Care Under Pressure: a realist review of interventions to tackle doctors’ mental ill-health and its impacts on the clinical workforce and patient care

PROSPERO record2017 CRD42017069870 


In recent years, increasing workload due to societal demand for healthcare services, combined with increasing external scrutiny, has been associated with a high prevalence of mental ill- health amongst doctors. In November 2015, the Head of Thought Leadership at the King’s Fund said stress levels among NHS staff are “astonishingly high”.

Our focus on doctors working in the NHS reflects the pressing recruitment and retention issues in this profession (e.g. doctors-in-training, general practice, emergency medicine), the significant potential for sick doctors to cause harm to patients and the financial implications of doctors’ mental ill-health and loss from the profession.

Changing the work environment to prevent the development of mental ill -health would be preferable to a focus on alleviating the ‘symptoms’, such as presenteeism, absenteeism and workforce retention. However, prevention strategies may be challenging and take time to implement.  A multi -pronged approach of prevention, support and treatment is likely to be needed for the foreseeable future.

Project Aims

This research aims to improve understanding of how, why and in what contexts mental health services and support interventions can be designed in order to minimise the negative impacts of providing care on UK doctors’ mental ill-health.

Project Objectives

1. To conduct a synthesis of the literature (realist review) on interventions to tackle doctors’ mental ill-health and its impacts on the clinical workforce and patient care. We draw on diverse literature sources, and engage iteratively with diverse stakeholder perspectives to produce actionable theory.
2. To produce recommendations that support the tailoring, implementation, monitoring and evaluation of contextually-sensitive strategies to tackle mental ill-health and its impacts.


This project is funded by the by the National Institute for Health Research (NIHR) HS&DR (project number 16/53/12) and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.