What if I have had mental health problems myself?

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What if I have had mental health problems myself?

Postby russ » Sun Apr 15, 2007 3:41 pm

Why do they need to know my MH history?

There are good reasons for people having to disclose all important aspects of their history (including mental health issues) when applying for posts that have access to vulnerable client groups, as ours does. This is important to protect both the clinician and the recipients of their service.

Mental health problems affect one in three of us at some point in our lives, so they are very common and not a blanket reason not to be able to progress in clinical psychology, but there are risks and some tragic cases highlight the need to be vigilant and ensure that the full information is taken into account when assessing who is suitable for certain jobs.

Honesty is key in applications, partly in order that the employer is able to judge the real you, and partly as you can be fired if you turn out to have lied anywhere in your application process.

Will past MH problems be a barrier to gaining psychological posts?

I think that in general terms, mental health problems will not be seen as a major problem to employers if you can show that they are not currently impeding your ability to function, that you have protective resources around you to prevent relapse, and that you have been able to reflect on these difficulties and how they impact upon your current life and potential professional role.

In terms of whether there is a bias against people with a history of mental health problems in our profession, I would say that most people are quite open-minded. However, I think that it would (rightly) put your motivation for working with the client group you empathise with under greater scrutiny, and there might be an assumption that you would need greater supervision to ensure that you remained professional and objective.

I want to work with the issue I had myself

Clinical psychology is a very diverse profession, and I think that you would also be seen as overly narrow if you only had an interest in working with the one client group you yourself had belonged to. It is also sometimes surprisingly difficult not to be drawn into clients relationship patterns, even when you have not had similar experiences yourself, and I would be concerned that working with client groups that you over-identify with might mean that this is much more likely, or that you have less insight into it (as my own recognition comes from thinking/feeling/behaving in a way that "doesn't feel like me").

When do I mention my MH history? At application, interview or in post?

So, in answer to the question "should I mention my history of mental health problems in my application" I would recommend honesty (although not necessarily telling the whole thing up front on the application form or in interview), but with an awareness of the issues that this might raise.

I think the key point here is showing that you are able to reflect on the experiences you have had, and use them to add to your professional knowledge rather than over-identifying with clients or carers. I think it can be a strength, but you need to think about it carefully as a psychologist and put on the form what you have gained professionally. The risk is that you may be seen as wanting to gain something personal from your professional role (e.g. knowing how to help your partner better) or that you could not be detached enough to see client's issues objectively. You therefore need to show that this is not the case. You also need to be willing to talk about these issues in the interview if you mention them.

Confidentiality of counselling

Even if your (potential or current) employer knows or were to contact the person you have seen for therapy, the code of conduct we all work by is that we work on a need-to-know basis - the detail of anything you discuss with your counsellor remains confidential between you and s/he unless you are in significant danger of harming yourself or others.

Disclosure to occupational health

My experience of this is that if you apply to be anything in the health service (including most assistant psychologists and lots of research assistants posts), they require you to fill out occupational health questionnaires. However, these usually appear once you have been for interview, and have been offered the job, pending satisfactory references. Given this late stage, whatever problem there is with occupational health would have to be quite major, for them to retract the offer at this stage. The forms invariably ask about mental health issues, and whether you have attended for treatment of these. You often have to consent to them contacting your GP, and whilst you are free to lie or omit information, you run the risk of the employer finding out, and refusing to employ you. Whereas lots of them are sympathetic if you reply honestly, and you're not too unwell!

Although I too considered it, I'm not convinced the way through it is to lie - that's one of the things I don't do as a psychologist. I didn't feel able to spend the whole of my time with the NHS looking over my shoulder either.

The other, and perhaps more concrete, situation here is whether or not your disorder was recorded in your medical notes. If it was, you will be required to disclose it when you are screened by the occupational health department of the NHS trust. The argument you will have is that you are now well, and have been for years. Mental illness is only a barrier to entry if you are in the midst of an acute episode (and there are exceptions even to that) and their job instead will be to support you if/where your work would be in danger of making you ill.

From a member's personal experience
Occupational health checks require the completion of a form, which asks questions in the form 'have you ever had ...' and one of these is something like 'mental health problems, which may or may not have been treated'. You are then required to provide more information in the box, with regard to severity, duration and treatment. I believe there is some clause about being liable for dismissal if they find that you've omitted or lied about something on the form.

When they receive this, you will be sent a letter, telling you that some of the information you provided means that you will have to speak to the occupational health nurse, on the telephone. Thus far, I have always found this to be unpleasant. The nurse will ask blunt questions about your MH history, and will then need to ask the doctor what to do. The doctor will request your consent for him to contact your GP for a report. When received, the doctor will then decide whether he or she still needs to assess you, and then say yes or no to your application as to whether you are fit for work. The Occ Health nurses and doctors, however, will often have very little experience of psychiatry, so will generally defer to your GP's/psychiatrist's assessment of your fitness.

