Having suffered herself from depression and now chronic fatigue syndrome and Lupus, OH nurse Felicity Paterson knows only too well that people with invisible disabilities can need as much support in the workplace as those with visible conditions. In fact, in an intensely personal account, she argues that her experience of disability has, if anything, made her a better OH practitioner.
I qualified as a nurse in 2007 with a degree in adult nursing. I was unsure of the path I wanted to take so continued to work my final placement in all-male acute general medical ward.
After a few months I fell pregnant for the first time and started to plan a new career, which would include child-friendly hours (as my partner worked offshore). Unfortunately at between 10-12 weeks’ gestation the baby stopped growing and we miscarried shortly after.
About the author
Felicity Paterson is an occupational health nurse and runs F J Paterson Occupational Health
I remained absent from work for around two weeks because of medical complications but each time I went back to work once I had healed physically, I wasn’t able to concentrate.
Following a bout of such absences, I was referred to occupational health. I remember at that time it was perceived as more of a ‘threat from management’ than a support system. Indeed, I can’t remember much about the occupational health appointment I attended and didn’t see the point of it at that time.
I do, however, remember feeling as if I was being punished by my manager for something that was out of my control and traumatic enough without feeling like I had upset my manager and colleagues.
Little did I imagine at the time that one day I would myself became an OH nurse. But looking back now as an OH nurse of eight years, I can see what a missed opportunity that appointment had been for me and my recovery.
Had I received the help and support I very much needed at that time, I may have been better equipped to deal with the post-natal depression and anxiety I subsequently was diagnosed with.
By the time it had been three years since the birth of my first daughter and five years since the miscarriage, I remember sitting on the edge of my bed, having not eaten properly for days or showered. My mother-in-law had her arm around me and told me, “you can’t carry on like this”.
Coping with depression, anxiety and Lupus
My mother-in-law was right. She got me dressed and bundled us all into her car and drove me to the GP. As I completed the depression questionnaire I realised just how low my mental health had got. Fortunately, I got the support from my GP at that time and was started on medication.
But that was just the start. Following a few other tests I was diagnosed with chronic fatigue syndrome and later the auto-immune condition Lupus. In the past, the GP would say, “you’re a nurse, I don’t need to explain this illness to you” as if being a nurse would mean I knew everything health-related.
I thought to myself, “yes I am a nurse but I am also a patient needing help”. I was extremely concerned with how these illness would affect me and my future employment.
You would think, being a nurse, I would have noticed the signs of depression in myself. But when you are thick in the middle of it, it is near-to-impossible to step outside of yourself and rationalise your thoughts.
After all, depression is a chemical imbalance in the brain (it’s like trying to walk on a badly broken leg). Looking back now, the signs were all there for depression: when I was pregnant with my first daughter following the miscarriage I would be so scared every day that I was doing to lose her that I would cradle my ever-growing belly and pray to a god I wasn’t sure existed to “please let her be ok”.
My daughter was born via C-section and she was the most beautiful thing I had ever seen in my life; so tiny and helpless.
I fell in love instantly with her, but almost too much. I know what you must be thinking “you can’t love a baby too much!”. But I did.
We took our daughter home and from there I swore to be the best mum I could to her. The problem was I wouldn’t let anyone else near her except my husband. I didn’t want anyone’s perfume to rub off on to her, I didn’t want anyone to pick her up unless they’d asked and there was good reason; I didn’t even want anyone to push her buggy.
This went on for a whole six months and I didn’t spend one day away from her. Looking back now, it must have been heart-breaking for my family and close friends. She was the first grandchild in my family, the first baby in my crowd of friends and they were all so excited for her arrival. They would ask me out for drinks and nights out (I was still only 24-years-old) but I just couldn’t leave my baby. My heart and my head would not allow me.
It’s probably not well enough known, even among OH nurses, that 96% of illnesses are invisible. Such illnesses and disabilities are also often described as chronic illnesses.
