Hiding in Plain Sight: The Stigma of Nurses With Mental Illness

My brother killed himself in early 2019. My last memory of him is us saying our goodbyes through my closed bedroom door after I had just come home on Boxing Day morning after doing a 12-hour night shift on Christmas. I received a text from him later that day letting me know he got home safely. He asked me if my kids liked the gifts he brought them. The presents he brought when he visited were always my kids’ highlight of his visits. “They like them,” I briefly replied. The presents are how they continue to remember him today. I still have that text message on my phone. He took his life less than a month later. His suicide rocked my world. I am a Registered Nurse (RN). I’ve been one for 13 years. I work in mental health and substance use services and my career has encompassed all kinds of roles, from direct care nurse to clinical educator. I’ve been a mentor to my nursing colleagues and students, and am vocal in my opinions about patient rights, the anti-stigma of mental illness and substance use, and equitable access to health care. One thing I am not vocal about, however, is my own experience with mental health and substance use issues.

I have had my own struggles.

Mental Health Has Always Been a Challenge for Me

I have had my own struggles. In my early 20s, I lived with undiagnosed depression and alcohol issues, the latter of which ended shortly after becoming a nurse. After I graduated from university at age 21, my life stalled. I ran away to New Zealand with a man that abused me. I returned to Canada four months later unsure about the direction of my life. I moved back in with my parents when I was 23. I applied to nursing school on a whim because I needed a job and didn’t know what else to do. Shortly after applying, my dad’s decades of heavy alcohol use caught up to him. He died of liver failure weeks after I accepted a spot in school. I made it through my education despite struggling with the grief of his death, remedying it with excessive drinking to feel closer to him. My life took a hard right when I moved to another province with my partner to start fresh. I began to shift towards what I identified as adulthood, and my partner and I decided to start having children. My mother’s health began failing after my dad’s passing and I became her caregiver. Months before my brother’s death, she received a cancer diagnosis. This was stressful, especially for my brother, who I do not think ever recovered from our dad’s death over a decade earlier. One morning, after a tough night shift, when I was giving my colleague a report, I started crying. I felt like a failure, professionally and personally. I felt overwhelmed. My colleague was kind enough to take me aside and ask me what was wrong. I knew I was deeply impacted by caring for my mom through her cancer treatment. I shared this with my supervisors and managers at the time. I received radio silence. Was it lack of caring? Or did they just not know how to approach this with a co-worker instead of a patient?

The First Sign of a Toxic Workplace

In late November 2018—the middle of my mother’s cancer treatment—my brother visited to take her to chemo. She did not get chemo that day. He was overwhelmed by her frail appearance and instead took her to the emergency department. Not one nurse or doctor asked my brother how he was doing. I imagine he wasn’t well. That night we ended up fighting because she missed the treatment. I saw him one more time at Christmas. It was an impromptu visit. The last time I said goodbye through my closed bedroom door, it didn’t even cross my mind that I would never see him again.I will never forget the moment when I saw two police officers at my door. I thought they were following up on a call I had made earlier that day about suspicious people in the neighborhood. When they asked to come in, I knew something was wrong. When they told me my brother was dead and it was an apparent suicide, I was in shock. My memories of him were as a jovial, positive, overly optimistic person. A decade earlier, he’d broken up with his then-girlfriend, two days before my wedding, because she was “too negative.”My world exploded. It was only when I was in the thick of it that I realized the “generous” five days of bereavement leave at work was nothing. I had to go to a different city in a different province to do all the things that I never thought that I would have to do—like make funeral arrangements for my sibling, close his bank accounts, clean up his apartment. It was surreal. I was overwhelmed and scared to go back to work caring for another youth who had recent suicide attempts and ongoing suicidal thoughts.

My world exploded.

There’s No Support for Nurses With Mental Health Problems

Upon my return, I emailed my supervisors to request accommodation because of the nature of my brother’s death. I did not hear anything back. In those moments of desperation and despair—met with nothing, not even an email to acknowledge my loss—I realized that working in mental health did not foster a psychologically supportive work culture that prioritized the mental wellbeing of the staff. I felt alone. I felt like I failed my brother. The shame of not knowing, of not seeing the signs, tormented me. I felt guilt that I did not save my brother. But, at the same time, I understand the decision he made. His death helped me understand the anguish and pain that people struggling with the choice of life and death must have experienced, the silence, the determination, the desperation. My shame is ongoing. I feel it when someone asks me if I have a sibling. I have that feeling of dread, waiting for them to ask how. I feel ashamed that I have lied. I have said, “accidentally,” to avoid having to give them that upsetting information. It’s the same fear that I experienced a decade ago when someone would ask me about my dad. I am older now, so it is not as unusual that my dad is dead, but for now, it is unusual that my sibling is gone.It isn’t a secret that my dad died of health issues related to alcohol use and that my brother died by suicide, but that doesn’t mean that I feel any less uncomfortable when someone asks how they passed. I wish I didn’t feel like I caused the person asking to be upset when I unleash that answer on them. At the same time, I’m not sure what answer they want. Or what response I want.

Being a Nurse With a Mental Illness Shouldn’t Be Difficult

The lack of kindness and empathy in my workplace leaves me unsure that anything can change if we cannot even make space in our workplace—a community of mental health clinicians—attuned to the mental health needs of our workplace peers. It took a great amount of bravery for me to disclose my brother’s cause of death, and I received nothing. When I requested bereavement leave it was as if nothing had happened to me. There were no kind words to acknowledge my loss, no sympathy from my work organization. There was no flower basket or sympathy card like the one I received from my youth care organization when my dad died. What does this mean? Mental health workers often pride themselves on being person-centered and trauma-informed, but we are not as attuned as we think. The line that divides us is arbitrary. The line that divides us is based on someone’s reaction to a crisis at a moment in time, the people who they have in their life, the weight of the world that they feel that day, and the factors in their life that help them keep going or cause them to need professional support. The line between my patient, their family and me as a clinician is a boundary we built to keep us apart. I am not sure we will ever be able to extinguish the stigma of mental health and substance use issues if we keep treating them like they live in a particular kind of patient—in a particular kind of situation that divides us and them.