stigma

BEING AN NHS CHIEF EXECUTIVE…

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

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

Why did you write it?

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

Is there still stigma about mental illness?

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

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

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

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

What is your biggest regret?

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

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

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

What are you writing now?

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

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

Watching my privilege

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you.

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.

Improving the NHS: with added tribute to Dr Kate Granger

Last week I was introduced by Dr Kathy McLean, Medical Director at NHS Improvement to 180 people comprising senior NHS clinicians, managers, directors, chief executives, patient representatives and members of staff at NHS Improvement, including most of their executive team. And I wondered how my homespun talk about improvement, leadership, the universe and everything would go down.

As it turned out, quite well.

The cartoon above was drawn by Inky Thinking. I don’t know how they do it, but they capture everything you say that you want people to remember.

Here is a word-based precis:

If you forget that culture always trumps strategy, your efforts to improve services will be ineffective. I’ve been there and occasionally done it the right way. But more often the wrong way.
You can’t help others to improve unless you are OK yourself. I have form on not remembering this.
Leadership in public services has never been harder with our 24/7 media, including social media, and the anti-public sector rhetoric that appears in most newspapers.
Plus we live in a post-fact world – see this article by Guardian Editor-In-Chief Katherine Viner. People believe things that are not true, and don’t believe things that are. I’ve had personal experience of this. And it is horrible.
Being an NHS leader is very lonely. Never more so than when you are awake at 3am. People get in touch to congratulate you when something goes well. But when things go wrong, people you thought were friends seem to melt away.
There is never enough time to think when you are running NHS services because of competing demands, often from those who are meant to be there to help you make improvements. But you must create time to think or you will make bad decisions.
Filling senior vacancies in the NHS is getting harder. And we should worry about this. Because if we aren’t careful, the only ones who apply to be in the firing line will be those who don’t care what others think about them. And that would be very bad for all of us.
We cannot separate leadership from mental health. In my opinion, people who experience mental illness from time to time can make exceptional leaders. It is only one thing about them. Plus, they develop skills through therapy that are invaluable – such as managing their own mood, listening really carefully, and not making assumptions about others.
I have experienced depression off and on since the age of 15. A nurse said something damaging to me when I was 22 and vulnerable which I absorbed deep into my psyche. For the next 36 years I stigmatised myself, despite being an active campaigner against the stigma of mental illness. It was when I finally came out about my experiences that I was able to address my self-stigma. I have made many friends since then. But if only I had done it before, I could have been a better, more authentic leader.
Mental illness messes with your head. It affects 1:4 of us. But 4:4 of us should care about it, not just on humanitarian and economic grounds, but because almost everyone can be affected. We are all on a spectrum of resilience, and if enough bad things happen to us, especially at a young age, most of us will experience post traumatic damage.
When I appeared suddenly to get ill with an acute onset of depression in 2013, it was a culmination of things. My own susceptibility, but also workload, loneliness, weariness as I approached retirement, not taking care of myself, listening too hard to my own negative voices, and putting a lot of energy into maintaining a positive front. It wasn’t caused by internet trolls. But they didn’t help.
So please don’t do what I did. Get to know yourself. Talk to yourself honestly about how you are. Talk to your loved ones. Take care. Be the best version of you, but make sure that it is you. And try always to see yourself as an improvement project – this makes it easier to accept criticism without it cutting you to your core. I’ve only learned this in the last few years, and it is a revelation!
I am lucky. I have dear family and friends. And I got great care. I was able to go back to a job that I loved, which was a major part of my recovery. I know it isn’t the same for everyone.
Since the summer of 2014 when I finally hung up my chief executive boots, I’ve been helping others in various ways to be the best version of themselves. And I’ve written a book which I hope you will read when it is published later this year.

