Self Harm – the crashing of the waves on an ocean

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Last week saw a flood of stories on the prevalence of self harm amongst our young people and especially girls and LGBTQ+ youth, stemming from the publication of the Children’s Society’s “The Good Childhood Report”. 

The report makes interesting and saddening reading, highlighting the deterioration in the emotional wellbeing and life satisfaction of children – those who if our parents’ are to be believed are supposed to be living out the best years of their lives.

What I found even more interesting, and alarming, in some of the commentary and discussion I read was the angles taken on it by some.

  • Disbelief – this can’t possibly be true. The definition is too vague. I didn’t know anyone who did this so it can’t really be a thing, it’s exaggerated.
  • Blame the media/internet/awareness – I never knew about this stuff when I was young so it’s because people see tv stories about it, or look it up online, or (even better) mental health awareness campaigns tell them that self harm is a thing, so people then go and try it.
  • Focus solely on the self harm – what can we do to stop people harming themselves?

So few seemed to be interested in discussing why 15% of young people are feeling the need to hurt themselves. 22% girls. 45% of those who may be LGBTQ+. (And ignoring the fact that the question asked wouldn’t necessarily pick up those, probably mainly boys – who turn the same urges outwards and get into fights or engage in risky behaviour)

Ignoring the rest of the report which explores the decline in happiness experienced by the young – as Matthew Reed, Chief Executive puts it in his foreword:

Children’s happiness with their lives had risen steadily in the 15 years from 1995 to 2010. But this progress has now been reversed and children’s well-being is now as low as it was two decades ago.

Hurting yourself is not ideal. Sometimes indeed it can be very dangerous. But to focus too intently on the act of self harm is to not see the wood for the trees. To not understand the nature of the act.

Self harm is not the problem. It is a symptom. Even if, for the sake of argument, we say that some people decide to hurt themselves because they heard about it on tv, the internet, or a mental health campaign. You will not continue to do it, unless it does something for you. Unless it serves a purpose. If it just hurts, and you have no need – it won’t become a habit. But for some, self harm serves a very real purpose in that it helps to relieve, express, or respond to deep emotional pain.

If someone hurts themselves and finds that it somehow distracts from, or drowns out the pain – how do we think it feels when someone tells them they shouldn’t do it?

Self harm is not ideal. We need to help people to develop healthier, less risky coping mechanisms. But it is not the main problem. It is the white horses on the wave as it crashes to shore, the sound of the surf on the pebbles. The problem is the ocean. That deep, dark, powerful and destructive mass which is the sadness, distress, anger, fear, hurt, frustration, anxiety that people are experiencing, which makes them seek ways to block out the noise, or show their emotions, or punish themselves for not coping, or feeling like a bad person. That is what we need to understand.

Why are our children in such pain?

We need to listen. Not assume. Not say it’s all social media, or exams. Because it’s so much more.

I was one of those LGBTQ+ children. I cut myself to relieve the pain caused by loneliness, emotional turmoil, feeling like I couldn’t talk to anyone, like my family would reject me. I was also worried about my exams, the future, my physical appearance, etc. etc. etc. The world these days is different but the same. Ensuring our children are loved, protected and accepted for who they are, supported through all their difficulties, shown that no matter what they can talk to someone without fear. Listen to them. And when they tell you they fear for their futures, look around at the world and ask yourself if you are surprised.

Ask them how they are feeling. What’s going on in their lives. Explore ways to keep them safe through harm minimisation. Get them some help and make sure they know they are loved.

https://youngminds.org.uk/find-help/for-parents/parents-guide-to-support-a-z/parents-guide-to-support-self-harm/

Cause of Death – not just suicide we need to worry about.

I was just checking to see if there were any updated statistics yet on the number of suicides in the UK – not yet. I wanted to see if last year’s slight reduction was the beginning of a trend or just a blip. Anyway – I found myself perusing the figures, and also those for all causes of death.

We, rightly, are making more noise about the fact that suicide is the no. 1 cause of death for men aged under 49. But other things also stand out to me. I need to spend more time looking into this stuff if I can.

Suicide is the leading cause of death for both males, and females aged 5 – 34. It continues to be the leading cause of death for men until 49. But lets look at some of those other causes.

3.6 Table 2. Leading causes of death by age group for males in England, 2015

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3.7 Table 3: leading causes of death by age group for females in England, 2015

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(Tables from: https://www.gov.uk/government/publications/health-profile-for-england/chapter-2-major-causes-of-death-and-how-they-have-changed – Open Government License)

 

Accidental poisoning, Cirrhosis and other liver disease, Homicide. Think about these first. Accidental poisoning is frequently a drug overdose. Cirrhosis and liver disease are heavily related with alcohol. Nearly 60% of violent crime is known to be alcohol related and this is an underestimation as not everyone is tested on arrest or note made of their level of intoxication.

Each suicide is a tragedy, 80-90% of which are related to mental ill health – whether diagnosed or not. But suicide is not the only way in which mental ill health is killing us. Many people, of whatever gender, respond to their mental distress by self-medicating with alcohol and drugs. We might not think it, but that glass of wine, those few pints after work on a Friday after a difficult week – if we are doing it to help us cope with stress, to distract ourselves from our difficulties, to help us sleep (a counterproductive measure) – that is self medication. It is a coping mechanism. Just not a healthy or very helpful one.

