What would Mary Seacole do today?

Mary Seacole Trustees Karen Bonner and Jermaine Sterling

​On International Nurses Day, I have been thinking about what nursing means in our troubled world. And how nurses through the ages and across the planet have devoted their lives to helping others.

It was lovely for the Mary Seacole Trust to be invited by one of our trustees Karen Bonner to hold a stall at St Thomas’ Hospital as part of the Guys and St Thomas’ NHS Foundation Trust’s International Nurses Day celebration. Our display was right by Mary’s beautiful statue. We sold books and badges and signed people up to our mailing list. But most of all we talked with nurses and members of the public about the legacy Mary Seacole has left us. Despite all the challenges she faced, she refused to give up on her mission to help the sick and dying, including soldiers in the Crimea fighting a world war. She knew that nursing, in the 1850s not yet a recognised, respected profession, is so much more than delivering medicine or other treatments. It is about being with people in life and also in death. It is about combining compassion with practicality. And it is about speaking up when something is wrong and fighting for the rights of those at the bottom of the pile.

Mary continues to be a role model for millions of us. As a middle-aged woman of colour, she knew discrimination and hardship. Mary’s mother was a free-woman in around 1805 when Mary was born, having previously been a slave. Mary experienced racism when she came to the UK, as well as many other challenges and setbacks. But through her courage, tenacity and entrepreneurship, she gained recognition and gratitude not just from those she nursed, but also the British government and media, and even Queen Victoria herself. And yet Mary died in penury. It is only recently that her legacy has begun to be recognised.

Some of the skills and knowledge I acquired as a nurse from 1973 – 2000 remain with me, although I would need considerable retraining if I wanted a job in nursing today. The same would apply to Mary. But the core qualities and values needed to be a nurse have not changed. The ability to listen without judging. To see the person not just their disability or disease. To stand up for those who cannot stand up for themselves. Never to give up on anyone. And to seek out and build on the shared humanity that brings us together rather than the differences that can drive us apart.

Were she alive today, on International Nurses Day 2017, I wonder what Mary Seacole would do? And as I look at her statue as she strides calmly but resolutely towards the Houses of Parliament, I can almost hear her telling me and others who have chosen to become nurses never to give up on our fellow humans. Because we are all part of one human race.

All in the Mind?

I love BBC Radio 4’s All in the Mind. It takes a compassionate, measured view of what’s new in psychiatry and neuroscience. Presenter Claudia Hammond considers research into the normal functioning of the mind and brain as well as mental disorders and brain diseases. Claudia has been quietly beavering away on All in the Mind since 2006, debunking myths about mental health and mental illnesses. She does other cool stuff on mental health too.

In 2015, I was interviewed for All in the Mind about The Recovery Letters, written by people like me who have experienced depression to help others facing something similar. This is my letter. James Withey, the inspiration behind the Recovery Letters, has been working on a book which will include the original letters plus some new ones. It comes out later this year.

Anyway, Claudia ran a positive piece about the letters. So when I was contacted a few weeks ago by All in the Mind producer Lorna Stewart about making another contribution to the programme, it was easy to say yes. This time, it was to ask for my thoughts on a series of questions from listeners about getting the best from mental health services.

I went to the studio and had what felt like a good conversation. My understanding is that there will be short inserts most weeks amongst the main items that make up the programme. It is called An Insider’s Guide to Mental Health Services. Here is a link to the first programme.

Are here are some things I thought about before I was interviewed.

