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

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

Am I too late to the ‘NHS staff wellbeing research’ party?

I began this research journey because I saw an opportunity to make a positive contribution to the healthcare community (and gain a PhD)! I believed that NHS Staff wellbeing was an under researched and undervalued subject (and it is to a large extent). When I began my time at Coventry University, I presented my research proposal to a group of peers at the West Midlands Health Informantics Conference just before Christmas 2014. My ideas were met with enthusiastic conversations and praise for my work, people were excited that it was happening, it was ‘new’.

Then of course I begin to delve into the literature and start to see a plethora of papers and super duper academics who have introduced me to this wondrous world. I see TV snippets, twitter conversations, national and local conferences, action groups and new research on the topic. Am I too late to the party?

What I plan to do has never been done before, but I know that many people have had the same idea. Will it be a race to publish? I hope not. I hope I can find similar minded people to drive forward this positive movement forward, collectively. We should all be in this together, making change happen through collective leadership and a shared passion for the wellbeing of NHS staff. I do worry that I am not really contributing towards new knowledge, but I must keep focussed on the end goal (and beyond the PhD)!

The most refreshing thing is the open discussions being generated through twitter – The next one I will be involved with is on the 11th March, 2015 hosted by WeDocs using #WeDocs – Preventing suicide in NHS staff

This new research is inspiring and I would like to share it:

Wilkinson, M (2015) UK NHS staff: stressed, exhausted, burnt out. The Lancet Volume 385, No. 9971, p841–842, 7 

Sheen, K, Slade, P, Spiby, H (2014) An integrative review of the impact of indirect trauma exposure in health professionals and potential issues of salience for midwives. Journal of Advanced Nursing. Volume 70, Issue 4, pages 729–743, April 2014

Implementing culture change within the NHS: Contributions from Occupational Psychology