Mar 8, 2021
By The Lyra Team
Over the past year, the pandemic has underscored many long-entrenched socioeconomic disparities in the United States. Few systemic inequities have emerged more starkly than the disproportionate lack of support for women and female-identifying individuals in the workplace. In the last year alone, women have left or been pushed out of the workforce at almost seven times the rate of their male counterparts. This and other startling statistics have illuminated the lack of systems in the U.S. needed to support women’s mental health during public health and economic crises like the pandemic.
“I knew the systems were failing us,” says Danielle Cottonham, PhD, Clinical Manager of Diversity, Equity, Inclusion, and Belonging at Lyra. “But I’m still shocked by the lack of urgency or care to try to do something different, especially given that there is so much data showing that women are suffering.”
In honor of Women’s History Month, the Lyra team is taking a closer look at some of the challenges that women–a term we here use to mean all individuals who identify as female–face today, and what employers can do to mitigate some of the impact on women’s mental health. In this first part of our series on women’s mental health, Dr. Cottonham, alongside Lyra therapists and Clinical Quality Leads Megan Kelly, PsyD, and Elizabeth Rojas, PhD, discuss key issues affecting working women’s mental health and wellness.
Cognitive load is defined as the mental energy spent on problem-solving and coping with stress. Over the last year, women–especially working mothers–have taken on a substantial increase in cognitive load, research shows. This may be because many women are the primary caregivers in a family–in fact, according to the American Psychological Association (APA), 68 percent of family caregivers are women. With 43 percent employed full-time, women in the U.S. are managing a lot of moving pieces, which can quickly lead to burnout.
Research shows that the pandemic has also exacerbated the unequal division of labor prescribed by traditional gender roles. “Women have multiple roles with COVID-19,” Says Dr. Rojas, “They have to be a wife, partner, and a mother–and also a full-time worker. Among my clients, I’ve noticed that men seem to be assuming that the women in their lives will take on the role of primary caretaker. Men have very much fallen into their expected gender roles: ‘I work, so you have to take care of the house and kids so I can work.’ My female clients don’t necessarily notice that this is a problem, and are almost conditioned not to complain about it.”
This means that the responsibilities traditionally placed on women –as managers of the homespace, including child care, elder care, and domestic care–have grown substantially. What’s more, many women must also work a second shift–handling most household and child care responsibilities after a full day of paid work–a disparity that has only become clearer as the pandemic continues.
Additionally, paid domestic workers–many who are women of color–have been severely impacted by the pandemic; the National Domestic Workers Alliance (NDWA) found that less than 34 percent of care workers received their stimulus checks. This is partly because these workers are responsible for labor that is difficult to perform while observing social distancing protocols, and also due to the lack of federal and state security systems in place to support them. These care workers–who, according to the NDWA, “are the backbone of our economy and our families”–have not only lost jobs and income, but are no longer there to relieve the growing cognitive load impacting many other working women.
The pandemic has also made clear that institutional systems like–more accessible child and healthcare benefits–are not in place to support working women during this type of crisis. This is an example of institutional betrayal, defined by psychologist Jennifer Freyd as the “wrongdoings perpetrated by an institution upon individuals dependent on that institution,” and includes failure to respond to crises affecting these individuals.
As a result, many women feel as though it’s their fault when they are unable to perform in their roles as mothers, partners, or employees.“I’ve seen clients internalizing their flaws, but not acknowledging the fact that the institutions we live in are not set up to care for caregivers or people who have been put in the position of being a caregiver,” says Cottonham. “I hear clients make statements like ‘I didn’t get a promotion because I had to take care of my kids,’ but it’s ultimately an unfair choice to have to make.”
Similarly, Rojas notes she has seen clients and employees resign from their jobs because their child care has fallen through, or they’ve gotten sick and exhausted all of their leave options and still had to care for their families. “My clients find themselves overwhelmed beyond capacity and blaming themselves for it–because their attention is constantly divided. It doesn’t feel like this dividedness is coming up as often for my male clients; they talk about the fact that their partners are struggling, but don’t really understand how or why. It’s made it clear that even well into the twenty-first century, women still can’t put a job or a career before their families.” She adds, “It’s almost impossible to balance this type of pressure.”
