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Barriers to Accessing Mental Health Support Services in Undergraduate Medical Training: A Multicenter, Qualitative
Wen Qing Wendy Ye1, Bradley A Rietze2, Sydney McQueen3
1W.Q.W. Ye was resident physician, Michael G. DeGroote School of Medicine in McMaster University, Hamilton, Ontario, at the time of writing and is now resident physician, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Purpose:
Medical students report higher levels of burnout, anxiety, and depression compared with age-matched peers. These mental health challenges have been linked to reduced workplace productivity, empathy, and professionalism. Yet, students experiencing mental health issues often decide not to access mental health resources, citing limited time and concerns about confidentiality, stigma, and the cost of private therapy. This study aimed to provide a framework for understanding barriers medical students face regarding access to mental health resources.
Method:
A constructivist grounded theory approach was employed, with 24 students from 6 medical schools in Ontario, Canada, participating in semistructured telephone interviews between May 2019 and February 2020. Participants were purposively sampled to capture a broad range of experiences, institutional contexts, and training levels. The authors then developed a framework to conceptualize the barriers that medical students face while accessing mental health resources.
Results:
The information obtained from the interviews revealed that the barriers were both overt and covert. Overt barriers were primarily administrative challenges, including restrictive leave of absence policies and sick days, mandatory reporting of extended sick leave time during the residency selection process, time-restricted academic and clinical schedules, and difficulty in accessing mental health supports during distance education. Covert barriers to accessing mental health supports included a medical culture not conducive to mental health, felt stigma (i.e., fear of stigma and being labeled as weak), and the hidden curriculum (i.e., the unofficial or unintended rules and mannerisms propagated within medical education systems).
Conclusions:
Better understanding the overt and covert barriers that medical students to face while accessing mental health supports may help guide and inspire new advocacy efforts to enhance medical student well-being.
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