Psychiatric Staff Burnout?

Marvin Ross

By Marvin Ross

Recently, I reviewed a book manuscript from a woman who had developed bipolar disorder in her 40s and had been hospitalized a number of times. What I found particularly interesting was that the woman had originally been trained as a nurse although she was not working in that capacity. She said that as a student nurse, she and her fellow students hated their rotation on the psychiatric ward. She admitted that she and the other students had disdain for the patients and that they felt that their illness was their own fault.

I don’t know how many of those student nurses ended up working with the mentally ill nor do I know if those attitudes are held by the majority who work in this area. And,  while I recognize that there are many kind and compassionate people working with the mentally ill, I’ve found from personal experience and from what others have told me that there are still far too many who display the same attitudes as those student nurses. Is it the attitudes they came into the field with or is it burnout? I don’t know. These are but some examples reflecting attitudes between those who do work with the mentally ill and those professionals who only come in contact with them periodically.

A young man with schizophrenia had been going to a very nice community dentist who left his practice and so he asked his psychiatric case worker to recommend one. He was sent to a dentist who looked after many of the clients of this particular agency and the dentist was rude, impolite and suggested that this individual needed to have a number of teeth extracted. He complained to his caseworker and was told that many clients complained about this dentist but they had no one else they could recommend.

I referred the individual to another community dentist who saw no need to extract any teeth, was aware that his new patient had schizophrenia and bent over backwards to provide caring and compassionate service.

Now because this person is on clozapine, it requires regular blood monitoring to ensure that the white blood cells are not being depleted – a serious side effect of this particular anti-psychotic. The agency has all its clients go to one blood lab which is not convenient for many of them who do not live near the lab. The agency refused to allow any client to have their blood taken at other labs and argued that only this particular lab could do the job as they specialized in clozapine blood work.

That was absurd as the blood work is for a white blood cell count which is a common and standard test. In fact, the blood labs that take the samples do not do the analysis as the samples are sent to a central laboratory. The real issue was that the staff of the psychiatric agency could not be bothered to write up a separate requisition for each client who wanted to go to a more convenient lab. I suspect that they had one requisition and just sent in a long list of names of clients who required the test.

When this individual went to another case management agency, the staff expressed surprise that he was only allowed to go to one inconvenient blood lab and gave him a requisition that he took to a lab withing a short walk of his home.

And, outside of the psychiatric hospital pharmacy, only one drug store dispensed clozapine so clients from that agency had to have all their prescriptions dispensed by that one pharmacy. And the staff at that pharmacy were completely rude to their customers which I observed on a number of occasions myself. Again, the new agency arranged to have the clozapine dispensed by the hospital pharmacy so the individual could take his other prescriptions to a more convenient community pharmacy. He was quite tense about the move and tremendously relieved to find that the new pharmacy was efficient and treated him with respect.

A number of years ago, I did a short piece called a Tale of Two Systems where I compared the care given to a man with schizophrenia between a specialized psychiatric group home and a residence for seniors. The relatives could not believe how much better care and respect the man received from a seniors home than he got from the psychiatric facility. In fact, the mental health staff ignored what were obvious signs of developing Parkinson’s until the poor man broke his hip, developed pneumonia and ended up in a seniors home. And the relatives got much more information from the staff. They did not hide behind privacy as an excuse to ignore the family as often happens in psychiatric facilities.

Katherine Flannery Dering describes a similar situation in her book Shot in the Head A Sister’s Memoir, A Brother’s Struggle about her late brother Paul. Hospital staff in the psychiatric stream noted and ignored a tumour on Paul’s lung. It was only when the family moved him into a seniors residence that the doctor also noted the existence of the tumour on his lung, had it biopsied and discovered lung cancer.

People with schizophrenia have a life expectancy that is about 20% less than others. Part of this stems from the condition itself but studies have also shown that assessment and treatment of common physical health problems in people with schizophrenia falls well below acceptable standards.

Now, I realize that It is not easy dealing with people who can be difficult and frustrating to work with because of the very nature of their illnesses. I get that but management should be better attuned to burnout if these attitudes stem from that and should develop strategies to deal with it.

I’d love to hear from others if what I’ve observed is as common as I’ve noticed and some ideas that might help burned out staff to deal with their problems.

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5 thoughts on “Psychiatric Staff Burnout?

