Suicide among healthcare workers is, sadly, not a new phenomenon.

In late April, Dr. Lorna Breen, an emergency medicine doctor who had been treating COVID-19 patients — and had herself contracted and recovered from the illness — died by suicide.

Her father, Phillip Breen, believes the virus and the devastation it inflicted on New York City, including the hospital where Breen worked, is responsible. He told CNN, “She went down in the trenches and was killed by the enemy on the front line.” 

Frontline healthcare workers, especially those at hospitals that have been hit with surges of patients, have been faced with a confounding disease they don’t fully understand how to treat, and multiple deaths in a single shift. 

Wesley Boyd, staff psychiatrist at the Cambridge Health Alliance and associate professor of psychiatry at Harvard Medical School says, “Historically, in medical training, having a patient die is seen as a failure.”

“Even if it was an inevitability, even if there was nothing they could have done, [death] is seen as a failure.”

For doctors, who tend to be overachievers, Boyd says patient death after patient death — as has been happening in some hospitals with COVID-19 — has an immense mental health toll. 

Exacerbating this toll on healthcare workers is the lack of personal protective equipment (PPE), isolating themselves from their family out of fear of getting them sick, fear that they themselves will contract the virus, and seeing their co-workers falling ill from COVID-19. 

But depression, anxiety, post-traumatic stress disorder (PTSD), and suicide among healthcare workers is, sadly, not a new phenomenon.

Prior to the pandemic, a study found that almost 16 percent of emergency room physicians met the criteria for PTSD.

Medical professionals have higher rates of suicide risk than most other professions. Male physicians have a 1.4 times higher suicide rate, while women have a rate 2.2 times higher than the general population.

Few people are more aware of the mental health crisis among physicians than Dr. Pamelia Wible.

Eight years ago, Wible was at a memorial for a doctor who had died by suicide. It was the third doctor who had died by suicide in 18 months. It was a crisis Wible herself intimately understood.

“In 2004, I kept praying to die in my sleep,” she said. “And I was sure that I was the only doctor in the world who felt that way.”

By 2018, when Wible was sitting in those consecutive memorial services, she knew she wasn’t alone. But there was another thought she couldn’t get out of her head: why.

Not just why so many physicians were dying by suicide, but why weren’t people talking about it? And most importantly: Why wasn’t anyone doing anything about it?

She started writing about suicidality among physicians on her blog and soon had medical students and physicians reaching out to talk to her.

Wible believes there are a number of factors making the mental health crisis among physicians so severe. Wible says it often begins in residency, when residents are used “as cheap labor,” making on average $61,000 a year for working 80+ hours a week.

“About a decade ago, they limited residency hours to 80 a week,” Boyd says, “but in many programs, you’re supposed to know everything about your patients before you begin rounds — where you walk in a group with other residents to check on patients.”

Boyd says that means residents often have to arrive well before their shift starts to do pre-rounds, like checking lab work. “So at a minimum, it’s 80 hours a week on the clock, plus everything you have to do around those 80 hours off the clock.”

Unfortunately, there are many reasons why healthcare workers — especially doctors — don’t seek professional help for mental health issues.

A doctor at a New York hospital who spoke on condition of anonymity said that too often mental health issues are seen as a sign of weakness in a profession where “resiliency” is a prized trait. 

But there are more concrete reasons for not seeking help.

Wible and Boyd say that some state licensing boards and job applications ask if the doctor has “ever had mental health treatment.”

“It’s a complete violation of their rights,” Wible says. “If I sought treatment for postpartum depression years ago, why does the licensing board or my potential employer need to know that?”

Boyd agrees. “What they should ask is ‘are you currently unable to perform your work duties?’ Too many states and potential employers still don’t do that,” he says.

“Unfortunately, there’s a lot of legitimacy to being fearful that if the board hears… it could be held against you.”

Even doctors who have recovered from substance use disorders have a hard time getting “matched” with hospitals as medical school graduates.

Another tragic example is that of Leigh Sundem, a medical school graduate who died by suicide two years after her medical school graduation. She had struggled with addiction in her youth, but was in recovery and had done well in medical school.

Her history of addiction, however, prevented her from being matched with a hospital for her residency. Burdened by debt from medical school and seeing no alternative, Sundem died by suicide on May 5, 2019.

With healthcare workers already in a dire mental health crisis, and with few options for getting help, a deadly pandemic of a new virus is a recipe for an even worse mental health crisis. 

Hospitals do seem aware of the likelihood that healthcare workers struggle with trauma-related disorders during and in the wake of a pandemic.

Many have hired mental health professionals to meet with any staff who want to talk about their feelings. Mental health organizations like the national Trauma Recovery Network and the Frontline Workers Counseling Project in the Bay have been organizing free therapy for medical workers. 

It remains to be seen, however, if the stigma and potential professional consequences can be reduced enough that those who need it will actually seek help.

Changes were long overdue before the pandemic — they’re an absolute necessity now. 

Katie MacBride is a freelance writer and editor. In addition to Healthline, you can find her work in Vice, Rolling Stone, The Daily Beast, and Playboy, among other outlets. She currently spends far too much time on Twitter, where you can follow her at @msmacb.