Abstract
BACKGROUND:
Work and employees are often marginalized in studies on community-based psychiatric care and support systems. This paper highlights the role of the worker at congregated supported housing for people with severe mental illness (SMI). Housing support workers (HSW) are a fairly new professional role and have developed as a result of major changes in Swedish mental health care and services. The development of new roles is not unproblematic and raises intriguing questions.
OBJECTIVE:
The purpose of this article is to describe housing support workers’ experiences of meaning in their work, and in addition illuminate how the work identity of HSWs can be negotiated and constructed.
METHODS:
Four focus group interviews were conducted with a total of 25 participants. Additionally, three follow up sessions were conducted with the same participants. The material consists of employees from four different sites. The intepretation of the material was inspired by a constructionist approach.
RESULTS:
The analysis generated three themes: to do a good job, everyday needs and the formal role. The work identity for HSWs is complex and not easily interpreted.
CONCLUSIONS:
The experience of an unclear assignment affects the description of what is meaningful and important—the work identity and significant affiliations for HSWs. In the long run, this fragmented world can have negative implications for the HSW.
Introduction
Work and employees are often marginalised in studies on community-based psychiatric care and support systems. The focus is more often on the user [5]. This is also true when approaching studies on employees, work, and work organisations—i.e., the emphasis is on effects, consequences, and room for improvement for the users [see, for instance, 8, 30]. Naturally, ‘user organisations’ exist because of the users, and their well-being should consequently be of interest and form the basis for the existence of the organisation. Nonetheless, there are limits to this type of approach to organisations. If one only focuses on a user perspective, important narratives concerning these arenas are lost. The aim of this article is to develop the understanding of the professional group housing support workers (HSWs 1 ) at congregated supported housing for people with severe mental illness (SMI 2 ).
A work-scientific approach is taken in this article. Hence, the focus is on the interaction between the employee and the work, and the effects of this interaction. Work science has always tried to balance the organisational tension between financial and social objectives, and argued that social values may contribute to the competitiveness and profitability of organisations. Thus, social values have sometimes been individually studied, but more often there have been implicit presumptions that such a focus has had positive implications on the financial values and/or well-being of the organisation’s clients, patients, and users. The content of these social values with regard to the employees has changed over the years; at first, they concerned material wealth [30], then comfort [23] and motivation [13, 11], and in the last decade(s) meaningfulness, meaning in work, and work identity [15, 32]. Meaningfulness and meaning in work are closely related to the formation of a work identity: ‘ … meaning in work should be conceived of as closely related to what is perceived as “the core work” and thus to professional or work identity’ [15:3].
Meaning in work and the experience of meaningfulness are inseparable from the formation of identity: who we are, and how we interpret our roles at work and in an organisation [9, 37]. Several references highlight the importance of meaning in work and work identity, and how these affect one another reciprocally [18, 39]. A person’s identity is not something fixed but something that is in the process of becoming [24, 29]. This means that we are not handed an identity, nor are we fully free to choose one. This is a process of negotiation and ‘we call this process identity work. It aims to create a sense of coherence and distinctiveness in response to changing environments and enables one to answer the question, “Who am I at work?”’ [26:2].
Wresniewski and Dutton [39] say that prerequisites and a sense of being able to affect the meaning of one’s work and work identity will also affect the well-being of the employee. This deals with the individual’s possibilities and active attempts to affect his/her actual work and identity. The ideas of Wresniewski and Dutton are similar to those of Aronsson [1], who focuses on room to manoeuvre in organisations. In contrast to a simplified stimulus-response relationship between the individual and his/her surroundings, Aronsson claims that human beings are capable of affecting their surroundings. In other words, we do not simply adjust to set conditions, but are active ‘co-writers’ of a constructed situation: ‘through the implementation of this construction, the behaviour of human beings becomes the most human’ [1:77]. The meaning of work and the formation of a work identity may thus be closely connected to the personal well-being of an employee.
