Managers of nurses and midwives — you can support your employee’s mental health

Nursing/midwifery are caring professions. Naturally, we see the mental health of nurses and midwives as important — but mental health is complex and the competing priorities for nurse/midwife leaders and managers means it doesn’t always get the attention it requires. At this moment in history, it’s more important than ever that we recognise that the mental health of healthcare workers is a shared responsibility and work to give it the priority status it deserves. 

I’ve been a nurse and mental health nurse for nearly 30 years. I care about the mental health of all.

I know many nurses who have struggled with their mental health and that support, compassion and kindness can be a gateway to a conversation that can change a life.

My mental health nursing career started in a Melbourne Western Metropolitan Adult Acute Psychiatric Unit as a graduate nurse.

I’m now the Director of Nursing – Mental Health for Barwon Health in the beautiful city by the bay — Geelong. I’ve been a clinician, manager, and nurse educator in a variety of mental health services and teams in addition to periodically working as an academic. 

Early in my career, I became aware that the mental health and wellbeing of our workforce must be a priority for health services, managers, and employees. This became especially clear in my early career as a mental health crisis assessment and treatment (CATT) clinician and manager, treating and caring for fellow nurses and healthcare professionals from a range of clinical settings and disciplines. Being a nurse or midwife doesn’t prevent us from being human and experiencing mental health distress and illness. 

During my career, the tragedy of nurses’ suicide has touched me. Sadly, I’ve attended funerals of my nursing colleagues. The tragedy and suffering at the time is unbearable. You’re left feeling loss and guilt as you witness the suffering of those closest to those who have died in such tragic circumstances. On several occasions, I have supported the mental health treatment and admission of colleagues, peers and those who have reported to me.

The mental health of the nursing/midwifery workforce should be a priority for nurse/midwife leaders, boards, and managers. Given nursing/midwifery are caring professions it is vital that nursing/midwifery managers ensure the mental health of employees is cared for.

Learnings and reflections over my career have highlighted there is more managers can do to prevent mental illness in our colleagues and promote mental health and wellbeing in our workplaces.

As a nursing leader I would much rather invest my efforts in mental health promotion than reacting and responding to mental health distress, crisis, and loss that mental illness can often lead to.

Mental illness is more prevalent than many people realise. The 2007 ABS National Survey of Mental Health and Wellbeing showed that around 45% of Australians aged between 16 and 85 will experience a mental illness at some point in their life, while one in five Australian adults will experience a mental illness in any given year. The ABS conducted a new survey in 2020–21, with the results to be released soon. Given the unique stresses of the global pandemic, it seems possible that number might now be even higher. 

Being a nurse/midwife requires us to rely on the therapeutic use of self. We invest ourselves not only in the complex clinical tasks that we undertake, but the emotional labour of our work.

This investment can make us vulnerable to empathy fatigue and vicarious trauma. A 2017 study by Joyce Yan Lee showed that there are “high levels of undiagnosed PTSD in Mental Health Nurses”. Australian health professionals are also at a higher risk of suicide than the general population.  
 

One of the major barriers for people seeking support regarding mental health is stigma. It plays a part in how we care for others and ourselves.

These negative attitudes may extend to how nurses or midwives treat a fellow nurse/midwife with a mental illness.

Ross and Goldner examined stigma and discrimination towards nurses experiencing mental illness. They found that nurses who suffered from mental illness often felt that they were targets for ‘horizontal violence’ — that is demeaning, contemptuous and shunning reactions from supervisors and colleagues. Nurses' negative judgements towards nurses with mental illness may also contribute to the development of self-directed stigma as well. Shame and negative self-image makes it much more difficult to reach out for help. 

Boards, leaders, and managers are recognising the importance of staff health and wellbeing. Our employees are our greatest asset. Prioritising the health and wellbeing of employees makes good business sense.

