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Friday, 22 March 2019

Supporting Providers: Report Back

In the fall, we released a survey directed at providers and their need for support and networking opportunities. Specifically, we sought to explore how providers are feeling they are supported when they themselves are struggling, as well as when they are looking to push back on problematic practices and/or find more creative approaches. This exploration was spurred by a number of things, including the growing number of providers reaching out to the RLC for support, and recent changes in local services. Perhaps more than anything, though, it was spurred by our realization that we’re only aware of two people dying by suicide who’ve attended our Alternatives to Suicide groups, and they’ve both been providers working in clinical roles.

This ‘report back’ is meant as the next step toward exploring the results of that survey, and thinking about next steps.

Overview of Respondents:

At the time of this report back, there are 100 survey responses. The respondents self-identified as follows:

•Clinician in a provider organization: 26 (26%)
•Direct support worker in a provider organization: 23 (23%)
•Other: 22 (22%) [Includes nurses, a clinical director, a former DMH employee, a handful of peer supporters, an employee of the Department for Developmental Services, harm reduction counselors, an individual working in homelessness services, a community organizer, and two family members.]
•Administrator in provider organization: 11 (11%)
•Clinician in private practice: 10 (10%)
•Department of Mental Health employee: 6 (6%)
•Psychiatric in a provider organization: 2 (2%)
 
Geographically speaking, respondents landed as follows:

•Living and/or working in Western Massachusetts: 62 (62%)
•Other: 26 (26%) [Includes residents of 14 other US states, and Canada]
•Living and/or working in Central Massachusetts: 7 (7%)
•Living and/or working in Massachusetts, but not Central or Western Mass: 5 (5%)
 
When respondents who worked in a setting that included co-workers (i.e., any respondent other than those in private practice) were asked if they are able to share when they are struggling or going through a difficult time at work, just under a third (31.25%) selected, “I feel like I'm able to be honest about that at work as makes sense to me”. However, everyone else indicated that their ability to share was either significantly limited by employer expectations, or that they were afraid to test out those limits for fear of job loss. One respondent pointed out that they had just learned that doctors are flagged by their medical board when they admit to seeking help for suicidal thoughts.
 
When asked if respondents felt able to openly challenge workplace policies or approaches, the numbers who felt comfortable and able to do this dropped to around a quarter (24.36%). The majority of others indicated that they are only able to question things “up to a point” or with a supervisor. Over 10% said that questioning policies and practices just isn’t welcome at their organization. Some respondents pointed out that the ability to question within their own organization is much less problematic than the ability to question practices within the broader mental health system:

“I feel comfortable being open and vocal within my own organization but questioning policies and practices within the larger "mental health system" including state funders, community stakeholders, etc. is risky. Questioning the status quo can lead to lost contracts.”
 
Another respondent local to Massachusetts added that the new Adult Clinical Community Services (ACCS) contracts have meant the Department of Mental Health asking for “more coercion than ever” [before]. More than one respondent reported that they’d been cautioned against speaking up about concerns to the Department of Mental Health.
 
When asked what people most wished were different in their workplaces, multiple people said they wished that senior leadership would show more vulnerability “otherwise statements that "it's OK" come off as hollow or untrustworthy”. More than one person also offered that they feel that organizations are driven above all else by trying to please funders. For example, one respondent has this to say:

“DMH is the mighty power and everyone is just trying to please them no matter the impact on people served lives.”
 
The issue of wanting more protection from retaliation or punitive actions against those who speak up also came up several times.

“I wish that management and supervisors were actually open to criticism and able to admit that policies are bad. Instead many get knee jerk defensive or targeting f you have the audacity to speak up.”

When asked what supports this group wish would be created, more than 60% wanted in person and/or on-line opportunities to discuss how to develop and implement creative approaches in their work. Just over half also indicated they would appreciate in person and/or on-line opportunities for emotional support. Over 43% said they would appreciate in person and/or on-line opportunities to process their role in using force and coercion in their jobs.
 
When asked how respondents felt these opportunities might help, an overwhelming number of them stated some variation of wanting to feel more connected and less alone.

“It'd be helpful first to simply know which of my own concerns are shared by others.”

Yet, when asked about barriers, a significant number of respondents also expressed that they feared any supports might not be confidential enough, or could lead to consequences in their work. Some worried that they would be seen as "unprofessional” or “unfit to work” by sharing concerns. Some also noted fear or worries about opening themselves up to criticism from people in peer roles and/or those receiving services.


Ideas for helpful events included:
•On-line or in person trainings on Non-Violent Communication
•Trainings on ethics and rights
•Trainings on how to support a supportive debriefing process for employees
•Dialogues on work/life balance
•Event to discuss strategies on creating change
•Event to reduce shame around providers needing support
•Strategies for protesting bad policies (including protections against retaliation)
•Event on recognizing and addressing workplace trauma
•Event on harm reduction approaches in mental health
•Going deeper with being ‘trauma-informed’ (including recognition of privilege)
•Training on employee rights
•Offerings of yoga and other healing modalities for providers
•Dialogues on taking care of one’s self and speaking truthfully about feelings and emotions
Dialogues on relationship between trauma, oppression, and healing
•Discussions on history of mad pride movement, language, etc.
•Discussions on coercive therapies and their impact
• Specific to alternatives (withdrawing from psychiatric drugs, etc.)

More than one respondent suggested that some of these events be sponsored by the Department of Mental Health so as to ease the fear of punishment for participating. To be clear, this summary just scratches the surface of the rich and often detailed responses left by respondents. We are so very grateful for all the responses that were offered, and hope to make more comprehensive results available with attention to not disclosing anything that might risk revealing anyone’s identity.

So, what’s next?

Although this process has been initiated by the RLC, it would not be a true ‘peer-to-peer’ effort without involving people in provider roles in every step of the process. In January, we are going to begin reaching out to those respondents who said they’d be interested in helping get things rolling. Questions we will seek to answer:
 
•What can we do to create as safe a container as possible for conversations and events to be able to happen?** What protections can we put in place for people who are worried about the consequences of participating? What can we ask of local providers in the way of reassurance? What role might the Department of Mental Health play in this process?
•Among all the ideas, what one or two events or groups should we begin by offering?** What funding might be needed to support them? Who will lead coordination and/or facilitation of them? What resources, skills and strengths do we already have among us? What opportunities do we not want to miss?


We look forward to this collaboration, and to where this can take us in the New Year. Thank you.

 

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