By Abeer Sikder, Dai Nguyen and Katherine Emerson
Americans in recent years have experienced increased levels of mental health conditions, according to new data. However, as the problem persists, a large number of these individuals maintain that the mental health care system is failing to meet their individual, familial and communal needs.
“Even before the pandemic, millions of Americans were experiencing stress, trauma, anxiety and heightened levels of depression,” said Hannah Bristol, senior advisor in the White House Office of Public Engagement. “The COVID-19 pandemic exacerbated these conditions, creating an unprecedented mental health crisis across our country, especially among frontline workers and health care workers.”
There are multifaceted considerations for policymakers and communities to examine when addressing mental health for workers in essential roles — most notably among those who dedicate their careers to public service. These considerations include comprehensive support programs, flexible workplaces and accessible care to address recent systemic breakdowns while also preventing future public health crises.
PRESERVING THE MENTAL HEALTH OF AMERICA’S FRONTLINES
Public sector workers are necessary for effective government, as they provide important services for all residents, and, oftentimes, are on the frontlines during economic downturns, disease outbreaks and political turmoil. The weight of this critical work can take a heavy toll on their mental health as they face unique stressors in their vital roles.
“Many people are drawn to the public workforce sector because they put the needs of others first, and this can translate into a lack of attention to their own needs, including their own mental health and wellness,” said Adene Karhan, an extension associate specializing in trauma-informed care and mental health at the Yang-Tan Institute on Employment and Disability at Cornell University. “This lack of self-care can ultimately lead to burnout and to a host of other mental and physical conditions, which can cause talented and caring public workforce employees to leave their jobs.”
State workforces encompass a diverse community that includes civil service, law enforcement, health care and public education. Over the past few years, government workers had to adapt to new challenges that affected their work-life balance, accommodate new settings and expectations, overcome record high overdose deaths, and navigate continual stress and burnout. According to the Eagle Hill Consulting Workforce Burnout Survey conducted by Ipsos in February 2023, government employee burnout levels of 52% were higher than those in the private sector at 46%. Those levels were further elevated for women, younger workers and lower income government workers.
Federal, state and local employers and policymakers are fundamental in addressing the mental health of public sector workers who often perform high-demand and high-risk jobs.
“When it comes to mental health, America’s workplaces have a critical role to play,” said Assistant Secretary of Labor Taryn Williams in a Department of Labor news release. “That’s why we at the Labor Department are committed to helping employers — including state and local public-sector agencies — understand the steps they can take to promote mental health-friendly work environments.”
States and localities recognize the importance of increased mental health supports for a workforce that has consistently sought these resources and understand how recent events have brought the issue to the forefront for policymakers to consider. Furthermore, data shows how proactive policies and early intervention can reduce and address mental health conditions, cut health care costs and help the economy.
“Working in the public sector comes with emotional attachment and purpose, often with the inability to escape the reality facing those we serve,” said Yvonne Wright, Missouri deputy director of workforce development. “This can have a significant impact on workers’ mental health, with effects similar to those in other service professions, such as education or emergency management.”
EMPLOYEE ASSISTANCE PROGRAMS AND WORKPLACE WELLNESS
State governments have access to expansive employee assistance programs that help workers resolve various personal problems and life challenges that can negatively affect their ability to work. As a potential improvement in the mental health of public sector employees, managers and human resources staff of public sector employers can highlight mental health services during orientation for new hires. Programs generally include supports for mental health and well-being, and can also include a variety of services to address trauma, abuse, depression, substance use and financial need.
In Oklahoma, the state Employee Assistance Program is available to all state employees and their immediate family members to address medical and mental health conditions. The program includes an advisory council that promotes wellness-related policies and provides support to expand and improve mental health services.
Oklahoma’s advisory council and other state leaders also noted the need to address external factors related to mental health that are not always considered. As a result, policymakers developed Thrive, a public sector workplace wellness program for state employees. It considers eight holistic components of wellness — physical, emotional, environmental, financial, intellectual, occupational, social and spiritual — “by providing educational programs, recreational activities, rewards, incentives and more for state employees and their immediate families.”
Thrive’s success has led to extensive services with a variety of channels to support worker mental health and well-being, including lunch and learns to discuss new ideas; specific support groups focused on topics like hardship, loss, addiction and health; and recreational outings that engage family and friends.
Much like city leaders in Port St. Lucie, Florida, policymakers can also consider incorporating general wellness supports into employee assistance programs at the local level. A worker wellness program was established in Port St. Lucie promoting various holistic needs for employees, including mental, physical, nutritional and financial wellness. Services include seminars, exercise programs and paid incentives for completing “wellness incentive activities,” which include attending events or accomplishing a health goal. The city encourages employers to further promote wellness and keep workers engaged and productive. Mental Health America certified Port St. Lucie with the Bell Seal for Workplace Mental Health, a national certification program to recognize employers committed to creating mentally healthy workplaces.
Basic employee training programs and guidance can also promote general wellness for workers. Examples include toolkits like the Kentucky Personnel Cabinet’s “Mental Health First Aid Guide.” The toolkit helps state employees and managers feel more confident in supporting coworkers experiencing a mental health challenge. It also addresses opportunities such as the appropriateness of approaching a colleague, offering initial support, and selecting a suitable time and place to initiate a conversation. The guide suggests reaching out to impartial, external sources for support when considering whether to approach a coworker to discuss mental health.
