Barriers remain between physicians and needed mental health care

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Physicians struggling with mental health challenges, and their patients, would benefit from comprehensive changes across education, programming and policy reform, said three physician experts.

“Reducing Barriers to Mental Health Care for Physicians: An Overview and Strategic Recommendations,” published in JAMA, described the state of the U.S. health care system as it relates to mental health care for struggling doctors.

There are multiple, interrelated barriers that hinder physicians and medical students from seeking help if they need it, said the special communication by Daniel Saddawi-Konefka, MD, MBA, Christine Yu Moutier, MD, and Jesse M. Ehrenfeld, MD, MPH.

Daniel Saddawi-Konefka, MD, MBA

Christine Yu Moutier, MD

Jesse M. Ehrenfeld, MD, MPH

“The most urgent priority is closing the implementation gap by universally adopting proven strategies, such as removing intrusive licensing and credentialing questions and expanding confidential care options,” they wrote. “A sustained commitment to this work, coupled with thoughtful exploration of future innovations, is essential to support physician well-being and optimize high-quality patient care.”

Saddawi-Konefka, an anesthesiologist, is president and co-founder of the Emotional PPE Project, a nonprofit foundation dedicated to raising awareness and reducing barriers to mental health care for doctors. Moutier, a psychiatrist, is chief medical officer for the American Foundation for Suicide Prevention (AFSP). Ehrenfeld, an anesthesiologist board certified in clinical informatics, is a past president of the American Medical Association (AMA).

Their article was published in August ahead of National Physician Suicide Awareness Day, Sept. 17. The day is part of Vital Signs, the health and wellness campaign sponsored by The Physicians Foundation, the Dr. Lorna Breen Heroes’ Foundation, and ALL IN: Wellbeing First for Healthcare, a coalition of health care organizations dedicated to the health of the medical workforce.

‘Profound consequences’

Physicians have rates of depression (33%), anxiety (24%), and post-traumatic stress disorder (10%) at rates higher than the general population, with depression and anxiety on the rise. Among doctors and trainees, up to 14% have experienced suicidal ideation and up to 2.5% have attempted suicide, which from 2015 to 2021 has been the leading cause of death of resident physicians.

“These mental health challenges have profound consequences for patient care, workforce stability, and the physicians themselves, including decreased quality of life and increased suicide risk,” they wrote.

There are benefits to seeking mental health treatment, but relatively few physicians — 13% to 36% — seek it.

Getting in the way

The authors outlined barriers to seeking treatment, and possible ways to remove those.

• Inadequate self-care has been normalized, with medicine maintaining a culture of stoicism and endurance that discourages physicians from disclosing personal distress.
• Stigma and fear of professional consequences that gets worse as medical students progress through their training and begin their careers.
• Logistical challenges, due to demanding schedules and physicians’ desire to pursue mental health help outside the health systems they work in. That in turn leads to added cost if they pay out of pocket.

Possible solutions

The physicians proposed a multilevel approach for overcoming barriers to mental health aid.

Education is a start. AMA, AFSP, the Dr. Lorna Breen Heroes’ Foundation, the American Psychiatric Association and other groups all have sustained educational campaigns to emphasize the commonality of mental health conditions, the benefits of seeking help, and ways to recognize concerns in oneself and colleagues.

Licensure and credentialing reform remains a key to removing a barrier to care, the authors said. The Dr. Lorna Breen Heroes’ Foundation has become a driving force in removing potential professional penalties for physicians who seek treatment. The foundation advocates for licensure board, hospitals and health systems to remove intrusive questions about mental health from licensing and credentialing applications. As of this year, the foundation has recognized licensing board reforms that benefit more than 1 million health care workers, and hospital and health system reforms that affect more than 200,000 staff.

“To be effective, these policy shifts require ongoing communication and trust-building efforts because many physicians may be unaware of or skeptical about the changes,” the authors wrote.

Other potential resources

• Peer support programs have shown benefits, although program structure varies widely and more evidence is needed on program design and evaluation.
• Confidential counseling outside of employer-based programs may be accessible and convenient. The 988 Suicide and Crisis Lifeline and the 741741 Crisis Text Line are available to anyone and have enhanced privacy. The Emotional PPE Project also has connected physicians and other clinicians with free, confidential therapy with a network of volunteer mental health professionals.
• Anonymous screenings such as AFSP’s Interactive Screening Program, which has been used by more than 20 health systems and state medical boards. Counselors use motivational interviewing in anonymous dialogues to evaluate a physician’s readiness to accept a referral to mental health care.
• Opt-out programs that make mental health engagement a standard element of training or practice. Regular check-ins make mental health evaluation a normal part of work.
• External oversight through accreditation or regulatory bodies would drive institutional attention to mental health and well-being, although the authors noted meaningful implementation remains a challenge.
• State-led physician health programs traditionally focused on substance use disorders, although that is changing. The authors cited the Tennessee Medical Foundation’s interactive screening and the Wisconsin Medical Society’s partnership with a behavioral health service as examples.