How can I approach my work as a mental health nurse, who values meeting people who are using the services I work in with an open mind, advocating where needed, supporting people to understand their experiences in a way that makes sense to them without stigmatising, blaming or pathologising, when in relation to my own experiences I have felt shame, guilt, a sense of failure and fear and haven’t been able apply these values to me? I have wondered, “what do I believe if I am applying different values to myself privately than I apply towards others? Does it make me a fraud? Am I stigmatising mental health problems? Or because I am a professional, am I subject to different unspoken rules?”
I am not different from the people who use the services I work in, difficulties are on a continuum and I have been an in-patient years ago. I am not different in the sense that I have feelings and struggle and that my life can be complex and that I have a breaking point like anyone else. But as a mental health nurse as well, other things have shaped me and increased my sense of isolation.
I trained in the 1980s, it was about keeping your place and doing what you were told. You needed to be “professional” and not get “over-involved” somehow and it was instilled almost implicitly that you get on with it – the “if you think it’s hard now, you wouldn’t have lasted in my day” attitude. The measure of a good nurse was how strong you seemed, how tightly you pulled up those bootstraps and you were letting others down if you weren’t there. At 18 years of age those messages had a lot of power when you don’t know any different. It becomes second nature, to shut down and block out what’s going on around you to function effectively, compliantly, for many hours in busy wards.
Added to that is what I carried from formative experiences. Feelings of badness, worthlessness, guilt for things that I was not responsible for, problems that were not mine to fix, pain that wasn’t my own. It is said people can be drawn to the helping professions due to their own experiences, many unresolved. When you can’t cope at times with this huge job you’ve unconsciously assigned yourself, for whatever reason, and you realise you cannot in fact be some perfect, invincible, healing machine, what does it mean? Does it make you unfit to practice? Incompetent? Not suitable? Or does it make you human, affected by life on a very personal and individual level like anybody else.
Mental health nurses “on the floor” don’t “do therapy” with service users. Yet we listen for many hours to distressing, disturbing and poignant stories, often as uncontained fragments, abruptly interrupted while running a shift, supporting unqualified/less experienced staff, responding to incidents, amidst other daily tasks, bureaucracy and fewer resources. This reduces our ability to be present with service users as often as they need. We are letting them down daily and we can feel that systemic failures are our own and there are many ways this is reinforced and encouraged. The “hot potato” is passed and someone hasn’t the power or knowledge or strength to say, “this is not my failing, this did not and could not have occurred only because of me.” If you are struggling and doubting yourself as a mental health professional, stigma aside, how safe or easy is it to trust, to be open, to look after yourself?
Many years ago, I challenged a manager who was bullying junior colleagues. She then tried to use my mental health problems to attempt to undermine me. Another manager protected me and supported me to challenge the colleague directly and I will always remember it. It is so important to support and try to protect and empower each other when needed.
There can be indifference to the psychological needs of nurses, a belief that there is little that can or needs to be done; nurses burn out, discard and get the next lot in. I wasn’t taught much in my training about self-care or how to manage other people’s extreme distress, pain, trauma, projections, enactments. I was barely managing my own. It was a kind of double life I led, my self kept apart from my work.
I continue now to try and practice self-care in a job that doesn’t really enable it. There is a lot you can absorb when you have prolonged intimate contact with many service users for 13 hours with no break as the only qualified nurse, working closely with colleagues who are also overwhelmed. It’s normalised, but even if it is normal it doesn’t mean it’s healthy. The difference it can make to be given understanding, supervision and relevant training and to not feel frightened and ashamed to need and have help cannot be underestimated. It enhances the skills, empathy, strength and insights you do have due to your own experiences.
in2gr8mentalhealth is a forum for mental health professionals with lived experience of mental ill health. It provides a safe space to explore, humanise and destigmatise this identity, and a platform for members to speak out and convey their experiences. Professionals working in mental health, and have lived experience of it, are well represented in staff groups. Knowing pain is what drives us to help alleviate it in others. Stigma makes navigating this complicated, but needlessly. We have always been a part of mental health services and always will be.
If you are a mental health professional with lived experience of mental ill health and want to join, sign up at www.in2gr8mentalhealth.com.
If you are a member and want to write your MyShare about your navigations of the personal and the professional, get in touch with the Founder Natalie in the forum or via contact@in2gr8mentalhealth.com, she will be ready to help you write what you need to write.