The effects of burning out…..
This is factual article describing the challenges faced by a hugely unrecognized community -“ The Therapists!” They are not doctors, or nurses or even dentists or technicians. They are a unique group of professionals, as noted by Fleming-Castaldy (2014), who use expertise knowledge either in the form of exercises (Physiotherapists), activities, games or occupations (Occupational Therapists), speech and language related tasks (Speech language Therapists). In doing so, they definitely contribute hugely to the wellness, betterment and rehabilitation of different service user populations who belong to various cultural and socioeconomic contexts of the Indian society (All India Occupational Therapists’ Association AIOTA 2017). This does not result in them having careers that are laced with positivity but plagues them with a complex myriad of challenges in both professional and personal lives resulting in them “Burning Out”!(Skovholt and Trotter-Mathison 2016). Therefore, this article is written with a view to highlight challenges faced by this professional community.
I. D. Yalom (2002) quoted “… Our work becomes our life. At the end of our workday, having given so much of ourselves, we feel drained of desire for more relationship.” People caring for others professionally, or caregivers, are a huge but distinct population including healthcare professionals, aides, helpers. To understand the concept of burnout which was a term coined in the 1970s, it is necessary to primarily describe this very real, serious mental health challenge faced by many professionals. While burning out is a very broadly described phenomenon, consensus is held between theorists and critics who categorize it using some of these words — exhaustion, weariness, fatigue, frustration, cynicism, tiredness, depersonalization and severe disengagement (Maslach & Jackson, 1981, Skovholt and Trotter-Mathison 2016, Wolfe 2016).
Secondly, it is very important to distinguish Occupational Therapists from other healthcare professionals to better understand their professional responsibilities. Occupational Therapy (OT), according to the World Federation of Occupational Therapy (WFOT 2017), is currently defined as “a client-centred health profession concerned with promoting health and well-being through occupation”. OT as a profession, believes in using occupations or activities to optimize quality of life for individuals who require habilitation or rehabilitation due to an array of physical, mental health or medical conditions. While this profession has been active over the last six decades, Western influences on OT have created grave hurdles for practitioners working in India (Iwama 2006). Not being able to clearly stand as an individual profession by propagating an unique viewpoint in the Indian healthcare system, this profession is still wrestling to attain a national recognition in India (Karthik 2011). This is an obvious cause for concern as OT practitioners are not always viewed as medical professionals but many times are confused with similar caregiving professionals like ‘teachers’, ‘doctors’ or ‘nurses’ based on their working environments. Though, this is definitely is not derogatory or defaming, it certainly does not equate or highlight the unique work that this professional community does (Whilding and Whiteford 2007). Moreover, this lack of professional ‘identity’ is a huge contributing factor to professionals experiencing burnout in their careers.
Although mistaken identity is a vital contributing factor, the major crises is the imminent invisibility of this noble and hardworking profession in various Indian healthcare policies and position papers (The Mental Healthcare Bill 2016) which makes the challenges faced by this professional community truly inconspicuous. An Occupational Therapist’s journey, right from inception, is interspersed with confusion as a student to trying to fit in the medical world (Maharashtra University of Health Sciences MUHS 2016). Everly et al (1994), asserted that professional training in itself is perceived as demanding and in the case of Indian OT students, this robust career path is further burdened by the lack of clear professional role, thus creating anxiety and panic about their futures. Thus, proving Shrivastava’s (2009) view appropriate, burnout sets in early in an Indian OT practitioner’s professional life. Also,coupled with this, OT students have to undertake rigorous and extensive medical courses and modules during their baccalaureate programmes along with mandatory fieldwork training in various branches of healthcare like pediatrics, mental health, orthopedics, neurology, surgery and so on which act as a catalyst to precipitate fatigue, exhaustion and stress (MUHS 2016). While the learning curve is enormous, Indian OT students are left to practice as lone workers during the course of their studies which adds to their stress levels causing disengagement and depersonalization. Overwork and tremendous stress results in students coming out of professional training as exhausted, frustrated cynics who are garbed by a confused identity ( Shrivastava 2009).
