Untreated Patient Depression and Provider Burnout

Hailey Osmond in The Sixth Sense

Hailey Osmond in The Sixth Sense

“I see dead people everywhere.”

Sometimes I feel like Hailey Osmond’s character in the Sixth Sense, living in some alternate reality. Hundreds of studies illustrate the connection between untreated mental health issues and poor clinical outcomes, but there is no discussion of how patients’ untreated depression and mental health problems affect healthcare providers.

“I see suffering everywhere.”

Patients suffer silently which negative impacts everything including the very people tasked with caring for them.

As a psychotherapist by training and Orchid (my term for sensitive, feeling people) by birth, I pick up on other people’s emotions. Emotions are contagious on a cellular level and experienced in the body. If someone is sad and within arm’s reach, I’ll start feeling constriction in my throat and heaviness in my chest. My patients are always shocked when I ask them in real time if they have a lump in their throat or heaviness in their chest. They don’t realize their sadness is contagious to everyone around them. (Good therapists understand this phenomenon and use it to help their patients identify, label and manage their emotions.)

Most people aren’t consciously aware of this contagion, but they know it unconsciously which is why most of us dodge depressed people. Who wants to feel hopeless?

When I worked as a medical social worker—before creating STI–I actively avoided my depressed patients. What could I possibly do to help these patients? Almost all of them refused to go to outpatient psychiatry. Most would not take anti-depressants. When we talked, there was an endless litany of seemingly unsolvable problems. I left these conversations feeling defeated, angry, sad and guilty.

• Defeated: there didn’t appear to be a solution.
• Angry: it felt like I had wasted my time.
• Sad: I felt incompetent. (“A good social worker would know how to help this patient.”)
• Guilty: I “shouldn’t” feel angry and shouldn’t dodge my patients.

It was a daily cycle of unproductive conversations, bad feelings, and self-flagellation. When things in my personal life were going well, this wouldn’t impact me as much, but when things weren’t going well, the experience was more intense. I’d call in sick. I’d feel angry for no known reason.

…which is why most of us dodge depressed people.

I used to think it was just me, but after talking to thousands of healthcare professionals around the country, I discovered other clinicians had similar experiences.

Different professions experience it differently: Doctors might experience their patient’s fatigue and lack of motivation to change behaviors. Nurses might feel their patient’s anxiety waiting for test results. Dietitians and pharmacists possibly experience their patients’ frustration with complicated medication regimes.

My theory is that patients are silently struggling with mental health challenges, often unaware of what is happening. Health care professionals feel our patients’ unprocessed emotions, internalize them and wonder why we feel burnt out.

It wasn’t always like this.

Back in the good old days–before electronic health records and onerous regulations–there was time to sit face-to-face with patients and talk. A few minutes of real attention is healing. Even if we couldn’t fix their problems, patients sensed we cared for them which in and of itself was healing. As a result, they felt better, and we felt like healers.

Now we’re so anxious about getting everything done that sitting with patients for two minutes seems like a luxury we can’t afford. We intuitively sense and internalize our patients’ emotional distress and depression, but don’t have the time or resources to understand it much less connect with our colleagues to process it or do self-care behaviors. Over time, we start shutting down.

As a result, we experience the same symptoms of emotional distress as our patients. It’s a parallel process. Doctors are committing suicide at a record rate. Forty percent of hospital nurses report feeling burnt out. Social workers leave the profession.

It’s critical that we address our patients’ untreated depression and mental health struggles for the sake of both patients and healthcare providers. We can’t roll the clock back on electronic records and regulations, but health care organizations can implement innovative collaborative care solutions for the sake of their patients and health care providers.