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Student and resident mental health and wellness: 'It's OK to not be OK'

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Managing stress and anxiety is a normal part of life for medical students, residents, and fellows. But the unprecedented nature of the COVID-19 pandemic presents a different type of psychological challenge for learners on campus.

“While medical school and graduate school can be difficult, the stress imposed or experienced is time-limited, discrete, and finite. Time is marked with milestones and goal posts, and the rituals associated with them,” said Dr. Preston Wiles, Assistant Dean, Student and Resident Mental Health and Wellness.

“The pandemic limits or removes these rituals and changes the timing of them – or moves the goal post entirely,” he said. “For people who crave certainty and the ability to control their lives, changes like these can produce much fear and anxiety.”

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Members of the wellness team include (clockwise, from top left): Daniel White, Sarah McNease, Dr. Preston Wiles, Wadeeah Hasan, Dr. Alyson Nakamura, and Dr. Ellen Greenwald.

A team of psychologists, psychiatrists, nurses, and social workers at Student Wellness and Counseling is available to offer assistance with a wide range of issues including anxiety, depression, marital problems, and learning challenges. More than 1,700 students in the UT Southwestern Medical School, Graduate School of Biomedical Sciences, and School of Health Professions can access these services, and a similar program exists for the more than 1,000 fellows and residents. The services covered by insurance and available to students, residents, and fellows have been temporarily moved online during the pandemic.


Reducing the stigma

When Dr. Wiles first arrived at UT Southwestern in 2010 to take charge of the student mental health program, he was immediately confronted with a serious challenge. A student had recently committed suicide. As a trained child psychiatrist with 20 years of clinical practice at Yale University under his belt, Dr. Wiles was hired to ensure all possible steps were taken to prevent more cases.

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Dr. Preston Wiles

“Instead of treating suicide prevention as a dirty secret, we decided to make it our calling card,” said Dr. Wiles, also Director of Student Wellness and Counseling and a Professor of Psychiatry.

Soon after his arrival, alumni gifts helped fund suicide prevention training for all second-year medical students. Every UT Southwestern student is now trained to recognize distress in fellow classmates and to actively respond. A peer advocate program can refer fellow students to resources and support, and the UT System funds a 24/7 crisis response hotline.

“If students are reluctant to come to our clinic, they can talk to another student first to address their fears. It’s about both education and reducing the stigma surrounding mental health treatment. It’s OK to not be OK. That’s the drum we beat,” said Dr. Wiles.


Growing the program

The success of UT Southwestern’s student mental health and wellness program is evident in its growth. During the past 10 years, annual visits to the clinic rose from 900 to 4,800, and the number of unique users quadrupled. A combination of building trust with the campus community and finding a better location for the clinic fueled this success.

“The mental health clinic was in the shadows and not really part of the student services mix. We moved from Aston to just off the Plaza in 2014, and now we’re more visible and integrated into every school experience,” Dr. Wiles said. “We’ve built our program by being a reliable resource to students in distress. It’s been a really gratifying experience.”

“We see about 30 to 40 percent of students sometime during their studies here, which is consistent with research showing what student mental health and wellness programs experience nationwide,” he said.

Over the years, the student body has become more diverse in gender, race, and ethnicity. More than half of the students are now women. With such diversity, “you don’t necessarily know what that individual student is experiencing. It’s important to have a very open mind and not start with a predetermined set of biases based on your experience,” said Dr. Wiles. Today’s students want to continue the personal growth that they began in college, challenge authority, and remain open to new ideas, he added.


Toolbox for coping and recovery

Difficulty sleeping, a marked shift in ability to concentrate, rapid shifts in mood and anxiety, increased substance use, irritability, and preoccupation with negative thoughts are all indicators of the need to reach out for help, according to Dr. Wiles. He recommends the following coping tips for everyone feeling stressed by the COVID-19 crisis:

  • Use slow breathing techniques.
  • Cultivate awareness of the body’s need for sleep, nutrition, and exercise.
  • Focus on what you can control versus not control.
  • Limit exposure to news media and social media.
  • Stay safe and practice social distancing.
Infographic. Coping with stres during the COVID-19 outbreak. It is normal to feel sad, stressed, confused, scared or angry during a crisis. Talking to people you trust can help. Contact your friends and family. Maintain a healthy lifestyle including proper diet, sleep, and exercise. Don't use smoking, alcohool or other drugs to deal with your emotions. Get the facts, gather information that will help you accurately determin your risk so that you can take reasonable precautions. Limit worry and agitation by lessening the time you and your family spend watching or listening to media coverage. Draw on skills you have used in teh past.

Students and residents also have access to mindfulness classes where they learn coping skills that can be applied throughout their professional lives.

“Mindfulness is paying attention to the present moment and the awareness that emerges,” Dr. Wiles explained. “It encourages the development of compassion, gratitude, and generosity, qualities of the spirit that lead to personal happiness and benefit those around you.”


What’s ahead

Looking to the future, Dr. Wiles hopes to offer wilderness retreats, where students can learn coping techniques and how to work closely together as a group while enjoying activities such as whitewater rafting, rappelling, and rock climbing.

Combining coping techniques with exercise and social activities can add to the toolbox for recovery, Dr. Wiles said.

“One of the most rewarding experiences for my team is when students who have experienced high levels of distress come back from it. They solidify the gains they’ve made in treatment, go into their specialties, and thrive during their residencies,” he said.

For many, the first step toward better mental health is learning that it’s OK to not be OK.

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