When helpers need help: compassion fatigue on the frontlines

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Kelle Greene has seen a lot in her 33 years at the Winnipeg Humane Society, but it wasn’t until organizational restructuring brought the animal lover into close contact with difficult cases that she started to notice her mental health was being impacted.

“I had become attached to a couple of animals, and then, as we sometimes do, we had to make the really tough decision to euthanize them for humane reasons,” said the director of foster and volunteer services.

“I assessed myself, and I knew I needed to take a break,” Greene said.

Like many who work in helping professions, Greene was suffering from compassion fatigue, a unique type of burnout that develops as a result of intense, ongoing demands on someone’s time and emotional energy, as well as exposure to chronic or vicarious trauma. 

Experts believe people who work with vulnerable adults, children and animals are especially at risk, although anyone can be affected.

“Compassion fatigue happens when we spend so much of our human energy trying to listen, understand and support others that we become exhausted ourselves,” said Allison Dunning of Peer Support Canada, speaking to the Western Sentinel.

“We can spend so much time thinking about other peoples’ experiences, needs and wellbeing that we can forget to think about our own.”

A recent study by Michigan State University determined that 61 per cent of animal rescue volunteers experience some level of compassion fatigue. In comparison, another analysis put the number of American social workers experiencing compassion fatigue at more than 70 per cent.

Canadian statistics are harder to come by, but a 2016 report by the Mental Health Commission of Canada found that more than 40 per cent of Canadian physicians and nurses identified themselves as being in the “advanced stages of burnout.” 

The cost of caring

First coined by Carla Joinson, a registered nurse, in 1992, the term compassion fatigue was initially used to describe the impact continually responding to emergencies had on the wellbeing of hospital staff. 

Its definition was later expanded by Charles Figley, a prominent American psychologist and traumatologist, who called it “the cost of caring.”

“It’s based on the idea that people that go into helping professions or helping roles obviously have a desire to help be of service; they tend to be very compassionate folks,” said Nicole Caines, a Clagary-based phycologist. 

“But that personality characteristic is kind of a double-edged sword,” she said. 

“What makes you good at your job is also what puts you at risk for compassion fatigue because compassion and empathy are finite resources.”

Symptoms of compassion fatigue can include intense cynicism, a loss of empathy, rumination, feeling helpless, exhausted, overwhelmed, angry and irritable, and difficulty sleeping and concentrating. 

Some people may also neglect their self-care, withdraw, self-isolate and self-medicate.

While most compassion fatigue research has focused on healthcare settings, Caines said it can develop in any frontline profession.

“I think (healthcare) is probably where it’s talked about most, but I’ve spoken with people that work in homeless shelters or that work in animal rescues, and it happens there too,” she said.

Compassion fatigue, as well as burnout more generally, has been a growing concern for non-profits dealing with homelessness and substance use in recent years, which have seen demand for service grow exponentially since the beginning of the COVID-19 pandemic.

Marion Hoadley, director of human resources at Our Place Society in Victoria, B.C., said the toxic drug crisis — which has killed more than 13,000 British Columbians since April 2016 — has exposed the organization’s 300 staff members to a growing number of challenging and traumatic incidents, including deaths. 

The society, which also relies on about 300 volunteers, serves Greater Victoria’s most vulnerable, including people struggling with homelessness, mental health challenges, substance use issues, the working poor, and the impoverished elderly.

“One thing our staff does on a very regular basis is wellness checks, and often they find people who have died,” Hoadley said. 

“And that’s something that really affects them; these are people, residents, they are people they know.”

Secondary trauma accumulates 

However, even small but persistent encounters with secondary trauma can lead to compassion fatigue, said Sogand Zakerhaghighi, an Edmonton-based mental health professional.

“A lot of folks might think that compassion fatigue only impacts people like me who work in mental health or medical professionals,” she said. 

“But that’s not true. Grocery store clerks can deal with it, or bank tellers, because the reality is you’re in regular contact with folks that may trauma dump on you.”

Pandemic restrictions, followed by economic turmoil and sociopolitical upheaval, also continue to impact people’s mental wellbeing negatively, Zakerhaghighi said. 

“I think everybody has a level of compassion fatigue because we are all just trying to survive.”

According to the Canadian Mental Health Association, the peak years of the COVID-19 pandemic did decrease people’s ability to feel empathy. Only 13 per cent of Canadians said they felt empathetic in 2022, compared to 23 per cent just two years earlier. 

At times, compassion fatigue may also be unintentionally exacerbated by friends, family and co-workers who overshare their own painful emotions and thoughts, Zakerhaghighi said. 

She suggested developing a neutral code word to let those close to you know when you don’t have the emotional capacity to take on secondary information.

“If we get into a habit of creating those personal boundaries with ourselves through our self-care and then creating social boundaries with those around us, it will slowly start to refill our compassion so that compassion fatigue won’t have as much of a hold on us,” she said.

The Winnipeg Human Society has gone one step further with its Compassionate Hearts Program, which gives staff or volunteers who just want to work quietly or avoid small talk after a challenging case or tough situation the option of wearing a purple, heart-shaped button or placing a similar sticker on their workspace door.

