After almost one physician or medical student suicide each year for more than a decade, UC San Diego Health’s Physician Well Being Committee (PWBC) knew something had to change. Not a single one of the people who had died had come to the PWBC for help. So in 2009, the group created Healer Education, Assessment and Referral (H.E.A.R.), the first physician suicide prevention program of its scale in the country. 

While it initially served only medical students, residents, and faculty physicians, H.E.A.R. has now expanded its reach to pharmacists, nurses, and clinical staff within UC San Diego Health. It has been recognized as a best practice by the American Medical Association and American Nurses Association. 

One of H.E.A.R.’s core principles is that they don’t wait for people to recognize they need help and then seek them out; they go to them. The program encourages participation in its online suicide screening tool, created by the American Foundation for Suicide Prevention. The evaluations have been revelatory — uncovering high levels of burnout, depression, and other forms of distress. 

H.E.A.R. also provides education on mental health issues and wellness, does extensive outreach to build awareness of its services, and connects caregivers with outside behavioral health services. It has gradually expanded its offerings — all free — to include individual and group counseling, critical incident debriefing, emotional process debriefing, peer support training, and Schwartz Rounds. 

“Healthcare workers are inserted into the most tragic and intimate moments of people’s lives,” said one nurse and quality program manager. “We cry alone. We close off from our loved ones. The skill of the H.E.A.R. team is extraordinary. I have watched them navigate clinical debriefings with world-class surgeons, waiting for the moment when the emotional impact of events can be explored. They have helped employees struggling with one another find common ground. I have also watched them sit quietly while we cried. Their value cannot be overstated.” 

The steady increase in service requests over time indicates the H.E.A.R. team is also shifting healthcare’s culture of stoicism that discourages people from asking for help. Supporters say the fact that the program fiercely protects anonymity and confidentiality is another reason people prefer H.E.A.R. over other services. 

During the pandemic, requests for services have escalated and H.E.A.R. also has been proactive in offering help to managers of COVID units. Debriefings, where staff process difficult cases, increased from an average of 30 per year to more than 130 in the first year of the pandemic. “Again and again and again, H.E.A.R. provided a safe place to share, listen, grow, and experience new ideas for coping,” said one nurse. “They were gentle soul savers for all of us.”