No them and us. Only we

Some people call antidepressants “happy pills”. I’m not keen on this description. In my experience, they slice the top and bottom from my emotional range and I feel neither happy nor sad. Instead, they bring a calm which is welcome but can leave me feeling blunted, even flat. I know others describe similar effects.

Antidepressants helped me go back to work very quickly after my breakdown in November 2013. Skilled care from my psychiatrist and GP, timely psychological therapy, and the kindness of colleagues helped even more. Plus an over-developed work ethic. For those lucky enough to have decent jobs, going back to work and feeling useful can play a big part in our recovery.

I mention this because I want you to understand my state of mind on 24th February 2014, 6 weeks after I went back to my job at the time, running a mental health trust. Going back to work was probably the hardest thing I have ever done; one day, I hope to feel able to share why.

Anyway, on this particular day, I attended a round-table event arranged by Time To Change. Had I not been on my medication, I might have felt the need to challenge what we were being told. Or wept. Because I and the other NHS leaders present heard stuff at that meeting that we desperately wanted not to be true. And yet deep down we knew it to be so. It was like learning about institutional racism. Only this time, it was institutional stigma and discrimination from the services we were responsible for towards people who use our services.

We heard that, despite the measurable shifts in attitude of the general public (published in July by Time to Change for 2015 and again showing small but significant improvement), attitudes within the NHS haven’t shifted. In some cases, they have got worse. And the places where they appear most entrenched, as reported by those who know, ie patients, are within mental health services. And it rang horribly true.

From this meeting was born a desire amongst a number of us to do something to change this. Five months later, at my retirement party, I listed some of the things I planned to do with my new free time. One of them was to offer my services to Time to Change to help tackle this intrinsic issue within mental health services. And although I planned to earn a modest living writing, speaking and coaching others, I wanted to do this work as a volunteer. I felt I had something to pay back.

It has taken time to set up the project. But now it is underway. Time to Change are working with two mental health trusts, 2Gether and Northumberland, Tyne and Wear. Like me, they are volunteers. The trusts were selected because they could demonstrate their readiness at the most senior level to address stigma within their own services with integrity, hard work and, most importantly for me, compassion. On the working group, which I chair, we have reps from the two trusts, four experts by experience, our full time project manager, senior colleagues from Rethink and Mind who together are responsible for running Time to Change, and two people from a social research company who are doing the work on attitude measurement.

You can read more about the purpose  and details of the project here on the Time to Change website, including quotes from those taking part.  And Community Care have published a piece about the project today.

Stigma towards those who need mental health support is alive and kicking within the NHS. It manifests itself with lack of empathy towards those who self harm or are otherwise in crisis, as described in the recent CQC report; low expectations from clinicians about future prospects for people who experience serious mental illness; lack of investment in research into new treatments; marginalisation of mental health in the way the NHS is planned and organised; and unfair treatment of mental health services by local and national commissioners in their expectations and funding decisions.

But I have high hopes. There is an absolute acceptance amongst those involved in our project that things need to change. And that instead of simply asking people who work in mental health to be more compassionate, that the change needs to start at the most senior level. We have sign – up for this work from the very top of NHS England, Mind, Rethink, Time to Change and at the trusts. And we agree that for staff to work respectfully with patients and treat them with optimism, expertise and compassion, they need to experience the same from their colleagues, including their most senior leaders, their commissioners and their regulators.

It was a long time ago that I was told by a nurse that I was a waste of space and that looking after me after I had hurt myself took him away from patients who were truly deserving of his care. At the time, I absolutely believed him. It took me many years to unlearn what he said. And it nearly broke my heart to hear, at that meeting back in February 2014, that such attitudes are still relatively commonplace today. The difference now is that we are talking about them. And acknowledging a problem is the first and most important step towards solving it.

