May is National Mental Health Awareness month. It seems like the appropriate time to share my thoughts regarding the stigma that exists regarding Mental Health treatment in the world of Executive Leaders, Physician Leaders, and the like in healthcare.
I recently had an intense conversation with a young medical professional, I will refer to him as “Jim.” Jim was just beginning his practice, serving as clinician and co-owner of his small but growing group. His marriage was in trouble and he thought that ending the marriage might be the answer to lighten his heavy load.
As our conversation continued, there were some markers that made me think that Jim might be struggling with some diagnosable and treatable mental health issues. Underneath his charming smile and professional facade, he was hiding a lifetime of anxiety and depression. He spent years compiling academic and professional achievements to cover-up, or attempt to outrun, these issues.
But, as these things tend to do, they kept bubbling to the surface.
As the conversation continued and we attempted to discuss how he was feeling, Jim physically tensed up. “I’m not good at talking about that stuff – feelings,” he said. So, we switched gears to focus on goals.
Eventually, though, the discussion circled back to the issue of his marriage and divorce. Jim decided divorce was the only choice. He could not, under any circumstances, get any kind of counseling. He was adamant that counseling was unacceptable for someone in his profession and he would be “punished” (his word, not mine) if he reached out for professional help.
I wasn’t shocked by his mindset. It’s common in the field of healthcare and healthcare leadership.
There is a perception and expectation that medical professionals should be immune to the problems and struggles of “ordinary people.” This stigma has made it inconceivable for many medical professionals to seek help when they need it.
Physicians have one of the highest suicide rates in the country, and yet we’re baffled when a physician or any clinical leader dies by suicide. They appear to have a perfect life with buckets of money and achievements – all the things that are supposed to make a person happy.
It is the image they are supposed to have. They are supposed to look like they have it all together, but it is often just a veneer. And if they don’t uphold this image, there is a stigma attached: a belief they can’t do their job if they have mental health challenges.
In my twenty-five years in healthcare and around healthcare professionals, I have found that doctors, dentists, and clinical leaders are masters of disguise. They have perfected compartmentalization. They spend their days healing the same hurts, bad habits, hang-ups, and mental health struggles that they themselves are living with and covering up.
In fact, many of our healthcare providers and leaders are living with the heavy burden of hiding a treatable mental illness because it carries a stigma.
The training and the practice of healthcare professionals fuel the flame of stressors that amplify ordinary and treatable mental health challenges. Long hours, relentless demands, and expectations of perfection coupled with unmet emotional needs and being stretched beyond measure in personal life is not sustainable for anyone.
Terms like “burnout,” “stressed,” and “tired” are used to distract and deflect from the stigma of anxiety, depression, and/or post-traumatic stress disorder. There is a fear of being disgraced or punished for struggling with these common diagnoses. The stigma that looms over many healthcare professionals drives them to hide their own mental health needs. They can grow desperate, seeking relief in any form, including divorce, substance abuse, or even suicide.
This was the case for Jim. Fears of punishment, lack confidentiality, and negative public perception kept him from seeking the treatment he needed. When I assured him that our conversation was confidential, that I was not taking notes that someone could accidentally read, his tension eased.
He shared his fears of being disciplined by a licensing board, that his EMR could be accessed by someone he knows, and of not being able to build a financially sustainable practice if patients knew he had mental health struggles. He was “horrified” at the possibility of being perceived as incapable of performing his duties by his colleagues and bosses.
Sadly, his fears are not invalid.
Thankfully, Jim recognized that dissolving his marriage would only be collateral damage for his deeper struggles. He reluctantly agreed to counseling.
He decided to drive 90 miles out of state, pay cash, and use a fake name to hide from his patient base and colleagues. He felt this would protect him from licensing boards and insurance providers that may interrogate him regarding a potential diagnosis which might prevent or delay health plan coverage or put a black mark on his permanent record.
This self-protective plan required at least a half day of lost revenue for every appointment, which seemed incredibly costly while trying to build a private practice.
The truth is, what happened to Jim, happens to many medical professionals and leaders. The choice of our organizations and our culture to avoid this reality and responsibility literally defies the creed to “first, do no harm.”
The lack of support provided for our own sustains the stigma. Professional mental health treatment must be accessible without shame and judgment for all people – medical professionals and leaders included.
This must be a system-wide change.
By embracing the fact that providers and leaders are human, we begin to replace old mindsets with newer, truer ones: mental health is part of healthcare for everyone. We educate and communicate so that the stigma, shame, and potential punishment that can come from receiving mental health treatment is eradicated.
Now is the time for change. Stop the stigma.
