Challenges of living with a mental health condition as a registered healthcare professional: exploring experiences of organisational support and stigma

Abstract

The prevalence of serious mental illness is higher in healthcare professionals than in the general population. Mental health issues are associated with more lost workdays than any other chronic condition within the NHS. For healthcare professionals, disclosure of mental health condition can lead to stigmatisation and devaluation as a professional. The aim of this study was to investigate the experiences of living with a mental health condition as a healthcare professional and access to support. The study used qualitative methods combining data from semi-structured interviews (n = 10) and textual data from Twitter threads (n = 51). Purposeful sampling was used to achieve maximum variation in terms of serious mental illness experience, health care professions, and location of work. Search criteria for identifying relevant twitter threads followed the same sampling criteria. The data was analysed using thematic analysis. Three themes were identified: importance of support and advice, need to tackle stigmatisation, and challenges to improve mental well-being. Emotional validation of living with a mental health condition as a health care professional was an important factor for feeling supported. Organisational mismanagement and negative attitudes about mental illnesses were considered as key reasons for persistent stigmatisation. Challenges included disparities in support between the professions, high expectations by self and others, and fearing to disclose suicidal thoughts and ideation. Organisational changes are needed to better support healthcare professionals living with serious mental health conditions. Barriers to seeking support could be addressed by providing better training and toolkits for managers and colleagues.

Keywords:

• Mental health
• health care professional
• occupational health
• stigma
• mental health support

REVIEWING EDITOR:

• Daryl O’Connor, University of Leeds, United Kingdom

SUBJECTS:

• Mental Health Research
• Mental Health Services and Policy
• Occupational Health and Safety
• Psychiatry

Introduction

Mental health is defined as a state of mental well-being that enables people to cope with the stresses of life, realise their abilities, learn well, work well, and contribute to their community (NHS, 2022). However, the definition of mental health is much broader and varies between individuals due to factors, such as background and environmental factors. In recent years, although the stigma towards mental health has reduced, mental health overall has declined (Evans-Lacko et al., 2014). The number of antidepressants prescribed increased by 25% in the five years preceding COVID-19 (Lalji et al., 2021), presenting not only an increase in poor mental health and well-being but also a reduction in stigma surrounding mental health as more people are seeking help and employing self-care.

Mental health conditions are often characterised by a clinically significant disorder in an individual’s cognition, emotional regulation, or behaviour (WHO, 2024). In 2019, It was estimated that worldwide 1 in every 8 people live with a mental health condition, with anxiety and depressive disorders being at the highest prevalence (WHO, 2024). In 2021, it was estimated that 3.8% of the worldwide population was affected by depression (Institute of Health Metrics and Evaluation, 2024). Other common mental health conditions include bipolar disorder, schizophrenia, eating disorders, and post-traumatic stress disorder (PTSD) (Institute of Health Metrics and Evaluation, 2024; National Collaborating Centre for Mental Health, 2011).

Although the stigmatisation of mental health has seemingly declined, stigma continues to be a barrier to receiving mental health treatment for many individuals (Sickel et al., 2014). Mental health stigma can particularly be a problem for health care professionals. Doctors and other healthcare professionals are often visualised as heroes or super people within a culture where they are seen as healthy people who treat sick patients and do not need treatment themselves (Stanton & Randal, 2011). Patients can have negative perceptions of health care professionals (HCPs) with a mental health condition which is a factor that can significantly affect HCPs’ mental health (Corrigan et al., 2012; Parcesepe & Cabassa, 2013). Schizophrenia and bipolar disorder are often referred to as an serious mental health condition (SMC) but more generically any psychological problems with debilitating impact on person’s functional and occupational activities would be included in this category too.

There is also a fear amongst healthcare professionals that showing vulnerability means to risk losing respect of peers, which can deter healthcare professionals from seeking help (Sickel et al., 2014). Some healthcare professionals feel that they cannot be honest about their mental health due to what it will mean for their career (Oxtoby, 2016; Stanton & Randal, 2011). Confidentiality issues can act as a deterrent for healthcare professionals from accessing help for their mental health because there is uncertainty regarding how their information will be concealed when there is overlap between their personal and professional lives (Oxtoby, 2016; Zaman et al., 2022).

