I have worked with colleagues who have mild mental illness: in medicine you can expect between a third to half of your colleagues to be borderline depressed or burned out at any one time. At least in the NHS, which is toxic enough that many take a pay cut to work in New Zealand.

Note that this study is from 1994

Overall, the main and disturbing findings are nearly half of the consultants, general practitioner and managers scored positively on the general questionnaire (version 28), whereas in the population only 26.8% would be expected to positively on the general health questionnaire 30) in the East Midlands. A recent major survey British population found that the percentage positively on version 30 for those in the profession and managerial group was 27% for men and 28% women.10 This version, which although not comparable with version 28, shares many and a similar modal cut off score for identical “caseness.” Other studies, including those on hospital doctors by Firth used version 12. compared the three versions in the same common population and found high correlations between with version 28 proving to be the most reliable three, showing the highest sensitivity and especially with a cut off point of 5/6.11 I used 28 as it allows for more detailed investigation depression and in particular suicidal thinking. comparisons can probably be drawn between by using either version.

There are no normal population values hospital anxiety and depression scale-A or the anxiety and depression scale-D, but there are accepted cut off values which have been valid several studies.12 With these cut off values only senior doctors and managers would be regarded from anxiety, with 25% scoring as borderline case 29% likely to be experiencing clinically symptoms. The findings for depression are some concern, especially for general practitioners with 27% scoring as borderline or definitely like depressed.

This level of depression, in population studies, would be considered significant. Within medicine, this is tolerated: one seeks care from your psychiatrist, psychologist or GP.

I have also worked with colleagues who had serious mental illness. These were under fairly tight restrictions from the medical council: they had to be under the care of a named doctor and have a named mentor, who both had to report regularly on them. If they had signs of decompensation, they were to stop work.

I have examined: in this situation you do recuse yourself from any candidate with whom you have significant knowledge or mentoring. I know very little about those I examine but that they are in a process I went through that tests fairly senior registrars, seeing if they can perform clinical tasks under pressure and in a high stake situation.

The sad, broken doctor has always been with us. The death rate of medicos is increased by our high rate of suicide. So one wonders about the timing of this resolution.

At the AMA House of Delegates’ annual policymaking meeting last month in Chicago, the 500-plus members all but unanimously approved a resolution encouraging state licensing boards to “consider physical and mental conditions similarly” in the evaluation of applications for medical licensure and to focus on current impairment rather than past treatment. The resolution was brought to the House of Delegates by the AMA’s Resident and Fellow Section.

The licensure resolution was one of several focused on mental health—especially the mental health of students and trainees—during a meeting in which delegates also struck back at the Republican-led health reform effort and immigration policies of President Donald Trump.

“This is an issue of stigma against mental illness,” said Claudia Reardon, M.D., a member of the AMA Section Council on Psychiatry, during hearings on the resolution. “We should not be asking questions on medical licensing applications that are different when it comes to mental illness from those regarding general medical illnesses. … [W]hat matters is whether there is current functional impairment.”

The issue is one of impairment, agreed. But is not one for politics: it is one where (at least in my small country) there is agreement. We want functional, safe doctors — I have seen socialist and conservative ministers of health support rehabilitation of medics. A similar situation occurs in Australia, where often Labour runs the state and the Tories the commonwealth, or vice versa.

This is the derp state talking: this is derp politics. This is appeasing the current narrative.

“APA has a lot to learn from its past, from what it did and didn’t do, and I hope this conversation will continue,” said Levin. “We owe Dr. Pierce a debt of gratitude. He was a life-long advocate against disparities, stigma, and discrimination. Many of the issues that became a hallmark of his career are still critical to our patients and our profession and to APA itself.”

“Chester Pierce made a difference for so many of our members,” said Oquendo. “APA has made great strides, becoming ever more inclusive and diverse and is committed to continuing this essential work. When an organization is made up of people from many different backgrounds, it can generate more complex perspectives and greater creativity. Diversity makes our organizations, our cities, and our country a better place.”

Everett agreed. “Diversity gives us better ideas and better ways of looking at things. Diversity makes us stronger as an organization and as a profession. With diversity we are better for our patients. Figuring out how to achieve diversity so that it endures is a priority for APA, and the end result will be a stronger, more effective organization.”

It is far better that the APA (American Psychiatric Association) concentrate on the serving those who are mad. They will lose political battles. The issues of addiction, the serious mentally unwell, and access to care cut across racial grounds, and the experience of minorities in the USA is not the experience of minorities in other countries. We need a place to discuss disparities in the risk of such between ethnic groups and in health behaviour without filters or ideologies.

The narrative has many of these. But they stop our theories fitting the facts on the ground.