To say it’s The Sun, it’s not very bright.

Corona of the Sun during a Solar Eclipse

Of course it can’t be merely coincidental. That only a week or two after the Almighty twitter storm that brewed up over Asda, tesco and amazon stocking Halloween costumes with insensitive, stigmatising names, The Sun decides to run a front page proclaiming “1200 killed by mental patients“. Ok. Maybe it’s progress. A few years ago it might have been “killed by nutters” or “psychos / schizos”. However I don’t think they’ve got the point of the campaigns to combat stigma around mental ill health.

What is the purpose of that headline? They misrepresent figures, omit to mention that homicide by people with mental health problems is lower than it has been in 7 years. What’s a mental patient? Are they seeking to make the public afraid of all those ordinary joes who tweeted their pictures as part of the excellent Mind response to the Halloween costume fiasco? Are they going to give us any more detail about the tragic circumstances around those deaths?

No one is saying that it never happens. It is a sad fact that sometimes it does. But unless I’m missing something – it is not only “mental patients” who kill people. Even if we take The Sun’s figures – 1200 in ten years. (Which maybe we shouldn’t) With a total number of homicides around 8089 for that period, you’d think it slightly more of a worthy story to say “6800 killed by people supposedly in their right minds”.

Who should you be more afraid of? You’re more likely to be killed by a drunk than someone with a mental health problem. And the stigma and fear that stories like this cause is one of the reasons that a “mental patient” is more likely to be a victim of violence than the cause of it. It’s also a major reason why people refuse to accept they are Ill, don’t seek help- and so if untreated their condition may worsen and the potential for a dangerous situation arising increases.

So again, I ask. What is that headline for? What is The Sun for? By alarming people, increasing stigma, they increase the risk they are bewailing. They hurt real people with complex problems that are more individual and difficult to deal with that can be expressed in the handy “mental patient” epithet.

The influence of our media is truly toxic these days. Has been for many many years. It is bad for our society and most certainly bad for our mental health and Wellbeing.

Roly poly roller coaster of doom

Fahrenheit Rollercoaster HersheyPark

Aye sheesh kebabs. It’s been a funny couple of weeks. Month. I have being honing my mood swing skills something chronic. Funny how the slightest thing sends me spinning into a spiral of despair. Take my last post for example. You may notice it’s been a while. And to be honest. I’m not that happy with it. But unfortunately my ipad didn’t want you to read the really, really good and pertinant version which I wrote on the train last week. Because it ate it. Just as I was posting it. Suddenly half of it was gone and I was left watching the memory of those clever words and phrases disappearing off into my mental distance.  I swore. A lot. And got very cross.

I don’t get cross much when I’m well. I’m a very mild mannered creature. Too mild mannered, it has been said. But when my mood slips I get very impatient and crotchety with everyone including myself.

However – it wasn’t really the losing of work or temper that was problematic here. It was that something hadn’t gone as I had expected it to. My plan was ruined. (Not that I’d strictly speaking made a plan to write and post the blog and be happy with it – but once I pressed “Publish” that was clearly what I expected it to do.)  If there is one thing which I have come to realise can pre-empt an almighty push on the Sarah Mood swing-o-meter, it’s a plan gone awry.  Silly little things. My husband announcing he’s getting the 10.20 bus when i thought we were going out at noon. Totally stupid and irrelevant. But the lack of an ordered, reliable, predictable plan makes me deeply uneasy. So I got off the train in an almighty huff – furious at Northern Rail, Apple, 3G, the Gods and the universe for their conspiracy against me. But no problem. It was a friday – usual plan, go for a drink in town, come up with an idea for food, either at home or out, and ease out the troubles of the week.  Except for whatever reason, we can’t agree on a plan. We drink more than I want to, I feel stupid for not being able to make a decision, I get upset, I feel stupid and guilty for getting upset over a stupid thing, and suddenly I am thinking of all the stupid things I have ever done and I’m hating myself and thinking my husband must hate this and he will leave me or something horrible will happen and everything will fall appart and it will all be my stupid fault and oh god why don’t I just die.  Or something like that. Ridiculous.  I know it is these days. I can see it for what it is. My illness going into overdrive at the slightest derailing trigger.  So I try to plan.

It’s always a sign I’m going into a bit of a manic phase, or a really wild up and downy phase. When I start planning. calendars of what we will do, or eat, on different nights of the week or month. Who will do what tidying. When will I write or work on some project or other.  I never stick to them. I usually meltdown shortly after. But I think it is my subconscious telling me – you really need structure. Structure, routine will keep you sane.  Unfortunately it doesn’t send a care package of fortitude or willpower with this insight and so I never manage to hold to my elaborate and beautifully drawn out plans.  Planning my wedding for the last two years I think kept me pretty well. I was able to be single minded about that. Had a goal which had to be acheived. Now that time has passed – I lack focus again, and the roller coaster returns.  My challenge is to try and find a new goal I can believe in and use it like a trellis to prop me up.