Parallel to these ideas, several authors claim that it has become increasingly difficult in our contemporary society to construct and re-construct our identity in general [2, 3], which is also true when it comes to our work identity [28]. Sennett [28] says that this is most apparent when asked to maintain and support our work-life narratives, who we are in these narratives, where we are going, how this movement is connected to where we came from. Comparing this with Giddens and the idea that ‘[a] person’s identity is not to be found in behaviour, nor – important though it is – in the reactions of others, but in the capacity to keep a particular narrative going’ [10:54], Sennett offers an illustration of a contemporary problem. The formation of identity and our ability to sustain a specific narrative are therefore closely interconnected. If we find it difficult to maintain and support these narratives, we probably also have difficulties when it comes to feeling a sense of clarity and stability about who we are or what we represent.
Work identity in health care and community-based care is often approached in a routine manner. In this context, history and tradition are often in focus [4]. Lindeman [20] focuses on the importance of actually considering temporary conditions and local contexts with the purpose of understanding work identity. Of course this is true for just about any type of professional group, although it is very obvious for HSW professionals. HSW is a fairly new role that is undergoing development, and similar to their assignment [7], the work role of an HSW is often complex and multifacetted [25, 30]. The role of an HSW seems to embrace both longstanding traditions in connection with psychiatric work [see for instance 21] but also looks to the present for salient cues in attempts to form a work identity.
The context of an HSW
The professional role of an HSW has emerged through major changes in Swedish mental health care and services. Nowadays, it is the municipalities (and private organisations) that are responsible for the users and not the county councils as it was before. One important change due to this is that people with severe mentalillness live out in the community with some kind of housing support [5]. Employees at congregated supported housing normally have a background as psychiatric aides or assistant nurses. Three main obligations for the HSW with reference to the users are identified by the Swedish National Board of Health and Welfare [29]: i) support in everyday life involving the content of their assignment; ii) the inside and outside of the home – i.e., the arena; iii) relationship aspects – i.e., the interaction between the user and the HSW [29]. These are obligations that the HSW is supposed to relate to in everyday work. The work of an HSW is ambiguous and complex [7, 29]. One way of understanding this complexity is to acknowledge the work of an HSW as emotional labour. Emotional labour has traditionally been regarded as less important than physical labour [14]. In caring and supporting occupations, it is common to downgrade the relationship aspects of work, and these aspects are consequently not seen as ‘real’ work. Emotional labour takes time, requires substantial knowledge of the user, and is difficult to quantify. The latter does not support the contemporary view of work organisations in general and community-based psychiatric service organisations in particular, where an increase of mapping, evaluation, and comparison between organisations is a fact [12, 27]. This development is of a regulated character and reduces the room to manoeuvre for employees [27, 38]. However, parallel to this increase in routine-based ideas on work organisation and the work itself, research has shown that the earlier, more pre-determined tasks have been replaced by overall responsibilities [17]. This change seems to be in accordance with the work of an HSW and can also be seen in the above-mentioned obligations identified by the Swedish National Board of Health and Welfare. The three areas aim to identify the responsibilities of the HSW, but with regard to these responsibilities it is difficult to understand what is not included in their work.
A great deal of the resources invested in the work by the HSW is of an emotional character. Work consists of many different things, many of which are unpredictable and spur-of-the-moment tasks [25]. Working close to people in their everyday lives means that all kinds of things may occur, and in the middle of ‘all kinds of things’ is where the work of the HSW is found. The fact that the actual work consists of partially ambiguous responsibilities opens up the possibility of other actors and their interests defining the assignment of an HSW. Consequently, several actors are part of negotiating the content of the assignment, for example, the users, the company, colleagues, psychiatry, documentation, close kin, the municipality, the Swedish Disability Act (SFS 1993:387 LSS 3 ), and the National Board of Health and Welfare [7].
Accordingly, there are two existent but incongruent sides to the practice of an HSW. On the one hand, a high level of complexity where work is of an emotional character and difficult to anticipate, and on the other hand, a general increase in instrumental and routine-based ideas. One way of interpreting this is to see the professional group of HSWs as equilibrists between situation and instrumentality [7].
