This June, OhioPHP began a campaign entitled “The Power In Reaching Out” as a way to end the silence and stigma surrounding substance use disorders, mental health issues, and burnout in healthcare professionals. In her recent blog, Dr. Phuong Huynh noted that 88% of physicians preferred to receive support from other physicians (1). It is likely that other healthcare professionals would also benefit from speaking to someone who works in the same or a similar area of practice.
Like first aid, which is applied when an individual suffers a bodily injury, there is a protocol which supports an individual who may be experiencing a stress injury, called Stress First Aid (SFA) .
A stress injury is “any severe and persistent distress or loss of ability to function caused by damage to the brain, mind, or spirit after exposure to the overwhelming stressors of fatigue (burnout), trauma, loss, or moral injury.” (2)
What does a stress injury look like? Behavioral changes resulting from a stress injury may include:
Withdrawal from friends and family
Increased irritability
Decreased impulse control (e.g. displays of anger in patient care areas)
Impaired judgment when making clinical decisions
Decreased self-care
Working longer hours or becoming more rigid about following protocols
The Stress First Aid model has “Seven Cs” which may help you remember the three steps involved in supporting someone who has experienced a stress injury.
Step 1 is to recognize a stress injury (Check and Coordinate)
Step 2 is to provide Primary Aid (Cover and Calm)
Step 3 is to provide Secondary Aid (Connect, Competence, and Confidence)
Step One - Check and Coordinate
This step in SFA includes the first 2 Cs, Check and Coordinate. In the first part of Step 1, the key is to recognize a stress injury and check in on your colleague. Realize that individuals with a stress injury may not be aware that their behavior has changed or that they are at increased risk of more serious consequences including depression, PTSD, or sleep disturbance. It can be intimidating to check on a colleague because it feels intrusive and uncomfortable. Understand that cultivating a habit of checking in can decrease the stigma of asking for help. In fact, you may be helping to save a colleague’s life.
What is the best way to have a check-in conversation? The acronym OSCAR is a specific communication strategy that outlines how to talk to a struggling colleague in a respectful way.
O - Observe
Look for changes in usual patterns of behavior. Perhaps you have noticed that your colleague is more withdrawn, unhappy, frustrated, or irritable in recent days or weeks.
S - State observations
Summarize what you have noticed without interpretation or judgment. For example, you might say “I have noticed over the past few days/weeks, that you seem [frustrated/irritated/lost in thought/etc.].”
C - Clarify role
Explain why you are addressing the issue and why you are concerned. For example, you might say, “As a [supervisor/coworker/colleague/friend}, I am concerned because….”
A - Ask why
Try to clarify and understand the individual’s perception of their behaviors. For example, you might say, “Help me understand what is going on. If possible, I would like to help.”
R - Respond
Discuss the desired outcomes, using behavioral terms. For example, you might say, “Thank you for trusting me enough to share that issue. I want us to be comfortable working together and I respect your privacy. If not me, would you be willing to talk with [names of two trusted resources]?”
Following your OSCAR, coordinate activities based on your findings during the check-in conversation. If you have recognized significant stress in a colleague, ask yourself these two questions:
Who else can help?
Who else needs to know about this individual’s stress?
Depending on your role, you may take different actions. If you are a colleague, it is appropriate to express concern, offer support, and ask if the individual would like additional support from others. If you are a leader or supervisor, you will likely have a greater responsibility to act and more resources to offer, such as a referral to the company Employee Assistance Program (EAP) or contact OhioPHP for additional resources and support. In either case, there may be an immediate need for referral, which is part of SFA Step 2.
Step Two - Cover and Calm
Step 2 of SFA includes the next 2 Cs, Cover and Calm, which can be thought of as Primary Aid. Cover means to protect the individual from impending harm or danger. Calm means to promote physical stress reduction in the individual who is experiencing an acute stress injury and in yourself as well. Calming strategies include slow deep breathing or other grounding activities, maintaining eye contact, using the person’s name, and talking in a quiet and direct voice.
Step Three- Connect, Competence, and Confidence
This step includes the final 3 Cs, Connect, Competence, and Confidence, which can be thought of as Secondary Aid. Secondary Aid supports long-term recovery by connecting the individual to positive social supports, and by restoring competence and confidence in practice. Visit OhioPHP's website for a comprehensive list of supports.
Another Way to Help - Mental Health First Aid Training
What is Mental Health First Aid Training?
An evidence-based program that has been adopted by over 20 countries, Mental Health First Aid teaches adults how to identify, understand and respond to signs of mental illnesses and substance use disorders.
Utilizing a five-step action plan, participants learn to assess for risk of suicide or harm, listen non-judgmentally, give reassurance and information, encourage appropriate professional help, and encourage self-help and other support strategies. Participants also receive detailed information regarding local providers, community services and national resources available for support and recovery.
To register to take a training with Mental Health America of Ohio visit https://mhaohio.org/get-help/mhfa/ .
To learn the difference between Mental Health First Aid, Stress First Aid, or Psychological First Aid, click here.
Resources:
(1) Huynh P. “The Power in Reaching Out.” OhioPHP Blog Post. Accessed 6.16.23 https://www.ohiophp.org/post/the-power-in-reaching-out
(2) Westphal R. J., Watson P. (2021, May 6). Stress first aid for healthcare professionals: Recognize and respond early to stress injuries [Webinar]. AMA STEPS Forward. AMA STEPS Forward. https://edhub.ama-assn.org/steps-forward/module/2779767 Accessed 6.8.23