Poor mental health and the stigma associated with it can lead healthcare professionals to take unexplained time off work and not reaching out for help. Healthcare professionals in the UK have higher absence and sickness rates than other professions (Edwards & Burnard, 2003). It is necessary that these issues are identified and addressed within all healthcare sectors to improve the mental health and well-being of the healthcare workforce. It is also important to discuss these issues to prevent the current issue of a high labour turnover, where more healthcare professionals are leaving their jobs than the number of people being employed to take over their position (Buchan et al., 2019).

In this study, we sought to explore the lived experience of HCPs who are presently living with a mental health condition or who have worked closely with colleagues who with SMC, to develop a greater understanding of their personal struggles or challenges faced in clinical practice and adequacy of support systems in place, to identify practical strategies to address these prevailing issues.

Materials and methods

Design

This study used a qualitative design with semi-structured interviews and textual analysis. Interviews were chosen over focus group as the study topic is sensitive and interviews allow personal space for participants to share their experiences in a safe place. Twitter¹ was selected as a source textual data as online environment is often treated as a way of processing thoughts and experiences in a moment and of the social media platforms it is more often used for professional purposes than others. The theoretical and epistemological alignment of this study is with pragmatism.

Participants

Ten participants (nine females, one male) from UK took part in the study. The research team were in agreement that data sufficiency and information power occurred after eight interviews but further two interviews were carried out as they had already been organised (Braun & Clarke, 2021; Malterud et al., 2021). Even though data sufficiency was reached we acknowledge that a larger sample would have allowed for variation in terms of ethnicity and LGBTQ representation.

Sixty Tweets and threads (TaTs) were identified but following the application of inclusion criteria, 51 were included in the analysis. In threads with multiple replies, only the first 50 replies were included. This resulted in 90 pages of textual material (standard font and line spacing). The inclusion criteria are presented below in Table 1.

Table 1. Inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
TaTs written in English only Replies to TaTs TaTs from relatives of HCPs with mental conditions TaTs from patients’ perspectives on HCPs with mental conditions Retweets relevant to mental conditions Quote tweets relevant to mental conditions TaTs from retired HCPs Only the first 50 replies of large threads TaTs that discuss experiences with burnout and stress	TaTs before 1st January 2018 TaTs from Twitter accounts with <50 followers TaTs not relevant to SMCs TaTs from Twitter accounts with a tweet history <100 Private accounts TaTs that include hyperlinks TaTs from bot accounts TaTs from ‘accounts that no longer exist’ TaTs that have no text and only use ‘emoticons’

Procedure

Between October and December 2022, registered healthcare professionals in North East England were recruited via social media and professional platforms. Written and verbal information of the study was provided. Ten health care professionals agreed to participate and signed an informed consent. Inclusion criteria were (i) being a registered health care professional who’s had practiced within the last two years and (ii) having experience of mental health challenges either from personal lived experience or from working closely with colleagues with SMC. Purposeful sampling, which allows the identification and selection of information-rich cases, was used to recruit the participants. The aim of the sampling was to achieve maximum variation in terms of serious mental health experience, health care professions, and location of work.

During same timeframe, search strategy was developed to identify tweets and threads on Twitter by registered health care professionals focusing on practicing as a health care professional with an SMC. A project specific Twitter account for conducting the searches was created to ensure no existing algorithms skewed the search results. Search criteria for identifying relevant Twitter threads followed the sampling criteria for the interviews. TaTs older than five years were excluded as were TaTs from accounts with <50 followers or 100 posts. TaTs from bot, private, and no longer existing accounts were also excluded as were TaTs including hyperlinks or only using emoticons. The data extraction was carried out by AE who is a black male researcher undertaking the research as part of their Master of Pharmacy dissertation work.

The study received ethical approval from the Faculty of Medical Sciences Ethics committee at Newcastle University (25582/2022, 25649/2022²).

Interview schedule

Interviews were semi-structured to enable flexibility. Topic guide included structured opening and closing to ensure time was allocated for clarifications at the start and that the interview ended with questions outward focused questions allowing the participant to finish on a positive note after potentially sharing challenging experiences. The questions focused on participants experiences of being a registered health care professional and living with a mental health condition either personally or peer experience. The topic guide was develop by LL and MB. The interviews were carried out by MB who is a white female researcher who was undertaking the research as part of their Master of Pharmacy dissertation work. MB was well qualified for carrying out interviews with semi-structure topic guide as this is similar what she would have done in clinical consultations with patients and health care professionals since stage 1.

