Saturday 14 February 2015

About beating the stigma's on mental illness at the workplace

Last week I read a tweet about a BBC article on prosthetic Hollywood masks being used to educate trainee mental health nurses. The writer of the article seemed enthusiastic about the idea and so were the people in the attached video. 

What surprised me most was that they seemed to be unaware of the stigma attached to using those masks. To me they seemed to portray people with mental illness as weird Hollywood movie characters.  They didn't look at all like the people I have been supporting in my 25 years of mental health nursing. 

This article shows again that there is still a lot of stigma's to beat within the profession. Besides: what about non-verbal communication, the most important thing to learn about because most people put their 'mask' on pretending they are fine. As very often, do we all. But maybe more when we are anxious or paranoid and don't feel safe enough to express ourselves. 

"I am fine" is the most commonly told lie. When you use masks you can't see the look in someone's eyes or their facial expressions. 

This idea isn't helping trainee mental health nurses and as a result of that its not helping the people who have mental health problems. Its  counter-productive. A much better idea would the use of trained actors as we had when I was at nursing school. 

We all stigmatise and probably much more than we think.  The stigma attached to mental illness is a major obstacle to our patients and to better care. Lives will be improved if we keep ourselves and each other aware of that.

The stigma within the profession leads to a lot of unwanted and serious effects. A few examples: 
It makes people feel unwanted; 
I'm not understood and;
I'm uncared for. 

Apart from that it's a great danger to their physical health because it leads to not being taken seriously when having a physical health problem. I have seen people die from stigma, from not being believed, from assuming it was "psychosomatic"or "attention-seeking" It's that serious. 

I once supported a patient to ER after she suddenly lost the sight in one eye. She talked very slowly, a reason for the triage nurse to think that it was psychosomatic and if I had not been there to urge her to contact an ophthalmologist that patient would have been blind now. 

The stigma within the profession discourages our patients to dare to take chances in life, to improve their future. It prevents family members from being important team members. It leads to people feeling labelled instead of being a person with many strengths and skills, someone who is more than just a diagnosis. It prevents us from really listening to someone. 

I have a patient who was put in an isolation room for throwing a glass on the floor because a voice told her so. She wasn't hurting anyone. Later she said : "if only someone had asked me why I did that they would have known I had voices. And I would have cleaned it up and paid for a new glass if they had asked me ".

I used to get annoyed about stigma's but nowadays I find beating them a challenge instead of a problem. The stigma on mental illness is an important reason why people don't understand and why those who with  mental health problems often don't dare to seek help in time.
I hope this mask issue will lead to better awareness of the stigma within ourselves and our colleagues.And to improved support of people with mental illness so they feel listened to ,accepted and cared for.


  1. Yes, the use of trained actors or even people who have had MH issues and can be supported as they talk to health professionals and students. How can we talk parity and co-production if we don't fully work alongside survivors and users from the very start?

    That would be agency at its most powerful.

    here is a link that explains the approach and the merits of the Mask-Ed approach, utilised for the last 5 years effectively in Australia. No evidence of a stigmatising approach instilled in health professionals, quite the opposite. Its disappointing you did not include this in your piece to provide balance.

  3. as someone diagnosed as schizoaffective 25 years ago i appreciate any efforts professionals make to beat stigma. It is the major reason for sufferers being unable to build a normal life on medication. Its like having a criminal record where people constantly want you to re serve your sentence.

  4. Watching the video made me feel very uncomfortable, completely inappropriate way to train for a mental health crisis. Why not just spend the (who signed off on this) budget to employ actors to do the part? To me, the 'patients' problem seemed to be trivialized by the hideous mask on their face. Stupid idea.

  5. But why choose fake mental health patients when there are so many willing to talk to student nurses and other HP's in training?

    There's really no need. It is, once again, the mental health industry putting up walls both literal and metaphorical between patients and those who seek to work with them.

  6. GOOD POINT! Why not choose real people with real problems? I can imagine there is a rationale of "protecting the vulnerable" behind the mask idea.

  7. This 'Masked Education' is wrong on so many levels.
    1. Patronising to students - they have imaginations, they can also observe reality
    2. Putting educators' egos ahead of authentic voices
    3. Reinforcing the disempowerment (vulnerability, incapacity, otherness) of people experiencing mental illness
    4. Manifesting a demeaning metaphor (the mask of mental illness)
    5. Spending on shiny new things, instead of on people
    6. Commercialising a questionable tool (I see it's a trademarked education product in Australia)
    I have no doubt those involved are studiously proud of their efforts, but they have completely missed the mark. It betrays the kind of presumptuous patronising arrogance that fuelled institutionalisation in the first place. It's like something out of the 1950's. There's room for role-play and demonstration in education, of course, but not this macabre theatre.

  8. We had special trained actors at nursing school. They acted so real that it felt like an actual situation at the ward. We had to pay attention to body language too. After the roleplay they gave us feedback about how we made them feel, how we could have encouraged them to talk or to calm down, how we would have gained more information about the situation etc.
    I think its not always possible to ask that from patients in distress to join in to teach nurses.If I was in a crisis I wouldnt prefer to communicate with an unexperienced nurse.. So actors can be very useful there.

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