ArticlePDF Available

Abstract

Although many social work students suffer from mental health symptoms, the majority of them do not seek help, because of shame. Accordingly, the purposes of this study were to evaluate social work students’ attitudes for mental health problems, and explore relationships among shame, mental health symptoms, self-criticism, self-compassion and role identity. First, eighty-four UK female undergraduate social work students completed a measure of attitudes towards mental health problems, and were compared with ninety-four UK female undergraduate students in other subjects. UK female undergraduate social work students had a higher level of negative perception in their community’s attitudes towards mental health problems. Second, eighty-seven UK social work students completed the attitudes, mental health, self-criticism, self-compassion and role-identity measures. Self-criticism, self-compassion and role identity were significantly related to mental health symptoms and identified as significant, independent predictors of mental health symptoms. This study confirmed that social work students consider that their community perceives mental health problems negatively and that their self-criticism, self-compassion and role identity relate to their poor mental health. The findings may help social work students, educators and researchers to deepen the understanding of their mental health symptoms and identify better solutions.
1
ACCEPTED MANUSCRIPT
Mental health attitudes, self-criticism, compassion, and role identity among UK social work
students
Reference
Kotera, Y., Green, P., & Sheffield, D. (2018) Mental health attitudes, self-criticism, compassion,
and role identity among UK social work students. British Journal of Social Work. doi:
10.1093/bjsw/bcy072
2
Abstract
Although many social work students suffer from mental health symptoms, the majority of them
do not seek help, because of shame. Accordingly, the purposes of this study were to evaluate
social work students' attitudes for mental health problems, and explore relationships among
shame, mental health symptoms, self-criticism, self-compassion, and role identity. Firstly, 84 UK
female undergraduate social work students completed a measure of attitudes toward mental
health problems, and were compared with 94 UK female undergraduate students in other
subjects. UK female undergraduate social work students had a higher level of negative
perception in their community’s attitudes toward mental health problems. Secondly, 87 UK
social work students, completed the attitudes, mental health, self-criticism, self-compassion, and
role identity measures. Self-criticism, self-compassion, and role identity were significantly
related to mental health symptoms, and identified as significant, independent predictors of
mental health symptoms. This study confirmed that social work students consider that their
community perceives mental health problems negatively, and that their self-criticism, self-
compassion, and role identity relate to their poor mental health. The findings may help social
work students, educators, and researchers deepen the understanding of their mental health
symptoms and identify better solutions.
Keywords: help-seeking, self-criticism, compassion, role identity, social work students
3
Introduction
More than a third of social work students indicate high levels of depressive symptoms and are at
high risk of clinical depression. Additionally, 40% reported having suicidal thoughts at some
point in their lives, with 4% reporting they were recent (Horton et al., 2009). Poor mental health
is related to reduced academic achievement and higher dropout (Poh Keong et al., 2015).
However, social work students do not seek help (Ting, 2011), and help-avoidance can be
problematic; leaving mental health symptoms untreated worsens the problems. Help-avoidance
was associated with depression in 700 social workers (Siebert, 2004). A major reason for help-
avoidance was stigma about mental health problems (Byrne, 2000; Eisenberg et al., 2007; Ting,
2011). Common stigmatised beliefs include people with mental health problems are weak,
incompetent, and could increase harmful attitudes, namely discriminatory behaviors toward
people with mental health problems, causing social isolation (Corrigan et al., 2001). Stigmatised
attitudes can also lead people to internalise negative views, which may cause feelings of shame
(Byrne, 2000). Social work students are afraid to seek help, as they aspire to help people with
mental health problems. About a quarter of 171 social work students reported stigma was the
main barrier for their help-seeking (Ting, 2011). Despite its significance, research into help-
avoidance in social work students has been limited, and requires more investigation (Reardon,
2012).
Though stigma and shame are highly related, they differ in that stigma is a social mark,
an undesirable quality to cause isolation (Lewis, 1999), whereas shame is an individual's
negative emotion of inadequacy, caused by failing to meet some standard (Tangney, 1990).
Stigma leads to a sense of shame (Corrigan et al., 2014). This discernment may help to interpret
previous findings. For example, while American university students with mental health problems
4
reported stigma was a major reason for their help-avoidance (Eisenberg et al., 2007), no
significant relationship between stigma and help-seeking was found in a longitudinal study
(Golberstein et al., 2009). It is possible that the students were aware of stigma yet still received
help because they did not experience shame.
Shame and recognition are particularly important to social workers, as these concepts
could impact their agency and empowerment (Frost, 2016). While recognition relates to feeling
of trust and acceptance, misrecognition pertains to being denied citizenship in a social life, being
evaluated unworthy of respect (Fraser, 2013). Shame is one salient psychosocial consequence of
misrecognition (Frost, 2016). Indeed, shame involves a negative emotion such as global
devaluation of the self, whereas guilt involves a condemnation of one’s unethical behaviour and
a concern about its negative influence on others (Tangney et al., 2007). Shame leads to concerns
over one’s image, causing hide, escape, and repair of one’s self-image (de Hooge et al., 2010),
whereas guilt leads to apology and compensation. Shame is general negative self-evaluations
(Benetti-McQuoid and Bursik, 2005), relating to worries about others' judgement on them: a
regret for who they are (Tangney and Dearing, 2002). This general, comprehensive nature
distinguishes shame from guilt, which is a regret for violating their moral code (Tangney and
Dearing, 2002). In other words, shame is comprehensive negative self-evaluations related to their
identity, hence it is a stable, pervasive attribute, rather than a transient behaviour (Tangney et al.,
2007). Gibson (2014) identified ‘social worker shame’ (p.417), thus shame is worthy and
appropriate to be measured in social work populations. No study to date explored shame about
mental health problems or about different dimensions of shame (internal, external, reflected
shame, and related attitudes). Accordingly, the present study aimed to evaluate different
dimensions of shame about mental health problems in social work students.
5
Shame and related psychological constructs
While psychological research generally has a segmented view on shame, focusing primarily on
one’s self, which may hinder our understanding of shame (Gilbert, 2007), social work research
has taken an integral view, considering psychological, social, and cultural contexts, and
including shame variants such as embarrassment and humiliation, acknowledging it may be
misnamed (Brown, 2006). Social workers encounter shame in various settings. For example,
people in poverty may feel shame about living in a poor area, leading to reduced dignity and self-
esteem (Jo, 2013). Social workers may need to understand this shame, in order to support them
effectively (Beddoe and Keddell, 2016). Social welfare beneficiaries may be fearful of benefit
agency staff who control their benefits, which implies to the beneficiaries that accessing benefits
is shameful, causing feelings of humiliation, distress and withdrawal (Morton et al., 2014).
Another example is parents’ shame about their children’s mental health problems, which could
harm their family and therapeutic relationships (Cohen-Filipic and Bentley, 2015). Thus, social
work students need to be able to work with shameful issues of service users (Bentley et al.,
2016).
Shame also exists among social workers themselves. Although shame has not been
studied thoroughly in social work, Gibson (2016) found social worker shame negatively affects
their job satisfaction, retention, and ethics: social workers may feel shame about telling anyone
that they were assaulted (Enosh et al., 2013), bullied at work (van Heugten, 2010) or service
users committing suicide (Ting et al., 2006). Social worker shame is related to the devalued and
inadequate feelings (Gibson, 2006). Social workers perceive they are less respected by their
service users and other professionals (Lynch, 2011): nurses are metaphorised as angels, while
6
social workers are metaphorised as child catchers (Bailey and Liyanage, 2012). Social workers
reported that they feel devalued as they are not placed higher in the local authority hierarchy
(Coffey et al., 2009). This creates shame-based fear where they feel fearful about their future
position in the organisation, which is dependent on those of higher rank (Smith et al., 2003).
