By Dr Jo Clarke and Dr. Michael Carroll
There are some jobs which, of their very nature, leave individuals open to danger. Often called “critical occupations”, these jobs are unique in that professionals can encounter traumatic events which may, under certain circumstances, exert critical impact on their psychological well-being. It’s not difficult for most of us to name the kinds of jobs we are talking about. Emergency service personnel and disaster responders are two clear examples where front-line workers face acute risk owing to the nature of their work. Body recovery after natural disasters, removal of victims from vehicle crashes, attending scenes of terrorist activity can all be readily identified as situations likely to challenge any individual’s psychological equilibrium. Drawing up an inclusive list of ‘critical occupations’ would be a considerable challenge, but no doubt Garda would feature high on the list.
An organisational strategy to enhance the well-being of staff working with the most difficult, disruptive and damaged prisoners held in High Security prison discrete units in England has been devised. Much of what is now in place is very applicable to organisations and individuals in other environments e.g., police, fire brigade.
Traumatic Events and Well Being
A traumatic event is one that is outside of the range of usual human experience and that would be markedly distressing to almost anyone. Examples given of such events include threat to life or physical integrity or seeing another person being seriously injured or killed. Clearly, front line emergency responders (like the Garda) face such events frequently.
From research and from reviewing backgrounds to help outline and implement the well being strategy above a number of factors has merged:
• It’s not just the events that can traumatise. How individuals react to events is vitally important (there will be individual differences here). Age, gender, length or service and previous history of trauma are all factors in how stressful an event can be.
• Interestingly, organisational practices will also impact e.g., For example, organisations characterised by high levels of bureaucracy, internal conflicts regarding responsibility, persistent use of established procedures (even in novel situations), and a strong motivation to protect the organisation from blame or criticism, have all been found to increase the risk of poor post-trauma outcome Conversely, positive organisational practices, such as adoption of autonomous response systems, consultative leadership styles, training to develop adaptive capacity, and tolerance of procedural flexibility, can all enhance the likelihood of positive outcomes
• Finally, events removed from the work context, but significant to the individual, also need to be understood if risk potential is to be managed. For example, in a study of prison and community-based sex offender treatment providers, respondents who had experienced a non-work related adverse event in the previous six months, also reported significantly higher levels of dissatisfaction with their organisations. Such events included illness, relationship breakdown, house moves and so on.
An engaged workforce is identified by high levels of resilience, characterised in turn by the ability to bounce back from negative emotional experiences despite threats to the individual. This is illustrated by staff who are competent, autonomous, understand the difference they can make to their work place and have personal values and beliefs that fit the needs of the role they undertake. Consequently, an engaged and resilient workforce is one that has low rates of turnover, low levels of sick absence and high levels of performance. The development and maintenance of such should arguably then be the number one priority for both individuals and organisations in the critical occupations business. How can we ensure such a workforce exists?
Our well-being model included three sets of interventions: primary, secondary and tertiary. The first two aim to prevent stress occurring in the first place. Tertiary interventions are those put in place to support individuals if distress is experienced.
Primary interventions are concerned with the individual. They cover issues of selection, training and preparation of the individual to undertake a critical role. In addition to skills and competencies to do the job, self-care skills also need to be considered (psychological self-maintenance). The aim here is not to deselect staff who have yet to acquire the requisite skills, competencies or values to stay psychologically well and perform highly, but to generate a profile that enables the individual and organisation to work together to achieve such a position if potential is shown to do the job.
Further interventions concerns the job itself, and relate to the workplace, the work force and the work people do. Here, consideration needs to be given to the environment, organisational policies and procedures, on-the-job support, frequency of exposure to traumatic events, recognition of distress and so on. However, recognition and understanding of the impact that dynamic factors can have on well-being enables appropriate responses at both the individual and organisational level. Disclosure by a worker of difficult family circumstances, for example, can enable a manager to initiate different support options; understanding the impact on the team of a new manager can allow apposite preparation and so on. Intervention here would be an example of secondary prevention. Tertiary responses might include referral to a mental health professional or counsellor, adjustment of work demands, retraining and so on.
With the support of the prison’s senior managers (essential to the perception of meaningful intervention), a five stage process was initiated. This included:
1. Focus groups with frontline staff to identify their perceptions of barriers to well-being and high performance.
2. Examination of which of these (if any) could be removed or changed.
3. Use of training in how to manage the demands of work that cannot be adjusted.
4. Consideration of best methods to support managers.
5. Consideration of new ways of working to encourage resilience.
A number of practical interventions were proposed. To aid the management of physical energy, regular formalised breaks were introduced. Five to 10 minutes in every 90 was recommended, with team members physically leaving their work stations for that period of time. Some team members additionally opted to undertake a lunchtime exercise programme to augment their physical energy. To assist with the renewal of emotional energy, formal debriefs were recommended to provide team members with an opportunity to off-load the issues at the end of each day. Voluntary sessions with a mental health professional or counsellor were also offered on an ‘as needed’ basis. To help staff remain mentally engaged, a rotation system was recommended, whereby team members moved between the tasks needing to be undertaken. In addition to the above, preparedness training was also advised. Training in psychological self-maintenance skills, emotion management and the nature of psychological distress can enable staff to feel equipped and empowered to manage their emotional reaction as it arises, rather than feel overwhelmed or baffled by it.
Training focused on the development of psychological self-maintenance skills. As most practitioners in high risk jobs would probably affirm, training in the skills to do ones job is often comprehensive, but in the skills to look after oneself, non-existent. Based on the principles of emotional detachment, the programme describes the behavioural and psychological process of stressful responding. Attendees generate their own risk profile and then practice methods for managing risky elements and enhancing protective ones. An empirical evaluation of the programme when used with police officers demonstrated significant increases in job satisfaction and reduced absenteeism.
Well-being in critical occupations
Clearly, organisations have a duty of care to their employees to generate working environments that are as safe as possible. Individuals also have a duty of care to themselves to ensure they avail themselves of all opportunities to stay psychological well in the work context. These responsibilities are likely to be most effectively executed where there is a genuine desire to enhance performance and well-being through consultation and collaboration. Organisations that impose support structures from the top down are unlikely to reap the benefits of their intentions. It should not be surprising that many of the interventions included in our Well-being strategy, were also recommended by frontline staff –testament to staff’s wisdom, experience and intuition for what works in enhancing their well-being.
Many thanks to both Dr Jo Clarke and Dr. Michael Carroll for allowing me to publish their article.