The society also favours one-on-one conversations after traumatic events, rather than group debriefs, to avoid inflicting vicarious trauma on staff whose initial experience may have been less intense than that of their colleagues, said Meghan Irwin, the society’s director of behaviour and retail services.

“Being open and honest has definitely really helped us be more progressive with compassion fatigue,” she said. 

“But sometimes debriefing and talking through it can bring on more challenges, and we’re not therapists, we’re not counsellors. So, in my experience, it’s often best to refer to the professionals.”

Mental health professionals say self-care is vital to recovering from compassion fatigue and building compassion fatigue resilience. 

However, sometimes, talking through difficult situations and emotions with a counsellor or psychologist may be necessary. 

“And self-care isn’t just going home, laying on the couch, watching Netflix and having a glass of wine. It’s about daily practices,” Hoadley said.

Staff at Our Place Society receive training on effective self-care. That might include meditation, walking a dog before work, debriefing with colleagues, creating strategies for difficult situations before they occur, journaling or practicing mindfulness.

“It’s just becoming much, much more important,” said Hoadley. “For people to be able to stay in the field, they have to practice really good self-care.”

She added all staff also have access to an employee assistance program, which includes free counselling services 24 hours a day, seven days a week. 

Additionally, employees working more than 20 hours a week can access psychologists through their benefits program.

“People should not be afraid to reach out for help because, if the last three years living in a pandemic have taught us anything, it’s that we need each other,” Zakerhaghighi said.

However, the SZ Wellness founder cautioned that self-care can come with pitfalls and barriers. Getting more sleep, for example, is challenging advice for someone whose system is stuck in fight or flight mode.

Likewise, inflation coupled with low wages can make it difficult for a person to eat healthier meals or prepare favourite dishes, said Zakerhaghighi. It can also push professional therapy out of reach.

“People may experience shame and guilt about their self-care not being good enough or not being perfect enough, and … that feeds into that negative loop of compassion fatigue,” she said. 

“So, if you’re not able to go to therapy or you’re not able to get mental health support … are you able to do one thing that fills your cup up a day? Can you find pockets of joy?”

Mental health hotlines or community organizations may also offer free or low-cost assistance to people dealing with compassion fatigue, Zakerhaghighi said. And home workouts or online sleep meditations might be able to replace gym memberships or sleep therapy without adding to someone’s financial burden.

Transparency matters

Frontline staff can also build compassion fatigue resilience by acknowledging systemic limitations when dealing with challenging situations, said Caines.

“We can’t always help in the way that we want, particularly if you’re working in an imperfect system, which we all are,” she said. 

“Sometimes people end up blaming themselves for systemic failures, and that can lead to decreased satisfaction and compassion.”

Zakerhaghighi adds that employers and managers who are open about their struggles in the workplace create space for staff to speak openly about their challenges. This practice can help address compassion fatigue in the early stages and build resilience.

“I think the number one thing is transparency,” she said. “Number two is for employers to be open to feedback.”

She suggested check-ins and casual conversations rather than formal sit-downs or formulaic reviews. Simply reminding employees of available services or asking how they’re doing is helpful. Still, employers should also be prepared for feedback that might not be positive and be responsive to those concerns, Zakerhaghighi said.

Greene said her employer was very supportive when she took a couple of weeks off work to regroup and recover from her compassion fatigue. 

“I needed to sort of bring myself back to why am I here and look at the positive things that we have done as an organization rather than the individual cases that might be difficult,” she said. “Now I’m back with a new focus and a new balance between my life and my work.”

That balance includes leaving more work at the office and limiting the number of messages she gets after hours. 

Greene has also rediscovered old hobbies and started doing volunteer work unrelated to animal welfare.

Spending time with her two “tripod” cats, Henry and Honey, is also part of her self-care routine. “They remind me of the positive every day; it’s just been a joy to have them in my life.”

Celebrating positive accomplishments is an essential part of creating workplaces that guard against compassion fatigue, Caines said, something that’s often overlooked when workloads are excessive.

Showing appreciation

Greene said volunteers are also susceptible to compassion fatigue and burnout, and need to hear their contributions are valuable and appreciated. 

“I think that’s also an integral part of combating compassion fatigue,” she said. “Saying thank you goes a long way to helping people feel like their work is valuable … and when you can go home, and you’re like, yes, I made a difference today, that’s going help when those tough situations come up.”

But there are times when even self-care and counselling aren’t enough. Sometimes, the only solution to compassion fatigue and burnout is to step back and look for work in another field.

“And I don’t think there’s any shame in that at all,” said Zakerhaghighi. “You may fall out of love with your career, and that’s okay. You may wake up and decide that it’s no longer filling your cup that you’re giving and giving and giving, but you’re not taking as much in.”

But the more people discuss compassion fatigue and build resilience, the less turnover non-profit organizations will see, Hoadley added.

Greene said mental health wasn’t on anybody’s radar when she started working at the Winnipeg Humane Society more than three decades ago.

“I’m from that generation where you just work and work, and you suck it up,” she said. 

“But our culture or maybe our way of looking at things is changing, which I think is super good … it’s a healthier approach to the work we do. Work that can be mentally exhausting sometimes, but also super rewarding.”