Claire Collins and Cayla Pichan are both aspiring physicians who care deeply about their education, as well as the individuals that they work closely with. But they also have something else in common, an often-overlooked story centered around depression and anxiety.

"During my first year as a medical student at the University of Michigan, I went through a terrible time marked by my own depression and anxiety," said Collins. "Although I had support from our academic counselors, I didn't have many options involving peers or professionals that I could easily turn to for help. This left me feeling really isolated in my struggles."

Pichan notes that she, too, felt very much alone when it came to her mental health when she first started medical school.

"I have definitely had my own journey with anxiety and when I first started as a medical student, I knew that I needed to find reliable psychiatric care in order to succeed," she said. "And even though I followed everything I was advised to do; it was still really overwhelming to manage the many aspects involved in seeking mental health services."

Pichan adds that this inspired her to talk to some of her peers about their thoughts around access in the world of mental health.  

"Many of my friends agreed that they were also confused about where to start looking for help," she said. "And things like cost and time constraints added an extra barrier to actually seeking the help that many of them needed."

In the Spring of 2020, Collins and Pichan connected with another peer, Lauren McGee, to collaborate on a student needs assessment that focused on the wellbeing of their fellow medical students.

"After the survey, we put out a call to any and all students who were interested in helping us create a presentation for our executive leadership team regarding the evidence that we had collected, as well as our recommended next steps," said Collins. "In August of 2020, we presented to the deans of our school and requested the creation of a workgroup solely focused on addressing issues of access, time, equity and stigma around mental health."

Erin McKean, M.D., M.B.A., FACS, who serves as the assistant dean for student services at U-M Medical School, then teamed up with Collins and McGee as co-chairs for this newly formed committee.

"This complete overhaul of our medical student mental health services is critical for our community, and it was particularly meaningful to me given my own prior experience as a resident physician and patient in the U-M House Officer Mental Health Program," said McKean. "When I took on my role in Student Services in 2020, I realized that we didn't have any free programs for medical students and the existing program was strictly insurance-based, limiting accessibility to students in need."

Once the workgroup convened, the co-chairs ran weekly meetings and eventually set up one-on-one conversations with each team member to help complete their final proposal.

"We developed a 44-page proposal that encompassed our comprehensive plan for revisioning the Medical Student Mental Health Program. This outlined an initiative where students could access psychological care and psychiatric services at no cost as a part of their enrollment in the U-M Medical School," said Collins. "This, of course, was possible through the hard work of the entire group. We collaborated with the Office of Medical Student Education, the Office of Counseling and Workplace Resilience, the Michigan Medicine Wellness Office and medical school leadership to eventually gain full institutional support for our program. It was a really exciting time."

Funding for the program went into effect in July of 2021 and since that time, there has already been an uptick in the use of psychiatric services among the medical student community.

"A key aspect of this program is the implementation of our opt-out mental health screenings, called M-Checks," said Pichan. "It's important to recognize that many of our students dealing with mental health challenges don't necessarily show any outward signs of struggle. And many students have never even seen a therapist or talked to a professional about their issues."

Pichan adds that the M-Checks screening mechanism is designed to "reduce stigma associated with mental health," as it allows for every medical student to meet with a counselor confidentially.

"Our students no longer have to jump through hoops to accommodate therapy in their already busy schedules," she said. "Through M-Checks, mental health is truly built into the medical school curriculum, which is tremendously forward-thinking. Students can also opt out of the program if they so choose. We just really want individuals to know that these options are readily available to them, confidential and free of cost."

Whitney Begeman, Psy.D., serves as the lead therapist for the Medical Student Mental Health Program. She notes that this initiative is groundbreaking in the realm of mental health services for aspiring physicians.

"Fundamentally, I hope that this program changes the narrative and culture around the importance of mental health and being attuned to oneself," she said. "Being attuned to oneself allows for acknowledging and compassionately attending to the distress you have rather than minimizing or ignoring it. Being attuned to oneself allows for seeking out resources and/or support when you recognize that you are struggling. And finally, being attuned to oneself allows for developing valuable self-care practices and resiliency skills."

Begeman adds that this program inevitably "helps medical students learn how to better care for themselves in the midst of their academic work, clinical training and life, in general."

"And when medical students pay attention to their mental health, they're better able to care for others and that ultimately has positive outcomes for patient care."