The Hazards of Helping (1)

The hazards of helping: Work, mission and risk in non-profit social

service organizations

Agnieszka A. Kosnya* and Joan M. Eakinb

aInstitute for Work & Health, Toronto, Ontario, Canada; bDepartment of Public Health Sciences,University of Toronto, Canada

(Received 10 November 2006; final version received 16 April 2007)

Non-profit organizations play an important role in the provision of health and socialservices. No longer temporary providers of emergency services, non-profit organizationsappear to be permanent features of the social service landscape. Despite some of theintrinsic rewards that work in non-profit organizations offers, jobs in theseorganizations can be characterized by high demands, long working hours, low payand exposure to violence and infectious disease, conditions which may be deleterious toworker health. This paper is based on an ethnography of three non-profit organizations:a homeless women’s drop in, a drug treatment agency and a men’s homeless shelter. Weexamine organizational ‘mission,’ a dominant discourse about the purpose and value ofproviding ‘help’ to marginalized clients, and the implications it has for work practicesand for the way that workers understand work-related risk in these organizations. Wedescribe how the notion of mission is continually reproduced, and trace its relationshipto worker risk acceptance and risk taking. We suggest that the functions of suchdiscursive commitments in organizations, and their implications for the well-being ofworkers, underscores the importance of understanding organizational culture and thesocial construction of risk when attempting to improve working conditions and protectworker health in social service non-profit organizations.

Keywords: risk; social services; non-profit organizations; occupational health and safety;mission

Introduction

Non-profit organizations play an important role in the provision of health and socialservices. No longer temporary providers of emergency services, non-profit organizationsappear to be permanent features of the social service landscape. Non-profit organizationsprovide a wide array of tangible (clothing, shelter, food, health) and non-tangible(support, recreation, counselling) services, often within the same organization (Shields2002). Since services are typically offered at no financial cost, marginalized populations(the homeless, those struggling with poverty, addiction and mental illness) are often theclients of non-profit organizations providing health and social services.

Although most non-profit organizations employ paid staff and volunteers, they arerarely viewed as ‘workplaces’ in the sense typically used by researchers and policy makers.Not a great deal is known about the nature of work or working conditions in theseorganizations. The few studies examining work in non-profit social service organizations

*Corresponding author. Email: [email protected]

Health, Risk & Society

Vol. 10, No. 2, April 2008, 149–166

ISSN 1369-8575 print/ISSN 1469-8331 online

� 2008 Taylor & Francis

DOI: 10.1080/13698570802159899

http://www.informaworld.com

have found that, despite some of the intrinsic rewards the work offers, jobs in theseorganizations can be difficult and demanding, characterized by high demands, longworking hours, low pay, exposure to violence and infectious disease, conditions which maybe deleterious to worker health and safety (Baines 2004, Holness et al. 2004).

Despite some of these challenges associated with work in non-profit organizations,there is some evidence to indicate that workers in non-profit organizations gain a greatdeal of satisfaction and intrinsic reward from their work. Many non-profit organizations,and those working in them, are guided by strong values that serve as a base for theiractivities and involvement (Allahyari 2000, Jones 2000, Leete 2000, Cloke et al. 2005).Workers may construct their identity and role as social service providers by way of thesocial values found in the organization. Although we propose that non-profitorganizations can (and should) be considered as workplaces, often social service work,particularly ‘street level’ work with marginalized clients, is considered to be more than justa job. As Cloke et al. (2005) argue, serving the poor and marginalized often requires acommitment that is less like work but more like residing in solidarity with those you serve.They highlight that solidarity with the poor requires ‘a deprivation of some of the normalcomforts of the self’ (Cloke et al. 2005: 387). Karabanow (1999), for example, in his studyof a Canadian youth shelter notes how the executive director describes what the workers’role is: ‘we are here to give kids our ears and shoulders, yet most importantly, to give themour hearts’ (p. 345). Karabanow argues that this ‘gift of self’ often comes at the cost ofworker health and well-being. This type of ‘giving’ seems to become part of theorganizational ethos so that being a ‘good worker’ means staying overtime, beingemotionally and physically available and never forgetting that workers are ‘there to servethe kids’ (Karabanow 1999: 346). These sorts of organizational norms, as well as therelationship between the client and the service provider, are dimensions of social servicework that may have a considerable impact on working conditions (Hasenfeld 1992) andperceptions of risk in the workplace. Thus, if they are to be successful, approaches to themanagement of occupational health and safety in non-profit organizations must take theunique social relations of these workplaces into consideration.

The study from which this paper is drawn examined the nature of working conditionsin three organizations providing social/health services to clients who had problems withmental illness and addiction, as well as those who were living with poverty andhomelessness. A key finding of this research was that organizational ‘mission,’ a dominantdiscourse about the purpose and value of providing ‘help’ to marginalized clients, hadimplications for work practices and for the way that workers understood work-relatedrisk. In this paper, we describe the notion of mission, how it is produced and reproduced inthe workplaces studied, and trace its relationship to workers’ willingness to take andaccept workplace risks. We suggest that the functions of such discursive commitments inorganizations, and their implications for the well-being of workers, underscores theimportance of understanding organizational culture and the social production of risks inthe workplace when attempting to improve working conditions and protect the health ofworkers in social service non-profit organizations.

