How do you Save a Drowning Man?

Following my previous blog post, Danger, Breakdown Ahead, I had a number of people ask questions about how to approach someone who appeared to be struggling and also feedback from readers about the quality of help and support they had received when in a similar position.  Here are some thoughts and challenges around these issues those trying to help might consider, using the question, ‘How do you save a Drowning Man?’

How do you Save a Drowning Man?

It’s a lovely summer’s day and you are walking along the edge of a local swimming spot when, unsurprisingly, you see someone in the water.  You look more closely and recognise your neighbour, Jim.  You see that he is struggling to stay afloat: the water is churned up by splashing as his arms claw at the water, his head keeps dipping below the water line, and every time he comes up for air he chokes and splutters as he tries to draw another life sustaining breath.  What would you do?  Here are some options:

  1. Walk away…just leave him.  The fact is that water can be dangerous and it was Jim’s responsibility to learn how to swim.  Life is hard and lessons must be learnt…sometimes the hard way.
  2. Stand and watch because, well, you don’t really know what to do.  Call 999, use a lifebelt or try and swim out to help?
  3. Ask Jim if he is alright, after all, if there was a problem he’d be shouting for help, wouldn’t he?  If Jim says he needs some help then you’ll do something but if he doesn’t, or says he’s fine, even if it looks like he’s going under then that’s his choice.  Jim is a competent adult (even if he doesn’t look like a competent swimmer) so you’re not going to stand in his way.
  4. Realise he is drowning and decide to help.  Clearly what Jim needs to know is how to swim so you start shouting encouraging tips from the canal side: ‘Don’t panic’, ‘Kick like a frog’, ‘Cup your fingers, don’t claw at the water’.  If Jim listens to you now he’ll learn to swim and be able to look after himself in the long term.
  5. Realise Jim is drowning, throw him a life belt and pull him from the water.  Once there, make sure he has a chance to recover before suggesting some swimming lessons might be useful.  Perhaps, if you are close, you offer to be there when Jim first goes back to the water, offering encouragement, support and a wary eye to ensure the lessons have been helpful.  As he goes back to the water you understand why he might feel wary and why, perhaps, he never wants to swim out of his depth ever again.

Walk Away.  I don’t believe that anyone would walk away from someone who was drowning.  There is something innately human about trying to help someone who is struggling…and yet, there is also something horrifyingly recognisable in the idea of slowly watching people breakdown at work.  From some of the correspondence I received, it appears it happens far too often…or certainly feels that way to those doing the struggling.  Perhaps it is more of an ‘institutional’ response than one of individuals, after all institutions don’t have empathy, people do.  Institutions are faced with targets, financial constraints and the tyranny of short-termism, ignoring the drowning man usually has no impact upon targets, requires little or no resources and is easier in the short term.  Maybe, as staff become more institutionalised, conditioned to respond to those same drivers, to align their priorities with the organisation’s, they lose their empathy, their humanity, and start behaving the same way?

Before we lay all the blame on NHS management, let’s remember our own professions’ ability to institutionalise behaviour. The old school ‘survival of the fittest’ attitude which many doctors grew up with, is slowly dying, but sadly does still survive and can lead to some appalling failures in human compassion: ‘He just needs to toughen up!’ and ‘I survived worse, why can’t she?’  This attitude is unworthy of staff who have chosen a career in caring and must continue to be called out as inappropriate.  You see, if we are prepared to have that attitude as individuals, how can we expect an organisation, or even a department, made up from those people to behave any differently?