As I finish this blog, I think of someone who embodies improvement in everything she does. The talented, compassionate and extremely resourceful Dr Kate Granger. Kate is currently in a hospice in what are probably the final stages of a rare and awful form of cancer. But as well as sharing the intimacies of her progress through terminal illness via her wonderful talks and social media, Kate has also revolutionised the NHS and other healthcare systems around the world with her #HelloMyNameIs campaign. She has written several books, and completed amazing things on her bucket list. And not content with that, Kate and her husband Chris Pointon are urging people to make donations to the Yorkshire Cancer Centre, a small charity that helps improve the quality of life of people living with cancer. You can donate here.

Kate and Chris demonstrate that being a leader isn’t a job, it is an attitude of mind. That anyone can make a difference if they focus on something that matters, turn a great idea into an innovation and build support for it through honest endeavour. We can all learn about improvement from them.

May you go well, both of you.

25 July 2016 postscript:

Chris has just posted on Twitter that his wonderful wife died yesterday peacefully in the arms of her family.

I only met Kate once. I will never forget her. She had an extraordinary stillness and presence. I hope the knowledge of the difference she has made and will continue to make for many years to come will sustain Chris and all who loved her in the difficult times ahead.

My heart goes out to all of you. May her lovely soul rest in peace.

What would Mary Seacole do?

Professor Elizabeth Anionwu and me

On difficult days, I ask myself what Mary Seacole would do.

Those who seek to denigrate her memory are more than mean – spirited. They not only question her nursing contribution in the Crimea – for which she was honoured by the British Army, the Times newspaper, Her Majesty Queen Victoria and 80,000 members of the public who attended celebrations in her honour. They also question whether she actually was a nurse. They say that she wasn’t really black. And having campaigned as hard as they could to undermine the Mary Seacole Memorial Statue Appeal, they now say that it is OK for there to be a statue to commemorate her, as long as it is small and not in a prominent position.

I will not stoop to naming these people nor to referencing the nastiness they have whipped up. Articles in The Independent and The Guardian have helped set the record straight. And today my dear friend Professor Elizabeth Anionwu CBE, Vice Chair of the Mary Seacole Statue Appeal, pictured with me above, will be on Woman’s Hour talking to Jenni Murray about the importance of Mary’s memory to all who believe in equality.

And today is the day that Mary’s beautiful statue, created by renowned sculptor Martin Jennings, will be unveiled outside St Thomas’ Hospital in London. Mary will proudly face the Houses of Parliament across the river. And she will be the first statue to a named black woman in the whole UK.

This is what will be written underneath:

“I trust that England will not forget one who nursed the sick, who sought out her wounded to aid and succour them, and who performed last offices for some of her illustrious dead.”

Sir William Howard Russell, War Correspondent, the Times Newspaper, 1857

We need Mary’s legacy now more than ever. The referendum campaign has unleashed xenophobia and racism. The poster of people with dark skin queuing for refuge with that hateful slogan underneath said it all. Some hoped such ugly days were over. Many knew this was not so. Fear and hatred for “the other” lie behind words such as “I’m not a racist but….”.

The NHS is not immune to racism. Or sexism. I have nothing against able and honourable white men. But when the NHS workforce is 70% female and 20% BME, why does the top look so male and so white? This excoriating report by Yvonne Coghill and Roger Kline tells us a lot. About unfairness and disadvantage and about how NHS staff who experience these things can lose hope. It was published earlier this month. It is in danger of sinking without trace unless we do something different now.

I have no personal experience of racism, although I have seen it in action. Sometimes I have done something about it. And sometimes I have not. For this I am ashamed.

I do have experience of anti-Semitism, of being teased for having a “funny” surname, and of sexism. I know about the stigma of mental illness. And I know that, had I stayed where I started, at a London teaching hospital, I would not have become an NHS chief executive. My face would not have fitted.

It was for these reasons that I, a white woman, felt I had something to contribute to the Mary Seacole Statue Appeal.

