Provider Wellbeing in Team-Based Primary Care: Mitigating Burnout for Mental Health Care Providers

Background and Purpose: Maintaining the well-being of mental health providers is essential to the success of access-enhancing efforts in healthcare. Primary health care, an approach to structuring health care premised on access, equity, essentiality, collaboration, and community empowerment, is ideally positioned to provide mental health care. Ensuring primary care’s capacity to deliver mental health care is imperative in the presence of increasing need and patient complexity. However, the experience of mental health providers in team-based primary care (TBPC) is understudied.

This qualitative paper addresses this gap by exploring the experiences of TBPC mental health providers to better understand the individual and organizational facilitators of provider wellbeing that serve to minimize provider burnout, compassion fatigue, and/or vicarious traumatization in TBPC. Participants from both the provider and policy-informant levels offered suggestions regarding best practices for this equity-increasing approach that are unique to TBPC.

Methods: Ninety-six semi-structured individual interviews were conducted with 82 participants reflecting a diverse range of TBPC providers and administrators working in Family Health Teams (FHTs), one model of primary care in Ontario, Canada, as well as policy informants. Executive directors from the 184 FHTs were contacted from a list made publicly available from the Ministry of Health and Long-Term Care, and their staff was invited to participate. Initial inductive sampling sought participants from rural/urban locations, large (≥2 full-time mental-health professionals on staff) or small (<2 full-time-equivalent mental health professionals on staff) mental health teams, and by varying mental health team composition. Provincial policymakers and community stakeholders were also recruited via e-mailed invitations. Interviews probed participants’ experiences of providing mental care in FHTs (if applicable), as well as examined the organizational, structural, and intrapersonal contexts of care provision in FHTs. Interviews were conducted in-person, transcribed verbatim, and coded (using NVivo qualitative analysis software) using a collaborative team-based approach in accordance with the principles of inductive, constructivist ground theory.

Findings: Three themes were identified following data analysis: provider capabilities, organizational efficiencies of care, and collaborative culture of support. Participant capabilities and confidence for delivering mental health care, based on prior training, varied considerably. High service demands contributed to individual burnout and were exacerbated by insufficient resources and inefficiencies of care. Findings revealed the consequences of inadequate resourcing at the team and community levels for provider well-being, and barriers to provider collaboration and skill development despite their importance. Organizational processes that facilitated efficiencies of care (i.e., scheduling processes) were highlighted as mitigating burnout, and intra-team informal mentoring was highlighted as minimizing the impacts of vicarious trauma. Cultivation of compassion was explicitly named by providers as important for decreasing compassion fatigue, and as acknowledged as challenging given demand volume.

Conclusion and Implications: Results indicate the importance of organizational efficiencies of care, and facilitating intra-team connections. Explicitly fostering intra-team collaboration and knowledge-sharing is recommended. Further research on team functioning during the COVID-19 pandemic will offer additional insight regarding how primary care teams can mitigate provider burnout in a post-pandemic environment.