A new review, published in Psychiatric Services in Advance, explores what enables and prevents mental health professionals from sharing their own struggles with emotional distress and mental health issues in the workplace. The researchers highlight a “culture of nondisclosure” as being implicated in what keeps mental health professionals from sharing their lived experiences. They describe how creating a workplace culture where disclosure is accepted could allow for improved workplace well-being and diversity, which in turn could positively affect the treatment experiences of the clients they serve.
Researchers, led by Alicia J. King of La Trobe University in Melbourne, write, “. . . a pervasive culture of nondisclosure exists in regard to MHPs [mental health professionals] sharing their own lived experience. The inability of MHPs to discuss their own experiences in the workplace has been identified as both a cause and an effect of stigmatizing beliefs among MHPs.”
Stigmatizing beliefs about individuals experiencing emotional distress prevents them from seeking out professional care and can also lead to a sense of demoralization, or the experience of oneself as damaged. Sadly, such stigmatizing beliefs about emotional distress are held by mental health professionals – the very individuals educated and trained to help those experiencing mental distress.
Mental health professionals who hold stigmatizing beliefs are more likely to predict negative outcomes for their clients, overdiagnose them, socially distance themselves from their clients, and communicate a sense of hopelessness and deviance that is then internalized by their clients. A scale was recently developed to measure treating professionals’ perceptions of their clients to better assess the beliefs professionals hold about their clients.
Mental health stigma and discrimination has been linked to biomedical models of mental illness that dominate Western psychiatry, providing insight as to why those tasked with treating mental health issues may hold these beliefs. As a result, others have argued in favor of psychosocial models as a potential remedy, as they have been shown to reduce stigma in regards to particularly stigmatized mental health issues, such as psychosis.
Yet, despite potentially holding stigmatized beliefs, mental health professionals are not less likely than the general population to experience emotional distress – to the contrary, lived experience of emotional distress may inspire some individuals to enter into the mental health field. In fact, others have pointed to how lived experience can be useful when teaching in the mental health field, as it may help to reduce stigma, among other benefits.
Unfortunately, self-disclosure by professionals within mental health settings is mostly discouraged. This, in turn, both contributes to and is a result of stigma in the workplace, and causes a further division between clients and treating professionals – or what the researchers refer to as an “us and them” divide.
The researchers highlight how contact-based interventions have been found to be effective in reducing stigma and allow for treating professionals to become more comfortable with sharing their own experiences of mental health issues or emotional distress. Such interventions can enable professionals to gain an understanding that emotional distress is a spectrum – that we all experience distress at times, and that it is not relegated to only those in the “client” or “patient” role.
In the current study, researchers reviewed 23 studies that investigated the attitudes held by mental health professionals related to disclosing their lived experience of emotional distress and mental health issues to colleagues and their supervisors. In their investigation, researchers identified a number of themes prevalent in mental health settings that both prevent and encourage disclosure to colleagues and supervisors by treating professionals.
Researchers highlight the theme of the “impaired professional” as being particularly evident in workplace settings that discouraged clinician disclosure. In these settings, treating professionals received direct or indirect communications that experience of emotional distress or lived experience of mental health struggles is not appropriate and should not be disclosed. The studies demonstrate how fears of being discriminated against or being perceived as incompetent or as a liability prevented mental health professionals from feeling comfortable opening up about their struggles.
The researchers quote a participant in one of the studies that illuminate concerns of perceived incompetence:
“Some supervisory and administrative staff were dismayed by my self-disclosure and expressed concern (though not directly to me) about my ability to do my job adequately, despite this never before having been a question.”
The “us and them” divide was also identified as an inhibitor to self-disclosure in the workplace, with treating professionals feeling as if they cannot be both a professional (us) and someone who struggles with mental health issues/emotional difficulties (them). Stigmatizing language and stereotypes about emotional distress and mental health issues were found to contribute to this divide, on both the side of treating professionals and clients, who in some studies were found to be suspicious of mental health professionals who self-disclosed.
On the contrary, a major theme that contributed to mental health professionals feeling comfortable and even encouraged to self-disclose in the workplace was that of the “wounded healer.” The term “wounded healer” reflects a recognition of the beneficial nature of using one’s suffering as a way to relate, empathize, and engage in work with clients.
A participant in one of the studies reviewed describes quite a different environment from the nondisclosure workplace settings discussed above:
“My current employer recognizes that many providers in our field are also survivors and have stories to share. The employer invites a dialogue about recovery and offers these stories to be shared with clients as supportive outreach.”
Additionally, the belief that emotional distress is a continuum or spectrum also contributed to treating professionals sharing lived experiences in the workplace. In some of the studies reviewed, workplaces that fostered this belief even provided training wherein a continuum model of emotional distress was presented and taught to staff members.
An open environment wherein professionals are encouraged to share their stories supports staff well-being and a recognition of the humanness of professionals. The researchers write:
“Having a workplace culture that is open, inclusive, and generally supportive of staff well-being reflects an acknowledgment of staff as human beings with emotional needs in the workplace.”
Researchers also examined the internal struggles related to considering self-disclosure by mental health professionals. They describe experiences of treating professionals who felt as if they had separate internal identities – a professional identity and a client identity.
Researchers bring attention to the fears expressed by some treating professionals surrounding self-disclosure, which were, at times, based on past experiences of being discriminated against and stigmatized. Yet, despite this, the researchers describe how many treating professionals felt a sense of pride in their lived experience, recognizing it as a benefit to their work with clients.
Mental health professionals actively experiencing emotional distress expressed fears of being perceived as “impaired professionals,” – which prevented some from disclosing their distress, while on the other hand, motivated others to self-disclose, citing an ethical duty to inform their coworkers and supervisors of their struggles.
The review suggests that physicians are less likely than psychologists to disclose lived experience, citing the culture of distance and objectivity that is prominent in medicine as the probable cause. Women were also found to be more likely to self-disclose than men, which may be reflective of societal gender norms and expectations. Further, how invested the individual is in their professional identity also influenced whether professionals were more likely to disclose experiences of emotional distress. Researchers also identify the desire for authenticity and to challenge stereotypes as being motivating factors in clinician self-disclosure.
Although researchers only reviewed 23 research studies, reflecting a limitation of this research, the findings provide the groundwork for future research into the barriers to and benefits of self-disclosure in the workplace – both for treating professionals and for the clients they serve.
The researchers conclude:
“This review underscores the many reasons MHPs choose to stay ‘in the closet’; however, it also highlights the many ways employers, supervisors, and colleagues can create workplaces where sharing lived experience becomes possible. Stigma, as a socially constructed phenomenon, can be deconstructed by breaking down the ‘us and them’ barrier and acknowledging the reality that we are all more alike than we are different.”
King, A. J., Brophy, L. M., Fortune, T. L., Byrne, L. (2020). Factors affecting mental health professionals’ sharing of their lived experience in the workplace: A scoping review. Psychiatric Services in Advance. DOI: 10.1176/appi.ps.201900606. (Link)