Mental health issues among college students have been an increasing concern of health officials.
However, one subset of college students has risen to the top of many experts’ concerns: medical students.
Studies have found that while physicians and physicians-to-be generally have physically healthy lifestyles, the stress and long hours notwithstanding, they are prone to more mental health issues than the general public.
In September, Cornell University drew attention to the issue by holding a national conference billed as the first comprehensive, multidisciplinary forum to examine the mental health needs of medical students.
A year ago, Elina Maymind, an associate professor in the department of psychiatry at Rowan School of Osteopathic Medicine, founded the Rowan University Medical Student and Graduate Student Mental Health Program. She is now its director.
Originally, she ran the program solo. But in that first year, two more staffers were added — psychologist Paul Furtaw and psychiatrist Ashley Martin.
“We have the unique opportunity to care for medical students and residents from two different medical schools at Rowan, one of which offers a doctor of osteopathic medicine degree, and one of which offers a doctor of medicine degree," Maymind said. "This affords us a unique opportunity to serve and learn from both populations. We are a specialized program that has set out to find a complex solution to a complex problem. Our hope is that this difference will ultimately positively impact anyone who interacts with the medical system.”
She recently spoke to us about the problem, and the program.
What do the data show about mental health problems among medical students?
We are seeing an increase across the country — in suicides and the need for mental health services — among medical students and residents.
We know there are approximately 400 physician suicides a year. A widely cited meta-analysis suggested that the suicide rate among male physicians is 40% higher than among men in general, and the rate among female physicians is 130% higher than women in general. However, the rate is likely much higher. No one wants to report that a death is a suicide, so they are underreported.
When it comes to medical students, medical schools are very hesitant to report deaths as suicides. I have been unable to find any statistics. We do know that many students are seeking care. When I started this Rowan program, there was only one of me because people said that was all we needed. Now, we are a staff of three. And we are on the verge of publishing research detailing what percentage of medical students seek care.
If we only try to think of programs for people who are already in the professions, that’s too little, too late. Catching things early is, we feel, one way to manage this crisis that’s occurring.
Tell us about the crisis.
Every person we’re seeing — the medical students and residents — is entering this very rigorous training. When they start having symptoms, when they start facing depression, anxiety, suicidality, or very serious substance-abuse problems, it’s not just the individual who suffers. If these symptoms aren’t treated, we know it leads to things like suicide.
It also has a ripple effect. The reason I feel so strongly about this is it’s no longer just the patient in my office. These students are going to go to their third year of clinical rotation and will be interacting with patients. They are going to graduate and take care of people in hospitals across the country.
What is not talked about very often is, what does that look like for the patients they’re going to see? Someone has an outpatient practice and then kills himself. Then, you have all these patients whose physician is gone.
Also, we know there may be a higher rate of medical errors among physicians having mental health problems. We see a decline in empathy as training goes on. You can imagine if someone is clinically depressed and highly anxious. They are going to have a harder time engaging with the patient and making eye contact.
We feel very strongly that there’s a much bigger problem with the people we’re seeing. It’s not just the risk to them and their families. It impacts patients at large, hospital systems, and on and on.
No one wants to talk about this because it becomes a blame game. My hope is for patients to have a greater understanding of what their physician may be going through, and that ultimately it may affect their care.
How are the mental health issues of medical students different from those of undergraduates?
Some of the things are the same. The issues are similar. But the undergraduates are not necessarily being asked to do the same highly demanding tasks that medical students and residents are asked to do.
One thing that’s another shock to people is really, truly how hesitant people are to seek help when they are a medical student or a resident. In many ways, the undergrads are more willing to seek help. In some ways, the stakes for medical students are higher. They have just completed four years of undergraduate school. They are hundreds of thousands of dollars in debt. They come in and say, “If I fail the national board exams my life is going to crumble.”
Medical students are so fearful that [seeking help] will somehow be stamped on their record, that they won’t be able to get a job or maintain a license. That’s just not the case. We are completely confidential. For 99% of the people we see, the school has no idea. Most of the time, there is no safety concern — for the person seeking help or others — that would warrant calling other officials.
What are some of the things you’re doing?
We are a specialized service. I’ve tracked every student and resident that’s walked through the door. We’ve used clinical scales that look at depression and anxiety in a completely de-identified way. We’ve been able to look at how those rates compare to other patients walking through our doors. They are quite high. That’s not a new finding.
But what is somewhat groundbreaking is the amount of resources we’ve been given to even start this program. People across medical schools know mental health problems among their students is an issue, but when it comes to funding and supporting programs — just like in undergraduate school — they say, “Well, let’s just get a part-time therapist and that will be enough.”
It’s challenging to refer people for help off-campus. There aren’t enough psychologists and psychiatrists overall anyway. To have this specialized service, where we are dedicated to seeing this specific group of people, is unusual.
You’ve also started prevention programs.
I think this is the way the country is moving — the prevention and outreach aspect.
We started something called Let’s Talk at the Stratford campus. It’s modeled on a program at Cornell. It’s free, confidential drop-in sessions that are meant to be problem-solving. Every other week, Paul or Ashley or I go to the Stratford campus, where students show up for 30-minute time slots. They can talk about anything. What we’ve seen occur is it engages them with us in a way they have never been engaged before, and by the end we’re often talking about them coming into the office for an initial evaluation.
The other thing we’re just starting is called Gatekeeper Training. We’re going to be meeting with student affairs faculty and staff and going over how they can deal with a student who is distressed and sitting in front of them. How do you recognize what’s going on? How do you respond? And where do you refer them? We’re hoping to prevent bad outcomes. We’re not waiting for a crisis point. We’re catching people earlier.
One way to assess a student’s mental health is to ask about their level of functioning. Are they able to maintain their relationships? Pass their classes? Do the tasks they’re asked to do as a student? Are they eating and sleeping? I can’t tell you how many students come in and say, “I haven’t slept well for months” or “I have one meal a day.” That’s a sign.
People say: “It can’t be me having mental health problems. I’m just lazy. I don’t need help.” That’s why this gatekeeper program is important. Someone else might say: “Do you think you should talk to someone about that? There might be something going on.”