COMPASSION FATIGUE & BURNOUT – the hidden risk

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A vast amount is written and published about animal rescue work, usually on topics relating to the animals themselves or their welfare.  Veterinary articles on health and behavioural issues are also common place, with animal care being a major industry in the UK.  Conspicuous by its absence, however, is the lack of articles centred on the welfare of rescue centre or veterinary staff themselves, and considering that vets have a rate of suicide four times that of the general population and around twice that of other health care professions in the UK (1) due to compassion fatigue and burnout, this is simply astonishing.

Compassion fatigue was first diagnosed in nurses in the 1950’s, so it is not as if this serious and widespread problem has only just come to light, but for some inexplicable reason, this, together with burnout, is hardly ever raised as a topic for discussion at all.

People who choose to work with animals either in a rescue centre or as a veterinary professional do so because they want to make a positive difference for animals, and are often extremely compassionate individuals driven by a strong desire to prevent animal suffering.  Instead, they often find that the emotional stress is draining and exhausting, affecting their health and mental wellbeing, with many opting out and choosing other occupations.  Turnover of staff and volunteers in animal rescue centres is high for this reason, and rabbit rescues are affected equally as badly as rescues for dogs and cats.  Compassion fatigue has become an occupational hazard when working with animals.

Initially when people start working with animals they often feel ready to take on the world, are full of energy and ideas and set about their work with great enthusiasm, sometimes to the point of obsession.  Over time, however, this changes, and depending on various circumstances there is a real risk of the development of compassion fatigue or burnout or both.  It is common for people that are drawn to animal work to be in need of care and help themselves because they have suffered abuse, abandonment or neglect in their own lives, and thus they are already mildly compassion fatigued or depressed before they start.  This can increase the risk of developing further problems in a fairly short space of time.

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So, what exactly is compassion fatigue, and what is the difference between that and burnout?  “Compassion fatigue is caused by empathy.  It is the natural consequence of stress resulting from caring for and helping traumatized or suffering people” (2) or animals. Compassion fatigue, also known as secondary traumatic stress disorder, is characterised by a gradual reduction in the feeling of compassion over time, and being swamped with symptoms such as hopelessness, a decrease of pleasure, constant anxiety and stress, a numbing of emotion, depression, alcohol dependence, eating disorders, problems with sleeping and a nagging negative attitude leading to vulnerability and loss of trust in other people, loss of confidence and inability to focus.  Flashbacks can also occur in some cases, especially if the person has witnessed some kind of trauma or has been affected by the trauma of someone else close to them, and from this point of view, compassion fatigue is not dissimilar to post traumatic stress disorder that affects soldiers and other front line services such as nurses and fire service personal, leading in some cases to severe depression and thoughts of suicide.  However, ask someone with compassion fatigue if they still enjoy and believe in what they are doing, they will usually say yes, whereas with burnout, the person will inevitably say that they no longer enjoy what they are doing and want out.  Compassion fatigue comes on relatively quickly, and can be resolved with the appropriate help and lifestyle changes over time if recognised quickly and treated, whereas burnout creeps up over months and years and there is often no turning back and no resolution and the only way forward is to change direction and do something else completely different.

Anyone in the caring professions can develop compassion fatigue, but there are several personality traits that can place you at higher risk.  This includes people who are conscientious, perfectionists, and those that give a lot of themselves and their time to the cause. People who are more isolated with little social support or high levels of stress in their personal lives are also more likely to develop it too, especially if they have been affected by trauma in earlier years (3).  There is some evidence that vets may be additionally more likely to suffer from compassion fatigue due to the stress put on them regarding the euthanasia of animals under their care, especially those to be put to sleep that are deemed to have had previously a poor quality of life due to neglect or cruelty compared to an animal to be euthanized due to cancer or similar terminal disease that has otherwise been well cared for (4). This is on top of feelings of grief that can be felt in such situations, which in itself can lead to depression and inability to cope.

So, what can be done to help someone with compassion fatigue?  The best way is not to let it develop in the first place by being aware that you are at risk and taking positive steps to prevent its development, but once the condition has developed there are ways of treating it, starting with the realisation and acceptance of the reality of your situation – you simply can’t save every single animal that you hear about or that comes your way.  Doing what you can in a realistic manner makes a huge difference to those individuals that you can help, and you must take satisfaction from that and not fret over the ones that you simply do not have the resources, emotional or otherwise, to save.  Focus on what you can actually control, not on what you can’t, and know your own limitations and don’t push beyond them.  To survive intact in the world of animal caring you have to develop a protective outer shell – this does not mean you don’t care but it gives you the ability to carry out what you need to do without it impacting directly on your physical and mental wellbeing. You must learn to say “no!”

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Early recognition is crucial in the fight against compassion fatigue, and keeping your life in balance, adjusting your priorities and looking after yourself better are vital components in treating this debilitation condition.  You are not going to be resilient or of any use if you are exhausted and ill, and unless things are changed there will be no resolution apart from giving up and doing something else completely.  Taking regular exercise, eating healthily, taking breaks and holidays and meeting up with family and friends are all vital components to the journey back to mental and physical health.  Trying to fool yourself that it will go away or that you will sort it out once this or that task is finished is simply not going to work and all that will happen is you will develop burnout as well.

So, how is burnout different from compassion fatigue?  Burnout develops slowly over months and years and gradually builds to a breaking point where the person can no longer carry on nor actually wants to, and can happen to anyone in any profession or walk of life, not just the caring professions.  It can occur to anyone who works too hard, too long, or under too much stress but without the necessity of being exposed to trauma or trauma survivors as in someone diagnosed with compassion fatigue (5).  It is often associated with the feeling that your efforts make no difference, with a high workload or a non-supportive work environment (6).  Loss of motivation is another common symptom of burnout, as all the drive to do your job as well as you can virtually disappears.  Although the symptoms of burnout are similar to compassion fatigue, the outcome is not as positive as it is far harder to come back from it and find your way once more if staying in the same job.

Rescue work is an extremely stressful activity with a high rate of burnout.  Efforts to try and prepare and warn new volunteers about the risks are often rejected as their enthusiasm blocks out the message and they assume it is something that happens to other people, not them.  The implications are often not understood until they start to experience it themselves, by which time it is often too late and they leave to do something less stressful, thus rescue centres lose valuable volunteers together with their skills and experience.

Perhaps the reason that compassion fatigue and burnout are rarely discussed is that we are afraid of being seen as weak or pathetic and not up to the task of what can seem to outsiders as an easy job – playing with animals all day (if only …).  By admitting we have a problem we are also having to accept that there is an issue that needs immediate attention, and by doing so are admitting that in some way we have failed, which of course we have not.  Until this condition is brought out into the open, many more people will continue to disappear into the black hole of compassion fatigue and burnout and the loss will be to the detriment of rescue centres and veterinary practices and ultimately it is the animals that will suffer.  By informing people of the risks and the causes, we may just be able to save some from developing these conditions entirely, and those that are already affected may be encouraged to seek the help they need to set them back on track again and find that their way once more.

References

1.  Bartrum & Baldwin, Veterinary Record 2008; 162: 36-40

2.  Portnoy, Health Progress, July-August 2011; 47-50

3.  Dake, CoronerTalk, Secondary Traumatic Stress, March 2015

4.  Tiplady & Walsh, Animal Abuse:  Helping animals and people 2013; 117-122

5.  Jessica Dolce, 2013: http://notesfromadogwalker.com/

6.  Stamm, ProQOL 2nd edition, 2010: The concise manual for the professional quality of life scale.