May is Mental Health Awareness Month. Mental health providers play a critical role in promoting awareness and working to improve the lives of others. Yet, compassion fatigue and burnout are very real issues for those in the field. Last week, the PAR blog explored the state of burnout among mental health professionals. This week, we look at the signs of burnout and provide solutions for self-care.

Mental health providers continue to face a workforce shortage and ongoing burnout risks. Organizations and individuals need to prioritize and implement strategies to prevent and reduce burnout.

Mental health professionals were understaffed and facing a mental health crisis before the COVID-19 pandemic hit, which only exacerbated the demands on a healthcare system already stretched beyond its breaking point.

According to the 2023 Mental Health America report, nationally, there are 350 patients to every mental health provider. However, the ratio widely varies from state to state; for example, the Massachusetts patient-to-provider ratio is 140:1, and in Alabama, it is 850:1.

The American Psychological Association conducted a survey in 2022 that found that more people required treatment for anxiety or depression than there were mental health professionals available to provide it. According to APA, 6 out of 10 practitioners claimed they had no opening to take on new cases, 46% said they couldn’t handle the demand, and 72% said their patient waitlists had only grown since the onset of the pandemic.

Seeing the demand and shortage of mental health professionals highlights just one pain point of many that mental health professionals contend with daily. Many mental health professionals are so passionate about attempting to meet the needs of their patients that they may sacrifice their own physical, mental, and emotional health and well-being. Yet, even with this devotion, they realize that it still isn’t enough to be able to help everyone who needs help. It isn’t difficult to see why 45% psychologists reported feeling burned out in 2022.

Mental health professionals and organizations should not assume that their education, training, and experience make them immune from experiencing compassion fatigue and burnout. In fact, those in the mental health field need to be vigilant and watch for the signs that they themselves or others they work with may be experiencing burnout.

Signs of burnout

Three of the most common signs of burnout include:

Exhaustion: Individuals often feel emotionally exhausted or drained, unable to cope, and have low moods and energy. They may also experience physical symptoms such as gastrointestinal problems.

Loss of interest in work-related activities: Individuals often feel increasingly frustrated and stressed by their jobs. They may experience growing cynicism about their work environment or colleagues and emotionally withdraw and feel numb regarding their work.

Decreased effectiveness or performance: Burnout affects daily tasks at work or home. Individuals experiencing burnout may be pessimistic, have difficulty concentrating, lack creativity, and lack energy and enthusiasm.

Individuals, organizations, and the media have helped spread the word about burnout in healthcare, but that isn’t enough to prevent it from continuing. Organizations need to work to prevent and reduce burnout among mental healthcare staff.

Strategies to combat burnout

The Substance Abuse and Mental Health Services Administration (SAMHSA) argues that organization-level interventions should target burnout using a “whole-organization approach” due to the complex nature of burnout with many root causes and drivers.

According to SAMHSA, there are six areas that organizations need to address through improvement strategies to work towards preventing and reducing burnout among mental health workers. These six areas are:

• Workload
• Control
• Reward
• Community
• Fairness
• Values

SAMHSA outlines several strategies that can aid organizations in combatting and addressing burnout, such as:

• Building a planning and implementation task force
• Conducting a needs assessment
• Identifying available resources and strategies for implementation
• Sustainability planning

Practicing self-care

Although mental health professionals counsel others on the importance of self-compassion, it doesn’t mean they may not neglect its practice when it comes to themselves.

Self-care can help reduce stress, compassion fatigue, and other factors leading to burnout. Building the practice of self-care doesn’t have to be all or nothing. You can gradually add in one or several of the following:

Practice self-compassion: Self-compassion may work as a protective factor against exposure to secondary traumatic stress and burnout. Individuals need to see themselves as more than their job and know they are also due kindness and understanding.

Eat a balanced diet: Workloads may be excessive, and it may be tempting to work through lunch to squeeze in another client, a meeting, or other work, but don’t do it! It is important to take a break to eat nutrient-dense foods to keep your energy levels up and to help combat daily stress.

Get enough sleep: It is important to prioritize getting enough sleep. The CDC reports that adults need at least 7 hours of sleep. Studies have shown that sacrificing sleep can lead to anxiety and stress and how stressful events are perceived.

Exercise: Even taking a brisk walk can help remove you from your work and create a much-needed break, which helps to counter chronic stress and boost mood. Aerobic activity can also contribute to feeling better and increase endorphins in the body.