However, once all that is out of the way, as with all medical matters, it is your choice what to reveal to your supervisor, your course and your colleagues.

What if my mental health or MH history is impacting on my work?

Assuming you decide to be honest, what happens now depends on whether you are currently free of depression (or your issue), or whether it's still biting. If it's still biting, consider the effect that working around unwell people may have on you at the current time. If you're well, it's likely that Occupational Health will ask to see you. My experience of occupational health is that they are honest and will do anything they can to give you clearance. It may well be worth going for a chat with the GP, and agreeing with them how they will respond to an occupational health request. If it's obvious that you've recovered, the GP is likely to be sympathetic, especially since a lot of us going into these kind of jobs have 'been there' in the past.

The most important thing though, I believe, is to get appropriate treatment as soon as you realise there is a problem. Better this, and get better (although it doesn't look pretty on the records) than ignore it, and have it build up to a worse situation later on, which may be far more disruptive to your career.

What about disclosing your own MH issues or history to clients?

In a professional position, depending on your theoretical orientation, it may not be appropriate to share your personal history. I would only share my own history of mental health stuff with a client if I felt it would benefit the therapy significantly, and I have never been sufficiently persuaded that it would. I do draw considerably on my own experience in my therapy though, and prefer to use 'I had a client who...' which seems just as good, and perhaps use (very limited) self disclosure on other issues. I choose to be more open in supervision, but that is my own choice.

This is my experience, and may not represent that of others. Anecdotally, however, I've found that many have gone through a very similar time.

Do I have to reveal to my employer if I have been abused?

With regard to abuse, I have never heard of anyone being 'required' to disclose this - as it is not a medical matter - although it would be highly relevant in supervision, with regard to countertransference issues. I guess there is a chance though, that if it's in your medical notes, it might end up reported somewhere. It would depend how it manifests these days.

Some other personal experiences and comments:

I think professionals are sometimes more accepting of issues than your family! It took months before I could tell my family that I was on antidepressants, and didn't get much benefit from that. Having the awareness and guts to go to therapy though, and persist with your degree and career, are strengths to be proud of.

Everyone I have encountered in clinical areas (i.e. not occ health), especially other trainees, have been supportive when I have spoken about my own MH stuff, and many have shared similar stories, all of them getting through occupational health. It's not all bad and it does make me wonder what it would take for them to actually prevent someone from taking up a position. I was only just off antidepressants (after 3 years) when I cleared occupational health for my assistant's post. Do remember that occupational health checks are only done once you are offered a position/training place, and it is up to them to prove that you are not fit to work, rather than the other way round.

Having said all this, I'm wondering what they do with all this information in people who are currently asymptomatic. I can't imagine how one would determine how an individual with mental health history is likely to tolerate working in mental health...

Many forms get away with having you disclose everything that's ever happened to you by asking 'have you ever...' questions about very general matters, and then asking if it has ever had medical/professional attention, so I'm thinking there would be a question on an OH form that would require a 'yes' response from you. Your alternatives are to say 'yes' and go through the checks; or to lie, and risk them finding out - the consequences of which would be severe.

You wouldn't have to reveal the private counselling, but would probably be obliged to reveal an anxiety episode that required medication. They'd phone you up to talk to you about it, and probably get your GP to report on it, or ask you to see their medic. They would consider whether this stress reaction would be likely to occur during clinical posts/training, whether it would affect your work as a clinician, and how Trusts could support you with managing this.

You might consider having a chat with your GP beforehand, and sounding them out as to what they would say/not say. I did this with mine, who was wonderful.

If it's ten years ago and you're managing stress better these days, it's less likely to be a problem. Occupational health should only be there to protect you from your work, and secondarily, protect your clients from an unwell psychologist - so they are allowed to know about anything in your medical history that might affect either of those things. So they will probably want a medical opinion, but it sounds like that needn't be negative - if your GP isn't concerned, then OH aren't likely to get too stressed.

There is some discretion about whether you disclose private counselling that isn't on your GP record. Some people want to disclose as little as possible, but I'd encourage you to admit to any significant mental health issues wherever you got them treated.

However, the stuff that was on my medical records was far more 'worrying' than private counselling, so for me, it felt more appropriate to disclose the lot. Further, once I got on to training, it felt a lot easier to speak with colleagues and supervisors about this stuff. It makes supervision and appraisal a lot more authentic, means people generally keep their eye out for me, and as I won't be going through occupational health again until I qualify and take my first qualified post, there's no threat from that side either.

