Suicide of Health Care Professionals: A Concerning Occupational Hazardby Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP on 06/16/18
The recent suicides of two celebrities has captured the attention of the public. The statistics for suicide in the United States (US) are glaring:
· 10thleading cause of death
· Cause of 44,965 deaths annually, with 123 suicides a day
· The rate is highest for those in middle age, especially men.
· 800,000 deaths annually, with one person every 40 seconds
· 2ndleading cause of death among 15-19 year olds, and
· 17thcause of death overall.
The tragic nature of these numbers are one of many reasons I embarked on a clinical social work path, striving to understand and enhance the human condition. I never thought I’d be extending my lens to focus on the escalating suicide rate of my valued colleagues across the health care workforce, including all health and behavioral health professionals.
The Interprofessional Evidence
The causes of suicide range from the reality of occupational pressures to safety concerns. The increased uptick in workplace bullying hasconsiderably impacted many professionals, with those subjected to bullying more prone to suicidal ideation, and twice as likely to take their own life. A prior blog discussed the influence of mass violence episodes on workforce trauma, and subsequently frontline practitioners. Stress from the profound accountability experienced in the scope of treating clients (or patients) becomes another driver. For those reading this blog, consider how often you have become frustrated, if not depressed by a client’s treatment or intervention that does not go as well as expected. A medical complication develops unexpectedly, or a psychological trigger sends a stable client down a rabbit hole of despair and suicidal ideation. It becomes tough to reconcile the inability to cure, fix, or enhance every client’s condition. We have all shared this common experience, independent of professional discipline.
Close to 400 physicians die annually, with nurses more likely to commit suicide than women in general. Studies have shown that being a social worker increases the odds of death by suicide by 55.6%. In a list of the top 20 professions with the highest suicide rates, health and behavioral health professionals are prominently featured:
· #12: Doctors, dentists, health care professionals
· #15: Nursing, medical assistants, health care support workers
· #16: Social workers, and other social service workers
The fact that today’s health care professional is fried to a crisp, is not an overgeneralization. The 2018 Medscape National Physician Burnout & Depression Report had over 15,000 respondents. Forty-two percent admitted to burnout, with 12% colloquially depressed, and 3% clinically depressed. At the top of the specialty list for those physicians most impacted by stress were:
· Critical Care: 48%
· Neurology: 48%
· Family Medicine: 47%
· OB/GYN: 46%
· Internal Medicine: 46%
· Emergency Medicine: 45%
Women were more impacted then their male colleagues: 48% as opposed to 38%. The average age of the highest rate of burnout was 45-54. Bar none, the job itself was the highest contributor to level of depression for physicians. Over 40% identified that their depression affected professional relationships with colleagues or staff. Less than 24% reported obtaining clinical support for their mood.
A Traditional Culture of Caring Takes a Toll
Moving around the interprofessional landscape yields similar concerns. The intense psychological stress experienced by social workers and other mental health professionals around the extreme needs and circumstances of clients pose considerable risks. While professional education focuses on the development and maintenance of critical boundaries, as well as the importance for all disciplines to self-protect, constant exposure to client realities remains an occupational hazard. Nobody is immune from feeling like their boundary armor has weakened, independent of years of experience, expertise, or training. Yet most professionals put the client first and themselves last. They go beyond that point of no return. The lessons taught about limit setting and self-protection go out the window when faced with having to prioritize their own self-care over rendering care to clients.
The desire to improve the human condition brings many health care professionals to the industry. It is fascinating to ask students entering the field why they have chosen these professions. With few exceptions, the answer is a unanimous, ‘to help people’; evidence of their respect for humanity and a desire to serve. However, that desire to blessing and a curse, for it drives talented professionals to dire actions. Nobody has an endless reserve to help. That is far too great a burden to bear, particularly when dealing continuously with life, death, and the reality of the human circumstance.
The pressures faced by the collective health care workforce start early on during academic preparation. Stressors wrought by academic pressures of failing classes are experienced, plus competition to obtain quality practicums, residencies, internships, and fellowships. Upon graduation there are licensure and credentialing exams to pass. Then the work world greets us, plunging all into assessing the pathophysiology and psychopathology of physical illness and behavioral health respectively, if not co-morbidly. We reconcile the various faces of human suffering, from trauma, the social determinants of health, to countless other complex population challenges across the biological, psychological, sociological, and spiritual domains. Changing demographics, cultural considerations, and complications await us at every turn.
The juggling of regulatory and organizational requirements, along with professional ethics and personal values breeds the essence of moral distress. Reimbursement and the fiscal focus of care is a prominent theme, with pressures to treat and swiftly discharge, at times prematurely. Reconciling medical and medication errors, treatment variances, amid the drive for successful outcomes are a triple threat. Last but certainly not least come those documentation requirements, which no amount of technology has been able to reduce. Too often I hear of colleagues putting in 14-16 hour days, only to then bring home assessments yet to complete.
The power of technology has provided us the ability to document remotely from home; not always such a benefit. One colleague shared how the scribes hired by the practice to document in the electronic medical record were an asset, with a big caveat. After completing a full day of seeing patients, he returned home to view his sleeping children, then began to review and sign off on the scribe documentation; another two hours tacked onto the day. Getting insufficient sleep only compounds the challenges faced, with limited ability to recharge from one day to the next.
Change the Culture
No health care professional is immune from the stresses and strains of the job. The mantra of some may be to “tough it out” or “make it to vacation”, but being responsible for the care of others mandates we be attentive to ourselves first and foremost. A vacation can do wonders but helps for the short-term only. Health care professionals are the consummate rationalizers. Common phrases typically heard include, “I’m in the biz and know what I need” or “what’s a therapist going to tell me that I don’t already know?”. These are faulty rationalizations at best. No one can be objective to their own situation. That is one main reason to seek counseling; to gain an unbiased perspective from a professionally educated and trained clinician who is the expert in rendering mental health care.
I recognize some health care practitioners may perceive that their organizations and/or professions do not support their request for help or acknowledgment of the need for behavioral health support. The industry must get past the stigma of mental health treatment. Seeking treatment is not a weakness but an indisputable strength. We must attend to our own human condition to be responsible for the human condition of so many others.The alternative? We lose more talented health care professionals, who succumb to the occupational hazards and realities of their roles, becoming numbers added to the growing suicide tally.
My esteemed colleagues, that option should not be the preferred choice for any of us. #MustDoBetter
American Psychiatric Association: Employee Assistance Programs
Mental Health.gov: Local Organizations with Mental Health Experience
National Alliance on Mental Illness: Top 25 Helpline Resources
Psychology Today: Find a Therapist
Healthcare Professional Burnout, Depression and Suicide Prevention: American Foundation for Suicide Prevention
Comprehensive Blueprint for Workplace Suicide Prevention: National Action Alliance for Suicide Prevention
Until next time...Stay Resilient