Refugees, Mental Health and the Work Place
By Yusrah Nagujja, Anthony Ochora & Jaclyn Kerr (Published 10th October 2017)
The theme for this World Mental Health Day, is “Mental Health in the Work Place”. With over 300 million people suffering from depression worldwide and 260 million suffering with anxiety disorders (WHO, 2017), it is estimated that these disorders result in approximately US$1 trillion in lost productivity within the global economy (WHO, 2017). Thus, this theme is quite timely.
As we spend anywhere from eight to ten hours a day, for 3-5 days of the week in the workplace, it is extremely important for individuals to maintain and monitor their mental health in the workplace A workplace that does not promote mental wellbeing can have staff experiencing physical, social and psychologically negative consequences. Even though it is vital to an effective workplace, employee mental health remains an overlooked concern. This is especially true in industries that are oriented to human service, as it can directly impact the quality and quantity of care given to the clients.
For staff serving in humanitarian contexts (service providers), much of their time may involve listening to and supporting clients with traumatic histories. Such people are at risk of developing post-traumatic stress disorder (PTSD), secondary trauma, or vicarious trauma. PTSD is a disorder that develops in individuals who have experienced one or more shocking, scary or life-threatening event (NIMH, 2016). Vicarious trauma is a permanent change in the service provider resulting from empathetic engagement with clients’ traumatic background (Pearlman & Saakvitne, 1995). Secondary trauma occurs when a service provider relates to someone who has undergone a traumatic event or a series of traumatic events to the extent that they begin to experience similar psychological and somatic symptoms of post-traumatic stress disorder (Baird & Kracen, 2006).
Others, as a result of listening to similar stories over and over again, develop a condition known as compassion fatigue which eventually affects the quality and quantity of intervention they give to clients. Compassion fatigue is defined as a caregiver's reduced capacity or interest in being empathic or “bearing the suffering of clients” (Figley, 1995). It is characterized by an indifference to charitable appeals by those who are suffering that is experienced by the caregiver after exposure to a high number of such appeals.
Employees who are not involved in direct service provision with clients are also at risk of developing “Burnout”. This can impact negatively on their productivity at the workplace and can simply be explained as a state of mental and/or physical exhaustion caused by excessive and prolonged stress (Girdin, Everly, & Dusek, 1996). In Girdin, Everly, & Dusek (1996), much of the literature has noted that two of the major causes of burnout are bureaucratic atmospheres and overwork. Stress and burnout are considered epidemics of modern society, and their importance to physical health and work disability has been acknowledged worldwide (Hallsten, 2005; Schaufeli, Leiter & Maslach, 2009; Spielberger & Reheiser, 2005). The continuing importance of burnout is based on at least three issues: 1) Burnout is quite prevalent and has been shown to be an economic, human and social burden to societies and individuals, 2) burnout can be a protracted and hard to shift condition, which makes preventing it before it occurs even more important, and 3) it is possible to prevent burnout through workplace development and health promotion.
A brief study involving 17 staff of RLP who directly deal with clients discussed their mental distress. All 17 staff members indicated they felt some symptoms of stress and secondary trauma. These symptoms mostly related to: conflict among the personnel, excessive workload, lack of sufficient recovery time, difficult collaboration with stakeholders, interrelation of individual stress and work-related stress, past traumatic experiences (especially staff coming from war affected areas). The high level of cumulative stress in some cases induced a silencing response, whereby the staff members were unable to listen to the sad experiences of the clients (Berti, 2014).
Each person reacts differently to these situations and, unfortunately, those who are affected usually need time before they can fully recognize what they are experiencing and the personal and professional effect it has on them. Furthermore, many are unsure about how to help themselves or how to seek treatment so as to return to their earlier levels of efficiency and effectiveness.
Such a situation can threaten an organization, leading to preventable accidents on the part of the employees. In the past, this has manifested through harming clients, destroying company property, unproductive conflicts at work, diminishing capacities, loss of joy at work, cynicism, loss of mastery, low professional efficacy, low self-esteem, absenteeism, and psychosomatic disorders.
However, the effect on one individual can ripple out to affect those around them who care for them including workmates, friends and family who depend on this particular individual. It is therefore important for the family and the whole community to ensure their mental health.
There are a number of sequelae that commonly occur in individuals who have been exposed to traumatic events, such as; substance abuse, interpersonal conflicts at home, heightened stress, anxiety, depression, anger management problems, poor performance in other areas of their life, etc.
What can we do to help employee mental health?
- Create common cafeteria or eating space for staff to socialize and wind down away from clients and where they have time to get to know each other
- Peer support and peer counseling from colleagues
- Invest in staff mental health so that they can invest in the people
- Compliment people on smaller achievements
- Equip staff with skills so that they may be self-assertive and bold
- Supervisors should not isolate themselves from their team
- Clearly outline targets and expectations for the staff
- Ensure open communication between colleagues and between supervisors and subordinates
- Communicate the importance of delivery and continuous nurturing of talents and strengths
- Positive criticism
- Managers need to be trained in management skills like people management and self-awareness
- Communication should be nurturing not threatening
- Internal mainstreaming. This involves offering the same services to one’s staff that are offered to clients. For example, an organization providing mental health to clients should ensure that its own staff mental health is covered. If the organization is distributing items, they should ensure that its own staff has them. This can be through different strategies like hiring external counselors, or a once focal person to attend to staff, in-house activities
The authors work at Refugee Law Project under the Mental Health and Psychosocial Wellbeing Programme.