Method

This study investigated the nature of work and working conditions, from the point of viewof occupational health and safety, in non-profit organizations providing social and healthservices. We examined the mechanisms through which understandings of job risk, risktaking and risk acceptance were influenced by the organizational environment, and the

150 A.A. Kosny and J.M. Eakin

ways in which harm was avoided and safety enhanced in the organizations. The study wasan ethnography involving three case studies. The case study design is a research strategywell-suited to the exploration of power relations, motives and complex social interactionsin organizations (Kitay and Callus 1998). In each organization, the first author didapproximately 3 weeks of direct observation of daily life1 and interviews with workers andmanagers.

Direct observation

Direct observation is a method of data collection that allows the researcher to enter anorganization and observe operations and activities. Through direct observation, theresearcher is able gain information first hand, without relying solely on written documentsor verbal explanations offered by participants. The observer may see things that routinelyescape the conscious observation of research participants. For example, because the firstauthor was specifically interested in working conditions and matters of health and safetyshe paid careful attention to how workers did their jobs, the physical conditions of theirworkplace, the pace of their work and so on. Workers, conversely, immersed in the routineand demands of their jobs, did not always seem to pay attention to the same issues.

In the course of this research, the first author went into each organization several timesa week for half a day each time. The times varied so that she could experience what it waslike to work in the organization at different times and during both quiet and busy periods.The author participated in a range of activities in each organization and helped in the dropin areas, cooked food, cleaned up, did dishes, helped out in the office, played games withclients, participated in staff meetings, etc. She also often sat around talking informally tostaff in common areas and in administrative offices. Direct observation allowed theresearcher to get a sense of the daily operations of the organizations, including the flow ofwork, workload and client–worker interactions.

Interviews

In addition to direct observation, interviews were conducted with workers and manage-ment. The interviews were semi-structured and allowed participants to discuss their jobsand experiences at work. All also included some closed-ended demographic andorganizational questions at the end of the interview. Interviews with upper managementwere slightly different from the worker interviews. Instead of focusing on their jobs,managers were asked questions about the organization, funding issues, general workplaceconcerns, etc. Interview questions were pre-established, however some questions changedfrom organization to organization. On-going analysis and data coding guided subsequentdata collection in order to examine emerging categories and their relationships.

Thirty workers and six individuals in management positions (executive directors orsenior managers) were interviewed. Two of the managers were women. The 30 workersinterviewed did a variety of jobs, many of them overlapping. These included health care,cooking, cleaning, counselling and direct client support work such as helping clients withforms, driving clients to appointments, recreation with clients, personal hygieneassistance, etc. The characteristics of the organizations and participants are describedin Appendix A.

There were slightly more women than men interviewed. Employees tended to be fairlyevenly distributed in terms of age. Most workers had a college or university education.Most workers had permanent jobs at the organization and formal benefits (such as a drug

Health, Risk & Society 151

plan, dental benefits and long term disability). A great majority of workers had beenemployed in the organization for longer than a year, with almost half for more than6 years. Nine out of 30 workers had another job besides the one at the organization wherethey were interviewed and nearly half had unpaid care-giving responsibilities outside oftheir regular work, for example child or elder care.

Participation in interviews was voluntary and participants could refuse to answer anyof the questions posed. Individuals read and signed a consent form prior to interview.Participants all received a small gift certificate as an honorarium for participating. Theinterviews were audio taped, transcribed and entered into NVivo, a data-managementprogramme.

Analysis

The process of data analysis occurred iteratively and simultaneously with data collection,using some of the core techniques of grounded theory methodology (e.g. theoreticalsampling, constant comparative analysis, progressive coding, testing of emergent analyticexplanations; Glaser and Strauss 1967, Corbin and Strauss 1990). Analysis focussed onpractices, understandings and conditions at the local workplace level. Our interpretationsof underlying rationalities were based not only on what workers reported in interviews,but also on how they spoke about their work, what was not said, and what they actuallydid. We examined why certain explanations or understandings were put forth while otherswere excluded. Similarly, we asked what enabled or constrained particular actions andpractices in these workplaces. Eventually, through progressive waves of increasinglyfocussed conceptualizations, and simultaneous marshalling of relevant theory fromsociological and other literature, we distilled an explanation for how mission wasimplicated in workers’ understandings of risk. This process also allowed us to generate aconceptual apparatus for theorizing the dialectic relationship between adherence tomission, risk acceptance and risk taking.

Study setting

Within the inner city of Toronto2 there is a high concentration of marginalized inhabitantsand organizations that provide a variety of social, health and other services to them(2001). The three organizations approached for participation in this study were all locatedin the inner city of Toronto3. All were not-for-profit and received a large part of theirfunding through government grants. None were explicitly political or religiousorganizations.

Jenny’s Drop In4

Jenny’s Drop In is a small social service organization serving women who are sociallyisolated or homeless. Many of these women also have physical or mental healthproblems and addictions. The organization is a place where women can go to ‘get off thestreet.’ Clients can have a meal, take a hot shower and do laundry. Jenny’s Drop Inprovides clients with a wide array of services including health care, lost identificationreplacement and financial management. Clients have access to a clothing and food bank.The organization offers formal and informal counselling and runs various supportgroups. Workers also do some street outreach which involves visiting sick or elderlywomen in their homes and helping women on the street get into stable housing. Jenny’s


also does advocacy work on behalf of clients. This may include going with them tocourt, arranging for admittance to a detoxification programme or securing long term/palliative care.

Healthy Horizons

Healthy Horizons is a medium-sized agency that provides addiction counselling andaddiction related health care services. The organization runs a methadone clinic which hason-site drug screening, a medical clinic and pharmacy. The organization providescounselling to drug users, youth at risk for drug use and their families. Various healthpromotion activities, such as parenting groups, yoga and safe drug use demonstrations arealso organized. Workers help clients with housing and social assistance applications andwith the replacement of lost identification. Health Horizons is involved in much serviceoutreach, both inside the organization and on the street, including a needle exchangeprogramme and counselling in prisons.

