I am frequently infuriated by the incredibly poor understanding of risk in this sector. The standard hr templates are inadequate to a level bordering on neglect. They are aimed at protecting the organisation rather than creating mutual safety for organisation, staff, and clients. The resources around risk and safety are so fragmented and limited, so inapplicable to our actual work and our actual workforce, and so distracted by the risks we can easily find words for and pretend to ourselves we have adequately controlled. The real risks are frequently completely missed, unspoken and unspeakable. And many of the strategies used to manage the risks we can talk about are profoundly destructive.

Humans are, by and large, rubbish at accurately assessing many kinds of risks. We are also not particularly wonderful at coming up with fantastic solutions for managing them. In fact, sometimes our solutions are so bad they make us feel better but make the actual risks worse. In public health we call this the unintended consequences of our interventions. A basic tenant of all work in public health is that all actions will have unintended consequences. If you think you’ve done something and got away without having any unintended consequences, it means that either you’re not looking hard enough, or you’re not asking the right questions.

This process of examining the impacts of our actions is called evaluation, or critical appraisal. In public health it’s the macro version of what we do in intimate psychological services where we engage in supervision and reflective practices on a micro level. It’s an essential step that is utterly missing from most risk management approaches. It’s a catastrophic omission.

Without this step we often have no idea if our management approach is working, or not working, or actually making things worse.

Worse, our assumptions are embedded in the framework in ways that forces our thinking down very particular pathways: all risks should always be eliminated where possible. Compliance is always the goal.

Starting with these two premises unquestioningly immediately reduces the whole conversation around health and harm and quality support work to something so narrowly defined it makes my teeth ache. How we define if something is ‘working’ can be so limited it’s dehumanising.

Take a step back even further and we often miss the real risks completely. Entire policy suites are written from what is effectively a set of unquestioned assumptions that doesn’t reflect the real work or risk accurately, and worse, is usually profoundly embedded in all kinds of discriminatory, abelist crap that sets the tone and culture of the work and the workplace in subtle but powerful and destructive ways.

So there’ll be pages of crap and all kinds of training about managing difficult behaviour from clients, but nothing about handling difficult behaviour from co-workers or your managers. Why? Because we have othered the clients as uniquely dangerous and subhuman, and because the exhausting and terrifying mental health risks of dealing with highly stressed and stressful colleagues and bosses is still an unspeakable nightmare. It happens, we just don’t admit it and we sure don’t provide nuanced and compassionate training about it.

There’ll be policies full of waffle about how to do risk assessments to allow our clients to even leave the house, mainly driven by pressure from greedy, unethical, vile insurance companies who don’t care a fig about staff safety or client wellbeing, but are looking for excuses not to cough up when something goes wrong. These requirements are swallowed whole as reasonable and ethical and in the best interests of the staff and clients instead of being red flagged as the undignified, butt covering, traumatic and bureaucratic bullshit they really are.

There’s a hyper focus on physical risk and injury because it’s easier to define, and creating long lists of forbidden activities is much simpler than co-designing individualised protocols tailored to each staff members capacity and each client’s needs.

The assumptions are that risks are intuitive. That it’s easy for us to guess at them, rank their severity and likelihood, design and implement management approaches, and move on. The actual research is sobering. Frequently the risks are wildly different from what you’d guess. The pain points are not intuitive. Severity and likelihood is extremely hard to estimate accurately, even for people fully trained in this field for whom this is their bread and butter. Designing and evaluating effective interventions takes serious skill, and more than that, it takes a framework that draws on essential values and principles such as co-design, lived experience, continuous improvement, open dialogue, client centred care, the dignity of risk, the social determinants of health, trauma informed care, relationship based services, and critical appraisal. Risk management that’s high quality is inherently relational.

Did you know that one of the highest risk services a support worker can provide for a client is to trim their toe nails?

One of the leading causes of death for people with disabilities in Australia is dysphagia (swallowing difficulties).

The working from home guidelines about ergonomic office setups presume all employees are able-bodied and neurotypical. There’s no scope for people who need to move, fidget, or curl up in a bean bag. It’s so hard to get our exploitative workplaces to fund chairs that won’t hurt us or screen armature that’s set at the correct height to prevent eye and neck problems. We haven’t even managed safety 101 for the average worker, no one has got up to including divergent people and the best practices for us yet! We are still largely invisible.

Myths about Duty of Care continue to harm participants too, as this DSC article explores, exposing them to overprotective misguided restrictions that limits autonomy, freedom, and opportunities to connect and engage with the world in meaningful ways. Risk is frequently framed for them through a narrow lens of physical harm or making bad choices and rarely explored as a potential consequence of engaging with services who are risk adverse.

The biggest risks most support workers face are psychological – burnout and vicarious trauma. Undertrained or put through rubbish training, under resourced, frequently without any access to quality supervision or debriefing, we often witness discrimination, ableism, and injustice in contexts where we have very little power. Many of us have lived experience of disability and marginalisation we draw upon for this work, which is a powerful resource but also a source of vulnerability in how we are treated by our workplaces and other organisations. Magdel Hammond has beautifully articulated the risks of moral injury which are frequently suffered by lived experience workers in this linked in post. Moral injury – the profound distress we experience when we witness or ourselves engage in behaviour that violates our values and beliefs – presents profound risks in the workplace. But you’re very unlikely to see it mentioned in your policy suite. Trauma informed care demands we acknowledge the risks of structures and organisations to individuals, to be attentive to signs of distress and harm, and responsive to those indications. We aren’t even having the conversation. When faced with work requirements that are at odds with our personal values, we most often privately and silently choose between compromise, or judicial non-compliance. Both can take an extremely high toll on our mental health.

We keep blaming the individuals when things go wrong. Individuals do the best they can where they find themselves, and that’s a horrifying reality when you really think about what it means that some of the horror stories out there were someone’s best. Our tools let us down. Our language, our training, our incident report forms, our risk policies, our management approaches, our gig economy, they are all fundamentally inadequate for this work, in extremely dangerous ways. We have the frameworks we need. We know about trauma informed care, about the value of cultural awareness, the empowering dynamics of the recovery model. We know that values based work is essential when supporting people. What we don’t have is those models translated into our structures and tools. Our working practices, policies, and documents. We talk about dignity of risk then have lengthy processes that gatekeep leaving the house. We acknowledge the value of individualised care then write policies without any flexibility that must be applied to all clients. We understand the risks of bearing witness to suffering, then create training that’s little more than an instruction to try not to be affected, building shame and secrecy around people’s struggles. We are not effectively translating our values into our work, and it’s putting us at risk. We are most often silenced about those risks, and silenced about the impact on us. We are trying to provide safety for clients in contexts where we don’t get to experience it.

It’s not just us, all workplaces remain bastions of trauma, abuse, and suffering, particularly for those already marginalised. The power of the bosses and the risks of the work are only vaguely contained by laws protecting those dependent on their paycheck. The rules are written by the powerful who have agendas of their own. Most harm happens exactly where harm is always found – in the unspeakable. What we feel we can’t discuss, or write into policy, or create training for. There’s no accountability for the lovely mission statement. There’s no way to ask how it translates into this policy or that practice. So the beautiful values and the elegant frameworks remain as unrealised dreams, guiding lights or stars to navigate by if we’re lucky to be in a good workplace, but far, far from hand. We work down in the mud and the mess with tools that harm as much as they help, and cultures much more likely to blame us for breaking, than to admit it was always a possibility, and one we were not protected from.