The toll it takes

It is time we recognised that better experiences among health, legal and social service practitioners will likely produce better outcomes in terms of the health and wellbeing of the people they support, writes Dr Tessa Boyd-Caine, CEO of Health Justice Australia.

The personal toll of professional practice has become a source of increasing concern across the health, legal and human service sectors. From suicides among sitting Magistrates to inquiries into the hours worked and stress levels of newly-qualified doctors, a clear picture is emerging: we need to start taking better care of professional practitioners. 

Not only is this a question of duty of care for employers and in workplaces, it is likely that professionals under such stress and fatigue are struggling to secure good outcomes in terms of the health and wellbeing of their patients, clients and communities. 

It is time we recognised that better experiences among health, legal and social service practitioners will likely produce better outcomes in terms of the health and wellbeing of the people they support. 

But what does “professional wellbeing” look like? 

In some professions, external supervision is a required and key element of taking care of practitioners. For psychologists, supervision is a condition of their professional registration; respect for which extends to obligations on supervisors themselves to be professionally trained in their supervision practice. Similarly, the professional body for social workers regards supervision as central to best practice.

Not so for medicine or law, even when doctors and lawyers are working in the same service settings, responding to the same community needs, as their social work and psychology colleagues. 

And here lies the problem: our health, social and legal services have failed to keep up with the growing complexity in people’s lives; with the reality that health, legal and social needs often intersect; and when they do, each can drive or exacerbate the other. We maintain outdated notions that lawyers and medical professionals are somehow immune from vicarious trauma and the impacts of work-related stress. 

This is a reality faced every day by practitioners working in health justice partnerships. While these collaborations between health and legal services target a range of complex health-harming legal needs, Health Justice Australia research shows that most of them are responding to family violence among the people they see. Family violence services can take many forms: from helping people navigate complicated systems like financial services as they disentangle their superannuation or mortgage from an abusive partner; to providing legal advice about separation or custody; to counselling and therapy in response to the emotional impacts of family violence; to treating the wounds and injuries of physical violence. The skills and expertise drawn on through this range of services extends from social workers and financial counsellors to psychologists, lawyers, doctors and nurses.  

These practitioners are often providing key support at a time of maximal stress, anxiety and danger in someone else’s life. Each is responding to similar levels of need with similar emotional impact. Yet among the mix of professionals involved in these service responses, they and the professional cultures around them have vastly different mechanisms for supporting their own wellbeing. 

The systematic professional supervision required of social workers and psychologists is a far cry from the responses available to doctors, nurses and lawyers, who might at best have access to a limited number of sessions with an employee assistance program.

Practitioners in this work are often taught to compartmentalise their emotions to preserve their own emotional wellbeing in the face of the hundreds – if not thousands – of clients they might see over their career. But practitioners are often drawn to this work because they care. Invariably, the emotional and other impacts of the work builds up. Inevitably, this work takes a toll. The burden of this toll should not fall solely on the shoulders of individual practitioners. 

We need to start looking after practitioners working in these contexts at a systemic level; to regard practitioner wellbeing as the responsibility of employers, of professional regulation and of our health, social service and legal systems as a whole. 

How can we expect health, social and legal practitioners to take good care of the people they’re here to help, if they’re struggling themselves? 

This question informs a key discussion on “practitioner wellbeing” at a forthcoming conference in Sydney. Health Justice 2019, running from 24 to 25 September, will bring together people working at the intersections of health, legal and social need. 

The people working in health, social and legal services are the backbone of those organisations. They drive the impact that is possible in the lives of people affected by poor health; people who are vulnerable to unmet legal need; people who are experiencing disadvantage. We need to ensure that practitioners are given the best chance not just to survive but to thrive in the work they do and the impact they have.