A new tool helps physicians to identify warning signs of mental health crises and to make preparations before a crisis strikes.
Physician burnout is widespread in the United States. In a survey The Physicians Foundation conducted in spring 2020, 58% of physicians reported feelings associated with burnout compared to 40% of physicians in a survey the organization conducted in 2018.
"We know from that survey last spring that only 13% of physicians sought medical attention for mental health problems, but 30% of them cited feelings of hopelessness or having no purpose and 50% reported having inappropriate emotions. In addition, 8% of physicians reported having thoughts of self-harm as a result of COVID-19's impact on their practices," says Gary Price, MD, president of The Physicians Foundation.
The Physicians Foundation's Personal Crisis Management Plan tool for physicians features five questions that physicians should answer before a mental health crisis arises:
1. What are my warning signs that a crisis is developing?
2. What are my healthy internal coping strategies—name a few things I can do to take my mind off my problems without contacting another person?
3. Who are a few people or what are the social settings that can provide me with a distraction?
4. Which people can I ask for help?
5. Who are the professionals or agencies I can contact during a crisis?
Personal Crisis Management Plan fundamentals
There are two primary reasons for physicians to use the Personal Crisis Management Plan tool, Price says.
"The first reason that it is important is that we had an epidemic of burnout among physicians even before COVID-19 struck. While we are still waiting for definitive data on the impact of COVID-19, it would be difficult to imagine that the burnout situation is any better. Another reason to have the Personal Crisis Management Plan in place is that when you come to the point of feeling overwhelmed and being in a crisis, that is not the time to figure out how to get help, especially when one of the symptoms is feeling powerless," he says.
The easiest way to remember the warning signs of a mental health crisis is to think of the HEART acronym, Price says.
"The 'H' in HEART is health, which includes a tendency to increase the use of medication or alcohol. The 'E' in HEART is emotions such as drastic mood swings and feelings of hopelessness. The 'A' in HEART is attitude such as negative feelings about professional life or personal life. The 'R' in HEART is relationships—withdrawal from relationships that are normally important in one's life. Temperament is the 'T' in HEART, which includes feelings of anxiety and agitation," he says.
There is value in having people who can serve as a distraction when a physician is at risk of a mental health crisis, Price says
"A lot of the warning signs involve feelings of powerlessness or being overwhelmed so that the physician is not engaging with others. The very act of engaging with other people—particularly other people who care about you—can offer short-term relief to help the physician feel more grounded and more in control. That kind of distraction is a quick and easy step to change direction and start to deal with things better instead of feeling out of control," he says.
It is important for physicians to have people from whom they can ask for help, Price says.
"When we surveyed physicians more than a year ago, we found that the first place physicians turn to is their families and the second place is to their professional colleagues. So, if a physician is in a crisis and feels alone and struggling, sharing that with people they trust and turn to for help in other situations can begin to break down the feeling of isolation. They are also recruiting allies in dealing with the things that have gotten out of hand," he says.
Physicians should note professionals or agencies that they can contact when they are at risk of a mental health crisis, Price says
"Just like other health problems, a mental health crisis deserves someone who is an expert at treating a crisis and managing it. So, like someone who has allergies, the time to make sure that you have access to medications or phone numbers for emergency contacts is when you are feeling fine, not when you are having an allergic crisis. Mental health is exactly like that. You want to have all of the treatment options and the protocol that you are going to follow if a crisis happens ready in advance," he says.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Warning signs of mental health crises include emotional turmoil such as dramatic mood swings and withdrawal from relationships.
Physicians at risk of a mental health crisis should reach out to loved ones and professional colleagues to avoid isolation.
Before a mental health crisis arises, physicians should have a list of professionals or agencies that can help.