Feelings of inadequacy are experienced particularly in comparison with expectations on
them. Many social workers perceive that their society does not condone any mistakes, feeling
shame-based fear that they must always be a perfect practitioner (Gibson, 2016). For example,
social workers reported being over-scrutinised, causing them to feel their work is not good
enough (Smith et al., 2003). Some service users are disappointed in social workers as they are
ordinary people (Pockett, 2002), while their code of ethics portray them as perfect practitioners
(British Association of Social Workers [BASW], 2012). Often social workers feel torn between
their understanding of their role and their perception of expectations of them (Leichtentritt,
2011). This gap between the ideal and reality may lead social workers to feel inadequate and
incompetent (Weuste, 2005), which are strong indicators of shame (Nelson and Merighi, 2002).
Shame and the fear of shame are a serious problem to social workers, because these feelings can
be perceived as being worse than the fear of physical assault (Enosh et al., 2013). Additionally,
shame can affect many behaviours that good social work practice entails: observations,
communication, and judgements, which are crucial to develop healthy self-concept and
therapeutic relationships (Gibson, 2016). Therefore, an exploration of shame is highly relevant to
social work practice (Gibson, 2016).
Shame is associated with mental health symptoms (Tangney and Dearing, 2002),
including depression (Matos and Pinto-Gouveia, 2009), anxiety (Tangney et al., 1992), paranoia
(Matos et al., 2013), post-traumatic stress disorder (Harman and Lee, 2010), eating disorders
7
(Troop et al., 2008), and personality disorders (Rüsch et al., 2007). Unsurprisingly, shame
predicts the levels of mental health problems in university students (Arimitsu, 2001).
Self-criticism and self-reassurance are related to shame and mental health symptoms
(Gilbert et al., 2010). Self-criticism and shame can activate our threat system, while a low level
of self-reassurance can hinder our well-being (Gilbert, 2010). However, no study has focused on
whether shame and self-criticism are related to mental health symptoms in social work students.
Self-compassion is related to shame, mental health, and self-criticism. Self-compassion
promotes resilience against mental health problems, and reduces self-criticism (Trompetter et al.,
2017). Self-compassion is an understanding and kindness to the self during times of suffering,
aiming to ease the suffering (Neff, 2003). Good mental health is associated with self-compassion
(Muris et al. 2016): compassion-based interventions (Gilbert, 2009) reduce mental health
symptoms, shame, and self-criticism (Braehler et al. 2013; Gilbert and Procter 2006).
Forgiveness of self, one of the effects of compassion, is positively related to self-esteem among
American social work students (Turnage et al., 2012). To date, no study has explored
relationships between self-compassion, mental health, and other related psychological constructs
in social work students.
Lastly, as qualitative responses of 171 social work students about the reason for help-
avoidance (Ting, 2011) suggested, social work students’ caregiver identity might be related to
their shame about mental health problems. Research has reported that caregivers in other
professions (e.g. nursing, counselling) often fail to recognise their personal problems (Kottler
and Hazler, 1996; Nace, 1995). Role identity theory (McCall and Simmons, 1978) posits that
behaviour is shaped by perceptions of self in personal and professional roles. Social workers
have multiple professional and personal identities (Brody, 2010) defining how they should
8
behave (e.g. helper, manager, mediator). This may make it difficult for them to acknowledge that
they have similar problems to their service users, because their ideal self-image conflicts with
their problems (Siebert and Siebert, 2005). However, no study to date explored correlations
between role identity and shame about mental health problems in this population.
In this study, therefore, we first examined the levels of shame about mental health
problems in UK social work students, comparing with similar university students from other
disciplines (Gilbert et al., 2007). Because the comparison population comprised female
undergraduate students, only female undergraduate social work students were used for this
analysis. Second, we explored the relationships between shame, mental health, self-criticism,
self-compassion, and role identity in the whole sample. Finally, we examined which of these
variables predicted mental health levels. This study focused on symptoms of depression, anxiety,
and stress because these were the most common types of mental health problems in both the
general public and students (Aronin and Smith, 2016; European Community, 2005).
Method
Participants
Participants, aged 18 years or older, were social work students at a UK university. Of 106 full-
time students (88 undergraduates and 28 postgraduates) completed the ATMHP, 84 were female
undergraduate students (77 British, 6 African, 1 other European; age range 18-58, mean=30.29,
SD=9.13 years). Though we did not explicitly exclude Asian students, there were no Asian
student participants in this study. The representativeness of our sample to the general population
was still maintained as the number of Asian students studying social work in the UK is small
(Skills for Care, 2016). The 84 female undergraduate students were compared with 94 non-Asian
9
UK female undergraduate students from two UK universities in life science subjects including
psychology (Gilbert et al., 2007). Asian students were excluded to permit comparison (age range
18-46; mean=20.93, SD=4.92 years).
For the second and third aims of the study, 87 social work students (80 female, 7 male)
completed all five self-report measures. The age range was 18–58 (mean=30.76, SD=9.53) years;
14% were postgraduates; 8% were international students (from other European countries and
Africa).
Instruments
Attitudes Towards Mental Health Problems (ATMHP). ATMHP comprises 35 four-point Likert
items measuring attitudes towards mental health problems and shame, in four sections: i) their
community’s and family’s attitudes towards mental health problems (their perception of how
their community and family perceive mental health problems), ii) their community external
shame and family external shame (their perception of how their community and family would
perceive them if they had a mental health problem, respectively), iii) their internal shame (how
they perceive themselves if they had a mental health problem), and iv) their family-reflected
shame (how their family would be perceived if they had a mental health problem) and self-
reflected shame (fears of reflected shame on themselves, associated with a close relative having a
mental health problem). All of the subscales had good Cronbach’s alphas of between .85 and .97
(Gilbert et al., 2007).
Forms of Self-Criticising/Attacking & Self-Reassuring Scale (FSCSR). FSCRS (Gilbert et
al., 2004) evaluates people’s perception of themselves in difficult times. The 22 five-point Likert
scale items assess two forms of self-criticalness (inadequate-self and hated-self), and one form of
10
self-reassurance (reassured-self). Inadequate-self relates to a sense of personal inadequacy (e.g.
‘I am easily disappointed with myself’; nine items), hated-self to a desire to hurt or persecute the
self (e.g. ‘I have become so angry with myself that I want to hurt or injury myself’; five items),
and reassured-self to a sense of self-support (e.g. ‘I am able to remind myself of positive things
about myself’; eight items). Cronbach’s alphas were between .86 and .90.
Depression Anxiety and Stress Scale (DASS21). This 21-item, four-point Likert scale is a
short-form of DASS42 (Lovibond and Lovibond, 1995) comprising three seven-item subscales;
depression (e.g. ‘I felt that I had nothing to look forward to’), anxiety (e.g. ‘I felt I was close to
panic’) and stress (e.g. ‘I found it difficult to relax’). These subscales had good reliability; α=.87-
.94 (Antony et al., 1998).
Self-Compassion Scale-Short Form (SCS-SF). This self-report measure is a shortened
version of the Self-Compassion Scale, comprising 12 five-point Likert items (Neff, 2003).
Cronbach’s alpha was high (.86).
Role Identity Scale (RIS). This eight-item measure evaluates participants’ caregiver role
identity by considering how they view themselves as a caregiver, and how they perceive others
view themselves as a caregiver (Siebert and Siebert, 2005). Participants endorse how much they
agree to each item (e.g. ‘It is my responsibility to be helpful to family and friends’) on a five-
point Likert scale. The internal consistency was high (α=.78).
Procedure
After consenting to participate to the study, participants were sent links to the online scales,
which were followed by the debrief. In case students were distressed by issues raised by the
study, information about available mental health services was provided. Available mental health
11
services inside and outside the university were introduced to ensure any issues might be
addressed in a sensitive manner. Ethics approval was obtained from the University Research
Ethics Committee.
