The Other Side of Stigma

It is estimated that every 1 out of 4 people will experience a mental health problem in their lifetime.  Mental health refers to what we feel, as well as how we think and act. It is how we go about our daily lives, go to work, attend lectures, engage in meaningful relationships, and interact socially. 

The majority of us will experience a mental health problem at some point in our lives, but not all of us will go on to develop a mental illness. Let’s imagine a line where good mental health sits on one end, and poor mental health sits on the other. During a good week, we might find ourselves on one end, only to find ourselves moving towards the other end on a bad week. Say you have a deadline coming up at work or at school. It makes you feel worried and anxious because you cannot handle it on your own, but you do not turn to your colleagues for help. If that anxiety grows within you, you might find yourself experiencing poorer mental health. The very same thing actually happens with our physical health. 

When we notice changes in our physical health which may indicate we’re not well, we usually phone up our GP or go to the clinic to check it out. We might even take a few days off work until we recover. The question is, do we visit the clinic as readily if we notice these changes in our mental health? The number of people seeking help is on the rise and has increased steadily over the past years; however, we still continue to see many people refusing to seek help, with only 36% of adults with common mental health problems receiving treatment. Despite the continuous efforts to mitigate this in Malta, stigma still remains a big part of the reason why many fail to seek professional help. 

Stigma is a collection of thoughts or attitudes towards something or someone.  It is seen as a mark of disgrace, as though needing help (in this case, for mental health) is somehow shameful. So what effect does stigma have on us?

Stigma is a collection of thoughts or attitudes towards something or someone.

Stigma might hold a person back from even admitting their mental health problem to themselves. The fear of being misunderstood by those around them makes it less likely that they will reach out for help. These misunderstandings may lead to feelings of hopelessness and shame as people struggle to cope with their situation. Unfortunately, this may result in a wall being built between individuals and seeking help. Stigma affects people every step of the way, from diagnosis and all throughout treatment since there is a perceived shame around receiving treatment for mental illness. 

Stigma leaves a profound impact on how people feel about themselves and how those around them perceive them. The bright side is that a lot is being done about this, and a lot can be done about it on an individual level: that means you reading this! 

It starts with being aware of your own attitudes and behaviours. The way we speak can have a profound impact on the people around us. When we talk disparagingly or mockingly about an issue such as mental health, we are closing the door on that issue.  Being open about our mental state of mind can help overcome this taboo. Education also plays a big role in all of this — get to know the facts and educate yourself about mental illness. While you’re at it, educate those around you too; pass on real facts and positive attitudes. This may serve to challenge the myths and stereotypes we have unfortunately picked up along the way from society and the media. 

Support is crucial if we are to overcome mental health stigma

Finally — and possibly the most important point – support. Treat those around you with dignity and respect. Support those around you who may need it: offer practical help or ask what they need from you. Sometimes listening without judgement is enough. Normalise difficulties and issues, because even though they might not always be physically seen, everyone is fighting their own battles behind closed doors. 

If you or someone you know is struggling, reach out to us on our freephone 1770 or through our online chat We’re here 24/7.

This article was written in collaboration with the Richmond Foundation.

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In airplane safety demonstrations, we are always told to put oxygen masks on ourselves before we help others. If we are not well, how can we help others efficiently? Dr Patrick Barbara writes about burnout among Malta’s mental health professionals and what we can do to resolve this worldwide issue.

Mental health professional ‘Joe’ works in the Maltese hospital’s  services. He feels emotionally drained and at the end of his rope. In the morning, he wakes up dreading his workday. The passion for it has dissipated. Maybe, he thinks, it’s time to quit.

Dr Patrick Barbara

Dr Aloisia Camilleri and I explored the concept of burnout in professionals working within our mental health system. The research project itself was born from the notion that to support those who need care, service providers themselves need to have good mental health. 

To understand job-related burnout, it is best to see it as a spectrum. People can be happy, satisfied, and fully engaged, or they can be completely disinterested and disengaged. This framing helps us understand that there are differing degrees of burnout, while also highlighting that different definitions of burnout can lead to different results.

In our research, burnout was defined as a process where a person’s psychological resources are gradually depleted as a result of prolonged stress at work. This then manifests in emotional exhaustion, depersonalisation, and loss of personal accomplishment. The person feels worn out, fatigued, detached, and cynical about their job. Ultimately there’s a sense of inability to cope, and low morale sets in. This is the ultimate lose-lose situation where both the employee and the patients suffer as the organisation loses efficiency.

For the study, we invited 322 professionals to participate anonymously. The roles they occupied varied and included psychiatry doctors, nurses, occupational therapists, psychologists, psychotherapists, and social workers. In the end, 230 agreed to answer our standardised questionnaires. The results were in line with those of similar studies conducted abroad.

Emotional exhaustion scored highly (40.4% of respondents), as did poor personal accomplishment (30.4%). A fifth (18.3%) experienced high depersonalisation levels, while 13.9% scored high on all three features of burnout.

What causes burnout is complex and difficult to explain. The healthcare environment and the systems operating within it do tend to put healthcare workers at risk. They suffer from time pressures, emotional intensity, role conflict, and difficult relationships between employees and management.

Research suggests that people at risk of experiencing burnout often experience a mismatch between their personality and abilities and the role they are in. This mismatch is subjective, depending on the individual as much as it is related to any particular job. So while it can mean that a person has chosen a job outside of their natural abilities, it can also mean that there may be a discrepancy in expectations between the person and the organisation. So this is not just an issue of too much work. Other central elements include control, values, community, fairness, and rewards.

To prevent or resolve some of the issues associated with burnout, people need to have a sense of control at work. They need to feel rewarded (not just financially, but also socially) and treated fairly. They need to feel that they are part of a community that communicates in a civil manner and shares the same or at least similar values. Since this job-person mismatch is a subjective experience, a positive outlook towards work also helps avoid burnout. Our research showed that people who have a better ‘match’ in one factor tend to score better in the other factors as well.

So how can burnout be addressed? Awareness is the first step towards recovery. Education is essential for people to recognise and identify burnout. Practising mindfulness can prove to be an excellent tool for anyone. By becoming more in tune with our own thoughts and emotions, evaluating them in a non-judgemental way, we can avoid falling down the slippery slope towards an unhealthy mental state.

Keeping boundaries and a correct work-life balance is another point. Having time for life outside work and being passionate about other activities is critical. Whether it’s exercise, writing, or creating art, cultivating other interests keeps our worlds varied and occupied. It creates a situation where there are other things to focus on when difficult times come.

From an organisational perspective, we need to work harder to recognise that employees are the most important resource at any workplace. They need to be supported and involved in decision making as much as possible.

Burnout is linked to other mental health conditions such as depression and anxiety. Any employee who experiences mental health problems that impinge on one’s life must feel that they are not alone and help is available. Most people spend the majority of their day and life at work so we need to make sure that it is experienced as positively as possible.