A Thanksgiving for mental health caregivers

Thanksgiving in the United States is a family-centric holiday. Families get together to try to express gratitude for one another and avoid family conflict. A divorce rate hovering around 50% for decades makes it apparent how difficult it is for families to succeed, whether on Thanksgiving or the rest of the year. However, there is some cause for optimism. In the group of millennials, who are marrying later, the divorce rate has been dropping. Moreover, research on successful marriages suggests what has to be added to the original passion to sustain love. One strategy is that positive praise and gratitude for one’s partner must well outweigh any negative criticism and condescension. Originally, however, Thanksgiving was not so focused on families. It was founded on the success of our country’s second war of settlers, though at the expense of our first settlers, the Native Americans, a group that has our country’s highest rate of alcoholism and other mental health problems. In other words, Thanksgiving was originally work-related. Over those same recent decades, when our divorce rate got so high, burnout in our workplaces rose more slowly, but significantly. That was attributed to the demise of lifetime jobs, with pensions replaced by job uncertainly and increased productivity pressures. Exempt from that burnout increase in society was healthcare institutions—that is, until about a decade ago. What happened then was that medicine, especially including mental healthcare, become more of a business as for-profit managed care, insurance companies and pharmaceutical companies dis-empowered physicians and other members of the team. The result? A rapid increase in burnout which, at over 50%, greatly exceeds that of all other professions and workplaces. Indeed, an internal survey done by the American Psychiatric Association, for which I was on the Workgroup of Psychiatrist Burnout and Wellness, suggested a staggering burning out rate of about 75% of the psychiatrists who filled out the online questionnaire. This blockage of our ability to heal as we know how to is correlated with a reduction of the quality of care of our patients. Often there is a spillover to homelife, adversely affecting relationships there. Moreover, with both parents working so often, parental burnout is also rising. What can be done to reduce burnout and increase wellness, and what does Thanksgiving have to do with it? In 2016, I was awarded the intermittently given Administrative Psychiatry Award from the American Psychiatric Association. For my required lecture in receiving the award, building on the success of some non-medical workplaces, I focused on the administrative “love” needed to counteract the negative forces, no matter the loss of resources and reduced time with patients. This is not the passionate love of falling in love, but more akin to the ongoing love of caring for one’s partner, children and friends. Some ways it can be done: The administrator expresses gratitude often and readily for jobs well done. The administrator empowers staff to contribute and develop. Colleagues support one another and try to avoid envy, jealousy and too much competition. Expectations for performance are realistic and practical. Our leaders advocate with politicians and payers for healthcare ethics over business ethics. One conclusion that can be made is that, just like in families, giving thanks to others at work is a key to wellness. Why not, then, have a Thanksgiving day at work on the Thursday after our national holiday? Maybe that will prime us for more workplace gratitude every other day.