$#*£ Resilience
A mid week rant
I was going to relax this evening. Tune out, hunker down, look after myself. I need it. I am exhausted. Thoroughly used up. And it's only Wednesday. Not even half way through the week. A week that in the UK, is Mental Health Awareness week. I don't know who decides these things, who gets to co-opt a day, a week, a month, and declare it a thing about a thing. But I do know a lot about mental health. I know a lot about mental health AND I know a lot about working for the UK's National Health Service. And so it was with interest that I clicked play on the below video, earlier today. By the time I finished, I was in tears.
Now I know this video is carefully calibrated to tug at the purse strings, via the heart. But there is nothing here that is not true. Trust me. I know.
Of course, even though I opened this video on my laptop, my phone somehow knew, and when I flomped onto my sofa wondering where I was going to find the energy to mother my children, the first thing it suggested I read, right when I might have benefited from videos of cats, was the article below, which you do not have to read to get the gist of what I want to say:
This would not be my usual reading material, I confess, but I am a believer in not sinking into an echo chamber online, and I was curious. The author made some valid points. It IS a rare privilege to have a side room in an NHS hospital rather than a bed on a multi-bedded bay, though they are always full, so not that rare. It is also the case that we should be concerned about the wellbeing, or lack thereof, of our NHS staff. The author writes that "if NHS conditions are so bad as to bring them to this state, it should surely be up to the NHS itself to provide this sort of treatment. But we all know the answer to that: Our NHS is cash-strapped, especially in the mental health department." This too, is true. But what this neglects to mention is that the NHS does provide this sort of treatment. Employee assistance programmes and staff support services are in place across many NHS Trusts offering support for a range of practical and emotional difficulties and wellbeing initiatives abound. They are needed.
NHS Digital’s most recent published figures, for November 2023, show that mental health difficulties are the most frequently reported reason for NHS staff sickness at 26.2% of all sickness absence in that month (586,600 full time equivalent days lost). Indeed mental health related absence has consistently accounted for the highest proportion of sickness absences over the past four years. Of course, not everyone who feels emotional distress takes time off work, do they. But results of the 2022 NHS staff survey, completed by over 608 000 staff members (a little over a third of the staff body), shows that 44.8% of respondents have, over the 12 months preceding the survey, felt unwell as a result of work related stress. As the article above so rightly observes, "conditions for staff in the NHS may be difficult and in some places dire".
Stay with me, I am coming to my point. And it is a point that is relevant to you. This is the passage from the article above I want to discuss:
..."maybe at least part of the problem is not the conditions, but the staff. Is the NHS perhaps recruiting the wrong people? With degrees now required for nurses as well as doctors, maybe what the NHS really needs is fewer A* grades and more of that quality called ‘resilience’."
Anybody see any issue here? Well I do. I very much do. There is an argument here, isn't there. Hire tougher people! TRAIN them to be resilient! According to the King's Fund, there are around 110 000 unfilled posts in the NHS. The NHS cant hire enough people. Why can't it hire enough people? We all know there is no simple answer to that, but we might wonder if the unforgiving working conditions plays into it a little? And the people that DO step forward into careers in which pay diminishes in real terms year on year as demands continue to grow? These people care. These people want to help, and they want to help because they feel for their fellow humans. Our nurses, our healthcare assistants, our midwives, staff across the organisation, tend to be empathic and conscientious. Which, to be frank, is kind of exhausting. Particularly when staffing is so stretched that they often find themselves providing care in ways which they know to be unsafe. Too many patients, too few staff.
So here we have a workforce who are suffering. On top of the standard stressors of working with unwell fellow humans we might expect, staff are doing so with too few pairs of hands, too little time to attend to their own basic needs, and, where this used to be called "winter pressure", they are now doing so unrelentingly. Many are stressed. Many are struggling with a sense of moral injury. Many are burnt out. Many are leaving, leaving more burden still on those left behind. It's a downward spiral from here.
Now put yourself in those shoes. Is more resilience what you need? Let's try a different scenario. If you ran a fruit stall, and every day kids came into your fruit stall with their mums and and had a good grope around to find your best peaches, what is going to happen? Your peaches are going to get bruised and unsaleable aren't they? OBVIOUSLY the solution here is buy better peaches from the wholesaler. Right? You know, those peaches with the extra tough skin? But peaches is peaches. They have a soft skin, they have juicy delicious flesh. They are perfectly peachy. So what are you going to do? You know what I'd do? Move the peaches. Rearrange. Protect the peaches.
