Mental Health in the Workplace and Disclosure

An interesting retweet popped up in my timeline this morning (I’m there as @gregeverything by the way!):

I’ve talked here before about the difference between physical ailments and mental ailments from my own experience (here). In an ideal world, we’d be treated just the same whether we were suffering with a broken arm or depression.

My involvement with Mind and Time to Change meant that we visited workplaces and talked to staff about mental health, with the aim of dispelling harmful myths about it. One thing that really stood out to me was how, in general, unprepared and scared managers felt about the prospect of a disclosure or managing someone who had been signed off for a mental health issue. We also encountered managers with damaging stigma too about people they considered were taking advantage of the system.

Coming back to the Tweet, the gentleman says that his colleagues sent flowers when he had appendicitis but when he was signed off with depression, nothing. I wonder if his colleagues know about his depression? If they do, then yeah his colleagues are showing a distinct lack of empathy and a whole lot of stigma around mental health.

I have been fortunate that I have not needed to be signed off from work – actually at my worst, work was a place I felt safe and had a sense of routine. However, had I been off, I’m not sure I’d have wanted my colleagues to know why. I have learned to disclose my problems a lot more, but I only do that when appropriate and/or to people I trust. Not all colleagues fit into that category for me. There’s probably a little residual stigma of my own in there too, not wanting people to know my business, pry or think differently of me because of my illness.

And this way of thinking must put managers in a difficult position. I’m not sure what the legal/HR position is on how much a manager can/should disclose to the rest of the team about why a person is signed off work. All the rest of the team know is that they are having to work harder as a result. It can create a toxic environment. Some managers I have known have disclosed physical injuries to us ‘oh Steve broke his arm over the weekend, the idiot, he won’t be in for a few days’. We all had a wry laugh at his expense and got on with it.

A final thought is that despite the strides we have made, sometimes people don’t have the words when it comes to mental health. Maybe this guy’s colleagues feel embarrassed by not knowing what to do or say. Maybe it’s so far out of their understanding they are paralysed. Lots of possibilities, I suppose.

Some tips on having conversations on mental health are provided on the excellent Time to Change website.

Reflections on the broken ankle

This weekend marked 9 weeks since I broke my ankle in a freak, and slightly ridiculous, volleyball accident. I re-read my post of 6th March (here) and found my mood to be, on the whole, anxious and negative.

So what was the reality?

I sulked and licked my wounds for a few days (not literally, that would be both weird and probably impossible!). Actually I have noticed this to be something of a pattern for me. For example, recently I have been looking for work. I am happy to say that I am now back in the workplace, but before that happened I received a couple of knock backs from interviews or people just not getting back to me. Again, in the immediate aftermath of the setback I was a little down and didn’t really want to talk to anyone.

The epiphany here is that I think I’ve realised that’s OK. I have recognised that the way I deal with less than positive situations is to initially withdraw and feel a bit sorry for myself. If I try to force a brighter outlook before I’m ready it invariably doesn’t work out. I suppose on some level it is a similar process to grieving. I have a certain image in my head, or routine, and that is interrupted or taken away and I have to take the time to adjust to that.

In the case of my broken ankle, once I was ready I began to rationalise. Yes getting around was going to be more difficult but not impossible. I couldn’t go play sports or train and so I found other focuses for my attention. I made plans of action and followed them through. I arranged to see friends to maintain that social contact that my injury would prevent me from getting in some areas.

And the truth is it wasn’t as bad as I imagined it would be. Imagine that. The reality not being as bad as the thought. Who knew? (Oh yeah, just about every therapist I’ve EVER seen!).

Tomorrow I will be 3 weeks out of my protective boot. I am still hobbling a little but I am on the right track to recovery. Life has changed again because of my new job, but a good deal of normality is returning too!

Deficiencies or Strength?

It occurred to me recently that we’re constantly told, probably mainly by ourselves but also doctors and friends and family, that to have a mental illness is to have a major deficiency. Whilst on some level there’s possibly – possibly – something in that on a technical level, people who have a mental illness are the people who probably the people who least need additional negativity and stigma attached to their condition, given our proclivity to inward reflection and self-criticism.

In my case, as alluded to before, the negative reinforcement comes from myself. I should be able to go on trains and planes. I should be able to go to social gatherings and not be looking over my shoulder every five minutes. I should be in a better place in my career given my experience. Jeez, when I write it all down I realise I wouldn’t say that to anyone else. And yet I say it to myself. As far as I am thinking, I am failing at some important aspects of life or at least not meeting expectations.

It’s true, I wish the above wasn’t true. But I suppose the important thing is continuing the work and acknowledging my strengths.

And so I suppose this piece is about self-kindness. I can change those ‘shoulds’ to ‘coulds’. I can celebrate successes, be they minor to the everyday person. I can take great pride in the fact that, no matter the pace, I am gradually moving towards where I want to be.

Take the time today to remember that however hard things seem right now, you (we) have already been through tough times and come out the other side. Comparison and high expectations are potentially very damaging. Remember, those ‘normal’ people out there that we think have their lives together really don’t (despite what Social Media might tell you!). We aren’t burying our heads and pretending things are OK. We are some of the strongest people around and continue to be.

