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Opinion: 'Frontline workers are close to falling over the burnout cliff'

Johnny Moran of Trauma Response Network Ireland outlines the key signs of trauma burnout in essential workers.

Johnny Moran

THE SIGNIFICANT EMOTIONAL stresses and demands of the Covid pandemic relentlessly over the last 12 months have opened up unprecedented exposure to emotional burnout across a wide range of professions working as essential staff.

This includes not only frontline health and care workers, first responders, police, carers in nursing homes, direct provision workers, homeless services, but also at levels never previously experienced across professions such as teaching, childminding, funeral directors and the like.

Even among reporters and journalists well used to deadlines and work pressure but the relentless negative news cycle that the pandemic is creating is resulting in severe work burnout and trauma in a lot of cases.

Work burnout is characterised by physical, emotional and mental exhaustion caused by overwhelming exposures to a stressful working environment. Burnout is prevalent in working environments that present overwhelming demands, conflicting pressures, inadequate resources and support.

The consequences of work burnout are not limited to work performance and have the potential for significant negative consequences for life outside of work including family and personal relationships.

The links between burnout and compassion fatigue and loss of empathy are well established and can have toxic consequences for work and home life.

Distressing days

Our engagement with essential workers to date has revealed many are in significant distress, struggling with symptoms of burnout impacting both work and home life. Many are reporting that their only options available and on offer to them was to visit their GP.

Also, various workers report feeling a sense of shame, embarrassment and inadequacy of not being able to cope.

This also included a sense of duty and moral obligation to meet increased organisational demands and expectations on them as well as a deep sense of obligation to support and stand alongside work colleagues witnessing the same levels of overwhelm.

Essential workers commonly reported a sense of being stuck in survival mode while working in chaos and within traumatised, overstretched working environments at the edge of breaking point.

They recounted ongoing pressures of literally risking your own health and safety on a daily basis, working extended hours with considerably greater demands and for healthcare workers working within a health system that was under-resourced and inadequate well before the arrival of a worldwide pandemic.

The HSE as the country’s public health service provider was a dysfunctional and inefficient organisation and highly vulnerable prior to the pandemic, reflected in waiting lists of over 500,000 people, an ongoing reliance on putting patients on trolleys due to unavailable beds.

Despite an annual spending budget pre-Covid of €18 billion in 2018 and €19 billion in 2019 it was ill-equipped and highly vulnerable to respond to a worldwide pandemic when it struggled consistently over the last decade to manage Irelands cold and flu season.

For frontline health and care staff working long day/night shifts with unprecedented roster demands in the eye of the pandemic storm from the outset, there were experiences of ongoing chaos, fear, PPE shortages, staffing shortages, inadequate facilities and equipment.

The backbone of a creaking system

The fact that the HSE had to shut down almost its entire public health services to muster a response to Covid has resulted in a significant increase in waiting lists yet to be addressed and unless there are significant policy changes this pending tsunami is very likely to put many frontline and essential workers over the burnout cliff.

Progressing through first, second and third pandemic waves reports of helplessness and witnessing thousands of deaths, loss of colleagues, significant emotional impacts and increased work pressure due to a wave of Covid related sickness, absenteeism of colleagues, the mental and psychical pressures for frontline and essential workers have been unprecedented.

These combined unprecedented circumstances put even the most resilient of workers under constant and unsustainable emotional pressure to the point that their mental health and wellbeing are being placed at considerable risk.

An alternative reality for many care workers, first responders, gardaí and teachers are those same people who we have relied upon and sacrificed so much working at the frontline through the pandemic is that they have being consistently working in environments impacted by budget restrictions, recruitment bans and pay freezes over the last decade.

Such workers were already overstressed and in over stretched positions, in work environments already highly vulnerable to burnout.

Trauma Response Network Ireland is offering free trauma therapy support for essential workers as part of a study to develop further the research needed to better understand trauma and elevate the suffering so many frontline workers are experiencing.