Reach out: If you are experiencing burnout, contact your supervisor or human resources about your hours or workload. If you are a solo practitioner, take some time to decide what boundaries you may be able to create to allow yourself a break.

Use time off: Vacations and breaks from work help prevent burnout.

Practice stress reduction activities: Yoga, meditation, deep breathing can provide short, much-needed breaks in a busy day.

Socialize with colleagues: Taking time out to connect with peers can help with the feeling of connectedness and reduce emotional exhaustion.

 

Mental health professionals must take steps to prioritize your own health and well-being. This will not only help to prevent burnout, it means you will be your most effective self and equipped to provide your clients and students with the quality care they need.

 

 

 

 

 

 

 

May is Mental Health Awareness Month. Mental health providers play a critical role in promoting awareness and working to improve the lives of others. Yet, compassion fatigue and burnout are very real issues for those in the field. For the next two weeks, the PAR blog will explore these issues within the mental health community and provide guidance on how those in the mental health field can prioritize self-care to protect their own mental health needs.

Mental health providers with prolonged or cumulative exposure to compassion stress may be vulnerable to burnout if early steps to counteract excessive empathetic involvement are not taken.

A major part of a mental health professional’s job is the ability to empathize with clients. Developing a successful therapeutic alliance leads to better outcomes and correlates with the capacity to identify, comprehend, and share an individual's feelings, thoughts, and experiences. However, prolonged exposure to distressing information can negatively affect a mental health professional and is a risk factor for secondary traumatic stress.

Studies have shown that health professionals have moderate to high levels of burnout and secondary traumatic stress, but few present the prevalence of compassion fatigue and burnout found among mental health professionals.

Past studies have reported that people who work in helping professions have prevalence rates of compassion fatigue ranging from 7.3% to 40% and estimate that 21% to 61% of mental health practitioners experience signs of burnout.

According to an APA survey, the number of psychologists who said they could not keep up with patient demand increased from 30% in 2020 to 41% in 2021 to 46% in 2022. Similar amounts were recorded in 2020 (41%) and 2021 (48%), with nearly half (45%) of respondents in 2022 reporting feeling burned out.

Compassion stress

Secondary traumatic stress (compassion stress) negatively impacts mental health and can lead to psychological issues such as strained relationships, insomnia, poor sleep hygiene, severe depressive disorder, and compassion fatigue. Mental health providers with prolonged or cumulative exposure to compassion stress may be vulnerable to burnout if early steps to counteract excessive empathetic involvement are not taken.

Compassion fatigue

Compassion fatigue is caused by extended exposure to traumatized individuals. Mental health providers belong to a profession that demands constant empathy. While empathy is essential to your work, persistent and excessive demands for empathy can become emotionally exhausting and depleting without adequate time to recharge.

Signs and symptoms of compassion fatigue

Compassion fatigue stems from exposure to vicarious trauma and can affect people differently, but common signs to watch for include the following:

•            Chronic emotional and physical exhaustion

•            Anger or irritability

•            Headaches

•            Weight loss

•            Increased anxiety or irrational fears

•            Issues with intimacy

•            Decreased sympathy and/or empathy toward patients or coworkers

•            Dread in working with certain patients

•            Negative feelings separate from the work environment about work, life, or others

•            Negative coping behaviors, like alcohol and drug use

•            Increased absenteeism

•            Feelings of inequity and pessimism

•            Self-contempt

•            Low job satisfaction

Sometimes compassion fatigue and burnout are used interchangeably. There is a distinction. The onset of compassion fatigue is more abrupt, whereas burnout develops gradually over time. 

Burnout

The World Health Organization (WHO) defines burnout as a “syndrome conceptualized as resulting from chronic workplace stress that has not been fully managed.” The WHO's definition of burnout distinguishes that “burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”

Symptoms of burnout

There are three key signs of burnout, which include:

•            Exhaustion: Individuals often feel emotionally exhausted or drained, unable to cope, and have low moods and energy. They may also experience physical symptoms such as GI problems.

•            Loss of interest in work-related activities: Individuals often feel increasingly frustrated and stressed by their jobs. They may experience growing cynicism about their work environment or colleagues and emotionally withdraw and feel numb regarding their work.

•            Decreased effectiveness or performance: Burnout affects daily tasks at work or home, and individuals are often very pessimistic, have difficulty concentrating, lack creativity, and lack energy and enthusiasm.

