Duty of care

I was listening to the latest episode of Brene Brown’s podcast, Dare to Lead yesterday. A second part to her interview with Aiko Bethea, Diversity, Equality and Inclusion expert. I recommend both this podcast and Brene’s other one, Unlocking Us, for lots of insight on leadership and what makes us tick. There are lots of discussions relating to the difficult but vital work needing to be done around race, – and the impact of recent times on people of colour, along with many other important issues.

Something Aiko said in this podcast got me thinking in all directions. “Stop asking for the business case for diversity and inclusion work”. (I could be paraphrasing)

Business case. What is in it for me? For the business? Will this make us more money? More productive? Give us a better reputation in the community? The answer to all of these by the way is generally yes. But what if it wasn’t?

What does it say about a business that is are only prepared to make things better for their staff if it pays? It says firstly that you acknowledge there is a problem, which is negatively impacting your teams or your community, but that you don’t care. And that message in itself makes it so much worse for those staff. Destroys any idea they might have that they are valued by their employer.

For Diversity, Equality and Inclusion, you can also read mental health, health and wellbeing work. If we see evidence that our staff are struggling with their mental health, or know we are going through a period of intense stress (either within the organisation, or in the wider world), and we shrug our shoulders and tell our staff to get on with it, then we are failing in our duty of care to those staff.

We’re also failing to question – why? What’s going on? Are we causing these problems or worsening them by the way we work or do business? We have reached a point in time where we accept, hopefully, that the risk to people’s health that they face in the line of their work should be the absolute minimum necessary. Some jobs have a certain amount of inherent risk, unavoidable risk. Even then we know we should be doing our best to protect the worker – Soldiers given bullet proof gear and weapons to defend themselves, Firefighters with breathing apparatus and fireproof clothes. Doctors and nurses with effective PPE (more important right now than ever), Factory workers with ear, eye and foot protection.

We carry out risk assessments to make sure the environment people work in is free from avoidable hazards – things we might trip over, sharp edges, unstable items in high places. We test air quality, light, noise, fumes. Over the course of the past few years, working in a variety of industrial settings I have been provided with ear plugs and visors and strange rubber shoes and ventilators, had to take courses and pass tests to be even allowed onto a site. Most employers (if not as many as should) take Health & Safety pretty seriously. If only because they know there will be hefty fines and potential liability if it goes wrong. In some professions where the duty of care is inherent (i.e. medicine, nursing) there are avenues for whistleblowing if conditions within an organisation are preventing the proper implementation of that duty.

And yet when it comes to our mental or emotional health and safety, there is a sad lack of awareness or concern about why this should be any of their business.

The Health & Safety at Work Act etc Act 1974 gives a general duty to look after the welfare of employees, The Management of Health and Safety at Work Regulations 1999 require the assessment and management of risk.

This includes mental welfare, it includes the need to assess the risk of stress and the illness that it can cause – or worsen.

Thinking about looking after the mental welfare of your employees needs to be preventative and pro-active as well as re-active. If there are factors in your work or business that increase risk, you should be either eliminating these, or ameliorating the impact, and protecting your staff. If there are things you could be doing to actively improve the mental and physical wellbeing of your staff – which in itself is protective, you should be doing them. And you should also be thinking about whether there is any way you can help those staff who are struggling with their mental health – whether wholly work related or not.

There is a business case. There is a legal case. But the most important is the human case. People are struggling. More so than ever in these difficult pandemic times. We certainly don’t want to make things worse than they have to be – but employers have a perfect opportunity to actually make things better. To improve life and working conditions, to challenge behaviours which are unnecessary and unkind, (bullying, harassment, discrimination – all of which negatively impact mental health), to equip people with an understanding of their mental health, skills for wellbeing and coping with life’s challenges – and also, in the case of larger organisations, providing access to information, advice and services which help us to get back in control of our lives sooner – if we are struggling to access that help outside of work.

Too often I find Mental Health is only taken seriously in an organisation when someone at the top is personally affected, or one of their family members is struggling. Suddenly they get it. Suddenly they realise it is important, and that they have it in their power to do something.

We all have that power, to some extent. To learn more. To support our friends, families and co-workers. To lead by example in our words and acts. But businesses and government have the most power of all – and could transform the world if they chose to use it properly.

Where do you live?


It’s an interesting word. It means the home itself, but also what we do in it. It also means something else. To dwell upon something. To linger thinking on something, to cogitate, ruminate.

In an effort not to ruminate upon the troubles, large and small which afflict us these days, I have been painting – a mindful activity, involving sufficient detail to take most of my attention. In order to occupy the remaining bit of space in my head I tend to do it while listening to a podcast or watching something fairly familiar or mindless.

I decided to rewatch Star Trek – Deep Space Nine. Not that I am accusing Star Trek of being mindless. Quite the opposite sometimes. But it is familiar, and took me back to watching it for the first time around when living with my parents. Star Trek is very much a shared family interest so it makes me feel more connected to them somehow in these days of not being able to see each other.