  1. Good article Marvin! I too have noticed sometimes the very people that should be caring and warm are cold and uncaring. Worse, sometimes they can actively undermine care. A few years ago, a woman wrote a letter to the editor about a piece I wrote about how important medication is to the treatment of sz, She dismissed meds and suggested that they were not necessary. Upon checking I discovered that this woman was in fact a professor of psychiatric nursing at Brandon University!

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  2. Here’s one theory… fyi, my wife is a psychiatrist now in private practice partly because of too much bullshit in the hospital system (did her residency at Mac actually, which was a prime example of bullshit). Hospitals are inherently places of conflict, what with different reporting streams, different agendas from different disciplines, and poor accountability (once heard by a SW doing mental health assessments in a hospital ER: “I don’t believe in the biological model”… no consequences). People who go into mental health tend to be the ones who like consensus and making sure everyone is heard, etc. Try asking a bunch of psychiatrists to pick a place for lunch vs. a bunch of surgeons. In that kind of environment, the consensus types never feel heard, get frustrated very easily, and have a difficult time dealing with it. That leads to burnout big time.

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  3. Excellent article. As a former professional in the mental health system, my opinions were considered with some degree of respect. Now in the role of a family caregiver, a number of the same psychiatrists that I had formerly worked with have had difficulty believing my observations. Are my observations being dismissed because I am a family caregiver? Gives one pause for thought. I do have to clarify that there are good and kind psychiatrists though. Also, I have had personal experience with the enactment of privacy legislation. It seems that my son’s right to privacy trumps his right to physical safety. I learned this when I complained that no-one from the case management agency responded when I had called in distress because I believed my son’s safety was at risk. The reason no-one returned my calls was “that there had been a directive from the client that no conversations were to take place unless he was present!” That means that a professional, who is enacting her or his interpretation of the laws of the state, can have the power over the safety of my son, a person that I gave birth too.

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  4. I thought this was a fantastic article! I don’t normally speak about this due to the stigma attached, almost 2 years ago I was diagnosed with a “bipolar-like” disorder. So I skip the niceties and go ahead and call it as it is…Bipolar Personality Disorder. It actually got me fired from my job…working for a community mental health center!!! Ironic, huh?!! I was absolutely mortified. I have dealt with a pretty good case of ADHD, which has been shown to have some relationship, but was doing well on my medication. Although, one of the side effects is that my hands tremor some. But no biggy. I experienced 3 huge events in succession in less than a year; my mother falling and suffering a severe TBI, a few months later, my father committed suicide, which I got the treat of personally seeing his headless body on the laundry room floor, and several months after that, I lost my 6-figure job in pharmaceutical sales with the company I’d been with for almost 15 years. But so did 2700 other people. All of this combined, opened a gate that changed my life, as I worked at my job at the Mental Health Center as a Case Manager. Apparently, due to the tremor of my hands, my quiet, nonsocial personality (down curve), mixed with my hyper euphoria that caused me to talk too much and become a little flirtatious caused a great deal of concern…along with a GREAT DEAL of exaggeration…by my 3 coworkers I shared office space with. And, to be perfectly honest, I can’t remember everything. I just know that I would feel like I could do ANYTHING one moment, and feel paranoid and anxious the next. I also had started feeling very vindictive toward my Manager because I felt he focused on me and would ridicule me whenever I got a chance. So, this became a darker side. I could feel it, but honestly liked that darker feeling and didn’t care. Intervention from my family took place, and through a psychiatrist I was placed on a great mood stabilizer. I was like a different person the next day! Amazing! But too late for the mental health professionals where I worked to try to understand that this was something that I’d never experienced before! They were so rude and didn’t care. Of all places! I remember telling the woman who simply said on 5 occasions to me,”you need to get help”, that I had gotten help, I was on medication, and feeling well. She told me it did not matter, that I was terminated and I would be escorted out. I turned to her as I headed toward this fat ass that would be my escort, and said, “I really feel bad for you.”. She showed no emotion, so I finished, “it must be very embarrassing for you to work at an agency that is supposed to support mentally ill individuals, yet you treat your staff who go through a mental health crisis like crap, and throw them out, while hypocritically telling them they need help!” Needless to say, I’ve been a thorn in their side letting people know exactly what “support” means to them, without revealing that I’m actually talking about myself.

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