STAFF BURNOUT....CHILD AND YOUTH CARE IN SOUTH AFRICA

This week the blog is (somewhat) longer than usual. 

Social media post: "I burnt out - only now referred to a psychologist" The organisation blamed for the lack of support and caring, delaying intervention until it was too late and an implied apparent unenthusiastic referral to external professional support. The post raised comment. "Does the organisation pay for your medical aid?" "Were you given proper supervision? " There was perhaps a masked hint that the workplace could be "toxic" ( another word being bandied about on social media now).

All relevant. All important.

What then, is burnout? .....Burnout in the helping professions has also been called Compassion Fatigue. With constant stress you have a feeling of helplessness and are completely exhausted. Problems seem insurmountable. Detachment threatens your job and your relationships. It is a state of physical and emotional exhaustion. (adapted from www.helpguide.com).

Some serious questions surface. Who cares for the caregiver? Who cares for the carer of the caregivers?

I know burnout......been there twice. Each was a different experience. 

The first time I had no idea that I was burnt out. At 5.00 one morning I got out of bed to go wake the boys. But I sank to my knees next to the bed. There came from within me.....from the very pit of my stomach a loud wail, a scream. I didn't initiate it. I had no control of it. It just welled up frightening me. I called it a "primal scream". Crying all the way up to the boys dorm. I experienced an increase in my heart rate. I felt trapped - no escape.

Looking back, the actual workplace situation was something I should never have allowed for myself. No breaks, no leave, no weekend off early 'til late. Neglect of family, relationships, doing two jobs at once, on constant call and every day a new huge child related human drama to be faced. Some would say it's the calling. I now call my burnout my foolish self uncaring.

It's the old story. On the aeroplane you are told......fix your own oxygen mask before helping others.

I referred myself to a doctor. I think that he experienced physical state. My psychological state was a mystery to him. He didn't recognise compassion fatigue. only anxiety. So, he prescribed Ativan. Ativan is used for anxiety and some neurological brain irregularities. I was not anxious I was physically and emotionally worn out, now with nothing more left to give. The Ativan got flushed down the toilet. It has a reputation of becoming addictive.

I insisted on three days leave in in my caravan in the Hogsback mountains with my family

It was as I had thought. Came back to chaos. The children had pulled every wire in the building to set off the fire alarm. It was to create an emergency dramatic enough to get me back. There was a fear that I would never return. Something very wrong. Organisationally, children can't be that dependent on one person. For some child and youth care workers it may feel good to be so needed, but its part of the toxic workplace.

There was a psychologist, the only psychologist in the city at that time. He sat on the management board. He was the one to see the signs ( after the event). He volunteered his time then to give me 6 months weekly, what he called, supervision. It was really psycho therapy. A life saver, a job saver. The problem was I had allowed myself to get sucked into a toxic workplace of my own making.

There was a child and youth care worker heading toward burnout. She recognised the symptoms,. Shut herself in her room one day. We asked why did you not pick up the phone we have a policy to organise a retreat, support and relief. She said, "This is a place of caring. Why should I have to tell you I need care? You should have noticed". I'll never forget that. She was right, but only partly right...The oxygen mask story again. It really should not be like this, but if you  need care you sometimes have to take the first step

This makes it important to recognise the signs of burnout.

My second burnout was somewhat different. I found myself focusing on small things. To protect myself from feeling overwhelmed and not coping. I focused on the easy to handle and deliberately avoided the major pressing issues. Any form of confrontation for example. A brooding, looming disaster. Like, I'm a very tolerant person but the toilet roll must not be in its holder the wrong way round. A child smoking becomes an issue when he is facing a major relationship breakdown not addressed. Responsibility was reversed. "I am to blame" The children's behaviour became my fault, my inadequacy. In a toxic workplace that is an organisational norm and heavily underscores faulty child and youth care thinking, especially by management. 
There were emotional symptoms. I lived close to tears all the time Without actually crying tears. The inside of me was crying. Not a primal scream this time, a primal weeping. Physically the experience of fatigue was overwhelming. It was a huge effort to go to work, to respond to call - outs, to focus.

Then came the heartbeat thing. This time coupled with nausea. The doctor ruled out a heart attack. Prescribed a tonic.

Again, a Psychologist board member came to the rescue. Six months weekly therapy.There is a lesson here. It's not shameful to be in therapy if you are in the helping professions.

What then is the treatment.?

The most obvious answer to this is that prevention is better than cure. It really is the facility, organisation or programme's responsibility to provide policy, procedures, services which prevent burnout. Also to provide immediate intervention if it should occur. 

There some unnegotiables. the organisational imperatives for the avoidance of staff burnout.

Regular supervision.....and by this I don't mean hierarchical "snoopervision".  I mean personal "inter-vision" "I did this. "I felt this". I'm feeling".........proper supportive workplace supervision with a child and youth care worker. Not with someone from another profession, and not the manager. Not with someone who will say, pull yourself together. Go get vitamin B12 or a tonic.

Then comes case-load. When I had my first burnout I had a full junior and senior dormitory of boys in my direct care. and then the young people who had been placed in boarding schools but were attached to the facility. 8 - 12 is recommended with support.

Long working hours. This idea of 24/7 is obsolete and illegal. The practice of long shifts even if kept within the weekly limits of working hours as set out in the Conditions of Service Act. The 12 hour shift has risk of negative effects on staff performance on that day, and so burnout risks.

The boss. Has to be alert and caring as well as really understanding of the work of child and youth care. Studies, serious research frequently quoted also in the social media has shown that a poor boss can make employees sick. Most employees leave, not because of the work but because of the boss. The boss doesn't have to be a single person. Quite often the boss is an external system.

A team approach. Child and youth care workers can't do this on their own. It's a team thing. A child and youth care worker can and should have focus children or a focus group. What we call the primary worker, but there has to be a team. A team of like minds, real support, caring and skills at different levels. Left to be responsible and accountable on your own contributes to burnout.

Self care is essential in the prevention of burnout....Remember the oxygen mask story. The seven R approach is useful: 
RECOGNISE the warning signs
REVERSE THE DAMAGE by seeking support
RESILIENCE take care of your physical and emotional health
RECREATE have other interests and use time to REFLECT, RECOVER and RELAX.

This implies regular leave.  It must be allowed and taken No such thing as "pay out in lieu" or a few days here and there.

Burnout should not be allowed to happen. The question of treatment of it, is a difficult one. It HAS to be HOLISTIC. No single pill. No three days off story.Treatment has to address the physical, social, family, emotional, cognitive (an individual staff development plan), spiritual and life-stage task domains. It does mean that you may have to get help from a psychologist, compulsory leave which should be sick, or special leave, a plan for personal development, the 7 R's , and an overhaul of the organisation's practices. A support group is essential. Be prepared to have your friends support. But also, child and youth care workers need to gather supportively around a colleague in the recovery period. Social contact is essential to the recovery of burnout.
Management must be be particularly caring and supportive of the needs of child and youth care workers and to provide organisational safegaurds against compassion fatigue occurring or re- occurring.

How wonderful it would be if questions about burnout and its treatment did not have to be asked.

Child and youth care burnout should never happen

Perhaps more accurately, child and youth care burnout should never be allowed to happen.