The first episode sees the newly arrived Commander Sisko venturing into a wormhole and there encountering a new, powerful alien race of energy beings who exist outside of linear time. They see into Sisko’s mind, events of his past, including the tragic loss of his wife. He tries to explain the nature of how we live in time, how when something has happened it is gone for us, never to return. And yet, the aliens keep asking him – “Where do you exist?”, because when they look in his mind they see the currency of his pain and grief about his wife. Despite the fact the event happened three years ago, it is as raw for him as if it were yesterday.

And this how trauma can affect us. It is only when we find a way to put it in its place, learn from in sometimes, or sometimes just accept – and allow ourselves to live in the present moment, and finally have a chance to move forward.

Grief, bereavement – of course we perhaps never leave it fully behind. But to be able to regain control of and a positive forward momentum for our lives we have to find a way to accommodate the memory of the lost in our lives without it overwhelming us.

Dwelling to an extent serves a purpose. If we experience a traumatic event – it is natural that we don’t just shrug our shoulders and move on. If we have been injured, violated, nearly died, or been in a situation where we felt incredibly unsafe – there is a period of sense making. Our brain’s main job is to keep us alive, to keep us safe – and if it has failed in that in any way, it needs to understand what has happened in order that it might do whatever it can in future to avoid it happening again. So we dwell upon it for a while, we go over the story in our head, or out loud. We may even relive it. And perhaps we realise something we could have done differently, or perhaps we reach the conclusion that it wasn’t our fault, it was out of the blue – say a car mounts the pavement and runs us over, unexpectedly, due to a tyre blow out. And at some point we realise there is nothing more to learn, and mentally file the event away in our archives.

But sometimes that doesn’t happen. Sometimes we can’t shake it. Sometimes we see fault in ourselves where there was none – there are a million “what-ifs” in any situation – we have no way of knowing if any of them would truly lead to any different outcome. Even if we had set out ten minutes later or taken a different route – who is to say some other calamity may not have befallen us. But sometimes we cannot make ourselves put the event to rest, it plagues us in different ways, and remains in some ways as current to us as it was when it happened.

Not just big stuff either. Emotional, relational trauma can have a lasting effect on our personality, our feelings of safety, confidence, self esteem. Specific triggers can subconsciously remind us of interactions earlier in life, and we respond automatically as we did at the time.

How long is too long to dwell upon something? Some amount of thought over an issue helps us to understand and clarify it. It is surely better to pause and think things over than to respond rashly, whether that be to get angry and lash out, or hurt and upset. If we can stretch the moment between prompt and reaction we have the opportunity to try and make our reaction more positive or helpful for us. Though that is of course easier said than done. There is a mechanism which keeps our worries on our minds. Sensibly – in some contexts – our brain, once it notices a threat, wants to make sure we don’t forget it, so every time we think of it, we are rewarded for our continued awareness with a little hit of dopamine. Excellent, if we are keeping our eye on what that bear in the distance is doing, or the traffic as we walk along a road with no pavement, or the proximity of the edge when we walk along a cliff path. Don’t daydream and drift in those circumstances, stay alert to the danger.

But we know that many of our modern problems with mental health come from the fact that this ancient fire alarm system is ill suited to modern needs. The smoke alarm goes off all the time, when we are cooking bacon, the steam from the kettle, even Uncle Bob’s vape cloud. Stress builds, and at some point we start to see it as a threat – You’re in debt. You’re not going to get that work done in time. You don’t think that person likes you. That headache you keep getting could be something serious. – All concerns which may be worthy of our attention. So we think about them, and our brain is happy we have noticed and it rewards us. And then we go about our day, and at some point we think of it again and get rewarded again. And dopamine makes us into the worst fiends – addictive as it is, driving many of our addictive behaviours – we become stuck in this cycle, going over and over the worry in our mind, anxiety building all the time, body responding to the “threat” with our Autonomic Nervous System and all that that entails.

We ruminate. My mother used to say to me – “You think too much” – when i worried about something, or became desolate about things like Death. “Just stop thinking about it”. How? I thought. I didn’t understand how people could be going about their day casually in the knowledge that we all die one day. How were they not all on their knees like the last man in a cheesy horror or disaster movie crying “Why?! God, Why?!”

And then I read something about how people with depression are x percent more prone to rumination than those without. I forget the percentage. I was certainly depressed, much of the time. Something in my head was making me dwell on things that worried or distressed me more than other people might. And it is unsurprising that if we spend a lot of time thinking about these things without finding positive solutions or interpretations we are going to get more distressed. I had to find a way to break the cycle.

A rough drawing of a stick person with a house for a head
Where do you live?

Where was I living? I spent many years dwelling on events in my past – negative ones which had unquestionably had an impact on me, positive ones which I missed and yearned for. Or in the future – worrying about what might be, fearing death, and what comes after (or doesn’t), mine or my loved ones’. And all I knew was in this present moment I was unhappy. I was depressed. I wasn’t able to see the world around me. The blessings I had, the chances, and opportunities. I drank to feel better, adopted a nihilisitic, hedonistic stance, which led to behaviours which in the end increased my woes.

Mindfulness activities try to get us to be in this present moment more. To realise that what is past is as gone as we allow it to be. And that we cannot predict the future. That the only moment we are absolutely sure of is the here and now. This breath. This breath. This breath.