The professional role of a Housing support worker is fairly new, and in the intersection of the professional, public and private. The uncertain boundaries between private and professional in a publicly financed care (and in this particular case executed by an profit-driven care company), creates a degree of ambiguity of what the work actualy includes (or should include) and affects the understanding and formation of work identity [15, 28]. Based on our earlier research [7], we regard the employees at congregated supported housing for people with SMI as being at an early stage of developing their work identity, making the outcome of this process still unclear and potentially interesting. How this particular professional role is being negotiated and constructed in this instersection of public, professional and private space, can shed light on questions of meaningfullnes, health and well-being for the HSW, as well as finding the pre-requisites of enabling good work performance and therefore better service and support of the users. Therefore, we want to continue our attempt to widen the knowledge and understanding of the HSW role. Hence, the aim of this study is to describe the HSWs’ experiences of meaning in work and also to illuminate how the work identity of HSWs can be negotiated and constructed at congregated supported housing for people with SMI.
Method
Participants and procedure
Twenty-five people were included in the focus group interviews, of which twenty-two were women andthree were men. Four different sites of congregated supported housing for individuals suffering from severe mental illness were represented in the material (FG1 n = 6, FG2 n = 8, FG3 n = 6, FG4 n = 5). All twenty-five employees worked at private housing. The local government had contracted a main part of the service of supportive housing for people with SMI to profit-driven care companies. There were twenty-seven employees in total at the four facilities. The participants were employed as housing support workers (HSW). All the informants have a background as either psychiatric aides or assistant nurses. The four facilities (two clustered apartments, one villa, and one rebuilt former psychiatric hospital unit) have accommodations for a maximum of 42 users, and the rooms were fully occupied at the time of this study.
E-mails containing information and an appendix about informed consent were sent to the department head of each facility. The department head distributed the information letters to the staff members and all but two then gave their consent to participate in the study. In order to facilitate combining the staff schedule with the focus groups, we conducted the focus group interviews at so-called workplace meetings, i.e., obligatory meetings during regular working hours. However, the staff members were informed that these particular meetings were not mandatory. The written information that every staff member received included the assurance that the focus group interviews were voluntary. This was repeated initially at the actual focus group interview. None of those who intended to participate at the meetings had declined to participate in the study. Prior to the introduction of the focus group interviews, all participants handed in a signed consent form to the researchers. Then, the participants were also informed orally about the purpose of the study and its practical execution. The department head of each facility did not participate in the focus group meetings.
The focus group interview and feedback sessions
The focus group approach was chosen because of its group dynamics and potential for rich material, particularly when there is not much prior knowledge about a phenomenon, i.e., housing support workers in Sweden. The aim was to explicitly base the focus group study on the practical situation of HSWs, what they do, how they perceive their work, how they interpret their assignments, and their roles in the organisation. All four focus group interviews revolved around these areas. Each focus group meeting was consequently introduced through the question of what a typical workday looked like for them. The groups often related to a particular day that was in close connection to the focus group meeting. This day became the centre of attention for the rest of the interview. Sometimes, the group members chose to ignore the events of that particular day if they felt a need to explain certain events, and an expansion of that particular day was also used in order to validate particular statements, which were gathered from actual situations at work [7].
The role of the researcher in the focus group was to attempt to allow the informants to expand on their arguments, which they may have felt self-evident to them, and ask them to focus on a specific event, activity, or situation and explain the scene in more detail. In close connection to this, we also asked for concrete examples. This mostly happened when the descriptions offered seemed too abstract. All the focus group interviews were conducted by this article’s first author.
The focus group interviews were scheduled to take between one hour and thirty minutes and an hour and forty-five minutes. All the focus group interviews were recorded with digital recording equipment. The digital recordings were later transcribed verbatim.
Approximately six months after the focus group interviews took place, some reconnecting meetings were scheduled, all conducted by this article’s first and third authors together. Three such meetings were held for participants at all four facilities. Two of the facilities were joined together as a single group. These meetings were based on a preliminary analysis of the material gathered from the four focus group interviews. The meetings integrated empiric presentations of the focus group material and the participants’ responses to this data. Thus, these sessions had two objectives: i) reconnect and give feedback to the participants, and ii) collect more material. These reconnecting meetings took about one hour and fifteen minutes each, and they were recorded and transcribed verbatim. Similarly to the focus group interviews, the department head of each facility did not participate in the feedback sessions.
The further interpretation (see below) of the material from the focus groups are our primary interest in this study analysis, although the data gathered at the reconnecting meetings has been used in order to complete and expand on some parts.
