Home | Jessica Giddens DNP, BA, APRN, PMHNP-BC, RN-BC |

*disclaimer – thoughts are always my own – my posts are not to take the place of seeking help with a medical professional has an established relationship in your care*

I came across an interesting article last night that I thought I would share some thoughts on: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2778209

I believe this is an exceptionally important read. What struck me most about this article was that it showed the rates of suicide among nurses is so high. As a nurse practitioner for the past 5 years certainly I have heard all the news and headlines of the crisis of physician suicides, but what is interesting about this article posted in JAMA is that physician suicide rates were comparable to the general population, where nurses were higher. There is some research that shows that rates are higher yet for health support workers.

https://jamanetwork.com/journals/jama/fullarticle/2809812

I find this interesting in light of how much more physician reach is, how many lobbyists they have, and how they have the power to influence the media so much more than other health professionals. Overall, I am happy that we are openly discussing the high rates of suicide in healthcare professionals, but saddened that multiple other groups were largely left out of the discussion for years with only attention paid to physician suicide rates. (Which I do not want to downplay).

I lost one of my collaborating physicians (psychiatrist) to suicide while he was collaborating with me and another collaborating physician (psychiatrist) to suicide after he had been collaborating with me. We need to do a better job considering the mental health of healthcare professionals and still within the community itself. A core theme here is stigma. We are still making slow and laborious progress in really getting people to be open about their mental health – mostly because it really has to move beyond getting people to be open about it, we have to accept people when they do disclose and not assume that they are less effective, less human, less capable because they have a mental health condition. People should be able to comfortably dialogue about their health.

For healthcare professionals the stigma is even more real. I like to use the story of my first collaborating physician about how BAD the stigma is. First, I had patients with suicidal ideation all the time in practice. They did not want to go to the hospital. It was frequently a resounding “we get worse in the hospital”, so I did everything I could in my power as a practitioner to keep may patients out of the hospital, extending my availability in almost every way that I could. I got it. I have worked inpatient units. I didn’t want them to go there anymore than they did. I am telling you we have serious changes that need to happen for the inpatient behavioral health care management when it comes to decreasing stigma as well.

Back on the collaborating psychiatrist and suicide. He did not go to an “inpatient unit” either. In fact, a mentor psychiatrist sought to manage his care outside of the hospital. It is not surprising. Psychiatry is a small world. They were afraid of being judged by all the other local psychiatrists. Heartbreaking. But I have seen it in my world. Other healthcare professionals talking about another practitioners in negative light if they had any sort of mental health difficulties or even just the general backbiting of people tearing down other professionals. It is not healthy. So, they sought to manage his suicidality outside of the hospital. Sadly this collaborator had supports, family came in town, a psychiatric mentor was caring for him. You would think that with all the access to resources, family, and his own knowledge of mental health (this guy was brilliant with neuroscience), that tragedy would not take his life. But it still did.

This moves into a whole other conversation. What happens to patients after the loss of a practitioner. The trauma sequela that befell others. Hundreds of psychiatric mental health patients were displaced. I as a Nurse Practitioner in the most restrictive state of Missouri, my hands were tied. Not only were my collaborating physician’s patients unable to be seen, so were mine because in MO I can practice without a collaborating physician. The trauma that ensued for the practice was immense. Patients were scared of withdrawing off drugs, patients with trauma were scared of having to find another provider they would have to open up to after years of care, staff were suddenly out of a job (we were a small and independent practice that could have kept running if I had full practice authority). I know people think about the trauma of suicide from an emotional perspective from grief and loss from family and friends, but in the case of a healthcare professional the reach can be vast for how many lives are being affected.

I wish I could say that healthcare providers should feel comfortable going to an inpatient unit, but they are not. I remember a nurse who was admitted to one of the psych units I worked on when I was an RN. There were always hushed voices, and sadly whenever this person was discussed even with the condition was stabilized and managed, everyone always questioned their capability, safety, and ability to provide care. The same happens on some level to any patient with mental health related conditions. This is part of the essence of how the stigma is formed. At some point we stop believing and stop trusting that someone can be better, that they can be well, and that they will be successful despite that moment in time. At this moment when we put that diagnostic label on that person, they become their label to the outside world and all the scrutiny that comes with it. For healthcare professionals the stigma is even worse.

Coming from a practitioner in mental health – I have always been that provider that wasn’t afraid to step on the mental health unit. To have mental health difficulties in a lot of ways is to be human is how I saw it in my eyes. Anyone just has to look at how common mental health conditions are to see how it affects so many. I have always gotten in and believed that people could be better, and I think for that I had some amazing patient outcomes when I was better because I refused to believe that someone couldn’t progress from where there were in that moment. That is how we need to be. That is also what it means to be an ally or be supportive.

For healthcare professionals we especially need to support each other. All healthcare professionals talk of “eating their young” or “pimping the medical students” or engaging in behavior that is not demonstrating compassion, empathy, support, mentorship, or being an ally. I will probably write more on this topic in the future, because there are so many other factors that tie into healthcare professional related trauma and mental health outcomes. Suicide is the most severe and on that path is post traumatic stress disorder, burnout, fatigue, and host of other related concerns. I think the community at large would be shocked to find out how little healthcare professionals actually take time to care for themselves.

I really truly welcome feedback to my posts. I appreciate dialogue and discussing the science. So please write to me, message me, etc.

For today remember:

-Be the Light You Wish to See in the World –

Also if you are thinking about suicide, or know someone who is thinking about suicide – I used to tell my patients – there is at least one person out there that cares about you (me) and I might not be much, but that is one. Secondly, please contact the suicide prevention lifeline. There are supportive, compassionate people waiting to help you or a person you know with suicidality and mental health crises.