  1. We are all as different on the inside as on the outside. Advice that works for one person will not work for another. To be honest, the concept of even giving advice on such a sensitive subject troubles me.
  2. On the other hand, there are things it can be useful to think about which people who are distressed or in crisis may either not know or they may forget. Plus, mental illness messes with your head. It can make you think bad things about yourself and consider doing bad things to yourself which you might later regret. It certainly did that to me when I had my last episode of depression. A kind word from someone who has been there might just be a lifesaver.
  3. Just as with physical illness, mental illness isn’t one thing. For example, a chest infection can be painful, even dangerous, but will almost certainly get better with treatment. Whereas lung cancer is likely to be more serious, and some types cannot be cured, just palliated. While no mental illness is nice, they can vary hugely in severity and impact. In our modern world we have become preoccupied with diagnoses, so I won’t start listing all the possibilities here. Suffice to say, some people will experience mental illnesses which cannot be cured. Therefore they have no choice but to find ways to live the best life possible with that particular condition and all it entails. Others may experience episodes of mental illness from which it is possible to make a full recovery. This is a great blog on the subject by Bipolar Blogger.
  4. Staying in bed all day and avoiding other people may be all you can face when you are experiencing an episode of mental illness. But in almost all cases, it is not a good idea. Humans are social and even the shyest and most traumatised among us need human contact. This is why we are encouraged to talk to someone – a GP, a trusted friend or family member, or to call a helpline. Here is a recent blog by me called What to do on a bad day.
  5. All sorts of things can go by the wayside when we are experiencing mental illness: getting enough sleep; drinking sufficient fluid; eating healthily or even at all; taking exercise; going out in the daylight; spending time in nature and/or with animals; being with those who love and care about us; personal hygiene; wearing comfortable, weather appropriate clothes; not self-medicating with alcohol, nicotine or other substances; and spending time doing meaningful things. It is important not to force yourself, but trying to reintroduce a few of these gradually will almost certainly help, even if you don’t feel like it. Just do it gently. Take baby steps. And be kind to yourself. Progress towards recovery is likely to be slow and not linear.
  6. I am sure there will be quite a lot in the programmes about medication. It is a hotly debated topic. I will just say this: the best clinicians will work with you to find the right treatment for you. It might or might not include medication. What is right for someone else may not be right for you. Also, most medications take time to start working. And sometimes the side-effects can be really tough.
  7. It is true that anyone can experience mental illness. But people who face other major challenges find it even harder to cope with and experience more lasting damage than those who do not. These include financial hardship, homelessness or insecure housing, loss of job or role, social isolation, bereavement, loneliness, abuse past or present, bullying and relationship problems can both cause and exacerbate a mental health problem. We are all born with a level of mental resilience which is then either added to or depleted depending on our childhood experiences. How we respond to later trauma is linked to these early experiences. Most therapy is about learning to understand ourselves better and to care for ourselves in a positive, kind way.
  8. Specialist mental health services are experiencing unprecedented demand. They are all making attempts to modernise and improve access to services and the appropriateness of treatment. But severe cuts have been made over the past 5 years which have reduced availability and in some cases removed very good services altogether. The government says they are reversing this. Some of us are keeping a very close eye to see whether they honour their word. But this doesn’t mean you will get poor care if you are referred to mental health services. You may have to wait a while. But you will find that most staff go out of their way to provide effective, compassionate, safe care.
  9. Your key mental health professional is your GP. Many GPs are really good at mental health. It is a significant part of their work. But they are also under huge work pressure. If yours seems to be one of the minority who are not so good, or you can’t get an appointment, you can arrange to see another doctor at the same practice or even change practices. It is a good idea to do this at a time that you are not in crisis.
  10. People who need help with mental health problems are not weak. In fact they have to be very brave to ask for help, and to do the things that are needed to recover. Doctors, nurses and therapists can help, but most of the recovery work is down to you. People who live with serious mental illnesses are heroes. They should be applauded every day for their tenacity, patience and courage.

The most important lesson I have learned, and it has taken me far too long to learn it, is that I need to listen to myself and be honest with myself about how I am feeling. At the time, it seemed that my last major episode of depression came out of the blue. With hindsight, it had been brewing for many months. How ironic that I, who was running mental health services, should have been so bad at spotting my own warning signs.

Intervening early and getting help when you need it should be standard across the UK. I make no apology for encouraging listeners to All in the Mind to ask for help if you need it, and not give up if it seems you aren’t getting it.

And if you are feeling desperate or suicidal, please talk to someone. There are various helplines listed here. The one I personally recommend is Samaritans on 116 123 or email Jo@samaritans.org. They will listen and help you make your own decisions. It may not sound like much, but it can be the greatest gift of all.

Sssshhhhh….

​My first blog for a month. A number of lovely people have been in touch to check if I am ok. They know that going quiet can be a bad sign with me.

The reasons for my recent radio silence are several. I admit that I have had one or two days of lower than optimum mood. Nothing terrible, just feeling a bit bleurgh. This came as no surprise; my mood tends to reflect the lack of daylight at the start of the year. As usual, I am perking up with the lengthening of days.

