In honor of Mental Health Awareness Week, October’s #JHMChat focused on physicians’ mental health. It was inspired by this article from the Journal of Hospital Medicine, centered on Dr. Justin Bullock’s personal experience with seeking treatment for his mental illness. His account was the backdrop of the article’s discussion of what happens when physicians disclose and put their trust in the system to support their mental health-related needs.
The institutional challenges of supporting physicians with mental health disorders, promoting patient safety, and minimizing liability are difficult. Healthcare organizations often fall short in terms of providing substantive resources for physicians, such as swift access to mental health professionals and appropriate workplace accommodations. We invited the authors of the article, Dr. Justin Bullock, Dr. Lisa Meeks, and Dr. Leigh Kimberg, to join us for the discussion.
Many participants thought that medical culture has made strides in prioritizing mental health equally with physical health but acknowledged that there is still a stigma surrounding physicians with mental health disorders that may prevent appropriate help-seeking behaviors. Resident participants noted that scheduling or attending regular therapy appointments is also challenging.
T1 I think it’s still a huge stigma to say you’re getting help even though we all need it. I find younger generations more open about this which gives me hope #jhmchat
— Vinny Arora MD MAPP (@FutureDocs) October 12, 2021
A1: Encourage: Grateful to be at a program that has adapted #OptOut counseling to connect residents to mental healthcare and normalize this amongst our program #JHmChat Discourage: it is VERY challenging to schedule or attend regular therapy appts on any intern schedule
— Becca R-K, MD (they/them) (@rrkolker) October 12, 2021
A1. Our graphic lays out so many intersecting reasons for discouraging help seeking. #JHMChat pic.twitter.com/d6dP61IH3m
— Leigh Kimberg (@LeighKimberg) October 12, 2021
Participants also shared thoughts on systemic barriers and facilitators to supporting physicians’ mental health and echoed Dr. Bullock’s experience that state licensing paperwork, fitness-for-duty evaluations, and institutional lack of mental health resources continue to be barriers. During the chat, participants also raised the issue of the reluctance to call out for mental illness due to burden on coworkers for inherently tough-to-cover schedules. Dr. Lisa Meeks promoted opt-out counseling programs as a proactive way to normalize therapy and allow for more frequent check-ins. For residents, ensuring safety and confidentiality through a provider who is not involved in assessments/evaluations and increasing sessions after emotionally taxing rotations is an important strategy.
T2. Systemic barriers: state licensing paperwork, need for FFDs/oversight committees influencing treatment, lack of mental health resources for HCW.
Facilitators: new focus on #wellbeing & humanities in medicine#JHMChat— Anika Kumar, MD (she/her) (@freckledpedidoc) October 12, 2021
A2: Opt out Counseling Programs is a big one–be proactive and normalize therapy and check in’s! #JHMChat #DocsWithDisabilities pic.twitter.com/zVJmiDOh3O
— Lisa M Meeks, PhD (@meekslisa) October 12, 2021
#JHMChat A2: one of the helpful things in residency was monthly group mtgs w a SW who we knew would never be involved in evals. She also did extra sessions for those finishing months on PICU, NICU, oncology (all q4 28-hr call w a lot of extra emotional burden)
— Dr. Jennifer Chen, MD FAAP (@DrJenChen4kids) October 12, 2021
A2: There needs to be a robust backup system, so that having someone take a day off is not a crisis for the rest of the team. That also means addressing burnout in a myriad of ways so that people have the bandwidth to be the backup person. #JHMChat
— Lanna Felde (vax’d and relaxed) (@LannaFelde) October 12, 2021
Participants observed that the COVID-19 pandemic had increased the public’s awareness of healthcare workers’ mental health issues but acknowledged that mental illness and burnout had been an issue long before the pandemic.
A3 well it’s made the public more aware of the plight of healthcare workers and mental health. The irony is that burnout was declared a crisis in healthcare BEFORE the pandemic – imagine the aftershocks now #jhmchat
— Vinny Arora MD MAPP (@FutureDocs) October 12, 2021
A3. I think that COVID has made it so that departments, hospitals, schools etc have no choice but to talk about mental health because of the collective trauma of this pandemic. We are stressing a stressed system & seeing that anyone can struggle with their mental health. #JHMChat
— Justin Bullock (@jbullockruns) October 12, 2021
A3: The impact has been overall positive but the price has been steep…we know that healthcare workers have made different career choices as a result of the pandemic. The conversations we are having now are so important but overdue #JHMChat
— Ndidi Unaka MD, MEd (@NdidiUnaka) October 12, 2021
The final topic posed the question raised by the article: “How can we create systems that are informed by a genuine understanding of suffering to promote healing and avoid re-traumatization?” Common themes included reorganizing systems to allow experts in mental health, substance use disorders, and disability to inform the fitness-for-duty process and state licensure requirements reform.
A4:
I guess for starters get rid of those in power who profit from traumatizing others. Get rid of the licensure requirements that penalize getting help. Get rid of the stigma that some MH comes with (e.g. neurodivergence). Promote justice.#JHMChat— Dhruv Srinivasachar MD (he/el/ele.) (@TheRealDSrini) October 12, 2021
A4: Having true advocates/allies in positions of power is ?! However, working to advocate for better individual work environments must be done simultaneously w/ widespread collective action to change our system. 1/2 #JHMChat
— Becca R-K, MD (they/them) (@rrkolker) October 12, 2021
Mental health awareness will continue to be an important focus for hospitalists and healthcare systems, especially with increasing concern over healthcare workers leaving their occupations and the alarming rates of physician suicide. Critical thought and reformation about systemic and institutional barriers to physicians’ mental health is crucial to overcome these barriers and could be lifesaving.
Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices.
Talk about your feelings. Talking about your feelings can help you stay in good mental health and deal with times when you feel troubled. Keep active. Eat well.