The Unspoken Truth of the Frontline

Anna Suswillo, Mayday’s Asset Coach, shares the unspoken truth about working on the frontline and her experiences of being in and against the system.

When I tell people what I do, they often tell me how worthwhile it is, and how “good it must make you feel”.

In many ways, this is true. There are few feelings better than seeing someone you have worked with reach that milestone or make that decision. It’s what we’re about.

But it is also true that there are elements of the job that can leave you feeling frustrated, useless, powerless and not at all “good”. These are the ones that aren’t talked about, because it’s not fun to hear and it detracts from the successes. The closest reference people might make is, “I couldn’t do your job”, but the presiding belief is that every day you must go home with a glow of do-gooder satisfaction.

Some days, I go home feeling that I do very little good, for anyone, ever.

The origins of this feeling operate on two different levels.

On the one hand, the people you work with can contribute to chipping away at self-worth. If you do not have thick skin, a strong understanding of emotions behind abusive behaviour, and a robust support system (professional and personal) you will very quickly find yourself on a train ride to low self-esteem-ville. There will always be people who take their frustrations out on you; it’s not personal, they need to express the injustice of their situation. But this does mean that you will repeatedly hear that you are useless, that you don’t care and that, actually, they don’t like you at all.

As someone who comes into the sector because you fundamentally do care, and want to be useful, this can be very demotivating to hear. Especially when it is your job to pick yourself up, bounce back and approach the same person again with no judgement, resentment or fear. But you must do it. You don’t need to be liked to help. You do need to be there.

The other hand hitting you is what we murkily refer to as ‘The System’. The System is ever-present and it is rarely your friend. If you are not careful, The System will take all your motivation, good intentions, innovations and eagerness to help and flush it down the toilet. That referral will be rejected due to an obscure technicality; that person’s case will be closed when they can’t attend an appointment for mental health support because they are enduring an episode of poor mental health; this person won’t be treated because they are not ill enough.

Sometimes it can feel like it is the people in the other organisations and services that are standing in your way, but it isn’t; it is their part within The System that is. They, too, are frustrated and upset with the way things work but feel it’s impossible to change them. Constantly slogging against The System, trying to negotiate your way through it, or trying to creatively work outside it is tiring, especially when you know that things could be so much better.

These are not the heart-warming elements of front-line working that people want to hear at a party. And, as a person, these are not feelings that you want to have. But how can you combat them and still stay in the same role? Because, certainly, if we want the system to change, this can only be done by combating it and persistently shouting out when you see something wrong.

Firstly, personal disposition cannot be overlooked. That is not to say that everyone needs to be exactly the same, but there does need to be an element of passion, motivation and positive belief threaded through with a solid line of steel. This does not mean that you cannot be emotional or compassionate; it means you need to be able to reason your way through complicated behaviour and, more importantly, ‘bounce back’.

These people need to be put together. Combating a system and sometimes verbal abuse is going to be more difficult if you are not surrounded by people who share your core values and mission. You need team members who can understand that sometimes things hurt and are upsetting, but who are also able to give you a perspective on why that person did that or how you can work around that barrier; or when you need to lay down a reasonable boundary.

Finally, you need to be appreciated by those that employ you. Not in the “worthwhile” sense, but in an organisation that respects the work you do and the difficulties you encounter every day. You need to feel trusted and empowered to make decisions, but also supported to say when things are building up. I think this is something that a lot of organisations need to work on. Sometimes it is not enough to say that you respect staff; you need to show it too. And showing it can take the form of practical support, such as supervisions and reflective practice.

For me, personally, this is the work that I love and enjoy. So in many ways, the decision to work on the frontline is not a “selfless” act; I would go mad if I had to sit in an office all day. I work with people, not damaged objects, and there is always an emotional toll of working with people. We must not romanticise the roles of people working on the frontline, but accept the roles in all their gruesome detail and come up with better plans to support, encourage and enable those who are striving to support, encourage and enable people facing difficult situations.

A Disorder for Everyone

Nikki Aitchison, one of Mayday’s PTS Coaches, blogs on how frontline workers can challenge diagnosis and the ‘let’s fix it culture’ prevalent in mental health and homelessness services.

Last month, I attended an exciting conference called ‘A Disorder for Everyone’ in Bristol. The day explored how strength-based and personalised interventions could offer an alternative to the current biomedical framework and the ‘let’s fix it culture’ prevalent in our public services.

More people are being diagnosed with mental health problems every year, this is partly due to the success of public campaigns aiming to destigmatise mental health problems. But as Carl Rogers says “the shoe that fits one person pinches another”, simply speaking out about mental health problems and relying on more diagnosis, and more professional support is not a recipe that will appetise everyone.

