A matter of stigma or just exhaustion?

You may have noticed a distinct lack of comment from me on the mental rethinks anti stigma campaign first phase report and as this would appear to be right up my street, so to speak, it would seem a big omission. Well apart from my earlier exposé on the research done prior to the full campaign and sadly concluding that such campaigns are extremely difficult to manage or evaluate effectiveness of them I found that I had nothing more to add than had already been reported.

Well until now that is and as a first thought I would like to say that much as most people have reported good news this article in the guardian did not.

While notable improvement was recorded over the four surveys on measures including discrimination by friends and by family, there was no comparable change in discrimination by mental health professionals: 34.3% of respondents reported such treatment in 2008, falling only slightly – and not statistically significantly - to 30.4% in 2011.

 Although the argument is sound I find myself repeating ‘Aren’t all medical professionals also friends, family member and associates of those who are suffering mental health problems’ and as such were just as targeted an audience as everyone else. That none of the campaigns specifically looked at working with the mentally ill is true but really it seems the lack of improvement goes far beyond the cynical view point a worker can get about their job that was suggested in that article

I feel they really do need to look at why this group of people did not respond as positively to the campaign as others. This article goes on to give reasons but I think the most telling and the one that I feel most appropriate is about burn out and how it relates to what can be termed secondary traumatic stress.

So what is that?

Well this is what Wikipedia has to say

Compassion fatigue, also known as secondary traumatic stress (STS), is a condition characterized by a gradual lessening of compassion over time. It is common among individuals that work directly with trauma victims such as nurses, psychologists, and first responders.

... Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, sleeplessness or nightmares, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self doubt

I’m no expert but still I find that quite a lot of that rings true for some of the medical staff that I have met. I am also reminded of an article in the guardian from 2011 that stated

Average bed occupancy rates in English inpatient units are much higher than the 85% standard, with some wards running at 120% occupancy

...The report reveals that more than half of all adult general wards run at more than 100% occupancy, with 16% meeting the required target. Just 21% of acute wards meet the 85% target

 

...Daily one-to-one contact with nursing staff is less than that accepted as being conducive to recovery

Not in the same order as in the article

Well if this is still the case or even close then it is no wonder these particular staff have trouble with compassion. At least half of all staff on mental health wards are working beyond what’s expected of them are not meeting the requirements considered to give recovery.

And please remember that it is not just staffing levels that can cause problems the care quality commission report into hospital safety has shown that there is a more widespread problem with 17 hospitals, 8 of which mental health trust, were found to be non compliant on safety inspections and set deadlines for improvement. ( as reported in the guardian)

I think if you were working over and above the expected levels you also would have a problem.

But is there really a problem?

Well I found this article on Compassion fatigue in health professionals  and granted it’s not overly current but it has this to say

Statistics Canada recently published their first ever National Survey of the Work and Health of Nurses (2005) which found that “close to one-fifth of nurses reported that their mental health had made their workload difficult to handle during the previous month.”

The Bristish Journal of Psychiatry published a similar article about mental health, burnout and job satisfaction among mental health social workers in England and Wales in 2006 in which they quoted

With 81% of local authorities in the UK reporting problems recruiting and retaining social workers, staffing is more problematic in social work than in any other professional group (Employers’ Organisation & Provincial Employers’ Organisations,2002)

And in the conclusions and discussion it points out that

The most striking findings of the survey are the very high levels of stress and emotional exhaustion in the sample.

 

... The GHQ-positive rate was 47% using the cut-off of 4, which was almost double the rate for consultant psychiatrists (25%;Pajak et al, 2003) and nearly three times the level in the general population (17%;Department of Health, 1995). Similarly, mean scores for emotional exhaustion were higher than for psychiatrists (Pajak et al, 2003) and mean scores on all three burnout sub-scales were higher than norms for the mental health workforce (Maslach & Jackson,1986).

Which kind of suggest that these particular people may well be suffering far more burnout and therefore more lack of compassion than the rest of the population, which might explain why their attitudes to mental ill health have not improved.

And instead of worrying about their attitudes it might be worth improving the working conditions by reducing the stress and providing better support for them as suggested in the article.

 Particularly as they also suggest that this will likely affect staff retention and recruitment in the future. Equally it might well be worth considering that more staff to clients would improve things immensely.