Brother Shelter

Brother Shelter’s main role is to temporarily house homeless men. Although theorganization serves as a temporary hostel, there are longer-term beds for men who havelong-standing physical and mental health problems and addictions. This large organiza-tion provides meals, a clothing room, counselling, help with money management and hassocial activities for clients. Staff also do work outside of the organization. They take clientsto appointments, visit them if they are hospitalized, attend court dates, bring clientsmedication once they have been housed, etc. Workers are involved in informal and formalcounselling and referrals to other services. They help clients with various applications,facilitate entry into detoxification programmes and help secure more permanent housing.Many of the clients at Brother Shelter have problems with alcohol and drug addiction, andhave complex mental and physical health problems.

The nature of work

The work in the organizations studied had several key common features. First, the work ofthe agencies was organized around meeting the needs of other people. Second, staff tendedto work with clients in different capacities and contexts because work task boundarieswere not clearly defined (workers ‘pitched in’ and helped out in a variety of ways) andbecause the organizations provided a variety of services to clients (from health care torecreation programmes). Third, through face-to-face contact with clients, workers came toknow their clients personally, and often intimately, and developed particular under-standings of the circumstances that brought them to the organization. A final commonfeature of work in these agencies was its articulation through a strongly expressedadherence to an ethos of helping, which we have called ‘mission.’ This strong sense ofmission proved central to how risks were understood and acted upon by workers, and isthe focus of the rest of this paper.

The mission

Although each of the organizations studied had a formal mission statement, we proposethat in these workplaces the mission was much more than some abstract project or


directive put forth by the organization. It was clear that workers played an important rolein the creation and maintenance of the mission:

I have my own little analogy to what this whole situation is here. [The ED] is the angel. She’sthe one that dreamt up this house and allows everything to be the way it is. She’s the angel.We, her front-line workers, are her wings. So I say without us, she can0t fly. But without her,we’d probably just be flying in circles. So it’s a perfect match. Her workers and her. Togetherwe make it all happen.

Many workers shared the sentiments expressed in this quote: the provision of services andthe creation of a particular environment for their clients was a joint project that dependedon the efforts and commitment of everyone in the organization.

The mission appeared to be an evolving or ‘living’ philosophy. Rather than being astatic, state of mind or reified ‘attitude’ held cognitively by individuals, we found empiricalsupport for a concept of mission as a socially produced posture that was continuallyrecreated through various organizational structures, language practices and throughworker experiences of providing help5.

Key beliefs embedded in the mission

Although the organizations studied provided different services and programmes, the work,in all its various iterations, was fundamentally about providing help and support tomarginalized clients. Within each organization there were powerful discourses6 whichcontinually reinforced the importance and necessity of helping. The mission discourseseemed to be comprised of several important features which guided how workers did theirjobs. One part of the mission had to do with treating clients with dignity and respect, ‘likehuman beings’:

Sitting in on the first case management meeting, they knew so much about [the client], hishistory, his illnesses, it just blew me away. Because out on the street, it’s just a fellow with adirty face leaning against a wall. But in here, he’s got—he’s a whole life, a whole personality.He’s got all this history and it’s such a colourful life, with so many aspects, and angles7.

Agency workers maintained that clients were not just another ‘dirty face’ to be pushed outthe door as soon as possible. Rather, workers insisted that once clients entered theorganization, they were to be provided with treatment that was kind, caring and personal.

‘Justice’ was another key feature of the mission discourse. To workers this meant thatclients they served had to be treated fairly when they visited their organizations. Forexample, workers recounted how many of their clients were treated poorly anddiscriminated against by the police and the social assistance system. A worker at BrotherShelter described how the police treated clients:

They’re very rude when they come into the hostel. Like—a client to them is garbage. This ismy experience seeing how they deal with clients. It’s like they’re garbage. They talk to themlike they’re garbage. They talk to them like they’re nobodies.

Implicit in such accounts is that workers and the organizations they work for, by contrast,strive not to treat clients in this way. For many, treating a client with dignity andcompassion seemed to be a direct response to the injustices clients were perceived to sufferin day-to-day life.

Another important part of the mission discourse was respecting clients ‘for who theywere.’ Some workers felt that the general public and the ‘typical bureaucrat’ approached


homeless people and drug users with a definite lack of acceptance. One worker at HealthyHorizons provided an example of a typical attitude toward individuals with drugproblems:

Don’t help those drug users. Even if they die, too bad for them. You know? Like they’rejunkies. So there’s sort of a societal attitude that’s not really for acceptance and forgiving. And[it] permeates everything. The jail, the other professionals, probation officers, welfare workers.They all think they’re a bunch of scum. And it shows in their actions. How they treat people.

In juxtaposition to the lack of acceptance and compassion in this approach, workers oftensaid their role was not to judge clients but accept them for who they were:

[You] take people where they’re at. You can’t, you know, give somebody needles if you’re notaccepting that’s where they’re at . . . Which is that they’re using [drugs], then that they’re usingneedles. So I accept that. So here’s your needles. The philosophy [is] about beingcompassionate and non-judgmental.

To this worker, giving out clean needles was an act that symbolized compassion andacceptance of the client. Several interviewed workers said that their organizations aimed tocreate a space where clients could ‘be themselves’ and were accepted without manyprovisions or expectations.