The collected data was, first, screened for the assumptions of parametric tests. Second, t-
tests were conducted to examine difference between the two groups (Aim 1). Third, correlations
between their attitudes, mental health, self-criticism, self-compassion, and caregiver role identity
were explored (Aim 2). Finally, multiple regression analyses were conducted to examine the best
independent predictors of depression, anxiety, and stress (Aim 3).
Results
Analyses were conducted using IBM SPSS version 23.0. There were no outliers in ATMHP
responses for t-tests. Skewness values ranged from .26 to 1.55, Kurtosis values ranged from -.58
to 2.35 and the Cronbach’s alpha was .94. For the correlation and regression analyses, two scores
in RIS and one score in ATMHP were identified as outliers, using the outlier labelling rule
(Hoaglin and Iglewicz, 1987), hence were winsorised (Tukey, 1962). Skewness values ranged
from -1.41 to 1.64, and Kurtosis values from -.68 to 3.04. Cronbach’s alpha for ATMHP was .95,
FSCRS was .70, DASS was .93, SCS was .84, and RIS was .83; demonstrating high internal
consistency.
Next, differences in attitudes toward mental health problems between the female social
work students and the female life science students, were compared using t-tests.
Table 1 Comparison between female undergraduate social work students and life science
students
Female undergraduate
social work students
Female undergraduate
life science students
12
Subscale (Range)
M
SD
N
SD
N
CA (0-12)
4.87a
2.89
84
2.74
94
FA (0-12)
2.46
2.59
84
2.79
94
CES (0-15)
5.14
3.30
84
3.88
94
FES (0-15)
2.01
2.60
84
4.14
94
IS (0-15)
6.46
4.14
84
4.57
93
FRS (0-21)
5.51
5.03
84
5.24
93
SRS (0-15)
3.04
3.69
84
3.50
93
CA=Community Attitudes; FA=Family Attitudes; CES=Community External Shame;
FES=Family External Shame; IS=Internal Shame; FRS=Family-Reflected Shame; SRS=Self-
Reflected Shame.
Superscript indicates significant difference between the two groups (aP<.05).
The female social work students had significantly higher community attitudes (how negatively
they perceive their community viewed mental health problems) than the life science female
students (Table 1). In our sample, there were no differences in any subscale between the male
(n=4) and female social work students.
Correlations
Of total 15 subscales, data in eight subscales were square-root-transformed to satisfy the
assumption of normality: family attitude, family external shame, family-reflect shame, self-
reflected shame, role identity, depression, anxiety, and hated-self. Pearson’s correlations were
used to examine relationship between attitude, mental health, self-criticism, self-compassion, and
caregiver role identity in 87 UK social work students.
Table 2 Correlations among ATMHP subscales and demographics in UK social work students
(n=87)
13
1
2
4
5
6
7
1 CA
-
2 FA
.48**
-
3 CES
.54**
.40**
4 FES
.35**
.69**
-
5 IS
.21
.21*
.17
-
6 FRS
.33**
.35**
.39**
.48**
-
7 SRS
.30**
.24*
.26*
.27*
.30**
-
GN
.02
-.002
.20
.08
.17
.13
Age
.29**
.22*
.20
-.15
.07
-.07
GN=Gender (1=male, 0=female); CA=Community Attitudes; FA=Family Attitudes;
CES=Community External Shame; FES=Family External Shame; IS=Internal Shame;
FRS=Family-Reflected Shame; SRS=Self-Reflected Shame. *p<.05; **p<.01.
There were positive relations between the different dimensions of shame, and community and
family attitudes (Table 2). Age was positively related to community and family attitudes. Among
female students only, the same correlations were found.
Table 3 Correlations among ATMHP, DASS, FSCRS, RIS, and SCS in UK social work
students (n=87)
CA
FA
CES
FES
FRS
SRS
Dep
Anx
Strs
ISelf
RSelf
HSelf
RIS
Dep
.03
.19
.31**
.23*
.21*
.21
-
Anx
.04
.02
.23*
.09
.15
.20
.58**
-
Strs
.06
-.01
.20
.10
.13
.18
.67**
.75**
-
ISelf
.08
.02
.37**
.21
.27*
.21
.44**
.27*
.36**
-
RSelf
-.02
-.14
-.34**
-.17
-.14
-.10
-.46**
-.26*
-.26*
-.44**
-
HSelf
.12
.05
.28**
.10
.11
.15
.33**
.27*
.25*
.48**
-.59**
-
RI
-.17
-.15
-.11
-.15
-.16
-.06
-.06
-.29**
-.40**
-.01
-.03
-.05
-
SC
.08
-.09
-.22*
-.17
-.15
-.16
-.45**
-.28**
-.43**
-.72**
.60**
-.42**
-.05
14
Dep=Depression; Anx=Anxiety; Strs=Stress; CA=Community Attitudes; FA=Family Attitudes;
CES=Community External Shame; FES=Family External Shame; IS=Internal Shame; FRS=Family-
Reflected Shame; SRS=Self-Reflected Shame; ISelf=Inadequate-Self; RSelf=Reassured-Self;
HSelf=Hated-Self; RI=Role Identity; SC=Self-Compassion. *p<.05; **p<.01.
Table 3 shows relationships between shame, self-criticism, mental health symptoms, role
identity, and self-compassion. Shame was positively related to depression, inadequate- and
hated-self; and negatively to reassured-self and self-compassion. Mental health symptoms were
positively related to inadequate-self and hated-self, and negatively related to reassured-self, role
identity and self-compassion. Self-compassion was positively related to reassured-self and
negatively related to inadequate-self and hated-self.
Regression
Finally, multiple regression analyses were conducted to explore the relative contribution of self-
criticism, role identity, and self-compassion measures to mental health in 87 UK social work
students; ATMHP was excluded for its relation to mental health symptoms was not as strong as
the others (Table 4). At step one, gender and age were entered to adjust for their effects, and at
step two, all the scores for self-criticism, role identity, and self-compassion were entered.
Because of the many predictor variables, adjusted coefficient of determination was reported.
Multicollinearity was not a concern (tolerance values .88).
Table 4 Multiple regression: Mental health for shame, self-criticism, role identity, and self-
compassion in UK social work students (n=87)
Depression
Anxiety
Stress
B
SEB
β
B
SEB
β
B
SEB
β
Step 1
15
Gender
.82
.51
.17
.27
.57
.05
4.50
3.32
.14
Age
-.02
.02
-.11
-.02
.02
-.15
-.20
.10
-.22*
Adj. R2
.02
.002
.04
Step 2
Gender
.76
.45
.16
.14
.53
.03
4.08
2.79
.13
Age
.01
.01
.06
-.01
.02
-.09
-.09
.09
-.10
ISelf
.04
.02
.23
.01
.03
.05
-.02
.14
.02
RSelf
-.07
.03
-.31*
-.02
.04
-.09
.01
.19
.003
HSelf
-.05
.15
-.04
.16
.17
.13
.33
.91
.04
RI
-.10
.13
-.07
-.46
.16
-.30**
-3.86
.82
-.42**
SC
-.28
.30
-.14
-.26
.36
-.12
-5.07
1.88
-.39**
Δ Adj.R2
.24
.13
.30
ISelf=Inadequate-Self; RSelf=Reassured-Self; HSelf=Hated-Self; RI=Role Identity; SC=Self-
Compassion; B=unstandardised regression coefficient; SEB=standard error of the coefficient;
β=standardised coefficient; *p<.05; **p<.01.
After adjustment for the demographics, self-criticism, role identity, and self-compassion
predicted 24% of the variance for depression, 13% for anxiety, and 30% for stress. Reassured-
self was the only independent predictor for depression; role identity was the only independent
predictor for anxiety; and role identity and self-compassion were independent predictors for
stress.
