‘Coming Out’. Again. And again.

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Last week I attended the Occupational Science Europe Conference about “Health and Wellbeing through Occupation” at Bournemouth University. It was a lovely conference and very refreshing to be able to indulge in pure occupational science for two days. I also enjoyed how international a conference it was – I really valued hearing from people working and studying in different systems to the United Kingdom.

At the conference I presented a paper about self-defeating occupation  in Borderline Personality Disorder. As I predicted in my last blog post about presenting at a conference I wasn’t *quite* as avoidant about preparing for it – leaving it only until the night before this time! I felt more confident that I had valuable material to contribute, but I also had an ‘itch’ to take a step on from my last presentation and completely join things up. At the COTSSMH conference (mentioned in the earlier post) I was aware that those people following on Twitter would have the full story of how I had developed the concept of self-defeating occupations from my own experience of self-harm and eating disorders, but this was not included in the paper and so those not using social media would not know. This time I wanted to make it explicit. I felt it was important to the narrative. I felt it was important to the research concept. I felt it was important to me. I was a person whose valued occupations were ‘self-defeating’ and without understanding the importance of those occupations I couldn’t have found a new way to manage my life. I also wouldn’t have become an occupational therapist or researcher and developed the ideas further.

So yes, I included a slide that allowed me to discuss the importance of this blog in generating the research. And when it came to that slide I felt really proud to stand there and explain exactly where the idea came from. It felt honest, and congruent and real. I have no idea if anyone in the audience had any judgements or other negative thoughts, however the feedback I got was overwhelmingly positive and allowed for a much more meaningful discussion in the questions section at the end.

This experience got me thinking, yet again, about mental health stigma. It’s a topic I explored in my last blog post and I think I’ve perhaps moved a step onwards. I’ve realised how fed up I am of having to ‘come out’ as someone who has had mental health problems. Not because I’m ashamed, or because I want people to magically ‘just know’. But just because of that uncertainty of how it will be received. Most of the time I’ve found it to be a positive ‘coming out’, but there is always the fear that, just one time, it will be met with prejudice and stigma. I do love the fact that this blog and my Twitter account means that sometimes I get to meet people who already ‘know the full story’ and it’s such a lovely experience to be me, without any further discussions. And obviously there are plenty of people in the world that I meet who never know, or never need to know. But yes, it can get tiring to have to analyse and assess if it will be safe to be honest. And that needs to change. Mental health stigma needs to stop. I can see that the world is changing, but is it changing enough?

Related to this topic I was really pleased to discover that Linda Gask, a psychiatrist, has written a book about her experience of having depression. Moreover I valued the discussion on her blog about stigma and only being able to ‘come out’ after retiring. From the blog post I find myself agreeing with the sentiments about the mental health profession’s desire to deny the struggles of those who work in the field. It’s also nice to see a psychiatrist discussing mental illness so candidly. Within the blogging community I can think of many other types of professionals who discuss their own experience, but I haven’t come across many psychiatrists who do – and I can’t imagine for a moment that’s because they don’t have first-hand experience. I’ve ordered the book and am looking forward to reading it, so I may well have some more thoughts soon!

So, what have I learned? I’ve realised I’m actually happier when I can join up the person who has experience of mental health problems and services, with Sarah the occupational therapist and PhD student. It may feel risky to need to explain that side to people, and I remain very clear that there is more to me than just that experience, but as it was such a large part of my identity and has shaped who I am today it feels an important thing to do. And if me ‘coming out’ helps challenge some of the stigma that remains then I am more than happy to keep ‘coming out’, over and over.

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Pd2ot Becomes an Occupational Therapist.

IMG_20150323_223948I miss blogging. I could make excuses about my lack of posts being due to being busy at work, but that wouldn’t fully explain it. When I first started writing I had so many ideas to explore and I made time for the blog. Now it’s dropped into that rather full  category of “things I’ll do when I have some free time/am not so tired/am bored”, which has a very low probability of being the chosen occupation if/when any of those situations arose. Why am I not blogging any more? I suspect it’s a combination of feeling a little like I’ve moved on a lot from ‘needing’ to explore pd2ot-type topics and a less conscious disconnection from pd2ot. However, in recent weeks I’ve had a little more time for all things pd2ot, which has reminded me how much I enjoyed writing.  So, this is going to be a pretty basic ‘catch up post’ to get me writing.

