Honest, open, proud

Ella Rhodes reports on the latest from the Collaborative Learning Network, on mental health disclosure.

Two surveys that revealed a high prevalence of significant mental health problems among clinical psychologists and trainees, as well as a fear of disclosing them, have led to a follow-on project conducted by the Unit for Stigma Research at University College London. The new centre is running a trial intervention aimed at supporting psychologists and other mental health professionals in reaching careful decisions about disclosure of any current or past mental health problems.

The two surveys, by UCL with support from the British Psychological Society’s Division of Clinical Psychology, showed around two thirds of clinical psychologists in the UK had experienced significant mental health problems. Further research into rates among trainee clinical psychologists revealed similarly high rates, with depression and anxiety the most commonly reported issues but with the full range of problems represented.

Around this time, following the introduction of an annual Wellbeing Survey, the BPS and New Savoy Conference developed a Charter for Psychological Staff Wellbeing and Resilience. Its implementation has been led by a Collaborative Learning Network (CLaN), chaired by Amra Rao, Chair of the BPS Leadership and Management Faculty, and Jeremy Clarke, Director of the New Savoy Conference. Several pathfinder sites for the CLaN have been selected, each focused on the wellbeing of mental health professionals – the new UCL project is one of these.   

We spoke to Dr Katrina Scior, Senior Lecturer in Clinical Psychology, and Chair of the new UCL Unit for Stigma Research. UCLUS brings together two distinct areas of stigma research: tackling the traditional taboo of mental health professionals disclosing their own lived experience of mental health problems, and research on the stigma associated with intellectual disability.   

As a stigma researcher, Scior said the high incidence of lived experience reported in the two UCL surveys left her feeling uncomfortable about a general reluctance to talk about our own vulnerabilities and tackle mental health stigma within clinical psychology and other mental health professions: ‘We ran those two surveys and came out with findings I think are pretty surprising. Around 11 per cent said they’d never disclosed their experience of mental health problems to anybody, and the vast majority hadn’t talked about them in their workplace because they were worried about what others might think of them.’ She added that with a prominent focus on concepts such as ‘resilience’ and ‘robustness’, mental health professionals and those in training or seeking to enter training are often worried about being seen to lack these attributes.

Scior and her colleagues have subsequently adapted an intervention for clinical psychologists and other mental health professionals to try to encourage more open conversations about lived experience among mental health professionals: ‘We want to tackle the fact it’s taboo and that there’s still stigma attached to that within our own profession. We’re hoping to actively support people in thinking about whether they might want to disclose their lived experience, how they might want to go about that, with whom, and in what context.’
The Honest, Open, Proud (HOP) programme was originally designed as a group intervention for people with lived experience who want to think about talking to others about their experience in a safe and empowering way. However, given the taboo of disclosure among psychologists, Scior and her colleagues adapted the programme into a self-help manual and renamed it HOP-MHP (HOP for mental health professionals). This version will be tested in a pilot randomised control trial beginning this month and running till Christmas.
Those who take part in the HOP-MHP arm of the trial will receive a self-help guide consisting of three sessions. The first session asks people to weigh the pros and cons of disclosing, using exercises and worksheets; the second helps them consider different contexts and levels of disclosure – from telling a trusted colleague, to giving a talk in a public setting; the final session, gives ideas for how to tell one’s story in a way that is personally meaningful and safe. Those who still decide not to disclose at this point are given space to think about their decision and its implications.

Scior said there is a second important aspect to the programme: ‘Changing this intervention to a self-help model removed the elements of peer support that are central to the original HOP programme, so we’re setting up a web-based peer support forum. It’s a closed, anonymous forum that anyone who joins the HOP-MHP trial can sign up to and use to discuss their experiences, thoughts and information about other resources with peers.’

Scior said she had been struck by how very interested people had been in their group’s research and the new HOP-MHP project. ‘People feel it’s needed. Kat Alcock and I presented the results of our trainee survey at last year’s Group of Trainers in Clinical Psychology conference. When we showed that around 29 per cent of trainees were currently experiencing a significant mental health problem, quite a few chins in the room dropped, including colleagues who have been in the training area for 20 or 25 years.’

Away from psychology, members of the Royal College of Psychiatrists, those involved in the IAPT programme, and the Royal College of Nursing have all said these issues are highly relevant in their fields. Once the pilot has been completed, and if it is shown to be of benefit to those using it, Scior said she hopes to run a larger trial involving psychiatrists, nurses and psychological wellbeing practitioners, and eventually make the HOP-MHP freely available to all mental health professionals.

To find out more about UCLUS see https://www.ucl.ac.uk/pals/research/cehp/stigma-research
For a discussion on disclosure see tinyurl.com/kbgq6tj For more on CLaN see tinyurl.com/ybr4a98q

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