When I catch myself ruminating on a worry, I try to break the cycle. First – with action. If there is an action I can take to alleviate the worry, that is something the brain likes even more than knowing we are alert to the danger, and will give us an even bigger reward for. Hopefully if successful we can sort the issue out so it doesn’t trouble us again. However many worries are not so easy to tackle in one fell swoop. So then, I try just to name the worry. Make my brain aware that I have noticed its concern. Thanks, I haven’t forgotten the debt. I know it’s there. I’m working on it. And then I move on to distraction. Deliberately trying to break the cycle. Sometimes focusing on my breathing works. Focusing on physical sensations. Scanning through my body – moving my attention methodically from the souls of my feet to the top of my head. Grounding techniques that check in with my five senses. I try to read a book, if I am ok with being awake – overwriting my brain’s anxious narrative with some other storyline. Or if I am trying to sleep, and my head will not stop drifting into the past or future – I allow it, but I instead try to take it to happy memories. Or imagine pleasant futures. Decorating an imaginary house for instance, or trying to vividly remember the sights and sounds and sensations of a day on the beach on my last holiday.

Sometimes we need to learn a wide array of techniques to help us break the cycle. Different forms of counselling or therapy can be helpful. Specific therapies like EMDR (Eye Movement Desensitisation Reprogramming) can help in cases of trauma. It isn’t always easy. Our worries, these things we dwell upon, within – can become obsessions we cannot escape, paranoias that haunt our every moment. They can develop into serious mental illness. We can lose the ability to exert control over these cycles of fear. We can become convinced of our powerlessness, of the reality of all manner of delusions.

So if we can learn to recognise when we are dwelling on something more than it warrants, ruminating for longer than is helpful, and try and find a way to shake it, it is in our best interests. If our anxieties are dominating our lives, our fears and sorrows robbing our days of joy – if past traumas or bereavements are influencing our lives in such a way that we cannot live them the way we want to – then if we cannot shake it off on our own, we may need some professional help to learn techniques which could set us free.

Managing expectations – what do you want from your training?

Street signs indicating one way - pointing in different directions
Photo by Brendan Church on Unsplash

I deliver several different mental health training courses at the moment, some of them well established, others just finding their feet (and new ones in the pipeline). They all have their subtle differences, are great for different requirements – and are generally well received. However sometimes it is possible to tell from feedback that someone was expecting something else. Usually it is not that the course has not delivered – but that they had a different idea of what they were going to be learning.

Often sadly this comes when an organisation talks about “Mental Health First Aid” training, but then commissions shorter “Mental Health Aware” courses. It’s important to recognise that not all MHFA England accredited training is “Mental Health First Aid” training. All of it aims to improve your understanding of mental health, and ability to manage your own and support others to some extent, but it’s obvious that a 4 hour course is going to teach you much less than the two day or 4 session online course. So – be clear about what you need, and what you are getting.

Mental Health Aware training is excellent for a broad brush initial approach to raising Mental Health literacy in your organisation. But those who you expect to be offering more direct support to individuals need to take a deeper look at the issues, and be given an opportunity to discuss and practice a bit more. You should also be giving careful thought to how you support those Mental Health First Aiders, and if possible ensure they have good resources to which they can signpost employees in distress.

It’s common for employers to choose the cheaper option and perhaps think Mental Health First Aid training is out of their budget range – but if you come to an independent accredited trainer like myself we tend to offer at a much more affordable rate – so do ask for a quote for all options to make sure you make the right decision for your staff.

Another common disappointment comes from the age old urge to fix things. To do something. How do I approach this, what technique can I use to make this better?

Of course we cover some basics in this area, considering how and when to raise our concerns with someone. The kind of things we might want to bear in mind, and thoughts about the kinds of questions we ask. But there is no one right set of words to say, no one magic exercise which will help every person you are faced with. It would be wrong to pretend there is. Even things which many can find very effective may be completely wrong for some. All we can do is give you a framework, and encouragement to build your own toolkit for yourself, and to be able to support others to do the same. And the one universal tool that enables us to do this is talking. More specifically – listening. Giving someone else the space to listen. Unconditional, non-judgemental and empathetic support. Sometimes that is all people need – someone to hear and validate the difficulties they are facing, the pain they are in. Yes we can go on to help them work out a way forward, find solutions and draw on other supports. But we mustn’t underestimate the sheer power of being able to let go of all we have been bottling up.

That’s not to say I don’t think there is space for a more practical approach – and I hope to offer something soon – first on boosting wellbeing, and then on managing mental distress. But they are in general individual approaches, things we can practice ourselves which can make our more difficult moments more bareable, or which over time increase our experience of more positive mental states. When it comes to what another person can do for me, if I am struggling – It’s not about them giving me some tips on calming down or cheering up, I want to know they care. That they see me, my pain, and they are there for me, listening, holding, hearing.

So which course is right for you and your staff? Some basic pointers below, but please get in touch if you would like to discuss the courses on offer in more depth.