Data analysis

The data was analysed using inductive thematic analysis as outlined by Braun and Clarke (2006, 2012). NVivo was utilised for the analysis. MB coded the interview data and AE coded the textual data in discussion with LL and APR who supervised the projects. MB and AE both developed initial themes and the initial analysis of each data set was combined and further developed by LL and APR to finalise the themes and to refine them to ensure they had enough supporting evidence and were distinct. The use of thematic analysis enabled the research team to analyse participants own stories and how the experienced they had had or had witnessed had impacted them. The themes were not returned to the participants for comments.

Reflexivity

MB and AE kept research diaries throughout the project where they recorded the development of their thoughts. Issues arising around positioning, values, and judgements were discussed as part of weekly supervision meetings with LL. As 4th year pharmacy students nearing qualification MB and AE felt the importance of the research keenly and many conversations were had about the perception of acceptability of being an HCP with SMC. LL and APR were conscious of the potential bias that having students undertake the fieldwork could introduce and undertook weekly individual supervisions and biweekly group supervisions as part of the 20-week research period.

Results

Ten participants took part in the interviews (9 = female, 1 = male). Each participant presented a different health care profession. These were biomedical immunologist, dental therapist, mental health nurse, midwife, nutritionist, community pharmacist, hospital pharmacist, pharmacy advisory, physiotherapist and trainee GP. Only one participant said they had never struggled with their mental health. Two participants had diagnosis for depression and seven said they struggled with their mental health regularly but had not sought diagnosis. The participant who had not struggled with mental health themselves had a close colleague with diagnosis of bipolar disorder.

Twitter users whose TaTs were identified included 11 male and 21 female Twitter users. Further two did not disclose their gender identity and one identified as other. Most were doctors (n = 20) or pharmacists (n = 11). The ethnicities included White (n = 15), Asian (n = 7), Black (n = 3), and mixed (n = 1), nine users did not disclose their ethnicity. Of the TaTs 12 were linked to unspecified mental health diagnosis, eight linked to specific diagnosis (including depression, anxiety, PTSD, OCD), nine related to HCP suicide, and seven focused on impact of work pressures on HCP mental health.

Themes

Three themes were identified: importance of support and advice, need to tackle stigmatisation, and challenges to improve mental well-being. The themes are presented below. Each will be described and illustrated with exemplar quotes.

Theme 1. Importance of support and advice

This theme captured participants experiences of support and advice they had received and would like to receive. When the participants talked about support, they identified that the current support services provided to them were not as useful as they expected. A few participants said that there was no consistent approach for mental health support across community, primary, and secondary care. Participants felt there was a lack of communication about the options of support available and explained that those who have tried accessing occupational health had not always had a positive experience, whether that was themselves or a colleague.

“It has a long waiting list… I have heard bad things about it and I don’t think I would be very inclined to use it.” (P1)

A participant who had accessed occupational health expressed that the service was not effective in preventing them from leaving their occupation and once they left their employment due to a mental health crisis, all support was ceased. Some participants felt lost and did not understand the support available to them. Most of the participants had a brief idea of what support what available to them but did not feel like support was offered until they were at a breaking point regarding their mental health. Those participants explained that they thought support should be offered before this point and should be used as a preventative measure.

“It gets to the point where people notice something is wrong with you and then your managers will say they are there for you.” (P7)

Participants’ experience was that the current mental health support offered to healthcare professionals does not provide an effective service and that there are many challenges facing the available support. Nevertheless, some participants felt that other forms of support were more effective in helping them cope with stress and poor mental health, such as self-care and reflection. The participants explained how they were taught to use these techniques from their employer and that they have found them to be the most beneficial for themselves. This was reflected in the tweets and replies that often highlighted the importance of self-care and seeking activities that had positive impact on mental health.

