Motivation and emotion/Book/2021/Lived experience in mental health professionals

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Lived experience in mental health professionals:
What is the role of lived experience for mental health professionals?

Overview[edit | edit source]

Figure 1. Mental health professionals are not immune to mental health problems or mental illness.

There have been significant shifts in mental health care intervention over the last 40 years (Drake et al., 2003). Although, understanding mental health, disorders and effective treatment continues to evolve (Drake et al., 2003). The voices of those with lived experience have been and continue to be, influential to this process particularly regarding advocacy efforts for rights-based changes to the mental health system (Probert, 2021).

Current evidence suggests that mental health professionals are not immune to mental health problems or mental illness (Elliott & Ragsdale, 2020) and many professionals have reported seeking psychotherapy at some point (Victor et al., 2021)(Figure 1). This chapter explores the growing research of lived experience from a mental health professional perspective (King et al., 2020) and associated benefits and challenges that lived experience has for mental health professionals.

Focus questions:

  • What is 'mental health' and 'lived experience'?
  • Do mental health professionals experience mental health problems or mental illness?
  • How are mental health professionals affected by mental health and what are the implications?

Mental health[edit | edit source]

According to the World Health Organisation (WHO), mental health is a state of well-being in which an individual realises:

  • their own abilities
  • they can cope with the normal stresses of life
  • they can work productively
  • they are able to make a contribution to their community.

Mental health is considered to be more than an absence of illness, it is said to be central to functioning and life enjoyment as individuals and as a society (Gilmour, 2014). Further, to be mentally healthy, it is argued that there needs to be a combination of emotional, psychological, and social well-being (Westerhof & Keyes, 2010).

Mental health and mental illness are said to be related however separate (Westerhof & Keyes, 2010) . The concept of mental illness, like physical illness, encompasses a broad range of conditions such as brain diseases and disorders which explain mental and behavioral disturbances, bound by the jurisdiction of psychiatry (Insel & Wang, 2010)

WHO indicates it is of high importance to promote, restore and protect mental health on an individual and societal level (Gilmour, 2014).

History[edit | edit source]

Figure 2. 'Forms of restraint for the mentally ill'.

Historically, mental health and mental illness was conceptualised in a very different way. Personal rights aside, patients were often subject to treatments (Figure 2) including heavy sedation and electroconvulsive therapy. Lobotomy was also commonly performed tin the 1900s to calm and control violent or emotional patients. This was achieved by first shocking patients in to a coma followed by a surgeon hammering a tool much the same as an icepick through the top of eye sockets to sever nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain. Results of lobotomies ranged from poor impulse control, absence of feeling, patients that were unnaturally calm and shallow and death. After subjecting tens of thousands of people to this procedure worldwide eventually this was replaced with the introduction of psychoactive drugs (Foerschner, 2010).

It was assumed that people with mental illness:

  • had no capacity to look after themselves
  • should be separated from the rest of society
  • were people considered ‘dangerous’
  • should live in gaol or asylums
  • some were considered "insane" and seen to be responsible for their illness due to moral weakness and personal deficiency. (QLD Health).

With the introduction of medications to control symptoms ,eventually there was a human rights movement to deinstitutionalise people however, this led to other problems including high rates of homelessness and incarceration (Foerschner, 2010).

Figure 2. Australian mental health policy requires involvement from those with lived experience at all levels of the mental health system.

Lived experience[edit | edit source]

There is a lack of consensus in defining 'lived experience' although previous literature has focused on individual experiences relating to diagnosis, service-use and life-changing effects of mental health challenges (Roenndfeldt & Byrne, 2020).

A lived experience perspective is an understanding of mental health based on having:

  • experienced mental illness
  • cared for someone with mental illness
  • received, or being unable to receive, services in the mental health system.

Lived experience is based on a belief that consumers and carers are "the experts" about their own lives and carry the wisdom to best articulate their needs' (Mental health lived experience framework, 2019).

