A review of 24 mental health services and solutions offered to nurse professionals.
Before you read:
This analysis is meant to serve as a starting point for nursing staff, managers, executives, and advocates better to understand the breadth of mental health offerings, as well as help them evaluate which services or solutions may be right for them based on several factors including cost, category, features, and implementation.
This is by no means an exhaustive list of all mental health services and solutions. If you feel we missed an important consideration, please contact us: communications@anacalifornia.org
Disclaimer: The American Nurses Association\California does not and will not recommend, promote, or advertise any products or services that are not its own. This document is purely for the analysis of marketplace solutions and their ‘fit’ with nurses and health institutions.
The Background
In the last two years, several studies conducted by government organizations, policy associations, academic institutions, research centers, and third parties found significant evidence of nurses feeling overwhelmed, exhausted, cynical, anxious, detached, and hopeless, as well as the prevalence of long-term effects such as burnout, moral injury, PTSD, and suicide.
For many in the nursing profession, this isn’t new. Studies conducted prior to the pandemic - in 2008 and before - noted the role of ‘work environment’ and ‘working conditions’ in burnout and stress among nurses.
However, the exacerbation of these issues by the pandemic is creating compounding conditions such as critical staffing shortages. Additional studies noted:
One in three newly-licensed registered nurses are leaving the profession within 2-years of licensure,
26% of nurses ages 55-64 are planning to retire in the next two years (double the percentage over years past),
And a growing elderly population who is actively seeking care is being challenged by the nursing shortage.
"The state of nurses’ mental health is not only a concern for patient safety but also the integrity of exisiting healthcare systems." -Dr. Marketa Houskova, ANA\California Executive Director
To adequately address these issues, we must remove barriers impeding nurses’ access to mental health care as well as foster new policies and partnerships to increase support for our profession.
Four Barriers
There are several barriers to addressing nurses’ access to mental health services and solutions. They exist within federal legislation, health systems, operational policies, and the services and solutions offered.
In October 2021, ANA\California’s Advocacy Institute Fellow, Carolyn Duenas, co-hosted the Mental Health Panel Discussion: Uncovering Barriers to Access, to uncover these barriers.
Joined by nationally-recognized experts including Dr. Dan Weberg, Dr. Bernadette Melnyk, Dr. Jim D’Alfonso, Dr. Bonnie Clipper, and Dr. Anita Girard, Carolyn and the panel highlighted four primary barriers that exist across varying institutional structures.
These barriers are:
1. Lack of Destigmatization of Mental Health Illnesses Among Nursing Professionals
Stigmas persist through a variety of channels such as organizational culture, patient-provider interactions, and nurses’ reluctance to disclose information or receive care. These include a wide range of concerns, symptoms, syndromes, diseases, and addictions.
2. Lack of Standardized Employee Protections and Benefits
A critical concern among nurses is the fear of losing their job or license, which includes an aversion to programs collecting and/or sharing personal information with employers and/or regulatory agencies. Furthermore, the time at which current services and solutions are offered by institutions creates additional obstacles to accessing care in times of need.
3. Lack of Employer Awareness and Responsibility
In an effort to control liability, Risk Management and Human Resources departments (or similar) refrain from acknowledging, and thus accepting accountability for, an employee’s mental health, including but not limited to the study of current mental health within their institution(s), and the integration of technologies that collect this data. This creates a cyclical loop that further restricts information sharing. Furthermore, staff and management who expressed interest or having a role in addressing mental health levels in their institution mentioned ‘not having time to implement solutions they don’t know will work.’
4. Lack of Evidence on Nurses’ Utilization of- and Attributed Health Improvements from- Offered Services and Solutions
While services and solutions are being implemented across varying health institutions and health systems, further analysis of these services and solutions relating to nurses’ acceptance and utilization of, as well as the perceived or real benefits attributed to the utilization of said services or solutions, is needed. In addition, the task of educating the nursing leadership on these results is needed.
Final Thoughts
Significant time and resources will be needed from individuals, institutions, nursing programs, and associations to address all four barriers listed above.
It will take time to review workplace cultures, organizational policies, responsibilities, and plans in an attempt to create sustainable change. It will take vigilance in our practices to collect evidence not only on the solutions themselves but their collective effect on the nursing workforce.
However, the variety of services and solutions listed below should be considered options by nursing and healthcare leaders to expand their offerings to address this crisis.
For additional concerns or questions, please contact relations@anacaliforna.org.
5 Mental Health Services and Solutions with the "Best Fit"
"Product-market fit" - an industry term used by professional marketers - points to the idea that a product's or service's proposed value, as well as the features and experiences a user has when interacting with the product or service, must match the underserved needs of the target audience.
