Many comparisons can be drawn between the legal and medical professions. Both professions are steeped in elitism, entrenched from long histories of tradition and societal respect. For junior lawyers and doctors, entry into these professions is defined by rigid paths of vocational training, which is highly competitive and heavily relies on the collegiality and support of your senior supervisors and peers. Tragically, both professions have also been touched by spates of suicides at the junior level and increasingly high levels of mental illness amongst its ranks. Despite this, both professions have been slow to address the systemic issues that give rise to mental health issues and little has been done to address the entrenched attitudes that dismiss mental health issues or worse, perceive mental illness as a personal weakness that justifies why some people aren’t ‘cut out’ for the profession.
We have a problem
The statistics are in and it is now is undeniable that people in the legal and medical professions suffer from a disproportionately higher level of mental distress than the general population. A 2013 report commissioned by Beyond Blue found that doctors suffered ‘substantially higher rates of psychological distress and suicide attempts than the Australian population and other Australian professionals’. Alarmingly, 24.8% of those surveyed had suicidal thoughts within the last 12 months, with 2% attempting suicide during this period.
These findings closely reflect similar studies conducted in the legal profession. In Courting the Blues, one of the most comprehensive studies into Australian lawyers’ experience with mental health, the authors found that respondents reported a higher level of psychological distress not only when compared to the general population but also when compared to medical students.
Interestingly, this report also gives us insight into attitudes towards mental illness. 50% of respondents thought that their employer would be discriminatory about mental health. This was higher in the student population at 62.6%, likely because they have yet to have experience in the workplace. Whilst most of the respondents reported positive attitudes towards people with mental health issues, the report found that a significant number of people still held negative attitudes about mental health such as the 19% of law students who believed that people with depression are dangerous. In short, we have a well established problem that needs strong leadership and significant reform.
Stop using resilience as a cop out
What prompted me to write this post was the response to a recent Insight episode on SBS that explored mental health amongst medical students and junior doctors. The overall consensus was that the crippling hours coupled with an unsympathetic work culture led those interviewed to experience depression, anxiety and suicidal ideations.
What pissed me off was reading a letter to the editor published the following day from the dean of one of Victoria’s medical schools. In this letter, he acknowledged that rostering could be improved as a means of improving mental health but concluded by saying that ultimately doctors needed to develop resilience to deal with the hours, stress and daily trauma. This struck me as such a cop out and a real divergence from a rare opportunity to actually reform aspects of the profession. By putting the responsibility solely on the individual, the profession can essentially wash its hands of its culpability.
Following the suicide of her sister Dr Chloe Abbott earlier this year, Micaela Abbott spoke at an Australian Medical Students’ Association conference saying that it wasn’t the lack of resilience that killed her sister, rather it was the systemic failures within the profession. It strikes me as insulting to insinuate that doctors or lawyers who suffer from mental health issues or commit suicide are somehow less resilient than others as a means for entire professions to avoid having to do the hard yards and critically examine the entrenched cultural problems. I’m not denying that resilience is a crucial tool for everyone but the roots of mental health problems are multifaceted and cannot be solely blamed due to a person’s lack of resilience.
In the legal profession, firms have rushed to introduce mindfulness programs and yoga as a means of ensuring their employees’ wellbeing is being looked after. Again, these solutions place the responsibility solely on the individual to build coping mechanisms to deal with the large workloads, hours and stress, rather than addressing any structural causes of these problems and attempting to address the harder issues of workload allocation and billing structures.
There are solutions, but…
There are certainly practical solutions that can be utilised to overcome this rise in mental health issues. For lawyers, it has been suggested that the abolition of time-based billing will alleviate some of the pressure placed on lawyers. Time based billing involves billing clients in six-minute increments, something which strikes me as inefficient and also destructive as many are expected to bill 7 hours a day which usually requires a minimum of 10 hours in the office (a conversation for another day!). For doctors, it has been suggested that rosters are amended, with the AMA Safe Hours campaign leading the charge to regulate breaks and shift hours. Overall, the recommendations for reform rest on practising safe work hours.
However, none of this will ever be implemented until those within the profession recognise there is a problem and do something about it. This needs to come from all levels of leadership. These ideas will be difficult, if not impossible to implement, unless there is consensus that something needs to be done about it accompanied with a huge attitudinal and cultural shift.
We have been brainwashed
In numerous conversations with junior doctors and lawyers, many recoiled at the possibility of challenging the crippling work hours they are expected to perform. Junior doctors routinely work two to three hours over their rostered hours due to the cultural expectation that if you were really serious about your job, you would be ‘putting in the hours’. This can result in 12 to 14 hour shifts. Imagine that next time you’re at the hospital.
It is a similar story at most top and mid tier law firms where 3am finishes are the norm, particularly in the litigation world where it is expected you will be on the beck and call of the client.
As a junior lawyer, I get it. It is impossible to challenge the status quo when your non-existent career is at risk. It’s viewed as career suicide. But we also need to critically examine these conditions, compare them to other professions and realise that this is not acceptable and that we can play our small role in advocating for reform by acknowledging it as a problem rather than blindly resigning ourselves to it.
During those conversations with junior doctors, I sat there dumbfounded whilst they competed over who performed the most overtime and was even more astonished when they said that working 14 hours is not a problem, it was merely a rite of passage for a junior doctor. When I raised the possibility of rostering reform, one person said that it would be ‘impossible’ to reduce the hours doctors work without disrupting patient changeover. It was so disillusioning to think that this culture had this junior doctor so deeply within its clutches already to the point where he was resigned to the fact that it will never get better. It is even worse to think that he is likely to do nothing to make it better for the next generation of doctors.
Ultimately, no regulation or yoga or mindfulness will ever work unless these cultural issues are addressed, particularly at the senior level. Whilst building resilience is an important aspect, we also need to critically examine the wider problems leading to this significant mental health problem in these professions. We need senior lawyers and doctors to get rid of this notion that they need to put juniors through the ringer because that’s what they had to go through during their early years and start leading the charge with making things better for the next generation. But for the younger generation of doctors and lawyers, we need to switch our critical minds on and get some perspective. These are, objectively, unhealthy practices. Without recognising this as a real problem, things will never change and some of our most brightest and talented peers will continue dying.