Figure 2. Australian mental health policy requires involvement from those with lived experience at all levels of the mental health system.

Focus questions:

  • How has lived experience shaped mental health care?
  • What impact does lived experience have on the work of mental health professionals?
  • What factors affect disclosure?

Significance of lived experience[edit | edit source]

Figure 3.The voices of those with lived experience has assisted change

The human rights movement evolved in some countries and it has eventually been recognised that the voices of people with lived experience themselves were required to create change.

Mental health service design, delivery and evaluation[edit | edit source]

Those with lived experience have been actively and more increasingly involved in the design, delivery and evaluation of mental health services (Nilsen et al., 2013 cited in Scholz et al., 2017).

Examples include:

  • balance of power shifted to place mental health service users on an equal footing with professionals
  • it was recognised that mental health consumers have their own expertise in their knowledge of mental illness
  • health policy began to support the active participation of consumers, families and carers in all aspects of policy, planning and services.

(The road to recovery - a history of mental health services in Queensland 1859-2009)

Recovery approaches[edit | edit source]

Figure 4. Lived experience has shaped recovery approaches.

With the consumer movement and recognition of lived experience, Recovery approaches were developed as an alternative to the medical model which had an emphasis on pathology, deficits and dependency. Central to all recovery paradigms are hope, self-determination, self-management, empowerment and advocacy. Also key is a person's right to full inclusion and a meaningful life of their own choosing, free of stigma and discrimination.

Some characteristics of recovery commonly cited are that it is:

  • a unique and personal journey
  • a normal human process
  • an ongoing experience and not the same as an endpoint or cure
  • a journey rarely taken alone
  • nonlinear—frequently interspersed with both achievement and setbacks.

The principles of recovery-oriented mental health practise have been introduced in some countries to ensure that mental health services are delivered in a way that supports the recovery of mental health consumers and meets national standards.

Workforce[edit | edit source]

Lived experience has increasingly emerged as being desirable, sought after qualities in the workforce as an alternative to the traditional mental health worker role and is even considered best practice (Roennfeldt & Byrne,2020). Workers with lived experience have specialised knowledge and skills of mental health challenges, service engagement and recovery, unique in supporting mental health consumers (Roennfeldt & Byrne, 2020). Evidence indicates that workers with lived experience are just as effective at supporting consumers as traditional mental health workers (Roennfeldt & Byrne, 2020). However, there are still challenges for those with lived experience in these settings. For example, findings suggest that organisational health settings need to create cultural norms that are more inclusive and empowering of those with lived experience to improve the benefits of partnership and fulfilling policy expectations, and with non-consumer health professional allies (Scholz et al., 2020).

Education[edit | edit source]

To reinforce the importance of lived experience-driven change, it is suggested that those with lived experience are in the best position to genuinely understand, explain, and convey stories of the very internal, individual and unique processes of recovery that cannot be seen or understood from an observer. Further, it is indicated that those who have struggled then overcome mental distress are in an ideal position to teach others about these issues including challenging mental health professionals who hold stigmatising views and increasing consumer participation (Byrne et al., 2012). Research findings suggest that student nurses were positively influenced by recovery concepts taught by an academic who had lived experience of significant mental health challenges and thus recommendations were made to utilise educators with lived experience as an educational strategy (Byrne et al., 2012).