Mental Health Aware Courses

For general awareness and some pointers on managing your own mental health

Mental Health Champion Courses

for more depth & an opportunity to consider supporting people
– great for team leaders & management who need to understand why
mental health needs supporting in the workplace

Mental Health First Aid Courses

To learn more about mental health, signs and symptoms,
what helps, and an approach to offering initial help to people in distress (Excellent for line managers, union reps, HR staff, those who people come to for help – as well as setting up a support panel)

MHFA Refresher Courses

To refresh your skills and knowledge if you have already done a
mental health first aid or mental health champion course
over three years ago

Mental Health Skills for Managers*

to improve your skill or confidence in having supportive mental health conversations with the staff your manage

Return to Work and Mental Health*

for HR Professionals dealing with staff returning to work after absence relating to mental health – to improve the support offered and make those returns more successful in the long term

*Mental Health Skills for Managers & Return to Work and Mental Health Courses

These courses are currently only available to book directly from MHFA England – either see their website for more details or contact me and I will put you in touch.

Bespoke Courses

If the above courses do not meet your requirements – please contact me to discuss designing a course specifically to meet your needs.

Mind Your Head – Happy Valley Pride

In addition to starting an evening class on Tuesday, last night I had an engagement to appear on a mental health panel discussion for Happy Valley Pride – talking about mental health with the LGBTQ+ community in mind particularly.

It was nice to connect with others in the community and think about the ways in which this peculiar year has impacted us.

There will no doubt have been many LGBTQ+ people who have found the restrictions of this year more challenging than others – I think especially of young people, building their confidence in their identity. Being stuck at home for longer periods of time, not able to socialise – perhaps in family settings which are less than supportive or even safe, is difficult, unsettling, even dangerous. We go through a stage of working out and asserting our identity in our teens/twenties – if we find ourselves having to suppress or hide how and who we feel we really are, that can have consequences.

So much “replacement” social activity, and also access to services is now online – there’s a big assumption there that it will be possible for people to access these things. That people will have the techology, the internet connection, the technical capability, and the privacy where needed – to be able to participate. That is not the case for everyone – and there are significant numbers of vulnerable people who are missing out, and have been so glad to be able to reconnect even in the limited ways that have been able to re-start in some places.

Many LGBTQ+ perhaps rely more heavily on their family of choice, their social circle, – people who you are not necessarily going to be living with – and so maybe feel the separation more keenly when we have to restrict our social connections.

The statistics around mental health and the LGBTQ+ community don’t make for pretty reading. Many of us have gone through years of difficult circumstances, discrimination and trauma – which leads to increased risk of developing mental health difficulties. It can also be a barrier to engaging with services – or finding services and mental health professionals who have the understanding to meet our needs.

However – there is strength and positivity in the LGBTQ+ community which if harnessed can paint a different picture – of a community which supports each other and helps to build a future of ever improving wellbeing, which overcomes isolation and boosts connection.

We touched on many topics, challenges of intersectionality – thinking about LGBTQ+ people of colour, (we did notice we were an all white panel – regrettable, while recognising Happy Valley represents an area with very low ethnic diversity – hopefully in future suitable people can be found to bring other perspectives into the conversation). We also considered the experience of growing up Trans, and how that has changed over the last few decades. Current arguments and pushback may be disconcerting for young people who feel their rights being challenged, but our hostess Kate had reassuring words for them – that things are much better than they were, and will keep getting better.

People shared their top tips for wellbeing – some highlights:
* Get moving. Find an activity that suits you. Dance in disco pants.
* Write your worries down, get them out of your head
* Practice 10 minutes of proper relaxation – no distractions – no screens.
* Reach out and ask for help if you need it. Talk to friends, family, see your GP.
* Schedule a time to worry – if you are being troubled by anxieties.
* Practice self compassion – give yourself a break, treat yourself with kindness.

A pleasure to be invited and reminded of the fabulous community out there. I look forward to when we can welcome back our Happy Valley Pride festival in all its rainbow glory.

What is wrong with me?

It’s a question I’ve asked myself many times. It’s a question that most people who experience mental health difficulties ask themselves. Especially in the early days. When maybe they don’t realise what’s going on.

It’s not just a mental illness thing. There are so many people living with experiences, symptoms, they don’t understand. That we wish we could have explained and hopefully fixed. That is what we are lead to believe happens. You get sick. You get symptoms. You take your symptoms to a wise doctor. They believe you, investigate, identify and issue a nice little prescription to make it all better.

But of course we know life is seldom like that.

I’ve spent 30 years trying to understand “what is wrong with me” or “why am I the way I am?”. I’ve never got far with doctors, but then so much of what I feel is wrong is hard to explain, express. And seeing as I have been mostly functional, most of the time – it’s no one’s priority. Unless it gets in the way of work, no one seems to care. No matter that you live your life in pain, discomfort or emotional torment. No matter that you have no energy and cannot for the life of you manage to keep things in order for more than two days together, and you battle with self destructive urges every day of the week.

I’m having a bad day. Part of a bad week, bad month – unsurprising having gone through such a momentously rubbish year.

