A psychologically healthy workplace is essential to good mental health. Learn how a staff member or manager trained in Mental Health First Aid can benefit your veterinary team.

During the latter half of the 20th century, society’s views of mental illness underwent a profound shift. People began to question the stereotypical and prejudiced beliefs that those living with mental illness were violent, helpless, or a risk to society. Now, decades later, we recognize that people with mental illnesses, given treatment and self-care, can contribute to society, lead fulfilling lives, and enjoy everything life has to offer — including satisfying careers.

Society has recognized the need for more workplace planning that removes all discrimination and stereotypes. This includes analyzing the way work is managed to provide working environments that are appropriate, safe, inclusive, and incorporate everyone’s human rights. An inclusive workforce at a veterinary hospital or any other workplace recognizes the risks to both occupational physical and mental health. We can no longer afford to damage people’s mental health at work by excluding occupational psychological risk management.¹ Having a staff member or manager trained in Mental Health First Aid work is an important beginning.

Occupational psychological health 

To perform a job or task with empathy, compassion, and professionalism, we need occupational psychological health^.2 Working in a veterinary workplace exposes the worker to emotional stressors that affect mental health and job satisfaction.³ In fact, mental health illness is four times more prevalent among veterinary team members, including practice owners, than among the general population.⁸ A discussion of common occupational psychological health risks appears below.

In 2013, the Canadian National Standard for Psychological Health and Safety was released. It was researched and coordinated by the Mental Health Commission of Canada, and written by the CSA (Canadian Standards Association), which publishes standards with an internationally accepted level of quality that implies they can be used anywhere in the world.⁴

The Canadian National Standard is designed to help employers and employees assess the psychological health and safety risks of their workplace, and apply the internationally written framework designed to protect and promote mental health and wellness at work.⁴

In the US, the AVMA has designed a website that assists veterinary practices in the formation and monitoring of a mental wellness program (Guiding Principles for State Veterinary Wellness Programs).⁵

Psychological health and safety liability 

Just as with physical safety, employers are responsible for providing a psychologically healthy work environment where mental health is protected and promoted.^1,4,26

Employers should notice when their staff members exhibit symptoms of psychological stress, such as being:

• Inefficient, exhausted

• Uncooperative

• Cynical, negative, anxious, over-reactive

• Gossiping, whispering

• Low performing

• Burned out, stressed

Normalizing asking for help

All too often, the stigma8 of asking for help when mental health is in jeopardy means the situation becomes more impulsive and urgent. A staff member/manager trained in Mental Health First Aid (MHFA)^25,26 can help reduce this stigma and normalize asking for help when workplace stress becomes overwhelming and mental health starts hurting. This can be invaluable to employees and practice owners.

The roles of a mental health first aider in veterinary workplaces^25,27

1. Support the psychological risk mitigation plan and the psychological health and safety risks of veterinary workplaces.^4,5,26
2. Keep a person safe from harm where he/she may be a danger to herself/himself or others.
3. Guide a person to appropriate help to prevent the mental health problem from becoming more serious.
4. Support the recovery of good mental health.
5. Give comfort to a person experiencing a mental health problem.
6. Champion a return-to-work program.^1,28
7. Reduce stigma associated with asking for help.

A person trained in MHFA (MHFAider) can offer a confidential discussion, provide a listening ear, and allow the time an employee or practice owner needs to talk about their mental health. A Mental Health First Aider provides help to a person developing a mental health problem or experiencing a mental health crisis, or a worsening of their mental health. When mental health pain becomes too intense, a MHFAider on staff is often already familiar with employee history and can recognize needed support.

A MHFAider is trained to initiate open, non-judgmental dialogue for someone who feels they aren’t able to cope with the thoughts and feelings they are having. This is important because the person who needs help feels alone, isolated, and may even be confused about their overwhelming feelings and thoughts. A MHFAider is trained to quickly gain the trust that is needed to help someone in distress, get some help, and save a life.

How to become trained in mental heath first aid

A two-day course (eight hours total) is available online at https://www.mhfa.ca/en/course-types in a group format. The course teaches you how to:

1. Recognize the symptoms of mental health problems. It does not teach diagnosis.
2. Identify situations that are emergencies or life-threatening.
3. Offer a listening ear and how to ask appropriate questions.
4. Guide a person towards appropriate professional help, or determine if more serious action is required. It does not teach people to be therapists.

A MHFAider can provide early detection and determine how to help a person who is not feeling well, a huge benefit to the individual, their family, and community. A MHFAider can bring light to a stigma that needs to be erased.

