Burnout

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. 

Cycling to University: motives and barriers

This time last year, I decided to start cycling to my office at the University of Malta. Though much of my work focuses on this kind of behavioural change, I would be lying if I said that I did it for environmental or research reasons. I did it out of sheer despair: I felt like I was wasting my life, stuck in traffic for hours on end. I will also readily admit that when I started, I was not adequately prepared: I was not fit enough for it. Nor did I have the agility and speed to compete with cars while balancing on two narrow wheels. But I somehow hung in there. And somehow, before I knew it, a whole year had gone and I had never used a car to come to university—nor ever wanted to.

One of the forces that made a real difference was ‘others’. While I’d long marveled at my friends and colleagues at universities overseas who cycled to work without much fanfare, it was finding a community of commuting cyclists here in Malta that really made a difference. Gathered as the ‘Bicycle Advocacy Group‘ on Facebook, they are a new cyclist’s best allies. They helped me find bike-friendly (and unfriendly) roads, plot routes ahead of time, and consoled me after bad incidents. They organise group rides. They advocate and educate. Groups on campus such as the Green Travel Plan people were also great. In the world of cycling, unlike that of driving, the more we are, the merrier it is!

The second major step in this journey was to make it increasingly easy for me to choose the bike over car. A car key always looks so easy to pick up. Instead, I prepared my bike, my bag, my helmet, and all my accessories by the door. I left some extra clothes and toiletries at work, ready when needed. I changed my days around to make them cycle friendly, clustering meetings, avoiding heavy loads. I also made it a point to reward myself for cycling by keeping snacks handy for energy. This probably explains why I did not lose any weight despite a whole year of pedaling.

While I’d long marveled at my friends and colleagues at universities overseas who cycled to work without much fanfare, it was finding a community of commuting cyclists here in Malta that really made a difference.

All this said, the main barrier for lots of people (and myself) is the fear of being hurt on the road. I learnt a few practical tricks that made cycling less scary. The first is that lowering risk is entirely possible. Some times are better than others for cycling. In peak traffic, cars are moving very slowly or at a complete standstill, making it somewhat safer for you to cycle! Some roads are also better than others. With time, I found out that it is possible to use country lanes or smaller urban roads for most journeys. Where traffic is unavoidable, I stick to the middle of the lane, especially if a driver cannot safely pass while leaving a meter of space. Traffic will wait behind you (often the speed limit is 30km/hr anyway). This is even more important if there’s a row of cars to your right where anyone can open a door and knock you off the bike. Thirdly, I learnt to signal large so drivers know my intent. I also learnt cycling is a mental and physical work out. You need to be completely focused and watch out for any possible danger. Where needed, I get off my bike and cross roads on foot.

While poor public infrastructure and law enforcement remain a constraint, I gradually bought things that made the cycling life easier. My first purchase was the bicycle. I started with a basic folding bike (€200 or so). I chose a folding bike to give myself a parachute in case I got too tired and needed a lift home. The climb to Gharghur from University was nothing short of exhausting. I walked most of it for the first few weeks. Then a very attractive grant was issued for e-bikes. This changed everything: you may pedal less on an e-bike but you will certainly cycle more frequently. Later, I stuck a rack and a basket to the bike. I bought a trekking backpack (which means I sweat less), a good water bottle (which also comes in handy to wash my hands), and a helmet (even though it’s not a legal obligation to wear one). I got a high visibility vest (free from several campaigns), white and red lights and reflectors (though I’m still rather scared to cycle at night), and a mirror, which helps me see cars coming from the rear without having to turn my head and risk losing my balance. I’m still angling for a good bell, better fenders, and flat tyre-changing supplies. I eventually bought a good lock—a must.

Like other positive habits, the more you do it, the more you love it. I especially love not having to look for parking, getting to places quickly and on time, and discovering new routes. I love smiling at people, feeling younger and fitter. In hindsight, and with a rather limited sample size of one, I can see that what made it work (consciously or not) was quite in line with research: a break in habit, a combination of lower barriers, and stronger motives.

  Author: Dr Marie Briguglio

Sharing is caring, but at what cost?

Dr Anna Borg

Life is hard sometimes. Juggling the demands of work with family while remaining healthy and sane can be tough. Done successfully, that lifestyle can look like a carefully choreographed dance. Add a bout of the flu to the mix though, and the dance gets thrown off. Now you find yourself strewn on the dance floor, with hurdles coming your way. 

So far, mothers in our societies have carried the lion’s share of caring responsibilities and bear the Motherhood Penalty, affecting their earnings and career progression, amongst many other things. The International Labour Organisation claims that closing the gender gap in caring responsibilities between women and men is a priority for social development in the 21st Century. 

The European Union (EU) is proposing a series of measures which aims to do exactly that. The first tackles paternity leave. At the time of writing, men in Malta are allowed at most two days off from work when they become parents. Under the new scheme, fathers will be able to take at least 10 working days of paid paternity leave around the birth of their child. When it comes to parental leave, a non-transferable quota of four months will be reserved for each parent to take, up until the child is 12 years old. It should be noted that 90% of fathers across the EU do not make use of parental leave at present. Finally, there is caring leave for workers who care for seriously ill or dependent relatives. These people will be entitled to five additional days of paid leave.

Whilst these three initiatives make sense, when analysed through the gender lens, the reality is that when people make use of these measures, they will not be compensated in full, but at the replacement rate of compulsory sick pay level. This immediately sets off the alarm bells. 

Taking parental leave could mean a reduction of around 80% in income. Are Maltese parents, especially fathers, willing to accept such a drastic pay cut with every new child that arrives, along with a spike in costs? The result will be that fathers are likely to shun this additional leave, while mothers may be more prone to take the extra leave at the reduced pay rate. This will simply reinforce gender roles and gender stereotypes.

The aspect of this law that equates parental and caring leave to sick leave has to be removed. Parents manoeuvring through the fast lane of life and trying to care for their children by taking paternity, parental, or caring leave are not sick, so why pay them as such? Why impose a parental penalty on parents who are bringing up the next generation of citizens? The EU needs to do some serious rethinking if it really wants to contribute to the most significant social development of the 21st century.  

Author: Dr Anna Borg