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Addressing the Mental Health Crisis among Psychiatrists and Resident

Doctors in Switzerland: A Closer Look at the Role of ReMed

Poster · July 2023

DOI: 10.13140/RG.2.2.25647.71842

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Davide Zani
University of Zurich
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 31st EFPT Forum Zurich 2023
30th EFPT Anniversary
Addressing the Mental Health Crisis among
Psychiatrists and Resident Doctors in Switzerland:
A Closer Look at the Role of ReMed
MD Achudhan Karunaharamoorthy1, MD Davide Zani2,3, MD Catalin Georgian Ivanov4,
MD Violette Corre5, MD Tigran Chahbazian5, MD Filippo Toni5

1 Kinderpraxis IFA, Baden; 2 Psychiatric Services Grisons; 3 University of Zurich (UZH) ; 4 Réseau de l’arc, Biel/Bienne; 5 Department of Psychiatry - CHUV

information. Data were summarised and analysed with the appropriate me-
Introduction asures and non-parametric tests (median, IQR, Cronbach’s Alpha, Fisher’s
exact test) using the statistical programme R, version 4.2.1 (2022-06-23).
Mental health care workers often face high-stress environments1. In recent
years, burnout among Swiss physicians has reached its peak prevalence with
a reported rate of 30%2. Psychiatrists and trainees are indeed among the Results
highest risk groups for mental distress and suicide in the field3. Despite the
57 trainees responded to the survey. The demographic data are described
challenges, Switzerland maintains a robust mental health care infrastructure
in Table 1. The Cronbach’s Alpha of the questionnaire is 0.67. The subjects
with a high density of psychiatric inpatient facilities and mental health care
were first asked to rate how much symptoms such as depression, burnout,
providers4. ReMed, a unique support system in Europe by the Swiss Medical
insomnia, substance abuse, suicidal ideation, panic attacks and eating di-
Association (FMH), supports physicians in crisis. The organisation provides
sorders impacted their training on a scale from 0 (none) to 4 (very much).
confidential, unprejudiced and personalised help in private, work-related
The first three symptoms showed a severity-weighted average prevalence
or health crises. This forum poster analyses ReMed’s role through relevant
(>= 3) of 26.1%, the other symptoms to a lesser or mild degree. Numerous
data and testimonials.
subjects complained of frequent and/or moderate-severe symptoms (see
Plots). 71.9% stated that
The Challenge they had thought about se-
The psychiatrist’s practice exposes to risks that are peculiar compared to eking professional help at le-
other specialities. Second-hand trauma and patient suicide are major stres- ast once. Despite this, only a
sors in relation to the mental health of clinicians5,6. If we combine this with minority knew about ReMed
the ubiquitous shortage of clinicians in psychiatric services and the conse- and 3 had used it. In case
quent work overload for trainees, a tangible risk arises. of need, most would turn
Insufficient supervision, excessive workload, young age and female gender to a private psychiatrist or
are among the main factors determining the severity of the consequences psychotherapist (61.4%) or
of clinical practice stressors. The high number of scientific papers confir- to their supervisor (17.5%).
ming an epidemic of mental issues in psychiatric trainees is therefore not
surprising.

The Swiss Solution 80.7% 54.4% 10.5%

ReMed is a non-partisan, independent organisation with the goal of assi-
sting Swiss physicians in critical times. Medical confidentiality, data privacy
and the physicians’ consent are among the utmost important pillars of their Report at least one symptom Frequently suffer Report severe
from these symptoms symptoms
services. They do not conduct investigations, issue sanctions or grant FMH of distress during training

access to their cases files. Its structure includes the FMH Central Board
for strategic decisions, executive committee, programme management for
structural development, and back office. After reaching out to Remed, a
counsellor will contact the physician within 72 hours to analyse the situa-
tion, discuss first steps and accompany him or her throughout the crisis.
Established in 2010, ReMed has supported approximately 1500 doctors
in crisis with a yearly increase in demand (+33% in 2022, +11% in 2021,
24,6%
+5% in 2020)8. Main reasons for contact were workplace stress, depression,
anxiety, and self-doubt. The majority of those seeking advice was from Ger-
man-speaking Swiss regions and female, their average age dropped from
45 to 40 years. During the Corona pandemic, ReMed expanded its services,
including online coaching and a tool for managing stress and preventing
Only a quarter of the participants are familiar with ReMed
overwork. and their services, and only 5.3% (n=3) have used it

