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RECENTLY, I was walking home from the local supermarket, when I finally decided to dial the Lifeline suicide hotline.
I had noticed I was feeling a little uneasy over the past couple of weeks. I could not enjoy things I typically did for fun, and my emotions were consistently flat. Notably, I started to have thoughts about suicide, and a disturbingly peaceful outlook on the prospect of making an attempt.
Being a researcher in suicide prevention, I was aware of the warning signs. I sat down on the steps in front of my apartment and began to share with the person on the other end of the line.
It was hard. After all, I was a “mental health expert”. I had published papers on suicide prevention. I had presented to national and international audiences on the topic – and yet here I was. These thoughts were not overtly present but manifested as shame.
However, having made the call, I am glad that I did. I realised that in the medical battle against COVID-19, the people who needed the most protection against the virus were the professionals who frequently came into contact with it.
In the same way, shouldn’t we – mental health professionals who frequently engage with suicide and psychopathology – also be extra careful with our emotional wellbeing?
Suicide contagion is a documented phenomenon in which proximity to suicide may cause an increased likelihood of a suicide attempt. For example, hearing about suicides through the media or being in proximity to a suicidal individual, or an individual who died by suicide (here, and here), have been associated with suicide risk. Researchers and mental health professionals may be even more at risk given we not only hear about suicide but frequently engage with it on a much deeper and thorough level. Consistent with this, a task force found that psychologists and mental health professionals are at elevated risk for suicide. In addition to contagion, mental health professionals are also exposed to a plethora of mental health risk factors including burnout, compassion fatigue, countertransference and vicarious trauma, as well as being exposed to many of the stressors for which people seek help in the first place.
Furthermore, the onset of COVID-19 has been found to have negative effects on wellbeing which may compound and further elevate the risk of suicide and mental health problems. Studies in the United States and Asia have noted an increase in depression rates during the pandemic (here, and here), with the US-based study finding a threefold increase in certain populations. A survey distributed throughout North America, Europe and the Middle East found that across multiple continents people were working longer hours, which may lead to burnout. Indeed, in a recent webinar by the Faculty of Medicine at UNSW, a colleague of mine put it aptly: “Are we working from home or are we living at work?”. The data seem to suggest that in an already stressful time, mental health professionals may be at even greater risk for mental health issues.
Therefore, in a time when mental health is at risk, and mental health professionals are most needed, we must be careful to protect ourselves and our peers. So, what can be done? Here are three suggestions:
First, we need more research into the wellbeing of mental health professionals and their specific needs. During the pandemic, the leap from using masks by laypeople to entire hazmat suits by medical professionals was justified, because the solutions were proportional to the nature of engagement.
In the same way, no other profession engages with mental health and suicide as much as those directly in the field. It is therefore conceivable that people in the field may require tailored or “higher dose” interventions to keep ourselves safe.
Second, institutions need to implement practices to protect their mental health professionals. For example, ethics approvals are required to protect the participants in a study, but rarely are there such guidelines, initiatives or protection for the experimenters. While there needs to be discussion on what these guidelines may look like, how to design them so as to not clash with productivity standards, and where they lie on the spectrum of “mandatory” to “completely optional”, these initiatives need to be considered – especially if we want a mental health workforce that is well equipped to tackle the challenges ahead.
Third, as mental health professionals, we need to be diligent in maintaining our own mental health.
We often talk about being aware of one’s wellbeing when it comes to clients and communications, and what to do when certain thoughts or sensations arise. However, we must be diligent to practice what we preach; not for any sort of moral standing, but simply because it is good for us.
Recently, on World Suicide Prevention Day, also known as R U OK? Day, we discussed how asking a simple question could save a life. When was the last time we asked, or were asked, such a question? Further, if the data show that mental health professionals are at greater risk of mental health issues or suicide, then shouldn’t the rates of help-seeking reflect that proportionately? All in all, we need to be implementing good mental health practices – and if we aren’t, we are best tasked to understand why.
As in any occupation involving trauma, distressing situations and circumstances, we as mental health professionals need to passionately protect our own mental health in the same way we champion and fight for that of others. Not only for our own sake, but for a society that desperately needs its mental health professionals.
Dr Sandersan Onie is a Post-Doctoral Fellow at the Black Dog Institute, Centre for Research Excellence in Suicide Prevention, University of New South Wales.
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The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.