A Mental health case study; an employee’s perspective with a positive outcome.
By Libby Morley-Hassanali
I managed this case between September and December 2021, during the Covid 19 Pandemic. I spoke with Debbie on three occasions, supporting her and guiding her employer. What started as upset and tears ended up with laughter and tears… for both of us! Below is an extract from my book “Mental Health in the Workplace: A Practical Guide for Occupational health Practitioners on Consultations and Report Writing.”
Debbie is a 55-year-old female, working fulltime as a community nurse. She has been working throughout the Covid pandemic and has been off work for four weeks but feeling mentally unwell for nine months. Her GP has diagnosed PTSD. She was also diagnosed with ADHD at the age of 40.
Symptoms/Impact of condition:
Self-care: Showering less often and wearing pyjamas all day. Having encouragement to self-care from her husband and friend gives her a nudge to do so, but if she lived alone, she feels she would stay in pyjamas all day and rarely shower.
Concentration/focus: Watching TV for long is not possible. When scrolling Facebook, she is not taking anything in. Nods off to sleep watching YouTube videos.
Motivation for hobbies/interests: Usually likes to read about quite distressing things but now she is unable as it is upsetting her. Photography, but feels less interested lately. Says she has the thought to do things but then feels no motivation.
Sleep: Wears a tracker and it shows sleep is poor. Bad dreams about work. Says she feels tired and is going to bed early but wakes a lot during the night. Is not sleeping during the day.
Suicide risk: Says no thoughts of self-harm or suicide currently but did attempt when younger. Says, “occasionally I think oh god I could have another 20 years of this sh*t”. No current risk apparent.
As well as providing her lived experience of PTSD or burnout symptoms, her words also provide valuable insight into her experience of living with ADHD.
She is now back at work. Her contribution to my book is further evidence that people can and do recover from an episode of mental illness. You might need a tissue!
In Debbie’s’ words:
When I first spoke with Libby, I was dreading the call. As someone who has come up against many well-meaning health care professionals in the past, I was dreading another list of things I was supposed to do.
I have ADHD and it means I am a super over achiever that cannot keep simple things together. I can take care of the seriously ill and manage their care but seem unable to focus on my own needs or those of my family. I often tie my self-esteem to my job and so when I started to struggle with my work, I became fearful and nervous.
The pandemic started slowly changing how I felt about people. I have always thought that I was an endless supplier of tea and sympathy, always trying to fix people. I went further than others because I thought it was my responsibility to care for them when they had lost their way physically. I rarely held people responsible for their behaviours or actions and often felt that, given the right kind of care, I could make a difference. I arrive early and stay late out of my desire to always give 100%
I caught covid, and later I was diagnosed with long covid. During the time of investigations, I was working full time and studying for my master’s degree. My husband also contracted covid and suffered ill health for the next 18 months.
By the time I had to admit that I was not OK I was tired, emotionally distant, and constantly angry. I am sure anyone close to me was worried about my constant obsession with the covid stats and my inability to focus on anything positive. I wanted to shout at patients who continued to come with their seemingly ridiculous issues. I had constantly tried to understand that they were going through this too, but eventually I just wanted to tell them that they had no idea what we were going through.
Just before I went off work there were some incidents that left me traumatised. Patients were becoming aggressive, there were patients self-harming in the department and staff were all feeling the same burnout. I had reacted out of character to a patient, and this had left me feeling ashamed to the point where I have put my head in my hands just thinking about it.
I went to my GP and sobbed to her about how I was feeling. I was not sleeping, was scared of everything, I jumped at loud voices or noises, and most upsettingly I had lost my empathy for others and spent my time either at work or at home thinking about work. Mostly instead of the accepting and helpful person I sought to be I was angry…really angry. I was scared by the depth of my feelings and totally overwhelmed.
So, as I sat in my car, parked near my church so that my husband didn’t hear the depths to which I had sunk, I got my first call with you. I remember little of what was said, I know I sobbed through most of it…I felt beyond sad, I felt broken.
I remember you said, “Debbie, you are very sick.” I felt like a weight was lifted at that moment.
Finally, someone who wasn’t trying to negate my feelings or give me some well-meaning advice. We did talk about some things that would hopefully help such as podcasts and mindfulness, and these were things I felt I could achieve. We finished with you telling me to rest and take care of myself and not to worry about letting co-workers down as I needed to be well to be able to help others. I remember thinking that for once I had not been blamed for feeling the way I did, I felt that someone had given me permission to feel it without having to justify my feelings. I felt legitimised.
My discussions with Libby were always about how I was feeling rather than what I was doing. In reality, of course there were always discussions about what I was doing but they never felt like that was the only point of the talk. Libby encouraged me to think about what I could do for me, rather than what I had to do for me. That might not seem like much of a difference, but it really was.
Obviously, the older we get, the more emotional baggage we have. As a woman with ADHD, I had challenges that impacted my life. I was diagnosed late in life, and it made a huge difference in my ability to understand some of my issues. I never leaned on my diagnosis. I hadn’t really given myself permission to be different and not feel like others would find me odd. Wearing a mask of normalcy can be exhausting day after day. I had suffered abuse as a child and had an eating disorder for many years. This had all been dealt with by me having a better understanding of why I had been vulnerable to such things. Low self-esteem and feeling like an imposter are two of the many challenges that have been there throughout my life.
Libby believed me when I told her that my past was part of my journey but not part of this journey. I have always felt that GPs looked at me as my issues and not as a person. I found myself worrying that they would judge me by my past diagnoses. I now also understand that not advocating for myself gives them little else to base their judgement on.
Libby helped me to allow myself to be kind to myself, and to stop blaming myself for not being more resilient. Instead, I looked for ways to build resilience again. To allow me the time to think without worrying. I truly believe that without Libby to support and guide me that I would have floundered further into a life disability.
Having someone who knew how to push me and when to push me while being there if I failed was amazing. I have rebuilt my structure and reconnected with myself. I am sleeping well, eating better, I do Pilates, which is fantastic, I listen more and worry less. I have stopped stressing about the small stuff, and I find myself stopping to question my assumptions or actions and changing course appropriately. Self-education and opening to new things are powerful when we are encouraged and supported.
If you asked me how Libby did this, I would say by being supportive, constructive, and honest. Of course, I know she used all her professionalism and training to do what she does very well, but the best bit is that I never felt managed. I felt treated.
I have learnt to say no, I have learnt that I do not have to be extra just because I’m not neurotypical…that has been fantastic for me. I am embracing my differences and learning to use my newfound strengths.
Libby has become part of my journey, one which I will always remember with a grateful heart. I am not religious, but I do believe as I sat there next to the church, baring my soul, I found the best person to help me, and I cannot thank her enough.
Libby Morley | LinkedIn
Libby is an Independent Occupational Health Nurse Practitioner and trainer in Stress & Mental Health. She is the Author of the book “Mental Health in the Workplace: A Practical Guide for Occupational Health Practitioners on Consultation and Report Writing”, published in March 2022.