Changing minds of medical practitioners

I recently had an amazing opportunity to interview Dr Mark Cross. I believe his insight into mental health, stigma and doctors' mental health can change our minds.

Dr Mark Cross, MBChB (Cape Town), MRCPsych(UK), FRANZCP: A Psychiatrist with a background of medical training in South Africa and Specialist Training and consultant work in England and in Australia, specialising in adult general psychiatry and Consultation/Liaison, specifically HIV.

He moved to Sydney in 2005, initially as Director of Consultation/Liaison Psychiatry at Liverpool Hospital, in 2006 he was appointed Clinical Director of Psychiatry at Liverpool Hospital until October 2014. In October 2014 he moved within the Sydney South West Local Health District to Campbelltown Hospital as Senior Psychiatrist running the only Youth ward (public) in NSW-Birunji- and MacArthur Youth team.

He now runs a private practice at Northside MacArthur clinic in Campbelltown and Northside Cremorne. He is a Senior Lecturer at UNSW. He was awarded a teaching award by the school of Psychiatry at UNSW in 2014.

He was the senior clinical lead and one of the developers of the TV series "Changing Minds" the 1st series broadcast in October 2014, the 2nd series was aired on the ABC on the 6-8th October 2015, as part of the ABC's "Mental As" week.

He is currently a board member of SANE Australia. He was awarded the NSW RANZCP Meritorious award for 2015 for his "significant contribution to Psychiatry".

He was a recipient of a 2015 NSW Premiers awards for service to public health.

Growing up in South Africa and moving to London, what was the main influence that made you want to work in Australia? 

I specialised in London, however I graduated in South Africa and did my internship and house officer job, in a hospital where they opened the ward to people of colour for the first time, that was in 1992. I worked in the psychiatry ward where my supervisor was 300 miles away, so I learnt from the nurses  and that's how I became quite practical in the way I practice. I worked there for a year and then I went through to England in '93 where I specialised and eventually worked as a Consultant Psychiatrist in London from 2001 to 2005.

What made me move to Australia was probably a mid-life crisis, when I turned 40 I felt Sydney was calling. I love London, but my partner and I decided we wanted to have just one more move. Moving to Australia gave us a feeling of being closer to South Africa – in a roundabout Southern Hemisphere way.

Has Psychiatry always been the field that you wanted to work in from medical school and what was the main reason that made you want to become a Psychiatrist?

I was always interested in psychiatry, but I quite enjoyed obstetrics and gynaecology- I delivered over 500 babies. There are a few babies in South Africa named after me, so that was quite nice.

How did the opportunity for your TV show Changing Minds come about and what made you decide that you wanted to go ahead and create a show based around mental illness?

My best friend whom I've known for 25 years, was diagnosed with throat cancer back in 2012 and had a psychotic episode at Christmas Eve. We'd been talking for some time about doing a TV show, but after her episode it made us even more motivated to create something together. We discussed things in 2013, and got approval between September and November of that year, and started filming in March 2014. It was all pretty quick, and I wouldn’t have done it if it wasn’t for her, because it entailed putting myself on the line and essentially allowing people to come into my private world with my patients. Suddenly I got 18 radio interviews, 2 TV interview and 6 print interviews prior to the 1st series of Changing Minds even coming out. Nobody even knew what it was about so it was pretty anxiety provoking. But then it did so phenomenally well.

If you could get one message across to the public about mental illness what would that be?

That mental health is not scary and it shouldn’t frighten you. I've got a big thing about stigma and mental health, and to empower people and show that even those with severe mental illness are just that: people, human beings. And if you treat them properly then they respond positively. 

How can we help increase awareness of the issues affecting the mental health of doctors and medical students? 

