Where do mental health professionals go when they need help?

For Dr Pramila (name changed), a psychiatrist with nearly 15 years of experience, a counselling session with her friend once a month is a must. But it is a session with a difference — Pramila is the client here, and she just seeks company to vent her emotions or talk about professional problems.

Mental health professionals deal with emotional exhaustion and empathy-induced stress when dealing with their clients. Sometimes, guilt and overcrowded schedules also burden them. So where do psychologists and psychiatrists go when their mental health takes a turn for the worse? Support groups formed by their peers might provide a solution for the occupational hazard.

Pramila says she realised the need for a one-on-one with a professional after a tryst with one of her older clients who suffered from depression.

She explains, “The patient was in her 80s and the time I spent treating her turned out to be a moment of epiphany. She made her realise the need to pay heed to her burnout.” The patient’s consultation — the last one scheduled for the day — turned out to be more difficult than ever. “She kept telling me there was no reason to live. I tried telling her she had many reasons to live longer — for her family and many things she was thankful for,” says Pramila. “But she begged me to not broach the subject and I finally said okay. It was the last time I saw her and in a month, she passed away.”

Pramila says the woman’s death made her blame herself for not doing enough. She adds, “Deep down I knew I had let her go that day because I was tired. So, I realised it was okay to be tired, but one must not let that take over you when treating a patient. I soon began talking about it to my friend, another psychiatrist, and decided to turn to her whenever I was overwhelmed by professional rigor.”

While Dr Pramila undergoes counselling in an informal set up, there are others like Saras Bhaskar, a psychologist, who paused to rethink her approach to work after a couple of burnouts in her three-decade-long career. This came about after her health took a hit due to overworking, and after a case shook her belief in herself. Bhaskar decided to seek help from a counsellor after the death of a young client. She says, “The person was accompanied by his father and was suffering from schizophrenia. While I recommended medications before starting sessions, the father refused to cooperate and pinned the blame on the son. After a point, when he refused to listen to my advice, I gave up and told them maybe he should seek help from someone else. A few days later, I learnt from a relative that the client had set himself ablaze. I was consumed by guilt and stopped rehabilitation counselling, which I specialise in, for a while.”

Bhaskar reached out to a counsellor and was ready to cooperate with him in whichever way he thought would suit her case. She recounts, “I sat through six sessions of counselling before I could be hauled out of the guilt. My counsellor told me that it was not the failure of my method of rehabilitation counselling as I had not even gotten there. He also convinced me that one cannot guarantee the best outcome.”

Burnouts more common among psychologists

The biggest factor that determines the success or effectiveness of a mental health expert is objectivity. However, objectivity can be compromised when they get too involved with their clients and their problems. As a result, emotional exhaustion is extremely common among psychologists, says Ravi Samuel, a Chennai-based psychotherapist, with nearly three decades of expertise in the field. “That is why we always believe in having a supervisor or a mentor whom you can turn to for both technical and practical purposes. All professionals need this kind of support and help,” he says.

However, he points out that frequent emotional exhaustion is an indication that one is not fully equipped to cope with the dynamics of the field. “They might see about four or five patients a day, but it is only that one patient who has a major issue that is affecting the practitioner as well. They can begin to relate very personally with the patient or client and that shows bad training. These can also get compounded when one has personal issues that begin to affect the practice as well,” he adds.

Experts also say there is not much difference when one deals with experts as clients. They could either go for short-term counselling sessions with a few sittings, or to long-term psychotherapy sessions that look at altering behaviour, cognition and emotions through application of clinical methods. “The sessions will depend on the scale of the problem. Some would need just about four or five and for some it might take months. While one might assume that being an expert themselves can make them cynical or resist therapy, the compliance is actually high,” says Samuel.

For expert-clients who do not cooperate because they know too much, there are tailor-made methods. Dr Vivian Kapil, psychiatrist, Sri Ramachandra Medical Centre, says, “I have had psychologists who claimed that they knew the solution but would never adhere to my advice. So I make them maintain a thought diary to see the progress in their thought process.”

Global phenomenon

Even Sigmund Freud, the father of psychoanalysis, suffered from neuroses, superstitions, substance abuse and blackouts. Probably that explains why mental health experts tend to grapple with mental conditions themselves. Experts acknowledge that mental health experts are at a higher risk of alcoholism and substance abuse apart from committing suicides and suffering from depression. The World Health Organisation (WHO) recognises burnout as a medical condition, making it all the more significant to address it.

Burnout is an occupational hazard for those in the field of mental health, say experts who attribute it to several risk factors in the profession.  In fact, some studies also reported that an overcrowded inpatient wards and highly demanding work conditions make professionals a mental wreck.

A report published in World Psychiatry, journal of the World Psychiatric Association, noted that “Burnout is a serious consequence of chronic exposure to work-related stressors. As a group, psychiatrists are at a high risk of experiencing burnout, due to external factors such as work environment, internal factors such as personality and appraisal styles, and mediating factors such as support and resilience. The onset of burnout can be seen as a consequence of the interaction between predisposing, precipitating, perpetuating and protective factors.”

Peer support heals

The same report highlights of a support group or peer group. There are fully functional support groups abroad and closer to home The Chennai Counsellors Foundation co-founded by Bhaskar, among other services like bringing together qualified psychologists for knowledge exchange, also addresses burnout prevention among experts. The foundation actively encourages them to seek help from other counsellors for burnouts.

Bhaskar attributes the burnout to inadequate mental health professionals. Going by her own example, she says, earlier she saw almost six to seven clients every day, while today it has been kept manageable at three maximum.

She adds that the stigma associated with mental illness can be alleviated with mental health professionals like her being open and willing to take help when needed. She says, “I have also noticed that the clients are like kids — they are sharp and know when you are tired, or being fake, or just not being able to concentrate fully on their conditions as a result of burnout. That makes it all the more important for us to rectify and look into the issue, as and when it crops up.