Doctors face huge stigma about mental illness. Now there's an effort to change that
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By any measure, Lisa Harbury Lerner was a high achiever. She went to Harvard, became a dermatologist, and started a family.
At her medical practice near Boston, she became an expert at diagnosing skin conditions with speed, confidence and accuracy, says her husband, Dr. Ethan Lerner, also a dermatologist.
Dr. Lisa Lerner also had depression, something she shared only with those closest to her. But like all doctors, she routinely had to fill out forms to maintain her license and credentials to practice medicine. And these forms commonly included questions about her history of mental health conditions.
The questions were an invasion of privacy and made it harder for her to seek care, her husband says: "It was just unbelievably uncomfortable. I mean — a huge stressor. No one worked harder than her, no one could do a better job than her, and so why was this relevant at all?"
The sudden death of their adult son, Max, in 2019, was too much to bear, her husband says.
Less than two years later, Lisa Lerner died by suicide. She was 58.
Physicians often fear they could be shamed or penalized — or could even lose their jobs — for disclosing details about their mental health to licensing boards and employers.
Now, there's a concerted effort to reduce that stigma.
In Massachusetts, all hospitals and health insurers have promised to stop asking clinicians about their history of mental illness and addiction in the paperwork used to determine if someone can safely care for patients. Instead, they'll ask only about current conditions — mental or physical — that could impair someone's ability to practice medicine.
Massachusetts health care leaders say it's the first such effort in the nation. It follows medical licensing boards in more than two dozen states that have stopped asking physicians broad questions about mental health.
"If you're currently able to practice medicine, and you're taking care of yourself, that's what we should be interested in — not what you did previously," says Dr. Barbara Spivak, president of the Massachusetts Medical Society. "That's a huge step forward.
"It's particularly important in today's world," she says, "where we're seeing so many physicians suffering from various levels of burnout, where the stresses of medicine are really interfering with the joy of medicine, and maybe even the joy of life."
Afraid to seek help
Physicians who admit to mental health or addiction issues typically are required to share more details and submit to scrutiny such as monitoring or periodic drug tests.
More than 40% of physicians in a recent survey said they didn't seek help for burnout or depression because they were afraid their medical board or employer would find out.
"The perception is that their livelihood is at risk," says Dr. Steven Defossez, vice president of clinical integration at the Massachusetts Health & Hospital Association.
The culture of medicine traditionally has held doctors to unrealistic standards — to be "super men and super women," Defossez says. "It means you don't get hurt, you don't have emotions. When you're cut, you don't bleed. And none of that is true."
"It's much healthier if clinicians can obtain the behavioral health care they need," he says, "whether it's psychological care for stress or anxiety or depression ... or whether it's care for substance use disorder. And we're removing barriers so that clinicians can do that."
Empathy, not punishment, needed
Dr. Peter Grinspoon, a primary care physician at Massachusetts General Hospital, who was not involved in the effort, says it's a meaningful change. "It allows doctors to be human beings," he says. "It allows them to deal with their problems without adding a whole layer of punishment."
Grinspoon suffered from opioid addiction, temporarily losing his medical license, and has been in recovery for 15 years. He says physicians with addiction and mental illness deserve empathy.
"People who are in recovery are great doctors," he says. "They are people who have made it to the other side. They are doctors who are really humble and connected and mindful, and they listen to their patients."
Burnout among health care workers has been growing for years, and the COVID pandemic exacerbated the crisis by forcing medical professionals to contend with surging numbers of patients, longer work hours, supply shortages and increased harassment and violence.
Nearly half of health care workers reported feeling burned out often in 2022, compared with 32% who felt that way in 2018, according to the U.S. Centers for Disease Control and Prevention. And surveys show that burnout rates are even higher among doctors. To cope, some health care professionals are leaving their jobs or reducing their hours.
High risk for suicide
Health care workers, especially female doctors, also are at disproportionately higher risk of suicide, compared to other workers. An estimated 300 to 400 doctors die by suicide each year.
Dr. Lorna Breen was an emergency room physician in New York City in the early days of the pandemic, when hospitals were overwhelmed with severely ill COVID patients. She was stressed, working long hours and she realized she was struggling. She became so despondent she could no longer move. She confided in her sister, who helped her get psychiatric treatment in another state. But Breen worried about what others would think. She was terrified she would lose her job.
"She was not well," says her brother-in-law, J. Corey Feist. "Once we got her stabilized, she said, 'Now my career's over. Now I'm done.'"
Breen died by suicide in April 2020.
Feist is chief executive of a foundation named in Breen's memory, which works to improve the wellbeing of health care professionals. The Dr. Lorna Breen Heroes' Foundation has been pushing state medical boards and hospital leaders to update their licensing and credentialing forms.
For example, instead of asking clinicians: "Have you ever been treated for or do you have a diagnosis for any mental health condition?" Feist says hospitals should ask whether they are currently suffering from any untreated condition that impairs their ability to practice medicine.
National groups, including the American Medical Association, as well as state and federal health officials, also have called for ending questions that could contribute to the stigma around seeking mental health care or addiction treatment.
The National Committee for Quality Assurance, which accredits health plans, recently removed its requirement that insurers ask clinicians about prior drug use.
These changes are happening amid a broader shift toward treating mental illness and addiction more like other medical conditions. There doesn't appear to be any significant opposition to the movement to update forms.
"Any organization we share this information with, they go back and look at their questions and are often horrified by what they're asking," Feist says. "Change is actually happening at quite a fast pace."