​Girls like Theresa 

Our Prime Minister reminds me of one or two girls I went to school with. Not the ones who were friends with me, I hasten to add. Girls like Theresa had a small coterie who made no secret of their opinion that girls like me were idiots. In my case this was probably true. But not so of everyone on whom they looked down their elegant noses.

Girls like Theresa almost always came top. They were clever. They also worked harder than anyone else. They took copious notes in lessons and revised studiously for tests because they despised failure. They seemed uninterested in the things that distracted girls like me – rule-breaking modifications to our school uniforms to make them less frumpy, for example. Plus pop music, make-up and Boys.

Occasionally a girl like me would get a better mark for an essay or exam than a girl like Theresa. And she would seem rocked by this. She had worked just as hard as usual; how could she have been beaten by someone like me? This outcome did not compute.

Girls like Theresa had parents who were sought after by the headmistress. Unlike girls like me whose parents either sucked up in an embarrassing way or were simply ignored. They won prizes for everything from needlework to deportment. Their school blazers were decorated with team captain, prefect and head girl badges. And correctly, they assumed that they would always be picked to represent the school at games. They had the right equipment, extra tennis coaching and at least one uncle who was a Cambridge blue. Girls like me had terrible kit. We had to fight for a place in the team.

But despite their sense of entitlement, girls like Theresa were also socially awkward. Now I understand the Myers Briggs Type Inventory (MBTI) I realise that they were probably introverted (I). Social interaction could be enjoyable for girls like Theresa. But it also required a huge effort. When an extrovert girl like me tried to chat lightheartedly with a girl like Theresa, she would be haughty and dismissive. I thought she hated me. But maybe she just didn’t know what to say?

Girls like Theresa were likely to have had a preference for Sensing (S) in how they dealt with the world around them. This made them great at retaining facts and revising for exams, but less good at dealing with abstract concepts and seeing the bigger picture. They could learn how to do these things, but they would always be more comfortable with detail. And at times of crisis, detail could overwhelm them.

Girls like Theresa almost certainly made decisions using rational thought and logic (T) rather than feelings. They were uncomfortable with people who expressed emotions too readily. Unless they were encouraged to develop their non-preferred feeling side, they were more likely to offer criticism than praise to others, and struggle to show empathy.

And girls like Theresa were more likely to have a preference for judging (J) and to seek to reach closure rather than to explore new possibilities. At their best, they could be decisive. They liked to plan everything and leave nothing to chance. But without encouragement and support to explore their non-preferred perceiving side, they could be closed to new ideas.

People with an ISTJ Myers Briggs profile can be great team players. They can also become very good leaders, but only if they pay attention to those aspects of their personality that require development. They will always find the demand for frequent interaction with others draining. They need wise and trustworthy advisers to encourage them when to be less cautious and when to follow their instincts. They must guard against making up their minds too quickly when they have yet to grasp the broader picture. And they will almost certainly need help to understand that if you allow your head always to rule your heart, you may come across as cold and uncaring.

I recall a girl like Theresa who became head girl. It started well. But the wheels began to come off quite soon. She lacked confidence to seek wise advice. And she uncharacteristically made one or two rash decisions because she relied on people who didn’t deserve her trust. This made her even more cautious and unapproachable. She ended up as a lesser version of herself than she had been before she first pinned on the sought-after enamel badge. I really hope that she is OK now.

Carl Rogers said: what I am is good enough, if I would only be it openly.

This applies as much to politicians as it does to ordinary people. Even head girls.

Sent from my Samsung Galaxy smartphone.

The Grenfell Tower fire – the political dimension to this tragedy

Andy Winter's Blog

This has been a week full of tragedy – the fire at Grenfell Tower. There has been an appalling loss of life and acts of amazing heroism.

We have been told that this is not the time to be political. But why not? Housing is political. The death of even one person is political

This was not a natural disaster. It was avoidable.

Everyone, rightly, is praising the emergency services. Fire fighters going into a burning building. Their bravery is beyond words.

But it was not so brave to close the three fire stations nearest Grenfell Tower.

There are 5,000 fewer fire fighters than there were 5 years ago. There has been a 25% reduction in fire prevention visits.