Discussion
This study evaluated the attitudes toward mental health problems among UK social work
students, and investigated relationships between their attitudes, mental health, self-criticism, role
16
identity, and self-compassion. We found that female social work students perceived more
negative attitudes toward mental health problems in their community than female life science
students, but there was no other difference between the two groups. Their attitudes and shame
about mental health problems were highly correlated. Their mental health symptoms, shame,
self-criticism, role identity, and self-compassion were also related to each other, albeit more
modestly. Multiple regression analyses revealed self-criticism, role identity, and self-compassion
were significant predictors of mental health symptoms. We will discuss each finding in turn
below.
Community attitude was higher in social work students than life science students, who
were younger than the social work students. Social work students reported that their community
perceives mental health problems as something to be kept secret, and views people with mental
health problems as weak (Gilbert et al., 2007). This may be related to their expectation of
themselves as social workers who are exposed to mentally challenging situations (Cohen-Filipic
and Bentley, 2015; Morton et al. 2014); thus, they need to be mentally well enough to help those
who are mentally distressed. Students may perceive that social workers are not expected to have
mental health problems and having those problems could mean they are not fit to be social
workers. Previous research suggests that clients expect social workers to provide high-quality
services (Malley and Fernandez, 2010) and make the society better (Braye and Preston-Shoot,
2006): having mental health problems may be perceived as a barrier to deliver those services and
meet those expectations. Professional expectations of social workers contribute to stress and
strain (Lev-Wiesel, 2003), and violations of these expectations can lead to self-doubt and
workplace conflict (Savaya et al., 2011). A recent qualitative study revealed high expectations
could cause distress and recommended the professional body to provide them with more
17
psychological support (Graham and Shier, 2014). Additionally, social work is a client-centred
profession, thus expectations could conflict with various policies they must follow (Beresford et
al., 2008). They often work inter-professionally but other professionals may not have a clear
understanding of the role of social workers (Graham and Shier, 2014). The complexity of social
work environments may hinder social workers from meeting their expectation (Ruch, 2002). The
high score in community attitudes may betray high expectations of themselves, difficulty of
meeting those expectations, and the consequences of failing to meet them. The lack of clarity
about social workers’ role and duties may cause unrealistic expectations in social workers
(Graham and Shier, 2014), so clarification of the role and duties of social workers to other
professionals and service users may be useful. Students can learn and practice informing others
of their boundaries during their studies, which may reduce their perceived negative attitudes.
Additionally, in order to reduce their overall shame about mental health problems, compassion
training may help them cope with shame (Gilbert, 2009), as it reduced shame and self-criticism
in high shame participants (Gilbert and Procter, 2006). For example, inter-professional
conferences may be an appropriate setting to implement this type of training. The researchers of
this study were involved in a compassion training workshop at such a conference, and the
attendants (including practitioners and students in social work, nursing, and occupational
therapy) left positive feedback: student attendants learned that self-compassion was important to
professionals too, to help overcome their shameful feelings. Indeed, shame is less visible in our
daily life, thus such an irregular setting with professionals and trainees who value caring and are
aware of safety, would help to facilitate discussions of shame in a compassionate manner.
Another form of implementation may be action learning groups, where a small number of
students/practitioners meet regularly to discuss complicated and challenging issues (Abbott and
18
Taylor, 2013). Sensitive, yet potent affects such as shame can be coped with compassionately in
such settings.
The positive relations between the different dimensions of shame and attitudes may
illustrate the multi-dimensional nature of shame. Internal, external, and reflected shame are
interlinked with each other (Gilbert, 2002), and one’s perception of how their community and
family see mental health problems are related to these shame dimensions (Gilbert et al., 2007).
Though not as strong, the relations among mental health symptoms, shame, and self-criticism
accord with previous findings in Japanese workers (Kotera et al., 2018). Shame was strongly
related to depression and self-criticism. This aligns with previous findings suggesting the
significant impact of shame on mental health (Tangney and Dearing, 2002), and may support
attempts to target shame as a means to reduce self-criticism and improve mental health. For
example, education about mental health problems may be useful: learning that mental health
problems could happen to anybody and having those problems does not mean they are not fit to
be a social worker, may reduce shame about mental health problems (Watson et al., 2017).
Mental health symptoms were strongly related to self-criticism, role identity, and self-
compassion. As previously reported (Gilbert et al., 2010), high self-reassurance and low self-
criticism may be conducive to mental health. The relation between mental health symptoms and
role identity may highlight social work students’ expectations about their future job role, as
discussed above. High expectations of the caregiver role may cause them mental distress (Lev-
Wiesel, 2003). The negative relation between mental health symptoms and self-compassion
echoes previous findings (Braehler et al. 2013; Gilbert and Procter 2006): the impact of self-
compassion on mental health was illustrated in this study too. Considering those correlations
with mental health symptoms, it may be helpful to include compassion training in the social
19
work curriculum (Toole and Craighead, 2016). Developing self-compassion may reduce self-
criticism and improve mental health. For role identity, self-awareness training may be useful so
that students are more aware of their own values and attitudes that may affect their work
(O’Connor et al., 2003). Although self-awareness training has been already used in some social
work programmes (Australian Association of Social Workers, 1994), this type of training,
focusing on their caregiver identity, may protect their mental health.
Finally, multiple regression analyses revealed self-criticism, role identity, and self-
compassion predicted 13-30% of mental health symptoms. Reassured-self, role identity, and self-
compassion were significant predictors of mental health symptoms. These results resonate with
our correlational analyses; mental health was related to self-criticism, self-compassion, and role
identity. Again, compassion training and self-awareness training may help social work students
to reduce self-criticism, enhance self-compassion, and develop a sound identity as a social
worker.
These findings and suggestions need to be considered in relation to the values and
principles of social workers which highlight challenging injustice, discrimination, and abuse of
the human rights, while maintaining confidentiality, accurate records, and trustful relationships
with other professionals and service users (BASW, 2012). These high and diverse demands on
social workers may explain their high levels of shame and self-criticism, as they constantly
compare themselves against their values and principles. Additionally, social workers have
diverse internal moral standards to evaluate their own work, hence their self-image (Stanford,
2010) and moral dilemma can cause psychological distress, often experienced in caring
professions (Weinberg, 2009). Believing that you have not met these expectations can lead to
feelings of inadequacy (Weuste, 2005), which relates to shame and poor mental health (Gibson,
20
2016). This imbalance between the demands/expectation and self-care in social workers
emphasises the importance of our findings and suggestions such as the provision of compassion
training to increase self-compassion and self-care (Dunne et al., 2016). Especially recently, the
importance of self-evaluation, acknowledging imperfection of one’s work, has been highlighted
among social workers (e.g. Brown, 2010), who believe in high personal accomplishment
(McFadden, 2015). While self-efficacy is essential for successful social work, recognising
inadequacy is equally important. For example, the Mirror method– self- and peer-evaluation of
practice using the internal mirror and rear-view mirror –has been practiced among Finnish social
workers to accumulate tacit knowledge and cope with imperfection (Yliruka, 2011). Similarly,
our suggested training would also help to embrace imperfection, as perfectionism is fostered by
high self-criticism (Shafran et al., 2010), which can be mitigated by self-compassion (Gilbert and
Procter, 2006).
There are several limitations to this study. First, the sample sizes were relatively small.
Second, in our t-test analysis, we compared only female undergraduate students; while the
majority of social work students are female, this finding requires replication in a larger and more
diverse sample. Third, 20% of the respondents dropped out. Though no compensation for
participation might explain this, the length of the scales might also, especially the ATMHP.
Fourth, though there was no association between shame and perceived risk of disclosing personal
information in UK samples (Gilbert et al., 2007), measuring shame using a self-report scale
might limit its accuracy. Fifth, the participants were recruited through convenience sampling.
Sixth, the causal direction of these related psychological constructs has not been evaluated. In the
future, longitudinal data would help illuminate the temporal patterning of the observed
relationships and may help develop interventions that would increase our understanding of
21
causality. Additionally, evaluation of training for self-compassion, self-criticism, and role
identity would be valuable.
