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