Author: LisaSaysThis

Loves people and Brighton and Hove Albion FC. Find me on Twitter @LisaSaysThis

Calling the Jubilee

yestolifeblog

“It may well be that we will have to repent in this generation. Not merely for the vitriolic words and the violent actions of the bad people, but for the appalling silence and indifference of the good people who sit around and say, “Wait on time.” – Martin Luther King

Several years ago I sat with my good friend Yvonne Coghill having dinner. We talked about many things. It was night of deep conversation, much laughter and real energy. Yvonne then told me something that shocked me. She explained that across the NHS when you go up the structure people like her – black people and people from minority communities – start to disappear. The top was all white. Yvonne explained all the evidence shows that this occurs all over our health systems. Yvonne also explained there was good work going on to change this. I was deeply disturbed and…

View original post 581 more words

Sorrow

20141214_115043

The Chattri, near Brighton

Some of you know I’ve been having a hard time in the media, linked to a job I left two years ago.

It is distressing to have my experience of depression raised in the context of questions about my reputation and competence. It brings back how lonely I sometimes felt in the 13 years I was a mental health trust chief executive.

But it is nothing compared with losing someone to suicide or homicide, whether preventable or not. My heart goes out to anyone who has ever experienced these terrible things. I am sadder and more sorry for your loss than I have words to express.

And to those who care for people who experience mental illness. We need you to keep going now more than ever. You are not perfect. None of us are. But no job could carry more risk and sadness or be less well understood by the media. Your courage and compassion in the face of everything I mention in my previous blog, make me feel humble.

Thank you.

Open dialogue

image1

I went to a conference in Nottingham yesterday to learn about a technique called Open Dialogue. I wanted to know more because of how it has revolutionised the care of people who are in crisis in parts of Finland and the US, reducing demand on mental hospitals and transforming lives.

I care deeply about mental health services, although I don’t run them any more. These days I campaign to make them better. I volunteer in suicide prevention. I chair the Time to Change mental health professionals project. And sometimes I need help from services myself.

I wish you could have been there too. Some massive pennies dropped, not just for me but for everyone who hadn’t already appreciated the possibilities. We learned that Open Dialogue is about being with people rather than doing something to them. And we realised that here was a way to mend things that previously seemed unfixable.

Let me explain.

There are some who say that the NHS is broken. And that mental health services are badly broken.

I’m not sure that broken is a helpful way to describe things. I prefer to think of them as badly wounded. And when someone is wounded, you take care of them.

I believe that people in highly influential positions do care about mental health. They are just unsure about what to to do, other than saying they care. They know that mental health services around the country are buckling under the strain of increasing demand. Referral rates have never been higher. And continue to climb. Services find it increasingly difficult to discharge people because there is nowhere for them to go. Staff are overwhelmed, and there is a growing recruitment and morale crisis.

Added to which, successive governments say one thing about the importance of mental health but allow the opposite to happen regarding funding. Despite the fine words and promises in the response to the Mental Health Taskforce report published in February, we heard just a few weeks ago from NHS Providers that mental health trusts are not seeing the promised investment and some are reporting funding cuts in 2016 – 2017. Parity of esteem? Actions speak louder than words.

How might Open Dialogue help?

Firstly, it isn’t simply a technique for listening really carefully to people who experience trauma and distress AND their families so that together they can work out their own solutions, with support. It is also an extremely respectful way for people to relate to one another, in teams, across teams, organisations, health care systems and society. Even the NHS.

Secondly, Open Dialogue is the antidote to what is sometimes called the biomedical model, when doctor knows best and patients are compliant. This works when there is a fairly simple problem and solution. For example, a broken leg. It doesn’t work for the vast majority of health conditions in which people need to become the expert themselves if they are to lead fulfilling lives. And it certainly doesn’t work in mental health. Mental health professionals know this. But we organise and regulate mental health services as though we were fixing broken minds instead of legs.