After the completion of Phase 1 of this study, burnout is coming up as a consistent issue reflected in reports of difficulty coping, fatigue, out on sick leave and reliance on medication. Worryingly, the application process for Phase 2 is now indicating higher symptom scores.

Key signs and symptoms of burnout:

Mental Exhaustion
It’s kind of like physical tiredness, except it’s your mind instead of your muscles. It tends to show up when you focus on a mentally tough task for a while. You might also feel this kind of brain drain if you’re always on alert or stressed out. Your job, caring for children or older parents, and other things can lead to mental exhaustion.

You’re angry or impatient
Mental fatigue can put you in a bad mood. You may be short-tempered or irritated, snapping at people more often. It’s harder to control your emotions when you’re mentally tapped out.

You can’t get work done
Everyone’s productivity goes up and down. But mental exhaustion can make it really hard to concentrate. It also saps your motivation. You might get distracted easily or start to miss deadlines. Even small tasks may seem overwhelming.

You zone out
This can look like mind wandering or drowsiness. It makes it hard to pay close attention to what you’re doing, and you may not react to things very fast. That can be dangerous in certain situations, such as driving.

You don’t sleep well
You might think it’d be easier to snooze when your brain is tired. But that’s not always the case. Research shows people who have jobs with a high “cognitive workload” report more symptoms of insomnia than those who don’t have mentally exhausting work. A lack of shut-eye can make mental fatigue worse. Tell your doctor if you can’t sleep or get really tired during the day. Treatment can help.

You do unhealthy things
You may start to drink or use drugs more than normal. Mental fatigue can take an even harder toll on those who already have a substance use disorder. Experts think that’s because drug addiction changes parts of the brain that help you manage stress and control impulsive behaviour.

You’re depressed
You may not have any energy or feel like you’re moving in slow motion. Some people say they feel numb. That can make it hard to finish things at work or do daily activities. Tell your doctor if you have really low feelings or a sense of hopelessness for longer than two weeks. That can be a sign your depression is more serious than you think.

You worry a lot
Mental fatigue triggers your sympathetic nervous system. That’s your “fight or flight” mode. Anxiety is an alarm that tells you something is wrong. If you’re always mentally exhausted, you might start to feel panicked or worried all the time. That often happens alongside symptoms of depression.

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Exercise feels harder
Experts aren’t sure why mental fatigue affects physical activity. Some think your tolerance for exercise might go down. So, it may seem like you’re putting in more effort than you really are.

Your eating habits change
Mental fatigue can affect your appetite in different ways. You may snack more than normal and not pay attention to what you eat. Stress can also make you crave sugary, salty, or fatty foods. Or you may not be hungry at all.

You make more mistakes
It’s impossible for your work to be perfect all the time. But mental fatigue lessens your ability to catch and fix your mistakes quickly or at all. That can cause serious problems in certain jobs, such as ones where you use machines, drive a vehicle, or fly a plane.

You feel more pain
Everyone is different, which makes it hard to say how mental fatigue will affect your body. But you might get headaches, sore muscles, back pain, or stomach problems. If you have an ongoing illness, such as fibromyalgia, you may hurt a little bit more than usual.

If you think you are experiencing the signs and symptoms of trauma burnout, please reach out to Trauma Response Network Ireland. We are a panel of accredited volunteer therapists, with advanced EMDR training in Early Response Intervention for Mass Trauma Events.

Johnny Moran is s an accredited integrative psychotherapist with IAHIP (Irish Association of Humanistic and Integrative Psychotherapists), an accredited counsellor with IACP (Irish Association for Counselling and Psychotherapy), Reg. ICP. He is the National Coordinator of  Trauma Response Network Ireland. Applications for TRNI Phase Two Research Study are still open, with the first round of Trauma Therapy sessions commencing on 12 April. All applications into the study are through the TRNI web portal – Please visit www.trnireland.ie to apply now.

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Johnny Moran

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