemic.

Black says TEN is the first time that leaders in mental health, academia, mental health research, technology and clinical care have come together to provide such assistance to healthcare workers during a crisis like COVID-19. Those involved in its development were This Way Up, The Royal Australian and New Zealand College of Psychiatrists, Hand-n-Hand Peer Support, SAS, APS, Cogniss, UNSW and the University of Melbourne.

Through the TEN website or app, free mental health resources and tools can be accessed anonymously and provide triaged support, as well as online programs and one-on-one consultations with expert clinicians.

Dr Melissa Black.

Clinical psychologist Dr Melissa Black says issues around fitness-to-practice could be a barrier for healthcare workers to seek help.

“There are lots of options for people and a centralised assessment tool allows people to get a gauge on how their mental health is tracking. They are then presented with different options on how they can follow up depending on their level of need or preferences,” Black says.

This may include self-care tools for managing wellbeing, relaxation strategies and video resources on how to manage healthcare worker-specific issues during this time.

“The other really important part is being able to link people with the right amount of professional support – whether this is the kind of information you can talk about with a GP, or here’s how to access a psychiatrist or psychologist. There’s a Hand-n-Hand peer-support resource that links healthcare workers with healthcare workers. There’s also some middle ground measures, such as online cognitive behavioural therapy resources that people can access themselves that have clinical support.”

Black believes TEN would be valuable to many optometrists and ophthalmologists who work in private settings and may not have access to employee assistance programs that are often accessible in public settings.

She acknowledges that, traditionally, issues around fitness-to-practice may have been barrier for healthcare workers to seek help and disclose a mental health issue.

“There are mandatory reporting guidelines by AHPRA and I think a lot of people think they are immediately going to be struck off the register, but that’s not the case,” Black explains.

“As someone who works with mental health and healthcare workers, the main concern is around whether you can do your job safely and if there is an actual risk to the safety of patients and colleagues. It’s very much a case-by-case basis, and there’s a graded approach to that which is done in collaboration with the healthcare worker.

“Seeking support for your mental health actually reflects really positively on the person. Plenty of healthcare workers with anxiety and depression can do their job and do it safely with the right support.”

Signs and symptoms of Depression

These can be physical, emotional and impact on the way people think. Having one or two of these symptoms may not necessarily indicate depression, but it’s a good idea to check with a GP.

You may be feeling:
– Sad, teary, anxious or irritable.
– Hopeless and negative about yourself and others.
– Alone and isolated.
– Exhausted.

Your thinking may be negative and critical:
– ‘My problems are too difficult to solve’.
– ‘Life is too hard’.
– ‘Everything’s going to go wrong’.
– ‘I’m no good’.
– ‘It’s all my fault’.

Perhaps there’s changes in:
– Motivation.
– Ability to find enjoyment and pleasure in things.
– Quality of sleep (sleeping a lot, waking up a lot, or insomnia).
– Appetite or weight.
– Interest in sex.
– Concentration and remembering things.
– Drinking or use of drugs.

Source: Black Dog Institute

If you need to talk to someone or need further support, call Lifeline on 13 11 14.