Who are the "listening friends"?

The Listening Friends scheme for pharmacists under stress has now been in operation for nearly seven years, and has so far provided support for well over 1,000 members of the Society, preregistration trainees and pharmacy students. In this article the co-founder and chairman of the scheme, Alan Nathan, gives an insight into its development and work. He also provides information about the listening friends volunteers, and their opinions of the operation and value of the scheme

See also Support & Services

The idea of a stress help scheme for pharmacists was first suggested by Sue Sharpe, who was at the time the head of the Royal Pharmaceutical Society's Law Department. In 1994, she approached me, as a member of the Society's Council whom she knew took a special interest in membership organisation and welfare matters, and told me that her inspectors had been coming across poor standards of premises and practice in some pharmacies, due not to deliberate negligence but as a result of them being unable to cope. It was about this time that the consequences of measures introduced by the Department of Health, which increased work rate and reduced profitability for pharmacy contractors, on National Health Service pharmaceutical services, and increasing pressures on workers within the NHS generally, were beginning to be felt.

The Society already had a scheme to help pharmacists with problems associated with alcohol or drug misuse or mental illness before these problems impacted on their practice and they had to be dealt with through the Society's disciplinary system. Sue Sharpe believed that something similar should be set up for pharmacists suffering from stress, and over the course of the next 18 months Sue Sharpe, I and the co- ordinator of the Society's Benevolent Fund, Beverly Nicol, worked to develop the Listening Friends scheme. Our underlying philosophy was that the scheme should be operated by pharmacists, since we believed that they would be aware of, and able to understand, the general background of any work-related problems being suffered, and therefore have an immediate empathy with clients, something that commercially available schemes could not provide.

[At about the time we were developing our scheme the National Pharmaceutical Association was planning to start a service for its members provided by a professional counselling agency and it invited the Society to join it, at a cost of about £80,000 per year. The costs of the Listening Friends scheme were projected to be low. The Council debated the two schemes at length before deciding to opt for the Listening Friends. The NPA scheme went ahead but was closed down after a year through lack of use, and the NPA now publicises and recommends the Listening Friends scheme to its members.]

How the scheme works

The Listening Friends scheme is a telephone counselling service. The Society has an unmanned telephone line, with a recorded message for callers outlining the scheme and inviting them to leave a number where they can be called back and a convenient time to call. The line can only be accessed by the scheme's three co-ordinators, who work for a month at a time in rotation. They pick up calls daily and either allocate them to one of the 28 listening friends, or handle the case themselves.

The listening friend contacts the caller and in the first instance offers a "listening ear", allowing him or her to explain what the problem or worry is. The listening friend then allows the conversation to develop with the intention of helping the caller to find his or her own way towards a resolution. The listening friend may make the caller aware of options open to them but will never suggest a particular course of action, since the aim is to support callers in making their own decisions, not to make them for them. In some cases callers need specialised help with their problems, such as legal or financial advice, marriage or relationship counselling, or medical or psychological help, and the listening friend can direct them to suitable sources. Most cases are resolved, or at least the caller feels able to cope with their situation without further support from the listening friend, within three calls, although there is no limit placed upon the number of calls and some cases have gone on for more than a year. Many cases require just one call, as callers feel that just being able to "get things off their chest" to someone who understands about their professional background is all that they need. For reasons of confidentiality no detailed, formal records are kept, but listening friends report that there appears to be total satisfaction with the service from callers.

Confidentiality

Complete confidentiality is most important in order to retain the confidence of callers, especially as the service is provided by the Society, which is also responsible for professional discipline. Members of staff within the Society have no contact whatsoever with the scheme, except for the co-ordinator of the Benevolent Fund who provides administrative support but has no contact with clients. Callers remain anonymous and are not asked for any personal details. The only person who knows any details of a case is the listening friend dealing with it, who may keep informal notes as an aide-mémoire, but these are destroyed once the case is concluded. The only data kept centrally are the number of callers, their gender and their branch of the profession, if known.

Training and group support

All listening friends are given a training course in listening skills before they can start taking calls. The group holds two meetings a year. These include further training, case review sessions, and discussion and planning for progress of the group. In the review sessions, cases dealt with are described in broad outline and significant issues from them are discussed. These are valuable, not only for the sharing of experience and the advice given by colleagues, but also as a means of off-loading the emotional burden that dealing with them can put on the listening friend. The three co- ordinators, all experienced counsellors and therapists, are also available at any time to provide advice and support to listening friends.

Costs and funding

The scheme is economical to run because all listening friends are volunteers and are not paid. The three co-ordinators receive a small honorarium for their work. The only other costs are for the calls themselves, the training courses and the expenses of the meetings. Funding for the Listening Friends scheme does not come out of members' fee income, but is paid out of the Benevolent Fund, which comes from charitable donations and legacies from members.

Who are the listening friends?

Of the 28 listening friends, 16 are men and 12 are women. As in the profession itself, community pharmacists are in the majority, including three who work as locums and one employed by a large multiple. There are four hospital pharmacists, three primary care pharmacists, three academics, a wholesaler and a medical writer; the only sector not currently represented is the pharmaceutical industry. However, cases are not normally allocated on the basis of the caller's occupation unless he or she specifically requests this. But callers are invited to say if they would prefer to speak to either a male or female listening friend. There is broad ethnic and cultural representation within the group, and two listening friends are also ministers of religion. Ages range from mid-30s to late 70s. Many listening friends have pyschology, psychotherapy or counselling qualifications and experience. Some also bring the benefit of experience and strength gained through personal adversity or tragedy. Some listening friends have worked for other counselling services such as the Samaritans and CRUSE, the bereavement charity. Several, including the three co-ordinators, have run their own psychotherapy, hypnotherapy and counselling practices.

