Understanding and addressing compassion fatigue and burnout

Article in review:  Sullivan, S. & Germain, M. (2020). Psychosocial risks of healthcare professionals and occupational suicide, Industrial and Commercial Training, DOI: 10.1108/ICT-08-2019-0081

Summary: Professionals in the healthcare and education fields are at a greater risk for developing burnout and compassion fatigue the greater demand on their practice for compassion-focused skills. The article describes how we are all open to the potential for burnout and compassion fatigue, with signs of negative thoughts and feelings relevant. In addition, the article considers workers ability to provide care and support to others, the importance of effective coping strategies, and how to bring them back to compassionate care. 

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Occupational suicide refers to suicide which has a correlation with the workplace. Occupational suicide has been increasing over the last two decades; up 22.2% since 1995. The World Health Organisation estimates that of the 800,000 global suicides each year, 150,000 are work-related (WHO, 2012). The stresses of modern work are a contributing factor; the increasing rate of occupational suicide has been exacerbated by globalisation, and the technologisation of our workplaces.

The number of people who die by suicide in their workplace is also increasing. Between 2003 and 2010, in America, 1719 people died by suicide while at their place of work. These numbers are significant, yet research and literature on employee suicide are scarce, and for many modern employers, there is a stigma associated with the discussion of occupational suicide. We need to better understand the link between work and suicide so that we can make changes in our organisations that address the trends in occupational suicide.

Suicide rates are known to be higher in certain professions, including protective services, farming, and the medical industry. Approximately 400 physicians die by suicide in the USA each year, a figure two to three times more than the general population. Access to firearms has long been a known risk influence for workplace suicide, while access to medicines, drugs, and poisons is now also recognised as an increase for medical professionals.

A recent literature review (Sullivan & Germain, 2020) used a systematic approach to improve definitions and work-related suicide in medical professionals. The review considered 34 articles and two books, which were published between 2007 and 2017. These sources were identified through keyword search and assessed for relevancy.

Findings
The review identified that there are psychosocial suicide risk factors associated with work in the medical profession. Psychosocial risk factors are defined as the characteristics at psychological, family, community or cultural levels that precede and are associated with a higher likelihood of negative outcomes.

For medical professionals, the particular risk factors of burnout and compassion fatigue are identified. Burnout and compassion fatigue, when unresolved, may lead to significant social-emotional distress, which in turn increases the risk of suicidality.

Burnout, a result of chronic occupational stress, refers to long-term exhaustion and diminished interest in work which can lead to feelings of “helplessness, hopelessness, chronic fatigue and one’s sense of being “trapped” in a job.” Burnout may manifest as irritability, hostility, and resentment in a workplace directed either at patients or colleagues. Higher rates of burnout are experienced by surgeons and medical students.

Compassion fatigue, unlike burnout, is indicative of specific behavioural changes exhibited by nurses providing constant care to the sick, suffering, and traumatised. Compassion fatigue is often linked to declining mental health and associated with feelings of being unsupported and unheard in the workplace.

Impacts
The impacts of occupational suicide are far-reaching. Although few studies have shown the financial impact of an employee suicide for an organisation, it is estimated to be significant, with the average work-loss and medical cost per case suggested to be as high as $1.3m (Research America, 2018). There are also costs of reduced productivity when employees are burnt out, stressed, fatigued or suicidal. Further, death by suicide often occurs at the height of an employee’s productivity.
Of course, when occupational suicide occurs, the effects may be far-reaching and long-term within the organisation. Colleagues are often likely to be deeply impacted by the suicide of a co-worker, experiencing grief or guilt, with their own productivity affected. Yet, most organisations are still ill-equipped to deal with occupational suicides.

While there seems to be recognition of the idea that job stress has a negative influence in the workplace, by extension, less is understood about the impacts of occupational suicide. Few focused support associations exist and there is an inadequate number of training and development programs on the topic of occupational suicide.

Conclusion
Although suicides occur due to a combination of complex influences and factors, if workplace stress and fatigue can be recognised as a contributor, employers must acknowledge and take action to address this factor. Australian organisations, particularly those in the medical and health industries, must make employee wellbeing a priority. Employers should create a “culture of care”; through policy, through training and development, and the creation of a culture that values the health and wellbeing of employees.