'Coming out' with a MH history

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workingmama
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'Coming out' with a MH history

Post by workingmama » Fri Apr 26, 2019 4:29 pm

A number of articles discussing the prevalence of qualified MH professionals note that those who have felt able to 'come out' about their own MH difficulties or history have been able to do so solely because they have got to the top of their own professional ladders. I can entirely see the rationale for waiting until the effects of stigma about MH difficulties are less likely to have a detrimental effect on career progression. At the same time I read frequent posts on here about whether individual should mention their own MH experiences on the application form, at interview, or once in post. I have had PMs over the years from people who have mentioned their own struggles but not felt able to share this at work. I had a discussion with my supervisor last week about the level of stigma and discomfort about qualified staff discussing MH difficulties and experiences, and was wondering what we can do to challenge this in our own (large-ish) department.

I am far from the top of my professional ladder (fingers crossed :lol: ) but have been increasingly curious about whether I might choose to be more open about my own MH background and experiences, in the hope that this helps other people to start the discussion about what we should say to colleagues when they return from time off (I have never needed time off, but when other colleagues have, they have mentioned that no-one knew what to say and that this made things feel awful for them), and to start challenging our own internalized stigma about what being a professional with MH challenges means. There are a few ways I could do this, including just mentioning it more often/at all in colleague discussions, or offering to host a talk with some other staff about 'When Staff are Patients too', or something totally different.

The concerns I have are:
How would I feel about knowing that I would have less control over who has information about me?
How would it be that patients may hear parts of 'my story' (bearing in mind that I have absolutely no problems in being boundaried about what specifically is shared, but that this boundary is inevitably different for what I share with colleagues/staff vs my own patients)
What if it DID affect my career
What if my being open about a MH history changes how people treat me (from being the truly amazing arse-kicking beast of strength that I am to feeling that people had to be 'careful' around me).

I am increasingly feeling the value of honesty, congruence, and integrity in my life and relationships with others, and feel that I am robust and able to tolerate people 'getting it wrong' - from that perspective I'm a pretty fair advocate for this sort of thing. I would also value being able to not feel 'hidden' about something related to such stigma. I would be grateful for anyone's thoughts and opinions on this.
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Re: 'Coming out' with a MH history

Post by lakeland » Mon Apr 29, 2019 10:11 am

I like the idea of a "when staff are patients too" event, where you could look at people's worries about "coming out" and worries / prejudices of those who would be hearing the "coming out." I always enjoy a nice post it note exercise where people can express some of these worries anonymously.

I think a lot would depend on the team you're in, I'd be less keen to share something personal if I was working in an inpatient service, where there are so many staff members and often a lot of gossip - in that sort of service I'd be worried about something being shared with patients without my consent and control over what is shared.

I always wonder about the value of sharing your own experiences with service users and would probably be more cautious around this, but this might be my predominantly forensic background. I don't think we should be robots, but I've still yet to get my head around what the right time and circumstance would be to share something about your own journey. People are surrounded by 'inspirational' stories now (overcome your anxiety by running or cleaning, or getting rid of your possessions) so to hear someone else say "I went through this too" (I'm not suggesting you'd say something as bluntly as that, but generally) might not do anything for the client.

More widely, I still think that there are "acceptable" mental illnesses. It's ok to be anxious, it's not ok to be chronically suicidal and in and out of crisis, or god forbid, have a personality disorder diagnosis. Please note this isn't my opinion but how I see mental health being discussed in the media. I can imagine people would be a lot less fazed by someone who had depression or anxiety and responded to a short term intervention or some medication, but a bit unsure about someone with psychosis who may or may not have had hospital admissions (I'm speaking in broad terms because I know all of these presentations are on a spectrum).

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Re: 'Coming out' with a MH history

Post by workingmama » Mon Apr 29, 2019 4:55 pm

Thanks for the reply :)

Yes, I had entirely only meant the discussion to be about sharing with other professionals rather than clients. I'm sure that appropriate and sensitive sharing with clients has and will be done by other clinicians, but it hasn't ever felt (for me) that this would have contributed to the work being done. I'd not say never, but it's not what I meant by the original post certainly.

I very much agreed with the 'acceptable mental illness' comments - it's undoubtedly easier for those of us that have what are perceived as 'everyday' mental health challenges rather than those who have suffered something that has been portrayed unhelpfully by the media or is a bit unknown to the general public.