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Re: What if I have had mental health problems myself?

Postby daydreambeliever » Tue Mar 17, 2015 9:56 pm

Hi, I've integrated some suggestions below on additions/ amendments to the Wiki following our discussion on the main forum, having taken on board Miriam's point that we all have a responsibility for this, not just mods. Caveat is these are just my ideas, and I think the Wiki will be stronger if more people weigh in.

russ wrote:As up to 1 in 2/3 of us may have some level of mental health difficulty at some time in our lives, it is fair to say you are not alone. This can however be a sensitive and emotive topic for many people, and the following is designed to offer helpful information to allow you to make informed choices. Wikis work best when the whole community contributes, and members with lived experience would be particularly welcome to contribute here.

(suggesting this as a more positive intro, others may well word it better!)

Why do they need to know my MH history?

There are good reasons for people having to disclose all important aspects of their history (including mental health issues) when applying for posts that have access to vulnerable client groups, as ours does. This is important to protect both the clinician and the recipients of their service.

Mental health problems affect one in three of us at some point in our lives, so they are very common and not a blanket reason not to be able to progress in clinical psychology (I've deleted the part about "tragic cases" as not sure what it adds here?)

Honesty is key in applications, partly in order that the employer is able to judge the real you, and partly as you risk disciplinary action if you turn out to have lied anywhere in your application process (think this sounds more balanced?).

Will past MH problems be a barrier to gaining psychological posts?

I think that in general terms, mental health problems will not be seen as a major problem to employers if you can show that they are not currently impeding your ability to function, that you have protective resources around you to prevent relapse, and that you have been able to reflect on these difficulties and how they impact upon your current life and potential professional role.

In terms of whether there is a bias against people with a history of mental health problems in our profession, I would say that most people are quite open-minded. However, I think that it would (rightly) put your motivation for working with the client group you empathise with under greater scrutiny, and there might be an assumption that you would need greater supervision to ensure that you remained professional and objective. (Can we acknowledge this is someone's own personal opinion and not a universally agreed position? We have several well known examples in our profession of people who did choose to spend their career working with the client group which they were once a member of and were well respected in doing so, e.g. Marsha Linehan who gave us DBT and chose to disclose her history at the end of her career - I do wonder if more people would feel safe to disclose during their career and seek appropriate support if there was less stigma, and that this would aid patient safety - that's my personal opinion and aware it isn't a universal one ).

I want to work with the issue I had myself

Clinical psychology is a very diverse profession, and I think that you would also be seen as overly narrow if you only had an interest in working with the one client group you yourself had belonged to. It is also sometimes surprisingly difficult not to be drawn into clients relationship patterns, even when you have not had similar experiences yourself, and I would be concerned that working with client groups that you over-identify with might mean that this is much more likely, or that you have less insight into it (as my own recognition comes from thinking/feeling/behaving in a way that "doesn't feel like me"). (Again, can we recognise this is one opinion? While I follow the thinking, I would play devil's advocate and argue that there is literature and evidence (e.g. around 12 step programmes in the field of addictions) that would be pro service users in recovery aiding in the recovery of other service users - also is there a point around possible increased empathy and insight into a client group through lived experience, if I revert to my Marsha Linehan example?)

When do I mention my MH history? At application, interview or in post?

So, in answer to the question "should I mention my history of mental health problems in my application" I would recommend honesty (although not necessarily telling the whole thing up front on the application form or in interview), but with an awareness of the issues that this might raise.

I think the key point here is showing that you are able to reflect on the experiences you have had, and use them to add to your professional knowledge rather than over-identifying with clients or carers. I think it can be a strength, but you need to think about it carefully as a psychologist and put on the form what you have gained professionally. The risk is that you may be seen as wanting to gain something personal from your professional role (e.g. knowing how to help your partner better) or that you could not be detached enough to see client's issues objectively. You therefore need to show that this is not the case. You also need to be willing to talk about these issues in the interview if you mention them.

Confidentiality of counselling

Even if your (potential or current) employer knows or were to contact the person you have seen for therapy, the code of conduct we all work by is that we work on a need-to-know basis - the detail of anything you discuss with your counsellor remains confidential between you and s/he unless you are in significant danger of harming yourself or others.

Disclosure to occupational health

My experience of this is that if you apply to be anything in the health service (including most assistant psychologists and lots of research assistants posts), they require you to fill out occupational health questionnaires. However, these usually appear once you have been for interview, and have been offered the job, pending satisfactory references. Given this late stage, whatever problem there is with occupational health would have to be quite major, for them to retract the offer at this stage. The forms invariably ask about mental health issues, and whether you have attended for treatment of these. You often have to consent to them contacting your GP, and whilst you are free to lie or omit information, you run the risk of the employer finding out, and refusing to employ you. Whereas lots of them are sympathetic if you reply honestly, and you're not too unwell!

