Someone I grew up with has seen me in mental health treatment. Now what?

September 20, 2013 12:21 PM

And I'm not talking just a visit to the shrink-- I'm in a program for the "severely-disabled mentally ill" and this man walked in as part of a group of social work students touring the facility. I am nearly 100% sure he recognized me and understood I was there as a client. He and the other students will be coming back to the program to volunteer over the next few weeks. They will be signing confidentiality agreements at that time, but haven't yet. I have social anxiety/phobia and this presses all my buttons. How do I deal?

I have asked my case manager if she can find out when he'll be volunteering so I can avoid coming on those days, but I'm not sure that will help anything, if it's even allowed. I'm considering leaving the program for at least a time-- it's something I've thought about before now after some really uncomfortable incidents with other clients being socially inappropriate. But a large part of the reason I'm in the treatment program is to learn to deal with uncomfortable social situations, and to avoid isolating myself.

We had a childhood enmity that I've outgrown and I would guess he has, too. If I saw him on the street I'd probably be like, "Yourname? Wow, yourname, you're all grown up now!" at least, I would have prior to this incident. We are the same age and have many mutual friends. Our families come from the same hometown and know a bit of each others' business-- his family is very well-off and well-respected, mine, not so much.

Despite having to attend mental health treatment, and see any number of professionals for services, and apply for disability, I want to have a life and identity that aren't defined by mental illness. When people ask me what I do, I tell them I study computer science, which is true, though some days are better than others. I have casually mentioned I have social phobia to friends but I don't outline its extent, I don't talk about my depression, and my hospital visits, for example, are something I'd rather keep to myself. I'm fucking smart and still have big ambitions-- they're what keep me going. I have to operate on the assumption that five years from now, I could be well enough to provide for myself and accomplish something meaningful.

I might have been better off calmly saying hi, but it's a little late for that now. I freaked out, hid away in a back room, cried, the whole shebang.

I'm sorry if this is overlong. How do I incorporate him-knowing into this life I've tried to set up for myself? I don't want to be cringing and begging him not to tell anyone, and I don't want to be pretending as if I'm not who I am. In short, I don't want to be pathetic, but I've already gotten a good start on it.

How do I deal with this, with all my issues and limitations, and hold on to my dignity?

posted by dee lee to Human Relations (15 answers total)

I would bet a dozen donuts (usually I just bet one) that this guy will see your participation in this program as a sign of incredible strength and bravery. Because you are doing a difficult and potentially embarassing thing so that you can take care of your health. Many people would hide from that and not operate on the hope that in five years things could look much better. You deserve a lot of credit for regaining your composure after what must have been a huge surprise in your safe space.

This person from your past has been taught the importance of mental health care, and has learned about stigma and shame surrounding exactly these types of issues.

AND this person knows that if they breathe a word of your presence in that clinic to anyone, he can be in very hot water, up to and including not getting a license to practice in the future.

Before the threat of professional sanction comes into play, this person is most likely embarking on this career to help people and knows that outing you will not achieve that goal.

The incentives to tell anyone are practically nonexistant. The incentives to maintain your privacy are great.

Please discuss all of this with your professional support team. They will help you develop skills for coping and moving forward with this and similar issues.
posted by bilabial at 12:29 PM on September 20, 2013 [49 favorites]

Even though he has not signed a confidentiality agreement yet, as far as you know, he is already informally bound by the ethics of his chosen profession. He knows this, he would not be at the point of actually volunteering with clients if he hadn't already completed some coursework. Please don't worry about it.

Just as you have changed over the years, so has he, don't assume he's still a jerk.
posted by mareli at 12:30 PM on September 20, 2013 [1 favorite]

Hi dee lee, I'm sorry that you're struggling right now. I'm not sure how well I can accurately address all of your concerns and phobias. But allow me to offer a little perspective. First, I once was in a psych waiting room, as I had to be admitted to a psych ward for fear I would harm myself. I was ordered to be "watched" by a nurse for the entire 8 hour wait. During that time, there was a woman who I went to high school with who works in administration at the hospital who passed me on the hall several times, I had not seen her since high school, and although we both seemed to acknowledge each other, we didn't speak. She found me on facebook about a month later, and I confirmed that it was her. We ended up having lunch. It turned out that she knew why I was there based on where I was sitting, but she reached out to me because she had been in a similar situation a few years before. She had more compassion and less judgement than I was worried about at the time. She has turned out to be a great friend.