If it is a now and again thing, and we are sensible with it – then maybe that is not so bad. But if it goes from being now and again, to every week, every night – from one pint to five, to eight. One glass of wine to a bottle, two bottles. And/or if we have no other way to deal with our stress, respond to our difficulties. If we become dependent on it for feeling ok, getting by. Then, Houston, we have a problem.

That’s just the short term. Of course there is also the fact that our coping mechanism may soon start to add to our difficulties. Financial problems, health issues, and also ability to cope and concentrate and perform well, keep up with our responsibilities, relationships. Dependence may further develop into addiction.

Yesterday I was listening to an LBC phone in around the topic of alcohol dependence sparked by the Adrian Chiles story – his realisation of the grip alcohol has on his, and many other lives. https://metro.co.uk/2018/08/21/adrian-chiles-drank-up-to-24-pints-a-week-as-he-admits-he-is-undoubtedly-dependent-on-alcohol-7864742/

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Many of us think alcoholic means someone hiding bottles of vodka around their house, or homeless and begging for money with a bottle of cooking sherry or special brew in their hand. Undeniably that is how some people end up. But an unhealthy reliance on alcohol is far more commonplace, and often comes hand in hand with mental health issues. People who don’t necessarily think of it like that. They know things are hard, that they are stressed, or down. But they don’t think – I’m not well, I need to go talk to a doctor, or my partner. They think, I’ll have a few beers and shake it off.  And then it builds.

For some – they use other drugs to get by. For relaxation, or confidence, or total distraction. While those drugs may be illegal and alcohol is not – alcohol is no safer. There is no such thing as “risk free” drinking. Keeping within the recommended limit of 14 units a week may lessen risk of negative consequences – but it does not remove it. And when 14 units can be 4 pints of strong lager, it is easy to see why some of us really have a much bigger problem than we think we do.

In many social circles it is less socially acceptable not to drink than it is to take drugs. We have an odd culture. But many are not just drinking to have fun. Many are drinking to cope with mental ill health. Sometimes mental ill health makes us more likely to drink or take drugs because we become impulsive and forget about risks – for instance in the case of Bipolar disorder. Sometimes people take drugs to drown out the voices or other hallucinations experienced in psychosis. There is a complex interaction with mental ill health at all levels of severity – and alcohol increases the risk of developing more serious mental health issues, and the risk of acting on suicidal thoughts.

But looking at these figures – seeing how many of those deaths are potentially mental health related – through direct action in suicide, accidental overdose, alcohol related conditions – even Breast Cancer, Heart Disease and Stroke – the risk of which is increased with alcohol consumption. We need to keep educating to bring down not only suicide, but all mental health related deaths. Not just campaigns to get us to cut our drinking – but also to realise why we are doing it, and what we can do instead.

I count myself among those who really need to change. I have got to a point where I don’t think I would act on my suicidal thoughts (as I have done in the past) – they come, they go. But I still drink way, way too much. Rely on it when I am stressed, anxious, down. Allow myself to go way too far when my inhibitions drop. And drinking leads to risk taking, and poor dietary decisions, and spending money….

So next time I am feeling the strain, or I want to celebrate the end of a difficult week. I am going to try and find a new coping mechanism or reward. Because it feels a waste to have done such good work on my recovery, to end up with a life cut short by beer.

[A Post Script btw – How horrific that the second most prevalent cause of death for infant girls is murder. Another fact worth investigating further.]

 

Why is challenging stigma the most important part of what I do?

Stigma stops people thinking about Mental Health
Stigma stops people learning about Mental Health
Stigma stops people recognising when their mental health is deteriorating
Stigma stops people recognising when their friends / family are suffering
Stigma stops people accepting they have a Mental Health issue
Stigma stops people telling their friends they are struggling
Stigma stops people telling their partners they are in pain
Stigma stops people telling their employer there is a problem
Stigma stops people asking for help
Stigma stops people going to their doctor
Stigma stops people attending appointments
Stigma stops people taking anti depressants
Stigma stops people going for counselling
Stigma stops people believing little things can help
Stigma stops people asking their employers for workplace adjustments
Stigma stops employers recruiting staff with mental health issues
Stigma stops employers treating staff with mental health issues fairly
Stigma stops employers supporting staff with mental health issues
Stigma stops employers retaining staff with disabilities
Stigma stops people being able to stay in work
Stigma stops people being able to get support if they are unemployed due to mental health issues
Stigma stops people offering support when they see someone with mental health issues in distress
Stigma stops people getting better
Stigma stops people getting help
Stigma stops people living the lives they deserve
Stigma kills

 

The many faces of O.C.D.

I’ve long known that obsessive compulsive disorder was not about being neat and tidy. That the stereotype of an excessively orderly person, or someone obsessed with cleanliness and avoiding germs – is a simplification of one part of this complex set of experiences. But I recently set myself to learning a bit more as a bit of Continuing Professional Development reading – and have been surprised to find myself recognising aspects of myself in the past – and also understanding experiences that other people have shared with me over time.

The concept of my having anything to do with O.C.D. would have my parents rolling in the aisles. Because they probably share that stereotyped understanding that many of us have from media representations. And I am many things, but I am not tidy, orderly, clean, or any of those other words. My messiness has been a source of distress for them for four decades. They worry about it far more than I do.

So what do I mean? What in fact is O.C.D.?