Moreover Karthik (2011) pointed that, therapists in India are continually overworked for a compensation that does not equate to the exercised efforts and diligence due to privatization of healthcare (Uplekar 2002). Since professional boundaries are not explicitly delineated, Occupational Therapists sometimes work as ‘gap-fillers’ and perform roles that are not unique to the profession (Fortune 2000). This definitely is the cause of burning out and rising depression levels amongst Indian professionals. Although appropriate remuneration is a crucial aspect that enhances self-esteem and feelings of ‘worthiness’, accurate workload is an even more crucial component for maintaining optimal mental health and well-being of practitioners (Skovholt and Trotter-Mathison 2016). Strenuous work situations, coupled with difficult clients seeking therapy services, poor work environments, high caseloads and disproportionate pay packages places OTs in serious and grave danger, both physically and mentally. The results of these causes is witnessed through high attrition rates, loss of quality in service provision, increase in mental health conditions amongst therapists like depression, guilt, hopelessness, aggression and exhaustion (Bailey 1990, Hooley 1997, Skovholt and Trotter-Mathison 2016).
Compounding these challenges, burnout amongst Occupational Therapists, is also influenced by the current trends of internationalization in India. Many Indian OTs have migrated temporarily or permanently from India to other countries to make their careers as noted by Brooks and Waters (2011). This has resulted in a severe brain drain within Indian OT community thus aggravating the continued wilting of this profession in India. Thus, stress and exhaustion amongst existing Indian therapists multiplies because of high job demands and reduced manpower (Bailey 1990, Leland 2015). This definitely pushes existing therapists to not only experience high levels of job related stress, but also to experience lack of time to get involved in ensuring provision of optimal quality of services as witnessed by Wressle and Samuelsson (2014). Nonetheless, Shrivastava (2009) declared that these professional stressors are compounded by stressors faced in the therapist’s’ personal lives, their interpersonal relationships and personal coping mechanisms.
Another important challenge that Indian therapists face is presented by clients who use therapy services. Lack of clear understanding about what OTs can provide in terms of service, causes a lot of friction between the two members of this relationship (Iwama 2006). Therapists, especially practicing in the Pediatric realm face acute criticisms owing to “not being able cure children with developmental disabilities like Autism, Cerebral Palsy, completely”. This again points back to the lack of infrastructures that delineates the role of therapists accurately and points to the dire need of bodies or organizations that advocate for the rights of healthcare practitioners in India (Hammell 2015). These factors definitely culminate in creating a dynamic of stress, burnout, frustration, cynicism and lack of engagement by therapists working in India.
Working through these challenges is essential to maintain the quality of life that is necessary for therapists practicing in India. AIOTA (2016) maintains that organizational challenges can be solved only through the development of an unique profession-specific national level organization that advocates and resolves issues nationally for the Indian Occupational Therapy community. Nevertheless, solutions can be sought at an individual level by developing resiliency, practicing mindfully and reflecting regularly (Skovholt and Mathison 2016). While resiliency can be described simply as the ability to bounce back; practicing that professionally is extremely arduous. Indian therapists, need to therefore understand the impact of practising mindfully, i.e. they need to start gaining awareness of the current situation and to focus on calming, acknowledging and accepting feelings, thoughts and body sensations associated with that particular situation before reacting (Luken and Sammons 2016) . Practising with a view of the future, recognising infrastructural limitations in an individual’s vocational setting and by distancing oneself from extreme demands of the work environment can aid reflection on these situations and facilitate objective problem solving (Skovholt and Mathison 2016).
Finally, it is crucial to understand that this population of professional misfits are also humans with feelings, aspirations and hope for practising in ways to contribute positively to the society. Hence it is vital to present their challenges in various platforms as the first step to acknowledge the very existence of these real problems faced by them and then to find solutions together as a society to ensure their well being as a professional community. Also, therapists in India need to form agencies and build networks to help themselves lay a foundation to solve these demanding,impending and gaping challenges and to find solutions that can help forward the profession in a manner that demonstrates both strength and upholds the true spirit of this noble, caring profession (AIOTA 2016).