Often, those who go into behavioral health are ideologically driven and passionate about their mission. Motivated by a sincere desire to help others, compelled to be of service, and inspired by the opportunity to witness healing in those who experience struggles can be a strong drive. The fact is, it’s an honor to not only be present for the vulnerability of the human experience, but to be relied on and trusted as a source of growth and strength. In addition to this, are the realities we are seeing today, as the amount of people in need of help and support climbs while access to care does not, and as the threats to our mental health and well-being may be at a peak.
Not Enough Care for Caregivers
Care providers can be sacrificial, at times forgoing their own peace of mind for the sake of the job. Triage situations, urgent crises, timely interventions, and the overall immediate nature of working in mental health requires a certain level of adaptability and presence. There are obviously many different layers in this field, some more acute than others, but it is undeniable that showing up for others is a requirement and the always-on approach can be taxing for anyone. Hence, helping others is also necessarily about helping ourselves. Sometimes, easier said than done, especially at a time when the data reveal some hard facts about the field.
We assembled some statistics to share along with some solutions—thinking globally, acting locally. And yes, spoiler alert, going outside is on the list. Coming from the healthcare space, as some of us served for decades in mental health and substance use treatment, this topic is not just near and dear to us, it’s critical. We’ve all witnessed burnout firsthand, as colleagues go through stress and overwhelm, working all hours, tirelessly to help others, and sadly, we’ve lost peers who were unable to ask for help before it was too late. The aspiration is to continue to uplift those who are ending the tired tropes of positioning practitioners as infinite superheroes (they’re heroes, don’t get us wrong, but they also deserve to be able to be human and treated humanely). Embracing our community of healers with compassion and healing is where we begin.
Mental Health Stats in Healthcare Workers
Working in healthcare can mean long hours, coping with emotionally charged situations, and high energy demanding scenarios that are often a matter of life or death. In mental health care and substance use treatment services, the work can also be challenging, especially at a time of mental health crisis that is more pressing than perhaps ever before—the stakes are high.
Covid shone a light of concern for health workers and their well-being, finally, after an unprecedented period of unacceptable conditions. But the concerns didn’t stop once the pandemic wound down. Research published in 2023 studying psychiatric issues in frontline health workers reveals that those in healthcare are still experiencing increased psychological problems and summarized that this population is more resistant to seeking care, when needed, for reasons such as stigma, access to care, insurance plans that don’t cover what they need—the list goes on.
According to the American Hospital Association, a national nonprofit that serves medical communities, providers, and patients, a study of behavioral health in healthcare workers found:
…that 93% of health care workers reported stress, 86% reported anxiety, 77% reported frustration, 76% reported exhaustion and burnout, and 75% said they were overwhelmed. Yet just 13% of front-line health care workers say they received behavioral health services.
Behavioral health workers, in particular, report, as summarized in a Medscape survey shared, that the country is still undergoing high rates of burnout among medical practitioners, including 42% of psychiatrists and mental health professionals.
The Mental Health of Mental Health Pros: The State of the Union
The general data on mental health in the US overall is the reality of what these providers are facing every day. Here’s a snapshot of stats that reflect the state of our union with numbers from SAMHSA.
· 1 in 5 U.S. adults experience mental illness each year
· 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year
· 50% of mental illness begins by age 14, and 75% by age 24
· Suicide is the 2nd leading cause of death among people aged 10-14
Among U.S. adults who received mental health services:
17.7 million experienced delays or cancellations in appointments
7.3 million experienced delays in getting prescriptions
4.9 million were unable to access needed care
Rural areas see a significant decrease in access to care, with less behavioral health professionals, which impacts the ones who are seeing clients. According to statistics from the National Alliance on Mental Illness, 22.8% of U.S. adults experienced mental illness in 2021 (58.7 million people).160 million people live in a designated mental health professional shortage area.
Mental Health Worker Burnout
As we know only too well, mental health and addiction challenges can be acute and, at times, life-threatening. Further, those who are drawn to careers in healthcare and the mental health field are often caregivers by nature, who may tend to put themselves last as they serve their clients, patients, and respective teams. This can deplete the individual, leaving the well of resilience dry. As the data reveals, mental health diagnoses are at an all-time high, there are not enough providers for those who seek treatment, and the burnout rate of providers is on the rise. According to the American Psychological Association, practitioners, are:
“… seeing more people than years prior and feeling the pressures of this increased demand. In response to a survey in September 2022,1 38% of US licensed psychologists reported that they were working more than they did before the pandemic. Faced with the increased workload, the percentage of psychologists who reported not being able to meet the demand rose from 30% in 2020 and 41% in 2021, to 46% in 2022. Almost half (45%) reported feeling burned out in 2022, with similar levels reported in 2020 (41%) and 2021 (48%)”
Following the concentrated time indoors and extended confinement—during and after the pandemic as many worked or attended school from home—mental health conditions became more apparent and at times, exacerbated. Behaviors that may have been unconscious or ignored were no longer hidden, and now exhibited as obvious or acute. In addition, the period accentuated stress and subsequent anxiety, depression, and resulting pathology for many.
