Mental health clinicians feel the impact of being too spread out

Source: Photo by Elisa Ventur/Unsplash

The COVID-19 pandemic has put a strain on the country’s health system. And this tension is perhaps no more evident than when we consider the difficult ethical decision-making dilemmas that clinicians have faced.

Much attention has been paid to front-line workers, and rightly so. With service demands exceeding capacity, a shortage of necessary equipment, and inadequate staffing, many healthcare providers have faced unprecedented moral dilemmas. As a result, “moral hurt,” the spiritual harm that stems from a betrayal of one’s core values, becomes a sad and serious feature of this pandemic.

Beyond the plight of frontline doctors and nurses, COVID-19 has disrupted mental health services. While offsite modalities, like telehealth, filled an important gap at the height of the pandemic, virtual mental health care cannot solve the mental health crisis, which the pandemic has only exacerbated.

What is moral damage?

Moral harm in medicine “occurs when clinicians are repeatedly expected, in the course of providing care, to make choices that transgress their long-standing and deeply held commitment to healing.” Although hurt feelings can be linked to other mental health issues, such as burnout, adjustment disorders, depression, and PTSD, it is distinct from them.

Moral damage is not classified as a mental disorder. However, it undermines clinicians’ capacity for well-being, confidence in meeting challenges, feelings of belonging and meaning, and overall sense of self. The key to hurt feelings is that it is associated with guilt and shame, and leads to behavioral effects such as withdrawal from daily routines.

Although mental health professionals have been discussing moral injury in the context of military and combat situations for decades (beginning with this groundbreaking article by Brett Litz, et al.), the current crisis has revealed the depth and extent of the potential impact of moral injury. on entire networks of healthcare workers.

For those on the frontlines of the pandemic, studies have shown that transitioning from ordinary standards of care to crisis care standards can provide a framework for making ethically difficult decisions and mitigating some moral wounds. One question is whether a similar mindset shift could also help mental health clinicians deal with moral wounds.

Moral Injury and Mental Health Clinicians

A silver lining of the COVID-19 pandemic is that patients in remote and historically underserved communities have been able to access mental health care for the first time through videotherapy sessions. Yet, although teletherapy has meant first access or easier access for many people, there are instances where an office visit is still necessary.

For patients who have domestic situations that require security and privacy, for example, the clinician’s office is a safe space where they can speak candidly. In their own homes, however, patients naturally find it more difficult or, in some cases, dangerous to speak openly about their situation.

Teletherapy can also be difficult for children who seek privacy from their parents. Mental health clinicians have reported parents listening or even intervening during their child’s therapy session. If a child confides in their clinician that they are having trouble with a parent and that parent walks into the room, clinicians have extremely limited options to protect their patient.

Essential readings on online therapy

Issues surrounding teletherapy and client safety raise the possibility of moral harm for mental health clinicians. While many challenges may have relatively easy solutions, amid the chaos of the pandemic, uncertainty about legalities or insurance policies, among other things, has left many clinicians in a bind.

Moreover, teletherapy cannot solve the biggest problem: the shortage of clinicians. The National Center for Health Workforce Analysis estimates that, by 2025, there will be shortages of psychiatrists, clinical counselors, marriage and family therapists, school counselors, and mental health and addictions social workers that will number by tens of thousands.

Teletherapy may allow some therapists to see more patients, but we can’t get much out of the current mental health workforce.

How to Prevent Moral Harm for Mental Health Clinicians in the Workplace

Until we have a clear set of guidelines and a well-thought-out plan to address the above issues, mental health clinicians will continue to suffer moral harm from what they cannot. not do for their patients. Yet organizations and leaders can play an important role in mitigating the impact on mental health clinicians.

The American Psychiatric Association has issued guidelines on hurt feelings during the COVID-19 pandemic. Here are some of the key recommendations that would help mental health clinicians in particular:

  • Start a conversation about hurt feelings: The goal here would be to give clinicians time to air their concerns, examine moral dilemmas, and discuss ways to promote resilience.
  • Provide support for ethically difficult decisions: This would involve ensuring that all decisions have supervisory support and ensuring that there are processes in place to ease the burden of these decisions from individual clinicians.
  • Identify resources to deal with moral harm: These can be spiritual, emotional or psychological.
  • Ensure quick and easy access to ethics consultation: In situations where it appears that any action could violate a core value of healing professionals, medical ethicists should be made available and ongoing consultation should be provided.
  • Ensure that leadership messages and actions consistently reflect an understanding of hurt feelings and a genuine concern for the well-being of clinicians: Contradictory, inconsistent or punitive messages and decisions undermine the morale of mental health workers and can increase the risk of moral harm.

As the shape of mental health care continues to change, it is in our power to ensure that the transition does not leave irreversible scars on our clinicians. Moral distress and moral injury are pressing concerns for those doing the heavy lifting here. Let’s address this reality, even as we face pressure on other parts of our healthcare system.

Comments are closed.