At the core for most, is some kind of intrusive thought. Indeed for some people – intrusive and unpleasant thoughts of one variety or another, are the whole of it. With Rumination O.C.D, sometimes known as “Pure O” – all of the action is in the head, those intrusive thoughts and a person’s mental response to them, which can go round and round and become all consuming.

But many others will develop a response to the thoughts which takes the form of an action. Something they find which temporarily relieves the anxiety caused by the thoughts – and which over time they feel compelled to do, again and again, more and more. This might be washing their hands to avoid contamination by germs, or avoiding touching things, or cleaning, or all of the about. It may be repetitive, ritualised behaviours that have come to “mean” something to the person – i.e., someone worries about their spouse dying, and somehow come to believe that if they never step on a crack in the pavement, and cross every threshold seven times then they will prevent that from happening.  Sometimes people become obsessively worried and doubtful and need to check things over and over again, or seek reassurance over again, never trusting their memory.

Simply keeping your kitchen clean and tidy because it’s a good thing to do isn’t O.C.D. Even if you have to have everything just so. But – if you are doing it because it alleviates some other distressing thought – for instance that you might poison your family by accident – and if you clean over and over again, even when it is not necessary, then there might be an issue.

So what have I recognised in myself? Two things. Not really from now – though there is a ghost of it still which could re-emerge to haunt me any time.

Firstly – lets talk about the other end of the scale from that clean and tidy kitchen. Hoarding has been recognised as a kind of O.C.D. – an anxiety related disorder where compulsive behaviours come as a result of underlying trauma of some kind. Part of the reason my parents bewail my scruffiness is that I have so much stuff in my house.  Not quite packed to the rafters yet – but in some parts not far off. Some of that is simply because I used to live in a bigger house, and I could do with few more rooms. But when I think back, I can recognise a period of time when my behaviour became problematic.

I have a lot of books. I mean a lot. I have about 8 bookcases, all double stacked, plus cupboards and drawers full of books, piled hither and thither. I love books. But I have come to hate the books in my house. I am a librarian. They are in not a great deal of order beyond fiction / non fiction. I don’t know where anything is. I don’t know what I have anymore. They certainly aren’t decoratively displayed. They even get stood on. I hate it.  I’ve had a lot of books for a long time but I used to try to keep on top of them. Get a new bookcase when I needed one. Keep them in order. Set my prized collections apart in some way. But then at some point I went a bit mad with it. Literally.

The more I think about it the more I see it. A long while ago, I had a hypomanic period when I spent a load of money. And part of that was going into bookshops and coming out with bags of lovely books.  When I got better, I banned myself from buying new books, except for very occasionally.  I have actually stuck to that most of the time. However. A couple of things happened. In my then workplace – we had to move the library. Again. We moved a lot. And each time we had to pare the stock down and get rid of books, which was not pleasant. This time we had to a) get rid of a huge amount of stock, space wise – and b) weren’t given a lot of time to make the decisions about what to get rid of, and what to keep.  I was deeply distressed by the amount of really useful and interesting material I saw being marked up for discard. So I took it upon myself to rescue a load of them.

It was probably not in any way insignificant that this coincided with a difficult break up with a long term partner. As well as adding hundreds of books to my shelves from the library – I also started buying from charity shops. Because charity = good, and second hand is not “new books” which were banned. And it didn’t cost as much money…  But suddenly it was getting out of hand.  So I limited myself again, said, I can only buy books from authors I want to collect. But that started with one or two, then I added another, and another, and another….

Anyway. Time passed, and I gradually stopped. I went through an interesting transition. I love books. I loved books. Books gave me comfort, made me feel safe. I could lose myself in books and forget the mess that was my world. But I had all these books and I wasn’t reading. I didn’t have time, or the ability to concentrate. Books had been my treasures, along with the relics of past relationships and experiences that I had carried from house to house like religious totems, polishing, displaying – each ornament or photo having sacred significance. And yet despite all of that – my relationship had still fallen apart. And while I had a new one, I still grieved for that loss. The person I loved, the life we had thought we might have together. And so all of those material things lost their meaning.

The books on my shelves don’t comfort me any more. They nag at me. They get in the way. They remind me of my inadequacy. I will – sometime soon, try and do something about it.  I wish that could be to have a library built, give them the space they need and put them in order, but it can’t be – so I need to cull, and bring them into proportion. Unless we make the decision to pay for proper storage.  Meanwhile, I am trying to work my way through the other things I have hoarded, or collected. Another aspect is the perfectionist standards I set for myself in moving house. New home, new town – I was going to be a new person. I was going to be super ethical environmentalist, crafty, gardeny goddess lady.  So I started collecting things I thought might be useful. Plastic pots, egg boxes, corks, lids, bits of string, bits of cloth, cardboard, jars.  Again. Great if I had the space, and if I ever actually did anything with them. But I don’t. But sometimes it is physically painful to throw things away. Even to put in the recycling, because I am not living up to those stupid perfectionist standards. Did I think that if I met those standards it would stop my relationship breaking down this time? That I have to prove something to be loved?  I see this same pattern sometimes in the paralysis I get when shopping, or deciding what to eat. Shopping – what are my priorities? How much does it cost? Is it organic? Free range? Fair trade? Rainforest friendly, Cruelty free, do I know about the ethics of the producer, yes but how many air miles and what about palm oil and but then what about the fat/sugar/additives content, but does it taste nice and does my husband like it and oh I am now having a panic attack and abandon the whole shop.  Sometimes we just need to buy something to eat.

