The mental health crisis that has struck hard at the legal profession will not be fixed until the issues of mental health are adequately addressed in the general population across the United States, said psychiatrists, judges and lawyers attending a conference focused specifically on mental health challenges in the legal profession.

Mental health experts and legal industry representatives praised recommendations made in the American Bar Association’s National Task Force on Lawyer Well-Being Report—a 2017 groundbreaking study on the mental health crisis within the legal profession. But they stressed that the mental health crisis is a national crisis, hardly unique to the legal profession. And it must be addressed at a broader level if the legal profession is overcome the challenges of alcoholism, drug addiction, depression and suicide, they said.

The conference, organized by Duke University School of Law’s Bolch Judicial Institute and held this week at the University of Miami, was organized by attorney Adam Moskowitz, who himself has dealt with issues of addiction and anxiety. Former U.S. Congressman Patrick Kennedy, former Greenberg Traurig co-president Hilarie Bass and Chief Judge D. Brooks Smith of the U.S. Court of Appeals for the Third Circuit, among others, made speaking appearances.

The mental health issues that are pervasive in the legal profession are merely a subset of the problems faced in the general population, experts said.

Adam Moskowitz

To be sure, attorneys are particularly susceptible to depression and substance abuse, according to Dr. Charles Nemeroff, a leading researcher and psychiatrist at the University of Texas.

“Attorneys and judges are almost the prototypes for a high-risk population,” Nemeroff said.

But in a speech Thursday, he said the problem runs across professions in the United States. He also noted that the U.S. is an anomaly in the developed world, as suicide rates in the country are climbing. Citing data from the Centers for Disease Control, he said there are 47,173 suicides a year in the U.S.

“That’s an entire law school class—sometimes two—every year that dies from suicide,” he said.

The legal profession has to recognize the tension between productivity and wellness, he said. Nemeroff and legal professionals pointed to the billable hour and workloads across all legal stratas as the biggest culprit.

“I read a story the other day about a public defender that’s juggling 400 cases—how can he be well?” Nemeroff said.

While only 6 percent of the U.S. population exhibits “problematic drinking”—defined as hazardous drinking with possible dependence—21 percent of attorneys exhibit the signs, according to a 2016 study in the Journal of Addiction. For attorneys under 30, that number jumps to 36 percent. Over the course of an attorney’s career, 61 percent will experience anxiety, 46 percent depression and 12 percent suicidal thoughts.

Law students report rates of binge drinking higher than their graduate school counterparts, according to a 2016 study in the Journal of Legal Education. An estimated 14 percent of law students reported using prescription drugs without a prescription, with 67 percent of those respondents saying they use drugs to study more effectively.

The judiciary does not yet have its own comprehensive study—a fact that exposes another serious gap in mental health progress, said David Shaheed, a former Indiana judge. While experts at the conference generally agreed that attorneys have begun to make strides in addressing mental illness in the profession, they said the judiciary has lagged behind.

It’s already hard enough to get attorneys to overcome the stigma of asking for help because of fears of damaging one’s reputation, Shaheed said. The problem is magnified for judges.

“In other countries, you choose whether you go the judicial route or practice route,” he said. “Any reporting or discussion of alcohol or drug issues is going to be seen as an impediment to your goal, as judges are seen as the pinnacle of legal achievement.”

Shaheed is working with a few organizations, including the National Judicial College, to conduct a judicial survey this spring.

Although experts said there is still a long way to go, many said some progress has been made, and when the stakes are life or death, any progress is meaningful.

“There has certainly been a big change in a lot of ways. When I started practicing in the ’70s, alcohol was everywhere in the profession,” said Chief Justice Paul Reiber of the Vermont Supreme Court, adding that other attorneys would measure distances, not in miles or blocks, but in the number of beers drunk en route.

Judges and attorneys on several panels at the conference said they have taken actionable steps to implement the recommendations made in the ABA report on mental health.

For example, judicial officers in the Third Circuit, Ninth Circuit and Tenth Circuit have access to wellness programs. U.S. District Judge Timothy DeGiusti of the Western District of Oklahoma spoke of the Tenth Circuit’s Health program, which provides education and confidential referrals to medical professionals. The Tenth Circuit Judicial conference also prominently features an on-site mental health professional.

“I believe strongly that judges have to be the leaders in this area,” DeGiusti said.

Sarah-Frances Nemeroff Warner, a labor attorney at The Law Firm of Paul A. Suhr in Raleigh, North Carolina, spoke about her efforts to improve mental health resources at her alma mater, the University of North Carolina School of Law, by lobbying for a full-time mental health professional. She said that when UNC’s medical school—often used as a parallel to law school due to their similar heavy workloads—hired a full-time counselor, they were fully booked immediately.

She, along with medical professionals, also lauded the 22 states that removed a question on the Bar application asking if a law student has sought help to deal with a mental illness, arguing that this further stigmatizes mental illness and discourages students from addressing any mental health problems. Florida is not one of the states that abstain from asking mental health questions.

Many experts at the conference said the stigma associated with mental health is one of the biggest barriers to mental health wellness programs. But speaking about the issue, whether it be at a conference, a speaking engagement or even just during a lunch conversation, can help combat that stigma.

Terry Harrell, executive director at Indiana Judges and Lawyers Assistance Program, said providing programs is only half the battle. “We can have all the most wonderful resources in the world, but it doesn’t matter if nobody accesses them,” she said.