When Samia Hasan, MD joined Indiana University School of Medicine as a psychiatrist in 2016, it quickly became clear there was a growing need for more mental health services for students.
“There really needed to be a review of what services were available statewide to create some equity and to increase and expand services for learners all across the state,” Hasan said.
IU School of Medicine is the largest medical school in the United States, with 1,400 medical students across nine campus throughout the state in the 2021-22 academic year. There were also 370 graduate students and 1,340 resident and fellow physicians. Before Hasan’s arrival, there was only one psychologist on staff to provide mental health services to students, residents and fellows. Hasan worked with school leadership, also receiving support from the Dean’s office, to expand their team and make some big changes to services they provide.
“I began by just looking at what was available and realizing that the first thing we had to do was try to figure out a way to meet demand,” Hasan said. “There was just so much demand for services and not enough resources. We contracted for a crisis line and hired a second therapist. Now, we have a mental health services team that includes six therapists, one of whom is also the program manager, two administrative staff and an opening for another psychiatrist.”
Mental health among medical trainees has been a growing area of concern for schools across the country. Studies have shown high rates of mental distress in medical students and residents, and these rates are high in comparison to the general population. Students may also experience increased distress over the course of their medical training. Depression and burnout can lead to many issues, like misconduct, increased errors, reduced empathy or even suicide.
Hasan said on top of all those issues, many medical learners may also struggle with accessing proper mental health care, either because of the cost or where they are located. They may also be concerned about their privacy.
“We needed to find ways to make mental health care more equitable, accessible and responsive for all of our trainees,” Hasan said. “There is no copay, there are no session limits and we offer some evening hours. Nothing goes on a trainee’s academic record and we use our own separate electronic medical record, so others working in the hospital system can’t look up that trainee's information.”
Hasan and her team kept track of how the new services were utilized with de-identified data and recently published details of their mental health services development in Academic Medicine. Over the course of four academic years, they saw a significant increase in medical trainees seeking services, seeing more than double the number of people during the fourth year. In the 2020-21 academic year, 30 percent of all medical students and 25 percent of house staff and fellows utilized services. In 2021, 38 percent of graduating medical school students and 27 percent of graduating residents and fellows had utilized mental health services at some point in their training.
“Anxiety is the number one concern for trainees,” Hasan said. “Other common diagnoses were mood disorders and ADHD, with some having more than one diagnosis.”
Because of the size of IU, Hasan said the school is in a unique position to develop these resources for a complex, diverse system with nine campuses. She hopes other medical schools will be able to take what they’ve learned and use it to develop their own mental health services.
“Medical schools across the country are building these services for students, but there hasn't been much reporting of it,” Hasan said. “We thought it was important to report, because it would be of interest to other medical schools. We go into a lot of detail about how we set up services and how we're tracking use of services.”
Hasan also credits increased use of their services with the school’s overall increased focus on improving wellness for students, staff and faculty. Their four-year study of how services were utilized also happened as the COVID-19 pandemic spread, causing major challenges and concerns for medical professionals and trainees.
“I think our utilization rates were so high in part because the system came together in many different ways to say taking care of your wellness and taking care of your mental health is really important and is valued at the school,” Hasan said. “Moving forward, we want to learn more about how preventative efforts could decrease distress and the need for treatment, as well as if stigma over utilizing mental health services decreases over time.”
To learn more about mental health services or schedule an appointment, visit the IU School of Medicine mental health services website.