'Slightly below average' isn't good enough for physician, clinician mental health

Health care workers spend their days looking after other people's well-being, but their own mental health trails the rest of the workforce.

In the TELUS Health Mental Health Index, which surveyed 5,000 U.S. workers, the health care and social assistance sector scored 69.0 out of 100, below the national score of 70.1 and in the index's "strained" range. Women scored 68.6, compared with 71.7 for men, a gap that weighs heavily in a predominantly female workforce. Workers who provide care or financial support to aging parents scored 63.0.

TELUS Health provides health and well-being services in more than 180 countries and works with employers in every industry. Paula Allen, its global leader of research and insights, said close to average isn't good enough for workers whose jobs demand high-stakes decisions. She spoke with Medical Economics about the findings, incivility in the workplace, caregiving and what employers can do.

This transcript has been edited for length and clarity.

How would you describe the environment health care workers face, especially since the pandemic?

Paula Allen: The first thing that comes to my mind, based on the research that we've done: My biggest concern for any worker in health care is the increased cynicism and the lack of civility that we have in the general population. There are certain professional groups that are harder hit, health care being one of them. People are putting pressure on workers because they themselves are feeling anxious. Their expectations have increased. The civility of the population has been declining.

So there are the things that our health care workers are facing on a day-to-day basis, over and above the existing stressors that they would have: the importance and the consequence of the work, the changes in funding and how that environment shapes work, and shift work for some workers. And then we have the strain of dealing with an angrier public, patients and families. That has really hit me quite significantly.

Health care and social assistance scored 69, slightly below the national average and down slightly from February. What do you read into that?

Paula Allen: Overall, health care and social assistance tends to be slightly lower than the average. There is fluctuation in every industry. We really start to pay attention at about three points, if that's consistent in terms of the up and down. But I think the more illustrative point is that health care is slightly below average: not the worst, but not the best.

If you put that into the context of what health care workers do, I would say we shouldn't feel comfortable with slightly below average, or close to average. When you think of the cognitive work that is important, the interpersonal work that is important and the escalating level of risk, I would feel much more comfortable if health care was above [average] and increasing.

You have to look at the support that's necessary based on the need. Part of the need is the work experience, which is rewarding but very difficult in certain situations. Then you think of what is demanded of that population: accuracy, highly consequential decision-making, interpersonal skill. Those are all the things that are damaged, or at least blunted, when you don't have optimal mental well-being. So there is a need for better-than-average support for the health care population because of those two factors.

Women scored 68.6 compared with 71.7 for men, and parents scored lower than workers without children, in a predominantly female health care workforce. How should that shape an employer's approach to mental health services?

Paula Allen: I think it builds another dimension on something that has started and is well overdue. Many employers are spending time thinking about the equity that's needed with women's health support. But here's the issue: A lot of the time, when people think about women's health support, employers might be having webinars or information sessions or services, and there seems to be an excessive focus on menopause.

Menopause is important. There are a lot of economic and workplace consequences as a result of not attending to it, so please don't think I'm saying that any of that is not good. But women are more than menopause, premenopause and postmenopause, and the life experience of women in our society is different. I'm not putting any blame. It just is.

One way that it is different is that we are still working towards just the consciousness of women in professions and the over-representation of women in professions that tend to be a bit lower paid.

The other is in terms of family responsibilities. You mentioned parents of children, but there are also one's own parents. We are getting into a phase where about a third of the working population has some level of elder care responsibility, and that will be growing over time and impacting us at a younger age, because people have been having children a little bit later and are living longer. So it's impacting us for more of our lifespan.

We are going to have a crisis that is disproportionately impacting the women in families. That is because of a number of social norms, and women making decisions for themselves and perhaps not asking for as much help as men ask for, but it is also really just the way we are in society at this point in time.

From an employer's point of view, we want to make sure that 100% of the population is supported based on their needs. When we are thinking about the health and well-being of women, we have to think more broadly than menopause. We have to think about financial well-being. We have to think about caregiver supports and navigation of systems.

Flexibility comes up as a screaming ask. When people think about flexibility, they think of work from home, which is out of the question for the majority of health care workers. But it's not just work from home. It is a much more controlled approach to managing shifts. It is backup opportunities and emergency opportunities. There are things that will come to you if you ask your population to help you problem-solve on flexibility that is realistic in a health care environment, and that can be very helpful to people's well-being as well.

Are many employers preparing for more caregiving among their workforce? If not, it seems it will come to their attention.

Paula Allen: It will come to their attention, in employees dropping out of the workforce, moving to part time, going on disability leave because of the strain, and reduced productivity if people don't feel supported. So it's a workplace issue, quite significantly.

The whole idea that some things are personal issues and some things are workplace issues is not really working, right? What is happening in your life impacts your work, and what happens at work impacts your life.