ED physician’s death by suicide sparks dialogue on culture, policy changes

Stigma and potential career consequences may prevent ED physicians from seeking mental health care, according to poll data discussed during an American College of Emergency Physicians’ teleconference.

The discussion took place Oct. 26, 6 months to the day after Lorna Breen, MD, FACEP, died by suicide in April. Her sister, Jennifer Breen Feist, , said during the conference that even after Breen contracted COVID-19, she continued to work remotely in her role as ED director at New York-Presbyterian Allen Hospital.

“With patients overflowing in the hallways, not enough PPE at the time and minimal supplies [compared with] the number of sick and dying patients, my sister rose to meet these challenges of COVID-19 and we believe that this ultimately cost her her life,” Breen Feist said.

She said Breen died about 5 weeks after initially contracting COVID-19. Breen Feist and her husband Corey Feist, co-founded the Dr. Lorna Breen Heroes’ Foundation with the goal to “reduce burnout of health care professionals and safeguard their well-being and job satisfaction.”

Depression and burnout are common among ED physicians, according to Mark Rosenberg, DO, MBA, FACEP, president-elect of ACEP.

“Our job’s hard. Even before the pandemic, frequently we see patients and we don’t even know their name,” Rosenberg said during the teleconference.

He cited research indicating about 6,000 ED physicians in the U.S. contemplated suicide and almost 400 had a suicide attempt in 2018.

“Working in the front lines over the past 6 months dealing with COVID really increased the crisis,” he said. “This was not business as usual.”

ACEP polled 862 member physicians across the U.S. between Oct. 7 and Oct. 13. Rosenberg said the results “underscore what we’ve known on the ground and what we’ve heard from our members.”

Since the pandemic began, 87% of respondents said they feel more stress and 72% said they experience increased professional burnout, but 45% said they would not feel comfortable seeking mental health care. Poll data suggested stigma is a more significant barrier than access to ED physicians seeking mental health care. Although 71% of respondents indicated their access to mental health care was “excellent” or “good,” 73% reported stigma associated with seeking mental health care in their workplace and 57% reported concerns for their jobs if they wanted mental health treatment. Age and demographic factors contributed to physicians’ concerns. Physicians aged 45 years or older (60%), physicians in rural communities (60%) and those in the South (59%) most frequently reported job-related concerns.

Professional concerns have a tangible impact on physicians’ decisions to seek or avoid care, with 27% of respondents reporting having avoided seeking mental health care at least once in the past due to fear of professional repercussions. Women (33%), ED physicians aged 45 years or younger (31%) and those in rural communities (30%) most frequently reported avoiding care due to fear of consequences.

The potential repercussions are multi-systemic and vary across the country. Feist said an analysis of state laws published in The Journal of the American Academy of Psychiatry and the Law found that some state licensing boards asked questions that were not consistent with the Americans with Disabilities Act. He also said hospitals, health systems and insurance companies sometimes ask highly specific questions about mental health or related treatment for privileges or credentials. He said Breen feared her license would be acted on in New York, and when he later learned that it would not have, he noted that this led him to believe that there’s a “large education opportunity here.”

Opportunities to effect change range from interpersonal to large-scale policy changes.

“Peer support networks are critical to addressing the solution, and so even if you don’t think you have the skills, you do by virtue of the MD behind your name,” Feist said. “Sit there and listen and just take care of each other.”

ACEP is advocating for large-scale policy changes. The organization said in a press release that it worked with Sen. Tim Kaine (D-VA) and Sen. Jack Reed (D-RI) on the Dr. Lorna Breen Health Care Provider Protection Act that aims to launch a national campaign encouraging physicians to seek mental health care, establish grant funding for mental health care among those who care for patients with COVID-19 and enact a federal study evaluating mental health and burnout among health care professionals.

Another step that anyone can take is contacting their representatives and request that they support the bill. Feist said there is a link to do so easily on the “Take Action” page of the Dr. Lorna Breen Heroes’ Foundation website.

“There is no reason that doctors on the front line have to worry about losing their professional opportunities for simple things, like if they have marriage problems and they need to see a marriage counselor, or postpartum depression, or just the anxieties and frustrations common to life in general,” Rosenberg said. “We need to have the opportunity to share that and maybe get professional help without being afraid of what’s going to happen.”

ACEP also helped inform and develop the Coronavirus Health Care Worker Wellness Act and supports the Helping Emergency Responders Overcome (HERO) Act of 2019, according to the release. If enacted, the legislation would create grant funding to provide mental health resources to frontline health care workers during the pandemic, as well as create a CDC database tracking suicides among public safety officers; evaluate interventions; establish grant funding for peer support behavioral health and wellness programs at fire departments, EMS agencies and for health care providers; and develop best practices to address PTSD.

“It’s the beginning,” Breen Feist said about the advocacy efforts. “It’s not the end, but the fact that we’re having a conversation, I think, is very important, and there are a lot of conversations that I think started because of my sister.”

References:

• About the foundation. Dr. Lorna Breen Heroes’ Foundation. Accessed Oct. 27. Available at: https://drlornabreen.org/about-the-foundation/.
• Dr. Lorna Breen Health Care Provider Protection Act introduced in Senate. (2020). American College of Emergency Physicians. Accessed Oct. 27, 2020. Available at: https://www.acep.org/corona/COVID-19-alert/covid-19-articles/dr.-lorna-breen-health-care-provider-protection-act-introduced-in-senate/.
• Mental health among emergency physicians. (2020). American College of Emergency Physicians. Accessed Oct. 27, 2020. Available at: https://www.emergencyphysicians.org/globalassets/emphysicians/all-pdfs/acep20_mental-health-poll-analysis.pdf.