Disclosure at Work in Mental Health

I work as a mental health professional in an inpatient setting. As a former patient (not at the hospital where I work) and as someone who lives with depression (currently in recovery) I have a lot of knowledge and experience that my coworkers don’t. This knowledge of the mental health system from the inside allows me to be more helpful to and better understand certain patients. It makes me better at my job! But I am not “out” at work as a person living with mental illness. My co-workers don’t know about my past.

I love my coworkers. The majority of them are very kind, caring people. I wish that I could comfortably tell them about my history of mental illness. But I can’t. Some people reading this will probably think that I am being paranoid, that my coworkers would be perfectly accepting of me and that my past would be no big deal to them. Some of my coworkers WOULD be supportive, but the fact is that there are also people who would react negatively. People who would feel threatened by me, who would begin to question my judgment and my abilities. If you don’t live with a mental illness the stigma of and discrimination associated with mental illness is probably difficult for you to see. Just like white people tend to “not see” racism and sometimes deny that it exists because it’s not happening to them, people who have not lived with severe mental illness often do not see the stigma and discrimination that happens, even perpetrated by well-meaning people. I want to open your eyes.

I have been reading an excellent book called “Consumers as Providers in Psychiatric Rehabilitation” by Mowbray, Moxley, Jasper, and Howell (1997). In their introduction to the section on disclosure (which includes four personal stories of mental health professionals disclosing at work) the editors write that, “The authors illustrate the costs involved in disclosure: loss of status within an organization, discrimination by colleagues, ostracism, lowered expectations for performance held by supervisors, and disbelief that one can actually perform well in a mental health role.” (p. 277). All of the authors describe experiencing some discrimination and negative reactions at work, but the experience of Barbara (a social worker in an inpatient mental health setting) is especially horrifying. She writes that, “My decision to disclose my illness to some of my co-workers proved to be irreversible and a major mistake. Instead of being considered as a team member with valuable insight, I began to be regarded with suspicion… I had not anticipated the material for gossip I would provide. Often when I stated an unpopular opinion or made a legitimate complaint, I was accused of being delusional and even of hearing voices, although this has never been a part of my condition…With regard to my mental disorder, an almost mass hysteria developed: staff pretended they were afraid of me.” (p. 302-303). These accounts are scary, and the injustice these people faced makes me angry, but they also validate my experiences. I am optimistic, but I have good reason to be cautious.

Why do some mental health professionals react like this? Likely because they want to believe that they are somehow fundamentally different from their clients. They know how much suffering mental illness can cause so they want to believe that it can’t happen to them. Discovering that a coworker, a “professional,” has mental illness challenges their beliefs and makes them uncomfortable and afraid. It requires that they view patients as people who have roles beyond just that of “patient”. These attitudes seem most prevalent in inpatient settings where the patients may be low-functioning and/or in crisis. I think they are less prevalent among outpatient therapists who work more in-depth with their clients because they also see them when they are functioning well, not just when they are in crisis.

I do plan on disclosing to my coworkers eventually, but I want to be strategic about it and do it in the best way. The first step was earning my coworkers respect and trust. Once I had made myself known as a competent, reliable person at work I began to mention to some coworkers that I have experienced mental illness. So far it has gone ok, but my coworkers have no idea yet how severe my illness really was. It will be a gradual process. And I hope that disclosing will not be an irrevocable mistake.

People talk openly at work about their personal health issues such as weight loss, blood pressure, arthritis, cancer, and diabetes. I wish that I could talk about my depression like that at work, casually say “my depression is flaring up today” like someone would say “my arthritis is flaring up today” and have it be no big deal, because while I may not be feeling my best that day I am not going to let it affect my job performance!

Sometimes at work I feel like a fake, a crazy person pretending to be well who has secretly infiltrated the other side. I feel stuck in the middle. Whose side am I on? Who do I empathize with? Who do I stand up for? The patients’ or my coworkers’? I am both a professional and a client, and I am constantly managing, balancing these two parts of me. I know that I will make some people uncomfortable, but I will inspire others. I exist. I am here to help. And I am not going away.