Self-Care & The Work-Life Balance...Are We Kidding Ourselves in the Behavioral Health Arena?

I spend a good chunk of time in presentations and during the delivery of technical assistance trying to convince people that the notion and promotion of self-care and a balance between one's work and personal life is not just important, it's critical to the overall well being of an individual. Most of us know that "all work and no play makes Jack or Jill a very dull person." We know that burnout within the field of healthcare, and especially within the subgroup of behavioral healthcare, is the number one factor people leave the field.  We all also know that within the behavioral health field vicarious trauma, re-traumatization of our own personal lived experiences, and compassion fatigue are always lurking possibilities for us.

Yes, we definitely know all of this, but years ago when I started working fulltime as a direct service provider instead of being a "service recipient," the issue of self care was damned near an afterthought, usually tacked on to the end of a daylong workshop or mentioned in passing as we all discussed the pressing issues of the day for us.

Sure, there were some real forward thinkers in my field who, back then, were pushing the idea of "managed and intentional" self care, but even they were usually relegated to the end of the day workshops and presentation slots, so that they were often presenting to more empty chairs than human beings, as folks lit out for airports or raced to beat rush hour traffic back to their offices.  That so many chose to go back to work rather than heading home should say volumes about the overall impact we were having with the message of self care.

We in the behavioral health world today are doing a much better job in promoting self care and work-life balance.  Lots of resources, trainings, and information are now available.  We even incorporate wellness into our training agendas as a normalized course of action to be done along with outreach, case management, supervision, and service delivery in general. Woohoo!

I'm not sure however, that we're practicing what we're preaching.

Consider that for most of us, a 9 to 5 job is such a fantasy as to be almost laughable.

On reason is that folks dealing with homelessness, addiction, and/or mental illness, do not have challenges and problems that only occur during normal business hours. Providing emergency services, locating folks who may be holding down day labor jobs or are out doing other things like can collection, selling street papers, etc., are hard to find, harder to engage when they're engaged already in survival mode, and then disappear during evening hours to places they've discovered that can be friendly - or at least tolerant - to their plight.

Another reason is just the sheer damned volume of  work that lands on our shoulders (and yes, I do realize I've repeated this yet again).  The vast majority of our workforce in this arena are deeply caring, compassionate, driven people who realize that homelessness kills.  While we may not be providing advanced medical care to those experiencing acute life threatening emergencies, we know that we are many times working with those who are seriously and chronically ill, as well as with those who live in such dangerous conditions that death is a very real possibility on almost any given day, and we take our mission to help end homelessness very seriously as a result.

Finally, it's the sheer volume of work - and yes, I realize I just mentioned that, but it's so damned important that it deserves a second mention. The work is never-ending and increasing by the minute. As budgets are slashed and the sequestration idiocy continues, homelessness increases and staff to assist those experiencing life on the streets decreases. Technical assistance to support those staff members in obtaining the best training and newest strategies also decreases, making providers' jobs more challenging and eliminating the benefits to our clientele that come from better training.

A big part of the problem seems to be that we're continually provided with less to work with - staff, resources, time, money - and at the same time, we're asked to do more.

Those who wonder why we're forced to work 50, 60, 70 or more hours each week look around themselves, see all their colleagues doing exactly the same thing, and then are reluctant to complain for fear of being branded as one who does complain, one who cannot "handle this work," one who should probably look elsewhere for employment lest she deteriorate further morale that is already often low because of the sheer volume of work and the incessant, screaming need of those who require our services in the first place. There is a sense of resignation and a refusal to appear "weaker" than our colleagues; "they're doing it without complaint and they do it every day.  I guess this is 'the norm.'"

Modeling of the work-life balance really comes from those who lead us. When we see our supervisors, our senior staff, our leadership teams emailing staff at 5am or 10pm, when we walk out the door at 6pm after a 10 hour day and our supervisors are still chained to their desk, laboring away, the message of work-life balance and self care are not in sync with the actions of those individuals we employees look to for guidance, mentoring, and leadership.  Worse, the message to many of us is that in order to "get ahead" and advance in our careers, this incredible demand on our time will only increase as we take on additional responsibilities.

In these days of extremely scarce resources, the competition for them is fierce, and agencies and organizations, just like the employees who make them operational, recognize that if they're going to compete, they're going to have to do more with less in order to remain competitive. Agencies respond to Requests for Applications (RFAs) in the hunt for elusive grant money knowing damned good and well that dozens - if not hundreds - of other agencies are doing the same, and we know that in order to be successful not only do we need to write an effective proposal, we've got to overpromise AND overdeliver because everyone else is doing exactly the same thing.  The mentality here is that "some grant money is better than no grant money and if we get less, at least we keep some folks employed and get to ultimately deliver services, so whatever it takes we've got to be willing to do."

Doesn't take a nuclear physicist to figure out that this is a recipe for very long and sustained workweeks.

We know too that those who work at this frenetic pace, day in, day out, over weeks, months and years at a time aren't long for this field.  It's why behavioral health professionals suffer burnout and compassion fatigue at unbelievable rates, and the best and the brightest in our field often suddenly disappear under the weight of retraumatization, vicarious trauma, stress-related maladies, and a hopelessness instilled by the knowledge that we'll never be able to see the light at the end of the tunnel, let alone actually enter into the daylight of a job that has left the tunnel completely.

I'd like to offer some solutions here rather than to simply articulate the challenges. I can offer up some good resources and some really worthwhile exercises and recommendations that come with solid evidence to support their efficacy.  But all the resources and training and cajoling and discussion we can throw at self-care and the work-life balance are frankly worthless if those we look to for modeling, mentoring and guidance aren't practicing what we're being told to preach.