A final element of the mission discourse was the importance of ‘going the extra mile’:

If my job ends at 5 o’clock and I get a phone call from someone who’s in crisis, I’m going totalk to them [. . .] It’s easy to stop an assembly line at a factory, but when it comes to workingwith humans and the services you give to humans, I mean especially if you really care, you can’treally . . . you can’t really cut back on your services.

To this worker, going beyond formal job descriptions itself constituted caring,compassionate service: if a worker truly cares about the client in need, she will not andcannot turn her back on that person. Respondents asserted that they sometimes stayed lateto help, visited clients at home, gave clients money or bought them things they needed, andother practices that they understood as being beyond conventional job requirements.These actions also demonstrated their commitment to the mission.

We suggest that workers’ direct, personal and hands on contact with clients helpedreproduce and reinforce the mission as described above. Such contact seemed to helpshape workers’ conceptions of clients, their understanding of the role their organizationplayed in providing help and the conceptualization of the problems that brought clients tothe agencies. It seemed that when workers got to know clients on a personal, deeper levelthey came to view clients not as ‘just a number’ or another ‘dirty face’ but someone with apersonality and unique history. Moreover, because most clients were seen as being rejectedby society and not individually culpable for their life situations, workers tended to viewtheir clients as a group that deserved caring, fair treatment. In effect, for many workersmission fulfilment seemed to be a sort of moral enterprise, one that workers often took onwillingly and enthusiastically:

I have a real thing that I do on my way home from work every night. I get in my car . . . andthen I say to myself ‘Were you kind to everyone? Did you treat everyone with respect? Did youdo everything you could today for every single person who walked in the door?’ [. . .] andsometimes I know there were two people today I kinda brushed off and I feel really bad aboutthat, but I will correct it in the morning. You know, yeah I did, yeah I really did, but you knowI need to apologize for that. So that is part of the relationship building and the respect and it ispart of the philosophy as well.


As this quote suggests, acting in ways that run counter to the mission (e.g. treating clientsunkindly or with disrespect) can be a source of moral distress for the worker and needs tobe promptly corrected with an apology and a change in behaviour.

The moral nature of the mission discourse was also apparent in workers’conceptualizations of their clients’ problems and workers’ perceived role in addressingthem. Workers often conveyed a sense of urgency when it came to the work they weredoing and the problems facing their clients. Many spoke passionately about the gravity oftheir clients’ problems, and some spoke about their work as a ‘battle’ or war againsthomelessness, addiction and poverty. Several workers stressed that fundamentally theirwork was about stopping the cycle of poverty, for if clients could overcome addiction,homelessness or mental illness, their children would grow up in better homes and have achance at a brighter future.

In this context, workers overwhelmingly viewed themselves and their organizations asplaying a key role in helping clients. They described their organizations as ‘unique’ placesthat provided ‘a haven’ for clients who had nowhere else to go. Many viewed theirorganization as a kind of ‘place of last resort’ for clients.

These understandings of clients, their problems and workers’ role in addressing themappeared to constitute important conditions for the carrying out the work of theorganization. For example, workers may feel more prepared to go ‘the extra mile’ if theybelieve that clients really need their help and are not blameworthy for their situation. Asimilar logic also affects workers’ willingness to take risks with their own well-being. In thefollowing section, we examine how the presence of a client-centred discourse played animportant role in shaping how workers conceptualized problems and risks in their jobs.The helping mission ‘made visible’ certain risks while subordinating others, and often ledin more direct ways to workers putting their clients’ well-being above their own.

Mission and risk

Mission and risk seemed to be related in a number of ways. The mission discourse, to anextent, seemed to shape ‘acceptable’ risks in the organizations studied. A strong focus onclients’ experiences and the injustices they faced appeared to deflect attention from theworkers’ own negative life and work experiences, and may have rendered workers lessinclined to complain about their own work-related risks. Workplace mission also seemed tolead workers to accept and take certain risks, particularly in circumstances when risk takingand risk acceptance were viewed by workers as helping clients. Finally, missions were also‘used’ by workers to manage certain workplace hazards. Workers seemed to developstrategies congruent with the mission discourse (for example, the building of close personalrelationships with clients) that, they perceived, diminished certain risks in their jobs.

The shaping of ‘acceptable’ workplace risks

In the organizations studied, the mission was influential in shaping what was viewed as ahazard by workers. Rather than raising issues such as workload, client generated secondhand smoke or client violence as hazards, workers more readily discussed vicarious traumaand systemic problems as negatively affecting their well-being. We propose that themission and a culture of client-centeredness made vicarious trauma and systemic problems‘acceptable’ risks in these workplaces.

For many front line workers, a key part of their job was being a source of support forclients. Often, this meant that workers repeatedly heard stories about physical violence,


sexual assault, neglect, childhood sexual abuse and so on. Other workers were alsosometimes exposed to such stories while they informally interacted with clients. Workerssaid they also heard about (and sometimes witnessed) clients being mistreated by otherclients, the police and other service providers. Many workers explained that they tooktheir experiences with clients ‘to heart’ and talked about being affected by themprofoundly. It is not surprising that workers often talked about the difficulty and stressassociated with offering support and counselling to clients. As opposed to issues related tolong hours, unpaid work, poor physical working conditions, etc., highlighting traumacaused by their clients’ stories allowed the focus to be brought back to the clients and theirdifficult life situations. Discussing how they were affected by these stories also highlightedtheir own dedication to clients; if they did not really care about clients, they would not beso traumatized by their negative experiences. This is not to imply that workers were notnegatively affected by bearing witness to the difficult lives of clients, but rather thatparticular work risks were emphasized and more acceptable in these workplaces preciselybecause they were congruent with organizational missions that valued client-centerednessand caring. Workers’ emphasis of these risks in turn reaffirmed, constituted andreproduced the mission discourse.