Conclusion
Despite poor mental health, high help-avoidance in social work students has been focused upon
in previous research. This study highlighted social work students’ negative perception of their
community’s attitudes toward mental health problems, and relationships between self-
compassion, self-criticism, role identity and mental health symptoms. The findings in this study
will help UK social work students, educators, and researchers deepen their understanding of their
mental health symptoms, as well as help identify better solutions
22
References
Abbott, C. and Taylor, P. (2013) Action learning in social work, London, Sage.
Antony, M., Bieling, P., Cox, B., Enns, M. and Swinson, R. (1998) ‘Psychometric properties of
the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and
a community sample.’, Psychological Assessment, 10 (2), pp. 176–181.
Arimitsu, K. (2001) ‘The relationship of guilt and shame to mental health’, Japanese Journal of
Health Psychology, 14 (2), pp. 24–31.
Aronin, S. and Smith, M. (2016) One in four students suffer from mental health problems,
YouGov. Available at: https://yougov.co.uk/news/2016/08/09/quarter-britains-students-are-
afflicted-mental-hea/ (Accessed:10 November 2017).
Australian Association of Social Workers. (1994) Australian social work competency standards
for entry level social workers, Melbourne, Author.
Bailey, D. and Liyanage, L. (2012) 'The role of the mental health social worker: Political pawns
in the reconfiguration of adult health and social care', British Journal of Social Work, 42 (6), pp.
1113–1131.
Beddoe, L. and Keddell, E. (2016) ‘Informed outrage: Tackling shame and stigma in poverty
education in social work’, Ethics and Social Welfare, 10 (2), pp. 149–162.
Benetti-McQuoid, J. and Bursik, K. (2005) ‘Individual differences in experiences of and
responses to guilt and shame: Examining the lenses of gender and gender role’, Sex Roles, 53 (1-
2), pp. 133–142.
Bentley, K., Cohen-Filipic, K. and Cummings, C. (2016) ‘Approaching parental guilt, shame,
and blame in a helping relationship: Multiple methods for teaching and learning’, Journal of
Teaching in Social Work, 36 (5), pp. 490–502.
23
Beresford, P., Croft, S. and Adshead, L. (2008) ‘'We don’t see her as a social worker’: A service
user case study of the importance of the social worker’s relationship and humanity’, British
Journal of Social Work, 38 (7), pp. 1388–1407.
Braehler, C., Gumley, A., Harper, J., Wallace, S., Norrie, J. and Gilbert, P. (2013) ‘Exploring
change processes in compassion focused therapy in psychosis: Results of a feasibility
randomized controlled trial’, British Journal of Clinical Psychology, 52 (2), pp. 199–214.
Braye, S. and Preston-Shoot, M. (2006) ‘Broadening the vision’, International Social Work, 49
(3), pp. 376–389.
British Association of Social Workers. (2012) The code of ethics for social work: Statement of
principles, Birmingham, Author.
Brody, S. (2010) What is the role of social workers?, Community Care. Available at:
http://www.communitycare.co.uk/2010/09/20/what-is-the-role-of-social-workers/ (Accessed:8
May 2017).
Brown, B. (2006) 'Shame resilience theory: A grounded theory study on women and shame',
Families in Society: Journal of Contemporary Social Services, 87, (1), pp. 43-52.
Brown, B. (2010). The gifts of imperfection: Let go of who you think you're supposed to be and
embrace who you are, Center City, Hazelden.
Byrne, P. (2000) ‘Stigma of mental illness and ways of diminishing it’, Advances in Psychiatric
Treatment, 6 (1), pp. 65-72.
Coffey, M., Dugdill, L. and Tattersall, A. (2009) ‘Working in the public sector: A case study of
social services’, Journal of Social Work, 9 (4), pp. 420442.
Cohen-Filipic, K. and Bentley, K. (2015) ‘From every direction: Guilt, shame, and blame among
parents of adolescents with co-occurring challenges’, Child and Adolescent Social Work Journal,
24
32 (5), pp. 443–454.
Corrigan, P., Edwards, A., Green, A., Diwan, S. and Penn, D. (2001) ‘Prejudice, social distance,
and familiarity with mental illness’, Schizophrenia Bulletin, 27 (2), pp. 219–225.
Corrigan, P., Druss, B. and Perlick, D. (2014) ‘The impact of mental illness stigma on seeking
and participating in mental health care’, Psychological Science in the Public Interest, 15 (2), pp.
37–70.
Dunne, S., Sheffield, D. and Chilcot, J. (2016) ‘Brief report: Self-compassion, physical health
and the mediating role of health-promoting behaviours’, Journal of Health Psychology, pp. 1-7.
Eisenberg, D., Golberstein, E. and Gollust, S. (2007) ‘Help-seeking and access to mental health
care in a university student population’, Medical Care, 45, pp. 594–601.
Enosh, G., Tzafrir, S. and Gur, A. (2013) ‘Client aggression towards social workers and social
services in Israel: A qualitative analysis’, Journal of Interpersonal Violence, 28 (6), pp. 1123-
1142.
European Community. (2005) Improving the mental health of the population: Towards a
strategy on mental health for the European Union, Brussels, Author.
Fraser, N. (2013) The fortunes of feminism: From state-managed capitalism to neoliberal crisis,
London, Verso.
Frost, L. (2016) ‘Exploring the concepts of recognition and shame for social work’, Journal of
Social Work Practice, 30 (4), pp. 431-446.
Gibson, M. (2014) ‘Social worker shame in child and family social work: Inadequacy, failure,
and the struggle to practise humanely’, Journal of Social Work Practice, 28 (4), pp. 417-431.
25
Gibson, M. (2016) ‘Constructing pride, shame, and humiliation as a mechanism of control: A
case study of an English local authority child protection service’, Children and Youth Services
Review, 70, pp. 120-128.
Gilbert, P. (2002) ‘Body shame: A biopsychosocial conceptualisation and overview, with
treatment implications.’, in Gilbert, P. and Miles, J. (eds), Body shame: Conceptualisation,
research, and treatment, London, Brunner-Routledge.
Gilbert, P. (2007) ‘The evolution of shame as a marker for relationship security: A
biopsychosocial approach’, in Tracy, J., Robins, R. and Tangney, J. (eds), Self-Conscious
Emotions: Theory and Research, New York, Guilford.
Gilbert, P. (2009) ‘Introducing compassion-focused therapy’, Advances in Psychiatric
Treatment, 15 (3), pp. 199-208.
Gilbert, P. (2010) The compassionate mind: A new approach to life’s challenges, Oakland, New
Harbinger.
Gilbert, P. and Irons, C. (2005) ‘Focused therapies and compassionate mind training for shame
and self-attacking’, in Gilbert, P. (ed), Compassion: Conceptualisations, research and use in
psychotherapy, New York, Routledge.
Gilbert, P. and Procter, S. (2006) ‘Compassionate mind training for people with high shame and
self-criticism: Overview and pilot study of a group therapy approach’, Clinical Psychology &
Psychotherapy, 13 (6), pp. 353–379.
Gilbert, P., Clarke, M., Hempel, S., Miles, J. and Irons, C. (2004) ‘Criticizing and reassuring
oneself: An exploration of forms, styles and reasons in female students’, British Journal of
Clinical Psychology, 43 (1), pp. 31–50.
Gilbert, P., Bhundia, R., Mitra, R., McEwan, K., Irons, C. and Sanghera, J. (2007) ‘Cultural
26
differences in shame-focused attitudes towards mental health problems in Asian and non-Asian
student women’, Mental Health, Religion & Culture, 10 (2), pp. 127–141.
Gilbert, P., McEwan, K., Irons, C., Bhundia, R., Christie, R., Broomhead, C. and Rockliff, H.
(2010) ‘Self-harm in a mixed clinical population: The roles of self-criticism, shame, and social
rank’, British Journal of Clinical Psychology, 49 (4), pp. 563–576.
