Suicide is the 10th leading cause of death in the U.S., and suicide rates are higher among physicians. Physicians have increased prevalence of burnout, depression, and other mood disorders and there are also significant barriers to seeking care due to the stigma of mental health issues. In response to the suicide of a faculty physician at the University of California San Diego (UCSD) in 2002, the medical staff executive committee charged the physician well-being committee at UCSD to investigate options for creating a suicide prevention program. Out of this tragedy, the (Healer Education Assessment and Referral Program) HEAR program was established. This program aimed to improve screening of residents for mental health issues and suicidality and then, in a completely anonymous and private way, provide referral to mental health services for those who screen positive for suicidal ideation and other serious mental health issues.
Organizational Culture and Values | Implementing a mental health screening program to provide services and help to struggling residents reflects an organizational culture that values therapy and mental health. |
Work-Life Balance | Mental health is an important aspect of personal life that should be considered and prioritized by residency programs in order to improve work-life integration. Facilitating referrals to mental health services enables work-life integration in a positive manner. |
1. Engage a task force of faculty and residents who are dedicated to the cause of improving mental health support for house staff and/or faculty.
1. For example, the UCSD task force had 5 goals:
a. Characterize the problem of depression and suicide risk among students, residents, fellows and faculty
b. Provide education on depression and available health seeking resources to destigmatize diagnosis and mental health
c. Confidentially identify those suffering from depression and suicidality
d. Provide prompt, confidential referrals to primary care and mental health services
e. Treat depression and prevent suicide
1. For example, UCSD had a two-pronged approach.
a. Utilize a web-based screening assessment and referral program tool based on the one developed by the American Foundation for Suicide Prevention (AFSP) https://afsp.org/
b. Face-to-face education to target groups about physician burnout, depression and suicide
2. The Mayo Well-Being Index is another screening tool that can be utilized to recognize emotional distress and suicidal ideation. https://www.mededwebs.com
3. Your institution may already have mental health resources in place. Identify what is available and how you can disseminate that information to you residents and faculty.
1. Review and determine a budget for the cost of the screening tools and referrals.
2. Review and discuss the cost to residents for referrals to mental health services (i.e. are such services covered under the resident health insurance? Are co-pays reasonable? Is there a limit to the number of mental health visits?).
3. Discuss the need for and feasibility of hiring an FTE to support this program.
1. Privacy regarding mental health and suicidality is a serious issue to consider. For effective screening tools, residents must feel that their privacy and confidentiality are absolute. However, task force members may find themselves in a difficult situation when an anonymous resident endorses suicidal thoughts but does not follow through with mental health referral. It is recommended that a residency program interested in instituting a project like this reach out to the hospital ethics committee. UCSD, for example, ultimately decided that maintaining 100% anonymity was for the greater good of all.
1. Discuss the importance and purpose of mental health screening with residents and faculty, possibly as a Grand Rounds talk
2. Emphasize the anonymity and confidentiality of the screening
American Foundation for Suicide Prevention - https://afsp.org/
UCSD HEAR Program- https://medschool.ucsd.edu/som/hear/Pages/default.aspx
Mayo Well-Being Index- https://www.mededwebs.com
1. Moutier C, Norcross W, Jong P, et al. The Suicide Prevention and Depression Awareness Program at the University of California, San Diego School of Medicine. Academic Medicine. 2012;87(3):320-326. doi:10.1097/acm.0b013e31824451ad.
2. Norcross WA, Moutier C, Tiamson-Kassab M, et al. Update on the UC San Diego Healer Education Assessment and Referral (HEAR) Program. Journal of Medical Regulation. 2018;104(2):17-26. doi:10.30770/2572-1852-104.2.17.
3. Haas A, Koestner B, Rosenberg J, et al. An Interactive Web-Based Method of Outreach to College Students at Risk for Suicide. Journal of American College Health. 2008;57(1):15-22. doi:10.3200/jach.57.1.15-22.
4. Garlow SJ, Rosenberg J, Moore JD, et al. Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University. Depression and Anxiety. 2008;25(6):482-488. doi:10.1002/da.20321.
5. Shanafelt T, Kaups K, Nelson H, et al. An Interactive Individualized Intervention to Promote Behavioral Change to Increase Personal Well-Being in US Surgeons. Ann Surg. 2014;259(1):82-88. doi: 10.1097/SLA.0b013e3182a58fa4.