In regards to your case in particular, I think that being mentally unstable is MUCH less stigmatized then it used to be. I am not particularly afraid of sharing my experiences with others, although I am guarded and careful at work and in other sensetive situations. Is it possible that this person is interested in social work because he's had some experience with mental illness? Perhaps among friends and family? Is it possible that he would safeguard your secret?

I would encourage you to continue with the program, perhaps consider approaching him and pre-emptively thanking him for understanding your need for confidentiality and anonymity. Consider saying hello and trying something like "Yourname, it is good to see you. I really appreciate that you will take my desire for complete confidentiality seriously and not talk abut seeing me here with family/friends from hometown..." Perhaps consider engaging him on why he chose this line of work?

Caveat, I do not know what it is like to have social anxiety or phobia, and am not sure if you feel you would be able to approach or speak with him.

I would just like you to know that many people with mental health issues are very smart and capable, and I doubt that most people volunteering or working there think that you are less capable as a human because you need help right now. It takes a lot of strength to admit there's a problem and to seek treatment. Don't sell yourself short because you are afraid of the stigma!
posted by thankyouforyourconsideration at 12:32 PM on September 20, 2013 [13 favorites]

It pressed your shame buttons because someone "on the outside" now knows you've sought treatment. But the good news is that he is there precisely to learn how to support people in your position, and he knows how common mental illness is, and how difficult it can be. So try to see understanding, professionalism and compassion in his eyes, and this is how your dignity will shine through. If you can handle that initial sting of embarrassment, of shame, of feeling less than, then the rest will go away and your truth and self confidence will come back online.

So relax.... take one big breath... it's ok to be who you are, where you are. We all fall down, and we all need help. We're all in this together.
posted by St. Peepsburg at 12:52 PM on September 20, 2013

I can certainly understand where the anxiety would come from- I too have encountered people I know in "real life" in such potentially embarrassing situations. Nothing has ever come of it, FWIW.

I think there are a couple things that work in your favor. One, there is the expectation of confidentiality, even if they didn't sign the paperwork. Two is that someone who has chosen social work is probably going to be empathetic.

I would work with your therapist or doctor to try and identify what part of your anxiety comes from the legitimate feelings of fear and embarrassment, and what part is just a symptom of your social phobia. Because as you probably know, some portion of what you are feeling is just part of your disorder.

Lastly, I would offer that even if your fears come to pass and this person starts gossipping, you won't be defined as a mentally ill person if you don't allow it. Own your problem, and own the work that you are doing to take care of it. "Wow, Bob told you I was a patient in the XYZ Center? I can't believe he would do that. Anyway, yeah, I was there because I was having some problems, and they really helped me. I'm feeling much better now!"
posted by gjc at 12:55 PM on September 20, 2013 [2 favorites]

Best answer: I have been forcibly restrained in a psych ward and don't give a shit who knows it.

Neither should you.

The stigma attached to having mental illnesses will not go away until people who suffer from them do the same thing gay people have done, and come out. Life's too short to live it in hiding.

How do I deal with this, with all my issues and limitations, and hold on to my dignity?

By taking the truly courageous step of not trying to hide from it any more.

By knowing that yes, you're busted, you can't actually prevent this person knowing what he now knows, and deciding that the inevitable is acceptable.

By confronting this issue instead of trying to find elaborate ruses to avoid it.

By holding your head high and reminding yourself that you have a perfect right to say Fuck You to any prick who gives you grief about being in treatment for a mental illness.
posted by flabdablet at 12:57 PM on September 20, 2013 [29 favorites]

There are sizable criminal and civil penalties under HIPAA should anyone disclose anything about your treatment (including the mere fact that you are getting treatment at all) outside of the circle of people who need to know (defined as people involved in Treatment, Payment, and Operations).

It would be a HUGE breach if anyone touring a mental health treatment facility for any reason revealed anything about who was in the facility. This is whether or not any specific agreement has been signed. It is unimaginable to me that touring group members would not have been forewarned that this could happen and that they absolutely cannot divulge anything.

You can absolutely request not to have any contact with this person if you like.
posted by jasper411 at 1:03 PM on September 20, 2013 [2 favorites]

Since this person is studying the field, I'd say it's a pretty good bet that he understands and appreciates what you are trying to accomplish, as well as the strenght of will it takes you to be there.

