This post is the second in a series. The first ‘Cannon Fodder: A Story of Vicarious Trauma’ is available here and the third post ‘On Supporting our PWPs to Thrive: A Leader’s Perspective’ will be available on the 19th December.
A note from NaG: I just want to say a huge thank you to Gemma, who introduces herself properly at the end, and the team from Insight Healthcare who have done so much work to boost wellbeing and celebrate Low Intensity work and the value of IAPT. It’s great to read voices who love Low Intensity work, and a joy to celebrate what they’re doing.
Blog author: Gemma Hulme, PWP, Insight Healthcare, Wirral with PWP colleagues from the survey and wellbeing group: Gemma Hulme, Chanel Hanes, Katy McDonald, Sofi Melvin, Joseph Range.
When the Notaguru blog asked for people to write a post on what helps us thrive and survive as a PWP, it was timely. I had just been spending a lot of time with colleagues from my own and other services in our organisation reflecting on this very thing. Our new Clinical Director approached us in August to do a survey of all PWPs in Insight Healthcare as part of our new wellbeing strategy within our service transformation programme. We were also invited to present the results at the national PWP conference held by The CBT Resource in September. So, along with a group of colleagues who also volunteered, we put together a range of questions exploring wellbeing, burnout, stress and retention in the PWP role. It gave me a great opportunity to reflect on my own experiences working in IAPT and compare them to others across the services. It made me question what is it, that make me really passionate about my job, what keeps me interested and thriving as a PWP, in a good way. Many of us have entered the PWP role for a variety of reasons, we often get caught up in the day to day of being busy, it can be easy to forget what made us passionate to be here in the first place and what makes us want to stay.
We sent the anonymous survey to all 156 PWPs within our services and had a 44% response rate, which was good given we only had the survey open for one week. I think this shows just how important this issue is for us all. The Surviving Work Survey had previously identified that some IAPT practitioners ‘felt training didn’t prepare them’, that they ‘have to explain the game’, or are ‘unsupported by managers’ or ‘work less hours to cope.’ The PPN Paper on PWP retention highlights four main barriers to remaining in the role ‘career progression, lack of opportunity, financial and burnout’. It is clear in the research that staff with burnout directly impacts on patient outcomes too, so we wanted to ask about all those areas. One thing that really stood out in the survey and in our internal discussions, was the main driver that makes us survive and thrive – patients. As one of the survey responses highlighted that really stood out to us all:
“It is probably so cliché, but I like helping people, it is rewarding. My colleagues say the same. Although IAPT has its flaws, it has provided much needed access to support for people who are struggling with their mental health, which is definitely needed when anxiety and depression rates are increasing each year. I am proud of what we do as PWPs, we make a difference. I directly see the impact on patient’s wellbeing and their ability to overcome future adversities through the interventions we provide.”
The so cliché theme seemed to run through the discussions we have had within our services recently when I mentioned I was going to be writing this blog. It may sound cliché, but a lot of people identified that they simply do it for the love of helping people with their difficulties, providing the right support at a time where needed, being there to offer a non-judgemental and empathetic ear, to give people tools to help themselves and see them improve. We also discussed that seeing such a wide variety of people and experiences in the PWP role also helps keep us ‘on our toes’, keeping every working day somehow different and unique, just like the people who access the service.
The survey helped me to feel empowered, it has also helped highlight what strengths we have. 79% of people who responded to the survey strongly/mostly agreed that the role of PWP is stressful, which supported previous findings mentioned above, so how do we thrive and survive within a stressful role? One of the main ways identified in the survey was supervision, which 93% of people agreed helped them with this.
‘Supervision is your best friend’
Especially when you are in a supportive supervisory relationship. It gives you the opportunity to share your current challenges. Themes within the survey of openness, honesty, constructive feedback and positive collaboration were key:
I have a supervisor who I trust and can open up too when I need to, who I know has my best interests at heart. They are honest with me and are always constructive with criticism.
My supervisor is very present. Truly supportive of me and always asks me questions about my goals and development. They are enthusiastic which is nice.
Supervision helps with emotional resilience, supported discussions when you are having difficulties, developing weaknesses, indicating strengths and achievements and gives you time to reflect on your week and the work you have done.
10 PWP’s reported that they would find their clinical skills supervision helpful with more direction, or that it was identified that this was less regular then the recommended guidelines or sometimes being missed, due to being part time. Some also reported finding discussing cases wasn’t as helpful and wanted more refreshers on skills. This is something we are making sure improves within our services as part of the transformation programme.
It is essential as clinical governance for the LI, high volume cases especially for assessments which may bring presentations outside of the practitioner’s role. It also acts as a safety net for clinical practice to oversee adherence to the evidence base, and is key to protecting PWP’s and trainee’s emotional health both for their own wellbeing and to respond to issues of counter-transference and therapeutic alliance so IAPT can further improve to support those from different and diverse backgrounds
We typically have case discussion in our clinical skills which is useful and I think is needed. However, at times it can feel like we are clutching at straws to discuss clients therefore feels like a wasted hour. So, as well as case discussed I would find the sessions beneficial to go over different step 2 interventions as a refresher. Or bring case examples to discuss how each of us would treat the client. In addition, with interventions which aren’t supposed to be seen at step 2 level such as social anxiety and health anxiety. It would be helpful to look at what we can do at step 2 with limited time and sessions for example potentially coming up with step 2 treatment plans or something
I love learning, this job presents you with options to learn, whether that is from colleagues, from clients or within the more structured Case Management and Clinical Skills, these set times each week give you the space to reflect and grow as a practitioner, when facilitated in the right way. It is invigorating that our survey has highlighted things we can improve and there is a real will within the organisation to do that and champion the role.
