Post traumatic stress disorder, work, burnout and the spiritual crises in health and social care.

The covid crises has created a huge amount of stress in frontline workers; and not least in the healthcare workforce who have dealt with trauma, death and dying on a daily basis.

As we (hopefully) come through the worst of this, it is of no doubt the impact of the Covid crisis will leave its mark on many. But this is not just in terms of the loss of loved ones, the loss of jobs and livelihoods, long covid or even the ongoing fears over the economy or an insecure future. No – it leaves a more far less recognised and more hidden shadow, especially for those who carried the responsibility  of caring during the crisis and that is the real possibility post traumatic stress.

Post traumatic stress disorder (PTSD) is now a well known condition recognised by several key factors including: the presence of one or more extreme stressors or traumatic incidents; flashbacks to the event; intrusive thoughts, often accompanied by imagery or sounds; intense distress and anxiety; disassociation or other avoidance behaviours.

This high state of arousal can result in incapacitating symptoms, such as panic attacks; irritability and aggressive or overly sensitive behaviours; disturbed sleep patterns marked by ruminations and/or nightmares and, unsurprisingly, a lack of concentration.

Such a complex picture does have profound impacts on the individual’s ability to function in everyday activities; strategies to support this incorporate a comprehensive range of person-centred approaches, including cognitive and dialectical behavioural therapies, hypnosis, the building of personal resilience and the strengthening of relational (family, friends, colleagues) networks.

Interestingly, whilst much of the research around the area of PTSD highlights the presence of specific traumatic events as the causal factor, a study by Mealer et al (2009) has identified how PTSD in health workers can emerge as a result of recurring daily events, like dealing with death and dying, excessive psychological demands and feelings of helplessness. Crucially, the study also identified that in this context, the diagnosis of PTSD always coexists with burnout, marked by psychological exhaustion and de-personalisation. When PTSD and burnout were found together, people described  lower levels of trust with both colleagues and clients/patients. They also  described  higher levels of psychological symptoms, like stress, anxiety and depression, and lower levels of functional abilities, like performance and effectiveness at work and home environments to those individuals suffering from burnout or PTSD alone.

These factors of course, impact not only the individual worker’s health and wellbeing and the efficacy of the outcomes for the employing organisation, but the ability to work effectively with others and to sustain the practical and emotional energy needed to care for clients/patients effectively. This is because it is not just the physical, emotional and psychological dimensions of the individual’s wellbeing that are disrupted, but also the spiritual (Clouston 2015), reflecting a breakdown in the core elements of the person’s existential essence or ‘being’ and thus their ability to connect meaningfully to self or others (McBride 2013; Shaw, Joseph & Linley 2005).

In terms of health care workers, this is a notable loss in an environment that now requires the abilities to be caring and compassionate as a prior skills to working in the health and social care sector (Francis 2013) and promotes the emotional use of the self as part of the therapeutic encounter (Solman & Clouston 2016).

To address this requires a pragmatic approach that not only requires the organisation to support the individual employee psychologically, emotionally and physically, but also at a spiritual level; only by working with this frequently overlooked dimension of human nature can health and social care organisations hope to support their staff to practice healthy and compassionate care for others.

This, of course is not easy and requires these organisations to tackle the roots of the problem, which includes an ‘illness model’ that indirectly enables them to place the fault of PTSD (and burnout) firmly at the feet of the employee, rather than as an outcome of the pressures and cultural context of the workplace. To confront this necessitates a reorientation of the organisation’s values, systems and practice at the most fundamental level in order to move from a performance orientation to a more caring and compassionate one; that in turn, requires a social structure and political and public mindset will that will support it.

This means a government that invests in its staff, values them, supports them and pays them fairly for the work they do and the public service they offer everyday.  Only then can we address the growing problem of stress, burnout and PTSD in health and social care workers and give these staff the sense of  value and worth they really need and deserve.

References

Clouston TJ. 2015. Challenging stress, burnout and rust-out: Finding balance in busy lives. London: Jessica Kingsley.

Francis R. 2013. Final report. London: The Stationary Office.

McBride JL. 2013. Spiritual crises: Surviving trauma to the Soul. Abingdon, Oxon: Routledge.

Mealer M; Burnham EL; Goode CJ; Rothbaum B & Moss M. 2009. The prevalence of PTSD and burnout syndrome in nurses. Depression & Anxiety, 26,12, 1118-1126.

Shaw A; Joseph S & Linley A. 2005. Religion, spirituality, and posttraumatic growth: a systematic review. Mental Health, Religion and Culture. 8,1, 1-11

Solmon B, Clouston TJ. 2016. Occupational therapy and the therapeutic use of self. British Journal of Occupational Therapy, 79,8, 514-516.

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