courage

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.

Please read Dr Dean Burnett’s brief analysis here.
Learn how depression is a physical illness and why exercising when you are having a severe episode can be very harmful here.
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.
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.
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.
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.

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.

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.

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.
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.
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.
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.
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.
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.
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.
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.
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.
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.

Baby boomer meets digital natives

The organisers @DanielOyayoyi and @RebsCullen and me

On Friday I spent a morning in Leeds with 100 trainees from the 2015 and 2016 intakes of the NHS Graduate Scheme. They had arranged a conference about digital media #NHSGetSocial. Thank you @DanielOyayoyi and @RebsCullen for inviting me to talk about raising awareness via social media. That I, an ageing Baby Boomer, should address a group of Digital Natives on this subject felt hilarious. As so often these days, I gained much more than I gave.

En route to the event I did a bit of crowd sourcing via Twitter to help illustrate my session. This was the first response:

The audience seemed to agree. They could think of examples of leaders who seemed uncomfortable with social media using it poorly, mainly to broadcast rather than interact.

There were also differences between how those with extrovert and those with introvert personality preferences interact with social media. Some had very sensible anxieties about tweeting first and regretting later. And others were honest about how hard they found it to decide what, if anything, to say via social media.

So I shared my social media tips:

Do it yourself.
Don’t rise to the bait or tweet when angry or under the influence of dis-inhibitors.
Share opinions but remember they are only your opinions. Others may disagree.
Where possible, stick to facts and values.
Don’t believe everything you read.
There ARE trolls out there. But not as many as you might be led to believe.
Be kind, always – to yourself and to others.

And I shared some of the responses I had received that morning, including these from @nedwards1, @forwardnotback and @anniecoops

The audience also seemed to agree with the Twitter response to my second question. We talked about the Daily Mail and other media that love to name, blame and shame politicians and those who work in public services but seem much less keen to call out wealthy tax avoiders or those who “create value” by paying minimum wages and offer zero hours contracts. And how even when they get things wrong they rarely apologise.

We talked about agent provocateurs and others who make things up and then either delete them or simply deny they have said it, even when there is photographic evidence to the contrary. The conspiracy theorists who lap this stuff up. And the anonymous characters who lurk on comments pages and bang on about no smoke without fire.

And we talked of the damage this all does to those who dedicate their lives to working in public life, but also how clinicians and managers can work together to call this dishonesty out, live by their values and counteract the post-fact world poison.

My other three questions were about patients and a paperless NHS.

Again, although hardly a representative sample, my Twitter replies accorded with the audience. They said that attitudes mattered as much if not more than IT. I told them the story of a medical colleague who would write to me every six months or so during my 13 years as an NHS CE listing everything that he felt was wrong with how I was leading the trust, including the inadequacy of his secretarial support, in a 3 -4 page letter typed, somewhat ironically, by his secretary. I would always reply, by email. By contrast, my own psychiatrist, a world renowned professor at another trust, personally typed his update letter to my GP during our consultation and gave it to me to pass on. He would have used email but it wasn’t yet sufficiently secure.

We also discussed the pros and cons of clinical staff spending increasing amounts of time away from patients collecting and recording data that someone somewhere thought might be useful. And that the gold standard of a fully connected wireless NHS when patients and staff freely shared information via iPad or other tablet device would happen one day. But that given the current state of connectivity, they probably shouldn’t cancel the contract for supplying paper and pens anytime soon.

Finally, I shoehorned in a reference to my muse Mary Seacole. I said that she, a 19th century health care entrepreneur, would have loved social media. And I gave Daniel and @HPottinger, in the picture below, my last two Mary Seacole enamel badges.

At the end I said that I would be writing a blog about the day. And I really hope some of them read it. Because those 100 young people made me think. Despite the financial challenges, morale problems, almost infinite demands plus the debilitating impact of our post-fact world, I think the NHS may be OK.

And you know why I think that? Because these young leaders, and thousands of other clinicians and managers like them, will make it so. With shining integrity, stunning academic AND emotional intellect, insatiable appetite for understanding, capacity for working smart as well as hard, courage to speak truth to power, and wisdom far beyond their years, they will do it. They will help our creaking NHS adapt for the new era. Whilst holding hard to our core values of high quality, safe care for all, regardless of ability to pay.

And as one who is likely to need a lot more from the NHS in the future, that makes me very happy.

