The Future of Medicine is at Risk: Medical Students and Suicide

This article originally appeared on Cleveland.com - as an editorial piece titled, "Blunt the suicide risk among medical students with more mental health, other supports"

Medical students are more at risk of committing suicide than their same-aged peers given that they are 15 percent to 30 percent more likely to meet the diagnostic criteria for depression.

In recent months, articles recounting the increase in suicides among our medical students and their struggle with mental health have become the norm — not the exception. Many of these articles are written by students and residents desperate to change the status quo — in part by sharing their own personal stories of struggle.

A groundbreaking study a decade ago found that burnout affects up to 50 percent of medical students, and that 10 percent of students had experienced suicidal ideation.

Unfortunately, very few students ask for help. In fact, my research shows that only 3 percent of all medical students are disclosing a disability. Under the Americans with Disabilities Act, these students are eligible for institutional support. The missed opportunity for intervention is startling if 15 percent to 30 percent of medical students are clinically depressed, as a recent meta-analysis shows, but only 3 percent are disclosing.

Medical students are perceptive. They pick up on the stigma of depression and mental illness, and worry that having a mental illness will harm their chances of honoring, matching, and securing licensure. Research shows that students are hesitant to disclose mental health concerns in this new setting over concerns regarding lack of confidentiality, the stigma associated with using mental health services, cost, fear of documentation on academic record, and unwanted intervention.

Despite the overwhelming evidence, some schools fail to acknowledge that their students struggle. The culture of perfection is highly ingrained, especially in the most competitive environments. Students are literally afraid to ask for help.

At a top medical school, I listened as a student fought back tears explaining his love of medicine and the struggle to access mental health supports. After asking for time off once per week to attend appointments with his therapist, he was refused. A resident at the same institution emailed me a week later to say she was leaving her residency because they would not support her need for weekly mental health appointments.

This refusal is in direct contrast to the Liaison Committee on Medical Education (LCME) — the very body that accredits these programs. The LCME requires Doctor of Medicine programs to provide 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."

The LCME urges us to accommodate the need for mental health care and prioritize this in our programs, yet in practice many still refuse this service to students or provide limited and inaccessible services with appointment wait times exceeding three weeks. As well, students see how their peers are treated and avoid asking for help.

We are at risk of losing some of the brightest minds and future physicians due to a lack of access to care. There exists a looming physician shortage yet we are failing in efforts to support the existing pipeline.

Medical schools must support initiatives around mental health and counseling and encourage destigmatization on their campuses through educational outreach.

Students see how their peers are treated and avoid asking for help.

Researchers have demonstrated the efficacy of intervention and improved student mental health directly through curricular changes, resilience/mindfulness experiences, and wellness programs like the program at Saint Louis University School of Medicine.

However, it is not enough to talk the talk; educators and medicine as a whole must walk the walk, and model positive self-care and wellness for their students and trainees.

Schools need experienced mental health and specialized disability providers. By connecting medical students to a "team," the university sends a very clear message: "We will support you through this time." Schools should make sure students are aware of the services available, acknowledge that students struggle and that medical school is hard.

Schools can normalize help-seeking behavior by encouraging students to seek mental health services and making sure these are readily available to students (onsite). As directed by the LCME, schools should also support student release for appointments. When warranted, schools should make taking a leave of absence easy.

Finally, schools must talk about mental health in the curriculum and normalize this as an issue for students and patients. 

Approximately 1 in 5 adults in the United States -- or 43.8 million individuals -- experience mental illness in a given year, making this a major health care issue. 

The status quo is unacceptable.

Medical schools must accept that there is an issue. Mental health is not simply a phenomenon to study, or to write about, but one that requires immediate action. Medical students who practice wellness become healthy physicians. Healthy physicians in turn provide excellent care to their patients.

Lisa M. Meeks is an assistant professor of medicine and director of medical student disability services at the University of California, San Francisco.