Barriers to mental health care: Options for opening greater access to treatment

Daniel Saddawi-Konefka, MD, MBA, and Christine Yu Moutier, MD, are co-authors with Jesse M. Ehrenfeld, MD, MPH, of the special communication, “Reducing Barriers to Mental Health Care for Physicians: An Overview and Strategic Recommendations,” published in JAMA. Their special communication includes a multilevel approach for overcoming those barriers. Here they pick two to highlight: anonymous screening and opt-out programs.

Medical Economics: Your article includes a concise, multilevel approach for overcoming barriers and seeking help. There were numerous options that you outlined. Is there was one you'd really like to highlight?

Christine Yu Moutier, MD: The way that I would look at approaching this important topic is, if you're if you're a leader in a hospital or in a training program, don't go it alone. Find a team of like-minded people who care deeply and passionately, try to get leadership buy in and approach this as a sustained, strategic effort over months to years, not as a one and done. This isn't something where we can flip a switch and have all the solutions ready to go, unfortunately, but most important things don't work that way. I think I will just highlight the anonymous screening programs like AFSP’s Interactive Screening Program that can make a huge difference in terms of lowering the barrier to disclosing that you're actually suffering and having the opportunity to engage with someone who can lead the individual to sort of customize best, next, safe resources, because it does need to feel psychologically safe.

Daniel Saddawi-Konefka, MD, MBA:You know, I think opt-out programs have significant potential. So opt-out programs, they reverse the paradigm, rather than waiting for distress to happen, for certain groups, the default is actually care and therapy is actually set up. It's part of the curriculum. I see this as kind of, you know, you turn 45 you get your colonoscopy. It's not because you're a bad person, it's because you're at risk, and we look for stuff because we care about you. And so by changing the default from requiring physicians to actively seeking help to just making a standard part of training or practice, I think it overcomes a number of the different barriers. It normalizes help-seeking. It takes away the fear of professional repercussions. And it gets over the logistical challenges because it's just embedded in the curricula. Now, obviously it has some challenges in implementing because logistically and funding-wise, it's one of the more expensive options. So maybe the more pragmatic solution there or approach would be to really prioritize vulnerable populations, so trainees, or we know that suicidality increases threefold in the wake of medical errors, so maybe it's just part of standard approaches to legal proceedings, or in the wake of medical errors. That'd be the other one I'm highlighting.

Christine Yu Moutier, MD: We also saw in the latest ACGME mortality study that came out in 2025 that the first quarter of the academic year appears to be the most vulnerable period for suicide risk for residents. So that's another consideration.