I’ve had a wide variety of experiences working in mental health. I’ve worked in rural communities, on First Nation reserves, and in urban settings. I’ve worked in community, non-profit organizations, within government agencies and privately. I’ve worked in crisis services, community mental health and in private practice. I’ve been a volunteer community member and a professional.
Over the years, I have been inspired by the wisdom that so many of my colleagues carry and the love that many have for their jobs and the people they serve. I’ve have also seen colleagues struggle and lose hope while working in this field, and sometimes, in their ability to continue in this work. I also hear from clients, friends, and family about their various experiences within the system, both positive and negative, and what kinds of things make them feel heard and helped when they are in distress.
For myself, I continue to learn about my own energy zappers and am working to gain skills and wisdom to work differently. I’ve also learned, through experience, and the wisdom of my colleagues and the people I serve, about how to keep hope and energy alive. I wanted to share some of what I’ve learned here. Each item is somewhat complex and so, I’m only going to go into two of them in this post and will share more next week.
Here are 7 things that can help reduce burnout in the mental health field:
1. Moving Away from a Gate Keeping & Policing Role
There is a finite amount of resources within our health care system. These resources are distributed on an ‘as needed’ basis. There is a sense, at times, that we, as the professionals need to safe guard resources against those who would ‘take advantage’ or ‘misuse them’ in order to protect the resources for those who really need them. While this may be true, over time, we become hypervigilent. We start to feel that our job is, primarily, to root out the manipulators. This is exhausting. We lose sight of the things that drew us into this field in the first place and start to lose faith in humanity.
When everyone is guilty until proven innocent, we may not notice the hostility and skepticism that we project onto clients, sometimes before we’ve even heard their story.
But when clients notice and respond, or react, and we take this as evidence of their bad intentions.
If there are policies which are constantly being violated, and staff are expected to police against these breaches, the wear and tear of policing can take away from the ability to be supportive. Constant breaches in policies are a sign that it is time for a policy review in order to ensure that the system is actually serving everyone.
Changing the approach
Clients know that resources are finite and that this means that they need to advocate for themselves and convince us that their needs are valid. They need to figure out the exact right way to present their concerns and ask for what they need. If this is not their first time through the system, and they have yet to meet success in getting needs met effectively, their level of frustration, their use of “our jargon,” or their ways of asking, might put us off. We may then jump to the conclusion that they are being manipulative, that they are just ‘playing the system’ and that they’re needs are not valid.
But aren’t we all playing the system, to some degree? Some of us get paid to play the game, ‘To refer or not to refer?’ ‘To give some leniency or come down hard?’ We like to think that we make all of our decisions based on policy, but there is SO much more involved. On any given day, my mood that day, how much empathy I feel for someone (based on how much I identify with them), or whether I care, at all, can contribute to the ways in which I might serve a client.
Our decisions rarely affect the rest of our own lives. Our clients, on the other hand, may risk losing even the most basic of needs, such as a safe place to stay, medication, access to other resources, etc., if they lose the game.
If we start with the assumption that people are doing the best they can with what they have, we can let down our guard, and our judgment.
If we can acknowledge the limitations of the system, honestly, to our clients, coaching them on effective self advocacy, then we can get back on the same team. Then we can work together to do our collective best to respond to the real needs with what we have available to us.
2. Remembering and Understanding ‘the Context’
When I am faced with an individual who has a complex mental health history and multiple complex ‘psycho social stressors,’ lots of system involvement, and who continues to present as unwell, I can get easily overwhelmed and frustrated. I want them ‘pull it together’ show up for appointments, take their medication, stop using meth, get away from the abusive relationship, etc. If I’ve seen them before, I might ‘lay into them,’ hoping that my frustration will compel them to do better. All I can see is the person in front of me and I feel at a loss as to how to help. This helplessness might translate into rudeness, on my part, or deciding against giving a particular resource or referral because I feel hopeless that it will help. When all I see is ‘a problem’ in front of me, instead of a person whose journey has led them here, and who, like me, did not earn every card they were dealt, it is easy to get frustrated and write them off. I lose hope.
There has been much written in the last decade about the social determinants of health. I think we sometimes forget the social determinants of mental health. Individuals whose life experience includes involvement in CFS, the justice system, residential schools, homelessness or violence are at the highest risk of experiencing, what we call a mental health crisis, in our country. (See A Good Time to Panic and Borderline Personality Disorder (BPD) – The New Hysteria for more about the context of mental health in context.)
I would argue that a client with complex psychosocial/ and mental health issues may be responding in normal ways to extraordinary life stressors and trauma. In this way, the ‘illness’ is actually in the environment NOT in that person.