Take good care of yourself

Leaving flowers 2014

Another longer blog based on a talk, this time for Point of Care Foundation Community Conference on 27.10.2016

These days I usually introduce myself as a writer, coach and mental health campaigner. Sometimes I say I’m a charity trustee. I might talk about Grassroots Suicide Prevention and how we help to save lives by training people in mental health awareness and suicide prevention techniques. Or the Mary Seacole Trust and that now we have achieved a beautiful statue to the first named black woman in the UK, we intend to smash the glass ceiling that still holds back the careers in business and in public life of women and, even more so, BME people. Occasionally I mention my voluntary work with Time to Change, or that I am training as a Samaritan. And I might say that I love writing fiction, cryptic crosswords, cycling, making jam, Brighton and Hove Albion FC, the Archers, and my family and friends.

Only if relevant do I refer to my 41 year NHS career as a nurse and health visitor, then manager. I prefer not to be defined by what I used to do. I don’t want to live my life in retrospect. I may be over 60, but I feel I have so much more to do and give.

However, for the purposes of today, I need to explain that I was chief executive of a mental health trust in Sussex for 13 years, from 2001 – 2014. And now I am a recovering chief executive. I have Professor Sir Simon Wessely, President of the Royal College of Psychiatrists to thank for that description. And he is right; it describes me well. I have been writing a book about my experiences. I thought I had finished it. But then a few things happened and now I’m less sure. Nonetheless, I have insights I want to share with you.

The main one is this: please don’t do what I did as far as looking after yourself is concerned. I didn’t always make a good job of it. And it wasn’t only me who suffered.

It started with that over-developed sense of responsibility that many of us who choose a career in healthcare seem to have. We are often the first child in the family. If not, we are the one who looks after our siblings, even our parents. In my case, I was also the only girl. Being caring and helpful was expected, and the best way to evoke praise.

People with certain personality preferences have a tendency to choose a career in a caring profession. Another tendency of those with these profiles, and I am one, is to find it hard to say no. We also tend to take criticism personally, we can be overwhelmed by setbacks, and we can experience guilt more readily than those with other profiles. We are also find it very hard to tell others when we are not OK. None of this is set in stone, of course. They are only tendencies; one can learn to modify one’s responses.

The classic personality profiles for people in senior leadership roles are different. They tend to be confident go-getters, driven by vision, analysis and logic rather than feelings of responsibility. They like making decisions, challenging others and being challenged themselves. And so the tendency of leaders who do not fit such a profile is to try to act as though they do. And to pretend not to mind things that they actually mind very much.

I struggled a bit as a student nurse. But once qualified, I got huge satisfaction from clinical practice. I loved helping people, especially those down on their luck. I always will.

I eventually moved into management via a series of lucky accidents.I had no long-term plan to become a chief executive, even a director. It just happened. I fell in love with the trust I eventually ran because of a chance meeting with some adults with learning disabilities who I had known as children many years previously. Their care wasn’t terrible. But it could have been so much better. And then a senior colleague told me that mental health services were a backwater and that if I took such a job, I would never escape to do anything else. And that was it really; I was hooked.

For the most part, it was wonderful for me to be able to influence the care received by people who were usually at the bottom of the pile, to challenge stigma and discrimination locally and also nationally, to be busy and in demand, and to have the opportunity to work with a bright, engaged team I had the good fortune to build from scratch. Whilst we were all different, we each cared deeply about providing care that we would be happy to receive ourselves or for a member of our own family to receive. And when the care we provided failed, we minded very much and did whatever we could to put it right.

But I also got some things wrong. I can ignore details if they don’t tell me what I want to see or hear. And I wanted every project to go well. So I sometimes reacted badly when not all of them did. I was often overwhelmed by self doubt and imposter syndrome. I had sleepless nights, especially after incidents when things went wrong for patients. I felt very lonely at such times, but I didn’t feel I could tell anyone – I thought I had to tough it out. And this was counterproductive because trying so hard to appear competent made me less approachable to others who were also struggling.

I also wanted my team to be one happy, harmonious family. Without breaking any confidences, I would overreact to disagreements and try to play the peacemaker when what we needed was more discussion and debate. It took me a long time to realise that I had assumed the role of parent or older sister, when a more adult to adult relationship would have served us better. I am grateful to those who persuaded me eventually to see this – we got there in the end.