Another work risk discussed in interviews that was congruent with the mission had todo with the systemic problems affecting the lives of clients and the services provided tothem. Workers often explained that systemic changes negatively affecting their clients alsohad a negative affect on working conditions and their own well-being. Workers wouldoften discuss how cuts in welfare affected clients’ access to housing or income support.They talked about rules which made it more difficult for clients to get a new identificationor access drug treatment. Workers and managers gave examples of clients being releasedfrom hospitals when they were still sick or from jail with few community supports.Workers were frustrated when they saw their clients struggling under these circumstancesand they explained that these systemic problems also made their jobs more difficult. Someworkers explicitly noted that it was not their clients which caused them burnout butdealing with an external system that was unfair, poorly designed and hurt many clients.Here is how one worker described it:

By far the most frustrating part of my job and the part that makes me angry, the part thatcould burn me out. Because, for me, it’s not the people, it’s not the clients that give me fatigueor burn me out. It’s the system, it’s either witnessing someone or trying to support someonewho, for example, needs to get on welfare. Cause if they don’t they’re going to lose theirapartment. But there’s so many examples of Catch-22s. Like if you don’t have this, you can’tget that [. . .] And I’m just seeing a lot of people fall through the cracks because of this, andhitting so many obstacles and I cannot imagine how frustrating that is for them. But speakingfor myself, it’s really frustrating for me.

Citing structures that disadvantaged clients as a cause of stress and work-risk was well-aligned with the client-centred mission. By fore fronting these types of concerns, workersseemed to be putting clients (and their problems) first. By voicing their own frustrationover systemic problems that hurt clients, workers also demonstrated a kind of solidaritywith the clients they served. As opposed to other work hazards (violence, second handsmoke) that may have cast clients in a less favourable light, the raising of systemicproblems reinforced that clients, for the most part, were not culpable for their actions andsituations. As we have already argued, such a view of clients, was a necessary condition forthe development of this particular client-centred mission and the apparent willingacceptance of certain workplace risks.


Taking and accepting risks ‘for the sake of clients’

Missions were not only implicated in ‘making visible’ and ‘obscuring’ particular risks. Inthe process of fulfilling the helping mission, workers sometimes participated in activitieswhich they understood to be health compromising and potentially hazardous. Sometimes‘going the extra mile’ or being caring and compassionate meant taking risks on the behalfof clients. It seemed that workers also believed that if they were going to do the job ofhelping clients, certain workplace hazards would have to be accepted.

Risk taking

In certain instances, it seemed that workers’ belief in organizational missions and theircommitment to clients compelled them to behave in ways which were deleterious to theirhealth. Workers may have sometimes put themselves in situations which wereuncomfortable, inconvenient, even dangerous, because their focus was on helping clientsand not their own well-being. Workers stayed late, put in unpaid hours and madethemselves available to clients in a manner which was sometimes emotionally exhausting.In such instances, workers seemed to be putting their clients’ well-being and the needs oftheir organization before their own. There were instances in the workplaces studied whereit seemed that risks were taken to both help clients and to prove one’s dedication to theorganizational mission. We argued earlier that workers often juxtaposed their organiza-tions to other more bureaucratic institutions. Many believed they were providing unique,cutting edge service and the stories they told often underscored their commitment toclients and the differences between them and ‘others’ who lacked the same dedication,bravery, commitment, etc. One worker described an incident where she put herself in adangerous situation for a client:

We had an incident many years ago, where a husband of one of the ladies here who was dyingof AIDS refused to go to hospital. He said ‘for me to go into hospital they will withdrawal orthey will only give me x amount of drugs for pain control and I will die this horrendous deathfrom my withdrawal and I’m not going’ and I said ‘I will try my best,’ you know and I waslittle bit green in those days and I was crawling up this horrendous crack house in the attic of athree story building by myself carrying Demerol. And I opened up the door one day and therewas 5 of the biggest Jamaican men I have ever seen and they were all actively shooting up and Iwas like ‘oh shit, oh shit!’ . . .

Although this worker recognized that she put herself in a potentially dangerous situation,she did not say that she would never put herself in such a situation again. In fact, a littlelater in the interview she described other instances where she had been in dangeroussituations again and tried to call public health officials for help:

I would call public health in and said I need some help. Like I need some help, I can’t do thisalone, and they walk to the front door and they are like ‘no way, it is too dangerous for us togo in and thank you very much and goodbye.’ And I went ok. Yeah. Those things can bescary.

It seems that for this worker, some risk taking while serving clients, although ‘scary,’ wasacceptable. She juxtaposes her commitment and bravery to that of the public healthofficials who decide not to help because of the danger involved. In each organization therewere workers who described how they had interacted with drug dealers, ‘took on’ thepolice, or went to see clients in unfamiliar places where they were unsure what/who theywould encounter in order to help their clients.


In the eyes of some workers, certain practices which were designed to protect theirhealth ran counter to the values of caring they espoused. For example, several workerssaid they sometimes did not wear gloves when dealing with clients, even if those clientswere dirty or sick, because they felt that wearing gloves made their interactionsimpersonal and seemed demeaning for the clients. As we have already noted, workersoften felt that clients were treated with a lack of dignity and caring by the outside world.Workers wished to provide a haven from this impersonal treatment and it is possiblethat, for some workers, the wearing of gloves, even if it helped decrease their risk ofcontacting an infectious disease, was incongruent with personal, caring treatment. Thetaking of risks, as described above, seemed driven, at least in part, by the powerfulmission discourse and, in turn, was implicated in its continual reproduction. By takingcertain risks, workers positioned themselves as committed to clients and the cause ofhelping them.