“The best way for me is just to talk about it.” (P5)

“If I feel anxious, I will try and do breathing techniques.” (P3)

“My favourite #selfcare are #running #walking #cycling #baking & #talking to friends & colleagues. #depression #MentalHealthAwareness #ItsOKToSay #ItsOKNotToBeOK #EndTheStigma” - [Thread 5 (pharmacists)–original tweet]

The support available to the participants varied by the setting they worked in and also by the professions. The participants were from a range of professions within the healthcare sector, and their experiences highlighted that different sectors of the healthcare system have different access to mental health support, differences in the struggles they face at work, and a lack of awareness of the support available to healthcare professions different to their own. Those working in primary care roles felt underappreciated and that they did not have as good access to support as secondary care staff did.

“There is a huge lack in support for mental health in dentistry.” (P2)

“We receive less options than other health professionals, like nurses. This is due to working for a company rather than working directly for the NHS.” (P8)

“The community pharmacy I work in has never really spoken about mental health… Even in the pandemic it was always thanking doctors and nurses whilst we were run off our feet.” (P6)

When considering the differences in the support given to different healthcare professionals, participants commonly mentioned that they felt nurses faced more difficulties than other healthcare professionals. Participants’ experiences were that nurses seemed to face higher levels of burnout and that there were systemic issues facing nurses, such as staff shortages and being underpaid.

“They seem to have a lot of struggles with pay and they do crazily long shifts.” (P10)

“So over the moon for you. With everything that has happened over the past few years it’s more surprising that anyone in the health service survived. You may not always be aware of it but you are all really appreciated by us your patients. Hope it goes really well for you now.” - [Thread 15 (doctors)-reply 23]

Theme 2. Need to tackle stigmatisation

Organisational mismanagement and negative attitudes about mental illnesses were considered as key reasons for persistent stigmatisation. Challenges included disparities in support between the professions, high expectations by self and others, and fearing to disclose suicidal thoughts and ideation.

Participants talked about their struggle with stigmatisation surrounding mental health and how it was a barrier to seeking help. For some, this meant they felt they could not access help from people within their peers or line managers due to embarrassment and fear of consequences. Most participants felt that there was still a stigma surrounding mental health and being a healthcare professional, making it harder for people to speak out about issues they are facing. Some felt that they created a stigma for themselves, meaning they felt uncomfortable in asking for support from their employers. For the participants, stigma prevented them from accessing the mental health support that they need.

“I would not feel comfortable speaking to other staff members or even my manager because it’s just a bit of a hard topic really… I tend to keep it to myself.” (P2)

“You don’t want to admit that you’re struggling.” (P6)

The replies to HCP tweets on experiences of discrimination at the workplace due to mental health often encouraged the person to seek legal advice to help navigate this issue. A common response from other HCPs suggested that lawyers were the best individuals to contact and encouraged the person to disclose no or minimal information to their line managers. It was implied that HCPs may not be aware of how to deal with discriminatory acts and might not believe they require legal advice.

“I advocate: 1) Don’t lie 2) Disclose only what you have to 3) Consult with a lawyer 4) Have the courage of your convictions that a mental illness is not a disease to be punished or stigmatized. We will win this fight.” - [Thread 1 (doctor)-reply 27]

The unwillingness to discuss mental health with peers and employers was also evident in the TaTs. Many tweets and replies spoke about the stigmatising attitudes they had experienced in workplace. It was commonly stated in the data that some HCPs may see SMCs as weakness. This often contributed to stigmatisation of SMCs in healthcare.

“Every time another doctor makes a flippant remark or snide comment about mental illness, a little bit of me dies inside, which is then made worse because I’m not brave enough to challenge them on it #MentalHealth #physicianhealth #WoundedHealer” - [Thread 21 (doctors)–original tweet]

Participants observed that the language used when discussing SMCs often has negative stereotypes attached to it. Stigmatising terms, such as mental disorder, mad, and psycho were used in very discriminatory way. Participants felt that new terminology for discussing SMCs may reduce the negative connotations surrounding SMCs.