Although suicide amongst those using mental health services accounts for only a quarter of such deaths, it is, very sadly, not an infrequent occurrence. It took me a long time to admit to myself that the reason I found it so distressing was because I knew something of how desperate those who took that step must have been feeling. And even longer to admit it to others. Although I worked hard not to show it, I found it almost unbearable to be criticised by regulators or via the media for failing to stop someone from taking their own life. I felt guilty both that we had failed, and that I wasn’t always successful in defending the efforts of the staff, who had often kept the person concerned safe for many years and were themselves also devastated. I also know that the effort of hiding my own distress sometimes made me less sensitive to theirs.

Risk assessment, of which much is made these days, is an imprecise science. Some believe it has no scientific validity in preventing suicide or homicide by someone who is mentally ill. And yet people lose their jobs, even their careers, over not applying it correctly. They are judged by those privileged to look at the full facts of a case at leisure, with the benefit of hindsight. Rather than under pressure in real time in a busy hospital or clinic or on a difficult home visit. And without enough of the right resources. Families can be led to believe, sometimes erroneously, that a chance event that has changed their lives forever might somehow have been predicted or prevented, and that someone must therefore have been at fault. Unless NHS staff have erred deliberately or been recklessly careless, it is seldom the right thing to do to blame them, whether they are a junior nurse or a very senior manager. It is cruel and reductive and unlikely to bring about positive change. In fact it is likely to make people fearful and to drive poor practice underground.

I am extremely grateful to those who helped me to understand a more nuanced way of thinking about suicide, especially to Dr Alys Cole-King of Connecting with People, my friends at Grassroots Suicide Prevention, and Samaritans. I also thank John Ballatt and Penny Campling, whose book Intelligent Kindness enabled me to understand what was wrong with the traditional NHS approach to serious incidents, as well as a few other things. And to the Point of Care Foundation, whose outstanding work helps professionals to nurture their compassion and non-judgemental curiosity, despite the challenges of today’s NHS.

Some people reading this know that I saw my first psychiatrist aged 15, and have been troubled off and on with anxiety and depression throughout my life. I am still trying to make sense of why i felt so ashamed of this for so long, and how I managed to get through 12 of my 13 years as a chief executive of a mental health trust without blowing my cover. All I can say is that I am well-practised at pretending to be OK when I am not.

I eventually began to talk about it the year before I retired as my personal contribution to reducing stigma. It was even more painful than I had expected. I felt exposed and brittle. I couldn’t sleep or think straight. I was forgetful, jumpy and irritable and my judgement went downhill. I wondered if I was going mad, and in a way I was. I had such terrible stomach pains that I thought I might die. It would honestly have been a relief. And then I started to cry, and couldn’t stop. Driving home, I nearly crashed the car on purpose into the central reservation. It was only the thought of the fuss it would cause for others that stopped me. For the next 8 weeks I huddled in the dark. Slowly the kindness of my GP and psychiatrist and that of my family, closest friend and work colleagues made me realise that perhaps I wasn’t the worthless pile of ordure I had thought I was.

Although I will let you into a secret; it wasn’t until I had been back at work a few months and had undergone a course of therapy that I finally accepted that I hadn’t been faking my latest bout of depression. And that I wasn’t the selfish, lazy, waste-of-space I was called by a nurse when I made an attempt on my own life many years earlier. His words stayed with me because I agreed with him.

If speaking up was hard, going back to work in January 2014 was harder. But it was also part of my recovery. It felt liberating to be able to be open about why I had been off. I found conversations with clinicians, managers and most of all patients were deeper and more meaningful. I was a better listener, and I wasn’t rushing to solve everything, as had been my wont. I found that I could listen properly to criticism, and appreciate what the other person was trying to say without feeling the need to defend the trust or myself. My final eight months before retiring in the summer as planned were the happiest of my whole 13 years.

If you have the sort of tendencies I have, here are five tips from me to help you take care of yourself.

When something goes wrong and you or those for whom you are responsible make a mistake, try not to be disheartened. Allow yourself time to process what happened and why. Apologise wholeheartedly. But do not be rushed into snap decisions. Treat yourself and your team as a work in progress.
When someone offers you criticism, try hard not to be devastated by it. But also try not to reject it out-of-hand. Take it for what it is, just an opinion that may or may not be useful.
Don’t pretend to be someone or something that you are not. It is exhausting.
Exercise is important, and so is eating well. But sleep is healing. We all need it or we can’t function. If you are having trouble sleeping, then you deserve some help. This advice from Mind is a good starting point.
Remember that being kind to yourself is not selfish. It is actually extremely unselfish. Because it is only through being kind to yourself that you can truly be kind to others.