Stand and Watch.  I don’t think anyone stands and watches their colleague break out of morbid fascination, they do it because they don’t know what else to do.  We are unprepared for this, untrained and so, like the inexperienced doctor who doesn’t know how to act as their sick patient deteriorates, we become paralysed by fear, worried we might make things worse.  Similarly just as they confidently dive in to the ALS algorithm when their patient finally arrests, we find a broken colleague, easier: remove them from work, send them to their GP, call in Occupational Health, get a locum.  It becomes obvious at that point but before then, when they are disruptive, moody or ineffective, that’s much harder, more unclear.  If someone is drowning, even if you don’t know what to do yourself, you can pick up a phone and dial 999 and get immediate help.  My experience of the NHS suggests that getting help for a colleague you thought was struggling requires a number of signatures, from people who can be difficult to track down, on a form stored in an inaccessible folder on the intranet…or being told to send them to their GP.

We must do better than this.  We must learn to recognise the signs of psychological stress which means we not only have to be taught we must be teachable, understanding why it is necessary and not pushing it to the side as ‘tree hugging nonsense’.  We must then also have better systems for dealing with issues raised and not expect staff to sort things out for themselves.  Nothing kills an awareness campaign quicker than the recognition that nothing changes when you raise the issue or the realisation that you are just making more work for yourself.  Staff identified as struggling must be given expert support, not just so that they benefit but so that those watching on know it is something worth doing.

Ask.  Jim,are you okay?  Yeah, fine. You?  If we shouted to Jim to ask how he was and he said he was fine, would we believe him…really?  Would we not possibly ask again, I mean REALLY ask and even then, given how things look, just get on and save him?  You see, assuming that a person would ask for help it if they wanted it or even that they realise they are struggling is just asking for trouble.

Most people bending under the pressure of work probably do know they are struggling but they just don’t feel able to ask for help.  They feel a pressure not to let the team down, not to be a burden to others or just to keep going.  When asked if they are alright they say they are fine, not because they are but because that is what they are supposed to say.  As colleagues, as friends, we must be prepared to see the reality, we must be willing to think harder, to probe further, to care more deeply.  A quick chat on a busy shop floor is unlikely to result in a meaningful opportunity to listen, we must make the effort to find time and space away from the pressures of work.  I know some people worry they will make things worse or be unable to help but really, if you keep your mouth shut and your ears open, you’re unlikely to push someone over the edge and may actually give them the opportunity to open up and be honest because they know there is time to do so and because someone actually seems to care.  Surely that has to be worth the risk?

But what if someone you think is struggling really doesn’t seem to recognise this, what do you do then?  Even in the midst of tears or an epic rant they excuse their behaviour as just a bad day, the way things are or being in need of a holiday.  What do you say to them?  Well, how about saying something like this:

‘I’ve noticed you seem quite short tempered (unhappy/tired/negative/distracted) these days and that’s not like you, is there anything I could do to help?’

You are simultaneously explaining why you are worried, demonstrating you feel there has been a change and offering support.  This is important for three reasons.  Firstly, the individual may not realise they have changed on the outside, even if they know they have on the inside.  They may think their behaviour hasn’t been affected and as such aren’t aware of how this impacts upon their job or those around them…it gives them honest feedback.  Secondly, even though you’re giving negative feedback, you are saying that you know this isn’t who they really are, whatever they are doing, and you still care about them.  When one is feeling ugly, angry and bitter on the inside it is hard to love oneself, so to have someone else remember the old you, understand that you are not your behaviour, is a powerful support.  Finally, you are offering care rather than discipline.  It isn’t always easy to chastise someone for their behaviour directly, particularly if they are becoming aggressive or they are senior to you but we live in a world with bullying and harassment policies and weaponised IR1 forms so people have got used to using these as safe ways of doing so.  Now, discipline must happen, inappropriate behaviours must change but is that the best way to get to the root of the problem?  Does this actually affect real change or does it just delay the next event.  By offering help you are reaching beyond their behaviour, trying to get to the root problem and asking how you can make a difference…together.  The next time you come across a colleague who is struggling, take a risk and ask ‘What can I do to help?’

