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A bill now in Congress honoring Lorna Breen, MD, an emergency physician who took her life last year, aims to prevent other healthcare workers from completing suicide and to reduce mental health stigma.

Sen. Tim Kaine (D-Va.) reintroduced the and touted it to reporters during a Zoom call with reporters on Thursday morning.

Breen's suicide was "not an aberration," Kaine said, calling suicide among healthcare workers a "fact of life."

Roughly 400 physicians die by suicide each year, though many experts find that estimate too low. Nearly one in four physicians knows a physician who has completed suicide, according to .

But a poll released by the American College of Emergency Physicians (ACEP) and Morning Consult in October 2020 found that are not comfortable seeking mental health treatment.

Lorna Breen, MD, was the medical director of the emergency department at NewYork-Presbyterian Allen Hospital in New York City and was actively caring for COVID-19 patients when she fell ill with the virus herself.

After she recovered and returned to work, the pandemic had worsened, "and her own feelings about not being able to help everybody she wanted to help really overwhelmed her," Kaine said.

Jennifer Breen Feist, Lorna's sister and co-founder of the Dr. Lorna Breen Heroes Foundation, noted that the coronavirus hit New York "hard and fast" last spring, and she believes her sister was scared.

But "she just had it in her blood, to get back in there and to not complain and to not ask for help. And that was her undoing."

After Lorna Breen hit a crisis point, Breen Feist and her husband brought her back to Charlottesville, Virginia, where she grew up.

When she got there, she appeared very anxious about seeking mental health treatment. Lorna, up until three weeks before her death, had no "known or suspected" mental health problems.

But Breen Feist recalled Lorna repeatedly saying, "'I'm gonna lose my license' and 'I'm gonna lose my job.'"

She and her husband tried to reassure Lorna that that was not true. According to Breen Feist, New York state has "some of the best licensing laws in the country " related to healthcare providers' mental health.

But Breen's anxiety about it continued. She ended her life on April 26, 2020.

Secondary Trauma

Emily Boucher, RN, of Johnston Memorial Hospital in Abingdon, Virginia, who worked through some of the most difficult periods of the pandemic in Virginia, recalled seeing patients die "shift after shift" without their families around.

Clinicians carry the weight of these memories with them all the time, but "feel a sense of duty to be strong for our patients," Boucher said.

"We feel guilty and sometimes ashamed to acknowledge our struggle and to ask for the help and support we need, because we see that others are suffering and need our help," she said.

Despite enduring "repetitive trauma" said Corey Feist, JD, MBA, Breen's brother-in-law, said many healthcare workers don't feel comfortable seeking help for a mental health issue.

And when it comes to physicians, Feist blames mental health stigma and "institutionalized reinforcers," such as medical licensure and credentialing rules that can require physicians to answer probing questions about their mental health, such as whether they've ever seen a mental health provider or taken antidepressants.

Physicians can be subjected to these kinds of questions at four different stages, Feist said, "when they apply for a state medical license, when they apply to go work at a hospital ... when they apply to get malpractice insurance... and then, when they apply to be paid by private commercial insurance for seeing patients."

Forms and applications across all four of those areas need to be reviewed and corrected, he said.

Actions to Address Suicide Prevention

Portions of the Dr. Lorna Breen Act are reflected in the latest COVID-19 relief package now being debated in the Senate, Kaine said. They include:

• $80 million to train healthcare provider and public safety officers in strategies to help address suicide, burnout, and mental and behavioral health conditions
• $20 million earmarked for the CDC to develop an educational program that would scale best practices, encourage healthcare providers to seek mental health resources when they need them, and help providers to identify risk factors for mental health problems, burnout, and suicide
• $40 million in grants for healthcare providers to develop or to expand programs aimed at promoting mental and behavioral wellness

However, passing Kaine's bill would formally authorize additional programs and "provide more direction on how the money should be spent," as well as "honor Dr. Breen," whose name was not included in the text of the relief package.

In particular, the Lorna Breen Act would establish a nationwide, comprehensive study to identify best practices for addressing healthcare provider wellness and suicide prevention. Among other things, it would examine whether questions about mental health in physician recertification processes are a disincentive to seeking help.

"We need to really understand the depth of the challenges and craft the solutions to eliminate any kind of licensing or credentialing or professional regulation that would get in the way of people seeking the help they need," Kaine said.

Kaine first introduced the bill last year with senators Bill Cassidy, MD (R-La.), Jack Reed (D-R.I.), and Todd Young (R-Ind.), but never made it through committee.

He would like to see the re-introduced version marked up in the Senate Health, Education, Labor & Pensions Committee and hopes to see it become law later this year.

Medical Groups Respond

Gary Price, MD, president of The Physicians Foundation, applauded the bill's reintroduction.

, he noted that physician suicide and burnout had reached crisis levels even before the pandemic, and COVID-19 heightened those challenges.

A , released by the group in September, revealed that 58% of physicians "often have feelings of burnout," -- an increase of 18 points from 2018 -- but only 13% sought help for a mental health problem related to COVID-19's effects on their practice or their employment, Price wrote.

Mark Rosenberg, DO, MBA, president of ACEP, called the bill "a lifeline for emergency physicians who absorb extraordinary levels of grief, anxiety and other stressors but feel their only option is to struggle in silence," according to a .

He highlighted 40 other medical groups to "remov[e] existing barriers to seeking treatment, including the fear of reprisal," and calling for promoting clinicians to engage with professional and non-clinical mental health programs including peer support.

Rosenberg also underscored ACEP's endorsement of the that a "history of mental illness should not be used as an indication of a health professionals' current or future ability to practice medicine."

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