Mental health and exercise

Me on my bike

This week, we heard about a US study which apparently showed a link between exercise and improving one’s mental health.

“How marvellous” cry quite a few people who have been fortunate enough never to experience any sort of mental illness. “Here is proof” they go on to say “That lying around in bed all day is bad for you. Next time I meet someone who says they are depressed, I will tell them to go out for a jolly good walk. A bit of fresh air will blow the cobwebs away. After all, I always feel better after a walk/run/session with my personal trainer/ swim in the health club pool ” they remark helpfully.

Thank goodness for wise owls like Dr Dean Burnett who, while welcoming the study, reminds us of the likelihood and risks of overstating the findings, and of its limitations, such as that the participants self-reported their improved mental health, that most of them didn’t have a serious mental illness to start with, and that anyone with anything other than depression was excluded from the study.

Exercise can play a positive part in managing our mental health. But it’s not a magic cure-all. Here are some things I’d like anyone feeling excited by this study to do. And a few that I and others with similar experiences would prefer you not to do.

  1. Please read Dr Dean Burnett’s brief analysis here.

  2. Learn how depression is a physical illness and why exercising when you are having a severe episode can be very harmful here.

  3. Remember that prevention may be better than cure, but that to muddle the two is both dangerous and cruel. Imagine telling someone having chemotherapy just to eat more vegetables? It’s the same with mental illnesses (of which there are many) as with cancer. What helps us stay well is not an alternative to the treatment we need when we are poorly.

  4. Remember that many people who experience mental illness face other challenges which compound their situation, including poverty, insecure housing and post-traumatic stress. So please tread gently. Don’t make suggestions that seem obvious to you but may be daunting, even terrifying, or that they just can’t afford.

  5. Do all you can not to offer advice to your friend who seems be showing signs of mental illness. Instead, sit with them and just listen. Help them by showing that you care enough to stop whatever else you are doing and giving them your undivided attention. Be patient. Be courageous. Be quiet. Be there.

  6. IF they should decide that they want to try a bit of exercise, offer to walk, run or cycle beside them. Show them that you have their back.

Finally, in case you or anyone you know needs it, here is My Letter To You. 

Take it gently. This world is a tough old place.

Thank you.

 

 

 

 

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BEING AN NHS CHIEF EXECUTIVE…

 

No blogs from me for a while because I’ve been finishing my book Being an NHS Chief Executive.

In these early weeks after publication, it is nice to talk to a few reviewers about the book. Here are some of the questions I’ve been answering.

Why did you write it?

Because I felt I had something to say, about our attitudes to mental illness, and about suicide and abuse. I wanted to speak directly to those who devote their lives to public service. I also wrote it for a bit of catharsis. I haven’t had a work dream since I finished it, so that plan seems to be working – so far…

Is there still stigma about mental illness?

You bet there is. It will take more than a few people in the public eye talking about their own experiences to rid us of that terrible stigma. It manifests itself in the way people who are mentally ill are portrayed in the media, although have seen some progress. But more in how society (including government, who are elected by the people and in effect do their bidding) treats people who experience mental illness. There is unfair discrimination in access to decent housing, welfare benefits, support in finding meaningful employment, and to timely, compassionate, effective health care. Here in the UK, people with the most severe forms of mental illness die on average 20 years earlier than the general population. That should be a national scandal. The fact that it isn’t seems to me to be cast-iron evidence of the stigma that still exists.

Why did you decide to come out about your own experiences of anxiety and depression, having kept quiet for 58 years?

Until I was in my early forties, I wouldn’t have described my experiences as that. My self-stigma was so great that I viewed my inability at times to face the world, simply as personal weakness or flaws in my character. And then, once I began to accept my experiences for what they really were, I felt that talking about them would be self-indulgent, given the good luck I seem to have had with my family, friends, education, home and job.

This is something that people like me must always look out for. When I had my last major depression and was huddled in the dark wanting to be dead, I didn’t have to worry about being made homeless, having no money and getting no treatment or support. So I should watch my privilege.

What is your biggest regret?

Probably not dealing with all the above sooner, so that I could have used my understanding to help tackle the stigma that mental health services experienced throughout my 13 years of being in a position of influence. In fact, cuts to services are increasing as I write this, despite all the government rhetoric.

