This chapter will give you some insights on dealing with your own mental wellbeing. The next paragraphs will guide to some of the basic principles in safeguarding your own mental health. Moreover, it will give you some information on protective and risk factors for developing mental health problems. Lastly, this chapter will discuss some of the consequences and effects as a result of high demands on professionals.
Background to distress in professionals
As a primary health care provider working with refugees, you are bound to be confronted with stories on severe physical harm, shocking stories or mental distress. Often, you are perfectly capable in dealing with these events, but sometimes you can cross your personal boundaries. It is important to realise that you, as a professional, are the most important person to recognize this and actively deal with the source of distress. In other words, you have the responsibility to actively detect distress. Hence, it is important to constantly guard your own wellbeing and assess if you are still able to deal with the problems you encounter on a day-to-day basis.
A well-recognised possible outcome of prolonged work related stress is burnout (Freudenberger, 1974; Maslach, Jackson & Leiter, 1996; Maslach & Leiter, 1997), with its key elements of emotional exhaustion, cynicism and reduced feelings of personal accomplishment. In understanding burnout the Job Demands -Resources model (JD-R model) is proposed (Schaufeli&Taris, 2014). This model emphasises that burnout can be the result of an imbalance between job demands and job resources. Job demands are certain aspects of work (e.g. physical, social or organizational) that require you to sustain a certain physical and mental effort. Hence, these conditions are associated with certain physiological and psychological costs (idem). Job resources, on the other hand, refer to those aspects of work that help you with, for example, achieving work goals, reduce job demands or stimulate personal growth and development. Lastly, social resources, such as support from colleagues, family or peer groups, also have a significant influence on work outcomes. In other words, in order to have positive work outcomes, the balance between job demands, job resources and social resources should be balanced.
Distress is a result of a (prolonged) imbalance between these resources. As a practitioner you have a responsibility to identify sources that give you energy (job resources) and that cost you energy (job demands). Moreover, you should identify the social support that you can rely on. It is important that you can assess your own position within the balance and that you can pro-actively act upon this.
Protective and risk factors
In line of the above-mentioned model, several protective and risk factors can be identified. Protective factors are a result of the way work is structured. In many professional organizations this refers to autonomy over the way work is organized, opportunities for personal development and availability of social support at work. Risk factors include the degree of exposure to potential shocking events, work related ideas and beliefs (e.g. job satisfaction and dedication), work specific problems (safety, role insecurity), and social recognition. In other words, it is important to recognize that, to some extend, you can organize protective factors and that some risk factors are a direct result of the way work is structured.
Possible health complaints
If not dealt with properly, mental distress as a result of potential shocking events and an imbalance between job demands and job resources can result in several health complaints. In early stages some form of tension can be identified, also insensitivity (even cynicism), emotional levelling, and sleeping problems can occur. This can result in work dysfunction and work conflicts, leading to an increase in absenteeism. Burnout can be a result. Problems at work can go together with private problems, such as marital problems or substance abuse. Other effects can be depression or secondary trauma. Secondary trauma can, in some cases, be developed after being exposed to information and stories on suffering. It is a condition that exists of symptoms that are similar to symptoms of PTSD, such as sleeping issues, fear, anxiety and anger. However, it is only in very few cases that severe mental health problems occur as a result of the aforementioned events. Nevertheless, it is important to always guard personal wellbeing in work related contexts.