This week actually marks the beginning of my PhD. I’ve spent the last six months working full-time in my clinical role to have time to embed my skills as a newly-qualified occupational therapist and develop a better understanding of the client-group and service my research will be focused on. It’s been great. Tough, challenging, I’ve learned a lot, AND I’m really ready to start work on the research. I’ve always struggled a lot with routine and getting bored, and although my clinical work is so varied and without time to breathe,never mind get bored, I do find that I’m grateful for a new dimension to my weekly routine. I’m really excited to have 3 days every week to just focus on research.

It’s probably good timing that I’ve just returned from the College of Occupational Therapists – Specialist Section: Mental Health’s (COTSSMH) Conference at the University of Liverpool. I’m feeling motivated and ready to start my study. As I first discovered at Emerging2OT, live-tweeting added a valuable dimension to my participation in the event. I always enjoy reading other delegate’s perspectives and thoughts on the session they are attending. The only downside is when you’re following the hashtag you may read tweets from a different session that sounds unmissable. At least with tweeting you still get the opportunity to read the tweets even if it can feel like you missed out!

The live-tweeting may not have been a new experience for me. However, presenting at the Conference certainly was. I was fortunate enough to have an abstract accepted for a 45 minute seminar on self-defeating occupation, a concept I developed from this blog post. I’ve always been a little ‘last-minute.com’ with my preparation for assignments/presentations, however I was probably pushing it to the extreme with this paper as I was frantically trying to decide what to say and scribble some notes in the break immediately before the session. Fortunately it all seemed to come together in the minutes before and I actually really enjoyed presenting my work. Who knows, maybe I won’t avoid thinking about it so keenly before the next one…

Public-speaking and presenting is not something I get too worried about normally, however I suspect the content of this presentation meant I was more concerned about its reception than a piece of assigned academic work. It was my original thoughts and ideas, rather than an answer to a question set by others. I’d debated whether to include my Twitter name on my title slide and to explain where the concept originated from during my preparation. In the end I didn’t include it, but actually felt quite sad that I didn’t ‘join things up’ so fully in the end. The paper was received well and the live-tweeting that accompanied it allowed for pd2ot to be joined up with Sarah, the presenter, which felt really positive and congruent.

My experience at the COTTSMH Conference prompted me to reflect on how I feel about the ‘pd2ot’ side of me. At times I almost forget that that side ever existed. I think in my current line of work it’s quite easy to forget. So how have the first six months of being qualified occupational therapist been given my history of mental health problems? To answer that I’ll explain a bit more about what’s been happening in that time. I work in a service that is in the early stages of becoming an integrated care team, but at present the physical health side of the job dominates. I work with a great team of people, including a large team of district/community nurses. However there’s minimal formal mental health experience within the team. I think this leaves me wondering ‘how much do my colleagues understand about mental health’.

Unlike when I was a student I haven’t needed to disclose much about my mental health history as I am well and don’t need significant adjustment to my work pattern. I do, however, where a uniform that exposes my arms which are very scarred from previous self-harm. As I student I was absolutely terrified of this, and generally agreed with educators that I would wear long sleeves other than when it was necessary for infection control reasons. So in general I’d have a cardigan on when I was in the office. In fact, my university supported me to have a first placement that didn’t require me to be bare below the elbows at all, and allowed me to gradually develop the confidence to expose my arms. On my first day in this job I decided I’d just make sure I was in my short sleeves even when in the office so that I stopped needing to be self-conscious about it (fortunately my office is very warm, so that became a promise I was very relieved to keep!). In terms of reactions from colleagues it has been minimal. One person said “that looks sore” and another asked “Sarah, what happened to your arms?”. Out of the two approaches I prefer the latter. It allowed for a brief, yet honest, discussion about it. Most people, however, have not commented. Partly it feels like it’s a difficult thing for people to talk about and I’m left wondering if people actually know the cause of the scarring – I find it difficult to appreciate how much awareness of self-harm people have if they don’t work in mental health or have personal experience of self-harm. Mostly, though, it feels that my colleagues simply accept me as I am. I’ve always wondered how I’d feel if a patient commented on them. I suspect it will happen at some time but my experience to date would suggest that most people I visit have far bigger things to worry about or even notice, than some old scars on my arms.

