Thursday, Sept. 17, 2020 marks the third annual National Physician Suicide Awareness (NPSA) Day.¹ NPSA Day remains a day of reflection, dedicated to honor the memory of our colleagues who have died by suicide. The day raises awareness about physician suicide and should encourage discussion of how we can prevent it. This year’s theme is “One of Us,” and is meant to remind us that we, as a community, are at risk. The theme is also meant to remind us that we all have a part to play in preventing suicide among our colleagues. Suicide is preventable if we take the time to care for one another and destigmatize the issues that underlie it by being vulnerable and open to conversations about them.

A Year of Challenges

This year, in the shadow of the COVID-19 pandemic’s dramatic arrival in New York, we lost Lorna Breen, MD, FACEP, to suicide. Dr. Breen was one of us. She was radiant, charismatic, powerful, interesting, kind, and adored by those around her. She was an adventurer and snowboarder. She was a friend who loved and was loved by so many. She was the director of a major New York City emergency department. She led her department with every fiber of her being. She was an educator and mentor to colleagues, residents, and students. She was also a longtime ACEP and New York ACEP member who participated in committees and Scientific Assemblies. She was optimistic and had even taken on the challenge of starting a new educational path in 2019, studying for an MBA. She had no history of mental health issues and, though she was a colleague and friend, she revealed no signs to suggest she was at risk.^2,3 She was an incredibly strong and effective person. She was the epitome of emergency medicine. She was one of us.

Dr. Breen’s death, as well as the deaths of so many others, reminds us that many among us are at risk and struggle to process and vocalize our own emotions. Though each story varies, we physicians tend to have a problem acknowledging our own mental health struggles and we need to make concerted efforts to change that. While we have always been the safety net for our communities, we lack our own safety net to effectively deal with the barrage of psychological injuries that our jobs confer.

2020 has given emergency physicians front-row seats to one of the most tumultuous periods in generations. The COVID-19 pandemic has put the spotlight squarely on the health care system, medicine, and, in particular, on us as the front lines for our communities. The record number of unemployed due to furloughs and layoffs has given way to social and economic strife, even affecting emergency physicians. Our communities have also seen increasing numbers of opioid-related deaths, domestic violence, and gun violence. It would be ignorant to assume that we are all somehow psychologically insulated from our environments.

How We Can Help Prevent Suicide

Though there is a need for broader systemic change to improve the physician experience, changes are occurring. For example, as a result of Dr. Breen’s suicide, her family helped push the State of Virginia to make changes to several laws to better protect physicians seeking mental health care.⁴ (See page 4 to read about how Dr. Breen’s family is honoring her legacy.) Similarly, on July 29, 2020, the U.S. Senate introduced bipartisan legislation, the Dr. Lorna Breen Health Care Provider Protection Act, that aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals.⁵ Recognizing the need to minimize barriers to obtaining help, the Federal Communications Commission (FCC) unanimously voted to create a national three-digit suicide prevention hotline, 988, which will be implemented on July 16, 2022.⁶ Organizations like The Joint Commission, the Federation of State Medical Boards, and the American Medical Association have released statements to aimed at making it easier for physicians to access mental health services without deleterious effects on their own ability to practice medicine.”⁷ ACEP has expanded its offerings for mental health and well-being support by compiling wellness resources and even offering three free confidential counseling or wellness coaching sessions.⁸

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.

Dr. Lakoff is co-creator of National Physician Suicide Awareness Day and assistant professor of emergency medicine at NYC Health + Hospitals, Harlem Hospital, in New York City.

Dr. Swisher is co-creator of National Physician Suicide Awareness Day and associate professor of emergency medicine at Mercy Catholic Medical Center in Philadelphia.