If you’re eager for meaningful action on mental health in health care workplaces, you’re in great company.

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.

We created a guide to futureproof the mental health of health care workers. Will health care leaders use it? - Featured Image
Australian health care leaders are struggling to support their increasingly anxious, depressed and burnt-out staff (shin sang eun/Shutterstock).

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.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners. 

If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au. 

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

  1. Anonymous says:

    I can understand the recommendations in the report are adaptive and forward-looking but I would submit my opinion that to call it “future-proof” is rather ambitious and unrealistic.

    Being a healthcare worker has always been challenging and stressful, and while I support the current idealogy of being more inclusive and having a broadchurch, we have to be careful of being held hostage to the lower denominator, where a group is doing the majority of the heavy lifting while (intentionally by the process or not) the other group are not as productive and contributing. When a multitier system exist, where some traits (or lack of) accommodated as cost of diversity, then ultimately the cohesion and productivity to keep the system viable deteriorate.

    In the 41-paged report, resilience is only mentioned 6 times and the phrase “building individual resilience” is placed in a negative light as a contrast to “changing organisation environment”. In intergenerational culture war as we have in contemporary society, the word resilience is shouted down as a swear-word, and those free-management solutions utilising building individual resilience as the main strategy are seen as the problem and akin to enabling bullying or discrimination.

    It is therefore not a surprise to myself (and maybe some others) when a major crisis occur, such as the COVID-19 pandemic, which cohort of HCW (as well as society at large) attrition from mental health problems has the most effect. The other crisis, in human resources, from generational work culture shift and attitude, was just gathering momentum for several years before 2020, contributed to HCW attrition.

    In considering the report’s ability to “future-proof” the HCW workforce, I doubt any organisational system can cope with the effect of the pandemic crisis which was wholesale across all domain within healthcare and outside.

    The report does not and cannot address the mismatch in workload (with exponential increase in older population in their 80s and beyond with expectations, and these boomers demand that they maintain their abilities and independence, unlike their parents) and effective workforce (where the increase in local graduates, 20 years after relaxation in medical school entry intake numbers, failed to account for these graduates not willing to work the same unsustainable amount of hours as their predecessors, some choosing to work part-time as work-life balance, shorter working lifespan – as more medical graduates are older, as well as not willing to fulfill their original government scholarships tied to post qualification rural placement). The recommendations in the report will accommodate the workforce of the newer generation, but is likely to address the productivity issues as well as effective workforce availability to cope with excessive demand on healthcare.

    Calling the report recommendations as “future-proof” is contentious, and in my opinion, misleading if the crisis triggering this report is COVID-19, as no system can claim to be so, although countries like Sweden copes better than others, despite being flamed for their pragmatic pandemic strategy (the psyche of the Swedish population, including their individual resilience and outlook are likely to be the main reason why they are less affected than the rest of EU). The real crisis is the outlook, expectation and resilience of the HCW entering the workforce in the last decade and beyond, as no support system proposed here will plug the gaps left by these recommendations demanding organisation change. Ironically we will end up importing (and taking advantage of) IMGs who by default have to be more personal resilience than local graduates to uproot themselves to work in a foreign country for a better life).

Leave a Reply

Your email address will not be published. Required fields are marked *