Burn out. It's something I heard time and again in school for social work. We talked all about the burnout rate in the mental health field. We talked about how turn-over was incredibly high. I never thought in a million years that I would be a part of that statistic.
So how did I end up here?
Friends and family still know me as the social worker or just the helping-people-person. I went to college with an interest in studying the human mind and a desire to come alongside people in their various struggles and sufferings.
This is in part fueled by my faith, as I know the world is a broken messy place. I know that pursuing mercy and justice, doing everything I can to #reversethecurse, is part of what it means to follow Christ.
Nowadays though, to the bafflement of some, I work at an Express Laundry. I spend my shifts running the store, assisting customers, and cleaning and folding people's clothes. A lot of people don't quite understand that. It wasn't for lack of social-work-esque jobs that I took this one.
The time and space away from the mental health field have given me the ability to reflect on my experiences and share them with those who are interested to hear about it.
Becoming a Statistic
Before I start, I want to say that some who know me know the specific places I've been employed. I'm not going to be specific in my post here, but for those who know, I want to make it clear that this is not meant to reflect negatively on my former co-workers or employers.
What I encountered was in large part a product of the way the mental health system in the US is structured.
My experiences in the mental health field are shaped by the community service boards (CSBs) that I have worked for. CSBs are organizations that are mandated by the government to provide mental health and substance use services to their local area.
I worked at a crisis stabilization unit (CSU) in one such CSB as both a med tech and a case manager, and I worked very briefly as a PACT case manager in another.
Freshly graduated with my bachelor's in social work, I jumped into the field with eyes wide open.
Nothing can really prepare you for what the work is really like. No amount of classes talking about burnout and how to avoid it, no amount of safe spaces to process experiences... none of that can really prepare you for the chronically short-staffed shifts where you are constantly waiting for something to go wrong.
It wasn't too long after I was hired at the CSU before I intervened in a situation where a client attempted suicide. They had tried to hang themselves with their bedsheets. I'll never forget them. I'll never forget anything about that evening.
After that, I was scared of that ever happening again. The reality of clients engaging in self-harm in life-threatening ways was ever-present in my mind. I took safety checks incredibly seriously.
The hardest thing was holding the position which required me to be out on the unit all the time. If anything happened, I was the one there. It was both a rewarding position and an incredibly difficult one.
The connection with those coming in was beautiful, and I loved it.
The feelings of vulnerability and helplessness, though, those I could do without. I still remember feeling alone during the multiple occasions where a client would be aggressively acting out, posturing, threatening, sometimes throwing things.
I remember thinking, "I have to be here. I have to take this." I would do my best to de-escalate the situation. I remember the feeling of helplessness when that was ineffective. I remember feeling incompetent, feeling responsible for the other clients watching who were no doubt being re-traumatized.
I remember rationally knowing exactly what a therapist would say to all of those thoughts I was having. I remember knowing exactly what coping skills someone would advise me to use to cope with the stress and anxiety of the job.
The frustration when it seemed that nothing could really make the repeated barrages of always feeling so hyper-vigilant all the time better.
Always trying to be a shield, trying to absorb it all. Keeping that professional mask on. Reassuring everyone and making sure they were okay. Listening to the clients as they processed their own feelings. Swallowing my own feelings down my throat until I could find a time and place to process them. Getting off and feeling exhausted. Dreading coming back in.
That position, by the way, was one that paid me 11.95 hourly. As a case manager, I made 19.25 and then 18.00 hourly.
Hourly therapy sessions cost me 80.00 dollars per session.
I make 15.00 hourly plus tips at my current position at the laundromat.
You do the math.
It was no walk in the park being a case manager either. At the CSU, I still had all the same duties as before, but this time with extra responsibility. I would run groups. I would do therapeutic check-ins with clients. It was a lot.
It paid a lot more, and I was happy to get the experience doing the thing I thought was the job I'd always wanted.
But eventually, the short-staffed shifts and the emotional exhaustion just got to me. I found myself at a place where I was having panic attacks all the time. I constantly dreaded going in to work. Sometimes I couldn't keep my professional mask in place when I felt like a client was in an acute crisis. I let slip and broke down in tears once on the job because someone reminded me too much of the person who had tried to commit suicide. I found myself crying and shaking, and my amazing co-worker covered the desk for me and sent me home.
