Staying mentally healthy is essential for everyone, and it’s vital for physicians. As medical professionals, you’re continually exposed to overwork, burnout, stressful situations, and challenging ethical decisions. Yet seeking help for mental healthcare may be last on your to-do list — or completely off your radar.
That’s sad and dangerous, since the American College of Emergency Physicians says 300-400 physicians die by suicide each year, and the stigma keeps 69% of female physicians from seeking mental healthcare, according to a pre-pandemic study.
In A Tragedy of the Profession: Medscape Physician Suicide Report 2022, 11% of female doctors and 9% of male doctors said they have had thoughts of suicide, and 64% experienced colloquial depression (feeling down, sad, or blue).
What’s more, physicians are typically seen as strong and capable and are often put on a pedestal by loved ones, patients, and the public and thought of as superhuman. No wonder it isn’t easy when you need to take time away to decompress and treat your mental well-being.
“There is a real fear for physicians when it comes to getting mental healthcare,” says Emil Tsai, MD, PhD, MAS, professor at the Department of Psychiatry and Behavioral Sciences at the University of California, Los Angeles (UCLA), and an internationally reputed scientist in neurosciences and brain disorders.
The fear, says Tsai, comes from the stigma of mental health issues, potential repercussions to employment, and conceivable medical board suspension or revocation of your medical license.
Tsai tells Medscape that to combat anxiety about "punishment" that many physicians fear when seeking care for their mental health, we must allow physicians to take time away from their day-to-day patient care for respite and treatment without reprisal.
Since the medical profession is high stress and has a high depression and suicide rate, finding solutions is imperative. And physicians must feel supported enough to seek treatment when needed. So how can we normalize seeking mental healthcare among physicians?
Get Honest About Stress and Burnout
The only way to normalize any behavior is to be open and candid, Tsai tells Medscape. The mental health conversation must occur across the board, not just within the medical profession.
“The greatest thing we can do to try and lift the burden that we place on physicians is to be willing to talk and be honest about the stress that physicians deal with and the importance of everyone feeling free to seek treatment and rest to strengthen their mental health,” says Tsai.
The more we talk about mental health and its treatment, the more we lessen the stigma, says Tsai. That could be more employer-employee check-ins, counseling as part of physician wellness, and programs structured so as not to construe a penal system.
“Mental health in the medical profession is a big issue and one that has to be met with the same compassion and care as it should be for any patient. We have annual physical checkups. Why don't we offer annual mental health checkups for all, physicians included?” asks Tsai.
Evaluate the Workload
Elizabeth Lombardo, PhD, psychologist, coach, and global keynote speaker, thinks that healthcare employers should reexamine their physicians’ workloads to see if they’re contributing to mental health issues.
The conversation on mental health in the workplace shouldn’t be about whether a certain person can handle stressors that are “normal” for healthcare settings. Instead, workplace managers in healthcare institutions should redefine workloads to ensure that physicians aren’t too heavily burdened with responsibilities that can cause overwork, burnout, and mental health problems,” she says.
Lessen the Stigma
Even when physicians want to seek help for their psychological struggles, they may be weary of how their colleagues would react if they knew.
Raffaello Antonino, MD, clinical director at Therapy Central in London, United Kingdom, says several underlying fears may exist at a physician’s core that prevent them from seeking care — being seen as weak, being judged as unfit to practice medicine, and the notion that "something is wrong with them."
Antonino says we need to understand that physicians face challenges of bereavement and trauma derived from losing patients and the inability to save someone’s life. “These issues can easily develop into an accumulation of difficult, unprocessed emotions, later arising in symptoms and signs of PTSD, anxiety, and depression,” he says.
Education is the best way to end this stigma, just like with any form of prejudice and stereotypes. For instance, we know that healthcare professionals are at risk of developing burnout. So, educating physicians on the symptoms and management of burnout and its consequences and prevention strategies is a must.
“Imagine what could happen if there were regular opportunities to work through the day’s events before signing out from a shift. The idea that individual weekly therapy is the only way to relieve mental distress is false,” says Lori McIsaac Bewsher, MSW, RSW, a trauma therapist and owner of a trauma-focused mental health clinic in New Brunswick, Canada.
"There are ways of integrating individual care into our doctor's offices and hospitals that can be brief, effective, and confidential. The best way to introduce these interventions is early and collectively; no one is immune to the potential impact of exposure to trauma. The earlier these interventions can be accessed, the better the outcomes for everyone,” she says.
Antonino suggests, perhaps in the future, organizations can have "burnout checks" or mental health wellness checks for physicians akin to how we also have quick examinations for various physical ailments. What if physicians regularly answered a 10-question mental health survey as part of a burnout or trauma prevention strategy?
“Theirs is a profession and an identity which is often linked with a sense of strength, leadership and (benevolent) power: adjectives, which on the surface one might see as incompatible with what instead, unfortunately, and wrongly, may be associated with mental health issues,” says Antonino.
Keep It Private
When it comes to removing the stigma from mental healthcare and treatment for physicians, privacy is top of mind. There needs to be some form of privacy protection for physicians who seek professional help for mental health reasons. Lombardo says physicians need to have the choice to keep their mental health journeys private. “Ideally, normalization should mean openly conversing about mental health, but for physicians, it can be a matter of life or death for their career, so the choice to remain private is something that should be afforded to them,” she says.
Along those lines, the American Medical Association is pushing for system changes in legislative and regulatory arenas to support the mental health of practicing physicians, residents, and medical students. The organization is also urging health systems and state medical licensing bodies to remove questions on their applications that ask about prior treatment for mental health conditions.
Among many programs across the country, the Foundation of the Pennsylvania Medical Society has also created a Physicians' Health Program, which provides confidential assessment, counseling, and referral services for physicians with mental health concerns.
“All of these initiatives are important in helping to destigmatize mental health issues among physicians,” says Harold Hong, MD, a board-certified psychiatrist in Raleigh, North Carolina.
Hail the Benefits of Treatment
Hong says to continue to destigmatize mental health among physicians and normalize its treatment, we not only have to emphasize how attending to mental health has individual benefits but also how it helps us help our patients.
“One key aspect that perhaps underpins this issue is the still present separation between mental and physical health, between mind and body, Hong tells Medscape. “Feeling sad or angry or anxious should become a fact of life, a characteristic of being human, just like catching a cold or breaking a leg.”
It's a normalization that, perhaps more than anything else, can lead the way for improving physicians' mental health outcomes while also improving them for the rest of society. When society can finally see the health and well-being of someone in both their psychological and physical status, some of the stigmas may dissipate, and perhaps more physicians' lives can be saved.
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Cite this: The Danger When Doctors Don’t Get Mental Health Help - Medscape - Nov 07, 2022.