As well as being cruel, this is a false economy. Most mental illnesses start when we are young. If young people get the right advice and treatment straight away, the chances are they will be able to resume their education and personal lives fairly quickly, growing up to become full participants and contributors to society. It doesn’t mean they will necessarily be cured, but it does mean that the disabling impacts of mental illness will be avoided or kept to a minimum. Imagine if we said to people with cancer, look, your tumour isn’t causing you enough problems yet. Go away and manage it yourself and only come back when you are dangerously ill. There would be an outcry.

But just having regrets is wasted energy. So I’m doing what I can, writing blogs like this, talking about it to anyone who will listen, and using the book as an introduction to a having a different sort of conversation.

What are you writing now?

A novel set in a choir school. It is half done but I am trying to concentrate on it properly now. When writing fiction, you need to let the creative juices run, which for me means starting to write as soon as I wake up. Some days I am in still in my PJs at 3 o’clock in the afternoon. At least that’s my excuse!

 

If you want to read my book, you can get it in paperback or on Kindle here.

 

 

My Brew Monday

This morning, Samaritans volunteers were shivering on Brighton Station, Hove Station and 80 other railway stations around the country. We’re at it again tonight. If you see us, feel free to say hi, and take one of our free Brew Monday teabags or SHUSH Listening Tips leaflets. You can pop a few coins in our collecting tins. And talk to us about how you are doing.

You can even discuss the possibility of volunteering as a Samaritan yourself. Samaritans are ordinary people. We have no special powers. We don’t get paid but we do get the most excellent training and a great deal of support to do what we do. Read more here.

Let’s be honest. There is no such thing as Blue Monday. It was a clever advertising gimmick thought up by a travel company 15 years ago. And yes, Brew Monday is a bit of a gimmick too. But it’s a good way of grabbing people’s attention for a much better reason than selling them a holiday they may not be able to afford. Brew Monday is a way of reminding people that they have the most valuable thing that other people need. And that’s the gift of their own time. Time to ask the other person how they are. And to really listen to the answer. Time to be with them if they are OK but even more if they are not. And time to help them come to their own conclusions about what action, if any, they want to take. And what better way to help the conversation flow than with a lovely cup of tea? This link will take you to the Brew Monday part of the Samaritans website.

Here are the SHUSH listening tips:

S = Show you care – stop what you are doing, put away your phone, perhaps offer a cup of tea

H = Have patience – forget the emails piling up. And don’t give up.

U = Use open questions. And include space for the other person to think.

S =  Say it back – use their words, without offering an opinion or judgement.

H = Have courage. This can be hard, especially if you get initially get a dusty answer. But please keep trying.

If you want to hear yours truly talking about Brew Monday, Samaritans, and the listening tips mentioned above, you can find me here on Radio Sussex talking with the lovely Allison Ferns from 2hrs 46 minutes – 3hrs.

And most of all, please try to find time this week to have a cuppa with someone and really listen to them. It could make a huge difference.

Thank you.

 

 

Mindfulness and Listening

The Chattri, near Brighton

Christians get upset about the commercialisation of religious festivals like Christmas and Easter. Increasingly I appreciate why.

It is probably just as annoying for Buddhists that meditation, fundamental to a generous approach to the world, also appears to have been hijacked. This Washington Post article suggests that the me-generation has taken a practice essentially about becoming self-less, and turned it on its head to be about self absorption via the mindfulness movement.

The argument is plausible, but I disagree, perhaps because my first experience of mindfulness was not at a self-indulgent spa. It was gained through hearing from mental health colleagues and patients engaged in mindfulness as an evidence-based method for helping to live with disturbing voices in the head, one of the most unpleasant symptoms of schizophrenia and other psychotic illnesses.

I wanted to learn more. I went on a few courses, Buddhist and secular, and began to practise myself. I was also lucky enough to play a tiny part in supporting The Sussex Mindfulness Centre which today goes from strength to strength in helping patients and practitioners to practise mindfulness in their daily lives.

There will be some reading this who detest mindfulness. I accept that it isn’t for everyone. I know that it doesn’t actually solve anything. And I am aware that when it is suggested casually to those in distress, it can belittle the depth of trauma and anguish they are experiencing. Mindfulness can be seen as a panacea, even a mumbo-jumbo cult. And in the workplace it can be misused as a low-cost alternative to comprehensive employee support.

I really do appreciate these views. And yet having experienced anxiety and depression myself and been helped by those who practise mindfulness, I know it doesn’t have to be that way.

Because there is something wonderful about people who are truly mindful. I’m learning this while I develop as a Samaritan. Listening really carefully without judgement to someone in distress seems to me to be the very essence of mindfulness. Samaritans don’t just learn how to do this once. We spend our first year in training. And then however experienced we are, we listen very carefully to one another, in order continually to improve. Because we don’t just care about our callers, we care about our fellow Samaritans.

