Working in mental health and recovery can be incredibly rewarding but also emotionally difficult. In their work, providers often deal with structural obstacles, stressful circumstances, and emotional burdens that can impact their personal and professional well-being. These aspects of clinical practice can result in the behavioral health workforce experiencing burnout, compassion fatigue, and/or moral injury. This blog series will clarify each term, provide recommendations and strategies to manage burnout and compassion fatigue, and discuss ways to promote organizational wellness and team building.
Burnout is an occupational phenomenon due to exposure to extreme physical, mental, and emotional exhaustion and ongoing stress. Burnout can be experienced by anyone in any profession. Per the World Health Organization (WHO), the following are characteristics of burnout:
Other factors that may contribute to burnout among mental health professionals include excessive caseloads, a lack of resources, and organizational inefficiencies. It is recommended to screen for burnout in the workplace. Early detection and action are essential to prevention because it frequently develops gradually.
Compassion fatigue is sometimes called secondary traumatic stress because it can mirror symptoms of post-traumatic stress disorder. Compassion fatigue is an acute reaction due to the exposure to clients’ trauma and the professional desire to provide support. Unlike burnout, which is tied to work demands, compassion fatigue stems from the empathetic engagement in others' pain.
Professionals could experience several symptoms such as:
Mental health professionals with an unresolved personal history of trauma, those who are highly empathetic, and women practitioners are at heightened risk of experiencing compassion fatigue.
Other risk factors could include service providers with:
One way to self-assess for compassion fatigue is by using the Professional Quality of Life Scale (ProQOL). This scale is a helpful tool for exploring symptoms related to your actual work situation.
Moral injury is defined as psychological, social, or spiritual distress resulting from taking part in, witnessing, or failing to prevent an act that is not aligned with one’s values or moral principles. It occurs when health and mental health professionals face situations that violate their moral or ethical beliefs. Individuals may experience feelings of profound guilt, shame, and intense self-condemnation.
For mental health providers, this may arise when systemic barriers prevent them from delivering the care they believe is necessary, such as when insurance limits therapy sessions or when organizational policies conflict with client needs.
You can take steps to reduce workplace risk for moral injury by:
Unlike burnout or compassion fatigue, moral injury is deeply tied to a sense of betrayal and ethical distress, which can lead to feelings of isolation and a loss of professional identity.
The 2021 Mental Health at Work Report, published by Mind Share Partners, reports that employees who feel supported tend to be less likely to experience mental health symptoms and less likely to underperform and miss work. Also, 81% of participants responded that they will be looking for workplaces that support workforce mental health in the future. Organizations and agencies that invest in professional wellness programs addressing burnout, compassion fatigue, and moral injury are shown to have improved their overall employee satisfaction and retention.
APA Committee on the Psychiatric Dimensions of Disaster and COVID-19. (2020). Moral Injury During the COVID-19 Pandemic. https://www.psychiatry.org/File%20Library/Psychiatrists/APA-Guidance-COVID-19-Moral-Injury.pdf
Henderson, A., Jewell, T., Huang, X., & Simpson, A. (2024). Personal trauma history and secondary traumatic stress in mental health professionals: A systematic review. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/jpm.13082
Hudnall, B. (2009). Professional Quality of Life Scale (ProQOL). https://www.camh.ca/-/media/professionals-files/childhood-trauma-toolkit/proquality-life-self-score-pdf.pdf
Mind Share Partners. (2021). 2021 Mental Health at Work Report—The Stakes Have Been Raised. Mind Share Partners. https://www.mindsharepartners.org/mentalhealthatworkreport-2021
Peterson, S. (2018, February). Understanding Who is at Risk. The National Child Traumatic Stress Network. https://www.nctsn.org/trauma-informed-care/secondary-traumatic-stress/introduction
World Health Organization. (2019, May 28). Burn-out an “occupational phenomenon”: International classification of diseases. World Health Organization. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
Mark Sanders, LCSW, CADC, is an international speaker in behavioral health whose presentations have reached thousands throughout the United States, England, Canada, Spain, Lithuania, West Indies, and Guam. He is the recipient of five behavioral health lifetime achievement awards, including the prestigious NAADAC Enlightenment Award. He is the founder of The Museum of African American Addictions, Treatment and Recovery, which was honored as the 2023 winner of the Faces and Voices of Recovery Innovations In Recovery Award. He is the author of 5 books on recovery and has enjoyed a 30-year career as a university educator.
Isa Vélez Echevarria, PsyD, is a Puerto Rican clinical psychologist. She is the Ohio State Project Manager for the Great Lakes Addiction, Mental Health, and Prevention Technology Transfer Centers managed by the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison. During her pre-doctoral internship at Children’s Institute in Los Angeles, CA, she was certified as an Interpersonal Psychotherapy Clinician. She was trained in Trauma-Focused Cognitive Behavioral Therapy and Family Therapy. In addition, she provides telehealth services to communities of color in Massachusetts and Puerto Rico. Her clinical work has focused on culturally tailored and trauma-informed services for Latinx communities.