"From the perspective of the individual with mental illness, recovery means gaining and retaining hope, understanding of one's abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life, and a positive sense of self. It is important to remember that recovery is not synonymous with cure. Recovery refers to both internal conditions experienced by persons who describe themselves as being in recovery – hope, healing, empowerment and connection – and external conditions that facilitate recovery – implementation of human rights, a positive culture of healing, and recovery-oriented services". (Jacobson and Greenley, 2001, p.482)

Science and lived experience[edit | edit source]

WORK IN PROGRESS

  • What theories guide researchers in the field of lived experience?
  • How does lived experience contribute to psychological science?
  • Recovery Colleges (Australian Study) = https://doi.org/10.1111/nhs.12637
  • Phenomenology:
    • Is the study of human experience and the meaning that is derived from lived experiences which are considered subjective and interpretive
    • The European perspective of Transcendental phenomenology assumes that knowledge comes from insight and is interpretative rather than objective (Husserl).
    • The North American approach of phenomenology focuses on the meaning made from experiences via the mental processes (Denscombe, 2010)

Lived experience and mental health professionals[edit | edit source]

[Provide more detail]

Types of mental health professionals[edit | edit source]

Figure 5. Mental health professionals with lived experience are called 'prosumers'.

There are many types of health professionals who work in mental health care including:

There are mental health professionals who have a lived experience of mental illness and they are referred to as "prosumers" (Boyd et al, 2016).

Types of mental health challenges in mental health professionals[edit | edit source]

WORK IN PROGRESS

Mental health professionals are not immune to mental health problems (Elliott & Ragsdale, 2020). Sharing personal journeys of lived experience publicly aims to promote understanding, empathy, hope and recovery as well as fight stigma and discrimination amongst prosumers (Vierthaler & Elliott, 2020).

Journal articles:

  • Psychologists - working in mental health perceived as satisfying however negative affect can result from work with clients, linked to burnout and distress (Scibberras & Pilkington, 2018).
  • Psychologist - depression with mania and psychosis (Vierthaler & Elliott, 2020).
  • Psychiatrist - bipolar disorder with attacks of mania, depression and psychosis (Freisen, 2020).
  • Psychologists - non-suicidal self injury (Victor et al., 2021).

Case study Nuvola apps package wordprocessing.png

True story: Juli was receiving treatment for depression during her undergraduate degree in psychology. She was a registered psychologist and had been practising for a number of years when she experienced her first manic episode which lasted for 3 months. She was ill and did not realise it. As a dedicated psychologist, she was now experiencing acute mental health needs, yet was apprehensive to disclose her experiences or seek help due to concerns about the professional risk to do so. With support from close colleagues, Juli eventually sought treatment.

"Disclosure has not stopped me from working for a large health care system, being an Assistant Professor and Director of Clinical Training, and serving as the board president of a non-profit focused on suicide prevention...(disclosure) was and continues to be the most powerful and courageous thing I have done in the field..." - Juli' (Vierthaler & Elliott, 2020).

"For those we treat to trust in us, we ourselves need to trust in what we promote. Individuals with mental health struggles can and do recover" (American Psychological Association & Jansen, 2014, cited in Vierthaler & Elliott, 2020).

Barriers and challenges[edit | edit source]

Mental health professionals with lived experience have expressed a state of disharmony with regard to their identities as both professional and service-user further affecting the combining of their clinical and experiential knowledge (King et al., 2020). A culture of non-disclosure exists for mental health professionals in workplaces and five themes have been identified that contribute to stigmatising attitudes and behaviour (King et al., 2020).

Stigma[edit | edit source]

Multiple studies indicate that stigma is evident within the field (Boyd et al., 2016). Furthermore, studies indicate that stigma directed at mental health professionals with mental illness is similar to, or worse than stigma towards non professionals in the general population5 (Elliott & Ragsdale, 2020)

