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Burnout among Missouri’s doctors, lawyers and executives rarely announces itself. It shows up as a surgeon in Kansas City who stops sleeping through the night, a litigator in Clayton who adds a second drink most evenings, a hospital administrator in Springfield who snaps at a staff meeting and spends the drive home replaying it. Their work stays excellent. That is exactly the problem.

I am a licensed clinical social worker, and the people I see most often in this situation are not short on money, insurance or information. They are short on one thing: a way to get help that nobody at work will ever hear about.

The research on attorneys makes that point more clearly than anything else I know. The largest study of lawyer mental health, published in the Journal of Addiction Medicine in 2016, screened 12,825 licensed, employed attorneys. When the authors asked why people had not sought help, the two most common answers were not wanting others to find out and concerns about privacy or confidentiality. Among attorneys who had been in treatment, about half named the first reason.

That finding has held up. A 2026 research paper by my firm, CEREVITY, works through the decade of studies that followed and notes that the headline numbers vary with the method used. The fear of exposure is the one finding that shows up every time someone asks the question, in attorneys and in law students alike.

Doctors and senior executives carry the same calculation. A physician wonders who at the hospital will see the claim. A chief financial officer pictures the board hearing about it. A partner thinks about origination credit and what the firm did the last time someone admitted they were struggling. Each person decides, usually quickly and usually alone, that the safer move is to wait.

Here is what that waiting looks like in practice, in a composite drawn from common patterns rather than any one person. A Kansas City executive notices in January that she is lying awake at 3 a.m. By spring she is canceling lunches and rereading emails four times before sending them. By late summer a colleague asks if she is OK, and she says she is just busy. She finally calls someone in the fall, after a panic attack in a parking garage. The care she gets then is harder and slower than it would have been in January.

Missouri already has a piece of the answer, and it deserves more attention. The Missouri Bar’s lawyers’ assistance program offers counseling and referrals to every lawyer and judge in the state at no cost, and the Bar states plainly that its services are confidential and that reaching out does not affect a lawyer’s license. That last sentence matters more than any brochure. It answers the exact question that keeps people away.

Three changes would extend that logic beyond the bar.

First, employers should say the confidentiality promise out loud, in writing and from the top. A benefit nobody trusts is a benefit nobody uses. If a hospital system, law firm or company in St. Louis or Kansas City offers counseling, its leaders should spell out who can see what, and who cannot.

Second, boards and managing partners should stop treating a request for help as a performance signal. The people most likely to hide strain are the ones whose standing depends on looking unshakable. If the first person to admit difficulty gets quietly passed over, everyone else learns the lesson.

Third, professionals themselves should stop waiting for a crisis to make the decision for them. Early signs are ordinary: broken sleep, short temper, more alcohol, less patience with family. Help works best at that stage, before the panic attack in the parking garage. Confidential options exist, including burnout therapy for leaders delivered by video, and many people never need to tell their employer anything at all.

Missouri asks a lot of the people who run its hospitals, courtrooms and companies. The least the state’s institutions can do is make sure the help they offer is help those people will actually use. That starts with taking the fear of being found out as seriously as the people feeling it do.

This article was originally published by Missouri Independent and is republished by MetroSTL under a Creative Commons license. The reporting is the outlet’s; please support them.