The Time Is Now to Address Moral Distress in Health Care

By Alison Sutton-Ryan, DBH, LCSW, LISAC

The NASW 2022 Annual Conference in Washington, D.C. highlighted the important theme “The Time Is Now.” For someone whose work focuses on the mental health of medical providers, it was the perfect fit to highlight the moral distress and related mental health impact of our health care professions. After years of providing countless therapy sessions for medical providers, only standing witness to their pain did not seem enough. Story after story of anguish was shared. Listening to caring individuals being forced to make impossible choices while risking their own health in the pandemic; tremendous disparities in compensation; racial and gender bias going unreported due to fear of retribution.

It was my time to speak up on behalf of those whom I have served. “The Time Is Now: To Address Moral Distress and Mental Health in Medical Providers” focused on my research related to the barriers to mental health care for medical professionals.1 When 300 to 400 physicians die each year by suicide, the time is now to respond.2 The system is broken. Long-term providers are leaving at alarming rates, and new providers are questioning their choice of career, all resulting in decreased patient outcomes. The system of health care is collapsing while some private equity concerns increase their coffers and needed services such as social work, palliative care, and clergy are being eliminated to save money.

The day following my presentation, Roe v. Wade was reversed.

Now, the already taxed physician must add the pressure of pending legal concerns with the changing laws that restrict the practice of evidence-based medicine.

Moral distress does not begin to capture the devastation this creates to our health care system, with providers’ and patients’ decision making regarding bodily autonomy lost. The weight of this burden will collapse our already failing system. Now, numerous laws taking away health care decisions are being enacted all over this country. When trained providers can’t make an evidenced-based decisions in collaboration with the patient, health care is no longer about health or care.

I entered this work as a psychotherapist. As a former director of mental health for a college of medicine and health sciences, I developed embedded programs to better support health care providers. I believed that decreased stigma, increased access, and more mental health care would ease the distress for health care providers. Although those goals may still have merit, I now understand that it’s the system/institution that needs intervention. It’s not about burnout or compassion fatigue. It’s moral distress—the inability to provide ethical care consistent with training, skills, and patient/provider decision making. It’s a system failure growing to epic proportions accelerated now by a political environment that’s stripping away the ability of providers and patients to make medical decisions. Physicians are now adding legal consultation to their days with no respite. Fear from even asking evidenced-based questions places physicians at risk.

This is not sustainable, and we all will suffer.

As social workers, we are well trained to address the complex experience of the provider and patient in the environment of health care. Integrated and interdisciplinary models of care are becoming increasingly recognized. Our skills go far beyond hospital case management. Social workers have the skills to be at the decision-making table. Organizational change in health care can improve outcomes for provides and patients.3 The social work strengths of a person-in-environment perspective, valuing social justice, prioritizing self-determination, and stressing importance of interpersonal relationships along with expertise in behavioral sciences have been highlighted to improve the triple aim of health care.4 The triple aim addresses the need for 1) improved population health, 2) decreased costs, and 3) improved patient outcomes. However, without a fourth aim of provider wellbeing, the other three goals cannot be accomplished. Social workers have the skillset to address this fourth aim. Interprofessional teams are forming to address it.5 Social workers need to have a voice on these teams. Now is the time to use our skills to advocate for health care change on behalf of patients and providers. The time is now for social workers to use our voice and have a seat at the table.

— Alison Sutton-Ryan, DBH, LCSW, LISAC, is a clinical assistant professor of social work at Salisbury University. Previously, she was director of mental health at the University of Arizona College of Medicine, Veterinary Medicine, and Health Sciences, where she developed embedded programs aiming to increase access and decrease barriers to mental health care. She has more than 25 years clinical and program development experience, including maintaining a private practice.

References
1. Sutton-Ryan A. Access and barriers to mental health care for medical residents [Unpublished Doctoral dissertation]. Arizona State University; 2020.

2. American Foundation for Suicide Prevention. 10 facts about physician suicide and mental health. https://www.acgme.org/Portals/0/PDFs/ten%20facts%20about%20physician%20suicide.pdf. Published 2019.

3. Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Intern Med. 2017;177(12):1826-1832.

4. Straussner SL. Integrated health care—what do social workers contribute? Social Work Today. 2020;18(2):32-33.

5. Bachynsky N. Implications for policy: the Triple Aim, Quadruple Aim, and interprofessional collaboration. Nurs Forum. 2020;55(1):54-64.