Just Surviving

Despite being a reluctant participant in the UK’s wellbeing industry, when I hear the words ‘survive and thrive’ I feel the bile rising up. As someone who works under the title of Surviving Work it’s been a long running and daily process to explain why I’m so quiet about the prospect of thriving.


In my defence I’d like to say that in my experience the people who have a problem with the word ‘surviving’ without ‘thriving’ are generally doing well. Many of them in my experience are paid well and in senior positions. “But Elizabeth, some of us actually ENJOY our work!!!?!”


These are often the same people who spent the mental health awareness week giving possibly the worst advice imaginable in a recession, that the mental health crisis in the UK can be solved by people disclosing their mental health problems.


Deep breath.


I’m reminded of 2014 when I spent a whole year trying to raise money developing a wellbeing at work App called No Punching or Spitting.


I’m trying to say this really calmly now, but I strongly suggest you do not disclose your mental health problems to employers unless a) they are an ethical and progressive employer with a clear anti-discrimination and anti-victimisation mental health policy b) there is a functioning trade union in place c) you absolutely have to. If you can’t tick all three boxes don’t, just don’t.


Another deep breath.


All the statement that someone is ‘surviving and thriving’ says is that some people are happy in work. For now. What it does not say is that any of us can bypass the realities of working life like young gazelles. Seriously, ignorance about mental health at work is not a good strategy.


Added to which it’s pretty rude to downplay the problems that many of us experience with work in the current climate. On a bad day in higher education, just as a completely random example, the insistence that it’s possible to really thrive brings a rage channeling Genghis Khan.


As anyone speaking from a position of actual experience of mental health problems can testify, you’re OK until you’re not.


The other day I was speaking at a mental health event for doctors, presenting my profoundly bleak view of what it takes to survive working in healthcare. Rather than appearing to be a total hypocrite and racing out of the door after my performance I sat through the following session on mindfulness. Tearful testimonies of a breakdown, ‘fun’ pictures on the ol’ power point and a psychological activity attempting to prove with absolute certainty that in order to function at work we just need to do more meditation. Then the ideological punchline. A slide that proves categorically that mindfulness = happiness = going to work = alls well with the world. A massive drain on our collective good will takes place in our attempt to humour a twenty something person who has no concept of how brutal the world of work can actually get.


Tempting as it is to dance on the grave of workplace wellbeing it’s worth knowing how we got ourselves into this mess. I’m now going to lay-in to Layard. See what I did there?


In addition to being the daddy of IAPT, the UK’s largest public mental health service, Richard Layard of London School of Economics fame has laid the foundations for a national drive in wellbeing and ‘happiness’ initiatives in the UK. The specific model of wellbeing that is being used is based on positive psychology, developed by the American psychologist Martin Seligman, which is based on the principles of cognitive behavioural therapy (CBT) promoting ‘positive’ cognitions and behaviours. Within this model, wellbeing is encouraged through positive thinking and behavioural exercises using educational and therapeutic techniques that aim to reduce the symptoms of depression and anxiety and increase levels of optimism.


Note to self. Symptoms not causes.


This wellbeing model has been aggressively promoted in the UK, most recently at an LSE and OECD co-sponsored conference on subjective wellbeing, where Layard provocatively argued in the media that wellbeing, measured on the basis of people’s reported subjective satisfaction levels, is not based on income rather on our relationships and health levels, specifically the absence of mental illness.


Despite the meteoric rise of health inequalities research, including a sickening report  from the Equality Trust that the richest 1000 people in the UK have wealth equivalent to 40% of the population, apparently money doesn’t matter.


From an employment relations perspective, workplace wellbeing programmes are often viewed with some scepticism partly because they depoliticise the issues facing workers. Trade unions have been highly critical of ‘resilience’ agendas precisely because of the emphasis on individual cognitions and behaviours which under-emphasises external factors such as working conditions or, in lay terms, crap jobs.


It’s also pretty slippery to pretend that the growth in the wellbeing sector hasn’t happened during a period of profound welfare reform and austerity. Despite the powerfully obvious and painful failures of Universal Credit, Employment and Support Allowance reform and the use of sanctions, this combination of wellbeing and work remains central to government policy.


If you’re voting in the next election, you might want to re-read that paragraph.


This compulsion to wellbeing is a particularly painful issue for health workers. Research into the health of health workers is a source of great contention and more than a degree of irony. A 2015 survey of senior hospital doctors showed that 80% are considering early retirement and a Mind research report in 2016 said that 88% of primary care workers find work stressful with 21% developing mental health problems. Even more chilling is the reality that along with the UK population, most health workers are taking medication to deal with this.


As a result, state funded positive thinking provokes a deeply cynical response from clinicians when there are attempts to build their collective ‘resilience’ through training designed to bolster their toughness, including the ability to ‘bounce back’ from adversity. As 74% of GPs say their workload is unmanageable the current suggestion that they might want to lay off the vino and go to Zumba may be met with some hostility.



The main objective of my book is to present my best shot at giving you some useful ideas about how to survive work in healthcare. If you do not have time to read this book I can summarise for you everything I know so far:
Don’t blame yourself: understand the social, political and economic factors that make your work what it is
Don’t keep calm and carry on: find a way to actually feel what you feel about that – from anger to the need to punch and spit, feel it and find ways to express it that will not end up with you losing your job
Don’t be brilliant: resist the temptation to be a superhero and single handedly overcome the systemic failure of welfare capitalism. Try to be an ordinary person.
Don’t go it alone: just stop fighting the obvious that you have to get on with the people you work with enough to talk to each other and where possible collectivise around what is important at work



Yup, wellbeing at work rests on taking a political position. Time to dig deep and become healthcare citizens, not just clinicians.



Surviving Work in Healthcare: Helpful stuff for people on the frontline has been published by Routledge. Click here quoting code SUR230 to buy a copy for £17.50.

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