The following five mental health services and solutions mentioned below earned their placement by providing a solution deemed having the best "product-market fit." Evidence of this was shown in the adoption of said services and solutions by healthcare professionals, health systems, and other partnerships. This also included conversations with their staff and leadership, product demos, service summaries, website reviews, and more.
Summary: Developed more than 30 years ago, HeartMath is an evidence-based methodology. HeartMath shows participants how to re-balance the body and mind by activating positive emotions to help the systems in our body synchronize and work better, building our resilience.
The HeartMath Research Center, independent researchers, and universities have published over 300 peer-reviewed studies that validate the HeartMath System. HeartMath is used by hospitals and with health care providers, Olympic athletes, first responders such as law enforcement and fire departments, corrections officers, schools and universities, and military and special forces.
Implementation: Individual and organizational educational modules, trainings, and workshops are available.
- Individual Implementation:
The intervention consists of two workshop sessions, the ‘Transforming Stress’ and ‘Level 5’ workshop.
The Transforming Stress session is a 5‐hour course that focuses on the impact of stress on the body–mind–spirit. This includes several techniques for learning how to better self‐regulate stress responses by shifting into a more coherent physiological state.
The second ‘Level 5’ workshop is a 2‐hour session that builds on the basic techniques and provides participants the chance to ask questions and get helpful pointers about using the techniques.
- Organizational Implementation:
Four internal employees attend a three-phase training to become certified trainers and build an internally sustainable program. These trainers then conduct workshops for their organization.
Features: Certified Trainers and Mentors, Apps, Wearable Devices for additional monitoring
Cost: ~$100 - $3,995*. This includes all small offerings up to certification training for one individual. *Organizational plans may exceed the pricing listed.
Link: https://www.heartmath.com/
Why mention it?
Once learned, the HeartMath system can be used anywhere, anytime. The implementation required is a very low lift for individuals and organizations and can add another resiliency tool to the mix. Furthermore, the volume of peer-reviewed studies makes it perhaps one of the most documented mental health solutions.
Summary: Wambi is a holistic recognition solution for patient and team member experience. Through its gamified digital platform informed by real-time patient, peer, and leader feedback, team members are armed with their individual data as a means to elevate recognition and promote autonomy while inspiring a sense of belonging. Leaders are motivated to quickly and easily share appreciation and are equipped to communicate more effectively across their teams.
For patient-facing team members, Wambi begins by empowering the voice of the patient to provide real-time recognition for their care providers. By capturing individual and team-based recognition, employees and staff are engaged and a culture of gratitude is created which ultimately creates meaningful and sustained change. This three-prong approach brings recognition full circle to positively impact patient engagement, enable real-time service recovery, and reward staff engagement.
As a platform focused on providing solutions across the continuum of care (i.e. everyday stress and fatigue vs. severe trauma and distress), Wambi then facilitates partnerships to deliver additional catered services and solutions based on feedback interactions.
Currently (March 2022), Wambi has partnered with EvenHealth and Corporate Counseling Solutions to deliver complementary solutions through its recognition platform.
EvenHealth - EvenHealth is the creator of Cabana. Cabana is the first digital counseling platform designed for difficult conversations through anonymous group support. Cabana's offerings can engage users with a variety of increasing care options from psychoeducational tools and training to direct psychological support.
Corporate Counseling Associates - CCA is a premier HR consulting firm, dedicated to improving workplace culture and emotional wellbeing while reducing organizational risk. Drawing on nearly four decades of business experience and behavioral insight, CCA provides comprehensive support for organizations through a suite of integrated services that include strategic consulting, behavioral health and enhanced EAP, learning and development, and coaching.
Implementation: HR and/or HRIS integration. Executive leadership buy-in, IT department (for security check) needed.
Features: Built-in recognition system, patient feedback included, catered services and solutions, integrated into workflows
Cost: Pricing is based both on the total number of employees and the support package selected. Levels of offerings have been created to meet specific needs, the size of the organization, and the budget. Special pricing has been designed for members of the ANA\California and pricing is provided upon request.
Link: https://wambi.org/
Why mention it?
Building their value proposition off of recognition and rewards software, Wambi is uniquely positioned to integrate several services under one roof. Real-time feedback can cater personalized services to the healthcare professional no matter their spot on the continuum of care.
Summary: Part of The Schwartz Center for Compassionate Healthcare, Schwartz Rounds offers healthcare providers a regularly scheduled time during their fast-paced work lives to openly and honestly discuss the social and emotional issues they face in caring for patients and families.