It was Carl Jung who initially wrote about the wounded healer. There is nothing wrong with being motivated to help others partly because one has issues oneself; such experiences can help the care giver to be more empathetic. But if we truly care about others, as I have learned at great cost, it is very important that we do not pretend to be OK when we are not.

Because, as Karl Rogers, a successor of Jung said: what I am is good enough if I would only be it openly.

Dear Rob Titchenor

Dear Rob

Last week I wrote a letter to Helen. It went down quite well. I’m not sure that writing to you will be quite so popular, but I feel rather strongly that you need support. Although probably not for the reasons you think.

You seem to believe that you have been badly wronged by recent events. Life is rather grim, despite the prospect of the new job. But until you take responsibility for the pain and psychological damage you caused Jess and Helen, you will continue to hurt others and yourself.

You talk about Henry and Gideon/Jack as though they were your personal possessions. Everything you say about them is expressed in relation to how you feel. This is not how good, loving parents behave. Good parents put their children’s needs before their own. They are prepared to give up anything for their children’s sake, even if that means never seeing them again. They would give up their own lives for them if they had to. Could you do that?

Your psychological development has been badly affected by your own parents. Your father is a cruel ill-tempered man who judges others harshly and withholds love. He has abused your mother psychologically for many years. She has learned to accept his put-downs and capitulate to him, including sending you away to boarding school when you were very young. This has left you deeply scarred.

You have absorbed your father’s misogynistic attitude to women. You love your mother but treat her as a useful fool. You treat the women you have relationships with as sex objects and workhorses to be manipulated and controlled. You are ultra-competitive, deeply jealous and you struggle with controlling your temper. You have an unreasonable sense of entitlement and you perceive your own attributes and the faults in others far in excess of reality. This causes you problems in your work and personal life.

Some people would describe you as a narcissist, a person whose psychological development has been arrested in response to excessive criticism or other trauma as a child. I’m not sure if such a label is useful, unless it encourages you to seek help. What I do know is that you need help. Badly. Because your behaviour is going to get you into really serious trouble one of these days. And because although you pretend otherwise, you are very unhappy.

It won’t be easy. You are going to have to rethink everything you currently believe about yourself and others.

It is possible that you can be rehabilitated. It can happen in real life as well as in a soap. And if you and the writers of The Archers can do it, it would be a good thing. It would send a positive message that it isn’t down to the woman and the criminal justice system to combat coercive control. The only thing Helen got wrong was to be vulnerable. It was you who targeted, hoodwinked, bullied, abused and raped her. So it is you who needs to change.

There are services available to help men like you. Although not nearly enough of them. Such work takes great patience and skill and it isn’t quick. But it is essential because there are far too many men who physically and psychologically abuse the women they profess to love. A few end up in prison. The majority get away with it. And go on to ruin the lives not only of those they have already abused but also of the next women and children who are unfortunate enough to form relationships with them.

So I encourage you to seek some professional help. Here are some useful numbers and websites:

Respect – organisation that specialises in helping to end domestic abuse
Respect Phoneline 0808 802 4040 – Confidential helpline for those who are worried that they are abusing a partner
Refuge – website with information about help if you think you may be an abuser

If you can admit to what you have done, Rob, it would be a very good first step. You talk frequently about “being a man”. Facing up to being an abuser is what a real man would do. It will take considerable bravery. And it won’t be easy.

Helen showed immense courage in eventually standing up to you. Could you find courage like that to face yourself? I really hope so.

Wishing you well.

From Lisa

Dear Helen

At last it’s over. You are free and safely home at Bridge Farm. The judge saw through Rob and gave you full custody of both boys. Your nasty husband won’t be allowed to see Henry at all and will only be able to spend limited time with Jack under Pat and Tony’s supervision.

The nation breathes a sigh of relief. We can return to wondering who will win the Flower and Produce Show.

But I’m still worried about you.

I’m worried because you can’t cut Rob out of your life completely. He’s Jack’s father, and he will no doubt be manipulative over access. And he’s still living in Ambridge. You have a divorce to face, with legal and financial settlements to get through. You have been very brave, but you are going to need to continue to be so for a long time. And that will be hard.

I’m worried that things may be rocky for a while with Henry. He’s only a little boy, and he is bound to have a reaction too. Despite ‘Daddy’ having been unduly strict and irascible, he was there when you were not able to be. Henry may resent you for disappearing while you were in prison: he won’t be able to understand why you couldn’t be at home with him. He may tell you he misses Rob, and you will have to work out what to say and do that will help him.

