Occupational Barriers Experienced in Mental Health

What are Occupational Barriers? Simply put, this term refers to Barriers-in-Occupation. Let's break it up for a better understanding

Occupation refers to "Everyday personalized activities that people do as individuals, families, and with communities to occupy time and bring meaning and purpose to life." (OTPF-4, 2021)                                                                                                   

Barriers are defined by Google as any form of blockage or obstacle preventing something. 

Hence, Occupational Barriers can be conceptualized as factors that prevent individuals from engaging in an activity or hinder their ability to do so.

 Now, a quick look at the notion of "Mental health" in order to elucidate our discussion.             We know 'Health" to be a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Similarly, Mental Health is more than just the absence of mental disorders. Rather, it is a "state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community" (WHO, 2018)

Hence, mental health can be conceived as an integral part of overall health. The WHO even goes on to state that mental health is fundamental to our ability as humans to think, emote, interact with each other, earn a living, and enjoy life. Essentially it is the quintessence of our existence as humans. On this basis, identifying occupational barriers to mental health is of vital concern to individuals, communities, and societies as this would allow us to better tackle these barriers, subsequently establishing a meaningful existence.

 Should you wish to be more conscious of mental health determinants along with protecting and promoting mental health, you may visit this link- https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

 Henceforth, here is a list of some of the occupational barriers I have identified in Mental Health.

1.      Stigma

As a culture, we celebrate people taking care of their physical health- Think of all the obese to fit transformation videos that are lauded on social media. However, rarely is such attention given to mental health. When we become ill, break a bone, or notice something out of the ordinary, in a heartbeat we seek medical attention. Nobody thinks too much of it as it is "socially acceptable". Furthermore, we are usually open to discussing the physical ailment without a second thought. Nevertheless, when it comes to expressing mental health concerns relating to disorders such as anxiety, depression, bipolar disorder, schizophrenia, and other psychotic disorders, people are not quite comfortable. This is potentially due to a person being shrouded in disgrace due to their mental illness. People tend to presume that mental illnesses can be overcome simply if one makes an effort to "snap out of it" or "try hard enough". Furthermore, stigma is often perpetuated into society from the negative portrayal of people with mental illnesses. An example of this would be movies wherein the villain is often depicted as an individual with a mental disorder. Remember the movie "Joker"? 

The protagonist is depicted as having some kind of severe mental illness- one that triggers a series of violent acts. It perpetuated a rather toxic idea of associating a severe mental illness with extreme violence. Studies actually reveal that this association is exaggerated and people with severe mental illnesses are more vulnerable to violence from others than the general population (Perry, 2020).

Here is a list of popular movies and series like these, which one should be aware of, as they only fuel misrepresentations and misunderstanding surrounding mental health deterioration- https://www.rtor.org/2015/10/27/6-movies/

Inaccurate representations like these evoke fear in the population, causing them to distance themselves from persons with mental health illnesses. This potentially causes social exclusion in persons with mental health disorders, causing a decline in their interpersonal relationships, subsequently hindering social participation. Inadequate social participation in turn, has a ripple effect on community survival and volition to participate in other meaningful occupations to live a fulfilling life.

 2.      Discrimination & Social Exclusion

Stereotypes and prejudice against persons with mental health disorders are more often than not embodied in laws, institutions, and preferences. Due to the stigmatization, as discussed above, persons with mental health disorders often face barriers to acquiring a fulfilling life. Some of these challenges entail employers not hiring them, landlords not renting to them, and being offered a lower standard of care. These forms of discrimination have detrimental effects on persons with mental health disorders. These entail but are not limited to (Borenstein, 2020):

• internalization of negative beliefs
•  social isolation
•   lower self-esteem
• hopelessness and shame
• avoiding treatment or not being consistent therewith
• worsening symptoms
•   lack of criminal justice
•   difficulties with social relationships
•   discrimination at work and unemployment

You may visit this link to educate yourself regarding strategies to tackle discrimination and social exclusion in persons with mental health disorders- https://www.psychiatry.org/patients-families/stigma-and-discrimination

3.      Lack of insight around mental illnesses

The biggest contributor to stigma is a lack of education about the nature of mental illnesses. Often, there are no physiological signs that explain the condition, which results in blaming the individual and/or their family for their problems. Furthermore, for many years, there was no effective treatment, which led to massive institutionalization of those with mental illness. That has changed, but the social perception is still there. Media also plays a role in the perpetuation of stigma, as mental illness is commonly used as a scapegoat for acts of violence. (Masciandaro, 2019). Therefore, in my opinion, it is a social responsibility to educate ourselves regarding mental health illnesses as they are on the rise especially with the pandemic and our demanding academics and careers, there is a high chance you know of a family member with one or someone who is masking it be it diagnosed or undiagnosed and you, yourself may be at risk of one. Hence, being well-informed will aid us in being more empathetic, thereby allowing persons with mental health disorders to be comfortable. Eventually, this would potentially tackle stigma and may even improve mental health in people because of positive social interactions. Furthermore, lack of awareness around mental health could explain why many persons are undiagnosed, do not receive treatment, and continue to deteriorate, preventing them from leading a meaningful life.

4.      Generation & Culture

Gen Z is more likely than other generations to report that their mental health is fair-poor (Aduro, 2021). This suggests that all the generations before Gen Z are not as comfortable with expressing mental health concerns. This could potentially be due to a lack of awareness around mental health back then.

Moreover, it is the heavy use of social media which pushes Gen Z to be more open to sharing mental health issues- "about 71% of 18- to 29-year-olds say they use Instagram, compared to 65% for Snapchat and about 48% who use TikTok" (Aduro, 2021). The previous generations are not as well-acquainted with these social media platforms, which can be considered a barrier in discussing and gaining insight into mental health.

 5.      Financial resources & Access to psychosocial rehabilitation

Those qualified to offer mental health rehabilitations are often specialists with private practices (Health, 2020). Subsequently, the fees are quite costly thereby limiting access to psychosocial rehabilitation. Furthermore, the percentage of government health department expenditure devoted to mental health is not known at a national level, which is indicative of poor financial management with regards to mental health services allocation- "Only 3 of the 9 provinces were able to report on health expenditure on mental health: Northern Cape spends 1%, Mpumalanga 8%, and North West 5% of its health budget on mental health" (WHO and Department of Psychiatry in Mental Health, 2007).

Refer to page 11 in this link to view further discrepancies in mental health services in SA- https://www.who.int/mental_health/evidence/south_africa_who_aims_report.pdf

 

Hence, in light of the above mentioned, there are several occupational barriers experienced in mental health. Nevertheless, I believe that whatever may be the problem/s, one must always strive to be part of the solution. Being an Occupational Therapist in the making, this brings me to a question as to How Occupational Therapy can be valuable in light of the abovementioned?

Text: OTs work with individuals to determine barriers to their preferred activities. Then we brainstorm creative solutions collaboratively to lessen these barriers. The result is occupational engagement and a better quality of life.

In essence, OT forms part of the interdisciplinary team involved in treating mental health illnesses. This is achieved with the therapeutic use of everyday activities to enhance health and well-being. Therefore, receiving OT can be valuable in combating symptoms associated with mental health illnesses, thereby allowing for a better quality of life.