Approach and analysis
The study takes an interpretative and constructionist approach [6, 34]. The conversations and narrations of the participants concerning their work, work situation, and roles have paved the way for the formulation of a research objective. The constructionist approach suggests a focus on how something is made up of available material, i.e. how the participants construct their work, roles, and organisations through their actions and interpretations. Consequently, it is the construction of meaning and knowledge in a specific context offered by the participants that is of interest for this paper. The ambition has continually been to encourage the participants in their narratives. An attempt has been made to stay as closely connected to the actual work situation as possible and base our arguments on the reality of the participants, as opposed to a limited focus on predetermined theoretical assumptions. The development of specific themes was empirically driven. The material was initially analysed impartially, but with one overall goal, i.e., to study what they were doing and how the work and the assignments were crafted. The first analysis generated four distinctive themes: i) Different actors – different expectations, ii) Regulation and disciplinary objects, iii) Daily activities and expectations, and iv) Interruption in the flow of events [7]. If not highlighted in each theme, the terms of meaning and identity were visualised throughout the entire material. After consulting theory regarding the first and foremost meaning of work and work identity, the material grew and new cues emerged, so this was expanded on. Hence, our analysis of the material continued and did so with the aim of describing the HSWs’ experiences of meaning in work and, additionally, illuminate how the work identity of housing support workers could be negotiated and constructed at congregated supported housing for people with SMI. This generated three themes, which were significant regarding the meaning of work and work identity: To do a good job, Everyday needs, and The formal role.
Results
The results focus on three themes that were identified through the empirical material, themes that were often repeated in the conversations and narratives of the HSWs: To do a good job. Participants emphasised the central elements of their experiences when it comes to doing well at work, as well as experiencing a sense of being able to finish something. Everyday needs. Everyday needs take the following three expressions: Belonging, Contributing, and Recognition.
The formal role. The formal role constantly interacts with all of or some of the additional two themes. However, it is difficult to extract an exact definition.
To do a good job
As an employee at congregated supported housing for people with SMI, one never speaks plainly about performance. This, however, does not mean that the participants were not talking about this, driven by this, and felt the need to perform well. In all the focus group interviews, the participants highlighted the importance of doing a good job. One factor they experienced as more important had to do with their ability to finish certain parts of their everyday work, and doing it well. This was related to their experience of completing something. Any success could be ‘self-evaluated’ at the time of reporting and handing over to someone else as the HSW left work to go home. In order to feel satisfaction, it was important for the HSW to be able to hand over a ward that was working and being harmoniously balanced. According to the participants, this meant they had done their job well. At the same time, several of the participants spoke of very difficult and highly set objectives that required a lot from them, but also of those living at the supported housing. A number of the focus group participants described situations in which the main focus was to break the everyday pattern. The participants experienced such events as a result of the users having made some progress.
Researcher (R): Since we are discussing it, what does it mean to you to do a good job?
NN2: When you get the sense that, or someone says that, you have done a good job. Or that the one upstairs who does not say much or do much all of a sudden likes to do a little dance in the hallway. That he has blossomed, if only for three minutes. You saw it …
NN1: A sparkle in his eyes …
NN2: Yes, or that someone gets to leave, do something, buy crêpes for dinner. She went out all on her own in the evening and bought herself something to eat. (FG1)
Simply put: when unexpected things occur. The statements were often made in reference to Daily activities and to Personal development plans. The participants explained that Daily activities is a technical term used to describe things that the facilities are expected to contribute, and it also includes being able to support the users in their daily activities. Accordingly, it is difficult for the participants to define the concept. In the focus group interviews, the participants asked rhetorical questions such as: ‘What is an activity?’ and ‘Is a certain activity the same for everyone?’ Consequently, they reported that they all seemed to have their own ideas of what was included in the term ‘daily activity’. With ‘all’, they meant the users, the municipality, colleagues, the National Board of Health and Welfare, the company, and close kin. The participants said this made the answer to the question of what good performance is somewhat blurry.
The participants explained that the Personal development plan included the idea that the users along with the HSW (and sometimes also other actors, e.g. close kin) were to set up objectives for their everyday lives. These objectives should be documented, and this documentation should also include notes concerning whether the objectives were met and, if not, why. In the same manner as the Daily activities, the participants felt it was difficult to clearly define the objectives, i.e. their content, level of responsibility, and design. The participants said this insecurity and the ambition to perform well at work sometimes created unreasonable expectations on their activities and objectives.