“We definitely need a new paradigm for messaging with regard to “mental illness”. That term is too loaded with negative (& imprecise) connotation from decades ago. It’s time for new terminology. Even movies portray “mental illness” as Horror. It’s in the collective subconscious.” - [Thread 2 (doctors)-comment 17]

All participants talked about their struggle with stigmatisation surrounding mental health and that it can become a barrier to seeking help. Some of the participants discussed that they felt they could not access help from people within their healthcare team due to embarrassment, fear, and also worry of the consequences. Some participants also expressed how there is often more stigma regarding mental health for males because they may find it harder to discuss issues with their mental health than females.

“As a doctor with mental illness, one of my greatest fears has been to be seen as weak. This is particularly hard as a trainee, but doesn’t go away” - [Thread 2 (doctors-comment 2]

“There is something about being a man and my mates don’t really talk about those kinds of things. Whereas if I work with female colleagues, they can be a bit more open.” (P9)

From the participants and the TaTs, it was clear that HCPs and patients identified some strengths of having HCPs with lived experience of mental health challenges. It was frequently suggested that HCPs living with SMCs can understand, be more compassionate, and empathise with patients better than a HCPs without mental health conditions.

“Sometimes I worry that being a pharmacist with ADHD and anxiety makes me a bad pharmacist, but then yesterday I had a consultation with a girl who also had both (I could tell by meds but also body language), and I really think my perspective helped make it a success!” - [Tweet 5 (pharmacist)]

Theme 3. Challenges to improve mental well-being

There were system wide issues that the participants shared and that were also prevalent in the TaTs. The support available to the participants varied by the setting they worked in and also by the professions. The participants were from a range of professions within the healthcare sector, and their experiences highlighted that different sectors of the healthcare system have different access to mental health support, differences in the struggles they face at work, and a lack of awareness of the support available to healthcare professions different to their own. Those working in primary care roles felt underappreciated and that they did not have as good access to support as secondary care staff did.

“There is a huge lack in support for mental health in dentistry.” (P2)

“We receive less options than other health professionals, like nurses. This is due to working for a company rather than working directly for the NHS.” (P8)

“The community pharmacy I work in has never really spoken about mental health… Even in the pandemic it was always thanking doctors and nurses whilst we were run off our feet.” (P6)

When considering the differences in the support given to different healthcare professionals, participants commonly mentioned that they felt nurses faced more difficulties than other healthcare professionals. Participants’ experiences were that nurses seemed to face higher levels of burnout and that there were systemic issues facing nurses, such as staff shortages and being underpaid.

“[Nurses] seem to have a lot of struggles with pay and they do crazily long shifts.” (P10)

“Not a day goes by where nurses are not extremely stressed and feeling burnt out.” (P5)

The participant’s perceptions indicated that workplace stress was indicated systemically and not just individually. Most of the participants felt that all healthcare professionals within the UK’s healthcare system struggle with workplace stress. All apart from one participant indicated that their mental health had been impacted by work related stress. There was a recognition that a system wide change is needed to not only make it easier for HCPs to share their mental health challenges but to improve the mental health of the workforce in general.

“I think the whole of the NHS is just stressful.” (P1)

“No doubt the system is broken and excellent practitioners are leaving the profession. Until we challenge it, things won’t change.” [Thread 18 (doctors)-reply 3]

Poor work environment was also perceived to contribute to workplace stress. One of the participants, who is relatively junior in their career, outlined how working within a poor work environment directly correlates with having poor mental health. Participants felt that a safe and clean work environment for healthcare staff to improved job satisfaction. Participants also felt that working within a clean and organised environment increases productivity at work. For some of the participants, having an unorganised and unclean work environment led to them being unable to relax during break times at work.

“I have worked in really dirty staff rooms with no natural light, and some do not even have clean cutlery.” (P10)

Long working hours and staffing issues were commonly shared challenges in interviews and TaTs. All the participants discussed how both factors contribute to high levels of workplace stress, which they believed results in a decline in staff mental health. Participants shared about not having enough staff for the workload that needed to be done. Lack of staff and high workload were placing a heavy burden on healthcare staff, which at times seemed to be unmanageable to the participants and had negatively impacted on their mental health. The participants shared how these issues can cause a knock-on effect outside of work and impact their personal life.

