It’s no surprise that mental health and the risk for suicide go hand-in-hand; however, both topics often go unaddressed, especially in the medical profession. Physicians and trainees experience higher degrees of mental distress and are less likely than other members of society to seek professional treatment. The reasoning for this ranges from time constraints to self-medicating, to concerns regarding personal reputation and confidentiality. In addition, the suicide rates for both male and female physicians exceeds that of the general population – 1.41 times higher for males and 2.27 times higher for females.
IU School of Medicine offers a variety of services and resources to all medical students, residents and fellows, free of charge. Samia Hasan, MD, director of mental health services at the school, discusses the importance of self-care, when to seek professional treatment and how to approach someone you feel may be suicidal:
Tell us about your background and experience in psychiatry.
I joined the IU School of Medicine faculty last year. Prior to that, I worked for 17 years in a multidisciplinary private practice in the Cleveland area where I provided psychiatric assessments, medication management and therapy services. In that course of work, I treated many physicians and physicians-in-training who preferred to be seen outside of their training or work settings, as many of those settings did not offer the kinds of private and confidential services available to trainees at IU School of Medicine.
As the new director of IU School of Medicine Mental Health Services, what are your priorities for the school?
The first priority has been to expand the mental health services available to trainees statewide. This includes crisis intervention services as well as accessible, confidential and high-quality mental health care. The second priority is to develop our psychoeducational, preventative mental health and wellness programing across all nine IU School of Medicine campuses. The third priority will be to assess the outcomes and impact of our interventions.
What types of services are offered through IU School of Medicine Mental Health Services?
We offer psychotherapy services, psychiatric treatment, teletherapy, telemedicine and crisis management. We have a 24-hour mental health crisis line (1-800-278-HELP) for trainees or others on their behalf. Medical students, residents and fellows also have access to mental health services at each of the host university counseling centers. Trainees may contact us if they would like information on resources outside of the IU School of Medicine system as well.
When should a student, resident or fellow reach out to you and your team?
I would recommend that trainees reach out when they are in distress, and if possible, before any impairment in functioning has been noted. I also encourage trainees to think about counseling, not only as a means of dealing with distress, but also for personal growth and development.
Studies show that the suicide rate for both male and female physicians exceeds that of the general population. Why do you think that is?
Suicide is a complex problem that has a multi-factorial etiology that includes health, environmental and historical factors. We do know that physicians and physicians-in-training have very high rates of distress, including depression and burnout. Despite evidence that physicians experience high rates of depression, they often do not seek treatment for mental health conditions. These conditions left untreated increase the risk for suicide. Self-treatment and access to medications are additional factors that put physicians at greater risk.
In addition to seeking mental health services, what are some other tools students, residents and fellows can use to combat mental illness, burnout, etc.?
It’s important to pay attention to the many aspects of one’s wellbeing, and there are a myriad of ways to nurture and safeguard one’s wellbeing. This includes taking care of one’s physical health through exercise, a healthy diet and getting enough sleep, socializing, having fun, being creative, spending time outdoors, connecting to one’s spiritual beliefs, looking out for and giving back to others, doing work that is meaningful and the list goes on!
What are some warning signs that someone may be suicidal?
The American Foundation for Suicide Prevention provides a great summary of warning signs that include three components: talk, behavior and mood.
- Talk: If a person talks about being a burden to others, feeling trapped, experiencing unbearable pain, having no reason to live or killing themselves.
- Behavior: Specific things to look out for include increased use of alcohol or drugs; looking for ways to kill themselves, such as searching online for materials or means; acting recklessly; withdrawing from activities; isolating from family and friends; sleeping too much or too little; visiting or calling people to say goodbye; giving away prized possessions; aggression.
- Mood: People who are considering suicide often display certain moods, or a combination of moods. These include depression, loss of interest, rage, irritability, humiliation and/or anxiety.
What’s the best way to approach someone who you think may be suicidal?
It’s important to engage with someone about whom you are worried. You might ask them how they’re doing, mention that they look distressed, or that you’re concerned about them. Let them talk and try to listen rather than offering insights or solutions. Supporting comments such as, “I’m sorry that things have been so hard” are often helpful. If you are concerned that someone is suicidal, it’s important to ask them if they are having thoughts about giving up and also to ask them directly if they are having thoughts about hurting themselves. You can also ask them what you can do to help.
