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

Starting the Conversation – How to Approach Your GP About Your Mental Health

In one of today’s posts, I have talked about my initial experience attempting to access help via primary care services. I’m now going to flip that on its head and talk a bit about what did work for me when I finally changed doctors and started on the path towards recovery.

  • Be Prepared

This is so vital. Here in the UK, GPs have around 7 minutes per appointment to assess your issues and decide what to do. Anything you can do to make the reason for your visit clear will help. For me, that included tracking my mood swings on mood charts and bringing those along to my appointment. I used It allowed my GP to see clearly that there was an issue with my moods and enabled him to take action based on that. I also had been keeping journals full of my psychotic ramblings, and my husband brought those with us to give the doctor an insight into my state of mind.

  • Don’t Be Scared

Well obviously it’s a scary prospect. Most of us aren’t good at talking about ourselves when it comes to the mysteries of mental health issues. But if you think of it like a physical illness (which it kinda is, seeing as it is effecting your brain!) then hopefully some of the fear will dissipate. You wouldn’t hesitate to visit your doctor for an ear infection after all. The other thing to remember is that this isn’t some middle-ages quack. Your doctor is a trained professional, who is in their field for a reason. They care about people’s health and will be open minded with your concerns.

  • Pick The Right Doctor

This one doesn’t necessarily work for everyone, but it is helpful if your doctors’ office has a good website you can research on. My GPs surgery has their team listed on their website, along with a little information about each doctor’s special interests. So if you can, see which one is interested in the field of mental health, and make your appointment with them specifically.

  • Advocacy Helps

Having someone (my husband) to speak up on my behalf took half the battle out the equation. If you can talk to a friend or family member about what’s happening, you probably will be ok to ask them to come to the appointment with you. There are also advocacy charities who will talk to you and arrange for one of their volunteers to sit in on your appointment with the doctor.

  • Know Your Options

Referring back to my earlier post, it is clear I’d have had far less of a problem if I’d researched the options available to me before I saw the GP. Know your mind; do you want to try medication, or would you give talk therapy a go first? If you are considering medications, ask your doctor about side effects and potential issues during the appointment. Talk therapies offered initially are usually conducted over the phone with a trained counsellor, or in group settings, so if you don’t feel happy opening up in front of a group of strangers, let your GP know this.

  • Be Honest

Your doctor is not going to be fazed by tears. Crying is a natural and understandable reaction to what you are going through, and it may well help for your GP to see that you are struggling. When I saw my doctor for the first time, I was manic and psychotic. I couldn’t sit still, I was beyond agitated and I couldn’t hide it – I paced the office whilst we talked and my rapid-fire speech was another sign to him that something wasn’t right. On top of this, let them know if you’re self-harming or suicidal. They are not going to judge you, and they can only be effective if they have the whole picture.

Sadly there are primary care doctors out there who have one eye on the budget and the other on the clock, as I found out the hard way. But if you go in with getting help in the forefront of your mind, the majority of doctors will be listening with a sympathetic ear.

Starting the Conversation – How to Approach Your GP About Your Mental Health

Spotlight on Anxiety

Let’s talk about anxiety. As a headline mental illness this is something a lot of people know a bit about. The feeling of panic that can be so overwhelming is fairly common in our western world.

I am inclined to split anxiety into two classes. There’s the anxiety that warrants its own diagnosis (for example, Generalized Anxiety Disorder or Social Anxiety Disorder), and there’s anxiety coexisting with another mental illness. I’ve experienced a little Generalized Anxiety Disorder (GAD), but mostly anxiety has been as a by-product of psychosis.

GAD is defined by excessive and irrational worry about events and activities, to a point where it interferes with daily life. The gold standard test for diagnosing this disorder is the GAD-7, which rates daily experiences of anxiety and assigns a score. Essentially, the more anxiety affects your functioning in life, the higher the score is. People with GAD often struggle to remember the last time they felt relaxed.

Anxiety is also a primary symptom of many psychiatric conditions; notably phobias and post-traumatic stress disorder. In these cases the anxiety is less generalised – it tends to relate to specific circumstances that trigger the panicked feelings.

Alongside the diagnosis of anxiety disorder often comes depression. Comorbidity of depression and anxiety exists in between 5% and 10% of the population each year (based on those seeking primary care services for these issues). The existence of these disorders together is probably the most common presentation, but not the only one. Bipolar mania can cause a state of agitation and worry that is uncomfortable. Psychotic symptoms such as paranoia can also manifest in a specific anxiety about given situations, as I’ve touched on elsewhere on the site.

The symptoms of anxiety are not just mental. It affects the body in many ways. Stomach upset, heart palpitations, headaches, dry mouth, sweating and more are common presentations of anxiety, as well as the general feeling of fear and tension. Interestingly, as a nurse explained to me, many of these symptoms come down to the flight-or-fight response. As she explained it, the body begins to divert key resources (such as oxygenated blood) to key areas in preparation for flight – as well as the increased adrenaline that floods the system.

Treating anxiety comes down to personal choice. Anti-anxiety medications such as benzodiazepines can be very helpful in the short term when taken as needed. They have a sedative effect on the mind and body that helps with finding calm and relaxation. Unfortunately benzodiazepine medications such as temazepam and diazepam (Valium) can be highly addictive and are a stop-gap solution that deals with the immediate effects of the anxiety.

In the long term, treatment of anxiety with talk therapies can be very productive. CBT (cognitive behavioural therapy) seeks to understand ones’ thoughts (cognition) and re-program the behaviours that result from the pattern of thinking. CBT uses exercises to identify and change key thought processes, and those exercises can be used outside of the therapeutic setting. For example, STOPP is one such exercise, and one I’ve found personally very helpful.

