The mental health of health and aged care workers in Australia

As more concerning data are published, is it time to hit the panic button?

There was concern about the mental health and wellbeing of Australia's health and aged care workers well before COVID‐19, with good reason. We have known for many years that large numbers develop symptoms of depression or anxiety, but many find the barriers to seeking help too great to overcome.1 This burden of untreated symptoms, combined with factors such as knowledge of and access to means, has led to health professionals (including nurses) having a 30% higher risk of suicide than people in other occupations.2 But concern about the mental health of our health care workers has surged since COVID‐19, with many reporting feeling traumatised and exhausted.

A steady stream of publications have reported overseas surveys of health care workers during the COVID‐19 pandemic.3 They all tell a similar story, with higher than usual rates of psychological distress; about one in five workers report symptoms consistent with post‐traumatic stress disorder (PTSD).4 However, as the Australian experience of COVID‐19 was different to that of many European and North American countries, it has been difficult to know how relevant these findings were to our workforce.

The latest results from the Coronavirus in Victoria Healthcare and Aged Care Workers (COVIC‐HA) study, published in this issue of the MJA,5 provide a timely update on our own health care workers. McGuinness and colleagues provide both positive and concerning insights. On the positive side, there is evidence that rates of depression, anxiety, and PTSD symptoms peaked in late 2021 and are now declining. While the absolute rates remain high, the survey response rate of 3.3% makes it difficult to determine whether these prevalence estimates are accurate.5

Health professionals have embraced the concept of burnout to a greater extent than any other profession, an observation that perhaps highlights the perceived stigmatisation still attached to diagnosable mental health conditions in this group.6 Burnout was first characterised as a concept in 1975,7 but its measurement and consequences were made more widely known by Maslach and colleagues.8 Initially regarded as a social construct, it has increasingly been discussed as a diagnosis. Studies such as the COVIC‐HA study5 report that more than 70% of health care workers experience the emotional exhaustion symptoms of burnout, suggesting they are now a normal aspect of health care work. However, it is the linked finding that more than half the workers surveyed had considered leaving the health or aged care workforce5 that is most concerning. Such an exodus would cripple our health care system.

What can explain the apparent disconnection McGuinness and her colleagues report between objective mental health symptoms and more subjective appraisals, such as measures of burnout and career satisfaction, which appeared to be moving in opposite directions over time?5 One possibility is that burnout is the result of cumulative stress, with a pandemic the latest hit for these workers. While this almost certainly applies to many, an additional explanation is the way we speak about burnout and wellbeing in health care staff. We know from research concerning other professions in which workers are exposed to trauma that too much of the wrong type of mental health awareness can lead to problems and can chip away at workers’ perceived resilience and wellbeing.9 The perception is growing that any health care worker is doomed to “burn out” at some point, and that it is just a question of when.

So how should we respond to what McGuinness and colleagues report? We cannot go back to ignoring the problem; we have come too far for such regressive steps. However, we must also ensure that the tone of our discussion does not induce panic or undermine the incredible resilience that has always characterised those who work in health care. This need for balance should not be misinterpreted as a desire for inaction: quite the opposite! The COVIC‐HA report strengthens the case for immediate action regarding the factors that research has identified as problems, including working hours, work–life balance, fatigue management, administrative burden, and appropriate supervision and resources.10 This will require organisational and industry‐wide interventions, not just more individual resilience training for health care professionals.

The results of the COVIC‐HA study also show us the power of data and the care needed when interpreting results. Australia urgently needs better, nationally representative information about its health and aged care workforce, a discussion of its implications, and controlled trials of new workplace interventions. Otherwise, we risk rising panic and a wasted opportunity for targeted action.