Listening friends' opinions

The following views of listening friends were given to me in response to questions I put to them on issues related to the scheme.

What motivates the listening friends? Listening friends' reasons for joining the scheme are based in the main on their desire to help people. Several said that in their practice as pharmacists they had found that people tended to confide in them and tell them about their problems. One of the co-ordinators said: "When you are in the pharmacy people come in and talk to you and raise problems that are not related to their medication, but social problems. Some people have the ability to have a 'listening ear', they give out this aura of 'I'm sympathetic, talk to me'." Some listening friends said that pharmacy had given them a lot and that they wanted to give something back. The academics said their interest had grown out of the increasing number of students, preregistration trainees and newly qualified pharmacists who had come to them for help in recent years.

Why do pharmacists use the Listening Friends scheme? The general opinion here reflected Sue Sharpe's and my ideas in planning the scheme: that many pharmacists work in professional isolation and have nobody with whom they can share or discuss problems, and that our service could provide that. One listening friend explained: "People feel a sense of isolation in pharmacy. A lot of people work on their own and the person up the road is their competitor rather than their colleague. I tend to find that people feel 'Am I alone in this? Does anyone understand me?' Speaking to another pharmacist is probably a big advantage in that, as we instantly know about the day-to-day problems they have." Another listening friend said that it helps if a pharmacist is able to off-load problems in confidence to someone not known personally, but to whom they can relate as a pharmacist. This was endorsed by one of the co-ordinators: "Whoever the listening friend is, we are all pharmacists and we understand the background we all work in. I think that's a big plus for the scheme."

What kinds of problems do listening friends deal with? Problems dealt with include occupational, business and personal, with the degree of seriousness varying from the mildly troubling to those that induce thoughts of suicide. Work pressures and stress have increased in pharmacy, as they have in other occupations, in recent years and many callers just want to unburden themselves. Listening friends repeatedly told me that the scheme acts as a safety valve, allowing pharmacists under pressure to, as they put it, "let off steam". One said: "In most cases the problems can be resolved fairly quickly and many clients only want a sympathetic ear." Typical professional and business problems dealt with are listed in Panel 1. Sometimes an apparent work problem is used to broach something more serious and personal, although these problems are usually raised directly by callers. Some of these personal problems are listed in Panel 2.

Is the scheme being used to its full capacity? Although the service has been used steadily, it has not been overwhelmed by demand and there is currently spare capacity. Yet pharmacists are claiming, both in my own contacts with them and in letters and articles in the pharmaceutical press, that they are highly pressured and stressed. I wondered therefore why the service was not being used more? Several possible reasons were suggested by the listening friends.

Lack of awareness of the service is one possible cause. Regular announcements are made in The Pharmaceutical Journal and the scheme shares a regular advertisement in The Journal with the Society's other welfare services. There have also been occasional articles in the pharmacy press and announcements in house journals such as the NPA Supplement, but listening friends believe that many of the people who may need the service still do not know about it. The only answer to this, they say, is more publicity.

Some listening friends thought that it is probable that more pharmacists dial the number but then hang up. "Silent calls" are a well known phenomenon in counselling agencies, when people use all their reserves of courage in dialling the number and lose their nerve when it is answered. Some listening friends also thought that employers might be introducing their own stress support schemes but others believed that people might be reluctant to use these for fear of being regarded as unable to cope with their job.

The sponsorship of the scheme by the Royal Pharmaceutical Society was identified as a possible deterrent to potential callers, who may associate the Society with discipline and punishment. Listening friends thought there may be a fear that something said during a call could be reported back: "People might feel that they may be on a file somewhere in Lambeth if they ring the number. We cannot over-emphasise the confidentiality and that we are not an arm of the inspectorate." "Reporting back" cannot happen as the scheme's code of conduct imposes a duty of absolute confidentiality upon listening friends, which the Professional Standards Department respects. The only circumstance under which a listening friend may contact any authority, such as the police or emergency services, is if he or she believes the caller is threatening harm to others.

Most listening friends believe that pharmacy is no more or less stressful than other health care occupations, but several think that the professional role of the pharmacist as a helper and problem-solver may make them reluctant to acknowledge their own need for help and support. One of the co-ordinators said that they tend to adopt the attitude that "pharmacists ought to be able to cope with this stuff". A view expressed by another listening friend was: "There is possibly a bit of looking down on counselling. People tend rather to deride it as being slightly cranky."

Conclusion

The Listening Friends scheme is now well established and doing a worthwhile job, and it appears to be appreciated both by pharmacists who have used it and within the profession generally. The listening friends feel that they could probably help more people, but for a number of reasons not everyone who might benefit is using the service. More prominent and consistent publicity may help.

The scheme shows that pharmacy is truly a caring profession, and the listening friends are caring people, looking not just after the public in their work but also the Society's own members in their voluntary role. In doing so they are carrying on one the Society's fine traditions of benevolence and welfare established by its founders.