The other day, I heard about the case of Wendy Potts, a UK GP who wrote a blog about her experiences with bipolar disorder. A patient of hers read the blog and raised concerns over her fitness to practise. As a result, Potts was suspended from practising while an investigation took place, but she committed suicide before the investigation was complete. The corner involved said that the case was not an “isolated” one, and that he was concerned similar fitness to practise investigations were carried out every day against NHS doctors. For me, the case of Wendy Potts highlights a few things regarding working within the NHS, but also having a mental health condition.
As a GP, Potts was quite clearly intelligent and competent enough to qualify and work as a doctor…had she a physical condition would her fitness to practise have been questioned in the same way? Would a doctor who blogged about their experiences of a physical health condition online have their fitness to practise questioned? Or would a nurse who had to regularly check their blood sugar on shift or carry an inhaler? What about a healthcare professional who needed to use a wheelchair or had a hearing aid? If a patient or colleague took offence or raised concerns, would they too be subject to a fitness to practise meeting or undergo suspension? Is stigma and discrimination against NHS workers with a mental health condition more apparent than against those with a physical condition?
Secondly, there’s a rhetoric of needing, wanting and valuing people with lived experience working in healthcare- two months ago I was told the same by the chief executive of my health trust. And yet, it’s not uncommon to hear of cases, either anecdotally or in the news, of people who have been discriminated against or slapped with fitness to practise hearings because of their mental health. Who better to nurse or treat someone with a particular condition than someone who had experience of it themselves? And yet those with mental health conditions are still discriminated against, even within healthcare professions. Anecdotally, a nurse that’s treated me in hospital admitted had she had to interview me for a place on a nursing course (I’d applied to a university she was on the interviewing panel for), she wouldn’t have admitted she knew me, because if she explained how she knew me, it might have affected my chances of getting an offer.
In the media, I’ve read about a nurse in Scotland who was placed on special leave while occupational health investigated claims that his mental health was ‘deteriorating’ following a dispute with his colleague. After his psychiatrist assessed and determined he was not symptomatic at the time of the dispute, an employment tribunal ruled that the nurse who had put him on special leave had done so assuming a relapse in his illness before asking for his version of events- which cited a personality clash as the cause of the disagreement. A blog written on timetochange tells of a mental health nurse that was admitted to hospital for bipolar disorder, and had a former colleague breach their confidentiality, with the gossip reaching other colleagues. In the comments section of the post, there are reams of comments with people sharing similar experiences of facing stigma working in mental health settings while being sufferers themselves, or stating they haven’t disclosed their mental health condition to their NHS colleagues precisely because they were aware of the discrimination they might face. One reader commented they felt their mental health condition was like a “dirty little secret”. It would seem then that not all NHS workers with lived experience of a mental health condition feel ‘needed, wanted and valued’.
But why should having a mental health condition be a ‘dirty secret’? Why should having a mental health condition call into question your ability to work in a healthcare setting? In the case of Penelope Rees, who had a bipolar diagnosis and was investigated and convicted for ill-treatment of two patients, an NMC spokesperson stated that having a mental health condition didn’t mean someone was “incapable of being a good nurse”, after the judge in the case asked how Rees had been “allowed” to nurse because of her condition.
Mandy Stevens is a former NHS director and nurse that was admitted to hospital for depression last year. In recent months, she’s been hugely vocal about this, using her experiences to educate, campaign and raise awareness. Her story highlights a crucial point: that mental illness and mental ill health can affect ANYONE- even big shots high
up in healthcare. She took time out, she got to a better place and then she used her experiences to tackle stigma, and perhaps most importantly, encourage other nurses to speak out about their own difficulties. She’s been through it, she’s on the way out of it, and she has a lot to give, a lot of first hand knowledge she can use to improve mental health treatment.
Often, people choose to go into certain fields of healthcare precisely because they have some sort of experience with that field. At university, when asked to do an exercise showing what had led each of us to choose mental health nursing, most (if not all) of us had either personal experience or a family member or close friend who had a mental health condition. Lived experience can add untold amounts of value to, and enrich, healthcare practise. Drawing on personal experiences or being open to learning from others with a particular condition can be far more beneficial than reading something in a book and can offer unique insight into how best to approach or treat a particular patient or condition. What if voices like Mandy Stevens’ were ignored? What if people like her were declined posts or subjected to fitness to practise hearings as a result of their past or ongoing mental health conditions? Why should they be, when they have got to where they are despite their health condition, and when actually, they might just have something very important to say, and something very special to offer to their professions. It is unfair to jump to suspensions, special leave, occupational health hearings or dismissal on the basis of a complaint, that essentially, cites the fact a particular person also has a mental health condition as being a concern.
In the UK, 1 in 4 people will experience a mental health condition in their lifetime; the NHS employs roughly 1.5 million people. A third of NHS doctors have a mental health problem, while between 2010-2014, hospital staff in the NHS taking time off for mental health reasons doubled. The reality then, is that is is not uncommon to be an NHS doctor, nurse, occupational therapist, radiographer, secretary or director, and to also have mental health condition. Rather than discrimminating against these people, or subjecting them to (in many cases) unjust fitness to practise hearings, better support should be put in place and more accommodations should be put in place to ensure NHS workers can access help for their mental health discreetly and in confidence.
A BBC investigation found that only 57% of NHS trusts had plans in place to support staff’s mental health, and both the NMC and GMC have recognised the risk of suicide amogst doctors and nurses undergoing fitness to practise investigations, while those who have been cleared following their investigations have talked about damaged reputations, difficulties in finding work, conditions imposed on their ability to practise and personal distress, shame, trauma and loss of confidence as a result of their fitness to work being questioned. In the case of Wendy Potts, the coroner involved said that the suspension and investigation was “something of a sledgehammer being used to crack a nut”- in other words, the whole thing could have been looked into and dealt with in a more sensitive manner and at a much smaller scale. The ‘punshment’ didn’t fit the ‘crime’, so to speak, and highlights the serious need for the NHS, GMC, NMC and other bodies to both readdress how they deal with fitness to practise concerns of those with mental health conditions and create an environment in which NHS staff feel safe and supported in being open about their mental health.
It is non sensical for a healthcare system to fail to accept the reality that its workforce will too suffer from some of the medical conditions they are employed to treat. The case of Wendy Potts- as with many others across the UK, points towards the fact that even within healthcare settings, mental health is still very much stigmatised, feared, and discriminated against, and real efforts need to be made to address this. The example of Mandy Stevens suggests that, perhaps, some of this stigma and discrimination is completely unwarranted.