Barriers to mental health care: The role of medical school instruction

Medical schools have formal policies and a significant focus on student well-being. Instructing physicians also have a role to play in forming young doctors able to recognize signs of distress in themselves and in their colleagues. 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. Here they discuss medical instruction and its importance in treating physician mental health.

Medical Economics: For medical schools and instruction,what should be that role in addressing mental health wellness and well-being for physicians?

Christine Yu Moutier, MD: Well, there is a requirement for American medical schools to actually address well-being and issues of mental health and have a supportive culture and policies and very specific requirements around faculty who have evaluative roles to not be clinically treating medical students with mental health conditions. So there are very specific sort of a framework that's required in order for medical schools to keep their accreditation.

Daniel Saddawi-Konefka, MD, MBA: I'll add, it's a really good question, Richard, because we know that fear of stigma, the desire for confidentiality increases substantially even during med school. Med students come in with only about 30% of them being worried about the fear of stigma. It becomes over half of them by the time they finish training. So it is a really important thing. I think a lot of med schools, thankfully, are focused on improving the well-being of their students. I think a lot of the focus, at least my impression, not working in UME, but a lot of it does seem to focus on decreasing the discomforts associated with training. And that's critically important. I think if we were to consider it well-being more holistically, it should also include curricula around, as Dr. Moutier was saying, the commonality of these conditions. And also in those curricula the importance and the benefits of seeking help for these things, and probably also just as important, training on how to recognize distress in yourself that might benefit from from help. So I think med schools have a significant focus on on well-being, and I think a lot of them are doing exceptional things, and I think there's still an opportunity to elevate nationally through curricula around mental health and med students.

Christine Yu Moutier, MD: Yeah and if you make it part of the curriculum, rather than kind of a side topic, I think you really normalize and elevate the importance that this is part of professional development and training, to recognize these as serious matters, to become proactive about it for ourselves, as well as for our colleagues, and to really learn how to be a support to others. It's an interesting thing to start, because I was a dean in a medical school, to realize that modeling a level of human vulnerability does not lower your your reputation or your ability to be effective. In fact, I think that's a very powerful way for educators and clinical leaders to actually move the needle and create psychologically safe environments so that all the people who work and learn under their unit leadership, can see that it's OK to be fully human and to address your health needs, to address your family's needs, and that there's a way to do that even with the busyness of a physician's life.