UMHS 2015 graduate Dr. Rohit Shah completed his residency in Psychiatry at Southern Illinois University. He was chief resident there. He then completed an Addiction fellowship at Indiana University. Dr. Shah currently works in various settings: detoxification, residential, in-patient, partial hospitalization program, intensive outpatient program, and clinic.
In recognition of National Suicide Prevention Month, the UMHS Endeavour spoke to Dr. Shah about the state of Psychiatry and what med students and doctors need to know regarding warning signs for suicide, the correct terminology, training for healthcare staff, physician suicide, specialists known as suicidologists, and more.
Dr. Shah currently works in various settings: detoxification, residential, in-patient, partial hospitalization program, intensive outpatient program, and clinic.
What made him select the specialty?
“I have always been fond of Psychiatry and Neurology,” Dr. Shah said. “I appreciate all the underlying neuroscience, especially seeing patients responding to psychotropic medications and the neurotransmitters involved. Addiction for me is rewarding as it is more medical with detoxification and having objective evidence of labs and vital signs. Furthermore, it is inspiring to see patients in their recovery and how resilient they have become. The work-life balance of psychiatry and potential for one of the highest compensated specialties is also a plus.”
Dr. Shah specializes in Addiction Psychiatry and is dual board-certified in both Psychiatry and Addiction Psychiatry.
National Suicide Prevention Month
September is National Suicide Prevention Month. Dr. Shah discussed the many misconceptions about suicide, particularly the way it is talked about.
“Suicide is a very sad and unfortunate cause of death that can be prevented many times,” Dr. Shah said. “I prefer to refer to suicide as a person died of suicide rather than the stigmatizing ‘they committed suicide.’ Many have a limited understanding and can tend to blame the individual; [saying] ‘it was a selfish act. How could they do it; they have kids?’”
He said people must understand that “suicide is complex with neuropsychiatric, genetic, psychosocial mechanisms. There are even specialists in this area, suicidologists.”
Common warning signs
There are many things medical students and doctors should look for in both patients and coworkers who might be at risk.
“Warning signs can include isolation and being withdrawn, appetite or sleep changes, anhedonia, depressed moods. Deteriorating emotional health (history of mental health conditions such as major depressive disorder, bipolar disorder, post-traumatic stress disorder, schizophrenia, etc.) along with substance use places an individual at a higher risk.
“A major life event can be triggering, such as job termination, loss of a loved one, or relationship termination. There can be the expression of passive death wishes (example, ‘I would rather be dead than alive and would not mind if I didn’t wake up') that can progress to active suicidal ideations with a plan; these can be actively voiced or hidden unfortunately. At times there can be a suicide note. A family history and a past history of suicide attempts are risk factors. Other risk factors can include elderly, unmarried, male, Caucasian, chronic pain, history of abuse.”
Besides encouraging someone to speak to a therapist or psychiatrist, what are things one should ask someone if you fear they might be considering suicide? Specifically, should one avoid clichés like debating the quality of life or minimizing their problems?
“There is a fear that talking to an individual about suicide can increase their risk,” he said. “It is always worthwhile to ask about suicidal thoughts and plans, sense of hopelessness, future orientation.”
Many mental health issues have become issues during the COVID-19 pandemic. depression and suicide during the pandemic.
“There has been a significant increase in new onset depression, anxiety and worsening depression with suicidal thoughts and attempts during the pandemic. Many have lost their jobs and the financial distress has negatively impacted their mental health.”
Substance abuse was a problem long before the pandemic, but the isolation caused by lockdowns made matters worse.
“The opioid epidemic was already concerning with a high amount of fatal opioid overdoses. Opioid overdoses were one of the top causes of death under age 55. Substance use disorders were exacerbated during the pandemic. Many relapsed after in-person 12-step meetings became less available and isolation increased. However, the development of virtual meetings has been helpful. Alcohol sales during the pandemic skyrocketed. I have seen countless patients coming in for alcohol withdrawal detoxification that had never developed a physiological dependence to alcohol until the pandemic.”
