Who Cares for the Caretakers? Burnout in Mental Healthcare Providers

While the concept of burnout, particularly in caretaking professions, is not new, this term became popular in industrial-organizational psychology most recently in the wake of the COVID-19 pandemic. With students, teachers, healthcare workers, and creatives all facing a sense of collective fatigue in their work, concepts like “quiet-quitting” have become more popular as people toe the line between work-life balance and burnout1. The focus of this article centers on burnout among mental health providers, since they are often a major source of support for others encountering burnout. This is especially a significant issue given the serious implications of provider burnout for both the provider themself and their clients. When those who dedicate their careers to supporting the wellbeing of others are rendered unable to do the same for themself, it is imperative to find solutions to ameliorate the pressure and fatigue they face.

What actually is burnout?

Just like any other mental health concern, burnout looks different on everyone. One individual’s occupational context and personal factors, from coping strategies to job satisfaction, may lead to a completely different experience of burnout relative to someone else. Even within mental health providers, a crisis counselor will encounter burnout in their role far differently from a child and adolescent psychiatrist. That being said, burnout is generally viewed as a sense of being depleted or unenergized by the demands of an occupation, typically related to prolonged emotional, physical, and/or mental fatigue2. It is critical to point out that burnout is not a psychiatric diagnosis or explicit condition of mental illness, and it should not be treated as such. For many, though, burnout that goes unaddressed to a severe extent may cause depressive symptoms that should be taken seriously. Burnout can also be an effect of an existing depression diagnosis.

 

Types of Burnout

Melody Wilding, LMSW, discusses the main types of burnout in her article for Harvard Business Review, which provides a useful outline in conceptualizing different provider experiences in the mental healthcare space3. According to this article, burnout can present in three broad categories: overload, under-challenged, and neglect. Overload burnout is what most people might visualize when thinking about this experience: working unsustainably hard at something you are dedicated to, even to the point of exhaustion3. This form of burnout can be driven by achievement or an overly demanding work culture that enables providers to ignore their own needs in favor of productivity. Mental health care requires that providers bring their full selves to their work, so when that sense of personal identity and purpose becomes overloaded, patient care suffers in the process. Rebuilding that requires rest and balance, though someone facing overload burnout may see that as an additional obstacle to being successful at work though it is truly a prerequisite. Underchallenged burnout typically results when there is a perception of not contributing to important work or developing one’s skills3. If a provider is in a practice setting where they see very similar patient cases continuously or do not feel stimulated by opportunities for meaningful continuing education, underchallenged burnout could be a serious concern. Particularly for highly qualified practitioners who have a high level of internal motivation, this kind of burnout can reduce the fulfillment and curiosity that their work might otherwise inspire. Finally, neglect burnout represents an end-stage feeling of helplessness when there are too many obstacles, mistakes, or conflicts at work, causing someone to tune out their occupation3. Much of this is as a result of learned helplessness, when problem-solving at work seems too daunting even if it is possible. For example, many of the administrative burdens involved in mental healthcare, from prior authorizations to charting workload, may begin to seem insurmountable, shrouding the positive difference someone makes. This can lead to a sense of helplessness and demoralization on facing work that can, over time, result in burnout. While these three types are generalizations of a highly nuanced state, it can be helpful to recognize the diversity of patterns that may actually be burnout.

Symptoms of Burnout

Now that it is clear what burnout is and how broadly it can manifest, how do you recognize it? The Mayo Clinic generally suggests that frequent and persistent feelings of being drained, unable to cope with job stress, sleep issues, depersonalization, cynicism or apathy towards patients or colleagues, irritability, reduced personal satisfaction, and poor work performance could all be signs of burnout4. While there is no objective screener for a mental state as variable as burnout, the following set of questions could be a guidepost for seeking professional mental health help, since burnout and depression can be linked.

Do you question the value of your work?

Do you drag yourself to work and have trouble getting started?

Do you feel removed from your work and the people you work with?

Have you lost patience with co-workers, customers or clients?

Do you lack the energy to do your job well?

Is it hard to focus on your job?

Do you feel little satisfaction from what you get done?

Do you feel let down by your job?

Do you doubt your skills and abilities?

Are you using food, drugs or alcohol to feel better or to numb how you feel?

Have your sleep habits changed?

Do you have headaches, stomach or bowel problems, or other physical complaints with no known cause?

 

Causes of Burnout

While burnout can be triggered by a variety of environmental and personal factors that may accumulate over time, there are a few patterns that may increase burnout risk in this specific field. Mental healthcare providers often have prolonged exposure to the emotional distress and trauma of their clients, and maintaining an empathetic, attentive, and collaborative approach to supporting them can be associated with taxing emotional demands, especially if a provider is unable to form healthy work-life boundaries5. This can manifest as a sense of compassion fatigue in which an individual feels a reduced capacity to extend empathy to their client, directly impacting outcomes. Further, the larger structural issue of mental health provider shortages contributes to the intense workload many in this field face. Without enough providers, mental health professionals often work long hours seeing a high patient volume, which can make someone more prone to self-neglect and physical or emotional exhaustion6. Particularly in hospital settings, a perceived lack of support from administration or ineffective supervision/feedback can contribute to the sense of learned helplessness described above. Feeling as if one is not growing or advancing in a position or personal skillset can add to this frustration with bureaucratic burdens.

 

Addressing Burnout

Given the uniquely serious implications of decreased care quality, errors, and provider turnover within the field of mental healthcare, it is all the more important to make note of some key strategies for addressing burnout7. While self-care universally is an important part of any daily routine, integrating convenient strategies for turning self-care into a habit can be critical for busy providers. Setting non-negotiable time for exercise, hobbies, and sleep that cannot be encroached upon by work tasks can be one helpful way of reinforcing work-life boundaries7. Small changes during the workday like healthier eating, taking movement breaks to stretch, stepping outside, and regularly checking in with coworkers can prevent burnout and promote helpful support networks. It is also important to note that mental healthcare providers also need professional mental health support, and there is no shame in seeking that out. Peer support and professional counseling can be effective methods in unpacking difficult interactions and finding healthy ways of coping with work stressors. Finally, many providers find that digging deeper into the curiosity that drove them to their respective fields initially can help to mitigate burnout by returning a sense of fulfillment and joy to their work. Teaching opportunities, mentorship for students and early professionals, along with advanced trainings on forthcoming innovations in mental healthcare can simultaneously improve job skills and efficacy while contributing fresh perspectives.

The brunt of the change that is needed to address burnout falls on the organizational, not the individual. Until mental healthcare providers have more supportive work environments that standardize a culture of mutual support and collaboration, it may continue to be difficult to establish work-life boundaries, regardless of individual behaviors9. Advocating for practice models that reimburse providers on the basis of quality outcomes rather than client volume can reshape the value system that many professionals come into conflict with at work. Further, ensuring providers have access to timely support when they face difficult, even potentially traumatic, encounters is an important protective factor in turnover. It goes without saying, but the work of mental healthcare professionals is invaluable. Their work deserves to be recognized and rewarded, and appropriate celebrations of outstanding efforts can be extremely meaningful in returning a sense of satisfaction to those at risk of burnout.

Addressing burnout among mental health providers requires a multi-faceted approach that involves both individual and organizational efforts. Recognizing the signs early and taking proactive measures can help prevent burnout and promote a healthier, more sustainable work environment.