By suggesting the problem is a lack of resilience, we place responsibility for emotional distress - often very ecologically valid emotional distress - on the individual who is experiencing it. We are saying "you just need to try harder". I don't think for one second the issue is a snowflake workforce. You ever met a snowflake nurse? These men and women will catheterise you with one hand, and clean up your vomit with the other while you verbally abuse them because they wont let you smoke on the ward. They shouldn't HAVE to, but they do. No, this is not where the lack of resilience lies. Where resilience needs bolstering is the system itself. And I have no easy solution here. There are obvious things, of course. Funding, always, and relatedly, staffing, definitely. But the point is wider than this slight against the NHS workforce. Resilience has become a buzzword, not just in board rooms and in the press, but filtering into classrooms too. And I dont deny resilience is needed in life. We all need to learn how to pick ourselves up and manage challenges, because we WILL face them. But there is a danger here that by stressing resilience, by placing the culpability for mental health with the individuals, not only do we layer a sense of inadequacy on top of whatever else was already going on for someone, but we sanction the neglect of the very real systemic issues which are causing difficulties. Is it right to ask people to be resilient in the face of racism for example?
So this is my mental health awareness week thought for the day. Take messaging about resilience with a pinch of salt. Don't be told that the fault lies in some lack within you when something feels wrong to you. It isn't that we cant enhance our coping skills, the way we manage when things feel challenging, of course we can, but sometimes we are just papering over the cracks. If it feels wrong, perhaps something outside of you needs to change. Recognise that we are all peaches. We bruise easily, but our softness makes us perfect.
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Generally, this platform is my place to play, but today is World Mental Health Day. Which is not to say there isn’t space to be playful when thinking about mental health. Playfulness, after all, is a route to several fundamental protective elements of good mental health – connection, cognitive flexibility, learning and pleasure. But I’m not playing when I say that mental health awareness is important. According to the World Health Organisation, nearly three quarters of a million people die by suicide every year, and this is the tip of the iceberg – the stark, measurable tip. Below the water line people in their millions are impacted by struggles with mental health difficulties, in themselves or those they care about. Most of us, I would say, have a stake in that iceberg. And this is just it – most of us.
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Comments (21)
Congratulations on it. You did it well.
Congrats on Top Story! :)
This makes me so angry - "By suggesting the problem is a lack of resilience, we place responsibility for emotional distress - often very ecologically valid emotional distress - on the individual who is experiencing it." is such a powerful way to put it, and I absolutely agree with you. A well deserved top story!
Made my blood boil, tbh. As if NHS staff aren't being shat on enough, now they're being told their burn out is their own fault. Not because they've been over worked, underpaid and undervalued for fucking ever, oh no. It's because they're not tough enough. Make it their fault, and let the culprits off the hook. I couldn't roll my eyes harder.
While resilience, and honouring that characteristic in others, is a powerful tool, unfortunately, it tends to put the responsibility on those who have often been abused or mistreated. Ironically, it can encourage people to stay in negative situations. Sometimes, our emotions teeter not because we lack appropriate self-regulation, but our minds are trying to tell us that something is not quite right. This survival mechanism should be headed, not silenced by talk of resiliency.
Back to say congratulations on your Top Story! 🎉💖🎊🎉💖🎊
For me, that was a very valid rant. The kind that should go viral to initiate awareness. I never really stopped to think of what the Health Care staff in every country must go through on a daily basis. Hats off to all of them. 'Resilience' is a cheap attempt to reprogram the human condition. I don't think one person could use it as a method for coping with stress. It just doesn't work that way. I agree that some people are stronger than others, but like the video stated, workers don't always let their feelings and stress levels show. An old friend of mine went to school to become a respiratory therapist. He quit after a month on the job, saying it was too stressful and he didn't know how he would feel working with sick people, he couldn't do it and went back to bartending for a number of years. It's a tough profession indeed but doesn't require resilience, it requires the drive to help others. Thank you for writing this.
Interesting and very true although I must add that if a person is fully comfortable and good with themselves, their morals and who they are in general then they will find it a lot easier to help others deal with their challenges and mental health decline
Your discussion of resilience and the peach analogy are astute and well voiced. I started reading this yesterday and had to come back to it today so I could fully attend to it with a fresher brain. A very worthy Top Story!
