September 18, 2020 - How to prepare one's mental health for economic crisis, and what to expect? Interview with Tomislav Bunjevac, a psychologist at the Institute for Organizational and Personal Development in Zagreb.
Q1. What are the historical examples and studies related to mental health changes resulting from the economic crisis? Do we have any research done in Croatia?
It is not easy to assess the impact of the economic crisis on mental health. To quote one of the researchers who addressed this issue on the occasion of the last significant financial crisis, which began in 2008: "During a financial crisis, the state of the economy can be tracked in seconds, and public health data is usually outdated a few years" (Martin McKee, 2014, Health Cuts Have Consequences, Perth).
The economic crisis to which this statement relates is vastly simpler to the one we are facing today.
Maybe we need to repeat what it is about first. The model for the emergence of the current crisis, which has not yet occurred in the history of civilization, is straightforward and probably understandable to everyone. It started with a massive health crisis in the form of an epidemic that turned into a pandemic. At the same time, we have the fact that the global health system and medicine, as a rule, do not have sufficient knowledge about the disease itself (first of all, this concerns the lack of a vaccine and effective therapy). Subsequently, the general lock-down brought an economic and financial crisis that massively threatens the naked existence and survival. That led to a general sense of a complex threat to health and existence.
In this context, the aspects mentioned above of the crisis have negative consequences for the overall quality of life, particularly in the area of mental health. Traditionally, mental health is defined by so-called mental health 'negative' definitions that describe a 'threat' to health. In particular, disorders in cognitive functioning and/or mental illnesses are predominantly clearly defined, and it is sporadic to determine what mental health is.
This anomaly exists because the disciplines traditionally associated with mental health (psychiatry as part of medicine and psychology as an independent discipline) were becoming more critical and developed most during and after a significant mass crisis. Considerable development of these disciplines is evident during the First and Second World Wars, between which there was also a tremendous economic crisis. Accordingly, the interest of those disciplines was mainly focused on 'problems' and 'damage' caused by the situation, so most research is related to mental disorders and diseases, as well as to psychosocial consequences.
People's health depends on many factors, and it is doubtful to attribute serious health consequences only to factors related to the economic crisis. For example, during the financial crisis, there is no overall increase in mortality. On the contrary, Baumbach and associates noted the downward trend in mortality in eight European countries after the 2008 crisis (Baumbach A, Gulis G. Impact of the financial crisis on selected health outcomes in Europe. Eur J Public Health. 2014;24(3):399–403).
Also, experience shows that during a severe and massive crisis, the suicide rate falls, but after the crisis, this indicator returns to the pre-crisis state, or it even increases.
There are no general systematic studies in Croatia aimed at studying the relationship between economic crisis and mental health, although there are some studies on partial aspects of that relationship. Most often, it is about the relationship between socio-economic and material status and quality of life. These studies attempt to gain insight into the relationship between unemployment and quality of life and mental health aspects.
Q2. What are the most vulnerable groups of people whom we should pay particular attention to?
As always, when it comes to times of crisis, when the likelihood of experiencing unpleasant, threatening, and traumatic experiences increases, there are groups of people who are more at risk than others. Those are usually people who, before the crisis, did not develop active and positive ways to deal with the problems, stress, and risks that the crisis brings. Entrepreneurs can be expected to be less risk-averse than others because they are somewhat more prone to taking risks and more active, which increases the likelihood that they perceive a crisis more often as both an opportunity and a challenge.
Q3. Should 'normal' people, with no symptoms or history of problems so far, be concerned for themselves?
I don't think there is a need to ask if 'normal' people should be concerned about their mental health. It is essential for most 'normal' people that they assess their threat as accurately and realistically as possible, in terms of their existence and maintaining the lifestyle they are used to. Then, to evaluate their capabilities and reserves as accurately as possible, plan their needs and expenses within a reasonable time frame. At the same time, it is vital to avoid the experience of one's helplessness (so-called 'learned helplessness') and adapt the expectations to reduced opportunities during a crisis. As a rule, the smaller the gap between our capabilities (which usually decrease during a crisis) and our expectations (which is reasonable to decrease during a crisis), the less negative consequences for a person can be expected.