My Trust is an enormous one with inpatient and outpatient services, but I would be truly surprised if any staff member felt it was appropriate to share 'gossip' with patients. I am slightly horrified (too strong a word, but can't think of the diluted version!) to think of a service where that might happen, but then consideration of what one doesn't expect is what is needed when thinking about things like this! Inevitably colleagues work with surgeons who work with radiographers whose son is in treatment for X or Y and then before you know it, your business is known to the sister of the woman who cuts your hair :lol:

I think it's entirely appropriate that we need to put thought into this sort of thing, but I'm at the same time aware that if it was 'disclosure' about a dodgy leg or arm, I wouldn't use words like 'disclosure' in the first place or have this sort of conversation. I wouldn't think about whether someone with a physical disability should make efforts to hide their disability, and we wouldn't think about whether patients (and colleagues) thought us to be less able or have less insight due to a different kind of illness or impairment. I'm aware of how far we are from an environment in which mental health is spoken of as easily and openly as physical health. I hope that I can contribute helpfully to our reaching that place, and welcome any comments/suggestions in that direction. xx
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Re: 'Coming out' with a MH history

Post by lakeland » Mon Apr 29, 2019 5:13 pm

My experience of patients finding out information about staff in inpatient services is when staff have been gossiping between themselves while a patient is nearby and they've overheard - so not a direct conversation with a patient but rather a careless one. For example patients knowing that a member of staff is pregnant, or off on the sick for example.

I wonder if your Trust has a working group (or you could start one) for staff with lived experience, as I'm sure there are many others who have experiences they want to share but don't know how to, or don't feel safe to. I'm thinking more of a group that gets to inform training at things like induction and can attend team meetings. I think it would be really powerful for some people if there were "successful" people sharing their own experiences - again successful probably isn't the right word, but I sometimes think that service user involvement is tokenistic and is very much done in and us and them way - whereas if it's the 'us' speaking up, it might bridge the gap. Not sure what Trust you're in, but the big one in your area (or at least the area you trained in if you've moved on) seems to do quite well with employing staff who are open about their mental health.

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Re: 'Coming out' with a MH history

Post by miriam » Fri May 03, 2019 1:50 am

I'm probably "safe" now, as a service manager/consultant CP, but as far as I can remember I've always been fairly honest, on here, in my book and in person in the workplace, about my own times of depression and stress. I talk about having sought my own therapy through OH, and how helpful that was for me. Maybe that is because life-event-related-stress is quite socially acceptable, and my periods of depression were relatively mild (I was always able to work, to function socially and to maintain self-care, for example). If I think about the power-threat-meaning dynamics, I've always been very lucky to have good sources of support, and not to have had people wield power over me abusively, so I generally have trust in others (especially with the assumed shared values of colleagues in health and social care services) being kind in how they will respond. But I fully appreciate that for people with more severe or less socially accepted difficulties, or who have experienced more adverse events or who have had less positive elements in their life it might feel entirely different. But I always think that those of us with privilege are in some ways more beholden to take the small risks that would raise issues that might affect others, and allow diverse voices a platform to be heard.
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Re: 'Coming out' with a MH history

Post by workingmama » Fri May 03, 2019 7:56 am

But I always think that those of us with privilege are in some ways more beholden to take the small risks that would raise issues that might affect others, and allow diverse voices a platform to be heard.

Jolly well put - that's how I've been feeling, that if I can do something that could be helpful, that I should in so far as my ability lies.

It's been interesting having some brief conversations with colleagues about this subject recently - people within our own profession, some of whom react to the idea that we might usefully be more open about MH (both healthy and unhealthy) as if I've suggested I might arrive at work in full fancy dress. The fact that talking about MH brings up conversations that include the words 'careful', 'professional', 'think about', suggests that even in MH settings, the idea that someone talking about their MH would inevitably be on the borderline of unprofessionalism is eye-popping.

