“I wonder if it's something like, women just accepting that they're going to be paid less for something, and that the payoff is caregiving. Because that's what you're told you should do, and you can do”.
- Michelle, 25, Youth Lead Support Worker
The Chancellor promised, in July 2020, a pay raise for ‘frontline workers’ in healthcare to recognise the efforts of those risking their own health to support others during the COVID-19 pandemic. The beneficiaries, however, do not include junior doctors, nurses and many others in frontline social care. In August, National Health Service (NHS) workers organised over 30 marches across the UK to demand more equitable treatment, but again the social care sector went largely unnoticed. These events confirm the comparative invisibility of the ‘third sector’ of social care: frontline workers exposed to similar risks in stressful and often poorly supported roles. Such workers may be reluctant to protest due to fear of the effects taking time off work would mean to their service users (SUs). Or they may be lacking in the confidence needed to speak out, being resigned to society’s long-term under-recognition of their work. Whatever the reasons, investigation is needed to explore the experiences of those working ‘behind-the-scenes’ in human services (HS).
The issues experienced by support workers had really grabbed my interest from seeing multiple female friends keen to pursue such careers but constantly being faced with demands that, over time, have led to severe burnout. Such detrimental effects on their mental health are due to a number of factors including being on minimum wages, insecure contracts, experiencing a lack of organisational support and under recognition/value from society. Conversations around their declining mental health and struggles to make ends meet piqued my curiosity to develop a research plan delving into the work further. Luckily I had the ability to do this for my masters dissertation, while studying Social and Cultural Psychology at the LSE.
My research project presented here in short, was designed before the COVID-19 pandemic began. The evolving crisis has turned it into a timely and even more important study. It focused on human service (HS) professionals as those who are “concerned with the intervention and empowerment of vulnerable social populations”. This group includes support workers, social workers, and carers, as well as back-office staff, fundraisers and treasurers. Such roles are most often undertaken by women and include occupations which inspired the phrase ‘burnout’. I therefore interviewed 22 female HS workers, in an attempt to shed light on the experiences of those whose voices, jobs, and services are so often under-recognised and undervalued.
The next section will outline why and how HS professionals are facing the problems they do, interspersed with relevant quotes from the women interviewed in my study.
According to the UK Department for Education (2018), 85% of social workers providing support to children and families are female. While much has changed in the 100+ years since the role first emerged, this distorted gender demographic remains relatively stable. Over time, researchers have postulated the reasons for this. Feminist social writers and academics of the 1980s highlighted the hierarchical structure and segregation of managerial positions (filled by men) and practitioner roles (filled by women). In the following decade, scholars drew parallels between social work’s menial status and other low-status and low-paying, predominantly female professions.
“I don't know if they feel they [men] are more entitled to fight for more pay or negotiate it. Why shouldn't I do the same thing and demand more pay as well, rather than thinking, ‘Oh I'm just so lucky that I even got this job’”
- Olivia, 26, Programme Officer
Theoretical explanations include Social Role Theory (SRT) which proposes that gender stereotypes stem from the traditional roles of women as housekeepers and primary caretakers of children, and men as breadwinners. These socialised roles lead women to take up primary caretaking jobs in the economy. Whilst gender roles have become more flexible in some countries, the roots from which they were established remain common and deep, such as greater physical strength in men and more caring, nurturing traits in women. Additionally, it is argued by those researching Expectation States Theory, that division of labour emerges from expectations that men and women develop when seeing each other in societal roles. For example, women are more commonly seen in caring roles such as nursing or teaching children and are thus inferred to have certain psychological traits pre-disposing them for such work. Correspondence bias then leads people to essentialise genders as deeply embedded in biology and social experience. From such expectations within a culture, both sexes tend to conform to such beliefs. Socialization, mediated by parents and peers, acts as an agent in self-development and so, when an individual reaches adulthood, biosocial mechanisms are at play to direct role-appropriate decisions.
The majority of participants reported a distortion when it comes to roles, with c.75% female frontline workers and 75% male managers, in line with other findings in non-profit organizations.
