Would you want a mental mental health nurse?

Whoops! I seem to be disclosing all over the place.

Which is odd, even the word, “disclosure”, as though you’ve committed a crime. A lot of other illnesses are just, well, discussed. In a camaraderie sense, or even (if you’re Northern Irish like me, as it is our national pasttime) in conversation over the fence with a fag. Fibroids, thrush, pus-squishing ingrown toenails. Nothing is too personal for the Northern Irish.

Except, maybe, mental illness.

In placement I have only admitted that I have my own mental health problems to people I feel I can trust. I wonder why I tell them, and the reason is (partly) that it’s very difficult not to. I don’t habitually wear my, “I AM A MENTAL” t-shirt (that’s for special occasions). But I do have more knowledge than the average first year student mental health nurse, I know THE SHIT out of the benefits system, and it’s because of my experiences as a patient and activist, and of my interest in mental health.

So this is why it has only been broached with the people who I feel comfortable with. They are generally the ones who ask, “So, how do you know/why are you/what got you interested in mental health?” I don’t want to lie, and I’m not sure what the lie would be. I know because I was a patient and because I am interested, my knowledge has been extended by being a writer and an activist on mental health issues. From the latter, it is guesswork that I became so passionately interested and involved because of my own experiences. It is the nature of activism.

It’s also because it’s everywhere, and making me more aware that this issue of the mentals will probably rear its head again. For example, I spent the day with a perinatal psychiatry team. I want to have children one day, very much. I have generally been advised against it for health reasons, and there is the reality of it. People are automatically referred to the service (good) if a) their mother had post natal psychosis (in that case my mum gets me an automatic referral as she suffered from it twice) and b) if they have a history of severe depression, bipolar disorder or schizophrenia. It makes me afraid for myself. I feel I will cope with it, but it taints the whole rosey image of pregnancy somewhat.  You’re meant to be in a rocking chair, smiling serenely, with glowing cheeks and long hair, not having people monitor you in case you go mad.  I’m glad they do, of course.  But it was never how I imagined these life events. Nor to being advised to, “take care” planning my own wedding in case the stress and excitement makes me go a bit doolally.

I wouldn’t disclose (tell?) anyone I got even the faintest bad vibe from and it has all been in relevant, fairly passionate conversation.

I don’t feel particularly ashamed.  Not as much as I used to, anyway. Indeed, I guess a bit of me still whispers, “Stigma is bullshit! Disobey! It’s their problem if they treat you differently!”, even though I have long since said that nobody should feel the need to OMG FIGHT STIGMA!!!!1 on their own, putting themselves in situations that might make them feel uncomfortable.  It is not, one by one, our fight, not alone.

There’s also the fact that I’ve been largely fine for quite a long time. I have my little lapses due to stress but so far I have managed them. More than my illness these days, it’s my medication that affects me. It’s the medication that means I sometimes utterly just blank out and have no idea what someone said to me and renders me a DUUUUH in the mornings.  Often I mix up my words (I have done so a few times in this post, the edit button is lovely).  But I’m quite high functioning. I don’t think people can guess without any foreknowledge.

It all begs the question though- what should I do with this blog? When I was applying for jobs and university, I hid most of the archives (and most remain still hidden), leaving up the Stable Years. But I’m going to be Googled by patients, I’m fairly sure (I’d do it).  It is something I need to give some serious thought to.

It’s not just Dr. Google and people I might care for.  It’s the professionals, too. There is still undoubtedly stigma in the mental health system against professionals and wannabe-professionals with mental health problems. To see the devastating impact of that, read the Daksha Emson Enquiry. Dashka Emson was a psychiatrist with bipolar disorder who hid her illness for the most part, but more than that, her care team downplayed her illness due to the stigma of it. She killed herself and her baby daughter.

