‘Coping with Stress … A psychologically informed reflection on keeping that balance when working in the homeless sector’

13.08.2021: When reflecting on the past week for this PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity; Centrepoint, I cannot help but think back over what has been a very busy week. For many of us, we are used to being busy in our roles, but this week has been particularly full as I am about to go on some annual leave for the next three weeks so have lots to try and get finished before I go. In these ongoing COVID-19 pandemic days, this sadly does not mean that I will be jetting off on an aeroplane to take a holiday somewhere warm and sunny and of course having children on their summer holidays, much of my time will likely be focused on childcare! Nevertheless this will be a welcome break from work that I hope will leave me rested and rejuvenated, ready to pick up the next steps of our PIE journey in Centrepoint on my return. However, it has reminded me once again of the importance of taking ‘time out’ and focusing on my self-care in order that I can help others.

The topic of self-care has been one that I have discussed in previous blogs (e.g. https://drhelenmiles.medium.com/if-you-are-travelling-with-another-person-who-requires-assistance-secure-your-mask-first-before-a19f112c426) and certainly the recent COVID-19 lockdown(s) has been an important reminder of the increased importance of looking after our psychological well-being in these challenging times. However, I wonder now whether now the world is starting to return to ‘normal’ (whatever that may turn out to be!), it can be too easy to forget this importance of ensuring that we are looking after our own psychological well-being. For example, many of us who work in a ‘caring’ profession can easily find themselves putting others needs before their own. It is very easy for work to become stressful and challenging, especially when we have competing demands on our time, deadlines to meet or crises to resolve. Yet, if we do not balance or cope with these stresses by looking after ourselves, how can we look after others? Moreover, what sort of role model are we to the homeless young people we support, or to our colleagues or teams if we do not ensure that we prioritise well-being as at least equal to performance?

The PIE Good Practice Guide (Keats et al, 2012 — https://eprints.soton.ac.uk/340022/1/Good%2520practice%2520guide%2520-%2520%2520Psychologically%2520informed%2520services%2520for%2520homeless%2520people%2520.pdf) explicitly acknowledges that ‘working [with] clients with complex trauma can be challenging and exhausting’ (p.21). Consequently, staff self-care / team collective self-care is emphasised in our PIE day training and within our reflective practice sessions at Centrepoint. Work in the homeless sector is stressful, and to acknowledge this impact on ourselves wherever we working within the organisation is ‘awareness’ not ‘weakness’.

There are many well-known negative impacts of not looking after ourselves in the psychological research literature. The most significant is that of ‘Compassion Fatigue’, or to put it another way, that feeling that we just ‘can’t care anymore’ (Figley, 1995). This normal occasional temporary state can easily become permanent if we do not recognise this, and the topic of compassion in our work is so important that I have discussed this in a previous blog (c.f. https://drhelenmiles.medium.com/running-on-empty-dealing-with-compassion-fatigue-in-a-psychologically-informed-environment-8af533f15013). For example, one research study of homeless frontline staff in Canada found that almost a quarter of their sample (n=245, 24%) were found to have high levels of compassion fatigue and burnout (Waegemakers et al, 2016). Burnout and/or resignation are the negative consequences of not taking care of ourselves and the homeless sector unfortunately commonly has high rates of sickness and staff turnover (Hagen & Hutchison, 1988; Robinson, 2014; Sutton-Brock, 2013)

Professionals working with traumatised clients are also susceptible to secondary traumatic stress, known as ‘vicarious trauma’ (Figley, 1995). Listening to and empathising with the distress from those homeless young people we support, can of course be difficult and this indirect trauma exposure can lead to negative impacts such as symptoms of intrusion, avoidance and arousal (Figley, 1995; Molnar et al, 2017). There is therefore a significant psychological literature that notes that encountering our clients’ suffering and/or regularly hearing clients’ stories and traumatic experiences places a major demand on our own emotional resources (e.g. Ferris et al, 2016; Grimm et al, 2017; Guhan & Liebling‐Kalifani, 2011; Kidd et al, 2007; Kosny & Eakin, 2008; Lusk & Terrazas, 2015; Robinson, 2014). Even if we do not have these significant impacts upon us of compassion fatigue and vicious trauma, there is evidence to suggest that homeless workers are prone to feelings of frustration, demoralisation, stress and sadness resulting from their work (Guhan & Liebling‐Kalifani, 2011; Lusk & Terrazas, 2015).

There is also a risk that working in the homeless sector can result in physical health issues such as tiredness and exhaustion, which can lead to experienced and skilled workers leaving the profession (Guhan & Liebling-Kalifani, 2011; Kidd et al, 2007). Issues with mental health are also common. For example, psychological studies (e.g. Guhan & Liebling-Kalifani, 2011; Kidd et al, 2007; Kosney & Eakin, 2008) have shown that homeless workers can sometimes struggle with ‘mentally switching off’ after their work (i.e. continuing to ruminate or think about their clients’ issues outside of work). This can lead to feelings of guilt, anger, fear or a sense of persecution or ‘moral injury’ (Jameton, 1984).

One way of theoretically conceptualising the impact of our work upon us is the ‘Job Demands-Resources Model: JD-R’ (Bakker & Demerouti, 2007). This assumes that every job role has its own specific job resources and demands including areas such as the organisation of work, the content of our role, the social relationships within the work place and the physical environment. All areas that are arguably key to consider as we are developing our psychologically informed environment or PIE in Centrepoint. Specifically, this model assumes that available job ‘resources’ have the potential to be motivational and lead to engagement from employees whilst job ‘demands’ are associated with stress and the development of physical or mental health problems. The demands upon our role are often varied by role but a review by Wirth et al (2019) specifically looking at staff working in the homeless sector found some interesting results specific to this population.

