Gaining momentum for honesty

I am writing in relation to the letter 'Clinicians with mental health difficulties' in the October issue. I was glad to see I was not alone though it was sad to see somebody feel they had to remain anonymous and keep their mental health a secret, as I have for many years. It was a relief then to see our Professor Hacker Hughes in the November issue be open about his own struggles with bipolar disorder ('Experiencing what clients experience').

This then begs the question: If the British Psychological Society's own survey has shown that 46 per cent of psychologists report depression, and we are trying to tackle stigma against our clients, why are we not comfortable being more open about our own mental health? In theory mental health professionals should be amongst the least stigmatised in our society, but perhaps they actually know too much about mental health problems, and have seen too much of what can go wrong. Say to somebody in the street about bipolar disorder, which I have a diagnosis of, and they may say something like 'Up and down, Stephen Fry'. Say to an NHS clinician and they may think of poor outcomes, high risk of suicide, etc.

We all have a right to keep our health private, but it seems many of us keep silent for fear of being judged. I have told colleagues on a need-to-know basis until this year when after years of careful consideration I told all the team I work with about my diagnosis. I have also published about being a clinical psychologist with bipolar disorder (Richardson, 2016), and have been in touch with Dr Louise Beattie who wrote about a psychotic episode she experienced whilst doing a psychology PhD (Beattie, 2016). Louise also tried to hide her experiences out of fear of being judged negatively, and felt that as a psychologist she should have better control over her thoughts and emotions, contributing to shame about being unwell. I similarly have been reluctant to be on medication in the past because I felt as a clinical psychologist I should be able to cope myself. We both feel a sense of relief about writing openly about our mental health now.

My colleagues have been very supportive, and it has been positive for my own wellbeing that I can be open, rather than only tell people when it is too late for early intervention. I have told a handful of clients when relevant (and some have guessed by pointing out that I seem to know bipolar thinking patterns very well!) and their response has been overwhelmingly positive, with comments such as 'So you really do know this mindfulness stuff works then?!'. There is still occasional anxiety that being so open is a terrible mistake for my career, but I console myself with the thought that anybody who has an issue working with someone with mental health problems should not be working in our profession.

I feel the momentum is gaining for more honesty in our profession. These letters have inspired me, and I am happy that Dr Katrina Scior of UCL is working on an 'Honest Open Proud' project to support clinical psychologists who have mental health problems of their own. Maybe we could even set up a special interest group within the Division of Clinical Psychology for those with lived experience? I hope the time is right for us to 'come out of the woodwork' and acknowledge that for many of us a big factor in us wanting to go into this profession is because of our own difficulties. Perhaps our colleagues won't be as surprised as we expect them to be.

Dr Thomas Richardson
Principal Clinical Psychologist (Research Lead), Solent NHS Trust
Visiting Tutor, University of Southampton

References
Beattie, L. (2016). Experiences of a first-episode psychosis by a psychology graduate student. Schizophrenia Bulletin [Advance online publication]. 
Richardson, T. (2016). The dark side of being a clinical psychologist with bipolar disorder: A response to Ho [Letter to the editor]. Psychosis, 8(4), 374.

I'm writing in response to the letter 'Clinicians with mental health difficulties'. I am a clinical psychologist with a long-term (20-plus years) history of depression/anxiety and, more recently, postnatal depression. Since having my daughter, I have chosen not to return to work as I feel that the emotional burden of working as a clinical psychologist is detrimental to my own mental health. I have also had the experience of being a 'client' and seeing a variety of other mental health professionals.

My experience is that talking to someone who owns and will discuss their experience of mental health difficulties and can share their lived experience of managing them, learning from them, and succeeding at 'life' despite them, is far more inspiring than someone talking from theoretical perspective. There is surely a reason why people seek out others who have had similar experiences, are keen to read books written by 'survivors', etc.

I believe it is high time for a step-change in the dynamic between clinician and client in mental health services, as the 'I'm OK, you're not OK' dynamic is so often a refuge for the clinician, and a means of distancing the client. Surveys time and again state that around half of our mental health clinicians consider themselves to be experiencing difficulties – that's higher than statistics for the general population, which comes as no surprise given what we know about 'wounded healers' coupled with the stress of the job itself. The 'I'm OK, you're not OK' dynamic is unhelpful for clinician and client alike.

In the years I have worked as a clinician, I have seen for myself the impact of 'coping on the outside' on my colleagues, which has ranged from addictions, need for medication, extended sick leave, relationship breakdowns and, sadly, even suicide. It's hypocritical to deny that this is the state we are in, and self-destructive to think we must be paragons of mental health and virtue in order to be good clinicians. Life is hard, the best we can do is learn to manage it. Psychology should be about acknowledging these truths and embodying them without shame or pretence of super-human qualities. By pretending we're unaffected we are perpetuating the stigma that we claim to work to overcome.

Personally, I found that clinical work wasn't good for me, but I never felt that I wasn't doing a good job – only that I was being a fraud in reaching to help others when I felt at the bottom of a hole myself most days. I can't help but feel that a culture shift in how we discuss amongst ourselves as professionals would open doors to fruitful avenues of improving the mental health of the workforce, exploring constructive therapist disclosure, and closing the power gap in therapeutic settings. So please keep writing about this!

Anne-Marie Green