Burn out… it’s like asking me to binge and purge.  

The following entry is going to be a (very) long one. Today I came home from work frustratingly talking to myself in my car on the ride home. I work with mentally ill and I assure you, I am not psychotic. I am just frustrated and seriously burnt out. Do you know what serious frustration and burn out does to a former bulimic? This burn out inspires me to seek comfort. As a former bulimic, this comfort seeking behavior by history has lead directly to binge-purge behaviors. How dare my job make me want to binge and/or purge. I am fed up with being fed up. I am sick of working in a job that makes me even think about seeking food for comfort. This is my burn out story…



Wanna talk about burn out? Let’s talk about clinical case management.
More specifically, let’s talk about clinical case management for a homeless division in the metropolitan area of Tampa Bay, Florida. The first thing we’ll touch on is the pay scale; they call it a salary but, it hardly qualifies. In fact, the salary I was presented with on my hiring date is almost low enough to reach 50% AMI. AMI? You might be wondering what that stands for. Well, as an employee of a Hillsborough County mental health care agency who utilizes the Shelter Plus Care assisted housing program funded by HUD, I wondered that very thing myself for some time. HUD? Shelter Plus Care? What? I used to wonder about those, too. I’ll throw one more abbreviation at ya: FMR. FMR? You guessed it, I wondered about that one, too.
Let’s get back to the topic at hand – burn out – as I attempt to explain those previously mentioned abbreviations and acronyms.
Right now, at this very moment, I feel incredibly burnt out. As a clinical case manager, working for a government and privately funded mental health care agency, I am fried. The program I work under comes with the following abbreviated description:
The ________ program serves individuals and families who are homeless and have been diagnosed with a mental illness as well as possible substance use disorders. The ________ program provides case management, life skills training and employment services utilizing the Shelter Plus Care program to provide stable housing for the consumer(s) with an ultimate goal of consumer self-sufficiency.
Let’s break that down so you understand the population in which I “serve”. Mentally ill, possible substance abusers; variable and quite possibly erratic individuals and families. Homeless; low-to-no income. If they do have income, it probably isn’t via earned paycheck. Nope; these consumer’s are not what you may think of as a consumer. They are not shopping or spending, they are quite literally consuming.
These consumer’s more than likely have no income. The income that usually comes with a low-income, homeless individual or family is likely in the form of a child support check (or multiple child support checks), cash assistance or TANF (yep! there’s another abbreviation to wonder about), social security disability checks and non-cash assistance SNAP, formerly known as food stamps (I figured out right away that “SNAP” and “food stamps” were synonymous, but not because I was trained to know so…).
Coincidentally (uh, sorta), when dealing with a homeless population, you also find a trend of lower education levels and/or more detailed criminal records. So, in allfactuality, some of my clients are educationally ignorant and/or criminals. Now, if you knew me, you would know that I am not a jerk. I realize calling the people I “serve” ignorant and criminal sounds harsh. Its not meant to be, however. Its just the truth. Through my experience, I can handle this truth. Hopefully, so can you.
On the note of some of these consumer’s being uneducated and/or felons, let’s just brush lightly the topic of employment services. How productive or easy does it sound to attempt to find employment for such a population? And, I didn’t even remind you that they are also mentally ill by diagnosis. On top of that, some of them are current or prior substance abusers, remember? Thank God we have a separate person that attempts to handle that tall order. The next fact of the matter is that the employment specialist (ES) hardly ever actually finds anyone of the consumers employment. Let me assure you if you need to be assured; this fact does not exist because the ES doesn’t try their damnedest to do so. Talk about burn out… the ES definitely, and rapidly, become’s a likely candidate for burn out.
As a clinical case manager (CCM) with the above described variable and likely labile population, it too is a position that one is likely to get burnt out in.
Shelter Plus Care (S+C), lets talk about that. HUD (US Department of Housing and Urban Development – thank you, google), has a government funded supported housing program called S+C. This housing program is to be utilized by those that have become homeless, chronically or initially by Florida definition (don’t ask…), and are mentally disabled. S+C supported housing assistance varies and is based on AMI, FMR, percentage of verifiable household income and average utility allowances. What?