‘A Disorder for Everyone’ challenges the current system within mental health and looks at every single individual case. Instead of saying ‘what’s wrong with you? They ask ‘what happened to you?’ – A language shift surely makes less severe subconscious stamps and makes recovery an option. Clinical Psychologist Lucy Johnstone explained that if each individual case is to be looked at uniquely using a method called “formulation” there would be far less diagnosis and less prescribing. It is a person-centred process that creates a unique intervention.

In other words, ‘diagnosis’ is a generic identity – for example, hearing someone has been diagnosed with depression, tells very little about the influencing factors that brought to person to feel and behave in a certain way. The diagnosis of depression tells nothing about our interaction with the environment, culture, media, parents and social networks around us. So the question we should be asking at the frontline is not ‘what diagnosis should this person receive (or should they have received)’ but ‘how can I include the person in their recovery and encourage them to recognise their strength so that they can bounce back from tough times’.

Alongside this, I recognise that the reliability and validity of ‘mental disorder’ remains contested by people who survive the psychiatric system – but for the purposes of this blog, I will not go into a debate about how well the diagnostic manuals measures what they purport to measure – it is not a field I am trained in – but I will reflect on my experience of coaching people who received a mental health diagnosis, and how, if at all, this should have an impact on how we work in the frontline.

In my experience of working with people who are going through tough times like homelessness, leaving prison, care or psychiatric hospitals, I find three key principles ensure a quicker and more positive transition:

1- Challenging identities based on diagnosis, as any label, including those given by medical profession attempts to neatly categorise individual experience. The language and labeling that comes as a result of the diagnosis can give someone a false generic identity that can leave them feeling hopeless and discourage their drive forward

2- Challenging our ‘let’s fix’ culture of the overly diagnosed and prescribed generation, and instead of offering a new psycho-active drug, or even a psychological framework, sitting down with the individual and having a honest conversation about who they are, what matters to them, and ask what, if any, support they want from us, rather than assume what is best for them.

3- Recognising “what happened” that led to someone experiencing tough times, but focusing on “what is next”, what their dreams and aspirations are, and what strengths they already have and can build on to get there.

Let me illustrate this with my experience of working with Peter:

Peter made it very clear from the beginning that he does not want any support with his mental health diagnosis. For years and years, he was pressured to engage with mental health services and was feeling sick and tired of people nagging him about the same issues. We agreed we would focus on his aspiration – developing his knowledge and skills in Street Art. We spent much time walking across East of London, looking at street art, talking to artists, building positive networks and finding exciting projects for Peter to get involved in. Focusing on what Peter wants to do became a positive motivation to tackle and overcome challenges, including those caused by previous mental health problems, and Peter continues to learn to work through what life throws at him and build the resilience to overcome challenges in the future. In other words, Peter has better mental health, because he has not focused on it!

Starting the conversation with dreams and aspirations, focusing on strengths, and slowly building on what is already good (and important for) people is far more empowering and useful. This strength-based and personalised approach gives people hope, whereas a support to fix problems based on a diagnosis leaves people hopeless. Labeled as mad, bad, sad, client, service user doesn’t motivate anyone to take a positive step and move forward – instead, labels reinforce people’s insecurities, ‘places in hierarchy’ and makes them dependent on services. We all go through a rough patch – some rougher than others – but these difficulties should never define us!

I hope this blog encourages other frontline workers like me to consider strength-based and personalised practice, and together we start a front-line revolution by putting people (not the labels) at the centre of every decision and action.

For us to keep sharing opinions and voices that may not always be popular or heard we need your help: 

Mayday, Soundworks Studio & Midcounties Co-op broker a new tune for Rob

On Sunday 12 March, Rob and our volunteer, Chris Williams have been interviewed by Sophie Law on BBC Radio Oxford. The powerful interview can be listened to at the bottom of the page, with kind permission of BBC Radio Oxford.

Rob has been picking up a guitar on and off for the past 20 years and has never progressed past the same song and the same few chords. He is a massive music lover and his knowledge on the subject is outstanding. He knows the lyrics to countless Bob Dylan and Black Sabbath songs but he has never been able to play and share them. Rob has been on the streets and in and out of services for years but he was never asked what he liked or enjoyed, he has not been given the chance to further this positive hobby. This changed when he was given the opportunity to expand his music repertoire and explore his love of music further by visiting the Soundworks Studio in Oxford. Access to the studio came about through local brokering conducted by Mayday coaches and this has been funded through successfully applying for a grant through Midcounties Co-op which will keep this exciting project going for the next year. Here Rob worked with a Mayday volunteer who was able to teach him guitar and move on from that 20-year-old tune. By the end of 4 weeks, he recorded himself playing and singing a Bob Dylan song.

Rob was delighted. As we sat over coffee, he proudly presented me with his CD. He said he couldn’t get across how much this meant to him and how pleased he was that he was able to do it. He walked into the studio and never thought he would be able to record a song. He left with a CD; a solid tangible outcome that demonstrated to him he is capable and he can achieve. He was proud of how far he has come.

