The Power of Professional Witnessing and Peer Support Against Stigma and Organisational Denial
On 20th September I co-facilitated a workshop for the Division of Clinical Psychology South East Coast Branch, with Amra Rao, consultant clinical psychologist, Chair of the Faculty of Leadership and Management and Lead for the annual Staff Wellbeing survey in the psychological professions. The name of the workshop was "Taking Responsibility for Valuing and Supporting Psychologists' Wellbeing and Lived Experience of Mental Health Difficulties". I brought my lived experience of breaking down in service, what I've learned about the common humanity of vulnerabilty in the helping professions, how we work with ours and others' vulnerability in services, and what can happen to vulnerability in organisations.
The workshop aimed to encourage thinking about what we might do in our localities to support and value lived experience, but it became so much more because some attendees brought their lived experience, and because we had decided to use a group reflection format. What was revealed, as well as thoughts of 'what next', was something of a reparative intervention that I think needs to be held in mind going forward.
A reparative intervention? The workshop became a witnessing circle for those of us who have been in pain in organisations, because some felt ready and able to bring their experiences. I was so moved when I heard of the difficulty others had had navigating their organisations when struggling, particularly when one of the stories had begun with a staff member giving feedback to an organisation about what was not ethically workable in their service, which then got reframed by the same organisation as a questioning of that staff member's capacity to work, and non-choice referrals to occupational health. Put these together with other stories where peoples' exits and re-entries at work after mental health leave have been unnecessarily fraught with stigma, and we begin to see the human fallout of poor organisational capacity to support normal vulnerability, because it does't look at it's own attitudes and practices. A possible reframe here, is that these individual stories of poorly met vulnerability are a marker of organisations that are less fit to service. And as for valuing the insights that lived experience of mental health difficulties can give - the personal transformations and knowledge of hope and change, and also the investigative insights on the subject from going through services, that can help the integral design of mental health services - forget getting that far! Yet in this group, we began to understand and talk about this, and by both sharing and witnessing, we kicked stigma out of the room through understanding.
Why should services resource around the mental health of it's staff anyway? Because the energies of those working with vulnerability (psychologists, therapists, doctors, occupational therapists, nurses and so forth) are inherently bound up with the energies of those seeking help, the helper - helpee (whoever we are at any time) caring relationship is a symbiotic one where we respond and move through different phases of containment need over the course of any acute and recovery journey, this is the normal emotional labour of the work and what is so rewarding. In order for services to work well, the service must look after the energies of both parties equally, so that both are enabled to flourish. When the focus is on resources for the client only, there is an assumption of the invulnerability of the provider (which increases the stigma of any breakdown), and little attention or care paid to one half of a whole process. We hear much about the importance of the 'patient journey' and tracking that to ensure that it is as seamless and as resourced as it can be, but who is looking on the inside?
The stories I witness here at in2gr8, and through others who may not be members but speak to me, tell me that it is an area of great neglect not 'got at' through staff wellbeing policies. It seems as if there is no ground up exploration of the 'insider patient journey' and we are just beginning to understand how difficult it is, as a provider, to say we need help, because of the stigma of mental health problems, but also because we have to shatter an illusion of invulnerability, of being the 'perfect provider'. It is services which need to provide constantly, but the humans who work within those services need to be able to flex through that service provision with the impact of personal life challeneges. The solution is a flexible system of working that needs to be provided at an organisational level, which does not judge when many of us hit mental health problems, as we know humans often do throughout the life course.
How does it feel to be a member of staff with mental health problems facing organisational processes and attitudes? Like David and Goliath. I fear if these staff voices aren't heard, less enlightened organisations will be allowed to carry on as they are, attacking vulnerability by denying it, by neglecting to listen to it, and worse, if it is organisational processes and attitdes that are lacking, they will make the overworked staff member feel it is they who are incompetent rather than vice versa. Getting to a point where voicing is possible requires safe passage, via compassionate reflective groups supported by the professions, as Friday's workshop became, via anonymised blogs like the #MyShare ones at in2gr8, and perhaps via formal published research that has power because it meets the establishment where it says it likes to stand, on evidence-based journals.
What was powerful on Friday, was not just that those of us who have hurt in organisations were joined by our peers who had experienced the same, but that we were cared for in a circle of others in our profession. Remembering this brings tears to my eyes. We were listened to compassionately, and what we had to say was held as important and for ongoing work. There was hope and a sense of advocacy. This is an extension from the initial idea of the individual peer in2gr8 groups of the early days, that didn't take off because we were so spread around the UK, too scared, or using precious energy fighting our corners locally. It has always been my wish to integrate these conversations into the various establishment institutions where it belongs - training courses, NHS Trusts and professional bodies.
Yes peer groups are important, but witnessing is too. I would like us to hold onto the following as important when thinking about the staff lived experience agenda of the future:
1. Peers being able to join with other peers who have experienced being in mental distress in mental health work, whether the causal formulation would look like pain triggered from outside of work, or from pain within it.
2. Opportunities for safe witnessing of these stories by colleagues in our own professions, held as confidential, experienced as validating, important and therefore reparative. Leading to actions to make things better at all touch points of a staff member's journey: with supervisor, manager, occupational health and mental health strategy feedback under the charge of directors.
3. Supported ways to get these stories into the world 'out there'. The in2gr8 blog can easily be ignored as a rookie venture by me, and denigrated, it's not enough unfortunately. Formal routes to publishing stories would be brave but important. The mental health professions need to think about their stance on challenging individualisation, and organisational ills, in such an emotive, narrative way.
Despite being a co-facilitator on Friday, I was also a recipient of an intervention because of the joining and witnessing that happened. Sometimes I feel quite alone in this work, as my peers in this are dealing with their pain in their locality as best they can, usually also feeling alone and isolated. Keeping voices fragmented is a useful way of witholding their power. During quieter times I can question my stance, but I know from experience, and from psychological training, that thats when I'm getting pulled into powerful organisational denial and silence which would prefer to alienate these narratives of vulnerability. Its the David and Goliath feeling, or the "Oh, there are staff wellbing policies everywhere, its obviously fine now, I must be wrong". I've learned to wait patiently until the next peer emails me with their story or joins in2gr8, or the next talk when people share or approach me afterwards because they are still too understandably scared to talk, and then I'm reminded that it's definitely not ok yet. It is not good enough. After Friday, I had a shot of validation again. I've learned that speaking about vulnerability is a slippery mission, organisations don't like it and you have to work hard to stay with it, yet we must all keep it on our agenda as best we can.
Keep going. I can because I know my rest points, know yours.