second half consisted of constructive actions to address the diffi culties. These included staff presentations/exercises on a staff development day (2014) and in a staff meeting (2015), a capacity paper for managers (2015) and a staff survey (2016).
Some soundings “I feel worried about managing my
Some of the members of the ‘Staff Working Group’. From left to right: Wendy Dyer, Marie Johnson, Elizabeth Boyd and Liz Bodycote
Part of the reasoning for the changes
was a move to the model of functional leadership, which removed leadership from the disciplines and handed over the lion’s share of clinical leadership to psychiatry. One post from the disciplines was to be designated as psychological therapies lead and two others would be team leads. All consultant psychiatrists automatically became clinical team leads. This model promoted the importance of the clinical team (as opposed to the discipline team) with leadership held there. It was also argued that this was an economic style of management and necessary in these austere times. Whatever the validity of this, it fi tted with a concentration of power being handed to psychiatry. In a wider sense, the change of structure was motivated by a wish to streamline CAMHS across the trust in order to present an economical and coherent model of delivering services which could promote the successful takeover of other similar services elsewhere.
The values of diff erent perspectives
The heads of discipline were viewed as
too expensive in this new lean model of CAMHS. What went unacknowledged was the value of having diff erent paradigms of thinking as well as values, which the diff erent disciplines brought to CAMHS. One could argue that the disciplines remain, but just don’t have formal leadership, except I think this represents the ‘thin end of the wedge’. Without
40
designated leadership the disciplines are at risk of losing their infl uence in a context dominated by the medical model. The service set up to meet the increasingly complex mental health needs of children and adolescents can only be poorer as a result. Diff erence of perspective brings richer and wider solutions; why would we put that potential at risk when the mental health of children and young people continue to challenge our services in ever more acute ways?
The staff working group Following the consultation, a group of
us continued to meet and we renamed ourselves the Staff Working Group. We decided that the group should be transparent in its activity. The minutes of each meeting were therefore circulated in the service, a move which I think gave infl uence. We did not want to be experienced as secretly plotting to undermine management. Our motivation was to constructively bring staff ’s experiences to managers’ attention. The results of the cuts and restructuring
were staff who frequently felt overwhelmed and who missed their seniors. It was a traumatic period in the service’s history and there were many unresolved feelings around. The monthly group meeting became one of two halves. The fi rst 30 minutes consisted of ‘soundings’, where members talked about their experiences. This was often when emotions were shared. It had a therapeutic focus; people were listened to and gained colleague support. The
high-risk cases” (Feelings of professional vulnerability featured frequently, with staff concerned about a serious incident happening). “There’s a sense of hypomania in the clinic – change, change, change, even the waiting room is changing – however beautiful, isn’t it like dressing the window when the shop is closing...” (even good change emphasised loss and aroused suspicion). “I can’t sleep properly these days”
(clinicians reported sleep disturbance, waking early and making lists of jobs in the night). “I need to do considerable overtime just
to try to keep up” (staff worked over their hours in response to reduced resources). “I miss my discipline lead, I can no longer
seek their clinical advice” (loss of senior staff left clinicians without a place to consult within their familiar discipline). “I felt shocked when having to change
rooms” (when processing signifi cant change, we can’t manage another change whatever the size or nature of it). “My work is intruding into my day-to-
day life” (overwhelmingly change starts spilling into other areas of capability). This is a snapshot of the many soundings
made during the four-year life of the staff working group. Looking back, I think the service was deeply wounded by the changes and the group played the role of witness, allowing expression of the feelings and helping to process the experiences. It reminded me of the outsider-witness practice (White, 2007) where a group listens to an individual’s story, authenticating people’s claims about their history and identities. The group played, in some sense, the role of a ‘defi nitional ceremony’ which acknowledges the experience of invisibility and marginality, providing “opportunities for being seen and in one’s own terms, garnering witnesses to one’s worth, vitality and being” (Turner & Bruner, 1986). The individual’s story could be shared with others who joined in the process of producing a richer narrative. The working group meant there was a forum for the telling, and retelling
Context 164, August 2019
Holding onto hope in the midst of austerity: A staff response to serial cuts and restructuring of a CAMHS
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