Rob decided it was OK not to have a drink the night after he recorded a song, he felt that the buzz he got from his studio experience was enough. We talked excitedly about it for some time and hatched plans for future musical adventures. Rob found something positive, something he deeply cared about, that he could grow and build on.

These moments are very special. As a PTS Coach at Mayday, we do not identify needs and deficiencies, provide fixes and constantly measure progress, we focus on the strengths of individuals so that they realise that they have the potential and ability to achieve their own aspirations. Developing this self-belief and providing suitable platforms to facilitate it is central to everything we do. We do not direct people to a sector-specific, trivial social activity centre, we broker real life opportunities (such as recording a song at a studio) and work with volunteers to nurture people’s interests.

Rob surprised himself and saw himself in a different light. He was able to redefine himself from the guy who wished he could play more than a few chords to someone who records songs in a studio! This single triumph can then percolate through his whole being and allow him to reimagine many areas of his life where he had defined himself as inadequate.

Rob is going to send his CD to his daughter so she can enjoy it and he can share his new found skill. He is excited about her reaction and to know her thoughts on it. He knows his daughter has always believed in him and here is his evidence for her. Rob has planted a seed of belief and our job now is to nurture this in order for Rob to change other 20-year-old tunes.

Living on the streets, you get accustomed to that lifestyle. It takes a while to adjust to living on the mainstream. You take it for granted that people don’t care about you. When you work with Mayday, they do . . . Never in my wildest dreams, I would have thought I could be recording in a studio. (Rob)

On Sunday 12 March, Rob and our volunteer, Chris Williams have been interviewed by Sophie Law on BBC Radio Oxford. The powerful interview can be listened to below, with kind permission of BBC Radio Oxford.

For us to keep sharing opinions and voices that may not always be popular or heard we need your help: 

In Memory of Martin

Anna Suswillo, one of our Asset Coaches discusses how people like Martin struggle to navigate through a complex system of homelessness, care and health.

Whenever I pass the high street early on a weekday, I always half-expect to see Martin sitting there, waiting to meet me. Usually complaining that he had been there half an hour already – he was always early. Always so early, in fact, that I often had to warn him not to be when it was raining or very cold. He could be conscientious to a fault.

Our meetings would always be short, in line with his attention span. We would laugh about different DVDs or the TV shows he watched religiously. He would tell me which superhero comic he had taken out at the library that week (and which he would be sure to return on time). Sometimes, he would tell me proudly of an achievement, such as putting on weight – one of his regular goals from the doctor.

Over the time we worked together, I gathered the snippets he would offer me. I knew his jokes, what he found funny, what enraged him, and that he put on a suit and visited his parents at the cemetery every week. He took no sugar in his coffee because he was, always, “sweet enough” and he loved fish and chips on a Thursday. I knew he liked to walk his friend’s dog. I knew he had a sister, with whom he had fallen out of touch, but who he always recalled warmly and wished they spent time together.

We focused on the things that he liked. He enjoyed making models out of matchsticks. We provided a personal budget for the necessary supplies, and we went to buy splints, baselwood, and glue. I remember the confidence with which Martin talked with the shopkeeper about his plans and techniques; I had not seen him do so anywhere else. He confided he hoped that modelling would mean he would feel less inclined to go out drinking. He attended cooking lessons, which he loved, and he would enthusiastically call me to tell me what they had made.

Did Martin have complex needs, or was he stuck in a complex system?

Life has not been kind to Martin. He had suffered several losses – from his mother’s death which had made him homeless; to his fiancée; and then his best friend.

Martin was struggling to navigate his way through homelessness, care and health systems and was also physically unwell. It was suspected that he had a learning disability – by both ourselves, his doctor and previous workers – but as he was in his fifties, and had never been officially documented as having one, he was not entitled to support.

Martin lived with his mother until his late forties. He had never paid rent, never managed bills and never cooked for himself. He did, however, pride himself on his cleaning and regular laundry. He struggled with reading and writing and comprehension of complicated matters. He had no concept of the value of money. He wanted to be in a supported living scheme, because he didn’t feel safe on his own. But he was not eligible for the support he wanted, and in his distress and confusion, he was self-medicating.

We approached the social care services, but the reply we received depicted a very different man to the one I knew. He was identified as “an alcoholic, who did not want to engage with abstinence services”. The tone painted the picture of a contrary man who refused to make things easy, even though he was one of the most engaged and reliable people I worked with. Everything hinged on his alcohol use, and his ‘choice’ to continue drinking. Any chance of a learning disability was disregarded in the face of his drinking. The reasoning was that so long as he stopped drinking, he would be able to receive help – “stop drinking; then we can talk”. There was no consideration of the fact that Martin was drinking to cope with an unstable situation that he could not understand.

