Being Managed

There’s nothing like the satisfaction of being completely right in the face of a complete wrong so I’ll admit I was a bit disappointed that only 57% of IAPT workers we surveyed didn’t think their service was well managed. Honestly, I was surprised at how generous our 650 respondents were about the realities of managing mental health services. The recent Senior Management Survey carried out in Higher Education reported a number of universities where 100% of their staff rated their senior managers as inadequate, with a maximum of 38% saying they were doing OK. Since HE and healthcare are subject to the same crushing consequences of institutional failure it got me thinking about why it is that so many frontline workers were able to see the mental health crisis from a management perspective.

In a way it’s comforting to know that a bunch of professionals who try to work through projections and splitting the world into good and bad resisted the urge to slate the gaffers behind a mental health service in crisis. Black and white thinking although immensely satisfying in the organisational playground is ultimately only for those driven by instant gratification, of whom there appear to be mercifully few working in mental health. 

Even in a simple survey like this, complexity in the employment relationship comes spilling out. Many of the people who responded to our survey were managers but that didn’t lead to a paternalistic pat on the back. It’s a striking feature of mental health workers that even the ‘successful’ class feel like failures. No chorus of j’accuse on either side. 

There is a profound ambiguity in the profession when it comes to the question who is responsible for the mess we’re in? As you would hope from a group of grown up people, there’s a level of really welcome reflection and understanding shown towards managers often squeezed between politically set targets and front line fatigue. But there’s also the presence of the over-rated stuff of self-sacrifice which dominates the profession. And here’s where we seal our own fate - the problem with professional heroics is that they can easily slip into masochism and a collective letting-off-the-hook of the people paid to manage services. An omnipotent trap where the failings of the system become personal failings, if I just work harder I can make it/you better. Tragically untrue, tragically limiting to finding a collective response to the crisis and just tragic for the professional casualties that are increasingly evident in mental health. 

I think this has a lot to do with the fact that the majority of people working in mental health are women with a disproportionate number of male managers. Women are generally nice as a matter of survival and that means we make it too easy for managers to underestimate the anger and frustration we experience. For that we’ve got to do the embarrassing and painful work of learning to get red-faced-and-sweaty at department meetings and supervisions. For that we have to change our comfortable martyrdom and punch and spit our way into change. 

The quotes in our second infographic about management in IAPT are striking because they recognise systemic pressures and an acknowledgement that an old school, unreformed hardened bruiser is often a real asset to a team’s survival. To take one for the team when it comes to targets and performance data. 

But within this there is also the realisation for some that understanding can be used to block change in the UK’s largest mental health service. It can deaden our anger and seduce us into giving in to the line about no funding or pressures from above that gets wheeled out when we complain. It allows us to evade our responsibility for reclaiming our agency. 

The slow political and consciousness raising process that is underway in mental health is nudging us in the direction of doing not talking, and using our precious time and energy to be part of the alternative that is emerging.

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.

To download your Pdf of Management in IAPT click here.