A rose by any other name – Diagnoses and Labels

During the last couple of Mental Health First Aid Courses I have done, the subject of diagnoses and labels has come up several times in one way or another. Different angles on the same topic perhaps:

– Do we clinicise what used to be normal human emotions?
– Do people cling to / identify with a diagnosis or label and can this hinder their recovery, or make them think things are worse than they really are?

There’s something about some of this type of comment that speaks to me of mistrust. Either of the psychiatric / mental health profession, or of people with these diagnoses, or of the pharmaceutical industry perhaps. Not of all of which mistrust might be unfair or misguided.

Are we clinicising normal human emotions? Are we saying that people have a disorder that can or should be treated, when once they would have been acknowledged with a shrug – as part of the normal range of human experience. On the one hand, I don’t like the way this sounds a bit like “we didn’t get depressed in my day”. On the other – it seems obvious. Our understanding of what the full, natural range of human emotion is – why it is the way it is, what influences it – is evolving all the time. There are clearly things which once were perhaps as being unalterable – which we now understand more and have the option of seeking to resolve. You don’t see many people dismissing arthritis and refusing pain medication, saying “in my day you just accepted the aches and pains of old age”. The key to whether this is a good or a bad thing is perhaps in the word “range” – in the phrase “range of human emotions”.

MHFA (and I) explores the concept of the mental health continuum. All things in life are experienced by degrees. Stress, anxiety, sadness – there is a point at which these are normal, necessary responses to life, with positive impacts on our survival. However, if they worsen, and begin to impact on our ability to carry out the necessary tasks which keep us alive and operating in society – then they become problematic, unpleasant, and it is not unreasonable for someone to wish to find a way to alleviate those symptoms and be able to live a normal and happy life again.

What is crucial – is that it is the person experiencing the symptoms who expresses when they have reached that level of unacceptability and also that they are involved in choosing how they wish to alleviate them. It should not be for the doctors alone, or the influence of the pharmaceutical industry to say – you experience symptom x, therefore you have y, which is treated by product z. It’s fine to know that product Z may be useful – but perhaps the patient doesn’t find symptom x so bad yet, or finds some other course of action helps them instead.

Do people cling to labels? Maybe. Diagnoses can be hard to come by. If you have struggled with difficult emotions or symptoms for years and been ignored, ridiculed, felt shame or self doubt over your stupid inability to just be like everyone else – then having a “professional”, and “expert” agree with you – and say, yes, there is something going on with you, you have depression, or anxiety, or whatever, and I’ll agree that your symptoms must be causing you tremendous difficulty. That can be such a massive relief. A vindication. And if it is also the only way you can access treatment, or adjustments in the workplace, or even just respect from others who’ve previously dismissed you as faking it – then you might cling to that diagnosis.

Diagnoses on the other hand can be millstones around our necks. Especially if they prove not to be the right ones. Once a label of depression or anxiety has been attached, prescriptions prescribed, it is incredibly difficult sometimes to go back to the doctor and say – hang on. This isn’t quite working. Either – the medication isn’t working, or there are other symptoms which are not being addressed. It seems almost impossible to get a referral to someone who has the time and inclination and specialism to go through everything that is going on with you and come up with an accurate diagnosis. It’s not easy – so many conditions have overlapping symptoms. Without living with a person all day every day it is difficult to know what they are like. A doctor has only the time you are with them and what you say to judge by. And that relies on you being well enough to go, to speak, having insight into your condition, having the strength to talk about it – and overcome the inclination that your depression will give you to not want to bother other people with it. It’s nothing. I’m overreacting, I’m not worth worrying about…  If you are concerned that what is going on with you, or your loved one, is more than “simple” depression or anxiety (not that I really think there is any such thing.) – it is hard work to get the right attention if you have a reluctant (or overworked) doctor. And also to get them to recognise that not everything that goes wrong with you is to do with your depression. Granted, some things may be connected. Stress and tension may well cause back ache and headache and stomach upset – but a diagnosis of a mental health condition does not make us suddenly immune to slipped disks, brain tumours or ulcers – so it is important our doctors make as much effort to rule these possible causes out as they would with a person with good mental health.

So a label can be a good, or a bad thing. Sometimes it can be very bad. If I take my diagnosis, go away and read up on it, try various treatments / therapies / self help methods – to better understand what’s going on in my head and why – to recognise my triggers and lessen my symptoms – then my diagnosis has been valuable to me. However, if I wear it like a badge, and an excuse. I am a depressive – I always have been, always will be… I have OCD, I have a phobia… Like having it means I can give up on trying to live a normal life. That’s bad. Presumably we seek help because it has become a problem for us. Just knowing its name doesn’t make it less of a problem, and we should use the power that naming and understanding a condition gives us to help lessen its interference in our lives.

