Marc Caulfield, Chief Executive and Co-Founder at Demolish the Wall, helps us to understand our mental health and how we can ensure we support ourselves and those around us.
When I was asked to write this piece, my first thought went to my late stepfather’s care worker, who told me a hard-hitting story along the lines of this:
‘I was working for a large, well-known care organisation. They sent me to a client who lived on the other side of London to where I lived, with no offer to compensate or contribute to my increased travel costs. It became apparent that this male client had taken a fancy to me and, after a couple of weeks of being groped and listening to his lewd comments, I discussed the issue with my manager. ‘Deal with it’ was the advice.
‘My professionalism and the client’s clear need for my care led me to continue in this role to the detriment of my mental health, until I had no choice but to the leave the company I was working for.’
Whilst I know this is a sample of one, my research suggests this is not uncommon. The combination of a client in need, uncaring employer and the professional and vocational nature of the care worker delivers a toxic mix. So, as I have become more involved and learnt more about the care industry, I have kept this front-of-mind.
Before I get into the meat of this piece, I feel it is important to frame it in the context of mental health in general, so here a few eyewatering statistics:
- The Royal College of Psychiatrists states, ‘Mental illness is the largest single source of burden of disease in the UK’.
- 676 million people are affected by mental ill health worldwide.
- One in four adults in the UK will experience a mental health issue per year – this figure is the diagnosed number, so the true statistic will be far higher.
- Mental health issues account for 91 million lost working days per year, costing the UK economy £30bn.
The science of stress
Front-line care staff are the people who drive business. Their urge, or vocation, to care is a massive positive for businesses for obvious reasons, but as always there is a downside.
Vocational jobs include careers such as care work, nursing and teaching, and people rarely do it for the money – at least not solely. These careers are about purpose, passion and making a difference. When your working life is centred around these three tenets, being able to walk away at the end of the working day becomes very difficult.
Let us all be honest here, if these three tenets are not a solid part of an employee’s mindset, you likely know they will not last long in the role. It is this mindset that makes a great care worker, registered manager or senior manager. But it is also this that leaves one open for consistent and high levels of pressure and stress.
Unless stress is managed, it can, and probably will, develop, becoming anxiety and potentially depression. Managers need to act by the time pressure – a normal feeling that we all need in order to be productive – becomes stress.
Training and support are two main areas that can have positive impacts here. Once someone has moved towards anxiety and depression, the level of help that is required will often be out of the manager’s control and area of expertise. Going back briefly to the vocational aspect of the job, the likelihood is that someone who is driven by purpose, passion and a desire to make a difference will ignore the early warning signs consistent stress is having on their mind, body and performance. This is where managers need to be super involved. The industry must practise what it preaches here and demonstrate care in care.
A word on stress before we move onto the practical steps that can be taken to ensure you are looking after yourself and your staff, and therefore the people you support. Stress is a natural human physiological reaction; it ignites the ‘fight or flight’ response in our bodies allowing us to fight our way out of, or run away from, danger. This response was designed to allow us to escape attack from a sabre-toothed tiger, not to be a constant presence in our normal day-to-day life. In times of stress, the body releases two main hormones; adrenaline and cortisol.
Most people have certainly heard of adrenaline but not so many have heard of or understand cortisol’s role in a stressful situation. Adrenaline will ebb and flow over time, delivering an increased heart rate and blood pressure and delivering more oxygenated blood to our muscles. Nothing too scary there. Cortisol delivers the fuel, at all costs, to those muscles, resulting in spikes in blood sugar levels to fuel fight or flight. This is great if you are using this energy boost in fighting or flighting, but not so good if the physical activity is limited, and you are therefore not burning that blood sugar.
Whilst cortisol can deliver heightened memory and attention, which might be helpful in your day-to-day work, the negatives of this hormone outweigh the so-called positives. It reduces serotonin, the ‘happy’ brain chemical, clearly showing the link between consistent stress and poor mental health. It also suppresses a person’s immune system, leading to more time off sick.
If there is one thing the care industry must act on, it is consistent, unmanageable levels of stress in its people. Senior management, registered managers and care workers all have a duty of care for each other and their clients and their families. This duty of care covers the spectrum of moral, ethical and legal care.
The Mayo Clinic states, ‘Stress symptoms can affect your body, your thoughts and feelings, and your behaviour. Being able to recognise common stress symptoms can give you a head start on managing them. Stress that is left unchecked can contribute to many health problems, such as high blood pressure, heart disease, obesity, and diabetes.’ So, what can you do?
Steps towards improvement
It is clear to see how, as a great senior manager or registered manager, your role can easily expand into far broader areas than your craft skill. The duty of care mentioned earlier is predominantly centred around the law.
Mental health must be treated the same as physical health. An employee who bravely states they are struggling with a mental health condition should be treated the same as the employee with a cold or broken leg. Indeed, the Equality Act 2010 makes this crystal clear. Care organisations must ensure they have legally robust policies, procedures and training in place to ensure all staff can recognise issues in themselves, and all managers should be trained in spotting the signs in others, as well as themselves.
As managers there are four main areas to focus on: spotting change, talking, listening and acting. Firstly, you need to learn how to spot the signs of difficulty in your team and/or yourself. You do not need to understand mental health conditions in detail and you certainly do not want to diagnose – this can be a side effect of too much knowledge. You simply need to be able to spot any issues.
The main thing to look for here is change. Changes in behaviour, attitude, appearance or alcohol consumption can all be signs of difficulty. Try to ‘look in the mirror’ or listen to colleagues, family, or friends with regards to yourself. The idea of putting on your own oxygen mask before helping others is essential here. You will not be able to help others if you do not look after yourself.
Next is learning to talk. Learning to talk in an open way is not always easy when you are busy. You must ensure you take the time and space to have this conversation. Saying, ‘I am worried you are depressed’ will not work the same way as, ‘I have noticed you are not yourself, is everything OK?’. Sensitivity and compassion are key, so give yourself the time to not rush. You also need to be prepared for a colleague coming to you, so do not start a conversation you do not have time for.
Listening is by far the hardest part and quite frankly something most of us are not very good at. I always say to remember we have two ears and one mouth, so listen at least twice as much as you speak. It is also is very important to listen non-judgementally. Your opinion on someone else’s mental health is not important. Hearing what they are saying is.
The final area is to act. What should you do now you realise that you or someone you know is struggling? You must remember you are not a therapist; your role is supporting that person, giving them some time off, providing additional resource, having a tricky conversation with a senior manager or client etc. Signposting someone to their GP and/or counselling and therapy services is really where your responsibility should stop. Legal action can be the unfortunate outcome of a clumsy handling of a delicate situation. Sensitivity and training are the name of game here.
Taking care of each other
Prevention is always preferable to cure, and managers can do things to prevent mental ill health in their organisations. As a manager ask yourself these questions: Do I actually know my people; what makes them tick; what their personal life is like? Do I know the people they are caring for? Would I recognise them struggling?
If the answers to these questions is negative, then you need to address this urgently. In the eyes of the law, not knowing your people is not an excuse. Let’s all look out for each other, especially during these incredibly tricky times and continue the hugely important work the highly skilled Care industry does day in day out.
How do you support your mental health and that of your staff? Write your comment below and share some of your strategies.