When Dr. Hannah Szewczyk reflects on her medical career, she can’t remember ever feeling exhausted. But she says it may have happened without her realizing it.
“It’s tricky because I think (burnout is) also kind of normalized in medicine,” she told ABC RN’s This Working Life.
The chair of the Australian Medical Association’s Council of Physicians in Training says burnout is very common in the healthcare profession, and it’s something that’s been highlighted during the COVID-19 pandemic .
Dr. Szewczyk says there are several reasons for this, including long hours.
“But there are also other things that contribute. Many doctors in training and young doctors do not always feel valued by their workplace. They feel like they are just another cog in the production line,” she says.
“It’s also a very stressful job. There’s a lot of pressure… there’s a lot of life and death in the hospital. There’s also this risk of hurt feelings. And I think that all contributes to burnout.”
Burnout clearly has a significant impact on this sector. Last year, a study of nearly 8,000 healthcare workers found that one in 10 had thoughts of suicide or harming themselves during the second wave of the COVID-19 pandemic.
“It’s really, really late”
Medical workers aren’t the only ones facing serious mental health risks in the workplace. It has also been reported that a shortage of teachers is causing burnout in the sector, while other industries, such as hospitality, can have unhealthy workplace expectations.
Some employers are trying to address the issues by considering initiatives such as the four-day or longer work week to provide flexibility and job security for workers.
But a solution may now be available. And it is one that places the psychological health of a worker under the responsibility of employers.
In June 2022, the government agency Safe Work Australia updated its Occupational Health and Safety (WHS) regulations to include some specific regulations to manage psychological risks in the workplace. These are also known as psychosocial risks.
In August 2022, the agency released a new code of practice that addresses these risks.
This code names potential psychosocial risks, ranging from the demands of a job as well as flexibility and autonomy to workplace interactions and the physical environment of a workplace itself.
Safe Work Australia offers WHS regulations and codes of practice to be adopted in all jurisdictions in the country. And so far the Commonwealth, New South Wales, Queensland, Tasmania and Western Australia have adopted regulations on psychosocial risk management, with regulation in the Northern Territory due to start in July.
“It’s really, really overdue, so I’m glad to see that. Hopefully, if we can improve the well-being of these doctors through this code, there will be more retention,” says Dr. Szewczyk .
Labor and labor lawyer Ian Neil SC says the introduction of this new code is significant.
“(This Code of Practice is) seen primarily as evidence of what is known about a hazard or risk – or a risk assessment or risk control. And a demonstration of that that is reasonably achievable to address those hazards and risks,” he says.
“It Won’t Be Enough”
Neil believes that with this new code, mental health risks will be taken as seriously as other occupational hazards have been in the past.
“For a very long time, the focus has been on physical hazards, physical risks, physical injuries, and no doubt that’s because they’re the most obvious,” he says.
“But it has long been recognized that work, like any other human environment, poses risks to people’s psychological health (and well-being).”
“It will no longer be… available to anyone involved in a process to say, ‘Well, stress, anxiety, worry, etc. are only an inherent and inevitable part of any meaningful change, and there is nothing we can do about it. This.
“It won’t be enough.”
Response to stress
Researchers have often considered how work can harm our mental health.
For example, in 2015, a study of 240 healthcare workers reported that burnout was associated with mental health, indicating that higher levels of burnout were linked to higher levels of depression.
And in 2020, US researchers studied the effect of job insecurity on nearly 5,000 young people during the COVID-19 pandemic. They found an increase in symptoms of anxiety and depression in people with precarious work.
Dr Ruchi Sinha is Associate Professor of Organizational Behavior at the University of South Australia. She says expected things like bullying, lack of communication and lack of recognition can cause mental damage. But stress is another big mental health risk, she says, and it can result from issues like unclear work and poor organization.
“The severe and prolonged presence of these dangers creates stress. This stress can have cardiovascular and musculoskeletal effects (impacts), thus having pain in the bones of the neck, the joints. And having blood pressure and cardiological problems comes from very long chronic stress,” she says.
“Similarly, your feeling of exhaustion, burnout, anxiety, depression: these are psychological reactions to stress.”
Chronic stress has also been linked to physical conditions such as diabetes and cancer.
There are clear ways to solve problems. For example, research has found that eliminating mental health risks can improve workplaces through increased productivity and reduced costs.
And Dr. Sinha says a positive work environment can also help buffer stress reactions.
“When you have good leadership, an atmosphere of trust, mutual respect, and shared leadership with your peers, it provides a resource for dealing with work stress,” she says.
The code sets off alarm bells for employers, she said.
“I think this regulation adds that layer of (employer) obligations. If you don’t deal with your employees in terms of burnout and then increased levels of cynicism, or you potentially have interventions to prevent suicide and other stress disorders, then you are responsible in some way for enabling poor mental health.”
How it works?
While the benefits of this new code are clear, there are questions about how it will be implemented and how employees will respond to it.
Neil predicts that regulators will “pay real attention to these types of injuries” thanks to the new code of practice.
“All jurisdictions, Commonwealth and State, have inspections the purpose of which is to investigate and take action to ensure compliance with occupational health and safety legislation and obligations under it legislation.”
Neil says compliance issues can come to the attention of regulators, including whistleblowers. Workplaces will also be required to report any potential hazards.
However, Dr. Sinha worries about how this code will translate into everyday language and behavior.
And she worries about the number of employees who will voice their concerns.
“(For example,) there’s a lot of research to show that there are employee assistance programs (that) there are initiatives that work, but actual participation – if people opt into the services – is gendered and is driven by a lot of self and societal stigma.”
Dr Sinha says those who report dangers can be split based on gender. She says some men may feel the need to appear “strong, empowered, action-oriented, in control of their lives.” But after “any stress reaction where they feel out of control,” they may feel uncertain, helpless, and in need of support.
“These (responses) go against their stereotypes. And we find that self-stigma is not someone telling them openly that they can’t do it. behave in a non-ideal gendered way,” she said.
Dr. Sinha says that for women, there are similar reactions to workplace events such as microaggressions and issues around childcare, IVF and menopause.
“These are topics that we know are part of gendered stress responses. (Women) don’t talk about them because then they would be seen as causing trouble. And they would see that these are female topics, and therefore they ‘must not be discussed (at work).”
The stigma of mental illness can also prevent some people from speaking up or seeking support in the workplace.
According to Dr. Sinha, in order to create a safe environment that encourages dialogue, organizations need to promote inclusion, including providing role models.
“You might have all of these written down in policy documents, but not a single person modeling these behaviors in reality,” she says.
“The climate is what determines what is acceptable and unacceptable in the workplace. And now, making psychological harm unacceptable is where the opportunity lies.”
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