The pandemic has increased the already large need for mental health services. The system hasn’t kept up, putting more pressure on those on the frontlines.
Micah Makoni, a mental health care provider in Kalamazoo, didn’t know she was experiencing burnout until her husband and others around her pointed it out. Her behavior was changing, and she lacked passion for her usual pleasure
“It almost seemed like depression and I’ve also witnessed others in the profession who are experiencing that,” says Makoni, who is Black and attributes her professional and personal fatigue to being a clinician of color who sees many clients of color.
Burnout among mental health professionals “is driven by high job stress, time pressure, over-capacity workload, and poor organizational support,” according to a 2022 issue brief from the National Council for Mental Wellbeing, a non-profit advocacy group. “These factors have been compounded by the COVID-19 pandemic.”
This story was originally published by NowKalamazoo.com and is part of the Mental Wellness Project, a solutions-oriented journalism initiative covering mental health issues in southwest Michigan, created by the Southwest Michigan Journalism Collaborative. SWMJC is a group of 12 regional organizations dedicated to strengthening local journalism. Visit swmichjournalism.com to learn more.
Makoni says the stress then manifests as “compassion fatigue,” when providers are so drained from others’ emotional pain it impedes on their ability to empathize with people. It’s a condition she’d suffered and seen in her previous jobs at domestic violence shelters in Kalamazoo and Kansas City.
Burnout may impact therapists of color more often. A 2021 article “Investigating Race-related Stress, Burnout, and Secondary Traumatic Stress for Black Mental Health Therapists,” published in the Journal of Black Psychology, found that Black therapists can be more likely than white professionals to suffer from stress and burnout.
Therapists of color carry an additional burden, the study concluded: they are more likely to have experienced racial discrimination themselves that “may overwhelm their ability to cope in their personal and professional settings.”
The problem is multilayered, as indicated by anecdotes from local professionals of color and supported by national data and research. There’s a disproportionate shortage of Black, Latinx, and other ethnic mental health care professionals while concurrently many clients desire a counselor that matches their ethnicity. In 2015, according to the American Psychological Association citing U.S. Census data, 86% of psychologists in the U.S. workforce were white, 5% were Asian, 5% were Hispanic, and 4% were Black or African-American.
Makoni, now a program coordinator and an intern clinician at Synergy Health Center in Kalamazoo, said that while everyone in the field can feel the stress of the job and the times, professionals who are persons of color have unique reasons for feeling an additional burden because they and their clients of color share many traumatic life experiences involving racism and discrimination.
“You feel like you don’t want to mess up. You don’t want people to look at you even more. You want to be perfect, so nobody has a reason to say, ‘Oh, because if I did something wrong, everybody’s going to know that’s me.’ It’s that pressure to try to prove a point that we can do it too.”
A study published this year in the Journal of Employment Counseling linked perceived cultural racism, hours worked per week, and burnout among Black mental health therapists. The findings highlight the importance of attending to cultural racism as a work stress that impacts the well-being of Black mental health therapists. Further, the authors state, “because prospective and current Black clients have shown a strong preference for Black mental health therapists, the lack of minoritized practitioners has proven troublesome.”
There’s added pressure on mental health professionals of color because so-called “racial matching” has been shown to increase the longevity and improvement of such patients in counseling. Data from a sample of 644 clients of a counseling center from a large Midwestern university found that clients “working with counselors of matching ethnicity/race attended more number of counseling sessions than those with counselors of different ethnicity/race,” according to a 2018 peer-reviewed article. Moreover, the ethnic/racial matching between clients and counselors led to a higher improvement of overall functioning as assessed by the counselor.
“I think, as folks of color helping and providing care for other folks of color, burnout can be related to frustrations that we’re seeing our same population go through,” says Sonja Roseman, Synergy Kalamazoo’s clinical director. Roseman, who is Black, says health care professionals of color experience the burnout differently than their white colleagues.
Many professional organizations advocate for all mental health professionals to receive training in cultural competence. Research has shown that a counselor-client ethnic match might not significantly affect counseling outcomes if the counselors are culturally competent.
Efforts to address burnout include promoting cultural competency among all professionals, recruiting and training more practitioners of color, offering specific training for working in same-race therapeutic pairs, limiting the hours worked per week, mindfulness practices and garnering social and professional support through peer consultation and clinical supervision training.
Dealing with burnout often comes down to putting an emphasis on self-care for providers, including flexible scheduling, virtual work options, and vacation days without the guilt.
Roseman says that flexibility allows staff members to better cope with the day-to-day stress of family and personal life. Synergy offers yoga and massage therapy to help its staff relax and rejuvenate.
But even with support like that, being a mental health counselor can sometimes become overwhelming. Similar challenges face others in health care. Michigan now has a program to help crisis workers suffering emotional crises themselves. The state Department of Health and Human Services launched the “Stay Well” program as the COVID-19 pandemic ramped up in March 2020. A few months later, Gryphon Place in Kalamazoo got the contract to provide the service. Gryphon Place’s Maricela Alcala says that Stay Well supports the people working crisis lines or medical providers who need that emotional support.
Alcala says Gryphon Place, which has staffed suicide prevention crisis lines for decades, also gives its employees support.
“We have what we call a ‘wellness room.’ It’s a very quiet, very quaint space for staff to be able to step away and just relax and de-stress and regroup,” Alcala says. “Sometimes what you need to do is just step away from it, take that breather, and then come back.” She says it also helps professionals of color to have support networks of coworkers, families, and people in their communities who can understand what they are going through as they tend to others.
Kalamazoo County Commissioner Veronica McKissack can attest to how consuming a career in mental healthcare can be for workers. She has decided not to seek re-election this fall due to the demands of her role as a quality assurance and compliance officer at the state-run Kalamazoo Psychiatric Hospital. McKissack also serves on the board of Integrated Services of Kalamazoo, previously known as Community Mental Health.
“There are a lot of daytime meetings, and I couldn’t pull away from my day job because there’s an increased demand,” McKissack says. “We have admissions weekly, almost daily. I really want to focus on my career path rather than on politics.”
McKissack, who emphasizes that she speaks only for herself rather than the hospital, says the pressure got worse during the COVID-19 pandemic. Despite that, McKissack says she has no plans to join the “Great Resignation.” She says the need for mental health services is everywhere.
“Providing the needed service will help us overall; it’s the social worker heart of me. I still have hope that our systems can improve service as well as outcomes,” she says.