Factors that may lead to  burnout

Mental health professionals work with patients with mild to severe depression, anxiety, trauma, abuse, neglect, addiction, and other mental health illnesses, all of which can take an emotional, mental, and psychological toll on providers. Aside from the psychosocial issues, Patel and colleagues divide the contributing factors for provider burnout into workplace, organizational, and personal characteristics.

Workplace factors

There are many factors related to the workplace, such as excessive workloads, increased stress levels in overworked providers, the need to keep meticulous records, and time-consuming clerical duties. One national survey found that each hour spent interacting with patients added 1-2 hours of additional work with no additional compensation. Long work hours, lack of downtime at night or during the weekend, and the need to bring work home instead of taking time for themselves are also factors in burnout.

Organizational factors

Organizational factors include negative leadership behaviors, little to no reward or room for advancement, poor social support, and lack of interpersonal collaboration.

Personal characteristics

Personal characteristics include self-criticism, unhealthy coping strategies, perfectionism, poor work-life balance, poor sleep habits or lack of sleep, and inadequate support systems outside of work may also contribute to burnout. Studies have also shown that new and younger health providers have twice as much stress as older colleagues. Age and gender may impact levels of burnout, and studies have shown that younger workers and women may be at higher risk for burnout.

The impact of burnout

There are many downstream effects that burnout causes, such as:

•            Providers are at increased risk for developing cardiovascular disease, depression, or substance dependence.

•            Providers who lose their empathy could invite secondary harm to patients.

•            Increased healthcare costs are more common when providers suffer from burnout.

•            Compassion fatigue may lead to decreased retention and increased turnover and may lead some mental health professionals to leave the field.

Though empathy is the cornerstone of a strong connection and ability to treat and improve the mental health of their patients, mental health professionals must remember to prioritize their own physical and mental health. For health professionals to give their patients the best care possible and enhance client's quality of life, taking time off from work is essential to unplug, decompress, and practice self-care.

Come back next week to learn self-care tips meant specifically for those in the mental health field.

The pandemic has made it difficult to do many things, and it’s also had a huge impact on printed and mailed materials. Many people find that their magazines and catalogs are delayed or are no longer available.   

PAR’s Winter 2021 print catalogs were delivered to your home or office last week. However, we know that many of you continue to work from home or have restrictions on your mail and may not have been able to access them.   

Our new e-Catalogs allow you to conveniently browse our catalog pages from your computer or tablet 24/7.  See what’s new! 

Our Clinical Assessment Solutions catalog showcases the importance of wellbeing, offers solutions on how to stay safe during therapy sessions, and provides tips to overcome “Zoom fatigue.”  

Our School Assessment Solutions catalog helps you understand how trauma affects students, offers ways to assess the impact of trauma, and provides strategies to help you develop a trauma-sensitive environment.  

 Choose the catalog you need! 

As children return to school, many may exhibit signs of anxiety and stress. Your job is to find out whether these are existing issues or whether they are related to the pandemic and quarantine.

Help is here.

The Pandemic Anxiety Screener for Students–12 (PASS-12) is a 12-item checklist developed by FAR, FAM, and FAW author Steven G. Feifer, DEd, designed specifically to evaluate the impact of a pandemic on a child’s school-based functioning.

Related article: OUR STORIES: STARTING THE NEW SCHOOL YEAR

A parent rating form, it allows you to rate the severity of anxiety symptoms specific to the pandemic and quarantine and provides information to help school professionals make important decisions.

• Entirely digital, the PASS-12 is administered and scored via PARiConnect, our online testing platform, in about 5 minutes—for the combined price of just $1.
• Raw scores and percentiles are provided for quick and easy interpretation; follow-up with more comprehensive assessment is recommended if the total raw score falls within an elevated range.
• Intervention recommendations and resources are provided in the Score Report, and the free Technical Paper provides administration guidance.

To learn more or order, visit parinc.com/PASS-12. 

In the context of mental illness, the word “asylum” conjures, for many of us, some very negative images. We picture a scene with characters like the abusive Nurse Ratched from the movie “One Flew over the Cuckoo’s Nest,” or even worse, tragic true stories of the overcrowded, understaffed psychiatric hospitals of the last century where healthy, sick, disabled, and poor patients alike were locked away for years with no effective treatment or hope of release.

