‘When a flower doesn’t bloom, you fix the environment in which it grows, not the flower.’ Alexander Den Heijer
Earlier this year we did a chambers wide audit of mental health and wellbeing and provided a wellbeing workshop for barristers and staff. I have been in practice for nearly thirty years and the mantra ‘work comes first’ dominates my work ethic. I know this has been to my detriment. For example, going to court on the morning my father died because I couldn’t let the court down.
Until recently this was a source of professional pride. Now, hearing from junior barristers I can see how damaging my example has been. It is ridiculous to pretend that life can carry on as normal in the face of such tragedy. Yet, I never spoke of it, so those around me probably thought I carried on regardless.
My career began at a time when mobile phones were a rarity, papers were hand delivered in pink tape and the fax machine revolutionary. Email did not exist. As such, at least you had a modicum of time in which to prepare, now you can receive a thousand pages by email the night before and be expected to have an in-depth knowledge of the case by 9 am the next morning.
It is no wonder that wellbeing in the profession begins to suffer. For more junior professionals this is setting them up to fail. Technology is brilliant but it should be a servant and not a master.
During the course of the pandemic, I have heard from colleagues across the profession of how they are feeling the strain. The isolation and loneliness of working at home with no outlet has taken its toll on so many. Coupled with loss of family members, illness and worry about work and finances, it is no surprise that one fifth of barristers surveyed want to leave the profession. One barrister pointed out how caring for one’s wellbeing was yet another burden on an expanding list of obligations.
We were fortunate to have our wellbeing training delivered by an experienced mental health professional. Some of the research and the current understanding is shared below. It explains why ignoring mental health and wellbeing is no longer an option in the profession. Our ranks are full of academically able people who have strived to carve out a career in a relentlessly demanding and competitive sector. To be a successful family lawyer requires a unique combination of both academic and emotional intelligence. In my opinion, we need to use some of that wisdom on self-care.
I read Mohsin Zaidi’s article in the January edition of Counsel magazine (the magazine of the Bar) and felt sad but also heartened. Here was one brilliantly able barrister prepared to talk about the subject of stress and wellbeing. He pointed out research conducted by ‘Wellbeing at the Bar’ that 70% of barristers consider talking about stress as a weakness. No profession changes overnight but I hope this article goes some way to giving you permission to care for yourself and make that change.
It is estimated that workplace absence costs the UK economy £18bn in lost productivity each year, a figure which is set to rise to £26bn by 2030 (FirstCare, Cost of absence to UK economy rises to £18bn 2017). The most common cause of long-term absence is stress, which can be defined as any type of change or circumstance that causes physical, emotional, or psychological strain (Chartered Institute of Personnel and Development, Annual survey report: absence management 2016). Now more than ever, against the complex backdrop of a global pandemic, the role of leadership and workplace wellbeing has never been more crucial. Mental health and wellbeing in the workplace have become a societal challenge with staggering economic and human costs (Goetzel RZ, Roemer EC, Holingue C, Fallin MD, McCleary K, Eaton W, et al Mental health in the workplace: A call to action proceedings from the mental health in the workplace: Public health summit. J Occup Environ Med (2018) 60(4):322. 10.1097/JOM.0000000000001271]). The working environment represents an ideal context for the promotion of mental health (Mykletun A, Harvey SB. Prevention of mental disorders: a new era for workplace mental health. Occupl Environ Med (2012) 69(12):868–9. 10.1136/oemed-2012-100846), with claims that better mental health support in the workplace could save UK businesses up to £8bn per year. Moreover, important considerations are needed that take into account the impact of the pandemic on people’s wellbeing, with over half of the UK adult population reporting feeling worried or anxious due to the Covid-19 outbreak.