I feel much like I used to feel. Last night was spent alternating between on the one hand lying awake, in pain, feeling tense and sad and trying not to spiral. I can’t use twitter as a benign distraction any more because the world makes me sadder. Or more accurately more frightened. On the other hand when I did sleep I got fitful, terrifying dreams. I can’t remember them now, but I woke with sorrow in my chest. That kind of waking where you open your eyes and feel more tired than you have ever felt. You can’t even move your face. You stare at whatever happens to be in front of you, heavy lidded. You will yourself to move but your body doesn’t listen. Your body feels like it is still asleep. Only a notch up from sleep paralysis. You feel the guilt and self loathing begin to rise.

Not this again. Why can’t I just be normal?

Photo by Cris Saur on Unsplash

When people say that people with depression can’t get out of bed, I really don’t think some people get it. I mean yes – there are days when I am “only” so down that I don’t want to get out of bed. That it feels pointless, or frightening. That I know I’m going to be no use to myself or anyone so I might as well stay where it is safe and dark and warm. But those are not the worst days for me. The worst is when I want to move, and try to move, wanting to shake it off – but just can’t. It takes hours. Like turning the key in the ignition over and over and over until finally the engine starts. And every action from there on in takes herculean effort.

About three days in every month I am organised. I am a whirlizer of tidying and cleaning, and admin and sorting thing out and getting things done. And then slowly it all falls apart. Washing mounts up, dishes gather either dirty or on the draining board, somehow never making it to the next stage. I just about manage to keep doing what I absolutely have to do. Working. Emails. Feed cats and us. But I see around me everything I am not doing and I feel shame and sadness that I can’t be who I want to be, can’t have the life I want to have.

What is wrong with me? Knowing what I know now, I do at least give myself some slack. Executive dysfunction can be a big part of Depression. We don’t just do things. Same as a rocket doesn’t just launch. We have to put a hundred things in place in the right order to complete any task, either literally – like having a cup of tea:
recognise you are thirsty
decide what you want to drink
remember that to make tea you need
to put water in kettle
to switch kettle on
where the teabags are
to get a teabag from the box
to put the teabag in the cup
to notice when the kettle boils
to pour the boiling water on the teabag in the cup
to wait a while
to remember that you take milk
to remember that the milk is in the fridge
to get the milk from the fridge
to add the milk to the tea
to squeeze and remove the teabag
to stir the tea
to take the tea with you to where you are sitting
to remember to actually drink the tea
to remember to blow on it if it is hot

Or we are doing a bunch of things subconsciously in our bodies and minds to make things happen – like getting up.

People with dementia can have issues with executive functioning because they forget aspects of this. My gran used to have lots of falls and they said it was because while her head knew it wanted to get up and go somewhere, the message wasn’t getting through to her legs sometimes as quickly as it needed to. She could move her legs, she just didn’t, and so top half lurched forward before the bottom half was there to carry it.

People with depression can have issues with this – but there are also other issues which may be going on in the background that we might not know about – issues of neurodiversity for instance, Autism, ADHD, Dyspraxia etc. Far more of us may fall into these categories than some people think. And many people may be struggling with anxiety, depression, OCD, and other issues as a result of living with these issues undiagnosed – causing life and certain situations to be more challenging, not understanding why we don’t find it as easy as other people seem to.

But getting any of this checked out as an adult is not easy. And it’s something I have chosen not to pursue at present. But on days like this, when I used to beat myself up for being a failure, I try to remember that there is more going on that other people can see. For whatever reason, be it hormones, atmospheric pressure, stress or the phases of the mood (who knows) – some days are harder than others. And the first thing that helps is giving myself a break.

6 months in – mental health and the pandemic

Photo by Nick Fewings on Unsplash

I keep hearing people talk about the mental health impact of the pandemic. But as with seemingly everything else in life, people are polarised about it. There are the people who think the impact of lockdown is too great, the separation and financial concern too unbearable – and there are those whose anxiety is skyrocketing at the lessening of that lockdown, returning to work, to school, to college. Even more so now the numbers are rising again – but then increased restrictions, a threat of a more severe lockdown again, has the first group rattled. Swings and roundabouts. You cannot please everyone whatever you do.

I get frustrated and annoyed when I see definites, certainties – This will make x worse, This will cause y. I think it’s irresponsible. There are issues which will undoubtedly be getting worse for some. And other which are affected in more complicated ways. Suicide may be increasing – but figures come through slowly, and figures have been increasing already for the past few years. Is the current crisis making it worse? It might seem reasonable to expect so – but mental health is not always reasonable. Sometimes being in a shared crisis can make our own personal nightmares fade into the background for a while. A bit like I would always sober up if a friend was in trouble on a night out, no matter how much I had had to drink.

But the practical concerns of the pandemic will certainly be causing some people to experience mental health struggles who never have before, and who have never developed any coping strategies to deal with mounting anxieties, panic, dark depressions – because they’ve never needed them. Some pushed over the edge by money worries, furlough, redundancy, loss of work – some desperately lonely, missing social connection.

Others though will be more concerned about their health and that of their loved ones. One way or another. If you are concerned about the impact of catching this illness, then no matter how difficult the financial situation gets you will never be totally comfortable about exposing yourself and your family to risk. Even if you have loved ones needing treatment for other illnesses – when called in to hospitals when this treatment resumes – there is the fear, is it safe? Hospital Acquired infection is a terror at the best of times and this is not the best of times.