And if that's not enough, per my niece (currently working on a doctorate in social work), if someone were to breathe one word that could possibly identify you or any other specific person as a patient, or talk about any specific patient's history, he would a)Lose the respect of his fellow students; b)Get in deep shit with his instructor; c)Risk getting tossed out of his program; d)Risk getting tossed out of his whole school; e)Risk the possiblilty of never getting licensed as a social worker.

So: he's in the field to help people, and more than likely understands what he has to risk if he talked about you to other people.
posted by easily confused at 1:05 PM on September 20, 2013 [1 favorite]

As someone who's been there... people are kinder than you think they are. Really.
posted by PMdixon at 1:10 PM on September 20, 2013 [8 favorites]

Here are some of my thoughts:

1. If he's in the field of psychology, he likely has compassion for people who are suffering. Many psychology students, in fact, have gone through their own mental health issues. At the very least, he probably has some scientific understanding of mental illness and if he's a worthwhile person at all, he won't judge you negatively.

2. If he disclosed anything about you to his friends/family/the community at large about your treatment, he most likely would be kicked out of his program. I completed a master's in counseling psychology and if anyone had divulged client information to their friends, that student would have been kicked out of the program. It doesn't matter if he didn't sign a confidentiality agreement yet. Maintaining confidentiality is an inherent part of the field.

3. If he did disclose information about you to your friends, what do you think your friends would think? If I was on the receiving end of this sort of information, I would immediately question whether I wanted to remain friends with the person DELIVERING the information.. Basically, I would think of this guy as a scumbag, while my opinion of you wouldn't change.
posted by parakeetdog at 1:51 PM on September 20, 2013 [3 favorites]

There may be penalties, but if he just tells a couple of close friends and they never tell you about it, your secret is still out.

Good news is that you'll never know.

Bad news is they do know.

I would see if I could find an alternative group or treatment plan. However, I'm private. I wouldnt even go to a primary care doc if I had someone I didn't trust working there. My health is my business.

P.S. I'm very familiar with HIPAA, but I'm also familiar with how people are sometimes. They tell a couple of people, swear them to secrecy, and so it has no affect on you. But, if you don't want anyone to know, you have a right to that.
posted by superfille at 2:07 PM on September 20, 2013 [2 favorites]

When I was a student studying in a program that ended with a professional healthcare license, it was very clear that any and all people observed in a clinical setting were treated in a way that complied with HIPAA. Absolutely no discussion of private patient information or even the fact that I had seen them in a clinic setting was allowed. To this day, if I see a person I treated in a clinical setting out in public, I'm not allowed to acknowledge that I know them unless they approach me first and open that specific door in conversation. If he's in a professional program, he is very likely being held to the same standards. It's federal law.

You can request that he not be allowed to observe any of your treatment or activity there. He is not entitled to have any sort of contact with you. You are the protected person in this situation.

Your response to seeing him in a place that you consider a trusted healthcare location and sanctuary wasn't undignified or out-of-bounds. Work with your treatment team to create the boundaries you need for comfortable treatment, it's the first and most important priority in this situation. Your treatment team should do whatever they can to keep you in a program that's important for your health and treatment.
posted by quince at 2:11 PM on September 20, 2013 [2 favorites]

My husband completed several internships while working on his coding degree and certifications. He worked in an inpatient mental health facility and only told me, "The building and grounds are pretty." That's all I knew about his days for six weeks. Confidentiality is built into the curriculum long before people go on site visits.
posted by RogueTech at 3:31 PM on September 20, 2013 [2 favorites]

I would tell your program you're not comfortable with him watching your treatment. They should be ones working around this problem. I would probably feel very much like you do. Who wants someone they didn't particularly like when they were younger watching them in a circumstance like this? Nobody.
posted by xammerboy at 7:45 PM on September 20, 2013 [6 favorites]

Nthing that you can request that he have no contact with you. Something else to think about-- a lot of people who get involved with social work, especially mental health, have personal experience with mental illness and trauma. "His family is very well-off and well-respected, mine, not so much." seems to indicate a lot of shame triggers for you, but you may not know the whole story on this guy, his family life, and what he's gone through either when or since you knew him as kids, and the "respectable doctor--> not-so-respectable mentally ill patient" dynamic might not be as clear cut as you think.
posted by moonlight on vermont at 8:33 PM on September 20, 2013 [3 favorites]