I do not want to be labelled as someone with mental health problems as it is only a tiny bit of me. I don’t want it used against me. But at the same time, I do need certain concessions and I don’t want to feel ashamed of it- in fact, I’m downright proud of a lot of the things that having mental health problems has led me to, gotten me involved in, opened my eyes to.  I also don’t so far don’t think it has affected me on placement or my practice.  I hope it doesn’t and I will make sure of that.  So far I also haven’t had any, “Oh my god, that’s ME!” moments, nor do I want them, because it <i>isn’t</i> me. I <i>don’t</i> know how someone <i>feels</I> just because we might have similar experiences and I haven’t fallen into that trap yet.

I need to be careful though, and I am realising this. I think because it’s my first placement I’m still in trial and error stage, and I have met people on it that I get on well enough with to relax around. It will not be like this in all places, and I think for my own piece of mind I will hold that information back. Also in subsequent placements, I will have the previous placements to explain my knowledge/experiences.  I don’t really want everyone knowing.

I would never disclose to a patient (client? Service user? I’m not sure what the word is) .  It is not appropriate, it’s not professional.  On a more human level, I also don’t think it’s right.  It might make them feel, “Oh great, so I have to deal with your stuff now!”  That’s not their job!  It’s a professional relationship, I worry about them, not the other way around!  And as much as you may care for, relate to and get on with somebody, you’re still in a position of authority.  It’s something I find it hard to get my head round, but it’s true.   I’ve been on equal footing for so long I’m still not sure how to navigate that. If I was giving a talk or something, or they Dr. Googled me, that’s different.  I don’t want to hide in the shadows for that reason.  Google and suchlike isn’t the same as having someone in a room and saying it.  Either way, I think I’d be quite uncomfortable and it’s something I have to begin thinking about.

It’s a double edged sword. Personally, I have found it quite inspiring when someone with mental health problems functions well after not-functioning. I know how impossible, ridiculous and surreal it is to believe that could ever happen when you are in the depths.

I also like the, “Aaah, you understand!” feeling of speaking to someone with mental health problems.  Even if they are totally different ones.  They understand the stuff not in papers or seminars; the loss of your identity, the loneliness, the slog, the feeling ashamed and apart on the bad days.

But as a nurse? Or as a therapist? (When I am finished my nurse training and get more experience, I want to train in psychotherapy. Which type, I’m not sure. I might try and get some therapy myself to see.  I know I will be getting my own therapy if I go onto train- I think that’s such a good idea that all health professionals should be offered this).  I’ve had a few different perspectives on this, ranging from, “It’s brilliant! You know the system from the inside and outside, you can be a wonderful advocate” to more cautionary ones.  But that’s having mental health problems- it’s not the same as people in your care knowing that you do.

Are they a good example or bad example? Do they have a right to tell you what to do if they didn’t do it themselves? Would you worry about having to look after them too or feeling they are assuming your own experiences, based on theirs?  Would you worry they can’t keep a proper distance, one you might need, and one they do, too?

If you are being really honest with yourself (and me), how would you feel knowing your nurse, doctor, therapist and etc had mental health problems?

(My own answer- I don’t know).

28 Responses

  1. Normalized. I’ve never had a psyc or nurse out themselves as mental to me before, but one of my counselors did and it was a revelation. The idea that he really got it in a way that others didn’t (or wouldn’t own up to) was liberating. If I had the opportunity to be treated by Kay Redfield Jamison I’d do it not just because she’s brilliant, but because she’s been through a particular kind of hell I recognize. I don’t think you have to tell all your clients (I saw one of my psycs out getting pancakes one day and thought “Oh my God, she gets pancakes where i get pancakes! Yikes!”), but there will be some people who know your work and seek you out because of it.

  2. I have the diagnosis of Emotionaly Unstable Personality Dissorder and have been in and out of hospital like a yo-yo over the past few years but my long term goal is to be a mental health nurse, I think you are right when you say you would not want patients or co-workers to know about your problems but I find it inspiring that you have managed to get to where you are now and like you I hope to bring my experiences of services and being “mental” to give me a better understanding of other peoples issues, Long story short Good on you! and thank you for making me believe it’s possible to get to where you are now.