Open Dialogue builds on what some call the Recovery Model, based on hope and fulfilment rather than simply diagnosis and treatment. It provides a method to apply a recovery-based approach, involving the whole family and team. It is the antidote to outpatient clinics and ward rounds.

Thirdly, Open Dialogue provides the basis from which to challenge many of the perverse incentives and restrictive practices that have grown up in mental health care out of fear of incident, media criticism or what a regulator might say. Such as staff spending more time documenting care than in giving care. The absolute adherence to risk assessment even though successive independent investigations show it to have limited predictive value. And risk management, which taken to extremes means that those who might possibly pose a risk to themselves or others, are cared for in inhumane conditions with no privacy or dignity, no sheets, cutlery, shoelaces, phone chargers or indeed any other item that someone somewhere has said might pose a risk. And yet we know that ligatures and weapons can be fashioned from almost anything. And that people who are ill, frightened and alone can be driven to do increasingly desperate things. The greatest risk management tool available is compassionate, skilled attention. Open Dialogue offers high quantities of that.

Open Dialogue is being used in a growing number of services in the UK. A research bid has been submitted and passed the first round of scrutiny. If successful, it will explore human, clinical and cost effectiveness, as well as developing a model that is scalable and sensitive to local circumstances.

I want to thank everyone at the conference for opening my eyes. Including Tracey Taylor, Simon Smith, Pablo Sadler, Lesley Nelson, Jen Kilyon, Russell Razzaque, Mark Hofenbeck, Julie Repper and Steve Pilling.

And to Corrine Hendy, who I first met at an NHS England event about putting patients first last year: Your journey from being locked in a mental hospital to becoming a skilled mental health professional, public speaker and highly effective advocate for Open Dialogue, is more inspirational than any you will hear on X-Factor. I want to repay the inspiration you have selflessly given.

I’m going to do what I can to spread the word.

 

Three blogs and a bike ride

This week has been Mental Health Awareness Week.  I’ve written three articles, visited a friend, given a talk, attended a party and been on a bike ride.

There’s been some other more difficult stuff which I don’t feel able to write about just now. More anon.

I wrote this piece about the loss of Sally Brampton through depression and what is assumed to have been suicide.

Suicide casts a long, cold shadow. My heart goes out to all who have lost someone that way. And to all who have tried to keep them safe. There is sometimes talk of failure in such circumstances. I fully understand why. But it can be cruel and destructive to those left behind. It can affect the grieving process and have terrible repercussions. I decided a while ago to devote some of my time to being a volunteer in suicide prevention. This work can of course be distressing. But is so worthwhile. If more people were involved in understanding about suicide, it would improve compassion and more lives might be saved. Blame doesn’t save anyone. If anything, it can have the opposite effect.

image

On Monday I popped up to Rugby to see the lovely Gill Phillips and learn more about the groundbreaking work she does through her company @WhoseShoes. Gill had a special birthday this week – now she’s nearly as old as me! I love the way that this entrepreneurial woman has started a new adventure. I hope I can support Gill to bring Whose Shoes to the world of mental health. Go us!

Just Giving asked me to write this list of ideas to help people to manage their own mental health. It’s been fun watching the list grow throughout the week, and hearing comments from unlikely places about the tips. I just curated the list – none of them were invented by me. I try to follow them, not always successfully.

And I wrote this piece called Serendipity for NHS Employers. It was also Equality and Human Rights week. It was serendipitous to bring two things together that matter very much to me but which I hadn’t realised before had so much in common. I’ve had some useful feedback. It has sparked conversations about how we can use Mary Seacole’s legacy to inspire young people not just to dream, but to work hard and not be deterred by setbacks from achieving their ambitions.