Although I too considered it, I'm not convinced the way through it is to lie - that's one of the things I don't do as a psychologist. I didn't feel able to spend the whole of my time with the NHS looking over my shoulder either.

The other, and perhaps more concrete, situation here is whether or not your disorder was recorded in your medical notes. If it was, you will be required to disclose it when you are screened by the occupational health department of the NHS trust. The argument you will have is that you are now well, and have been for years. Mental illness is only a barrier to entry if you are in the midst of an acute episode (and there are exceptions even to that) and their job instead will be to support you if/where your work would be in danger of making you ill.

From a member's personal experience
Occupational health checks require the completion of a form, which asks questions in the form 'have you ever had ...' and one of these is something like 'mental health problems, which may or may not have been treated'. You are then required to provide more information in the box, with regard to severity, duration and treatment. I believe there is some clause about being liable for dismissal if they find that you've omitted or lied about something on the form.

When they receive this, you will be sent a letter, telling you that some of the information you provided means that you will have to speak to the occupational health nurse, on the telephone. Thus far, I have always found this to be unpleasant. The nurse will ask blunt questions about your MH history, and will then need to ask the doctor what to do. The doctor will request your consent for him to contact your GP for a report. When received, the doctor will then decide whether he or she still needs to assess you, and then say yes or no to your application as to whether you are fit for work. The Occ Health nurses and doctors, however, will often have very little experience of psychiatry, so will generally defer to your GP's/psychiatrist's assessment of your fitness.

However, once all that is out of the way, as with all medical matters, it is your choice what to reveal to your supervisor, your course and your colleagues.

What if my mental health or MH history is impacting on my work?

Assuming you decide to be honest, what happens now depends on whether you are currently free of depression (or your issue), or whether it's still biting. If it's still biting, consider the effect that working around unwell people may have on you at the current time. If you're well, it's likely that Occupational Health will ask to see you. My experience of occupational health is that they are honest and will do anything they can to give you clearance. It may well be worth going for a chat with the GP, and agreeing with them how they will respond to an occupational health request. If it's obvious that you've recovered, the GP is likely to be sympathetic, especially since a lot of us going into these kind of jobs have 'been there' in the past.

The most important thing though, I believe, is to get appropriate treatment as soon as you realise there is a problem. Better this, and get better (although it doesn't look pretty on the records) than ignore it, and have it build up to a worse situation later on, which may be far more disruptive to your career. (If you are concerned about acquiring an NHS mental health record, there is the option to seek counselling on therapy in the voluntary or private sector. Having an NHS mental health record however is not a barrier to a career in CP).

What about disclosing your own MH issues or history to clients?

In a professional position, depending on your theoretical orientation, it may not be appropriate to share your personal history. (To balance that however, in other theoretical orientations such as Acceptance and Commitment Therapy, appropriate personal self-disclosure to clients is viewed as a core competency). I would only share my own history of mental health stuff with a client if I felt it would benefit the therapy significantly, and I have never been sufficiently persuaded that it would. I do draw considerably on my own experience in my therapy though, and prefer to use 'I had a client who...' which seems just as good, and perhaps use (very limited) self disclosure on other issues. I choose to be more open in supervision, but that is my own choice.

This is my experience, and may not represent that of others. Anecdotally, however, I've found that many have gone through a very similar time.

Do I have to reveal to my employer if I have been abused?

With regard to abuse, I have never heard of anyone being 'required' to disclose this - as it is not a medical matter - although it would be highly relevant in supervision, with regard to countertransference issues. I guess there is a chance though, that if it's in your medical notes, it might end up reported somewhere. It would depend how it manifests these days. (I would be tempted to clarify this bit to say there is a chance it would come up in a report from a health professional involved in your care to an Occupational Health professional, but that this report would not be made available to line managers, supervisors, course staff etc unless you wanted it to be).

Some other personal experiences and comments:

I think professionals are sometimes more accepting of issues than your family! It took months before I could tell my family that I was on antidepressants, and didn't get much benefit from that. Having the awareness and guts to go to therapy though, and persist with your degree and career, are strengths to be proud of.

Everyone I have encountered in clinical areas (i.e. not occ health), especially other trainees, have been supportive when I have spoken about my own MH stuff, and many have shared similar stories, all of them getting through occupational health. It's not all bad and it does make me wonder what it would take for them to actually prevent someone from taking up a position. I was only just off antidepressants (after 3 years) when I cleared occupational health for my assistant's post. Do remember that occupational health checks are only done once you are offered a position/training place, and it is up to them to prove that you are not fit to work, rather than the other way round.

