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Priority Area: Support Mental Health and Reduce Stigma

Provide support to health workers by eliminating barriers and reducing stigma associated with seeking services to address mental health challenges.

“We need investment in mental health in the long term, funding and access to care, and change in barriers to access like conversations about care and stigma in our culture.” - Frontline Health Worker¹

Mental health is a “state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community” (WHO, 2018). Mental health disorders affect 15 to 20 percent of U.S. adults in any given year and are the leading cause of disability in the country (U.S. Burden of Disease Collaborators, 2013). For health care workers specifically, the nature of their clinical training and work is linked to substantial increases in depression, anxiety, suicidal ideation, and other mental health conditions upon entering the profession, with high rates persisting through their careers (Bellini et al., 2002; Mata et al., 2015; Melnyk et al., 2020). There is a continuum of stress in the environment with multiple phases and implications (Nash et al., 2010). Past pandemics and emerging evidence suggest that many health workers will have experiences along the stress continuum, which could include COVID-19-related trauma,

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¹ For background on this quote and those in other chapters, visit the NAM’s Clinician Burnout Crisis in the Era of COVID-19: Insights from the Frontlines of Care webpage at: https://nam.edu/initiatives/clinician-resilience-and-well-being/clinician-burnout-crisis-in-the-era-of-covid-19/.

posttraumatic stress disorder (PTSD), risk for substance use, and depression (McKay and Asmundson, 2020). Ultimately, if health workers are not well, health care delivery and patient safety may suffer (Fahrenkopf et al., 2008).

There is robust evidence that mental health disorders can be prevented, and prevention approaches have the potential to substantially reduce the public health burden of these disorders (Muñoz et al., 2012). It should be noted that prevention strategies and treatments differ for mental health challenges and problems that are potentially linked with substance use and addiction. Prevention efforts should be aimed at populations, such as health workers and other professionals, where the prevalence of disorders are high and important drivers of poor mental health have been identified. To decrease the number of health workers and learners who develop depression, anxiety, and other mental health issues, it is critical that health systems address the structural challenges that are driving some of their employees’ poor mental health, such as high workload, administrative burden, and work-family conflict (Fang et al., 2022; Guille et al., 2017). When mental health issues arise, these upstream drivers must be addressed, in addition to the provision of appropriate mental health resources and referrals. This requires appropriate triage by skilled mental health professionals at the individual level who can distinguish between burnout and mental and behavioral health issues and make an accurate referral for treatment. Health workers struggling with addiction and fearful of losing their licenses should have assistance, since there are significant consequences—not only to themselves but also for their patients—if they remain untreated (Butler Center for Research, 2015).

In the United States, stigma associated with seeking support for emotional and mental health and substance use is widespread in the general population (NASEM, 2019). Negative perceptions, attitudes, and discrimination regarding help-seeking are entrenched in the health professions’ culture and training, as well as individual perceptions of and the actual expectations and responses of health systems, licensing bodies, and other governing forces (NASEM, 2019). As such, many mental health programs, even when implemented, face resistance from health workers, so planning for psy-

chological intervention programs should include promotion and awareness campaigns at the organizational level (Buselli et al., 2021). At the state level, despite progress in recent years on updated licensing applications to encourage treatment-seeking among health workers, this stigma continues to be pervasive (FSMB, 2018; Halter et al., 2019).² In practice, health workers may still internalize shame, avoid speaking up and getting care, or avoid fully sharing their experiences with their employers. Continuing to eliminate both policy barriers to care and cultural stigma are foundational to the professional well-being of health workers and learners.

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² In 2018, the Federation of State Medical Boards released recommendations for licensing applications to ask only about current impairments to practicing—not all conditions—that might undermine a physician’s ability to work safely (FSMB, 2018). These licensing updates would be consistent with the Americans with Disabilities Act, which prohibits discrimination against those with mental health conditions. Many state boards of nursing are also modifying their licensing applications (Halter et al., 2019).

Goal 3.5.	Access to mental health resources is correlated with improved health worker well-being.
Actors		Academic Institutions, Clinical Training Programs, and Accreditation Bodies
		Federal, State, and Local Governments
		Health Systems
		Professional and Specialty Societies
Actions	3.5.A. Track the use of mental health services and programs (e.g., Employee Assistance Program) to ensure programs are designed to meet the needs of health workers, whether efforts to seek assistance and treatment have increased, and whether organizational barriers (such as stigma, lack of confidentiality, fear of punitive consequences, etc.) have been removed. NOTE: Data should be de-identified.
	3.5.B. Track whether state-level barriers have been removed.

NOTE: The list of actors in this table is not exhaustive. Many of the actors named in this table will need to plan and coordinate their actions with each other as part of a systems approach to health workforce well-being.

RELATED RESOURCES^{3 1}

Cultivate a Culture of Connection and Support

• Organizational Guide: 2022 Healthcare Workforce Rescue Package (National Academy of Medicine and All In)
• Organizational Guide: Conversation and Action Guide to Support Staff Well-Being and Joy in Work During and After the COVID-19 Pandemic (Institute for Healthcare Improvement)
• Organizational Graphic: Psychological PPE: Promote Health Care Workforce Mental Health and Well-Being (Institute for Healthcare Improvement)

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³ For additional resources, visit the NAM’s Resource Compendium for Health Care Worker Well-Being webpage at: https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/.

• Organizational Guide: Peer Support Programs for Physicians (Shapiro, 2020)
• Organizational Guide: At the Heart of the Pandemic: Nursing Peer Support (Godfrey and Scott, 2020)
• Organizational Guide: Preventing Physician Suicide: Identify and Support At-Risk Physicians (Brooks, 2016)
• Individual Support Guide: Provider Well-Being for Behavioral Health Professionals (Mental Health Technology Transfer Center Network)
• Individual Support Guide: Health Care Professionals (National Alliance on Mental Illness)
• Resource Compilation: COVID Resources (American Psychiatric Nurses Association)

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