Trevor Sterling, new charity chair, Leon Mann, ambassador and me last year at the site where Mary's statue will be unveiled tomorrow morning

Trevor Sterling, new charity chair, Leon Mann, ambassador and me last year at the site of the statue

And now, trustees of our new charity, the Mary Seacole Trust, chaired by the brilliant lawyer Trevor Sterling, will be calling on Mary’s legacy to inspire those at risk of disadvantage. In schools, universities, communities and workplaces including the NHS. We will encourage people to work hard and do their best. To be compassionate AND entrepreneurial. To aspire to great things. To speak up for what is right. And never to give up.

Despite not bring born in the UK, Mary Seacole never gave up playing her part in helping those from a country she loved. Throughout her life she remained proud of her dark skin and her heritage.

I urge anyone in despair or need of inspiration to visit Mary’s statue. It depicts her coat furling around her as she strides defiantly into the wind to meet her destiny.

These are very difficult times. Let us join Mary Seacole. And let us never give up.

An earlier version of this article was published in the Health Service Journal. I have updated it for my blog and to increase access beyond the NHS. I will update it again with photographs of the statue.

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.

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.

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.

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.

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 🙂

The ones who matter

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.

How are you doing today?

I love talking about mental health. What could matter more? This blog is drawn from ideas I have developed (and squirreled) while thinking about well-being at work for a slot I did at the Health at Work Conference in Birmingham last week, and in advance of an NHS Employers webinar on staff well-being yesterday. I used an earlier version of this blog to give my talk, and I warmly thank everyone who contributed. Your questions and comments were wonderful and you will be able to see that i have made some changes because of them.

And what an exciting day yesterday was. Because the Girl Guides Association announced their first mental health badge. It has been developed with the excellent charity Young Minds. It uses theories about emotional literacy and resilience to help young people take care of themselves and help others. If only they had done this 48 years ago was I was a Girl Guide. And wouldn’t it be great if such an approach could be rolled out across all schools and colleges and youth groups? What a brilliant start this would give young people facing the world.

At the conference last week, we heard from companies large and small who are putting employee wellbeing front and centre of their investment strategies. And this isn’t because of any sense of duty or even kindness. They know that it pays. They want to know the best ways to help staff achieve optimum health and how best to work with employees who have physical or mental illnesses to manage their conditions and get back to work quickly and well.

If we consider the NHS as one employer, it is the largest in Europe, many times bigger than even the largest multinationals at that conference. And yet we seem slow to follow suit. I say we…I don’t work for the NHS any more. But having done so over a period of 41 years, I feel deeply concerned for its staff. So I was very grateful to take part in the NHS Employers webinar.

Well-being and resilience are the new buzzwords. They are being used everywhere. I like them. But I also have a few issues with them. If we aren’t careful, well-being strategies can feel as if they place responsibility on the individual. And I see well-being as a partnership between the individual, their employer, their co-workers and anyone else they choose to invite to help them achieve their optimum health.

I like the Maudsley Learning model of mental health very much. It shows a series of steps and explains that we are all on a spectrum of mental wellness. I like the way it removes a sense of us and them.

But there are nonetheless inherent dangers in such models. Unless you have felt the terrifying symptoms of psychosis, clinical depression, an eating disorder or any of the other hundreds of mental illnesses, you might think that mental ill-health is merely an extreme version of the distress that anyone might feel when something bad happens. Using well-intentioned euphemisms like mental distress, intended to reduce stigma, can add to the isolation felt by people who experience mental illness. It’s important to say that most people won’t ever experience mental illness, just as most people won’t ever experience cancer or diabetes.

But 1:4 of us will. And we need skilled help from our employers if we are to go back to work at the right time and give of our best. The last time I was ill, I was lucky that I got the right help. Not everyone does. And that is why I do the work I do now, campaigning to improve things in the NHS and beyond for patients and staff.

I shared two specific insights at NHS Employers webinar. The first is that we separate mental and physical health for laudable reasons but at our peril. Obesity might get more sympathy if it were treated as an eating disorder; the most effective treatments combine diet with psychological support, including CBT techniques. Exercise is known to increase endorphins and improve mental wellbeing as well as physical health. People with serious mental illnesses die on average at least 20 years too soon, mainly because of associated poor physical health. And there is an increasing evidence base that people with chronic physical conditions such as cancer, heart disease and strokes have a greater tendency to experience clinical depression. Which comes first doesn’t really matter.

