Mental Illness Relapse in the Workplace
When I first entered the professional world working in the mental health system, I never shared my lived experience of recovering from schizophrenia for a few reasons.
First, I had spent so much time investing in my recovery that I wanted to focus on my career.
I also knew there was still a stigma about having a psychiatric diagnosis, and I wanted to see how pervasive it was among practicing clinicians. I hadn’t spent enough time working in the system yet to know how people felt about people with lived experience working as clinicians and being open about their diagnosis.
So, when I first began working for a non-profit organization as a mental health clinician, I never talked about my history or recovery. It was a difficult thing to hide. While mental illness is invisible, the people who carry their diagnosis are living, breathing people. As a living, breathing person having a diagnosis, working for a mental health agency in the same geographical area that I was in treatment for my mental health disorder, it became increasingly difficult to hide my history.
There came the point when I finally realized I couldn’t hide it anymore. That moment was when I truly got to know about peer support and supposedly not being embarrassed by my diagnosis. Learning about the history of the movement allowed me to begin thinking about my recovery as a source of pride and, in turn, using it to model recovery for my fellow peers in recovery. At that moment, I disclosed my diagnosis and history of mental health issues and joined the peer network in the agency.
A few months into my career as a peer professional, the leadership in the peer network began to unravel.
My peer supervisor was clearly becoming more and more unable to supervise, was increasingly agitated, and ultimately, was openly and visibly delusional. Her relapse opened my eyes to an entirely unspoken stigma that is still rampant in the mental health system today.
In a previous article written for MIA, I wrote that a peer should not be judged by their diagnosis or by an invisible set of ‘symptoms’ from a ‘disorder.’ For peers labeled with certain illnesses, I had observed specific behaviors in the workplace. These behaviors were very benign expressions of healthy human oddities (e.g., incongruent tone/expressiveness or even use of language which just didn’t fit during conversations and team meetings or supervision).
I want to clarify that I am describing something riskier to client safety than idiosyncratic. In the cases I am highlighting now, the peer behaviors were not benign, superficial displays. These displays were disruptive to the agency workflow and its operations. On a more critical level, the behaviors displayed at team meetings I had observed were wildly inappropriate. Name-calling, talking over staff and talking about team members who were not in the room. There were also supervisory recommendations that would have put clients and me in unsafe situations if carried out.
You would think someone at my mental health agency, someone with a good clinical background, would have intervened and connected my supervisor to treatment. At the very least, someone could have spoken openly to my supervisor about her shift in presentation and how it might present a problem about her ability to carry out her job responsibilities.
My peer supervisor had her supervisor, the director. During my supervisor’s relapsing tenure this time, I would listen to my supervisor rant about the endless emails coming in from her supervisor trying to either ‘sabotage her program or make it difficult to complete her work.
It is my understanding that more conversations were held in private about my supervisor than with my supervisor. In the end, my supervisor was utterly unaware that our peers all detected a radical shift in her mental status.
Her ultimate termination and exit from the agency were looming. One day, I got to work early and saw my supervisor sitting in her office with a cardboard box and the director.
That was the last time I heard or saw my supervisor speak somewhat coherently until her hospitalization months later when she revealed she had stopped taking her psychotropic medication. Only months later, when I visited my former supervisor on the psychiatric unit, she began to make much more sense when speaking to me.
After she left, rumors began to spread about the peer supervisor who went ‘crazy,’ behaved bizarrely, and in turn, this created problems and a bad name for the peer network. Not only did the situation develop issues, but these problems were a direct result of her mental health diagnosis.
All of this was highly disillusioning. I had just openly” come out” as a peer, and my supervisor, a so-called expert in recovery, fell victim to her mental health disorder.
Thinking back now, the peer network in the agency could have used this as a learning lesson for us peers. Peer supervision could have included a robust discussion around relapse and the ongoing need to be mindful of what can happen to each peer with particular vulnerabilities. The agency could have also used this to develop a protocol on how to handle such a situation. But instead, there was silence.
What happened next was even more disillusioning.
A few months later, the very same situation happened again. The new peer supervisor, who replaced the supervisor who relapsed, experienced a relapse of her own. Nobody said anything. Whenever one of our peers would ask for her, we were told the same thing: ‘It’s been quiet, nobody has said or knows anything about what’s happening, or how she is …’
While I wasn’t looking for my ailing supervisor’s exact psychiatric or mental status, I wanted to know why, in general terms, she wasn’t at work to get a better idea of where and when I would get guidance on my cases. The agency could have said she’s out ‘sick’ without violating HIPPA or her privacy.
However, given the bizarre, flat, confused, and vacant answers, we peers got about our supervisor’s ongoing absence, our minds began to speculate on any number of circumstances preventing her from coming into work. None of this reflected well on any of our peers or the agency. In terms of the agency’s effort to teach healthy practices in the workplace to retain peers, more education was necessary.
What’s even more ironic is that some of us knew this person from other agency programs before taking over the vacant peer position. You would think we would have a vested interest in her health. I later discovered that very few people reached out to this person in crisis, and ultimately, after her job too was terminated, there were again no learning lessons. Instead, there was a whole lot of taboo, stigma, and shame surrounding her mysterious departure.
While there are privacy issues with medical information, many of us personally knew our supervisor in the community. At the very least, perhaps a member of the peer network could have stopped by my supervisor’s apartment or knocked on her door. My supervisor’s apartment was only a few blocks from the agency’s community center. Given her apartment’s relative proximity to the community center, peers knew my supervisor’s habits and could offer input if her behaviors were different lately.
There was no discussion about the more significant implications of these seemingly reoccurring and understandable occurrences of relapse when you have a mental health disorder.
I recommend all disillusioned peers and all people working in the mental health system with a diagnosis: ‘have enough insight into your diagnosis to know when you are relapsing. Modeling health, wellness, and openness around your lived experience so if you do relapse, people can feel comfortable having an open discussion around it”.
While all of us are victims of injustice, prejudice, and at risk of victimization, until we come out and fight against the taboo and tucked-away nature of mental health disorders, even peers will always feel awkward about the realities of their health publicly. In the end, back then, I was no better than the rest of the agency.
I may not have contributed to the displays and increasingly tense environment in the peer leadership. Still, I passively observed someone who is now a good friend actively decline in her connection to the world.
Today, our peers cut through any red tape in social graces or awkward feelings between us when looking at our mental health. After all, checking in on a friend or peer entails prioritizing health and attending to wellness before the politics of intra-agency affairs.
In the end, my peer’s health is more important than putting on airs and pretending everything is alright when we know this isn’t the case.