As many people with be very conscious of, mental health problems are often invisible. Given that my mental health is pretty good at the minute, the only indicator of previous problem is the scarring. I think this probably explains why the ‘pd2ot-side’ can feel very distant at times.  As ever, I feel grateful for my experience as a service-user. There are numerous skills/experiences I wouldn’t have without it. I’m also really glad that it is not a defining feature of my experience as a clinician. I feel like I’m a BETTER occupational therapist due to my experience as a service user, but that it is not the only thing I offer the profession.

Checking in – pd2ot and the brain.

brainIt’s been quite some time since I blogged. The dissociation post remains a 70% complete draft and my list of blog topics I want to write about is growing, yet I have been pretty silent on here and Twitter (except for much needed #teamduvet chats at the weekends). So I thought this post could be a brief update and pave the way for more regular blogging.

At the moment I’m getting to grips with unstructured time again. I’ve just finished an 8 week placement in neurosciences and now have some assignments to do before I break up for the summer. A big part of me is terrified of the thought of several months with no placement or assignments, so I’m noticing I’m having problems engaging with my work for fear of finishing it. Mindfulness is helping and I know I’ll get there in the end.

Placement itself… Possibly my most challenging placement to date, and also probably the first one that I could see myself working in as a qualified occupational therapist. I think the variety appealed to me. My youngest service user was in their teens and my oldest in their eighties. I worked with people with a wide variety of conditions (in fact most of my preparatory reading about Parkinson’s Disease and Multiple Sclerosis was in vain as we experienced a series of referrals for people with much more uncommon neurological conditions). The interventions used ranged from work on personal activities of daily living and equipment assessment to work on leisure occupations and vocational rehabilitation. The settings included inpatient wards, outpatient appointments and community work. Needless to say this variety prompted me to feel a little(!) overwhelmed at the start, AND I loved it – because I wasn’t going to be bored or unchallenged.

Before starting the placement I was worried about a number of things. Firstly, this was going to be a ‘properly physical’ placement. My comfort zone is mental health and while I enjoyed my first placement in a physical setting (social services) I was still afraid that I wouldn’t be any good at the ‘bread and butter’ occupational therapy required in this setting. Fortunately my fears were unjustified and the combination of university work, previous experience and transferable skills from other settings made this nothing other than a manageable learning opportunity.

My other worry had been about the requirement to be ‘bare below the elbows’ when working with patients. My arms are scarred from past self-harm and it is only within the last year that I have done any, literal, ‘exposure work’ of having them uncovered when exercising, I also have not yet had a placement that required me to be bare below the elbows. I was worried it might cause judgment from others or prompt me to feel insecure and exposed. Mostly, I feared it would be a barrier to my usual ‘apparent competence‘. The reality? I didn’t experience any overt negative attitudes from others and mindfulness prevented me attempting to mind-read their thoughts. However, the internal fallout, initially, was huge. I spent the first two weeks cycling home from placement at high speed, as an attempt to escape the discomfort of being there. I drafted many an email to my tutor and the placement co-ordinator saying that I couldn’t cope and wanted to quit. But, like in other placements where there were challenges I also knew that I didn’t want to give up, and this particular placement experience was not an opportunity I wanted to lose. I think I knew the emails would never be sent and were simply a way of validating the experience to myself. I’m also grateful that I tend to be incredibly stubborn and it takes a lot for me to stop doing something. Gradually, as I became more confident in my work being bare below the elbows was easier to manage. I don’t think I ever became less aware of it but I did become much more secure in my role as a competent occupational therapy student.

While the personal and professional challenges of this placement were probably the biggest I’ve encountered to date I know I benefited from the time of year of the placement. Like many, I really struggle with the winter. Although we had several weeks of bitterly cold weather at the start I found my energy levels were helped by the increasing daylight. I also found being able to cycle to placement so helpful, not just in the reduced journey time compared to previous placements but also starting and finishing the day with physical activity. I also found myself able to get to the gym several nights during the week, which I find so helpful for my mental health but just hasn’t been possible during my placement experience up until now. Fortunately my final placement falls at the same time of year next year, so I feel confident that I can manage it with similar success.