NAVIGATING TRAUMA AND STRESS
Many public sector workers experience trauma as a result of their professional experiences. This can include secondary trauma or the emotional duress an individual experiences when they hear about someone else’s firsthand traumatic experiences. High rates of secondary trauma occur among various parts of the public sector, particularly among educators, health care workers and law enforcement officials. Members of the public sector workforce are vulnerable to developing this type of trauma and related adverse outcomes, including disassociation, anxiety, stress and physical ailments. If unaddressed, the symptoms can result in problems with mental and physical health, strained personal relationships and poor work performance.
Workforce systems that embrace a more holistic view of employees to account for specific ways trauma directly and indirectly affects them can facilitate recovery. Missouri is one example where the mental health crises among state employees is getting addressed through trauma-informed care.
“To address this potential crisis, the Missouri Office of Workforce Development has procured a vendor to provide statewide trauma-informed care training,” Wright said. “This training will not only educate staff on methods to enhance service delivery to job seekers with multiple stressors, but will also focus on recognizing and mitigating their own mental health issues.”
The Missouri Office of Workforce Development is teaming up with the Corporation for a Skilled Workforce, a national organization that partners with government, business and community leaders to support the creation of good jobs and the highly skilled workers to fill them. The corporation’s Trauma and Resilience at Work team has partnered with Michigan and other states to advance culturally-responsive, trauma-informed, resilience-building workplaces.
States can provide comprehensive, direct and confidential services for public sector workers to cope with stress or burnout, which often result from trauma. Maryland’s state employees and their dependents have received access to MyMDCARES, a recently developed 24/7 support service that is available at a moment’s notice, confidential and comes at no cost.
“Workplace strategies such as this are becoming more common and are a recognition of the increased importance of mental health and wellbeing from the classroom to the workplace,” said Jade Gingerich, director of employment policy at the Maryland Department of Disabilities. “Mary-
land also offers targeted mental health services and supports for essential public sector workers who worked throughout the pandemic, taking on additional roles and responsibilities, to ensure the health and safety of Maryland citizens.”
CHALLENGES OF THE PUBLIC WORKFORCE
Workers in the public sector — particularly first responders, law enforcement officials and health care professionals — have increased rates of post-traumatic stress disorder as a result of pandemic era work conditions, according to Dr. Holly Kennedy-Hansen, author of “How employers can help first responders stay mentally and emotionally strong.”
Last year, the Centers for Disease Control and Prevention found a nearly 12% higher rate of mental health conditions among public health workers than among the general population. Factors included not being able to take time off and working more than 40 hours per week.
First responders, who routinely work 40-plus hour weeks, undergo intense training to prepare for dangerous jobs and situations. They are often the first to observe a traumatic and dangerous situation. The Substance Abuse and Mental Health Services Administration found that first responders are more likely to experience post-traumatic stress disorder, depression and related mental health challenges.
Government agencies can prioritize first responder mental health by implementing statewide standards. In Utah, HB 23 (2022) was introduced, requiring all first responder agencies to provide mental health resources for public employees and retirees and their spouses and children. The state also enacted the First Responder Mental Health Resources Grant, which tasks the Utah Department of Public Safety with improving and increasing mental health services for first responders. It also funds resources that include periodic screening for first responders, peer support resources, and availability of mental health services for those involved in a critical incident within 12 hours of an incident.
Creating direct pathways to mental health services can simplify access and help first responders avoid the stigma associated with seeking health supports. For example, in 2021, Nevada passed a bill creating the Emergency Response Employees Mental Health Commission, as well as a tollfree hotline in 2019 operated by peer support counselors. First responders can call the hotline when experiencing mental health challenges.
“A feeling of helplessness settles in when you promote all these practices, but part of the community feels antagonistic at your efforts or feels you have an ulterior motive,” said Alison Krompf, deputy commissioner of the Vermont Department of Mental Health, in an article from Stateline, an initiative of The Pew Charitable Trusts. “It can cause you to question your sense of purpose.”
Other challenges for the public sector workforce include stigma in the health care community toward mental illness, increased patient volumes in health care facilities, and threats of violence instigated by resistance to vaccine mandates and by COVID-19 conspiracies.
SERVING AS A MODEL TO ADDRESS THE MENTAL HEALTH CRISIS
Mental health challenges reduce productivity, retention, morale and general well-being. Many states, workplaces and organizations have recognized these challenges and dedicated resources to overcoming impediments.
“I think the pandemic has taught many helping professionals that we have to build wellness into our daily life so that we can keep showing up for our loved ones and for our jobs,” Karhan said. “It’s no longer seen as a moral shortcoming if you need to seek out mental health services, but, instead, it shows that we are practicing what we preach in terms of taking active steps to maintain wellness.”
State policymakers and employers can model success in overcoming challenges. Michigan is an example of this through its workgroup of public, private and nonprofit groups that integrate mental health strategies in the public and private sectors. Making the state a model employer for workplace mental health has the ability to improve the public sector workforce and establish best practices for businesses to follow.
“By giving Michiganders the comprehensive care they deserve, and by making investments in mental health strategies in the workplace, we can build a stronger Michigan with a resilient workforce,” said Michigan Gov. Gretchen Whitmer in a news release.
States benefit by addressing mental health. Employees who feel supported with their mental health needs are more productive, have higher job satisfaction, are less likely to miss work and have higher job satisfaction.
“Now, more than ever, we all benefit from flexible, supportive workplace practices and employment services that promote good mental health,” said former Secretary of Labor Marty Walsh in a Department of Labor blog. “Doing so is good for workers, good for business and good for America.”