mind.org.uk – An Overview of a Great Resource

Mind.org.uk is a UK based mental health charity which works to support and inform those with mental illness as well as those who are interested in learning more about the world of mental health.

Their site is incredibly informative and easy to navigate – including a ‘not sure where to start’ link on the front page that takes you to an initial menu of pages to read including mental health problems, supporting those who suffer, drugs and treatments, tips for everyday living and a link to their helpline.

The A to Z of mental health issues lists the diagnoses and links to easy to digest information about each. From depression, to bipolar and onto schizophrenia, each diagnosis page is split into sections; about, diagnosis and causes, treatment and support, self-help, friends and family and useful contacts. It is a great place to start if you’re newly diagnosed and need more information about it.

They also have personal accounts listed on each diagnosis page – the stories are from people who live with and have experienced mental illness. They are a great resource that shows the human side of the labels given and the people who have shared on the site give a voice to those who suffer.

Currently, mind.org.uk is running a campaign to bring mental health to the table in the run up to the General Election 2015. They have written a manifesto  ‘Take action for better mental health’ that aims to bring the topic of mental health to the front of the debate. This is a great initiative as having enough funding for early intervention in mental health issues can save the NHS money in the long-term.

The section on mental health at work offers support and guidance to employees and employers and should be the first stop for any employer wanting to make sure their employees are well supported in the workplace. They also offer consultancy and training to work places.

Mind also offer helplines where you can talk to someone about what you are experiencing.

Check out mind.org.uk and see what they offer for yourself – it is a great resource and one that people can really make good use of.

mind.org.uk – An Overview of a Great Resource

The People Who Help

I wanted to write a little bit about the people in my life who have supported me over the last three years. Without them I believe I wouldn’t be here to tell my story.

The primary supporter in my life is my husband Luke. We’ve been together since we were in our late teens and got married in Dec 2011. When we first began getting serious (i.e. after about a month!) I explained my struggles with depression from my early teenage years and the anxiety that had gone along with it. He made a promise to always be there for me when I need him, and he’s gone above and beyond that time and time again in the years that followed.

It was Luke who first noticed my mental health deteriorating in early 2012. As you’ll hear a lot from people who have been psychotic especially, it’s those around them who notice it even before the sufferer. I was living in an alternate reality in which it was perfectly normal to be hearing voices, not sleeping and suffering paranoia over the people living next door. Amazingly, and thankfully, the paranoia did not extend to my husband. Although I’d visited the GP on my own to get help for the anxiety, the warning signs of mania and psychosis had not been picked up.

Luke has since stood by me through thick and thin. He has sat with me in the hospital following overdoses. He has accompanied me to appointments and talked to the mental health team on my behalf when I couldn’t speak for myself. He is my carer; I still struggle with being out in public without him if it’s not part of my routine, and he makes sure I take my medication morning and night. When I’ve been unwell he’s kept the house clean and us fed. The stress I have put him under is unbelievable and he is still his jolly, jokey self.

What do I owe him? Everything – and nothing. What he does for me comes from a place of true love. I couldn’t be more appreciative, and I have no idea how I can repay it all. But he tells me regularly that he did it because he loves me and couldn’t imagine being without me – that he’d do it all again in a heartbeat.

My family have also been there for me in an entirely supportive capacity. My mum has driven me to the hospital a few times, and never judged me for it. She is a lovely, warm and caring woman and I am so lucky that she’s supportive and understanding. Never one to shy away from anyone in need, she makes sure I know she’s there for me any time I need her; as she says, her kids come first.

I didn’t speak to my father for three years following an argument in the run up to my wedding. When we got back in touch early last year I debated with myself for a long time over whether to tell him everything or not. I decided that honesty was my best course of action and wrote him a letter that described what had been happening with my mental health. I was terrified that he would see me differently once he knew everything, but there was nothing to worry about. He told me he supported me.

Unfortunately there is so much stigma surrounding mental health issues that there’s no guarantee that people will be supportive of those who suffer. I used to feel ashamed of my diagnosis, that the important people in my life would somehow blame me for what I was going through. The fear of them taking it personally was huge; I was worried that my parents would wonder what they’d done to cause it, or that my husband would think my suicidal ideation was proof I wanted to leave him behind.

I am so thankful to those who have supported me over the last few tumultuous years. I have learned that I have nothing to feel guilty for; no guiltier than someone who’s suffered a heart attack feels. It is my hope that this blog is not just for those with mental illnesses, but that the people supporting them will read and understand that the best thing they can do is be there for their loved one.

The People Who Help

Spotlight on Self-Harm (trigger warning)

Self harm is a growing problem worldwide. Statistics here in the UK suggest as many as 13% of 11 to 16 year olds purposefully hurt themselves, but it’s not just a problem that adolescents face. It can be a life-long battle for many.

I started to hurt myself by cutting my arm aged 13. At first I used safety pins to scratch my wrist; small half-centimetre scars that have now faded with time. Over time I progressed to using scissors and the self injury became a ritual I used to cope with the pressures of teenage life. At the time I told myself it was temporary, just a stop-gap to last only as long as it took me to grow up and learn to deal with the world.

