Factors Affecting Mental Health Professionals' Sharing of Their Lived Experience in the Workplace: A Scoping Review

Family-centered service through the eyes of insiders: Healthcare providers who are parents speak about receiving and providing healthcare in child health

BACKGROUND

When healthcare providers (HCPs) become patients, the experience affects their sense of identity, the care they receive, and their clinical practice. In child health, considerably less is known about the experiences of HCP-parents who access the pediatric healthcare system with their own children with disabilities and/or chronic medical conditions.

AIMS

This study aimed to examine the experiences of HCPs who have children with disabilities to identify their experiences with healthcare delivery.

METHODS AND PROCEDURES

A qualitative descriptive study was conducted with HCP-parents, using focus groups and open-ended interviews. Data were analyzed using reflexive thematic analysis.

RESULTS

For HCP-parents, the experience of having a child with a disability affects how they see themselves, their patients, service organizations, and the healthcare system in general. Having medical knowledge and access to networks brings both benefits and unique challenges. HCP-parents also have unique needs that are not currently being addressed. The lived experiences of HCP-parents can contribute to improving patient care. However, the value of this lived experience is unrecognized and underutilized.

CONCLUSIONS

The lived experiences of HCP-parents can contribute important insights regarding service delivery, and in particular regarding the application of Family-Centered Service.

Perspectives and Experiences of Stakeholders on Self-Disclosure of Peers in Mental Health Services

With the movement towards recovery-oriented mental health (MH) services, individuals with MH lived-experience are increasingly employed as peer providers (peers). Peers are unique in that they bring knowledge from experience and eye-level connection to service users that enhance the quality of services and humanize MH systems' culture. In Israel, hundreds of peers are employed in various roles and settings across the MH system. However, peer integration into MH services faces challenges. One issue involves the use of self-disclosure (SD) in MH services which varies with explicitness across roles and settings. This study sought to understand perspectives and experiences regarding peers' SD (use & sharing of knowledge from experience) among different stakeholders in MH health services. Six focus groups and 4 semi-structured interviews (N = 42) were conducted as a part of a larger international project (UPSIDES; ERC Horizon 2020, Moran et al., Trials 21:371, 2020). Data was transcribed verbatim and analyzed using thematic analysis. Four categories and 7 themes were identified regarding current perspectives and experiences with peers' SD in MH organizations: (i) Restrained or cautious organizational approach to SD; (ii) Attitudes of peers to SD approach; (iii) The influence of designated peer roles on SD; and (iv) Unwarranted SD of peers working in traditional roles. The findings reveal that peers' SD in MH services is a complex process. Organizational approaches were often controlling of non-designated peers' SD practices; participants had diverse attitudes for and against peers' SD; SD occurred according to personal preferences, specific peer role and the director's approach to peers' SD; Conflictual SD dilemmas emerged in relation to service users and staff. SD sometimes occurs unwarrantely due to ill mental health. The presence of peer-designated roles positively impacts peers' SD. We interpret the current mix of views and general conduct of peer SD practice in statutory MH services as related to three aspects: 1. The presence of a traditional therapeutic SD model vs. a peer SD model - with the former currently being dominant. 2. Insufficient proficiency and skill development in peers' SD. 3. Stigmatic notions about peer SD among service users and staff. Together, these aspects interrelate and sometimes create a negative cycle create tension and confusion.A need to develop professionalism of peer SD in statutory services is highlighted alongside enhancing staff and service user acknowledgement of the value of peer SD. Developing peer-designated roles can positively impacts peer SD in MH statutory services. Training, support, and organizational interventions are required to further support for peer-oriented SD and the enhancement of a person-centered and recovery orientation of MH services.

[Disclosure of Own Crisis And Treatment Experiences By Staff Of Psychiatric Institutions In BerLin And Brandenburg - An Underused Resource For Reducing Stigma?]

AIM

This article is part of the EKB-study which explores lived crisis and treatment experiences of mental health professionals in Berlin and Brandenburg. It addresses the disclosure of mental health workers' lived experiences in their workplace.

