Caregiver crisis: 3 steps to avert physician and nurse suicide

This is the fourth blog in a six-part series on the state of the healthcare workforce.  

Blog #1: 4 immediate interventions every leader should consider; Blog #2: Tackling workplace violence and compassion fatigue in healthcare; Blog #3: How to reduce nurse turnover in first-year nurses

One percent of anything doesn't sound like much, but in a 2020 Medscape survey of 12,000 physicians, it represents the alarming number of respondents who have attempted suicide: 120. An additional 13% have thought about it, and those who have carried it through do so at almost twice the rate of the general population. 

Though not studied nearly as often, the mental health of nurses requires equal focus, particularly when a female nurse is twice as likely to die by suicide as someone in the general female population, and 70% more likely than a female physician, according to the University of Michigan. 

While long thought of as an individual problem rather than a systemic one in the healthcare industry, untreated caregiver mental health has become an unavoidable emergency amid the pandemic. Clinicians, many of whom are comfortable treating a variety of physical and/or mental health conditions for their patients, may be far less willing to acknowledge or get care for their own mental health. Clinicians may try to cope on their own or leave their jobs instead of seeking the support and mental health resources they need. Those who stay are under even greater strain, unable to decompress or balance their professional and home lives. Organizations need to lead the way to a healthier workforce by changing the narrative around mental illness, both through open communication and comprehensive action. 

Normalize the discussion and treatment of mental health

The typical physician or nurse is hardwired to overly extend themselves for a number of reasons, from a competitiveness that their work environment teaches or feeds to an innate sense of purpose and disregard for self-care. Asking for help is seen as a sign of weakness—an admission they fear will get back to their peers and leaders. Worse, receiving a diagnosis can impact their ability to get or retain a license and obtain insurance, particularly in the case of physicians, leaving them nowhere to turn.  

Ignoring depression and suicide risk can be disastrous for both the individuals themselves and patient care. Managers need to set an example by speaking about mental health as a critical aspect of overall well-being. They can demonstrate their commitment to wellness by: 

• Reiterating appreciation for the work that clinicians do and acknowledging how difficult the pandemic has been 

• Emphasizing why mental health is so important, for workers and patients 

• Talking about risk factors for depression, including commonalities like stress, isolation, and sleep deprivation 

• Highlighting the benefits of self-care even if workers don't feel what they're experiencing is "serious" 

• Sharing authoritative sources for more information and help 

• Providing schedule flexibility so those who wish to pursue treatment options, including regular therapy, can do so 

• Stressing organizational dedication to mental health as a lasting systemic priority, even after the pandemic 

• Incentivizing education on self-care and promoting its practice 

Evaluate existing organization support 

It's imperative that healthcare professionals trust and believe in their organization's policies and leader outreach, but knowing where to make improvements can be overwhelming, especially with limited time and resources. Decision-makers can start with small adjustments to daily operations and build a support structure that fits the needs of their workforce. 

Increase leader visibility. Preventing the onset and escalation of mental illness starts with being present to know what challenges workers face. The leadership at Houston Methodist used an American Medical Association recommendation to better connect with its front-line healthcare workers. Within an eight-week period, an executive and behavioral health professional rounded on 75% of COVID units in an eight-hospital system, with a sole focus on physician and staff resiliency. They evaluated these rounds through rounding team feedback, number of staff interacted with, number of 1:1 employee assistance program (EAP) sessions used, and unit leadership follow-through. 

Ensure sick leave policies cover mental health. Workers should not be made to feel they can't take time off for emotional health needs. 

Secure the help of behavioral health professionals. Having a counselor, social worker, or other behavioral health professional frequently visible on units can ease the tension for clinicians who may not be ready to initiate a scheduled visit on their own. These experts can also provide education on how to recognize those at risk, as well as intervention training for managers and guidance for all healthcare workers on handling difficult encounters.  