Having said all this, I'm wondering what they do with all this information in people who are currently asymptomatic. I can't imagine how one would determine how an individual with mental health history is likely to tolerate working in mental health...

Many forms get away with having you disclose everything that's ever happened to you by asking 'have you ever...' questions about very general matters, and then asking if it has ever had medical/professional attention, so I'm thinking there would be a question on an OH form that would require a 'yes' response from you. Your alternatives are to say 'yes' and go through the checks; or to lie, and risk them finding out - the consequences of which would be severe.

You wouldn't have to reveal the private counselling, but would probably be obliged to reveal an anxiety episode that required medication. They'd phone you up to talk to you about it, and probably get your GP to report on it, or ask you to see their medic. They would consider whether this stress reaction would be likely to occur during clinical posts/training, whether it would affect your work as a clinician, and how Trusts could support you with managing this.

You might consider having a chat with your GP beforehand, and sounding them out as to what they would say/not say. I did this with mine, who was wonderful.

If it's ten years ago and you're managing stress better these days, it's less likely to be a problem. Occupational health should only be there to protect you from your work, and secondarily, protect your clients from an unwell psychologist - so they are allowed to know about anything in your medical history that might affect either of those things. So they will probably want a medical opinion, but it sounds like that needn't be negative - if your GP isn't concerned, then OH aren't likely to get too stressed.

There is some discretion about whether you disclose private counselling that isn't on your GP record. Some people want to disclose as little as possible, but I'd encourage you to admit to any significant mental health issues wherever you got them treated.

However, the stuff that was on my medical records was far more 'worrying' than private counselling, so for me, it felt more appropriate to disclose the lot. Further, once I got on to training, it felt a lot easier to speak with colleagues and supervisors about this stuff. It makes supervision and appraisal a lot more authentic, means people generally keep their eye out for me, and as I won't be going through occupational health again until I qualify and take my first qualified post, there's no threat from that side either.
daydreambeliever
 
Posts: 318
Joined: Mon May 05, 2008 10:29 pm

Re: What if I have had mental health problems myself?

Postby daydreambeliever » Mon Apr 13, 2015 5:45 pm

As up to 1 in 2/3 of us may have some level of mental health difficulty at some time in our lives, it is fair to say you are not alone. A recent BBC article highlights an increase in NHS staff absence for mental health reasons - http://www.bbc.co.uk/news/health-32029802. This can however be a sensitive and emotive topic for many people, and the following is designed to offer helpful information to allow you to make informed choices. Wikis work best when the whole community contributes, and members with lived experience would be particularly welcome to contribute here.

Working in psychology with a MH history/condition

Strengths you can bring to the work

Well respected people in our field who are open about their mental health condition and how it affects/ has affected their practice and how they manage that have written really interesting work on this topic. For example:

Kay Redfield Jamison:
http://www.amazon.com/Unquiet-Mind-Memo ... bc?ie=UTF8

Marsha Linehan:
http://www.nytimes.com/2011/06/23/healt ... d=all&_r=0

Kelly Wilson:
https://www.psychologytoday.com/blog/li ... nt-sitting

Rufus May:
http://www.rufusmay.com/

*and others who are less known and well published, could be a long list*

Difficulties you might face in the work

What if my mental health or MH history is impacting on my work?

From original Wiki post by Russ: “Assuming you decide to be honest, what happens now depends on whether you are currently free of depression (or your issue), or whether it's still biting. If it's still biting, consider the effect that working around unwell people may have on you at the current time. If you're well, it's likely that Occupational Health will ask to see you. My experience of occupational health is that they are honest and will do anything they can to give you clearance. It may well be worth going for a chat with the GP, and agreeing with them how they will respond to an occupational health request. If it's obvious that you've recovered, the GP is likely to be sympathetic, especially since a lot of us going into these kind of jobs have 'been there' in the past.

The most important thing though, I believe, is to get appropriate treatment as soon as you realise there is a problem. Better this, and get better (although it doesn't look pretty on the records) than ignore it, and have it build up to a worse situation later on, which may be far more disruptive to your career. (If you are concerned about acquiring an NHS mental health record, there is the option to seek counselling on therapy in the voluntary or private sector. Having an NHS mental health record however is not a barrier to a career in CP). “

What about disclosing your own MH issues or history to clients?

From original Wiki post by Russ: “In a professional position, depending on your theoretical orientation, it may not be appropriate to share your personal history. I would only share my own history of mental health stuff with a client if I felt it would benefit the therapy significantly, and I have never been sufficiently persuaded that it would. I do draw considerably on my own experience in my therapy though, and prefer to use 'I had a client who...' which seems just as good, and perhaps use (very limited) self-disclosure on other issues. I choose to be more open in supervision, but that is my own choice.