NN4: Yes, there should be objectives. This is part of the Personal development plan. We should have them, and the user should be included in the process. Of course they may object; we do have a person who has opted not to participate at all in this. The municipality accepts it, perhaps that is what I sometimes feel a bit worrying. It is one of my residents, a person for whom I am the contact person, who has objected to this. Perhaps I sometimes feel that I want to do too much, that I want to show them that this is what we do. Most of all, I am quite good at it. But you cannot do it on paper. Then there are many other ways for us in the staff group to identify personal development in that particular person, even if there are no set objectives. For him, it might be a huge objective, although you cannot put it down on paper.
NN3: And I think that at first, when the Personal development plan was introduced 5-6 years ago, the objectives were meant to be huge. Perhaps it is only about maintaining something, maybe simply being in everyday situations. At first, our objectives were huge, everyone should be able to move out, take care of themselves, and receive education … that was how it was at first. Later on, when they got here, it felt as if you could not expect so much of the users. They simply just wanted to get through each day. That could be one of the objectives today. That was not true at first, in my opinion. Back then, we almost had to come up with our own objectives, such as are you sure you do not want to get some education? Or something like that. (FG2)
Some of the participants reported an on-going change in the interpretation and assessment of reasonable demands and expectations on the users. However, not everyone saw this change.
The participants experienced that the demands from the municipality and what the users wanted was not always the same thing. In the focus group interviews, the participants discussed how the different expectations made it difficult to interpret what could be seen as doing a good job. Nonetheless, they expressed an insight that they had to accept that previous highly set standards sometimes had to take second place to the benefit of lowering the standards and adjusting to everyday situations.
NN1: The municipality, for instance, now that they have their question rounds, they once again focus on these damned activities. I should not say damned. It is just that no one understands that it sometimes just comes down to simply feeling safe and good.
NN3: You should not put your own personal values into what is good and not good.
NN1: Yeah, when you have been to this rehab course, and you should exercise and exercise although you are old, then perhaps you just want to be left alone …
NN4: I have two men who have asked me about this development plan, how they want it in the future, and they say that they want things to remain as they are right now.
NN: That is proof that you like things the way they are … (FG1)
The participants experienced that the well-being of the users was closely related to how the HSWs had done their job. In the focus group interviews, the discussions revolved around the issue that well-being does not simply happen: it all comes down to a job well done, according to the participants.
Everyday needs
The participants described a number of various situations and events that they deemed important to their own personal situations at the workplace. These descriptions were often in the form of basic expectations and demands on their work, the work content, and the surrounding, a sort of everyday drive among the HSWs. The participants explained that it had to do with feeling recognised and contributing in a social context. Related to this, the discussions in the focus group interviews revolved around how the participants experienced their own importance in connection with their relationships to the users. Very similar to the section above, the participants discussed the importance of contributing and getting recognition when doing so. They meant that their job had a lot to do with contributing to the well-being and security of the users. Well-being and security were, according to the participants, important to the users’ everyday lives, and if these requirements were properly met, everyone was pleased with the situation. The participants experienced that they were the mortar that held the place and the users together.
NN3: You become the hub around which most things revolve, a security for them.
NN: And we are always here, so to speak …
NN2: Mmhm, they immediately worry if they don’t know where we are. If you forget to write on the board and perhaps quickly stop by the store, they start wondering. So they keep track of us all the time.
NN: We become the link. What if they had been living on their own? Then, they would never have met anyone. That would just not have happened. (FG 4)
Naturally, there were differences in how the HSWs felt that they were able to make a contribution, from down-to-earth everyday things to more extensive projects that were successful. When asked directly what made them ‘put on their spiked shoes and run to work’, one of the participants said:
NN2: Like when we took our trip, Jack … I have been working so hard with a person to get him to come along for a ride to visit his relatives, a trip he wanted to make but could not pull through, for different reasons. Obsessive problems, anxiety that has been going on for years. And then we manage to go on the trip and had a really nice time. I’ll remember that for a long time … until it is time to set up the next objective … (FG2)
The most common answers, however, when asked about the ‘spiked shoes’, were the work group, the colleagues, and the social context. Thus, they experienced a need to feel like they belonged and were confirmed in this setting.