I decided to apply for positions at other case management jobs. I thought a more 9-5 schedule would help me. I thought it would make the work-home transition easier. So I got a job being a PACT case manager with a different CSB. I was told I wouldn't have to work weekends. I was told I would only have one evening shift a week.
The reality was different. I was constantly accruing overtime. They were going through a period of high turnover, and they were (surprise) quite short-staffed. There was no time to give me the proper training I needed to do the job. I was suddenly given an overly-full caseload. Only a week or so in and I overheard our director saying the situation with a client I had just been given could not happen again. This was a client who we discovered had just attempted suicide recently. This was blamed on the former case manager's inability to meet with the client twice a week for the two-hour increments mandated.
I found myself spending a lot of time alone in the car with clients which provided its own set of stressors.
I remember being in the car, feeling threatened by a client who, as I just then learned, had stopped taking his lithium and was now using meth three times daily.
I remember him ordering me to drive him to the office so he could sit all of us down in front of him. I wondered what would happen if I refused. I remember his rage. I remember doing everything I was trained to do - validating feelings, using a calm voice and demeanor, using every technique I had - to de-escalate the situation.
I remember feeling vulnerable and helpless.
I should have just pulled over. I could have asked him to get out. My co-workers told me I could always ask someone to get out if I ever felt unsafe. I communicated that I didn't feel safe being alone with this client. But everyone's caseloads were full. I would still get asked to deliver things to that client. My supervisor told me she understood I didn't want to work with this client because of his "symptoms". I liked my supervisor. She was great. But that made me feel incompetent.
That's not why I felt uncomfortable. It wasn't a matter of "symptoms". I felt unsafe and threatened. I felt like he did not respect me or my boundaries. Or was I just weak?
But maybe what was most frustrating was to have felt so afraid and vulnerable and not have that acknowledged.
Then COVID-19 hit and our pay was furloughed for a week.
I turned in my two week's notice shortly afterward, feeling guilty for abandoning my clients, and wondered if I could ever work in this field again.
I don't think I can.
I could go to grad school, get a Master's, and become an LCSW or LPC. None of those options appeal to me, though. I do not want to provide therapy and I do not want to hold an administrative position. I've seen what those positions are like, and you could not pay me enough to do that work.
But this is how I found myself becoming a statistic. One of those burnt-out mental health workers that people talk about.
For a while, I felt guilty for the decision to leave. I wondered if I was just weak or incompetent.
But I question if anyone could endure what I endured for any length of time. In the field of mental health, a fully-staffed team with low rates of turnover is a bit like a unicorn. It's hard to find.
And yes, the field is quite underpaid.
Though I wonder what figure someone would have to show me to tempt me back into the positions I used to hold.
Finding Joy in Work Again
As melodramatic as it sounds, I wondered if I would ever be able to find a job where I wouldn't feel so stressed and anxious all the time.
My time working at the local laundromat, though, has proven to be exactly what I need right now. I am so glad to have an employer who pays his employees a living wage and cares so much about our welfare.
I enjoy coming alongside people when they come in to do laundry in little ways. I enjoy the connection with them and providing them what service I can. It feels so refreshing to be able to help someone in such a tangible way.
I hope in the future to continue my education. In what yet, I'm not entirely sure. But I know now that there's something out there for me and that God has a plan for me.
It's nice to be optimistic about the future again. It's nice to have the space to reflect on all of my experiences. It's nice to feel stable financially. It's nice to be able to do something full time and not dread it or try and protect myself from it.
To my former co-workers and those who work in mental health, just know I see you and you're not alone. I know just how hard and stressful the job is. I know how often people pay lip service to it, yet how little change in the field really happens.
This post was perhaps selfish and mainly so I could put words to thoughts and feelings I've been having. But in the off-chance that it causes edifying and needed discussion about our system of mental health care here in the US I wanted to write it.
Thank you for those of you who took time out of your lives to give this a read.