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Success Story: HEAR to Identify Care Team Members at Risk of Suicide

Learn how a Healer Education Assessment and Referral (HEAR) program can be applied to all members of the care team to identify those at risk of burnout, depression, and suicide.

What Was the Problem?

Leaders at the University of California San Diego (UCSD) School of Medicine were concerned about the well-being, mental health, and risk of suicide among caregivers at their institution.

Developing the Intervention

The leaders launched The Healer Education Assessment and Referral (HEAR) program in an effort to increase the use of mental health services and decrease the risk of suicide among faculty members, residents, fellows, and medical students. The program includes two components: education and assessment.

For the educational component, a multidisciplinary committee consisting of school faculty, program counselors, and medical students deliver 1-hour presentations about physician suicide. These live presentations generally consist of:

  • An informational lecture

  • A 15-minute screening of the American Foundation for Suicide Prevention's film about physician suicide, Struggling in Silence: Physician Depression and Suicide Community

  • A question-and-answer period

The lecture reviews the scope of the problem, discusses the relationships between burnout, depression and suicide, and highlights factors that affect physicians' care-seeking behavior. Presentations are modified for different educational forums, such as professional workshops, brief meetings, and departmental grand rounds. By providing tailored presentations, the HEAR program has the flexibility to reach a variety of audiences.

The second component of the program is a web-based screening tool that is housed on HEAR's website. The medical students, residents, fellows, and faculty members are encouraged to complete a brief online questionnaire to determine how stress and depression may be affecting their personal and professional lives. The screening tool, developed by the American Foundation for Suicide Prevention, includes items from the Patient Health Questionnaire (PHQ-9) and gathers information about prior suicide attempts, affective states (eg, anxiety, panic, rage, desperation, and loss of control), alcohol and drug use, eating behaviors, and current mental health treatment. Responses to the questionnaire are completely anonymous. If an individual chooses to provide his or her email address, a counselor will contact the individual to provide an interpretation of the assessment, recommendations for further evaluation, and referrals to local resources. The HEAR screening questionnaire is not a crisis intervention tool; it is designed to provide individuals with rapid feedback about their current mental health status and encouragement to seek further evaluation and access external support.

Since the inception of the HEAR program, the team has delivered almost 120 presentations that reached medical students, pharmacy students, residency training directors, chief residents, faculty chairs, leadership, and attendees of multiple local, regional, and national conferences. More than 2600 individuals have completed the anonymous HEAR Program online questionnaire. The most recent published report describes how the HEAR tool found that 8% of medical students were at high-to-significant risk of suicide. The study also reported that the number of medical students completing the online questionnaire steadily increased over time. Additionally, HEAR has since expanded to include at-risk nurses.

About the Organization

The University of California San Diego School of Medicine has 500+ medical students, 900+ residents and fellows, and hundreds of graduate students who have some interaction with School of Medicine labs and programs. In addition, the school has more than 1500+ physician and scientist faculty members. The HEAR service is independent of the service provided by the UC San Diego Physician Well-Being Committee (PWBC).

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Article Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

 UC San Diego Health Sciences HEAR Program.  UC San Diego School of Medicine. Accessed April 1, 2020. https://medschool.ucsd.edu/som/hear/pages/default.aspx
Downs  N, Feng  W, Kirby  B,  et al.  Listening to depression and suicide risk in medical students: the Healer Education Assessment and Referral (HEAR) Program.  Acad Psychiatry. 2014;38(5):547–53. https://pubmed.ncbi.nlm.nih.gov/24705825/Google ScholarCrossref
Moutier  C, Norcross  W, Jong  P,  et al.  The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine.  Acad Med. 2012;87(3):320–6. https://pubmed.ncbi.nlm.nih.gov/22373625/Google ScholarCrossref
Norcross  WA, Moutier  C, Tiamson-Kassab  M,  et al.  Update on the UC San Diego Healer Education Assessment and Referral (HEAR) program.  Journal of Medical Regulation. 2018;104(2):17–26. Published July10 , 2018. Accessed April 1, 2020. https://afsp.org/wp-content/uploads/2018/11/HEAR.Update.JMR-Aug-2018.pdfGoogle ScholarCrossref
 Suicide prevention: a Healer Education and Referral program for nurses.  J Nurs Adm. 2018;48(2):85–92. https://pubmed.ncbi.nlm.nih.gov/29300216/Google ScholarCrossref

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