  3. I knew of a Nurse who had battled with her own mental health and was now recovered. Working, leading a successful life etc. It gave me a lot of hope and inspiration – that people can and do get better and they can go on to work in the health profession. This was important to me because I want to as well. I also found her helpful to talk too because she could relate on some level and I felt ‘got’ things more than others.

    I suppose there have been times where I have been worried about saying things just in case it hit a nerve or was too close to home but I would worry about that with any Nurse, regardless of it being their mental health or because they had had an argument with their partner that day etc.

  4. I’m a medical student. I have an obvious physical impairment and when patients ask me questions about that I will tend to say something like ‘i have a problem with my joints, but we’re not here to talk about me’ (in a light-hearted way, it sounds quite bitchy written down!)

    I know that isn’t what you asked, but my answer to what you asked is relevant to what I’ve said (honest!) – to me there needs to be a distance for the sake of both people. The interaction is about the patient, so it would have to be in their interest to be told. I have had MH problems too so have thought about this. I think if someone was asking me, then I would want to know why because then I’d know how to answer. If the question is ‘do you know how I feel?’ then the answer is probably no, because no two people’s experiences are the same. If the question is ‘do you know what it feels like to be frustrated by psychiatrist?’ then you might have some common ground.

    Sorry, this wasn’t as coherent as it seemed in my head… Maybe I’ll try again later…

    • No, I agree with you! I don’t feel I would ever tell a patient, but if they googled me, there’s a mad good chance they’d find this blog! I need to think about that. I don’t want to, I love my blog, but it may come up!

      • Yes, I see what you mean. I worried when my scars were more obvious that people ‘in the know’ would twig and ask about them. It’s a tricky one =] I suppose ‘yes, I am she, I am therefore awesome, yes you may have my autograph’ wouldn’t quite cut the mustard…

  5. If I was seeing a doc/nurse/consultant (whatever) for mental health problems, I think I’d feel immensely reassured knowing that person had personal experience to draw on. If you’ll allow the analogy: who’d want an atheist vicar? Whether it’s mental, physical, spiritual or any other sort of problem, I want someone who’s been there, who can understand.

  6. I think it would encourage me if I knew my CPN had been very, very mental and was ok now.

  7. Coming from someone who has a diagnosis of BPD…

    It’s a tough call and I suppose it comes down to professionalism, there should never be a stigma in mental health or in disclosing a mental health issue regardless of what job you do as someone pointed out to me today. Discrimination in mental health is still very rife and apparently, it is something that is to be addressed shortly in parliament.

    From my own view and as someone that was supposed to be going into MH Nursing 18 months ago, I planned to cease blogging. I hated the thought of patients viewing things I wrote because admittedly I google names and my old psychiatrist tweets away on twitter but I think he is unaware of how visible his tweets are, the drunken pictures especially had me laughing and shouting, “he’s normal, he’s normal!” I also have had friends who blogged and have gone into nursing, but our friendships have diminished I guess partly because they have a new life in terms of uni but partly because they do not wish to be associated with the mentals!

    In your case, you are an active person in mental health and no doubt one who will perhaps be remembered for lots of good things, many would miss your blog…

    From another angle if things change for me and I make it to where you are now ;) then I know I will cease blogging (again!) as hard as it would be. I would feel fine disclosing to staff I could trust but then again I would be likely to end up on wards where I volunteer and have been a patient, so it would be hard to hide the fact… although sometimes I question if training in my trust would be a good idea! As for disclosing to patients, again I would find it very strange if I was doing a placement in my hospital and there were patients on the ward who knew me from being an inpatient, I expect that would be a difficult situation… (Ahhh your post has got me thinking now!)