Caregivers have an opportunity to share their experiences, thoughts, and feelings on thought-provoking topics drawn from actual patient cases. Panelists from diverse disciplines participate in the sessions, including physicians, nurses, social workers, psychologists, allied health professionals, and chaplains.
Hundreds of healthcare organizations around the world are Schwartz Center Healthcare Members and conduct Schwartz Rounds® to bring doctors, nurses, and other caregivers together to discuss the social and emotional side of caring for patients and families.
Implementation: Schwartz Rounds staff help organizations successfully set up sustainable programs within their own institutions. Existing communication channels used.
Features: In-person and/or virtual opportunities possible based on institutional resources. Communities.
Cost: Membership in Schwartz Rounds
Why mention it?
Having a regularly scheduled time to destress is the closest solution to providing 'in-the-moment' support. Schwartz Rounds can be implemented with little support staff which is why it has been implemented successfully across hundreds of facilities.
Summary: MINDBODYSTRONG is a cognitive behavioral skills building (CBSB) program that provides a theory-based approach to improving mental health, healthy lifestyle beliefs and behaviors, and job satisfaction in clinicians.
Created by Dr. Bernadette Mazurek Melnyk and now backed by 20 studies, MINDBODYSTRONG participants reduce stress, anxiety, depressive symptoms, and suicidal ideation, as well as improved healthy lifestyle behaviors and academic performance.
Implementation: Consists of seven manualized weekly 35-45-minute sessions led by a trained facilitator.
Features: Flexible schedule, manualized and live training.
Cost: Certification, certification renewal, and organizational licensing.
Link: https://nursing.osu.edu
Why mention it?
MindBodyStrong is one of the few solutions that has been specifically tested on nurses in varying environments - one of the barriers mentioned above. Furthermore, MindBodyStrong has shorter training sessions compared to other services meaning these could be integrated into work schedules.
Summary: Transcendental Meditation® is an easy-to-learn mental technique for deep relaxation and stress reduction producing a unique neurophysiological state that combines deep metabolic rest with heightened mental alertness.
Peer-reviewed published studies on TM® have documented improvements in a wide variety of stress-related disorders, as well as significant improvements in cognitive function, overall health and well-being, PTSD, and more.
Implementation: Taught one-on-one in four sessions by a certified TM for nurses teacher.
Features: No prior training or education needed. One-on-one and community support offered.
Cost: Free introductory call. Trainings based on income.
Why mention it?
Backed by hundreds of studies, the American Psychological Association, and the American Heart Association, TM®'s 'effortless' meditation that is not just a solution for healthcare professionals but also their family.
11 Notable Mentions
Summary: Provides debriefing and education to individual nurses, small groups, corporate institutions, hospitals, and universities across the nation in safe spaces built for sharing truths, emotions, and healing.
Implementation: Debriefing facilitator, Debriefing sessions.
Features: Daily communication, monthly subscriptions
Cost: Complementary and made possible through donations from CommUNITY.
Summary: Members meet twice a month on Tuesdays at 8:30 PM EST via Zoom. Meetings are led by a nurse and focus on topics presented in the curriculum.
Cost: Free
Summary: Online course designed with challenges to increase happiness and build more productive habits.
Implementation: 10 weeks
Features: Flexible deadlines, shareable certificate
Cost: Free
Summary: A whole human approach to address the needs of frontline workers in order to support their ability to serve on the frontlines of the COVID-19 pandemic. An initiative of Harvard T.H. Chan School of Public Health, Thrive Global, and the CAA Foundation.
Implementation: Remote microlearning modules, facilitated learning circles, self-care support groups
Features: Interpretation services
Cost: Donations
Link: https://thriveglobal.com/categories/first-responders-first/
Summary: Through smartphone-based technology, the platform was designed to identify patterns of anxiety, stress, and depression, and alert patients and their healthcare providers to deliver care. Ginger was founded in 2011 by a team of entrepreneurs and data scientists at the MIT Media Lab.
Implementation: App on smartphone.
Features: Text-based behavioral health coaching, video therapy & psychiatry, self-guided care resources, flexible and weekend hours
Cost: Member and Employer options. Insurance coverage possible.
Link: https://www.ginger.com/
Summary: Gratitude Practice for Nurses offers research-based strategies to support your well-being and help build a culture of gratitude in your organization. Created and supported by the American Nurses Foundation and the Greater Good Science Center at the University of California, Berkeley.
Implementation: Download toolkit with eight evidence-based activities.
Features: Survey and implementation guide.
Cost: Free
Summary: Wellness program dedicated to providing holistic strategies and coaching staffed by APN candidates at The Ohio State University.
