I am a social worker psychotherapist in youth mental health in a CLSC, lost in a behemoth called a CIUSSS.
I have worked for almost 20 years in the public network. I had the chance to know the magic era of the CLSCs when we were a small team assigned to a specific neighborhood to meet the needs of the neighborhood according to its colors. Since then, I have experienced two major reforms, each time with massive staff departures – sick or leaving the ship. The Barrette reform was certainly the most difficult to live with.
There are currently demands to increase the salary to retain professionals. Of course, the salary is important. We are underpaid for our professions despite our higher education. But if we do a job of a psychosocial nature, it is often out of passion, out of a desire to connect with people.
When I read that Mr. Dubé wants the network to be more efficient and effective1, I too want to jump ship. First, what is performance? Currently, performance is counted using statistics (with a completely archaic system – you don’t need to be a statistician to understand that this system does not at all reflect our reality on the ground). Lean methods of accounting for results have been decried for several years, but the decision-makers of the CAQ continue to believe in their effectiveness. They want to recruit “performing” managers who come from backgrounds that have nothing to do with the health system (and are highly paid, as if the field work depends on them or that their work is more important than ours ).
But what about the quality of services? How do you assess network performance and efficiency if you never analyze the quality of services? The fashion is for short “episodes of care” because it’s statistically more expensive when you see more people. It doesn’t matter if the person’s condition deteriorates or improves – it is not taken into account. It does not matter if she subsequently consults the emergency room because the follow-up offered was not sufficient. We’re creating a revolving door system that’s not at all effective or efficient at the macro level – all to meet the performance and efficiency stat count requirements. We are creating a void and this has an impact on the clientele who are doing less and less well.
I’m very afraid of “top guns”. Besides, what a choice of expression by Mr. Dubé. He really wants to shoot our services and our collective well-being.
We have a serious problem with retaining professionals in the helping relationship, and not just among psychologists. People leave because they can’t find it anymore. We have positions available and sometimes no one applies. The work approaches are increasingly imposed on us (the subject of the Quebec Mental Disorders Program could be the subject of a complete column. I will never understand that it is the Ministry that imposes an intervention framework on us, so that he has no training in psychotherapy). Professionals prefer to create private workplaces to meet their need for humanity and professional autonomy or retire prematurely.
The helping relationship requires time and skill. It already takes time to create the link with the person. Time to fully understand his situation. The time she trusts us enough to open up about the most painful issues she has never dared to talk about. Our profession is perhaps more like a work of art to be created and refined, a dance for two, than a factory for making as many cookies as possible. With an accounting approach, there is a real risk of leaving behind all those families who are struggling to mobilize or deploy for all sorts of legitimate reasons.
Please stop talking about efficiency and talk to us about humanity, depth of connection and listening. The world badly needs to find its human qualities of listening and relational sharing, which are at odds with the approaches of competitiveness and accounting performance. Let us do our job without pressurizing ourselves further.
