Reflections of a mental health nurse on reducing stigma
Reprinted from "Recovery: Stigma and Inclusion" issue of Visions Journal, 2017, 13 (1), p. 14
One of the first memories I have of my dad was when I was in Grade 5. My mom had gone to work—she was a licensed practical nurse who worked nights in a seniors’ care facility—and my dad was up late, listening to jazz music. I was trying to sleep, but my dad was blaring his music so loudly that even with my door closed and my bedroom on a different floor, I could hear it clearly.
My older brother and I begged him to go to bed, even directing him firmly to his room, but he kept going back downstairs and turning up the music. I stayed up for what seemed like forever, deep into the night, begging him repeatedly to stay in his room. I remember the movie that was playing on the television. I remember being so tired at school the next day, and having an intense feeling of shame in the pit of my stomach, knowing my dad had been so drunk the night before that he wouldn’t go to bed, wondering if any of my classmates or teacher somehow knew.
I don’t know if that was the first time I realized that my dad had a problem with alcohol, but it was the first time I understood how big the problem was, and the first time I remember feeling so scared and alone trying to manage him without my mom.
One of the final memories I have of my dad was when I was 23 and living in Vancouver. I was nearing completion of my second semester of graduate studies, prior to starting nursing school. I wasn’t happy; I felt lost and lonely. I called my parents back home in Calgary. Without any hesitation, and without any interrogation or judgement, my dad told me he would immediately come out to Vancouver and help me move back home. All I needed to do was ask.
So I asked. And he came.
I remember anticipating how painfully long the car ride back to Calgary would be, 12 hours in a car with someone towards whom I still had so much anger and resentment. But I also remember that when we stopped for gas in Golden, BC, my dad looked at me and apologized for drinking too much when I was growing up. That was the first time I can recall him acknowledging to me that he had any issues with alcohol. In that moment, I realized that my dad loved me and was doing the best he could, despite living with persistent mental health problems.
Today, I am a mental health and substance use nurse. Whenever I hear co-workers’ judgements about a client family member’s lack of insight or understanding into a loved one’s mental health and addiction problems, I feel personally affected. In those moments, I think: “That was my family. You are judging me.” I try to re-frame the situation, using it as a teachable moment to call out stigma and encourage reflection. But I rarely share my own story because I am still unsure how much of it I feel safe sharing with colleagues. I am constantly asking myself, “Would sharing be helpful at this particular moment? Am I sharing in order to help the person I am talking to grow and reflect or am I trying to shame them into doing something differently?”
In hindsight, I believe that my dad was doing the best he could, given the multiple challenges he faced. But even today, 11 years after my dad’s death (which was identified clearly as being due to complications related to liver cirrhosis), my mom—who talks about the professional nursing care she has provided to people with alcohol addiction—will still not acknowledge that my father had any mental health or substance use issues.
Multiple factors contribute to insight. When people in our care are not acknowledging or talking about a problem, this does not necessarily mean they completely lack understanding about the circumstances. It might just be their way of coping. Approaching the situation from the perspective of the patient and the family (their experiences, not yours) can help build empathy and understanding.
None of us is immune to making judgements. I find that I constantly reflect on the value judgements that I make, reminding myself that we each bring our own experiences to our workplaces. I think that the key to being a caring, compassionate, empathetic and ethical mental health worker is understanding how our first-hand experiences impact the care we give.
Even though I have first-hand experience with some of the challenges faced by family members when a loved one struggles with mental health and substance use issues, my insight into my own experience, while it shapes my compassion and empathy, is not necessarily helpful to my clients. So, I go back to that first question: “Would sharing be helpful at this particular moment?”
My dad died shortly after I found out I was accepted to the nursing program at the University of Calgary. It wasn’t until I started nursing school that I began to reflect on the care my dad received as a patient in the emergency room, in the intensive care unit and in palliative care. I began to see the moral judgements and negative assumptions that many health care staff make, not only about people living with substance use problems but also about their families and loved loves.
I think that sometimes health care providers forget that the issues and problems our patients face are the same as those faced by our co-workers and loved ones. When we make implicitly or explicitly judgemental comments aloud, we may be sitting in a room with others who have experienced or are currently experiencing similar circumstances.
Mental illness and substance use touch all of us. When I hear off-the-cuff remarks by my co-workers about partying on the weekend or drinking in the evening, I cannot help but think, Do you have a problem? Is this a cry for help? Maintaining the status quo of the health care worker as “well” and the patient as “sick” perpetuates a culture of shame, stigma and silence. Part of creating an inclusive, accepting, empathetic and compassionate workplace means disconnecting the terms “sick” and “well” from “them” and “us.” Slight changes can help create a culture where our co-workers are not afraid to share their personal struggles.
When I started working in Vancouver, I found myself in a culture where the language used is deeply embedded in moral judgement. In my practice, I consciously use non-judgemental language when speaking about people living with substance use and mental health issues. For example, I talk about a “user of [specific substance]” or an individual who “currently has not used substances for [number of days/months/years]” rather than referring to someone as “clean,” which presupposes that the opposite is “dirty.”
I also use person-first language, which means that I put the person first rather than the illness.1 For example, I say “[person], who lives with schizophrenia” or “[person], who lives with alcohol addiction” rather than referring to the individual as “a schizophrenic” or “an addict.”
When someone uses language that isn’t person-first language, I sometimes re-phrase their words in the context of our conversation as a way of normalizing and integrating these terms within my practice. Though these changes seem small, they have a powerful effect on the way those around me refer to mental health and illness and substance use, think about mental health challenges and, in turn, speak and act around people living with substance use and mental health issues.
My father’s issue was alcohol, a legal substance. But his substance of choice could easily have been any other mood-altering substance. The current opioid crisis has brought the issue of substance use to the forefront in everyone’s minds. When I turn on the radio today, I hear about “addicts” daily; the language used often makes me cringe. Using person-first language might seem like an insignificant change, but the result may be profound as we begin to see the people who are suffering from addictions issues as people—parents, friends, children, family—who have interests and have had and can have lives beyond their current addiction issue. Using person-first language can reduce the stigma of substance use and help create safe spaces for health care delivery, where those accessing care know that we see them as people, not addictions.
About the author
Michelle is a Registered Nurse. She graduated from the University of Calgary nursing program in 2008. She has practised in the Lower Mainland, BC, and in Calgary, Alberta. Currently she works in the Vancouver area in adolescent and adult mental health and substance use, and in assertive mental health outreach
For more on person-first language, see Jensen, M.E., Pease, E.A., Lambert, K., Hickman, D.R., Robinson, O., McCoy, K.T., Barut, J.K., Musker, K.M., Olive, D., Noll, C., Ramirez, J., Cogliser, D. & King, J.K. (2013). Championing person-first language: A call to psychiatric mental health nurses. Journal of the American Psychiatric Nurses Association, 19(3), 146-151.
See also the Recovery Research Institute’s “Addiction-ary,” at www.recoveryanswers.org/addiction-ary/.