The stigma that stings – one doctor’s story

8 minute read

In response to the rollout of the Mental Health Plan 2017-2022, Dr Danielle Smith wrote this letter to SA’s Commissioner of Mental Health, Chris Burns

Dear Mr Burns, I am very encouraged by the implementation of this plan.

I have suffered with bipolar affective disorder (BPAD) after being diagnosed at age 26 in late 1999. I am now 44. I graduated medicine in 1996.

I have worked for SA Health for 19 years, the last 17 in SALHN.

I am a GP consultant in emergency medicine. I believe I am successful and perform my job well. My patient care has never been compromised due to my illness.

I have had several very negative experiences in relation to the treatment of mental health from a personal viewpoint. Due to stigmatisation within our profession (which should be the most sensitive and compassionate one to work in, one would think) I have always felt somewhat discriminated against and unable to openly share that I have a mental illness or my experiences with it.

AHPRA, with the difficulties and obstacles it presents, and its completely unsympathetic approach to health professionals with mental illness, compounds the impact of the disease, and at least in one instance, contributed to precipitating a relapse, in my case.

When we were regulated by the Medical Board of SA and dealt face-to-face with doctors it was a much fairer and more sympathetic environment, where disclosure of illness was much simpler.

AHPRA makes you “jump through hoops” to prove that your medical condition/disease (which one can’t help having any more than diabetes or heart disease) will not impact on patient care.

I have a colleague who has recently experienced some mental health issues and my understanding is that AHPRA has also made things very difficult for him.

I have had three relapses in my life requiring hospitalisation, the first during a year I was not practising medicine, (precipitated by an extraordinary amount of interstate travel in a very short time period and subsequent sleep deprivation), the second postpartum (almost certainly predictable due to  the state of hormonal dysregulation) and the third and most recent, occurring after an overseas trip (a very active trip including several job interviews via videochat, phone or in person).

The last episode caused a very significant amount of personal and family trauma as well as some financial hardship.

It was particularly traumatic for my husband and 11-year-old daughter.

The manic phase of the illness is the most disturbing for those close to me as my contact with reality is lost.

My manic or psychotic symptoms include very elevated mood, racing thoughts, limitless energy and euphoria, pressured speech, grandiose as well as paranoid delusions, ideas of reference, looseness of associations, and a type of auditory hallucination relating to the ideas of reference (I believe television and radio personalities and artists are talking to me).

While high in the manic state I am largely unaware of these symptoms due to a loss of insight.

Before the last episode took hold, I did recognise some early warning signs but treatment by a family physician overseas did not sufficiently halt the episode, and my treating psychiatrist in Adelaide at the time had not made herself available to contact for advice.

From the perspective of a BPAD sufferer, the worse part of the manic phase, in my case at least, is almost total recall (albeit like remembering  a bad dream) and feeling mortified and embarrassed by my behaviour, as well as anger towards the neurochemistry of my brain for deceiving it into believing this alternate reality is real.

Then there is the tremendous guilt felt due to the hurt caused to loved ones.

The worst part of this roller-coaster illness for me is the post-mania depression which sees me struggle to get out of bed,  struggle to dismiss any fleeting suicidal thoughts (my amazing family serve as my protective factors),  struggle to function through the most basic of tasks and somehow return to work due to financial necessity.

I am still in awe of my strength and perseverance to push through this phase, trying to believe and reaffirm myself daily that it will get better. And, touch wood, after months of this attitude and increasing antidepressants, life does eventually get back on track.

Despite private health insurance, I was managed very harshly and unsympathetically initially in public emergency departments (no availability in private) with undue physical force, in a manner which was in total contrast to the way I would manage a similar patient in my emergency department.

I take pride in the fact that in my ED we are sympathetic and compassionate, only applying physical force if totally necessary for the patient’s or staff safety.

We do this for the minimum time possible and aim to utilise pharmacological agents to help settle the agitated minds of acutely unwell mental health patients.

During my last relapse I was stripped of any dignity whatsoever. I had four stays in the public system during my 2015 relapse, which altogether spanned 83 days.

It was only after my new treating psychiatrist (of the last three years) became involved that I was treated well and started to make inroads into recovery.

Due to the stigma and approach by AHPRA over my 18 years of dealing with this illness,
I have not felt comfortable sharing my diagnosis with colleagues, except for one who is a close friend.

All of my friends and family are aware of my illness, including my medical friends with whom I don’t work. They are a good source of support.

After my last relapse, I obviously informed my manager, who has been very supportive, and three other colleagues, so I could get some support. But largely, I still don’t talk about it at work.

The last episode saw me in hospital in total for about eight weeks, and off work for 11 weeks. There were no get-well wishes from work, aside from visits from the one close colleague that had been aware of my illness.

I was forced to use all my annual leave, sick leave and 15 years of hard earned long service leave to manage our mortgage, bills and living costs. Excessive spending due to my grandiosity further hurt our family financial situation and we are still not fully recovered.

Our government super fund makes it too cumbersome and difficult to access income protection, particularly when someone is battling mental illness.

I have costly private-income protection, but this, of course, has a “mental health clause”, because like most junior doctors, I hadn’t got around to getting income protection before I was diagnosed.

I believe I am a competent, successful and compassionate doctor. I am actively involved with training junior doctors and would very much like to see this become something we all learn to talk openly about and deal with better in the medical workplace.

From my experiences alone, it doesn’t surprise me the high suicide rates in young doctors.

I am a wife and mother as well as a doctor and recreational athlete, and I believe myself to be strong and successful, yet have always found it very disappointing that I’ve felt the need to hide my illness to avoid discrimination and judgment.

I have a disease, like many people, why should I have to feel ashamed?

I also believe I have taken a very good approach to managing my illness with the help of my psychiatrist and family, I am very proactive in getting help early when I think I need it, and, unfortunately, the three episodes where I became too acutely unwell to function in the community were the worst times of my life.

I believe if I had been treated better in the public health system, which I acknowledge was difficult due to attempting to preserve my anonymity and reputation, the hospitalisations might not have been so awful.

With less stigma and easier disclosure without judgment, perhaps public hospital treatment will improve.

In a day and age where we are all about awareness to improve health, it is time the medical profession wakes up, improves its game, and, frankly, sets a better example to the rest of the community.

The one in five people diagnosed, (one in three not diagnosed) includes doctors, nurses and other health professionals.

It stands to reason that we will likely over-represent the mentally ill population, given the link between mental illness and high intelligence.

We need to destigmatise, allow people to talk about it openly if they wish, be supportive and approach mental illnesses as we would any other illness.

I am more than happy to offer to share my story in a formal or informal manner in the future with health professionals that may have faced, or are facing similar difficulties.

Kind regards,

Dr Danielle Smith


GP consultant in Emergency Medicine 

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