Please don’t just wish us luck. Please join in and help us tackle stigma towards people like me and millions of others who experience mental illness from time to time. I’ve been off my antidepressants for several months now. I feel like the whole me again, which has one or two negatives but is mostly pretty amazing. And whilst I am doing lots of things to look after my mental health in my new world, who knows if I will need treatment from mental health professionals again one day?

Because there is no them and us. Only we.



  1. A courageous piece by someone who knows and cares. You are not a waste of space. You are an incredible person who is making change rise up out of the ashes of her past.


  2. I was a service manager in mental health when I had my first period of significant sick leave due to depression almost 20 years ago. At the time I think the biggest stigma I faced was my own. Eventually with help I was able to put things back into context and by being candid about my problems I hope I have helped other staff along the way and I think it made me a better nurse.
    Ten years later I was on sick leave again and for the first time started on medication and totally agree about them top slicing emotions. Eventually after some scary moments we found something that worked for me with out me becoming “robotic” as my wife called it.
    I guess what I am trying to say is that the nature of depression is that you can not see a way positive way forward but this illness does not have to define who you are.
    Health workers are some times viewers of the worst case scenarios. The more examples of positive outcomes they see can only be a good thing. So perhaps those of us that come out the other end and challenge the pre- conceived image need to make more noise but as I said you need to face your own stigma first.


  3. Phil, that was such a good and useful comment to receive. I’ve hesitated about sharing my own depression in the past partly because of that blimming self-stigma thing. I’ve been through grim periods when I didn’t even accept I’d had depression – it was just me being useless, lazy, pathetic, work-shy etc. You’ve helped more than you can possibly know. Big thank you from me to you. Lisa 😊😊😊


  4. To the person who has left two long comments: I can’t approve your comments because they relate to my old job and this isn’t the place for that.

    Thank you for your positive remarks about me. I made a great deal of effort to help you and I’m deeply sorry you don’t feel it had an impact. All I can say now is that yes, I know there is stigma within mental health services and yes, it is awful. And yes, I have experienced this personally.

    But I have also experienced tremendous compassion and skill which is how I am here today. We can only change these kind of things through compassion. Naming and shaming simply pushes people into corners and creates more conflict. That’s my opinion but it is also based on evidence, including the Truth and Reconciliation Commission in South Africa and the subsequent work of the Tutu Foundation.

    Something that I find helpful is to recognise that, even if something is 99% someone else’s responsibility and only 1% mine, the only part I have control over is my 1%, and how I respond to what has happened. I guess I’m saying to you that you have some choice about whether you allow yourself to be defined by horrible things that have happened in the past.

    May I wish you much love and luck in the future.



  5. Hi Lisa,

    I’ve experienced stigma within the NHS when I had strong urges to self-harm a few years ago. I went to A&E and the nurse told me I was wasting her time. I subsequently self-harmed a few hours later. I suspect she was suffering from the stress of overwork. Never the less I felt (and also became physically) wounded by the experience.

    I think what you are doing is brilliant.

    I’ve decided to comment because the title of your post was something I was coincidentally thinking about last night and I would like to share my philosophy (if that is ok?).

    I think you are effectively calling for an ethic that we need to identify with all people to care for them. And particularly in the NHS.

    I think that is quite hard to achieve. Is it possible to have a sense of pride in work if we have no distinct identity to form pride?

    Perhaps the phrase could be “Them and Us and We”.

    Any movement for change requires consciousness and identity. So we need difference to define the edges. To then achieve clarity we paint in the detail with colour. We are all people. But for medical professionals to change there has to be awareness of their role (one aspect of that role, hopefully, being caring) and a sense of pride in their professionalism. Which is a different role to the person needing to be cared for.

    “Only we” lacks clarity (clarity being both detail colour and edges) and in itself creates a duality between “them and us” and “we”. That duality may sub-consciously, perhaps, create resistance in the mind of the medical professionals that you hope to change. Because, I would argue, stigma is not just a lack of consciousness it is also a disrespect for others.

    From an existentialist viewpoint, “Them and Us and We” is saying “please care for others because we are all people”.


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