End the stigma. Discuss, Disrupt, Direct the Narrative. Be happy, Be Bright, Be You.
My Background and interest in Mental Health:
I come from a family of Doctors on both sides. Therefore, I can safely say we have a healthy crop of all specialities. It is particularly useful at family barbeques, because should I collapse my chances of survival are very high :-D
Jokes aside, my Father who is my Role Model, Inspiration and the Gold Standard I strive to achieve, a now-retired and brilliant Psychiatrist raised me to appreciate the need to deeply understand and appreciate issues surrounding mental health. He cared about his patients with a passion to a degree that drove me to deeply care about every programme/project I did, every activity I pursued and ensured that I maintained High Protected Values at all times for my clients.
He also talked with me about human behaviour from a young age and how I should analyse the root causes of my behaviour constantly. My ‘telling off’s’ were less ‘time outs’ and more an exchange in the fashion of the Socratic Method. This method encouraged me to reflect and think independently and critically understand and better myself. An example is the use of non-threatening dialogue to seek to understand and be understood.
I naturally developed a passion for both psychology and psychiatric works and developed a deep appreciation of the spectrum of mental health diagnosis and the suffering directly as a result of the underlying condition and from external sources not related to them.
It also made me see the need for people to easily access a robust mental healthcare system to reduce their unseen suffering. It showed me the need for a more proactive dialogue at all levels in society (e.g. schools, organisations and so on), for individuals to feel safe enough to open up and ask for appropriate help. An individual should always feel confident to talk openly about pertinent issues, gain support and accept treatment for any mental health issues.
I cannot stress the importance of people from all backgrounds asking and accepting treatment for mental health problems. This single most important action significantly improves the probability of having a full and productive life.
Progress in mental health awareness is being made with influencers on social media and celebrities opening up about their struggles and life experiences. The value of this cannot be understated as role models will help followers through leading by example and encouraging dialogue.
Furthermore, in the UK the Department of Health (DoH) has designed “A Framework for mental health research”, which has synergies with other organisations activities, such as the NHS and YMCA’s anti-stigma campaign #IAMWHOLE.
These initiatives have gone a long way to reducing roadblocks such as stigmas arising from cultural and ethnic backgrounds. For example, educating families not to hide the problem and ‘save face’, has encouraged information seeking about what help is available for conditions and how they can be accessed. Such projects have also equipped families with tools and support to enhance their ability to care for their family members in need of help. These initiatives have gone a long way in reducing mental health inequalities.
My Experience and Thoughts:
My work as a management consultant- primarily for the healthcare sector in the UK, Northern Europe and the Nordic Countries has brought me in contact with various mental health programmes of work.
In one of my first projects, I found myself working for a large mental health care provider trying to improve a variety of problems to serve their wide geographically spread community in obtaining equal and timely access to the services. The Community Mental Health Teams (CMHT) were also geographically separated due to vast catchment areas which imposed restrictions to their work pattern.
As a young management consultant with a keen interest in mental health and reducing inequalities, I jumped straight into analysing available qualitative and quantitative data. This was to understand the key obstacles that prevent an efficient, effective and economic provision of healthcare.
However, something was missing in the evaluation process: The opinion of the patient, their experiences and their needs. The prior projects never involved patients directly and only used the data provided by caregivers and medical professionals. These second-hand data can be prone to Explicit and Implicit Biases such as ‘Diagnostic Overshadowing’ which usually stem from the stigma associated with individuals with mental health disorders. This fact makes the data less useful because of the inaccurate picture it provides. For example, it will skew the data due to not reporting discriminatory practices and poor quality of information provision based on stigma which both already impact the quality of service the NHS Trust provides.
I realised that without understanding the qualia and real experiences of the patients themselves about the care, a full tailor-made option could never truly be realised. I asked the team if I could speak with the patients and the feedback from the patients indicated that they were keen to participate. It was a surprise to get access to and willing participation by patients as many feel reluctant to speak out as they fear reprisals from staff or medical professionals.
In organised group discussions the patients were very happy to discuss their experiences, look at solutions that they felt were important and discuss positives and improvement opportunities with the current healthcare provision. I got feedback such as “I prefer to have a structured program of care without pottery and making sandwiches” and “I prefer to have my independence and discharged, with the assurance of easy access if needed”.
The patient voices combined with the secondary data allowed the cross-functional group of project members to design simple yet elegant solutions which worked with the wide geography of the region. It also improved new patient access and in-patient progress from admission to discharge. It was not high tech or expensive system- but a simple ‘Traffic Light System’ for all patients under the respective CMHT. The Traffic Light System Information indicated patient entry, length of stay, progress from red to amber and green as they improved and were discharged. It made an opaque system transparent and a system that can be described as sludgy one transit to a more smoothly flowing and effective one for both parties.
Involving the patients in the process was invaluable. But, it was overlooked due to stigma and uncertainty surrounding how they would react to sessions and questionnaires. However, asking them directly was not only a key to unlocking an iteration of elegant simple solutions and understanding the patients as people more than a diagnosis who had rich inner lives and value to society.
A few of my thoughts that may be helpful for anyone with mental health issues out there:
From my direct contact with patients, discussions with family and friends from various backgrounds I found a few factors limiting those affected:
- The day you get a diagnosis it feels as if their lives have changed dramatically and for the negative. I cannot stress this enough- ‘You are not your diagnosis’. Your life did not change on the date you were given the diagnosis. This part of you has been with you and giving it a name does not reduce your worth or value to society one iota. The diagnosis is a chance to get the appropriate psychological and pharmacological support to live a full and productive proactively managed life. It is an opportunity to allow your family to understand your needs better and be a knowledgeable source of support. It is the day you continue to be your best self.
- The second part of the Diagnosis is that people start identifying themselves with it i.e. Self-Labelling and short-changing yourself in having a full life experience by taking up the new diagnosis or label as a new definition of who they are. You are a person, and a label can help describe one small facet you manage, but it can never define who YOU are. Do not get wrapped up in the disorder/disease you have and reduce the rich and complex experiences you can have to a one-dimensional caricature. Take pride in your abilities, embrace your uniqueness and individuality as a person and hold your head up high.
- Understand the facilities that are there to support you. Such as being registered with a G.P. access to mental health services, what reasonable adjustments you can expect from your employer and the benefits you can claim. For example, help with housing, education or re-training programmes, support from mental health social workers that help reduce or eliminate social isolation and much more. Knowledge about what is out there for you is a key enabler of a healthy, inclusive and productive life.
- If you feel discriminated against or fear when interacting with Health Care Services you have many options and rights. Some of these are the Equality Act 2010, The Human Rights Act 1998, to give the NHS feedback on your treatment and officially complain. This journey need not be undertaken alone in these stressful processes. You have access to the facility to use advocacy for support.
I conclude with one of my favourite quotes: “Participate joyfully in the sorrows of the world. We cannot cure the world of sorrows, but we can choose to live in joy.” -Joseph Campbell