Mental health has traditionally been explained through a medical lens that relies on a disease or illness-based model. The medical model interprets mental ‘disorders’ as a product of physiological factors, whereby mental conditions are related to the brain’s physical structure and functioning. According to Lucy Johnstone & Mary Boyle (2018) (Johnstone, L. & Boyle, M. with Cromby, J., Dillon, J., Harper, D., Kinderman, P., Longden, E., Pilgrim, D. & Read, J. (2018). The Power Threat Meaning Framework: Towards the identification of patterns in emotional distress, unusual experiences and troubled or troubling behaviour, as an alternative to functional psychiatric diagnosis. Leicester: British Psychological Society) ‘medicalisation operates through medical language (eg, symptoms, disorders, illness, treatment), through practice (eg, diagnosis, hospitalisation, administration of drugs) and through research which tries to discover genetic and biological causes of ‘mental disorders.’ Our current mental health system in the UK is founded on this approach, however there is growing consensus that the current way of classifying and understanding mental health is not fit for purpose and that a paradigm shift is needed. Perhaps one of the most startling comments about the current system for classification of mental illnesses (The DSM-5) came from the former Chair of the US National Institute of Mental Health, Dr Steven Hymen, who described it as ‘totally wrong, an absolute scientific nightmare’.
An alternative approach and understanding of mental health and wellbeing is that which is trauma informed. Trauma-informed practice is an increasingly prevalent approach being adopted in therapeutic, social and human services, and is also making its way into legal services. A trauma-informed approach recognises people’s life experiences and the impact these have on wellbeing, in particular the effects of adverse childhood experiences. More than 50% of adults report having experienced at least one adverse childhood experience, and more than 6% have been exposed to four or more. The long-term impact of adverse childhood experiences has been well documented, and includes poor mental and physical health, as well as poor social and economic outcomes (Racine N, Killam T, Madigan S. Trauma-Informed Care as a Universal Precaution: Beyond the Adverse Childhood Experiences Questionnaire. JAMA Pediatr. 2020;174(1):5–6. doi:10.1001/jamapediatrics.2019.3866). Perhaps one of the most important issues that a trauma-informed approach highlights is the impact of a person’s environment and social context on their psychological wellbeing. This goes some way in breaking down the stigma of mental health through the realisation that we are all to some degree at the mercy of our circumstance. We do not need to look any further currently than the global pandemic to witness and acknowledge human distress and the perfectly understandable responses to a very abnormal and painful circumstance. One important point to make is that a trauma-informed approach is not void of science and it does not attempt to diminish the very real suffering people face when experiencing emotional distress. It also important to acknowledge that for many individuals a diagnosis brings along with it access to services and a sense of relief and validation.
Trauma-informed practice recognises the impact of client’s trauma not only on the client but also on the practitioner, and thus methods to counterbalance this impact are encouraged. The practice of family law involves by necessity, listening to client’s painful life experiences. Clients seek legal assistance at a time in their lives when they are vulnerable and likely experiencing emotional distress and so practitioners need to recognise the effect that client’s stories and hardships have on their own advocacy and lives as a whole (Dawson S, Bierce A, Feder G, et al. Trauma-informed approaches to primary and community mental health care: protocol for a mixed-methods systematic review. BMJ Open 2021;11:e042112. doi: 10.1136/bmjopen-2020-042112). According to Katz and Haldar, there are four key characteristics of trauma-informed lawyering: identifying trauma, adjusting the client-lawyer relationship, adapting litigation strategy, and preventing vicarious trauma. Vicarious trauma is different from ‘burnout’ which can usually be mitigated by taking time off work or changing jobs. Vicarious trauma is a state of tension and preoccupation with client’s trauma stories, which can lead to an avoidance of client’s trauma histories (numbness) or a state of persistent hyperarousal. It is important for practitioners to be aware of some of the signs of vicarious trauma, which include feeling vulnerable, social withdrawal, feeling disconnected from loved ones, over-identification with clients, experiencing insignificant daily events as threatening, no time for yourself, feelings of despair and hopelessness and cynicism (Lisa McCann & Larie A. Pearlman, Vicarious Traumatization: A Framework for Understanding the Psychological Effects of Working with Victims, 3 J. Traumatic Stress 131,133 (1990).) Vicarious trauma and similar issues such as compassion fatigue, have been deemed as the cost of caring, particularly as it is the involvement of compassion and empathy when working with clients is what brings about these ‘costs’.
