Removing the Stigma from Mental Illness

Physicians should recognize problems of anxiety and depression and prioritize self-care

By M. Laurin Council, MD, MBA, FAAD, FACMS

From St. Louis Metropolitan Medicine, Fourth Quarter 2023

The SLMMS continuing medical education workshop in 2023 offered members the opportunity to hear from a variety of speakers around the subject, “Coping with Change Post- Pandemic: Building and Sustaining a Healthy Foundation in Medical Practice.” One of the speakers was Jessi Gold, MD, MS, formerly assistant professor and director of wellness, engagement and outreach in the Department of Psychiatry at Washington University School of Medicine, and now with the University of Tennessee. Although her presentation focused on finding meaning and self-compassion in a challenging workplace, one of the most moving moments of the discussion was when Dr. Gold disclosed that for years, she personally felt shame in the fact that she took an anti-depressant and saw a therapist. Why are we, physicians, still struggling with stigma around mental health?

For me personally, the topic of mental health sometimes comes up when I’m asked about my family. On a random Thursday, 16 years ago last month, my life was changed forever when my oldest brother, David, committed suicide at my parents’ home. I felt so helpless and distraught when it occurred, knowing that there was nothing that I could do to change the situation. I vowed to do what I could to prevent this from happening to anyone else. I vowed to take mental illness seriously.

I honestly believe that mental illness is something that I will never fully understand. I’m a dermatologist; my world is visual. Yet mental illness is something that you can’t always see. And if you can’t see mental illness, you don’t necessarily know that it exists, and it’s incredibly challenging to monitor something that you can’t easily, objectively measure.

But a quick look at the data around mental illness will show some alarming trends. According to the National Alliance on Mental Illness (NAMI), 1 in 5 U.S. adults experiences mental illness, 1 in 20 U.S. adults experience serious mental illness, and 17% of youth 6-17 years of age experience a mental health disorder.¹

Additionally, the presence of mental illness can have a ripple effect on other aspects of an individual or society’s well-being. For example, people with depression are 40% more likely to develop cardiovascular and metabolic disease than the general population. A third of individuals with mental health conditions additionally suffer from substance abuse. The rate of unemployment of individuals with mental illness is higher than those who do not have mental illness. In the U.S., serious mental illness is estimated to cause $193.2 billion in lost earnings annually. Across the global economy, depression and anxiety cause $1 trillion in lost productivity.¹

What Can Physicians Do?

So what can we as physicians do to combat these statistics? First, as Dr. Gold so eloquently described, we have to be comfortable talking about the problem. Physicians are in a unique position to influence the public perception of mental illness, and as such, we have to remove the stigma. We have to normalize discussions around anxiety and depression so that our patients, families and colleagues are comfortable sharing their feelings with us. We must create an environment supportive of open communication, for without open communication, we may not fully understand the depth and breadth of mental illness in our community.

In the process of creating this open environment, it’s important that we also prioritize our own well-being. A 2018 study published in the Journal of Internal Medicine highlighted some of the consequences to patient care from lapses in physician well-being.² Physician burnout is associated with a doubled risk of medical error and a 17% increased odds of being named in a medical malpractice suit. Additionally, such errors are associated with worsening burnout and depressive symptoms, suggesting a bidirectional relationship. Another consequence of decreased well-being is decreased productivity and even leaving medicine altogether. A physician can’t take care of others if he or she doesn’t take care of themselves first.

We as physicians have a duty to promote well-being of others. We must normalize conversations around mental illness and the treatments and resources that are available. As part of our community outreach events, we have to include mental health education to the same extent that we promote awareness of other conditions such as cardiovascular disease and cancer. We must advocate for our patients at the local, state and federal levels for improved access to mental health care and resources.

Like Dr. Gold mentioned, it’s incredibly difficult to speak openly about mental illness, but also so incredibly important. Being open and honest about our own experiences with anxiety and depression invites others to be open and honest about theirs. This dialogue will allow us to identify and help others who are suffering, to share resources that can change the trajectory of the illness, and to fully understand the extent of the problem with which we are dealing. We have to change the statistics and reverse the growth in mental illness. This can have an incredible impact not only on individuals, but on society as a whole. We must prioritize our own well-being, for this is beneficial for our patients as well, and will demonstrate to others that self-care is important, normal and valuable. And finally, we must promote policy at all levels that will help our patients to receive the care that they need.

Mental health does not have to be an enigma. It is our duty, as physicians, to acknowledge its existence, to work towards a reduction of its impact on our patients, families, friends and selves, and to advocate for resources to combat its growing threat to public health.

M. Laurin Council, MD, MBA, FAAD, FACMS, served as 2023 president of St. Louis Metropolitan Medical Society. She is a professor of dermatology at Washington University School of Medicine, along with director of dermatologic surgery and director of the micrographic surgery and dermatologic oncology fellowship.

References

1. Mental Health by the Numbers. National Alliance on Mental Illness. https://www.nami.org/mhstats. Accessed on Oct. 4, 2023.
2. West C, Dyrbye L, Shanafelt T. Physician Burnout: Contributors, Consequences and Solutions. Journal of Internal Medicine. 2018 June;283(6):516-529.