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Naming Mental Health as the Cause for Disaster means a Reversal of Gains to Reduce Stigma

I am almost at a loss for words when I see the headlines in relation to Andreas Lubitz and the tragedy of Germanwings 4U9525. The horror is unbearable, but the press coverage surrounding the story has been abhorrent. I am scared to write this post as I do not want my words to detract from the pain that the families involved must be feeling…and I am sure I will not cover this issue as well as @MentalHealthCop or @BlurtAlerts… but I must share my thoughts.

Relating this story back to my own PhD research in supporting health professionals in psychological distress, this story should remind us all that high profile jobs in high pressure environments placed in the public eye can produce adverse health problems. Many people have been questioning what ‘Burnout’ actually is. For clarity I will define this as follows:

Burnout is a syndrome of emotional exhaustion. Burnout has been defined by Maslach as a syndrome consisting of emotional exhaustion, depersonalization, negative thinking towards others and a reduced sense of personal accomplishment (Maslach, 1986, Maslach, 1996).

Moving on to depression:

“Depression is a common, disabling disorder characterized by a period of at least two weeks in which a person loses pleasure in nearly all activities and/or exhibits a depressed mood“(Stewart et al, 2004;19).

Symptoms of major depression include feelings of sadness and hopelessness, diminished pleasure, changes in weight, changes in sleep patterns, lack of interest in life, chronic fatigue, a sense of worthlessness or guilt, muddled thinking and poor decision making (APA, 2013).

Sadly depression can affect all areas of a persons life, and yes some of those with depression will die by suicide. However, the headlines seemingly suggest that depression is the cause of this ‘Murder’. It will not be the only cause of this tragedy, and nothing is confirmed as yet. It frightens me to think that these assumptions are coming up so thick and fast before the facts are known. This highlights to me the stigma still apparent and surfacing in the wake of fear.

We do not know all of the facts, perhaps Andreas dissociated from everything around him and any decisions he may have been making, perhaps this is something completely unrelated. Whatever happened, the headlines of this story are damaging and risk the reversal of any progress we have made in reducing stigma.

Some news companies are scaremongering and stating that nobody with depression should be allowed to fly a plane. This at least makes a change from them saying that all those with depression are ‘fit to work and lazy’ – but I digress.

This idea is ridiculous as those with mental health issues can achieve great things… remember 1 in 4??? Do we get rid of 1/4 of our pilots?

What if our pilots have a headache? what if they have a brain tumor? what if they have a seizure whilst in flight? – the ridiculous parodies may continue…

I was hoping this would get people talking about what can be done to support those in *potential* psychological distress in order to improve overall services, instead it has led to an immediate reaction of fear. I am hoping the long term story will be a different one.

American Psychological Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders (V) American Psychiatric Association, Washington, DC (2013)

Maslach C, Jackson SE. Maslach Burnout Inventory Manual, 2nd edn. Palo Alto (CA): Consulting Psychologists Press Inc; 1986.

Maslach, C Jackson, S Leiter, M, Schaufeli, W, Schwab, R (1996) MBI: The Maslach Burnout Inventory: Manual. Consulting Psychologists Press, Palo Alto (1996)

Stewart Donna ; Gucciardi Enza ; Grace Sherry (2004) Depression BMC Women’s Health, 2004, Vol.4(Suppl+1), p.S19

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Hospital Staff Absences for Mental Health Reasons Double – but do the Figures Add Up?

Today I was up early to watch Danny Mortimer NHSE_Danny (Chief Executive Employers) Speak on BBC Breakfast in light of new figures obtained via a Freedom of Information Act Request, that Hospital staff absences for mental health reasons has doubled across England in the last 4 years!

This information is obviously very relevant to my PhD study, and I will be reviewing it in time. However, the initial response that Danny Mortimer gave was that  staff feel comfortable talking about their . Hmm…

Has all of my research to date been wrong? Are #NHS staff comfortable talking freely about their mental ill health? (would love to hear your thoughts, but ironically you may feel unable to speak out – I tell myself this is the reason for a lack of comments on, and interactions with my blog all of the time :P)

Anyway, as you can imagine, I became worried that I was ‘missing something’ and asked Danny if he had any evidence for this? – See our conversation here

As you can see, he did not provide me with evidence for this statement, but agreed that we all need to do more to support our colleagues, and I know that we all share the same constructive goals. Unfortunately people don’t always have an answer, they just know that something needs to be done. I still believe that my PhD research could be the key to effective support, but this project is in its infancy and I will keep the readers of this blog as updated upon its progress as I am able.