People can talk about a broken leg in a way that shows high distress, trauma, unprocessed emotions. People can talk about MH conditions in a way that is considered, measured, contained. The fact that there is the implication that people with their own MH conditions/past conditions are de facto going to suddenly become uncontained and chaotic simply because they are associating themselves with MH conditions suggests to me the level of stigma we know surrounds MH. I have known some of my colleagues for nearly five years, and the surprise with which I have received the response 'oh, I didn't know that' when I have spoken about previous MH conditions would (I would imagine) suggest that I am not known widely for turning up to work painted bright blue and dancing on the table (although I will concede that there is a very good 20 year old undergraduate photo of my doing exactly that at which I had a jolly good time, thank you very much :D ). Yet there is the subtext in some conversations that, once one talks about their own MH, the person that they have known for years ceases to exist and this new, chaotic and barely safe to attend work individual arrives (being rather tongue in cheek, I accept) :roll: , and the conversation takes the tone of advising or guiding this 'new' MH patient.

I think there is a significant gap in our profession between those who see service users as, essentially, 'just like us', but that at the specific time point are seeking MH support. That group may or may not have had life experiences that have made them more vulnerable to mental distress, but that in essence are fundamentally no different to the clinician in any meaningful way excepting the reason they are in that clinic (i.e. Today you are in that seat, tomorrow I may be in that seat). There is another group that I encounter who fundamentally see clients as 'other' (I think Lakeland referenced this), who speak of patients in a certain way and who (I believe) see themselves as clinicians as invulnerable to poor MH based on their own superiority and strength of being. I've seen this a good few times now, and I don't think my experience of this is unusual. The conversations which suggest that a minority of my profession hold their patients/clients with a patronizing sort of lip-service compassion, in order to demonstrate their (clinicians) great beneficence and professionalism have increasingly made me think that I'd like to do something to challenge that 'them/us' unspoken and defended belief that I've seen.

Anyway, for me that's quite a long grumble. I don't want to not acknowledge the amazing number of skilled, human, caring, and humble colleagues who commit their lives to supporting people with current MH difficulties or in distress. I doubt that I managed to communicate even one quarter of what meant, but wanted to try to get my thoughts over and to ask for any support/guidance/thoughts quite practically on challenging this within the profession.
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Re: 'Coming out' with a MH history

Post by miriam » Sun May 05, 2019 1:08 am

I think it is easy to other people, so much so that I think we all do it every day. I don't think we could handle the news if we felt full empathy and association with every person mentioned. So we think of people out there in the news and in other parts of the world as less three dimensional than the people we interact with personally. And the environmental issues we imagine to be far away in time before they will reach crisis and someone else's problem to solve.

Our brains also all make some shortcuts that involve stereotyping, whether it is about the hair-extensions-nail-extensions-heavy-makeup-branded-handbag-and-shoes women that it is easy to assume are a bit shallow and possibly a bit dim until proven otherwise, or my negative judgements about Brexiteers and Conservative or new right voters, or the common assumption fat people are greedy and lazy, or that the beggar will spend the money on drugs or alcohol (and that this isn't a choice we want to fund, even if that is the coping mechanism that lets them survive in highly adverse circumstances), or the "can't-he-even-speak-English?" frustration we get when customer service calls to big companies are sent to call centres that could be anywhere in the world. No matter how educated or empathic we are, we might be unaware of the stereotypes that are informing our reactions until we shine a light on them.

And in amongst those stereotypes come the implicit messages about professionalism being quite calm and neutral, cognitive rather than affective, and associated with educated middle-class norms. Whilst the implicit associations for mental health problems are of people who are emotionally and behaviourally dysregulated, and of different social economic demographics - particularly if that is the predominant picture we interact with in our professional capacity. Hence being a little surprised if the calm middle class professional suddenly says they had a history of being distressed or suicidal, having an abuse history or having been a service user. Likewise they might be just as surprised to hear that the person under section has actually been a successful bank manager/academic/medic for many years.

It isn't an excuse, but it might help you to understand the initial reaction might not be the full extent of someone's capacity as a friend or human being, and as we all know there is a load of stigma and misinformation about mental health around in the world to get over before we recognise we are all the same underneath. And just like the heartwarming stories where racist people meet and get to know people from different countries and ethnicities, and victims speak to perpetrators of crimes, so we can also learn that our clients are more like us that we imagined.
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Re: 'Coming out' with a MH history

Post by Randomswirls » Wed May 08, 2019 8:07 am

It’s interesting as a trainee that I feel this is changing a bit as I know several assistants, trainees and newly qualified who are open about having lived experience of some form or other.

I’ve been open and have never felt much stigma around within the profession itself and if it has been there I don’t feel it’s held me back. Occupational health and the like are a different kettle of fish. I am currently of training on long term sick due to having had a crisis a few months ago so it will be interesting to see how things go when I return but (maybe naively) I don’t anticipate to many difficulties.

