An examination of healthcare workers’ and trainees’ reasons for seeking mental health counseling: a retrospective qualitative study

Healthcare systems have historically operated within a culture that rewards self-sacrifice and emotional endurance among workers, often at the expense of psychological well-being. While burnout and mental health concerns among healthcare workers are widely documented, institutional responses frequently focus on individual resilience. Less is known about the circumstances that prompt healthcare workers to seek organizationally embedded mental health counseling. Understanding these drivers may inform earlier and more effective strategies to support healthcare worker well-being. A retrospective qualitative study was conducted using de-identified intake responses from employees who sought services at a Midwestern academic medical center’s Wellness Center (WC) between 2020 and 2024. The WC provides free and confidential counseling and wellness services to employees, trainees, and students. Responses to the intake question, “What brings you to counseling at this time?” were analyzed using inductive thematic analysis. Three overarching themes emerged from the analysis. The first theme, feeling overwhelmed by work/school and personal circumstances , described how workplace demands and personal circumstances interacted and influenced participants’ decisions to seek counseling. Theme two, managing or coping with major life transitions , demonstrated how life transitions provoked distress, which facilitated the seeking of counseling. The third theme, incongruence between personal , familial , and cultural expectations , captured how discrepancies between a person’s values and expectations and those of their family and society contributed to seeking counseling. Our findings highlight how healthcare workers’ and students’ distress stem from multiple and often intersecting influences at the intrapersonal, interpersonal, and societal levels. Organizationally embedded mental health services may be a useful, responsive approach to help healthcare systems better identify and respond to the complex, multilevel factors influencing healthcare worker and student well-being. Furthermore, meaningful improvements in well-being will likely require coordinated strategies that address the broader systemic influences of stress for healthcare workers and students.