The other time is last year and my troubles with health anxiety. Obsessive worrying about my health – be it my heart, my digestion, my hernia, my operation, sepsis, my fall, my leg, tetanus, any of the above and more. Responding to said worries with checking – looking up on the internet, reading everything I can – ostensibly to understand the risk better, but actually fuelling it. Checking the physical area, poking, prodding, testing. Changing my diet, my habits. Asking people, doctors. It took about 6 months, at least, to bring it under control again. Though I still think my leg is broken.

I know people who are troubled with intrusive thoughts that make them think they are bad people, people who struggle with crowded places or public transport for fear of something bad happening. Some of them develop avoidance or safety routines that distract from their anxiety. I know people who compulsively shop online and then find themselves surrounded by boxes of stuff they don’t really want and certainly don’t need – not to mention the credit card bills.

At the root of it all is that anxiety – that fear of some perceived danger – insecurity, loss, trauma.  Something we need to work through, and something which we may need help to overcome.  Avoidance and distraction and these safety rituals only ever help momentarily, and they can become a bigger problem in themselves if they begin to take over.  If this is you – talk to someone. A friend, your GP, contact an organisation who may be able to help you free yourself from its grip.

OCD UK http://www.ocduk.org/

Anxiety UK https://www.anxietyuk.org.uk/

https://www.nhs.uk/conditions/obsessive-compulsive-disorder-ocd/

Lets talk about resilience

A weightlifter holds a heavy bar laden with weights above his head.
Image by flickr user Yasunobu HIRUOKA CC License

To some people resilience seems to be a dirty word. I get it, and I don’t get it.

What is resilience? To me – it’s like an immune system for the mind.

We all have an immune system that helps us fight off illness, disease, infection. When we get ill it is our immune system – sometimes in conjunction with medication, surgery, physiotherapy, other medical intervention – that will help us to recover. Some of us have superhuman immune systems and never seem to get sick. Some of are less fortunate for whatever reason and are prone to pick up colds, or stomach bugs. Some of us have weakened immune systems due to other conditions we live with, or have experienced in the past.

There are things we can do to strengthen, or help our immune system, and things that we sometimes might do that are not so helpful.

If we get a cold or flu, friends will often suggest remedies, or preventive measures.

“I like whisky and lemon with a paracetamol”
“You should gargle with aspirin and eat a slice of dry toast”
“I take [ecinacea / vitamin c / zinc / oil of oregano / etc…] and I hardly ever get colds”
“I find that first defence / Neti pot stops it in its tracks”

They aren’t trying to rub their relative healthiness in your face like a snotty tissue, they are trying to be helpful.  They’ve had colds, and they know they are rubbish, and that if we could, we would all like to avoid them. They’re offering both something which they think will make you feel better in the short term, reduce the length of your suffering, and their ideas for what might help avoid the situation in the future.

On the other hand, we know that no amount of vitamin C is likely to help if we come down with Pneumonia or Tuberculosis.

For me – the concept of resilience is really helpful. It tells me that I can have some power back. That I am not completely at the mercy of medications and waiting lists and availability of services all of the time. That sometimes, I might be successful in fending off a deterioration in my mental state by looking at what’s going on in my life, making changes if I can, or drawing on other resources.

I have had periods of my life which have been utterly blighted by mental ill health. Suicidal depressions. Life monopolising anxieties. Irrational and irresponsible highs that led to debt, ill health and destroyed relationships. I do not want to go back there if I can help it. I will take any help I can get – be it medication, therapy, or advice on what I can do myself to lessen the likelihood of that occurring. And because I have difficulty with medication (side effects), and because therapy is not always easy to come by – I think the latter is even more important.

It doesn’t always work. That word “Sometimes” is important to remember. Sometimes we spiral too quickly – there is no gradual decline that allows for spotting the warning signs and taking steps to try and prevent things getting worse. Sometimes we are running on empty and just haven’t got it in us.

When I am particularly unwell – with no energy, no motivation, no hope – everything feels so much more difficult. Weights are heavier, shadows darker, my skin is more sensitive, moving is exhausting. Even dragging myself out of bed to stare at the television is too much effort sometimes. So in those moments – thinking to myself that going for a walk, getting a shower and some make up on, eating some fruit, even meditating for 5 minutes, feels as pointless and intimidating as thinking I might climb mount Everest, run a marathon or win Strictly Come Dancing.

So I guess I understand why some people bristle – if resilience and self help is waved in their face at the wrong moment – too soon – in their recovery. It feels impossible and insensitive.

But on the other hand it is hope. It is saying – once you feel a little bit better, if we start doing a little bit of this, then hopefully it will help you to feel a little bit better still, and then even better, etc etc.

And if I can catch on to that hope, then I might think – “Ok. I can’t go for a walk, but I can look out of the window. I can stand on the doorstep for a moment and get some fresh air. I can’t face getting properly dressed, but I will wash my face. Or brush my hair. I will have a glass of water or juice. I will close my eyes and focus on my breathing for a minute.” Any one of these things. And maybe tomorrow I will do two of them.

And the better I am – the more I will try to build this into my life, in the hope – that when life throws some difficult stuff at me again – it doesn’t knock me completely over. Or if it does, that I am able to get back up more quickly, and get back to living my life the way I want to live it rather than being in the grip of my illness.

