Staff burnout is increasingly viewed with serious concern in the mental health field. Morse, Salyers, et al. reported in 2012 that “across several studies, it appears that 21–67 percent of mental health workers may be experiencing high levels of burnout. In a study of 151 community mental health workers in Northern California, Webster and Hackett (1999) found that 54 percent had high emotional exhaustion and 38 percent reported high depersonalization rates, but most reported high levels of personal accomplishment as well.”
In order to minimize the impact of stress that comes with the terrain of their job, mental health professionals need to engage in self-care activities on a regular basis. In her presentation as part of the Williamsburg Place Lecture Series, Xanthia Johnson offered evidence-based strategies for dealing with job-related stress. Johnson is a licensed psychotherapist and creative arts therapist. She is also the CEO and founder of Urban Playology.
Johnson began the lecture with her personal journey to self-care. She started out in public health working with children who had been severely affected by domestic violence. It was tough work, she remembered, with a long commute and even longer hours. At one point, she was so exhausted from work that she couldn’t remember her commute.
She left the agency she was working for at the time and started her own private practice. Johnson went through what many of her colleagues experience. “I know what it’s like to have so much paperwork that you can’t see straight,” she told the audience. “I know what it feels like when you can’t do another thing. When you don’t even want the raise,” telling them, “keep the money and let me keep what little bit of sanity I have left.”
To counter the relentless stress, mental health professionals need to engage in self-care or they won’t be able to continue helping their clients. First, that requires to actually acknowledge the problem.
There are three levels of stress response, said Johnson:
- Positive: brief increases in heart rate, mild elevations in stress hormone levels.
- Tolerable: serious, temporary stress responses, buffered by supportive relationships
- Toxic: prolonged activation of stress response systems in the absence of protective relationships
The worst stress for many mental health clinicians is caused by vicarious trauma— the emotional residue of exposure that counselors have from working with people as they hear their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured. It is important not to confuse vicarious trauma with the phenomenon of burnout which results from an overloaded work schedule.
“Burnout is generally something that happens over time, and as it builds up a change, such as time off or a new and sometimes different job, can take care of burnout or improve
it,” explains a fact sheet of the American Counseling Association. “Vicarious trauma, however, is a state of tension and preoccupation of the stories/trauma experiences described by clients. This tension and preoccupation might be experienced by counselors in several ways.”
Burnout may lead to broken personal relationships, substance misuse, depression, and suicide on a personal level and decreased quality of care, decreased patient satisfaction, decreased productivity and effort on a professional level, explained Johnson. Secondary traumatic stress may have an equally devastating impact.
To guard against burnout, compassion fatigue, and vicarious trauma, mental health professionals need to engage in self-care. Johnson stressed the importance of professional supervision to ensure this is happening. “It’s not enough to be a good person, you have to create spaces for yourself.”
Interestingly, four major dimensions that support life in recovery are applicable in professional self-care as well.
- Health: overcoming or managing one’s disease as well as living in a physically and emotionally healthy way.
- Home: a stable and safe place to live.
- Purpose: meaningful daily activities.
- Community: relationships and social networks that provide support, friendship, love, and hope.
And another recovery concept is crucial for self-care: boundaries. To explain, Johnson showed participants a TedTalk video in which Sarri Gilman recommends a yes/no approach.
“Boundaries are made of Yes and No. Boundaries are our compass, the guidance system we use to make every single decision,” says Gilman. To avoid burnout, mental health clinicians have to learn when to say no. They need to develop self-care habits that could be as simple as a half-minute daily activity. Daily routines could include nature immersion, meditation, peer check-in, or even simply drawing pictures. Other options are quality time with loved ones, prayer physical exercise, and humor. A hearty laugh can go a long way.