Pieces came together, only too late

Martin died in the ICU, following an ongoing and complicated lung problem. He did not want to go to hospital. He did not want to give up smoking and he had remained drinking down by the river. In his mind, if drinking and smoking made him feel good, while everything else made him feel bad, why on earth would he stop? For Martin, drinking was not a ‘choice’, but a survival tool. Alcohol and cigarettes were steadfast companions that brought him drinking buddies, warmth and moments of positive feelings.  Although our work together had begun to offer feelings of friendship, warmth and well-being from a source besides alcohol, I was just too late.

While he was in the ICU his sister was found. It was a bittersweet moment that she was, finally, there – but he was unconscious and would not wake up. I was grateful then, that I was a person who had vivid, human memories of the time I had worked with him. I knew his jokes, what he found funny, what enraged him and that he put on a suit and visited his parents at the cemetery every week.

As a worker, the death of someone you work with is devastating, and it is hard not to question yourself and to feel blame.

Martin was let down by a broken system: a system that slammed doors shut tohim, because he did not meet the desired criteria of ‘sick enough’ or ‘well enough’; a system that could not see him as an individual rather than a shopping list of problems.

It was a privilege to get know him and listen to his story. It is not easy to push aside what ifs, but it is important so that we can turn to what now; now, Martin’s memory motivates me every day to always see the person first, and everything else second.

From Big Sleep Out to Big Share

Nikki Atkinson, Asset Coach at Mayday Trust, asks how charities can develop the momentum created by Big Sleep Out and suggests a deliberate city-wide approach to providing resources to promote and strengthen the aspirations of people experiencing homelessness.

As the beautiful autumn leaves are swirling throughout the city, and we set our clocks back preparing for winter, many of us were overjoyed with the prospect of having an extra hour’s sleep in our warm and comfortable beds. But how about those of us who will be sleeping out, in the longer, darker and colder months?

According to the latest figures, 3,569 people are estimated to be sleeping rough on any one night. The number of people sleeping rough has more than doubled in the past five years, with a 30% increase in just the last year.

Last Friday, charities across Oxford organised the Big Oxford Sleep Out, inviting people to sleep out for the night, and reflect on how they can help people move out of the streets. People from all walks of life gathered together in Oxford City Centre. There was music, friendship, and many cold hands and feet. It was a successful event raising awareness, and crucial funds for charities – and we thank every person who participated and donated, for their fantastic spirit and intentions to change our city. The event not only raised money to support the crucial work of local charities but also made the scale of homelessness visible in our city.

For many people, seeing their friends and loved ones on the street, even for one night, and even on a night to raise money for the charities is hard to digest. Luckily, the participants had warm clothes, hot tea, food, and more importantly friends to support them throughout the night, and they had the luxury of going back home the next morning. How about those who do not? And what can we do to help them?

What do we have in common?

“I believe we have far more in common with those people than just the experience of sleeping out (once), and these commonalities can help a lot more to end homelessness.”

As a coach at Mayday Trust, I have had many conversations with people who are experiencing homelessness. Generally, people feel that the ‘homelessness’ label only excludes them further. Most people are fully aware of whatever situation they may be in, talking about it all day creates negativity. People need to be recognised for their skills, qualities and identity in order to feel good and want to move forward and for the right reasons.

So how can we ensure next time, we go beyond sharing the experience of sleeping on the streets, see people for who they really are, listen to their stories, and support their strengths to achieve their aspirations and dreams? And how can we do this together, not just as charities alone, but as a whole city?

Big Oxford Share Day

I am writing this blog to ask for your help to organise a Big Oxford Share Day – where everyone in the city shares their skills, talents, resources and friendship with everyone else.

My vision is a spring day in our beautiful city Oxford, where everyone shares what they have with everyone else, indiscriminately. The high street, the parks, the college grounds, everywhere in the city opens their doors to people experiencing homelessness. People of all ages and from all walks of life bring what they can: music, arts, dance, food, or just good old friendly smiles and chatter. And we use all these assets to discover what matters to people, what support and help people want from us, and to help them realise their full potential.

A day of sharing what we have, to find and grow the spark in people. That will be revolutionary.

Call to Action

You can help us in many different ways:
• Opening the doors of your business, or organisation to people for a few hours
• Setting up an outdoors cinema, theatre, or music hall
• Performing arts, painting, drawing
• Playing football, volleyball, rugby, etc.
• Sharing clothes, books, and other things you think no one should live without
• Donating a fun session, e.g. paintball, go karting.
• Cooking, baking, making tea
• Having a stall offering volunteering, training or job opportunities
• Talking to everyone, and being friendly
• Many many other things that I can’t think of, but you are willing to share

So if you want to join the Big Oxford Share, or if you have any questions, please contact our Oxford Asset Manager for further information, and we will make sure to get back to you!