I owe it to myself and to the field of mental health counseling through support and multi-faceted services in which I believe in to grind a different gear for at least a minute. I have to admit, I have had some pretty pricelessly rewarding and heartwarming days in my position. There was one time that a consumer on my case load credited me for their continued life. It all started when this particular Major Depressive, Post Traumatic Stress Disordered, non-medication compliant, previously homeless consumer called me (screaming) with homicidal ideations. I reacted without reacting. I knew my consumer. I knew her uproar was not directed at me or the psychiatric doctor’s office receptionist she cursed out and threatened homicide to. This manic uproar was indirectly directed directly toward her former sexual abuser. Knowing this and being able to be compassionate to the facts of this particular consumer’s case allowed me to be patient despite her obscenities. I was able to de-escalate the consumer and assist her in finding what it was she was in seek of: help. After having done so, she credited her still-beating, non-murderous nor incarcerated heart to me. Priceless.
As I sit here tonight, eating peanut M&M’s and drinking red wine for dinner, I imagine if my ringing phone would have presented such an angry and erratic greeting towards me from this consumer or any other on my case load today. Today, I worked in burn-out mode, frustrated and swearing against a job that a little over 4 months ago saved a life. Today, I don’t think I could have accomplished what I accomplished on that day with that client (or any other) in that state. I do not know if I would have had it in me to remain patient and compassionate today. I do not know if I could have saved the same life if I had to save it in the same fashion today.
Burn out. I am feverishly burnt out in my position. I have thought I might be getting there for a couple months now. Today I reached the broiling point. Today I reached the step before last in a S+C housing application process for a consumer, household of 4; himself and his long-time girlfriend, their son and their daughter (ages 5 and 8). This is the second time I have reached this step before last with this family. Today is the second time I have had to tell this same family that I’m sorry, but you will remain homeless today. I’m sorry but that light at the end of the tunnel I keep promising is there keeps getting burnt out (right along with your case manager). AMI, FMR, HUD and S+C. What do all of these things mean? Today, Area Median Income, Fair Market Rate, US Department of Housing and Urban Development and Shelter Plus Care meant that this family that has been sleeping in a local park since last week are going to have to remain there. The tunnel just extended and the light I have been encouraging them exists has, again, been burnt out and is still, once again, out of their reach.
Had I been trained on these things, these resources and abbreviations, I would have been able to catch the discrepancy in their S+C landlord portion of paperwork myself. In other words, I would have been able to do someone else’s job along with my own for the same whopping $14-and-change per hour “salary” I make now. And, its not that I WANT to do someone else’s job because, I don’t; I don’t want to, I don’t have time to and I (obviously) don’t have the training to do so. This someone else didn’t catch, and neither did I, that the consumer’s (second) prospective unit was unaffordable according to HUD’s FMR calculation worksheet which is based on 50% AMI. The overall calculated expenditure was over the maximum allotted amount of $958.00 for a 2 bedroom unit.
Wow. Look at that! I made an accurate sentence with the same previously questioned and quizzical abbreviations. Ya know how I did that? Experience. I repeat, experience, not to be mistaken for training. You know where that experience has gotten me? In this hot seat called burn out. That’s where I’m sitting after today’s horribly informative puzzle called experience. I have been putting the pieces of this puzzle together through frustration and aggravation, mistakes and confusion (mine and other’s) since June of last year. I have been putting a puzzle together in the world of clinical case management for a homeless services division at the largest mental health care agency in Tampa since I got hired through burning and tormenting experience.
Experience. I repeat, experience, not to be mistaken for training. I have been putting a puzzle together through scorching experience, my own inquisitions, google searches and the most frustrating of mistakes; mistakes of which really couldn’t possibly be my own. A mistake is when you learn something and you still don’t do it right. You see, you can’t achieve if you aren’t exposed to the material in which you are expected to achieve. Productive achievement, known as intelligence in a classroom, can only be measured in terms of what the employee, or student, has been taught or trained to do and know. You see, today I felt frustrated not because I had to be the middle man and the bearer of bad news due to someone overlooking necessary calculation discrepancies. No. Although that lead to it, I felt frustrated and ultimately burnt the heck out because I had to stop and wonder for a moment, did I do that? Was I supposed to have caught that? Is that part of my job? Should I have been the one to catch the discrepancy in order to more immediately find alternate housing options for this park-residing family of 4? Did I do that?
