By NAMI Frontline Wellness Team
If you or someone you know is experiencing a mental health, suicide or substance use crisis or emotional distress, reach out 24/7 to the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) by dialing or texting 988 or using chat services at suicidepreventionlifeline.org to connect to a trained crisis counselor. You can also get crisis text support via the Crisis Text Line by texting NAMI to 741741.
Sept. 17 marks the fifth annual National Physician Suicide Awareness Day, a day dedicated to preventing suicide and reminding physicians that they are not alone. NAMI supports physician mental health and wants to ensure that access to support — and caring for those who care for us — remains a priority.
Physician suicide is a topic historically shrouded in stigma and secrecy. While an exact statistic is difficult to pinpoint, we know some estimates show that suicide affects doctors at a rate that is 1.4 – 2.3 times higher than the general population. Clearly, there is a need for awareness and action.
If you’re a physician, it’s time to talk about it.
Suicide is a complex problem, with multiple risk factors that can change with time, and rarely due to a singular cause or event. This is true for everyone, including physicians. However, there are additional factors particular to the profession of medicine.
For example, physicians are problem-solvers, healers who undergo rigorous training — and this mindset may make it difficult to accept that you need support. You may subject yourself to unrealistic standards of perfection and may judge your self-worth by whether or not you reach them. Constantly striving for perfection can take a toll on you over time.
Additionally, you may experience trauma and moral injury in the course of your work, and these factors can lead to depression and substance use, as well as suicidal thoughts. Physicians of all specialties also face burnout, a stress reaction that builds up over time and results in mental exhaustion, cynicism and a sense of hopelessness. Prolonged stress can have a serious effect on both physical and mental health, and burnout is a common reason for leaving the field of medicine.
“Burnout has many dimensions — psychological, physical, spiritual and more — but in the simplest of terms, it is an erosion of the soul. And that is an awful feeling, one that alarms and saddens doctors, who seriously question why they went into medicine in the first place.” – Dr. Michael Myers.
While diagnostically different, burnout, moral injury and depression share many overlapping features, including a significant impact on mood, sleep and energy levels. These factors interact in complex ways and can sometimes be difficult to differentiate.
You may resent that your treatment decisions are often hampered or overruled by distant bureaucratic or insurance-driven dictates. You may also become frustrated by having to devote more time to electronic health records and other administrative burdens than patient care — the very reason you chose to become a physician. These are frequent causes of burnout.
Scenarios like these can also result in moral injury, as physicians are sometimes unable to alter the course of care decisions that are beyond their control, yet medically and ethically flawed. Or you may face the rising frequency of treating victims of senseless trauma, scenarios that expose you to suffering and lead to a loss of empathy or feelings of intense anger.
While those suffering from burnout may not necessarily experience moral injury or develop depression, it’s important for you to understand the symptoms you’re experiencing, so you can access the kind of support needed to regain a sense of well-being.
It’s also key to preventing an escalation of symptoms. Untreated symptoms of depression can be dangerous, as depression is a major factor in suicide. Similarly, if you’re experiencing burnout that hasn’t yet led to depression, managing stress and finding solutions to specific challenges can help you prevent negative mental and physical effects from worsening.
Don’t let stigma convince you that it’s “just burnout.” Identify what you’re feeling, be aware of warning signs, and explore options for support.
Even physicians who recognize warning signs may still struggle to access support. Personal stigma or concerns over how colleagues or family might react may make you hesitant to seek treatment. Or maybe you feel reluctant to focus on your own distress and mental health symptoms when the patients you treat are battling illnesses that are “visible” or “testable.” There may not be a blood test for depression, but it still presents in the form of mental and physical symptoms, and treating those symptoms can help you feel better. Your patients would never want you to suffer in silence — neither would your peers and loved ones.
Even aside from these concerns, physicians in many states face an additional risk: the fear of professional repercussions if they seek mental health support. You may worry about losing your license, hospital privileges and job if you disclose access to mental health treatment.
NAMI believes that this is unacceptable – seeking treatment should be encouraged without such fear. We’ve taken a stand on this issue with a public policy statement regarding licensure application questions on mental health for medical professionals:
NAMI supports limiting medical license application questions about mental health to only those necessary and relevant to assess an individual’s current ability to practice medicine safely and competently. NAMI further supports and encourages the use of language in the licensure application process that is supportive of seeking mental health treatment.”
Medical professionals who would like access to confidential support are not alone. NAMI Frontline Wellness offers resources for professional support options that protect your privacy. You can also find information on warning signs, when to reach out for support, how to build resilience and strategies for wellness.
You can also download the National Physician Suicide Awareness Day toolkit, which contains tips and resources for individuals and organizations. Share these resources with peers, your leadership and hospital or practice administrators.
Remember that you and your peers are also a resource for support. If you’re struggling, or notice that a colleague appears to be, don’t wait. Taking action can be as simple as having a conversation that begins with, “It’s been rough around here the past few days. Are you doing ok?”
Asking simple questions and acknowledging that your colleague seems to be struggling lets them know that someone cares and they don’t have to struggle alone. As a physician, you know what other physicians face, and that experience can make peer support invaluable. Talking through challenges and concerns and sharing strategies for wellness can help generate new ideas and motivation for self-care for both of you.
You face many challenges and stressors each day, but there are ways to effectively cope with the resulting experiences and emotions. As you work hard to take care of your patients, remember that you’re at your best when you also care for your own health.
If you or someone you know is in crisis, there are resources you can turn to.
The 988 Suicide and Crisis Lifeline offers free, confidential crisis counseling 24/7/365 just by dialing or texting 988.
If you don’t want to talk on the phone, you can also text the Crisis Text Line for free 24/7 mental health support. Text “SCRUBS” to 741741.
Visit nami.org/FrontlineWellness for more information and resources.
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