The Elephant in the Room

…or perhaps the ‘PDtoOT’ in the room?

I’ve just returned to university to start my second year. I began the week looking forward to a year that might suit my learning style better as it’s more focused on critical thinking and appraisal of information. I’ve also had my first experience of mental health specific lectures, which have given me a lot to reflect on and are the catalyst for this post.

Before I begin I must state that I don’t believe my university is intentionally causing stigma, nor is every lecturer/workshop leader ‘guilty’ of what I’m about to describe, but I do feel that my experience this week highlights problems. I also am conscious that the topic of stigma in mental health is such a giant topic, and many of the questions floating around my head of ‘WHY are we (society) so scared of talking frankly about this?’ are too big to be considered entirely in this post, so I shall stick to my university experience.

What happened? (Albeit, in my subjective experience)

My university, thankfully, is normally very good at challenging use of language that encourages stigma. Terms like ‘Mrs X suffers with bipolar’ and ‘Mr Y was a schizophrenic man I saw on placement’ will usually be noticed and corrected. That said, I’ve heard it be said and remain unchallenged in several sessions this week. I did challenge a friend on the matter and it was met with a response of ‘Oh’. I’m not sure if, when these issues were mentioned in our first year, people sufficiently understood the effect of this use of language. I suspect some felt they weren’t allowed to use the terms without understanding why it is reductionist and encourages a victim-projection into the client.

‘Them and us’ – I was very relieved, after the majority of a lecture had been spent referring to ‘them’ (as shorthand for people with severe and enduring mental health problems), when another student raised the point of the challenge of considering vocational rehabilitation for ‘them’ when it would contain so many people with different life experiences, never mind varying severe/enduring mental illnesses. The lecturer did validate this point, however I don’t feel it was sufficient after a whole morning where I felt this client group were being considered as a very separate group, that had to be handled with kid gloves and the therapist must have very low expectations of achievement. It felt like the client-centredness approach was entirely absent. For some people a successful OT intervention may result in a small period of voluntary activity each week, but for others this would be significant failure of the rehabilitation for that client. If the lecture had been discussing physical conditions I think the expectations of what an individual can achieve would be much higher. Of course, I am aware that for some mental health problems will prohibit a return to work, but unless we are brave enough to imagine people recovering enough to lead ‘lives worth living’ I fear the profession will not help people achieve the full extent of recovery that is possible for them.

I was glad that we were encouraged to share preconceptions about mental health problems and, for those that had been on a mental health placement, how they had changed after placement. As I discuss below I value an open and frank discussion, but this all felt one-sided. Yes, the point that fears that people with mental health problems were violent was discussed as unfair, but the point was not elaborated on to increase understanding about what the reality is. For those in the room that have this preconception all they now have to go on is the knowledge that one student doesn’t believe this is true, but no understanding as to the reasons violence may happen, or about clients that would only ever inflict violent acts on themselves, or even the many clients who will have significant mental health problems, none of which involve violent behaviour of any sort. This is a point I feel can only be delivered by service-users, to truly impart understanding of the reality of mental illness and how it influences behaviour.

My final issue relates to the ‘them and us’ issue raised above. The times I felt myself cringeing most in the lectures were when I felt that people with mental health problems were being patronised, either by staff or students. I’m not sure why anyone feels this is appropriate or helpful, but comments like ‘x struggled with ;, bless him’ are not ok and actively encourage stigma. If a soldier who had recently had a limb amputated was finding a self-care task challenging I seriously doubt they would be patted on the head and told, ‘ah, bless you’. I also sincerely hope if they were finding the same task difficult due to Post-Traumatic Stress Disorder they wouldn’t be treated in this way, but after this week I’m not entirely confident of this. Again, it feels like validation of the capability, resilience and skills of clients with mental health problems is not sufficiently present.

Am I more sensitive as an ex-service-user?