There has also been a 15% increase in the last year in the number of fire-related deaths in the UK, from 264 to 303.

If you put money before lives, people die.

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There is no such thing as a “suicide bomber”

​On Friday, mental health hero Professor Louis Appleby gave voice to the disquiet many of us have been feeling about the use of the term “suicide” in relation to the Manchester bombing. Overnight, we have learned of more atrocities around London Bridge and Vauxhall. Our hearts go out to all who are affected.

Now let us face facts. Taking one’s own life as a way of killing others is NOT suicide. It is multiple indiscriminate murder, even if those who do it have been callously brainwashed by others who view the lives of fellow humans as infinitely expendable.

After I had endorsed Louis’s comments via Twitter, I was challenged by Karen Machin @kmachin to use my influence to do better. I joked that she might be overestimating my potential impact, but I also remembered something.

When I retired from the NHS, I made a promise to others but mainly myself to use the connections I had developed to campaign for improvements for those needing help with their mental health. I do this as an ex-nurse and NHS leader but also someone with my own experiences of mental illness and occasional suicidal thoughts and feelings.

This time last year was not good for me. But not as bad as 2013, the year before I retired, during which I spent months ignoring my increasingly negative thoughts, growing ever more irrational and obsessed with unimportant details before finally breaking down, unable to speak or look other people in the eye because I was consumed by shame and self-hatred. I had no wish to remain alive. On the day things finally fell apart, I came close to crashing my car on purpose, but could not face hurting others because I knew it was only me who was a worthless piece of shit. I was luckily surrounded by love and exceptional care. And slowly, I came through.

Last year was more of a blip than a breakdown. A few things conspired to make me wobble. But at long last I have learned to spot my warning signs before it is too late – disturbed sleep, unexpected tears, irrational thoughts, heightened anxiety, self loathing and suicidal feelings. Fleeting, but suicidal nonetheless. Asking for help will always be difficult for me, because when I am not at my best, I feel that that my place is to help others and to need help myself is self-indulgent and selfish. But when I did, again I got unconditional love and support. A week or so later and I was on the mend. Yes, I remain on medication, but it is about maintenance. Others take statins, I take SSRIs. I also ride my bike, meditate, write, grow and make things, and spend time helping others. When I get the proportions right, this is a therapeutic mix.

One of the ways I help others and myself is by volunteering in suicide prevention via Samaritans and Grassroots Suicide Prevention.

It is a privilege to be there for people experiencing suicidal thoughts and feelings, or who are actively planning suicide. I know I have been dealt a more privileged hand than many, and I am in awe of the courage and fortitude people show in deciding either to keep going in the face of horrific challenges and experiences, or in reaching a decision that is the hardest anyone can make. Grassroots and Samaritans believe in self-determination. At Samaritans our entire purpose is about preventing suicide by giving people a kind and confidential place to share how they feel. We do not judge those who decide to take their own lives. We know that careful listening and compassion at such a time can help even those in the darkest places to find a reason for living after all. And at Grassroots, we believe that in reducing the stigma of suicide and helping friends, neighbours and work colleagues to develop understanding and skills, we can help save more lives. Our training is based on the best international evidence. It works.

Suicide can be an impulsive act by someone not in their right mind. It can also be carefully thought out and planned. Suicide casts a long shadow, not just on those nearest and dearest, but also on professional carers and volunteers who may have done all they can to keep the person alive. Samaritans and Cruse have recently started support groups for people bereaved by suicide. This work is much needed; although suicide has not been a crime since the 1960s, there is sadly still fear and stigma associated with such a death. It can be the most difficult of losses.

So given the complex sadness and what-ifs that accompany a death by suicide, and the guilt and shame felt by people like me who occasionally find ourselves thinking about it, may I ask for your help please? If you hear someone describing a mass murderer as a “suicide bomber” in future, please show them this. And please ask them to choose their words more carefully and reserve the suicide word for those times when it befits the anguish of the person considering it.

For confidential help 24/7 365 days a year call Samaritans on 116 123 or email jo@samaritans.org

For information on suicide prevention training, take a look at Grassroots Suicide Prevention

To download the free Stay Alive suicide prevention app, go here.

Take care. And thank you.

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.