I get that some people think that a focus on resilience is like blaming us for our illness. If there are people out there who think like that – (and I don’t doubt it, the Human capability for cruelty and heartlessness is matched only by our capacity for good and compassion.) then they are stupid and in need of some education. Just as with physical illness – the reasons that some of us develop mental health difficulties are manifold. The factors that influence our likelihood to become unwell complex and intertwining.

  • What is going on in our lives at the present moment?
  • What is going on in the world around us – environment – society?
  • What has happened to us in the past?
  • What has happened to our parents?
  • What have we been taught to believe about these things?
  • Biology / Psychology / Personality

Even this is a simplification of the varying factors which may increase our risk, or protect us from developing issues.  There may be things we can learn to help offset, or deal with some of these things – but there is nothing that is guaranteed to work in every circumstance, and it is always a work in progress which can be sabotaged by events, physical illness, or other people’s thoughtlessness.

Similarly sometimes people say that emphasis on resilience takes the onus off health services, or employers, to fulfil their part of the bargain. If resilience training is all that is offered, then that is shoddy. That is not to say that it is not worth doing in those cases. After all, if your employer is taking such a minimal approach to wellbeing then you may need all the help you can get. However – resilience based approaches, mindfulness, stress management etc. should be offered as part of a wider, organisation based approach. Mental Health Promotion, Mental Health Awareness, Mental Health First Aid training, Mental Health Champions. Stress Audits and Risk Assessments with proper strategies on reducing stress across the organisation. Business planning which considers and does not place undue stress on employees either through workload, lack of resources, business practices or workplace culture.

Ditto – we need decent and comprehensive mental health services across the country. Sufficient beds and therapists and specialist services. They need to be adequately resourced, more people trained and recruited. They also need to be more flexible and person centred, and to listen to and engage the user base to ensure that they properly understand people and the barriers we face to recovery. We need those services to be there even more so when we think about resilience, because sometimes what we need to do to prevent our situation from worsening is to seek professional help. Recognising our boundaries, recognising when things have got too bad for us to continue trying to manage on our own – or with our friends’ and family support, no matter how well meaning. We need to know that actually – this is beyond our ability at this moment, and we need someone else to help us for a while.

The more we raise awareness and help people understand the signs and symptoms of mental ill health for what they are, the more there will be a draw on those services. So I think it is vital to also raise awareness that there are things that we can do which sometimes help us to stay well, or recover more quickly. Both to reduce that draw on services, but also to prevent people suffering any longer than they have to.

I’ve had a really painful arm for over a year. I pulled it carrying heavy bags or something. Finally I went to the GP who diagnosed tendonitis and referred me to physio. The physiotherapist explained the need to massage and stretch and exercise the damaged tissue. Things I had been avoiding because they hurt. I have had to go away and do those exercises myself. And it is getting better. If I had known what might help a year ago, I could have started recovering earlier – rather than avoiding activities which I thought would aggravate it, which instead compounded the problem. I am as much a part of my recovery as the physio, as the GP. I don’t mind that. If it were worse, I’d need a surgeon. And I’d need support until I was strong enough to start my physio. I wouldn’t want them to push me too hard too quickly – but I would also take heart from their belief that I have it in me to progress my recovery. It might mean they can see glimmers of something in me that I can’t yet see myself.

Mental Health First Aid – New Date

Book now to join us on the Adult Mental Health First Aid Two Day course:

Hebden Bridge Town Hall
Monday 4th / Tuesday 5th June 2018 (9am-5pm)

Learn to understand the relationship between stress and mental ill health, spot signs and symptoms of some mental health conditions, and how the Mental Health First Aid Action Plan can be used to help offer support to people experiencing a range of different forms of emotional distress.

Hebden Bridge is easy to reach from across the North – being near the West Yorkshire / Lancashire border, with excellent transport links to Halifax, Bradford, Leeds, York, Manchester, Burnley, Rochdale and more.

Read more about the course here: https://slongmhfa.wordpress.com/course-costs/mhfa-2-day/

Book with Eventbrite here: https://www.eventbrite.co.uk/e/mental-health-first-aid-hebden-bridge-adult-2-day-course-tickets-43162860277

Contact me to enquire about discounted rates, or in house training for you organisation.

MHFA

Recovery

When I deliver training – be it Mental Health awareness, or Mental Health First Aid courses, I bring my own experiences into the classroom. I don’t have to. The course content is fairly comprehensive – but it is the aspect most frequently mentioned in positive feedback. I think it is important for two reasons – firstly to put a human face, a context on what we are talking about, make it real, for those trainees who have no previous exposure to mental ill health – but also to help create a safe space for people if they do have relevant comments they wish to share.

Over the past month, I have reflected on my recovery. Where I was once, where I am now. What got me here. I am not “recovered”. I don’t know if I will ever think of myself as that. It feels more like an alcoholic’s recovery – a process – being “in recovery”.

At one point, I was just about holding on to my job. I was lucky to be in a public sector role which was not as strict on sickness absence as some places (though it later became more so). 22 days off in a year – not long term, lots of short term absences.  I was also late a lot. And I mean a lot.  I suffered severe depression and anxiety issues – I couldn’t get to sleep at night, and/or couldn’t wake up in the morning. I found it hard to concentrate, to hold my tongue and not snap at managers or colleagues about the injustices or petty behaviours I encountered. I cried in the toilet nearly every day. I self harmed, and made myself sick fairly frequently.  I was tired beyond belief, and suffering with aches and pains. I was prone to picking up every bug that was going, so suppressed was my immune system.  My long term relationship had fallen apart, I was in tens of thousands of pounds of debt, renting, hating my job. I drank too much – self medicating? Maybe – distraction, pleasure seeking. I occasionally veered into hypomania, losing my inhibitions and common sense for periods of more spending, drinking, risk taking behaviours.