A Samaritan shift can be the ultimate mindful practice. The room is peaceful and quiet. You listen, moment by moment, to your caller. You are listening in order to understand. You respond only when the caller seems ready, and use their words to reflect what you have heard. You give them space and time. You do not make suggestions and you do not judge. Your whole purpose is to be there with them while they explore their feelings and make their own decisions, if indeed they feel that any need to be made. The time simply disappears. At the end of your shift you debrief to another experienced Samaritan, not really about the calls, but how you handled them, what you might do differently another time and how you are feeling yourself. You are reminded of the valuable service you have given. And you go away feeling calmer and lighter because of the mental discipline and compassion you have been practising. That is my sort of mindfulness.

If you want to know more about how Samaritans listen, here are some wonderful tips.

And for those who like meditation, this is one of my favourite practices. It is about loving kindness. The point being that only if you are kind and forgiving to yourself can you be truly kind to others. It may be a huge effort. But it is really worth it.

This blog is dedicated to a good Samaritan who helped me to listen. May they rest in peace.

Zero suicide and the absence of blogs

Sarah Hughes, Alys Cole-King and me

On Friday 29th September, I approached Towards Zero Suicide, a Healthcare Conference UK event, with trepidation. As a conference chair, you need to be on top of your game – or least appear to be. And I hadn’t been at my best for the past month or so (hence the absence of blogs). No trigger this time, just lower than usual confidence and mood, disturbed sleep, horrid dreams and heightened anxiety. Despite all the good advice I write about here, my tendency is still to plough on through this stuff until it goes away of its own accord or bubbles up into something worse.

But this time I confided in a friend, who had already guessed I wasn’t OK. This led to me ‘fessing up to those closest to me and my GP, and then doing what was necessary to gradually get back on track. And I’m getting there. I cancelled a few things but this conference seemed too important, and anyway, I am the sort of person who needs the buzz that comes from intellectual stimulation and being in the spotlight.

There was another reason for feeling nervous. As someone who has experienced suicidal thoughts and feelings from time to time, and as a Samaritan (see my last blog), I have to admit to feeling conflicted about such an aim. I worry it could send a negative signal to those experiencing such feelings or who have lost someone to suicide.

But also I dedicate a considerable amount of my time these days trying to prevent suicide. This is why I had agreed to chair the conference, and why I thought carefully about how make the event respectful and supportive to all concerned, while also challenging the stigma and shame still associated with suicide.

En route, I did my own, unscientific, Twitter poll. Thank you if you participated. All I take from this is that I’m not the only one who started my day with mixed feelings about a laudable aim.

This was the conference programme.

And this is what I took away:

  • Some of us are more vulnerable than others to thoughts of suicide. But with enough stress and pressure, almost anyone will think about it.
  • Whether you have, as Sarah Hughes of the Centre for Mental Health described, made your peace with the term Zero Suicide, we can all embrace the hope behind the message. Because as Keith Waters of Derbyshire Health Care and the National Suicide Prevention Alliance reminded us, suicide is not inevitable.
  • The long history of suicide in our society helps us to understand the shame still associated with it. And we still need to tackle that shame, because ultimately it can kill.
  • There are no simple solutions to suicide prevention. It has to be locally relevant, dynamic and evolving. And it must involve everyone, from individuals to organisations, public and private. Those who traditionally resist engagement with suicide prevention strategies, such as coroners and the media, must be persuaded that they have a part to play.
  • While there are links to mental illness, most deaths by suicide are of people not in touch with mental health services. And yet suicide prevention is often seen as the sole responsibility of those working in mental health.
  • As Pippa Smith of British Transport Police said with such kindness and eloquence, a death by suicide is like no other. It touches not just those directly affected. And it can cause lasting damage.
  • Removing the means to carry out a suicide can save lives. But at the same time, if applied without sensitivity, it can also remove a person’s dignity, which may be the only thing they have left.
  • Mental health first aid is as effective as physical first aid. So why is in not mandatory in workplaces, universities, schools, hospitals, public spaces and across society? Including in mental health services, where staff sometimes lack the basic knowledge and skills to be effective in helping a suicidal person.
  • Too much emphasis is placed on risk assessment. As Alys Cole-King so brilliantly put it, you cannot accurately predict risk. It differs from person to person and changes moment by moment. Instead, clinicians need the latest evidence so they can assess the person rather than the risk, and provide treatment and care accordingly.
  • I loved Alys’ idea that when someone is suicidal, emergency services would ring ahead, as they do for major physical trauma cases. But instead of asking for the resuscitation room to be made ready, they would say “Please get the compassion room ready.”
  • NHS crisis services are being reduced to save money, causing damage to clients and staff. Why is this not a national outrage?
  • Third sector organisations such as  Suicide Crisis, run by Jo Hibbens who spoke eloquently about the people they support and the lives they save, can be wonderful. But they need the safety net and professional support of statutory services. They are not a cheap alternative.
  • Suicide prevention apps as we heard from Iain Murray, Choose Life Co-ordinator in Aberdeenshire, can really help to save lives. I loved how he has marshalled such wide community support for this work. Here is a link to the Scottish app and also the Grassroots Suicide Prevention Stay Alive app which I have mentioned before.
  • It was good to be reminded of the physical and psychological determinants and consequences of mental crisis, and how we can all help ourselves and one another. Thank you Luke Sullivan – great job.
  • Mental health staff are experiencing increased stress at work, according to investigative work done by Radio 5 Live. Here’s me talking to Rachel Burden about why we cannot expect them to give compassionate care if they are not treated with compassion themselves (at 2:39:50). It seems so obvious, and yet…

