When healers hurt: How to support a colleague in need

Physician suicide is not an abstract public health concern; it is a loss experienced across our profession, our institutions and our communities. The death of emergency physician Lorna Breen, MD, in 2020 brought renewed national attention to the mental health burden carried by physicians and healthcare professionals and led to the creation of the Dr. Lorna Breen Foundation, which works to reduce burnout, safeguard professional well-being and remove barriers to seeking mental health care.

In addition, the Lorna Breen Act, which supports federal initiatives to improve mental health among healthcare professionals, was made law in 2022 and was recently reauthorized through September 2030 following AOA advocacy.

Despite progress, barriers to seeking help remain

The scope of the problem is difficult to measure precisely because physicians often face professional, cultural, logistical and personal barriers to disclosure and care. Concerns about licensing, credentialing, stigma, time, professional identity and perceived failure may prevent physicians from self-reporting distress or seeking help early.

Frequently cited estimates suggest that roughly 300 to 400 physicians die by suicide each year in the United States, although some researchers have noted that exact incidence estimates vary by methodology and data source. What remains clear is that physicians, particularly female physicians, as noted in several studies, face significant suicide risk, and physicians who experience suicidal ideation may be less likely than others to seek help.

In the osteopathic community, attention to well-being must begin early. Osteopathic medical students report stress, burnout and other indicators of ill-being before they even enter osteopathic medical school. These findings remind us that suicide prevention is not limited to responding in crisis; it also requires a culture that acknowledges distress, normalizes help-seeking and supports physicians and trainees before distress becomes an emergency.

As our profession prepares to observe National Physician Suicide Awareness Day on Sept. 17, we are bringing physician suicide to light to reduce the silence surrounding it. The burdened mind of the healer can become overburdened, and the signs are sometimes not even easily visible to those close to us.

How do you know someone (or you) is/are at risk?

Risk may appear as a change from a person’s usual behavior, especially when the change is new, increasing or connected to a painful event, disappointment, loss or transition. A colleague, student, resident or friend who has become unusually angry, withdrawn, agitated, reckless, isolated or disengaged may be signaling distress. Do not assume they are simply too busy, aloof or difficult. Behavior changes of any kind can be a red flag.

Language may also signal risk. Statements such as “I will never pass this course,” “I will never succeed on this exam,” “I will not get the residency,” “I cannot keep doing this,” or “people would be better off without me” may represent movement from disappointment to hopelessness.

Other warning signs include talking about wanting to die, feeling trapped, feeling like a burden, increasing alcohol or drug use, sleeping too little or too much, showing rage, or demonstrating extreme mood changes.

It is also important to recognize these signs in yourself. Caring for others begins with extending that same compassion to your own needs. If you feel yourself withdrawing, or feel hopeless, or if you have an inability to rest, escalating distress or thoughts of suicide, please seek support right away.

Also be sure to get support during stressful moments—academic setbacks, difficult patient outcomes, lack of sleep or major life changes such as moving before residency or entering practice—as these times can make anyone more vulnerable.

Physicians and trainees devote themselves to caring for others, but they deserve care, support and understanding, too, especially from their colleagues and themselves.

What to do if you think someone is at risk

Ask directly, privately and with compassion. A straightforward question such as, “Are you thinking about suicide?” can open the door to an honest conversation. Then listen. Do not minimize, debate, diagnose or try to solve everything in the moment. Believe what the person tells you and stay focused on connection, safety and support.

One of the most harmful misconceptions about suicide is that asking about it will “put the idea in someone’s head.” Evidence does not support that fear. Asking in a calm, nonjudgmental way can reduce isolation, make it easier for the person to be honest, and create an opportunity to connect them with help. The question matters because support can only begin when the risk is brought into the open.

If they say they are considering suicide, stay with them and get help immediately. The Physician Support Line is a free, confidential support service run by volunteer psychiatrists, is available Monday through Friday, 8 a.m. to 11 p.m. ET, at (888) 409-0141.

Do not leave the person alone if there may be immediate danger. Contact the 988 Suicide & Crisis Lifeline by calling or texting 988, or using the online chat function.

The lifeline is not only for people experiencing suicidal thoughts; it also supports those who are worried about someone else and need guidance. If there is imminent danger, contact emergency services or follow your institution’s emergency response process.

After the immediate moment has passed, follow up. A brief message, call or visit can reinforce that your concern was genuine and ongoing. Let the person know they are not alone and continue to check in without making their care depend solely on you.

Resources are available

The Physician Support Line is available for any issue, not just in times of crisis. The volunteer psychiatrists working the support line provide emotional support and a safe space for both physicians and medical students. Call (888) 409-0141, Monday through Friday, 8 a.m. to 11 p.m. ET to speak to a physician dedicated to helping other physicians.

The 988 Suicide & Crisis Lifeline is free, confidential and available 24/7/365. The Veterans Crisis Line is available by calling 988 and pressing 1; the Spanish-language line is available by pressing 2.

Designed for all stages of training and practice, the AOA Wellness Toolkit shares resources on wellness, mental health and sustaining a fulfilling medical career. AOiA’s new Emerging DO platform also has a Well-Being Resources section that includes ideas on cultivating wellness, well-being CME courses and more.

The American Foundation for Suicide Prevention offers physician- and healthcare professional-focused resources, education and workplace tools. The Dr. Lorna Breen Heroes’ Foundation provides advocacy and resources to reduce stigma and remove barriers to mental health care for health workers. State physician health programs and institutional employee assistance or well-being programs may also provide confidential support.

A path to help and healing

Bringing physician suicide into the light is an act of care. It reminds us that strength is not the absence of distress, and professionalism does not require silence; it demands compassion. When we notice, ask, listen, stay, connect and follow up, we make it more possible for someone to survive the hardest moment and find a path toward help and healing.

Related reading:

DO’s bipolar diagnosis leads him to a career in psychiatry

Physicians and mental health: We’re making progress, but there’s still work to be done

National Physician Suicide Awareness Day: Turning awareness into action