  • Figure 6. How does lived experience impact on the work of mental health professionals?
    Internalising the stigma - Paraphrase - "A total of 23 studies were included in data extraction and synthesis. Factors that influenced MHPs’ sharing of their lived experience in the workplace were categorized into five overarching themes: the “impaired professional,” the “us and them” divide, the “wounded healer,” belief in the continuum of emotional distress, and negotiating hybrid identities. MHPs with lived experience described feeling conflict between professional and service user identities that affected the integration and use of their clinical and experiential knowledge. Enabling factors reflected best-practice human resource management, such as organizational leadership, access to supervision and training, inclusive recruitment practices, and the provision of reasonable accommodations".... '...enabling, constraining, and intrapersonal factors influencing disclosure...' (King et al., 2020)
  • What is the Wounded Healer Paradigm? Paraphrase 'The need to recognize counter-transference responses is generic but when they highlight the internal conflicts of the counsellor, the supervisor must decide how far they can or should pursue the unravelling of such conflicts' (Ref https://doi.org/10.1080/14753630701455838)..... Assumptions...
  • Impact of mental illness on work in the field
  • While some professionals are open about their lived experience of mental health issues and consider this as advantageous, others indicate caution about disclosure. Boyd et al, (2016), indicated two-thirds of respondents (n=77) in their research did not disclose to their patients and only a small few of those respondents disclosed to colleagues.
  • Further,
  • Empathy can trigger own symptoms (Elliott & Ragsdale, 2020)

Benefits[edit | edit source]

Figure 7. My superpower is...Breaking the stigma on mental illness.

WORK IN PROGRESS

Studies are increasingly exploring lived experience and disclosure within the scope of therapeutic relationship between health professional and service-user (King et al., 2020)

It has been suggested that high functioning professionals who have lived experience as mental health consumers are in a valuable position to decrease stigma and discrimination as well as increase individuals' concepts of hope for recovery (Boyd et al., 2016). Further, studies show that mental health professionals see their lived experience as an asset and also advocate for their own self-care in order to continue in their professional work (Boyd et al., 2016).

'Findings suggest stigma is still prevalent even in organizations that have consumers in leadership positions, and consumers are often perceived as less able to work in mental health organizations than non-consumers. Several discourses challenged such a view showing how consumers bring value to mental health organizations through their expertise in the mental health system, and their ability to provide safety and support to other consumers. Through a social exchange theory lens, the authors call for organizations to challenge stigma and promote the value that consumers can bring to maximize mutual benefits'. (Scholz et al., (2018)


  • 'Clinician's Illusion' phenomenon
  • 'things you cannot learn from books' - human experience that can not be learned from a book vs clinical professional wall (Byrne et al., 2012). Like a feather in your cap
  • How has lived experience influenced the health care system/consumers? e.g Policy, professional practice, training,
  • Mental health professionals diagnosed with mental illness can contribute to the mental health field, counter stigma and strengthen the recovery movement. Visibility of prosumers assist to model wellness and contribute to the field. (Vierthaler & Elliott, 2020).
  • Probert et al., 2021 - human rights approach

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Working notes[edit | edit source]

FOR AUTHOR ONLY - WORK IN PROGRESS

Articles to look at:

https://doi.org/10.1111/j.1540-4560.1997.tb02453.x

https://doi.org/10.12968/ijtr.2009.16.9.43765

https://doi.org/10.1007/s11097-018-9597-4

Exploring lived experience: principles and practice of phenomenological research | International Journal of Therapy and Rehabilitation (magonlinelibrary.com)


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Other linked ideas: emotional regulation, recovery philosophy, trauma, narrative therapy, Professionals with/without Lived Experience, personal growth, Self-determination Theory, Stigma, PSYCHOLOGICAL NEEDS (Consumer Vs Facilitator)

'To flourish, motivation needs supportive conditions' - social context that support and nurture needs and striving = vitality, experience and personal growth p20


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  • What are the challenges for professionals with lived experience? Why is it important?
  • How can specific motivation and/or emotion theories and research help?
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Conclusion[edit | edit source]

WORK IN PROGRESS

To summarise, mental health and mental illness impacts mental health professionals just as it does the general population however stigma may affect professionals worse than the general public if disclosed (Elliott & Ragsdale., 2020)


How can prosumers influence the future of mental health care?

...increasing hope for recovery and reducing stigma (Boyd et al., 2016).

How can prosumers be better supported?

