Open letter from Coalition concerning wellness and mental health

September 27, 2017

 

Open letter from the Coalition regarding the mental health needs of health science students. 

 

Dear Colleagues,

 

I write to you this afternoon saddened by the news of yet another tragic loss in medical education to suicide. I have grave concerns about medical student wellness, and health science students’ mental health in general.

 

We are in crisis. We know through research that medical students are more likely to be burned out[1] and express suicidal ideation[2] when compared to their peers. Our students enter medical school with better mental health indicators than age-similar college graduates in the general population and rates of depression (26.2%) similar to that of their same aged (22-32) non-MD seeking peers. However, these students quickly report significant differences after one year in medical school, with (42.4 %) of medical students reporting depression,[3] while 11.2% [4] report suicidal ideation. Some researchers suggest that elements of the training process, “contribute to the deterioration of mental health in developing physicians” (Brazeau, pg. 1522).

 

Given the high percentage of students with disabilities who report a psychological disability[5] it is imperative that we better understand the resources available on our campuses and the mandates for access to mental health services on behalf of our governing organizations. For medical schools, the Liaison Committee on Medical Education (LCME) mandates that schools meet the following standards in order to retain or obtain accreditation: [6] Please keep these standards in mind when discussing the reasonable nature of accommodation requests such as release from clinic.

 

12.3 Personal Counseling/Well-Being Programs. A medical school has in place an effective system of personal counseling for its medical students that includes programs to promote their well-being and to facilitate their adjustment to the physical and emotional demands of medical education.

 

12.4 Student Access to Health Care Services. A medical school provides its medical students with timely access to needed diagnostic, preventive, and therapeutic health services at sites in reasonable proximity to the locations of their required educational experiences and has policies and procedures in place that permit students to be excused from these experiences to seek needed care.

 

12.5 Non-Involvement of Providers of Student Health Services in Student Assessment/ Location of Student Health Records. The health professionals who provide health services, including psychiatric/psychological counseling, to a medical student have no involvement in the academic assessment or promotion of the medical student receiving those services. A medical school ensures that medical student health records are maintained in accordance with legal requirements for security, privacy, confidentiality, and accessibility.

 

Although the increased probability of developing a mental health disability in medical school is troubling, it is not as disturbing as the inversely disproportionate number of medical students seeking help. Despite the aforementioned commitment by LCME to ensure students have access to mental health services, most students do not engage with these services. In fact, studies suggest that only one third of medical students experiencing burnout or depression are likely to seek care [5]. Medical students who seek mental health or wellness services are twice as likely to report being judged poorly by their supervisors for using these services [7]. Students also report perceptions of weakness, stigma about mental health, concerns regarding professional consequences both short-term, i.e., graduating and matching [5], and long-term, i.e., obtaining licensure and employment [8], and lack of time6 as barriers to help-seeking behaviors. We must address this stigma and do so through education and protected time for students to seek help. The stressors that come with a health science education can be unforgiving.

 

I want to remind you of the existing Coalition resources regarding support for students with psychological disabilities including a webinar and article on the topic. I also want to stress that I am encouraged that our students are seeking accommodations and may be more likely to seek mental health resources in addition to accommodations. Other resources are also available. In response to this crisis, the AAMC is implementing wellness activities on campuses, as well as taking deliberate action to destigmatize seeking help in medical school, residency training, and practice. The AAMC has developed a new online portal that aims to provide resources and information to programs looking to develop robust supports for students and residents—I encourage our medical school providers to avail themselves of these resources.

 

Over the next few months I plan to engage with our Board of Directors to determine how the Coalition can best support our membership and the students we serve around the issues in mental health and wellness. I encourage all of you to identify the resources on your campus, educate your faculty about the appropriateness of release from clinic for appointments as an accommodation, and identify resources available through your professional organizations. I implore everyone to engage with their students, attend to warning signs and encourage help-seeking behavior.

 

In partnership,

 

Coalition for Disability Access in Health Science and Medical Education Board of Directors

 

Lisa M. Meeks, Ph.D,  University of Michigan Medical School, President

Timothy Montgomery, MA, University of California, San Francisco, Past President 

Jan Serrantino, Ed.D., UCI-retired, President Elect

Barbara Blacklock, MA, LISW, University of Minnesota, Secretary

Christine Low, LCSW-R, Icahn School of Medicine at Mount Sinai, Treasurer

Alison May, PhD, Northwestern, Communications Chair

Kurt Herzer, MD, PhD, M.Sc, Oscar Health, Research Chair

Mijiza Sanchez, Ed.D., Stanford School of Medicine, Diversity and Inclusion Chair

Joshua Hori, University of California, Davis, Assistive Technology Advisor

Neera R. Jain, MS, CRC, University of Auckland, Policy Advisor

Elisa Laird-Metke, JD, Samuel Merritt University, Legal Advisor

Joseph Murray, MD, Weil Cornell Hospital, Clinician Representative

 

 

References

 

1. Dyrbye LN, West CP, Satele D, et al. Burnout among US medical students, residents, and early career physicians relative to the general US population. Acad Med. 2014;89(3):443–51.

 

2. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among US medical students. Ann Intern Med. 2008;149(5):334–41

 

3. Brazeau, C. M., Shanafelt, T., Durning, S. J., Massie, F. S., Eacker, A., Moutier, C., ... & Dyrbye, L. N. (2014). Distress among matriculating medical students relative to the general population. Academic Medicine, 89(11), 1520-1525.

 

4. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among US medical students. Ann Intern Med. 2008;149:334

 

5. Meeks, L. M., & Herzer, K. R. (2016). Prevalence of self-disclosed disability among medical students in US allopathic medical schools. Jama, 316(21), 2271-2272.

 

6. https://www.ama-assn.org/sites/default/files/media-browser/i16-cme-reports.pdf

 

7. Dyrbye, L. N., Eacker, A., Durning, S. J., Brazeau, C., Moutier, C., Massie, F. S., ... & Shanafelt, T. D. (2015). The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Academic Medicine, 90(7), 961-969.

 

8. Jennifer Tjia Md, Msce, Jane L Givens Md & Judy A Shea Phd (2005) Factors Associated With Undertreatment of Medical Student Depression, Journal of American College Health, 53:5, 219-224, DOI: 10.3200/JACH.53.5.219-224

 

 

 

 

 

 

 

 

 

 

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September 27, 2017

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