One of my ambitions is to see the top of the NHS become less white and less male. Nothing against you guys, but as it says in my blog, the way things are now just isn’t representative. And having an unrepresentative leadership breeds alienation and resentment which has a negative impact on services.

image

On Thursday afternoon I spoke at a Brighton Housing Trust Health and Wellbeing Service event (photo above). I was invited there to inspire the women with my experiences of being a high profile woman who is also open about my own mental illness. But to be honest, it was they who inspired me. I heard some stories I will never forget. I want everyone to know what we agreed, which is that people who live with mental illness have assets to share. Rather than deficits to avoid or accommodate. I’m going to be returning to this theme in the future.

image

I was at the beautiful Black Cultural Archive in Brixton on Thursday evening at a comedy night with a purpose – to thank all the ambassadors and trustees who have spent 12 long years raising money for the Mary Seacole Statue.  That’s me with our brilliant and indefatigable Vice Chair Professor Elizabeth Anionwu CBE. Mary’s statue goes up in six weeks – much more about this soon.

image

And on Friday I was out cycle training with my friend Sally who is joining me on Ride 100 on 31st July when we will be raising money for Samaritans. You’ll be hearing a lot more about that shortly. Suffice to say, after doing 20 miles of hills, including the notorious Box Hill (twice) we felt pretty smug 🙂

 

In memory of Sally Brampton. You are not alone

image1

I was saddened to hear of Sally Brampton’s untimely death after a long battle with depression. She was 60, the same age as me. From my own experiences of depression, I know a little of how things must have been for her. My heart goes out to all who loved her. May she rest in peace.

Next week is Mental Health Awareness Week.

For those who are struggling, I say this. Mental illnesses mess with your head. They make you believe bad things about yourself. That there is nothing wrong with you other than laziness, moral cowardice, being hateful and lacking what it takes to lead a normal life. That you are not worthy of help. And that you must face this awful, isolating thing alone.

But struggling on alone is not a good idea. Nor is pretending to be OK when you are not. I know this from my own past, effective but wrong-headed attempts to keep how I was feeling to myself. In the end, keeping secrets just causes more damage. It can be really bad for you and those you care about.

If you are overwhelmed by negative or frightening thoughts, if life feels grim or even just pointless, please, please ask for help.

  • Talk to a friend or someone else that you trust.
  • Make an appointment to see your GP.
  • Check out the Grassroots Suicide Prevention StayAlive app – available free to download to iPhones and Androids.
  • Phone Samaritans on 116 123 or one of the other helplines.

If you don’t know what to say at first, or feel embarrassed or tongue-tied, it doesn’t matter. If you are afraid that the words won’t come, try writing it down.

Social media has been a massive help to me. I have made friends online who always seem to be there. They have been to those evil places. Not the same as mine, because we are all different, but their own terrifying versions. They know how lonely it feels.

Contrary to what you may hear, there are wonderful services available and treatments – medicines, many different sorts of therapy and other practical techniques – that work for most people. It can take time to find the right ones, of course. And it will take a lot of courage and effort on your part. There are no miracle cures. But I promise you, seeking help really is worth it.

Believe me, you are not alone.

For the want of a nail

Lisa oval

I’m at that age where my contemporaries are gradually losing their ageing parents. Plus doing all they can to help the ones who are left to cope with the indignities of living longer than our society seems to be set up for.

We are all born. And we all die. And people haven’t suddenly started to live longer. It’s been happening for years. And yet we seem to have devised our health care system as though none if this were the case.

As if there really were such a thing as saving lives.

There isn’t. All health care folk can do is help to prolong a person’s life, hopefully until that person feels they have lived a full one. And in doing so, take account of their needs and wishes. About how they want to live and also how they want to die. In the NHS we aren’t always very good at the first. And we are often very bad at the second.

There’s something very odd about the NHS. It’s called the National Health Service. And yet the majority of NHS time, attention and money is spent on hospitals. So much so that services that used to be called community health services were recently re-named ” Out of Hospital Care”. This may not seem important.  But it really is. And this is why.

Many years ago when I was a student nurse, I spent three months at what was then called a geriatric hospital. I remember an elderly lady who had suffered a stroke. Her face was turned literally and metaphorically to the wall. When I left the ward for my next placement, it was assumed she would soon die. Then a few weeks later, I had the opportunity to accompany the Health Visitor for the Elderly on her rounds. And in a tiny Cambridgeshire cottage, who should hobble to the door, all smiles, to let us in and offer to make us a cup of tea while her cat snoozed on the sunny window sill, than that lady?  And I suddenly realised that people live in homes not hospitals, and that being in hospital for even a day longer than is necessary diminishes people. My lady managed to escape. But these days, not many are so lucky.