Lots of self care.
Self-care also came out as a theme in the survey. Not to tell you ‘how to suck eggs’, but with a high caseload and admin to stay on top of, for me personally, some of the ways I make my caseload manageable is by condensing my hours, I have two 9-8 days and then work till 6.30pm on Wednesday and then till 5pm on Thursday, I have Thursday just for clinic, which I find more enjoyable and less taxing, which leaves me with a precious three day weekend. For me working hard for a period of days works better, for others they might prefer things to be more spread out, working your diary in to improve your productivity, just like we would do for a client’s BA diary is very helpful. I make sure that I take a lunch break and stop working at the end of the working day, I try my best to be organised by writing lists and using spreadsheets, this means I always know where I am at. PWPs in the survey identified similar methods of managing their stress;
My supervisor always ensures that I am maintaining a good work life balance and taking annual leave at regular intervals to help with this. I feel able to broach matters confidently and overall, I feel well supported
It is a very fast paced and busy role, which becomes even harder should there be anything else personal / work related going on that adds to that balance of work/life and so supervision is vital to prevent burn out and give PWPs space to breathe.
So, I know people are thinking, great, you have done a survey, but what are you going to do now?
Insight Healthcare are currently undergoing a transformation programme, one of the key strands of which is improving staff wellbeing which is really great to see happen. We are implementing monthly self-care sessions for PWPs and therapists within the services. We are also changing clinical skills supervision to include more work on refresher training, identifying therapy interfering beliefs and behaviours and using Self Practice, Self-Reflection techniques to work on them. I have realised that this has been invigorating too, having someone ask what makes a difference to our role, empower us to find out and then make organisational wide changes. We are also all having a new pay award from October 2020, which helps too! We have started to improve career development, by getting the PWP’s involved, we currently have a PWP secondment out to help with clinical training and CPD and two more PWP secondments to work on our new patient facing website and clinical resources for the services to use. We are going to nationalise monthly CPD training across all services to help to fill the gaps where there is variance from many of us training at different universities the survey identified. We are also looking at how we can revise how the specialisms/champions and senior posts function and support training for their area across all services and share their knowledge and expertise. Our aim is to develop innovative internal career pathways in clinical/management and leadership further to retain skills.
We don’t want to just leave the survey there though. As part of the wellbeing strand we are going to use some of the measures and calculator from What Works Wellbeing pre and post to measure change and have an exciting call on this booked with them about the wellbeing project we are doing this month. This will enable us to use further measures of staff burnout as part of a longitudinal study into analysing the success of the service transformation. As we know as PWP’s, practice informs research which informs policy, so we feel this will be a great step in the direction of improving both staff and patient outcomes service wide. We have all been saying it feels like it is a good time to be a PWP in Insight. Like our role is really appreciated and we are supported.
For me, the longer I work in mental health, the more I can see how mental health difficulties seep and permeate into so many different areas of our life, our day-to-day functioning, jobs, appetite, sleep and our relationship to those around us, friends, families and children. The impact mental health has on the people I speak to in the assessments I do every day really stands out to me and the fact that we are still only seeing the tip of the iceberg of people who could benefit from our help. While writing this blog I looked in my diary and since April 2019 I have had 760 assessments booked into. People need what we do. We are important, we are often the faces people first see when they seek help, when they are unsure, when they are at their most vulnerable. This is what keeps me in the job, understanding the importance of our role in society, a society that before IAPT meant that those people would have waited sometimes up to two years or more to get access to psychological therapies, if they got any access at all.
IAPT may not be perfect, no system is, but it is a damn site more effective than what came before it. It frustrates me when people criticise IAPT in public forums but give no reminders of how it was before we provided these free services to people who need them in weeks, not years. Many of these people are not themselves on the front lines delivering these assessments and treatments, seeing what we see, doing what we do. They are not just numbers to my colleagues and I; they are people. So, here is an open invite to anyone who criticises the PWP role, come walk a day in my or my colleagues’ shoes. See what we see, do what we do, try to get the outcomes we achieve in the sessions we have. We do make a difference, we are well trained, we care about our patient’s recovery rates, we care about each person we see. We don’t just stop thinking about them when their session ends, we plan, we take their problems and treatment plans to supervision, we reflect, we are full of hope of change for each and every one of them.
What I hope this blog has given you is refreshing look at what is a very hard job, to help you ‘fall in love’ with the reasons why we do this all over again and to help explore and reflect on what you do to survive and thrive within this job role. It is important to remember that while no system is perfect, IAPT leaves us with the opportunity to give support to those that would probably have never received it in the past. As PWP’s we are gifted with peoples vulnerabilities and openness daily, to help teach people tools to help themselves and use when they face their future adversities in life. We all make a difference.
I was also asked to write a little bit about myself, so here is a little P.S on the end, my name is Gemma, I have been working in mental health for nearly 10 years and as a PWP for three, hopefully as you can tell I am passionate about mental health within our community. Outside of work I am an avid podcast listener, I love spending time with family and friends, people who know me are shocked about how busy I am. I love wild swimming and I do pole fitness, during lock down I bought a pole for my lounge to practice on. I love music and spend a lot of time watching local musicians. I hope you have all found this blog post helpful and hopefully interesting, thanks for reading.