To me – my diagnosis (which I don’t think is completely accurate, but I have an inkling what might be) – is a name for a bunch of symptoms that piss me off. If I can address and challenge, and conquer each of those symptoms separately – learn techniques to keep them under control – I won’t have cured myself of depression, but I will have drained it of its power over me. However I will also know that if I stop using those techniques, the depression will most probably creep back. That is what my diagnosis means to me I suppose. Always having to look over my shoulder no matter how well I feel, because as soon as I let my guard down it will come back. And I’m not very good at keeping it up.

Death and Statistics

They’re quite effective, I think – those “kill your speed, not a child”, or “don’t drink and drive” adverts we see on our televisions each year. Especially around Christmas, when there is a little too much festive spirit in our veins, and a stark reminder of how suddenly our loved ones can be snatched from us might make some otherwise thoughtless people leave the car at home.

No doubt, it is a horrible thing. And if we can prevent it we should try everything we can to do so. Perhaps it is a sign of success that the number of fatalities from road traffic accidents was at an all time low of 1,901 in 2011.

On the other hand, 2011 saw an increase of adult suicide rates, leading to 6,045 people completing suicide that year.

6045.  That’s over three times the number of deaths on the roads. And yet – where is the hard hitting television campaign to try and reduce these deaths?  Where is the imagery of the person alone and depressed at Christmas – reminding people to reach out to friends, families, neighbours in the holidays and see how they are? Where is the advertising reminding people that alcohol and drugs can worsen depressive states and increase risk of suicide?  People sharing stories of hope, pointing people to sources of help, encouraging people to talk.  Why is it the work of charities such as the Samaritans to offer help? Why not a national public health campaign?

Good work is being done on raising mental health awareness, and trying to get people asking for help, and talking about mental health in general. But the hardest fact of all is seldom stressed. Mental Health problems can sometimes, if untreated, or unrecognised, be fatal illnesses. People can lose hope and take their own lives, leading to an ever increasing circle of impact and increasing risk. Maybe we can’t prevent every one of those tragedies, but help is available. Things can, and do, improve. And the more we can do to help people to remember that in their darkest hours – the better.

If you are having thoughts of suicide, please talk to someone. A friend, family member, your GP – or contact the Samaritans on 08457 90 90 90 (UK) / 1850 60 90 90 (ROI) – or email jo@samaritans.org

Holistic Health

MHFA recognises there are many different ways to improve our emotional wellbeing. Sometimes that might mean medication, sometimes talking therapies – but there are also a wide range of alternative therapies, and strategies for improving our coping skills which may be of use in our recovery journeys.

Some of them may have great bodies of evidence for or against their efficacy. There are huge debates around whether certain non- “conventional” medicines / therapies are any use, or whether it’s all just a placebo effect. Indeed there have been studies that say placebos can work even if we know they are placebos. The brain, as we know, is a funny, and powerful thing.

I’ve written something over on The Willow Twisted (where I put my personal witterings, poetry, etc.) about my own experiments with Binaural beats.  The “scientific” explanation for why these are supposed to work is dismissed by many as rubbish. I don’t know enough about neurology to say either way. But so far, it’s having a great effect on me. Whether for the reasons suggested or not. So does it matter?

It’s important that we make informed choices, whether with conventional or alternative therapies. We need to know about possible side-effects, or drug interactions, and if possible long term outcomes and / or health effects – before we can say, ok. I’ll give it a go and I’m prepared to take any risk involved.  We need to to be lied to, by snake oil salesmen or Big Pharma. We need to do our own research, or if we are unable, be able to trust our medical professionals to give us unbiased and accurate information.

I twitch a little when supposed miracle cures cost a fortune. If I hadn’t have been able to find free downloads – I might not have tried Binaural Beats. But that doesn’t mean to say that if it carries on working I might not be prepared to pay to explore what else it might help me with. I wouldn’t expect to go to a practitioner of some therapy for free- they’re giving me their time and need to make a living. But I would hope not to be ripped off. And the measure of that for me is whether it works. If it doesn’t work, I might give it a month, then pack it in as a bad job. If it does work – I have to decide whether the benefit to me is worth the ongoing cost.  Just as with anything we pay for. I’ve been having my nails done for the past few months. Is having pretty nails, and the nice feeling I get from looking at them, and the hour or so of setting the world to rights when they are being done – worth what I pay? Are the “side effects” – being over cautious with them, not being able to do certain crafty, manual things with ease, not going with all my clothes 😉 – something I can handle? My credit cards – is the convenience and extra spending power worth the interest / debt?

I keep looking and reading into different therapies. There’s always a worry that there’s a health risk I don’t know about. But for now, I’m happy to take the risks I know about (and the uncertainty) – for the benefit I am receiving. Regardless of whether there’s a scientific reason why it should or shouldn’t work.

