Piloting Opt-Out Mental Health Check-Ins to Support Each Other
Author: Eileen Barrett, MD, MPH
Medical training is a stressful time, and physicians experience barriers to receiving mental health care including fear it will affect their ability to be licensed or credentialed, scheduling constraints, stigma, and more. Even since before the pandemic, we’ve known that resident mental health declines over the course of their training. I learned about a residency program that provided opt-out mental health appointments for all new interns and that nearly all kept the appointments, and worked with colleagues to pilot a similar offering.
A core group of GME faculty collaborated with the university’s contracted Employee Assistance Program (EAP) that for years provided confidential, free, off-site mental health care to fellows and residents with a proposal to have brief, opt-out virtual meetings with therapists from the EAP. The EAP was fully supportive, and agreed it would be best if faculty didn't know who kept the appointments so the trainees could be confident about confidentiality. Appointments were made during orientation week, when incoming interns had more schedule flexibility, and were selected in blocks that were recommended by the residency programs so that key learning opportunities or crucial meetings were not missed.
Knowing residents may fear that if they get therapy that they may have to report a mental health care visit on their license or credentialing application, these sessions were titled and set them up to be ‘check-ins’ including to discuss stress management and precepts of self-care. This allowed residents to factually answer on such applications (if asked) that this visit was not a mental health appointment. Residency program faculty were informed about this service (and many explicitly supported it with residents) and intern orientation included a description of this offering, reinforcing it was confidential and free, would not need to be reported, and that they could opt-out. Interns were asked to watch for individual calendar invitations with Zoom links sent from the EAP.
How did it go? Over 100 appointments were made, more than 75 were kept, and a handful decided to continue to receive mental health care with the EAP. I don’t have the exact numbers because I wanted to respect the interns’ privacy so I only asked the EAP director for broad numbers to get a sense for the check-in utilization. But even without surveying residents for their experiences or collecting other data, it seems there was some meaningful outcome from this pilot because chief residents and faculty asked if they could implement something similar for their entire programs – including in internal medicine, pediatrics, surgery, and neurology. Many individual interns reached out informally to say how much they appreciated this.
Resident well being is complex and complicated, as is overcoming barriers to receiving mental health care. This is one small pilot done based on an existing service elsewhere that helped address several known barriers to residents receiving support for their mental health without fear of future reporting. Although I am now working in the community and now rarely work with learners, I continue to feel strongly we must do more to support them. When I refer to having been a part of this pilot, I see how interested medical educators and residents are in it. I hope others can try something similar, and look forward to hearing how it goes.
About the author: Eileen Barrett, MD, MPH, SFHM, MACP, is an internist in Albuquerque. (Twitter: @EileenBarrettNM)
