Caring for the Caretakers —The Dr. Lorna Breen Act

NOTE: This blog post contains discussion of sensitive topics regarding mental health, depression, burnout and suicide. If you or someone you know needs help, please contact a health care professional or the National Suicide Hotline, available 24/7: 1-800-273-8255.

Background

In March 2020, the world watched, as the COVID-19 pandemic descended on our health care systems. In the United States, we saw how underprepared we were for what was to come. Hospitals were understaffed and overflowing with patients, as the public remained confused and divided on which guidelines to follow and how to stay safe.

Although we clapped and banged pots and pans to honor health care heroes, physicians found little solace, when what they really needed was support and respite from the constant influx of sick people. Research demonstrates that only 55% of surveyed M.D.s felt that “physicians have an obligation to care for patients in epidemics, even if doing so endangers the physician’s health.” Anecdotes from providers on the front lines also suggest that the “hero” label is not always welcome; what providers truly need is concrete support, such as an adequate supply of personal protective equipment.

Who was Dr. Lorna Breen?

Dr. Lorna Breen was one such provider working on the front lines of pandemic care in New York City, in March and April of 2020. As an emergency medicine physician, she was often faced with difficult triage decisions in emergency departments that were bursting at the seams with people begging for help. Meanwhile, Breen herself contracted COVID-19 and then had to return soon thereafter, with few breaks. Her work was grueling and unrelenting — often entailing daily 12-hour shifts and, once, even requiring her to cover two emergency rooms at the same time. In the weeks before her death, she expressed to her loved ones that she’d been unable to sleep or even to get out of her chair. On April 26, 2020, Lorna Breen died by suicide. There was no documentation or knowledge of any prior mental health conditions, and it appeared that her primary risk factor was having been a physician who was overwhelmed by patient care demands and unable to provide effective treatment during that time for the deadly virus.

Although Breen was celebrated as an accomplished M.D., the Lorna Breen Foundation has emphasized the importance of learning about Lorna’s life outside of her work. She loved snowboarding, dancing and driving in her convertible. The hope of the foundation is to shine a light on the suffering and burnout many providers experience, while honoring Breen’s legacy.

The Scope of the Problem

According to the American Foundation of Suicide Prevention, every year, 300 to 400 physicians in the U.S. die by suicide. Female physicians have a 250% to 400% higher rate of suicide than females in other professions. These mental health challenges extend as far back as medical school, with medical students having 15% to 30% higher rates of depression than the general population. It is thought that even these numbers are not representative of the true scope of the problem, considering that physician suicides and mental health concerns are often underreported.

What is the Dr. Lorna Breen Health Care Provider Protection Act?

In the wake of Breen’s death, her family came together to form the Dr. Lorna Breen Heroes Foundation. The goal of the foundation is to address burnout for health care professionals and advocate for their safety and well-being — one avenue for this effort has been the passage of the Dr. Lorna Breen Healthcare Provider Protection Act in the United States.

Some of the stipulations of the bill include:

  • the development of Department of Health and Human Services (HHS) grants for mental health and resiliency programming and training for health care providers;
  • the establishment of an HHS campaign to provide suicide prevention education and to encourage providers to seek mental health care; and
  • the creation of HHS studies and policies focused on improving access to mental health care for health care providers, reducing barriers to accessing care, as well as drawing from other strategies to promote resiliency.

This act became public law on 3/18/2022, almost two years after Breen’s death.

Looking to the Future: What Is Still Needed

Although the Lorna Breen Foundation has made enormous strides in raising awareness and allocating funds for combating provider burnout and suicide, additional efforts are needed to bolster those strategies across the health care system.

The Foundation has developed a "CARE" acronym for health care organizations to use as a basis for how to continue moving forward.

C.: Commit: Health care organizations should clearly demonstrate to their employees that they are committed to their well-being and are valued as individuals.

A.: Assessment: Health care organizations should identify and assess the specific problems and how their workforce feels about the system. The AMA’s “Coping with COVID-19” tool is one such example.

R.: Respond: Health care organizations should evaluate and plan how to respond to the issues and needed improvements identified in the assessment phase.

E.: Education: Health care organizations should inform their workforce about the results of the assessments and share myths vs. facts regarding the workforce’s beliefs.

The fight to reduce health care provider burnout and support the health care workforce will require concerted efforts and public awareness about the complexity of issues that run and threaten well-being within the health care system. Real change occurs only when trainees and employees are supported and feel comfortable seeking help and sharing their struggles — fostering a culture of care that benefits an entire system. As Dr. Lorna Breen’s sister reminds us, “People need to be human. Doctors need to be able to be human.”


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