Under pressure – how can we better protect health professionals from burnout?

Stressed hospital consultant
Photo: REX/Monkey Business

NHS England’s announcement of a new mental health support scheme for doctors has put the pressures faced by health professionals firmly in the spotlight. A recent conference of the British Psychological Society and Society of Occupational Medicine looked at how health professionals can be better supported to avoid burnout, exhaustion and stress, as Ann Caluori reports.

Back in October, the British Psychological Society’s Division of Occupational Psychology (DOP) and the Society of Occupational Medicine (SOM) held their second annual mental health event. This year the focus was: “Health professionals under pressure: avoiding burnout, exhaustion and stress and caring for the care givers”.

The event was timely. Just three days earlier, NHS England chief executive Simon Stevens had announced national funding for a new mental health support scheme for doctors working in the NHS.

About the author

Ann Caluori is communications and events manager at the Society of Occupational Medicine

This announcement coincided with the release of a report commissioned by The Louise Tebboth Foundation (LTF) and SOM, carried out by Professor Gail Kinman and Dr Kevin Teoh, What could make a difference to the mental health of UK doctors? A review of the research evidence.

The report detailed evidence that UK doctors were at greater risk of work-related stress, burnout and depression and anxiety than the general population, as highlighted in the December edition of Occupational Health & Wellbeing.

Dr Mike Isaac, consultant psychiatrist and first speaker at the DOP/SOM event, discussed mental ill health as a challenge for health professionals. He considered some of the more common mental health problems in the workforce, and spoke about conditions in the workplace that could lead to poor mental health, such as bullying and harassment.

Dr Isaac also discussed perception and the common “isms”, such as racism, ageism, sexualism. These -isms are very prevalent. Shockingly, 90% of transgendered adults have reported experiencing harassment at work.

Image of ‘invulnerability’

Mental health seems to have recently emerged from the shadows, especially in light of the royalty-backed Heads Together campaign and the newly launched Mental Health at Work gateway. However, stigma still plays a large role in reluctance to seek help at work. In a “caring” profession, where it can feel as if you are supposed to be capable, invulnerable, and to an extent not human (or above human problems) this stigma can often feel overwhelming.

Dr Isaac pointed out that, when we are struggling with mental health, it can be difficult to find a means by which to share this struggle with others. It is important for OH professionals to recognise this, and to recognise that health professionals are subject to the same conditions and the same disorders as everyone else.

Professor Gail Kinman spoke next, focusing on the findings of the LTF/SOM report and what works in terms of interventions. And interventions are clearly needed, as the report showed:

  • Stress. A 2017 BMA study found that 50% doctors were unwell due to stress. A 2017 NHS survey found that circa 35% of consultants and trainees were unwell due to stress.
  • Burnout. High risk of emotional exhaustion, GPs (74%). Trainee GPs are at high risk, but 50% lack awareness, not recognising their own symptoms or having insight into their own state of mental health.
  • Common mental disorders (CMD). The suicide risk is two to five times higher than the general population, with women and GPs at the highest risk.

Workload is a risk factor, as is the intensification of the job and the increase in complexity and lack of control. Change fatigue is an area that warrants more investigation: it is possible to have so many changes imposed on you that you become resistant to changes that are positive.

Behaviours such as poor self-care, self-medication and the idea of self-sacrifice are compounded by a stigmatisation of help seeking. Different specialties might have different problems, but organisational factors are seen to have a greater impact than occupational factors.

When seeking solutions, evidence-informed interventions are crucial – these should involve public policy, the organisation and the individual. An “emotional curriculum” is required from recruitment to retirement. Demands must be reduced, and we must work to build supportive working cultures that encourage help-seeking.

I asked Professor Kinman for some points of guidance for OH professionals working in the area of healthcare and mental health. She said:

  • “Make sure that the support that is available for mental health and stress management is widely publicised and accessible. Encourage people at all levels of the organisation to attend, especially senior management – this will help reduce the stigma.”
  • “Encourage people to prioritise self-care and recovery – ‘putting on their own oxygen masks before helping others’ will help them avoid the burnout that is endemic in some types of work, such as health and social care and education.”
  • “Reinforce the message that long working hours do not lead to better job performance – responding to emergencies at work is fine, but long working hours will impact on health and increase the risk of burnout and withdrawal.”
  • “Be aware of the risks of presenteeism for health and job performance over the long term – encourage people to take the time off that they need to recover from illness.”
  • “Mindfulness can certainly be useful for wellbeing and effectiveness at work – several high-quality apps are available, for example Headspace and Buddhify.”

Dr Caroline Elton, a chartered psychologist who specialises in complex career counselling, was the final speaker of the day. To understand the psychology of the healthcare professional, Dr Elton drew a comparison to motherhood.

There is something about being tasked with caring for others that causes us to draw upon our own experiences of being cared for. When new doctors start taking responsibility for patients they need to feel supported by those who are more experienced than they are.

Unfortunately support for transitions into clinical practice can be poor. Dr Elton looked to the New Zealand Model for a possible solution, where medical trainees have a “trainee intern” year and work as apprentice first-year doctors, paid at 60% of a first year doctor’s salary.

At the end of the year most feel prepared to be a doctor and first-year doctors scored in the normal range for depression and anxiety. Perhaps the reason this seemingly successful model has not been adopted more widely is cost.