Cost: Free but limited space.
Summary: Directory for the modern online wellness providers and consumers. Sapshot of a wellness provider’s approach and business and easy connection to their services and content.
Features: Life coaches, Couples therapy, Addiction specialist, Therapists, Counselors, Psychiatrists, Naturopathic doctors, Nutritionists, fitness coaches, Certified holistic providers, and Dieticians.
Summary: The MHTTC Provider Well-Being Initiative was established to support provider well-being and work with agencies to implement organizational-level interventions that optimize provider satisfaction and health.
Features: Interactive exercises, courses, assessments, and events.
Cost: Free
Link: https://mhttcnetwork.org/centers/mhttc-network-coordinating-office/responding-covid-19-provider-well-being
Summary: Carebridge is an Integrated Employee Assistance Program with Life Management Services, including a network of 40,000 behavioral health providers.
Implementation: Servicing companies with 500 to 130,000 employers. Executive buy-in needed.
Features: Employee engagement, implementation and utilization, consultants and buyers, account managers, national and global capabilities
Cost:
Link: https://www.carebridge.com/index.html
Summary: Unwinding Anxiety is a step-by-step program developed by psychiatrist and neuroscientist Dr. Jud Brewer MD PhD.
Implementation: Subscription
Features: Video lessons, weekly expert calls, moderated community support
Cost: $29.99/mo. Deals for longer contract length.
Link: https://www.unwindinganxiety.com/
Other Notable Mentions by Category
Apps
Reflectly - A journaling app utilizing artificial intelligence to help you structure and reflect upon your daily thoughts and problems.
Slumber - The app that puts you to sleep with sleep meditations, soothing stories, and soundscapes.
eMeals Healthy Meal Planner - Each week the app provides you with new recipe inspiration and automated shopping list with smart grocery pickup or delivery options.
Calm - Improving your health and happiness through sleep quality, reduced stress, focus, self-improvement and more.
Fabulous - Daily routine planner using behavioral science to help people make smart changes and build healthy habits.
Headspace - Mindfullness app promoting the idea of learning how to be fully present and engaged in the moment, aware of your thoughts and feelings without distraction or judgment.
WaterMinder - Track daily water intake.
Balance - Improve your stress, sleep, and more with the world’s first personalized meditation program, now free for your first year.
InsightTimer - World's largest free library of more than 130k guided meditations, 14k teachers, and meditation timer.
SpringHealth - Mental healthcare that is online, convenient, 100% confidential, and personalized to you.
Happify Health - Design personalized, science-based care solutions to improve health and well-being across the continuum of care—from digital therapeutics and coaching to community and wellness.
Happy the Movement - Emotional support on-the-go related to specific topics including work/career, health, parenting, relationships, gender identity, and more.
Get Mood Fit - Moodfit provides the most comprehensive set of customizable tools to help you focus on what helps you most. Includes mood journal, assessments, tips, inspiration and more.
Counseling
Psychology Today - Psychology Today is the world’s largest mental health and behavioral science destination online. The directory lists clinical professionals, psychiatrists, therapists, and treatment centers providing mental health services.
Therapy Aid Coalition - Initiative connecting essential workers online therapy during the COVID-19 pandemic.
Hot Lines
National Suicide Prevention Lifeline - The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.
SAMHSA’s National Helpline - SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Magellan's Healthcare - Magellan’s crisis phone line offers free, confidential mental health services and access to other resources, such as community-based support, to assist those responding directly to the pandemic.
Conclusion and Call-to-Action
Compounding mental health conditions are leading to critical staffing shortages and negative workforce projections in California.
While health institutions have signaled responsibility for other systemic issues such as racism in nursing and healthcare, they have not acted with the same vigor or swiftness in regard to nurses' access to mental health care.
"It is important to have leadership and culture that communicates to nurses, through explicit permission if need be, that they can - and should - take advantage of these benefits at the moment in which they need them most." - Carolyn Duenas, 2022 ANA\California Advocacy Institute Fellow
With a variety of mental health offerings available in the market addressing a variety of symptoms, diseases, and addictions, it is crucial that nurses and healthcare leaders ensure adequate staff and resources are dedicated to analyzing new and existing services and solutions.
This includes conducting a parallel review of organizational policies and culture via executive leadership, shared-governance models, or similar.
We continue to call upon health leaders and institutions to take action now to remove restrictive policies hindering nurses' access to mental health care.
For media requests relating to this document, Dr. Marketa Houskova, or Carolyn Duenas, please reach out to relations@anacalifornia.org.
If you feel we missed an important consideration, please contact us: communications@anacalifornia.org.