The System beneath the Symptoms, Part 1: Levels of Intervention
Exhaustion, burnout, anxiety, and depression are commonplace topics in most workplaces in the United States. Higher education is no exception. In the Healthy Minds study from the 2021–22 academic year, 44 percent of the student respondents reported symptoms of depression, 3 percent reported anxiety disorders, and 15 percent reported having seriously considered suicide in the past year—the highest recorded rates in the survey’s 15-year history (Hienze, 2023).
The mental health of higher education faculty and staff is more difficult to track. In their review article in the Journal of Clinical Medicine, Hammoudi Halat et al. (2023) present a range of study results across countries reporting the prevalence rate of mental health issues (using different scales). For each of the four areas they found ranges of up to nearly 40 percent of for US university faculty respondents reporting anxiety (12–39 percent), depression (5–38 percent), stress (31–34 percent), and burnout (10–38 percent).
To me, these trends are symptoms of an educational system (embedded in societal systems) that needs immediate attention. Not only do we need to respond to the needs of the students, staff, and faculty who are suffering, but we also need to look below the surface of the trends to address the root causes.
To see beneath the surface, it can be helpful to think of campus as a work system. People experience the campus and its people, curriculums, classes, labs, physical and social environments, and policies and procedures day in and day out. Each of us is part of this dynamic, influencing it at the same time it affects us. Each of us responds to what we’re living according to who we are and what we’ve experienced previously.
Shifting a campus toward greater health
A campus is a complex system, with many structures influencing faculty, staff, and student health. Figuring out where to intervene can be challenging. I find it helpful to start with a simplified depiction of system change. Michael Goodman (2002) uses an iceberg analogy to explain levels of system intervention (Figure 1). Icebergs are attractive analogies for systems thinking because most of an iceberg’s mass is below the surface. What we see is only a small part of what exists.
In his systems thinking model, Goodman likens the tip of the iceberg to the events we live. Events are what we see and experience. When an event happens, our only choice is how to respond. For example, someone suffers from anxiety and chooses to seek treatment. Or at a macro level, students are reporting high levels of anxiety, so the campus creates additional mental health resources by hiring additional counselors and publicizing their availability. This is the tip of the campus system iceberg.
The causes of the events we live lie below the water line, usually unseen and unexamined. For example, we might begin to collect data about students’ mental and physical health to try to anticipate need and resultant staffing levels so we are better able to respond. If we find that certain times of the year are more triggering for students (e.g., orientation or finals week), we can more precisely anticipate what might happen, where and when. Anticipation is useful, but it does not reduce the incident rate of anxiety. It simply helps us better respond so events don’t take us by surprise.
To reduce the incidence rate, we have to look to the structures causing the patterns and trends. In this example, what are the structures that cause anxiety? If we can identify the campus structures at the root of the pattern and intervene by redesigning them, we can create different patterns and trends, changing the outcomes of the system.
Campus structures are many and varied including but not limited to coursework; curriculum; classroom teaching methods; physical environments (e.g., classroom design, student housing, accessibility); social environments (e.g., DEIB climates and subcultures); and financial challenges and resources. The list is long and affects each person differently. But when we see campus outcomes like high rates of student, faculty, or staff anxiety, we know there are at least a few prominent structures that need redesign.
The beliefs and values used to create the structures we live within form the foundation of Goodman’s systems thinking model. Many of these beliefs go unarticulated and unchallenged. For example, here are some common beliefs about people and work that helped to shape our current work and school systems:
- Work is unnatural, so people need to be coerced, monitored, and rewarded.
- People can work at 80–100 percent of capacity for weeks, months, and years without becoming ill.
- Competition makes people perform better.
- Productivity must and can always increase.
- Slack in a system (rest breaks, unstructured time, etc.) is unproductive.
- People are expendable; if we lose some, we will find others to replace them.
- Wellness programs can overcome unrealistic expectations and poor system design.
- Short-term accomplishments are more important than long-term sustainability.
- People catch up on their rest when they are away from work.
- Students can learn a way of working within a school system and unlearn those sets of behaviors when they move into their professional lives.
I’m sure you can add to this list of unchallenged, system-shaping beliefs. Values about hierarchy, conformity, professionalism, and learning as competition shaped our current systems of higher education. Those beliefs shaped how we do what we do, the trends we’re currently tracking, and the events we are all living. If we want different experiences, we need to challenge and update our understandings of people and the work of higher education so we can redesign the structures that shape our academic lives.
Workload as a starting place
One of the likeliest structural culprits in any work system trending toward anxiety and depression is workload. Workload is the amount of work we ask people to do. Overload is having more work to do than time or resources to do it. If overload lasts for weeks, months, or years, we expect to see patterns of injury, illness, errors, accidents, and exhaustion. Burnout is an expected outcome of overload. It isn’t surprising.
