RP 101 Mental Health – March 2019

Session Readings


Mental health conditions are some of the most stigmatized in our society. The casually used or cliche phrase “It’s all in your head…” reveals a common perception that these illnesses are not ‘real’.  If there’s nothing to palpate, nothing tender, nothing to detect on a lab or x-ray, it seems sometimes that condition loses legitimacy. There is also a pervasive bias that emotional and psychological problems are under one’s control or are a defect of character in a way  that getting cancer or multiple sclerosis are not.  In one way, we revere the mind for its power and place in finding meaning and resilience, yet we, as providers, somehow dismiss these conditions of the mind or the soul as weaknesses.  Because of how mental health conditions have been portray through the media sometimes persons with mental illness may also be feared or avoided because of the associations (some true, some not) between mental illness and violence.

As a result of this, people who suffer from mental illness may deny their symptoms, hide any signs of illness, and avoid seeking treatment.  This is life-threatening — and not only because of an increased risk of suicide associated with many mental health conditions. Mental illness is associated with increased risk of stroke, coronary artery disease, and dementia; co-existing mental illness can also increase mortality in people with cancer, diabetes, or chronic kidney disease and in those following myocardial infarction or coronary artery bypass surgery.

No person is completely immune to mental illness.  This includes us: providers. It should come as no surprise that there are clearly documented increases in the rates of suicide in health care professionals, including dentists, veterinarians, physicians(1).  Yet what some may not recognize is that the same characteristics which allow us, as providers, to be successful in our careers — compassion, drive, commitment – may also be interwoven with or make us vulnerable to anxiety or excess worry and depression. The burden of being a clinician struggling with mental health may feel insurmountable —  it may lead to feared or actualized threats to one’s job and professional identity. It is of no wonder, then, why healthcare providers have DOUBLE the rate of suicide than the general public. This doesn’t happen only to the most experienced providers — for many it starts as early as graduate school. Interestingly, while not quite doubled, the rate of suicidality for our partners and spouses is also higher than the general population.

Add to these layers the fact that we are military personnel. War, deployments, frequent moves and many other factors all take a toll on the average military member and pose significant threats to mental health. The military has actively worked to destigmatize mental health treatment at all levels of leadership, and yet many individual members may still perceive this stigma and continue to avoid seeking help.

In a first for this course, we are tackling the bias around mental health disorders, looking at different cultural perspectives around the topic, asking you to consider all the ways in which this might manifest for you and in your future practice, and reflect on ways to manage that.


Dr. Kay Jamison is Professor of Mood Disorders and Psychiatry at Johns Hopkins University, and an Honorary Professor of English at St. Andrews University in England. She is the author of the book, An Unquiet Mind, a personal account of her struggle with the diagnosis and treatment of bipolar disorder.


A 20 minute podcast exploring some aspects of cultural context around mental illness will be sent out on Sakai.



By the end of RP 101: Mental Health, you (the learner) will be able to:

  1. Thoughtfully examine your own reaction to and biases about mental illness and people who suffer with mental health conditions.
  2. Identify and explore the sources of your reactions.
  3. Identify the positive and negative implications of your reactions for patient care in the future.
  4. Consider what you’ve learned about yourself and about mental illness, and develop a plan to mitigate the negative and enhance the positive implications of the reactions you identified.
  5. Bring a question for discussion and explore, in a small group setting, the kinds of attitudes and behaviors that put health professionals at risk for mental health struggles, and consider how we might mitigate that experience.


Reaction: As stimulated by the speaker and supplemental resources, identify at least one reaction to the panelist’s narrative and at least one other to either the panelist, podcast or the supplemental resources.

Sources/Your Story: Explore the sources of these thoughts, feelings, and reactions, through your own narrative. As always, include specifics and be written in the first person. Your sources might include one or more of the following:

  • Your experience to date with mental health conditions – maybe as experienced by yourself personally, in your family, or by your friends.
  • Your perceptions of how mental health conditions are viewed in the military and medical communities
  • Your perceptions of how various your cultural contexts may influence the recognition, acceptance and treatment of mental health conditions.

Implications: Keeping in mind what your reactions and the sources of those reactions reveal about your perspective on mental illness, analyze both the positive and negative implications of this perspective for how you might care for patients in the future.

Plan: Develop a realistic and specific plan (NOT A GOAL) to mitigate the negative and enhance the positive implications described in your Implications section. Consider a lesson you learned either from the panelist or the resources, and think about how you might specifically take action around it. This could also include what you could do to keep yourself well during times of stress and fatigue.

Make sure to also include:  What question would you want to bring to the group discussion to further explore?

New York TimesThe "Madman" is back in the building A look at mental illness in the office place.
Topics: / / / Keywords: / /
NPRWhen Doctors Struggle with Suicide, their profession often fails them (3 min) Doctors commit suicide at twice the rate of the general population. Significant stigma surrounds the issue of mental health care for mental health professionals, but something has to change; the cost of their deaths is far far too high.
Topics: / / / Keywords: /
Active duty more likely to seek out MH care than veterans A stigma shift? The messaging and the access may be changing the habits of current and future generations of military personnel, but there is still a gap in how veterans seek out MH care.
Topics: / Keywords: / / / /
TEDxWe train soldiers for war; let's train them to come home too. (10min) TedTalk -- Before soldiers are sent into combat, they're trained on how to function in an immensely dangerous environment. But they also need training on how to return from the battlefield to civilian life, says psychologist Hector Garcia. Applying the same principles used to prepare soldiers for war, Garcia is helping veterans suffering from PTSD get their lives back.
Topics: / / / / Keywords: / / /
on beingOne family's struggle with schizophrenia Krista Tippett talks with a family struggling with schizophrenia. This is a listen or a read (transcript)
Topics: / / Keywords: / /
Stress, burnout and coping mechanisms in Nurse Anesthetists An increasing number of nurse anesthesia programs are identifying stress, burnout and poor coping mechanisms in their students, but the system has not been set up to address it well. This is a look at the scope of the problem.
Topics: Keywords: / / /
pulse_blog_banner_200x216pixelsA Soldier's Tale (by Scott Janssen) Scott Janssen is a hospice social worker and member of the National Hospice and Palliative Care Organization's trauma-informed care work group. His book Standing at Lemhi Pass: Archetypal Stories for the End of Life and Other Challenging Times explores the use of storytelling with hospice patients and families. "I think a lot about the guy in this story, wondering what happened to him and his wife, and hoping that the dice are always loaded in their favor."
Topics: / /