NN: Then, of course, it all has to do with the work colleagues. It would have been awful if you did not like them. Then, you would have had a difficult time getting to work.
NN4: You do not always feel that it is a blast to come here, sometimes you feel that you are really sick of that particular person [a resident], but in the work team, that is where you find joy to work. (FG1)
NN5: We have been working together for a long time and know each other really well, for good or bad. I mean, you can tell from a person’s look, the staff … mostly it is not that difficult. You sometimes know what the other person is thinking. It is simple, easy to come here … Yes, I love it.
NN3: … the joy of going to work is all about the work group that you enjoy being in. The other things with the residents is part of the package, it also works well … automatically, I think, to some extent you like your work, if you don’t, you would not enjoy going to work. I think it is about security and joy in the work group. (FG3)
To belong and to be recognised is here talked about as if they were integrated. Recognition, however, is not strictly limited to their colleagues, but also to the users. The users’ recognition of the work of an HSW was ‘hard currency’ according to the participants. They felt that the best way to be recognised was when the users did something unexpected, deviated from their everyday behaviour, or gave a small hint of positive change. The participants explained that one strategy for identifying one’s own and the group’s contribution over time was to read the documentation. Many of them said that they were able to identify a long-term, albeit small, change from the detailed descriptions of the users.
The formal role
The participants found it difficult to explain what the formal role, HSW, was really about. A clear definition and what distinguishes an HSW from a psychiatric aide is most of the time not available, and it is not properly crafted into the discussions among the participants. At the same time, they all tended to present themselves as being an HSW. On a straightforward question – What is an HSW? – one of the participants answered:
NN: Well, what is a housing support worker? Pretty much everything. I’m not really sure what a housing support worker is … it’s another name for psychiatric aide. You call it housing support worker, though, making it somehow seem much larger. I am not quite sure of the real difference between a housing support worker and a psychiatric aide. (FG 1)
The participants had the same difficulty when trying to sort out the Swedish Disability Act, which facilities adhere to.
NN1: Most people who live here are admitted in accordance with section 9, but I do not know what section 9 stipulates.
NN2: Well, it deals with those living here … special housing in accordance with section 9.9.
NN: And does section 7 deal with mobility services?
NN2: Oh God, no, it is an act dealing with rights …
[…]
NN1: We’ll have to take a closer look at that, heh heh heh... (FG1)
When dealing with direct attempts to actually illustrate their functions, the participants experienced their functions at the congregated supported housing as being ‘chameleons’, constantly ‘going in and out of various roles’. In reference to the image of the chameleon, the participants emphasise the knowledge and skills of an HSW. Primary skills included dealing with everyday knowledge in connection to the user. However, and in contrast, the participants experienced a form of resistance towards psychiatry and the attempts made by psychiatry to enhance their medical skills. The participants said that psychiatry tried to expand the field of responsibility and skills of the HSW. Such situations occurred, for instance, if a specific user was in need of immediate psychiatric care. The participants meant that this opened up gray areas that they tried to resist by lowering their expectations, pointing to their lack of skills, knowledge, and formal competence in connection with the users.
Discussion
Similar to the work and the assignments of the HSW at congregated supported housing for people with SMI, their work identity turned out to be complex and difficult to interpret. The everyday work of an HSW is characterised by predictability, regularity, unpredictability, and irregularities. Work is considered to consist of emotional strain Predetermined tasks are being replaced with overall responsibilities. At the same time, there is the paradox of an increase in rationally based ideas, i.e., documentation, mapping, and evaluating [7]. In this practice, the HSWs attempt to construct an identity for what they represent through the use of available material. The HSW is a fairly new function in community-based psychiatry. The conversations in the focus group interviews, and the narratives of the HSWs, did not offer a clear picture of their work identity, but rather helped to illustrate a goal that varies from what is meaningful and important in their roles as HSWs to how they see themselves. A few important dimensions in all of this were, however, distinguishable in connection with the experience of meaning in work – the core work – and the formation of a work identity for the HSWs. First and foremost, we have to highlight the complexity of their assignment and the continuous negotiation and interpretation that this involves. A number of actors are part of forming this assignment [7]. In direct association with the emergence of the assignment, we found three additional dimensions: To do a good job, everyday needs, and the formal role. The everyday needs were manifested in three different way through their ability to contribute, belong, and be recognised.