METHOD

An online survey was conducted among 182 mental health professionals, containing questions on disclosure of lived experiences. Data were analyzed descriptively and analytically.

RESULTS

Participants reported disclosure mainly to supervisors and affiliated colleagues. Experiences were mostly positive, with severe negative exceptions. Central motives against disclosure were fear of vulnerability, fear of compromising professional identity, and shame.

CONCLUSIONS

Disclosure of lived crisis experiences is not always the proper strategy for mental health professionals. Disclosure may be a means of reducing public and internalized stigma.

Nurses' career choice and satisfaction with mental health transition-to-practice programs: A cross sectional study

WHAT IS KNOWN ON THE SUBJECT?: There are significant issues recruiting nurses into mental health due to several reasons such as dilution of curriculum, and mental health being an unpopular career choice Transition programs provide nurses entering mental health with orientation, academic and clinical skills, and knowledge. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Transition programs need to be nuanced to specialty areas (e.g. community) to ensure nurses are given the support necessary to remain working in the field. Many nurses choose to work in mental health due to a lived or personal experience and as such strengthening wellbeing supports for transitioning nurses is an important role in retention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Tailored transition programs can help strengthen mental health nurse role clarity, and support staff retention. Transition programs should be a segue to formal postgraduate studies in mental health nursing to strengthen professional practice and retention of nurses.

ABSTRACT

INTRODUCTION: Globally, there are consistent issues recruiting staff into the mental health nursing workforce. In Australia, recent efforts to expand the workforce include recruitment of a wider range of nurses in addition to new graduates into mental health transition-to-practice programs. Understanding the career motivations of nurses entering the field is an important element of recruitment and retention.

AIM

To describe nurses' satisfaction with their mental health transition program and identify factors influencing their choice of mental health as a career.

METHODS

An online cross-sectional survey with questions on program satisfaction and career choice was responded to by n = 55 enrolled and registered nurses in a mental health transition program.

RESULTS

Nurses reported overall high satisfaction with their program and identified increased time release for professional development and being supernumerary as necessary to support role development. Almost 25% of nurses reported personal experience of mental illness as an influence in choosing a mental health career.

DISCUSSION

Mental health transition programs are important in recruitment and retention and need to be tailored to the needs of a wide range of nurses and include support for staff wellbeing.

IMPLICATIONS FOR PRACTICE

Tailored transition programs can help strengthen role clarity, and support staff retention.

Co-producing principles to guide health research: an illustrative case study from an eating disorder research clinic

BACKGROUND

There is significant value in co-produced health research, however power-imbalances within research teams can pose a barrier to people with lived experience of an illness determining the direction of research in that area. This is especially true in eating disorder research, where the inclusion of co-production approaches lags other research areas. Appealing to principles or values can serve to ground collaborative working. Despite this, there has not been any prior attempt to co-produce principles to guide the work of a research group and serve as a basis for developing future projects.

METHODS

The aim of this piece of work was to co-produce a set of principles to guide the conduct of research within our lived experience led research clinic, and to offer an illustrative case for the value of this as a novel co-production methodology. A lived experience panel were recruited to our eating disorder research group. Through an iterative series of workshops with the members of our research clinic (composed of a lived experience panel, clinicians, and researchers) we developed a set of principles which we agreed were important in ensuring both the direction of our research, and the way in which we wanted to work together.

RESULTS

Six key principles were developed using this process. They were that research should aim to be: 1) real world-offering a clear and concrete benefit to people with eating disorders, 2) tailored-suitable for marginalised groups and people with atypical diagnoses, 3) hopeful-ensuring that hope for recovery was centred in treatment, 4) experiential-privileging the 'voice' of people with eating disorders, 5) broad-encompassing non-standard therapeutic treatments and 6) democratic-co-produced by people with lived experience of eating disorders.