That’s not my lowest point. There had been other previous bouts, some suicidal – but this is the one from which I track my recovery.

Where am I now?

Before I left my job – my sick leave was down to 6 or 7 days in a year. Which had been mostly flu related. Now – I am self employed, working sporadically in terms of payment, but putting in plenty of hours behind the scenes. I am doing something I really believe in. My fingers are firmly crossed that it works out – but so far so good. And I am happy that my mental state is thus far allowing me to make a go of it. It is a virtuous circle. I am doing work that uplifts me – it feels worthwhile, important. People thank me and say it makes a difference to them. This in turn boosts my wellbeing. Hopefully I can hold on to that effect.

My old job did not have such a positive effect. Not so much the work – I loved some of the work, and my colleagues. But the culture and constant restructurings, the lack of resources and respect. It ate away at me. I had good terms and conditions and felt partly trapped by them (because of my debt) and partly like I was selling out my principles for material gain. The stress levels were awful sometimes – and the conflict around me as others struggled with their own stresses was uncomfortable for me to deal with.

My mental health is not 100% marvellous. I am having a good patch. Last year was less good. In between taking redundancy and starting to really work at getting my training business going – I had surgery and an injury, and spiralled into quite severe health anxiety, with panic attacks, paranoia, obsession and depression. I was prescribed new anti depressants I was too scared to take, saw a counsellor for guided self help up until just before Christmas. I gradually improved.  I still have my moments, but I am doing well for now. (I won’t talk about physical health. I am a wreck in that department but what do I expect, I turned 40 a year and a half ago – all downhill now right? And I still drink too much.)

What has helped me to get here?

When I was in my job that I hated, I tried to find things to make me hate it less. I got involved in other things to keep me interested. I volunteered. I took part. I joined the Disabled Staff Network and ended up running it for 10 years. I attended health and wellbeing events, took up opportunities for training courses. That’s when I first encountered Mental Health First Aid – and then became a trainer. I ran mental health awareness events, time to talk sessions. I found a passion.

As it happened, I also got promoted. Different work, different responsibilities, in fact much more work and responsibility. But the stress didn’t get more – it changed. And became more bearable for me. Perhaps because I felt more in control. I had more agency to shape how things were done. So felt less powerless and disgruntled. Not completely because I was still under ninety other layers of management, but it helped.

Eventually I also reconnected with my profession for a while – pursued my Chartership – got interested again, did some reading, training, followed stuff on twitter. More things to think about, be interested in – to distract myself from the mess in my head. Something to feel proud of.

I moved house. I had to – because my ex and I had to sell the house we had bought together. But I had a choice about where I went. I decided to make a massive leap and move to Hebden Bridge. Beautiful countryside. A community I hoped I could be a part of rather than the anonymity and clash of ideologies I had experienced in Leeds.

In work, as part of my work with Disability – I came to understand what a reasonable adjustment is. And that Occupational Health can be your friend.  Over time my management and I agreed adjustments which helped me.

  1. Work from home 1 day a week regularly where possible
  2. Extended flexitime where needed
  3. Work from home on emergency basis if couldn’t get in early enough, or if my state of mind was not good enough to deal with commute or face to face

Working from home regularly gave me a day’s decompression, a bit of space, somewhere I could concentrate. To begin with this was unusual, but by the time I left, nearly everyone did this anyway – seeing the benefits of being away from the distractions of the office. [Reductions in office space meant that this was also being seen as a necessity, with desk ratios of 8:10 or less, you had to arrange for someone to be out of the office].

We had flexitime, but some areas were funny about you using it. Also we were meant to be in by 10am. Ok normally, but when I am ill, I had what I call “bad nights”. Late night panic / anxiety / crying fits – not being able to sleep, lying awake in despair. The later it got the more I would worry about the morning and not being able to get up, being late for work. Because of bus and train connections – I either had to be up at 7 to get there for half 9, or I would be after 10, often closer to 11.

Agreeing that if it happened, it happened, and I should get in if I could – and that so long as I worked my hours it wouldn’t count against me, meant that when those worries started, I could break the spiral. I might feel dreadful, but I didn’t have to worry about the morning. Over time, this actually defused many of those bad nights, and meant I didn’t need to use the flexibility anyway.

If I had felt I could not get in before 11, I would often think there was no point, and have to take leave, or a sick day. Ditto when I had “bad mornings” – when sleep was like treacle and I couldn’t wake, or when I opened my eyes to feel like the world had collapsed, in abject misery – often I would actually be ok by late morning, but it was too late, I had to phone in sick.  “Emergency” working from home days meant that I could contribute more, either full or half days. In the former case I could be online and working by 8 or 9 even if in my pyjamas for the first hour. In the latter, I would work when I felt fit, and continue either for my full hours, or less if I felt I needed it. I would then log as flexitime and make up on a better day.

Overall, I probably worked more when able to work from home than I ever had when expected to be in the office regardless every day.

Removing the fear of being disciplined, or losing my job – (for the most part) – meant my anxieties had less to feed on.

