By Paul Sisson

Nurses commit suicide at a significantly higher rate than the general population, according to a recently released study from a team of researchers at the University of California, San Diego.

Examining nationwide data on violent deaths from 2014, the only year for which occupation information is included, the team found that suicide rates were nearly 58 percent higher for female nurses and 41 percent higher for male nurses.

It’s no surprise to Dr. Judy Davidson, a UCSD nursing and psychiatry researcher who co-authored the paper. After all, she notes, society has long demanded a certain stoicism from nurses that it has not expected from other professions that find themselves in similar situations.

“The truth is that people do get scarred by these events. They talk about something that happened 10 years ago just as if it happened today,” Davidson said. “We haven’t been caring for ourselves properly. For example, policemen and firemen get time off if they witness a death, but nurses have been expected to just keep going on to the next patient with maybe a 10-minute break in-between.”

But that’s starting to change, especially at UC San Diego hospitals, which have been at the forefront of a growing push to make mental health care a routine part of working in professions rife with stress, pressure and plenty of opportunities to observe and react to many of the most difficult moments that people experience.

Back in 2009, the university’s School of Medicine created the Healer Education Assessment and Referral program -- HEAR for short -- that has worked to take a more proactive approach to self-care among health care workers.

The program urges employees to reach out for help in that moment when they’re starting to feel overwhelmed.

For Marti Neuenswander, that moment came about 18 months ago. She was caring for a dying patient she had come to know well over a long stay in the Bone Marrow Transplant Unit at UC San Diego Jacobs Medical Center, where she now works as an assistant nurse manager.

At the same time, she said, there was extra stress in her personal life. The combination gradually snowballed into a stress level that started to feel overwhelming.

“I was feeling at that time like I would come to work and I would give my all and do my best to really connect with my patients, and then I would go home, and I would try to manage challenging situations there,” Neuenswander said. “I was feeling like I wasn’t getting a break, and I was starting to feel very distressed.”

That feeling, she said, jogged her memory about the HEAR program, which seemed to be getting good reviews from others. One confidential email later and she was sitting with a counselor whose conversation and referrals to outside specialists felt like just the pressure release valve she needed.

“She sat and took time with me and let me debrief with her and I felt very comfortable talking very openly about all aspects, work and home,” Neuenswander said.

There have been more than 500 such referrals since HEAR started, a fact that makes UCSD psychiatry professor and researcher Dr. Sidney Zisook particularly proud. Having co-created the program with Dr. Christine Moutier, a former psychiatry professor now serving as medical director of the American Foundation for Suicide Prevention, Zisook said the idea was always to reach medical professionals far before they ever have a suicidal thought.

Culture change, the psychiatrist said, has been the most important factor. Hospital administration invites doctors and nurses to fill out encrypted self-assessments that are shared only with a narrow set of counselors and never with supervisors or others in positions of authority. By sending out those surveys year after year, and by having administration send messages encouraging employees to raise their hands when they’re feeling anxious, asking for help hopefully starts to feel normal.

“We’re trying to do our best to make getting treatment for depression or substance use or whatever it might be less stigmatized and more available,” Zisook said.

Confidentiality has also been key.

Emailed surveys, and the responses to those surveys, are encrypted and the university does not itself have the digital keys, working with a trusted third party across the country in New York to handle the encryption process. That means that the university has a limited ability to respond to information that arrives in those encrypted emails. Technically, it’s possible for employees to make worrisome statements but refuse to come forward for help.

“Even if we see that somebody says, ‘I’m going to kill myself tomorrow, goodbye,’ there is nothing we can do to identify them if they don’t want to be identified,” Zisook said.

But, so far, that scenario has not happened, and program designers say they believe that such radical confidentiality really helps. In fact, since the HEAR program started for doctors in 2009, not a single physician suicide has been reported. The program was extended to nurses three years ago, and, as was the case for M.D.s, UCSD is not aware of any subsequent suicides for nurses. The story has been slightly less positive for medical students. There has been one suicide among medical students since 2009.

True ironclad confidentiality, Zisook said, probably has a lot to do with employee willingness to speak up. Some, he said, need to feel that whatever they say won’t make its way back to colleagues or supervisors.

“I think that we’ve been able to transition some of those people into treatment who otherwise would never have gotten in touch with us or responded to a survey that isn’t as truly confidential as this one is,” Zisook said.

But the HEAR program goes much deeper than connecting workers to mental health help. It is also designed to help front-line managers react to stressful situations, Davidson said. Managers are now encouraged to run their own “emotional debriefings” designed to get co-workers talking to each other about stressful situations when they arise.

“Now they’re encouraged to raise their hands and we’re encouraged to watch each other to see if somebody needs a break,” Davidson said. “In the past, in this profession, we were encouraged to just suck it up and take it. That was the nature of the job.”

Already, the HEAR program has been emulated for doctors at several other locations, including UC Davis.

Anyone contemplating suicide is urged to call the National Suicide Prevention Lifeline at (800) 273-8255 or visit suicidepreventionlifeline.org