For example, in Winnipeg, Indigenous people are WAY over-represented in the mental health system and in the areas of society that contribute negatively to health, due to colonial history and current experiences of ongoing systemic racism. See (Allies, Indigenous Youth Need You Now and How to Reduce Suicides – A Guide for Everyone).
Learning about this history and the current issues, will pull the lens back from the individual who is looking at you right now and provide you the context, the path, and the history which brought them in for services today. (Check out the website www.groundworkforchange.org for more on this).
Knowing the context, (historical, cultural, economic, social) helps the mental health professional to reduce their own feelings of judgment or lack of empathy that they may be projecting onto the individual, and, while it may increase an overall sense of helplessness about the bigger issues, when we can acknowledge the bigger issues, we can get back on the side of the client and together, look at what can be done today, in light of, or, in spite of, this context. (For ways to engage bigger issues check out 9 Mental Health Survival Strategies for the Current Apocalypse).
OF course, everyone has a responsibility for the decisions which they make, but I’ve found, that, assuming that a person is making the best decision they can with the information, tools an abilities that they have at that moment, has increased my empathy substantially. (See 9 Steps to Making Sense of Other People for more on this). When I’ve communicated this perspective to clients, many times, they’ve been able to receive my ‘unconditional positive regard’ and translate it into hope/motivation for themselves and make a new choice. This may not happen if I were to heap my own judgementalism on top of their own self loathing which is already sitting firmly on top of rejection many have experienced throughout their life.
Understanding the client’s context is only half of the work. You also need to understand your own context.
At this time, I are currently employed as a professional and am in a position of power above any one who accesses mental health services. I have the ability to grant or deny specific services. My time is being paid for. I have the ear of my colleagues and superiors in a way that clients do not. I am not homeless. I have education that gives me insight into mental illness in a way that most clients do not. I know what various mental health terminology means which many clients do not, even when these terms are applied to them. I do not have to go home to the client’s situation at the end of my shift. My shift will end (because I’m a social worker, an not a nurse —nurse’s mandated overtime can go ON and ON forever!!). While it is possible that a client may make more money than me, or be physically stronger, or have a position in society which is considered superior to my own based on class and professional biases, at this moment, I am the mental health professional.
Questions to Help you Understand Your Own Context
My position in society, racially, in terms of economic status, gender or sexuality, or historically, means that I have certain bias which influence which clients I see as deserving of certain types of treatment or resources. My job, and yours, is to understand our own bias.’ Here are just a few questions for thought to help uncover hidden biases which can impact the way we give service and the way we feel about those we serve:
- Who are the deserving clients?
- Who are not? Why?
- Who told you that they were, or were not, deserving?
- Are they like you in some way?
- What is it about them, and not others, that make them deserving of time, resources or kindness?
- What presses your buttons the most? What’s the history behind this? What can you learn about yourself through this?
- What beliefs or experience do you have that might be contributing to your strong feelings about this type of behavior or encounter?
- What do you do with your strong feelings?
- How does this translate into your care for clients exhibiting this type of behavior?
- Are there issues to which you have little patience for? What is this about? For me, a lack of resources or a lack of skills to help can result in anger towards a client for throwing something at me that I don’t know what to do with.
- Are there ways to get more skills in these areas so that they are not so taxing for you?
3. Preventing Compassion Fatigue
We all have a job to do. There are often people waiting for services, and management keeping statistics on our efficiency. For the goal oriented of us, we might rush through our questions, trying to get in as many assessments, sessions, visits or intakes as we can. For others, we may have gotten tired of trying to keep up with the never ending line of needs in front of us and just fall back on our rote scripts. When we get to this point, we may find our job boring, at best. Still others, find that in order to cope with the amount of pain and suffering we are exposed to, they need to stop caring all together. “Grow a thicker skin,“ “ Let it role off of your back,” is advice given and often taken. I think there is a better way.
I think that compassion fatigue sometimes happens when we’ve failed to understand empathy.
When we empathize by attempting or being unable to not feel what another human is feeling, we filter their suffering through our own history, personality and sensitivities and can easily be overwhelmed or underwhelmed, depending on the situation. If it’s a situation that would be overwhelming to us, if we were in it, or experiencing it, we might become overwhelmed. If it’s a situation we cannot identify with, or can identify with, but would respond very differently to, we can be underwhelmed and fail to show empathy.
Self-care is the prescription most often given for Compassion Fatigue, and I will talk more about this later, but one way to prevent this from happening is to understand that compassion is an action and not necessarily a feeling. It is not that we do not feel for people, but our task is show compassion.
