Canceling the Culture of Clamming Up

Addressing Mental Health in Nursing One Crucial Conversation at a Time

By Megan Hinners

Two people in conversation

Silence is Not Always Golden

“When in doubt, talk it out.” It’s an idiom that we seem to have ingrained in our brains throughout childhood as we are taught to address and tackle a wide array of issues and conflicts with the power of our words. Yet, by the time we reach adulthood, the culture of clamming up and suppressing our thoughts, concerns, and feelings is celebrated and encouraged across a variety of professional and personal aspects of our lives.

The cultural norm of clamming up instead of speaking up is no more evident than with topics related to mental health. The stigmas associated with mental illness are plentiful, and negative connotations abound as both public and self-perception lead to discrimination and adverse thoughts, opinions, and reactions. For those who struggle with any form of mental illness, stigma and discrimination can lead to increased difficulties, harder recovery, and the desire to keep their struggles to themselves.

According to recent mental health statistics, nearly one-in-five U.S. adults will have a diagnosable mental health condition in any given year. Forty-six percent of Americans will meet the criteria for a diagnosable mental health condition at some time in their life. However, more than half of people with mental illness do not seek help for their disorders. For nurses, it’s even more of a challenge to acknowledge and accept that mental illness can take its toll.

The Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Initiative (INQRI) found that 18% of nurses exhibit symptoms of depression, compared to the 9% found in the general public, and while data from the United States is limited on the toll that COVID-19 has taken on nurses, a 2020 JAMA Network Open study found that 50.4% of 1,257 health care professionals in China were experiencing symptoms of depression while working throughout the pandemic. The study also showed that they were experiencing increases in anxiety, insomnia, and distress.

Yet, nurses are less likely to seek support or treatment for mental health-related concerns. Mental Health America notes those in helping professions such as health care workers often struggle with asking for help for themselves. As ones who are typically doing the helping, it can create feelings of vulnerability and weakness to admit they themselves need assistance.

Difficult Conversations are Crucial Conversations

For some nurses, the stress and anxiety-inducing situations can begin even before their careers begin. The rigors of nursing school are tough, especially as a semester winds down and final exams loom on the horizon. Add onto that the stress of pandemic-induced challenges and the final few weeks of an academic semester can be downright daunting.

As the 2020-2021 academic year started to draw to a close, School of Nursing faculty saw the need to address potential mental health concerns of their students. “We found that it was coming up a lot in conversation,” said Assistant Professor Elliot Tebbe, PhD, LP. “Our faculty were wanting to support their students but did not exactly know how they should go about it — what support they themselves should offer, or what support could be provided to connect students with other services on campus.”

Tebbe partnered with Gina Bryan ’99, MSN’02, DNP’12, APRN, FAAN, clinical professor and psychiatric mental health certificate coordinator at the School of Nursing, and the two put their heads together to compile resources for School faculty and staff to utilize that would help them work through difficult conversations with their students should the need arise. In addition, they opened up office hours for colleagues to provide consultation services for any faculty or staff member who needed additional ways to discuss questions or concerns regarding the mental health of their students.

“There was a lot of initial discussion about what we could offer students,” Tebbe added. “We looked at the viability of trying to get a support group together, but time was a big factor in what we could and couldn’t make happen before the end of the semester. So, we whittled it down to compiling a comprehensive list of services, as well as the resources that we created for our faculty who may be having concerns about a student’s well-being.”

One of the resources was a mental health flow sheet that guided faculty through crucial conversation starters utilizing tough, but important questions about an individual’s mental health; questions that addressed conversations about mental health concerns with open, honest dialogue that supports empathy and understanding of an individual’s struggles.

Shifting from Mental Illness to Mental Health

For nurses, opening the doors to begin having those same types of crucial conversations, asking for assistance, and addressing mental health concerns head-on should begin with a foundation built on understanding and empathy. By normalizing these conversations about mental health and offering social and peer support for those who may be struggling, nurses can help erase the stigmas associated with mental illness. In addition, being honest about one’s own personal struggles can help mainstream the importance of openly addressing mental health concerns. Through building connections and creating straightforward and honest dialogue supported by compassion for an individual’s struggles, nurses can help shift the perception from that of illness to health.

“For a long time, mental health just meant, ‘What disorder or disorders do you have?’ But now we’re really giving attention to the fact that mental health is its own separate aspect of well-being.” —Assistant Professor Elliot Tebbe, PhD, LP

“One of the things that stands out to me is that there has been a big shift that I have noticed in conversations surrounding mental health versus mental illness,” Tebbe said. “As a society, we are starting to tease those apart. For a long time, mental health just meant, ‘What disorder or disorders do you have?’ But now we’re really giving attention to the fact that mental health is its own separate aspect of well-being. I think that destigmatizing mental health is so important because it means that we get to situate it for what it is, which is an aspect of well-being, just like physical health is an aspect of well-being amongst all the other domains of health. By having conversations and moving the topic into the realm of casual conversation versus this thing that we do in secret behind closed doors, it opens the door for connections to other people. The research is very, very clear that connection with others has enormous positive benefits. It’s also enormously helpful in terms of mitigating harm of various negative experiences. That’s the power of connection. Part of destigmatizing mental health is giving space for us to show up as our whole selves, including the parts that are suffering, including the parts of us that are in a lot of pain. I think there’s acknowledgment of the fact that people are struggling right now, and it’s opening up opportunities for conversations on a global scale.”

You are Not Alone

The most important phrase for nurses to remember when it comes to mental health and mental illness is simple: You are not alone. For nurses who are struggling with whether they should open up about their concerns or mental health struggles, you are not alone. For those who have concerns about friends and colleagues within nursing and health care, let them know they are not alone.


If you or someone you know is struggling with mental illness, substance abuse, or thoughts of suicide, there are resources available to help:

  • If you are in immediate crisis, call 911
  • If you or anyone you know is having thoughts about suicide, call or text the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255),
  • If you or anyone you know is struggling with substance abuse as a result of mental health issues, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662 HELP (4357),

There are also nursing and health care worker-specific hotlines, documents, and websites that address tackling the challenges surrounding mental health concerns.

  • Mental Health America (MHA)
    Mental Health America’s resources for COVID-19 workers help health care workers address fears and offer advice for various coping strategies. 
  • American Nurses Association (ANA) Resources
    The ANA’s “Mental Health Help for Nurses” webpage offers advice and resources for nurses struggling with stress, anxiety, fear, intrusive thoughts, or depressed mood. The organization also offers webinars and short videos to help nurses assess their mental health needs and find support. 
  • Anxiety & Depression Association of America (ADAA)
    The ADAA’s website can help nurses connect with a therapist and offers a useful guide to the various types of therapy available. Visitors can also find information about managing anxiety and depression as well as information about ADAA’s free peer-to-peer support communities. 
  • National Academy of Medicine (NAM)
    NAM’s website offers strategies to support health and well-being during the COVID-19 pandemic. NAM’s strategies include actions clinicians can take to support their own mental health as well as strategies for healthcare leaders and managers to support their staff. 
  • National Alliance on Mental Illness (NAMI)
    NAMI offers resources for a wide range of mental health issues. The NAMI HelpLine (1-800-950-6264) provides callers with free referral information and support Monday through Friday.