Surviving Self-pity

Here are the responses we had to our survey of 650 people working in the UK’s largest mental health programme Increased Access to Psychological Therapies (IAPT) to the question have you experienced burnout, depression or anxiety as a result of working in the service. 

To download this infographic click on the image above
To download this infographic click on the image above

In these bleak times the fact that 70% of mental health workers reported burnout and 68% experience depression/anxiety is no longer sufficient to raise even a compassionate eyebrow.

We have been saturated with testimonies of wounded healers, and poor mental health in the caring professions. Far short of the promises of a decade of time-to-talk, turns out that when it comes to the mental health of mental health workers we are in the epoch of don’t-give-a-shit. 

Sorry, that’s blunt – but for those of us in the business of researching social issues the common denominator is that while we’re not short of facts, we’re very very short of impact. As the recent RCN report about equal pay in nursing shows, presenting actual facts is at best met with an awkward silence, at worst a how-very-dare-you. 

As Covid-19 exposes, inequalities appear to have no societal importance whatsoever. Vulnerability and the absence of safe services for 20% of our society is totally acceptable. 

If pain was the basis of political traction we could have addressed the current mental health crisis in a matter of months.

So here’s where the data from our IAPT survey gets really baffling. Alongside the mental health data, was the statistic that 69% of IAPT workers said they were delivering good care in their service. Although nobody here said that they felt that the IAPT service was adequate, many people said that they did their best to provide good care. 

To download this infographic click on this image

The combination of 69% feeling they are providing good care and the highest rates of burnout I’ve ever seen in a professional group apart from mercenaries and racing drivers, is something I’ve been trying to figure out over the last few months. 

During this period I’ve been working with a group of senior public sector managers. Tucked away behind the language of leadership and management we ended up nose-to-nose with systemic failure and a discussion about why so many public sector workers are unwilling to face up to this reality. 

One of the participants working in mental health described a training session for CAMHS workers – usual stuff of new safeguarding manuals and an online filing system delivered a la jazz hands. Using an online app so that participants could type on their phone their input into the discussions, streams of consciousness anonymously appeared on a screen. In answer to the question (brace yourself) ‘taking the perspective of service users, what would they say about you?’ secure in the knowledge that there were no actual service users in the room, comments come flooding in. As you might expect from the replacement of co-production with co-option the feedback was ‘optimistic’. From “I felt really cared for” to “Sessions were on time and ended quickly” a fairy story version of lived experience rolled down the screen. 

Bearing in mind these were massively over-qualified and experienced clinicians at this event, why all this positivity? After some resistance to challenging the ‘nice’ training, we asked ourselves what could have been going on and explored the role of metrics and performance management data in distorting what it is that people are actually doing. The care, the attempt to support, the good job despite the horrors of the system within which they work. Maybe the back slapping on the screen is the feedback that got missed in all those tick boxes?

Although I don’t underestimate the power of denial in keeping the IAPT show on the road, I felt genuine tenderness towards the people typing away on their phones what they wanted to hear. Like sending yourself a Valentine’s card, just because you didn’t get one doesn’t mean you’re not lovable. And I guess the same can be said of most public service workers, just because nobody shows appreciation for your work, doesn’t mean you’re not doing a good job. 

I heard the journalist Dorothy Byrne on the radio the other day describe self-pity as an essential survival skill. To show yourself with real feeling some appreciation when you’re in a system that doesn’t value you. The realisation that the system doesn’t care about us is at the heart of the 68/71 split and the deep feelings of un-love and anger that knowing this stirs up. 

If you think that’s a bit far fetched I’m going to give you a response to a Guardian journalist from a health worker to the proposal that retired nurses should come back into the NHS during a state of emergency. “I would rather shove a rusty six-inch nail up my backside.” 

The requirement to distinguish your work from that of the system you work within is a survival skill for most of us working in the public service. Nothing new in that. But this split between our duty of care to our patients and our duty of care to ourselves is the reason why so many of us get split off from what we should be feeling, not self-pity but rage. The absorption of the anger that people feel from being forced to work within an IAPT model gets internalised and becomes our depression. And for people in the business of therapy, understanding this should not be a stretch. 

Therapy almost inevitably ends up with the painful task of acknowledging and owning our anger. It took me a decade of therapeutic slog to be able to articulate how angry I am about some things, and not expect the walls to cave in so believe me when I say that I don’t underestimate how hard this is to do. But we shouldn’t underestimate the importance of the task because when mental health workers can’t bear to feel anger about the abuse of their service they are at risk of a political blindness that denies them the possibility of resistance and change. 

The demand made on us to keep calm and carry on is not an attempt to protect us, it’s a way of controlling us.

Some events coming up

People Not Pathology: Humanising Counselling & Psychotherapy is holding the next big debate in Birmingham 2-3 May. No keynotes, no big names just us talking about the future of services. Book your tickets here

Breaking or Making of Professional Bonds in Psychoanalysis: College of Psychoanalysts, Institute of Education Room 731 5th June 6-8pm. Book your tickets here.

National Counsellors Day, 20th June 2020 London. An event organised by Counsellors Together UK, to book click here

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