I have also been busy. Family stuff, domestic projects, volunteering and my coaching work.

As a coach, it is important that I practise what I preach, and develop non-preferred ways of thinking, doing and being. By nature I am an extraverted thinker; I tend to work things out by writing about them or talking them through. What comes naturally to an introverted thinker, ie working out ideas fully before expressing them, takes considerable concentration and effort on my part. But I can do it when I need to. And I have felt that need recently.

Something I have been pondering is the personal cost of sharing, specifically in relation to the book I have written. It is a memoir of my NHS career as a leader, including a how-not-to-do-it guide plus a bit of polemic about the future. The style is similar to many of my blogs. It is ready to be published this year. But I have been wavering. What added value might publication bring? Maybe the benefit was in the writing of it? Some may find the stories of interest and the lessons useful. But there will also be criticism and negative comments about difficult stuff from the past. Can I face this? Do I need it? I grow increasingly unsure. Thoughts on a postcard please…

I have also been thinking about the nature of mental illness, and how some of us are prone to it while others seem to have greater immunity. I tend to agree with those who say that that there are few people, if any, who, faced with enough mental trauma, would not crack under the strain. Some of us simply experience mental distress more readily than our fellow humans.

But despite all the evidence about the impact of genetics, other inherited traits, early experiences of trauma and loss, plus environmental factors, to have a tendency to experience mental illness is still seen by some as an indulgence, a weakness, even a personality flaw.

Those who, despite all that has come their way, have learned to tame their mental health, are heroes in my opinion. They should be admired for their assets, not pitied or shunned for their deficits. Many are the kind of people you would most want to be stuck on a desert island with. They are kind, resourceful and patient, and often less prone to judge others than those at whom life has thrown less excreta.

I have also been thinking how lucky I am. When I was last off sick with depression (from my old job as an NHS chief executive), I didn’t want to be alive. But I wasn’t worrying about paying the bills, losing my job or being made homeless. A few nameless folk were judgemental, but the ones who mattered most were hugely supportive. I got excellent treatment when I needed it from a wonderful psychiatrist and GP. When I was ready, I had the wherewithal to pay for psychological therapy. And as I got better, I didn’t have to waste precious emotional resources fighting a hostile benefits system. Nor did I find myself in accommodation where I felt unsafe, or removed from a caseload because I no longer met their treatment criteria. And I had no fears of deportation or having to hide from an abusive partner, people traffickers, drug dealers, pimps or lone sharks.

It is true that mental illness can happen to anyone. If we can find the strength, most of us can do something to help ourselves. But people who are lucky like me have many times more chance of a meaningful recovery and successful management of relapses than those who have been dealt a less favourable hand.

It was always so. And as austerity sinks its vicious fangs ever deeper into public services, it is those who already have the least who are most negatively affected. Instead of achieving their optimum, they are diminished and disabled, not necessarily by the condition itself, but by the need to fight battles every day, the lack of immediate and ongoing support, and by not having all the other things people like me take for granted.

And that is why I have been quiet. I have been thinking about this a lot. I am privileged in so many ways, including having a voice. And I feel I have a responsibility to make use of it.

More anon.

What to do on a bad day

If, like me, you experience depression from time to time, you will know about bad days. They come and they go. Some are worse than others. On the very bad ones, it may be impossible to speak, even move.

It is not always the case that an accumulation of bad days will build up into a severe depression. But they might.

What is unfortunately true is that, on bad days, we may do things that we later regret. We may hurt ourselves, others or both.We may damage relationships and opportunities. And we may develop destructive habits that are hard to break, especially when the next bad day comes along.

If we are lucky, the good days outnumber the bad ones. On good days, it is easy to pretend that the bad days don’t happen. Or to forget what they are like. And the reverse is true also. On a bad day,  we can believe that we will never feel calm or happy again.

Today is a good day for me. And so I am making myself think about the things I would like to remind myself of when the next bad day comes along.