Provide assistance for work–life balance, particularly for working mothers and caretakers. The burden of having kids at home while working, and/or taking care of patients with COVID or otherwise ill or elderly relatives, has driven some clinicians out of healthcare. Organizational support can include offering innovative scheduling models with opportunities for hybrid work or flexible hours. Additional approaches include peer support groups, where colleagues can connect and share experiences and solutions; coaching and mentorship programs; mindfulness programs; and financial wellness programs. Tampa General Hospital used its Team Member Emergency Fund to support its workers through pandemic-related challenges. Among the help these funds provided was school supplies for children pivoting to virtual learning, including 130 laptops, and local hotel rooms for team members exposed to COVID.  

Consider regulations for shift length per 24-hour period. Physical fatigue, especially among nurses, is a major factor in burnout, and sleep challenges are extremely common in those with depression. While individuals can take many steps to manage fatigue, leaders can alleviate some of it with policy changes. 

Supply healthcare providers with well-being resources

EAPs are valuable across many industries, but in medicine, they should be supplemented with tools for addressing health workers' unique problems. Well-being programs, challenges, and additional material can be tailored to fit the clinician mindset and busy schedules, and they should be promoted across several communication channels and made accessible on multiple platforms. Best practices include: 

Education on compassion fatigue and resilience, followed by exercises and workshops. Compassion fatigue is the physical and mental exhaustion experienced by caregivers who treat sick and traumatized patients, which results in a depleted ability to cope with their everyday responsibilities. Educational modules designed to share compassion fatigue symptoms and preventative guidance can help your workforce become more self-aware and resilient. Some organizations take this one step further, including Houston Methodist, which used three key tactics to address fatigue. Leaders worked with mindfulness experts to train staff members on mindful living, and host practice sessions that have seen upward of 700 people join a 20-minute "mindfulness pause" on weekdays. They've held multiple resilience workshops throughout the pandemic, which required just an hour’s commitment per week over the course of four weeks and some home practice. In the July 2020 class, the perception of stress for participants at the end of the workshop, according to the Perceived Stress Scale, dropped 24%. And finally, Houston Methodist conducted positive psychology-based digital challenges, across a mobile and desktop application, with 5,000 sign-ups followed by 37% and 25% participation and completion rates, respectively. Workers who participated up to a certain threshold were eligible for a health premium discount. 

Comprehensive intervention tools. The American Foundation for Suicide Prevention offers an interactive screening program that connects individuals with mental health resources. It’s confidential and personal, connecting isolated individuals with counselors who answer questions and provide feedback, encouragement, and information on available services. Medical schools, hospitals, and health systems sign on for a three-year term and provide clinical support to improve the lives of students, trainees, residents, and physicians. 

Opt-out program in coordination with the psychiatry department. For a proactive approach, organizations can automatically connect caregivers to a behavioral health professional during work hours for 1:1 or group therapy sessions. Individuals have the option to opt out after a period of time. Some employers, however, are restructuring their benefits packages to reward those who continue participating in these kinds of programs. 

Peer support programs. The most utilized well-being resource in hospitals is peer support, which is perhaps unsurprising considering that more than half of physicians know a peer who has considered, attempted, or died by suicide. This can consist of debriefs that offer a safe space to share and grieve during a surge or after a difficult patient loss. Therapists can also give workers basic tools to have helpful conversations with each other and acknowledge or detect when someone's at risk. 

While data on clinician depression and suicides is dismaying, decreasing the rates at which they happen is entirely possible. It begins by dismantling negative systemic attitudes, policies, and actions that discourage acknowledgment and treatment of serious mental and emotional diseases. Ongoing provision of accessible and confidential tools and resources is a must-have as well. Finally, leaders can use continuous listening and help build a culture of peer support to adapt to employee needs, including brief, regular pulse surveys with as few as two or three questions on burnout and mental health. Learn more by requesting a demo or conversation with a Press Ganey expert.