  8. Spending six months in hospital gave me chance to observe my fellow inmates; the patients were generally medicated into a godot state but some of the staff were so ‘interesting’ that they really needed to be in a place of safety to prevent harm to themselves or others. Others were just plodders counting every minute until the handover and eventually the wonderful 1.5% pension, some wanted to make a difference and really did try to listen and find out what would make a patient’s stay, some were bullies who really liked having control over patients and other staff. The most human pdoc I met was cheerfully honest about the fact that she’d gone the mental route rather than general practice because she could not cope with the sight of blood. (the first time I had to guide the needle to my vein as she took a blood sample while looking the other way was a little disconcerting but I’d been in long enough to have learnt to go with whatever the flow was.

    Patients are people, staff are people. There are stringent selection procedures to ensure that the nasties will not make it to the wards. Of course a dedicated sociopath can insinuate through any hoop; if you encounter someone with no history then alarm bells will go off but in general terms I would say that it would not bother, that I would be reassured to know that I was talking to a human being.

    For example, to achieve accreditation a certified psychotherapist must submit to therapy themselves, not to ‘cure’ them but so that they might learn how to not visit there own demons on vulnerable others

  9. I’d actually be reassured to know that the professional with whom I was interacting knew what the experience was like from my side. it strikes me that there’d be a level of empathy there that even the most caring non-mentally-interesting health worker couldn’t match. plus, it’s inspiring to see that you’re obviously okay to be working (if I’m your patient) – that’d look like a light at the end of the tunnel for someone like me who often feels they’ll never be not-depressed or not-anxious enough to build a normal career.

    I actually want to work toward a D.Clin.Psych eventually, so this post is particularly interesting for me too.

  10. I would actually love it if my mental health worker had had mental health problems themselves – as others have said, I’d feel like they actually understood how I felt, which I feel would be especially useful if I was in crisis (& make me a lot more likely to heed their advice, lol!)

    However, I do think that if I knew that about them I would be unconsciously looking out for clues as to how they were feeling, mentally – and if they were having a bad patch it would worry me, so there would be pressure to always hide how you were actually feeling I think. But I suppose this is true of many jobs!

    Also, if you want to become a psychotherapist I might be wrong but I think it could be damaging to the process if your clients could find out too much about you, via google & your blog – I’m currently having psychoanalytic psychotherapy and my psychotherapist is literally just a sounding board for my angst; I know nothing about his life apart from a) the town that he lives in, b) his physical appearance (well-groomed and mid-fiftiesish?) and c) that he lives in a pink house with wind chimes in the back garden. (Possibly not even his garden, they could be in an adjacent one, but they sound very soothing while I’m lying on his couch anyway! Which, incidentally, could do with being full length – I’m sick of having to lie with my knees slightly up! BUT I DIGRESS) I find this helpful as it means that I can’t try to work out what he thinks of what I say, and when I speculate it says more about my unconscious processes than any sensible guesses I might make. So I think if I was pursuing a more traditional form of psychotherapy, I probably would take down my blog, or maybe make it un-googlable/annonymouse.

    But there are so many types of psychotherapy that you could provide a more personable type. My little sister’s therapist when she was a younger teenager used to tell her pertinent/random details about his life, even that he kept goats (which she thought was amusing as he had a goatee) & she found him extremely helpful.

  11. p.s. I just read a bit of that enquiry thingy you posted – oh my gosh it was brutal, made me cry. Do you think from what you’ve seen of the mental health infrastructure so far in your training that lessons about stigma etc. have been learned from this?

    Being quite mental at the moment, I felt reading that like it actually could have been about me in the future :S Oh God, I hope not. Then again, maybe it’s a part of bipolar to be really self-obsessed like that (this poor woman killed herself but it’s still all about me!) Or maybe I’m just self-obsessed anyway :p

    Also, it’s a bit off topic but as someone who’s taken 5 overdoses, but only of 25-30 tablets each time, I felt really inferior reading about her earlier suicide attempt; how fucked up is that, it’s not a competition! I think I feel as though hospital staff treated it as self harm cos I phoned NHS direct or told someone each time though, & especially as they were relatively small. I did think I felt suicidal each time though.