“There have been a few times where I have been quite new and been the only qualified person on a specific ward and that can be stressful and horrible if something happens.” (P9)

“However, this very sentiment, held by many, including medical administrators, public, and physicians themselves- that we should be available 24-7, work as super-humans with very mortal limitations- is the very reason we are in a physician mental health crisis.” - [Thread 9 (doctors)-original tweet]

“Sometimes I can be working until 9pm so I miss my son’s bedtime so work definitely can impact on my mental health.” (P10)

Suicidal ideation caused by work related stress and mental health issues only came through in the TaTs and not in the interview data. HCPs with suicidal ideation commonly described the stresses of work as a factor to suicidal ideation or suicide attempts. In their replies, members of public also expressed how shocked to hear about HCPs struggles with suicidal ideation. Both the public and HCPs noted that HCP suicides had come as surprises as there were usually no signs of distress or suicidal ideation. This demonstrates that some HCPs with suicidal ideation would prefer to suffer in silence and not seek support from other HCPs.

“A year ago. my plan was to drive over the bridge on my way to my shift at the pharmacy. My planned suicide date? A year ago yesterday. My reason? Other than my own misery? To bring attention to mental health struggles of pharmacists during the pandemic. #TwitteRx #trans” - [Thread 13 (pharmacists) – original tweet]

“I’ve known 3 physicians that died by suicide. I wasn’t in a position to know them on a personal level, but our hospital community was shaken. No one saw any signs” - [Thread 10 (doctors)-reply 20]

Discussion

This study aimed to explore the lived experiences of serious mental health conditions as a health care professional through interviews and analysis of Twitter tweets and threads. A key finding is that the current mental health support services available to healthcare professionals are not always effective in preventing a decline in mental health or in aiding people in improving their mental well-being. Many HCPs would not share their mental health struggles with peers or line managers however there was a positive peer support culture on Twitter for those who disclosed their struggles. The findings of this study suggest that HCPs experience an additional level of mental health stigma from peers and members of public in comparison to other people with mental health conditions. Conversely, having experience of struggling with one’s mental health was seen as an advantage by some as the lived experience would enable them to provide more person centered care.

Current mental health services not effective—importance of support

A key finding of this study is that the services provided to healthcare professionals are not effective in supporting them with their mental health. This finding aligns with existing evidence that identified multiple barriers to access occupational health support for mental health (Clarkson et al., 2023). The diverse participant sample in this study suggests that a concerted effort is needed to ensure parity of support across the professions and sectors. Conversely, a recent NHS long term plan highlighted the need for support for healthcare staff outside hospital settings (England, 2019). Many of the participants used their own methods to try to improve their mental health, such as using self-care regimes, including exercise or mindfulness. Other studies support the positive impact of exercise on mental health (Kandola & Osborn, 2022; Robson & Gray, 2007).

Experiences of negative perceptions of SMCs were common from HCPs in this study. This was portrayed through HCPs reluctance to share their mental health struggles with peers but also from experiences of peers who had been discriminated following a disclosure of SMC. In this study, HCPs expressed they felt that having a mental health condition made them feel weak. This feeling was due to other HCPs and the public having unrealistic and unhuman expectations of HCPs. This usually left HCPs in fear of having their mental health status being exposed to others. Other studies agree that the perceptions of SMCs from HCPs and the public were generally negative (Adu et al., 2022; Rivera-Segarra et al., 2019; Wallace, 2012). From the evidence of this study and other studies (Adu et al., 2022; Braun & Clarke, 2021; Chisholm-Burns, 2019; Rivera-Segarra et al., 2019); anti-stigma education aimed at HCPs and the public could be implemented to improve negative attitudes towards SMCs (Adu et al., 2022).

In this study, the HCPs preferred not to disclose their mental health conditions to peers or employers. This was often due to fear. Another study has suggested fear of judgement and a fear of dismissal of employment as reasons for both junior and senior HCP for not sharing about their mental health diagnosis (Waugh et al., 2017). There is a need to improve stigmatising attitudes towards SMCs (Winter et al., 2017). Rates of disclosure amongst HCPs might be improved by increasing awareness of the consequences of stigmatisation in the workplace (Knaak et al., 2017).

