During the COVID-19 pandemic, between January 2020 and April 2022, at least a quarter of health and care workers worldwide reported suffering from anxiety, depression and burnout symptoms. Although the global health emergency has now passed, large numbers of health and care workers are still reporting these symptoms. This is negatively affecting health settings through low job satisfaction, high staff absences, workforce strikes and individuals leaving the sector altogether – all of which makes it harder for these facilities to maintain high standards of patient care.
So, what are the causes of the problem and how can they be resolved?
For Petri Aspegren, a lecturer at the Oulu University of Applied Sciences in Finland, and a former paramedic, the causes of poor mental health are “manifold and complex”.
“In emergency care, for instance, the work involves exposure to death, human suffering, violence and the threat of violence, which is highly traumatizing, with the risk that it can lead to post-traumatic stress disorder,” says Petri.
“People in these situations often feel a sense of powerlessness and hopelessness. These are normal reactions, yet attempts to suppress and avoid them only makes things worse. It’s therefore important that those whose work involves dealing with distressing situations are given a safe space to share their experiences and to express themselves as human beings.”
Sampsa Suomi is a Process and Crisis Intervention Consultant who specializes in improving the well-being of staff within health-care settings.
“In my opinion, the number one cause is compassion fatigue,” he says. “Health workers deal with highly stressful situations day in and day out and the need to express emotional empathy with patients and their families undoubtedly takes its toll. I feel that this is something that is largely underdiagnosed and not properly treated.”
However, Sampsa agrees with Petri that dealing with traumatic and stressful situations on a regular basis also plays a big part in increasing levels of anxiety amongst health workers, but knowing exactly when or how to act on it is not easy.
“Cumulative trauma is hard to detect, and it is not always obvious when intervention is necessary,” says Sampsa. “Health care by its nature includes very stressful situations and it is impossible to remove these completely. In my opinion, the key thing is to focus on building the mental resilience of individuals, through workplace counselling and coaching, and to ensure interventions are made whenever traumatic events occur.”
Petri echoes this sentiment but also emphasizes the need to look at problems with health systems more generally.
“It is well known that health workers often have to cope with high workloads, long working hours and a lack of flexibility, all of which impact on their mental and physical health,” says Petri.
“Action needs to be taken at a health systems level to tackle poor working conditions, to redistribute workloads to make them more manageable, and very importantly to give individuals a better work-life balance in which they have sufficient down-time in which to recuperate.”
But to really tackle the problem, Sampsa believes employers also need to have a better appreciation of factors beyond the workplace that could be impacting well-being and performance at work.
“You have to remember that fatigue and mental health problems can happen to anyone at any point in their career and that any challenges we have in our personal lives naturally also spill over into the workplace – and vice versa,” says Sampsa. “So, if there is a lot of stress and challenge outside of work, then this could be the last straw if a traumatic work incident occurs.”
While both agree that employers need to promote a culture of open discussion and recognize the vulnerability of staff, Petri believes that organizations must also be willing to make sufficient financial investment in health worker well-being.
“Employers should always think of employees as their most important asset that needs to be nurtured, supported and encouraged to succeed and thrive at work,” says Petri.
“We know public health settings are stressful environments, and particularly so when many are now facing economic challenges. However, workforce well-being is not an area where savings should be made; one worker’s burnout will cost far more than the money spent on well-executed and timely counselling and could either prevent or reduce the time in absences and help build long-term resilience. We have the tools to be proactive on tackling the problem of workplace burnout, so why wouldn’t we invest in and use them?”
Sampsa and Petri acknowledge that stigma around mental health conditions still exists very much and needs to be broken down further. They are clear that attracting staff back to the workplace after burnout is not always straightforward and tactics to do this must vary from individual to individual.
“For one person, it may be appropriate to return to work as soon as possible, so their perceived anxieties of the workplace don’t become worse”, says Petri. “Another may need more time and support before they are ready to return to work. The worst scenario would be if the person with mental health issues is left on sick leave without any proper plan for care and support.”
WHO/Europe and the mental health of the health and care workforce
In its “Health and care workforce in Europe: time to act” report (2022), WHO/Europe highlights how health and care worker anxiety, depression and burnout are major factors in the health workforce crisis currently facing the WHO European Region, exacerbated by ongoing staff shortages, low pay, poor working conditions, stressful environments and a lack of adequate workplace safeguards.
To help countries tackle this crisis and issue, WHO/Europe has developed a European Framework for Action on Mental Health 2021–2025, endorsed by all 53 Member States of the Region, which includes a pillar for improving the retention and recruitment of health and care workers by better responding to their needs. Actions recommended include designing strategies for improving working conditions and work-life balance, developing supportive management systems, putting in place measures to protect mental and physical health, and taking actions to reduce stigma associated with mental health challenges.
WHO/Europe, partnering with the European Union in a project called “Addressing mental health challenges in the European Union, Iceland and Norway”, is also creating a survey to further identify the extent of burnout and psychosocial risks among health and care workers and identify the root causes contributing to this, so that policy solutions can be implemented. The survey will be launched in October 2024.
Taking care of those who care for us by improving working conditions and supporting health worker mental health is critical. It not only encourages health workers to perform to the best of their abilities by raising job satisfaction, but also leads to higher rates of staff retention, keeping key skills and experience within the health system that are vital to maintaining high standards of patient care.