DO

  • Get up. Do it slowly. But do it
  • Make the bed. It gives a sense of control. And it is nicer if you need to go back
  • Make some, albeit minimal, attempt at personal hygiene. Maybe wash your face gently in warm water with a soft flannel
  • Get dressed in comfy clothes
  • Accept that this is a bad day. Embrace it. Only do what you must.
  • If you can, use mindfulness to notice the bad feelings as they come and then go by
  • If you can, use CBT so as not to engage in the negative thoughts
  • Make a plan to do very little. And then do what is on the plan. Drink tea. Eat toast. Watch comfort TV. If you can’t bear TV, listen to the radio
  • Spend time with the cat. He knows what to do
  • Cancel things that you can cancel for the next couple of days to give yourself some breathing space. This will probably include asking for help, which can be really hard.
  • Plan to go out for a little walk – if not today, then the next day. Or the one after. You will know when.
  • Tell someone you trust how you are feeling. I know this is the hardest part. But please, do not avoid this.
  • If you haven’t been recently, make an appointment to see the doctor
  • If you are desperate, call Samaritans

DON’T

  • Don’t tell yourself you are a useless lazy good-for-nothing selfish cow for not being able to do whatever you feel you ought to be doing today
  • Do not make any important decisions (like resigning from your job)
  • Do not stop your medication
  • Do not force yourself to exercise or berate yourself for being unable to exercise
  • Do not work, read anything other than the lightest of fiction or do anything else demanding
  • Do not watch the news
  • Do not read emails
  • Do not use social media
  • Do not write lists of how useless you are
  • Do not worry about the world
  • Do not go outside in your pyjamas. Or if you do, wear a coat

This is only my list. It might help you. But, even better, you might want to write your own.

If you do so, I would love to hear whether you found it useful.

Remember this; we are not alone.

 P.S. A few hours after posting, someone v wise pointed out to me that those with caring responsibilities don’t have the luxury of “duvet days” (they didn’t call them that but I know what they meant.) So I have amended the Do list slightly. 

It is still only my list. I don’t recommend any of it really. But I do recommend that you consider writing your own.

Social media meanderings from Saltaire

Image by Dan Bailey

Saltaire

By the time you read this, I will have given what has been billed by my Twitter chum @PGTips42 at Bradford District Care Trust as a Social Media Master Class. 

In fact you would have to look hard to find someone who is less of a social media master than me. If they were paying me, the 60 attendees would by now have asked for their money back. Luckily, I am doing it for free. This gives me a chance to explore some recent thoughts with them and to visit the beautiful model village of Saltaire in West Yorkshire. The legacy of Sir Titus Salt could teach us a thing or two about philanthropic investment in social capital and infrastucture for the good of everyone, not just the richest.

Back to social media. One of the promises I made to myself when I retired from the NHS was that I would accept speaking engagements only when they were about something that really interested me, and that I would never again use Powerpoint. I’ve stuck to this for 2 1/2 years and it has served me pretty well. I did think about breaking the second rule for this session, as some screen grabs from Facebook and Twitter would have been nice, especially if they included kittens. But I decided against it.

Instead, I will have meandered through some personal insights, drawn from this blog and the references herein, and even better, found out what the attendees think.

My personal approach to using social media is how I tend to approach most things – I jump in and have a go, ignore wise advice and instead work out the rules as I go along. This isn’t the wrong way, but nor is it the right way. It’s just my way. But however you choose to get started, putting yourself out there via social media is undoubtedly scary. It is important to take care. I do highly recommend this very well constructed article by Annie Cooper and Alison Inglehearn. It will help you stay safe.

Once you have chosen your preferred social media platform – such as Facebook, Twitter, Instagram etc (and this can feel like a Betamax v VHS choice), here are an updated set of rules I shared in a previous blog that might help a social media novice get started.

  1. Do it yourself.
  2. Listen twice at least twice much as you speak.
  3. Don’t rise to the bait or post when angry or under the influence of dis-inhibitors.
  4. Share opinions but remember they are only your opinions. Others are allowed to disagree!
  5. Where possible, stick to facts and values.
  6. As in face-to-face conversation, seek common ground.
  7. Don’t believe everything you read.
  8. Don’t only talk to people you know you will agree with. Some people describe those who do as living in an echo-chamber.
  9. There ARE trolls out there. But not as many as you might be led to believe.
  10. Be kind, always – to yourself and to others.