Having someone on staff who is trained in Mental Health First Aid is part of the paradigm shift that veterinary hospitals can implement to assist employees when they need help. These trained personnel can recognize signs of mental distress, offer practices as a preventative approach to a mental health crisis,²⁹ and promote mental well-being in the workplace.

Common occupational psychological risks in veterinary workplaces^2,6,7

1. Stress⁹

Stress is a common workplace risk that occurs when workloads or demands exceed your comfort zone. Although stress is common in the workplace, it doesn’t negate the need to have conversations with a Mental Health First Aider early on, before it begins to affect performance. A Mental Health First Aider will listen and ask questions that will help you cope or find assistance.

2. Burnout^9,10

Burnout is a psychological syndrome that emerges as a prolonged response to chronic interpersonal stressors on the job. The three key dimensions of this response are overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment.

3. Compassion fatigue²

Compassion fatigue is defined as a never-ending exposure to suffering and pain that can cause personal emotional distress and a reduced ability to be empathetic and provide occupational cooperation to patients, owners, and coworkers.^2,11 Job satisfaction is difficult to achieve with compassion fatigue.³ It is considered a risk factor for mental illness, and a contributing risk factor for suicide.¹⁸

Organizational compassion fatigue¹⁶ is a chronic and cultural form of worker stress, also known as a toxic work environment.^9.17 Organizational compassion fatigue affects morale, esprit des corps, and workplace engagement, amongst other toxic workplace factors.^3,17

The stress of working with the public and relieving the suffering of animals in distress comes at a cost to mental health.^8,19,2,14 Organizational compassion fatigue¹¹ can occur when employees are stressed and burned out, and team cohesiveness, occupational performance, satisfaction, and civility lag.^9,17,20 Unfortunately, most workers cannot identify their emotions and biases because they never received any formal training in this area.²¹ This leaves employers wondering how they can help those who are not able to understand the problems they are facing.

4. Moral distress¹²

Moral distress is characterized by three components: emotional exhaustion, depersonalization, and lack of personal accomplishment. Moral distress is the inability of an individual to act according to his or her core values and perceived obligations due to internal and external constraints.

5. PTSD — Post traumatic stress disorder^7,13

Those with PTSD re-experience trauma through intrusive and distressing recollections of the event, flashbacks, and nightmares. They also experience emotional numbness and avoid places, people, and activities that are reminders of the trauma.

6. PITS — Perpetrator induced traumatic stress⁷

This form of PTSD arises when a person creates and/or controls the trauma, such as having to euthanize/cull large numbers of healthy animals.

7. Caregiver burden transfer¹⁴

This involves the transfer of emotional stress and pain from a client to a veterinary team/veterinarian who is consulting with the pet owner and diagnosing and treating the animal. Often, the owner doesn’t realize they are doing this. This is a fairly new discovery of potential occupational psychological risk for the veterinary team.

8. Anxiety and depression 

These two mental health concerns also affect the general population and need to be considered as risk factors that contribute to a worker’s mental health status.^8,15

9. Suicide⁸

When individuals feel they can no longer endure their high levels of mental pain and suffering, and/or they feel hopeless about finding a way out of their situation, suicide may seem the only option.

 

References

¹Mentalhealthcommission.ca. The Aspiring Workforce: Employment and Income for People with Serious Mental Illness. Available at: https://www.mentalhealthcommission.ca/sites/default/files/ 2016-06/Workplace_MHCC_Aspiring_Workforce_Report_ENG_0.pdf.

²Cohen SP. Compassion fatigue and the veterinary health team. In:Veterinary Clinics of North America: Small Animal Practice. January 2007; 37(1):123-134.

³Chu L-C. The Influence of Compassion Fatigue on Job Performance and Organizational Citizenship Behaviours: the moderating effect of person-job fit. J Nurs Scholarsh. March 23, 2021.

⁴Mentalhealthcommission.ca. The Canadian National Standard for Psychological Health and Safety. Available at: https://www.mentalhealthcommission.ca/English/what-we-do/workplace/national-standard.

⁵avma.org. Guiding Principles for State Veterinary Wellness Programs Available at: https://www.avma.org/resources-tools/wellbeing/guiding-principles-state-veterinary-wellness-programs.

⁶Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: influences, opportunities and research directions. Veterinary Record. 2008;162: 36-40.

