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Going Beyond Wellbeing Narratives in Healthcare Provider Mental Health

Those of you who follow our work will know that whilst we think wellbeing policies and staff support is important in mental health services, we struggle with seeing it as an answer to the mental health stigma that can be experienced by mental health providers with lived experience of mental health difficulties. Maybe it doesn't pretend to be, but in some places we hear that it does. In those places it over-reaches. Lets talk about stigma and valuing.

We are all well aware that mental health stigma has been around in society for centuries. In addition, those of us familiar with the mental health scene also know that an 'Us And Them' divide (we give it capital letters here, as one must with anything that is a central concept to what one works with) has permeated services for as long as we can remember. 'Us And Them' is predicated on the idea that there are two different types of humans (of course): those who experience mental health difficulties and use services 'Them', and those who provide the services who are forever flourishing beautifully thank you very much 'Us' (not a sticky wicket in existence). We sit in different chairs and never the twain shall meet. I hope you're picking up the nonsense in this concept.

These two factors (general societal stigma and specific 'Us And Them' concept) are why providers with past or present experience of mental health difficulties can feel so ashamed of and disadvantaged by their experiences. For centuries mental health difficulties have meant that a person is 'weak', 'broken', 'worthless', 'incompetent', 'untrustworthy', 'dangerous' and 'irresponsible' (and just about as many other denigrating terms as you'd like to think of) . Should providers actually have these experiences, well, a great transgression has occured in the 'Us And Them' rule, and people are effectively cast out to a nomansland; or if you like, positioned in a liminal space between 'Us And Them' for which there is little narrative or gathering, as this space shouldn't exist according to the more pernicious cultures lingering in the systems that we work in. What does that mean? Few words, few connections, and a system doesn't know what to do with you except tell you to go away somewhere else, 'Fix and Return' - we'll get to that.

Stigma is not resolved by providing wellbeing policies which focus on support and compassion, or doing yoga at lunch break. Or even having a lunch break. Did we just poo-poo compassion?! No, we just ask you to extend your view further beyond the need for compassion for the individual struggling over there. Could we be open to their flourishing as well too? (too nuanced?) Or to the strength of vulnerability? (we can hear the huh?). Or even, to the value of what can be brought to the table from this experience, that helps us improve systems and models, and how things are done? Another question: are they sitting next to you on your Trust Board? What positions are they holding in your heirarchy? When you say you value lived experience in your service users, who aren't mental health professionals, are you able to show those service users that you are valuing lived experience in your own ranks? Its a BIG tell if you can't - because what are you really saying - it's ok over there but not in here? Not on my watch? And do you value lived experience in your service users? Are you DESIGNING with them at concept level? Some may be. Many definitely not.

We have heard that some staff support services are struggling to get people to approach them. Hurdling social stigma to knock on a door for mental health help is a big deal anyway, and then especially when you are the one who usually provides that help (see 'Us And Them' above again). Excuse me? Aren't you supposed to be on the other side of the desk? Other other other. So much othering.

Here's the other thing, the 'Fix And Return'. And so on to valuing here. You've hurdled the stigma (including the stigma that stays with you because somehow in your most vulnerable time you've agreed with those desperate messages), you've knocked on the door, and you've (hopefully) been compassionately met and signposted to support, perhaps therapy, or you're in crisis needing an inpatient stay. To get 'fixed'. So the system feels comfortable on your return and you can come back, and carry on as usual please. We like lived experience left out there thank you, not in here! But here's the rub!

People who work in mental health services, who have lived experience of mental health difficulties, invariably describe going through this as something like 'punching a hole' through, or 'lifting a veil' on, the way services work. Which is interesting when you also then work in them. Some bring their lived experience already and come in to try to blaze a trail of improvement. Some breakdown whilst at their career. Cue experiencing everyday aggressions against mental health difficulties within the very mental health scene you work in. The disparaging or hopeless remarks about clients by a workforce at its limit (when you were just a client somewhere else). Knowing the limitations of services, and that you would be deemed 'too complex' for the very service you might lead. Not feeling able to say when you see policies and procedures in HR or Occupational Health that don't help, or are short sighted or worse, which your experience could really change for the better. Experiencing procedures and processes by your Regulator which feel like they criminalise your distress. Finding awkward silences when you return from a period of sick leave for your mental health, and then Flo comes back from a car accident and she's inundated with cards and flowers. Your manager double checking you when you say it would be fine to tell the team you were off for your mental health (are you sure?!). Finding your request for supervision (which the service has not got properly in place) reframed as your 'safety behaviour' because you told them a couple of weeks ago that you can struggle with anxiety sometimes.

Have you got a wellbeing policy or a yoga pose for that?

No of course you don't. This is also not in2gr8ing our lived experience of mental heath difficulties in any way. There is no whole self allowed here. Can we listen to people's experience of this culture around them, and the services they've used, and make things better? Can they lead on this please because they know? Is it too much to ask? Stigma says yes of course it is too much, we don't know what we're talking about and we mustn't be trusted.

Anna and Natalie are really looking forward to talking about the work that we do at in2gr8mentalhealth at this conference, we seek not only to support those with lived experience through peer support, but we actively do things to destigmatise attitudes and get involved in how we can operationalise how it is done in our mental health systems. Sometimes we've put down hard boundaries. Many times it's hard. All the time we are dedicated to it because we really care. We have walked this path ourselves, we talk about it openly and we table difficult conversations. Natalie was a lead author on the guidance 'Supporting and valuing lived experience of mental health difficulties in clinical psychology training' that will be launched at the conference, as well as a co-author of the 'Statement on clinical psychologists with lived experience of mental health difficulties', because we get involved with the pillars of the mental health professions on this - it is a whole systems endeavour. When Anna is in her NHS role and Natalie is a Clinical Tutor on the clinical psychology doctorate - all of our in2gr8 ethos is employed in a granular, integrated way wherever they go. We don't offer therapy at in2gr8, we are clinical psychologists who are proud peer workers here. We offer solidarity, connection and support for the energy of activism through our individual peer mentoring and our PeerSpace groups. It's not rocket science to us, but is seems difficult for the mental health scene to grasp sometimes.

So we're glad to go beyond the wellbeing narratives, and frankly, we think it takes lived experience leaders to get us there. We need overt representation. While we're on that exact theme, read David Gilbert's The Patient Revolution, we are talking together, tunnelling under all the nonsense to get at the same thing from different positions to raise valuing our lived experience of mental health difficulties, and what that means, whether you're a provider of services or not.

If you want to hear more, please get some tickets. UCLUS work on the nail of stigma in mental health professionals and we informally consider them our research partners whilst we are out here in the field living and doing it. They are great and have offered free tickets for those mental health professionals currently out of work due to mental health difficulties, which is also good because we know no one usually thinks about that for us, or that we might be on benefits. We are also really chuffed to share in the proceeds from any tickets that are sold, we can do much with investment in our PeerSpace and individual mentoring programmes, there's no one quite like us (thank god the 'Us And Them' concept says). Thank you UCLUS for your signal support and faith in our work.

Best as ever,

Team in2gr8


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