What made things more challenging for providers included unprecedented heavy caseloads, excess administrative duties, shortages of staff, physical exhaustion, isolation, and all the resulting emotional effects. This has seen many leave the field of healthcare altogether.
Are We Helping the Helpers?
Clinicians, peer supports, utilization review teams, recovery coaches, therapists, and outreach professionals often work long, and at times, random hours, due to immediate needs or emergencies. Clients are experiencing a myriad of concerns, including suicidal ideation, self-harm, alcohol abuse, substance use disorder, trauma, self-harm, and the daily output and intentionality of creating a safe container for clients to process and heal can take a toll. The work is deeply rewarding but can also leave practitioners depleted, in need of their own care.
Those on the frontline go through times when they need to be truly offline, to avoid fatigue and emotional exhaustion. Along with this, many who devote their lives to helping others have been in similar situations. They may have their own experience with self-destructive behaviors and chose the path following their own journey to healing, or they’ve gone through similar with a family member or someone they love. This background means one must enact vigilance about their well-being as a mental health or addiction professional since the compulsive nature found in many self-harming patterns can cause damage. Work can become another addiction.
“Mental Health providers stress the importance of holistic balance and self-care to our clients all the time, yet we are often the last ones to heed that recommendation. We want to be there for our clients whenever and wherever, but we need to tend to our needs, recharge, and reenergize, as well. Burnout, vicarious trauma—these things are real, and prioritizing attending to our own well-being is something that gets a lot of verbal attention and social media hype, but sadly doesn’t get put into action nearly enough. This is why we’re on a mission to disrupt the mental health field with direct acknowledgement, articulation of, and most importantly care for, the caregivers.”—Josh Flaherty, LMSW, AR Executive Director
There are, of course, providers and mental health workers who diligently maintain balance, self-care, unplugged time, and ensure they hold strong awareness to monitor themselves in the field. Through structured practices, they can fill the well and ensure they have what they need to sustain in a demanding field. But it’s not always easy and during a time when there are not enough skilled practitioners for the increasing numbers seeking treatment, burnout is real.
“Often, we celebrate people who sacrifice themselves, validating and reinforcing an unhealthy perception and subsequent unsustainable dynamic. The purported high ground around therapists as endless givers, always putting others first, may be an underlying cause for institutionalized lack of boundaries and acceptance of this exhaustive pace. For people in the mental health industry complacency can inadvertently tax this also vulnerable population, exploiting the dedication and commitment of those in the field. We are all participants and have an opportunity to change the narrative, both as industry leaders, and as peers in recovery.”—Rourke Weaver, Community Relations, Adventure Recovery
As we know, the first step in solving any problem is recognizing there is one. Then, the next is taking action to solve it without getting stuck in blame or dichotomous cycles of thought. We can be the change.
Mental Health in Behavioral Health, Unplugged
Getting out of the office and away from the daily routine can go a long way for mental health outcomes, creating deeper capacity for self-regulation, connection, and resilience. Data reveals that nature is medicine, providing a much-needed respite for rest, restoration, and renewal. When we are in nature we find a direct positive impact on our physiology and state of mind, leading to a potentially lower heart rate and blood pressure, and decreased levels of the stress hormone, cortisol. When we combine time outdoors with movement and adventure, the patterns within which we may at times feel stuck, are disrupted. Fresh air, fresh water, and new sights and sounds bring us back to our senses, invigorating and increasing our capacity to manage with a more positive outlook. This is documented, including in one study examining nature-based interventions for essential workers which demonstrated a clear healing effect on psychological health that resulted in less anxiety and generated a tangible feeling of connectedness.
“We found that participating in nature-based activities significantly decreased stress, especially cognitive anxiety and somatic anxiety, which indicates that such activities are psychologically beneficial for people experiencing high levels of stress.”
The Natural Mental Health Solution
As organizations, teams, and individuals feel the increase in awareness and the mounting growth of demand, we can examine the ways in which we support our providers. Further, we can create opportunities for practitioners to fill the well, through holistic approaches that treat the individual, rather than assume they must be an automaton. To bolster the mental wellbeing of our therapists, counselors, psychiatrists, coaches, peer specialists, behavioral health pros, and everyone on the frontline of mental health, we can create better systematic support through robust sick leave and mental health policies, family leave policies, and solutions that nurture moving away from the “always-on” approach in treatment.
Untethering from triage and creating space for mental health professionals is where we begin. There are many ways we can do this but one that we are already implementing is unplugging and allowing the parasympathetic nervous system down time. In addition, time in nature offers a much-needed respite—space to cultivate the sacred. For us, this means we prescribe time outside, connection with others, meditation, self-reflection, time off screens, rest, and connection. These are things, let’s face it, we all need.
Caregivers need care. Healers need healing. As we seek to reduce the stigma of being a healer who needs healing, we create greater opportunities to serve those who serve. We start by acknowledging the state of affairs, articulating the need, and serving those who are on the frontlines every day.