I actually feel that when mental health matters are discussed in an open and frank matter, without any trace of ‘tip-toeing’ around the subject, I am no more sensitive than any other person (and possibly far less than many people). I don’t mind if people ‘get it wrong’, I also don’t mind if people have strong opinions or judgements, so long as both they and I are able to have a discussion in which both parties can express their opinion and attempt to listen to, and understand, each other. I have delivered teaching to psychologists and counsellors in which I was asked directly if my self-harm had been manipulative or attention-seeking. This did not upset or offend me, it simply pleased me that people felt able to ask directly and listen to my response.

I struggle more when I feel lectures are delivered in a way that encourages stigma and misunderstanding, due to an overly sensitive and patronising delivery. I tend to go quiet rather than offer an alternative opinion, perhaps indicative of how unhelpful and silencing such an approach would be with clients.

I am mindful of the fact that I do find myself slipping into criticism of my university regarding a somewhat incongruent approach on their behalf. I have attended lectures that highlight the poor statistics for return to work for people with mental health problems after long period of sick-leave, and discussed intervention strategies that highlight the employer’s role in allowing an adjusted return to work. This is the first point in my life where I have been able to consider full-time work for 9 years, and the area of my life that still limits my performance is a very poor sleep pattern due to re-experiencing of traumatic events. Despite this I am about to embark on my second placement that involves a significant commute. While I function very well during the day I tend to have a few hours in the morning where I feel more vulnerable, almost like an emotional hangover from the night before. I have had several discussions with my university about these matters and feel slightly ‘not listened to’. It’s not my style to make a fuss and I’m also aware that I have internalised stigma and feel desperate to ‘just cope like everyone else’, but the reality is that it hurts to feel dismissed after taking steps to admit vulnerability.

Do I have a perspective that could help my fellow students?

One thing I am very clear on is that I have no experience of what it feels like to be an OT student that is nervous about working with people with mental health problems due to lack of experience, and for that reason this is the area I need to listen to those peers who are brave enough to admit the preconceptions and fears they have, to increase my own understanding of the issue.

I’m very conscious that my experience is just one of many people who have had mental health problems. Even if my peers all knew my views and experience this would simply give them insight into one person’s experience. That said, I feel the ‘power’ of my story is that these people know me primarily as a student, most people I know struggle to imagine me as the sectioned, destructive, despairing girl that spent several years in hospital. And that is my point, both those things are true. I am the person I am today AND I’ve had significant mental health problems that I almost didn’t survive, with many professionals feeling I’d always be detained in secure facilities.

What could be done to improve matters?

It’s very early days in the semester and I’m not sure if our teaching involves service-user involvement. If it doesn’t I think this is a significant oversight and will not challenge perspectives sufficiently. I know we have some lectures and workshops in the next few weeks delivered by people who I am confident will not teach in the manner that I feel silenced by, so perhaps I will contribute more of my perspective then.

Part of me would love to deliver a session, one that discusses the experience of a young woman with BPD who is intently suicidal and ends up sectioned and on 24hr-observations with all professionals at a loss of how to help, who eventually recovered due to treatment at a therapeutic community involving intensive psychotherapy, DBT and OT, and finally reveal that person is in fact standing in the room with them. I’m sure that at some point in my career I’ll be able to challenge views in this way. However, the time isn’t now, my priority is my own learning but I can’t help feeling my learning would be much less frustrating with a teaching programme that was less ‘fearful’ of upsetting the people with experience of mental health problems.

 

 

11/10/12 Update

I considered editing this post in light of recent developments at university, but I feel it’s better to leave it as is, with this update. I’m really pleased to say the second and third weeks of term have included some fantastic teaching on a variety of psychosocial issues for occupational therapy practice. That doesn’t make my frustrations with the first week any less valid but I am grateful that the issues I raised did not continue. I’ve also had a lot of support from my tutor and placement coordinator to resolve my worries about placement, and used my own therapy sessions to explore why I find communicating my needs so difficult.

