Compassion Fatigue Solutions

Last week, both my children came down with the flu (likely the most popular strain currently deluging the media). So my husband and I juggled: we shared the home care for the week (I was co-teaching a three day Crisis intervention course) and washed our hands like mad and tried to resist giving hugs and kisses to them (now, that was hard). They are back in school and seem to be on the mend and we are trying to catch up on missed deadlines and the lot.

It was nothing very serious, but it reminded me of the incredible stress of having younger children and getting the dreaded call from the daycare, which normally meant that not only Poopsie was sick today, but he/she was going to be banned from daycare for the following day, until they were deemed to have been fever-free for a full 24 hours. As soon as I would see the daycare number on call display, my mind would start racing, thinking about coverage for the following day, what was I going to do with the suicidal client I had just safety contracted with (the deal being that they would come back to see me on the next day), who would see the couple who had travelled 2 hours to come for a session who were already on their way to the office, and where would I fit in all the people who had been moved to the following day. Of course, it always worked out, somehow, but the stress involved was significant. And I'm talking about minor ailments here, not the catastrophic illnesses that so many people cope with.

Working as a front line worker has many rewards but the challenging reality is that you have to be "on" when you're at work. You were up all night with a sick family member? Too bad, you have to be 100% focused right now. There are no half measures really. Of course, there are many ways to help each other out - family and friends can step in, if they live nearby, but the stress of the unkwown never really goes away when you are a front line health care worker.

Of course, with the flu outbreak this week, hospital and public health workers are facing a mounting workload and having to deal with many stressors all at once - the hours-long lineups for vaccination speak for themselves, as do the crowded flu clinics.

This morning, I heard a very topical radio interview on CBC's The Current on the impact of the pandemic on health care workers. On the show was Dr Robert Maunder, a psychiatrist at Mount Sinai Hospital in Toronto who is part of a team who have developed The Pandemic Influenza Stress Vaccine, an online course for health care workers to help us develop resiliency skills while facing the pandemic. He said that several studies found that health care workers who were in the thick of things during the SARS epidemic were found to have lasting psychological effects from working in the SARS environment (more fearful of contamination for long periods of time following the end of the SARS outbreak).

Let me quote from their press release: "A computerized course for health-care workers worldwide to build their resilience during a pandemic. Based on the SARS outbreak in 2003, Mount Sinai experts understand that the spike in health-care workers' stress-related absenteeism results from fear of contagion, concern for family health, job stress, interpersonal, isolation, and perceived stigma. That's why Mount Sinai researchers Dr. Robert Maunder and Dr. William Lancee led a pilot study of computerized training for 150 Mount Sinai health-care workers in 2009. The results suggest that the training improves health-care workers' belief that they can handle the changes a pandemic brings, confidence in support and training, and interpersonal problems. This also suggests that the training may be able reduce stress-related absenteeism. From these findings, the researchers are launching The Pandemic Influenza Stress Vaccine course, which will be an education tool and also the basis of pandemic resilience research.

The course is available over the Internet making it widely accessible at no cost for the health-care workers. The goal is to reach 3,000 health-care workers worldwide.

The course is now live. It is part of a randomized control trial. Hospital-based health-care workers can register at
www.msh-healthyminds.com/stressvaccine. The pilot study was funded by Canadian Institutes for Health Research."

I have not yet had time to go take a look at the course, but Dr Maunder suggests that if you are a health care worker facing the onslaught right now, it may be very worth your while to take a few minutes out of your day to take the course now, rather than wait until you are not in the eye of the storm.

(photo from Tema)

A few days ago, my daughter and I caught a public service announcement (PSA) on TV that took our breath away. Maybe you've seen it - During the first few frames, cute little kids in various emergency personel uniforms state their career dreams: "I want to be a police officer" says a sweet 6ish year old girl, "I want to be a firefighter" says a gorgeous nine year old boy, and so on. Then, the ad returns to each one and they continue: "But I'm scared..., (and now I am basing the rest on recall) "I'm scared that my job is going to hurt me, I'm scared of the nightmares, the horrible images, of not being able to get them out of my head. I'm scared that helping other people is going to permanently damage me" and gradually you realise that this is an ad about PTSD (the ad was far better that my clumsy attempt at describing it!).

The hockey game were were watching was "Don Cherry Military Night in Kingston" - an OHL game in honour of Canadian military personnel. There were several PTSD awareness-raising messages throughout the night and the aim of the whole evening was clearly to convey to soldiers of all stripes that PTSD is a common problem for military personnel and that help is available.

Having worked with the military for the past decade, I believe that this message needs to be conveyed to military staff in as many ways as possible. There is still a huge stigma about PTSD among the Forces - many military clients have told me that they would never want the label as they see it as a sign of weakness and they fear that if they sought help for it, they might be demoted or, worse, discharged from the military. There is also a perception among many soldiers that it's a "copout label" - sometimes, they say, used dishonestly to seek a pension and benefits. Perhaps that is true on occasion, but my own clinical experience and the data shows that there are far more genuine cases of PTSD than malingerers and this perception is yet another obstacle for soldiers who really need help.