Make it about teams, not just individuals

In terms of an overarching solution, Dr Elton argued that we must move away from the idea of the wellbeing of healthcare professionals being primarily an individual issue of resilience, or lack thereof.

The emotional wellbeing of the healthcare professional should be approached in the same way that we approach infection control at every level of healthcare (washing hands after examining patients; national policies for pandemic control and so on).

It should be viewed as an issue for the teams in which the individuals work, the organisations that these teams exist within and within the NHS as a whole, instead of simply an issue of individuals.

Only by viewing the emotional wellbeing of individuals as a multi-level systemic issue can significant improvements occur. This is as per the approach of Stanford professor Tait Shanafelt, who has identified nine drivers of burnout in doctors, for example control and flexibility over work, and mapped them against individual, team, organisation and national factors.

After her presentation, I asked Dr Elton for tips for OH professionals dealing with the mental health of healthcare professionals. This is what she had to say:

“The more doctors I talk to about the pressures they experience at work, the more I am struck by the power of connectedness – both within and beyond work. So if I had to give one tip to OH professionals it would be to ask the doctor about their relationships at work, and who can they turn to for support – and also about their relationships beyond work, and who supports them in their personal life.

“If it emerges from these questions that the doctor is poorly supported within and/or beyond work, the OH professional can work with the doctor to think about potential sources of support that they could turn to.”

The afternoon closed with a panel discussion, chaired by SOM chief executive Nick Pahl, which saw the three speakers joined by occupational health advisor Jane Boulter and Dr Rebecca Tory, a former colleague of Louise Tebboth.

Dr Torry explained that, after the suicide of her colleague and friend Louise Tebboth, little support had been given to the practice. It had fallen to Dr Torry and her fellow doctors to notify the practice staff of Louise’s suicide before they arrived for their next shifts. It was also left to them to plan and discuss how to present the news to patients and to organise memorial events.

Dr Torry described how dealing with patients’ emotions, while trying to manage her own grief and distress, had been emotionally draining.

Jane Boulter, an OHA with more than 20 years’ experience, shared with the room that, despite working in OH, she had only acknowledged her depression in the past two years. Nick Pahl suggested that there was an opportunity for OH psychologists to be change clinicians.

Dr Torry, who has extensive experience as a GP trainer, stated the need for assistance for trainees as well as GPs. Schemes such as Tea and Empathy, Take Time, the NHS Practitioner Health Programme and DocHealth were mentioned.

Overall my takeaways from the day were the need to talk more about mental health at work, to break through the stigma, and to raise awareness of the programmes that already exist to help those in need. Taking a wider perspective, and perhaps more problematically, it is also evident that the systems in which healthcare professionals work play a huge part.

References

NHS to prioritise doctors’ mental health, NHS England, 5 October 2018, https://www.england.nhs.uk/2018/10/nhs-to-prioritise-doctors-mental-health/; NHS England extends mental health support for doctors, https://www.personneltoday.com/hr/nhs-england-extends-mental-health-support-for-doctors/

Kinman, G, and Teoh, K. “What could make a difference to the mental health of UK doctors? A review of the research evidence”. Society of Occupational Medicine and The Louise Tebboth Foundation, September 2018. Available online at:
https://www.som.org.uk/sites/som.org.uk/files/What_could_make_a_difference_to_the_mental_health_of_UK_doctors_LTF_SOM.pdf

Heads Together, https://www.headstogether.org.uk/

Mental Health at Work gateway https://www.mentalhealthatwork.org.uk/?ctaId=%2Fworkplace%2Fmental-health-at-work-gateway%2Fslices%2Fintro%2F

Tweed, M J, et al. “How the trainee intern year can ease the transition from undergraduate education to postgraduate practice”, The New Zealand Medical Journal, 16th July 2010, Volume 123 Number 1318, available online at: https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2010/vol-123-no-1318/special-series-tweed

Tea and Empathy, Facebook group, https://www.facebook.com/groups/1215686978446877/

Take Time, https://www.yorksandhumberdeanery.nhs.uk/learner_support

NHS Practitioner Health Programme, http://php.nhs.uk/

DocHealth, http://www.dochealth.org.uk/

3 Responses to Under pressure – how can we better protect health professionals from burnout?

  1. Avatar
    Harold A Maio 4 Jan 2019 at 5:55 pm #

    … However, stigma still plays a large role in reluctance to seek help at work.

    I believe you miss the point, it is teaching stigma that is the culprit. Why do we do it? Who knows. Perhaps out of ignorance, or viciousness, or out of habit.

    Whatever our motivation, we can stop. You can stop.

    Harold A Maio

  2. Avatar
    Jane Boulter 6 Jan 2019 at 1:24 pm #

    In addition to the references provided in Ann’s piece, can I also signpost your readers to the Time To Change website. Their Time To Talk Day is on 7th February. I worked with the SOM and Charlie Waller Memorial Trust to publish the leaflet, Looking After Your Mental Wellbeing:A guide for Occupational Practitioners. This is available on the SOM website. I would signpost anyone, who deals with common mental health conditions, whether at work or non work, to this leaflet.

  3. Avatar
    Russell Childs 11 Jan 2019 at 1:10 pm #

    Excellent article. So very true and some great advice.

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