This is my experience, and may not represent that of others. Anecdotally, however, I've found that many have gone through a very similar time.”

In other theoretical orientations such as Acceptance and Commitment Therapy, appropriate personal self-disclosure to clients is viewed as a core competency.

Attitudes of employers to applicants with MH history/condition

Will past MH problems be a barrier to gaining psychological posts?

You may encounter a range of different opinions on this topic, built by people’s own experiences.

From original Wiki post by Russ: “I think that in general terms, mental health problems will not be seen as a major problem to employers if you can show that they are not currently impeding your ability to function, that you have protective resources around you to prevent relapse, and that you have been able to reflect on these difficulties and how they impact upon your current life and potential professional role.

In terms of whether there is a bias against people with a history of mental health problems in our profession, I would say that most people are quite open-minded. However, I think that it would (rightly) put your motivation for working with the client group you empathise with under greater scrutiny, and there might be an assumption that you would need greater supervision to ensure that you remained professional and objective.”
“I want to work with the issue I had myself”

Different people will have different views here too.

From original Wiki post by Russ: “Clinical psychology is a very diverse profession, and I think that you would also be seen as overly narrow if you only had an interest in working with the one client group you yourself had belonged to. It is also sometimes surprisingly difficult not to be drawn into clients relationship patterns, even when you have not had similar experiences yourself, and I would be concerned that working with client groups that you over-identify with might mean that this is much more likely, or that you have less insight into it (as my own recognition comes from thinking/feeling/behaving in a way that "doesn't feel like me").”

To offer another perspective on this question, there is also literature and evidence (e.g. around 12 step programmes in the field of addictions) that would be pro service users in recovery aiding in the recovery of other service users. If we look at well-known people who work in our field and have an MH history, such as those indicated above, there is some anecdotal evidence that one may have increased empathy and insight into a client group through lived experience.

We have several well-known examples in our profession of people who chose to spend their career working with the client group which they were once a member of and were well respected in doing so, e.g. Marsha Linehan who gave us DBT and chose to disclose her history at the end of her career. I wonder if more people would feel safe to disclose during their career and seek appropriate support if there was less stigma about this, and in my view this would aid patient safety.

Courses and their attitudes/approaches to this

If you are reading this at a pre-training stage and considering which course would be right for you, you may wish to seek more information about the particular courses you are interested in and their own orientations to this topic, e.g. Does the course have any particular stance on whether trainees are supported or encouraged to have personal therapy during training? Does the course have experience of making reasonable adjustments for trainees who have had disabilities or mental health difficulties? You could seek information online, by approaching the course directly and asking about what you need to know for your own situation, or it may be helpful to read the BPS alternative handbook for a flavour of what trainees say about their course and how supportive it is/ what it’s like more generally to train there.

http://shop.bps.org.uk/publications/the ... entry.html

HCPC and their approach to this

All qualified practitioner psychologists need to register with the HCPC. On registering with the HCPC, you would need to disclose any mental health problems that currently impact upon your fitness to practice at the time of registering. You then need to either sign a health and character statement to say that you are well at 2 year intervals to maintain your registration, or at that time disclose any material information to HCPC if you are not well and feel this is impacting upon your practice and as such not able to sign. Disclosing information does not mean you could not register/ continue to be registered, but that the HCPC would need to review it in terms of their processes to ensure you are still fit to practice by their standards. The HCPC also encourage you to update them of significant changes at any time. To practice as a psychologist, you need to satisfy the HCPC that you are fit to practice, and like the advice for Occupational Health above, you would risk losing your right to practice if you are not honest with them in the information you give.

Here’s some more information:

http://www.hcpc-uk.co.uk/aboutregistrat ... isability/

HCPC: A disabled person’s guide to becoming a health professional: http://www.hcpc-uk.org/publications/bro ... asp?id=111

HCPC Guidance on Health and Character: http://www.hcpc-uk.org/publications/bro ... asp?id=220

*Link to any relevant BPS guidelines? I'm not aware of any specifically on this topic but may well be missing something!*

When I checked (13.4.2015) The BPS website did contain a recent article about burnout, and stigma as a barrier to addressing it, in mental health workers - http://www.bps.org.uk/news/mental-healt ... wn-burnout. I found it a sad read, but it motivated me to contribute to this Wiki as in our current NHS climate of targets, pressures and cuts, it really is a time we need to be thinking and talking about staff wellbeing and mental health.

Declaring a MH history/condition: The occupational health system and how it works

Why do they need to know my MH history?