I’m also worried because you’ve experienced a series of terrible traumas – coercive control over two years, multiple rapes, the incident that led to the stabbing, imprisonment, loneliness and separation from Henry. Plus the fear of being convicted, having Jack taken away and never seeing Henry again. You are a very private person; the trial must have been excruciating, with everyone knowing your business. These things will have had an impact. And there is bound to be a reaction. You may find yourself feeling flat and exhausted. Or even sinking into despair. Please don’t pretend to be OK if you are not. Please talk to someone, maybe your Mum or Kirsty, however hard it feels to do so.

And I’m worried that the reasons Rob was able to manipulate you haven’t changed. You are a thoughtful, caring person. But you are also vulnerable. You’ve lost a brother and a previous partner, and now all this. Even if you don’t feel the immediate need for professional help, when you are ready it might be good to explore the things that have happened to you, the impact they have had and how you want to live your life in the future. If you need professional help to do this, it is nothing to feel ashamed of. In fact it is a courageous and unselfish thing to do. Again it won’t be easy. But it will be worth it.

I’m not a complete idiot, Helen. I am well aware that you are a fictional character. But you represent something very real to listeners. You have touched a nerve in all of us about narcissistic charmers like Rob who in subtle and not-so-subtle ways undermine and manipulate their partners, leaving them confused, diminished, even broken.

We Archers fans love how this story has been given time to breathe. No other soap could have done this. As there is no other soap that could allow your character to face the aftermath of the abuse slowly and gently, in real time.

Some people think The Archers is all about smug middle class farmers to whom nothing ever happens, with a few working class folk thrown in for a bit of comic relief. How wrong they are.

Thank you Helen and The Archers for showing us what it’s like to meet Mr Wrong. It is a lesson that we all needed to learn.

Wishing you much love and luck for the future

Lisa

#DearDistressed

Letter for World Suicide Prevention Day 10^th September 2016

Written for the #DearDistressed campaign launched today by Connecting for Health and republished here with their kind permission.

Dear Distressed

Thank you for opening this. You probably won’t feel up to reading much. So I need to grab your attention.

I want to tell you something. I have been where you are. I have felt that my life wasn’t worth living. Sometimes I knew why; mostly I didn’t. It has happened a number of times over many years. I have contemplated suicide. I even tried to take my life. But I’m very glad to be here because otherwise I couldn’t write to you now.

Making an admission about feeling suicidal isn’t easy. It can be shocking to face, for you and others. But also you don’t want people to overreact. You just want to be able to talk. And yet the chances are, you won’t have spoken to anyone about it. You may feel ashamed, as I once did. And still do, on a bad day.

Distress of this sort is overwhelming. Especially if you keep it bottled up. It blocks out the sun. Yes, it is different for each of us, because we are all different. But what makes us similar is the awfulness of it. Lying awake for hour after endless hour, whether alone or next to someone you can’t talk to about the darkness of your thoughts. Everything seems pointless. You worry about stuff you used not to worry about. And the big things that were worrying you already are overwhelming. You feel loathsome, undeserving and useless.

So what might have helped me when I was where you are right now?

It would have helped if I had managed to talk to a loved one or a friend. Eventually I have learned how to do this, although I still find it hard. I have been surprised by the kindness and understanding shown. Suicide is still taboo for some, but less than it was. And talking can really help.
I called Samaritans a few times, from a phone box – there were no mobile phones in those days and I didn’t want to be overheard. They were amazing. They weren’t shocked and they listened really carefully. Nowadays calls to Samaritans are free so you don’t need credit. Ring 116 123 anytime, day or night, and talk to a trained volunteer.
A hospital nurse once told me that I was a cowardly, selfish waste-of-space who had taken him away from looking after people who were really ill. I believed that nurse. And that was how I saw myself for many years. I wish I had instead remembered what a kind GP said when I apologised for bothering him, which was that I was worth the effort.
I wish could have had a smart phone installed with the #StayAlive app by Grassroots Suicide Prevention for androids or iPhones. As well as useful information, advice and support, it encourages you to store reminders of how you feel on a good day, and keep special pictures and notes in one place. Now I look at mine most weeks. It makes me feel safe.

Learning to be kind to oneself can be a lifelong project. But if you aren’t kind to yourself, it is much harder to be kind to other people. For that reason, it is a generous and thoughtful thing to do. Rather than a self-centred indulgence, as I once believed.

Thank you for reading this. I hope it helped a bit. And if it didn’t, it doesn’t matter.

Because know this: you are not alone.

With loving kindness from