SWEET INSTITUTE – Continuing Education for Mental Health Professionals

Burnout: An Epidemic

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW

“Those people are never going to get better. Nothing is going to change. I sometimes wonder what exactly we are doing with them.” Guerline was surely irritated, as she articulated these words to Rodis, the consultant to the HOPE Care Center.

Rodis looked at Guerline and asked, “What’s going on, Guerline.” “They just are not going to get better. They say one thing and do something else. I don’t see why they are even in treatment. I drag myself to work every morning, and these people are not going to get better.” With tears in her eyes, Guerline seemed to be at the “end of her rope.”

The Agency for Healthcare Research and Quality published an article on Burnout Among Health Professionals and Its Effect on Patient Safety that outlines one of the common definitions of burnout. Cynicism, depression, and lethargy are some of the manifestations of burnout, and Guerline has been experiencing all of these. Burnout is present in about 21-67% of mental health professionals. The ramifications can be devastating for our patients and clients, our clinicians and advocates, and for our agencies and the healthcare system, as a whole. Burnout can and must be prevented. Self-care can and must be promoted. Here are the benefits of addressing this epidemic.

Patient and Client Perspective

Being present

In New England Journal of Medicine, an article entitled On Presence: A Tale of Two Visits, cites the beloved Abraham Verghese around the value of being present, how our patients and clients want us to be present and how being present is one of the few things that are timeless in the work we do as clinicians.

“Sometimes it’s just one more number. You just focus on writing your note while your client is speaking, and you hope he or she does not ask a question, because, frankly, you were not really listening. You are not really there.” Doris articulated these words during the self-care group that Rodis recently instituted at the HOPE Care Center. Doris felt safe and was courageous enough to speak out her mind to the rest of the group members. Everyone agreed, nodding and whispering, “So true.” “That’s me, too, sometimes. I am ashamed to admit it, but that’s me, too,” Paul added quietly. Whether we feel comfortable admitting it or not, or whether we even recognize it, burnout is dangerous. It prevents us from being present for our patients and clients, and it needs to be prevented.

Responding in lieu of reacting

A previous article entitled, De-escalation Skills: 6 Reasons Why, narrates the story of Eileen, Matthew’s therapist, who uttered, “I don’t know what to do anymore. Two weeks ago, I called 911 for 4 clients, just in a space of 2 days. There was not even enough guidance available for me, to know if I was doing the right thing.”

When Stephanie, the front desk staff, called Eileen to attend to Matthew, who had already started to escalate, Eileen was already managing a challenging client, trying to prevent him from escalating. By the time she arrived at the front desk and saw Matthew, all Eileen could think to recommend to Stephanie, “Enough with this. Just call 911.”  She had had enough, and, at the point of burnout, Eileen reacted instead of responded.

A previous article entitled, 5 De-escalation Principles to Master, explains that in order to adequately respond, you would first need to do active listening, while taking yourself out of the equation, before reacting to the assertion of your patients and clients. I also described that staying calm and managing ourselves will allow us to listen with the “third ear,” and, at the same time, before reacting, it will allow us to seek to understand what might be going on. This will then allow us to empathize, avoid any type of argument, and “respond” in lieu of “react.” When we experience burnout, it is difficult to do active listening, to stay calm or to manage ourselves. It becomes more challenging to seek to understand and empathize. As a result, it is easy to “react” in lieu of “responding.”

Being able to engage

Some previous SWEET articles (De-escalation Skills: 5 Reasons Why Patients and Clients are Likely to Escalate; 5 De-escalation Principles to Master; and 5 Tips to Help Engage Your Patients and Clients – Parts I and II), cite limited engagement as one of the main factors leading to escalation, and illustrate the story of Nate and Harry.

Nate failed to focus on Harry, because he was too preoccupied with external distractions. I also mentioned, meeting them where they are at, focusing on the patient and client, and, having an overall engagement strategy, as part of principles of engagement.

“Sometimes I just can’t focus. I wish I could just say, John or Jane, I currently am not listening to you. Part of me is not in this room. I just need a break. Please come back in two weeks. But then you have six more clients for the day, and you need to write your notes, and you need to be productive. It becomes a cycle, and it never stops,” Guerline said to Rodis. To provide tailored care to our patients and clients, we need to be able to engage them, which becomes rather impossible to do, if we are experiencing burnout.

Clinician and Advocate Perspective

Career gratification

“Why should I be thinking about career gratification? All I need to think about is my client,” said a clinician, with confidence and pride. In a system, where we have been educated to practice martyr-ism (like a social work director once told me), or else we are not good enough as clinicians or advocates, we may be doing more harm than good.

This mindset perpetuates the false and dangerous belief that we are not dedicated enough to our patients and clients, if we think about our own career gratification, self-care promotion, and burnout prevention. “Son, do your best to be at the table and to be a voice for the voiceless, but, remember, you cannot give what you do not have.” Growing up, a wise man said this to me, and enough times to remember.

Finding meaning in my work and sense of career gratification will trickle down to the work with my patients and clients and the staff that I supervise and support. Feeling grateful and satisfied in your career allows you to be present for your patients and clients in the room, to “respond” in lieu of “react,” and to fully engage.

“Those people are never going to get better. Nothing is going to change. I sometimes wonder what exactly we are doing with them.” Guerline was surely irritated, as she articulated these words to Rodis, the consultant to the HOPE Care Center. Guerline was experiencing burnout, something that happens for up to 67% of our mental health workforce. This is an epidemic and an infectious one that cannot continue to spread. It must stop, and the ramifications will be gratifying.

LEARN MORE, PRACTICE DIFFERENTLY, AND FEEL CONFIDENT WORKING WITH CLIENTS BY JOINING US FOR A SEMINAR ON, “PREVENTING BURNOUT: SELF-CARE FOR CLINICIANS AND ADVOCATES,” ON FEBRUARY 6, 2019, 9:30AM – 4:30PM

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References:

  1. Acker G. The challenges in providing services to clients with mental illness: Managed care, burnout and somatic symptoms among social workers. Community Mental Health Journal. 2010;46(6):591–600.

  2. Ahola K, Honkonen T, Isometsä E, Kalimo R, Nykyri E, Aromaa A, Lönnqvist J. The relationship between job-related burnout and depressive disorders–results from the Finnish Health 2000 Study. Journal of Affective Disorders. 2005;88(1):55–62.

  3. Canfield J. Secondary Traumatization, Burnout, and Vicarious Traumatization: A Review of the Literature as It Relates to Therapists Who Treat Trauma. Smith College Studies in Social Work. 2005;75(2):81–101.

  4. Carney J, Donovan R, Yurdin M, Starr R. Incidence of burnout among New York City intensive case managers: Summary of findings. Psychosocial Rehabilitation Journal. 1993;16(4):25–38.

  5. Chemiss C. Staff burnout: Job stress in the human services. Beverly Hills, CA: Sage; 1980.

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