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school, and continuous care from his
treating physicians. Our medical school
is progressive and proactive about mental
health care. During orientation,
the student affairs dean described the
symptoms of depression in detail. Any
medical student can call or go to several
places for confidential and professional
services, and mental health treatment
is provided by professionals who do
not teach or evaluate students directly.
The medical school has a unique contract
with mental health professionals
to establish mental health treatment
for students, including the proviso that
students do not have to wait more than
two weeks for an appointment. The cost
is covered by student insurance, and
any out-of- pocket expense is minimal.
Sessions are not limited—students get
the care they need to succeed in medical
school. A twenty-four-hour helpline is
available, staffed by peers on the Student
Wellness Committee, as well as confidential
counseling, separate from the
College of Medicine administration.
Mike was being helped for his depression.
A team of caring professionals
was actively trying to help him and the
best current treatment was offered. All
this effort was not enough—he refused
treatment that might have saved his life.
I struggle to comprehend his final act.
The fact that Mike was a medical
student may be part of the answer to my
confusion about his suicide. Even though
the general population accepts the need
for psychological care and treatment,
the physician community seems to lag
behind. Physicians’ reluctance to seek
help is nothing new. It probably has its
roots long before medical school. Many
medical students are driven, competitive,
independent, and confident people. But
the characteristics that make a person a
successful medical school applicant and
student are often the same characteristics
that make asking for help difficult.
Data in a study on mental health and
help- seeking behavior in medical school
indicate that only twenty-two percent
of medical students identified by the
Beck Depression Inventory as being
depressed sought help. Even worse, only
forty-two percent of students with suicidal
ideation asked for help. Students
cited the following barriers to accessing
mental health care: lack of time
( forty-eight percent), lack of confidentiality
( thirty-seven percent), stigma
associated with using mental health services
(thirty percent), cost ( twenty-eight
percent), fear of documentation on academic
record ( twenty-four percent),
and fear of unwanted intervention
( twenty-six percent). 2 Fear of having
stress- related or psychologically- related
issues appear on academic records is
widespread. 3
To date there have been limited studies
on suicide in medical students. A survey
of American medical schools from
1989 through 1994 found that suicide
was the second-leading cause of death
among medical students. 4 Previously
cited studies of medical students found
that twenty percent and twenty-six
percent of depressed students (or six
percent of total medical students) had
contemplated suicide. 2,5 One author reported
that physicians are exceptionally
successful in their suicide attempts.
This observation held true with Mike.
He chose carbon monoxide to end his
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