It is possible, and great fun, to crowd-source a seminar, as I have now done a few times. Yes, it takes more time than the usual approach. (And it doesn’t finish on the day. It is important to thank people properly who have made the effort to help you.) The benefits are the potential to engage many times more not only with your direct audience but also with others via social media. And to widen your own learning in ways you could not have imagined. Most of what you see here has been achieved with the help of my social media friends. 

Given my passion about mental health, I must mention the impact of social media, which can either be overlooked or understated, in my experience. I thank my friends for reminding that social media is only a very small part of the world. It can be a source of solace and support, as I have sometimes found.  But it can also cut you off, if you let it. And it can be vicious, self-righteous and damaging. People can hide behind anonymity, so bad behaviour is invariably worse, goes more unchecked and can be more intrusive than in face-to-face interactions. I wrote this blog about Twitter  in 2014 which you might find helpful.

Blogging is not compulsory. If you like sharing thoughts in writing, you will probably enjoy blogging and learn to do it well. Like everything worthwhile, it takes practice. And if you don’t, you won’t. 

I would also mention that, however much you like the blog site you have chosen, unless someone (i.e. you and/or your readers) are paying for it, you and they ARE the product. The same applies to all social media platforms and indeed all publications, such as “free” newspapers. If we want original, independent writing to thrive, we MUST pay for books, journals, newspapers, even blog-sites. Otherwise it won’t be long before the only things available are products sponsored from a commercial or otherwise partisan perspective. And that is a very sinister prospect. 

Some people use social media platforms such as Twitter for swift repartee, and blog about more considered and complex thoughts.  I would argue that blogging can help us to work out what we think. And that we can use Twitter and other chat sites for this too. After all, there is no point getting involved in conversations if we have already made up our minds about something. Here is a bit more about why I write a blog.

Just to show that I have been thinking about social media for a while, here is something I wrote for the HSJ in 2012.

This slide deck on the role of social media in health is the extraordinary Dr Helen Bevan, @HelenBevan on Twitter. Helen is a genius in improvement methodology and practice as well as new ways of working, including using social media. 

And I thank another wonderful friend @AnnieCoops for introducing me to this lovely video poem about the social media imprint we leave behind us. Like all good things on social media, it will make you think really hard. Which is the best sort of thinking. 

Here are some of my new friends at Bradford District Care Trust. They were AMAZING!!!

And given that I mentioned kittens, here is William to wish you all well for 2017.

Suggested Ambridge New Year Resolutions 2017

Brian

Stop behaving like an ageing alpha male lion. Otherwise you might lose more than your pride. Give in graciously to Adam’s plans. Once you accept that you are, just like the rest of us, completely replaceable, you will be a lot happier.

Adam

See above. Also, maybe you could get in touch with Charlie?  We liked you being with him much better than poor old Ian.

Jennifer

Keep Brian on a shorter leash. Buy plenty of tissues for Lilian. And make more time for your writing.

Lilian

Dump Justin before he dumps you. He’s not nearly as much fun as you think. You can do much better than Ambridge’s answer to Sir Philip Green.

Toby

Don’t let people’s low expectations define you. Get a proper job, preferably in Brighton.

Tom and Kirsty

Buy a pram.

Helen

Do not, on any account, let Rob back into your life. Whatever he tells you, abusive males like him are extremely unlikely to change. Do everything you can to keep your lovely boys safe. One day you might meet someone else. But for now, while you recover from such a damaging few years, you are much better off alone.

Pip

Do not let other people tell you who to go out with. But equally, don’t let the poor opinions of your family cast Toby as Romeo to your Juliet. Like Lilian, you can do better. You won’t meet new people working on your parents farm and living at Rickyard Cottage. Time to spread your wings in 2017.

Jill

What is going on with you, Jill? Why do you hate Toby Fairbrother quite so much? You have alienated your beloved granddaughter, you risk doing the same with your daughter-in-law, and as a church-goer, you are showing some extremely un-Christian attitudes. And you won’t listen to reason.  It isn’t really about Pip, is it? Nor is it about Toby’s father and his long-ago affair with Elizabeth. It goes much deeper than that. I suggest you talk to someone outside the family who you trust, possibly Reverend Alan, and explore these feelings. You may need some professional help. Because such uncharacteristic vitriol at your age is really worrying.