Employers should, in my view, use this knowledge of the inherent links between mind and body to devise their wellbeing strategies and make this explicit. Bringing the mind and the body back together needs to become the next Big Thing.

And secondly, I am increasingly of the view that people who experience mental illness, who are open about it and learn to live well with it despite the massive challenges it poses, can become even better employees than those who don’t have these experiences. I’m talking about people like many of the friends I have met since I came out about my own depression. Such people show extraordinary resilience, compassion for themselves and others, patience, creativity and highly developed social skills that would be valuable in any workplace. They are truly amazing. I try not to have regrets. But one of mine is that it took me far too long to realise that my experience of mental illness could become an asset, if I let it. So now I’m trying to make up for lost time!

I want to share links to my other blogs that I think might be helpful to anyone thinking about wellbeing at work.

This one is about taking the plunge and talking about your own mental health, perhaps for the first time.

This is my plea to be kinder about obesity, because what we are doing now simply isn’t working.

This is about the things you can say and do to help a friend or colleague who is experiencing mental illness. And the things that really don’t help.

These are my ten commandments for working in mental health

This is a blog in which I thank people who have helped me in my journey of self discovery – still very much a work in progress.

And this is my Letter to You. Which you might want to suggest to someone who you think may be struggling.

Life is hard for most employees these days. Working in the NHS holds particular challenges. Stress at work doesn’t have to make people ill. But it can. Employers can make a difference. And so can co-workers.

Please take a moment to think about your colleagues, especially the ones who are having a tough time, seem a bit quieter than usual or not quite their usual selves. Ask them how they are. And really listen carefully to what they reply.

And if you are one of the 1:4 of us who experience mental illness from time to time, I say this: go us. Because we rock. 😎😎😎

Is it Rob or Helen who needs a psychiatrist?

Last night, some of us were tweeting about The Archers. Specifically, about the scumbag Rob Titchenor whose latest act of psychological warfare against his wife Helen was to hit her and then make her feel so bad that, by the end of the 13 minute programme, she had apologised for making him do it. He then delivered his coup de grace, that she was in need of psychiatric help.

As you can imagine, this generated much debate. Quite a few people said that it wasn’t Helen that needed a psychiatrist, it was Rob. They said he was sick. I believe they are wrong. And I want to explain why I think this.

Is Helen mentally ill? And if she is, could Rob have caused it?

Only someone who is clinically qualified can really answer this question. But as Helen is a fictional character and therefore unavailable for an assessment and formulation, we are entitled to make assumptions.

Helen has a tendency to depression, anxiety and problems such as anorexia in part because of her personality. She is someone who sets herself high standards and drives herself very hard. She has an overdeveloped sense of responsibility. She judges herself harshly and punishes herself for her own perceived failings. And she reacts badly to criticism from others.

She has some additional risk factors. She is, or rather was, a single mother. She has experienced several major losses: her older brother died in a farming accident when she was a teenager. Her last partner died by suicide. Also, her father was recently very ill. Her younger brother went missing for a year and her best friend felt betrayed by her.

All of this makes her vulnerable. So Rob hasn’t exactly caused it. But he has exacerbated it. And now he is using it against her.

Isn’t Rob also sick in the head?

Rob is also fictional. We only know what the writers have shown us. But again, we can make assumptions.

He certainly shows narcissistic tendencies. He cares a great deal about his own feelings, but little for those of others. He views the world as there to serve him. He constantly reminds Helen that she is Mrs Titchenor now, and that she must dress and act to please him. Henry must be “obedient”. The coming baby is “my son”. The house revolves around Rob . He is jealous and actively excludes those Helen is close to.

