TIME’S UP Healthcare: The Role of Mental Health

According to the National Academies of Sciences, Engineering, and Medicine report on the culture of sexual harassment in academic institutions (1), sexual harassment is extremely common across scientific fields, with the highest prevalence in medicine (2). These high rates are pervasive across sites and disciplines, including psychiatry (2–6).

Sexual harassment and gender discrimination are intimately linked (7). Gender disparities in salary and career advancement exist across health care fields (8–10) and serve to devalue women in the workplace. These disparities also create an environment with detrimental power dynamics that limit women’s ability to report or defend themselves against harassment (11). These dynamics are even worse for women from diverse backgrounds (e.g., racial-ethnic minorities; the lesbian, gay, bisexual, transgender, queer community) (12).

Given this current landscape, TIME’S UP Healthcare was launched on March 1, 2019, with the mission to ensure a safe, equitable, and dignified health care workplace. With the support of TIME’S UP, its parent affiliate, TIME’S UP Healthcare is a 501(c)(3) organization that combats gender inequity and sexual harassment through advocacy, education, and action. The value of diversity has been imbued throughout the TIME’S UP Healthcare organization. Founding members represent women in leadership throughout medicine, nursing, physician assistants, pharmacy, research, and administration. Our diversity extends beyond job titles and includes representation across race, sexual orientation, gender identity, and women at the intersections of multiple identity groups. Five psychiatrists are among the 50 volunteer founding members, including two past APA presidents.

Using its national platform to raise awareness, TIME’S UP Healthcare will attempt to provide health care workers with the knowledge, resources, and support to speak up (Table 1). In addition, TIME’S UP Healthcare has partnered with health care organizations to promote an equitable work environment and protect targets of harassment and discrimination. Partners committed to date include the American College of Physicians, the American Nurses Association, Brigham Health, the Mayo Clinic, and the Yale School of Medicine.

We believe that mental health care providers should be leading the fight for change. We are trained to understand the emotional toll that stressors like harassment, discrimination, and abuse have on individuals from all backgrounds. We also know that these stressors often require clinically complex interventions, including targets at the individual, interpersonal, community, and policy levels. The combination of our clinical and research skills positions us to better help develop system-level solutions, as described below.

First, our expertise in mental health can help design a person-centered and trauma-informed approach to individuals and systems affected by discrimination and harassment. We can educate leaders to recognize and respond to the psychological burden of these experiences without retraumatizing victims. We can also highlight the importance of supporting those helping the victims, who are at risk for both primary and secondary trauma themselves.

Second, we understand how structural factors influence well-being (13). It is well recognized that institutional discrimination, caused by systemic practices, regulations, and policies (e.g., lack of paid maternity leave) (14), requires intervention above the level of an individual worker. Because our patients disproportionately face discrimination, mental health clinicians routinely navigate the complex interrelationship between systemic and individual challenges. We hope to use this knowledge to inform our work with Title IX offices in medical schools to develop pragmatic solutions to address underreporting and ensure that trauma-informed care is easily accessible.

Third, behavioral health scientists are uniquely prepared to study the impact of workplace gender inequity upon mental well-being and burnout. Research suggests that gender inequity and sexual harassment can contribute to the development or exacerbation of mental health disorders such as depression, substance use, and anxiety (15). Burnout, depression, and suicide are also highly prevalent in health-related professions (16) and affect patient care (17). Understanding the association between gender inequity and burnout—and their associated human and economic costs—can help galvanize organizations that are already committed to fighting burnout to enact change.

The launch of TIME’S UP Healthcare is a unique opportunity to raise awareness about the challenges that women face working in health care. However, awareness is not enough. It is time to develop systemic solutions to confront gender disparities in the health care workplace and the mental health sequelae that may result. We can all help foster equitable work environments, and some potential options described in Table 1.

TIME’S UP Healthcare believes that a safe, equitable, and dignified workforce will promote high-quality patient care. As mental health professionals, we must take a leadership role in addressing the corrosive impact of gender discrimination and harassment in health care. This is critical for the well-being of both our colleagues and our patients. The time for change is now.