Health Anxiety, Panic Attacks, Obsessive Compulsive Behaviours, Phobias, Eating Disorders, Self Harm – all on the increase.

And then there is the curious question of those who come down on the side of thinking this is all a hoax and a grand conspiracy. Maybe you are one of them. I am not. Apologies. I err on the side of caution, and draw on my experience to inform my decision about what to believe. I also have my thoughts on how easily such storms are whipped up in this era of mass disinformation and how it relates to aspects of mental health. But that’s for another day.

I’ve worked in health information for decades, I’ve seen the warning signs of a pandemic looming, I’ve seen the lack of preparation. Much like people have held the NHS too lightly because they have forgotten what life was like before it, people have also forgotten that before vaccination became possible epidemics were rife. Anyone who has done family history research that takes them into the overcrowded inner cities of victorian times know that families were decimated, wiped out – Smallpox, Typus, Cholera, Diptheria, TB, Polio.

We stopped being scared of illness. We’re scared of things you can’t catch, like cancer – but not infections. We have become complacent. The attitude we have to sickness in the workplace shows we see health as the default. The difficulties (and indeed abuse and punishment) faced by disabled people simply trying to get support to be able to live their lives and do their best with a minimum of pain and discomfort. We could easily have demanded more hygiene protocols at any point to minimise the risk to the vulnerable from colds, flus and other bugs – but it is seen as weakness to get sick, a personal failing for which you can lose your job.

Perhaps covid will change that. When a cough really can carry you off, perhaps we should be doing more to identify and understand the seasonal ailments which have plagued us for years. I also hope that businesses transform themselves to be more resilient – and in doing so bring about a new era of flexibility and compassion. I genuinely think the world could be better for it – and that their profits would also see the benefit.

The mental health impact of the pandemic is so varied that there can be no universal approach. Everyone must look at their own situation, what are their specific issues, problems, how can they be addressed. Personally I don’t think denial serves anyone for long. Acceptance of where we are, and then seeing what is reasonably practicable to do about it. Accepting that it will take time for things to change, and we may not get back to where we were before. We need to share strategies on how to cope, and help each other get through this, not just rail against the fact that is happening. How many people give up hope because people have told them there is none? There is always hope, always light however feint.

My mental health has gone up and down and up and down again. Relief at being able to protect myself, stress and anxiety at not having any money, Enjoyment of time at home with my husband and cats, loneliness and missing my parents and friends, Taking time to do new things or get on with projects, letting my fitness slide and becoming anxious about leaving the house. Learning new skills and finding new ways to work and meet people online, realising I haven’t brushed my teeth or hair in days, only getting properly dressed if I have to go on zoom. Panic attacks at the state of the world and the division in society. Post apocalyptic nightmares. Obsessive searching for information and constant scrolling, scrolling, scrolling for connection. Occasional urges to return to old habits of self harm, or purging. Suicidal thoughts.

Each time I feel it slide I try to do something to counteract it. Exercise more, eat better, look after myself, push myself to talk to the few friends I have. I keep an eye on it. As does my husband. Increasing lockdown measures put off the thing i’m really fearing – going back to travel and being in rooms with people. Something I know others are itching to do again. I know it will be a challenge for me when it comes. Winter may be a financial challenge – not that it has been a party so far. When my depression rises one of the sticks it beats me with now is “why isn’t this having more impact on your life, why don’t you have friends and family you socialise with and therefore miss, why aren’t you out doing things all the time,” – but I counter with the fact that my life may be quiet and small compared to some -but I am happier and mentally healthier than I was when it was large and noisesome. Perhaps I have deliberately made it manageable.

I remind myself what helps me. Meditation. Breathing exercises. Sleep. Immersing myself in something. Learning. Helping others. Acting on trying to alleviate my worries. Watching the clouds, the birds, the wind in the long grass. Focusing on whatever small circle of calm I can make in this moment. Putting the chaos off until I have more energy to deal with it.

As well as the necessary financial support for individuals and businesses – we know there needs to be massive investment in mental health to help us get through this. Both by the government, and by businesses. It has been needed for decades, and this is just the flood that comes after you neglect a leaking pipe for too long. We need to stop seeing mental wellbeing as a luxury. If you want a country, a business, an individual that is thriving – you have to give them the right environment and meet their needs. We’re not that different from plants after all.

The good news however, is that we all have the power to support those around us. Reach out if you need help, reach out if you are worried about someone, reach out if you aren’t worried but just haven’t spoken for a while. We may be distanced but we don’t need to be alone.

If you are struggling now – click here for some resources

If you’d like to learn more about mental health and supporting people, join me on one of my upcoming courses

If you’d like to arrange training for your workplace or organisation – contact me on sarahlongmhfauk@gmail.com

For more on looking after our mental health through this period:




Life as Trauma

Black and white picture of two books - The Body Keeps the Score by Bessel van der Kolk, and The Inflamed Mind by Edward Bullmore

What is trauma to you? What do you understand by the term?

The dictionary gives us two definitions –

(a) severe emotional shock and pain caused by an extremely upsetting experience
(b) severe injury, usually caused by a violent attack or an accident.