Golberstein, E., Eisenberg, D. and Gollust, S. (2009) ‘Perceived stigma and help-seeking
behavior: Longitudinal evidence from the healthy minds study’, Psychiatric Services, 60 (9), pp.
1254–1256.
Graham, J. and Shier, M. (2014) ‘Profession and workplace expectations of social workers:
Implications for social worker subjective well-being’, Journal of Social Work Practice, 28 (1),
pp. 95–110.
Harman, R. and Lee, D. (2009) ‘The role of shame and self-critical thinking in the development
and maintenance of current threat in post-traumatic stress disorder’, Clinical Psychology &
Psychotherapy, 17 (1), p. n/a.
van Heugten, K. (2010) ‘Bullying of social workers: Outcomes of a grounded study into impacts
and interventions’, British Journal of Social Work, 40, (2), pp. 638-655.
Hoaglin, D. and Iglewicz, B. (1987) ‘Fine-tuning some resistant rules for outlier labeling’,
Journal of the American Statistical Association, 82 (400), p. 1147.
de Hooge, I., Zeelenberg, M. and Breugelmans, S. (2010) 'Restore and protect motivations
following shame', Cognition and Emotion, 24 (1), pp. 111-127.
Horton, G., Diaz, N. and Green, D. (2009) ‘Mental health characteristics of social work students:
Implications for social work education’, Social Work in Mental Health, 7 (5), pp. 458–475.
Kotera, Y., Gilbert, P., Asano, K., Ishimura, I., and Sheffield, D. (2018) ‘Shame and mental
27
health in Japanese workers’, Manuscript submitted for publication.
Kottler, J. and Hazier, R. (1996) ‘Impaired counselors: The dark side brought into light’, Journal
of Humanistic Education and Development, 34 (3), pp. 98–107.
Leichtentritt, R.D. (2011) ‘Beyond favourable attitudes to end-of-life rights: The experiences of
Israeli health care social workers’, British Journal of Social Work, 41 (8), pp. 1459–1476.
Lev-Wiesel, R. (2003) ‘Expectations of costs and rewards’, International Social Work, 46 (3),
pp. 323–332.
Lewis, M. (1998) ‘Shame and stigma’, in Gilbert, P. and Andrews, B. (eds), Shame:
Interpersonal behavior, psychopathology, and culture, New York, Oxford University.
Lovibond, S. and Lovibond, P. (1995) Manual for the depression anxiety stress scales, 2nd ed,
Sydney, Psychology Foundation.
Lynch, S. (2011) Health system factors affecting communication with pediatricians: Gendered
work culture in primary care, Social Work in Public Health, 26 (7), pp.672-694.
Malley, J. and Fernández, J. (2010) ‘Measuring quality in social care services: Theory and
practice’, Annals of Public and Cooperative Economics, 81 (4), pp. 559–582.
Matos, M. and Pinto-Gouveia, J. (2009) ‘Shame as a traumatic memory’, Clinical Psychology &
Psychotherapy, 17 (4), p. n/a.
Matos, M., Pinto-Gouveia, J. and Gilbert, P. (2013) ‘The effect of shame and shame memories
on paranoid ideation and social anxiety’, Clinical Psychology & Psychotherapy, 20 (4), pp. 334–
349.
McCall, G. and Simmons, J. (1978) Identities and interactions: An examination of human
associations in everyday life, New York, Free.
McFadden, P. (2015) Measuring burnout among UK social workers: A Community Care study,
28
London, Community Care.
Morton, K., Gray, C., Heins, A. and Carswell, S. (2014) Access to justice for beneficiaries: A
community law response. Christchurch, Community Law. Available at:
http://www.communityresearch.org.nz/wp-content/uploads/formidable/Access-to-Justice-online-
edition-11-Dec.pdf (Accessed:7 July 2017).
Muris, P., Meesters, C., Pierik, A. and de Kock, B. (2016) ‘Good for the self: Self-compassion
and other self-related constructs in relation to symptoms of anxiety and depression in non-
clinical youths’, Journal of Child and Family Studies, 25, pp. 607–617.
Nace, E. (1995) ‘The professional paradox’, in Nace, E. (ed.), Achievement and addiction: A
guide to the treatment of professionals, New York, Brunner/Mazel.
Neff, K. (2003) ‘The development and validation of a scale to measure self-compassion’, Self
and Identity, 2, pp. 223–250.
Nelson, K. and Merighi, J. (2003) 'Emotional dissonance in medical social work practice', Social
Work in Health Care, 36 (3), pp. 63-79.
O’Connor, I., Wilson, J. and Setterlund, D. (2003) Social work and welfare practice, 4th ed,
Frenchs Forest, Pearson.
Pockett, R. (2002) 'Staying in hospital social work', Social Work in Health Care, 36 (3), pp. 1-24.
Poh Keong, P., Chee Sern, L., Ming, F. and Che, I. (2015) ‘The relationship between mental
health and academic achievement among university students–A literature review’, in Second
International Conference on Global Trends in Academic Research, Bandung, Global
Illuminators.
Reardon, C. (2012) ‘Supporting social work students with mental health challenges’, Social
Work Today, 12 (5), p.10.
29
Ruch, G. (2002) ‘From triangle to spiral: Reflective practice in social work education, practice
and research’, Social Work Education, 21 (2), pp. 199–216.
Rüsch, N., Lieb, K., Göttler, I., Hermann, C., Schramm, E., Richter, H., Jacob, G., Corrigan, P.
and Bohus, M. (2007) ‘Shame and implicit self-concept in women with borderline personality
disorder’, American Journal of Psychiatry, 164 (3), pp. 500–508.
Savaya, R., Gardner, F. and Stange, D. (2011) ‘Stressful encounters with social work clients: A
descriptive account based on critical incidents’, Social Work, 56 (1), pp. 63–71.
Shafran, R., Egan, S. and Wade, T. (2010) Overcoming perfectionism: A self-help guide using
scientifically supported cognitive behavioural techniques, London, Robinson.
Siebert, D. (2004) ‘Depression in North Carolina social workers: Implications for practice and
research’, Social Work Research, 28, pp. 30–40.
Siebert, D. and Siebert, C. (2005) ‘The caregiver role identity scale: A validation study’,
Research on Social Work Practice, 15 (3), pp. 204–212.
Skills for Care. (2016) Social work education in England, Leeds, Author.
Smith, M., McMahon, L. and Nursten, J. (2003) ‘Social workers’ experiences of fear’, British
Journal of Social Work, 33 (5), pp. 659–671.
Stanford, S. (2010) ‘‘Speaking back’ to fear: Responding to the moral dilemmas of risk in social
work practice’, British Journal of Social Work, 40 (4), pp. 1065–1080.
Tangney, J. and Dearing, R. (2002) Shame and guilt, New York, Guilford.
Tangney, J., Stuewig, J. and Mashek, D. (2007) 'Moral emotions and moral behavior', Annual
Review of Psychology, 58, pp. 345-372.
Tangney, J. (1990) ‘Assessing individual differences in proneness to shame and guilt:
Development of the self-conscious affect and attribution inventory’, Journal of Personality and
30
Social Psychology, 59 (1), pp. 102–111.
Tangney, J., Wagner, P. and Gramzow, R. (1992) ‘Proneness to shame, proneness to guilt, and
psychopathology’, Journal of Abnormal Psychology, 101 (3), pp. 469–78.
Ting, L., Sanders, S., Jacobson, J. and Power, J. (2006) 'Dealing with the aftermath: A qualitative
analysis of mental health social workers' reactions after a client suicide', Social Work, 51 (4), pp.
329-341.
Ting, L. (2011) ‘Depressive symptoms in a sample of social work students and reasons
preventing students from using mental health services: An exploratory study’, Journal of Social
Work Education, 47 (2), pp. 253–268.
Toole, A. and Craighead, L. (2016) ‘Brief self-compassion meditation training for body image
distress in young adult women’, Body Image, 19 ,pp. 104–112.
