In this series, AMS Healthcare addresses the challenges facing healthcare today – particularly in light of the COVID-19 pandemic. The AMS Community promotes compassionate care, development of the leadership needed to realize the promise of technology and the understanding of how our medical history influences the future of our healthcare. A new piece will be posted every Friday on Healthy Debate.
Would you react differently if someone said you were suffering from depression than if they said you were burning out? When it comes to the mental health of those who work in healthcare, terms like burnout, well-being, and resilience are often the first that come to mind. Reports of mental illness and depression are harder to find. Suicide is even less common.
The COVID-19 pandemic has led to a proliferation of resources on workplace wellness and health worker well-being. Organizations have set up support lines, websites and are offering psychological services. We know that among healthcare workers, pandemics lead to considerable emotional distress and have a negative impact on mental health. However, the number of healthcare workers reaching out for help does not seem to be commensurate with expectations.
Pre-pandemic statistics in Canada suggest that a significant number of physicians experience burnout. However, despite 80 per cent of physicians being aware of physician health programs, only 15 per cent accessed help.
Stigma is a powerful force. As Michael Rose, a medical student, wrote in the New England Journal of Medicine: “As someone who tries to be a voice for healthcare justice, and as someone who battles with mental illness, I should be a leader in fighting stigma. Yet I’ve remained shamefully silent. When classmates drop by my place, I sneak off to the bathroom to ensure that my pill bottle is well hidden.”
He is not alone.
Several studies have found that when the mental health of those who work in healthcare deteriorates, they are reluctant to access help because they are afraid of being judged negatively. For example, when offered time off, medical residents were frequently reluctant to accept, citing their concern about the impact of time off on peers and patients.
Medical students suffering from depression say their opinions would be less respected, their coping skills viewed as less adequate, that they would be viewed as less able to handle responsibilities by faculty members, and that telling a counselor about depression would be risky.
The culture of the healthcare workplace contributes to the problem. Workers and students are given consistent messages that the needs of others should come before their own. Even when the topic of well-being is raised, structural stigma remains. Despite recommendations from medical organizations, many regulatory authorities in the U.S. and Canada ask about mental health and accessing treatment when granting a professional license. A 2016 survey of female doctors found half would not seek treatment for mental illness because of their fear of regulatory authorities.
In our research, we have found that people suffering from mental illness and addictions are implicitly blamed and shamed for seeking help. Witnessing the way patients are treated for seeking psychological help, healthcare workers hide their own suffering deeper into the shadows. Over time, many absorb their own suffering and fall into cycles of self-blame, increasing the risk of suicide.
Addressing stigma requires awareness, training and structural change within organizations. For example, the Joint Commission in the U.S. “strongly encourages” organizations to not ask about a clinician’s mental health history or treatment. As a regulatory body, it highlights that any inquiries should be limited to conditions that currently impair job performance.
The COVID-19 pandemic may have lifted the veil on the psychological toll of working in healthcare. Time will tell if the pandemic will provide a meaningful opportunity to address stigma within our organizations. As many hospitals develop peer support programs and hotlines, we should be asking ourselves if our colleagues are comfortable asking us for help. And if we ask how they are doing, how will we react if they tell us an uncomfortable truth?
The comments section is closed.
I’m sorry you are experiencing mental health issues in addition to the lack of support at work. If the healthcare system can’t serve as a model for workplace wellbeing, what expectations can we have for non-healthcare workplaces?
I’m sorry you are experiencing mental health issues in addition to the lack of support at work. If the healthcare system can’t serve as a model for workplace wellbeing, what expectations can we have for non-healthcare workplaces?
Timely important perspective and thank you for sharing Dr. Sukhera. I certainly agree with you that the stigma around getting help needs to end (1). The stakes are too high, and no one should struggle alone. With the Covid-19 pandemic, medicine is at a crisis point. Health care professionals are responding with an astounding display of selflessness, caring for patients despite the risk of profound personal harm (2). COVID-19 pandemic presents an ongoing disruption to health care providers’ everyday lives that has significant implications to their psychological wellbeing. Meaningful conversation and engagement with health care providers to create a work environment and design it the way to enhance mutually respectful and caring workplace that enables clinicians to prevent and better cope up with the burnout. It is critical to pay special attention to how they are feeling and help them to react to the situation and meaningful resource allocation on their self-care.
REFERENCES:
(1). Desapriya EB, Nobutada I. Stigma of mental illness in Japan. Lancet. 2002; 25;359(9320):1866. doi: 10.1016/s0140-6736(02)08698-1. PMID: 12044414.
(2). Hartzband P, Groopman J. Physician Burnout, Interrupted. N Engl J Med. 2020 Jun 25;382(26):2485-2487. doi: 10.1056/NEJMp2003149. Epub 2020 May 1. PMID: 32356624.
I have hidden my depression for the whole 35 years that I have been a Registered Nurse. I have been off a number of times and shamed by management and ridiculed. I am off right now and was threatened with discipline by my manager when I return to work. I am made to feel guilty for leaving the area short staffed and am told that I don’t LOOK or SOUND sick. I feel guilty that I am off work. I have been ridiculed for not coping with stress and am told that I should “suck it up”. Mental health days are not allowed. Mental illness is not believed. I work at a place that says they support any appointments that you need to take….on your own time. Where is that support? When you have physio, massage, chiropractic or counseling appointments on a regular basis, you establish a set time and day. None or few of these appointments can be done “outside work time”. Management in my experience has NEVER been supportive and have ridiculed anyone that has had any issues. I was at one point having suicidal thoughts and my manager at the time joined in with the bullies in tormenting me. The Union did NOTHING to support me as it would be “member against member ” and that “costs too much” to defend a victim of bullying. So tell me HOW any of this is going to get any better? I am a good nurse and I give good care but I get NO support.