These images may be the reason that a JAMA viewpoint published last month has garnered so much attention: Bioethicists from the Perelman School of Medicine at the University of Pennsylvania are calling for a return to asylums for long-term psychiatric care.

At Penn, Dominic Sisti, PhD, Andrea Segal, MS, and Ezekiel Emanuel, MD, PhD, have been studying the current system for treating the chronically mentally ill and the evolution over the past half-century away from inpatient psychiatric hospitals. They observe that although the United States population has doubled since 1955, the number of inpatient psychiatric beds has been cut by nearly 95 percent to just 45,000—a very small number when compared to the 10 million U.S. residents who are currently coping with serious mental illness.

According to Sisti and his colleagues, the result of this trend has not be “de-institutionalization” but rather “trans-institutionalization.” That is, people with chronic mental illness are being treated in hospital emergency rooms and nursing homes at best, and more often receiving no treatment and living on the street. “Most disturbingly, U.S. jails and prisons have become the nation’s largest mental health care facilities,” say the authors, in a January 20 Penn Medicine press release. “Half of all inmates have a mental illness or substance abuse disorder; 15 percent of state inmates are diagnosed with a psychotic disorder…. This results in a vicious cycle whereby mentally ill patients move between crisis hospitalization, homelessness, and incarceration.”

As a solution, the authors propose a modern and humane asylum—but they use the word in its original sense, that is, a place of safety, sanctuary, and healing. In addition, they advocate reforms in the psychiatric services offered in such institutions, including both inpatient services, for those who are a danger to themselves and others, as well as outpatient care for those with milder forms of mental illness.

The proposal has been controversial, to say the least.  Some in the mental health community find the idea of a return to asylums misguided and even frightening. In her article called “Asylum or Warehouse?” author Linda Rosenberg, President and CEO of the National Council for Behavioral Health, asserts that although Sisti and his colleagues accurately describe the problems of the current mental health system, their solution is to “just simply lock some people up” and that “the simple solution offered, recreating asylums, is not helpful—it’s dangerous.”

Others have viewed the proposal in a more positive light. Christine Montross, a staff psychiatrist at Butler Hospital in Providence, Rhode Island and author of “Falling into the Fire: A Psychiatrist’s Encounters with the Mind in Crisis” wrote an op-ed piece in the February 18 New York Times in support of a move toward modern asylums.

“The goals of maximizing personal autonomy and civil liberties for the mentally ill are admirable,” says Montross. “But as a result, my patients with chronic psychotic illnesses cycle between emergency hospitalizations and inadequate outpatient care. They are treated by community mental health centers whose overburdened psychiatrists may see even the sickest patients for only 20 minutes every three months. Many patients struggle with homelessness. Many are incarcerated. A new model of long-term psychiatric institutionalization, as the Penn group suggests, would help them.”

What do you think? Are modern, reimagined asylums a potential solution for the chronically mentally ill, or has history proven that institutions cannot work? PAR wants to hear from you, so leave a comment and join the conversation!

 

Every day, police officers across the U.S. respond to calls involving people with mental illnesses. These individuals are often incarcerated, and nationwide jails hold 10 times as many people with serious mental illnesses as state hospitals, according to a report from Kaiser Health News.

“There are, shamefully, lots of people with public mental illness who are known to public systems, out there on the streets, very much at the risk of being victimized or engaging in conduct that could get them in trouble with the police,” says Robert Bernstein, president and executive director of the Bazelon Center for Mental Health Law, in an article in the online newsletter The Science of Us. When mentally ill persons are approached as possible perpetrators, the mental health system is failing, Bernstein says.

Michael Woody knows this scenario firsthand: on a call for the Akron, Ohio, police department several years ago, he encountered a 27-year-old mentally ill individual who threatened his life and ultimately committed suicide. This prompted him to question the small amount—just five hours—of mandatory mental health training officers were then required to take, and he pushed for more. Since then, he has become an advocate for training to help police officers de-escalate crisis situations involving the mentally ill. Today he serves as president of CIT International, a nonprofit whose primary purpose is to support mental health training for police forces across the country.

According to a recent FBI report, the expense to implement and maintain crisis intervention training (CIT) outweighs the cost of not establishing a program. Injuries to law enforcement personnel and individuals with mental illness as well as repeat calls for these issues are considerably reduced when CIT programs are in place which encourage officers to direct persons with mental illness to mental health-care facilities for treatment prior to issuing any criminal charges. This process reduces lawsuits, medical bills, and jail costs and improves the quality of life for the community, according to the FBI report.