Bodily trauma – could be a gunshot or stab wound, broken bones, bruising and lacerations. The impact of something hitting us with force and speed, or us colliding with something.

In emotional trauma – it is life which hits us. Events. Circumstances. Sometimes these events may also cause bodily trauma of course, but not always. They may be sudden, dramatic, life threatening, life changing events. Or more subtle, enduring difficulties.

I am learning. I have a basic understanding I think of how it works. I was taken by something Dr Stephen Porges said in a session I was listening to the other day – something along the lines of “Trauma is not an event, it is a response” It is not the explosion, the car accident, or the rape, which is the trauma, it is the way we are affected by it. Trauma is not the bullet – it is the damage it causes on its path through our body. The body breaks and bleeds, it cannot stay whole.

These major event-type traumas are understandable, recognisable to many. Though there are some, whose only encounters with trauma have been through the Post Traumatic Stress experienced by the military in war zones – who may not immediately accept that these experiences are comparable to other kinds of trauma. And in a sense they are right. Because no two traumas will be alike, because no two people are alike. How we respond to life and events, whether happy or sad, nurturing or traumatic, will depend on a million variables in our genetics, our biology, our upbringing, education and experiences. But a mother can experience PTSD after a difficult birth just as a soldier can after a wartime incident which sees them severely injured and losing squad mates.

The experiences are not the same. But part of the way the body responds to them, and why – can be understood on the same spectrum.

Most experiences which trigger a trauma response are those where we feel profoundly unsafe. In danger. Often our life is at risk, or we think it might be.

Similarly other kinds of trauma make us feel unsafe in more subtle ways. Rejected, unwanted, unworthy. Bullying, neglect, abuse – difficult and unhealthy relationships. At root we are primitive beings – and somewhere in us we have a sense that to survive we need to have the support and acceptance of our family and community, and if we are made to think that is in question, something in us feels genuinely that our survival is at risk, even if on the surface others might think the experience is relatively trivial or mild. Subtle emotional abuse or bullying might seem annoying, if admittedly unkind, to those looking from the outside – not realising the insidious nature, of ongoing, unrelenting cruelty which picks at your self esteem and questions your value as a human. These kind of complex and enduring difficulties can also lead us to a trauma response – and can be more embedded in our way of being, and complicated to treat. Sadly we know they can lead people to take their own lives out of desperation.

The traumas with a big T – are unmissable. We know they are happening. The question is how will they impact us. It is perfectly normal and reasonable to be shaken up and impacted by such events, for it to affect our sleep, our mood, to preoccupy our thoughts. After all – we nearly died, or some major harm may have come to us (or we witnessed something horrific, which made us empathically respond and imagine ourselves in the crisis). Our brain, with its one job, to keep us alive – has to take stock, and reflect – make sure there is nothing it could have done differently to avoid it happening again. But usually, if all is well, we would work through that and eventually put it in its place – file under, horrific accident, or unforseen event – not, “something that might happen every day”. Around a month I think is the benchmark for when these thoughts and feelings should subside.

Sometimes it takes longer. Sometimes we might need some help to process what we have experienced.

With Post Traumatic Stress the effects are different, may take time to come on, and may include flashbacks or re-living the traumatic situation in some way – our body taking us back to the physical and emotional sensations of the time. We may definitely need some specialist help to break these cycles and be able to move forward out of the trauma. EMDR Therapy is known to be particularly effective in helping people through these experiences.

There is no judgement or shame in finding yourself experiencing PTSD, or heightened anxieties as a result of events – even if someone who went through it with you has not been affected at all. There are, as I said, lots of variables. Aspects of ourselves and our genetic experience we know nothing about – other traumas we have gone through earlier in our lives, even if we have no conscious memory of them.

Everything we go though has an impact. Significant emotional difficulties, complex or unsupportive relationships, over time can lead to us feeling unsafe all the time. To feeling unworthy, like we have to do something to earn love and respect. To feeling stupid for ever thinking anyone might care for us. This trauma can shape how we act and interact with others, shape our way of being, our temperament, how we treat ourselves, whether we can regulate our emotions, trust, or get close to others. It can be at the root of many of our problems and difficulties.

In truth I doubt any of us gets through life without experiencing events which could lead to trauma. Some of us will be lucky in that our particular combination of background and experiences keeps us immune from too much negative effect. But most of us will carry some of it through life.

The question is – when does it become too heavy? And how do we set it down?

I am still learning. I am constantly unpicking the experiences I have had that I know now have contributed to my mental health difficulties, my problems with confidence and self esteem. My self sabotaging nature in relationships. But I’m also coming to realise how much they are probably at the root of my ongoing issues with obesity, problem drinking, and general lack of rigourous self care.

Next on my reading list is Bessel Van der Kolk‘s The Body Keeps the Score. I’ve been hearing about it for ages. I think it is going to help.

Thank You NHS/Social Care Staff

I am in awe of those of you who have been going out and putting your lives at risk working in our health and social care service during this COVID-19 crisis. You work hard enough anyway, you are generally not paid nearly enough, and the strain of this time must be enormous. You have my love and gratitude. I’m volunteering for the SHOUT frontline text support service to hopefully offer some emotional support – but as another gesture of thanks I am making a number of places available on each of my next few Online Mental Health First Aid courses for only the cost of the materials – £25. This is a massive saving on the £300 full price, and also on my usual discount rates, so I hope it will enable some of you to access the course who otherwise wouldn’t be able to. You might be able to do the course through work – but as places will be limited it’s nice to have this option too. This offer is for self-funding individuals and will run at least until Autumn.