After all, Prozac / Fluoxitine has a big body of evidence saying why it should be effective, but for me it did nothing more than make me vomit and bruise easily. Venlafaxine worked but turned me into a zombie. A cost I eventually could not afford.

How about you? What techniques / therapies / supplements do you find improve your mental health / emotional wellbeing? I’d love to hear.

Help for Line Managers

MHFA England have released an updated version of the Line Manager’s resource, originally developed by Shift – the Department of Health‘s campaign against stigma and discrimination relating to mental ill health.

This is a great resource and one I would recommend for everyone to have a read of – especially if you manage staff, or hope to in the future. It covers useful things like having conversations with people who are distressed, the impact of stress, your responsibilities under employment law. If you have mental health issues yourself, why not pass this to your own manager – they might find it useful, and you may benefit from their increased awareness.

http://www.mhfaenglandforum.org/download/MHFA%20Line%20Managers%20Resource.pdf

 

Calming the Nerves

It’s a shame we don’t deal with anxiety on the first day of MHFA training, because we could have just stood me at the front and said, there you go. Last Thursday, the first day of my first ever course as a (trainee) instructor. I felt so sick in the morning, after not a great deal of sleep. I couldn’t even drink the tea my mother made for me, let alone cope with breakfast. Sweaty palms, palpitations, a feeling of utter panic.

We understand anxiety at times like that. Before doing presentations, going for an interview, meeting your in-laws for the first time. Things you maybe would rather not have to do, but you can’t avoid them, and you want it to go well, you want to make a good impression. It is one of the few times I think I managed to get someone to understand the way my depression / anxiety can manifest physically, was when I said, remember how you felt before the last interview you went for. Now imagine you feel like that, or worse, all the time, and you don’t know why.

Or you know why, but you know your anxiety is out of proportion to the stimulus. You logically know the probability of the bus crashing, or you vomiting in the street is low, but you cannot overcome the fear and panic which the thought of it induces within yourself. And you beat yourself up, because you know you “should” be able to do these things just like everyone else. You assume everyone else would laugh if they knew how ridiculous you were.

Well. If only we were all as perfect as other people think we must be. Anxiety is one of the most common mental health problems, and who’s to say that a quarter of that bus load (or more) aren’t also in their own personal hell as they go to work. Maybe they’ve got a little way further in finding a way to cope. Maybe that’s why their music is so loud, or they won’t meet anyone’s eyes. Maybe that’s why that guy got off when it got too full. Maybe it’s not the bus that bothers them. Maybe it’s the tube, or taxis, or answering the phone. Anxiety is ubiquitous, problematic anxiety is common. You are not alone. And there are many ways to begin finding a way to cope and live fulfilling lives, from medication, talking therapies to self help and relaxation techniques. Don’t give up hope!

As for me, I pushed through the horrible pre-course nerves, stumbled my way through the first bit, and eventually found my rhythm, and you know what? I really enjoyed it. A day helping a group of engaged, interesting people learn about mental health and how to help someone who isn’t doing so well. Magic. Day two today, wish me luck!

Mental Health First Aid – a massively important programme

I first heard of Mental Health First Aid (MHFA) some years ago at a Mental Health and Disabilities conference in London. I picked up a flyer which showed what a particular regional organisation was doing and a little about this training they were rolling out which aimed at bringing a “first aid” approach to the helping people experiencing mental health crises.

“What a fantastic idea” I thought. As someone with, as they say, “lived experience” of mental health problems, I could think of a million scenarios where someone, a friend, a colleague, a teacher, – could have helped me if they’d have had a little knowledge, and a little courage. And countless times when people tried to help and maybe made it a little worse, or harder to deal with, because they didn’t understand what was happening with me.  I don’t blame them – at least they tried, but the potential benefit of giving “ordinary” people a little bit more knowledge about what to do in times of crisis – was instantly apparent.

Mental Health First Aid was developed in Australia and has been slowly spreading across the globe.

I attended the two day course in October, and learnt a great deal – more than I expected to. As someone with my own experiences of depression and anxiety – and many friends with an assortment of diagnoses – I have read a lot. But there is always more to learn. More importantly – I came away feeling better prepared to help others, and indeed myself, if the need were to arise again.

When my employer announced they were looking to get some people qualified to deliver the training, I leapt at the chance. And in February this year I joined a cohort of excited and committed people from many different backgrounds – all eager to begin delivering Mental Health First Aid training to the world at large.  We had a great, and quite intense time together learning about the course, about different conditions, different forms of treatment / therapy. It by no means made us mental health experts or therapists – but helped give us a grounding from which to build our knowledge.

Tomorrow, is the first day of my first course. I am nervous, but excited, and hope my trainees find the course as inspiring as I did last year, and go on to help lots of people.