On the front lines of medical care, health workers can be responsible for recognizing signs of suicide risk and connecting patients to potentially lifesaving treatment. Yet for many of these providers, this meaningful work can also take a toll on their own mental health and well-being.
Research indicates that physicians, nurses, health technicians, and others in the health care field are at increased risk for suicide compared with their nonmedical peers. A recent study of U.S. health care workers found that 14% reported suicidal thoughts, 6% reported suicidal planning, and 3.5% reported a suicide attempt in the past year. Every year, more than 300 physicians die by suicide.
Despite their elevated risk, nurses are less likely to seek mental health support when experiencing depressive or suicidal thoughts compared with nurses who do not have depressive or suicidal thoughts. And in contrast to the general population, physicians are less likely to seek mental health support even when experiencing suicidality.
According to research, three major challenges contribute to health care providers not seeking mental health care:
Stigma: Many health care providers report facing significant stigma when seeking mental health care for themselves. In a 2021 study, 47% of physicians agreed that physicians with a history of depression or anxiety disorder are less likely to be hired or appointed.
Licensing and credentialing: Relatedly, in many states, licensing and credentialing applications require health care providers to disclose whether they have ever had mental health concerns or received mental health care. Data shows that 40% of physicians and
35% of physicians assistants reported reluctance to seeking mental health supports because of concerns about licensure repercussions. Nurses may also fear professional consequences related to receiving mental health care. Concerns about repercussions are not unreasonable: There are examples of state licensure board executive directors reporting that a mental health diagnosis was sufficient to sanction physicians, as well as reports of overt and covert discrimination for physicians who received mental health care.
Access to mental health care: Job-related structural barriers can inhibit timely access to care. Seventy percent of physicians with moderate to severe depression reported that getting a mental health appointment that fits their long and nontraditional work hours was a major concern. Health care workers also face the same barriers experienced by the general population, such as long wait times and out-of-pocket expenses for mental health care visits. And confidentiality concerns can cause increased financial burden as health care workers sometimes look for mental health care outside of their network.
Sixty-one percent of physicians reported that their insurance covers only mental health clinicians within the same health system where they work and that this privacy concern makes them less likely to seek care.
These challenges have contributed to gaps in mental health services for health care providers. A 2023 survey of physicians found that 48% reported that they know a physician, colleague, or peer who said they would not seek mental health care, despite more than half reporting that they know of a physician who has considered, attempted, or died by suicide. Other research indicates that only 26% of physicians with mental health conditions seek treatment. Alternatively, physicians in states with licensing and credentialing applications that do not include questions about an applicant’s mental health treatment were more likely to seek mental health care.
Challenges in receiving mental health care not only affect the health care providers themselves but may have repercussions for the broader workforce and quality of patient care. “Health workers are experiencing unprecedented rates of burnout and mental health conditions due to factors like long, irregular hours, unsafe and difficult work environments, resource shortages, and high clinical demands they face daily,” said Stefanie Simmons, chief medical officer of the Dr. Lorna Breen Heroes’ Foundation. “Many of the operational policies and practices are there based on the misplaced belief that they protect patient safety, but the reality is starkly different: When health workers fear seeking help, the quality of care declines, mental health conditions and burnout intensify, workforce shortages grow, and lives are lost.”
Policy considerations could improve mental health care access
Federal and state policy can play a critical role in facilitating health care providers’ access to mental health services, primarily through funding for programs and training as well as state licensing reforms. For example, at the federal level, the bipartisan Dr. Lorna Breen Health Care Provider Protection Act was enacted in 2022 to help prevent and address suicide among health care providers. The law authorized grants to hospitals, medical professional associations, and other health care entities to promote mental health among health care providers, which enabled health systems to institute well-being programs, provide suicide prevention training for health care professionals, and establish peer-support groups among health care workers. The Lorna Breen Act is currently up for
reauthorization.
Approximately 40 medical and six nursing licensing boards and 1,850 hospitals, medical centers, and other care facilities have reformed their licensing and credentialing language to remove questions about past mental health conditions or treatment. In addition, state laws can alter licensing requirements. For example, a 2023 Virginia law directs the state’s health regulatory boards to remove existing questions pertaining to an applicant’s mental health conditions and impairment, replacing them with questions focused on the job’s essential functions and patient safety.
Health care workers provide critical services to people in need in jobs that can exact a psychological toll. Ensuring their own mental health and well-being is essential to both suicide prevention and maintaining high quality care for patients.
Stacey Baxter works on Pew’s suicide risk reduction project.