Multi-Disciplinary Summer School ‘Healthy Ageing: Enjoyment vs. Endurance’

I was fortunate enough to gain a place on The College of Medicine’s (http://collegeofmedicine.org.uk/) Summer School for students of healthcare professions, hosted by the University of Birmingham Medical School in partnership with the Centre for Health Ageing Research at the shiny, new Queen Elizabeth Hospital (left). Approximately 70 delegates gave up 2 precious days of summer holidays or Vital Money-Earning Time to consider the issues surrounding healthy ageing for older adults. The professions of medicine, nursing, podiatry, osteopathy, physiotherapy, psychology, diagnostic radiography, nutrition and dietetics, pharmacy, dentistry, herbal medicine, chiropractic, radiotherapy and of course occupational therapy were all represented by students from around the UK. I think the ‘multi-disciplinary’ label was certainly justified! The event was very well organised and every team member was helpful and friendly throughout the very intense 2-day summer school. This post is simply a personal reflection on the summer-school.

Friday

The first day of summer school was very much the ‘food for thought’. We had seven 30-minute talks, each followed by 15-minutes question and answer time. The topics covered were vast. The most scientific talks included; ‘Ageing, Infection and Immunity’, ‘Nutrition in Healthy Ageing’, ‘Cognitive Health and Ageing’ and ‘Physical Activity to Support Healthy Ageing’, all of which were presented by leading professionals in the areas who were able to share their latest research findings to support their presentation. The more practical and ‘in-practice’ areas were represented by presentations about the ‘Move-it or Lose-it’ exercise classes for older adults (http://www.moveitorloseit.co.uk/) as well as Well UK’s Director presenting the Upstream Project (http://www.upstream-uk.com/) as an example of a ‘Community Based Model for Healthy Ageing’. The latter was the most akin the models I’m familiar with as an OT student and I found it fascinating that the programme was so focused on meaningful (often leisure) occupations as a central point of a social group, despite not having OT involvement. I found it refreshing to listen to presentations concerned with physiological processes of ageing. I found it enhanced my understanding of the process and also allowed me to consider the likely relevance to occupational therapy. The common theme was that moderate activity is vital to limit ‘unhealthy ageing’ and so I found myself wondering how occupational therapists can encourage this, particularly for clients who may not select physical activity as a goal they wish to achieve. Can a balance be achieved between health promotion while remaining person-centred in approach? Another common theme was that ‘connectedness’ and relationships were important determinants of well-being, by limiting social isolation and mental ill-health. This wasn’t ‘news’ to me as both an OT student and someone who has recovered from serious mental health problems, but the key learning was developing awareness that for some professional-students this was a novel idea and reminded me just how ‘medical-model’ some of the other professions are.

Saturday

Day 2 mostly focused on small group workshops facilitated by service-users with an interest in a specific aspect of ‘older-adult-life’. These were; ‘spirituality, religion and ageing’, ‘sexuality in older age: an LGBT perspective’, ‘ethnicity in older age’, ‘mental health in older age’, ‘retirement and well-being’, ‘exercise in older age’. I was grateful to get into a more interactive style of learning after a long, albeit interesting, day yesterday. The facilitators of the sessions were all excellent. My only criticism was that some of the groups might have benefited from a co-facilitator that had a contrasting experience. For example someone who had been a reluctant exerciser, someone who struggled with the transition to retirement and someone who experienced mental health problems for the first-time as an older adult, not a working age adult. The students brought a range of personal experiences and it was all done in a reflective and open-minded manner. I was struck by how some of the topics being discussed were quite obviously ‘new territory’ for many of the students, particularly the workshop on LGBT issues. While I felt glad that at least the participants today may now be aware of their heteronormative use of language with clients, I felt quite sad that this was the first time they had ever considered it. The closing plenary was a summation of everyone’s thoughts and it was nice to hear the different ‘key points’ that people would take away. I was aware of how beneficial the summer school could be to other students, those perhaps who also need to challenge some of their assumptions.

What will I, personally, take away from the summer school learning?

Some of the professionals I work with are going to be very focused on diagnosis and symptoms. While this is not an approach I wish to take, the depth of their understanding of physiological processes is vital and will provide evidence for the interventions being provided by those with a more bio-psycho-social consideration of the person.