Thank you to everyone who attended and participated so wisely and generously. I think you are all amazing.

PS I posted this blog on Sunday 1st October and in 24 hours have had many extremely kind messages. Yes, I really am ok. And thank you very much for asking xxx

So what do you do these days?

Me and my friend Sally at the end of Ride 100 in 2016. Still laughing despite the pain.

People sometimes ask what I do these days. Here is a snapshot.

Today, I will be one of 12 Samaritan volunteers from the Brighton, Hove and District branch at TransPride.  This is a community event for people from the trans community to come together and be themselves in a safe, supportive space. Samaritans know it can be an alienating and difficult experience for some people just to be who they are. We are there to listen, but also to talk about what we do, in case anyone is interested in volunteering with us. I am really looking forward to it.

On Monday, 24th July 2017, Samaritans will be at railway stations across the country encouraging people to listen to one another and to know they are not alone. Volunteers from our branch will be on Brighton, Hove and Haywards Heath Stations from 7 – 9 in the morning and 5 – 7 in the evening, handing out leaflets, talking to commuters but most of all, listening. This national series of events is part of the ongoing partnership between Samaritans and the rail industry. Next time you travel by train, if you turn over your ticket you might see one of our messages. Please also look out for our posters on every station. As they say, we are in your corner.

On 6th August, we will be on the road again, this time at Brighton Pride, a massive event celebrating all things LGBT. We will have a well-staffed stall to publicise what we do. And because we also know that supposedly joyous occasions can be unbearable for those who are feeling lonely or desperate, we will be there as well for those who need us.

And I am back on my bike on Sunday 30th July 2017 raising money for Samaritans. You can read more about it here, including how to donate. No pressure, though – we all do what we can. 

I first learned about Samaritans aged 11 via an article in Readers Digest. I then read Monica Dickens’ novel The Listeners, based on her experiences of being a Samaritan volunteer in London soon after the charity started 64 years ago. Later, I read the collected short stories Is there Anyone There? edited by Monica Dickens and Rosemary Sutcliffe. And I called Samaritans once or twice, from a red telephone box like the one on the cover.

In my early twenties, I trained to be a Samaritan myself, and volunteered for a couple of years. I loved it. But I was economical with the truth about my own issues. While going through a particularly bad patch, I found I didn’t have enough to give. I should have told a senor Samaritan and taken time out. But instead I just left. I have felt bad about this ever since.

I think I always knew I would go back. But not that it would take quite so long. As I pedalled for 8 hours through Ride London 100 in 2015, raising money for Samaritans, I knew that the time had come. In January 2016, I booked myself into an information event at my local branch. And with support from amazing trainers and fellow trainees, I completed initial training, mentoring and probation and became a listening volunteer again.

What has changed in 38 years? More importantly, what remains?

New technology, of course. Emails and text calls, booking shifts and online recording. But still nothing beats listening to someone by phone or face-to-face. Nor being supported by a fellow Samaritan who somehow notices you’re having a tough call and offers you time to reflect. The equality between volunteers, new and experienced, lies at the heart of what we do. I’m so glad that hasn’t changed.

