By Christine Moutier, M.D., AFSP Chief Medical Officer, with Natalie Tietjen, AFSP Manager of Federal Policy
The Chinese character for “crisis” has two parts: one meaning danger and one meaning change point or opportunity. In my own life, my crisis came in young adulthood while I was in medical school, and it was indeed a change point that would set the course of my life’s work toward suicide prevention.
It’s for this reason that preventing physician suicide holds a special place in my heart. While suicide is the 10th leading cause of death overall in the United States, certain professionals, such as physicians, experience higher rates of suicide. Physicians die by suicide at nearly double the rate of the general population. These rates call attention to the need for changes within the culture of health professions and policies that will encourage rather than discourage help seeking. A first in our nation, we now have important legislation aiming to increase that support for healthcare professionals - The Dr. Lorna Breen Health Care Provider Protection Act (H.R. 7255/S. 4349), named for Dr. Lorna Breen, an emergency room physician who died by suicide in April 2020, after serving on the frontlines in a NYC emergency department during the COVID-19 pandemic. Dr. Breen was a beloved medical leader and colleague and had spent her career in practice at New York Presbyterian Hospital in Manhattan, becoming the director of the emergency room at the Allen Hospital in 2008.
When the opportunity to provide feedback about this vital legislation arose, I was reminded of my own earlier struggles and the serendipity that my path led to support, treatment and healing, and ultimately, a dedication to and passion for suicide prevention.
Growing up with a first-generation Chinese American father and Swedish American mother brought the high driving expectations of a tiger mom (or in my case, dad) and a nurturing but highly academic environment where discussions about quarks and relativity were the norm over the dinner table. My parents were intellectually curious, driven and also suspicious of American culture, which translated into the point of view that: you have your own bed so why would you sleep in anyone else’s house? (no sleepovers); and idleness and nefarious activities like dancing lead to nothing good (no school dances).
As a child, I internalized an impossibly high expectation of myself. For high achieving students, that inner dialogue is invisible, and the drive to succeed “works” – until it doesn’t. For me, the moment it stopped working was in medical school: as cliché as it was, not being at the top of the bell curve of my class led me to experience anxiety and, ultimately, develop an intense fear of failure. Without having built coping skills like the practice of processing fears, self-compassion, or flexibility, I only knew one way to keep going: buckle down and work even harder. The outcome was a serious mental health crisis that had been building over time and peaked after my second year of medical school, leading to a year-long break from school. During that year, I experienced intense struggle, questioning my self-worth, feeling petrified of and unfit for medicine. But I was also uncovering a key inner dialog – an inconsistency between how I viewed myself, versus how I viewed the rest of the world.
As painful and difficult as that period was, it was only such an extreme crisis that forced me to hit the pause button, get therapy, and do the gradual work that led me to a newfound sense that I get to live by the same rule I apply to others: that my life is valuable simply because I breathe air.
Going back into medical school after experiencing that transformation meant going back into a culture where, at the time, medical students and physicians rarely expressed any sign of distress, for fear of being seen as weak. By the time I was Chief Resident several years later, many trainees had shared their struggles with me, and I began to see the truth that all people, including doctors, have human struggles, and that many face significant mental health challenges. The denial and rationalization were apparent to me, and it became clear that not being able to address that part of our lives and our health not only didn’t make sense; I could see how it put individual physicians at risk and compromised our work as healers of others.
It became something of a mission for me to change the culture of medicine so that physicians could develop to their full potential. Based on my own personal experience, that meant taking care of our mental health.
An individual person’s path to a suicidal crisis is unique to them. Dr. Breen worked tirelessly on the frontlines of the COVID-19 pandemic, and it is in her memory that the Dr. Lorna Breen Health Care Provider Protection Act will serve to herald greater mental health support for the medical community. The legislation includes provisions that establish and expand mental health support programs to health care providers; fund research to evaluate healthcare professional mental health; and establish an education and awareness campaign. To learn more please visit the Dr. Lorna Breen Heroes Foundation website
Additional advocacy efforts outside of the legislation to support physician mental health include eliminating questions about physician mental health by licensing boards and health care institutions. This required disclosure in many states reinforces stigma, erroneously equates mental health conditions with impairment, violates the Americans with Disabilities Act, and has prevented physicians from reaching out for help.
We must prioritize the mental health of our frontline medical professionals who are caring for some of our most vulnerable patients, and encourage help-seeking behaviors for mental health concerns and substance use disorders by reducing stigma, increasing resources, and having open conversations about mental health.
Please visit afsp.org/actioncenter to learn more about the Dr. Lorna Breen Health Care Provider Protection Act (H.R. 7255/S. 4349), and how you can take action to let your elected officials know why suicide prevention matters to you.
Learn more about the Dr. Lorna Breen Heroes’ Foundation.