Compassion Fatigue

I'm sure those of you who care for sick or disabled family members or those of you like myself, who have a job that involves caring for people and then coming home to care for family, will be able to relate to this term Compassion Fatigue, sometimes described as 'burnout'.  Most of us have suffered from it at some point in our professional lives.  It comes down to recognising it early and doing something about it before you are too debilitated to work at all or worst still, become a statistic.

While the term 'burnout' has been around for awhile it's only since it got rebranded to compassion fatigue that educational programmes are now beginning to be set up, yet they are few and far between.

NZNO professional nursing adviser Cathy Gilmore said at a recent Mental Health Nurses Conference that:

"Every day, nurses are giving of themselves and being exposed "vicariously" to their patients' trauma and sadness. Nurses must be aware of their own and colleagues' fatigue and ensure management supports them to acknowledge and deal with compassion fatigue." 

So how exactly is management doing this?  The mental health service appear to do it better than most other areas as they offer 'debriefing' and 'clinical supervision' both which are compulsory for all staff.  While you would think this would be enough, we continue to hear stories of nurses (mainly) who lack any empathy or patience and are incredibly judgemental. 

But don't get me wrong, it's not only nurses that suffer in this way.  The Australian Beyond the Blue Study found that while doctors can identify the signs in their patients they won't seek help when they recognise the signs of depression or anxiety in themselves.  In the summary of the study it found among other things....

"A number of barriers to help-seeking in the medical profession were identified. These included concerns about stigma, career development, impact on colleagues, impact on patients, confidentiality, embarrassment and professional integrity. 

Psychiatrists were concerned about potential career implications. Doctors were less likely to seek help from colleagues and professional institutions due to concerns regarding professional integrity and career development, while they were less likely to seek help from family and friends, or not seek help at all, due to concerns regarding stigma and embarrassment.

The suicide rate in doctors was higher than the suicide rate in the general population.

The suicide rate varied between different medical specialties, with psychiatrists found to have the highest risk of suicide."

It seems that while Psychiatrists work to ensure patients can accept the 'labels' they place on them and work to teach them acceptance while encouraging them to ask for help when they are unwell, they fail miserably in doing it for themselves.  My question is, why Psychiatrists??  Is it because they are generally more caring and sensitive by nature or is it that they know more than anyone the stigma attached to having a mental illness of any kind?  Or is the trauma they listen to on a daily basis so soul destorying that supervision is not enough? 

Until some further research is done on just how these 'compassion fatigued' clinicians are impacting on the day to day care of their patients we will never know if they are they only victims here.  Is their lack of self care not only effecting them, but the whole of their health care delivery?

While I focus on Psychiatry here, in other areas of medicine or nursing there is no clinical supervision and very rarely, debriefing. The educational programmes on compassion fatigue are also not considered a priority.  If the mental health service can't get it right then what hope is there for the other areas?  Things won't improve unless we have caring managers making this a priority and, the mental health service lead by example.