This is the first in a series of articles that will address mental health and the healthcare professional.
Editor’s Note: Those who would like to seek help can visit the American Foundation for Suicide Prevention (https://afsp.org) and the National Institute of Mental Health (www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml), among others.
It’s one of the oldest (and most dangerous) adages related to the profession of healthcare: that those who take care of others do not take care of themselves. A major difference between today and yesteryear, however, is that there is increasingly mounting evidence that warns of the deleterious effects of the lack of appropriate self-health for licensed professionals without proof of significantly positive change to the working culture. Shifts may still exceed 8-10 hours. Staff shortages persist, as do the increasing rates of turnover, particularly among new professionals, factors that are said to negatively impact the caregiver’s physical and mental health in myriad ways. As studies have continued to show that chronic conditions such as obesity, depression and anxiety are affecting more providers today than ever before, the trending upward rate of these conditions among the caregiver population continues to worsen. Not coincidentally, as the likelihood of poor mental and physical health increase among caregivers, so too do the negative subsequent consequences for their patients, despite what may inherently be the providers’ best intentions for those in their care.
“Medical errors are the third-leading cause of death in America right now,” said Bernadette Mazurek Melnyk, PhD, RN, APRN-CNP, FAANP, FNAP, FAAN, chief wellness officer, dean and professor in the college of nursing at Ohio State University (OSU). The lead author of a recent national study on the connection that physical and mental health has on medical errors, Melnyk said her group’s study, published in the Journal of Occupational & Environmental Medicine, made a landmark discovery about the link between the caregiver’s depression and the patient’s health.
“Ours is the first study that shows depression in the nurses as the lead predictor of medical errors,” she said. “And depression was present in about 25 percent of our sample, which is much higher than the general population [rate], which, depending on the source is usually about 15 percent.”
To bring this all to a frightening full circle, caregivers who commit a medical error are more likely to experience the depression, the burnout, and to intentionally harm themselves up to the point of suicide. The “second victim” phenomenon, a term coined by Albert Wu, MD, director of the Center for Health Services and Outcomes Research at Johns Hopkins Medicine, to describe the profound distress that clinicians may feel if they are responsible for an adverse patient event, is a prime example of the emotional fallout that can affect any licensed healthcare provider involved in patient care. But the root cause of the clinician’s penchant to engage in poor self-care awareness does not stop there, especially on the mental health side.
“Stigma is still so high for mental health issues, especially if you’re a clinician,” said Melnyk, who also serves as vice president for health promotion and professor of pediatrics and psychiatry in the college of medicine at OSU. “The mindset of ‘I’m supposed to be helping everybody else, so how could I need that kind of help?’ persists.”
Longer shift work, certainly a telltale “symptom” of the clinician’s willingness to sacrifice their wellness to spend more of their time committed to their patients, is also a culprit of medication errors, further intertwining the dynamics. According to a 2015 study by Koinis et al, healthcare professionals are more prone to stress and professional burnout because they are responsible for human lives and their actions – or lack of action.1 The challenge for clinicians, on top of everything else, is recognizing when there is a serious problem to address for the betterment of their own health.
“It’s common for everybody at times to be ‘super stressed,’ to be a little ‘down,’ or to be anxious,” Melnyk said. “But if [those feelings]start to interfere with your functioning, that’s when you’ve got to get some help.” That interference of functioning often presents as an inability to think clearly, a pattern of disorganization and a lack of pleasure in things that the individual previously took pleasure in.
“You might become more irritable,” Melnyk said. “Many times, anger and irritability masks depression. And anxiety and depression usually underlies when people are very irritable or have frequent outbursts. One out of four people today are said to have a mental health problem, but less than 25 percent of these people get any treatment.”
According to studies cited by the American Foundation for Suicide Prevention, the most common cause for suicide is untreated or inadequately managed mental health conditions. The problem is exacerbated by an overall lack of awareness, not just among the individual, Melnyk said. “A lot of providers today still don’t screen for depression, even though it’s recommended by the United States Preventative Services Task Force that all adults be screened for depression in primary care,” she continued. “For those who do screen for depression, are they screening for suicide as well? A lot of people who commit suicide have seen their provider within the last month, studies show.”
There’s a bit of an onus on employers to help their clinicians be more proactive about their own healthcare before the situation becomes too dire, Melnyk said. It’s something that she’s willing to task the entire healthcare system with. “It’s much better to take a preventive proactive approach then it is to always try to manage something once it happens,” she said. “But we still live in a ‘sick care’ healthcare system, and that needs to change to a ‘well care’ system. We have to take care of the people who are sick, of course, but our whole approach to healthcare has to change to one that is wellness-focused regardless of what stage of illness that you’re in.”
The next article in this series will discuss how clinicians and their employers can build effective wellness programs.
Koinis A, Giannou V, Drantaki V, Angelaina S, Stratou E, Saridi M. The impact of healthcare workers job environment on their mental-emotional health. coping strategies: the case of a local general hospital. Health Psychol Res. 2015;3(1):1984.