Amid ongoing racial injustice, employers today want and need the cultural expertise of Black women–but they aren’t necessarily paying them for their contributions. According to Cottonham, “Intersectionality and gendered racism are essential to this topic. Because you’re a woman, people may ask you to do more labor and pay you less than they would a man. Simultaneously, women of color, particularly Black women, are holding the weight of educating their peers on racial injustice, which can be an emotionally triggering burden to bear.”
Kelly says she has observed that “Dominant culture is jumping on the bandwagon to ‘uplift’ Black voices, but not actually listening to what they need.” Black mothers, for example, are still three times more likely to die in childbirth than their non-Black counterparts, and Black, Indigenous, and People of Color (BIPOC) populations have been disproportionately affected by COVID-19. These staggering statistics indicate a desperate need for systemic change, but one that isn’t being adequately addressed by the health care system as a whole, despite “uplifted” voices.
This is evidenced by the fact that women of color are hit hardest by pandemic joblessness, but that government stimulus policies do not necessarily help, as they lack solutions for racial economic disparity. All of these disproportionate pressures put additional strain on Black women, as well as many women with intersectional marginalized identities–for example, transgender Black women or disabled Latinx women–both at work and outside of it. This results in mental health impacts like greater risk of depression and anxiety.
Women have also been substantially impacted by isolation during the pandemic. “Women can’t have supportive communities in the same way during COVID, making them more susceptible to depression, anxiety, and burnout, and they’re not necessarily finding that support network through work,” says Kelly. While virtual communities for women that existed since pre-pandemic days have been helpful, the networks that come organically from the workplace and in-person interactions are now much harder to build and access due to social distancing protocols.
Meanwhile, employee benefits aren’t making up for these disbanded communities. According to Kelly, “Workplaces are not using the right language to support women’s mental health.” While something like a maternity or mental health benefit may initially seem like a reasonable alternative for these frayed communities. Kelly notes that “A lot of these benefits are put in place to increase productivity rather than to provide for the wellbeing of the individual using them. That’s especially clear in benefits offered to women.” This can be seen with maternity benefits, which focus on providing helping women go back to work–and not on a new mother’s wellbeing. This puts pressure on women to return to work prematurely, or in some cases, to not use their benefits at all.
While there is no doubt about the need for more support for women both in and out of the workplace, there are actionable steps that organizations can take to account for these systemic inequities. According to Dr. Kelly, “COVID-19 is bringing to light that all of this investment in mental health may be where some of the solutions lie.” By providing employees with mental health benefits, employers can make a substantial difference in the experiences of women in their workforce. In our next post, the Lyra Team examines ways employers can create a safe and supportive environment for their female employees, even in the context of the pandemic.
If you’d like help connecting with a therapist or mental health coach, Lyra can assist you. You can get started today if Lyra is offered by your employer. Sign up now.
The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
ABOUT THE CONTRIBUTORS:
Danielle Cottonham is a licensed psychologist in California and serves as the Clinical Manager for Lyra Health’s Diversity, Equity, Inclusion, & Belonging initiatives. Her clinical and research expertise include: PTSD and co-occurring substance use disorders, race-based traumatic stress and the impact of racial discrimination on mental health in the Black community, and culturally informed evidence-based practice. Dr. Cottonham’s work is rooted in her experience as a Black woman who was born and raised in southern Louisiana. She has a passion for destigmatizing mental health in minority communities and providing safe spaces that promote connection, authenticity, and healing.
Megan Kelly is a Clinical Quality Lead with our Blended Care Therapy program and contributes to clinical quality and training development. Prior to joining Lyra, Dr. Kelly maintained a private practice in the San Francisco Bay Area and was clinical faculty at the Stanford University School of Medicine as a member of the comprehensive Dialectical Behavior Therapy (DBT) Team. She specializes in maternal mental health, women’s mental health and trauma. She received her Doctorate of Psychology from the PGSP-Stanford PsyD Consortium.
Elizabeth ‘Liz’ Rojas, Ph.D. is a clinical psychologist and serves as a Clinical Quality Lead and therapist at Lyra Health. Dr. Rojas oversees the clinical quality and training development for the Blended Care Program. She specializes in treatment of PTSD/trauma and co-occurring addiction and personality disorders. She earned her doctoral degree in Clinical Psychology from the University of South Florida and completed her internship and postdoctoral fellowship training at Veterans Affairs Healthcare System Consortiums in California. Prior to joining Lyra she served as lead clinical psychologist for the Substance Abuse Residential Rehabilitation Program at Palo Alto VA. She currently resides in San Diego, CA with her kitty, Granny Mushroom.