From original Wiki post by Russ: "There are good reasons for people having to disclose all important aspects of their history (including mental health issues) when applying for posts that have access to vulnerable client groups, as ours does. This is important to protect both the clinician and the recipients of their service. Mental health problems affect one in three of us at some point in our lives, so they are very common and not a blanket reason not to be able to progress in clinical psychology."

When do you tell?

From original Wiki by Russ: “Honesty is key in applications, partly in order that the employer is able to judge the real you, and partly as you risk disciplinary action if you turn out to have lied anywhere in your application process.

So, in answer to the question "should I mention my history of mental health problems in my application" I would recommend honesty (although not necessarily telling the whole thing up front on the application form or in interview), but with an awareness of the issues that this might raise.

I think the key point here is showing that you are able to reflect on the experiences you have had, and use them to add to your professional knowledge rather than over-identifying with clients or carers. I think it can be a strength, but you need to think about it carefully as a psychologist and put on the form what you have gained professionally. The risk is that you may be seen as wanting to gain something personal from your professional role (e.g. knowing how to help your partner better) or that you could not be detached enough to see client's issues objectively. You therefore need to show that this is not the case. You also need to be willing to talk about these issues in the interview if you mention them.”

How much do you tell?

Disclosure to occupational health

From original Wiki by Russ: “My experience of this is that if you apply to be anything in the health service (including most assistant psychologists and lots of research assistants’ posts), they require you to fill out occupational health questionnaires. However, these usually appear once you have been for interview, and have been offered the job, pending satisfactory references. Given this late stage, whatever problem there is with occupational health would have to be quite major, for them to retract the offer at this stage. The forms invariably ask about mental health issues, and whether you have attended for treatment of these. You often have to consent to them contacting your GP, and whilst you are free to lie or omit information, you run the risk of the employer finding out, and refusing to employ you. Whereas lots of them are sympathetic if you reply honestly, and you're not too unwell!

Although I too considered it, I'm not convinced the way through it is to lie - that's one of the things I don't do as a psychologist. I didn't feel able to spend the whole of my time with the NHS looking over my shoulder either.

The other, and perhaps more concrete, situation here is whether or not your disorder was recorded in your medical notes. If it was, you will be required to disclose it when you are screened by the occupational health department of the NHS trust. The argument you will have is that you are now well, and have been for years. Mental illness is only a barrier to entry if you are in the midst of an acute episode (and there are exceptions even to that) and their job instead will be to support you if/where your work would be in danger of making you ill.”

Do I have to reveal to my employer if I have been abused?

From original Wiki by Russ: “With regard to abuse, I have never heard of anyone being 'required' to disclose this - as it is not a medical matter - although it would be highly relevant in supervision, with regard to countertransference issues. I guess there is a chance though, that if it's in your medical notes, it might end up reported somewhere. It would depend how it manifests these days. (I would be tempted to clarify this bit to say there is a chance it would come up in a report from a health professional involved in your care to an Occupational Health professional, but that this report would not be made available to line managers, supervisors, course staff etc. unless you wanted it to be).”

People’s personal experiences of coping with the system

“Occupational health checks require the completion of a form, which asks questions in the form 'have you ever had ...' and one of these is something like 'mental health problems, which may or may not have been treated'. You are then required to provide more information in the box, with regard to severity, duration and treatment. I believe there is some clause about being liable for dismissal if they find that you've omitted or lied about something on the form.

When they receive this, you will be sent a letter, telling you that some of the information you provided means that you will have to speak to the occupational health nurse, on the telephone. Thus far, I have always found this to be unpleasant. The nurse will ask blunt questions about your MH history, and will then need to ask the doctor what to do. The doctor will request your consent for him to contact your GP for a report. When received, the doctor will then decide whether he or she still needs to assess you, and then say yes or no to your application as to whether you are fit for work. The Occ Health nurses and doctors, however, will often have very little experience of psychiatry, so will generally defer to your GP's/psychiatrist's assessment of your fitness.

However, once all that is out of the way, as with all medical matters, it is your choice what to reveal to your supervisor, your course and your colleagues.”

“Everyone I have encountered in clinical areas (i.e. not occ health), especially other trainees, have been supportive when I have spoken about my own MH stuff, and many have shared similar stories, all of them getting through occupational health. It's not all bad and it does make me wonder what it would take for them to actually prevent someone from taking up a position. I was only just off antidepressants (after 3 years) when I cleared occupational health for my assistant's post. Do remember that occupational health checks are only done once you are offered a position/training place, and it is up to them to prove that you are not fit to work, rather than the other way round.”

