$#*£ Resilience

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.