U of T's Trey Coffey on how to support health-care workers when they need help themselves

Thanks to advocacy efforts and public outreach campaigns, mental health issues have shed much of the stigma they once carried.

Health-care providers have played an integral role in helping to transform the mental health-care system and educate the public about the importance of accessing services when they require care. 

But who do doctors and other health-care providers turn to when they are experiencing mental health difficulties? In a field based around competency and that requires a high degree of resiliency, asking for help may not feel easy for some physicians. 

In an effort to break down social barriers around mental health, health-care and academic institutions have looked to workplace-based peer support programs to help employees access care. 

Dr. Trey Coffey, an associate professor at the University of Toronto's Faculty of Medicine, pediatrician and medical officer for patient safety at the Hospital for Sick Children, spoke to writer Ciara Parsons about the importance of initiatives like SickKids' peer support program; the notion of the “second victim,” or how health-care providers suffer after being involved in a mistake or other adverse event on the job; and how to be an ally to those facing difficulties in the workplace. 

What is the Peer Support and Trauma Program at SickKids? 

The program officially launched in January 2018. The goal is to help improve staff members’ psychological health and safety and to provide them with a support system through a network of trained peers.

The program is open to anyone who wears a SickKids badge and can assist with a range of issues one might be encountering in a health-care setting, such as burnout, second victim distress and traumatic stress while also providing support for personal or family issues.

SickKids’ Peer Team is comprised of cross-disciplinary staff who volunteer their time to the program and act as supporters to their colleagues. Before taking up their roles as peer supporters, volunteers receive specialized training and certification in assessment, communication skills, trauma principles and trauma response.

Those who have experienced a traumatic or distressing event may engage in a critical incident debriefing enabling them to confidentially share and decompress about the incident. The role of the peer in these situations is to allow participants to process thoughts and reactions about the event, to validate and to provide information on common responses and self-care. If preferred, one-to-one support is available to colleagues. For staff requiring more assistance, a variety of professional counselling options are available.

The second phase of this program, which began in the spring of 2018, focuses on physician peer support.

What is a second victim? 

The idea of the second victim refers to a physician or health-care worker who has been involved in an adverse event on the job. Second victim responses can sometimes spur feelings of guilt, distress, anxiety, fear and insufficiency. 

Research focused on second victim responses explains that there are six stages of progression within the second victim phenomenon. They include:

• Chaos and accident response: Error realized, distracted, possible need for others to take over treating patient
• Intrusive reflections: Loss of confidence in self, feelings of inadequacy
• Restoring personal integrity: Help is sought, but there is fear of how others will react
• Enduring the inquisition: Internal investigation, fears about employment outcomes and litigation
• Obtaining emotional first aid: Seeking and receiving professional support
• Moving on: Dropping out, surviving or thriving

This research also suggests that second victims require formal support at the department or unit level, which is why peer support programs are often recommended to help assist with second victim responses. 

How did you become involved with this program?

Before the launch of our Caring Safely initiative, where we brought patient and employee safety together under one umbrella, I knew there were issues with trauma to health-care workers, but I had a volume of patient safety problems to work on and felt like maybe employee safety was someone else’s issue to deal with. 

However, learning more about incredibly high rates of health-care worker harm and injury, along with my own direct experience being involved in a serious safety event, helped to change my perspective. These two things made me want to have more of a hand in directly supporting the peer support program at SickKids – and I think that sometimes the best way to support a program is to get involved and participate in helping to bring about change. 

Why do you think physicians are hesitant to ask for help? 

I think the major reason physicians are hesitant to ask for help, whether we're conscious of it or not, is that we’re preoccupied by reputation and we're kind of socialized to be somewhat “invincible.” We pass a lot of tests and go through medical training to demonstrate that we can withstand the rigours of medicine and go through things that society might deem “extreme” – and that’s a source of pride. 

So to fit this idea in which we have of ourselves, sometimes asking for help to handle difficult situations you are going through might be thought of as risky, because of how we think others might perceive us as maybe not being up to the challenges that we face in the workplace.

How can someone spot a colleague in need of help or distress?

People should be aware that it can be hard to spot someone in need of help or distress – especially within medicine, where we are trained to appear confident and competent in the workplace. Every time you have a moment of self-doubt, you can't show that as a doctor – and we're pretty good at pushing through these moments and ignoring them. That's a very adaptive thing to do in many situations. 

The other thing that's really tricky is that some people will just kind of withdraw from a lot of things they normally would engage in when they’re in a situation of psychological distress and or emotional distress – this is a more visible sign that someone is not OK. But others undergoing the same types of distress may appear to be unaffected because they are acting in line with how they regularly do, so this is why it is hard to pinpoint specific behaviours that might flag that someone is distressed. 

What are some tips you can give about how to be an ally in the workplace? 

I’ll give an example of what meant the most to me when I was struggling with an unexpected event and what helped me get back on track. 

I found that being recognized as a valuable member of the team helped me to get back on track. Sometimes when you’re in these situations, where you’ve experienced a safety event or something of that nature, you can have a very distorted view of yourself and think that everybody perceives you as a failure. There have been times over my career when somebody has made a remark like, “You know, everybody knows what a hard worker you are” or, “Well, we all know how much you care about this stuff and how seriously you take it.” These are seemingly minor remarks, but they can make a big difference – especially when you are a physician or a health-care provider going through a crisis of self-doubt from something like a safety event or burnout. 

It can be helpful to acknowledge that everyone has a turn with these types of issues or feelings – they aren’t just things that affect some minority outlier population. I think, in this regard, it is necessary to treat these events as part of life so that seeking treatment can be normalized and individuals can recover. These are important messages that educators and leaders should be sharing. 

How do you think the field of medicine can embrace a new culture around self-care and wellness? 

I think the medical community has steadily come to embrace the rhetoric around self-care and wellness. It remains to be seen how deeply and sincerely we will commit as a profession, though. I have noticed that the younger generations have been talking about self-care and wellness more openly and share a different mindset about it in terms of how they prioritize things like occupational wellness and work-life balance, and I hope that will be a driver for implementing better self-care and wellness in our community. However, there are some major barriers and so I would be naive to think that they are easy to solve.  

What would some of these barriers to wellness look like? 

Well, some of the barriers are structural and would include things like duty-hours and the strenuous working conditions that medical professionals and trainees face. 

You can acknowledge that some of the working conditions are beyond what would be considered healthy, but that doesn't mean that overnight you can have the resources and the restructuring to re-engineer the health–care systems that we currently work within.