If you wanted to devise a system that made sure that most elderly people die in their least preferred but also the most expensive possible place, i.e. hospital, it would be our NHS and the services that supposedly support it.

Local authorities have been starved of cash. And now hardly anyone except the most profoundly disabled gets any help at home with what is called social care, but includes essentials like eating, drinking, going to the toilet and having a wash. Organising private home care is in many instances a nightmare and a lottery. Simple adaptations to stop old people from falling down at home such as stair rails, bath handles and toilet grab rails are impossible to come by unless you have the money to pay for them and someone who will arrange for the work to be done. Such jobs may seem simple. But they can overwhelm an older person.

And yet as Atul Gawande says in his book Being Mortal, preventing falls is the top priority if you want to stop old people from being admitted to hospital. And where do they most often fall? On the stairs, getting out of the bath and getting on or off the loo.

Atul Gawande also writes about the importance of nutrition in old age, the positive benefits of minimal medication, and how vital it is to ensure good care of the feet. All of these help prevent falling. But here in the UK, NHS chiropody is a thing of the past for anyone who is “just” old. I don’t know of any older person who has had useful, regular advice and support about eating well. And many older people are on multiple medications which cause dizziness, which then leads to falling.

And when the almost inevitable happens and the older person “has a fall”, in most parts of this country there is still only one response, which is for two highly trained people to take them in a high-tech ambulance to the place where lives are saved, the hospital. And they will wait in A and E because it’s very busy there and their condition isn’t currently life-threatening. And they will deteriorate rapidly and possibly either get sent home, with an increased risk of readmission, or simply be admitted, in most cases never to go home again. Neither are great outcomes.

(I don’t know what the legal age is when one stops actively falling over and starts “having falls”. But I hope someone is campaigning for this term to be banned. Because it is passive and suggests that bad things just happen to older people. Which they don’t have to.)

In some A and Es, specialists in elderly care are at last being employed. We either need these people to be on duty 24/7 or we need everyone who works in A and E to become a specialist in elderly care because assessing and treating very old people is the majority of their work.

And we need to do all that we can to prevent as many as possible such visits in the first place.

As Benjamin Franklin said, for the want of a nail….

I love spending time with my mother and her friends and the parents of my friends. These people lived through WW2 and their parents through WW1. They have known hardship and loss. When they were growing up, anyone over 60 was old. They remember what things were like before the NHS. They are kind, funny and stoic in the face of much grimness. We owe it to them, and to the ones coming afterwards, including you and me, to reset the NHS dials so that it is possible to live well and to die well. And for everything to be focussed on helping older people to stay at home, or somewhere lovely that feels like home. In the end this will cost much less. And be so much better for everyone.

My elderly lady would probably not have survived another stroke. But how much nicer for her to die in her own bed, with the cat asleep on the end of it, than in a lonely hospital ward.

Now, can someone tell me who is in charge of Out of Hospital Care please? I’d like to help organise a renaming ceremony.

 

 

I wasn’t going to write another The Archers blog but….

My first Archers blog was about why it’s wrong to accuse someone of having a mental illness as if it were an insult. My second was about the chicken and egg relationship between mental illness and domestic abuse.

And this one? Well, it’s about the anguish we feel for women like Helen who find themselves caught in an abusive relationship trap. And my wish to make sense of this gripping story in both literary and psychological terms

How the story makes us feel

I defy anyone who has actually listened to The Archers recently not to find Helen’s situation upsetting. This week’s interview with her barrister, the apparently brilliant Anna Tregorran, was particularly so.

I know some people are saying it is too much. I understand. But I also disagree. Fiction plays an important role in our emotional and psychological development. It helps us to understand the bad things that can happen and practise emotions that we may one day need to use in real life. This is why so many children’s books feature cruelty, unfairness and loss – Bambi, Black Beauty, Little Women, Harry Potter.