    I really hope you can have children one day Seaneen. I’ve always dreamt of adopting when I was older, sometimes the only thing keeping me hanging on is the thought that I can be a good mummy to someone one day. But am I even allowed to adopt at my level of mentalism, does anyone know? What if you have a serious diagnosis like bipolar, but it’s been stable and well-managed for three or four years? I’ll be so gutted if I can’t adopt :(

    Sorry for the early morning emo-ness xxxx

    • You can adopt. You will have to have been stable for a good while, and show support systems, letters from psychiatrists, etc. They’d really put you through your paces, but having a mental illness does not necessarily disqualify you.

  12. it’s perfectly fine to draw upon your experiences, it certainly gives you the added bonus of true empathy. however, please be careful – it’s like walking on eggshells when it comes to disclosure and it’s not really appropriate to mention things in practice (i’m talking about with service users here). yes, i know that it’s terrible and it shouldn’t be that way, but often it takes away the focus from their treatment and it can complicate matters in alllll manner of ways (trust, have been there!)
    be careful with your blog too – absolutely nothing that could be misconstrued as PII or “giving the profession a bad name” – the NMC can be shit hot on it, i’ve seen that happen too.

    with your colleagues however, talk about it. bloody talk about it. the most stigma i’ve ever encountered has been in that damn office. it’s a perfectly valid reason to want to be a nurse, it gives you true insight of the services and it’s actually useful for them to hear about that (even if they might not want to think about it).

    - newly qualified, also mental, mental health nurse

  13. Hello, I’ve just found your blog, I’m currently waiting to be referred to a psychiatrist as my GP and a number of online symptom lists and tests think I’m Bipolar. I hope that if that is my diagnosis then I’ll be as brave and open as you.

    Take care xxx

  14. I have Aspergers Syndrome underlying my mental health problems. I have found it is more and more acceptable to admit to mental health problems but when I say I have Aspergers, people still react badly.

    It is almost as if I cease to be fully human – I get asked questions like “Do you care about people?” because they have heard we lack empathy. I have to explain that struggling to understand other people is not the same as not caring about them!

    But with the mental health problems, these days they say stuff like “I like Steven Fry” as if we are all genial, genius, TV personalities. Maybe what we need is a lovely celebrity to admit to Aspergers!

  15. I would have found it reassuring if I knew that any of the psychiatrists I saw had a mental illness, maybe I could have trusted them. When they made me take pills that made me ill, perhaps if I knew they knew what that’s like I would have found it helpful. Perhaps if they had a mental illness they wouldn’t have told me to take a bath when things got bad.

    But, and it’s a big but, any psychiatrist, nurse, etc. should be trustworthy if they are good at what they do. They shouldn’t have to be mental in order to be helpful.

  16. Honestly, if I had spoken to a professional when I was using the crisis team who openly told me they had once been in my position and sat where I was sitting, it would have boosted my confidence so much, to see I could still be something, still be someone, have a good job and be able to cope and deal with everyday things.

  17. My therapist and I had a great working relationship for about 3 years before she retired. Because she knew me well by that time, she was comfortable talking about her own illnesses (briefly) and I was glad, as it made me see that I wasn’t alone in how I was feeling.

    She had gone through PTSD and turned to alcohol for a while as a result, many years ago. She’s fine now, but has a good insight into these things as a result. I never turned to alcohol myself, but was at the time suffering from PTSD and dating an alcoholic (great combination eh!)