Findings from this study suggest that HCPs who have suicidal ideation would prefer to hide it, leaving them with no support from others. Other studies on suicidal ideation among HCPs, such as Ng et al. (2021) have commented on how the main reasons to suicidal ideation were low job satisfaction and lifestyle factors. A study by Chisholm-Burns (2019) on suicidal ideation across pharmacists also identified that suicidal ideation among pharmacists were commonly due to being overworked and stressed which supports the reasons for suicidal ideation presented in this qualitative study. Ng et al. (2021) and this qualitative study comment on how there are current barriers to mental health support and that HCPs fear seeking mental health support due to stigmatisation and fear of judgement. An improvement of mental health support may reduce the suicide rate of HCPs and may also reduce feelings of suicidal ideation amongst HCPs (Rubin, 2014).

A positive finding of this study is that HCPs living with a SMCs felt it enables them to be empathetic towards patients with mental health conditions potentially leading to better person centered care. Studies on the perceptions of HCPs on SMCs have observed HCPs displaying some positive attitudes towards SMCs (Henderson et al., 2014; Moll, 2014; Waugh et al., 2017). These studies, however, have not articulated any benefits from working with an SMC as a HCP. Having a positive outlook on SMCs could also potentially enable individuals living with SMCs to have a more positive mindset leading to better mental health and increased resilience which is significantly beneficial as an HCP (Boyraz & Lightsey, 2012). Increased resilience leads to individuals being better at managing stressful situations which HCPs are likely to often face (Boyraz & Lightsey, 2012).

Finally, HCPs in this study commonly felt that more could be done for mental health support within the NHS. The funding for mental health in the NHS has reduced from 11.0 to 9.93% in the last three years (James, 2022). Furthermore, both this qualitative study and a qualitative study by Clarkson et al. (2023) on the mental well-being of NHS staff reported that NHS staff expressed there was a need for improving mental health support. Furthermore, both studies also expressed how HCPs frequently encountered barriers to using mental health services, such as the perceived stigma of seeking help (Clarkson et al., 2023). Increasing the budget for mental health may allow implementation of peer training and manager training towards mental health which may attract more HCPs into seeking mental health support (Clarkson et al., 2023). Developing toolkits for managers may also help to create a workplace with supportive environment where HCPs feel accepted and empowered to share their lived experiences.

In conclusion, more emphasis is needed on reducing stigma of being a health care professional with a serious mental health condition. Many HCPs are not accessing or seeking the support available to them due to fear of disclosure to peers or line managers. There also seems to be a disparity of support available across the different sectors within the health care service. Organisational approach to reducing stigma and encouraging the use of non-discriminatory language would benefit many. There is also a need to address the organisational pressures, such as workload that are contributing towards the mental health challenges of health care professionals. For HCPs being able to share about their mental health without fear would potentially reduce the pressure they are feeling and enable better provision of person centred care.

Acknowledgments

The authors would like to thank all the participants who contributed to this study by giving their time and sharing their experiences openly and vulnerably.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data was not available due to ethical restrictions for the interviews. For Twitter data, it is available on request from the authors.

Additional information

Notes on contributors

Laura Lindsey

Dr Laura Lindsey is a senior lecturer in the School of Pharmacy and member of the Population Health Sciences research institute in the Faculty of Medical Sciences at Newcastle University. She is a chartered psychologist with interest in mental health research and interdisciplinary working. Dr Lindsey is an Associate Fellow of the British Psychological Society and a Senior Fellow of the Higher Education Academy.

Morgan Barber

Morgan Barber graduated as Master of Pharmacy in 2023 and is currently a foundation pharmacist.

Awwab Elawad

Awwab Elawad graduated as Master of Pharmacy in 2023 and is currently a foundation pharmacist.

Adam Pattison Rathbone

Dr Adam Pattison Rathbone is a registered pharmacist and independent prescriber. Dr Rathbone has a postgraduate diploma in clinical pharmacy and works at the Great North Children’s Hospital in Emergency and Acute Assessment. Dr Rathbone completed his PhD at Durham University, John Snow College and became a Lecturer in Clinical and Social Pharmacy in 2019. Dr Rathbone is a Senior Fellow of the Higher Education Academy.

Notes

1 Now rebranded as X but the article will use Twitter throughout as at the time of carrying out the research this was the name used.

2 There are two ethics numbers as each student submitted an application for the element of study they were undertaking as part of the requirement for their dissertation.