Why we need to reimagine frontline work to change burnout culture

[Music]

helping people tell their stories is at

the core of what i do

as a psychologist today i’m going to

start

by telling you a story adam was the type

of person that people found really easy

to talk to

he was that guy in school who knew

instinctively how to be empathetic and

support people in need

he naturally followed a pathway into

helping profession

and trained to be a mental health social

worker

in his first week on the ward he was all

full of energy

he was excited he couldn’t wait to use

his skills in connecting with people

eden was the one who sat for hours with

femi when he first arrived on the ward

scared and confused it was adam’s kind

presence

and big smile that helped femi feel seen

and cared for

weeks into the job and adam starts to

notice the traits of his colleagues

his manager never takes time off and

always works long hours

although she tells adam to go home on

time her behavior gives the message that

to succeed

he needs to be willing to give more of

himself to the work

his colleagues never take lunch and are

always complaining about how

overworked they are and he’s saddened

as he sees many of them working from a

place of disconnection

and the insensitive ways that they talk

about and treat the people on the ward

he worries that one day he may have to

become so disconnected himself

time goes on and he’s starting to feel

the pressure he’s getting less sleep

constantly

rushing from appointment to appointment

never feeling that he has enough time to

exercise the very skills that got him

into the work

it starts to have an impact on him he’s

taking time off work

for ill health and chronic stress and

eventually

he feels he has to leave his job

stories like adam they may be familiar

to many of you

in fact they’ve become so familiar that

in many lines of work

they’re expected i recognize much of my

own experience

in adam’s story in fact in the early

stages of my career

i also found myself in an impatient ward

often i’d returned to my office in tears

i was deeply affected by the ways that i

saw

my colleagues working from a place of

disconnection

many of the people on the ward had had

extreme life circumstances

or had experienced childhood trauma and

it hurt to see

how they were cruelly they were talked

about and treated

i spent the last 10 years of my career

asking myself the question

why why do good people

who can be so humane to each other and

to their families

end up treating people who are

vulnerable as if they are products

rather than people

i’ve come to the belief that one of the

many reasons are due to the things that

cause and maintain

burnout culture there are decades of

studies of so-called burnout

but what so many of these studies do is

individualize the issue of burnout

they make it into a phenomena that

happens to one match at a time

and the solutions are focused at one

individual at time

there’s this idea that all we have to do

is get workers to look after themselves

be more boundaried

you know just don’t work so hard but you

can’t solve this issue one individual at

a time

it’s like putting out a single match

when really you’re standing in a forest

fire

this culture is in all of our frontline

services and it’s going to take all of

us to change it

social workers like adam are likely to

burn out within eight years

91 of social workers report high to

moderate levels of emotional exhaustion

any statistics focus on social work but

the same could be said in many other

forms of work with marginalized people

in my professional psychology for

example

in medicine care work activism community

work teaching

the list goes on many of these issues

are central to our understanding of what

it means to help

there’s this unwritten understanding

that it’s just a part of the job

there’s this idea that those who give

support are full cups and need to empty

all of their resource into the empty

cups of the needy

it’s an old model of care that has some

of its roots in

charity and colonial missionary work in

those models

there were those who went to help the

needy they went from a place of moral

superiority

and they had an urgent and righteous

mission to change the circumstances

of those that were seen as less than in

our modern iteration of these models

people can work tirelessly for those in

need

not only is this model unsustainable

it’s a model that both harms those who

are expected to give unending resource

and those who are dehumanized in the

assumption that they’re empty of

resource

our tendency to ignore our own needs

it shows up in many other areas of our

life it actually makes me think about

the profound messaging

on the standard safety procedure of a

flight we often miss it

distracted by our fear or

excitement about the flight ahead but

it’s a deeply profound idea

that in the event of emergency we need

to make sure that we put on our own

oxygen mask first

before putting anybody else’s on it say

something about an element of human

nature

that we sometimes forget ourselves when

faced with somebody in need

when i hear these safety announcements i

think to myself yeah

it makes sense but i can’t say how easy

i would find it

flying with my daughter and faced with

an emergency situation

i hope that i’ll remember to put on my

own mask

that by putting my mask on i can more

likely ensure both of our lives

our images of the heroic form around the

idea of people who sacrifice their needs

for the good of another

we use the terminology a frontline

worker

it comes from military language and it’s

like we have this expectation that

workers are in combat and needs to be

willing to put their

lives on the line for others of course

there are those

who don’t try to avoid burnout basically

and they ignore how they feel and they

disconnect from the work

you know it’s just a job after all but i

believe that this disconnection harms