So… the evidence provided by NHS Employers upon the mental health & well being of NHS staff is this:

MentalHealth Infographic WEB FINAL

A great infographic! However, one thing concerns me…. Apparently 76% of NHS trusts report that they monitor the well being of their staff (RCP, London). Yet 3 out of 4 people suffering from mental illness get NO TREATMENT AT ALL. (www.mentalhealth.org). So, are NHS trusts doing anything about the staff they find to be unwell? or are NHS staff fine? I think not. I worry that there is a lot of good rhetoric out there around NHS staff health and wellbeing, but not many interventions to support staff. The figures don’t add up, and seemingly only smarties have the answer.

I hope I have the answer coming… I hope its not too late.

http://www.mentalhealth.org.uk/content/assets/PDF/publications/fundamental_facts_2007.pdf?view=Standard

http://www.rcplondon.ac.uk/resources/nice-public-health-guidance-workplace-organisational-audit’

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#GoodbyeHeadclutcher campaign significant for Health care professionals in psychological distress

Wow – I have been so impressed with the #GetThePicture campaign this week -> 

I felt that this would also be pertinent for those working within the #NHS who may be struggling with poor mental health. To me, the head in hands image that is used so widely within the media has connotations of those in distress being out of control and unable to manage their condition. Of course there may be times when those in need do hold their head in their hands, but their story will be much wider than this single portrayal of despair. Within the healthcare services, one of the biggest barriers to help seeking is the stigma, and self stigma associated with ‘not coping’ in the professional sense (Renton, 2014). The fear that a healthcare professional may be judged as being professionally as well as mentally unstable means that many health care professionals never seek help or do it after years of suffering (Clark, 1999, Laposa et al., 2003).

The leading reason given for non disclosure in health care professionals is that staff are concerned that the disclosure of mental ill health may negatively affect their careers (Dewa, 2014). With images in the media implying that those with mental ill health are constantly unable to cope and sat in despair, we may see rates of self stigma increase, and rates of help seeking decline. This will paradoxically put patients at risk of compromised care, and drive secrets underground (Moberly, 2014). We all would like to see those in need receive help and feel well. To do do this, they must be willing to seek and receive help. With this in mind, I would be pleased to see future images of those with mental health issues smiling, seeking help, talking and being a part of every day life.

Health care professionals in psychological distress are doing just this, smiling ‘coping’ and working in the #NHS. If we can normalise help seeking, rather than the stigma of not coping, we may be that much closer to healing the healer.

@TimetoChange has suggested the following things to end #Stigma in this area:

  • Picture editors – look for an image that is truly relevant to the story; think about mental health problems as you would when portraying other illnesses; avoid ‘headclutcher’ shots; be sensitive when illustrating stories about suicide and self-harm.
  • Members of the public – take a fun ‘headclutcher’ selfie, and tweet it with #GoodbyeHeadclutcher; if you see a picture you think stigmatises mental health problems in the media, contact that outlet directly, and tweet them with #GetThePicture.
  • Picture agencies – weed out ‘headclutchers’ and other stigmatising pictures from your image libraries; make sure your categories and keywords can help picture editors find appropriate images easily; commission your own range of positive images.
  • Photographers – think of new creative ways to portray mental health problems; use a diverse range of people; take more shots of people being listened to and supported by others.

#TimeToTalk #TimetoChange @TimetoChange

Clark, D. (1999) Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37 (1999), pp. S5–S27

Dewa, C. (2014) Worker Attitudes towards Mental Health Problems and Disclosure. The international journal of occupational and environmental medicine, 2014, Vol.5 (4), pp.175-86

Laposa, J. M., & Alden, L. E. (2003) (1). Posttraumatic stress disorder in the emergency room: Exploration of a cognitive model. Behavior Research and Therapy, 41,49–65.

Moberly  , T (2014) GMC is “traumatising” unwell doctors and may be undermining patient safety, Gerada says, BMJ Careers. Available from http://careers.bmj.com/careers/advice/view-article.html?id=20017662 (Accessed 11.11.14)

Renton, T., Tang HEnnis NCusimano MDBhalerao SSchweizer TATopolovec-Vranic J. (2014) Web-based intervention programs for depression: a scoping review and evaluation. J Med Internet Res. 2014 Sep 23;16(9)

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Health Professionals who Die by Suicide – 5 Tips for Change


If the content of this post has affected you in any way, please visit the support page of this blog….

Yesterday was #NHSChangeDay, and I pledged to #StartTheConversation and raise awareness about health professionals who are in psychological distress. As it happens, @WeDocs conveniently hosted a  #WeDocs Tweetchat on preventing suicide in health care professional populations. It was great to see an issue I feel so passionate about being discussed, shared and given some much needed attention. This kind of innovative Twitter usage is one of the things I love about our NHS radicals!

