Stigma drives mental health of healthcare workers into the shadows
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?
Javeed Sukhera, MD, PhD, FRCPC, Associate Professor of Psychiatry/Paediatrics, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University.