Mental Health, Burnout and the Critical Need for Culturally-informed Support
Clinical psychologist shares why current research, training, and practice should more closely examine how mental health stress is rooted in sociocultural trauma and injustice
By Molly Gluck
If you are experiencing mental stress or burnout, you are not alone. The past two years have not been easy on anyone — according to the World Health Organization, the COVID-19 pandemic triggered a 25% increase in the prevalence of anxiety and depression worldwide. May is Mental Health Awareness Month (started by Mental Health America in 1949), and this year’s theme is Back to Basics, formally recognizing that “after the last two years of pandemic living, many people are realizing that stress, isolation, and uncertainty have taken a toll on their well-being.”
Although mental health is becoming more widely acknowledged and addressed, there are still serious gaps in mental health access, education, research, systems, and support methods. We asked Dr. Usha Tummala-Narra — clinical psychologist, researcher and scholar who focuses on immigration, trauma, race, and culturally-informed psychotherapy — to help us better understand these gaps, the communities most impacted, and what needs to be done to better support mental health and burnout.
Dr. Tummala-Narra is the Danielsen Institute’s first Director of Community-Based Education, where she directly engages with underserved communities, as well as a Research Professor in the Department of Psychological and Brain Sciences at Boston University.
In part two of Boston University’s Medium Burnout Series, Dr. Tummala-Narra defines mental stress and burnout, explains how mental health and diversity issues intersect, and shares how we can protect, preserve and improve mental health across all communities. See below for the full Q&A.
How do you define burnout? How do burnout and mental health intersect?
Burnout refers to a physical and emotional state or position that is caused by prolonged stress at the workplace and other contexts, such as relationships with important people in one’s life. Burnout typically develops gradually, having a cumulative effect on a person’s emotional and/or physical well-being. Negative feelings about one’s work or relationships can feel out of one’s control, and there may be a disconnect between one’s work or relationships and their sense of identity.
How can individuals identify if they are experiencing mental stress and burnout?
It’s not easy to identify mental stress resulting from burnout. Usually, we continue to persist through work or engage in a relationship that has a negative and even toxic effect on our sense of safety, stability, trust in others, compassion, empathy, and sense of hopefulness. People around us may not always notice changes that we may experience as a result of burnout. Some common manifestations of burnout are emotional and physical fatigue, feeling disinterested in work, withdrawing from others, feelings of anger, irritability, and a sense of hopelessness.
How do mental health and diversity issues intersect?
Our mental health is influenced by our sense of safety and belonging in our communities and in the broader world, stable and fulfilling emotional connections with others, and a sense of trust in others, including the belief that we will be treated fairly and be protected in the face of harm. Many women, racial, ethnic, and religious minorities, immigrants and refugees, LGBTQIA+ people, and disabled people cope with not being able to secure adequate safety, trust in others, and support from educational institutions, workplaces and policy makers. They often cope repeatedly with stereotypes, micro-aggressions, verbal harassment, and violence. These challenges can contribute to mental health stress, such as isolation, depression, anxiety, post-traumatic stress, and suicidal ideation.
Are there specific populations and communities that are most vulnerable to mental distress and burnout?
People who have little control in their workplaces and relationships are especially vulnerable to burnout and mental health distress. When we feel more valued and respected in our workplace and in our relationships, we tend to feel more hopeful and vibrant, and stay engaged. If we feel constrained in our ability to have meaning or purpose in our work, or if we have few or no options to pursue other work or support, we are more vulnerable to mental health distress and burnout. This is especially the case when we rely on a specific job or role in order to secure an income and care for others — or a specific, unsupportive relationship to fulfill basic needs like food, shelter or financial support.
How are mental health conditions and burnout diagnosed and treated in a clinical setting? Are there gaps in current mental health support systems?
Mental health distress related to burnout is typically recognized by clinicians who inquire about a patient’s school, work, relationship history, exposure to traumatic events, and ongoing stress in various contexts, such as family, school, workplace, and living situation. It is often the case, however, that there are gaps in therapeutic practices where less attention is given to stress related to minority status and lack of access to resources.
For example, mental health research, training, and practice should more closely examine how mental health stress is rooted in sociocultural trauma and injustice. We now have ample evidence that experiences of racism contribute to mental health stress, such as depression, anxiety, substance abuse, and suicidal ideation. It is often the case that racial minorities are unaware that racism can be a source of prolonged psychological stress, and rather they may attribute their stress to personal factors. However, it is important for researchers and practitioners to recognize that racism can be a direct source of distress in a person’s life, and its effects can resemble traumatic stress related to other types of trauma, such as physical and emotional abuse in a relationship. My work is focused on expanding knowledge about traumatic stress experienced by racial minority immigrants, culturally informed theory and psychotherapy practice, and access to mental health education among marginalized communities.
Specifically, I have been working on modifying psychodynamic theory and practice to include sociocultural issues at the core of formulating individuals’ emotional distress. For instance, when a therapist explores a client’s early life experiences, it is important to inquire about sociocultural trauma and stress, such as being bullied at school based on one’s race, religion, gender, or sexual orientation. If we only ask questions about a person’s relationships within the family context, then we miss the opportunity to learn more about how their experiences in the broader social world may impact how they think and feel about themselves and others. In addition to modifying clinical theory and practice, I have found it critical to make education about mental health issues more accessible to the public. I am currently developing ideas at the Albert and Jessie Danielsen Institute aimed at translating research and clinical knowledge about issues such as the impact of sociocultural trauma on mental health, and making it accessible to underserved communities.
Can you share advice for how individuals can protect, preserve and improve their mental health?
There are many ways that we can preserve and improve our mental health when coping with burnout. Which approach to adopt depends entirely on what may work for us individually. In other words, I don’t think that there is any single best way to approach burnout. For some people, self-care strategies, such as mindfulness and exercise are helpful. Expressing our concerns to people whom we trust and deepening our emotional relationships with others can be helpful in countering the negative effects of burnout. In general, recognizing the signs of burnout and developing a sense of meaning and purpose in one’s current work or relationship — or considering options that allow one to develop meaning and purpose in a different workplace or a different set of relationships can help improve mental health. We all need to experience a sense of purpose, belonging, safety, and autonomy in our work and relationships to ensure our well-being.