Building Stronger Mental Health Support for Caregivers

Rosalyn Carter once said, “There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers.”

Caregivers, also known as “home care workers,” strengthen our communities by providing care, companionship and support for older adults and people with health conditions and disabilities. A caregiver’s work allows their clients to live at home with dignity, while providing peace of mind to their families.

Like many essential roles, caregiving is physically and emotionally taxing. Amidst the demands of caring for others, caregivers’ mental health is overlooked. In fact, estimates show 40-70% of caregivers have depressive symptoms, with 25-50% of caregivers meeting criteria for major depression. This can be due to compounding stressors, like time or financial constraints, social isolation inherent to the job and limited support systems.

An understanding of the unique challenges of the profession, and its structural policy gaps, can inform the work to build systems to support caregivers’ mental health.

Caregiving is Demanding Work

Many caregivers say they “fell into” this work but continued doing it because they found their calling. Despite the passion they feel, the challenges are significant. As Brittany Williams, a caregiver from Tacoma, Washington shared, “People don’t understand that, when you’re a caregiver, you’re literally using every part of your body and energy and strength to take care of people.”

This strain was exacerbated by the COVD-19 pandemic. A recent study conducted by the Centers for Disease Control and Prevention (CDC) shows two-thirds of unpaid caregivers experience mental health symptoms, such as depression or anxiety, compared to one-third of the non-caregiving population.

While more than one in five Americans are unpaid caregivers, those who are paid — either for supporting a loved one or a client — receive modest wages. As one of health care’s lowest paid professions, caregivers may need to work long hours to make ends meet, often leading to physical and emotional exhaustion. Those caring for a loved one may navigate difficult emotions, including loss of control, isolation or the feeling that caregiving is all-consuming.

Caregiving Has Been Historically Devalued

Compounding these challenges is the historical reality that caregiving has been seen as the benevolent duty of female family members or the responsibility of exploited labor rather than a health care profession worth investing in. Many assumptions related to workloads and compensation that underlie caregiving have their origins in slavery, when Black women provided care without pay. These attitudes persist in today’s home care workforce in which Black women continue to be overrepresented.

Additionally, caregiving was one of the few professions left out of the 1938 Fair Labor Standards Act, meaning generations of caregivers have been without the support and protections many workers depend on. 

These factors contribute to a profession that has lacked infrastructure to support the wellness of its workers who are often women of color and immigrants who may already face structural barriers to health equity and economic inclusion.

We Need Better Systems to Support Caregivers’ Mental Health

Our families and communities need caregivers. And for caregivers to be successful, they (like any profession) require systems that support their well-being and sustain them in their work.

We all have a role to play in building this solution. SEIU 775 Benefits Group, a nonprofit organization supporting 50,000 caregivers in Washington state through training, health, retirement and job-matching benefits that I have the honor of leading, is committed to supporting caregiver mental health in the face of the profession’s challenges and structural gaps.

Here are four areas where we’ve found success — and where we hope other organizations will follow suit:

Teaching skills to work with stress: One effective way to support the mental health of caregivers is to provide practical tools to work with stressors. Mindfulness has been shown to promote calm, relaxation and better sleep. By integrating mindfulness training into our courses, caregivers learn skills to identify and work through emotional challenges. Among participating caregivers, we’ve seen decreases of 20% in depression scores, 16% in perceived stress and 21% in insomnia severity.

Prioritizing access to care: The ability to see an affordable therapist is often a barrier to accessing mental health support. Despite our country's advances in providing access to health care, there’s still a societal norm that high-quality care is primarily for full-time white-collar workers. But all workers need and deserve health care. In our experience, providing access to affordable, quality health care significantly shifts caregivers’ ability to proactively care for their well-being.

Meeting caregivers where they are: For caregivers without health coverage or with limited insurance, high costs and long wait times present obstacles. Even those with good insurance may struggle to find culturally or linguistically appropriate therapists or feel uncomfortable seeking traditional therapy.

With this in mind, we normalize emotional wellness in our communications and training and regularly connect caregivers with low-or-no-cost resources. This includes access to emotional health coaching through a third-party phone app. Of our users who screened positive for depression, 76% showed improved symptoms after six-weeks of use. Resources like these can be a game-changer for caregivers needing in-the-moment support or feeling stigma related to mental health.

Focusing on economic security: Financial security lays a foundation for mental health. Yet, caregivers often don’t get this peace of mind. As a result, policies that support fair wages for caregivers, including union representation, are a crucial part of wellness. To support financial stability, we’ve adopted a first-of-its-kind retirement plan for caregivers with direct payments from their employers. And we connect caregivers to resources, such as childcare, food or legal assistance. These are important steps to reduce economic strain that can lead to mental health challenges.

As the wave of aging baby boomers strains the caregiving profession and demand continues to trend upward, investments must be made to support caregivers’ well-being. Ensuring this workforce is strong, healthy and able to support our communities’ growing needs requires building systems that prioritize the wellness of caregivers, including their mental health. 
 

Abby Solomon, MSW, HCA is the CEO of SEIU 775 Benefits Group, a non-profit organization providing training, health and retirement benefits and job-matching to 50,000 caregivers in Washington state.