“Our organization, they are very proud to tell you that it's 50/50 male/female. But, you know, that is a headline that they can just put out there and everyone can be like, ‘great!’. But then when you drill down into it....about 1% of them are men [in frontline]”
- Bella, 30, Social Integration Coordinator
Some interviewees found that it is easier for a man to pass through the qualification process into HS professions, a bias attributed to the need for more frontline men in the sector. However, perhaps as a result, participants found that the quality of work performed by men was generally poorer than that of female staff. For example in some cases dangerously misusing the power of having authority over their service users (SUs) lives.
Respect of work
Society tends to value roles at different levels, in respect to gender. Such valuation is linked to how work is seen as traditionally ‘for’ men or ‘for’ women based on claims around biological differences which constrain the options for each gender. Such focus, however, is less important than the influence of institutionalised hierarchies. The gendered nature of ‘women’s work’ is not based on maternal instincts or other biological aspects but results from socially constructed norms and power dynamics. The academic and specialist in work and organisation, John Budd, states that “we only see and value work when it conforms to our mental models of what work is”. Socially evolved norms, institutions and power structures determine which (usually commodified) jobs and careers are most valued, allowing other work to become almost invisible. Therefore, Budd argues, the power to turn invisible labour visible is in the control of our society. Whilst HS jobs may not always be explicitly ‘undervalued’, “the neoliberal market ideology overlooks critical aspects of work, such as freedom (thus democracy), psychological health, identity, caring and serving others”, all central to HS.
“…very frustrating because... our work is not valued, and our clients are not valued as well. So, you get this superficial veneer of admiration and there's no real respect”.
- Eve, 24, Care Assistant.
Social reproduction has meant that most of the undervalued and unstable work is ‘women's work’; it is a natural inclination and, therefore, ‘non-work’. Although not termed as such, it is in line with the call for ‘a politics of measure’ provided by the academic Geoff Mann. This is an analytic tool to address how work that is usually considered only through quantitative and economic value can be politicised in ways which redefine the measurement of value through cultural and qualitative weight. The commodification and quantifying of care work is uncomfortable as it is nested within a perception of social obligation. However, giving care requires significant energy, resources, and time, thus making it an economic practice.
“I care about justice. And I would see it as an injustice if I was not getting compensated for (the) serious amount of hours that I was doing regularly”.
- Helen, 30, Grants Officer.
Job burnout can be defined as a psychological syndrome marked by prolonged exposure to chronic emotional and interpersonal stressors of work. It is characterised by three dimensions: emotional exhaustion, depersonalisation, and lack of belief in personal accomplishment. Burnout is considered by many researchers as a “work-related mental health impairment”, and correlates with other mental health conditions such as anxiety and depression.
“It's understood as a necessary sacrifice”.
- Jasmine, 25, Support Worker
Compassion fatigue, also known as secondary traumatic stress (STS), was first explained as “the loss of ability to nurture”, and describes the psychological effects that extend beyond those directly affected by a traumatic event. Individuals are often motivated to work in HS because of their compassion but many experience its negative consequences, leading to a sort of numbness to the needs of their SUs.
Amongst HS employees, burnout and STS rates have been increasing due to, for example, rising caseloads, lack of resources, low and declining salaries, lack of job progression, lack of supervisory support, and role ambiguity.
“They always talk about resilience, … (but) if you've got a really big caseload, if you're underfunded, there's no support services to work with the family: that's beyond how resilient a worker can be”.
- Lily, 24, Student Support Worker
The consequences of these can mean workers are less productive, experience a lack of job satisfaction, a lack of empathy towards SUs, low self-esteem, poor decision making, headaches, aggression, and can increase absenteeism. Burnout therefore threatens the quality of work being performed and even patient safety. The academic Sigman found, at the time of research, the cost of sickness to corporate organisations in the UK was £8 billion, with 360 million working days lost per year. Stress was estimated to be the cause of at least half of these absences. Research like this has mostly focused on more visible work, such as corporate jobs and public healthcare. Stress and burnout in HS workers may be contributing to high staff turnover and continued poor representation in society, as well as detrimental effects to their wellbeing, thus warranting specific investigation.