Throughout the conversation, there were seemingly many people concerned and wanting to prevent clinician suicide, but not many solutions to prevention were put forward. -> See the chat summary here

A recent situational analysis into Suicide by clinicians involved in serious incidents in the NHS has identified the current support services available clinical staff, yet there is no consensus on how to effectively support clinical staff, and nobody has yet taken responsibility for the well being of NHS staff (Strobl et al, 2014). This has been further complicated by the fact that Clinicians often have difficulty in recognising symptoms and risk factors associated with their own suicidal behaviour (Goldney et al, 2002). Clinicians are at a higher risk of suicide than the general population, can be misunderstood and left unsupported whilst under immense pressure (Chan et al, 2014). The GMC have recently published a report in regards to a high rate of professionals dying by suicide whilst under investigation. A tragedy for all.

Psychological safety for NHS staff is critical for patient safety and every shiny new white paper will tell you this. But it is also critical for the NHS’s ‘ethical well being’ to care for it’s staff. If the NHS as an organization lets its staff suffer, how will it ever live with itself? The trauma will inevitably become endemic.

So what changes can we make to prevent suicide?

1. We could treat NHS staff as ‘innocent until proven guilty’ & eradicate ‘Name Blame and Shame’ Cultures.

2. Consider that poor behaviour may actually be ‘ill’ behaviour in need of medical treatment before disciplinary action takes place (Brooks et al, 2014).

3. Consider alternatives to discipline & create psychologically safe work cultures.

4.Expose investigation staff to front line clinical practice to understand organizational cultures and pressures.

5. Develop a tailor made national support programme for NHS staff which is confidential, anonymous and provides professional amnesty (The aim of my entire PhD research project)

Also… please keep the conversation going 🙂

Brooks, S, Del Busso, L, Chalder, T, Harvey, S ,Hatch, S, Hotopf, M, MadanHenderson, M (2014) ‘You feel you’ve been bad, not ill’: Sick doctors’ experiences of interactions with the General Medical Council BMJ Open 2014;Vol.4 (7) :e005537 doi:10.1136/bmjopen-2014-005537.

Chan, W., Batterham, P., Christensen, H., Galletly, C (2014) Suicide literacy, suicide stigma and help-seeking intentions in Australian medical students. Australas Psychiatry April 2014 vol. 22 no. 2 132-139

Goldney RD, Fisher LJ, Wilson DH (2002). Mental health literacy of those with major depression and suicidal ideation: an impediment to help seeking. Suicide Life Threat Behav 2002; 32: 394–403.

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A failing NHS… A self fulfilling prophecy?

“If you want others to be happy, practice compassion. If you want to be happy, practice compassion” (Dalia Lama XIV, The Art of Happiness).

I would firstly like to point out in this post that I am not a psychologist or psychiatrist, but I have always understood the power of the self fulfilling prophecy. It therefore baffles me how the media, political leaders and top think tanks can demonize the NHS front line staff by telling them that they are failing on a daily basis!

These sandbaggers continue to display a strategy, involving the false prediction or feigned demonstration of inability in NHS staff (Gibson et al, 2000). The danger is that NHS staff will begin to believe what they hear, and perhaps even become the terrible people they are being currently described as. Thus, the false prophecy will be fulfilled.

Negative press is inevitably damaging the self esteem of NHS staff, and low self-esteem in itself can become a self-fulfilling prophecy, leading staff to act in negative, unhelpful ways (Marshall et al, 2015). So why does this continue? Has nobody told them of the damage they are doing? (I think not!)

We all deserve compassion, and most of all, self compassion. Nobody goes to work to be mediocre or fail.

Self compassion is described as “being touched by and open to one’s own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness. Self-compassion also involves offering nonjudgmental understanding to one’s pain, inadequacies, and failures, so that one’s experience is seen as part of the larger human experience” (Neff, 2003).

When we are predicted lower performance we are more likely to actually perform worse – it works as a self-fulfilling prophecy.

The media and key leaders thus have the capacity to shape the confidence of NHS staff and influence their performance in both positive and negative ways. In particular, by showing that they believe in “our team,” leaders are able not only to make “us” a psychological reality, but also to transform “us” into an effective operational unit (Fransen et al, 2014).

So please, stop battering the NHS staff, but lift them up to believe they are the best thing ever! (which they are by the way)!

Give them a new prophecy to fulfill, and make it a good one.

Gibson, D.A. Sachau (2000) Sandbagging as a self-presentational strategy: Claiming to be less than you are. Personality and Social Psychology Bulletin, 26 (2000), pp. 56–70

Fransen, Katrien, et al. “Believing in “Us”: Exploring Leaders’ Capacity to Enhance Team Confidence and Performance by Building a Sense of Shared Social Identity.” (2014).

