Getting Granular

How out of date everything feels today. The notion that life is a big leveller, that normalcy will return through heroics and self-sacrifice  feels almost sentimental. A time when we could pretend that we all lived in the same universe. 

Every social commentary about Coronavirus is referencing, even by omission, what crisis makes visible. The parallel universes of profound and long held inequalities and prejudices that determine which bodies are worth protecting. 

That’s no longer a radical thing to say as the figures on the disproportionate number of BAME healthcare staff who have died of Coronavirus show. Yes, it’s been reported by the BMA but not picked up, more black people are dying on the frontline than white people. I received an email from a reader yesterday.

” I write this email with tears rolling down my face.  There are so many people of colour working for the NHS saving lives on a daily basis.

So why do the media  not want to promote  people of colour saving lives during this pandemic on there TV ads.

Local TV Live is running a TV commercial thanking the NHS they show different hospitals all over the UK  with different staff members from each hospital,  however there is not one single person of colour being shown on the commercial.

My family work for the NHS  and have done so for  many years. A family member at  the moment is nursing at 3 different hospitals he also volunteers  at a Cancer hospital and works with bereavement.

And on the  media  TV commercial not one black nurse or doctor is on the commercial, like they do not exist.”

This makes it easier to get granular about what this crisis looks like from the well referenced ‘frontline’. Youth services have stated that it’s game over, and recognise this is the key opportunity for the government to finally close down the sector. Immigration controls have been quietly escalated. Youtube versions of sub-clinical interventions as a substitute for public services. Promoted by a tribe of chirpy folk and people who have secure housing plus gardens and a desire to return to ‘normal’.

We still live in a society where 10% of nurses have used food banks. Doesn’t matter how many bunches of flowers we buy them this week, we’ve got to do something about how much they are paid if we still want a social service. Our only hope is that after this crisis is over we don’t slink back into the comfort of our past bad habits where the official narrative about angels and mythological creatures is used to body block the possibility of articulating another version of reality where some bodies are less valued than others. 

Last week an NHS frontline staff mental health hotline was announced, manned by unwaged volunteers. I had a quiet sob about the way in which mental health is treated with such disdain. The attempts to downgrade, industrialise, to digitalise mental health services and the people working in it. To hold the client responsible for their own care through positive-thinking-self-guided-exercises-videos-of-grass-&-mindful-birds completely unchallenged. Actually it’s welcomed as a radical progressive offering, rather than something both politically and clinically dodgy. 

And that is the granular state we’re in.

The reality is that there’s nothing heroic emerging in the mental health world right now. The usual institutional and corporate suspects are living the dream – pushing through neurolinguistically programmed policy shifts to cut out paid and qualified clinicians to do the messy business of relating and consistent care and replacing with short term manualised treatment that punishes everyone involved in the therapeutic relationship for being, well, human. They can do it now because at the end of all this there will be very little public service left, and not many employed securely enough to defend it. 

Just as the crisis kicked in, therapists and counsellors started contacting PCP members about the dramatic closure of mental health services across the UK. Here is an extract of an email I received from a senior psychotherapist in the NHS. 

“I received an e-mail last Monday 23rd March 2020 that directed us to stop all therapy by the end of the week with patients who were not red on the “RAG rating scale”, red meaning people who were at risk of killing themselves. The word “pause” was used to describe the stopping of therapy. We were to offer monthly “check-in” calls instead. All referrals to psychological therapies were to be stopped. This directive was given in the honourable act of redeploying us to help colleagues in community mental health teams. 

To speak up and question this decision feels as if it would be tantamount to treason and, when something cannot be spoken, I start to get interested in what is going on. 

This does not seem to make sense in terms of how it will affect the functioning of the organisation, the impingement on our patients and the disorientating impact on staff. I am thinking ruptured attachments and trauma. Surely bottle-necking all the patients in crisis services, including our own patients, is counter-productive. Surely if we are to have a hope of recovering from this crisis the flow of people into psychotherapy needs to continue; perhaps in a different way. Surely not allowing us to practice what we are good at is a false economy. Surely taking away all familiar structures for patients and staff will lead to more trauma not less. The amount of bureaucratic and administrative work that this change in service delivery is generating in itself needs to be questioned. 

I am aware that this is the direction of travel for two other Trusts but who are currently being less draconian in its implementation. I am interested to know what is happening in other Trusts. Are you hearing from others around the country?” 

If you genuinely think that mental health workers deserve some credit please don’t stop them telling us what is going on around them or having a few thoughts about that.

Part of the heritage of Coronavirus will be whether we take this moment to radically re-evaluate the way that healthcare staff are paid, treated and supported. Rather than reverting to an already tried-and-failed model of austerity can we imagine a way of building up from what we have just lost? 

In the current workforce context it is a form of sadism to demand compassion from people working under the low-wage-un-wage gig economy workforce strategy that is in place.  Nothing wrong with clapping and thank-you’s, but to then blackmail some bodies into a position of self-sacrifice is a form of cruelty, and will be the determining stuff of what happens next when this virus is done. It’s difficult to imagine that after all of this health workers will be prepared to go back to being treated as if they are worthless.

Nothing about working life will be the same again so the only thing we can do is prepare a future for everybody, not just somebodies. To choose to be on the right side of history. 

In mental health this is going to take an uncharacteristic turn towards working collectively to negotiate a way through. To help us do this Partners for Counselling and Psychotherapy is running our final mental health workforce survey to get a picture of what is likely to lie ahead. The survey asks mental health workers to tell us about service closure, redeployment, furloughs, unwaged and insecure work and where you think this will leave us. In  a months time PCP will publish the results and engage in a debate about the future of therapy across the sector.

To access the Coronavirus Crisis Survey in Mental Health go here  

or send this link to anyone you know working in mental health

Last week we launched a survey about Employment Assistance Programmes  and one about self-employment   and the impact on the 30% of people working in mental health who work insecurely in the system. Both surveys are still open for another three weeks so if you’re working for an EAP click here    or a self-employed worker let us know your experience here.

To get resources on how to survive working in mental health go to The Therapist Hub on the Partnership for Counselling and Psychotherapy here.

In the meantime Surviving Work is going to find a tree and sit under it for a while. A bonfire and a bit of primal screaming will be involved to clear the space for a new workplace reality and pause for thought on what it will take to survive it. 

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