I would welcome comments and questions below, on Facebook or via Twitter (@dontsayimcrazy).

Spotlight on Anxiety

Book Review – Reasons To Stay Alive by Matt Haig

It has been a while since I’ve bought a physical, paper-and-ink book but when I saw Matt Haig’s Reasons To Stay Alive in the book shop, I had to have it. A memoir of his battles with depression and anxiety, Matt has crafted a combination of narrative stories and thoughts on depression into a great read. So great, in fact, that I read it in two sittings.

It is full of insight; conversations between then-Matt and now-Matt in which he offers words of encouragement to his past, depressed, self are wonderful – words that can only come with the distance of hindsight. He beautifully sums up the desperation that a depressive feels when they are deep in the pit and can’t see the light (in fact, Matt summarises this situation as akin to being in a tunnel where both ends are blocked; it is dark and you are trapped). And he offers hope to those in that darkest of situations; the book features a list of things he wishes someone had told him at the time, including my favourite: So what, you have a label? ‘Depressive’. Everyone would have a label if they asked the right professional.

That is a powerful statement and oh so true of the way the mind works. When you are experiencing any disturbance of ‘normal’ thought patterns, you feel as though you are the only one in the world struggling through life. The reality is that you are not alone. Statistically one in four people will experience a mental health problem in the course of a year. Being an illness that affects the way the mind works, even more people will be touched by mental health problems through being friends with, family of or co-workers with those effected. Having said that; it doesn’t automatically make it better to know that you are not the only person in the world in the pit. It does, however, give some perspective on your situation – people have come through this and are on the other side living normal, happy and contented lives.

Matt isn’t afraid to tackle the big subject of suicide either. He understands what it is like to be so desperate to feel nothing that one would end their own life. In summarising the depths of feeling, Matt neatly states that zero is worth more than a negative number to the mind of someone suffering depression. The mind doesn’t see the green grass on the other side of the struggle; it just wants to not feel so awful. There is no wishing for happiness, no desire to feel pleasure. Instead there is a need to wipe the slate clean, to get back to ‘zero’. Further chapters on the subject seem to reflect how I’ve felt in the past. The way one is so desperate to feel nothing that they wish they’d never been born, for example. Death is scary, contemplating choosing it is scarier still.

But Matt believes in the power of words. Mental illnesses effect so many people worldwide and yet we still sweep it under the rug like it is a dirty secret – like we should be ashamed that we are unwell. We are making progress by speaking out. Books like Reasons To Stay Alive are starting to break down the stigma associated with those with mental health conditions; and I say let’s add more and more voices to the cause until we are impossible to ignore. I am not afraid to say I have an illness. Are you?

Book Review – Reasons To Stay Alive by Matt Haig

‘Coming out’

“Coming out” about mental illness is nerve-wracking! The stigma of society’s uneducated opinions on the subject weighs heavy on the shoulders of someone holding back on sharing their illness with friends and family. But being open and honest about the issues you face with your support structures can also be incredibly freeing.

That’s not to say you have to go around proclaiming your illness from the rooftops. An asthma sufferer doesn’t necessarily tell every person they meet about their asthma. But in the same vein, neither do asthma sufferers hide their inhaler. If they need to use it, they don’t go and hide in the bathroom first.

For me, the biggest change has come from being honest with my employers in particular. In a previous job, I did everything I could to hide what was going on for fear of people’s reactions. And of course, when things deteriorated with my behaviours in relation to being manic and psychotic, I found I had no support – because no one understood the root of the problem. When I needed people to be tolerant and forgiving I came across brick walls.

The first time I decided to share with a manager my hand was somewhat forced by a major depressive episode that saw me going into crisis care for a week. I had to come up with a reason for my absence and after a lot of deliberation and discussion with my husband I chose to tell the full story. I had left work at midday for an appointment with my care co-ordinator and by 4pm had been granted a bed in crisis accommodation starting the following day. I spent the next hour writing and re-writing the email to my line manager, fretting about what she might think or do in reaction to my revelations. In the end I kept it brief – I summarised that I was in a severe depression and feeling suicidal; that I needed to take a week off to get myself back to being myself. At this point I had been in the job for about eight weeks and was still on my probation period.

Around 10 minutes later my phone rang. It was my manager and I tentatively answered the call, my mind filled with all the awful possibilities. I needed have worried however, as she proceeded to tell me that I had her full support and backing, and finished by saying that if I needed her all I had to do was call. It was such a huge weight lifted to hear her saying that. On top of this, once I had returned to work she arranged for me to speak with an occupational doctor to review my working environment and check if I needed any adjustments made to accommodate my needs.

Fast forward a year and you find me where I am writing this from; a new desk, a new company and a new boss. In my first month working here I started having problems with paranoia and anxiety. Within another two weeks it had ballooned into a psychotic and mixed-mood episode. This time I didn’t wait till the last possible moment to tell my manager. With the help of my husband I drafted up an email and hit send; an hour later I was in a meeting room listening to the boss tell me that I have him behind me all the way. Once again I felt that burden lift – I had felt like I was carrying a dirty and shameful secret around with me before telling him (the irony being that I had nothing to feel shameful over).

I just want to share a few resources with you to wrap this up. First off is the Equality Advisory Service who have been brilliant at answering my questions (such as “Is asking to change my working hours considered a reasonable adjustment?”). Next up is Mind’s Mental Health at Work section. And finally the page on workplace support on the Time To Change site.

As always, I welcome your thoughts, comments and questions, whether you post them here, on Facebook or on Twitter @justdontsayimcrazy.

‘Coming out’