Family, friends and healthcare professionals all play a pivotal part in determining if someone might be at risk for suicide.
“Everyone can play an important role in assessing one for suicide. At times people are concerned about the stigma about seeing a mental health professional. This is where primary care physicians can play a critical role. I’ve seen many patients in the hospital that felt comfortable only talking about their mental health with their family physician. Often it is family and friends that are the best judge of how one is doing; it is critical to obtain collateral information. It can be tricky as there can be multiple warning signs but the individual is insisting ‘I’m fine! I promise.’ We see that patients can hide, minimize symptoms, or severity as they do not wish to be hospitalized or to decrease their admission length when in fact they are struggling immensely.”
Suicidal ideations are when someone thinks about or plans to take their own life.
“When an individual has suicidal ideations, it should always be taken seriously,” Dr. Shah said. “A proper evaluation should be warranted such and immediately brought to the local Emergency Department. It is challenging when individuals have chronic suicidality. Noticing deviations from baseline are helpful. Certain medications such as Lithium can be essential in these patients. Also, it is important to know about obsessive compulsive disorder and obsessions and compulsions revolving around self-harm versus actual suicidal ideations with a plan. There are patients that have borderline personality disorder that engage in self-injurious behaviors such as cutting; at times they have no intention of wanting to kill themselves. But it can be a ‘double-edged sword’ as they can be impulsive.”
What are ways to show you really care and connect someone in crisis to real help?
“The best way is going over to check in on your concerned one in crisis or even at times having the police do a wellness check. It’s great to see an individual that was brought in by their concerned friend to the Emergency Department.”
People in crisis can call the Suicide Prevention Hotline at 1-800-273-TALK.
Training for healthcare staff
It is essential for doctors and nurses in primary care or family medicine to be trained in mental health screening so they know when it is necessary to refer a patient to a psychiatrist or mental health professional. What should doctors look for when screening a patient?
“They absolutely have to be trained in basic mental health screening,” he said. “Furthermore, primary care physicians should be able to handle basic cases as there are not enough psychiatrists. Nowadays many primary care physicians have to (or should) do basic screenings with certain depression inventory scales such as PHQ-9.”
Helping doctors in crisis
2020 was devastating to frontline medical staff because of COVID-19 and is often more frustrating now, especially in areas where so many unvaccinated people are being put on ventilators
“The number of physicians that die from suicide every year is very concerning; about 350. The burnout rate is already high. The pandemic has put a huge strain on not just our frontline physicians but all physicians. In our medical culture it has been conveyed that we have to be tough and cannot show weakness. However, we have to overcome this. I encourage everyone that is struggling to reach out to colleagues. Discuss these struggles in safe settings such as the local doctor’s lounge. There are many state-specific resources for physicians struggling with addiction; state-specific professional programs. There are also closed 12-step Alcoholics Anonymous[International Doctors for Alcoholics Anonymous] meetings for doctors, doctors/nurses. I recommend the Physician Support Line, 1-888-409-0141. They have psychiatrists to support physicians and medical students for free.”
Dr. Shah has a list of books he thinks med students and doctors might find helpful on the subjects of mental health, physician suicide and doctor depression.
“I’m currently halfway through Why Physicians Die of Suicide by Dr. Michael Myers, MD. Great read. I also recommend Long Walk Out of the Woods by Dr. Adam Hill, MD. This is a pretty good book on a pediatric oncologist that was struggling with depression, substance use, suicidal thoughts and his tremendous journey. To better understand the opioid epidemic, I found Dreamland by Sam Quinones quite interesting.”
(Top photo): Dr. Rohit Shah—a 2015 UMHS graduate—is dual board-certified in Psychiatry and Addiction Psychiatry. Photo courtesy of Dr. Shah.
Scott is Director of Digital Content at UMHS and editor of the UMHS Endeavour blog. When he's not writing about UMHS students, faculty, events, public health, alumni and UMHS research, he writes and edits Broadway theater reviews for a website he publishes in New York City, StageZine.com.