Mental Health in the Workplace - Finding Dignity in Mental Health

Dignity in mental health not only covers primary and secondary mental health support and care, it also encompasses the day to day living experiences of those diagnosed as mentally unhealthy, or not healthy enough, and includes how they are perceived and treated in the workplace.

Readers who saw my post “Playing Truant” will know that I object to the sense that “mental health” has become a euphemism for “mental disorder” or “mental illness”. Just for today however, I’ll step down from that soap-box. Today is about dignity.

Defining dignity is more of a challenge, linked as it is to the sense of being worthy of respect. Dignity is in many ways personal to an individual, where it becomes inextricably linked with a sense of self-worth. However, for most of us our sense of  personal worth is also significantly affected by how we think we are viewed, valued and ‘read’ by others. My own thresholds for what dignity means for me have changed over time, and to be honest, I’ve dropped my standards as my own regard for my sense of self now has so much less to do with what others think of me. Having always been an “old child”, born aged about 30, I took myself ridiculously seriously; and maturing chronologically has fortunately seen me compensate by regressing in almost every other way, occasionally to the dismay of my daughter. There is a holiday story involving me wearing a cagoule as a skirt in a pub, where she disowned me and sat at a table on her own, like the nine-year old adult she is. I felt more comfortable that way than in the sopping wet jeans I’d gained in a canoe, so this was an affront to my daughter’s dignity only, whilst mine was relatively intact. Personally, I think I rocked the look pretty well, and besides, the only people there that I will ever see again are my nearest and dearest who have seen me look far worse.

Most definitions of dignity involve the idea of reciprocal respect and a degree of composure, but there are times when one’s mental health (or ill-health) can get in the way of both. Composure during a panic attack is impossible, and sadly it is still not uncommon for a person’s regard for another to slip a notch or several when they become aware of a mental health condition. The latter is often apparent in a work context, and one that sadly I still hear voiced by employers. There are health professionals who continue to advise service-users to be cautious about whether to reveal a mental health condition to an employer because it “cannot be unsaid”. GPs will ask how an individual would like them to word a medical certificate if time off is required. High blood pressure can be a side effect of stress, but is perhaps more acceptable on a medical certificate whilst we are all still much more comfortable with physical ill-health than psychological or psychiatric difficulties.

This is also borne out by the way mental health labelling works. I yelled at the television a year or so ago when the BBC news introduced a gentleman as “this is Mark (may have been something else) who was diagnosed as bipolar last year”. “Diagnosed as”. Defined “as”. Would we label a person as “diagnosed as tonsillitis”, or “diagnosed as kidney failure”? Generally people are diagnosed with a condition, and not in a way that turns the diagnosis into an identity. This, for me, is a major part of taking away the dignity of a person with a mental health condition.

Some conditions are so pervasive that it can be difficult for the person struggling with it to see themselves as anything beyond their condition. But peel away the layers of someone’s depression, or anxiety, or psychosis and there is still a unique person there. The sources of our identities that we may take for granted – our relationships as a wife, a mother, a daughter, a friend, a dancer, a teacher or a solicitor -–  endure even when hidden a while, or temporarily invisible to the person themselves. There is little dignity in not being able to control your crying, or in being unable to cook for yourself because you just can’t. However, there is a dignity in keeping trying. There is a dignity in knowing that you’ve said or done something whilst unwell that is mortifying in retrospect, but being able to accept that, and still move on. There is great dignity in enduring, surviving and recovering. I’ve seen and admire this dignity. Employers who see their employee as “mad”, “crazy” or, worse still, as a liability, purely on the basis of a diagnostic label, are failing to treat that employee with dignity, or to respect them as a whole person. 

There are a great many famous names who now openly discuss their mental health difficulties and the “mad pride” movement (users and refusers of mental health services who celebrate mental health culture) has gained momentum. We all now know that Stephen Fry has bipolar disorder and of England cricketer, Marcus Trescothick’s experience with clinical depression. This almost celebrates their disorders, and dares people to take issue with them. I am no more comfortable with that than I am with mental illness being hidden. However, the value here is that these are examples of highly successful people who have achieved in spite of their health condition. I wouldn’t take Stephen Fry on in an argument, or dare suggest that he is not capable of appearing on QI because “he’s bipolar”. To assume that a person is suddenly incompetent because of a diagnostic label is both illegal (in employment law terms), and short- sighted. 1 in 4 people will experience a mental health problem each year. To assume incompetence in those people will therefore alienate a quarter of your workforce; many more if you consider the friends or families of those people.

Treating staff with dignity is about not making assumptions. Crying in the staff room may be related to a person’s depression, or it may be that their dog had to be put down. Staff with depression, or schizophrenia or bipolar, or anxiety will take time off work. They get colds, flu, migraines and kidney stones. Sometimes they may need some time off to manage their mental health condition as well. But not only that. A mental health diagnosis is a short hand to professionals and often a route of access to appropriate treatment; but it is not a label that defines an entire life from that point on. People are first and foremost people. Define your staff by what they deliver, by the role they hold, the influence they have, and their achievements. Don’t define them by just one thing; their health condition. There are many ways in which I wouldn’t mind being defined – but with a nod to my daughter’s sensitivities, perhaps not as the cagoule–skirted canoeist.

The 5 Steps framework, just launched by the Anna Freud Centre, calls for change in the way schools and colleges support the mental health of their pupils and staff. This change requires leadership, and ‘Leading Change’ is the first of the five steps of the framework.