The Impact
In our theoretical case, a fourth-year psychiatry trainee is asked to support
an understaffed outpatient office. Overwhelmed, she starts to feel isolated,
anxious, and work late hours, affecting her sleep and overall well-being. Ini-
tially, she reaches out to her family doctor who prescribes antidepressants
and monthly monitoring. However, as her situation worsens, she contacts
ReMed. ReMed’s guidance makes her realise the inadequacy of her current
support system. They emphasise the necessity for weekly psychotherapy
and disclosure with her clinic and supervisor about her workload and pos-
sible reduction of her working hours. Following ReMed’s advice, she takes
more comprehensive measures towards her recovery.
Conclusions and Call to Action
While mental health is still a taboo subject particularly among psychiatri-
sts who are used to being the caregivers, not the recipients, it is crucial to
break the silence9. ReMed serves as a strong support system, but the onus
remains on us psychiatrists to make the first step.
Remember, your mental health is not a luxury, but a necessity for our pro-
fession. It’s okay to seek help, share your burdens, and lean on support ser-
vices like ReMed. As we continue to care for the mental health of others, let
us remember to take care of ourselves as well.
1. Romani, Maya, and Khalil Ashkar. “Burnout among physicians.” The Libyan journal of medicine vol. 9,1 23556. 17 Feb. 2014, doi:10.3402/ljm.v9.23556

Methods and Statistical Analysis

We sent an anonymous survey to Swiss psychiatry and psychotherapy trai-
2. Arigoni, F et al. “Trend of burnout among Swiss doctors.” Swiss medical weekly vol. 140 w13070. 9 Aug. 2010, doi:10.4414/smw.2010.13070
3. Dutheil, Frédéric et al. “Suicide among physicians and health-care workers: A systematic review and meta-analysis.” PloS one vol. 14,12 e0226361. 12 Dec. 2019,
doi:10.1371/journal.pone.0226361
4. Schneeberger, Andres R, and Bruce J Schwartz. “The Swiss Mental Health Care System.” Psychiatric services (Washington, D.C.) vol. 69,2 (2018): 126-128. doi:10.1176/
appi.ps.201700412
5. Boscarino JA, Adams RE, Figley CR. Secondary Trauma Issues for Psychiatrists. Psychiatr Times. 2010 Nov 25;27(11):24-26. PMID: 21212827; PMCID: PMC3014548.
6. Spruch-Feiner A, Labouliere CD, Brodsky B, Green KL, Brown GK, Vasan P, Cummings A, Layman D, Monahan MF, Galfalvy H, Rahman M, Kammer J, Wainberg ML,
Nicholson T, Leckman-Westin E, Finnerty M, Stanley B. Effects of Patient Suicide on Professional Practice Among Mental Health Providers. J Psychiatr Pract. 2022 May

nees concerning their mental distress during training and their familiarity
with ReMed. Trainees who were not familiar with the service were provided
with an explanation of its functions and a direct link to the website for more
View publication stats
1;28(3):184-192. doi: 10.1097/PRA.0000000000000626. PMID: 35511094; PMCID: PMC9097301.
7. Lai, Rhoda, and Christos Plakiotis. “Stress and Wellbeing of Psychiatry Trainees: A Literature Review.” Advances in experimental medicine and biology vol. 1195 (2020):
117-126. doi:10.1007/978-3-030-32633-3_16
8. ReMed, Annual Reports, 2022-2010, last accessed 25-06-2023 < https://remed.fmh.ch/ueber_remed.html#i103215 >
9. Firth-Cozens, J. (2007). Improving the health of psychiatrists. Advances in Psychiatric Treatment, 13(3), 161-168. doi:10.1192/apt.bp.106.003277