When a person is suffering, showing compassion means acknowledging their emotions. This is a way of honouring the vulnerability that they have chosen to share with us. Making space for the occasional rant, or off topic rabbit trail is another way of choosing to put the client ahead of our agenda. If we are able to see pain, suffering or distress in another, however it manifests itself, (silence, anger, tears or confusion) and be willing to be with that person, in that space, without judging, trying to fix them, or becoming overwhelmed by their emotions, then the interaction has a chance to be therapeutic and is more likely to contribute to a better outcome for them and a positive interaction for us.
In order for us to be able to be supportive and compassionate to others who are experiencing strong emotions is to make sure that we are caring for an honouring our own emotions. See An Emotionally Conscious Resolution for more about this.
Here are three things that I believe, influence secondary trauma:
- Unresolved issues/history
I’ve found that I am negatively impacted by an interaction, story or event when it touches an area of my own history that is unresolved. When this happens, it means that I have work to do and may need to talk to a counsellor about how to resolve this issues in order to find healing and growth in that area. Once I’ve done this, I will be more likely, in time, to be able to support others in this same area or with these same experiences. Until then, I may need to transfer care in order to avoid doing more harm than good.
- Situations outside of my control
When you receive graphic information about an assault or trauma, which you can not do anything about, the description might cause your adrenalin to flow. When that adrenalin has no where to go, no action by which it can be used, it may continue to circulate for a long time. In these situations, sometimes our brains get stuck, going over and over the description, essentially looking for a way to resolve it, even when we know we can’t. Later, I will take about how to engage with larger issues and issues outside of your current role, in order to reduce the feeling of helplessness we can all be plagued with, at times. But, in the middle of the night when there is no action to take, of any kind, learning to redirect your thinking, calm your body and relax and invaluable tools. Talk to a counsellor if you need help with this.
The other times I find myself “taking a situation or client home with me” so to speak, is when something bad happened which was beyond my control. This may be something that I didn’t have enough information about, or something that happened just out of my reach, i.e. a referral was dropped, the transition to a new service did not go as planned, etc. For me, I need to acknowledge the areas I do not have control over and do some DBT style “radical acceptance.” I may also use this mental energy to determine if there is any systemic, policy or procedural change which might prevent this type of things happening again.
CAUTION: making rules based on one incident will not necessarily prevent that incident from happening again. Always consider context when looking at things that have gone wrong. Humans are involved, they always are and a rule may not resolve everything.
- When I make a mistake, or think I might have make a mistake
Nobody likes to make mistakes. If something bad happens as a result of a mistake, it can be difficult to move past it. Check out 5 Steps to Recovering from Failure for more on ways to recover from these situations.
4. Reducing the Use of Behavior Modification Strategies
We all make many decisions throughout the day about the way we will interact with clients, whether to provide specific resources, information, or referrals. We also decide whether to make exceptions to rules or to ‘go the extra mile for someone.’ While these decisions may be based primarily on policy, they are also based on our level of empathy for that person. Another thing that influences our decision, in my opinion/observations, is an overuse of behaviour modification strategies. I feel that we have forgotten that behaviour modification is only one way of engaging with others and that there are the limitations to this theory/ therapy.
When seek to control client’s behavior through rewards and punishments, instead of interacting with clients as if they are adults who have made the ‘adult’ decision to seek help today, we risk seeing them as incompetent and out to ‘get away’ with something.
Trying to teach another adult a lesson can lead us straight into a power struggle which has a great possibility of zapping our energy and of perpetuating the cycle of coercion. We are attempting to coerce clients and they are attempting to coerce us, instead of everyone working together to solve the issues that brought the client to us in the first place.
For sure we need to set boundaries. We can do this by demonstrating respectful behavior and by inviting respectful behavior. Then we can set limits that are actually needed for the wellbeing and safety of all. We can communicate our rationale, and invite change by doing this.
See “Too many stick and carrots” for more on the limits of Behavioral Modification.
5. Regulating Our Own Emotions
When someone raises their voice, or shows anger in some way, my adrenaline spikes, especially if it is directed at me. I think that this is a pretty natural and important response in order to keep me alert and safe. I find that my biggest task, in these situation is to work at regulating my own emotions. I find that checking in on my own beliefs about the situation, at large, has impact on my ability to regulate myself in the moment. Here are some of the beliefs that have helped me do this:
Making space for anger
I’ve been working on internalizing the concept that anger is not bad. I’m trying to learn to make space for the expression of strong feelings. Anger can be a useful tool and can influence change. For a client, expressing anger might be therapeutic. We can support clients to express anger in respectful ways, but they are not likely to always be able to do this, any more than we can when we are angry. If we react by throwing the client’s own emotions back at them, we cease to be compassionate or therapeutic and simply become overwhelmed by that person’s emotions. Not judging anger as bad can help us to keep perspective.