Offering Advice.  When faced with a drowning man, yes, we know that learning to swim is important in the long term but in the short term it isn’t going to help.  A colleague weighed down with stress, anxiety and bitterness is unlikely to respond well to a chat about mindfulness and avoiding catastrophising (I certainly didn’t).  As one Twitter user responded to my previous blog post:

‘I remember someone suggesting mindfulness…and resilience, I’d have preferred if they stopped hitting me’

At this point, this type of advice is only likely to aggravate the situation, either through a feeling of being misunderstood or by implying that the person is failing and at fault…even though that isn’t what you are trying to say.  My advice, listening rather than talking is what is really needed at this point.  Help your colleague to process their thoughts and feelings so they can prepare themselves mentally for whatever is coming next, hopefully a rescue!

I think it also worth saying at this point that not every drowning victim is unable to swim.  Our neighbour Jim may be a very strong swimmer it is just that, eventually, exhaustion has kicked in and he cannot keep going, or the water suddenly got rougher or colder than he expected or maybe even he’s been attacked by a shark!  Offering mindfulness advice to someone who is exhausted, reached their limits or who has been badly shaken by a serious incident is not only irritating, it is missing the point completely.  These swimmers need rescuing precisely because their usual abilities mean they are out in the more dangerous waters, supporting others and dealing with bigger problems.  They don’t need more advice right now, they need rescuing!

Rescuing. Jim is in real trouble, life threatening trouble, what we need to do is to pull him from the water: instinctively we know this.  I genuinely believe that a person suffering with serious psychological stress needs immediate and absolute removal from that situation.  We don’t stand and watch Jim, just to see if he’ll suddenly start to swim, we don’t listen to his objections or protestations as we pull him from the water on to dry land, and we certainly don’t do so only to chuck him back in again just as he’s caught his breath.  No, we pluck our friend from the water and allow him to recover completely before letting him anywhere near the water again.  Why then, when we have colleagues clearly struggling, do we just keep watching, hoping that they’ll suddenly ‘start to cope’ or maybe accept their assertion that their doing okay or send them home for half a day and think that’s going to make everything alright?  I firmly believe we need to be proactive in our actions, insistent on our interventions and think in terms of weeks, not days when it comes to recovery.  Removal from the situation and reintroduction to appropriate levels of work…after some ‘swimming lessons’…will take weeks and probably months.  Too many good people are left struggling for too long, when we know they should be being cared for instead, and we end up breaking them.  We must be prepared to invest time and money urgently at this stage if we are not to end up paying an even bigger financial and human cost further down the line.

So why, when the drowning man makes our options so very clear, do we struggle to act like a good rescuer would?  Well, I think there is one very obvious flaw in my illustration, the position of the rescuer.  My rescuer is stood safely on the shore, away from the water, but we are more often in the water alongside our struggling colleague.  The splashing of our own struggles can mask theirs, making it harder for us to appreciate the difficulty they are really in.  We too need assistance and the thought of helping someone else to shore may feel to much… we all know what a drowning man can do to his rescuer.  None of us want to be dragged under with them and so we ignore their struggle and stay afloat ourselves.  It isn’t right, it isn’t fair, we know that, but this has become about survival and the first rule of rescue is don’t become a second victim.  But perhaps, if we are truly honest, the thought of someone else getting out and having a rest on the shore fills us with envy or bitterness: Why do they get rescued and not me?  Why can’t I have a break…I’ve been swimming here longer than they have, survived in choppier waters.  It isn’t pleasant to admit these feelings but to my shame I know I’ve felt like that as I saw others go off sick or have their hours reduced and I’m sure others must feel like that about me.

You see, the reality is that we are all in the water.  Some of us have been there longer than others, some are better swimmers and some have only just learned to float but we’re all vulnerable to fatigue, stormy waters and shark attacks.  We need to look out for each other, support each other and be prepared to rescue each other if we are going to survive.  Swimming lessons are great, life saving even, but sometimes, when the water is closing over our head, what we really need is a strong hand reaching in to our lives, taking control and placing us safely on the shore to recover.

Simon

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