Every day, physicians help improve and save lives. But when it comes to their own mental health struggles, they often don’t address the symptoms of trouble until they are in full-blown crisis. Sometimes, their mental health crisis turns deadly.
Physicians have one of the highest suicide rates of any profession in the US. Federal data show an estimated 400 physicians die by suicide per year. More than half of physicians know a physician who has either considered, attempted or died by suicide in their career, according to Vital Signs, a nonprofit aimed at ending physician suicide. They also report an estimated one million persons in the U.S. lose their physician to suicide each year.
"We must be vigilant for signs of burnout and depression within ourselves and among our colleagues, and we must not hesitate to seek help when we recognize something is amiss,”
former AMA president Susan R. Bailey, MD, told her colleagues at the AMA. “Physicians have resilience and self-reliance in abundance, but when we rely on those traits above all others, we put our own well-being and that of our patients and colleagues at risk."
Caring for the carers
"You can’t deliver care to people at risk if your healthcare workforce is struggling," says Julie Goldstein, Vice President and Director of Suicide Prevention Strategy at the Education Development Center (EDC) in Greater Washington, DC.
Goldstein oversees the EDC’s Zero Suicide program, designed to ensure that health care systems are prepared to screen, identify, and intervene when patients may be at risk. However, it goes further by focusing on the workforce culture within these systems, ensuring that health care workers are equipped and supported to do this challenging work.
The key then, is that beyond simply asking physicians to heal themselves, the culture where they work must prioritize their wellbeing. Knowing the mental health risks frontline clinical workers face is the first step.
Risks and interventions
High suicide rates have been correlated to intense job demands, long hours, and exposure to traumatic events. Many deal with burnout, overwhelming workloads, and a lack of mental health support, compounded by a culture that often discourages asking for help. That’s according to The Lorna Breen Foundation, which was created by the surviving relatives of emergency department physician, Lorna Breen, who died by suicide while coping with the stress of managing two hospital EDs at the height of the pandemic in New York City.
Additionally, physicians experience existential anxiety over the potential professional repercussions of answering truthfully to intrusive mental health questions on credentialing applications. These fears can lead physicians to isolate, leading to disconnection from peers and possibly depression. Meanwhile, the constant pressure to perform flawlessly in high-stakes situations, along with the emotional toll of negative patient outcomes, can worsen their mental health struggles.
Building a culture of wellbeing, offering H.O.P.E.
Easing this burden begins with what the Breen Foundation calls going ALL IN, where health system leadership addresses cultural and administrative barriers to mental health care, beginning with eliminating stigmatizing questions on licensing forms, and focusing on systematic approaches to creating a culture of wellbeing, where helpseeking for mental health challenges among medical staff is not fraught with fear.
When a culture is supportive of wellbeing, it is easier to feel empowered to intervene when a colleague or staff member appears to be struggling. Signals this might be occurring include when a person is emotionally exhausted, has impaired relationships at work, exhibits a self-destructive tendency, or is wrestling with a substance-use disorder. Unchecked, these become risks for suicide.
There is also H.O.P.E. (Helping Our People Elevate through tough times), a novel program offered by United Suicide Survivors International, for organizations seeking to engage their workforce, promote resilience, and develop and sustain a caring culture.
The program is implemented over a 12-month culture-changing period with quarterly training and ongoing coaching on how to implement the 9 evidence-based best practices developed from research literature and lived experience that form the National Guidelines for Workplace Suicide Prevention. Similar to how LEED Certification promotes environmental health in organizations, H.O.P.E. Certification provides a path to psychological health and safety in the workplace. It begins with leadership buy-in and then gets at the root of whatever is eroding workplace resilience.
Because the program is customized according to the participating organization’s strengths and weaknesses, it addresses the root causes of mental health challenges within that specific workforce in that specific workplace and builds upon what is already beneficial. In addition, there is third-party verification of completion and external verification to ensure guidelines are met.
Here are several other promising practices for physician mental health, addiction recovery, and suicide prevention:
Policy Development and an Industry Call to Action: Advocating for policy change and systemic support is essential to ensure that physicians struggling with mental health and addiction receive the care they need without fear of stigma or career consequences. This includes implementing policies that prioritize psychological safety, mandate confidential access to mental health services, and foster a culture where seeking help is viewed as a strength, not a liability.
Confidential Mental Health Services: Programs like the Physician Support Line offer physicians confidential, judgment-free access to mental health care, helping to reduce stigma and encourage help-seeking behavior without fear of professional repercussions. Successful integration of confidential mental health care into healthcare organizations, as seen in programs highlighted by National Physician Suicide Awareness Day, ensures physicians receive the care they need in a safe, supportive environment.
Peer Support Systems: Embedding peer support within healthcare organizations allows physicians to connect with colleagues who understand their unique challenges, fostering trust and open dialogue about mental health and addiction recovery.
Addiction Recovery and Support: Programs tailored to physicians, such as National Association of Occupational Health Professionals' approach to impaired physicians, emphasize early recognition, intervention, and comprehensive support systems to help physicians struggling with substance use or mental health challenges.
Tailored Physician Suicide Prevention Programs: Such as those highlighted by the American Foundation for Suicide Prevention, provide specialized recovery pathways, recognizing the intense pressures faced in healthcare.
These practices are key to creating a resilient healthcare workforce, offering physicians and other healthcare workers the tools and support needed to maintain their mental health and well-being.