Most listeners to The Archers don’t need to prepare for domestic abuse themselves. But they will undoubtedly come across someone else who experiences it. If Helen’s story has raised people’s awareness even a little, so that they are alert to the signs and don’t pretend it can’t happen in any family, then that is a very good thing.

Reflections in literature

I heard The Archers producer Sean O’Connor on the Today programme this week speaking about the literary references evoked by this storyline. He mentioned the Thomas Hardy classic Tess of the D’Ubervilles, which I could not bear to re-read because what happens to the central character is so awful. It made me think of that other classic, A Pin to See a Peepshow by F Tennyson Jesse, which has an equally grim denoument.

Women touched by madness who turn on their cruel husbands appear in other works of fiction, including Jane Eyre and Wuthering Heights. Both meet sticky ends, whereas their husbands survive, albeit scathed.

In real life, the last woman to be hanged in the UK was Ruth Ellis. She killed her abusive lover, handed herself in to the police and stunned everyone including her trial jury and executioner with a dignified acceptance of her fate.

Why can’t the police see through Rob?

I’ve been puzzling about this. Of course, it works for the story that Rob remains plausible for the time being. But is he faking it? Probably not. People like Rob, ie narcissists, really do believe their own hype. His reaction, being pathetically sorry for himself and yet capable of sticking his own metaphorical knife into Helen as soon as he gets the opportunity, is not how most of us would react to being stabbed by our partner. We would be deeply traumatised, shocked and inarticulate. Like Helen. I am really hoping that Borsetshire’s finest have got a good psychological profiler on the team who will help them see through his glib account.

Is it better for Helen that Rob has survived?

Initially, perhaps not. Rob is now a witness. The police must listen to his story and he will do his best to implicate Helen as a mad, bad attempted murderer. Plus he is allowed to see Henry and so has the opportunity to manipulate him and plant untruthful ideas to confuse the child about what he may have witnessed. Which at the very least was that Rob got the knife out and was inciting Helen to cut her wrists just before the incident occurred.

On the other hand, attempted murder is better than murder. At some point, Helen will start to remember how Rob made her feel. Without the guilt of having killed him, and with the help of her legal council, she will hopefully start to judge herself less harshly than she is doing at the moment. And the pain of Rob being allowed to see Henry when she cannot may just be the motivation she needs to make her fight for herself. As she was doing when the incident occurred.

What could happen to Helen?

I’m no legal expert. But I know a bit about mental illness. If Helen is convicted of attempted murder, I hope she would be assessed not to have been in her right mind at the time of the assault. She would then hopefully be sent to a secure mental hospital to receive expert treatment and care. With the right help, she could be released on licence within a few years. And with luck, she would see the children while she was in hospital and get help to look after them when she comes out.

But in reality there are not enough places in secure hospitals for women. And in any case Helen already seems to be being led down a criminal justice pathway rather than a mental health one. And so the likelihood, if she is convicted, is that she would go to a women’s prison and spend a number of years behind bars. The baby would probably be removed from her soon after birth because she would be considered a risk, based on the nature of her offence. And Rob would go to court and probably be successful in getting full custody of both boys. Helen is already at high risk of suicide; this outcome would increase her risk level.

But the most hopeful scenario is that, with support, Helen will be able to mount a successful defence that she acted in self defence and/or provocation because of the abuse. She might then be given only a suspended sentence.

But she will still have to fight Rob for custody of her own children. She faces a long, hard battle. And we all know her resources are already depleted.

What does the story tell us about the way we treat women?

For me, this is the key question. There are numerous real life cases of women serving sentences for the murder or attempted murder of abusive partners, despite suffering years of cruelty and abuse. When partners, usually women, act as Helen did either in self defence or because something finally snapped, they are judged harshly by the media and by juries.

