Why is it so challenging to support our colleagues with mental struggles?
You may have heard of Dinesh Palipana*. He is one of our residents who happens to have quadriplegia. We think he is spectacular. As a department, we are wholeheartedly committed to pulling out any stops that may threaten to stand in the way of him achieving career fulfilment. Our dedication is borne of what we have experienced of Dinesh’s motivation, diligence, work ethic, conscientiousness, and his ability to effectively manage his environment (and his team) in a manner that makes what he can’t do a redundant issue. We collectively feel that he has a massive contribution to make, including to healthcare, and we will enable this to the nth degree.
This dedication and inclusivity are a big part of what makes our Emergency Department an enviable team – a place where everyone belongs; everyone has a contribution to make; everyone is valued.
But I fear that we may not always do so well in supporting our colleagues with less visible disability. Arguably the least visible of these is mental illness, including the spectrum from occasional anxiety to full blown ICD10 disorders.
Upon reflection, I shamefully realise that I have sometimes been a part of “inside conversations” where a colleague’s demeanour, attitude or temperament are discussed in a negative light, calling into question their aptitude for the job. Confident that we all mean well, and are purely expressing concern, we make statements like “I don’t know why they still work in Emergency – they seem to find it so stressful” or “It would be a good idea if they considered a different area to work in”.
So, I ask myself, “Why is our attitude so different towards these two types of disability?” I think the following probably contribute:
- We experience counter-transference. In the presence of colleagues who are struggling to manage their own emotions, our emotions become triggered. When they arrive at work looking like a black cloud, it reflexively lowers our mood. When they tell us they are tired/overwhelmed/overwrought, we feel burdened about the perceived likelihood of needing to carry some of their emotional load on shift.
- Resulting from this is the systematic erosion and eventual destruction of relationships. The very illness that is crippling our sick colleagues is the same illness that compromises their insight, their awareness, and their ability to garner support. If Dinesh crushed our toes every time he moved past us, eventually we would start to feel hurt and resentful of this. But he is careful not to do this. For someone with mental illness, it is almost inevitable that their struggle will impact upon us directly in some way.
- We are confronted by our colleagues with mental illness because the illness is close to home – this could easily be us; it may have been us in the past; it may be us in the future. Statistically, we are much more likely to suffer mental illness than quadriplegia. So, we hope that if we don’t allow our minds to “go there”, then we can avoid facing this prospect.
- Unfortunately, the often-competitive nature of working in healthcare means that we are prone to thinking that we can elevate our standing by diminishing that of others. “At least I’m better than so-and-so” If we can stand among those who are throwing the stones, we are less likely to be struck.
- We can’t see the illness. We know how to help people with physical disability – the gap or need is largely obvious – and, often, they know how to ask or direct us for help. Even when we do see mental disability, we are less confident about helping or providing support around this. We have learned to ask, “Are you okay?”. But when the answer is “No”, we flounder for an action plan.
I don’t have the answers for how we can better support our colleagues who are mentally unwell.
Chances are that a large part of the solution lies in pausing to recognise that, while they are not in a wheelchair, their illness is often similarly crippling – causing an emotional paralysis that compromises their psychological, cognitive and physical function.
I suspect that what they need is not for us to ride in and rescue them when they fall. I suspect that what they need is simply to know that they are not alone, not isolated, not abandoned – and that, just like our colleagues with physical challenges, we see them.
Perhaps that recognition may then trigger a dose of compassion, which will then drive us to do what we actually do best – work together and support each other so that we can deliver brilliant patient care.
*Dinesh has kindly given permission for his identity and story to be included in this blog.
