As burnout and workforce shortages continue to threaten behavioral health systems nationwide, New York City-based NYC Health + Hospitals — one of the largest safety-net providers in the country — is taking a prevention-first approach to clinician well-being.
Omar Fattal, MD, system chief of behavioral health services, told Becker’s how his team is shifting from reactive crisis response to proactive emotional and workplace support, while addressing pipeline shortages and safety concerns across its 11-hospital network.
Following the pandemic, the organization — like many others — experienced a provider loss.
“We had the Great Resignation … people who were thinking about retirement, retired or went on medical leave and never came back,” Dr. Fattal said. “It was very tough. It affected our ability to deliver services, especially on the inpatient side. We had to take some beds offline.”
Dr. Fattal noted the system launched targeted efforts to rebuild engagement and address vacancy rates that produced measurable improvements: Turnover decreased from 18% to 12%, and it reported less than 6% vacancy across different disciplines.
Sustaining those gains, he added, has required the system to turn to psychiatric nurse practitioners and physician assistants and to continue innovating and clarifying training, particularly around those roles. Variability in training, limited understanding of scope of practice, and confusion between the roles of physician assistants, nurse practitioners and psychiatrists have been key focus areas for the organization, he said.
A major focus for the system is building structures that prioritize emotional well-being: creating multiple, complementary layers of support.
One part of that approach is a peer-support staff wellness program called Helping Healers Heal, which is designed to help staff connect with colleagues who understand the challenges of behavioral health work. This program provides clinicians with a space to share experiences.
“The idea behind it is to focus on well-being in a proactive way — to take it out of behavioral health and look at well-being as a general thing, not necessarily to medicalize it and to make it about behavioral health or about disorder, but to make it common,” he said.
In high-risk, high-stress environments such as acute psychiatric settings, Dr. Fattal said, it is essential to give teams opportunities to process specific incidents or difficult cases together. Through regular debriefs, clinicians can reflect on what happened and reduce the emotional toll that can accumulate when challenging situations go unaddressed.
Dr. Fattal emphasized that staff safety and wellness are inseparable.
“The other aspect of this is violence reduction and safety,” he said. “So we know there’s a lot of connection. … When you’re not feeling safe, when you’re feeling there’s a lot of violence in your unit, you tend to feel you’re not very satisfied in your job.”
Dr. Fattal said violence-reduction efforts are central to the system’s clinician well-being strategy, emphasizing that safety and wellness are complementary. He described initiatives such as proactive debriefing, staff training and empowering front-line clinicians to participate in violence-prevention efforts as key to improving satisfaction and stability across behavioral health units.