No. Well, not really. Experience. Once again, today I learned through experience and NOT from training. I get it now. I get it. Landlord deemed rental obligation plus average yearly utility usage in Hillsborough County according to HUD which is divided by the 12 month certification period together has to be under $958.00 per month for a family that is at absolute $0.00 income in seek of 2 bedroom housing assistance. Pheewww! I get it. I facilitated the filling out of the HAP contract and RTA (don’t even ask…) by the landlord. I faxed the paperwork to the appropriate housing program representative. I quite capably could have seen that the rental obligation of $849.00 per month plus a requirement that the tenants pay, not only electricity, but water, trash and sewer as well means that unit is out of the FMR price range of $958.00 for a 2 bedroom unit. Once again, pheewww!
I get it now. And now, through this wretched experience, I will NEVER NOT make it my job to notice such a red flag again. Not because I was trained, not because it is my job but, because of this scorching experience I will NEVER be able to NOT hold myself accountable in doing so again. Not because I hope for a raise or recognition, no; I will hold myself accountable for the notification of such a bright, and now obvious to me, red flag because it is ME that had to tell this family that they, in fact, cannot move into the home they have been sleeping in a park across the street from for a week. No raise in the world could make that task worth it or any easier, ever.
If I can help it, I will do anyone and everyone’s job I have to in order to never have to do that again (for the second time to the same family for two different overlooked yet obvious reasons). And, here it goes, the cycle of emotional burn out to physical burn out  back to emotional burn out and so on commences. I realize I hate my job today not because of what I do or the population I work with. I hate my job because I am not adequately trained to do it. I hate my job because I cannot do everyone else’s. I hate my job because I am burnt out, not to mention underpaid. Or, did I already mention that?
By the way, well, two by the ways… One: This person, this supported housing program manager who overlooked this discrepancy until today, on the family’s move-in day, is a person I actually genuinely care for and like. This person is nothing short of a great person. This person didn’t do his job. This is true. However, I am not naive. I am realistic. This person has probably been burnt out, overworked and underpaid for a lot longer than I have. It is not unrealistic that he could miss these things from time to time. Should he have missed it? No. But, he’s only human.
Second and the more important by the way: I absolutely insisted and worked on and found a loop hole or whatever it should be called for this family… I decided my job as their clinical case manager was to be the one to stand up for them when enough has become way more than enough! I decided my job as their clinical case manager was to demand alternate options after such mistakes were made and such obvious facts were overlooked. I demanded emergency housing for this family. They will not be sleeping in a park tonight, no way. I insisted and called and pleaded… they now have 3 nights worth of emergency hotel vouchers. Why/How can they be granted motel vouchers for emergency housing for 2 adults that have two minor children living with them in a park and they weren’t able to be granted such assistance before??? This is a question I literally cannot handle questioning or I won’t wake up to go to work tomorrow. Politics. There is always someone who says, yes. We will help you. Or, no. We cannot. Rhyme or reason? Not always…

I swear to the God of whom I did this work in’s name that by the end of these 3 days, every resource and every priority had better be placed on this family. This family better be in a home, preferably the one they’ve been staring at in the park across the street, by motel check-out time on March 8th. I refuse to make another, a third, phone call to this family. I refuse to make a third call like the second call I had to make to them today (not to mention the call I had to make to the [pissed] landlord who has been sacrificing rent checks from elsewhere to hold and make ready this particular unit for this particular family). If I do have to make a third call, that phone call is gonna go like this: I quit my job in which I hate because I am burnt out. I quit my job and therefore you are no longer my “consumer”. Now you are a human and I , I am a fellow human. In God’s name, I will quit my job and invite this family into my God given living room before I tell them their light has burnt out again. Do you “hear” my frustration in these words? You know where such frustration comes from? Burn out.

I am frustrated to a point that translates into hatred for my job. I am so drained that it translates into pure and overall exhaustion. I am so exhausted that I can’t do this job and have enough energy at the end of the work day to exercise my body at the gym or exercise my mind in my textbooks. I lack the energy to maintain conversation with my long-distance fiance or work on my graduate school class requirements. At the end of the day, all I can do lately is focus on putting out a fire that is my CCM burn out.
Burn out. I am an over-worked, under-paid and under-trained, emotionally and mentally drained clinical case manager. I am totally burnt out.