Janet Serwint, M.D.
After the phone call, I sat in stunned silence. I couldn’t believe that my colleague had died by suicide. A vibrant, passionate, brilliant physician, so full of life and promise. How could I not have known that she was struggling? How sad I am that she had suffered in silence. What a tragedy for our team of health care workers and also so tragic for her loving family.
“Doctors, more often than not, are left alone to struggle with their suffering. Many find it hard to ask for help, to acknowledge needing it: they are trained to be independent, to be accountable for decisions that cost or save lives, and to assume an undue portion of the miseries of others.”
– Jamison KR, Night Falls Fast, 1999
The culture of medicine supports physicians to strive to provide high quality of care, strive to be perfect, and deny their own struggles and vulnerabilities. This results in a culture of suffering in silence. Yet silence will not help us to address the mental health crisis facing health care workers today.
Many of my colleagues (coworkers) tell me they don’t want to think about or attend sessions on strategies to enhance mental well being because they don’t want to think about it or it makes them too sad. Yet the true sadness is that this crisis continues and we need to take action.
An important and critical step in addressing the stigma of mental health has been through the establishment of the Lorna Breen Hero’s Foundation which honors the legacy of Dr. Lorna Breen, a New York City Emergency Medicine physician who died by suicide during the COVID pandemic. The Foundation’s mission is to reduce the stigma concerning mental health and help advocate for a world where seeking mental health services is universally seen as a sign of strength. What a powerful message. The Lorna Breen Health Care Protection Act has provided federal funding to health care institutions to assist health care workers in enhancing their wellbeing and adapting evidence based strategies with a focus on reducing administrative burdens in health care.
Following in this trajectory, the CDC’s National Institute for Occupational Safety and Health, (NIOSH), announced in November 2023 the launch of the first federal campaign aimed at providing resources to hospitals to combat increasing health care worker burnout. What is refreshing and exciting to me about these recommendations is the critical focus on systems changes and recognition that organizational changes are essential, coupled with the need to involve hospital leaders and engage in team based approaches.
The 6 steps from the CDC campaign address the following: reviewing current hospital operations and determine how they support professional well being; creating a dedicated team to focus on the enhancement of well being; reducing stigma and removing barriers in seeking medical and mental health care including leadership sharing their stories of struggles and eliminating credentialling questions which may impact careers;, developing a variety of communication tools that allow leadership to share updates with workforce teams about their hospital’s journey to improve professional wellbeing and creating a culture of caring in our institutions; and integrating well being measures in an ongoing quality improvement process in our institutions along with a 12 month plan to move progress forward in improving health care worker well being.
Many components of our HRSA funded STREAM curriculum complement the components from the CDC recommendations. In the module entitled “Optimizing Well Being”, participants learn ways to take a deliberate approach to reduce the stigma of mental health by striving to normalize mental health issues and talking about it in a direct and transparent manner. Supportive leadership is key to affecting organizational change and ensuring a culture of caring. Public discussion by leadership sharing their stories of struggles is such a powerful intervention in normalizing the challenges we all face within health care.
The concept of mental health as a vital sign with periodic self review of our triggers is also introduced in this module. Just as during the COVID pandemic we began daily evaluation of our physical health and symptoms, ie do I have a fever, congestion, sore throat etc, we should and can conduct periodic mental health “scans” to determine our mental health status, i.e am I feeling fulfilled, rested, calm or experiencing anxiety, irritability, poor sleep to name a few?. This periodic reflection can guide us in determining how to replenish our individual well being reservoirs, and design well being plans for ourselves and for our teams. The curriculum suggests communication tools of how to reach out to colleagues who may be struggling in silence, how to bring up this conversation in an authentic and respectful way to further build a community of caring and support for each other.
Eliminating barriers to make it easier to access medical and mental health care is critical. Important components to consider include ensuring confidentiality of mental health services, availability of mental health providers who are familiar with the challenges health care workers face, and finding time and protecting time so health care workers can keep appointments. But it is critically important to remove the “stigma” of seeking mental health assistance by changing credentialling questions. Most health care workers with a mental health diagnosis are not impaired so it seems that the important questions is not whether someone may have a mental health diagnosis, but rather whether they are functioning well with needed treatment as in any other disease so supporting health care workers to receive the treatment they need and deserve to flourish.
The CDC also suggests incorporating well being interventions into a 12 month plan for each hospital and institution and assuring periodic assessment of well being outcomes. Making health care worker well being a quality and safety initiative again normalizes it and also stresses the importance to make our health care system more effective. Measurement within the quality improvement framework requires clear definitions, conveys importance of the concept and helps to set goals to strive for and to elevate well being to a system wide initiative which may save lives. When I think of other hospital wide safety initiatives such as measurement and reduction of CLABSI (central line bloodstream infection) rates, or immunization rates, incorporating well being as a quality improvement measurement will help keep this as a focus in improving our work environments and provide a compass or goal to which to aim to truly accomplish reductions.
In closing, multiple strategies are now available to enhance health care worker well being with a focus on hospital and organizational strategies and incorporating the support of leadership. Through the Lorna Breen Act, the CDC federal recommendations and encouraging participation in the STREAM curriculum, we will move the compass forward. And when I think of a compass I think of international goals. The World Health Organization has emphasized the importance of achieving dignity in mental health: “We will achieve dignity for mental health when communities, families and individuals have the confidence to seek help for mental health without fear and inhibition”. The Lorna Breen Foundation has as its mission that seeking mental health assistance should be seen as a sign of strength; what a wonderful perspective to share.
So, let us no longer be silent on these issues. I encourage you to have the courage to review the CDC recommendations, share them with your leadership teams, consider enrollment in the STREAM curriculum and embark on addressing the mental health crisis. The future of our profession is at stake and is in the hands of future generations of health care workers.
Bibliography
CDC. CDC’s National Institute for Occupational Safety and Health’s Impact Wellbeing Campaign releases hospital-tested guide to improve health care worker burnout. https://www.cdc.gov/media/releases/2024/p0318-Worker-Burnout.html. Published March 18, 2024. Accessed April 13, 2024.
Lorna Breen Heroes’ Foundation. Home – Dr. Lorna Breen Heroes Foundation (drlornabreen.org). Last accessed April 13, 2024.
Jamison KR. Night Falls Fast: Understanding Suicide, 1999.
World Health Organization, Dignity in mental health (who.int). Last accessed April 15, 2024.