Locally, there are actions within our grasp that can help create the safety net we need. Starting with empathy and kindness, we can create supportive workplace environments that promote a willingness to share experiences and permit both cognitive and emotional unloading. Just as we rally when critical patients arrive and support one another with treatment recommendations and procedural support, we must do the same when we are ourselves at risk. Over time, once momentum and buy-in from leadership is assured, operational changes can be implemented to better safeguard physicians.

We urge emergency physicians across the country and around the globe to mark Sept. 17 on your calendars as NPSA Day and to take the following steps at your home institutions:

1. Create a safe space by dedicating time to talk about mental health and suicide. Set aside time at your morning report, morning huddle, or faculty meeting to discuss physician mental health, depression, and suicide. More participation will allow individuals in your group to speak freely about these issues without creating a spotlight on any one person.
2. Speak the names of your colleagues who have died by suicide. Remember them, honor their memory, and share stories and lessons learned.
3. Be vulnerable and be a role model for your colleagues and trainees. Physicians are notoriously constricted in sharing their own emotions and experiences, which may contribute to higher rates of burnout, depression, and suicide. We need courageous individuals to start the conversation and break the ice. By modeling vulnerability, you are helping to change the culture in medicine.
4. Support access to mental health. This may take a little preparation, but review and share how mental health care and resources are accessed locally. As you are doing the research, look for the barriers to access care: How easy is it to access care? How long does it take to get an appointment? Is confidentiality protected? Does your employer-provided insurance plan have adequate mental health options?

If you would like to donate to Dr. Lorna Breen’s Heroes Foundation, visit www.drlornabreen.com.

If you would like to purchase National Physician Suicide Awareness Day pins, visit www.cordem.org/npsa.

If you are having thoughts of suicide or self-harm, please call a friend or a loved one or the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).

References

1. National Physician Suicide Awareness Day. Council of Residency Directors in Emergency Medicine website. Available at: http://www.cordem.org/npsa. Accessed Aug. 26, 2020.
2. Knoll C, Watkins A, Rothfeld M. ‘I couldn’t do anything’: the virus and an E.R. doctor’s suicide. The New York Times. July 11, 2020.
3. Kelly M. The pandemic’s psychological toll. Ann Emerg Med. 2020;76(3):A21-A24.
4. An Act to amend and reenact §§ 8.01-581.16, 8.01-581.17, and 54.1-2909 of the Code of Virginia and to repeal § 54.1-2923.1 of the Code of Virginia, programs to address career fatigue in certain health care providers; civil immunity. Virginia’s Legislative Information System website. Available at: https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+HB115ER. Accessed Aug. 26, 2020.
5. Young, Kaine, Reed, Cassidy introduce bipartisan legislation to support health care professionals’ mental health amid Covid-19. Sen. Todd Young’s website. Available at: https://www.young.senate.gov/newsroom/press-releases/young-kaine-reed-cassidy-introduce-bipartisan-legislation-to-support-health-care-professionals-mental-health-amid-covid-19. Accessed Aug. 26, 2020.
6. Bote J. FCC unanimously approves 988 as new three-digit suicide prevention hotline. USA Today. July 16, 2020.
7. Joint Commission statement on removing barriers to mental health care for clinicians and health care staff. The Joint Commission website. Available at: https://www.jointcommission.org/-/media/tjc/documents/covid19/statement-on-removing-barriers-to-mental-health-care-for-clinicians-and-health-care-staff.pdf. Accessed Aug. 26, 2020.
8. ACEP Wellness & Assistance Program. ACEP website. Available at: https://www.acep.org/life-as-a-physician/ACEP-Wellness-and-Assistance-Program. Accessed Aug. 26, 2020.