Resilience is an interesting thing to think about. Like, if we think about concrete or steel, both things are incredibly resilient - assuming that we take proper care of it. Maintaining the resource is critical to having it remain resilient during its effective life. Human resources are the same as concrete and steel. While we are remarkably resilient, incredibly adaptable, we are not infinite. Our ability to recover and bounce back is NOT the kind of thing that can simply be relied on again and again. Like rubber bands, eventually we stretch ourselves too thin and snap. Unfortunately, the thing that will create the most positive change, in my opinion, is funding. In Canada, and it seems Britain as well, we are constantly in a fight with our provincial governments to spend enough on Healthcare and improve our access. Money itself won't solve the problem, but filling those positions, creating a system that is mostly stable, will give us the foundation to build something better on. Sadly, the standard rhetoric these days seems to be "but private healthcare is better!" Despite the overwhelming evidence that, for the vast majority of the population, it really isn't. "Why should I pay for their care," types never think "they also pay for mine." But how, exactly, we correct the bureaucratic and political nonsense leading to this toxic and inefficient environment is beyond me
I saw the inside of this issue even as a student and it is a go-to M.O. used by managers/supervisors and the like for many issues. The nurse I saw back then had to slip into a busy office to cry, and in less than a minute was advised to take a deep breath and get back to work. People are treated like machines, and because it is so ingrained across employment sectors, people also treat themselves like machines. It is beyond sad. I had a completely different employment environment where I grew up, so it's really hard to watch, even after all these years. It will take a massive, consistent and concerted effort for this to change, because the workplace culture across the board needs to change completely and irrevocably. Thank you for highlighting a story that needed to be front and center.
Important points well argued. Congratulations on Top Story! 🥳
In our culture of, more is more, there is no end in sight. Thank you for taking the time to join us at least in the knowledge that we are not alone. Congrats on your top story
So when work-related stress causes mental and physical problems, the answer is "suck it up." Jesus. Unfortunately it's a world-wide issue. We've had so many nurses and other health professionals quit since the pandemic that wait-times in ER can be 24 hours or more. Even jad cases of people dying in hospital hallways waiting for treatment. Governments answer is to tell us what a great job they're doing and how many new staff they've hired, completely ignoring that it's still a net negative.
Beautifully described. Humanity has many terrible examples of what happens when tougness takes precedent in nuturing. Congratulations. A very deserving top story!
Not surprised but congrats on a timely and important Top Story!
I felt your rage and sadness through this entire piece. Completely agree with...in many ways saying "we need more resilience" is like telling depressed people to maybe "just stop moping" lol. It's important to have some kind of resilience because life can be very so very shit at times...but it's not down to the person who is suffering real and valid problems in a problematic work environment to just be more resilient. People need more trust in the system...and they can't get that at the moment it seems. My son has worked in NHS hospitals as a support thingy (I can't remember his position title...but it's lowered end, non-college/uni-qualified) and I get a sense from him directly that what we hear in the news is not far off from the truth and not just "nurses having a whinge" I wish for a kinder world...where people suffering weren't constantly told they were to blame....or they were at fault. But, the world continues to ignore my wishes. I really enjoyed this...well didn't enjoy it in that sense. But, you have a way of writing that makes for compelling reading and I am sorry it's affecting you badly too...given your work environment etc. Did it help to vent/write this, at least?
My son wants to do medicine. I worry for him already. This was a great piece, Hannah. Resilience is important but not if it is sacrificed to balance. I think people who work in hospitals are remarkable because they do it to help others, not for pay. They do it because they sense what others need and want to provide it. Why don't we value that more? Why do we see the ambitious, the power-motivated, the wealthy as our role models and what to aspire to? I don't know how to change it, that mindset. It's worrying.
"Move the peaches. Rearrange. Protect the peaches." Now that's the most sensible thing to do and I love how you used this analogy to explain the situation at hand
Thought this was so well written and such an interesting piece. I think there are a lot of things that have seeped in over the years that make me wonder what’s happened to compassion and common sense. When resources are limited or non existent, we seem to bang on about resilience and gratitude. I can’t help but think if you take care of people and treat them kindly, they perform better. Win win? Anyway. Great article.
This is another deeply felt and compellingly reasoned essay, Hannah. It reminds me of the health crisis in American medicine. The nurses here have been voting with their feet after two years of COVID hell. But the system is still placing the blame in all the wrong places.