Research shows the impact mental health and wellbeing can have on physical health, happiness, and productivity. According to one Australian study, on average, every full-time employee with untreated depression costs an organisation $9,665 per year. It also found that implementing early intervention programs could result in a five-fold return on investment, thanks to increased employee productivity. 

Organisations that offer staff a safe and healthy workplace report:

• less absenteeism
• slower staff turnover
• greater loyalty 
• a better return on their training investment
• better performance thanks to lower stress levels and good morale.

According to research, safe and healthy workplace also means less:

• breaches of health and safety laws and associated litigation and fines
• discrimination claims (which are time consuming and costly) and
• industrial disputes.

While mental health promotion is clearly a moral imperative, it is also a legal obligation. Organisations and leaders are required to take appropriate steps to eliminate and minimise health and safety risks in the workplace.

An employer or manager is obliged to: 

• identify possible workplace practices, actions or incidents which may cause, or contribute to, the mental illness of workers 
• take actions to eliminate or minimise these risks. Your occupational health and safety (OHS) obligations extend to any workers with mental illness.

The Australian Human Rights Commission published Workers with Mental Illness: A practical guide for managers to help people provide ethical and reasonable support for workers struggling with mental health concerns. 

Strategies for leaders to create a safe and healthy workplace

The report recommends the adoption of workplace-wide initiatives that can promote good mental health, including:

• have staff health and wellbeing policies and procedures 
• offer flexible working arrangements 
• provide mentoring and peer support 
• provide access to counselling services and/or specialist support groups 
• mental health awareness raising through education and training 
• ensure safe and healthy work conditions.

Tips for supporting colleagues

The report also provides advice for how to provide interpersonal support between colleagues. 

• ask the employee if they wish to privately talk about their mental health concern
• listen without judgement and offer support
• negotiate reasonable adjustments in the workplace 
• obtain advice and assistance from external support services (without disclosing personal information) or
• talk with treating practitioners (with the approval of the worker)

Mental health education for managers

As a manager, you may grapple with how to talk about mental illness with your employee. For managers who want to develop their skills in providing mental health support, training programs are available. Applied Suicide Intervention Skills Training (ASIST) ASIST and Mental Health first Aid (MHFA) are education programs specifically designed to assist employees and leaders to recognise and respond to mental health issues. 

Mental Health First Aid (MHFA)

MHFA is a universal training program available in 23 countries. It teaches people to help a person with a mental health issue, experiencing an escalation of an existing mental health problem or in a mental health crisis.

A study of over 15,728 nursing students who received MHFA revealed that participants experienced positive effects on intentions to provide MHFA and confidence in helping a peer, improvements in MHFA knowledge and a reduction in stigma. Similar results and evaluations have indicated that general confidence in helping to recognise and support mental health deterioration and reduce stigma improves for people who have participated in MHFA training. I can bear witness that at Barwon Health staff in the acute hospital and mental health programs completed this program and we have seen positive outcomes.

Applied Suicide Intervention Skills Training (ASIST) 

ASIST is a two-day interactive workshop in suicide first-aid. More than 80,000 people in Australia have attended ASIST, which is available in all states and territories.
ASIST teaches participants to recognise when someone may be at risk of suicide and work with them to create a plan that will support their immediate safety. Although ASIST is widely used by healthcare providers, participants don’t need any formal training to attend the workshop—ASIST can be learned and used by anyone.
ASIST supports employees to apply a suicide intervention model. It helps caregivers to recognize when someone may be at risk of suicide. It then explores how to connect with them in ways that understand and clarify that risk, increase immediate safety, and link them with further help.
 

Compassion, kindness, knowledge, and a commitment to focus on mental health are essential for managers committed to making a difference to the mental health of their employees.

It can be troubling dealing with mental health concerns, whether they are your own or someone else’s. If you are a nurse, midwife or student experiencing emotional and mental health upheaval, seek help! Talk to family, friends, your manager, the Employee Assistance Program or Nurse & Midwife Support — you can give them a call on 1800 667 877 or email them.

The mental health of our nursing workforce is everyone’s business.