De-Stigmatizing the Need for Mental Health Assistance

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

In the last four months, every study that I have reviewed indicates that nurses on the frontlines of the battle with COVID report deteriorating mental health. The current pandemic is equivalent to the type of trauma seen in wartime situations. Richard Tedeschi, an expert on trauma, tells us that PTSD is not inevitable (only 10% of those who undergo trauma have it). Still, without the ability to effectively process the experience – you are at much higher risk for PTSD.

Even before COVID, the National Academy of Medicine, in a landmark report in December of 2019, warned about clinician burnout’s widespread issues. They described burnout as a syndrome characterized by high emotional exhaustion, high depersonalization (i.e., cynicism), and a low sense of personal accomplishment from work. Pre-COVID research, according to the Academy, showed that between 35 and 54 percent of U.S. nurses and physicians had substantial symptoms of burnout.

The problem has significantly exacerbated with COVID – health professionals are openly admitting during TV interviews that they are completely burned out from the experience – and it is far from over. There is a significant imbalance between expectations of what clinicians will do and the resources to do it. The Academy reminded us in this report that there are serious personal consequences of burnout for clinicians, including occupational injury, problematic alcohol use, and the risk of suicide. It also significantly impacts the quality of care.

Seeking mental health assistance when working in a professional clinical role is stigmatized in healthcare. The NAM report highlighted the reality that clinicians worry about confidentiality and even the impact on their professional license. One of their recommendations was to lobby State legislative bodies to create legal protections that allow clinicians to seek and receive help for mental health conditions as well as to deal with the unique emotional and professional demands of their work through employee assistance programs, peer support programs, and mental health providers without the information being admissible in malpractice litigation. To some degree, we have institutionalized the stigma associated with seeking mental health assistance by making it a potential licensure issue. It is not viewed as a strength to seek help but rather a weakness.

There are no easy answers or next steps. Many leaders tell me that they have given their nurses referrals to their employee resources but they are not following through. Confidentiality and concern about how the information will be used is a key concern. Negative attitudes and beliefs toward people who have a mental health condition are common in society and healthcare environments. No one wants to be viewed as not being able to do the job or withstand the pressure.

In our April 2021 issue of Nurse Leader, we will publish interviews with four Nurse Executives at COVID hotspots. Kit Bredimus from Midland Memorial Hospital expressed the view that this is a situation where leaders need to model the way. He used the counseling service himself that is offered to the staff. He shared his experience with his staff about how counseling has helped guide him through tough times and made him a more effective leader. I think Kit is on to something here – leader vulnerability in this area could make counseling less threatening for staff. Another CNO has shared with me that she has embedded a mental health professional in every unit seeing significant numbers of COVID patients to do just in time counseling.

The news on the vaccine front is promising, but the battle with COVID is far from over. Now is the time to tackle the mental health issues that nurses experience before it is too late.

Read to Lead

National Academy of Medicine 2019 Report – Taking Action Against Clinician Burnout Available at http://www.nationalacademies.org/hmd/Reports/2019/taking-action-against-clinician-burnout.aspx

Tedeschi R, Moore BA. Transformed by Trauma. Boulder Crest; 2020.

Read Rose Sherman’s book – The Nurse Leader Coach: Become the Boss No One Wants to Leave