Occupational Barriers experienced in mental health in South Africa
In my second year of studying, we learned about occupational science, which is the “rigorous study of occupational beings.”(Asaba& Wicks, 2010) Here, we were introduced to Occupational Injustice and came to know the sad reality of how certain circumstances do not allow individuals to receive or engage in occupations. This can be through individual, community, or environmental stress, social conditions, limited access to resources and opportunities, and lack of occupation. These are referred to as Occupational Barriers.
The word ‘occupational’ (derived from occupation) is familiar to OTs, as we know it is the everyday activities individuals engage in to occupy their time and bring meaning to their life. The Oxford Dictionary describes a barrier as “a circumstance or obstacle that keeps people or things apart or prevents communication or progress.” Hence, an “occupational barrier” is an obstacle that keeps individuals from engaging in meaningful occupations every day.
When I reflect on what I have learned and experienced in many facilities in South Africa, it is evident that occupational barriers do exist, either in the form of deprivation, alienation, or apartheid, which impact mental health in various ways.
Occupational Deprivation refers to the “state of political, displacement, or socio-political restrictions an individual or group of individuals experience, that does not enable them to engage in occupations meaningfully.”( Whiteford G, 2000) This also includes social, environmental, geographic, cultural, and interpersonal factors. I have learned so far in the facility that I am in, that low self-esteem (which is an interpersonal factor) is a huge factor as to why individuals may not participate in occupations, as they fear they might fail or not be good enough. The National Library of Medicine states that there are various reasons as to why individuals do not seek professional help for common mental disorders and can include “negative attitudes towards seeking help, as well as costs, transportation or inconvenience, confidentiality, the feeling of being able to handle their problems on their own, and the belief that treatment will not help.”(National Library of Medicine) This is true because sometimes, it is factors out of an individual’s control that restrict them from getting the care that they need. I have seen clients not attend treatment sessions, as traveling to the clinic is expensive and a distance to travel. This can also mean that there are a limited number of clinics that offer OT services to clients in communities. Not attending intervention sessions, an individual may experience low mood, and further decrease in self-esteem, as they are not receiving the intervention and their condition may deteriorate as a result.
Occupational alienation is described as a “prolonged experience of disconnectedness, isolation, emptiness, lack of identity, a limited or confined expression of spirit or a sense of meaninglessness” (Townsend & Wilcock, 2004, p. 80) This also relates to “limited or forced participation in occupations viewed as meaningless or purposeless” (Stadnyket al., 2010; Wilcock, 2006). In my experience thus far, I have noticed how individuals experience low mood and isolation, especially when living away from family and friends. Many times, in situations when individuals are placed in a facility that caters to their needs, family and friends stop contacting individuals, which results in individuals experiencing isolation, grief, loneliness, and disconnectedness. They are forced to be disconnected from their family and past life and this can cause them to resent therapy or engage in occupations, resulting in depression. This also included institutionalization, where clients are forced to follow the routines and rules of an institution they reside in, which also affects their overall engagement in occupations as it can restrict their opportunities to try and be independent.
Occupational Apartheid, I think plays the biggest role in individuals engaging in occupations. This occurs in “situations where opportunities for occupations are afforded to some individuals and restricted to others based on personal characteristics such as race, disability, gender, age, nationality, religion, social status, and sexuality.” (Kronenberg & Pollard, 2005) I have personally witnessed this, when a client was diagnosed with right CVA, left hemiplegia. This affected his cognitive and physical abilities, and he was asked to leave his job as the company did not want to employ him because he would not be able to perform his roles in the workplace like before. Yet, what about the company adapting the workspace to allow the client to keep his job despite having a disability, as a return to work after he has received therapy? Is it necessary to exclude an individual from earning an income just because he may not look ‘normal?’ I can only imagine the effect it would have had on his mental health, the added stress it gave him, the anxiety and fear of whether he is going to ever be able to work again and not forgetting how his family would now have the burden of performing his daily occupations for him, which can cause the client to be vulnerable.
As a blooming OT, I have come to understand how important taking care of one’s physical and mental health is. It requires a lot of commitment, hard work, and acceptance. To allow individuals with mental health impairments to engage in meaningful occupations, change needs to happen, and that change begins with me, as a therapist. It is my responsibility to advocate and mediate for my clients, aim to equalize opportunities for participation, adapt the environment to suit my client’s needs, and to educate people that everyone has the right to experience meaningful occupations.
Bill Clinton said, “ Mental illness is nothing to be ashamed of, but stigma and bias shame us all,”(Holmes & Williams, 2015) so going forward, let us try to eliminate the stigma of mental illness and provide equal opportunities for all!
