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October 01, 2007

After reading the headline, you're probably wondering, “So what is the biggest secret about the behavioral health workforce?” Well, we're not sure this is the biggest secret in behavioral healthcare and, in fact, it may not even be a secret at all. However, it's certainly a topic that we pretend doesn't exist, so we rarely talk about it.

By now you may be thinking through all of your various secrets, wondering which one we could be talking about. So we'll put an end to the suspense right now and let you in on this “don't ask, don't tell” subject: Many professionals who work in behavioral health programs have been diagnosed with a mental illness at some time in their lives.

We aren't talking about those people in our workforces who identify themselves as “peers—those hired because they have a mental illness diagnosis and use their experience of recovery to give hope and inspiration to others. Instead, we are talking about all those other employees who also have had a firsthand experience but have kept it a secret. Hey, the statistic is “one in four” so there must be quite a few of us out there.

Disclosing a secret like this can be a challenge in any setting. Behavioral healthcare settings, though, are probably the most challenging environment for this sort of surreptitious confession for a couple reasons. First, we are supposed to be the people who know how to treat the illnesses, so we think we should be clever enough to avoid “catching” them. Second, since stigma is reportedly higher than average in behavioral health settings (see our May 2007 column), disclosing may come at a higher price than in other settings. Then there's the obvious question that inevitably comes up: “How can we provide services to ‘them’ if we are one of ‘them’?”

Lori has personally experienced this “secret” and has painful memories of trying to hide the shame and guilt she experienced from having a mental illness. It can be exhausting to try and hide a secret of this nature. Long before she had the courage to disclose, she remembers sitting across her desk from people she was providing services to and asking herself, “Why are we on different sides of the desk when they have the same diagnosis that I have? We're both experiencing the same symptoms and are taking the same medications, yet we are pretending that we are entirely different from each other at a very fundamental level.”

This was Lori's first inkling of recovery. It was during those “different sides of the desk” moments that she began to understand some of the things that help people recover. During those moments she realized that mental health isn't about the illness, diagnosis, or medication. It was instead something else that allowed her, and thousands like her, to override the effects of the illness and have a rather “normal” (pardon the term) life experience, as was evidenced in her work and family life.

What was it that allowed some people to override the situation and have a decent life, while others were left to try and survive as a “mental patient,” continually assured that they should have low expectations for themselves? It wasn't courage or brilliance, since the people on the other side of the desk had plenty of both; it had to do with something so obvious that it nearly became invisible. It was, as we now know, the elements of recovery.

Most secrets come with a considerable amount of baggage—suitcases full of stories and little lies designed to keep everything hidden. But perhaps the biggest piece of luggage is the truckload of fears about disclosing them. The fact that they have remained hidden for a while means that a certain amount of dishonesty has happened in the wake of the cover-up. Revealing long-hidden secrets can be a daunting experience since the original secret is only part of the story. The other part is all the other little stories told to cover up the secret. Now we have a “compound fracture,” partly from carrying all that luggage around. The bones of our personal integrity are broken in more than one place. We feel vulnerable because the only way to heal is to tell the truth, expose the broken bones, and set them in position to heal and become stronger than they were before.

What does it mean that employees, supervisors, managers, and CEOs who work in behavioral health systems don't feel safe about telling their stories of mental illness and recovery? What does this say about the work environments we deliver services in? We know that the people we serve need to feel a certain degree of trust and safety to begin their recovery journey, but does our workforce feel safe enough to role model it for them?

We aren't suggesting that everyone should speak up on this matter. We believe this is a very personal choice that each person should make for himself. However, if people do speak up, they could make a huge dent in problems related to stigma, and the dent would be in the place where stigma may be the strongest—the behavioral health field. They also could be a shining example of recovery—i.e., “If I can work on this side of a desk, so can you.”

Perhaps behavioral healthcare employees' willingness to disclose their own mental illnesses in their work environment is an indicator of not only their comfort level with themselves but also the “comfort level” of the organization in which they work. Our impression is that this organizational comfort level is characterized by how the entire staff (and not just folks with mental illnesses) feels about the organizational practices of their leaders, managers, and supervisors. We think that in this era of recovery that if a behavioral healthcare organization's staff does not even come close to the one-in-four norm, then it may not be demonstrating those principles and values that will lead toward transformation. We encourage organization leaders to reflect on the implications of our opinion.

Lori Ashcraft, PhD, directs the Recovery Opportunity Center at Recovery Innovations, Inc., in Phoenix. William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University.

To contact the authors, please send e-mail to

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