The physiological explanations of the ageing process and issues that determine the relative success of ‘healthy ageing’ were very helpful to understand. However, the practical ‘consequences’ mean that the approach for an OT focuses on occupations that support an active lifestyle and reducing social isolation, which would be similar for a working-age adult, adolescent or child. Furthermore, discussions highlighted how clients want to be listened to, not judged and have a clinician that doesn’t make assumptions as well as showing great kindness. Again, this is something I feel is important, irrespective of age.

Personal ‘Experiences’

As a representative of the OT profession I noticed certain issues repeating throughout the weekend. I anticipated having to answer the question of ‘so what does an OT do?’ but seemingly underestimated the frequency with which I would be trying to define and explain the profession. Fortunately it’s a topic I like discussing and was able to draw on the summer school content to put things into context.

One aspect that left me feeling a little sad was that in several discussions I noticed a marked change in peoples’ attitudes towards me when they discovered I had initially studied another degree at a prestigious institution, compared to when they thought I was ‘just’ an OT student. I am not an OT student because I can’t do any better, but simply because I think it is a profession that can make a real difference to people’s lives, in a way that fits with my own values and even ‘spirituality’.

Occupational Therapy’s Invisibility

The link to occupation was made on numerous occasions throughout the summer school, but never was it suggested that OTs could be crucial clinicians for encouraging healthy ageing. This, combined with the numerous ‘what is occupational therapy?’ questions, reminded me of some of the challenges the profession faces. I can’t help but feel that the answer lies in research and evidence production. There is clearly fantastic medical and physiological research available on this topic but unless this can be linked to the role of occupational therapy in enabling people to make the occupational changes in their lives that support good mental and physical health I feel we will always be invisible and misunderstood.

Areas for Continued Reflection

While a fan of evidence-based practice, I felt very aware that I spent a lot of time thinking that occupational therapy ‘just IS the right approach’. I suspect I need to challenge this and continue to explore the current evidence to evaluate this belief or moderate it accordingly. (For the record, after the numerous discussions with other-discipline students I do feel more content than ever embarking on a career as an OT, and equally I’m conscious of some of the frustrations I will, probably repeatedly, face.)

Don’t Handle Me with Kid Gloves.

When I created this blog I didn’t really imagine anyone reading it, never mind finding it useful. So, I’ve been very surprised by the response it has gotten on here, Twitter and Facebook. I suppose I was perhaps projecting judgements about my suitability to practice onto others, expecting that if anyone did read this they would be telling me I was too damaged or fragile to be an OT. Consequently, I have been reflecting on two loosely related areas; one, the extent to which stigma about mental health issues still causes an uncomfortable silence and two, how helpful is it to be a professional with extensive experience as a service-user and does it make me ‘different’.

Breaking the silence

I’ve embarked on this exploration of the experience of turning from service-user to service-provider under a blanket of relative anonymity. So far I have only given quite broad identifiable information, however I am not concerned about people who know me discovering this blog, in fact I suspect that one day soon I’ll be much more open and actively join up the facets of my life experience, due to the positive response I’ve received.

So, why have I felt the need to be so tentative in putting my story out there? Especially as I have had extensive, positive, experiences of being a ‘professional service-user’ providing training for a range of professionals and contributing a narrative on my experience as a service-user to mental health texts under my real name? I suspect it’s a combination of my own insecurities and a very real stigma in society. While I am very accepting of the path my life has taken, I think at times I get tired of having to explain myself to others. Most people see me as a competent and interested student but when the conversation, inevitably, gets on to what brought me into the profession and what I’ve been doing with the preceding years of my life, I groan inwardly. How much do I tell people? How much do they need to know? Will they judge me? Are they actually interested? Is it appropriate? All these thoughts, and more, go through my head. I often wonder if I had spent several years in hospital for a physical illness, how much would I say in the same situation? The answer is that I can’t know how I would respond, as I haven’t experienced it. I suspect though, that if the situation was right, I would be much less hesitant, while acknowledging that it’s probably not easy for anyone to disclose personal details early on in encounters.