Understanding that I represent the system to the client, for better or worse
I’ve also been working on not always taking things personally, unless I know that there’s something that I, personally, need to change. I’ve been reminding myself that that, to the client, I am a representative of the system. I can take anger from clients about the system, about ‘ “#$%!# white social workers like you!’ or whatever else gets thrown my way, because I am often their only open door to the system. This doesn’t mean that I don’t expect respect and set boundaries but if I am not passing judgement on their anger or reacting defensively to a person’s frustration with the system, then I have a much better chance of engaging that person in a positive way.
For better or worse, I am the system. We all are. I have the power to come down hard on a client or support them through this time. I need to remember that the system will not fall if one client rails against it, but many clients can fall if a system hits back at them.
Choosing to be a client advocate, not a system advocate
When I can take a client’s feedback and emotion, then I can become an advocate for them, to the system. This does not mean that I always agree with the client or never enforce rules or policies, it means that I remember what my job is, what my priorities are as a mental health worker. I remember my place in the system. I have more access to the system than almost any client. It may feel like more work to take complaints seriously, and, I may be tempted to disregard a complaint if it does not come in exactly the right language or tone of voice, but I need to remember whose side I am on. I can choose to advocate for the client or to give my energy to defending myself and/or the system. I have the opportunity to open my eyes wide and give value, validity and weight to a client’s concerns in order to increase my understanding, compassion and ability to make things better for all of us.
6. Don’t Be a Victim of the System.
When you believe that nothing will change and you have no power to effect change within the system you work, that helpless feeling can impact your own wellbeing and ability to advocate for the clients you serve.
Many of us are working between clients and management, between clients and other professionals, between clients and the system and we often feel caught.
We might do our best to advocate for someone to get their needs met and addressed, only to see them fall through the cracks, further along the line. We may notice a chink in the system that is just out of our reach but affects our ability to do our jobs effectively.
We may encounter superiors or co-workers whose philosophy, work style or personality conflicts with ours so greatly that we find it difficult to do our job.
I know many of us feel like the system is not perfect (when we’re being generous;) and “really screwed” at many other times. We feel like it is hopeless to try and change anything.
But ‘the system’ does not exist without us and, while we may be limited in our influence, we are not helpless.
We need to get proactive on multiple levels.
- We need to vote for people who will support changes to the system that we know are needed.
- We need to find likeminded colleagues who can join us in shifting cultures within our organizations and agencies to support the wellbeing of everyone within.
- We need to hone our conflict resolution skills and practice them with each other, putting aside the lazy, hopeless judgementalism and gossip that feeds negativity and burnout.
- We need to challenge our superiors to invest time and energy into tools and resources which will give us the expertise we need to do our best jobs. Training that is broad enough to reach the actual needs of the actual people we see and not just the workshops with the exact same title as our job title.
- We need to put our values into practice in all areas of our life, finding ways to invest and live them with integrity within and outside of our workplaces.
7. Self Care
This leads to the whole area of self-care. Here 7 strong suggestions:
- STOP TAKING OVERTIME!!! You can live on your salary. You cannot get time back. 40 hours a week is more than enough time to invest in the care of other people’s mental health. It barely gives you enough time to care for your own.
- TAKE YOUR VACATION TIME!!! If you are denied, keep applying. And don’t pick up shifts during this time!!
- Put your relationships ahead of your career.
- Put your health ahead of your career.
- Be your own boss. Work for the things you value, for the things that you care about. Take jobs you want, get out of jobs you don’t. Have your own life plan. The Rat Race Ain’t Made for Humans – Get out in 4 easy 😉 steps and What’s Worth Digging For? Finding your Values.
- See a therapist. Think of it like your workout, massage appointment or spa day. If you don’t do any of those things, check out What do you Really Need? A 6 Step Complete Self-Care Assessment Guide to get started.
- Spend time working on ‘the bigger picture’ this might look like joining a committee, running for office or protesting at some event, but you need to engage with something bigger than your day to day in order to get perspective and not be overwhelmed. (See 9 Mental Health Survival Strategies for the Current Apocalypse).
Our jobs are important. We have the ability to make big changes in the lives of others, but we need to be well in order to do this. We need to take charge of ourselves, our agencies, and our systems in order to do our jobs better. And we need to support each other to do so. So let’s get to work.