‘Knowing when to ask for help and doing so is a sign of professional competence’
Ella Rhodes on a new statement and guidance on lived experience.
29 September 2020
The British Psychological Society's Division of Clinical Psychology (DCP) has publicly recognised the 'unique and valued contribution' of clinical psychologists and trainees with experience of mental health difficulties in a recent position statement. It has also released guidance for supporting, and valuing, lived experience in clinical psychology training.
Co-lead author of the statement and CEO of in2gr8mentalhealth, Dr Natalie Kemp, experienced a breakdown around four years after qualifying as a clinical psychologist while working in mental health services. She said while her own supervisor and manager had been supportive, clinical psychology and the wider mental health scene had much still to learn about embracing the common humanity of its workforce.
'You were, and still are, idiosyncratically dependent on having a decent person supervising you or a good manager. Some people did have that, some didn't, and those who didn't have that had really poor experiences of being punitively met by the services they were in when they had difficulties.'
Second-year trainee clinical psychologist Camilla Hogg (University of Liverpool), became co-lead author through her role as Mental Health lead for the DCP Minorities Sub-Committee. 'I think it's great the position statement is out there and the professional body is acknowledging it. I think it's really important that we can stand clear and say "people do have lived experience within the profession".'
The paper points out that mental health difficulties are common and diverse – and may or may not be the reason people enter psychology as a profession. It also highlights the complexity of whether to share lived experience with colleagues. It suggests that those who do share such experiences should be supported, with destigmatising lived experience a 'whole-systems responsibility' across professional bodies, organisations, training institutions and services.
The authors also state in the paper that lived experience is viewed as an asset. '… lived experience of mental health difficulties does not have to be a barrier to training or practising as a clinical psychologist. On the contrary, people with lived experience are an asset to the profession and make a significant contribution to it.' Dr Kemp is clear that engaging with lived experience can deepen professional practice and help improve the staff systems we work in.
Hogg has previously worked as a peer-support worker and in lived experience roles – consequently revealing her own mental health difficulties when applying for jobs. She said that having always disclosed these difficulties to potential employers, she was unaware whether they held stigmatising views towards her or not. 'However, I am in many ways privileged… I am white, middle class etc. and thus I face less systemic discrimination than other individuals do. It's really important when considering this area that we don't just consider stigma on its own due to the importance of understanding and recognising intersectionality.'
While Kemp said that many people may have had more positive experiences, she truly felt the stigma of being a mental healthcare provider with lived experience. 'The only reason I came back [to work in the area] was to challenge the stigma of being a provider with lived experience of mental health problems. That's not only about the stigma that can still exist for anyone around mental health problems but something extra about being a provider with lived experience, because of the pervasiveness of us / them divides in mental health services and unwritten rules that providers must not break down, as if they were overly identified with the services they work in. But it is humans who work in services.'
Once Kemp had recovered following her breakdown she started feeling angry not only about the stigma and lack of support surrounding mental health professionals with lived experience but also 'the paradox of what we say compassionately to those who come to us for help, not seeming to apply to those of us who work in the profession'. She approached then-DCP chair Richard Pemberton to share her story and a sense of social injustice, and later began building a network on Twitter of others with similar experiences.
Kemp created the in2gr8mentalhealth Forum, which eventually drew in around 300 members connecting about their lived experience and providing peer support. She began lobbying the DCP to consider releasing a statement on valuing lived experience in mental health professionals, after which the Division brought together a working group to write one.
Kemp also worked as a Research Fellow at UCL on the DCP-commissioned guide for trainees with lived experience of mental health difficulties. The guidance, Supporting and valuing lived experience of mental health difficulties in clinical psychology, was written by Kemp, Dr Katrina Scior, Dr Henry Clements and Dr Kathy Mackenzie-White.
It covers ways of creating a culture of openness and compassion around lived experience in workplaces and training institutions, confidentiality, and deciding whether, and if so how and with whom, to share lived experience. The authors wrote: 'Central to this guidance is a belief that where mental health professionals are concerned, knowing when to ask for help and doing so is a sign of professional competence in action and not of failure.'
Kemp said there was a certain expectation in some areas that providers of mental health care of all sorts should be able to hold it together at all times – and there was stigma associated with not living up to such ideals. 'Stigma says that you're not allowed to have difficulties as a mental health professional, that you're not allowed to break down – that it's taboo because you're a provider. Stigma says that you are not a part of any common humanity, it stops people from asking for help when they need it. Support is good and important, but we don't have enough of a sense of flourishing. Lived experience doesn't make you any better or worse than anyone else, but engaging with it can deepen and enhance your personal wisdom, how well you know yourself and ultimately your practice.'