Risk acceptance

Although not every worker took dramatic risks for the sake of their clients, many workerssaw a certain degree of risk as being part of the job of helping. It seemed that given theclients served by the organizations, the nature of their needs, and the sort of activitiesworkers took part in to help them, exposure to some degree of risk was unavoidable.Many workers and managers understood that if they wished to help clients they could notexpect a risk-free environment:

If people wanted the safety levels of working in an insurance office in cubicle form well they’renot going to get it. You know because we have to go to jails and we have to go out intocommunities that aren’t safe. We have to work in a [place] where people are sometimes not ashappy as they should be. So I think balancing the need for safety for staff and the ability forthe programme to do its work is a very significant issue. And not one that’s easily solved attimes. You know? We can make, for example, the [drop in] programme a very safeenvironment. But we would lose a good part of the number of the people who go there. Andwe would not be effective at doing our jobs.

As this manager highlights, not only was risk considered to be part of the job, but therewas also some sense that the well-being of workers had to be balanced against the health ofclients. Sometimes providing a safe environment for workers might compromise themission-centred obligation to put the interests of clients first, a situation that, in manycases, was considered unacceptable by both managers and workers.

A mission predicated on values of caring, acceptance and justice required that a degreeof latitude be given to clients and to their behaviour. If the organization was to be a‘haven,’ clients would have to be accepted for who they were. One manager took this ideaeven further. For her, acceptance was necessary because the organization belonged to theclients not the workers:

It’s their house, it’s their place, it belongs to them, it doesn’t belong to us. And we walk to theirdrummer, they’re not walking to ours. Simply . . . it’s not very complicated. But everybody hasto have a place where they can act out. You know, we don’t always behave very politely in ourown homes. And anytime this population behaves badly, they get thrown out. Sometimes theyget thrown out here, too, if it gets to be an extreme and too much, but on the whole, wetolerate an awful lot, recognizing that people have to have a space to—especially if you haven’tgot a space of your own—if you’re living in a hostel, you can’t act out. If you’re living on thestreet you can’t.


In the workplaces studied, it seemed that the workers who could accept particular hazards(both emotional and physical) were precisely the sort of employees who were a ‘good fit’for the organization. One worker described how he dealt with verbal abuse at work:

I can have a client here and they can call me ‘nigger’ today, and tomorrow they’ll say ‘Hi, howare you doing?’ I don’t keep it as a thing. I realize the clientele I’m working with [. . .] If youcan learn to let things go, and that’s hard for some people, to let things go, you have to be ableto let things go in order to be more fulfilled in this work, because if you keep things in, it justbuilds up over the years, over the years builds up, and you develop a resentment to theclient . . .

This worker suggests that to stay aligned with the mission one has to accept certain clientbehaviours (for example, verbal aggression) without taking them personally. Some abuseis part of the work of helping this group of clients, he proposes. Understanding andaccommodating aggressive behaviour from clients could be seen as demonstrating that heis a ‘good’ worker who even in difficult and undesired situations, continues to work withclients without feelings of resentment. This worker later explained that the clients’ lifeexperiences and problems with drug abuse and mental illness meant that clients were notalways capable of appropriate behaviour and that workers could not expect it from them.

When workers understood clients as being victims of a number of systemic barriers ortheir own life histories, they were able to tolerate behaviours that may have otherwise beenintolerable. Problematic client behaviour was often viewed as symptomatic of largerproblems over which clients did not have control. For example, although workers describedscenarios where clients were disruptive, stole things, destroyed property, were aggressive orphysically violent, they often qualified their accounts with observations of their clients’ lackof control over their own behaviour, or with other forms of implicit justification.

Workers’ use of mission to manage potential hazards

Missions should not be viewed as only implicated in risk taking and risk acceptance. Onepossible reason that workers accepted some risk or discounted the seriousness of certainrisks was that workers seemed to use missions as a method of managing various hazards intheir workplaces. It seems that holding a particular view of clients (as marginalized, ill, notculpable) may have helped workers accept certain client behaviours and not take thempersonally, thus potentially reducing their emotional impact. One worker, for example,said that she used to feel frustrated and angry when clients would urinate or defecate intheir beds or in the showers. Once she had been at the organization for some time and gotto know the clients, she realized that they ‘could not help it’ because they were sick or hadserious addictions. As she said, ‘I feel sorry for them. I used to get really angry and nowit’s more of a pity and, you know, compassion [rather] than anger.’

Similarly, a worker at Healthy Horizons, explained client aggression in thefollowing way:

They’ll have days where they’ll treat you like crap and they’ll, you know, call you the worstnames you can imagine. You learn to have a thick skin and you realize that they’ve beenthrough something rough and maybe you’re considered close to them, so they’re venting out onyou.

This worker’s conceptualization of clients and her role in helping them has enabled herto reinterpret aggressive behaviour and ‘being treated like crap’ as an expression ofintimacy.


Workers were generally aware that they could be exposed to infectious disease, toclients who could assault them, or to situations which were stressful and emotionallytaxing. Yet, typically, workers wanted to and had to carry on working with the people whovisited their agencies. Workers developed both discursive strategies and workplacepractices for dealing with behaviours and situations that could be risky. These ways ofdealing with potential risks may have been acceptable in the workplaces studied becausethey were congruent with the mission discourse.

