Changing the Culture and Conversation around Mental Health

While many conversations are being had today about physician mental health and burnout, many physicians still face stigma – not to mention potential professional consequences - when they admit to struggling with a mental illness.

This is what makes Dr. Carrie Bernard’s narrative in the Canadian Medical Association Journal about her struggle with depression after the passing of her mother so brave and unique. Since its publication, Dr. Bernard, an assistant professor in the University of Toronto Department of Family and Community Medicine (DFCM), has received a much more powerful response than anticipated. She talks to us about her impetus to write the narrative and what leaders need to do to support physicians and other health care workers struggling with their mental health.

What led you to write the article?

I was in a writing workshop and the instructor asked us to sketch out some writing we were hoping to one day submit. I sketched out this article and when we talked about it amongst the group, while everyone was very supportive and kind, some feared for my professional reputation should I go forward with the piece. Others felt like I had reached a level in my career where I was respected enough to put something like this out there and not suffer professional consequences. That made me feel almost like I had an obligation to write it – because what about those who are newer to this profession? It made me sad you had to reach a certain level to be open about mental health.

Describe your experience with disclosing your depression with your colleagues.

The disclosure to my executive director was accidental in a way but it was really the best thing that could have happened. Her response was so dramatic, kind and compassionate – it really helped solve some of the things I was struggling with, and I felt respected and heard. It helped me feel better – I didn’t have to do it alone. She asked me if there was anything she could do and we had real discussions about what my schedule was like, if there were things I could step out of, and also things I enjoyed doing that I could lean into more.

I described her response in the article so I can show others in leadership positions what compassionate leadership can look like. When it comes to mental health it still feels like people need to figure it out all on their own. But mental health should be like physical health: if someone broke their arm and said “I can’t carry these books right now,” we wouldn’t judge them. If someone is dealing with a mental illness and says they can’t carry a certain load, we should be equally supportive.

What can leaders do? What does compassionate leadership look like when it comes to mental health?

We talk about wellness at the University and in our workspaces, but we need to make specific space for it. When I started at DFCM, Dr. Risa Freeman, who was the new Vice-Chair of Education Scholarship at the time, wanted to meet with me. In preparation I created a long list of all the projects I was working on. She looked at the list and said my projects looked interesting but also she said to me “this is a lot of work – when do you have time for you and your family”? I wish I had paid more attention to that at the time.

Especially in academic family medicine, physicians have so many different commitments to different places. We take on an 1/8^th of a day commitment here, a committee there and all the sudden we’re doing way too much.  Our Academic Hospital Chiefs don’t necessarily know about what everyone is doing. I think when Chiefs or other leaders have meetings with their faculty, the focus should also be around everything you are doing, how you’re fitting it all in and being upfront about wellness.

Leaders can also normalize conversations about mental health in their environment. My executive director went on to ask me about my mental health in the months after the disclosure because it became a normal part of our conversation. I never felt like I had to hide it. Even though she knew I was dealing with depression, she treated me like a competent person who could manage my own health.

Leaders also have to walk the talk. Everyone should be able to say “no” – I’m taking on too much, including those at the top, and support those who need to step away for a bit when they are struggling.

What has the response to the article been?

The response has been bigger than I ever imagined which makes me think this is a bigger issue than many of us assumed. So many people have come up and talked to me. It’s interesting:  some can talk to me about mental health in a real, conversational way. Others are whispering – some are also struggling with their mental health but don’t feel like they can be open about it so they are not talking to anyone else.

And these are real fears – the consequences of saying you have a mental illness publicly can be real. And not everyone will be working with a supportive leader like I was. So we need to change the culture and the conversation about mental health.

While in many ways this commentary was for leaders – to show an example of what compassionate leadership can look like - I hope that people who are suffering might feel less lonely and alone when they read it.

Since 1999, Dr. Carrie Bernard has practised comprehensive family medicine in Brampton, Ontario, with the Queen Square Family Health Team. She began teaching medical students and residents in 2003 at her clinic office, and at the William Osler Health System where she is an active staff member. Dr. Bernard is an assistant professor in the Department of Family and Community Medicine at U of T and served as Associate Program Director, Curriculum and Remediation, for the postgraduate program at U of T from 2014 to 2019.