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Physicians face mental health stigma, but efforts for change are underway

February 28, 2024

Dr. Lorna Breen, an emergency room physician in New York City during the early days of the COVID-19 pandemic, suffered the effects of long hours and stressful work. When she recognized that she needed to seek help, she did so out of state, concerned that her job might be at risk if her employer or licensure boards caught wind of the mental health care she sought. Breen died by suicide shortly thereafter, in April 2020. (Heroes’ Foundation, 2024; McCluskey, 2024)

For years, licensure boards, hospitals, and insurance companies have queried health care providers about their history of mental illness and addiction, even if the condition was being treated or did not hinder the provider’s ability to care for patients. The result is that current and future physicians report stigma and structural barriers that negatively affect their overall well-being and mental health. The Physicians Foundation 2023 survey found that approximately half of physicians, residents, and students said they know a colleague who said they would not seek mental health care, and four in 10 physicians were either afraid or knew another physician fearful of seeking mental health care given questions asked in medical licensure/credentialing and insurance applications. (Physicians Foundation, 2024)

Now the Dr. Lorna Breen Heroes’ Foundation, led by Breen’s brother-in-law, J. Corey Feist, and national groups like the American Medical Association, as well as state and federal officials are seeking out systemic changes and calling for an end to invasive questions about physicians’ mental health.

First-of-its-kind legislation to protect health care workers up for renewal

Feist testified this month at a House subcommittee hearing urging lawmakers to reauthorize the Dr. Lorna Breen Health Care Provider Protection Act. Republicans and Democrats alike have sponsored reauthorization of the bill, which since its passage in 2022 has funded $103 million across 44 organizations to implement evidence-informed strategies that reduce and prevent suicide, burnout, mental health conditions, and substance use disorders. (Heroes’ Foundation, 2024)

Feist said the reauthorization of the Act will widen its reach beyond the less than 1% of the 6,120 hospitals in the country that received grants to sustain and promote well-being, including changing the intrusive questions providers must answer to retain their credentials. For example, instead of asking about any previous mental condition, Feist says hospitals and credentialing boards should ask whether the clinicians are currently suffering from any untreated condition—physical or mental—that impedes their ability to practice medicine. (Heroes’ Foundation, 2024; Southwick, 2024)

According to the Foundation’s website, as of October 2023, 26 state medical boards audited and changed the intrusive language from their licensure applications, benefitting more than 673,000 physicians. Eleven states are in the process of making similar changes. And as of September 2023, 12 health systems audited and changed language from their credentialing applications and 21 health systems are in the process of doing the same. (Heroes’ Foundation, 2024)

States, national groups take action to support the effort

States are furthering the momentum for change and redefining when medical professionals can get mental health treatment without risking notifying the boards that regulate their licenses. Montana is among those states looking to boost confidential care and resources for health professionals if they are not deemed a current danger to themselves or patients. The state is modeling its efforts after Breen’s home state, Virginia, which passed similar legislation in 2020. (Houghton, 2024)

States have also reworked medical licensing questions to avoid scrutiny for providers who need mental health treatment. In Massachusetts, all hospitals and health insurers have pledged to stop asking clinicians about their history of mental health and addiction in paperwork used to determine if someone can safely care for patients. Instead, they ask about current conditions, both mental and physical, that could impair ability to practice medicine. In 2023, Virginia became the first state to pass a law that removes overly intrusive questions about mental health on all applications for all licensed health workers. A similar law was recently passed in Illinois. (Houghton, 2024)

In the meantime, physicians continue to architect their own mental health support systems

While systemic changes are underway at the national and state level, clinicians continue to advocate for prompt, proactive changes in their workplaces. Robyn Tiger, MD, founded StressFree MD, a trauma-informed wellness coaching practice for physicians, after losing three colleagues to suicide. Her practice is dedicated to elevating the health and well-being of the whole physician through an evidence-based approach to lifestyle medicine. (Tallent, 2024)

The Physicians Support Line, staffed by volunteer psychiatrists, is a confidential assistance that does not have to be reported as a therapy service. The support line was conceived of by a group of psychiatrists and is intended to be a safe space where physicians can express their fears, frustrations, and vulnerabilities without judgment. (Tallent, 2024)

While the medical community still faces profound challenges in addressing the physician mental health crisis, these resources can empower physicians to reach out for support as they contend with the pressures they face in their profession.

Sources:

Southwick, R. (2024, February 15). Chief Healthcare Executive. Pushing Congress to extend law to reduce burnout, suicide among healthcare workers. https://www.chiefhealthcareexecutive.com/view/pushing-congress-to-renew-law-to-reduce-burnout-suicide-among-healthcare-workers

(2024). Dr. Lorna Breen Heroes’ Foundation. https://drlornabreen.org/

(2024). The Physicians Foundation. Amplifying Physician, Resident and Student Voices to Drive Wellbeing and Care Delivery Solutions. https://physiciansfoundation.org/research/amplifying-physician-resident-and-student-voices-to-drive-wellbeing-and-care-delivery-solutions/

McCluskey, P. (2024, February 7). NPR. Doctors face huge stigma about mental illness. Now there’s an effort to change that. https://www.npr.org/sections/health-shots/2024/02/05/1228624738/doctors-face-huge-stigma-about-mental-illness-now-theres-an-effort-to-change-tha

Tallent, A. (2024, February 8). Cardiology Advisor. Doctors’ Orders: Mental Health Resources Developed by Physicians, for Physicians. https://www.thecardiologyadvisor.com/home/topics/practice-management/physician-developed-wellness-resources/?itm_source=Bibblio&itm_campaign=Bibblio_related&itm_medium=Bibblio_carousel

Houghton, K. (2024, February 22). KFF Health News. Health Care Workers Push for Their Own Confidential Mental Health Treatment. https://kffhealthnews.org/news/article/confidential-mental-health-treatment-for-health-care-providers/