One way that risks were managed was through the building of ‘good’ personalrelationships. This is not to imply that relationships between clients and workers were notgenuine. Many seemed to be characterized by respect, trust and caring. However,relationship building also made work with clients easier:

It’s also about sitting down with the guys and talking with them. Creating relationships. That’sone thing that we do a lot. Right? Clients are great. I can sit down and talk with them.Especially when you have a relationship with them. It’s so easy to deal with them. You can justsay, ‘Listen. Now what’s wrong? Let’s go talk about it.’

Workers reported that when they developed ‘good’ relationships with clients, those clientswere less resistant when it came to participating in their own care and more willing toparticipate in various programmes and activities. When trust was established with clients,workers and clients got to know each other and could work together more smoothly.Workers explained that when they got to know clients, their behaviour seemed morepredictable. They learned how to ‘read’ clients’ emotions and respond to them in anappropriate manner.

It is possible that the strategies described above helped workers manage some of thepotential hazards associated with client interactions. These client management strategieswere also congruent with the mission of ‘going the extra mile’ and client-centerednessespoused by workers. Talking to clients and getting to know them were ways to createrelationships, decrease risk and also to enact the mission.

Having strategies to work with clients may be particularly important for organizationsoperating in an atmosphere of scarcity and fiscal restraint. In each of the organizationsstudied, staff and managers noted that resources available did not meet client ororganizational needs. For an organization like Jenny’s Drop In, that did not have theresources to put toward workplace redesign that would have made work with clients moremanageable, the mission may have functioned as an informal resource to help make workproceed more smoothly and safely.

Discussion

Social processes such as relationships between clients and workers, the organization ofwork and the ways in which workers come to construct understandings of their work andtheir roles shape in large part what comes to be identified and treated as a risk (Douglas1992). Thus, in these workplaces, missions helped shape what types of events, behavioursand activities were regarded as hazardous by workers. Vicarious trauma and structuralproblems, for example, were seen as hazards because they were consistent with client-centeredness and reproduced particular conceptualizations of clients and the importanceof workers’ role in serving them. Expressing distress as a result of witnessing clientmistreatment, or expressing frustration with the systemic problems affecting client well-being, can be understood as responses that demonstrated solidarity with clients anddedication to the work of helping them—thus serving to confirm worker adherence to the


prevailing organizational mission. Other risks, which may have seemed less congruent withthe mission, were subordinated. While it may have been acceptable to discuss how changesto the welfare system affected clients and working conditions, bringing up issues such asclient-generated second hand smoke or high workload may have been more contentious,especially if these cast clients in a negative light. In this way, missions shaped ‘acceptablediscourses’ including those related to risk, in these workplaces. The mission may haveserved as an obstacle to addressing certain types of workplace concerns and risks. In part,this may have been the case because workers generally asserted that the problems of theirclients were far greater than their own problems as workers. Workers seemed to recognizethat, unlike their clients, they at least had jobs, a relatively steady paycheque and a place tolive. To workers, complaining about their own situation in the context of working withclients who struggled daily with poverty, addiction, serious illness and systemic abuse,seemed inappropriate. The metaphor of battle that ran through workers’ conceptualiza-tions of their work and their organization (e.g. workers wage ‘war’ against a problem) andadherence to the notion that their workplace was a place of last resort for clients, suggestsa further deterrent to staff prioritizing their own needs. In a ‘war,’ those in ‘battle’ rarelyhave the opportunity or luxury to contemplate or forefront their own needs, comfort orsafety. To do so would have perhaps called into question workers’ commitment and theirstatus as ‘good employees.’ In the workplaces studied, where the mission to helpmarginalized clients was a project imbedded in the structures and practices of theworkplace, going against the mission not only violated the workplace order but also themoral order. The power of the mission which, for the most part, was a readily acceptedjoint project was such that workers did not have to be instructed to put clients first. Theyoften did so willingly, sometimes at the cost of their comfort and well-being.

The taking of risks and the acceptance of certain conditions of work which workersunderstood to pose some risk to themselves seemed to be viewed as part of the job ofproviding help and care. In order to fulfil the mission, some hazards had to be expectedand accepted. Because the mission was based on values such as acceptance and justice,workers seemed to have a respect for clients’ rights and a tolerance for some potentiallytroublesome client behaviour. ‘Good workers,’ meaning those who acted in ways that werecongruent with the mission, sometimes took risks for their clients and accepted some risksas a part of their jobs. In turn, risk acceptance and risk taking for the sake of client well-being helped constitute the mission discourse. As such, the relationship between missionand risk was a dialectic one, in which mission created the conditions for the perception ofrisk, and risk beliefs and behaviours contributed to the production and reproduction ofthe mission discourse.

Similar to Taylor and Donnelly (2006), we found that workers are not always self-interested actors, concerned only for their own safety and well-being. Often there is atension between client needs and worker rights. Our findings also support Parker andStanworth’s (2005) assertion that individuals may take risks if they believe that risk takingsomehow helps others and increases the moral status of the risk taker. This study suggeststhat some workers may deliberately take or accept risks, not necessarily because they donot understand that what they are doing could harm them, but because some risk taking iscompatible with a mission of helping vulnerable clients. Risk acceptance and taking, whenconsidered in this context, should not be understood as ‘reckless behaviour’ or as a set ofactions stemming from a lack of knowledge about what is hazardous. Rather, risk takingand acceptance can be viewed as affirmations of strongly held social norms in theworkplace, in this case as expressions of participation in the organizational mission, and asgestures that elevate the moral worth of the risk taker.


