What a way to make a living is a series documenting the everyday conditions of working class jobs across a variety of sectors. In this instalment, a former care worker details her experiences in residential mental healthcare.
I worked at a mental health residential home, modelled around Therapeutic Community, where people with long-term mental health conditions live together, attend therapy sessions, prepare and eat meals together. It’s a place where being together and working with people are part of the therapeutic process. TCs are designed to be centred around the agency and the autonomy of its residents, who involve themselves in democratic decision-making processes and learn how to build relationships with each other. Residents were referred from hospitals via local authorities or self-referred and would ideally move on after two to three years to a step-down service or independent living. I worked there for two and a half years and left due to extremely difficult working conditions.
On a daily basis, we worked with the residents and supported them to clean their rooms, cook food, organise leisure activities, gardening, or carry out administrative tasks such as applying for universal credit and budgeting, but we were also expected to facilitate group conversations and be a practitioner with individual residents. We worked with each individual’s needs by being mindful of their experiences of trauma, their thoughts and behaviours.
There were various projects when I was working there—in my project, there were about eight in-house staff: a manager, lead psychotherapist, three senior practitioners and three junior practitioners, of whom two of us were people of colour. There were also outsourced agency staff, one day staff and one-night staff, who were migrants. Both were expected to work over 80 hours a week and live in the residential home with the residents. They would do so for a month or two (some even longer) and then different staff would replace them. Only the staff employed by the organisation received full mental health training, so these trained staff were left to explain the role to the new agency staff quite frequently. Agency staff were also expected to do the jobs that ‘nobody wanted to do’. The agency staff were usually the ones scapegoated by management and residents since they were there all the time but also not given full in-house training.
On bad days we faced violent abuse and racism from residents, which were difficult to deal with. I did not feel that the organisation had supported me enough with these issues or acknowledged that this violence was a response to a violently racist system. The junior staff were sometimes left to deal with complex incidents of self-harm or attempted suicides with assistance from agency staff who were sometimes new to the project and not fully trained.
My relationship with management was difficult. We acknowledged this difficulty—my manager was also my clinical supervisor and supervision meetings were complicated since they required honesty in terms of our client work. This honesty could often be manipulated to demonstrate ‘our lack of working’. I knew they had the power to fire me if I expressed my concerns a little too honestly. This created a sense of paranoia among the workforce, particularly before appraisals and Care and Quality Commission (CQC) inspections, which further created a binary of good workers and bad workers.
Working with the residents was one of the reasons I stayed in the job for as long as I did. It was challenging but also rewarding. We were working to keep people alive and give them the tools to help them navigate their world. Of course, there were lots of things that were difficult and some things you couldn’t just leave behind at the office.
Our problems were raised in supervision or in staff meetings. Since the workforce was mainly white it was difficult to address problems of race at the workplace or within the mental health sector. If you go to mental health hospitals, you will notice that most low-paid workers are BAME and the patients are also mainly BAME, women or working-class. This was clearly a gendered, racial and class issue. There was also a disjunct between the composition of the psychiatrist, management, and the lower-paid workers.
I was in Unite but I was the only one in a union in my project. It was difficult to organise because the workers who had been there for a long-time accepted that this is how things were. The newer workers were positive about unionising but also were low-paid and were never got to the stage of signing up. There was no sense of unionising from agency workers either. There were only pockets of time to talk about such things because we didn’t have a space where we could get away from it all. Unionising in this particular mental health context is also caught up in this ethical dilemma; that we, i.e., social reproductive workers, have a sense of responsibility for our residents and this would be seen as going against them. For me, it was strange because we were encouraging the residents to assert their agency but at the same time, we were denying our own agency to organise and demand better working conditions.
The majority of the workers in my project were women. A few of them had caring responsibilities and our working hours and patterns made it difficult to carry them out. A lot of the staff were young with huge commitments and we felt we were tasked with an impossible workload with risk assessments, incident reports alongside supporting residents. We voiced our concerns in the staff meetings, but we couldn’t find ways to formalise our concerns.
The sector has been underfunded for years and this is clearly important in regard to the treatment provided. We were undervalued as workers by the measly pay we received for the work we did. We felt undervalued by society since this wasn’t considered to be money-making work. The high turnover of staff did not help the residents at all since they needed some level of consistency and an ongoing relationship. Seeing new agency staff turn up every other month or burnt-out permanent staff leaving the job re-enacts feelings of abandonment. Even the local authorities that we liaised with regarding our residents were working on a model that required immediate results.
The mental health system feeds on over-medicated patients who are not able to connect with the society around them. While medication and CBT can help, it is being used as a way to produce individuals who can return to ‘productivity’ as quickly as possible. Most of our residents felt this to be a painful experience.
I think we must demand community-based programs that allow the residents to work with their inner struggles in their own time, on a gradual basis, rather than worry about producing results to appease commissioning bodies, local authorities or even the DWP. While the focus was on community building, our working conditions did not reflect that. Any workplace that aims to build communities needs to create the conditions for their staff to thrive.
The system is also inherently racist in the way that it operates. People of colour are often the lowest paid with the longest hours, while BAME patients are disproportionately institutionalised, characterised as aggressive and subsequently over-medicated. We should be able to demand external supervision, free therapy, free exercise classes, training for all and a unionised workplace, as well as increased state funding and an end to outsourcing and privatisation. We also need to move away from a model of managers and the ‘managed’ to a more democratic care system. How else can we support our residents to be independent and to be part of our community?