New Neighbours

Today some new people moved into the flat next to ours. The flat has been empty for a good few months and before that an old man lived alone.

I have noticed this evening the urge to reach for some old safety behaviours.

I have worried about neighbours in the past. I have moved house a number of times because I haven’t liked, or felt threatened by neighbours. This is, of course, all linked to my PTSD and the hyper vigilance that is a particular symptom for me.

I should also say that I actually met the new neighbours last week and they seem like perfectly nice people.

However, a sense of unease is upon me. The fear of the unknown. The change to the status quo.

And so I return to acknowledging the reaching for the safety behaviours:

• Thinking about staying away from the room adjoining the flat next-door, and staying away from the door
• Thinking about closing windows so no outside sounds can come in
• Thinking about having the tv/radio/netflix on constantly to manage what I can hear
• Thinking of how I can move house if things get unmanageable

The positive thing for me here is that I am recognising and acknowledging what is going on. By and large, I have caught myself when any of the above thoughts have cropped up, and not gone with it. I am watchful, I recognise that, but I am not giving in.

I also know that I am trying to get a sense of control when I can’t necessarily control what s going on. I can only control my reaction. I remind myself that what I am experiencing are just thoughts. I am under no direct threat. For me, this does feel like genuine progress. The real test will come if I do start to hear noise coming from there…

Selective Stigma. Just Stop.

One thing having a broken ankle has shown me is that people aren’t afraid to ask me how my ankle is. I’m sure my stock answer of ‘still broken’ is wearing thin but it amuses me.

What is striking to me is that the same people, at least those who know about it, don’t ask me about my mental health issues. And that isn’t necessarily something that I want people to always ask me about. I know I would struggle to have to answer that if people always asked.

However, a conversation last week with a good friend left thoughts about this lingering in my mind. My friend confided that she felt guilty for talking to friends about her depression or anxieties, that she was burdening them. I’m sure we’ve all felt that. I’m sure we’ve all felt judged when confiding in someone. I’m sure we’ve all been told to just pull ourselves together at some point.

Isn’t it interesting how society draws such differences between a physical and a mental health issue, problem, challenge?

I tried, inarticulately in the moment, to tell my friend that when I walk (hobble) into a room at the moment, there is no way my physical affliction can be avoided. I may want to do something, I may have every intention of doing something, but I just can’t. Example, I am registered for a 10km race at the end of the month, but clearly I can’t do it. And because people can see it, they can understand it.

So why would we treat mental health issues differently? Isn’t it true that some days it will stop us from getting out of bed? Isn’t it true that it will sometimes cause us to seize up in a conversation? Isn’t it true it will sometimes make us anxious to leave the house?

I don’t know the answer. All we can do is remind ourselves that mental health issues are real and impact us just the same as physical issues do. And we can keep talking, educating, listening and learning. And then maybe we can remove guilt as an obstacle to accessing support and care that we all need.

GPs and Mental Health – My Experience

I’ve been fortunate over the last few years that any time I’ve needed professional support for mental health challenges, I’ve been able to seek private treatment or access my work’s employee assistance program.

Currently, I am not working and find myself in need of help. So, with this I took myself to my GP surgery and what I encountered was not positive and I wonder whether I am actually going to get any support.

On a day-to-day basis I am generally fine however my life is limited in some aspects, particularly being in some public places and public transport. I know I have to address these issues in a supported environment to build on the progress I have made in the recent past. With this knowledge, I asked the GP for a referral for CBT. In fact, I said ‘Cognitive Behavioural Therapy’ just in case CBT meant something else. Here’s how the conversation went:

Me: Hi, I’d like a referral for Cognitive Behavioural Therapy.

GP: Cognitive….?

Me: Cognitive Behavioural Therapy…CBT.

GP: Oh! CBT!

LONG PAUSE. Really long. Awkward long. He appears to be looking at my history, but does not tell me this.

GP: So you’re still suffering with agoraphobia and panic attacks?

Me: Well not so much these days but…

GP: Fine I’ll refer you. Is your home telephone number still blah blah blah?

Me: No, that has changed.

Not joking, he spent longer getting annoyed with the computer because he couldn’t change my home number than he did on my consultation. But phew, they have my home number now!

That was Wednesday. Last night, around 8.30pm I get a call from the same GP saying that he has been told that he needs me to complete a GAD7 form and PHQ9 form before I can be referred and can I just come in tomorrow to do that? So presumably, if I don’t make the grade I don’t get treatment?

I must say that when I have heard people talking about their struggles getting support and treatment from their GP or CMHT, I have wondered from afar whether it was as bad as all that. It took a harsh reality check to show me that it was all that bad.

One memory from volunteering really sticks out in my mind. We visited a particular region’s NHS CCG to discuss mental health and stigma with the staff. The chief doctor who as part of his role had mental health provision under him couldn’t have been more disinterested and dismissive.

Is it true that all GPs know so little about mental health and how a service user needs support? That seem to be the overriding experience I hear from people. I find this all very backwards and worrying!