And is it also disturbingly the case that only a fraction of those who abuse their partners are ever convicted of assault. The new offence of psychological abuse has only seen a handful of convictions. Plus it will only apply in Helen’s case as a defence – Rob is not the one who has been arrested and charged.

There are no winners in domestic abuse. Victims often get blamed not only by the abuser but also by others. If there are children, their long-term mental health can be permanently affected by living in a culture of fear and violence or even being separated from their mothers, like Henry.

We need a more humane, honest approach to domestic abuse. We need to talk openly with boys as well as girls about what loving relationships are. And what they are not. And we need to find better ways to challenge the way partners, male or female, are treated by complete and utter tossers such as Rob.

The next time someone you know puts their partner down in public, speaks dismissively about them or seems overly possessive, remember Kirsty. Maybe you could find a way to speak to the person you are worried about, and ask if they are ok. Even if they brush you off, know this: at some level they will have been listening.

And that might just be the catalyst for them to get help. Before it is too late.

Respect

Lisa oval

With growing frustration, I watch how friends who are “experts by experience”* are increasingly being treated by the NHS and the various bodies tasked with inspecting and improving it. Such as being invited to be part of an inspection as an equal member of the team. But being paid many times less than anyone else, possibly even less than the living wage. Or being asked to join a group to produce guidelines or develop a new treatment or service change, bringing knowledge, skills and experiences that no-one else around the table can possibly have, for nothing or for a fee that is so close to nothing as to be insulting. Or being invited to speak at a conference but being told that “we have no budget for speakers” when clearly the conference is a commercial event AND the other speakers are being paid either by virtue of being in full time employment or a handsome fee.

I had an NHS career spanning 41 years, including 13 as a chief executive. My career as an expert by experience only began officially in 2013. But I have the benefit of an index-linked pension, which allows me to live well (although not as well as some might think because of decisions made when I was young and poor). Plus I can still earn money doing other things. So I can make choices about how I respond to people who invite me to speak at their events or otherwise draw on my experiences.

But many of my friends do not have that luxury. Opportunities to develop careers have been fractured by illness, disability and arcane, terrifying benefit rules which are themselves disabling. Their earning potential is therefore limited.

And my friends find that their generosity, goodwill and desire to help others is increasingly being abused. Despite rhetoric about patient centred care, co-production, peer-learning and a whole load of other worthy aspirations spouted by leaders in and around the NHS, those very same organisations are showing an increasing lack of respect and value for the only people who can truly help them achieve their improvement aims.

I’ve done it myself. Years ago, when I saw the size of the budget allocated to service user involvement on an important capital scheme, I knew it would be the first place I would have to go to make savings, should any be needed, despite it being a pittance compared with the professional fees being paid to architects, quantity surveyors, lawyers and the like. I did it, and at the time I rationalised it because I felt I had no choice. Looking back, I feel ashamed.

Why do we, as a society, place so little value on what matters most? Why do we pay the person who cares for our loved ones when they are dying barely enough to cover the rent on a pokey flat, whereas a man running some oil company gets £14 million a year? And why we do only see success in terms of earning potential, rather than the gifts a person brings to other humans and the planet?

I can’t change societal values. But I can make an impact on what we do in the NHS. I am lucky to have a voice. And I’m going to use it.

Wise managers understand this:

  • If you can save money and achieve the same outcomes, that is a cost saving
  • If you spend the same amount of money but do something better, that is a service improvement.
  • If you spend more money to achieve a better outcome, that is a service development
  • If you spend less money and achieve less, that is a service cut
  • But if you spend less money and pretend you are doing it to make an improvement, that is usually a lie and a cop-out

So to the people who say that they’d love to pay experts by experience what they used to pay them, or even anything at all, it’s just that the money is really tight and it’s getting even tighter, I say this. Please think again. What else are you spending that public money entrusted to you on? What really matters to you? And if you must make draconian savings, why not try being as parsimonious with your auditors, your bank, your staffing agency, all your other contractors for professional services, your regulators. Even your directors and your staff.

And let’s see what happens.

