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Reducing burnout among mental health workers: How community behavioral health clinics support their clinician teams

Here are some of the principles we have seen that effective organizations embrace to reduce burnout  that could serve as a guide for the larger mental health clinic community.

Today, behavioral health providers are straining to keep up with the increased demand for their services. Driven by the turmoil of the pandemic and its evolving impact – which continues to push mental health clinicians to increase their caseloads atop already overbooked schedules – these circumstances yield a severe recipe for burnout.

Defined as a “long-term stress reaction marked by emotional exhaustion, depersonalization and a lack of personal accomplishment” by the Agency for Healthcare Research and Quality, burnout is an endemic issue. Self-reported burnout rates among psychiatrists hover at an astounding 78% while nearly 50% of psychotherapists report job burnout. This is not surprising given that clinicians have little time for self-care, and additional clients means a never-ending list of administrative tasks, making it almost impossible to keep up.

Covid: Fuel to the fire

The Covid-19 pandemic disrupted nearly every aspect of society, triggering a 25% global increase in anxiety and depression, as well as addiction and substance abuse, and driving a spike in demand for mental health services. This uptick in client volume, combined with therapists pivoting to telehealth and virtual care delivery, has forced clinicians into increasingly reactive states as they contend with change and uncertainty at every turn. For those that continue doing in-person work, exposure risks persevere as a stress layer. For those able to work remotely, the initial refuge in the safety of their homes gradually changed into isolation and fewer opportunities for peer interactions and colleague support.

As the mental health toll continues in the long-tail Covid arena in what is being referred to as the “shadow pandemic,” a lesser-known aspect of the burnout experienced by clinicians is the increase in compassion fatigue, reducing their ability to empathize with clients and provide the best treatment. In at least some cases, compassion fatigue has caused therapists to leave the field, contributing further to the clinician shortages. With clinicians leaving the profession or retiring in greater numbers, it is critical to mitigate burnout rates, alleviate compassion fatigue and provide a clear path forward to support essential mental health care.

Driving organizational change to support clinicians 

The trends impacting mental health treatment are having an outsized impact on community behavioral health clinics, as therapists struggle with ever increasing caseloads. The leadership at these clinics are acutely aware of the challenges faced by their clinicians, many having started their careers as therapists themselves. They have been working to reduce burnout and compassion fatigue among their clinician teams through administrative and organizational initiatives, and by providing resources to promote mental wellness. The goal is to use any means available to reduce the strain on clinicians, and provide the proper support to boost their performance.

In our work with mental health clinics, we have observed that forward-looking organizations are addressing the new challenges faced by their clinicians by rethinking everything from management styles, to clinical workflows, to the use of new technology. In short, recognizing that things don’t have to be done the way they always have been done, and making judicious changes to procedures and policies, is going a long way towards helping to mitigate the onset of burnout and compassion fatigue.

Here are some of the principles we have seen that effective organizations embrace to reduce burnout  that could serve as a guide for the larger mental health clinic community.

  • Keep the lines of communication open.

Leaders who commit to providing support for their clinical teams and encourage two-way communication so that therapists can share their challenges openly, are finding greater success in reducing burnout. Therapists, especially those delivering care via telehealth, can be increasingly isolated and need additional support. By providing forums for input, whether it be through check-in calls, surveys, or other means, clinic management can better assess the overall strain faced by their teams, and encourage individuals to access support, whether it’s through EAPs or other systems, formal and informal,  set up for this purpose.

  • Increase work flexibility.

Although clinician schedules are incredibly tight, leaders are encouraging as much flexibility as possible. Therapists are encouraged to take their own mental health days, and work flexible hours as needed. Some clinics are implementing staff wellness breaks into their schedules that they can utilize to re-center between sessions.  Research has shown that giving teams flexibility can increase job satisfaction and reduce burnout and stress. Allowing time for therapists to decompress, enjoy time with their families, and engage in self care can go a long way towards mitigating burnout.

  • Tech-enable clinical workflows

The pandemic has given providers an unprecedented opportunity to rethink how services are delivered, and increased the use of technology such as telehealth. At the same time, clinical leaders are taking a critical eye to clinician workflows to determine what has been working, and what should be revised, and where new technology could make a difference.

One area that is ripe for improvement and judicious use of technology is documentation. Documentation burdens on clinicians are siphoning limited clinician capacity and have been shown to be a major factor contributing to burnout.  On average, clinicians spend about a third of their time documenting client data to fulfill electronic health records (EHR) and insurance coding requirements. These processes have the potential to divert time and focus from providing actual care to clients in ways that further exacerbate the time and energy shortage, compounding clinician overwhelm.

Any technology tools that allow for reduced documentation time will make substantial impacts on clinician ability to stay connected to their original purpose. In the past, there weren’t many options for documenting and creating session notes beyond manual documentation. Today, however, there are a number of advanced technologies, including artificial intelligence tools, that allow a level of automation in documentation that did not exist previously. Clinics who embrace technology to help reduce the time that clinicians spend on paperwork create a bulwark against burnout.

Championing clinician well-being

Mental health clinics have not been immune to the larger social forces impacting workplaces, including the “Great Resignation,” which are driving a greater focus on employee wellbeing. This extends to a focus on burnout, which requires new methods to support the emotional, cognitive and physical consequences of caregiving. Empowering clinicians with the tools and support they need allows them to focus on the wellbeing of the clients without sacrificing their own health and ability to do their job. Clinics who embrace these principles are better positioned  to retain and recruit clinicians so that they can meet the growing needs of their communities.

Dennis P. Morrison, PhD, Clinical Strategist, Eleos Health, previously served as the Chief Clinical Officer for Netsmart Technologies, the largest US provider of electronic health records in the behavioral health markets. Before that, he served as CEO of Centerstone Research Institute (CRI) which managed the clinical research and information technology needs of a multistate provider organization serving 70,000 consumers per year. Previously, Dr. Morrison was the CEO of the Center for Behavioral Health (CBH). Under his leadership, CBH won the Joint Commission of Healthcare Organizations (JCAHO) Award for excellence in the use of outcomes measurement and the Health Information Management Systems Society (HIMSS) Award for Excellence in the implementation of Electronic Health Records (EHR). Earlier, Dr. Morrison provided therapy and counseling to clients for 17 years. He served in the United States Navy as an Aerospace Physiologist. He earned his PhD in Counseling Psychology from Ball State University.

Alon Joffe is the Cofounder and Chief Executive Officer of Eleos Health. Founded in 2020, Eleos empowers providers to deliver the world's most effective behavioral care through data, measurement, and personalization. Eleos is pioneering CareOps Automation in behavioral health, using sophisticated Natural Language Understanding (NLU) technology. Eleos has raised $28M and grown its customer base to more than 25 community mental health centers across 15 states.

Alon has been touched personally by mental health issues through close friends dealing with PTSD from his military service in an elite Israeli Air Force Unit.

Prior to founding Eleos Health, Alon launched two companies and was part of the core investment team at a Boston-based venture capital firm, which led investment rounds in multiple companies with valuations exceeding $1 billion. Alon holds both a B.A. and an L.L.B (summa cum laude) from Rechiman University and was recently listed in Forbes 30 Under 30.

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