“However, the stuff that was on my medical records was far more 'worrying' than private counselling, so for me, it felt more appropriate to disclose the lot. Further, once I got on to training, it felt a lot easier to speak with colleagues and supervisors about this stuff. It makes supervision and appraisal a lot more authentic, means people generally keep their eye out for me, and as I won't be going through occupational health again until I qualify and take my first qualified post, there's no threat from that side either.”
“Having said all this, I'm wondering what they do with all this information in people who are currently asymptomatic. I can't imagine how one would determine how an individual with mental health history is likely to tolerate working in mental health...”

“Many forms get away with having you disclose everything that's ever happened to you by asking 'have you ever...' questions about very general matters, and then asking if it has ever had medical/professional attention, so I'm thinking there would be a question on an OH form that would require a 'yes' response from you. Your alternatives are to say 'yes' and go through the checks; or to lie, and risk them finding out - the consequences of which would be severe.”

“You wouldn't have to reveal the private counselling, but would probably be obliged to reveal an anxiety episode that required medication. They'd phone you up to talk to you about it, and probably get your GP to report on it, or ask you to see their medic. They would consider whether this stress reaction would be likely to occur during clinical posts/training, whether it would affect your work as a clinician, and how Trusts could support you with managing this.”

“You might consider having a chat with your GP beforehand, and sounding them out as to what they would say/not say. I did this with mine, who was wonderful.”

“If it's ten years ago and you're managing stress better these days, it's less likely to be a problem. Occupational health should only be there to protect you from your work, and secondarily, protect your clients from an unwell psychologist - so they are allowed to know about anything in your medical history that might affect either of those things. So they will probably want a medical opinion, but it sounds like that needn't be negative - if your GP isn't concerned, then OH aren't likely to get too stressed.”

“There is some discretion about whether you disclose private counselling that isn't on your GP record. Some people want to disclose as little as possible, but I'd encourage you to admit to any significant mental health issues wherever you got them treated.”

Support available for staff with mental health needs

The equalities act (which applies to the extent where a mental health condition could be classed as a disability)

Link to the Equalities Act (2010) http://www.legislation.gov.uk/ukpga/2010/15/contents

Guidance on the Equalities Act: https://www.gov.uk/equality-act-2010-guidance

Reasonable adjustments (what these are, the limits of these, typical ones that might be offered)

Here’s an NHS employers guide to supporting staff with mental health problems (2013)

http://www.nhsemployers.org/your-workfo ... h-problems

Here’s a link to an article by the Department of Health (2012) on the topic of reasonable adjustments for staff mental health problems in the workplace:

http://www.nhshealthatwork.co.uk/images ... y_2012.pdf

Here’s an older document from 2008 on the employment of staff with mental health problems in the NHS:
http://www.nhsemployers.org/~/media/Emp ... %20NHS.pdf

Personal therapy as a clinician and access routes

You could view having personal therapy as a clinician as one more professional issue to attend to, and can feel assured that plenty of us have had therapy during our careers. It can be wonderful for personal and professional development, even if you don’t define yourself as having a “mental health issue”.

An obvious route for anyone would be to see their GP and ask to be referred for personal therapy. Considerations if you do this might be – as a trainee, your course might be able to ask that you be seen out of area (i.e. not in the health board area where you see patients); that you be prioritised and “jump the queue” in terms of the waiting list that may apply; and that your referral not be discussed in team meetings, and that it be discreetly ensured that your therapist is a suitable senior clinician (i.e. not another trainee who you may know socially). Pre-training it may be helpful to mention to your therapist if you are applying for the course so they can exempt themselves from having a role in selection procedures involving you. If you do seek help through your GP, it is helpful to bear in mind that there will then be documentation about what is discussed in your medical notes, though this in itself will not be a barrier to your career in CP, you would definitely be wise to disclose it to Occupational Health.

You could also seek counselling through the voluntary sector depending on what the presenting issues are for you and where you live – an example might be seeking counselling through Cruse Bereavement Care.

You might also prefer to pay privately to have more choice about the therapeutic orientation and “fit” with your therapist – you could search the BPS register online, ask staff at occupational health or your course for recommendations, etc.

Confidentiality of counselling

Even if your (potential or current) employer knows or were to contact the person you have seen for therapy, the code of conduct we all work by is that we work on a need-to-know basis - the detail of anything you discuss with your counsellor remains confidential between you and s/he unless you are in significant danger of harming yourself or others.

Experiences of members at different stages

Relevant experience gaining stage pre-training/ job applicants

*future contributions could go here*

Trainees

*future contributions could go here*

Qualified

*future contributions could go here*

Personal experiences and comments where the person’s career stage is not specified:

“I think professionals are sometimes more accepting of issues than your family! It took months before I could tell my family that I was on antidepressants, and didn't get much benefit from that. Having the awareness and guts to go to therapy though, and persist with your degree and career, are strengths to be proud of.”
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