Against the backdrop of the Covid-19 pandemic, where home working has meant for many that court cases and client interaction quite literally have penetrated the home, where people have also been juggling home schooling, caring for loved ones, experiencing separation, loss, and grief, is it any wonder that people’s wellbeing has suffered? Now we face an opportunity to revisit the issue of mental health and wellbeing and decide where it lies on our list of priorities, both as individuals but also as organisations that employ and work with practitioners. Now is the time for compassionate leadership, for re-imagining work culture, and the way wellbeing concerns are responded to. Key considerations are how we adjust and create a balance between work and home, how we reduce stigma and open genuine conversations about wellbeing, what assistance we provide for employees and how we thread wellbeing throughout work life and the profession. The beauty of prioritising mental health and wellbeing is that the effects will spill over into work quality and productivity, as well as into family life and the wider community. By breaking away from the traditional approach of separating emotions from the law and borrowing techniques developed in the therapeutic context, family lawyers can provide more effective representation by becoming trauma-informed (Lynette M. Parker, Increasing Law Students’ Effectiveness When Representing Traumatized Clients: A Case Study of the Katherine & George Alexander Community Law Center, 21 GEO. IMMIGR. L.J. 163 (2007).) By remaining open and responsive to wellbeing needs, growth and development can be fostered and the way can be paved for a step change that will be of benefit to all parties involved.
One important step is to acknowledge mental health and wellbeing as something that everyone experiences and creating a culture of openness where these issues can be discussed without judgement. Unfortunately, mental health does still carry a lot of stigma and it is understandable that people may be apprehensive about opening up, however key messaging and education can begin to create a culture shift that could influence how soon people seek help. The role of leadership is particularly important when considering any changes in approach or culture, the influence that people in positions of power have cannot be understated and as such buy in from senior leadership is essential for a whole systems approach to wellbeing. Practical solutions that can support with the emotional impact of the role can include clinical supervision, where the impact of difficult cases can be talked through with a trained specialist and strategies shared on how to minimise these impacts. Often all that is needed when someone is struggling is a listening ear, and this does not always need to be a trained therapist, peer listening groups or debrief sessions often referred to as ‘reflective practice’ can make a big difference as they help professionals to talk through and organise their own thoughts and emotions. Options like this can become embedded in practice and develop the skills of practitioners’ overtime, increasing resilience and resilience assets within chambers. Many chambers already provide employee assistance programmes that can include access to psychological therapies.
There are many things that practitioners can do themselves to manage periods of stress or emotional difficulty. In such a fast-paced and busy culture it’s important to build in periods of rest and reflection into the working schedule. Taking regular breaks, especially larger holiday breaks away from work completely, will help to avoid burnout and overload. It is important to remember that a life outside of work exists, and time spent doing things that bring you pleasure, and joy serve as a reminder of life’s brighter side. Ensuring that there are strong ‘pillars’ of wellbeing in place, which include: exercise, a nutritious diet, routine, boundaries, getting out in nature, connecting to others, cultivating meaning and purpose in your life, giving back to your community, and reaching out when you need help early on. These may seem like simple things, but the idea of ‘pillars’ illustrates the importance of having as many of these things in place as possible so that you have a strong structure of protection built around you. The things we do repeatedly on a daily basis, have a huge impact on our lives, self-compassion and self-care is not ‘fluffy’, it is fundamental for a mentally and physically healthy life.
This article is dedicated to members of our community known to us who took their own lives – OG, KW and SC. If you have been touched by anything in this article and would like to talk the following helplines are available: www.lawcare.org.uk: 0800 279 6888; www.samaritans.org: 116 123