“As long as you are breathing, there is more right with you than there is wrong, no matter how ill or how hopeless you may feel.” - Jon Kabat-Zinn

The following is based on a true story.

Dr. Terhi Viiala, an adolescent psychiatrist in Finland, walks home in tears after a long day at work. She’s mentally and emotionally exhausted and her mother was just diagnosed with breast cancer.

Terhi works at the public hospital in Helsinki and her patients are teenagers who’ve been dealt the worst hand in life. Many of them grew up in the child welfare system with very little family or social support.

By the time she sees them at the hospital they’re on seven or eight different medications and barely getting by.

Like most doctors, Terhi is an extremely empathetic person. After several years at the hospital, she’s on the verge of burn out. Her family and friends are worried, because she’s barely eating and doesn’t seem like herself lately.

A few weeks later, Terhi goes to see her doctor. He diagnoses her with depression and recommends she take some time off.

What do I do? My patients need me. They have nowhere else to go. How will it look to my colleagues? We all have the same caseload and none of them are taking time off.

Terhi decides not to tell her boss — the hospital’s Head Psychiatrist — about her diagnosis. She carries on, to the detriment of her own mental health.

Suicide amongst doctors

Terhi’s case is not unusual.

Studies from Finland, Norway, Australia, Singapore and China have shown an increase in the prevalence of anxiety, depression, and suicidality among medical students and doctors.

Here in the US, physicians have the highest suicide rate of any profession (28 to 40 per 100,000), more than double that of the general population (12.3 per 100,000). What’s more, of all the medical specialties, psychiatry is near the top in terms of suicide rates.

Psychiatrists are killing themselves at a higher rate than people serving in the military.

Let that sink in for a minute.

Stigma within the medical community

Besides access to lethal means, stigma is a major contributor to high suicide rates amongst doctors.

Concerns around licensure seem to fuel this stigma, but the fact of the matter is many doctors are reluctant to seek help for their own mental health these days.

One study found that 50% of female physicians who completed a Facebook questionnaire did not seek treatment despite feeling that they met criteria for a mental disorder.

What’s going on here?

Self-care and support for psychiatrists

I have to admit, when I first came across these studies, I was skeptical.

Can it really be true that half of female doctors are too embarrassed to seek mental health care for themselves?

To get another inside perspective, I called my friend Sonya, a first-year psychiatric resident at NYU’s Bellevue Hospital.

According to Sonya,

In psychiatry, many of the cases we see can be really heavy and emotional. One of the most valuable things in dealing with all of this is self-care. A lot of psychiatrists go to therapy. In residency, we also have process group where we meet once a week to talk about what our emotions are in the moment, what we’re feeling and why we’re feeling like that. We all feed off each other and talk through it. It really helps alleviate that burden.

Sonya sees that sharing being done very often.

I felt a lot better after hearing this.

It seems like self-care and support for psychiatrists are built into medical education now, at least at NYU.

It’s a good sign that times are changing.

“I’ve been having a hard time too.”

Back in Finland, Dr. Terhi started going to therapy twice a week. It’s hard at first, but after a few weeks, she starts to feel better.

She opens up to a colleague she trusts — Dr. Anu — about her depression.

Anu looks at her with soft eyes and says, “Terhi, I’m so glad you told me this. I’ve been having a hard time too.”

Mental health is more than a medical issue

My hope is that more and more psychiatrists and medical students feel empowered to seek care for themselves.

If our psychiatrists are not mentally healthy, how can we expect them to adequately address and treat mental illness in their patients?

We also have a deeper issue at hand when our doctors are taking their lives at a higher rate than people in the military…

One way to look at it is we, as a society, are placing all the burden of mental health care on the shoulders of the medical community.

This is inhumane.

Lack of funding, lack of time, a medical system that’s too biologically focused… these are symptoms of a broken mental healthcare system that’s killing our doctors.

It’s time to start thinking of mental health as more than a medical issue.

Social change approach

When it comes to solving big, complex problems like poverty, unequal access to opportunity and the systematic incarceration of black and brown men, leading social change theorists apply a framework called systems change.

Tell me how suicide and widespread depression and anxiety are not just as big and complex as these other social problems. Yet, we expect our doctors to handle this alone?

So, dear reader, I leave you with this…

Mental health is a social issue.

The research is already there. The social change frameworks have been built. We can’t go on with 300–400 doctors killing themselves every year.

It’s time to apply a systems change approach to mental health.

If anything, let's save some doctors’ lives.