“The service has been for the past year constantly at crisis point [...] there's not been an opportunity for staff to get time away to discuss anything”.
- Sarah, 23, Residential Childcare Worker
Identity involves a multi-dimensional mapping of the human world and where we belong in it, both as individuals and as part of a collective. The influence of how we are regarded by others, and how we think we are regarded by others, comes to mould our sense of self. Social representations (SRs) are ‘common knowledge’ and provide the templates for individuals to integrate and associate themselves within society. The HS professional may be a co-constructor with ‘society’ of the representation of HS work as ‘low-skilled’, for example by modestly undermining the extent of skills needed. Labelled as the ‘caregiving bind’, this was found to occur when informal caregivers conceal the extent of care given in an attempt to protect their care-receivers’ identity. Self-actualisation of one’s personal potential may be also limited by the SRs attributed to one’s work as representations become internalized. This also has the potential of negatively influencing self-worth. Representations of HS workers may be shaped by societally assigned gender roles, the (mis)understanding of what the work entails and the disregard of, or even stigma ascribed to SUs. In my research this was found to lead to societal oversimplification of the work, with descriptions of the workers as “sweet” or “sensitive” whilst failing to acknowledge the reasoning and strategic skills required.
“…‘Oh, you must be a saint to do that’ or ‘you must have so much patience’ - I think it reflects quite negatively, like ‘Oh, you have to have that much patience to work with somebody like that’”.
- Julia, 24, Support Worker.
My research findings
All participants discussed representations of their work held by society, most commonly reporting the misunderstanding of the work as low-skilled. When asked if their salary reflects the work that they do, the majority did not hesitate to disagree, and share their feelings that compensation was inadequate. However, there was clear understanding that the sector as a whole is underfunded, and this was used as justification to work harder. Unpaid overtime work is common and represents an attempt to maintain justice for the service user (SU) when the organisation cannot provide the resources needed. The recent greater recognition as an essential service, due to the COVID-19 pandemic, has made many participants both thankful for the wider appreciation, but also pessimistic of any lasting change that this might achieve.
“You hope that kind of awareness [Covid-19] will mean eventually people recognize, and the government especially recognize, we need to get paid more, look after the staff better, prioritize their wellbeing better. Just people talking about it will only mean something if it translates into real improvement in the working conditions. It's not enough just to be like, ‘thank you’”.
- Rosie, 25, Community Support Worker
“I feel pretty cynical about the whole thing. People's skills should be recognized without a crisis”.
- Jasmine, 25, Support Worker
Many participants, including some back-office workers, expressed feelings of burnout and/or compassion fatigue, either presently or when describing past experiences. They reported the high prevalence of these conditions and the general expectation of them within the sector. Supportive colleagues were often cited as the primary salvation, particularly in the absence of sufficient organisational support.
These results clearly underscore the urgency for action to be taken to mitigate the maladaptive effects of working in this field. HS organisations seem to exhibit inconsistencies between their evident focus on helping their service users yet providing inadequate support for those responsible for delivering the service. The high incidence of burnout and consequent high staff turnover represent a cost to the sector that would be mitigated if greater investment were made in recognition, compensation and support. For society at large, the current perfunctory appreciation must be converted to a deeper-rooted understanding and respect.
“You're kind of split between really loving your job, seeing the value in it and having that motivation but also feeling the burnout and the lack of pay. [...] it's not even to do with the monetary aspect. I think it's more to do with the principle of being recognized for it and feeling valued.”
- Julia, 24, Support Worker
The funny thing is, I’m currently applying for these jobs which I know full well may lead to huge strains on my mental health and wellbeing. Like many others, the motivations, as well as the lack of other options to find my way down the career path of mental health support, outweighs the consequences of such work. It is with the knowledge gained from months of research that I can now try to address issues from the bottom up while trying to pursue my dream career of becoming a therapist. Having been immersed in the research I feel fuelled to continue advocacy within the sector upon entering it. Re-reading this article may also be helpful someday, to reaffirm my beliefs and self-confidence when feeling powerless in the face of burnout.