Safeguarding The Mental Health of Health Care Workers
By Louise Bradley
Health care workers are the lifeblood of Canada’s health care system. Yet, as a workforce, their health and wellness is under threat. Many report a wide range of health conditions related to workplace stress.
According to the Canadian Medical Association, anxiety, depression, substance use and suicidal thoughts comprise the daily reality for far too many health care workers. Forty per cent of physicians report advanced stages of burnout according to a CBC Survey. And Nancy Casselman, the director of Human Resources and Organizational Quality, Safety, and Wellness at Toronto East General Hospital, stated health care workers are 1.5 times more likely to be off work because of illness or disability than people in other sectors.
These numbers are concerning by any measure. As a nurse and former hospital administrator, I have been sounding the alarm on this critical issue since I began my tenure as president and CEO of the Mental Health Commission of Canada (MHCC) six years ago.
Health care workers face significant on-the-job pressures, experience heavy workloads and describe a lack of time and resources to adequately do their jobs. At the teaching hospital where I used to work, I spent long nights walking the halls and taking the pulse of my staff. Once we had built trust, I heard the truth about the effects of cutbacks, lay-offs and belt-tightening.
Increasingly, health care workers are asked to do more with less, work longer hours and contend with shift work and rapidly changing practice environments. This reality is unlikely to change, and we must therefore develop coping mechanisms. If we fail to do this, these stressors—combined with inevitable compassion fatigue—will form a perfect recipe for absenteeism, presenteeism and increased staff turnover.
Stamping out stigma
The first hurdle we have to clear—as a society and as a profession—is the stigma surrounding mental health, which breeds insecurity and fear of judgment. Sixty per cent of people with a mental health problem or illness will not seek help for fear of being labelled according to a Statistics Canada Canadian Community Health NSurvey. It is up to each individual health care workplace to stamp out stigma, and in doing so to allow employees to search out the support they need.
“Understanding Stigma” is a free online course (available at https://moodle9.camhx.ca/moodle), the development of which was funded by the MHCC, which aims to help improve the interactions between health care providers and people seeking treatment for a mental health problem or illness. It is a great tool to become more educated on the topic and banish common misunderstandings. It is also a way to challenge our own prejudices and replenish our well of compassion.
Once we have addressed stigma, we can begin to fully embrace the importance of promoting the psychological safety of health care workers. It is in everyone’s best interests to create mentally strong health care workplaces. They are the cornerstone of a well-functioning health system.
In short, health care workers cannot provide effective patient care if they are mentally unwell. Stress and emotional exhaustion can lead to interpersonal conflict and medical errors—not to mention the dollar value of lost productivity and the potential for poor patient satisfaction scores. It is no surprise that, in light of this compelling evidence, health care organizations are quickly catching on to the benefits of promoting psychological health at work.
In fact, many health care organizations have taken the lead when it comes to putting the health and wellness of their workers at the top of the agenda. For example, some are choosing to implement the National Standard of Canada for Psychological Health and Safety in the Workplace (known as “the Standard”), which the MHCC is very proud to champion.
The Standard is a set of guidelines, tools and resources focused on promoting employees’ mental health and preventing harm caused by workplace factors. Soon after its publication, HealthCareCAN, the national voice of hospitals and health care organizations, released a policy statement encouraging its members and all health stakeholders to commit to implementing the Standard.
Among the 40 organizations that participated in the MHCC’s three-year Case Study Research Project—launched in 2014 and designed to better understand how workplaces across the country were implementing the Standard—18 (45 per cent) are in the health care sector. Why such a high number? In part because the core mandate of organizations in the health care sector is to provide evidence-based care for all Canadians. This generates a sophisticated awareness of the importance, nature and treatment of physical and mental health issues. As we learned from the Case Study Research Project, an overwhelming number of organizations are motivated by good intentions—they cite “doing the right thing” as their primary incentive, over and above any potential tangible dividends.
Furthermore, health care organizations are primarily publicly funded, and thus accountable to provincial and federal governing bodies. This responsibility facilitates the early adoption of relevant policies and practices, such as the Standard. Finally, health care organizations are driven by cross-disciplinary work teams of highly trained staff from different professions. This provides a rich forum for dialogue on how to create the optimal work environment.
A blueprint for change
There is little doubt that the Standard offers an effective blueprint for organizational change. Take Michael Garron Hospital, formerly Toronto East General. Since implementing the Standard, the hospital has reported a seven per cent decrease in overall health care costs and four fewer days absent among employees. Impressively, the hospital’s overall staff engagement scores have significantly increased, and this is leading to improved patient satisfaction and overall quality metrics.
The even better news is that Michael Garron is not using a proprietary formula to make these changes. The capacity to effect this kind of change is in the hands of every leader, in every sector, in every organization across the country.
In any given week, 500,000 Canadians call in sick because of a mental health problem or illness. If you recognize yourself among this number, it is time to speak up and seek help. There is nothing shameful about coming forward with depression, anxiety or any other mental health concern.
To leaders, I implore you to consider how you can improve the mental health of your employees. Speak openly and honestly about the deleterious effects of untreated mental health problems, and reinforce that seeking treatment will not result in job-limiting action or other reprisals. We do not shun our colleagues with cancer or diabetes. We support them on their journeys and celebrate their successes. It is high time we acknowledged that those managing a mental illness and living in recovery deserve the same.
There are steps you can take, as a leader or health care worker, to make your health care setting psychologically safer.
References available upon request.
Louise Bradley, MS, RN, CHE, is the president and CEO of the MHCC (mentalhealthcommission.ca). Her platform is to urge increased mental health funding and highlight the need to work inclusively to address the mental health needs of at-risk populations.
Take action: Start now
Here are some actions your health care organization can take to get started transforming your workplace.
• Download the Standard for free: mentalhealthcommission.ca/English/issues/workplace/national-standard.
• Look at HealthCareCAN’s position statement calling on its members to implement the Standard: http://healthcarecan.ca/wp-content/themes/camyno/assets/document/PolicyDocs/2015/HCC/EN/PsychHealthWork_EN.pdf.
• Demonstrate visible, sustained commitment and leadership to psychological health and safety.
• Review your data/information to assess your workplace.
• Offer training to managers and supervisors to build the necessary competencies and skills.
• Offer training to staff to build awareness.
• Identify the key internal resources and policies that can support staff, and communicate them widely.
• Mentally unhealthy workplace settings are threatening to drain the lifeblood from Canada’s health care system. It is up to all of us to stem the tide.