And to my expert by experience friends I say this: we have something that the NHS should treasure, our personal intellectual property. Let’s continue to be generous and compassionate in how we share it.

But let us also expect respect.

*Post Script: I understand that the term “expert by experience” is of itself problematic. It implies that all the person brings is their experience of a condition and the treatment for that condition, rather than a much wider set of skills and attributes that, almost certainly, will bring richness and intelligence to the debate and from which those who work in the system will benefit in ways they had never envisaged. If, after conversations with wise people, I can work out something useful to say on this, I will. For now, I apologise about the paucity of the term.

Post Post Script: It is less than 48 hours since I posted this blog. It has been looked at 700 times, stimulated over 500 responses via Twitter, and comments such as the ones below. It seems that I have touched a nerve both for those affected by the things I have written about, and for those working in organisations that describe one thing in their values but seem to act in a different way. That was the purpose; there is no point blogging if there is no subsequent debate.

I am grateful to all of the commentators, but especially Alison Cameron @allyc375 who helped me over the terminology and with whom I am hopefully going to be doing a double act soon on this very subject – watch this space. To Dr Shibley Rahman @dr_shibley whose original thinking brightened my Saturday evening. And to David Gilbert @DavidGilbert143 who reminded me that Patient Leadership is a useful way of thinking about this. He kindly agreed to me referencing this series of articles co-written by him and Mark Doughty @markjdoughty which I would urge anyone who wants to think more deeply about this to read.

Time are indeed tough. And in tough times, it helps to know who our friends are, and whether the values they tell us they espouse are really their true values.

I send loving kindness to everyone reading this.

 

What mental health means to me

I took part in a Twitter chat recently on the above topic. Thanks to @AnthonyLongbone for encouraging me to join in. Below are some thoughts I shared in advance.

What does mental health mean to me?

  1. Mental health is the most important part of health. And it is integral to physical health. You can’t look after your body if your mind is in a poorly way.

  2. Mental health is a continuum with optimal wellbeing at one end of the spectrum and mental illness at the other. Some people seem to be able to take good mental health for granted. For others, maintaining our mental health requires almost constant vigilance and care.

  3. Facing up to my tendency to depression has been the most important self-help step I have taken in my life so far. I’m hopeful I won’t ever sink as low as I did in 2013. But I’m not making any assumptions. And I do not plan to judge myself negatively if I do experience another bout either.

  4. Judging myself – or indeed others who experience mental illness – is the least helpful thing any of us can do. Who knows why I or anyone else has this tendency? What does matter is what I do from now on to help myself and allow others to help me. Which includes understanding my own triggers and warning signs.

  5. All serious illnesses require some degree of courage, so that we can face the pain and the treatment required to help us get better. But mental illnesses can be harder to bear than physical illnesses . They mess with your head.  They make you believe bad things about yourself and others. They take away your hope and they affect your judgement and even your personality. They make you isolated and afraid. Some people hear the voices of others telling them bad things. In my case, I only hear my own voice. When I am poorly, my internal voice is harsh, judgemental and cruel. It tells me I am worthless and evil. I am still learning how to notice that voice when it starts whispering to me, and how to answer it.

  6. Since I decided to be more open about my own experiences, I have made some extraordinary friends. Our mutual support during rocky moments via social media undoubtedly saves and enhances lives. I love the equality and the loving kindness of these relationships. We all have something to bring.

  7. It’s because of all this that I know how amazing other people who experience mental illness are. How courageous, funny, honest, thoughtful and kind – hearted.  And this is how I know, beyond all reasonable doubt, that people who have had such experiences have assets that should be applauded and sought by others. Rather than deficits to be pitied or avoided.

…………………………………………………………

After the chat, I felt a bit overwhelmed. The people who joined in were just amazing. Brave, honest, intelligent, thoughtful, generous and kind. I am in awe of them. They have far more of merit to say than I do.

In conclusion, what mental health means to me is being part of a group of wonderful people like the ones I was talking with tonight. They are helping me to become the best version of myself, which includes being kinder to myself. Through this, I can become kinder to others and do my tiny bit to help them too.

