What are the effects on those of us who are trying to maintain good practice? Recently I decided to keep a diary of the 'petty' things which have lead to a feeling of being under stress. Workers used to talk about stress causing 'burnout' but there is no simple causal link between organisational problems and stress. Fruggeri and McNamee's critique of these concepts is immensely useful in questioning this thinking.
Social workers have never had a good press.(What's the difference between a social worker and a Rotweiler? - The Rotweiler lets go of your child first). However, the public, who according to a recent radio 4 programme see their Doctor as the closest thing to God, view nurses as 'angels', and agree that teachers do heroic work, tend to see social workers through the media's critical eye as interfering and negligent. Whilst Doctors have taken to stating their case in the media, we do not speak out, therefore the public is largely unaware of the complexities and frustrations of the work.
Once out of the training context there is no tradition of social workers writing theoretically or critically. We are encouraged to be doers, not thinkers. There is no room for research, training or writing within the profession as there is for Doctors.
There is a recognised career ladder for bright psychiatrists which is not available to social workers. Consultant Psychiatrists earn a considerable amount and are able to do research and to publish in academic journals, in the popular press and even to write books.
With daily news of job losses in social services, encouragement to take voluntary redundancy and the move to create short-term contracts, there are very real fears about the effect on one's job if one is at all critical. So the public is left to make up their own minds about the effects of government reforms on individual social workers.
Social work in acute adult mental health in an inner city is inevitably highly pressurised and often distressing. In addition there are structural changes in the quality of an already demanding workload which have been brought about by the effects of the government's Care in the Community policies which purport to give more choice and a better service for those with mental health problems.
As more patients are admitted to hospital every day, the case-load of the hospital social worker, who is required to take responsibility for patients who have been discharged and is unable to refer people onto community mental health social work teams simply because these are being systematically depleted, inevitably grows larger and larger. Care in the community has been stretched beyond endurance.
Whilst this inevitably makes the work immensely stressful, it is not these issues alone which create the anger and frustration which I have found leads to the loss of one's sense of humour. In my experience it is the small bureaucratic difficulties which affect people at a personal level.
Government Departments are working at odds from each other; the effects of grandiose policies which have not been thought-through at the level of implementation leads to a blaming of the victim. In an attempt to support me the Consultant I work with wrote to Virginia Bottomley recently to ask her about the lack of appropriate hostel accommodation for a particular in-patient. Two weeks later a panicky fax arrived on my desk asking what I was doing about it. A merry-go-round of paper , creating more work and nothing achieved.
Local authority departments are also working to the 'one hand not knowing what the other hand is doing' policy. The other day, as a requirement of the Care Programme Approach, I visited a highly vulnerable young mother with two children who had recently been discharged after a long admission in hospital, at home on a local estate. Afterwards, in an unusually ebullient mood since it was good to see how well she was coping, I went to my car which I had parked outside where there had been ample space. Then I saw it: an ugly red metal thing was attached to one of the wheels and a huge notice obliterated one of the windows. I had been clamped. I telephoned, but disinterested woman at the other end took no notice of the fact that I had been on official Care in the Community business, but simply demanded to know how I would pay. Fortunately I had the necessary plastic. The man who turned up, listened to my furious rantings, said he had no power to overturn the decision and charged me 58.70 (including VAT). Earlier in the week, he said, a midwife could not be unclamped because she didn't have the necessary cheque guarantee card. This private company has been contracted by the local authority, the same local authority which employs social workers to carry out its Care in the Community policy. At the end of a demanding week, knowing that this would create further paperwork, and not being sure that I would be reimbursed, this felt like a punishment for doing my job. The irony was that I was then too late to go to my weekly meditation group.
Sometimes one appears to be living in a Kafka novel. Getting a travel warrant to return a homeless penniless person with mental health problems to their town of origin used to be a straightforward matter. Now with the creation of separate hospital Trusts, departments which work together must invoice each other. Systems are mysteriously abtuse. One Friday afternoon, after several hours of telephone calls attempting to penetrate this, a colleague was told to collect the warrant from another hospital some four miles away, a ridiculously time-consuming, costly and unworkable 'solution'. The patient had to be kept in hospital for an extra night until someone was able to do this, at a cost of approximately ú300.00.
Admin support staff at the hospital are paid very little but the work that they do is vital. Staff-cuts create a 'jobsworth' approach; admin workers prefer to spend time gasping at the latest indiscretion of celebrities in The Sun and Hello magazine rather than overstep 'boundaries' to prevent potential overload. Without explaining why, someone 'refuses' to post the minutes and agenda for an important meeting; the Admin manager says that it is not an admin task to put letters into envelopes and says 'if we did this for you, we'd have to do it for everybody'. Admin workers are told not to file copies of letters they have typed, even if they have the time to do so. They do not do any photocopying, nor any faxing. When trying to complete an urgent task in limited time-scale, these additional tasks make the work highly 'stressful'.
In addition we have been told that we will have to download all client information onto the new computer database system when it is introduced. There are obviously advantages to having good information readily available, however, because of the Data Protection Act we are told that only social workers, not admin workers can have access to this information, despite this being easily accessible on client's paper files, which are unlikely to be totally superceded.
Highly-skilled workers are being expected to have admin skills in addition to all the others: for many reasons some social workers and Doctors now prefer to type their own letters and reports.
The effects of the above often leads to a case of the cobbler's children..... Whilst one deals with so many conflicting demands, one's own affairs get neglected. Colleagues reported the following: 'forgetting' to pay one's bills and so on meant incurring additional interest for late payment of a credit card, and having the telephone cut off.
Some workers choose a number of ways to prevent work-related frustration; although many do not choose alternative therapies, I have found reflexology, homeopathy, a regular massage and meditation helpful. Having a laugh with colleagues is also vital in creating a different way of describing events. Others chose to have a sauna in the staff gym when stress levels felt high. Some tried to confronting issues with their managers (unanimously seen as an unsuccessful way of managing the work-load). Some had had weekly counselling/psychotherapy (usually for training purposes) whilst others ensured that regular holidays kept them going.
The cost in human terms to Social Services and the Health Service of these 'petty' frustrations must be multiplied by hundreds. Every day excellent workers with many years of experience are leaving (some take up other jobs in Tory controlled, richer boroughs where they think the conditions may be better) or take early retirement. What a waste!
Doing creative work which used to be a way of balancing out the more stressful aspects of the work, such as doing additional training, taking on social work students, running groups for clients, and offering training for other colleagues is less possible because of the constant demands of the work and this in turn prevents one taking a creative approach to the work.
However, in my view the best way of dealing with the sense of hopelessness which all the above engenders is to respond in a creative way. For some this may mean finding another job (outside of the field) and this may be the only sensible solution in the end. However, continuing to do creative therapeutic work with individuals and doing couple and family work with a colleague using a systemic/social constructionist approach is exciting and energising. Deciding to write this article is itself a creative act. We can sink under the pressure of an impossible job or we can attempt to think differently about the work and create different conversations which will in turn change the way we work.
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