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Ellen remembers the first time she needed mental health support after she had started her medical residency. “I was in a new state, and it was much harder to find a provider here than it had been in the past. I wasn’t in school anymore, and there wasn’t a clear-cut and easy way to access mental health care,” she says.
While it may seem like it would be easy for a doctor–who is surrounded by health care providers every day– to find a therapist, Ellen’s difficulty accessing care is common. While 36 percent of clinical health care workers in a recent survey by consulting group PwC reported symptoms of anxiety or depression as a result of COVID-19, only 12 percent said their employer had offered them new mental health benefits to help cope with the pandemic.
“There wasn’t a clear track to getting therapy,” says Ellen. “And then there was some language around seeking care that was a little interesting, because the hospital administration essentially said, ‘Perhaps you would like to use an external service because you wouldn’t want anyone to know your record, or your thoughts.’ And that almost made me more uncomfortable than if no one had said anything, because I would have just assumed everything was confidential, and they suggested it wasn’t.”
While the need for privacy is crucial in all forms of health care, Ellen has found it especially important as a physician herself. Many state medical licensing boards tend to ask open-ended questions about whether a doctor has sought mental health care treatment in the past, and many medical practitioners rightfully worry that they may encounter future issues with their license if they do seek help. These requirements vary by state, and can include questions like, “Do you have any mental or physical conditions and/or take any medications that might affect your ability to competently and safely perform your job?”
Additionally, an article published by the American Journal of Psychiatry shows that the consequences of accurately answering these questions can be substantial. The article notes that “Although state dependent, the repercussions of full mental health disclosure can include being asked to appear before state board examiners or to pay for a board-appointed physician examination.” Ellen says, “[The lack of privacy around my mental health information] made me feel really unsafe, and I ended up getting a primary care provider who was then able to refer me to a licensed social worker who does therapy outside of our network.”
These board regulations contribute to an understandable perception of bias against mental illness–and this issue is not just limited to physicians: Clara, a nurse at an East Coast hospital, confirms that this is the case. Having first sought mental health support as a child, Clara has always been open about her mental health needs, but has seen some professional consequences to her transparency. “I’ve faced a lot of stigma from my coworkers,” she says. “I learned that there were certain people I couldn’t talk around about my [mental health].”
Unfortunately, Clara’s situation is not unique. According to an article published in the Healthcare Management Forum, “Mental illness-related stigma…permeates the health care sector as a workplace. It has been described as a problem of culture, where staff are often discouraged to talk openly or seek help for psychological problems.” The article notes that this stigma is, among other things, grounded in the perception that people with mental health needs have difficulty performing tasks in the workplace.
When asked why she believes this stigma is so prevalent in her industry, Ellen says, “I think health care workers are really bad at taking care of themselves in a lot of ways. Oftentimes I would think, ‘If I were my patient, I would tell myself that it’s totally okay to need therapy, it’s totally okay to need medication.’ But personally, it took me a long time to say yes to medication.” Clara adds that her coworkers didn’t necessarily know how to respond to her clearly stated mental health needs. “I’d be in a depressive episode and people just didn’t understand me. They would go to my nurse manager and say, ‘She’s acting really weird, I don’t know what’s wrong with her, she’s not happy,’” she says. With 62 percent of nurses reporting being regularly burnt out, Clara felt the expectation to appear cheerful at work was unrealistic. “It’s not possible to be happy at work all the time. We’re stressed out, nursing is stressful,” she adds.
Bias against mental health issues and treatment is especially troubling considering the prevalence of reliance on self-treatment, low peer support, and increased risk of suicide among health care workers. The American Addiction Centers note that in 2013, nearly 70 percent of medical professionals reported having misused prescription drugs at least once in their careers, with opioid use being particularly common. And perhaps most alarmingly, physicians die by suicide at twice the rate of the rest of the United States population. These dire statistics are some of many that highlight the consequences of unaddressed mental health needs in the health care industry. COVID-19 has imposed enormous challenges to health care workers’ mental well-being, with 8 percent of physicians reporting thoughts of self-harm amid the pandemic.
The effects of unmet mental health needs in the health care industry are not just detrimental to practitioners themselves–they can be harmful to patients, too. Pre-pandemic, 15 percent of physicians who had noted existing feelings of depression said that their low mood might cause them to make errors they wouldn’t ordinarily make, while 44 percent of nurses also reported that their mental health affected their work performance.
Both Clara and Ellen agree that now more than ever, it’s essential to destigmatize mental health care-seeking in the health care industry. With 93 percent of the industry’s workers experiencing stress during the pandemic, it appears that COVID-19 will have long-lasting implications for the health care workforce. It’s crucial that health care organizations show they are taking care of their people, who already faced mental health issues ranging from depression to suicide before the pandemic. “We can’t keep thinking, ‘Mental health care is other people’s problem, but we don’t need it,’” Ellen says.
How can we better support health care workers who are struggling and considering seeking mental health care? Both Ellen and Clara had been in therapy before entering the health care workforce, which seems to have contributed to their understanding of the value of this care. When asked what advice she would offer coworkers who are struggling to manage their mental health, Clara says, “I would encourage anyone who is thinking about seeking help to get it. If you’re struggling with these issues, you need a professional who can actually guide you through that experience, or even get you on medication.” Ellen adds that talking about mental health will be key to breaking the stigma in her community of coworkers. “The more of us that talk about it and get care, the easier it will be and the better it will be. And it’s really hard to be on the side of it where I feel like it’s not normalized yet.”
While peer support and encouragement are vital pieces of the puzzle, employers have a key role to play here too: Instituting initiatives that create psychological safety. According to Lyra’s Director of Workforce Mental Health, Joe Grasso, PhD, “Evolving workplace culture starts at top management tiers–so sending a strong message that mental health is a goal for your organization is crucial. This can be done through initiatives like testimonials from leaders within health care organizations, the importance of normalizing and even prioritizing mental health issues, and open modeling of self-care behaviors among leaders and supervising staff.”
Creating opportunities for employees to share their mental health experiences, equipping them with resources to help each other through emotional distress, and encouraging an open and transparent culture of communication are also important ways to lessen the burden of stigma. However, even with enhanced support from health care employers, Grasso notes, “There are still structural and systemic problems that encourage health care professionals to feel reluctant to seek help. Choosing to seek care is ultimately a personal decision that is based on circumstances, but I suggest people always put their mental health first, and when in doubt, discuss their concerns about the professional implications of doing so with a trusted resource within their organization.”
Ultimately, all of these efforts can empower health care workers, both in their personal and professional lives. “Everyone struggles, and everyone needs help and support sometimes,” says Lyra therapist Sheryl Merrick. “It’s so important to know that you can ask for it, and to be able to do so in an environment that can be supportive of that.”
Learn more about the impact of mental health stigma on employee wellbeing in Lyra’s latest report on the severe mental health challenges faced by the health care workforce.
If you want help connecting with a therapist, 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 AUTHOR
Mariam Helmy is a content specialist at Lyra Health, where she develops, writes, and plans content for the Lyra blog. Mariam has a background in writing and psychology, and has a Masters degree in educational content from the University of Cambridge.