Overwhelmed by soaring demand, mental health services are under growing pressure on both sides of the Atlantic. According to a 2017 Mental Health Foundation survey two-thirds of British adults experience mental ill-health issues at some point in their lives. In England alone, such issues in young people have risen sixfold since 1995. US figures paint a similar picture: a study published in Psychiatry Online in 2017 found that more than eight million Americans suffer from serious psychological distress.
But this crisis isn’t just affecting the general public; an increasing number of mental health professionals are also struggling with their wellbeing. In a recent survey undertaken by the New Savoy Partnership—a coalition of organisations that came together in 2007 to persuade government to recognise the value of providing psychological therapies free of charge—almost half of 1,227 NHS psychotherapists said that they had felt depressed in the last week “some, most or all of the time,” up from 40 per cent in 2014.
In already highly-pressured environments like the NHS, increasing demands on staff, tight time limits and the prominence of targets mean that many nurses and specialists are suffering from the same mental health problems they are treating in their patients. This isn’t just a problem for professionals who lack access to the appropriate support; keeping staff healthy is also crucial for patients, communities and our collective wellbeing.
“High caseloads, lots of clients back to back—the work of a therapist is tough emotionally and takes a lot of energy out of you,” counsellor and psychotherapist Katerina Georgiou told me in a recent interview. “It’s also a very responsible role—you’ve got vulnerable people placing their trust in you, and that’s a responsibility you can’t take lightly. You need to care about people and fully attend to them. You’re switched on throughout a session. If you’ve then got five or six sessions back to back, that’s a lot of time switched on,” adding that burnout can be common.
At a time when the demand for mental health services is rising, funding cuts and austerity measures have caused essential resources to dwindle, staff workloads to mount, pay stagnate and morale crumble. According to The Centre for Mental Health, mental illness accounts for 28 per cent of the overall disease burden of the NHS but receives just 13 per cent of total funding. Between 2009 and 2017, the King’s Fund think tank reported a 13 per cent drop in full-time NHS mental health nurses.
“Mental health professionals will feel the cuts in the sense of noticing increased caseloads, perhaps not having much time in between clients, not as much time to write up notes, and the demand for outcomes increased,” Georgiou says. “The breathing space decreases, which can increase stress, maybe even build resentment. And the thing is, you can’t let that stress and resentment get in the way of your work.”
Health staff are being asked to see huge numbers of patients for shorter periods of time, and their managers are under pressure to prioritise targets—like treating minimum numbers of clients—over their wellbeing. As a result, sickness rates among staff have become a common concern, with stress and anxiety-issues one of the most frequently stated causes of absence among mental health nurses.
“Working in an under-resourced, under-pressure NHS leaves doctors struggling to provide the high-quality care patients deserve,” British Medical Association Consultants’ Committee mental health lead Dr Andrew Molodynski told me. “This leads to doctors burning out and becoming unwell, and patients suffer further.”
Louise Watson, a UK-based clinical psychologist, adds that professionals working privately may also face “internal pressures,” perhaps seeing more clients in a day than may be healthy because of the intense nature of the job. Moreover, mental health professionals may struggle to come forward for help, or simply soldier on and mask their problems. “I think another internal pressure is that perhaps mental health professionals feel a level of demand that they shouldn’t be struggling with mental health issues themselves,” Watson told me.
“Most people who are in the profession are there because there is something in their personality or background that means they are comfortable in that role of helping other people, so to be on the other side of the fence is difficult. They may put off going for help longer than they should because of that.”
Making sure that everyone who needs help is able to access it is essential, not least because the number of people in need of specialist care is growing, and staffing levels are already in crisis. “It speaks for itself that if mental health professionals are off work with stress, or aren’t functioning to their full capacity because they are under too much pressure, then there won’t be anybody to look after anybody,” Watson says. “It’s a bit like on an airplane and the oxygen masks drop down, you need to fit your own oxygen mask first before you help others.”
Mental health services in the US are also under threat. Earlier this year, President Trump’s budget proposed slashing Medicaid, the major source of public funds for mental health treatment which serves more than 70 million low-income and disabled people. America is also facing an acute shortage of mental health professionals in rural areas, with 65 per cent of non-metropolitan counties lacking a psychiatrist and nearly half without a psychologist according to a recent study in the American Journal of Preventive Medicine.
It’s no surprise that a shortage of staff and other resources have had a direct impact on access to services, including longer waits for people in dire need of help, which can lead to an increased risk of self-harm and suicide. In 2018, the US Centers for Disease Control found that suicide rates have risen by 30 per cent in America since 1999. An increasing number of teenagers in England and Wales are also dying by suicide, with 177 suicides among 15- to 19-year-olds in 2017 compared to 110 in 2010.
“There would be an argument to say that we ought to be prioritising making sure people who are helping others are healthy,” Watson told me. “If we don’t, there won’t be any mental health care. And that will have knock on effects on society like having large numbers of people off work with stress.”
It’s not just public health that suffers if we fail to support mental health staff but the whole of society and the economy. The UK government’s Thriving at Work review published in 2017 concluded that poor mental health costs the economy up to £99 billion a year. Of this amount, employers lose up to £42 billion through staff turnover, sick leave and ‘presenteeism’—working while sick, which causes losses in productivity.
Importantly though, if a mental health professional is experiencing a problem and seeks help, this can be a positive thing for care all-round. “It increases your ability to empathise with your own clients if you have been through a similar situation, and gives you first-hand experience of seeing what you thought was helpful,” Watson explained. “If you work in mental health and you suffer with an issue yourself, maybe it ought to be seen as a helpful experience in terms of improving our own practice.”
It also breaks down the ‘them and us’ feeling that is common in the health system, Watson adds. “The client may see the psychologist as a doctor who is there to fix them, but what I think can be helpful in a therapeutic relationship is to feel a rapport—that we are both human beings. It is about working together to find an answer.”