even the most dedicated and empathetic

practitioner may find at times

that they need to approach their work

from a more objective and distant

position

often working with people who are full

of emotion and pain

we feel like we have to be a bit more

distant from them

sometimes we’re exhausted and we feel

like we need to disconnect from our

bodies

sometimes we just don’t feel like we

have the resource to be deeply present

with the people that we’re working with

but i believe that this disconnection

harms everyone involved

it’s from this disconnection that it

becomes easier for us to dehumanize each

other

some of what i’m saying it might be hard

to hear

there may be some of you who are saying

well yeah but not me

not my job not my work i can’t i get it

i’ve had those conversations myself

no one of us is the source of the

problem

and no one has got all the answers but i

do believe if we’re ever going to change

burnout culture

we need to be willing to fully confront

it

i’m not saying there’s never any place

for heroics in the form of sacrifice for

the needs enough of another

but the difference is that for many

front run workers those cons

those sacrifices are constant it’s not

just about jumping in front of a bus at

one time to save somebody

people can get stuck working longer

hours every day

constantly working even when they’re

unwell themselves

this form of heroic that is chronic and

inflexible it’s deadly for the hero

we’ve seen in the cover pandemic the

terrible consequences of the failure to

provide protective equipment

for those who work to save the lives of

so many

even when faced with urgent situations

people are not supported and given the

structures that they need

many of the health professions and

allied services were already

overstretched and heavily impacted by

burnout culture

in covid we see such an example of how

our models of care

fail to take care of the people that

care and the consequences

they’re terrible for all of us

we’ve also seen in covid an example of

just how

interconnected we are when one person in

the world becomes sick

we’re all affected

any gaps in our public health services

can have tragic

global effects

returning to adam’s story some of you

are listening to his story

might imagine that the reason he became

so exhausted

and eventually had to leave his job was

due to the behaviors of his colleagues

and his manager but it’s not really

about them it’s about an institutional

system that runs from a model of deficit

for example femi adam supported his

discharge out of the hospital but he

went home to an unstable housing

situation

he became homeless which increased the

likelihood that he’s likely to be

admitted to hospital again it’s these

multiple systems that fail to meet the

basic needs of the people that we work

with

not enough housing and few forms of

employment that are really responsive to

those with mental health needs

for me the problem has never really been

the people i work with or the pain

they’ve been in

for me it’s been witnessing the

marginalization inequality and

oppression on the lives of so many

i’ve been exhausted by that feeling i’m

trying to fill a bucket size cup with a

teaspoon

while other systems keep punching holes

in the bottom

so what do we do about it there’s no

easy neat step-by-step answers to how we

resolve this issue

but one of the ways that we can all

change is by altering our perception of

what it means to give help

we need to deeply dissolve the boundary

between those who help and those who are

helped

one of the best kept secrets about my

job is that actually

it’s a give and take relationship it’s

not that you get the

satisfaction of helping people in need

i’ve learned so much from the many

people i’ve had the pleasure of working

with

their wisdom bravery and inventiveness

have taught me so much about human

nature

about my own nature i’ve learned about

other knowledge systems

that medicine science and psychology

don’t have all the answers

and each of the people i’ve worked with

has an expertise of experience

and skills and knowledge that are as

deep and as significant as my own

we need to acknowledge that the boundary

between helper and health is actually

fluid and temporary

i’ve seen just how fluid and temporary

that boundary can be

in my own life moving from the position

of supporter

to someone who needed support through

extreme fatigue and chronic pain

i had to find the grace to ask for help

and receive it

i had to learn that my worth was more

than what i could do

and i was fortunate i saw my intrinsic

worth mirrored back to me by the

community around me

my experience of disability illness and

health

have given me a deep insight into one of

the fundamental truths

that human beings are a profoundly

interdependent species

we need each other no cup is full

and no cup is empty

one of the core messages of this talk

has been about disconnection

and how it can harm the people that we

work with

i believe we really need to look at this

connection

and to address it we need to be willing

to be vulnerable

we need to be willing to ask ourselves

difficult questions

we need to be willing to give ourselves

honest answers

why do we disconnect

why do we ignore our own needs and how

can we be more present

we really need to start reimagining what

it means to be a hero

heroes ask for help when they need it

heroes fight for more just systems that

fully resource

those who need support heroes take time

off

heroes prioritize rest healing and

resourcing themselves

heroes don’t have to strive alone but

are surrounded by communities that value

them

and the work they do there are heroics

in both giving

and receiving care in our moments of

need of vulnerability

it takes courage to truly receive care

we all need that courage if we’re ever

going to imagine that anything else is

possible

and to truly reimagine what it means to

give and receive

health and care