To Improve the Public Health Workforce’s Mental Health, We Must Look Upstream

As a nation, our mental health is on the decline. According to the National Alliance on Mental Illness (NAMI), nearly 23% of U.S. adults – 57.8 million people — experienced mental illness in 2021. These trends were exacerbated by the social isolation, economic decline, and overall fear that dominated the COVID-19 pandemic. According to an analysis of commercial insurance claims, adults’ use of mental health care services went up by 39% and total U.S. spending on mental health care rose by 54% between 2019 and 2022. 

In addition to the stressors affecting everyone during the pandemic, the government public health workforce had to contend with increased workloads and harassment. Findings from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) show that 41% of public health executives reported experiencing bullying or threats, and more than half of respondents reported at least one symptom of post-traumatic stress.  

This mental health crisis has, and will continue to have, serious implications for public health systems. In 2021, nearly a third of public health employees reported considering leaving their organization, and anecdotally we know that many did. With the effects of COVID lingering, the threat of emerging viruses like bird flu, and a long-term staffing shortage in states and localities across the country, we need to improve the public health workforce’s mental health and strengthen the system’s capacity to respond to the next public health crisis. 

Just like community mental health, upstream solutions are essential to workplace mental health.

de Beaumont has been sounding the alarm on burnout and mental health decline among public health workers and the field has acknowledged the crisis, but it has not been addressed at a national level. As a result, the burden of improving workforce mental health has landed on the burned-out people and organizations themselves: health department employees. And the programs that are readily available in health departments, such as employee assistance programs, are effective at treating mental illness, but they do not prevent it from occurring in the first place. As public health practitioners, we try to prioritize upstream solutions, because we know they are more effective and sustainable. Why, then, are we not looking further upstream as a field to solve our own mental health crisis? To make real improvement in the overall mental health of public health practitioners, we must address the systems in which they operate: in this case, the health department work environment. 

As public health practitioners, we try to prioritize upstream solutions, because we know they are more effective and sustainable. Why, then, are we not looking further upstream as a field to solve our own mental health crisis?

Transparency, trust, flexibility, feeling valued: these are the environmental factors that can bolster or undermine people’s mental health over time. Unfortunately, largely due to funding and human resources constraints, most health departments struggle to promote these features of a positive workplace culture. Health departments need support from national-level partners, and they need it now. 

As the largest national-level survey of the government public health workforce, PH WINS allows state and local health agencies to assess these intra-agency environmental factors. For the first time, PH WINS 2024 data will launch with a suite of recommendations and resources to help agencies address organizational challenges that can lead to employee burnout.  

PHIG funding is an opportunity to invest in workplace mental health now.

Agencies need not wait until the latest PH WINS data are available to begin addressing mental health challenges. The flexibility of current Public Health Infrastructure Grant (PHIG) funds offers an opportunity for state and local public health agencies to invest in improving working conditions. And while no large, national-level shift of public health systems is on the horizon, state and local health departments can chip away at workplace culture issues by focusing on solutions within their control. 

Examples of ready-made, organization-wide interventions that can support employee wellness within health agencies include: 

• Establishing employee resource groups: These voluntary, employee-led groups in which members often share a characteristic such as gender, ethnicity, religious affiliation, or interest create safe spaces for health department employees to connect and support one another. Employee Resource Groups can promote inclusion, foster connections, and provide safe, productive spaces to discuss challenges. They do not cost any money, and planning is a relatively low lift, requiring minimal staff time to organize logistics and encourage discussion. 
• Demonstrating work-life balance: Leaders need to communicate and model setting work boundaries by using paid time off and encouraging employees to take nonworking lunch hours. This intervention is cost-free and, aside from regularly communicating these expectations, does not require additional staff capacity — in fact, it supports staff capacity by encouraging more breaks. 
• Providing platforms for human connection: Open a non-work-related messaging channel for employees to share interests, hobbies, and personal milestones. This is a low or no-cost way to develop employee connection and relationship-building at work, which can have a positive impact on satisfaction and workplace culture overall. Giving employees space to share personal interests, additionally, can foster positive regard and trust among staff, improving culture overall. 
• Incorporating employee recognition and appreciation: Many health departments have employee recognition and appreciation programs, and there are countless ways to implement them; the most important aspects of employee recognition and appreciation programs is that they exist and are used regularly. Agency leadership and human resources departments must create these systems and ensure that supervisors access them frequently. This can help foster a culture where employees feel valued. 
• Educating staff on trauma-informed approaches: Trauma-informed approaches aren’t just about addressing prior trauma; they are also useful in preventing further harm. Educating leadership and staff on trauma-informed approaches to internal policy and programming supports an environment of safety and belonging. The Public Health – Hope, Equity, Resilience, and Opportunity (PH-HERO) initiative from the Association of State and Territorial Health Officials (ASTHO) offers numerous tools to support state and local public health agencies implementing trauma-informed approaches within their organizations. 

The next public health emergency may be emerging, and we can’t enter it with a burned-out workforce. It is urgent that agencies work to address these environmental challenges now so that public health practitioners are mentally and emotionally equipped to handle what comes next.