  • Stigma is still prevalent - Social exchange theory lens - Challenge stigma - however this paper does not discuss from a prosumer perspective (Scholz et al., 2018)
  • Promote value of consumers - however, this paper does not discuss from a prosumer perspective (Scholz et al., 2018)
  • Findings suggest that 'organizational interventions to support MHPs in order to share their lived experience may improve workplace diversity and well-being, with implications for service users’ experience'. (King et al., 2020)
"'The mental health field must publicly reinforce the contributions of prosumers and promote their continued potential as leaders (Vierthaler & Elliott, 2020).

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See also[edit | edit source]


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References[edit | edit source]

Boyd, J. E., Zeiss, A., Reddy, S., & Skinner, S. (2016). Accomplishments of 77 VA mental health professionals with a lived experience of mental illness. American Journal of Orthopsychiatry, 86(6), 610–619. https://doi.org/10.1037/ort0000208

Denscombe, M. (2010). (4th ed). The good research guide for small scale social research projects. Maidenhead: Open University Pres McGraw Hill.

Drake, R. E., Green, A. I., Mueser, K. T., & Goldman, H. H. (2003). The history of community mental health treatment and rehabilitation for persons with severe mental illness. Community mental health journal, 39(5), 427-440.

Elliott, M., & Ragsdale, J. M. (2020). Mental health professionals with mental illnesses: A qualitative interview study. American Journal of Orthopsychiatry, 90(6), 677–686. https://doi.org/10.1037/ort0000499

Foerschner, A. M. (2010). The History of Mental Illness: From" Skull Drills" to" Happy Pills". Inquiries Journal, 2(09).

Gilmour, H. (2014). Positive mental health and mental illness. Statistics Canada.

Freisen, A. G. (2020, August 27). Changeover—How My Lived Experience Changed My Life, My Work as a Psychiatrist, and How It Resulted in the Establishment of a Support Group for Prosumers in Germany. Psychological Services. Advance online publication. http://dx.doi.org/10.1037/ser0000487

Insel, T. R., & Wang, P. S. (2010). Rethinking mental illness. Jama, 303(19), 1970-1971.

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, 71(10), 1047-1064. https://doi.org/10.1176/appi.ps.201900606

Probert, J. (2021). Moving toward a human rights approach to mental health. Community mental health journal, 1-13.

Roennfeldt, H., & Byrne, L. (2020). How much ‘lived experience’is enough? Understanding mental health lived experience work from a management perspective. Australian Health Review, 44(6), 898-903. https://doi.org/10.1071/AH19261

Scholz, B., Bocking, J., & Happell, B. (2018). Improving exchange with consumers within mental health organisations: Recognising mental ill health experiences as a "sneaky, special degree". International Journal of Mental Health Nursing, 27(1), 227-235. doi:10.1111/inm.12312

Scholz, B., Stewart, S. J., Bocking, J., & Happell, B. (2017). Rhetoric of representation: The disempowerment and empowerment of consumer leaders. Health Promotion International, 34(1), 166-174. doi: 10.1093/heapro/dax070

Scholz, B., Bocking, J., Hedt, P., Lu, V. N., & Happell, B. (2020). “Not in the room, but the doctors were”: An Australian story-completion story about consumer representation. Health Promotion International, 35(4), 752-761. doi:10.1093/heapro/daz070

Sciberras, A., & Pilkington, L. (2018). The lived experience of psychologists working in mental health services: An exhausting and exasperating journey. Professional Psychology: Research and Practice, 49(2), 151. https://doi.org/10.1037/pro0000184

Victor, S. E., Lewis, S. P., & Muehlenkamp, J. J. (2021). Psychologists with lived experience of non-suicidal self-injury: Priorities, obstacles, and recommendations for inclusion. Psychological services.

Westerhof, G. J., & Keyes, C. L. (2010). Mental illness and mental health: The two continua model across the lifespan. Journal of adult development, 17(2), 110-119.

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External links[edit | edit source]


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