Trompetter, H., de Kleine, E. and Bohlmeijer, E. (2017) ‘Why does positive mental health buffer
against psychopathology? An exploratory study on self-compassion as a resilience mechanism
and adaptive emotion regulation strategy’, Cognitive Therapy and Research, 41 (3), pp. 459–
468.
Troop, N., Allan, S., Serpell, L. and Treasure, J. (2008) ‘Shame in women with a history of
eating disorders’, European Eating Disorders Review, 16 (6), pp. 480–488.
Tukey, J. (1962) ‘The future of data analysis’, The Annals of Mathematical Statistics, 33 (1), pp.
1–67.
Turnage, B., Hong, Y., Stevenson, A. and Edwards, B. (2012) ‘Social work students’ perceptions
of themselves and others: Self-esteem, empathy, and forgiveness’, Journal of Social Service
Research, 38 (1), pp. 89–99.
Watson, A., Fulambarker, A., Kondrat, D., Holley, L., Kranke, D., Wilkins, B., Stromwall, L.,
31
and Eack, S. (2017) ‘Social work faculty and mental illness stigma’, Journal of Social Work
Education, 53 (2), pp. 174-186.
Weinberg, M. (2009) ‘Moral distress: A missing but relevant concept for ethics in social work’,
Canadian Social Work Review, 26 (2), pp. 139-151.
Weuste, M. (2005) Critical incident stress and debriefing of child welfare workers, doctoral
thesis, The Institute for Clinical Social Work, Chicago.
Yliruka, L. (2011) ‘The Mirror method: A structure supporting expertise in social welfare
services’, Social Work & Social Sciences Review, 15 (2), pp. 9-37.
... A caregiver identity is viewing oneself and/or believing others view one as a helper or caregiver either professionally or personally (or both). Role identity as a caregiver was associated with burnout, depression, and not seeking help among social workers [9], and, in healthcare students, was predictive of mental health problems [10][11][12]. ...
... Mental health shame is feeling ashamed for having a mental health problem (Kotera et al. 2019d), and has been associated with poor mental health in business, psychotherapy, occupational therapy, social work, and nursing students in the UK [10,11,17,18]. One explanation for this association is that mental health shame reduces the likelihood that an individual will seek help for their mental health problems [19]. ...
... Relatedly, caregiver identity may heighten mental health shame. Indeed, among social work students, mental health shame was associated with caregiver identity [10]. ...
Article
Full-text available
Although students in education have high rates of mental health problems, many of them do not ask for help, which can exacerbate their symptoms. One reason for their low help-seeking is shame associated with mental health problems. As education students aspire to provide care for chil-dren, they may feel ashamed to care for themselves as the role identity theory suggests. Self-compassion is reported to reduce shame and mental health problems. This study explored the relationships between mental health problems, mental health shame, self-compassion and care-giver identity among UK education students. One hundred nine postgraduate students completed four self-report scales regarding those constructs. Correlation and regression analyses were per-formed. Mental health problems were positively associated with shame and identity, while nega-tively associated with self-compassion. Self-compassion was the only significant predictor of mental health problems. Findings will help educators and education students to develop effective approaches for their mental health problems.
... Social work education, therefore, needs to include self-care, allowing students to care for themselves (Collins, 2020). However, the level of mental health shame in this student population is high (Kotera et al., 2019a), making them difficult to practise self-care. This is especially concerning, considering the emotionally demanding nature of the work, with 80% of social workers reporting work-based emotional distress (Community Care and UNISON, 2016) and many social workers reporting abuse from service users (Ravalier et al., 2021). ...
... Mental health shame is shame about having a mental health problem (Kotera et al., 2020a). Social work students reported stronger negative attitudes in their community to mental health than university students in other disciplines; and the perception of negative attitudes in their community to mental health was associated with shame (Kotera et al., 2019a). Poor mental health has been associated with mental health shame in UK university students (Kotera et al., 2019b), including social work students (Kotera et al., 2019a). ...
... Social work students reported stronger negative attitudes in their community to mental health than university students in other disciplines; and the perception of negative attitudes in their community to mental health was associated with shame (Kotera et al., 2019a). Poor mental health has been associated with mental health shame in UK university students (Kotera et al., 2019b), including social work students (Kotera et al., 2019a). Mental health shame results in reduced help-seeking (Ting, 2011;Rüsch et al., 2014), in turn exacerbating mental health problems. ...
Article
Despite the well-known mental health difficulties of social work students such as high levels of mental health problems and shame, and low levels of self-compassion, effective interventions remain to be evaluated. Moreover, while the levels of mental health constructs vary cross-culturally, how cultures impact the mental health has not been appraised in depth. This study aimed to compare the levels of, and relationships among mental health problems, mental health shame and self-compassion between social work students in the UK and Ireland. Opportunity samples of 120 UK students and 129 Irish students completed self-report measures regarding mental health problems, shame, and self-compassion. Welch t-tests, correlation and regression analyses were conducted. Levels of mental health problems and shame were lower in British students than Irish students, while self-compassion was lower in Irish students. Internal shame was most strongly related to mental health problems in British students, while self-reflected shame was so in Irish students. Self-compassion was a significant predictor of mental health problems in both groups. Cultivating self-compassion, targeting internal shame in the UK, and reflected shame in Ireland, is recommended to protect and enhance the mental health of social work students.
... It is well established that negative attitudes about mental health can lead to internalisation potentially manifesting in a sense of shame [29][30][31][32][33]. The emotional state of shame is complex and arises when individuals feel that they fall short of internalised socially constructed standards [32,[34][35][36]. ...
... Furthermore, in our sample, while negative mental health attitudes and mental health shame were significantly correlated with mental health problems, these did not significantly predict mental health problems. This stands in contrast to some earlier findings [43], but echoes others [33]. A plausible explanation for this could be that perceived attitudes and mental health shame are not precursors of mental health problems but rather cooccurrences and consequences. ...
Article
Full-text available
High rates of mental health problems are a growing concern in Czech higher education; negatively impacting on students' performance and wellbeing. Despite the serious nature of poor mental health; students often do not seek help due to negative attitudes and shame for mental health problems. Recent mental health research reports self-compassion is strongly associated with better mental health and reduced shame. However, relationships between those constructs remain to be evaluated among Czech students. This study aimed to appraise the relationships between mental health problems; negative mental health attitudes; mental health shame; and self-compassion in this population. An opportunity sample of 119 psychology students from a Czech university completed questionnaires regarding these constructs. Correlation, regression and path analyses were conducted. Mental health problems were positively associated with neg-ative mental health attitudes and shame; and negatively associated with self-compassion. Self-compassion negatively predicted mental health problems, while negative attitudes and shame did not. Lastly, self-compassion fully mediated the negative attitudes-mental health problems relationship, and partially mediated the shame-mental health problems relationship. Findings suggest self-compassion is essential for mental health in Czech students; and associated with negative mental health attitudes and mental health shame. Czech universities can benefit from incorporating self-compassion training in their curriculum to protect students' mental health.
... Assimilació de l'etiqueta (Allport, 1958) Baixa autoestima (Ferrer et al., 2006) Submissió al poder (Illich, 1975) Dificultats en el identificació de les capacitats (Ahmedani, 2011;Michaels et al., 2012;Gelkopf, i Roe, 2014;Kotera et al., 2018) Dificultats en la concreció d'un projecte i uns objectius propis (Civivio i Carbajo, 1999;Prats, 2009;Idareta, 2018) ...