For example, research studies found that working in a bureaucratic environment was a stressful demand on staff, particularly if they were working within external systems (e.g. statutory services, welfare system) that they perceived as unfair or difficult to access that limited their possibilities to help those that they support (Guhan & Liebling-Kalifani, 2011; Kidd et al, 2007; Robinson, 2014). In addition, excessive paperwork, low pay in the sector, high caseload sizes, having little or low control over decision making and a perceived or actual lack of support from supervisors or managers impacted on workers’ stress (Chapleau et al, 2011; Hagen & Hutchison, 1999; Robinson, 2014; Sutton-Brock, 2013). The impact of serious incidents (e.g. sudden death of a homeless person through overdose, suicide or homicide) was of course also naturally associated with significant impacts on homeless workers’ well-being (Lakeman, 2011). Whilst, it was also found that maintaining professional boundaries in this work was challenging, particularly when they were faced with aggressive behaviours (Kidd et al, 2007; Kosney & Eakin, 2008).

So how do we cope with these expected challenges in working in the homeless sector? How do we balance the stresses of our role with our coping strategies or resources, which will keep us going in this type of work? One psychological model that is helpful to consider is that of the ‘Transactional Model of Stress and Coping’ (Lazarus & Folkman, 1984). This argues that in order to ‘cope’ with stress, we need to try to regulate the emotional distress caused by a stressful situation (i.e. emotion‐focused coping) as well as where possible try to solve the problem (i.e. problem‐focused coping). Other psychology studies have noted that where homeless workers could derive strong meaning from their work, and it aligned with their beliefs, values and interests, this helped them manage stress (Guhan & Liebling-Kalifani, 2011; Kidd et al, 2007; Robinson, 2014). In addition, having positive support from your team and the importance of a good leader were unsurprisingly key in coping with stress (Ferris et al, 2016; Lusk & Terrazas, 2015; Mowbray et al, 1996). Other personal resources such as a ‘good sense of humour’ helped staff to relive stress and frustration (Kidd et al, 2007).

Another helpful coping strategy has been noted to be ensuring that we maintain our professional boundaries with those we work with (Ferris et al, 2016; Guhn & Liebling-Kalifani, 2011; Lakeman, 2011) that we are ‘friendly’ but not actually, ‘friends’ with those we support. In whatever role we work within in the organisation; ‘frontline’ or ‘support’, managing our stress is easier when we maintain clear boundaries between our work and personal lives (Ferris et al, 2016; Guhan & Liebling-Kalifani, 2011; Kidd et al, 2007; Lakeman, 2011) and not dealing with work topics in our personal ‘down-time’. Of course this has been more challenging if we have been working from home recently due to COVID-19 but remains important as it is likely that many people are unlikely to be returning to full-time working in an office for the foreseeable future. Moreover, using reflective spaces and supervision sessions to accept our own boundaries of influence, namely focusing on what we can change or do rather than dwelling on what we can’t, is also helpful in managing stress (Ferris et al, 2016). Lakeman (2011) also noted the helpfulness in managing our stress if we acknowledg the small steps of progress we have made, whilst Kosney & Eakin (2008) highlighted the importance of not taking the challenging behaviour of the homeless young people we work with personally.

Critical to coping with our stress is also having a positive and supportive social network outside of work, with family and friends (Guhan & Liebling-Kalifani, 2011; Kidd et al, 2007; Lusk & Terrazas, 2015). And of course, giving ourselves time to ourselves for hobbies, exercise, meditation or mindfulness, reading, listening to music or watching TV are all helpful de-stressing or self-care strategies to cope (Guhan & Liebling-Kalifani, 2011; Lakeman, 2011; Lusk & Turrazas, 2015). Interestingly, some research studies have also identified religious practices as a key coping strategy when working in the homeless sector (Ferris et al, 2016; Guhan & Liebling-Kalifani, 2011; Lusk & Terrazas, 2015). Of course, what the self-care that helps us to ‘cope’ explicitly looks like depends on the individual. I think I have mentioned before that my partner is a big fan of running, which personally I do not find very relaxing! However, taking a walk with my dog or doing my morning yoga provides me with that daily fix of self-care that enables me to cope with the challenges that the rest of the day throws at me! Taking regular breaks and annual leave is also an important part of our self-care.

Finally, I think it is important to note that when feeling stressed it is a helpful coping strategy to reach out to others for support. Within Centrepoint, as well as the usual management structures we also have an external counselling service (i.e. EAP: Employee Assistance Programme) and support available 1:1 for staff from our PIE Team. Research in this sector has shown that job satisfaction and self-efficacy improves when staff were actively seeking and utilising consultation services, supervision or external counselling (Chapleau et al, 2011; Guhan & Liebling-Kalifani, 2011; Kidd et al, 2007; Lakeman, 2011; Robinson, 2014). The key role of the provision of staff training and team development has also been found to help manage stress in the workplace, as staff presumably feel more equipped to undertake their roles and supported by those that they work with (Mowbray et al, 1996; Waegemakers et al, 2016). On that note, I hope everyone reading this blog is keeping safe and well and I will see you again in three weeks after my annual leave. In the meantime, if you work at Centrepoint, I am extremely grateful to have a brilliant PIE team that can support you wherever you work in the organisation, so please do not hesitate to get in touch with them in the meantime.