Mission, risk and the improvement of working conditions

Understanding the workplace culture is critical to the design and implementation ofhealth and safety approaches in these workplaces. Given the importance of client-centred missions in these organizations, it would seem that if worker well-being andworking conditions are to be enhanced this should not be done at the expense of clients.This study speaks to the importance of considering how clients will be affected bycertain workplace practices and changes (or how workers perceive clients to be affected).Measures to moderate work-related risks and improve worker well-being may be morepalatable when these are also seen to enhance the service and care provided to clients.Taking care of one’s mental health by not working unpaid hours, taking regular breaksand limiting case loads can be re-framed around both client and worker well-being, forexample by suggesting that workers who are burned out do not provide the best serviceto clients. Improving worker well-being can mean that clients are served by workerswho are better equipped to deal with the emotionally challenging issues that cometheir way.

However, this kind of approach to intervention and change around the health andsafety of social service workers will be difficult in the context of welfare state restructuringand the consequent pressures it has placed on many non-profit organizations (Miller1998, Shields and Evans 1998, Foster and Meinhard 2002). Increased competition andfunding changes necessitate that organizations get as much as they can out of workers.The ‘marketization’ of social services means that organizations need workers to go theextra mile, do unpaid work and put their clients’ needs above their own. Explicitly orimplicitly, poorly funded organizations must rely on the values and commitment ofworkers to give as much as possible, and even to take risks, in order to continue servingtheir clientele.

An argument can be made that if an orientation toward client-centeredness (in non-profit organizations or in other workplaces) puts workers at risk or prevents them fromraising certain workplace problems, perhaps the answer is to change the conditions ofwork so that they reduce the extent to which workers are directly and personally engagedin their clients’ welfare. For example, if workers have fewer opportunities to get to knowclients personally, they might become less invested in their problems and less likely toprioritize client needs over their own. Indeed, such depersonalization has arguablyoccurred under current efforts to ‘marketize’ social services and to introduce goals of‘accountability’ and ‘efficiency.’ In such contexts, emotional connections to clients areoften discouraged lest workers develop time consuming and inefficient attachments(Aronson and Neysmith 1997). However, workers have largely resisted these changes totheir work (Aronson and Neysmith 1997, Williams et al. 2001). In this study, we foundthat missions and values such as caring, compassion and justice imbued work withmeaning and gave the worker a sense of moral worth. Working in ways that werecongruent with the mission also allowed workers to develop strategies that made workmore predictable, thereby potentially making workplace risks more ‘manageable.’ Becauseclient well-being is central to the mission, providing clients with a place of refuge andpersonal connection was very important for workers. Thus, instead of ‘fighting’ or tryingto work around the mission, we argue it is important to work within the mission,recognizing its importance in shaping both social relations and risk discourses inthese workplaces. In instances where client-centeredness and service are importantorganizational norms, perceived client well-being may be inseparable from worker healthand safety.


Notes

1. This study was the doctoral dissertation of the first author.2. Toronto is a large city in the province of Ontario, Canada.3. All had at least one site located in the ‘inner city.’4. All names are pseudonyms and certain details have been changed to ensure anonymity.5. Although each organization had a formal mission statement, most workers could not recite the

formal organizational mission statement. However, they were able to talk with facility aboutvalues underlying their work, their personal beliefs and important organizational goals. Ourexamination of mission is primarily based on these discussions and not on the content of theformal mission statements.

6. By using the term ‘discourse’ we refer to a set of texts, including things like procedures, words,common understandings, which give structure to the way a certain situation, object or process isconceptualized (Cheek 2004). There is a dialectical relationship between these texts (ordiscourses) and the situations, objects or processes they frame. For example, using familial orfamiliar language to refer to clients (client as brother or friend) might shape organizationaldesign. The workplace may be designed in a way that encourages socialization and freemovement of clients in the organization, in turn, such configurations may encourage workers tothink (and speak) of clients as family or friends. Discourse then is ‘socially consequential’(Wodak 2004) and plays a role in constituting relationships and practices in the workplace.

7. In all quotes, the emphasis is ours.

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Appendix A

Table 1. Respondent job types.

Job type Number of respondents

Senior management 6Middle management 6Frontline workers (e.g. client service, drop in worker) 10Volunteers/workfare/client-worker 4Health care (nurses) 4Service staff (cleaning, cooking, etc.) 4Counselling 10Administrative 5

Note: A number of employees had more than one job.

Table 2. Respondent characteristics.

Characteristic Number of respondents

GenderFemale 17Male 13

Age25–34 years 835–44 years 845–54 years 955–64 years 5

Place of birthCanada 21Outside Canada 9

(continued)


Table 2. (Continued).

Characteristic Number of respondents

Level of educationSome high school 2High school completed 3Some university or college 5University or college completed 16Some graduate education 3Undisclosed 1

Employment statusPermanent 22Temporary/contract 4Other 4

Time in current organizationLess than a 1 year 21–5 years 166–10 years 6more than 10 years 6

Formal benefitsYes 24No 6

Working more than one jobYes 9No 21

Childcare or other care giving responsibilitiesYes 13No 17

Table 3. Organizational characteristics.

Jenny’s Drop In Healthy Horizons Brother Shelter

Number ofpaid employees

*10 *25 *200

Number ofvolunteers

*6 (includingworkfare)

0 0 (but clients takeon some volunteerwork)

Main sourcesof funding

Government grants(project funding,core funding),donations

Government grants(core funding andproject funding)

Government grants (corefunding), donations

Changes infunding inthe last5 years?

Decrease Slight increase Same

Unionized? No Partially YesWorkers’compensationcoverage

Yes Yes Yes

*As reported by Executive Directors or Upper Management.


Documents

The Hazards of Helping (1)