He also has a nasty temper, is untrustworthy and lacks morals. He hit the hunt saboteur and later lied about it. He cheated on his first wife with Helen, and lied to them both. There are suggestions he may have lied when he worked with Charlie. And there has been at least one occasion where he either raped Helen or was rough enough during sex to cause her bruising round the neck. She seems uneasy near him.

But these are not signs of mental illness. They are the tendencies of all bullies, cheats and those who get through life by using others. Rob has chosen Helen because she is vulnerable, and has resources that he wants – she has her own house, and will inherit half of the family farm business. And she can give him a child.

What about his mother? Is she mentally ill?

Aah, Ursula. She is a manipulator. She probably learned to behave like this as a small child herself because her own family was dysfunctional. Her relationship with Rob is deeply dysfunctional too. She wants to please him, and will go to any lengths to do so. She perceives Henry’s unhappiness as bad behaviour. She thinks sending him away to boarding school will help him. Her interest in Helen’s pregnancy, labour and other intimate matters such as Henry wetting his bed is prurient. I wonder whether she is a sex abuser. She gives me the creeps.

Why can’t Pat and Tony see through Rob and Ursula and why can’t they see their own daughter is so unhappy?

Because they are nice people. And they are deeply invested in Helen having made the right choice. They feel bad about not warming to Rob at the beginning. The truth for them is too awful to contemplate…at the moment.

What will happen to Helen?

Who knows? Only the writers. Perhaps her love for Henry will override her feelings for Rob, and she will confide in someone like Tom or Kirsty and they will help her to escape. Or perhaps she will be assessed by a mental health professional who will ask all the usual questions about things that are troubling her, and leave her enough space to express the doubts about Rob that we can already see lie just below the surface. Or perhaps she will continue to be terrorised by him until something even more awful occurs. This is what happens in real life. And even if they get away, women who have been abused like this may suffer from a form of post-traumatic stress disorder for the rest of their lives.

Why do I mind when people confuse mental illness with bad behaviour and say that people like Rob Titchenor are mentally ill?

Because badness is different from madness. You can have both. But they are not the same thing. And until people stop equating them, and the media stops using terms such as “paranoid schizophrenic” as a term of abuse, we have a very long way to go.

Of course we need to provide skilled intervention for those who abuse. They may have defects in their personalities (sometimes called narcissistic personality disorder, psychopathic personality disorder or sociopathic personality disorder) that cause them to lack empathy and feel compelled to hurt others. These terms are understandably helpful in forensic mental health services. But they should not be bandied about by the rest of us. Because this is skilled work. And also because, for people who have been diagnosed with a Borderline Personality Disorder, which has at long last been recognised as an extremely traumatic, treatable mental illness, being lumped together with people like Rob under the overall heading of personality disorders is distressing and adds to their stigma and alienation.

Time to Change is the national mental health anti-stigma campaign. Over the next five years, for which most of the funding is now secured, they will be tackling some of this harder, more intractable stuff with people who need more persuading. And people like me will be volunteering and writing stuff and speaking at events in support of their campaigns until we have achieved greater awareness, understanding and empathy for people like Helen.

The use of mental illness as an explanation for people who do abhorrent or otherwise inexplicable things is part of the stigma that those of us who experience mental illness face on a daily basis. Please try not to do it. Thank you.

PS: I’ve just noticed people on Twitter saying this storyline is affecting their mental health. Hmmm….It may trigger thoughts and feelings in those who have been abused and/or experience mental illness. But it won’t cause mental illness.

Anyway, people who don’t like it can always switch off. And watch Happy Valley maybe….

A mixed week: updated Sunday 21 Feb 2016

It’s a good thing we don’t know what the future holds. Otherwise we might never get out of bed.

On Monday, the long-awaited Mental Health Taskforce Report was published. And it made grim reading. Behind the awful stories about people being let down or receiving no treatment at all is the spectre of stigma. How else can it be that government ministers have spouted forth about No Health without Mental Health and Parity of Esteem whilst at the same time services have seen real terms reductions to funding far greater than other parts of the NHS. And despite referral rates continuing to rise? The suicide rate is rising again too, even among groups not previously considered to be at high risk.