On the other hand, there is also a social solidarity mechanism that helps us in crises. This mechanism can significantly reduce adverse effects.
Q4. What are the most common disorders, and how long can they last?
One of the most severe consequences is an increase in the number of suicides. In a study that followed the 2008 financial crisis, 26 European countries saw a rise in suicides by at least 5%. (Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet. 2011; 378(9786):124–125).
In the US, during the post-2008 recession, of an estimated 4.750 suicides, 1.330 of them could be attributed to increased unemployment. (Reeves A, Stuckler D, McKee M, Gunnell D, Chang SS, Basu S. Increase in state suicide rates in the USA during the economic recession. Lancet. 2012; 380 (9856): 1813–1814).
An increase in the suicide rate was demonstrated in states with low pre-crisis unemployment, where there was a significant increase in unemployment after the crisis. However, those are only indirect indicators, based on which it is impossible to talk about a clear, direct cause-and-effect relationship.
Some authors have concluded that between 1970 and 2007, in 26 EU countries, every 1% increase in unemployment leads to an increase in the number of suicides by 0.79% under 65.
Besides suicide, the most common consequences are depression (in Greece, the prevalence of depression doubled between 2008 and 2011). Furthermore, those include negative mood swings, increased anxiety, an increased number of psychosomatic problems (pain, neurological problems, gastrointestinal problems, sleep disorders, and sexual functioning disorders), and addiction issues – primarily, increased alcohol consumption. In Spain, it turned out that the prevalence of the above problems in 2010 was significantly higher compared to 2006.
The significant impact of the crisis also considers reducing the use of most medical services (in Greece, during the financial crisis, 15% fewer people sought medical assistance, although they were free, and 14% fewer sought dental services).
Q5. In Croatia, as during the last crisis, small and medium-sized businesses were significantly affected. Many of them had to close the company and stay out of work. What preventive measures can be taken to protect oneself from upcoming stressors best?
Entrepreneurs, in particular, must adapt their expectations to opportunities. Among entrepreneurs, some have their own survival experience during and after the financial crisis (2008), which lasted longer in Croatia than in most other countries. Those who have experienced this already have some psychological defense mechanisms, on the one hand, and some desirable entrepreneurial competencies that can help them survive this crisis.
Also, between 2015 and 2019, for most entrepreneurs, the business was conducted in the context of making a profit (as indicated by statistics from annual reports for Croatia).
The best preventive measures for entrepreneurs are creating reserves during periods when the business is in a positive state, maintaining the readiness and waiting for a crisis, and planning for survival in adverse circumstances (crisis).
Q6. Are there specialized institutions or departments that would address precisely the problems that create unemployment and lack of income? If not, why and what can be done?
As far as I know, there are no such specialized institutions. When it comes to the consequences of compromised mental health, most mental health professionals are in the health system (for the most part) and, one smaller part, in the social security system. There were some programs that the Croatian Employment Service conducted in collaboration with NGOs (for example, The Association of the Unemployed), which offered advice to the unemployed persons. The content was most often related to job search support. But those programs had ambiguous results.
Q7. Do we have any other countries' best practices, how to deal with the psychological consequences that the crisis leaves on the labor force?
I do not know if there are any 'mass' and comprehensive 'state' programs for examples from other countries. Therefore, it is doubtful to talk about the 'practices of other countries.' Perhaps the most similar programs were partly implemented in some countries and related to the reintegration of war veterans into civilian life (USA, South Korea).
But perhaps we can talk about differences in common social values, upbringing, traditions, and climate in society. In this crisis, too, those differences are bound to show up. However, these are primarily phenomena that change very slowly and whose importance is underestimated in some countries/societies (for example, in Croatia). Thus, in different countries, people will dominate with psychological and psychosocial consequences, as defined by tradition, upbringing, and values. Suppose these values and traditions are dominated by 'proactive' ways to deal with stressful situations, positivity, optimism, social solidarity, and general social positive values. In that case, the effectiveness in dealing with the crisis will be higher, and there will be less damage.
It seems that the dominant phenomena in Croatian society, even before this crisis, is the one of 'learned helplessness,' which is the least sound basis for overcoming the consequences of any and, in particular, crises such as this one.