I have experienced a range of responses to people who discover my background. The only response that I find entirely unhelpful is that of pity and sympathy, and I am sad to say that has happened in my recent experience. Pity ensures that any professional working relationship is certain to fail, and leaves me feeling assigned to a ‘patient-role’. While people who respond in a way that suggests I have reason to hide my background are not the ideal, their attitude has helped me reflect on my own sense of self. When I was applying to university my tutor at college suggested that declaring mental health problems on my UCAS form might result in rejection. I gave this some thought, and while being aware that such a response would be illegal, I also concluded that I wouldn’t want to study somewhere that would only take the ‘undamaged’ version of myself, as well as feeling it was important to be congruent with my own values of honesty and integrity (as far as I can tell, the declaration had absolutely no effect on my application).

In general I find people are very positive when I disclose my history. From friends who are comfortable enough with me and my past to make jokes about it (while, very sincerely acknowledging that out of our group of friends I am the most ‘sorted’), to tutors and professionals who respect the extent of a journey that I have been on, as well as the valuable experience I’ve gained along the way.

Don’t wrap me up in cotton wool

Being an OT student I regularly am involved in conversations regarding people with mental health problems. Those who know my background may say something that is insensitive and then realise, with embarrassment, what they have done. Others who don’t know may talk about ‘these clients on the psychiatric ward, like, well they were a bit scary, but actually quite nice people’. I think it still surprises me that the stigma is present. However, on a personal level it does not upset me to hear conversations that contain judgements or ignorance, it simply provides me with an opportunity to introduce a slightly more accurate perspective and challenge some of their beliefs.

So while the above shows that there is still some very real stigma surrounding mental health problems. I do wonder if it is my own belief that I am in some way a weaker or less able person that causes me to question why it isn’t easy to stand up and say, ‘I’m pd2ot, I’m lucky to be alive as I used to be so self-destructive, and I have recovered. The ‘old’ pd2ot has not disappeared, but simply understood themselves and grown into the person you see today’. While I believe that statement to be entirely true, I have been thinking about whether I am, in fact, damaged and broken.

I remember a psychiatrist I was once under the care of saying, ‘you know, people with your background and extent of problems are usually either dead or in prison.’ While I found this statement validating of my experience, it did leave me feeling hopeless that I could ever be ‘normal’. I also have had various nurses and care staff acknowledge that they couldn’t foresee a future for me that didn’t involve hospital or serious self-harm. It’s understandable that with these external reinforcements that I have ingested some belief that I would always have to be a ‘disordered personality’. However, the reality of my current experience has proven these people wrong. I have recovered.

I also feel that my experience has given me a great deal of strength. In being a member of a therapeutic community (TC) I have had to sit with anxiety for others exhibiting dangerous behaviour, other clients running away and attempting suicide and been on the receiving end of intense anger and hatred directed, perhaps unfairly, onto me by struggling clients. I have experienced being pushed away, or even being put on some unachievable pedestal by the same clients. All of these experiences must be so common as a professional, and I’ve discovered that I can manage them even at the time when I was still engaged in my own therapy. Being part of a TC also exposes you to details of horrific abuse and violence. While some of it was traumatic to hear, it can only have increased my awareness and understanding of some of the terrible things experienced in the world and the consequences for those involved. I also have gained some incredible insights that only clients can share, such as how people can ‘con’ the staff and hide things from prying eyes, to understanding a range of people’s attitudes to services, what has helped them and what has happened.

I feel there is a real balance to be achieved between ensuring that my recovery is maintained and not overly protecting me from the real world. For example, my placement locations and settings are discussed regarding uniform, distance of commute, and to a lesser extent the client groups encountered. I don’t want to be held with kid gloves, but we might agree that placements that might have more impact on a personal level could be encountered later on in my study. The reality is, I think I’m more resilient due to my life experience; not only from what I’ve been through but also the skills and understanding I’ve gained along the way. On my first day of my first placement I went on a home visit to a place that my only previous experience of was being scooped up in an ambulance and taken to hospital for treatment for serious self-harm and prevented from attempting suicide. I was aware of the significance of the location, and also able to mindfully acknowledge this new experience at a different stage of my life.

Once again it’s all about the balance! I have no reason to be ashamed of my past and while I would never, ever, wish to repeat my life so far I am actually glad I’ve been through it. I believe I’m a more resilient, compassionate, resourceful and reflective person as a result, and for that I’m grateful.