So with PTSD, we are battling many layers of cultural assumptions, prejudice, institutional dysfunctions and shame. An uphill battle indeed. Meanwhile, the soldiers with undiagnosed PTSD continue to struggle on their own, often using alcohol to numb out, turning their domestic lives into total turmoil, lashing out at their spouses, their children and at themselves.

But let's go back to the TV ad with the kids:

It turns out the PSA was produced by a Canadian organisation called Tema: the Tema Conter Memorial Trust. Maybe you have heard of it? They are not an organisation I know anything about, so I went to their website to take a look.

Their story is as follows:
The charity was founded by Mr. Vince Savoia, an attending paramedic at the murder scene of Ms. Tema Conter in 1988. Upon coping with post-traumatic stress as a result of this horrible episode, Mr. Savoia created the Tema Conter Memorial Trust. The trust’s purpose is two-fold: to honour the memory of Ms. Tema Conter and call attention to the acute trauma encountered by emergency services workers. These courageous and compassionate individuals are haunted by the scenes they encounter on a regular basis, and they need our help. Because heroes are human.

If you go to their website they also have a very powerful second ad called "Hands".

On a personal level, it was a great ad as it led my daughter and I into an interesting discussion. She said "That's the work you do, isn't it mom? Help people who are hurt by their work?" and I said "Well, yes, and I help the people who help the people who are hurt by their work and that, in turns sometimes hurts them too." "Wow", she said "What a strange job you do!" And I thought "Yes, what a strange, painful, moving, wonderful, rewarding job."

There was a PTSD awareness-raising Major League baseball game this summer. It was for US military personnel and had a similar message: this is common, this is normal, get help, you are no less of a man for suffering from this.

Now, it would be pretty cool if we had a PSA about vicarious trauma one day, but I wonder how it would go over? How would we, the helpers feel? How would the public react to hearing how hard we sometimes find our jobs? A PSA about Vicarious Trauma. How about that?

I am right in the middle of reading this book but wanted to share it with you as it is such a find. The author has over 20 years of trauma work under her belt and brings a very fresh look to vicarious trauma.

She explains the use of the term stewardship in the following way: "As I see it, trauma stewardship refers to the entire conversation about how we come to do this work, how we are affected by it, and how we make sense of and learn from our experiences. In the dictionary stewardship is defined as "the careful and responsible management of something entrusted to one's care." (Van Dernoot Lipsky, 2009)

I was instantly grabbed by the book's introduction, called On the Cliff of Awakening, which articulated something I could completely relate to (so could thousands of helpers I have met along the way.)

To quote from her intro:

"Are you sure all this trauma work hasn't gotten to you?" He asked.
We were visiting our relatives in the Caribbean. We had hiked to the top of some cliffs on a small island, and for a moment the entire family stood quietly together, marveling, looking out at the sea. It was an exquisite sight. There was turquoise water as far as you could see, a vast, cloudless sky, and air that felt incredible to breathe. As we reached the edge of the cliffs, my first thought was, "This is unbelievably beautiful." My second thought was "I wonder how many people have killed themselves by jumping of these cliffs." Assuming that everyone around me would be having exactly the same thought, I posed my question out loud. My stepfather-in-law turned to me slowly and asked his question with such sincerity that I finally understood: my work had gotten to me. I didn't even tell him the rest of what I was thinking; "Where will the helicopter land? Where is the closest Level 1 trauma center" [...] this was the first time I truly comprehended the degree to which my work had transformed the way that I engaged with the world. " (Van Dernoot Lipsky, 2009)

I will share more about this book as I read on, but so far, it's very engaging.

Chapter headings are:
Part One: Understanding Trauma Stewardship
Part Two: Mapping your Response to Trauma Exposure
Part Three: Creating Change from the Inside Out
Part Four: Finding your Way to Trauma Stewardship

Hi! Here I am, after a bit of a silence. Last week was Thanksgiving and thus no Monday post.

I am just back home after a long weekend in Chicago. Once every two years or so, I try to arrange childcare (my wonderful friend and I have a great arrangement where we help each other out) and get enough air miles to join my partner as he attends a scientific conference. The kids and I teasingly call him and his friends "neuronerds" as they are all neuroscientists and really into their science. The nerd quotient was fairly high this time around (25 000 attendees). But nerds can let their hair down with the best of them, I assure you.

Chicago is a beautiful city with stunning architecture. We walked a lot, visited the Art Institute of Chicago and ate one of the best meals I have ever had (no joke) at Topolobampo. If you love authentic mexican cuisine and are going to be in Chicago consider booking a table (way ahead of time) at this spot.