That said I think training and below is a very protected bubble. If I had difficulties on a placement I would be on it for 6 months maximum before moving on. That’s very different to a job where you can’t upsticks so quickly and the risks are therefore inherently greater.

I think that the fact websites like in2gr8 exist does represent a change. I know that UCL had a thesis project that I think is ongoing in terms of recruiting called HOP that is all about thinking about disclosing so might be worth looking into that.

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Re: 'Coming out' with a MH history

Post by lakeland » Wed May 08, 2019 9:24 am

Randomswirls wrote:
Wed May 08, 2019 8:07 am
It’s interesting as a trainee that I feel this is changing a bit as I know several assistants, trainees and newly qualified who are open about having lived experience of some form or other.

I’ve been open and have never felt much stigma around within the profession itself and if it has been there I don’t feel it’s held me back. Occupational health and the like are a different kettle of fish. I am currently of training on long term sick due to having had a crisis a few months ago so it will be interesting to see how things go when I return but (maybe naively) I don’t anticipate to many difficulties.

That said I think training and below is a very protected bubble. If I had difficulties on a placement I would be on it for 6 months maximum before moving on. That’s very different to a job where you can’t upsticks so quickly and the risks are therefore inherently greater.

I think that the fact websites like in2gr8 exist does represent a change. I know that UCL had a thesis project that I think is ongoing in terms of recruiting called HOP that is all about thinking about disclosing so might be worth looking into that.
I'm glad you've shared your experiences as you're living the experiences that the rest of us are just speculating on. I'm glad the course are supportive - and I hope you're having some really valuable and relaxing time off.

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Re: 'Coming out' with a MH history

Post by Spatch » Wed May 08, 2019 10:09 am

For me, I think the "how" and "why" would be the important part.

I am not sure if the problems around disclosure are always about creating an "us" or "them", but being mindful about the focus of therapy and how this may be impacted by contextual knowlege about the therapist. Personally, I believe that in the therapeutic space my job is to be 100% focussed on the needs of the person in front of me, and I am wary of muddying the waters with that. I don't think it would be helpful for a client to be worried about me, to have their mind focussed on my traumas or experiences, or to have their experiences invalidated or trivialised because "Spatch had it worse, so I shouldn't worry about this". I am also wary about what people may project into me; that I am more knowlegable about certain things and better able to treat, because I have lived experience. However, subjectivity can get in the way as well as identification. To give visible examples, I have seen one therapy group session derailed completely because I have tried to validate a client by mentioning past incidents of racism directed towards me, and another because I turned up to work after being assaulted in the street and had obvious injuries.

There are also a lot of horror stories about therapists who have spent more time talking about their own personal problems in therapy rather than the client. I have had personal experience of starting with a therapist who talked a lot about the tricky divorce they were going through, and could barely contain their own psychological state let alone mine. There were 2 sessions of that before I left, but it did give me pause to think about what was being played out and the impact of their disclosures on me.

That said, I do disclose lots of contextual things about my mental health/ history within the therapy room. I do talk about feeling tired at a 6pm slot, being angry in response to someone's story, that I have been in therapy myself or that I know what a joint is. I think there is genuine space to be open about mental health histories, about how people have engaged with their own mental health care. Sometimes I think disclosure has been done very well especially combined with activism and community psychology approaches, like Rufus May or Rachel Perkins. I have also seen it go badly when the professional is less self-aware, and may not have worked through the experience as much as they may have thought. I think it really does depend on who we are, what we are comfortable with and the style we would want to develop.
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Re: 'Coming out' with a MH history

Post by workingmama » Wed May 08, 2019 11:42 am

Hi Spatch,

I don't mean to suggest that the comments and ongoing discussion needs to or should not deviate from my OP, but just to be clear that my own question was NOT related to whether mental health experiences should be discussed with patients. I think your points are all interesting and valid, and certainly worth wider discussion, but I did want to note that the experience of talking within professionals about professional's mental health does seem to inevitably lead to the conversation being steered into: 'But is it appropriate for the patient'. The implication that I take from this (having seen this occur quite a lot) is that it is seen as inevitable that a clinician with previous mental health difficulties will be planning to discuss these with the patient group.

