Mental health has blazed its way to the forefront of the national conversation over the last decade. Increased awareness and decreased stigmatization around mental health issues have undoubtedly allowed many to have access to necessary resources, and the world is better off because of it. Influencers no longer shy away from discussing these topics, and employers are taking steps to create cultural change in the workplace. Exacerbated by a global pandemic, it seems like the world is finally beginning to take notice that mental health matters.
Unfortunately, this new reality often looks a little different when it’s draped under a white coat.
Bold discussions about the importance of mental health are hushed to a whisper in the wards of a hospital, and health care workers are suffering.
A 2015 meta-analysis showed that case rates of depression among physicians are as high as 28.8 percent, and a 2020 survey found that nearly 1 in 4 (22 percent) of physicians know a physician who has committed suicide. This issue is urgent, and as we head into another COVID winter with new concerns about the omicron variant, the mental toll taken on physicians cannot be overlooked.
As a medical student, I worry that I am entering a profession where mental health awareness is severely lacking and barriers to accessing adequate care remain as strong as ever — the issue of physician mental health is pressing and change is long overdue.
There are clear barriers to treatment.
Physicians are less likely to seek mental health treatment for a variety of reasons. A major deterrent for physicians is a fear of professional repercussions in the form of medical licensing.
Physicians fear that disclosing mental health issues to state boards could jeopardize their ability to get or renew licenses, and many decide to stay silent. A publication by the Journal of the American Academy of Psychiatry and the Law discovered that 32 state licensing boards include questions that are outside the standards set by the Americans with Disabilities Act.
Intrusive questions about any past psychiatric treatment or illness history are asked, without mentioning whether they are relevant to the physician’s current ability to treat patients. According to a study published in Mayo Clinic Proceedings, nearly 40 percent of physicians report that they would be reluctant to seek mental health treatment due to fears surrounding medical licensure.
Fear of stigmatization in the workplace is also a major inhibiting factor to seeking care. Seventy-three percent of emergency physicians report feeling mental health stigma in the hospital, and concerns about confidentiality also contribute to reluctance. This has been compounded by the emotional and mental toll of the COVID-19 pandemic, where physicians do not feel like they have the time to prioritize their mental health.
The idea that health care workers are sacrificing their own well-being to help others during the pandemic has revealed a dangerous culture within health care, and it has underscored the need for urgent action. Rhetoric of “health care heroes” has served as a front for policy shortcomings in the arena of health care worker protection, and mental health is no exception.
Change is possible through physician-level advocacy.
Tackling these issues requires actionable change at multiple levels, and change is possible from the ground up.
In a recent case study in New Mexico, physicians effectively proposed and enacted a change in how the state board asks about physician mental health, updating language on the license application. These changes centered around ensuring that questions were limited to mental health issues that currently affect applicants and that they did not unfairly discriminate mental health from physical health.
Any action that makes it more likely that physicians disclose their mental health struggles is one that will benefit patients and providers alike, and other states can learn from these efforts. The American Medical Association has also adopted a new policy to attempt to combat stigmatism against mental health issues in health care professions, and steps are being taken to combat physician burnout.
There are larger initiatives to raise awareness.
Health care systems can support this change by joining the ALL IN: WellBeing First for health care initiative, which aims to provide hospitals with resources and funding to allow physician treatment. The National Alliance on Mental Illness (NAMI) is another pioneer advocating for physicians’ mental health.
Leaders can look to prevent burnout within their own cohorts by investing in physician-friendly technologies and scheduling, and physicians must work to support their peers in seeking out resources. Individual resources include the National Suicide Prevention hotline (1-800-273-8255) and online resources to combat physician mental health issues.
Ultimately, a culture change needs to be rooted in advocacy and discourse on the inside, and stigmatization needs to be addressed if physicians will ever feel comfortable seeking health care treatment.
As we continue to give mental health the attention it deserves, we have to ensure that health care workers are not forgotten. Physicians will continue to take care of patients, pandemic and beyond, and we must have the ability and resources to take care of them — our lives depend on it.
Rohan Moghe is a medical student.
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