I want to use this post to talk a little about the problems with self-harm I’ve faced as an adult. I stopped my teenage self-harm aged 17, and managed to stay away from it until I got unwell aged 22.

People tend to associate self injurious behaviours with depression. For me, I’ve found that I struggle more with it when I am manic or psychotic (or both, as they normally come hand-in-hand for me). My mind turns to it when I cannot cope with the high, wild level of mood and I’m looking for ways to calm myself down. I have learned great coping skills over the years but they are not always the first thing I turn to when I am ‘in the moment’. In adulthood I know I ‘should’ know better, but my insight when I am unwell isn’t always great.

As an adult, I’ve found that the extent to which I hurt myself is greater. I no longer use blunted blades for example – and so the resulting injuries are far worse. I also find that I can do more damage when I’m manic than when I’m depressed. When I am in a low mood, I feel the pain more. When I am in a dysphoric state I don’t feel it, and it’s hard to recognise when it has gone too far. It is also a control thing for me; a way of getting my head clear and bringing myself down to a normal level of functioning.

It is hard to talk about self-harm in public. Writing this feels like I am baring an aspect of my soul to the world and it’s not entirely comfortable. But it is a topic that is increasingly important to focus on. It is not something we should be sweeping under the mat.

There are so many great ways to cope with the urge to self-harm. The Butterfly Project is one such way; the idea is that instead of hurting themselves, the person copes with the urge by drawing a butterfly on their skin. Other ideas that I’ve tried in the past and had some success with include the ice method (whereby you hold an ice cube in the hand) and the elastic band one (you ping an elastic band against the skin). The only issue I have found with these moderation methods is that it’s not always the pain I’m craving – sometimes it is the damage I want to cause that makes me need to act on the urges. I’m still working out how to mitigate those situations; I would appreciate advice if anyone has it!

This piece has so far mostly focussed on cutting as a form of self-injury. There are many more forms; overdoses without the intention of suicide, punching walls and burning oneself are examples. Substance abuse can also be seen as a form of self-harm. As many as 30% of those with bipolar also abuse drugs or alcohol, compared with around 4% of the non-bipolar population.

Self-harm is a conversation many people are now getting involved in. The key to overcoming it is to learn healthy coping skills. If you are struggling with self-harm, you will be doing a great thing to look after yourself if you seek out help from your GP or a therapist.

Spotlight on Self-Harm (trigger warning)

Spotlight on Bipolar

Bipolar is the modern diagnosis of ‘manic depression’. There are people out there who prefer the old way of saying it. The bipolar label just isn’t as descriptive of the issues faced by those diagnosed with it.

Bipolar disorder is characterised by extremes of mood. There are varying degrees of it; from cyclothymia (more chronic but less extreme), bipolar I and bipolar II. All forms feature a mix of depressive and manic episodes, but the severity of the episodes can vary between diagnosis.

Bipolar I is a disorder in which the person experiences full manic or mixed episodes. They only need to have experienced one manic episode for diagnosis to be made, the severity of which causes impairment to everyday activities. The manic state is characterised by extravagance, grandeur, elation, pressured speech, irritability, reduced need to sleep, along with potential risk-seeking behaviours. There should also be, during a depressive episode, at least three characteristics of major depression.

Bipolar II is differentiated from BPI by the absence of full mania. Instead, the person can experience hypomania that lasts at least four days. The depressive state can be the more common and the intervals of well-being are generally shorter.

The risk of self-harm and suicide is increased in those with BPII, and especially those in a mixed-mood state. This can be due to an increased motivation to engage in risk-taking behaviour, coupled with depressive hopelessness. Substance abuse disorders have high co-morbidity with the bipolar disorders.

Treatment for bipolar disorder involves the use of medication. Mood stabilisers act to suppress the swings between highs and lows. In addition, an anti-depressant can be used to combat the depressive episodes, especially in those with BPII. Some atypical anti-psychotics also have a mood stabilising effect.

Talk therapies such as cognitive behavioural therapy can be used to support well-being and help the sufferer with learning skills to cope, triggers and help with awareness of early warning signs of an episode.

Living with bipolar can be a challenge. Episodes of depression and mania effect the ability to conduct everyday life.

Spotlight on Bipolar

The Anxiety of Suicidal Ideation

First up – a definition. Suicidal ideation concerns thoughts about or an unusual preoccupation with suicide. The range of suicidal ideation varies greatly from fleeting thoughts, to extensive thoughts, to detailed planning, role playing (e.g., standing on a chair with a noose), and unsuccessful attempts [Wiki].

When my ideation was at its worst, I visited my GP (this being pre-involvement of secondary mental health services). I was agitated and restless, and I spilled the beans. I had been planning and fantasising about hanging myself. I’d also been having vivid mental images of doing it, kind of like acting it out in my mind. It was overwhelming and upsetting.

It was almost like a craving to act on the urges. It felt similar to the times when I wanted a cigarette but had only empty packets. The totality of my attention was fixed on obsessing and planning the act in great detail, and it made me incredibly anxious.