The coverage was wide and mainly pretty fair. (I say mainly; the Metro managed to annoy almost everyone on my Twitter feed with an offensive headline.) I was impressed by what Paul Farmer and all my other friends on the taskforce have achieved, and by the measured response of NHS England and the Secretary of State. But instead of feeling proud to have played my tiny part, and girding my loins for the sustained effort that will be needed to hold the government and the NHS to account, I noticed my mood gradually getting lower throughout Monday. By the evening, I was overwhelmed with sadness that it has taken so long for so many people to be heard, and that many lives have been lost along the way. And I was assailed with despondency and a sense of utter failure for what I hadn’t managed to achieve in all those years I was running mental health services and had so much opportunity and influence.

Things got worse on Tuesday. I woke to find myself the subject of an article in my local paper, the Brighton Argus, along with a massive photo of me with a long-forgotten hair colour. It said that 19 staff at Sussex Partnership, the trust I used to run, had received severance pay-outs totalling several millions in the past four years, and that I had received the largest sum, £275k, in 2014.

It was wrong in every respect. The highest payment was £27.5k not £275k. And I hadn’t received one at all. And I felt tearful and scared and powerless and all the other things I remember about being public property for the 13 years I was a chief executive.

I minded most because leaving the trust caused me great anguish. Anticipating it almost certainly led to my last serious depression. Going back to work after my breakdown for another 8 months was very hard. It mattered greatly to me that, having managed to do so, I should leave on my own terms.

A few phone calls later, I was reassured that the story had appeared because of a combination of cock-up and further cock-up. Thank you to everyone concerned for your honesty; mistakes are always forgivable when people tell the truth. By the afternoon, The Argus had removed mention of me from their website and agreed to publish a correction the following day. Which they did. And today they published a letter from me here (there may still be issues with this link if you are on a smartphone. Try Argus Letters in your preferred search engine and ask your browser to use the Argus desktop site. Or try this link directly with the trust website http://www.sussexpartnership.nhs.uk/whats-new/no-severance-package-former-chief-executive-note-lisa?platform=hootsuite)

As I left the house yesterday afternoon somewhat surreptitiously to do some local errands and keep an appointment to give blood, I wondered what people must be saying behind my back. And I was reminded what it felt like to have no place to hide.

However, the week wasn’t all bad.

I was asked to appear on Radio Surrey and Sussex this morning to talk about the stigma of mental illness as part of the BBC #InTheMind series. You can catch me, Danny Pike and the wonderful Sue Baker of Time to Change here 1hr 10 mins into the programme.

Our choir has been rehearsing for a charity concert on Saturday afternoon – details here https://twitter.com/slondonchoir/status/699507596353499136 All welcome.

Brighton and Hove Albion drew away on Tuesday night with Championship leaders Hull and are now third from top, and only one point away from an automatic promotion spot to the Premiership.

And I have at last finished the first draft of my book, which is about being a chief executive who occasionally experiences doubts and depression.

One day I hope you will read it.

Update: I spoke too soon, which after 21 years following the Seagulls, I’ve found it’s easy to do. We got stuffed 4-1 yesterday by Cardiff City. Have a feeling this season could go right to the wire, just like every other year!

But the choir concert was – well I don’t have enough superlatives. Life – affirming will do. And today I helped my lovely husband Steve, who supports me in all my endeavours, to raise money for The Tall Ships Trust, a youth development charity to which he is very committed, via a jumble sale of boat stuff. The two of us were up at 5.00 am. By 2.00pm, we had made just shy of £1,000 which will help kids from disadvantaged backgrounds to experience the joys and lessons that can be learned through sailing.

And I’ve heard from hundreds of people who’ve said kind things. Which for someone like me means more than I can possibly tell you. On Tuesday I was in the depths of despond. Today, on balance, I’m really happy to be me.