... de les realitats on sorgeixen la major part dels problemes en relació amb les persones diagnosticades amb trastorn mental, perquè els subjectes solen ser identificats i definits per la seva etiqueta, amb la pèrdua corresponent de la identitat.L'atribut o l'etiquetatge es desenvolupa com a resultat d'un procés de selecció social per connectar una persona o un grup de persones amb un conjunt de particularitats determinades que els diferencia de la resta de la societat, i és a través d'aquest judici etiquetipus de relació, el grup dominant pot convertir el col·lectiu estigmatitzat en una víctima de la pèrdua d'estatus i de la discriminació. Aquest procediment guarda intrínsecament un sentiment de vergonya que afecta els propis implicats i els que s'hi relacionen(Ahmedani, 2011; Michaels, López, Rüsch y Corrigan, 2012; Gelkopf, i Roe, 2014;Kotera, Green i Sheffield, 2018). El resultat d'aquest procés de constant devaluació i qüestionament de les percepcions de la realitat de les persones a les quals la repressió externa ha assignat una etiqueta, en condiciona el comportament, fins al punt d'acatar la norma, ...
Thesis
Full-text available
Human beings are defined as a product of the culture where they are born and develop. Assimilation of the culture restricts the freedom of subjects in favour of social institutions. Mental health is one of these institutions that, in the rehabilitation or biomedical model, attempts to control all behaviour that departs from the norm by making individuals responsible for the limitations and barriers they face. Thus, mental health sidelines the participation of people in the processes and objectification of what is understood as a problem to be treated. The discipline of social work aims to promote a paradigma shift in the care of people who are diagnosed with a mental disorder from the perspective of the social model, which considers the social system to be responsible for the inequalities and exclusion that subjects undergo, while recognising their capabilities. This axiom identifies the ideal value of one’s life experience as a necessary tool in the process of dignifying mental health in the community, supporting the emergence and transformation of an environment that accepts mental diversity as a sign of social enrichment. The main goals of this research are to reflect on and frame the role that social work has historically played in the field of mental health and examine how this discipline achieves its task of improving people’s quality of life. Therefore, qualitative methodology is used to capture the experiences of different agents, such as people disgnosed with a mental disorder, from “first person” informants; family members and social workers. Six participant observations, twenty in-depth interviews and six focus groups were conducted. Analysis of extracted data allows deeper understanding and diffusion of the strategies and methods of social work to be attained, in which the importance of the emancipation of the discipline from the spheres of power is reconsidered to avoid the reestablishment of power structures and promote diversity in society. It emphasises the role of the discipline in identifying and humanising difference as a key element at the base of social structure. It is stated that social work is grounded in models of a critical nature with institutional and structural order to avoid a focus on pre-set responses and to consider the Other as a subject with the capacity to act. It has been determined that people diagnosed with a mental disorder frequently accept the label and the role assigned to them due to the benefits they receive as a consequence. These statements are based on the fact that political lines of action take advantage of the fallacy of participation or inclusion to homogenise and normalise differences. In this situation, social work has a continuing responsibility to ensure the diversity of the connotations of the concept to avoid binarisms, such as health and disease. Key words: Social work, Mental health, Social Model, Otherness, Power.
... These questions reflect the call by Iacono (2017), and the research of Kotera et al. (2019) to build self-compassion practices into Social Work curricula for field and post-graduation wellness and to stave off empathic distress and burnout in social work careers. ...
... Selfcriticism consists of two forms; 1) inadequate-self, which examines individuals' perceptions of personal inadequacy (such as being disappointed with themselves) and 2) hatedself, examining the desire to hurt or punish the self (such as stopping engaging in self-care). Previous studies have found that both components of self-criticism are associated with depression, anxiety and stress in social work, occupational therapy and psychotherapy students (Kotera, Green, & Sheffield, 2019a, 2019b: a highly relevant construct to student mental health. ...
Article
Full-text available
Academic motivation is recognised as a key factor for academic success and wellbeing. Highly motivated students actively engage with academic activities and maintain higher levels of wellbeing. Despite the importance of motivation in education, its relationship with engagement and wellbeing remains to be evaluated. Accordingly, this study explored the relationships between motivation, engagement, self-criticism and self-compassion among UK education postgraduate students. Of 120 postgraduate students approached, 109 completed three self-report scales regarding those constructs. Correlation, regression and moderation analyses were performed. Intrinsic and extrinsic motivation were positively associated with engagement, whereas amotivation was
Chapter
Full-text available
This chapter seeks to identify common predictors of mental health problems in university students studying healthcare subjects by synthesising our research findings, and to suggest helpful approaches for these issues. Poor mental health of students is a cause of concern in many universities, being associated with higher dropout rates and poor academic performance. In particular, students studying healthcare subjects are known to suffer from a wide range of stressors including academic pressure and stress experienced in practice. Accordingly, our research, recruiting various healthcare student groups, explored the mental health status of this student group, and found that self-compassion was consistently identified as the strongest predictor of good mental health. Students who were kind and understanding towards themselves and their weaknesses, tended to have better mental health. Our findings indicate that cultivating self-compassion is an effective way to protect the mental health of healthcare students. Strategies centred around increasing self-compassion are discussed. Social marketing and digitalisation approaches may be particularly useful to incorporate into the current curriculum in healthcare studies. Self-compassion needs to be cultivated in order to protect the mental health of this future key worker group.
Preprint
Full-text available
This chapter seeks to identify common predictors of mental health problems in university students studying healthcare subjects by synthesising our research findings, and to suggest helpful approaches for these issues. Poor mental health of students is a cause of concern in many universities, being associated with higher dropout rates and poor academic performance. In particular, students studying healthcare subjects are known to suffer from a wide range of stressors including academic pressure and stress experienced in practice. Accordingly, our research, recruiting various healthcare student groups, explored the mental health status of this student group, and found that self-compassion was consistently identified as the strongest predictor of good mental health. Students who were kind and understanding towards themselves and their weaknesses, tended to have better mental health. Our findings indicate that cultivating self-compassion is an effective way to protect the mental health of healthcare students. Strategies centred around increasing self-compassion are discussed. Social marketing and digitalisation approaches may be particularly useful to incorporate into the current curriculum in healthcare studies. Self-compassion needs to be cultivated in order to protect the mental health of this future key worker group.
Article
Full-text available
Self-compassion, sharing some commonalities with positive psychology 2.0 approaches, is associated with better mental health outcomes in diverse populations, including workers. Due to the COVID-19 pandemic, there is heightened awareness of the importance of self-care for fostering mental health at work. However, evidence regarding the applications of self-compassion interventions in work-related contexts has not been systematically reviewed to date. Therefore, this systematic review aimed to synthesize and evaluate the utility of self-compassion interventions targeting work-related wellbeing, as well as assess the methodological quality of relevant studies. Eligible articles were identified from research databases including ProQuest, PsycINFO, Science Direct, and Google Scholar. The quality of non-randomized trials and randomized controlled trials (RCTs) was assessed using the Newcastle-Ottawa Scale and the Quality Assessment Table, respectively. The literature search yielded 3,387 titles from which ten studies met the inclusion criteria. All ten studies reported promising effects of self-compassion training for work-related wellbeing. The methodological quality of these studies was medium. All ten studies recruited workers in a caring field and were mostly conducted in Western countries. The Self-Compassion Scale (SCS) or its short-form was used in almost all instances. Findings indicate that self-compassion training can improve self-compassion and other work-related wellbeing outcomes in working populations. However, in general, there is need for greater methodological quality in work-related self-compassion intervention studies to advance understanding regarding the applications and limitations of this technique in work contexts. Furthermore, future studies should focus on a broader range of employee groups, including non-caring professions as well as individuals working in non-Western countries.
Article
Full-text available
To protect wellbeing of healthcare and caregiving workers during COVID-19, the University of Derby has initiated to offer a webinar focusing on self-care. This one-hour webinar has been well-taken by many healthcare and caregiving workers, and has been requested to be offered at various organisations such as the National Health Service trusts, the British Association of Social Workers, and the Derbyshire Voluntary Action. This commentary reports the outline of the webinar including how the participated healthcare and caregiving workers perceived self-care, and suggests that the current situation may help de-stigmatise self-care among these crucial workforces.