From the other side, it is known that many organizations (primarily from the so-called real sector) invest heavily in development and improvement programs for their crucial employees. Traditionally, these programs place great emphasis on contents that help to deal with organizational or work stress as effectively as possible. It is often about developing and improving resilience to various organizational changes, especially those related to organizational stress.
People who have completed such high-quality programs can certainly develop better mechanisms to overcome this current crisis.
Unfortunately, such programs were very rarely used by small and medium-sized business owners.
Q8. Some research shows that in crises, people are better at recognizing opportunities and becoming more innovative. Are there any positive results that be provoked by a crisis at some people?
Some twenty years ago, a general trend called 'positive psychology' was promoted. It also emerged as a reaction to the aforementioned century-old tradition and the dominance of the so-called 'medical model' in psychiatry and psychology, according to which these two disciplines mainly dealt with consequences defined as 'damage' (disorders and diseases).
Positive psychology focuses primarily on psychosocial health and emphasizes the importance of achieving quality of life. In this context, one of the most important starting points is defined as follows: any situation we find ourselves in can be described as an 'opportunity' or 'challenge' from which we can learn something and come out stronger, more positive, better, and more satisfied. Of course, that is not easy. In this case, commitment to such a goal, motivation, participation, endurance, perseverance, and belief that the goal can be achieved is expected.
Also, any significant change (such as this crisis) forces some people to look for different solutions that can be innovative. Daily experiences confirm that idea.
Q9. A survey conducted by the Glas Poduzetnika Association on coping with stress and mental health gave interesting results. About 50% of entrepreneurs still manage stress well and effectively. More than 18% use conversations with family and friends to relieve stress, while 20% use, to a greater extent than before, alcohol or some psychoactive drugs or some pills. It is also interesting that a minimal number (less than 1%) said they use professional help from a psychologist or psychiatrist. Do we have comparable data to compare entrepreneurs with the general population?
Concerning these results, it would be interesting to apply the same questionnaire to some other samples in the Republic of Croatia. That would allow us to compare the entrepreneurs' results with the general population's or employees in some public sector segments. Perhaps based on such results, a more constructive discussion of the various characteristics of the work in the so-called 'real' and 'public' sectors could be formulated. I believe that such results would show that this situation is 'no easier' for anyone than it is natural that people from different sectors face this crisis and its consequences in different ways.
A small percentage of the use of professional help from psychologists or psychiatrists (less than 1%) may be: a) due to our social values and social climate (low propensity to seek such help), b) the general phenomenon of seeking services from the health system, or c) the general avoidance of physical contact with professionals, as many people have not yet reoriented to 'online' counseling and treatments.
However, there is no doubt that the need for such types of help will grow, especially as the crisis stops (as it has always been throughout the history of crises).
Q10. Assuming that the condition worsens in the next period, what would you recommend? How does one take care of their mental health?
First, the most important thing is to maintain your business and minimize the damage as much as possible. At the same time, within the limits of what is possible, it is crucial to redefine your business's goals and expectations. Also, if possible, focus on finding alternative and/or innovative ways to do business. While doing so, it is essential to focus on the potential positive aspects and, if possible, accept this crisis as a challenge or opportunity. That is an approach that will guide us in the direction of positivity. In this context, it may be useful to discuss issues with friends who are entrepreneurs and family members and ask for their opinion and support.
If our ways of dealing with it don't help us, or we think we're feeling bad, it might be helpful to search the Internet for useful information. Access to such content is effortless, and we should not underestimate the usefulness of such content. Even when we think that these tips are trivial, if we approach them with confidence, determination, and positivity, they can be useful for us.
If that does not help us, it would be a good idea to seek advice from consultants (the best would be psychologists) who already have experience working with people from the business, organization, and entrepreneurial field.
Only if all that does not help us we can ask for help from clinicians.
Here the best would be to see a psychologist/clinician first. If they can't help us, the psychologist/clinician may eventually refer us to a psychiatrist. Then the psychiatrist can prescribe our therapy, and, if we are talking about more severe problems, he is the only one who can determine the pharmacotherapy (medication) for us.
