Compassion fatigue

This is a guest blog by my colleague Ali Miller who leads on our work developing supportive shared living for survivors of domestic abuse and modern slavery. It originally appeared here.

Looking ahead to the Easter bank holiday weekend might not feel like such a luxury this year. Many people in the Shared Lives community are facing additional pressures and having to rise to challenges they never expected to face. So how do we suddenly adapt and take on these new challenges?

We all know where we’re at with our weekly routines and this is the same for people accessing Shared Lives. Whether that’s attending day services, getting together with friends, hitting the gym or volunteering, having to give up the things that we love is hard. Naturally, it can be even harder for people who really depend on these routines, or who may not fully understand why they’re missing out.

It’s a big challenge for people living in Shared Lives and the Shared Lives carers who support them. For carers, trying to help meet the unmet needs of people you care about can feel relentless when life is so restricted. As much as you feel someone’s frustrations and understand their emotional struggles, even the most empathetic person can develop compassion fatigue.

Compassion fatigue happens when someone becomes so drained and exhausted by the behaviours and needs of the people they support that there are real physiological changes in the brain. This impacts people’s ability to connect and empathise with the people they support in the same way. Experiencing compassion fatigue can cause tension and guilt but it is a normal human response to supporting people in crisis and distress.

Shared Lives carers shape their lives around connecting with people and supporting them to live fulfilling lives, so feeling stuck or helpless can feel like you’re not getting it right. A common response from professionals is to bombard carers with strategies and whilst these can provide solutions when the time is right, for anyone experiencing compassion fatigue it’s unlikely that strategies will be heard or taken up.

It’s easy if you’re used to caring for others to overlook your own needs. The same traits that make people great Shared Lives carers- empathy, compassion and genuine care, can turn into compassion fatigue unless self-care is prioritised. In fact, the antidote to compassion fatigue is self-care.

There’s no doubt that self-care seems even harder to make space for when lives are being turned upside-down, but it is vital. Giving your body and mind a mini-break ultimately helps everyone; it’s not selfish or indulgent, it’s a necessity.  Here are our three top tips for self-care

  1. Let go of perfectionism.

Remember that struggle is normal. If someone living with you is struggling, it’s not always fixable. You can be helpful, supportive and look for strategies, but you can’t always ‘make it all better’ and that’s ok. Just by being there, listening, and reminding someone that you care is helpful in itself. If you’re doing your best, you are doing great.

  1. Take time for yourself.

Self-care comes in many forms and it’s important to meet your needs. So, you can’t get to a yoga class or meet your friends down the pub, but how about having a bath, phoning a friend, cooking a nutritious meal or getting an early night- remind yourself that prioritising your needs helps everyone.

  1. Make mindful moments

We can get consumed by stressful moments, especially when our resilience is running low. If you find yourself in a tense moment, focus on something distant like the branch of a tree bobbing about outside your window, let it take you out of the moment. If you struggle with being mindful in the moment, but you’ve dealt with something stressful, take your phone to the bathroom and listen to a five-minute meditation.

Above all remember that you are important and worthy of self-care. So, this Easter weekend try to give yourself permission to check in with your own needs. If you find yourself asking for help, doing a YouTube Zumba class, or having a lie-in, congratulate yourself on meeting your needs and being kind to yourself because that is what success looks like right now.

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Always compassion

I chaired the final session of a King’s Fund conference on co-production and the six principles of the Five Year Forward View today. Mark Doughty who developed “life changing” arthritis as a young man and is a senior consultant with the King’s Fund reflected on the difference between the kinds of relationships we take for granted in most of our lives – respectful, compassionate – and the relationships we have within ‘the system’, which can feel far removed from that. Initiatives like the late Dr Kate Granger’s “Hello my name is” campaign and the work of Andy Bradley and Frameworks for Change are attempting to bring the compassion back into what should already be compassion-focused fields of work, but too often aren’t.

Delegates suggested that the gap between the relationships we want and the relationships we have if we work in or are users of health and care services can often come down to time. As resources get tighter, time gets more and more pressured. Stress levels rise and even the common courtesy of remembering to introduce ourselves to people who might need intimate or highly stressful care from us can go by the wayside. Bradley’s work has a strong focus on self-awareness and self-compassion as the building block for compassion for others.

It could be argued that the current cuts to health and care service budgets make creating the time and space required for compassion simply impossible. But even within stressed and faltering public services there is an element of choice about what people at each level within the organisation choose to value and allot time to. Neil Churchill’s presentation on Always Events – practices which are identified jointly by people using services, practitioners and managers as being important to compassionate, effective care – showed that the case for compassion is often also the case for achieving outcomes and creating better value for money.

Deciding what is important and what to spend time on is of course about power. Part of the reason that the Hello My Name Is campaign was – shockingly – needed, is that there is a pervasive history of medical professionals believing in status and deference within the NHS. What felt important to ‘patients’ is not automatically felt to be what is most important to the services which they use and ultimately pay for.

We can experience the demands of ‘the system’ as all-powerful and inhuman, but in reality there is no ‘system’, there is only us, and what we choose to value and give time to. At present there are, though, more divisions between the different tribes of our public service world than there are shared beliefs around which we can build our public service sector into a unified movement. Our challenge – which is also the challenge of making co-design and co-production into Always Events in all public services – is to insist upon compassion and connection as always more important than anything else we might achieve, and when the pressure, stress and frustration mounts, to model it even as we fight for change.