Improving the well-being of physicians and patients

Mental Health Month was established nearly 75 years ago to raise awareness about the importance of mental health and wellness in our lives. This designation for the month of May allows us to draw attention to the toll that mental illness can take on the physical and emotional well-being of individuals, families, and communities.

So much more is known today about mental illness than when Mental Health Month was established in the 1940s, starting with the basic understanding that caring for mental health is essential to and as important as caring for physical health. It is also well-established that behavioral and mental health conditions, when treated, do not prevent people from achieving personal or professional goals.

While there have been noteworthy advances, much more action is needed to support greater access to and utilization of behavioral and mental health services. This is especially true when accounting for the exacerbating factors of recent years, including the pandemic and social media.

According to the CDC, more than 50% of the U.S. population will be diagnosed with a mental illness or disorder at some point in their lifetimes, and one in five Americans experiences mental illness in a given year. The CDC also reports that in 2020 more than 1.2 million adults in the U.S. attempted suicide and 45,979 died from suicide. There are four hospitalizations relating to a suicide attempt and eight ED visits for every suicide death. American Indians and Alaska Natives have the highest suicide rate, followed by non-Hispanic Whites. And men are 49% of the U.S. population, but comprise nearly 80% of suicides.

Unfortunately, the health care community is not immune to this problem. Even before the COVID-19 pandemic, one study found 20% of medical residents met criteria for depression while 74% met criteria for burnout, and the suicide rate was 1.4 times higher among male physicians and nearly 2.3 times higher among female physicians compared to the general public. COVID-19 has generated a host of mental health challenges for the population as a whole, including elevated levels of anxiety, depression, and substance use. Physicians and other clinicians have the added burden of working in high-stress, overwhelmed facilities, facing deaths of patients and colleagues and extra barriers to seeking mental health care.

The purpose of Mental Health Month is not to remind people of grim statistics, but to raise awareness around the importance of seeking help and how to do so. ACP has a number of resources to support anyone needing behavioral or mental health care. The I.M. Emotional Support Hub reminds physicians that they are not alone and provides peer support, free and low-cost counseling, and other resources. ACP also has an advocacy toolkit to help physicians push for modernizing licensure and credentialling applications to remove stigma about receiving mental health care or having a mental health diagnosis.

Progress has also been made through the enactment of federal legislation over the past two years. The Dr. Lorna Breen Health Care Provider Protection Act was signed into law in March 2022 and authorizes grants for training health profession students, residents, or clinicians in evidence-informed strategies to reduce and prevent suicide, burnout, mental health conditions, and substance use disorders. In addition to this legislation, Congress has also provided more than $120 million to support grants for education, training, and services.

When raising awareness about mental health and associated risks, it is important to note that a firearm is the most common method of suicide. In 2020, a firearm was used in 52.8% of suicides. In addition to the Dr. Lorna Breen Health Care Provider Protection Act, Congress also passed the Bipartisan Safer Communities Act last year. This legislation provides funding to help states implement red-flag laws and other crisis intervention programs, as well as a significant investment in mental health care services and training for mental health clinicians.

There is also increasing recognition that administrative burdens have a deleterious effect on physician well-being. While much more needs to be done to reform and remove systemic burdens, incremental progress is being made on prior authorization processes and other time-consuming administrative requirements through ACP's Patients Before Paperwork initiative. In addition to advocacy, this initiative offers resources to help ACP members with processes for ordering diagnostic tests, prescribing medication, and navigating electronic health record systems.

Yet obstacles remain for those seeking behavioral and mental health care. Despite recent investments, workforce shortages continue and require longer-term solutions. Mental health payment parity laws need to be enforced and potentially strengthened. To address these challenges, one of ACP's public policy priorities in 2023 is improving access to mental and behavioral health care, which includes advocacy for legislation that would support the integration of behavioral health into primary care, expand the mental health clinician workforce, and bolster the enforcement of mental health parity in health insurance coverage. ACP also has a number of resources to further support behavioral and mental health care integration in primary care practices.

While more work is needed to reduce the stigma that some perceive around mental health, increase access to care, and remove inappropriate questions from licensure or credentialing applications, progress has been made in each of these areas. However, more important than advocacy for any policy is self-advocacy and support for one's peers.