Please drop me a line with your proof of eligibility at sarahlongmhfauk@gmail.com and I will provide you with a discount code.

Other discounts are available for charities, and people in receipt of benefits – again, please get in touch with your circumstances and I will let you know the rates.

Booking is generally via eventbrite – but I can accept payment via other means where necessary.

If you are able to afford higher rate tickets – please opt for these, to enable me to continue to offer discounts to those who need them and also pay my way!

Online Mental Health First Aid – Saturday Class

A lot of people have asked me about weekend courses in the past as they haven’t been able to make it to sessions in the working week. So I am delighted to offer this Saturday Morning class.

Over the course of four weeks you will learn about Mental Health, about different Mental Health related issues and how to support someone experiencing distress, and look after your own wellbeing.

The course is a combination of independent learning prior to each of four live sessions. I have scheduled from 10am-1pm but that’s to allow for tech issues and questions, main content is between 1hr 45mins and 2hrs 20mins, so we’ll hopefully be finished a little earlier each time – but I’ll be there if you need me.

Dates: Sat 11th July 2020, Sat 18th July 2020, Sat 25th July 2020, Sat 1st August 2020.

Book via Eventbrite below – more information, including about more discounts can be found on the event page – or drop me a line.

**Ask me about Special COVID-19 THANK YOU rate for NHS/Social Care Staff **

Online Mental Health First Aid

What a whirlwind couple of months! If it has taught me anything it is that plans mean nothing, that order can come from chaos, and that we as human beings are capable of great things when we work together.

So many tumultuous changes and challenges going on in the world right now. Something to come back to another day – but here I wanted to tell you about some of the changes that this momentous period has brought about in my world of work.

Mental Health First Aid training is usually delivered face to face, in small meeting rooms, with a good amount of close discussion and interaction. Which is great – but a perfect place for viruses to jump from host to host, and not easily adaptable to comply with social distancing.

So the good people at MHFA England have been working their wonderful socks off to develop a version which can be delivered and studied online, which is now just about ready to go. All across the country, MHFA England Instructor members like myself are busy completing the upskill required to be able to deliver this course and getting to grips with the new platform and logistics requirements.

The course isn’t exactly the same as the face to face two day version – but it has the same learning outcomes for the delegate. And lets face it two days of zoom covering heavy content is unlikely to help the mental health of any of us.

So – instead, this course is made of a combination of independent learning (videos, activities, reading) – and live session teaching with your Accredited MHFA Instructor to cement, supplement and build upon that learning. There are four sessions, to be delivered over the course of a longer period of time, say a fortnight or a month, with the independent learning to be completed prior to each session. You get the support of your instructor throughout, and the same eCertificate, and excellent learning materials as with the face to face course.

The course is delivered via a new Online Learning Hub – hosted on the Enabley Platform (which works best on Google Chrome).

The course is valued by MHFA England at the same price as the two day version, £300 (+VAT where applicable) – However, I, and many other instructors offer at discounted or subsidised rates where possible. (See below)

I have set up three open courses so far to run in July, and will set further dates soon – so if you have any requests / preferences for days or times please let me know and I’ll see what I can do. Happily – this new option allows for great flexibility in terms of when I can teach – so we have evenings and weekends open to us now as well as through the working week, which might be helpful for those of you wishing to learn independent of your work.

See current courses here on Eventbrite

(If you are an organisation looking to set up a course / courses for your staff or members, please contact me for a quote which is usually more economical than the per person rates below.)

I have a range of prices to suit your circumstances. If you are able to pay the full price, you are most welcome to do so, it has after all been a difficult year so far and I could certainly do with the support. However I also offer two usual standard rate discounts – £150 for individuals, £200 for employers. These rates are at your discretion – I simply ask if you are an employer booking for work, or for your staff and you are able to afford it, that you choose the £200 rate rather than the £150. The more people are able to pay the higher rates, the more I can offer lower rates to those who need it.

If you are a charity, or on benefits etc – please contact me with your circumstances and I can offer a further discount.

I am also offering a number of extra special COVID-19 thank you rate places, for people working in the NHS or Social Care – of £25 only. This covers the cost of materials. My teaching is my gift to you for caring for our vulnerable loved ones and putting yourselves at risk while I have been able to stay relatively safe at home.

I’ll do another more concise post to advertise the actual courses, but I wanted to put a bit more detail out there. I can also offer the half day Mental Health Aware, and MHFA Refresher courses via Zoom.

It’s been a busy old month or two, scary and exciting to be learning and using new skills. I’m looking forward to this new venture. There are pros and cons to online versus face to face, but the pros definitely include flexibility, – I can imagine it will be easier for some to find a few hours a week to free up staff, where two days was impossible. There are also savings in terms of travel costs and time (for both myself and clients – especially where attendees might come from across the country to one location).