{"id":65067,"date":"2025-10-27T13:51:57","date_gmt":"2025-10-27T13:51:57","guid":{"rendered":"https:\/\/www.cambridge.org\/core\/blog\/?p=65067"},"modified":"2026-02-17T12:14:05","modified_gmt":"2026-02-17T12:14:05","slug":"the-silent-strain-how-investigations-harm-psychiatrists-and-how-to-repair-the-system","status":"publish","type":"post","link":"https:\/\/www.cambridge.org\/core\/blog\/2025\/10\/27\/the-silent-strain-how-investigations-harm-psychiatrists-and-how-to-repair-the-system\/","title":{"rendered":"The Silent Strain: How investigations harm Psychiatrists – and how to repair the system?"},"content":{"rendered":"
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The RCPsych Article of the Month for October is \u2018Experiences and support needs of psychiatrists under investigation\u2018<\/a> and the blog is written by authors Dr Swapna Kongara and Dr Rachel Gibbons and the article is published in BJPsych Bulletin<\/em>.<\/p>\n<\/blockquote>\n\n\n\n

Organisational investigations into clinicians\u2019 conduct and practice are essential to maintaining professional standards and public trust. Yet, for many clinicians, the experience of being investigated can feel confusing, isolating, and deeply distressing.<\/p>\n\n\n\n

In our BJPsych Bulletin<\/em> study<\/a>, over 800 psychiatrists across the UK shared their experiences of investigations. Our survey focused on local organisational investigations within mental health trusts, though some respondents also reflected on experiences with external bodies such as the GMC.<\/p>\n\n\n\n

More than a third had been investigated at some point in their careers. Many said they were unaware of any concerns before being notified, often by email, and over half described the process as unfair. A consistent theme was poor communication, lack of support, and prolonged timelines that left clinicians in ongoing uncertainty.<\/p>\n\n\n\n

Psychiatrists spoke of anxiety, shame, and loss of confidence. Some described symptoms of depression or post-traumatic stress; others left their careers or retired early. These are not just individual struggles. They reflect systemic issues in how investigations are managed.<\/p>\n\n\n\n

Our findings suggest that organisational investigation processes themselves are rarely examined with the same scrutiny applied to clinicians. Without consistent oversight, they risk being shaped by local dynamics such as operational pressures, interpersonal conflicts, or professional rivalries. When this occurs, complaints may sometimes be used, consciously or not, as a means of expressing organisational strain rather than as opportunities for genuine reflection and learning.<\/p>\n\n\n\n

Psychiatry, with its understanding of human behaviour and group processes, offers valuable tools for improvement. A psychotherapeutic approach to investigations would ask: What is being communicated through this complaint? What anxieties or systemic stresses might lie beneath it? Approaching concerns in this way allows organisations to respond with curiosity and compassion rather than defensiveness.<\/p>\n\n\n\n

Where possible, informal and restorative approaches such as open conversations, mediation, and reflective spaces should be the first step, fostering understanding and resolution before escalation to formal procedures. When formal investigations are necessary, they must be transparent, timely, and impartial, supported by clear policies that guard against vexatious or malicious complaints.<\/p>\n\n\n\n

Equally, human errors and understandable mistakes should not automatically become career-ending events. Proportionate, learning-focused response can turn such experiences into opportunities for growth and improvement rather than fear and punishment.<\/p>\n\n\n\n

Meaningful support must also go beyond a checklist approach. Many participants described being handed lists of helplines or websites; possibly well-intentioned, but impersonal. Support offered should be tailored and relational, including access to reflective groups, therapeutic input, and trusted colleagues who can provide guidance and containment throughout the process.<\/p>\n\n\n\n

Finally, there must be avenues of redress for doctors who believe an investigation has been biased or procedurally unfair, and organisational handling of complaints should itself be open to external review. Accountability must apply in both directions.<\/p>\n\n\n\n

Investigations will always be part of professional life. But with fairness, transparency, compassion, and psychological insight they can evolve from punitive experiences into processes that promote growth, trust, and better care, for clinicians and for patients alike.<\/p>\n\n\n\n

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I\u2019m highlighting this paper as RCPsych Article of the Month because it is important for us, as psychiatrists, to understand what we, or our colleagues, might face under investigation. That psychiatrists are three times more likely than other medics to be complained about is concerning, but even more striking are the repeated flaws in investigative processes, and the potentially devastating psychological impact on those involved. The recommendations made by Baroness Dido Harding in 2019 (Box 1) \u2013 arising from the suicide of Amin Abdullah, who had been dismissed over an allegation of gross misconduct \u2013 remain highly relevant. Equally important are the survey-based recommendations (Box 2), taken directly from psychiatrists\u2019 experiences. With wider implementation, we can hope that fewer colleagues will feel isolated or scapegoated during what is already a deeply stressful process.
Andrew Forrester
Editor-in-Chief, BJPsych Bulletin<\/a><\/em><\/p>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

The RCPsych Article of the Month for October is \u2018Experiences and support needs of psychiatrists under investigation\u2018 and the blog is written by authors Dr Swapna Kongara and Dr Rachel Gibbons and the article is published in BJPsych Bulletin. Organisational investigations into clinicians\u2019 conduct and practice are essential to maintaining professional standards and public trust. […]<\/p>\n","protected":false},"author":661,"featured_media":65093,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[2584,251,2578,5590],"coauthors":[12002,12003],"class_list":["post-65067","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-psych","tag-bjpsych-bulletin","tag-psychiatry","tag-rcpsych","tag-rcpsych-article-of-the-month"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/posts\/65067","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/users\/661"}],"replies":[{"embeddable":true,"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/comments?post=65067"}],"version-history":[{"count":4,"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/posts\/65067\/revisions"}],"predecessor-version":[{"id":65082,"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/posts\/65067\/revisions\/65082"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/media\/65093"}],"wp:attachment":[{"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/media?parent=65067"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/categories?post=65067"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/tags?post=65067"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.cambridge.org\/core\/blog\/wp-json\/wp\/v2\/coauthors?post=65067"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}