Learner Access to Mental Health Services

To provide wellness interventions that meet the physical, mental, emotional, and social needs of residents and students, it is essential to ensure access to and utilization of mental health services. Enhancing learners’ mental health, well-being, and quality of life will prevent moral injury, promote wellness, and optimize the quality of patient care.

When institutions offer mental health services, multiple factors need to be considered. Potential barriers need to be addressed, including the stigma around mental health, unsupportive institutional culture, concern for confidentiality, and limited time. Mental health time and spaces should be prioritized and normalized, which an opt-out system accomplishes. Institutions should commit to, create, and foster a supportive culture around the use of mental health services on an interpersonal, institutional, and health system level. As examples, classmates can preemptively agree to cover each other without asking personal questions. Faculty can intentionally structure an educational environment that ensures learner wellness. And, institutions can host events that actively combat mental health stigma and promote learner wellness. Institutions and educators should recognize learners often live away from friends and family in an unfamiliar state, impacting their mental health. Additionally, learners may experience unexpected personal crises that require rotation schedule changes, and a support system should be in place to help facilitate their needs.

Physician self-care must not be seen as an indulgence but rather an essential component of the profession. This principle should be central to institutions’ culture and actions. Institutional leadership can create an automatic process to proactively address poor patient outcomes that can cause trauma and impact a learner’s mental health. Systematized mentorship by faculty and senior learners can bring value when learners experience patient tragedy and death.

Protected time in learners’ daily schedules during business hours is essential to attend mental health appointments, implement treatment recommendations, and focus on personal wellness. A learner must not be reprimanded or suffer negative consequences when they request time off for mental health. A learner should have the opportunity to receive mental healthcare from a physician or health care provider who has not and will not have a supervisory or evaluative role in their promotion through training, clinical competency, or graduation decisions. Learner confidentiality should be of utmost importance, and it is achieved when learners establish with non-faculty mental health providers and faculty’s knowledge of learners’ use of mental health resources is minimized. In addition to accessible care, the healthcare plan options available for learners must provide free or affordable mental health services. 

Family medicine residents have unique considerations related to mental health services. Residents have a responsibility to provide direct patient care in various settings. As they learn to make medical decisions that significantly impact patients, residents need to learn healthy behaviors to process the associated emotional burden. Programs need to recognize that long duty hours may leave limited time to process traumatic events and provide general self-care. If residents need time for mental health, programs need to minimize the impact on residents’ encounter numbers and other requirements. If residents must miss hospital and call shifts for mental health reasons, programs should help them navigate schedule changes needed to create protected time for residents who need it and ensure their co-residents are not overburdened.

Residents who utilize mental health services often worry about being asked questions for state medical licensing and hospital privileging. Programs should help residents understand terms used in these applications, such as the definitions for illness and impairment, and identify questions that focus on current impairment rather than mental health diagnoses.

Medical students also have specific considerations for mental health services. Students may see poor clinical outcomes for the first time that residents and faculty commonly see. Frequent check-ins with students can help them process these experiences. Medical school faculty and peers may be separated from students on clinical rotations based on the site(s), and these students’ mental health may not be monitored as closely. Residency faculty, preceptors, and residents can play pivotal roles in students’ mental health and their access to services. (January 2022 COD)