I tried various medications. citilopram, fluoxitine (didn’t work for me, made me vomit) – venlafaxine (ever increasing dose, made me sleep for hours and hours and hours). They weren’t compatible with full time working.

I sought counselling from the NHS. I did a group stress course, CBT, guided self help. I learnt from these things. Waiting times meant I was seldom getting the therapy when I really wanted it, (i.e. when I had been referred). I didn’t get the kind of therapy I thought I wanted, or needed – but I can’t say that what I did get wasn’t helpful in the long run. Once I opened my mind to it and gave it a try, it’s given me useful additions to my toolkit I suppose.

I got married – which was lovely in itself, but also gave me a focus and structure, and led to the development of new interests and hobbies as I DIY’ed a lot of the decor etc. I connected with friends and family for at least that brief period (though that held stresses of its own.)

I learnt a few really useful principles from Mental Health First Aid – which I really credit with helping me stabilise things.

  • Understanding stress. Looking at my life and evaluating the balance between stress, and what I am or am not doing to offset it. Thinking about whether I can amend or influence any of the stressors.
  • Self care, and self help. The importance of the first, and the fact that the second can work sometimes. I had always pooh-poohed self help books, and all that stuff in the “Mind/body/spirit” sections. But I found that reading about depression, anxiety and other things helped me understand it more, and feel I had more power over it. Different ideas and techniques – I’m willing to read, to try. I caveat that I wouldn’t usually spend (any/too much) money on something unless I was convinced about it helping me – but if it’s free, or cheap in a charity shop or sale – it’s not a lot to lose.
  • 5 Ways to Wellbeing / 10 Keys for happier living – another thing that is good to check in with when I am feeling rubbish. I think – how does my life measure up against these things. Are there areas where I could try something else which might start to help? Again – worth a try.

Small steps. I am still working on it. I am “lucky” in that when I am bad, it interferes more with my nights, my home life, than it does work. I have periods of functioning very well externally. I throw myself into work to distract from my pain.

At the moment I am trying to shape my life to be something which promotes good mental and physical wellbeing. I am starting to understand myself, what I need.  Retrospectively, I might had advised myself to pack in my job earlier, go bankrupt – make the change. The benefits feel worth it, and I find I need a lot less money than I thought I did. But I can’t know it would have all worked out. I can’t regret all of my experiences at my previous employer. They may have taken a lot out of me, but they did give me skills, knowledge, memories and friends that I wouldn’t be without.

My motto is to keep trying. Keep learning. The more I understand about myself, why I am how I am, what provokes negative responses – the more I can play my system. Monitor my mood, adjust, seek help early when it gets out of hand.

I know not everyone finds this approach to be useful or effective for them. That not everyone has supportive employers or works in a role that can be adjusted helpfully. That it’s not always possible to do things even if you want to. We need services to be more available and accessible and effective so that people can be supported in whichever way they need. And can try a range of different medical or therapeutic interventions to see which is most helpful to them.

But I do think it’s important to know that even when medicine or therapy isn’t working or available – sometimes other things can help. Even if only a little. Lessening a depression from a 9/10 to a 7/10 is still worth doing, and can make life more bearable.

Mental Health and Violence

Today again the headlines are full of mourning for the victims of another school shooting in the USA. Questions are being asked about how to stop such horrors. From across the ocean in the UK, where guns are strictly regulated and not widely available – the US obsession with firearms despite the terrible price, is quite baffling to many.

Whenever there is a mass shooting, there is a holding of breath, and some people argue the way the media will respond is predicated on the colour of the perpetrator skin. If the shooter has an Islamic name, darker skin, the response will be one way, calls for tighter immigration rules and Islamophobic rhetoric perhaps. If white, the response will suddenly be to shouting about mental health, and lone wolves. People use these tragedies for their own agendas.

But the issue of Mental Health and violence is an important one to think about. There are, sadly, a great many people out there who think that people with mental health issues are dangerous. More likely to be violent, commit murder even. Given the way mental health is often handled in the media, in TV programmes, in Film, it’s hardly surprising. Psychosis, Schizophrenia, have been used as a lazy shorthand in horror movies for decades. And for some people, when they hear the words “mental health” – their minds instantly jump to the most severe diagnoses. Of which they have little understanding.

What is the truth? What is the relation between mental health and risk of committing a violent act? This report goes some way to exploring the issues in the UK – the US of course has its own landscape made of a different healthcare system and readily available guns…

It’s a complicated issue. Because people with mental health issues are people. And people are complicated. Do people without mental health issues commit violent acts? Murder? It’s an interesting question as to whether it can ever be “sane” to punch someone in the face, to stab someone, to shoot someone – whatever the motivation. As a non-violent person myself, who rarely even gets angry – it seems alien.

Is it ever sane or rational to put on a suicide vest and blow yourself up, taking others with you (willingly, I mean – I can understand how the vulnerable may find themselves coerced through threat and/or promises of reward for their families). Or to do the coercing, the radicalising, the recruiting? Is that sanity? We have a spectrum in society of what we say is acceptable, or tolerable in our society. There are many ways in which things like aggression, or sexualised behaviour can spill over in ways we deem unacceptable – as is being evidenced by the wave of sexual harassment – abuse scandals. Some people think it’s ok to get into fights. Ok to kill for this cause, not for that. Where is the line that we say certain behaviour is alright and a step beyond is a sign of mental illness?