Recently in the UK, a GP suicided, she had been battling bipolar illness, and in my opinion she wasn't treated well by the governing bodies and professional institutions which govern medical practice. We need to take a long look at ourselves and how we govern ourselves – particularly our medical councils and medical boards and APHRA. We need to be more supportive and not stigmatising and punitive, because as more doctors “come out” with mental illness then more people will see that it's normal…I hate that word actually…that it's normalising, and it affects everyone and anyone. And so I think we should make it very easy, or much easier than it is currently for doctors to step forward and be open about things. Because otherwise what do we do? We hide. Women doctors are at the highest risk of suicide in our profession. Statistically more than men, even though men generally are statistically more likely to kill themselves. So of the 3,027 people who suicided in Australia last year 75% were men. It's a dreadful statistic. But in medicine, coming back to medicine, we have high levels of stress, high levels of relationship problems, drug and alcohol abuse, linked to our training. And of course, stress leads to illness.

What are your top tips for Doctors to relax away from work?

We need to be aware of work/life balance. I know that it seems to be a little catchphrase at the moment, but it's a very important one. We all need our own ways of coping with stress, because we take on stress from our patients. That makes us caring, empathic clinicians. We have to look after ourselves as well. That's why I'm going away for 3 weeks tomorrow. Take leave, spend time with your families, read books, exercise and eat well.

What are the issues with having the right work life/balance and what tips would you give to Doctors?

The common issue is an on-call commitment that comes with a lot of our work. But even with that you have to stick to boundaries. So share the on-call load so when you're not on-call be very clear about not taking calls. People can cope. I don't give my mobile number out to my patients. I'm not always available, I'm available to a certain point. And that's very good for my mental health. I take leave, I exercise, I try to diet properly. I spend time with my family. It is vitally important to be able to separate or compartmentalise at times. That doesn't mean that you're not a caring doctor.  

Are there any signs that employers or family can look out for if they feel their loved one might be suffering from mental illness? 

Generally speaking, if the person's not coming to talk to you as they usually do. So as a loved one, or as a carer, or whatever your relationship is to the person, the first sign is usually a behavioural change so the person becomes quiet, they become more withdrawn. Whatever is normal for them, if there's a shift in that then that's often the first sign, and one to look out for. 

Do you think the Australian society will be able to overcome the stigma of mental health in the next 5 years?

When we get things right in Australia, and I'm proud to be Australian, when we get things right and we truly look at the value of mateship and being supportive of each other, which is I think, a fundamental part of being Australian, we can do it. There's still a lot of stigmas, a lot of people unfortunately, who are wilfully ignorant, and that's irritating. For instance we’ve got to get men to be more involved in their health, we have to look at things in a different way we can’t just say to men oh come and see us: how can we change in the profession to enable men to feel more comfortable coming to see us? Dealing with a cultural shift in the way we view masculinity, “weakness” and being open to emotions. And I think that's sort of part of what you asked, but it's about changing that whole machismo thing and that weak/strong debate, which I can't stand. It takes a lot of guts to admit to being ill, and that's the first step sometimes.

If you would like more information on mental health, you can watch changing minds: The Inside Story on ABC or you can purchase Changing Minds: The Go-To Guide to Mental Health for You, Family and Friends (ABC Books, $29.99) is Dr Cross’s latest project, a book co-written with Dr Catherine Hanrahan, a researcher from the television series that is full of practical advice and information for anyone dealing with mental health related issues. Dr Mark Cross feels strongly that everyone should have easy access to information they can trust about common mental health problems, whether for themselves or to help family or friends. The result is this empowering guide which aims to cut through the myths and taboos about mental health and offer clear, practical help. It covers a wide range of common issues, from bipolar, anxiety, personality and eating disorders, to depression, post-traumatic stress and schizophrenia, and includes how to get help, what treatments are available and how to live successfully with a mental illness. Most importantly, it shows how carers and families can help a loved one through what can be a very challenging time. Since almost half of all Australians will experience a mental health issue at some point in their lifetime, this book is for everyone.

Interview conducted by Olga Kalenbach and Jess Watt