Put an end to stigma

Relationships between mental healthcare providers and clients can be shaped by the rigours of the job itself, says Sara Munro.

Relationships between mental healthcare providers and clients can be shaped by the rigours of the job itself, says Sara Munro.

Research has shown that public attitudes towards those of us with mental health problems are improving. However, there is a long way to go before no one has to face stigma and discrimination because of their mental health problem. One in three people say they have faced stigma within mental health services. This has to change.

I know from my own experiences, both personally and professionally, that many people choose to work in mental health services because they want to make a difference. However, the stats speak for themselves, with feedback from patients, carers and staff who work in mental health services showing that negative attitudes do exist among the positive ones.

Regardless of whether you work in mental health services, people develop attitudes in the same way: through early experiences, the media, socialisation and stereotyping. Having said that, there are also influences that arise from working in this sector that can impact on staff attitudes towards patients.

There are many things that affect our attitudes towards mental health, including personal and family experience of mental health problems, work stress and burnout, support to cope with the demands of the job, and stressful experiences at work, including disruptive behaviour among patients, and suicide.

I have heard staff talk about coping after a patient they have cared for has taken their own life, and the sense of responsibility this brings. Sometimes this can cause staff to withdraw from relationships with patients as they try to protect themselves from further distress. Similarly, when caring for someone who repeatedly self-harms, staff can feel a sense of failure for not intervening sooner and preventing the destructive behaviour from happening. In the same way that family members may think they should have done something, mental health staff will also focus on ‘what did I do wrong?’ or ‘what did I miss?’. These can be difficult thoughts and emotions for anyone to deal with, which are compounded by a job in which staff frequently work with people in distress.

This can have a subtle impact on the way staff work, and feedback from patients suggests that some staff come across as dismissive of their concerns or difficulties, and in some cases they come across as critical. If staff feel unable to deal with, cope with, or respond to, someone who is distressed, they may personalise the behaviour rather than see it as a sign of distress, and not offer help and support in a compassionate manner.

Better understanding

Negative experiences of mental health services mean that people may not feel able to ask for help in the future, and can be left feeling that they have done something wrong and, therefore, cannot be helped. Obviously, people not getting the help they need as soon as they need it impacts on their recovery in the longer term.

Mental health care is based primarily on the relationships between patients and care providers. Staff need to have the right support to maintain positive attitudes. Well-supported staff will provide much better support for patients.

To start making a difference we need to have a culture in place that focuses on the relationships between patients and staff, and recognises the impact this has on both parties. Such a culture would enable staff to speak out about their own personal and family experiences, and to get training and support to better understand the experience of patients.

This approach is about focusing on the person rather than the mental health problem or behaviour. Some good examples include:

  • Employing people who use mental health services.
  • Ensuring that staff training is delivered in part by people with their own experience of mental health problems and their carers.
  • Having regular and meaningful supervision and support for staff to prevent stress and burnout.
  • Providing good role models and leadership.

Time to Change, the mental health anti-stigma campaign run by the charities Mind and Rethink Mental Illness, has launched a pilot project to look at what can be done to improve people’s experiences when using mental health services. Also, the campaign is launching a training package in partnership with NHS England to help mental health professionals identify these problems and improve their own practice.

Throughout the project, insight and advice has been gathered from people who work in, and those who use, mental health services. They have advised on materials for the training resource and given feedback on the approach to take. The materials are for mental health professionals, but are shaped by examples from people who use services.

Find out more

More information is available at Time to Change professionals area

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