Depression and anxiety has affected me in many ways, both good and bad. I have missed out on many opportunities because of my illnesses on both a social and professional level.
Although, thankfully, my conditions are now well-controlled and managed with medication, some days they do still sneak up on me. For example, with my depression, I understand it now and can see the signs and symptoms before they happen.
My husband is also extremely aware of how my mind works and is able to see my depression and anxiety creeping in before it takes hold. Depression and anxiety effects people very differently but, with myself, I start to over-think and over-analyse everything. I start to withdraw myself from the world; I feel exhausted and have really bad “brain fog”. Luckily these episodes do not happen very often now, especially since I have gone self-employed and have been able to control my hours better.
Improving my practice as an OH nurse
Another plus point has been in terms of how my personal experience – especially having to manage and deal with own disabilities (ones largely invisible to everyone else around you) – has fed into, and improved, how I approach my practice as an OH nurse.
In fact, I’d go so far to argue that my illnesses (while, obviously, you would prefer not to have them) have helped and benefited me throughout my career.
I feel I have always tried to be empathetic and sympathetic with clients. But now I feel able to offer them the advice and support I wish I had received years ago. I feel able to supply information and advice to sufferers without the need to tell them about my personal experiences.
As a healthcare professional, I of course need to remain impartial, especially with the case management I conduct. In previous places of employment, if asked about medical conditions, I would declare my medical conditions but would not talk about them in the workplace unless I felt comfortable to do so.
There was always the concern in my mind that it would place me at an unfair disadvantage if my colleagues knew about my ill health. At that time, I was unaware that one in four people in the UK will have a mental health problem at some point and that I was not alone.
I started conducting occupational health as an agency nurse and caught the “bug” when my second daughter was around nine months old.
I loved it immediately and knew I had found “my path” at last. I was lucky to have a massively supportive and empathetic manager in the first place I worked, who was going through various illnesses too.
I continued to work for various companies providing occupational health services, such as health surveillance, travel vaccinations and case management but found it too difficult to balance my health, children and household all at the same time.
Pivotal role of OH support
It wasn’t until around two years ago that I became self-employed and then one year later I started my own occupational health limited company. This way, I am able control my own diary and complete work for clients, depending on my availability and commitments.
Conducting more and more sickness absence and case management, I began to realise how common depression was and how important occupational health is in supporting both individuals and employers in the workplace.
There is a vast amount of advice for employers and employees on the Health and Safety Executive (HSE) website, everything from case studies through to stress risk assessment templates; it is a fantastic, reliable source of information.
The Health and Safety at Work Act 1974 is there to support each and every employee, making sure each person is treated in a fair and equal manner; it is a huge document and acts an umbrella for many other acts, including The Equality Act 2010. The Equality Act also protects job applicants against discrimination and, therefore, states that an applicant is not required to give any health records before being offered a job.
That said, certain roles would require declaration of illness, for example, if the applicant was unable to carry out an essential part of the job. If the employee discloses health information after starting the position, then the employer has a duty to make reasonable adjustments to ensure workplace wellbeing (this again falls under the Equality Act).
Adjustments could include: buddying or mentoring schemes, flexible working hours or remote working, these however need to as reasonably practical as possible.
Any company’s commitment to supporting workers with chronic conditions should be included in its health and safety policy, together with the arrangements for implementing its integration into the company’s procedures.
This should include the person responsible for managing sick leave, reclassification processes, and who the employee can talk to and so on. Where possible, the management of chronic illnesses should involve all relevant stakeholders inside the company (HR managers, health and safety managers, health and safety committees) as well as occupational health.
Ultimately, even though it is 2020, the stigma surrounding mental health and invisible illness sadly remains. Because of the invisible nature of some illnesses, unless communicated, they will not be addressed efficiently and effectively. And that effective management and support should, of course, be the goal of all of us working within occupational health.