Marshall, Sarah L., et al. “Self-compassion protects against the negative effects of low self-esteem: A longitudinal study in a large adolescent sample.”Personality and Individual Differences 74 (2015): 116-121.

Neff, K (2003) Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2 (2003), pp. 85–102

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Should NHS Staff really ‘have’ to be resilient?

Firstly, I was very happy to see the issue of NHS staff stress and burnout recognized within the Lancet this week

Trawling through the literature this week and talking to colleagues, I find the word ‘resilience’ being thrown around as an offerable solution to stress. Resilience training has seemingly been offered as a tick box exercise to ‘equip’ staff with the right weapons to defend themselves, but should they have to be at war with the system?

‘Resilience is essential now for a nursing leader; you just won’t survive without it,’

Are we to be on guard at all times?

The word ‘resilience’ conjures up images of holding up the fort, guarding the gates and resisting some kind of attack. We are giving our warriors weapons for a fight.

So…after we have received our resilience training, are we expected to then cope?

Following any other form of NHS training, this would be the case. Training day = See one, do one, teach one…..right?

So, having been to resilience class, we no longer have any excuses NOT to cope…do we?

Suggesting that resilience is the remedy to cope with stressful situations, is to suggest that some people can cope, and others just cannot. ‘You either have it or you don’t’

Can it really be taught?

What if you have been to resilience training and you are still struggling?

With the stigma associated with ‘not coping’, the majority of clinicians will not feel able to seek help (Munro, 2011).

I am concerned that the focus of remedy seems to be based upon the resilience of clinicians and their abilities to cope rather than the fact that some of the things they have to deal with on a daily basis, should not be occurring in the first place. (Bullying, stigma, name, blame and shame cultures, punitive action and burnout etc..)!

There are obviously daily events which put a strain on our NHS workforce that are outside of any control. Can we ever prepare ourselves for coping with such things?

Sometimes, no amount of armor will protect us from the pain of experiencing a traumatic incident. Therefore, suggesting that there is a magic weapon to protect us from such things may be a dangerous thing.

One cannot fix the pressures of NHS work with training alone.

We all suffer from the condition of being ‘human’ – Should we ‘have’ to be resilient to a toxic work environment?

Or should the NHS be remedied to care for us when no amount of resilience training can catch us when we fall?

Resilience is a dangerous word with many connotations. There should be no bar set for what it takes to ‘cope’…the price of expectation is too high.

I would be interested to hear your thoughts on this – please see the support page if you have been affected by anything discussed within this article.

Munro, R (2011) Sick day scrutiny: as the NHS seeks to slash its 3 billion [pounds sterling] annual staff absence bill, nurses are facing tougher checks on leave taken; Nursing standard [0029-6570] Munro, Robert yr: 2011 vol:25 iss:18 pg:24

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7 Tips for Implementing culture change within the NHS: Contributions from Occupational Psychology

A shorter post from me today as I focus on a new report I have come across in my research. The British Psychological society has an amazing group of Occupational psychology experts which I felt would bring to light a new perspective on NHS staff well being.

The new report: Implementing culture change within the NHS: Contributions from Occupational Psychology presents a series of chapters by occupational psychologists, each drawing on evidence and expertise from the field to address the question of how this culture change can be implemented within the NHS. These tips are taken as a general overall structure of recommendations from the report.

  1. Implement a values-based recruitment for patient-centred care
  2. Effectively manage staff experience to improve organisational culture
  3. Ensure you have a work design for compassionate care and patient safety
  4. Effectively lead and manage high performing teams 
  5. Foster a continuous learning culture within the NHS
  6. Trust boards and governance: Improve Composition and behavioural styles
  7. Build cultures of transparency and openness  

Ultimately, the report embraces the concept that the psychological safety of NHS staff is critical for patient safety. The report clarifies the development of negative cultures within the system that erodes trust, openness and a just culture.

It suggests that the current NHS system drives organizational behaviour, and the tone of this behaviour is set at a senior level. Negative tones may lead to undue pressures and stresses within the NHS, which may in turn lead to NHS staff behaving counter-productively.

“Leadership predicts staff satisfaction, which in turn predicts patient satisfaction.”

The more staff we can empower to lead change and positive cultures, the better the outcomes will be. These staff want to set a positive cultural tone and promote positive organizational behaviours, but this must happen from the ‘edge’. key areas are still in need of improvement if we are to increase the levels of staff psychological well being.

Picking apart these organizational cultures seems to be filling up my thesis as I see it becoming a large part of why staff are broken and battered. New reports are being released almost on a weekly basis, illuminating new failings and seeing organizational cultures as the cause of poor behaviour.

These cultures are becoming viruses within our NHS, and whilst we are swamped by a fear of blame and failure, the NHS will not recover.