We had policies back in the day, but not like now. Over-reliance on them can have unintended consequences, stealing time, making people over-cautious and discouraging independent thinking. The policies we are asked to follow are designed to maintain high standards and keep everyone safe. And if they need to be changed, it is up to us to say why and how.

Training is more thorough nowadays – in 1978 selection and training happened over a weekend. But the focus on being there for distressed people hasn’t changed at all.

Once more, I find I get more than I give by being a Samaritan. I love the stillness and focus of the Ops Room. I am inspired by the courage of our callers and the humanity of my fellow Sams.  It is lovely to be back.

It is true that not everyone has the capacity to be a Samaritan. You have to be able to set aside judgement and the humility to learn how to listen really carefully. But I truly believe that many more people could do it than probably realise. All it really takes is genuine love for other humans.

If you are interested in volunteering with us, either as a listener or a support volunteer, please take a look at this. We would be so pleased to hear from you.

 

 

Watching my privilege

Trustees of the Mary Seacole Trust (from left) Jean Gray, Lisa Rodrigues (vice chair), Karen Bonner, Dawn Hill (President), Trevor Sterling (chair), Roxanne St. Clair (treasurer), Jermaine Sterling, Ros Trennick, Steve Marsh (secretary), Raf Alam.

In 1973, aged 18, I joined the NHS. My first job was at a learning disability hospital. It was a backwater for patients. And also for staff, 50% of whom were Black, Asian or other ethnic minority (BAME) backgrounds. Since its inception, the NHS has recruited internationally in order to meet staff shortages in less popular parts of the service. That hospital relied on nurses from Ghana, Nigeria, the Philippines, Mauritius, Sri Lanka and the West Indies to look after some of the most vulnerable people I have ever met.

Three months later, I left my new BAME friends to start nurse training at the prestigious Hospital for Sick Children, Great Ormond Street (GOS). Here, things were different. Of the 150 student nurses who started in 1973, 150 were female, almost all were middle-class, and every single one was white.

There were of course BAME staff at GOS. They worked in the kitchens and cleaned the wards. They served us in the canteen. There were a handful of black and Asian nursing assistants, and the occasional agency nurse. And there were BAME pupil nurses, doing a shorter, less academic course than ours, who would eventually become State Enrolled Nurses, a second-class role which precluded them from promotion to becoming a staff nurse or sister. I cannot recall a single black ward sister.

This is not a criticism of my alma mater, by the way. Things were the same across all the London teaching hospitals.

41 years later, we discovered that not much had changed. In March 2014, the year I retired from the NHS, Roger Kline published his excoriating Snowy White Peaks report. We learned that whilst 70% of the NHS workforce was female, and 20% BAME (30% BAME amongst nurses, and 40% BAME amongst doctors), the top of the NHS was almost totally white and predominantly male.

This stinks. It is institutional sexism amd racism. I have written about it before, and how Mary Seacole can help us challenge such shocking stigma and discrimination.

On Thursday 29 June 2017, 1 year minus a day since Mary’s beautiful statue was unveiled outside St Thomas’ Hospital, we launched the Mary Seacole Trust at the Black Cultural Archives in Brixton. Our aim is to use Mary’s legacy – compassion, creativity, dynamism, entrepreneurship and most of all, never giving up – to inspire people of all ages to achieve their best in whatever walk of life they choose. You can read about our first two programmes and a bit more about us on our new website. Plus a lovely 5 minute film made by one of our trustees, Jermaine Sterling. Do take a look – it’s great!

But when I was asked by our chair, Trevor Sterling (who left school at 16, yet is now a renowned lawyer and partner in a prestigious law firm plus one of the funniest, nicest and most effective people I have ever met) if I would be the new charity’s vice chair, I had to think hard. I felt the need to challenge myself about whether such an honour was deserved. I have had my share of difficult experiences, but I have not experienced racism. White people like me have to take care to avoid cultural misappropriation. We have to watch our privilege.

So I talked to my BAME friends, including some of the other trustees. And they said this. They reminded me that we are all part of the human race, brothers and sisters under the skin. And they welcomed my support because making sure everyone achieves their best is not just their fight. It is our fight.

So I said yes. I promise them and all of you to use my talents, such as they are, plus my experience and connections to help inspire people of all ages to achieve their best, based on merit, passion and hard work. Not what school they went to, who their parents are or the colour of their skin.

Just like Mary Seacole. Mary had to fight many fights. She never gave up. And nor shall we.

To sign up as a member of the Mary Seacole Trust, or just to learn more about us, click here.

Thank you.