⁷Whiting TL, Marion CR. Perpetration-induced traumatic stress — A risk for veterinarians involved in the destruction of healthy animals. Can Vet J. 2011;52(7):794-796.

⁸Bartram DJ, Baldwin DS. Veterinary surgeons and suicide: a structured review of possible influences on increased risk [published correction appears in Vet Rec. 2010 Apr 10;166(15):451].Vet Rec. 2010;166(13):388-397.

⁹Moore IC, Coe JB, Adams CL, Conlon PD, Sargeant JM. The role of veterinary team effectiveness in job satisfaction and burnout in companion animal veterinary clinics. J Am Vet Med Assoc. 2014;245(5):513-524.

¹⁰ada.com. Signs of Burnout. Available at: https://ada.com/signs-of-burnout/.

¹¹avma.org. Organizational Compassion Fatigue. Available at: https://www.avma.org/resources-tools/wellbeing/organizational-symptoms-compassion-fatigue.

¹²Epstein EG, Delgado S. Understanding and addressing moral distress. The Online Journal of Issues in Nursing. 2010;15(3). Manuscript 1.

¹³adaa.org. Symptoms of PTSD. Available at: https://adaa.org/understanding-anxiety/ posttraumatic-stress-disorder-ptsd/symptoms.

¹⁴Spitznagel MB, Ben-Porath YS, Rishniw M, Kogan LR, Carlson MD. Development and validation of a Burden Transfer Inventory for predicting veterinarian stress related to client behavior. J Am Vet Med Assoc. 2019;254(1):133-144.

¹⁵Murcia M, Chastang JF, Niedhammer I. Psychosocial work factors, major depressive and generalised anxiety disorders: results from the French national SIP study. J Affect Disord. 2013;146(3):319-327.

¹⁶Kabasakal E, Özpulat F, Akca A, Özcebe LH. Mental health status of health sector and community services employees during the COVID-19 pandemic [published online ahead of print, 2021 Mar 9]. Int Arch Occup Environ Health. 2021;1-14.

¹⁷Moore I, Coe JB, Adams CL, Conlon P, Sargeant JM. Exploring the impact of toxic attitudes and a toxic environment on the veterinary healthcare team. Front Vet Sci. 2015;2:78.

¹⁸Siegel KJ, Schembari BC. Compassion fatigue risk factors in suicide crisis hotline counselors. The 37th Annual Association for Death Education and Counseling Conference. April 2015. Available at: https://www.researchgate.net/publication/298215320_Compassion_fatigue_risk_factors_in_suicide_crisis_hotline_counselors.

¹⁹cdc.gov. CDC Employees: How to Cope. Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/mental-health-non-healthcare.html.

²⁰Pearson CM, Andersson LM, Porath CL. Assessing and attaching workplace incivility. Org Dyn (2000) 29:123–37.

²¹ehstoday. Is it even possible to exclude emotions from safety leadership?Available at: https://www.ehstoday.com/safety-leadership/article/21161959/is-it-even-possible-to-exclude-emotionsfrom-safety-leadership.

²²Wayne AS, Rozanski EA. Cataloguing the response by emergency veterinary hospitals during the COVID-19 pandemic via weekly surveys. J Vet Emerg Crit Care (San Antonio). 2020;30(4):493-497.

²³Mair, TS, Mountford DR, Radley R, Lockett E, Parkin TD. Mental wellbeing of equine veterinary surgeons, veterinary nurses and veterinary students during the COVID-19 pandemic. Equine Vet. Educ. 2021; 33 (1) 15-23.

²⁴cmha.ca. Mental Health Effect of COVID19 Predictions. Available at: https://cmha.ca/wp-content/uploads/2020/06/EN_COVID-19-Policy-Brief.pdf.

²⁵Keil K. Mental health first aid. Can Vet J. 2019 Dec;60(12):1289-1290.

²⁶Hadlaczky G, Hökby S, Mkrtchian A, Carli V, Wasserman D. Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta-analysis. Int Rev Psychiatry. 2014;26(4):467-475.

²⁷Kroll H. Mental Health First Aid: addressing mental health as a public health priority. Perspect Public Health. 2015;135(1):12-14.

²⁸chrc-ccdp.gc.ca. A Guide for Managing the Return to Work -Human Rights Commission of Canada. Available at: https://www.chrc-ccdp.gc.ca/sites/default/files/gmrw_ggrt_en_2.pdf.

²⁹washingtonpost.com. Coronavirus is causing a historic rise in mental health problems. Available at: https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/.