Ed and Emma

Stay as sweet and honest as you are. Undoubtedly we could do with more working class characters who are in the cast for more than just their comedic value. But you two are brilliant. Please don’t change a thing.

Usha and the new vet lady

Likewise, we need to see much more of you both, as well as a few more characters who just happen to be Black, Asian or from other Minority Ethnic backgrounds. Or those of us who argue that The Archers is no longer totally white and middle-class will have to admit we are wrong. Bring back Iftikar Shah; he is much more glamorous and interesting than that boring doctor, Elizabeth!

Pat and Tony

If you thought semi-retirement was going to be quiet, think again. Prepare for incoming grandchild number 4. And congratulate yourselves on being true to your characters but at the same time amazing in 2016.

Here’s to a wonderful 2017 in Ambridge, which remains an oasis of compassion and commonsense compared with the rest of the world.

My nine lessons for Christmas 2016

  1. In November, my friend Sally took me to The Church of St Mary the Virgin, Putney and reminded me about The Levellers. As she read aloud from Thomas Rainsborough’s famous quote, I felt a shiver. “For really I think that the poorest he that is in England hath a life to live, as the greatest he. After this terrible year, surely we can remember this, and act accordingly?
  2. History shows that, when times are hard, false prophets can persuade those who are suffering to blame the “other” rather than the ones who are the true source of their misery. And cause them to use their precious vote in ways that challenge more liberal values. But if we merely condemn such choices, we have no hope of turning the ugly tide lapping our shores. After the results of Brexit and the US presidency, I have come to realise that we need to judge less and listen much more so that we can understand why people are so angry with the established order.
  3. This year we lost far too many extraordinary people, including the wonderful Jo Cox MP. She wasn’t afraid to work with those on the opposite side of the political divide nor to challenge orthodox views. I have concluded that members of political parties who spend all their time arguing or blaming one another rather than seeking common cause, as Jo did, are a major part of why so many are mistrustful of politicians.
  4. This month, the government announced that, as a society, we are not doing enough to prevent suicide. And that there will be league tables published soon to show which areas are lagging most. As one who devotes time to volunteer in suicide prevention, I find this extraordinary. We can do a great deal to reduce the incidence of suicide by tackling stigma, offering education and training and supporting voluntary services such as the Samaritans. But ignoring the main reasons for the rise in the rate of suicide is dishonest. Benefit sanctions, fitness to work assessments and cuts in social care support are causing hunger, homelessness, and shame from being a burden amongst the most vulnerable of our fellow citizens. And for a growing number, the only options at night are a tent, a homeless shelter or a shop doorway. No wonder that life feels increasingly unbearable to some.
  5. And while the government congratulates itself on low rates of unemployment, zero hours contracts and minimum wages are directly causing the rise in reliance on food banks, payday loans and other expensive credit. It is not refugees or so-called benefit scroungers we need to fear. It is people who “create value” (what a meaningless and loathsome phrase) from the misery of others. The Mike Ashleys and Philip Greens of this world. And the Rupert Murdochs and Paul Dacres who would have us believe that fear of the other, rather than compassion for our fellow citizens, is what should drive us. But I realise that grumbling to those who already agree with me is not enough. I’m going to do better in 2017.
  6. I have been learning how to apply the Myers Briggs Type Indicator (MBTI) to use in my practice as a coach. I could bore for Europe on this subject, but suffice to say, it has been a revelation. And the greatest insight of all has been finally appreciating at a very personal level what Carl Rogers meant in 1961 when he said: “What I am is good enough, if I would only be it openly.”
  7. I have also been learning how to be a Samaritan. I will be writing more about this next year. All I need say for now is that I gain as least as much as I give, and that the training and support for volunteers is absolutely wonderful. And with all that I mention above, and at this time of year, Samaritans are needed more than ever.
  8. This year, we lost so many wonderful people, including Twitter friends @GrangerKate and @GraceAndGloryDan. I would like to thank Zoe, courageous mother of Adam Bojelian. Adam sadly died last year. And Zoe reminded me that people who are bereaved value nothing more than being given the kindness of time to talk about the person they have lost.
  9. Finally, I have learned that people like pictures of cats. So here is William, my personal pet therapist, to wish you peace at Christmas. And may those who are lost, lonely or grieving find kindness among strangers as well as friends.