starting where we are

Talking about working in mental health is not as easy as it sounds. Despite being of the dialogic persuasion many people working in mental health are reluctant to raise concerns about wages, progression and the downgrading of therapeutic services.



Despite the crisis in mental health being openly discussed, it appears that the people delivering those services are not talking to each other about how this public crisis might also be becoming a deeply personal one.



Nobody knows how many people work in the UK’s mental health services or the conditions under which they work. This year’s Mental Health Taskforce report bleakly reported that the data on who and how we work in mental health is not known.



Depressing pockets of data have surfaced. That 50% of us are depressed and that 64% of us don’t think that the therapy we offer is intensive enough to do any good. The ‘pervasive culture of fear’ within the NHS compounds this lack of information about mental health systems into a disorienting sense of impending catastrophe.



The job of containment becomes harder to do when we’re exposed to precarious working conditions – the stuff of monsters under the professional bed setting us up for a sectoral panic attack. People, when did we become so scared?

The Surviving Work Survey was set up 3 months ago to find out what is happening with work in mental health. The first phase involves an anonymous online survey for anyone working in mental health – and we’re now starting to carry out follow up interviews to look more closely at people’s experiences of working life and how it affects our own states of mind.



This is what we have found so far.

We’re not earning enough
The top issue for survey participants so far is how to earn a crust. Wages and the lack of a secure income was the number one issue of concern. 40% are working part time and 25% earn money from outside of mental health. 14% work unwaged as honoraries with an average loss of income at £200 per week. The vast majority estimated that 10% of their working hours were unpaid.


Precarious work is growing
A second tier of workers is developing rapidly in mental health. This includes the Psychological Wellbeing Practitioners who provide the main bulk of IAPT services, the hundreds of honoraries working for free in the NHS, the people manning the mental health call centres, the clinicians carrying out disability welfare assessments and the ones working in social care and support services who have been unable to secure clinical jobs.


The use of honoraries and unwaged labour to deliver NHS services, including IAPT, is widespread. Despite their fears of blacklisting the group most willing to be interviewed were IAPT workers – perhaps exposing the lack of opportunity this group has to talk about their working lives.


There is a growing number of people working for Private Employment Agencies – but only one respondent was willing to have an anonymous follow up interview. Respondents were extremely nervous about naming their private employers despite the survey being completely anonymous.


Many people said that the one thing that would improve their working life would be to retire.


What happened to teamworking?
Ours is not a sector which appears not to be well managed. Everyone reported problems of unmanageable case loads and work intensification. Compounded by staff shortage and short term contracts, the vast majority of people said that they were not functioning within their teams.


Many people reported that the NHS obsession with cuts, targets and unrealistic caseloads really forced us into a command and control system. Do it now rather than “what can we realistically do?”
Concerns aren’t being raised for fear of victimisation. Only 4% have raised concerns about patient safety – this goes up to 47% raising concerns about working conditions and wages.


We had only two reported cases of management responding to these concerns. Something is very wrong with our lack of capacity to negotiate changes in the way that we work with patients.



Start where we are
Despite the emphasis on relationships and group dynamics within our tradition there is very little evidence that we’re able to find a way of working collaboratively within our teams. At best we’re working without a real understanding of our sector at worst feeding what Sally Weintrobe calls Noahs-Arkism – a split between the growing number of precarious workers and the shrinking number of directly employed, permanent clinicians.



In our psychoanalytically-minded society there is a growing split between the established and the disestablished – we see it every day in our services but we now need to allow ourselves to see it in our profession.



If we can start where we actually are, rather than where we’d like to be, we stand a chance of talking honestly with each other about the future of our profession. At some point we have to organise and speak about what is going on in our professional minds. This cannot be done blindly or alone. A kind of professional first aid – where caring for our patients is based on a care for ourselves and the people we work with. At some point this will mean negotiating wages and challenging targets, something that a fragmented and isolated bunch of workers cannot do.



To do this, we need to go back to our roots. To start realistically, to talk, and stand up to the internal and external voices that say we can’t change. To contain the anxieties that are flooding our consulting rooms, and take some time to think about how we work. We have been humbled by the care and concern respondents have shown to mental health services where how we manage work is both a professional and personal issue of ethics of care. But can we really care for others when we care so little about each other?

If you work in mental health – particularly if you work for IAPT, a private contractor or a private employment agency or are working in an NHS service for free – help us map what’s happening in our sector by completing our anonymous Surviving Work Survey at



A version of this article will be produced in the Spring Edition of the BPC’s New Associations



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