A View from the Cockpit: It Should Not Be This Hard

February 2023

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It Should Not Be This Difficult.

"Words cannot convey the sense of loss we feel today. Dr. Breen is a hero who brought the highest ideals of medicine to the challenging front lines of the emergency department. Our focus today is to provide support to her family, friends, and colleagues as they cope with this news during what is already an extraordinarily difficult time."

~ Statement by Columbia University Irving Medical Center and New York-Presbyterian, April 28, 2020 after Dr. Lorna Breen’s suicide on April 26, 2020

 

It Should Not Be This Difficult.

The onslaught of patients and their suffering was relentless. Let us not forget that in the early months of the pandemic our healthcare systems struggled at all levels. Physicians, nurses, and other healthcare workers were routinely exposed to tragedy and overwhelming demands. These past pandemic years unmasked and further accentuated what we have known for years: the dark secret in our profession of physicians not “healing themselves”, not admitting fatigue, not asking for help. Four hundred physicians die by suicide each year. Countless others experience high levels of stress and forgo, due to fear of professional repercussion or lack of available confidential services, mental health treatment.

 

It Should Not Be This Difficult.

Nearly one-fifth of South Carolinians reported living with a diagnosed mental, behavioral, or emotional disorder in 2018.[1] The pandemic further eroded population mental health. Pre-existing behavioral health needs here in South Carolina increased in recent years with a noticeable rise in the incidence of patients with eating disorders, [2] anxiety and depression, suicidal ideation and behaviors, [3] opioid overdoses and substance abuse. [4] Our country’s life expectancy has decreased for the last three years in large part due to “deaths of despair”. [5] Access to behavioral health care ranks poorly here in South Carolina (40th out 50 states). [6] Seventeen of the 46 counties in the Palmetto State do not have any psychiatrists available to provide care to residents. [7] Psychologists, Licensed Social Workers, Licensed Professional Counselors, Licensed Marriage and Family Therapists, and Clinical Social Workers all play an essential role in the behavioral health care system in South Carolina but again, our state does not have adequate numbers of these professionals.

 

It Should Not Be This Difficult.

The mission and vision of the SCMA remains to serve and support the physicians of South Carolina and improve the health of all South Carolinians. The SCMA staff, physician members, and our SCMA Alliance continue to work steadily to address the behavioral health needs of all physicians and citizens in our state along with multiple partners including:

• South Carolina Institute of Medicine and Public Health
• South Carolina Hospital Association
• Blue Cross Blue Shield of South Carolina
• South Carolina Mental Health Commission
• Alliance for a Healthier South Carolina
• Physicians Foundation
• AMA

There have been some wins in the past year and there are plans for more.

• Discussions that began in January 2022 with the South Carolina Board of Medical Examiners resulted in updated medical licensure language that will allow physicians to receive mental health treatment confidentially without the need to report on conditions that are properly managed and treated.
• The Dr. Lorna Breen Health Care Provider Protection Act of 2022 was passed and provides funding for mental health education and awareness campaigns targeting the well-being of health care workers.
• Awareness of behavioral health gaps in care and needed improvement for our profession and patients are being addressed at multiple levels by the SCMA, specialty societies, SCMA Alliance, legislative, and regulatory bodies.
• The South Carolina Chapter of the American Academy of Pediatrics included lectures and panels on childhood mental health and suicide awareness and prevention in its recent Community Access to Child Health (CATCH) Program.
• The 5^th Annual South Carolina Health Equity Summit (Alliance for a Healthier South Carolina) in early April will look at the intersectionality of mental health issues and other inequities.
• The SCMA will hopefully hear soon from the legislature about its request for monies to address physician burnout.
• Our upcoming 2023 Annual Meeting website includes educational sessions about:
  • "Eating Disorders" (diagnosis/management)
  • "Reconsidering Race in Clinical Algorithms and Calculators"
  • The Opioid Crisis
  • Updates on addressing physician burnout and physician wellness
  • ... and much more.

 

“It should not be this difficult” to address these behavioral health challenges in our profession and our state.  I remain grateful to all of you who support the SCMA with your membership, contributions, and talents in its mission and vision to address these issues. We are better together and all of you make a difference. As always, I welcome hearing your voice at scmayeakel@gmail.com and seeing all of you in Myrtle Beach very shortly!

 

References:

[1], [4], [5]  https://imph.org/wp-content/uploads/2021/05/IMPH_SCBHC_Behavioral-Health-Progress-Report_Executive-Summary_May-2021.pdf

[2] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00435-1/fulltext

[3] https://covid19.nih.gov/covid-19-topics/mental-health

[6] https://imph.org/wp-content/uploads/2020/11/imph-access-behavioral-providers-1.pdf

[7] South Carolina Area Health Education Consortium’s (AHEC’s) Office for Healthcare Workforce 2019 Health Professions Data Book