Through the work of people like Woody and CIT International, police departments are beginning to take note and to require CIT. In San Antonio, Texas, police officers now take 40 hours of crisis intervention training, and the city has a six-person unit specially equipped to respond to 9-1-1 calls involving mental health disturbances.

The officers’ training helps them better determine whether people need to go to jail or a hospital or would be best served by being taken to the city’s Restoration Center. The centralized complex, across from the city’s homeless shelter, was built using cross-departmental resources to divert people with serious mental health illness from jail and into treatment instead. Among other things, it provides a space for police to bring arrestees to sober up, which saves them a costly trip to the emergency room. Together the CIT training and Restoration Center have saved the City of San Antonio and its police force an estimated $50 million over the past five years and at least $600,000 a year in overtime pay, according to the Kaiser Health News report.

According to new research conducted at Walter Reed Army Institute of Research in Silver Spring, Maryland, the proportion of soldiers using mental health services nearly doubled between 2003 and 2011. Furthermore, researchers found a small but significant decrease in the perceived stigma associated with seeking mental health services.

In 2003, only about 8 percent of soldiers sought mental health services. In 2011, about 15 percent of soldiers did so. Even with the increase in the number of soldiers seeking mental health help, researcher Phillip Quartana stated that two-thirds of soldiers with post-traumatic stress (PTSD) or major depression symptoms did not seek treatment between 2002 and 2011. More than 25 percent of active infantry soldiers from the conflicts in Afghanistan and Iraq, dating back to the beginning of the conflicts in 2001, met self-reported criteria for these diagnoses. While the number of soldiers seeking help has increased and the stigma associated with seeking mental health services has decreased, these results demonstrate that more progress is needed to increase soldiers’ use of mental health care services.

Researchers used data from active-duty personnel who completed Health-Related Behavior Surveys between 2002 and 2011. This study is the first to empirically examine trends concerning utilization of services and stigma across multiple wars.

The study was published online in the American Journal of Public Health.

According to a new report from the National Alliance on Mental Illness (NAMI), adults with serious mental health problems face an 80 percent unemployment rate, a rate that continues to become more dire over time.

In 2003, 23 percent of those receiving public mental health services had jobs; by 2012, only 17.8 percent did.

The survey reports that most adults with mental illness want to work, and 60 percent can be successful if they have the right support. However, only 1.7 percent of those surveyed received supportive employment services. Study author Sita Diehl says the employment problem has less to do with the workers themselves and more to do with the lack of organizations providing supportive services for individuals with serious mental illnesses. Due to decreases in funding, services have not been as available.

On a related note, people with mental illnesses are now the largest and fastest-growing group to receive Supplemental Social Security Income and Social Security Disability Income.

Unemployment rates varied greatly by state, with 92.6 percent of those receiving public mental health services in Maine being without jobs to 56 percent of those in Wyoming reporting they are without employment.

As those who work in the mental health arena know all too well, the stigma associated with mental illness often prevents people from seeking the help they need. Students at the University of Leeds in the U.K. chose to confront that stigma by sharing their personal struggles with mental illness in a powerful video. Directed by the university union’s welfare officer Harriet Rankin and featuring members of the Leeds “Mind Matters” mental health support group, the video has gone viral and is now being shared by major internet news outlets in the U.K. and the U.S.

The students’ message is very simple: You are not alone, and help is available. Please take a moment to view the video now!

https://www.youtube.com/watch?feature=player_detailpage&v=kYwyzkb67pA

 

According to a just-released statistical brief from the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, mental disorders were the most costly medical expenditure for those under 18 years of age during 2011, the most recent year for which statistics are available. More than 5.6 million children were treated for mental disorders at a mean expenditure of $2,465 each, for a total expense of $13.8 billion. In 2011, $117.6 billion was spent overall on the medical care and treatment of children.

The top five medical conditions that ranked highest in terms of spending included mental disorders, asthma ($11.9 billion), trauma-related disorders ($5.8 billion), acute bronchitis and upper respiratory infections ($3.3 billion), and otitis media ($3.2 billion). Although mental disorders affected the fewest number of children of the other top five medical conditions, they had the highest average expense per child.

In 2008, mental disorders ranked as the fifth most commonly treated condition; according to survey data, the expense per child has remained steady.

Nearly half the expenditures for mental disorders in children were paid by Medicaid.