Warning: This article contains reference to suicide and self-harm.
 
AHPRA has accepted 15 recommendations to help reduce the risk of suicide and harm to health practitioners subject to notifications, including a push to improve communication, build understanding of substance abuse and cut delays in the process.
 
The advice is included in the study, ‘Virtually daily grief’, published in the International Journal for Quality in Health Care last month.
 
High level findings of the AHPRA-commissioned research were previously released in March, revealing 16 confirmed deaths of practitioners subject to notifications from January 2018 to December 2021, as well as four attempted suicides or instances of self-harm.
 
Twelve of the deaths were confirmed as suicide while four were described as ‘likely’ to be suicide based on available information. Eight related to medical practitioners.
 
Of those 20 practitioners, none had a notification relating to clinical performance, but most had preexisting mental health issues or a history of a substance use disorder or both.
 
According to the study, a small subgroup was facing serious criminal or misconduct allegations.
 
The recommendations were made by an expert advisory group with a background in regulation and suicide prevention that was appointed by AHPRA as part of the project to build understanding of distress caused by the notifications process.
 
The study was informed by interviews conducted with 22 health practitioners – including nine medical practitioners – who had been the subject of complaints.
 
It also included analysis of documents linked to cases of suicide or self-harm among those involved in the regulatory process.
 
Participants highlighted the stress caused by the actual complaint, as well as communication issues with AHPRA and the length of time to close the notification.
 
One said the process ‘dragged on over years, so you’d literally be sitting in a cold sweat every day, just looking through emails waiting for the next message to come from AHPRA, which was invariably bad news’.
 
According to the study, interviewees ‘often mentioned the importance of empathy, sensitivity, and regular communication from AHPRA staff, noting that these helped to minimise their distress’.
 
‘Support from GPs and mental health practitioners, as well as connecting with other practitioners with similar experiences, were identified as helpful for managing distress through the complaint,’ the authors wrote.
 
The spouse of one practitioner who took their own life also spoke to researchers about their experience and made suggestions for change.
 
The recommendations, which are published below, include a suggestion to address misinformation among practitioners about what the process involves and the likely outcomes.
 
To help cut delays, the advisory group said ‘engagement with existing treating practitioners over requirements for independent health assessments’ should be preferred where appropriate.
 
The authors flagged a number of limitations in their study, including that interviewees were self-selected, with less than 10% of those approached taking part.
 
They also acknowledged there may have been additional incidents they were unaware of and called for better partnerships between regulators and stakeholders, including legal defence organisations, indemnity providers, employers, and those who have been subject to complaints processes.
 
‘Together they can improve the support for practitioners facing a complaint and address the stigma, shame and fear associated with regulatory complaints processes,’ they wrote.
 
‘This project provides further evidence that a more compassionate approach to regulation has the potential to be better for all parties and, ultimately, the wider healthcare system.’
 
The recommendations:

• Improve awareness and knowledge among AHPRA staff, Boards and committees about mental health and substance use disorders
• Improve consistency in decision-making in health and substance use disorder-related matters
• Decrease the significant stress and delays associated with seeking independent information about a practitioner’s health
• When appropriate risk mitigation strategies are in place, minimise the use of processes in health matters (such as immediate action) which may increase the length of the regulatory process for an unwell practitioner
• Commit to regulatory action that mitigates risk, to the community and practitioner, while supporting practitioner self-agency
• Provide realistic, regular and informative updates to help practitioners have accurate expectations of timeframes and outcomes
• Reduce misinformation among practitioners about the overall experience and likely outcomes of notifications
• Improve organisational knowledge, skills and expertise in communicating complex or challenging messages
• Identify actions to increase the uptake of professional support by practitioners involved in a regulatory process
• Consider the feasibility of a navigation service for practitioners with vulnerabilities
• Improve the knowledge and skills, as well as the policies, procedures and partnerships, to enable staff and Board members to recognise and respond sensitively to practitioners in crisis
• Identify and address the challenges of isolation and insufficient support systems for regional, remote, overseas-trained and Aboriginal and Torres Strait Islander practitioners
• Work with external partners to develop tailored support from other practitioners who have been through the process
• Ensure a commitment to learn from serious incidents relating to those involved in AHPRA processes and how it responds to them
• Provide good, targeted post-incident support for affected staff and boards.

Further detail can be read in appendix 1 of the study.