    Anyway, I found her candour most reassuring and it certainly didn’t put me of her – it made me like her even more, knowing that she was not just a mental health professional but also a real human being with real feelings and flaws, just like the rest of us. :)

  18. Thanks so much Narky, it’s really good to know I can still adopt one day :) It’s extra motivation to get well, although I know I can’t force myself to. But I can try to do things to help, like trying to go back to sleep when I wake up hyper in the night, instead of waffling on mental health blogs at 4am :p

    I’m sorry your psychiatrist told you to bathe, how useless – a woman on an out-of-hours mental health helpline told me to eat raisins once :S xx

  19. The best professional I have ever worked with is a mental mental health nurse. And yes, she did disclose to me – not immediately, and not so that I ever felt like I was listening to her problems rather than the other way around, but in a way that made me find it easier to talk to her, and made me think she would understand what I was saying and therefore I would feel less of a loon saying it. She didn’t volunteer information generally, but if I asked a question about her experiences she was usually fairly upfront. I know it is probably now what you’re taught to do, and I also know it is something she doesn’t routinely do with her patients, but in my case it was the right thing to do – partly because her experiences had been similar to mine, and so it was good to see that people can and do recover enough to hold down a job and have a life etc, and partly because I sometimes find it difficult talking to someone who I can’t imagine being able to relate to a thing I say, and who just doesn’t seem to ‘get it’. I really appreciated her honesty, and I think her telling me was a helpful thing. Obviously you have to use your judgement and not just go around mentioning it to everyone you see, but I think when you know someone well you might occasionally think it would help them to know that you did understand what it was like to be on the other side of the fence so to speak. Whether I would have felt comfortable googling her and reading about her problems is another question. I think I would have felt a) like I was invading her privacy, despite it being available information, b) I wouldn’t feel able to bring it up because I would feel like a stalker (we all google our therapists etc, sure, but you don’t tell *them* that!) and therefore I would probably always have questions I wouldn’t feel able to ask etc, and c) some people probably wouldn’t be comfortable with it, and if they get a letter with an appointment to see someone, google them, and read about their issues etc, it would be a very strange beginning to a relationship. In my opinion it is fine to disclose, in the right circumstances, and with a patient you know well and think it will benefit, but you probably do need to be careful about the information being out there for anyone with google to access. However, you will never really get away from that I suppose, because of the Radio 4 play etc and having been quite well known. Although I guess if you use your married name at work people wouldn’t be able to find things by googling your work name. Sorry if all of this has been said, I didn’t read all the comments!

  20. [...] Finally, Seaneen has been pondering what you would think if your mental health nurse was also mental: [...]

  21. I have had professionals disclose to me and to my Mum when I was ricocheting in and out of A+E.

    It gave me hope that I could get out of where I was mentally and come through the other side. Maybe even sitting on the other side of the room, helping someone like me. Sometimes professionals don’t come across as human, as I remember screaming to a table of psychiatrists at a CPA review. You’re thinking, how can you expect to sit in a university lecture for X amount of years and come out to tell ME what I should do and what would help ME?

    Being human means being vulnerable to life and to mental health problems, so I don’t think that is a bad thing, if the disclosure is handled well. That’s how life happens sometimes.

  22. Dear Seaneen, am very surprized, shocked and rather dismayed to read that you have been ‘advised not to have kids due to health reasons?’. What health reasons? so you have a mental health issue, if all the people who had mental health diagnoses didnt have kids there would be hardly any kids in the world.

    If you had diabetes would that stop you wanting to have kids, or, influence your desicion?

    Yes looking after kids is hard, you will probably still have episodes, guess what you will still be bi-polar with or without kids, you say you have been well for long time, then who the hell is suggesting tht you should not have kids?

    Am strongly against anyone, proffessionls or not telling anyone if they can or cant have kids on grounds of any health issue.

    People who have supposedly no health issues have kids and are less that perfect parents, (hence all the kids homes, and need for fostering).

    I urge you to go back to these people who have ‘advised’ you and ask for a more rounded and frank discussion, be your cutting edge no nonsence and interview them…. I would really like to hear back from you on this subject, as find it odd no one else seemed to pick up on it.

    have contacted you a couple of times and not heard back would be nice to hear from you and congrats on the job.

    Kind regards Poppy

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