Amy Ondeyka, MD, Inspira Health Network
Loice Swisher, MD, Drexel University College of Medicine
Submitted on Behalf of the Mental Health Task Force of the Resilience Committee
What would you do if a faculty member came to you with concerning behavior changes in a resident who seemed overly stressed or depressed? What if that resident confirmed that your perceptions were correct and wanted recommendations for extra help? Do you know what options are available at your institution? Would you be able to provide transparency (pros, cons, and logistics) of the process so the resident knows what they are getting into?
The new ACGME common program requirements for wellbeing (VI.C.e) encourage residents and faculty members to “alert the program director or other designated personnel or programs when they are concerned that another resident, fellow, or faculty member may be displaying signs of burnout, depression, substance abuse, suicidal ideation, or potential for violence.” In addition, programs are “to provide access to confidential, affordable mental health assessment, counseling, and treatment, including access to urgent and emergent care 24 hours a day, seven days a week. “ One resource that is likely already available at your institution is an Employee Assistance Program (EAP).
- Cost: Most institutions provide an Employee Assistance Program as part of their employment benefits.
- EAP Website- The website can typically be found by a link on the hospital’s intranet service. The website includes the bulk of information and resources. Logging onto the website is not monitored by your employer in any way.
- Phone- When one calls the EAP phone number usually a receptionist will answer the phone and will ask questions to establish eligibility for their services. This is followed by questions regarding the type of EAP services being requested. If there is an urgent or emergent situation (such as suicidality) a trained counselor will be placed on the phone to assess the employee’s needs and assist in arranging for these services.
- Confidentiality: All EAP services offered are confidential under HIPAA. No identifying information as to who calls or the content of the call goes back to the hospital, employer, or residency program leadership. There is one caveat- you cannot call to get resources for a colleague; the individual must reach out himself or herself in order to utilize this resource.
- Length of Service:
- There are a set number of free sessions included in the EAP service, the number of which is determined by each institution.
- If the employee wishes to continue beyond the free session limit, the EAP staff will help to find a counselor who is covered under the employee’s health insurance.
- If an employee is found to be in need of urgent care, the counselor coordinates getting the person to crisis services. These services can be provided in the form of an ED, local crisis center, or mobile crisis unit, depending on the location of the individual. Often times, the counselor will be able to arrange for a different location other than the hospital in which the employee already works.
- If the employee is not in imminent danger from self-harm, counseling sessions may be set up on an urgent or non-urgent basis. Each EAP has its own network of contracted counselors who offer a pre-determined number of free sessions to the employee.
- Type of services: An EAP offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work related problems. These include referrals for mental health, drug and alcohol abuse, and personal issues. An EAP also provides a wide variety of information such as work/life support, workplace violence, pet training, elderly caregiving, financial counseling, smoking cessation, weight loss, and much more.
- Service Providers: Services are typically given through a third-party program that has no direct affiliation to the hospital.
Beyond the EAP Basics:
- Critical Incident Response: There may be unfortunate times when a resident has died by suicide or another unusually stressful event has occurred. Many EAPs are able to provide rapid response and debriefing onsite at the institution. A call to the EAP will start with an assessment of the situation, including the location, type of incident, and onsite contact. Some EAPs can provide onsite counselors within 4-6 hours 24/7/365. In the interval gap, leadership telephone support may also be provided.
- Education: EAPs may also be able to provide training or educational programs, on site or through webinars, on issues such as recognizing emotional distress in colleagues, burnout, and others.
EAP Bottom Line:
Pros: The EAP is a widely available employee benefit that provides free individual counseling services. In addition, the EAP may be able to provide training and rapid response to a critical incident.
Cons: Although individual services are confidential, one is not able to remain anonymous during sessions. There are a limited number of sessions included in this benefit.
It is imperative that we educate our resident physicians, colleagues, and ourselves about all available resources at our institutions. We need to let our residents and colleagues know that it is OK to talk about mental health, and it is OK to get help. Seeking out help does not make anyone weak. The more often we speak transparently about mental health issues and resources, the further we will go in breaking down the stigma and in promoting physician well-being.