CONCLUSIONS

We reflect on some of the positives as well as limitations of the process, highlighting the importance of adequate funding for longer-term co-production approaches to be taken, and issues around ensuring representation of minority groups. We hope that other health research groups will see the value in co-producing principles to guide research in their own fields, and will adapt, develop, and refine this novel methodology.

Research Directions for Leveraging and Supporting the Lived Experience of Mental Illness within Psychology

This paper explores the lived experience of mental illness within the field of psychology across higher education and the mental health workforce. There is a high prevalence of mental health issues among psychology students and practitioners, and it is critical not only to provide support for these populations, but also to acknowledge the value of leveraging their lived experience within their education and practice. There has been increased interest in and advocacy for the involvement of those with lived experience of mental illness within mental healthcare service provision to improve patient experiences and outcomes. However, there have been limited acknowledgement and research regarding the role of psychologists with personal lived experiences of mental illness, and how to leverage this experience. Further, there are challenges faced by both psychology students and practising psychologists with lived experience that act as barriers to leveraging their unique skills and experiences. Psychology students with lived experience face stigma, inadequate support, and incongruence between the course material and their personal experiences. Similarly, practising psychologists with lived experience encounter stigma and isolation, indicating the need for a culture change that promotes transparency and understanding. The paper calls for research in five key directions to provide evidence that can be used to support and leverage lived experience in psychology.

Factors affecting knowledge of recovery-oriented practice amongst mental health nursing and medical staff working on acute mental health inpatient units

Over recent decades, the shift to recovery-oriented practice has been central to mental health policy. Despite this emphasis, mental health services can struggle to meet this expectation. This study explores the knowledge and attitudes in relation to the recovery-oriented practice of clinical staff working at an Australian acute inpatient mental health unit. The Recovery Knowledge Inventory (RKI) is a widely used self-report tool that assesses mental health professionals' knowledge and attitudes towards recovery; higher scores indicate higher levels of recovery knowledge and attitudes. Seventy-four staff members (44 nursing staff and 30 medical staff) completed the RKI via an online survey. The study has been reported according to the STROBE checklist for cross-sectional studies. The relationships between the RKI scores and a range of variables were considered using inferential statistics, including multivariate regression. Medical staff had higher mean RKI scores than nursing staff, although this did not meet the predefined threshold for a clinically significant difference. More years of mental health experience were associated with increased mean RKI scores for medical staff. This Australian inpatient staff cohort demonstrated higher mean RKI scores than have been observed in recent international studies of mental health professions. However, the recovery knowledge and attitude levels were disappointingly similar to those shown in earlier Australian research completed over a decade ago. Efforts are needed to further enhance the recovery knowledge of clinicians working in mental health inpatient units.

Researching the researchers: psychological distress and psychosocial stressors according to career stage in mental health researchers

Background

Although there are many benefits associated with working in academia, this career path often involves structural and organisational stressors that can be detrimental to wellbeing and increase susceptibility to psychological distress and mental ill health. This exploratory study examines experiences of work-related psychosocial stressors, psychological distress, and mental health diagnoses among mental health researchers.

Methods

This international cross-sectional study involved 207 mental health researchers who were post-graduate students or employed in research institutes or university settings. Work-related psychosocial stressors were measured by the Copenhagen Psychosocial Questionnaire III (COPSOQ III). Psychological distress was assessed using the Depression-Anxiety-Stress Scale-21 (DASS-21). Thoughts of suicide was assessed using an adaptation of the Patient Health Questionnaire-9 (PHQ-9). History of mental health diagnoses was assessed through a custom questionnaire. Pearson’s chi-square test of independence was used to compare mental health diagnoses and suicidal ideation across career stages. The association between work-related psychosocial stressors and psychological distress was conducted using multivariate linear regression controlling for key demographic, employment-related and mental health factors.

