Dr Nicola Holmes


Ending the stigma

Whether treating patients or handling the stress of being a doctor, all GPs need a good understanding of mental health.

This is something that Dr Nicola Holmes of Coffs Harbour is keen to highlight.

The GP and medical educator “drifted” into the sector via women’s health, and now works with young people at headspace.

She thinks mental health will be the major health challenge of our time.

“Between the ages of 14 and 44, suicide is not only the leading cause of death, but it is double the occurrence of next cause down,” Nicola said.

“That’s where I think the big challenge in medicine is going to be – getting those statistics turned around and nurturing mental health.”

That’s not to say chronic diseases and lifestyle illnesses aren’t also a priority. In fact, she sees them as intricately linked.

“The more I’ve done it, the more I’ve realised that mental health is actually applicable to all of general practice, not just the cranky adolescents, and not just the postnatally depressed mums.

“All lifestyle interventions involve motivational interviewing – for example people who are overweight and they have diabetes and they’re not exercising and they’re eating rubbish – to try and get to those guys to bring about lifestyle change, it’s actually mental health skills that you need.”

Turning young people’s lives around since starting at headspace, Nicola has discovered a passion for working with young people.

“I love that age group to work with, the 12s to 25s, because I see them as particularly flexible with their whole life journey,” she said.

“If you see a 10-year-old in a very difficult family who are struggling with mental health issues, school refusal, violence, whatever, it’s very difficult because it’s so dependent on their family environment and you can’t do much.

“And if you see people at 50 and they’re completely entrenched in their habits of thinking, they can be very hard to shift as well.

“The flexible adolescent age group is very exciting to work with because they often completely turn their lives around.

“It’s so rewarding when you see a kid who was set up to have gone through the justice system and dysfunction and chaos, and they actually start engaging in education, employment, and respectful relationships.”

Advice for registrars

Nicola acknowledges that the billing structures of mainstream general practice make it difficult to delve deeply into mental health issues.

Her advice to registrars interested in the area is to find a GP with an interest in mental health to mentor them.

She also recommends the courses run by the Black Dog Institute and the Australian Society for Psychological Medicine, and the free information and workbooks available on the website of the Centre for Clinical Interventions.

“Beyond that, it’s all about confidence. It really is about jumping in and having a go. It takes time to get confident with your own knowledge and I think also developing your own scripts, as in, the way you say things to patients.

“I’ve developed a whole series of analogies and language around mental health.

“So, I describe the brain as a city with all these roads going everywhere and messages like cars flying around all day and night. It’s very complicated and has a lot of traffic lights in it, and that helps the cars get around smoothly.

“But when you’ve got mental health issues, you’ve got a few problems happening in there.

“Commonly, you haven’t got enough traffic lights, and that’s where we use our medications and lifestyle changes like exercise, sunlight and sleep hygiene.

“But you can also have problems when the roads you’re using are inefficient. So you could be entrenched in lots of negative thinking patterns, and that’s where you do your psychology to rebuild roads in the brain, and this takes a long time.

“Everyone has different ways of explaining things, but it’s about finding a language that works for your patients.”

Nicola said asking supervisors for advice on how to explain health issues – whether physical or mental – could be even more valuable for registrars than the more technical questions they ask.

“This helps registrars speak confidently about mental health,” she said, which in turn reassures patients.

“One in two Australians will be treated, in their lifetime, for a mental health problem.

“So, confidently normalising, and trying to break down stigma is important. And if the GP is fairly confident, the patient is more likely to come on board.”

Don’t forget about yourself

Looking after your own mental health is also extremely important for GP registrars who are working in new environments and trying to fit in study too.

As a medical educator, Nicola said new registrars were often surprised by how much their jobs affected their mental health.

“Most doctors have personalities of wanting to help and rescue and serve, and there’s often not
space in that for self-care,” she said.

Combined with that was the fear and stigma around mental health that continues to linger, particularly for registrars considering confiding in their supervisor or training provider.

“They’re in quite a vulnerable position because those two senior positions hold the key to whether they become an independent GP,” Nicola said.

However, she said most supervisors were now conscious of providing a supportive environment, and there were certain signs of this that registrars could look out for when considering placements.

“When practices have teaching for the whole practice and fortnightly, or even just monthly, clinical meetings, where everyone comes together and talks about cases, that’s a sign the practice is going to be very supportive.”

Study groups are also a great way to give and receive support from other registrars. It’s also important to make time for the things you enjoy outside work.

“You need to prioritise time for things that are nurturing for you as a person,” Nicola said.

“For me, it’s riding a horse every now and then in the forest, and I ride my bike to work. Those things keep me sane and stable.

“Registrars need to have the courage to prioritise themselves.”

Banner photo by Jess Bailey