As previously mentioned, the aim of this paper is to describe the HSWs’ experiences of meaning in work, and also to illuminate how the work identity of housing support workers can be negotiated and constructed at congregated supported housing for people with SMI. The HSWs tried to balance their everyday working life between two ideas: one that was based on routines, written instructions, and formal expectations, and another that was based on active exploration and self-organising. In this tension, it is difficult to maintain a consistent narrative about what you do and how you see yourself in this narrative. ‘[T]he capacity to keep a particular narrative going’ [10:54], becomes difficult if the world is fragmented [28, 36], as stated in the narratives of the HSWs. The HSWs do not seem to be capable of assembling a plot and keeping it alive in a satisfactory way (for themselves). The narratives seem to be rather porous and fragmented.
Wresniewski and Dutton [39] say that meaning in work and work identity are intricately connected and continuously occur side by side. ‘What is the core meaning of the work?’, ‘What is the assignment?’, and ‘Who am I?’ are naturally interdependent questions the employee would ask [9]. For an HSW, this is most apparent in contexts that revolve around performing well at work. There is no good reason to question whether the participants all attempt to do their best at work. Of interest, however, is the actual complex assessment of what is considered doing a good job, i.e., good performance. Ambiguity in terms of what performance is corresponds to the fact that the employees are uncertain about their work assignments, which in turn affects who they are and what they feel they represent at the workplace. As opposed to this groping in the dark in an attempt to find answers to questions about good performance, the HSWs focus on more elementary forms of being part of a workplace. They focus on being able to contribute to a social context, on feeling validated in this context, and most importantly, on making their ‘everyday function properly’. An everyday that functions properly was the smallest common denominator on which the HSWs were able to reach agreement (both between one another and individually). Our commitment has not been to define the work identity of the HSWs, but to try to frame their negotiations and constructions in everyday work. We would like to claim that the identity work [26] – i.e., the process that aims to create a sense of coherence among the HSWs about who they are at work, what they do, and why – and that this is visualised through a complex interaction between the assignment, the formal role, everyday needs, and performance. It is plain to see that there are problems concerning this, and that it is difficult to keep track of the ongoing narrative. The problem with these difficulties is reinforced when considering how Weick [36] emphasises the importance of being able to create a good and plausible story.
A good story holds disparate elements together long enough to energize and guide action, plausible enough to allow people to make retrospective sense of whatever happens, and engaging enough that others will contribute their own interest of sensemaking. And a good story, like a workable cause map, shows patterns that may already exist in the puzzles an actor faces, or patterns could be created anew in the interest of more order and sense in the future. The stories are templates. They are products of previous sensemaking. They explain. And they energize. [36:61]
Conclusion
The plot that the HSWs attempt to present is, as mentioned earlier, fragmented and fuzzy. In this article, we have tried to demonstrate how this (negatively) affects the image of the assignment and the work identity of housing support workers. In the long term, this may affect the actual well-being of the HSW. A reasonable and functional narrative about the assignment, the workplace, and who you are in all of this relates to being able to grasp something, understand it, and find it meaningful [24, 36]. Although conscious efforts are being made, the plot of the HSWs’ narratives suggests, to them personally, that everything is not crystal clear or understandable.
HSW is an abbreviation for a housing support worker. In this case, the employees work as housing support at congregated accommodations for individuals suffering from severe mental illness. Henceforth, the abbreviation will mostly be used, but sometimes the full term.
Suffering from a mental disability mostly implies shortcomings with regard to social and cognitive functions, unmet needs in several life domains, stigmatization, and poverty.
LSS, SFS 1993:387. The Swedish Disability Act is an act that seeks to guarantee good living conditions for individuals with severe chronic disabilities. It ensures that individuals receive adequate help to carry out their everyday tasks, and be able to influence the support and services received. The objective is that the individual will have the possibility to live just like any other citizen (translated from The Swedish National Board of Health and Welfare: http://www.socialstyrelsen.se/regelverk/lagarochforordningar/lagenomstodochservicetillvissa).
Footnotes
Acknowledgments
This article was produced through a collaborative project between Kristianstad University, Carema, Care, and CEPI: Centrum for evidence-based psychosocial interventions for individuals suffering from psychiatric disability.