The anxiety was two-fold. In one aspect it was the frantic feeling of a need not being met. I felt trapped between my desire to carry out the fantasies and my fear of actually ending my life. It was hugely unsettling.

The other side to it was more of a guilty anxiety. I was beating myself up mentally; “How could you think these things? What about all the people who love you and care about you? Your family will be devastated. Your husband will never get over it.” and so on. I knew the rational case against suicide, but knowing things intellectually doesn’t often stop the mind from wandering off on its own path.

Since then, I’ve learned better coping skills to help take my mind off the thoughts. Meditation and mindfulness have taught me to observe my thoughts and then let them go. If I’m really struggling to deal with ideation I talk to my husband or an understanding friend. Most of all, I’ve learnt that I can forgive myself for having the thoughts and that’s taken away a lot of the panic from the experience.

The Anxiety of Suicidal Ideation

Tools To Mitigate Relapses

Writing about mental illness and health issues really brings things into perspective for me. I am able to notice that I am more self-aware and that my insight has improved greatly. No longer do I bury my head in the sand until things reach crisis point; instead I communicate openly with the Intervention team and my support networks to keep them in the loop over what’s going on.

There are many tools to help with improving your insight into your own red flags and issues. One of the most helpful things I’ve found is to keep a mood journal to track fluctuations in energy levels and symptoms. There’s a few online (Google search: mood tracker) or there’s a few apps out there too. I have just started using iMood Journal which is 69p on the Play Store for Android, and it’s fabulous. It asks you to rate your mood on a scale and then gives a journal page to take notes on what’s happening with your mood. It gives an overall picture of how your moods can change and helps with spotting patterns.

Another thing that helps is to have a list of your relapse indicators. In creating this, it is useful to consult with people in your support network who have seen you in the run up to a crisis. They can often highlight things that you weren’t aware of. For example, one of mine is increased religiosity which I didn’t think of as a problem until my husband pointed out that every time I’ve headed into a psychotic episode I’ve started attending church and taking more interest in religious issues (normally I am anti-religion and anti-church).

If you do find yourself reaching crisis point, a well written and realistic crisis plan can be a life saver. Written ahead of time, it will serve as a reminder of the process you can follow to access help. Mine has a list of steps to follow; first I should contact my husband who will contact my care co-ordinator. If I can’t get through to my husband and it’s out of hours for the EIiP team I have their crisis line phone number as the next step. The crisis line isn’t always helpful though, so I have the option of walking to my father in law’s flat so that I’m not on my own. And the last step is to get in touch with the authorities if necessary.

Do I always follow these action points? No. It has taken me a long time to get my head around the idea of asking for help. But experience has taught me that it is better to ask for help early on; before it gets to the point at which I am no longer able to ask at all. And that is something I am proud of.

Tools To Mitigate Relapses

Spotlight On Depression

So often in life I hear the phrase ‘I’m so depressed.’ Around the office, in public, with friends; depression has come to be the buzz-word of choice for emphasising just how sad a person is. The fact is real depression is not just sadness. Whoever decided to call it depression rather missed the point.

A huge number of people are affected by depression worldwide. The stats are something like 1 in 4 people will either suffer depression or support someone who does in the course of a year. But depression is a mixed-bag diagnosis just like other mental health problems and it doesn’t affect everyone in the same way.

Most of us have experienced situational depression at some point in our lives. This can be linked to life events such as the breakdown of a relationship, loss of a job or bereavement. It is short-term and usually has an onset within three months of the event that triggers it.

The DSM (Diagnostic and Statistical Manual of Mental Disorders) outlines the criteria for Major Depression. The symptoms can be the same for situational and clinical depression – the difference lies in the impact it has on normal life. For a diagnosis of major depression the person will have at least five symptoms simultaneously, and those symptoms will be severe enough to prevent their engagement with regular living.

The symptoms can vary depending on the individual and includes sadness, hopelessness, anxiety and worry, lack of concentration and lack of pleasure (anhedonia). There is usually a withdrawal from normal work, leisure and social activities. For some people, suicidal ideation is present.

Treatment for depression can include the use of anti-depressants and talk-therapies such as CBT (cognitive behavioural therapy). In very severe cases ECT (electroconvulsive therapy) can be used. This treatment uses electrical stimulation to induce seizures and is administered under general anaesthetic. It has proven to be very effective (mind.org.uk suggests that 74% of people treated with ECT responded positively), but is a last-resort option.

My own experience with depression started when I was 13. In the last few years I’ve battled with mixed mood episodes that have landed me in crisis care twice. A mixed episode for me is characterised by rage, restlessness, agitation, hopelessness and suicidal ideation. Commonly I have experienced a total inability to see past the present; a feeling of no hope and no future.

I read somewhere (Matt Haig possibly?) that depressives do not wish for happiness, they just wish for nothingness. Happiness is a luxury. A good day can mean a day in which symptoms are mostly absent. A bad day is the kind where the symptoms are overwhelming and feel endless.

I would love to hear of your experiences with depression. Connect with me on Twitter @dontsayimcrazy – or leave a comment below.

Spotlight On Depression