Upon my return, I had an interesting exchange with my eleven year old daughter. She reported feeling upset about all my travelling, and said that she liked it better when I didn't do so many speaking engagements, but rather stayed home all the time. I said to her "but sweetie, when I was doing clinical work 5 days a week, I often came home exhausted and grumpy, I was short-tempered with you, and I never had time or energy for anything. Now when I am not travelling, I am home a lot more, I can pick you up from school, we bake cookies, we have time for crafts, for errands...things are way better now." and she turned to me and said: "You were never grumpy. I never noticed that." Now, I don't think that is actually true, as her only goal at this time is to make her mother never leave the house again, but I thought "maybe I faked it better than I thought."

Ah, the joys of being a parent - guilt on tap every time you turn around.

In actual fact, I am home far more than I am away, and this is by far the best career choice I have ever made (and the most professionally satisfying choice to boot.) But it did make me think about the juggling most of do between all of the demands on our time.

It's never simple to simplify our lives. Ironically.

by Robert J. Wicks, Oxford University Press

This short, reflective book was written specifically for clinicians: psychologists, mental health counsellors and social workers. It will be most useful to those with a background in clinical psychology who do face to face work with clients on a regular basis.

Dr Robert Wicks is a psychologist and a professor at Loyola College in Maryland. "A recognized expert in the prevention of secondary stress, in 1994 he was responsible for the psychological debriefing of relief workers evacuated from Rwanda during that country's bloody civil war." (from his book bio)

I was thrilled to see that Dr Wicks centers his approach on the use of positive psychology and mindfulness.

Robert Wicks explains his goal in writing the book as: "to introduce and highlight those areas that can help renew clinicians in today's challenging climate. It is amazing how little it can take to change the emotional tide in favor of such a beneficial move. Small alterations can sometimes jumpstart a positive step to a healthier attitude more than disputing dysfunctional thoughts ever can."

Chapters headings are:

Sensing the dangers: Chronic and acute secondary stress
Enhancing resiliency: strengthening one's own self-care protocol
Replenishing the self: Solitude, silence and mindfulness
Daily debriefing; Mindfulness and positive psychology

My conclusion: A lovely erudite book on self care for clinicians who are ready to reflect on their own journey of compassion fatigue and self care.

I am just back from Yellowknife where I presented at a conference organised by the Federal department of Justice called "Northern Responses and Approaches to Victims of Crime: Building on Strength and Resilience." Over 250 victim support workers from across Canada met for three days to share ideas, research findings and to connect with each other. This was the first meeting of its kind and it was, in my opinion, a complete success. I had the opportunity to meet victim assistance workers from all areas of Canada, from Whitehorse to Rankin Inlet to Thompson Manitoba to Kuujjuak (my childhood villlage) in Northern Quebec. I have been to many conferences over the years, and this was the friendliest, most well organised of them all.

Why hold a victim support conference with a special focus on the North? Here is some sobering data from the Policy Centre for Victims Issues (PCVI) press release:

"According to the 2004 General Social Survey, residents of the territories were three times more likely than provincial residents to experience a violent victimization such as sexual assault, robbery or physical assault (315 versus 106 incidents per 1,000 population). Residents of the North also experienced higher levels of spousal violence than their counterparts in the provinces.

Approximately 12% of northern residents reported being the victim of some form of violence at the hands of a current and/or previous spouse or common-law partner in the five years preceding the survey. This compares to 7% of the population in the provinces. Residents of Nunavut were also far more likely to have been victims of spousal violence (22%) than residents of the Northwest Territories (11%) and the Yukon Territory (9%).

Similarly, police-reported crime rates in the territories were substantially higher than rates in the rest of Canada. Specifically, in 2005, crime rates in the North were over four times higher than rates in the provinces (33,186 compared to 7,679 incidents per 100,000 population). In 2005, the Northwest Territories had the highest police-reported crime rate among the three territories at 41,245 incidents per 100,000 population. This rate was 1.3 times higher than the rate in Nunavut, 1.8 times higher than that in Yukon and nearly three times higher than that in Saskatchewan, the province with the highest provincial crime rate (14,320)."

We heard a captivating and reflective keynote address by Justice Gerald Morin, Deputy Judge of the Territorial Court of the NWT and creator of the Cree Court in Saskatchewan. We were also were incredibly fortunate to have an evening performance by Leela Gilday, an award-winning Yellowknife singer and songwriter. Leela's songs were deeply moving and her voice was incredible. I was very glad that my meek keynote address came before her and not after her powerful performance!

Conferences such as this one offer all of us the opportunity to stop for a few days (well not really stop, it was a jam-packed agenda and people were working hard) but certainly the chance to get out of the trenches to connect and reflect on the work that we do. I met some victim support workers who had some significant challenges in their own lives (dealing with fostering several children with fetal alcohol syndrome, to name just one) and the complexity of offering services in a remote community, where everyone knows you and where you are often the end of the line. To all of these workers, I offer my most sincere thanks for their warmth, their open hearts and their willingness to participate in the workshops I offered.