As an Occupational Therapist (OT) who has been through burnout and now supports therapists feeling burnout, I’ve got to say it’s been a hard and full on week. Burnout is so rife in allied health at the moment and the recent NDIS proposals seem to be escalating the sense of moral injury and compassion and system fatigue so many therapists are facing. My social media feed is full of distress at upcoming NDIS changes which have also dominated plenty of my mentoring sessions the last few weeks. I think there’s still ongoing anxiety about the unknown; even with legislation being introduced, there are still unknowns because the legislation leaves plenty of room for things to still be developed such as proposed new “functional assessments” for entry.
For allied health providers, some of the proposed changes that impact us directly include
- Functional assessments and support needs assessments potentially replacing work that Occupational Therapists are highly skilled at and potentially being delivered by non-allied health professionals
- 10% capacity building cuts reducing access to allied health services and supports
- Participants being moved off the scheme or unable to access the scheme reducing demand for allied health services
- Minister being responsible for setting prices rather than an independent body meaning that pricing becomes political rather than objective
However, I think often the bigger stressor is what these changes mean. It’s not the direct changes themselves although they are frustrating. It’s the signal that these changes send. And that goes to the heart of health professionals and OTs and our values in our work.
Occupational Therapy Values
Regardless of what people think, OTs and allied health professionals generally do not go into this profession to make a lot of money. We go into these caring professions in order to help people, to make a difference and typically we have values around serving others and achieving results. The Australian Labour Market Insights website isn’t available online anymore however, previous information published indicated that OTs also value job security, good working conditions, autonomy and independence, support including fair treatment and recognition from others including the community.
This is what I think goes to the heart of what I’m hearing from the Occupational Therapy community. The changes proposed hit our values hard.
Because less people on the NDIS and less capacity building funding means less opportunity to serve and help others. It denies people with disabilities the chance to achieve functional independence and improve their skills, capacity and functional abilities.
The uncertainty around the scheme causes Occupational Therapists to feel insecure and uncertain about their future prospects. Many OTs become sole traders or small business owners, not specifically to profit from schemes like the NDIS, but for the autonomy and freedom of working for themselves. Many OTs didn’t want to “go into business” but this was the only way for them to be able to deliver services in line with their values. I can say that my “why” was nothing to do with financial reasons and purely because I had been restructured out of my job whilst on maternity leave and had been struggling with many business practices in my employment. I did not want to try to achieve 6 billable hours per day or cap the supervision and support I offered my OTs each week. I wanted to offer niche services, not be a generalist OT. And I wanted to work with other professionals who were also values aligned, not to implement a customer management model that meant trying to please demanding and difficult referrers. And I know I’m not alone! So many of the sole traders I work with have very similar reasons for choosing to work for themselves and deliver high quality services for their clients. If people with disabilities are moved off the scheme and onto block funded approaches delivered by NGOs (as proposed in NSW) then this impacts that autonomy and independence of OTs delivering services using our specific expertise within the community.
The reduced travel rate and maintaining the current funding cap alongside the persistent media commentary and public opinion about OTs price gouging and being fraudulent, erodes our sense of feeling valued and recognised for our skills and abilities. We don’t feel looked up to or respected in the community; many OTs feel like there is an assumption that we are doing the wrong thing and cannot be trusted. OTs report feeling disrespected by people within NDIS who read our reports and disregard our recommendations, who perceive us as biased or grasping somehow. OTs are criticised for recommending intensive therapy as this is perceived as somehow lining our own pockets or feathering our own nest; rather than a recommendation based upon clinical reasoning and best practice evidence.
And I think the thing that hits the hardest, is that it’s not about us. Yes, these changes may impact us. It’s about people with disabilities. Some of the most vulnerable members of our community. Many of these changes feel unfair and frankly, cruel.
One of the biggest assets most OTs have is empathy and compassion. We may feel these changes on behalf of our participants who are scared, worried and distressed for the future. Who feel like a burden. Who are ashamed to acknowledge their disability and feel they are someone who has caused a “cost blowout” to the tax payer (despite many of them also paying taxes now or in the past). I’ve had multiple clients contact me wondering if they will be kicked off the scheme. They’re worrying about their plan being cut back and what that will mean for their ability to achieve goals like being able to drive, to finish high school, to obtain employment, to care for their relatives or travel and access the community independently. And honestly, I don’t really know what to say to these clients. I cannot provide them with reassurance, except that we will keep on working together on their goals for as long as we’re allowed to do so. So whilst this all hangs over our head, it’s probably quite normal to feel a bit scattered and untethered. To feel anxious and uncertain about the future. To be weary of the noise and too tired to fight, argue or debate the value of disabled people and the worth of our own profession. I don’t have a magic wand to make this all go away (oh how I wish I did!) and there’s many days I just want to bury my head in the sand.
Compassion is key in burnout prevention, supporting clients and ourselves
However, in all my work on burnout prevention strategies, one of the things I learnt was that empathy can sometimes cause us to feel other person’s pain too deeply and then can become ineffective to assist others as too much empathy can exhaust us and wear us out. Susan David talks about the shift from Sympathy to Empathy to Compassion as shown below and how empathy can help us with perspective but compassion can move us to action- but within our capacity.
I think it’s important that we hold on to our compassion and recognise the suffering of others including those with disabilities who are struggling as well as therapists and providers who are anxious about the potential impacts on their work and their livelihood. However, compassion also means retaining some emotional distance and protecting ourselves emotionally and mentally. This might mean
- Avoiding social media or the constant news cycle for a period of time
- Protecting your energy and holding on to boundaries with our colleagues and others, including in our family or extended networks, when we dont want to discuss these things. I was recently at a Mother’s Day event and simply needed to declare it a “USA president free zone” because I knew it would upset me too much to talk about the events and decisions happening at the time.
- Joining various campaigns or advocacy efforts if you have capacity such as OTA’s campaign or joining the Occupational Therapy Society for Invisible Disabilities and their advocacy efforts. It’s also OK to skip straight to my last point!
- Seeking out mentoring or support to express your frustrations in a safe place and explore specific strategies and plans for your work or for supporting your clients to navigate this space
- Connecting with others. We are stronger together but this also needs to feel safe for you, wherever you’re at so choose your social connections wisely.
- Keeping up with self-care strategies (which always sounds so simple I know- but they’re so often the first things to go)
- Participating in expressive or somatic approaches to shift any “stuck” emotions or icky feelings
- Just putting your head down and focusing on the here and now.
Occupational Therapy Affirmations
One of the things I find really helpful is to focus on a bit of a mantra or affirmations when my brain is spiralling.
So for me, I continue to hold on to the following
OT existed before NDIS. We will exist no matter how or what changes happen with this or any other scheme.
We have a long and rich history of supporting people with disabilities (since at least World War 1).
We have value through our training and our skills and experience.
We are the ultimate problem solvers by considering the person, their occupations and the environment.
We have highly developed clinical reasoning skills, a holistic view of the individuals we work with and a compassionate and caring approach.
No matter what constraints may be thrown at us, we have so much to offer to support people with disabilities, health conditions and other challenges. We do this work because we care and value people with disabilities.
This has always been our work and we will continue doing this, however we can and in whatever scheme or system is present.
Onwards!