Results

Differences in ‘demands at work’ and the ‘work-life balance’ domain were lowest among support staff (p = 0.01). Overall, 13.4% of respondents met the threshold for severe psychological distress, which was significantly higher in students compared to participants from other career stages (p = 0.01). Among the subgroup of participants who responded to the question on mental health diagnoses and suicidal ideation (n = 152), 54% reported a life-time mental health diagnosis and 23.7% reported suicidal ideation since their academic career commencement. After controlling for key covariates, the association between the ‘interpersonal relations and leadership’ domain and psychological distress was attenuated by the mental health covariates included in model 3 (β = −0.23, p = 0.07). The association between the remaining work-related psychosocial stressors and psychological distress remained significant.

Conclusions

Despite working in the same environment, research support staff report experiencing significantly less psychosocial stressors compared to postgraduate students, early-middle career researchers and senior researchers. Future research that targets key modifiable stressors associated with psychological distress including work organization and job content, and work-life balance could improve the overall mental health and wellbeing of mental health researchers.

Supporting the Sharing of Mental Health Challenges in the Workplace: Findings from Comparative Case Study Research at Two Mental Health Services

Personal experience with mental health (MH) challenges has been characterized as a concealable stigma. Identity management literature suggests actively concealing a stigma may negatively impact wellbeing. Reviews of workplace identity management literature have linked safety in revealing a stigma to individual performance, well-being, engagement and teamwork. However, no research to date has articulated the factors that make sharing MH challenges possible. This study employed a comparative case study design to explore the sharing of MH challenges in two Australian MH services. We conducted qualitative analyses of interviews with staff in direct service delivery and supervisory roles, to determine factors supporting safety to share. Workplace factors supporting safety to share MH challenges included: planned and unplanned "check-ins;" mutual sharing and support from colleagues and supervisors; opportunities for individual and team reflection; responses to and management of personal leave and requests for accommodation; and messaging and action from senior organizational leaders supporting the value of workforce diversity. Research involving staff with experience of MH challenges provides valuable insights into how we can better support MH staff across the workforce.

Moving Toward a Human Rights Approach to Mental Health

The University of Florida Counseling and Wellness Center (UFCWC) has implemented peer support and professional training programs to address human rights identified within advocacy groups comprised of individuals who have, themselves, been diagnosed with mental illness. These programs are moving the UFCWC toward fulfilling a 2017 United Nations report emphasizing rights-based professional training, provision of genuine informed consent, and availability of non-compromised peer support alternatives. Collaborating with student peers, four UFCWC faculty members have facilitated forms of peer support developed within service-user movements, while openly identifying experiences of reclaiming their own lives from the impacts of adversity, intense mental distress, and traumatizing responses of others to their distress. In the wake of the current pervasive health, economic, and social justice crises, professionals have a collective opportunity to recognize the human experience and rights of those suffering mental distress. These UFCWC programs offer one example of steps taken toward that goal.

Healthcare professional disclosure of mental illness in the workplace: a rapid scoping review

BACKGROUND

Although mental health difficulties are common among healthcare professionals (HCP), little research exists exploring the decision to disclose these difficulties in the healthcare context.

AIMS

This rapid scoping review aims to explore HCP disclosure of mental health difficulties in the workplace.

METHODS

The methodological framework was based on rapid and scoping review guidelines. A thematic synthesis approach was used for data analysis.

RESULTS

Seventeen articles were included. Disclosure was found to be a process that starts with weighing its pros ("personal benefits", "personal beliefs", and "professional responsibility") and cons ("fears related to professional identity", "fears related to employment", "risk of stigmatization", and "personal experiences with mental health difficulties"). A decision-making process then occurs to help HCPs figure out how to disclose. Situations of nonconsensual disclosure can transpire through "third party disclosure" or "inadvertent disclosure". Disclosure results in outcomes including "positive experiences", "negative personal consequences" and "negative consequences related to others".

CONCLUSION

Disclosure in healthcare and other workplaces is a complex process with few benefits and many potential repercussions. However, there is an opportunity to improve. Recognizing the value of and educating the workforce about HCPs with mental health difficulties will help work environments become safer for disclosure.