Holistic Work is so Important - But We Must Ensure Staff are Supported

By Leonie Harvey-Rolfe

Every day in my job as a Service Coordinator at Golden Key in Bristol, I would meet women who had experienced, and continued to experience, daily violence, abuse, poverty, homelessness and addiction.

My work with these women was what is described in our sector as ‘holistic’. This means that we are striving to help the whole person, potentially in every element of their lives. If you imagine, you are having a problem with your housing, there are service available to help you with this. Or if you are struggling with finances, you might access a food bank. Or if you have had a run in with the law, you see your probation officer once a week.

But what if you are having to access all these things and more at the same time, all with different rules and remits? On top of this, you are sofa surfing at a ‘friends’ home who is asking for sex in exchange for drugs. You are working the streets to make some money to feed your own drug habit, awake at night, asleep in the day when services are open. How do you begin to join all these different strands together?

Holistic work is so important and is really valued by our clients, who would otherwise be passed around various services not knowing who they could turn to. With a holistic service they usually have one person who supports and navigates them through the system. For about 15 women in Bristol over 3.5 years that person was me. I witnessed all the women I worked with go through such repetitive cycles of violence, addiction, homelessness, offending, mental health issues all at the same time. An average day in my role may have looked something like this….

I meet the outreach team at 7.30am to go out together in an attempt to locate one of my homeless women and offer support. Then on the way back, stopping to pick up the phone to speak to a client for 45mins who is very distressed and suicidal. I listen, talk through what she is feeling, use my existing knowledge about the client to try to reduce her anxiety and lift her mood. Before hopping back on my bike, I follow this up with phone calls to the mental health crisis team, and email to update all professionals involved. Back on my bike again to support a client to a benefits medical assessment. We sit in the waiting room for an hour, her anxiety levels rising with each minute, only to then be told there is such a delay on appointments, it would be best for us to come back another day.  Then a phone call after with a client who needs to get documents together to extend their leave to remain as her years leave as a victim of trafficking is due to expire. Then a quick email to confirm my attendance to two multi-agency meetings next week – one to monitor a client’s level of risk to the public and the other, to build a joint safety plan to reduce the risk of death or harm of my client as a victim of domestic violence. I then nip to the office before the end of the day to write my notes which have been building up in my head over the last couple of days. Back home to relax and eat before going out on van outreach to support women street sex working. On the van we see five women. I am lucky to see one of my clients who is impossible to find during the day. She is very intoxicated and finding it hard to stand and speak. She manages to tell us about a recent assault she experienced from a punter. We record this and try to get her to eat. She does not want to eat, takes some condoms and off she goes back onto the streets.

One of my clients passed away, others I am amazed are still here. I went through almost every emotion with each and every one. They laughed and celebrated with me at the smallest of achievements; cried and despaired at the lows; and shouted, screamed and swore at me in the midst of their anger and frustration. Despite all the struggles, every single one of them is human like me. They have so much potential and so much to give. They are funny, intelligent and caring. To have known them is such a privilege.

But bouncing back between all these very complex issues five days a week can make it hard to establish your boundaries. When do you say no when potentially everything could be argued to be in your remit? And services around you are being cut so severely that your role is needed more and more every day, not just by clients but by professionals too.

In June this year, I went to the GP and was signed off sick for a month. It had been building up for a long time. I had done everything I could to work through it – using our various forms of supervision (clinical, line management, group reflective practice, peer supervision) to express what I was feeling. It was hard to put into words. I was not coming home everyday in floods of tears. The best description I found was a sense of feeling ‘full’. My head couldn’t take anymore. I also noticed that my threshold for what was shocking or risky had all but disappeared. After being exposed on a daily basis to horrific stories of sexual violence, exploitation, chronic hopelessness and very risky behaviour, my sense of what was too much for myself was very warped. My response initially, was just to pile more work on myself – keep going, keep going!

Taking the decision to go off sick was absolutely necessary. It gave me time to reflect and to really look at what might officially be referred to as ‘vicarious trauma’. I felt a sense of failure – that by being off sick I was weak and, despite all the supervision I was getting, I still couldn’t manage it. Outside of work, I taught and practiced yoga, I had lots of hobbies, I worked hard to have a good work/life balance. But I realised that no matter how much supervision you have or hobbies you do, it is not about getting to a point where you suddenly become immune to your clients experiences. It is always going to affect you and in fact, if it doesn’t, then there is almost more to worry about.

I also wondered about my role as a woman, working with women. When you are hearing about so much violence towards women, who are targeted because of their gender, the pain you feel is not just for your individual clients, but for women as a whole. It is something I can only express in words to a certain point.

I know that I am not alone. I have been part of a community of practice of about 35 professionals who work with women experiencing ‘multiple disadvantage’ – a range of complex, overlapping issues such as abuse, addiction, homelessness, etc. It was set up by AVA and Agenda as part of the National Commission on Domestic and Sexual Violence and Multiple Disadvantage, which has been looking into what help is available to women.

Self care as practitioners working with some of the most disadvantaged women has come up again and again. In team meetings, commissioning and professional forums, client need is almost always the focus. We know staff well-being is an important issue, but all too often these discussions are placed last on the agenda (and subsequently missed when we run out of time) or only really considered in reaction to visible signs of burnout like staff sickness or lower productivity.

Inevitably, this kind of work requires you to give a part of yourself to each relationship. When you are embedded in people’s lives to such an extent, and for many you are their only positive relationship, at some point it takes its toll. If we as professionals are to have the energy, tools and motivation to help women going through the worst life can throw at you – it is essential that staff well-being is prioritised. We need safe working environments which enable us to take time to reflect, define our own limits and unpick the day-to-day buzzing around. I was lucky enough to have a lot of support which so many people are still without in similar voluntary and public sector industries. But even still, sometimes a break is needed – not because we have failed or because we are ill, but because we are human.

Leonie was a member of the Community of Practice for the National Commission on Domestic and Sexual Violence and Multiple Disadvantage, established by AVA and Agenda. You can read more about the Commission and its final report here. You can read more from Leonie in this piece by Refinery 29.