My OP was addressing the sharing of this within the professional group. I reiterated this when a PP started the 'whether this is appropriate for patients' discussion the first time. I can only assume that clinicians with previous experience are viewed as inherently unable to boundary discussions to within the professional group, and will ultimately need guidance from their colleagues about how to appropriately share this with patients.

Whilst accepting natural drift in a thread to topics associated with the OP, I do feel quite cross about the consistency with which this type of conversation leads to 'but are you appropriately able to determine what to share with patients'. As iterated above, whilst not dismissing the utility of shared experiences in the therapeutic arena, it has not been my own experience that sharing would have been useful for my patients at any time.
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Re: 'Coming out' with a MH history

Post by workingmama » Wed May 08, 2019 11:44 am

Edit: Deletion of a disgruntled comment. I remain disgruntled. Just more quietly :roll: .
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Re: 'Coming out' with a MH history

Post by lakeland » Wed May 08, 2019 11:59 am

I feel a bit responsible for the derailing now, so apologies. Looking back, I think this bit:

How would it be that patients may hear parts of 'my story' (bearing in mind that I have absolutely no problems in being boundaried about what specifically is shared, but that this boundary is inevitably different for what I share with colleagues/staff vs my own patients)

... made me think that this was in relation to sharing with patients.

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Re: 'Coming out' with a MH history

Post by Spatch » Wed May 08, 2019 12:25 pm

I don't mean to suggest that the comments and ongoing discussion needs to or should not deviate from my OP, but just to be clear that my own question was NOT related to whether mental health experiences should be discussed with patients. I think your points are all interesting and valid, and certainly worth wider discussion, but I did want to note that the experience of talking within professionals about professional's mental health does seem to inevitably lead to the conversation being steered into: 'But is it appropriate for the patient'. The implication that I take from this (having seen this occur quite a lot) is that it is seen as inevitable that a clinician with previous mental health difficulties will be planning to discuss these with the patient group.

My OP was addressing the sharing of this within the professional group. I reiterated this when a PP started the 'whether this is appropriate for patients' discussion the first time. I can only assume that clinicians with previous experience are viewed as inherently unable to boundary discussions to within the professional group, and will ultimately need guidance from their colleagues about how to appropriately share this with patients.
I am sorry if I have misread anything and I do get your point, about profesionals talking about professionals health, but in an era where information is transmitted rapidly and freely, and with increased transparency, I am not sure how easy it is to keep the boundary between what happens in the "professional world" and how that bleeds into what a client could potentially see. I probably should have emphasised this element more in my original post to be fair. If a person was to write an article for a newsletter or the psychologist, it would be publically accessible. If they attend a trust meeting about service users as professionals it is likely to be disseminated, as is any advocacy or activism. I mean there are arenas where things could be assumed to be kept private (e.g. supervision, management reviews) but I made the assumptiuon that "coming out" meant coming out somewhat publicly.

Maybe I have had too many bad experiences making assumptions, even having what I have written on this forum used against me in the past, which has possibly made me paranoid. I appreciate you may be angry at me for potentially perpetuating stigma in some way or being part of the problem, and I would like to live in a world where those sort of barriers are down, but I do feel cautious about this topic.
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Re: 'Coming out' with a MH history

Post by workingmama » Thu May 09, 2019 8:08 pm

Quite right, Lakeland, and I entirely take your point, but the question I raised was about what happens if patients peripherally hear of clinician details (to which I accept you responded in that vein), rather than about how to directly discuss one's mental health with patients, which was raised twice.

Spatch, I also take your point. Social media in particular has altered the way that information travels and I do think that is an interesting point - how does a professional conversation with other professionals 'travel', and what are the implications of that more widely. I think there is a difference, however, between discussing about how to improve/support MH of professionals and suggesting that clinicians pop a post about their MH on Facebook (referring to your point about information moving more rapidly and freely - I assume you meant social media). I guess what I was responding to was less those points, and more a slightly ratty observation about the quantity, proportion, and general re-direction (focus) of what I was trying to discuss into a more narrow look at whether patients are poorly served by hearing that clinicians also have mental health difficulties or previous mental health histories. I'll not reiterate my point, as I feel that I did probably represent above why I feel that consistent redirection of this topic is evidence of the problem.

Thanking both of you for your responses. I remain committed to trying to think how we can move this topic forward in a way that addresses how we can challenge stigma within the profession, whilst acknowledging the ever-present issue of how to best serve our patient group.
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