And I’m really grateful to be on that journey.

The ones who matter

Lisa oval

It was nice that 12,500 people read my two recent blogs on the mental health angle of a current The Archers storyline.

But it wasn’t all good. I am a sucker for positive reinforcement, including WordPress stats. And I doubt I will ever again get 4,500 views in a single day.

And that’s the thing about maintaining one’s mental well-being if you are one of the 1:4 people like me for whom it is sometimes a struggle. I’ve been a bit down since those two blogs. I’ve questioned whether I’ve got anything interesting left to say. And yet I know I need to write about stuff to work out what I think.

Here’s what I’m thinking about today.

Someone said to me recently, with real sincerity, that the tide is turning on the stigma of mental illness. They said they thought that the battle had been won because people like me can stand up and say that we sometimes need help from mental health services. And not be judged.

But I thought hmm.

Because it doesn’t feel that way. Not to me, nor the friends I’ve made through social media and in real life. Especially not those who haven’t been as fortunate as me and are forced to grind out an existence on state benefits juggled with occasional paid work. The positives from such work are overshadowed by arcane, dis-empowering rules of which it is almost impossible not to fall foul. Nor does it feel that way to those who live in fear of losing their homes, or who haven’t even got a place to call home. Current government policy feels deeply discriminatory and the exact opposite of therapeutic for those already experiencing the potentially crippling challenges of mental illness.

It doesn’t feel that the stigma has gone away for the people who can’t get the right mental health treatment, or even any treatment at all. As a wise person recently said, imagine telling the parents of a child with early stage cancer that they have to wait until things seriously deteriorate before they can see a specialist. And even then, the care will be rationed and probably not what is recommended. That’s the reality in many parts of the UK, for children and adults too.

I heard a senior commissioner say the other day that they would love to invest more in mental health, but the evidence just isn’t strong enough (my italics). What planet are they living on?? True, spending on mental health research is woeful. But there is nonetheless masses of really good evidence about what works. And it starts with intervening early via properly funded local services delivered by highly trained, well-supported staff.

What also doesn’t help reduce stigma is the almost constant service redesign and reconfiguration. Indeed, the billion pounds of “new” money announced by Jeremy Hunt after the Mental Health Taskforce Report was published is not, in fact, new at all. It has to be achieved through efficiency savings. I know from experience that such initiatives rarely achieve all that is promised. And they almost never take account of the collateral damage to staff well-being.

Not to mention competitive tendering, which mental health services face at disproportionately greater levels than other parts of the NHS. Plus the drip-drip reduction in mental health funding and the erosion of national data collection so that it takes the skills of investigative journalists to uncover the ongoing cuts that have been made over the past 6 years despite government rhetoric about parity of esteem for mental health.

And what adds further to the stigma is that the media rarely mention mental illness or mental health services except when something appears to have gone wrong. Where are the motivational stories like the ones about people who have “beaten” cancer? Even when no mistakes have been made, the finger of blame gets pointed. Imagine how this feels to staff who work in these services, being pilloried for doing a job that most people couldn’t begin to contemplate because they don’t have the skills, patience, courage and compassion needed to work in mental health. They should be lauded and supported, not ignored and criticised.

So no, the stigma of mental illness is not a thing of the past. It is ugly, cruel, destructive and ever-present. Like racism, sexism and homophobia, it will never truly go away. We have to be vigilant. And we have to keep working at it.

Despite the job I once did, it took me until I was 58 to get over my own self stigma and admit that I experienced clinical depression from time to time. Coming out about it was the hardest but also one of the best decisions I ever made. I take my hat off to others who have got to that point sooner than me. You are braver than anyone who hasn’t been there will ever know. Showing the world that people who experience mental illness have hopes and ideas and other wonderful human assets to share is the best way there is to make others want to join us and change the way things are.

Writing about mental health and The Archers was fun. Writing this piece was harder but far more satisfying. I will try not to care how many people read it.

Because the ones who do are the ones who matter.