We applauded them from the rooftops, made viral videos to express our gratitude, and threw endless pizza parties. The nurses, physicians, respiratory therapists, and other healthcare professionals who stepped up during the pandemic were nothing short of heroic — but that heroism wasn’t without cost.
The mental, physical, and emotional burdens borne by the healthcare industry during the height of the pandemic were significant. Many healthcare professionals continue to struggle with the stress of it. Anxiety and depression are common. Finding mental health support for healthcare professionals, however, has proven to be a challenge.
Seeking mental health support for healthcare professionals
Despite an increase in mental health concerns over the past two years, research has not yet traced a correlation between the number of healthcare professionals dealing with these issues and those who seek professional care to address them, says Dr. Patrick Rowley, LPC, NCC, a licensed and nationally certified counselor.
Seeing those healthcare professionals who do address the mental health challenges they’re facing encourages Rowley.
“Hospital leaders are making a concerted effort to provide the accessible resources [for mental healthcare],” Rowley says. “We’ve made strides in drawing greater awareness towards mental health during the pandemic, but there are still pockets of conversations within specific professions that continue to [give pause to] those seeking the proper mental health care that they need.”
Telehealth and mental health
As someone who conducts weekly mental health tele-sessions specifically for healthcare professionals, Rowley estimates that approximately 15-20% of his clients are employed healthcare clinicians. “It’s a number that should be increasing,” he says. “Because the mental health pressure for this population has increased.”
Drew Contreras, PT, DPT, can attest to that. The vice president of clinical integration and innovation with the American Physical Therapy Association, Contreras knows firsthand the impact the pandemic has had on therapists and receives frequent feedback from within the industry.
Telehealth, for all its benefits, does have a potential downside. “The age of the electronic medical record has made it more flexible for clinicians to document. It also makes them more vulnerable to doing documentation from other locations besides the clinic,” says Contreras. “The same goes for those who may practice telehealth at home. Finding that work-life balance is essential.”
This gets to the core of what Rowley identifies as the telltale sign that intervention is needed: when one’s professional life is negatively impacting their personal life, and vice versa.
“It’s the intersection of professional and personal,” he says. “We’ve tied our lives together. If the first thought that comes to mind when you wake up is negative thoughts about your workday, you’re already creating that self-fulfilling prophecy. If you’re feeling negative because of your workday, more often than not, your day is going to be negative.”
The danger of burnout
Kruti Quazi, MA, LPC, NCC, CCTP, CFTP, CDBT, also estimates that about 20% of her clients are healthcare professionals, an increase from what she’s seen in years past. Most of these individuals are already experiencing signs of burnout when she meets them, typically due to staffing issues and increased patient caseloads.
“Several studies focusing on the healthcare sector have shown that healthcare professionals are exposed to a variety of severe occupational stressors, such as time pressure, low social support at work, a high workload, uncertainty concerning patient treatment, and a predisposition to emotional responses due to exposure to suffering and dying patients,” says Quazi. “Healthcare workers should feel comfortable going to their managers to let them know that they are beginning to feel burnt out, and that this may affect their job performance.”
A persistent stigma
That level of comfort can be difficult to reach. Stigmas around mental health persist among many healthcare professionals, say Rowley and Quazi. There’s particular reluctance around talking with an industry peer who isn’t already a trusted friend or colleague
“When speaking with these individuals, it’s clear that a stigma exists towards mental health professionals, such as psychologists, psychiatrists, counselors, therapists, etc. People are worried their peers will think they lack competence, or that they don’t have the appropriate mental health stability to practice their position in the most effective manner,” says Rowley. “It’s similar to what you see in the military. But we’re not trying to label you with a diagnosis. We’re going to make mutually agreed-upon decisions that allow you to reach your goals, whether they be professional or personal. We want to help empower you to overcome your difficulties.”
Rowley said this stigma persists even in places where employers are offering programs that encourage healthcare staff to speak with a mental health provider.
“The process of seeking an outlet for mental health support for healthcare professionals is still often something that providers shy away from because they’re worried about how their supervisors will view them,” Rowley says. “And that’s a major concern. But we still want to offer this service to these hospital systems. It takes great leadership from the top to tell their employees that this is a necessary service.”
Technology, stress, and telehealth
Varleisha D. Gibbs, PhD, OTD, OTR/L, vice president of practice engagement and capacity building at American Occupational Therapy Association Inc., North Bethesda, MD, says that part of the challenge is the unprecedented work environments that have developed due to the pandemic.
“New methods to deliver patient and client care, such as telehealth, have led to everyday practices shifting towards uncharted territory,” she explains. “Stress levels were high as technology presented the need to learn new methods, platforms, and policies. Some practitioners found it challenging now that ‘work’ and ‘home’ are synonymous. In certain settings, such as skilled nursing facilities and acute care, healthcare teams have stepped into various roles that may have been outside of their typical scope of practice.”
The value of listening
Regardless of the root of any healthcare provider’s mental health challenges, both Rowley and Quazi insist that no one expects healthcare professionals to manage these stress levels without assistance.
“We make no assumptions when walking into conversations with healthcare professionals about their subjective experiences,” Rowley says. “Two different providers could lose a patient, and their [individual] experiences with their emotions could be completely different. We must be cognizant of that without making assumptions or trying to over-identify with that individual with their experience. We need to ask them open, exploratory questions. Then we can come to a greater level of understanding about how they experienced that situation. If we are trying to interpret or provide insight, we have to approach that very delicately and respectfully.”
The importance of understanding leadership
Providers should not have to make a choice between work ethic and self-care, Quazi says. “It is possible to find or create a situation where you can speak up and advocate for yourself. That way you can present the best version of yourself to your patients and help them navigate their crises,” she says. “I speak with clients about creating time, even if it is ten minutes, to step away. They might take a walk outside for fresh air or grab a drink of water. Some might color or meditate for a few minutes.”
Those caring for patients are not the only healthcare professionals feeling these stressors. Individuals in management roles who might be experiencing the same challenges, says Dawn Neuhauser, MSN, RN. Neuhauser serves as the executive director of nursing at City of Hope, Duarte, CA, one of the largest cancer research and treatment organizations in the United States.
“There are also certain common assumptions about the work of those who are not specifically on the frontlines that have contributed to this [increase in mental health challenges],” says Neuhauser. “I think there’s more of an expectation that stress is a part of our roles. And it’s true that we all experience stress, but the burnout is really about when you’ve become detached.”
Moving toward positive change
Everybody can benefit from mental healthcare services, says Rowley. Determining when to ask for help comes back to honest awareness of one’s needs.
“There’s no right or wrong way to seek mental health support for healthcare professionals,” he says. “There are psychiatrists, psychologists, counselors, social workers, marriage and family therapists, life coaches, and peer support. No person is right or wrong in how they try to receive that support. All of these people can provide a level of mental health support that you may benefit from. You truly won’t understand the benefits until you make an attempt.”
He advocates for peer support, but does caution that additional support could still be clinically necessary.
“’Peer support’ lacks some of the clinically sound practices, policies, and procedures that are involved in mental healthcare,” he says. “You’re not being diagnosed, you’re not being put onto a treatment plan, and you’re not getting medication. The lowest level of care that you need is the care that you should seek. And if peer support fills that void, we’re excited for you as a helping profession.”