We created a guide to futureproof the mental health of health care workers. Will health care leaders use it?

We’ve known the facts for decades.

Health care workers (HCWs) face considerable mental health challenges due to high stress environments, long working hours, and the emotional toll of patient care. They are at increased risk of poor mental health, with burnout and post-traumatic stress disorder (PTSD) both major concerns for many HCWs. Worsening things, HCWs tend to avoid looking for help because of stigma and realistic concerns that a mental health diagnosis or treatment could be career ending.

Going into the pandemic, we also knew that HCWs faced unique stress in crises, like fear of infecting others or watching colleagues die, and a range of mental health threats, from moral injury, to burnout, to psychiatric disorders like PTSD. As COVID-19 cases surged and hospitals became the trenches of a global war against the virus, the mental health of health professionals plunged further. Despite rapidly emerging data, Australian health care leaders struggling to support their increasingly anxious, depressed and burnt-out staff asked again and again: What can I do?

We knew the facts; it was time to help health organisations face them. With the situation dire and our patience for inaction frayed, we united colleagues from leading hospitals and universities to study the problem at its source and produce a holistic, research-informed resource that could empower health care leaders to make real change.

The report

The resulting report — Future-proofing the frontline — provides clear ways of supporting the mental health of HCWs during crises and beyond. Our qualitative methods precluded surveying hundreds of professionals or generating qualitative models, but instead yielded rich personal insights from a range of professionals, captured in their own words.

Likely unsurprising to readers, HCWs already knew what they wanted and needed. Workshops with 32 frontline HCWs across disciplines and organisational levels identified numerous strategies to support mental health, such as peer support programs, flexible work arrangements and leave entitlements, adequate staffing and resources, clear and transparent communication and a supportive team culture and leadership.

Leaders across the fields of workplace mental health and health practice agreed. An e-Delphi study of 28 experts made similar recommendations, such as peer support programs, flexible working, and realistic staffing, along with complementary strategies like mental health training for leaders, resilience-building activities, and providing staff access to quality mental health care.

Our data coalesced around the “three Cs” of mentally healthy health care organisations:

1. Culture: an organisational culture that fosters collegiality, provides mental health training for leaders, and promotes psychological safety
2. Conditions: proactive crisis strategies like adequate staffing, supportive entitlements (eg, mental health days), getting serious about staff health and safety (eg, prioritising vaccinations), trauma-debriefing and facilitating help-seeking from quality mental health providers
3. Care: Fit-for-purpose strategies to support mental health, like embedded mental health support, along with diverse and accessible support options that respect the different ways that individuals cope.

Of course, acronyms don’t make change easy. Interviews with 29 health care leaders also revealed conflicts and challenges in supporting staff mental health, including tensions between individual and organisational needs, the hegemony of toxic organisational culture, barriers to clear communication with staff, and the seeming incompatibility between short term action and long term stability.

Taken together, our data tell a clear story about what needs to change, and the specific steps organisational leaders can take. Staff need a supportive culture, working conditions that are physically and psychologically safe, and mental health care that’s appropriate for HCWs. Importantly, our report is also realistic about the barriers to change.

Change is possible

Change won’t be easy, but early feedback suggests it is possible. A chief medical officer at a major Melbourne hospital told us they found our tools, “...very accessible, with clear and concrete recommendations that are feasible for any health service to implement.” They also commented on the “authenticity” of the report, given it was derived from the real experiences of colleagues, and the peace of mind that came with, “...recommendations [that] are supported by relevant and believable evidence that can assist [with] complex organisational change.”

At the Black Dog Institute, one of the largest mental health organisations in Australia, the organisational checklist in the Future-proofing the frontline report helped them discover that although they were strong on culture and care, there was room for improvement on working conditions. Their mental health leave, for example, needed to be clearer and more consistently enacted. Updating their policy wasn’t easy, and that wasn’t for lack of caring. Workplace policy change can come with operational, financial and legal risks. They couldn’t ignore these, but equally, they couldn’t allow them to be barriers to improvement. What worked for them was committing to the outcome, listening to both facts and feelings, and keeping the lines of communication open between different functions in the organisation. Today, Black Dog staff know they can take personal leave at any time for any reason — no questions, no reprisals.

The final challenge: taking action

It seems that the question is no longer “What can I do?”, but “What am I willing and able to do?”. We acknowledge that change won’t be easy, nor will every strategy fit every organisation. Some of our recommendations may even be met with scepticism. Where barriers exist, we invite leaders to test their assumptions and commit to the process of change, through the ups and the downs.

In health care, we tackle the world’s biggest problems head on. Surely, we can reconcile the humanity of our staff with the demands of our operating environment. If we accept this challenge and translate research into action, we have an incredible opportunity to futureproof the mental health of our workforce. Download our checklist, identify one opportunity for improvement, and start a conversation today.

Dr Peter Baldwin leads Black Dog Institute’s Policy Research Team, which aims to improve Australia’s mental health system by ensuring our state and federal policy makers have access to the best research.

Associate Professor Natasha Smallwood is a consultant respiratory physician with the Alfred Hospital, and chief investigator and project lead on the Future-Proofing the Frontline report.

Professor Karen Willis is Professor of Public Health at Victoria University, and chief investigator and project lead on the Future-Proofing the Frontline report.