Overload is one of the most obvious causes of poor mental and physical health outcomes. It isn’t the only potential cause—other common issues include low levels of autonomy, social isolation, role conflict, and inadequate resources—but it is one of the structures that often goes unexamined because it’s seen as “given.” The thinking might go a little like this: “This is how we do things around here. It’s always been this way. It used to be worse. It’s worked for the rest of us. If you don’t like it, leave.”
Instead of that set of default defenses, let’s look a little more closely at workload and challenge some of the typical assumptions about it. We’ll start by acknowledging that workloads come in different flavors. Here are some examples of different types of workloads:
- Physical: bending, twisting, sitting, standing, repetitive movements, shift work, avoiding safety hazards, holding static postures
- Cognitive: sensory integration, psychomotor skills, analysis, decision making, innovation
- Emotional: editing one’s own emotions to present a neutral or positive façade to others; processing and resolving one’s emotions, such as anger, fear, grief, and loss
- Spiritual: making meaning of our lives; creating an inner framework to explain and cope with grief and loss
Each of us handles these different types of workload differently. We might have more capacity for physical or cognitive demands than emotional or spiritual ones. Our capacities for each type of workload change over time, meaning that we can’t expect people to perform the same amount and type of work every day, week, month, or year. There might be months when I have the capacity to do a lot of mentoring, which might require high levels of emotional workload. But if I’m exhausted or ill or caring for a loved one at home, my capacity to do the same amount of emotional work will be diminished.
Different jobs make different demands on people even if we like to think of them as equivalent. An eight-hour shift in an emergency department is a different combination of workloads than an eight-hour shift in a dermatology clinic. A day teaching a class of 25 middle school children is a different combination of workloads than the same day spent teaching 25 graduate students.
If we wish to design structures of work that lead to improved human health and sustainable performance, we must acknowledge that different types of work are differently demanding and require different types of resources and accommodations. This understanding can translate directly into questions about faculty, staff, and student workloads.
Starting places to examine faculty, staff, and student workload
One of the educational structures that involves high levels of cognitive and emotional demands is classroom teaching and learning. Depending on the course, there could also be high levels of physical or spiritual demands. I believe it’s time to reexamine what we’re asking of teachers and students. How many classes can one person teach or participate in without becoming exhausted? How many students can faculty reasonably attend to? How long should classes be? How much time outside of the classroom is it reasonable to expect students to spend completing homework and studying? How many exams are necessary? Must faculty grade exams on a curve? Is competition for grades a health-promoting practice?
Similarly, the workloads associated with teaching and learning need to be reexamined at the curricular level. Is it possible for students to satisfy all the course requirements in the time allotted and come out whole and healthy at the end? How are project deadlines and exams coordinated between courses within a curriculum? When we are faced with incorporating more and more information into a curriculum, do we add a course on all topics (e.g., ethics), or can we find a way to integrate the topics into a congruent learning experience?
I make the same request for reexamining what we’re asking of faculty and staff regarding scholarship and service demands. Are we asking people to commit to conducting scholarship and leading committees when we know they are already overwhelmed? It isn’t reasonable or rational to keep adding responsibilities without removing some. What can we let go of to do the things that matter most?
We need to reassess what we’re asking of ourselves, our colleagues, and our students. When workload is too high, we expect to see exactly what we’re seeing: trends toward exhaustion, burnout, anxiety, depression, and stress-related health outcomes (depressed immune systems, reproductive issues, GI tract issues, migraines, etc.). If we are serious about reversing these trends, we must reconsider the structures causing them as well as the beliefs that shaped them.
In part two of this article, I’ll share another way to think about campus exhaustion and burnout to explain why some interventions (such as reexamining workload) are more useful than others.
Goodman, M. (2002). The iceberg model. Innovation Associates Organizational Learning.
Heinze, J. (2023, March 9). College students’ anxiety, depression higher than ever, but so are efforts to receive care. University of Michigan School of Public Health. https://sph.umich.edu/news/2023posts/college-students-anxiety-depression-higher-than-ever-but-so-are-efforts-to-receive-care.html
Hammoudi Halat, D., Soltani, A., Dalli, R., Alsarraj, L., & Malki, A. (2023). Understanding and fostering mental health and well-being among university faculty: A narrative review. Journal of Clinical Medicine, 12(13), 4425. https://doi.org/10.3390/jcm12134425
Katherine Sanders, PhD, is a work systems and human factors engineering consultant. She founded a faculty development center at the University of Wisconsin–Madison and led it for 13 years. Dr. Sanders teaches systems thinking, change readiness, and the design of work to promote employee health, innovation, and sustainable productivity.