Educating patients, identifying those at high risk for disease and taking preventive action are key parts of physician practice. Those methods also are proving essential to one medical school’s efforts to spot depression and thwart suicide. The University of California San Diego (UCSD) School of Medicine’s Healer Education Assessment and Referral (HEAR) program helps spot people at risk of suicide and depression through self-assessment and offers access to counseling for UCSD medical students, residents, fellows and faculty.
Sobering statistics tell the tale of why such an effort is needed, as the suicide rate among physicians greatly exceeds that of the general public. Yet worries about stigma and career impact discourage use of essential mental health services among physicians and doctors in training.
UCSD’s HEAR program combines a variety of approaches aimed at lowering the risk of suicide among faculty, residents, fellows and medical students.
Listening for signs of depression, risk of suicide
A key component of the program is a web-based screening tool, developed by the American Foundation for Suicide Prevention (AFSP). UCSD medical students, residents, fellows and faculty members are encouraged to complete a brief—and completely confidential—online questionnaire to determine whether stress and depression is affecting them in their personal and professional lives.
The screening tool includes the nine-item Patient Health Questionnaire scale, which assesses depression and gathers information about prior suicide attempts, suicidal thoughts and behaviors, alcohol and drug use, distressing emotional states, eating behaviors, and current mental health treatment.
Though the questionnaire is completely anonymous, participants may include an email address so that a counselor can provide an interpretation of the assessment, recommendations for further evaluation and referrals to local resources when needed.
The questionnaire is not a crisis intervention tool. Rather, it is designed to provide people with rapid feedback about their current mental health status and, if needed, encourage them to seek further evaluation and access external support.
The educational component of the HEAR program incorporates a multidisciplinary committee consisting of school faculty, program counselors and medical students who deliver one-hour, live presentations about physician suicide.
Presentations include an informational lecture, screening a 15-minute portion of an AFSP film about physician suicide called “Struggling in Silence,” and a question-and-answer session.
Lectures review the scope of the problem and discuss the relationships among burnout, depression and suicide, and highlight factors that affect physicians’ care-seeking behavior. Each presentation is modified for different settings, such as professional workshops, brief meetings and departmental grand rounds. This kind of flexibility allows the HEAR program to garner interest from a variety of physician and student audiences.
The results so far
As of 2014, the HEAR program had been delivered to 1,008 medical students, 34 percent of whom completed the questionnaire. Almost eight percent of those who responded met the criteria for high or significant suicide risk. Less than a quarter of the at-risk students were already receiving mental health treatment, showing how the program could help close the gap in access to potentially life-saving care.
In the seven years since the inception of the HEAR program, the UCSD staff has delivered almost 120 presentations. More than 2,600 medical students, residents, fellows and faculty have completed the anonymous online questionnaire.
A new module from the AMA’s STEPS Forward™ collection of practice improvement strategies focuses on the unique vulnerability and treatment needs of physicians. The module, “Preventing Physician Distress and Suicide,” includes four steps for identifying at-risk physicians and referring them to appropriate care, provides answers to common questions about physician distress and suicidal behavior, and offers downloadable tools to help you and your organization.
There are seven new modules available from the AMA’s STEPS Forward collection, bringing the total number of practice improvement strategies to 42. Several of the modules were developed thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.