CHAPTER FOUR: ANALYSIS, RESULTS AND DISCUSSION
4.2 Theme One: A Health Care System Driven by Business Ideologies and the Organisational Challenges that are Subsequently Present
4.2.2 Staffing Concerns – A Health Care System Operating on a Neoliberal Business Model
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4.2.2 Staffing Concerns – A Health Care System Operating on a Neoliberal
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“I’m doing the work of psychologists and more […] we were all trained up. But we've taken that in terms of our own professional development. Yeah, I know about dialectical behavioural treatment and CBT and ACT, and blah, blah, blah it's just that it wasn't my degree”.
(Participant #53)
“it's definitely not really my work, but I'm going to take them on, because no one else can see them […] in reality, I'm only taking them on because they won't be seen by someone else”
(Participant #11)
“there’s probably not enough highly trained professionals out there to do the work, even if there was the money to pay them”
(Participant #35)
Participants painted a picture of extreme waiting lists, busy and tired staff members who have to take on more work than they should, and staff members who
personally upskill or work outside their scope due to their personal and ethical drive to help young people in a failing system. Due to the organisational culture that is focussed on financial efficiency, participants said that staff are often also
insufficiently compensated. Participant #11 explained this, specifically analysing the influence this has on staff wellbeing. “From what I'm aware, we are underpaid. And therefore, people aren't as interested to come to the sector because of the wages or the salary.
They're like…...Why would I not prioritise sanity […] if I could work in another sector […]
there should be some compensation”. Participant #11’s comments about sanity and staff members mental wellbeing draws significantly on the concept of staff burnout, which was a prominent theme expressed by all participants I spoke to.
Via et al., (2022) defines staff burn out, specifically within the mental health profession as “a complex state manifesting in emotional exhaustion, diminished personal accomplishment, and depersonalization” (pp. 339). Staff burn out is
common in many organisations but specifically within “caring” professions such as
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the mental health sector, due to the emotional labour that is required when caring for mentally unwell individuals (Johnson et al., 2018; Via et al., 2022). While it must be acknowledged that working in a profession that requires high levels of emotional labour will always have its challenges - due to the nature of supporting people dealing with mental health conditions, suicidality, or addiction, among other issues - it is not so clear cut. Research does not indicate that every professional who enters the mental health sector will automatically experience staff burn out. Instead, Luther et al., (2017) states between 21% - 67% of mental health professionals will experience burnout and the variation in these statistics is due to a variety of contributing
factors.
Johnson et al., (2018) and Luther et al., (2017) explain some of these contributing factors including; having to work overtime, or complete work outside of the job description, dealing with staff shortages, a lack of professional support and underfunding directly resulting in “services that are stretched beyond their
resources, placing greater demands on staff and creating a stressful and pressurized environment” (Johnson et al., 2018, p. 23). These factors outlined by Johnson et al., (2018) and Luter et al., (2017) directly reflect the concerns expressed by the
participants I spoke to here in New Zealand. For example, Participant #35 stated that
“because of the shortage of staff, you've got people with really heavy caseloads, they're getting burnt out. They're not getting much support from their managers”. Almost all of the participants I spoke to described staffing issues, subsequently linking cumulative issues to high levels of staff burn out and therefore staff turnover. Luther et al., (2017) elaborates on this further, explaining that high levels of staff burn out doesn’t just directly impact the level of staff turnover, it is also directly linked to staff
absenteeism and reduced job engagement, therefore producing a lower quality of care provided. The Government Inquiry into Mental Health and Addiction (2018) provides an Aotearoa New Zealand perspective on these issues, stating that
“workers are often stressed and unable to work in the way that they want to and that
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would most benefit their clients” (pp. 70), and that directly contributes to a high turnover of staff and major difficulties recruiting new staff members.
Participant #15 described their experience of staff burn out within the mental health system stating “you come into the field or the service to provide support. And your wings are clipped […] then that leads to like, I guess morale for staff. I think that gets impacted a lot because most of them are trying to do the best they can […] But then the system burns them out, processes impede them from being able to do the work that they want to do”. Some of the processes that Participant #15 is referring to are the financial and staffing
limitations that prevent professionals from doing what they believe is best for young people. Arguably these staffing and financial limitations are a direct consequence of a health system that is operating on neoliberal policies and is therefore more
focussed on service efficiency through quick fixes, short term strategies and cost cutting measures, rather than creating a health care system conducive with quality, long term care for young people.
4.2.3 Lack of Kaupapa Māori Informed Practices – A Health Care System