The vast majority of people with mental health issues, even severe diagnoses, are never a risk to other people. If anything – people are more likely to hurt themselves, and sadly also at great risk of being victims of violence from others.

That is not to say it never happens. People with mental health issues do sometimes get involved in violence, or kill people, In cases like the shootings in America – people may leap on a history of one thing or another. The perpetrator of the most recent shooting was described as “depressed and a little quirky”. Is that why he did it? Depression doesn’t make a person violent. It’s not surprising that he was depressed given his situation – having lost his adoptive parents relatively recently.

Do we ask other questions about people like this? What has their life been like? What influences are around them, what media have they been consuming to shape their attitudes and behaviours? What pushes them from angry young man to murder, or bomber, or terrorist? Have these influencing factors led to the development of violent thoughts, as well as increasing the risk of concurrent mental health issues. i.e. the former are not caused by the latter, rather both are caused by the same set of precursor circumstances.

Without serious study and analysis, it’s hard to say – and sadly a lot of people are only interested in punishing or even killing criminals and terrorists, not seeking to understand why they become the way they are (in order to prevent others repeating this path).

There are some conditions, which can be related with risk, with anger management, with erratic behaviour and potential delusions, but in all cases, it is never true to say that x diagnosis = violent. People with mental ill health are no more violent than people with supposedly good mental health. Sometimes people do horrible things.

What is certain, is that accessing mental health services at the earliest possible stages, reduces the risk of a problem getting worse, and helps people to recover positive wellbeing, improve strategies for coping with difficult situations, and be able to engage in life and do the things they want to do, and be healthier and happier.

People who are happy with their lives and have the opportunities to do what they want to do in life, free from socioeconomic inequalities are less likely to carry out violent crime. This is one of many reasons we need to increase the availability of these services, make it easier to access them – and a huge part of that is working to reduce the stigma surrounding mental health that makes people not want to access them. The kind of stigma that comes from leaping on the mental health diagnosis of people who do bad things, whether or not there is any concrete evidence that there is any reason to do so.

We need people to recognise when they need help, or when their family members or friends are struggling, and be prepared to support them and love them, rather than ridicule or shame, leading to isolation and worsening of the problem.

 

 

Eating disorders – a growing concern

The news this week that there has been a dramatic rise in the number of people admitted to hospital who have a diagnosis of an eating disorder, combined with a leading ED charity reporting similarly rocketing numbers of calls to their helpline, goes to illustrate a distressing state of affairs in terms of treatment of eating disorders in the UK.

As reported in the Guardian and elsewhere, the number of admissions in the year to April 2017 was 13,885 – a figure which has been steadily increasing for many years. Figures for the under 19s were seen to double, from 1050 to 2025.

Listening to a spokesperson from BEAT Eating Disorders on the radio – we hear that the rising figures are part of a more complex picture. Not entirely about increased prevalence, as increased awareness inevitably leads to more people seeking help. But the fact we are talking about admissions is alarming – because there are also reports that a great many people are being refused referrals for treatment (hence would not be included here). Some people are sadly being turned away by doctors who suggest they are not “ill enough” if their BMI is not below a given figure.

While the physical effects of an eating disorder such as anorexia are of grave concern, and are the reason that it is suggested to have the highest mortality rate of all mental diagnoses, to suggest that someone is only ill when they reach the stage of being dangerously thin, is to misunderstand the nature of the condition. That it is a mental health issue, caused by many factors but often rooted in emotional distress, anxiety and harmful coping behaviours which mutate into something very dangerous and disruptive. The earlier someone’s troubled relationship with eating can be recognised and acknowledged, the easier it is reported to help a person to overcome these harmful behaviours through talking therapies and other support. In an ideal world this could be done before a person’s distress and condition deteriorates to the point now being considered as a threshold for treatment.

If this chart of the South London and Maudsley’s Eating Disorder Clinic Guidelines is anything to go by – Hospital Admission comes only with a BMI of 13.5 and below – where a person’s organs are in danger of failure. Is this the stage being reached by the 13,885 people logged above? Comments on the failure of some GPs to help people seemed to suggest that this also meant that they were not being referred for counselling at the earlier stages as recommended by this chart. And if people are not able to access such help at the earlier stage, it is no surprise that they end up needing hospitalisation further down the line.

Of course behind all of this, and potentially the reason for GPs’ reticence to refer, is the lack of available services, waiting lists for mental health services generally, but also quite specifically the postcode lottery relating to specialist inpatient or outpatient services for eating disorders. There are many deeply distressing stories of people having to travel hundreds of miles to visit their family member – who is often a child or young person. This difficulty can cause significant problems in itself – where to be involved in supporting a child through recovery a parent is unable to work, or where travel costs become simply unaffordable.

As ever, spotting the signs and symptoms of emotional distress at an early stage increases the chance of a good recovery – anxiety or depression may be evident before the eating disorder takes hold. Eating distress can take many forms – and does not always involve someone becoming very thin. Wherever a person’s behaviour becomes obsessive and their relationship with food causes them distress, or interferes with their ability to carry out normal daily activities, or social interactions (such as going for a meal with friends) – it could be problematic in the long run.

More about specific eating disorders can be found on the BEAT website – if you are concerned about a family member or friend, do take a look or call their helpline on 0808 8010677

The Mental Health First Aid two day course helps people to recognise and offer support to people experiencing a variety of mental health issues, including a short section looking at eating disorders.