ObjectiveTo develop a more in-depth understanding of how doctors do and do not access mental healthcare from the perspectives of doctors themselves and people they have contact with through the process.DesignQualitative methodology was used with semistructured interviews transcribed and analysed using Grounded Theory. Participants were 11 doctors with experience as patients of psychiatrists, four doctor and four non-doctor personal contacts (friends, family and colleagues) and eight treating psychiatrists.ResultsParticipants described experiencing unrealistic expectations and a harsh work environment with poor self care and denial and minimisation of signs of mental health difficulties. Doctor contacts described particular difficulty in responding effectively to doctor friends, family and colleagues in need of mental healthcare. In contrast, non-doctor personal contacts were more able to identify and speak about concerns but not necessarily to enable accessing adequate mental-health services.ConclusionsThree areas with potential to address in supporting doctors' accessing of appropriate healthcare have been identified: (1) processes to enable doctors to maintain high standards of functioning with less use of minimisation and denial; (2) improving the quality and effectiveness of informal doctor-to-doctor conversations about mental-health issues among themselves; (3) role of non-doctor support people in identifying doctors' mental-health needs and enabling their access to mental healthcare. Further research in all these areas has the potential to contribute to improving doctors' access to appropriate mental healthcare and may be of value for the general population.

The consequences of impairment among medical practitioners and specialist psychiatrists as well as the under-reporting of impaired practitioners is a significant problem.

ObjectiveTo better understand the complexities of developing an effective psychiatrist–patient relationship when both people involved are doctors.MethodIn-depth, semistructured interviews were conducted with 11 doctors with experiences as patients of psychiatrists (DPs) and eight psychiatrists with experience of treating doctors (TPs). A thematic analysis was undertaken.ResultsThe medical culture of unrealistically high standards with limited room for vulnerability and fallibility, vigilance for judgment and valuing clinical over personal knowledge affected both people in the relationship. DPs struggled with the contradictions involved in entering the patient role but tried hard to be good patients. They wanted guidance but found it hard to accept and seldom communicated dissatisfaction or disagreement to their TPs. They described widely varying responses to diagnosis and treatment within the biomedical model. TPs described enjoyment and satisfaction and extreme challenge in engaging with TPs. Despite focusing on providing ordinary care they described providing extra care in many ways.ConclusionsThis study brings forward important issues when a psychiatrist is building a therapeutic relationship with another doctor. These are also likely to arise with other people and contribute to making truly patient-centred ‘ordinary care’ a hard ideal to fulfil. They include: (1) doctors' sense of ourselves as invincible, (2) TPs' sense of personal connection to, and identity with, DPs, (3) having extensive medical knowledge and (4) striving to be good patients. We need to make these issues explicit and enable the DP (or other patients) to tell their story and speak about their experience of the consultation so that any potential rupture in the therapeutic relationship can be addressed early.

This paper describes the "Re-covery Model", an innovative approach to facilitating recovery in people with enduring symptoms of psychosis and other extreme states. This model has been developed by experience-based experts (EBEs), and mental health professionals, some of whom are also EBEs. It provides a shared understanding of the "human condition" in the bio-socio-psycho-cultural and spiritual developmental context in which resilience and vulnerabilities shape the person. It is easily understood and helps service clients, clinicians, and significant others to come to a shared identification of the patterns that create vicious cycles of stigma and deteriorating function. It offers a hope-inducing pathway towards victorious cycles of building resilience and manifesting a life worth living, and integrates intervention strategies from a variety of evidence based therapies to facilitate recovery. The approach and its implementation are discussed in detail.

Prevention, early detection, intervention, and treatment programs that are more continuous more sensitive to the needs of impaired practitioners, that are more continuous, better structured, and rehabilitation and recovery focused, may be more likely to produce a positive outcome.