Uncategorized

READING AND WRITING AS MEDITATION

Occasionally in life an activity not of our choosing is found to be enjoyable. This, of course, is part of the learning undertaken in school. If we chose to play all day, we would not learn to read and write, skills which enable us to disappear into another world either of our own or another author’s making.

Reading and Writing are a form of meditation but were sadly not encouraged in my mental health wards. To be read to is a wonderful gift and this could be done easily by a staff member, visitor or volunteer. To brainstorm ideas about depression and recovery and write a four line verse is creative and empowering.

I have never found the art activities on hospital wards helpful as I am not a person who paints or models with clay. I do decorate my own home and find that a calming and satisfying activity but to represent my feelings on a piece of paper is just not my way. My way is with words. Sadly the thinking seems to be that art is healing for the mind, so volunteers and even paid art tutors come to mental health units to conduct sessions. I can see how it can help some but, for me, I need the written word.

I have sometimes tinkered with the idea of volunteering to do some creative writing in our local hospital, particularly poetry which is a shorter, more easily composed form and with which I have had success. But always at the back of my mind is the thought that perhaps I do not want to return to the place that could remind me of my dark days one spring only two years ago.
Perhaps this year, which is a special year for me as I reach a birthday with a 0 on the end, I can add this activity to my list of firsts.

If I could open up someone’s mind to free or rhyming verse and start them on the road to reading and scribbling ideas, it will have been worth it.

Advertisements
Standard
Uncategorized

CHANGING ATTITUDES TO IN PATIENTS

CHANGE IN HOSPITAL ATTITUDES TO MENTAL HEALTH PATIENTS

I have written before about how mental health provision has changed over the last twenty years or more.

I have been reminded of this recently when speaking to staff on a relative’s ward. The patient has what they call ‘a late start’ in the mornings but they offer to get her some breakfast when she appears from her room. If she does not appear they go to see her and ask if she would like a drink or some breakfast.

How different to my experiences in the 1990s. Then we would be called at 7.30 to go for breakfast and if our drugs left us dozy and still sleeping, the next call would be sharply delivered. You did not choose not to go to breakfast but lined up at the locked door and, once open, you filed down to the dining room. You were not given a choice and this applied to all activities and meals.

At 9.30 everyone save for the new admissions was sent for ‘exercises’ regardless of whether they felt like it and art groups and T groups, where a facilitator encourages patients to share feelings were compulsory. Also mandatory were relaxation sessions and yoga.

While I like the new patient-centred approach, I am thankful that, on my hospital stay in 1996 under the old regime, I was introduced to yoga, something I continued after discharge. Indeed, ever since that first experience, I have enrolled in classes on an annual basis. The weekly class, with some practice at home in between, became a life saver for me. The calmness of the mind and the feeling of well-being after stretching and holding poses changed me from a stressed and anxious individual into a rational person with a range of coping strategies. When faced with a new or stressful situation, the yogic breathing brought a sense of calm.

If you haven’t tried yoga and cannot afford a class, get a book from the local library and try some of the exercises and the instructions for clearing the mind. It is the debris in the mind that hangs about that yoga can deal with.

The debris and clutter that builds up can bring on anxiety and depression if it is not cleared away in the same way as you clean and clear up your house. See yoga as the hoover for the mind and you will soon reap the benefits.

Go on, you can do it. Give it a try.

Standard
Uncategorized

Young people and mental illness

I have spoken before about how dreadful the situation is for young people who suffer mental illness. During my month in hospital in April 2013 I observed a very young girl in deep depression who rarely left her bed. One day she had visitors and spent much time that evening sorting through her bags. It was good to hear the rustling as it indicated she was actually doing something. My immediate thought with a young girl is that she has probably been badly let down in a relationship.

When I heard of the girl in Torbay who was put in a police cell in November I was, along with many others, horrified. Social media comment was fierce and has brought results. I am pleased to read in the Guardian this Tuesday 16th December that Theresa May is setting out legislation that will prevent this happening in future. I am not sure where vulnerable young people will be held but if large companies can put up a shop building quickly I am sure the NHS can do something similar. After all, a secure unit only needs one main door (plus fire exits of course). There are unused buildings, deserted buildings on hospital sites and many other places which could be converted to make for more mental health beds. We need them badly as there is more depression these days and the need is great. It surely must be possible for buildings to be quickly converted. Let’s hope the Government does not sit on this as they have with so many of their plans which fail to come to fruition. Believe me, David Cameron, we will remember you at the next election.

Whether this legislation would help my sister when she becomes unmanageable is not clear, as reading between the lines it would appear that some mentally ill people will still have to be held in police cells temporarily if they need to be held for their own and others’ safety. I still feel that a profoundly deaf and very sick woman should not be restrained in cells and in handcuffs. I would wish that paramedics could deal with such a situation and an emergency doctor could administer some tranquilising medication.

Let’s hope the treatment of the mentally ill improves as a result of this latest government initiative.

Standard
Uncategorized

Mental Health Services in crisis

Eighteen months ago I suffered a manic episode after acute pancreatitis was followed by kidney failure. I required urgent inpatient treatment in a secure unit. I am not blaming the infection and water retention entirely as there are people who suffer acute infections who do not go off their head. But I am Bi Polar so am particularly vulnerable when I have physical illnesses. Also the drugs which keep me well could not be excreted during my kidney failure and built up to a dangerously high level.

I cannot fault the treatment I received and the kindness of the staff but I live in Dorset. However, I am well aware of the patchiness of mental health care. As a member of Depression Alliance I receive Single Step, the bi monthly magazine which allows mental health sufferers to air their views on their condition and how their recovery has been helped in a variety of ways.

I also have a profoundly deaf sister whose mental health condition has deteriorated in the last few years. She lives in Oxford. In July after several months of deep depression and worrying behaviour, she became aggressive during a visit by her step daughter, who called the police. My sister was taken away but not before she had apparently attacked the police officers. This was during the day and she spent several hours at a police station as did her husband before he was allowed home but she was detained. I understand that thankfully interpreters were present. During the night – I presume she was detained in a cell – my sister decided she wanted to go home. Amazingly she had not been sectioned so she was taken back in the early hours to her quiet residential street by two women police officers. Unable to rouse my profoundly deaf brother in law – surprise, surprise – ladders were obtained from one neighbour but finally a neighbour who held a key was roused. These very same neighbours had experienced considerable disturbance both that evening and on previous occasions when my sister became unreasonable and police were called.

The following day the GP accompanied by another doctor – presumably for the purposes of sectioning my sister – arrived at the house. My sister refused their admittance but eventually allowed her GP into the house then barricaded the door thereby blocking his exit. After some time the GP left. Soon after this my sister became distressed. Neighbours report hearing her sounding very upset and shouting at my brother in law in the garden. She then suffered a serious fall sustaining a large cut to her face which required stitches. My brother in law took her to the surgery and the GP sent a referral to the local hospital recommending that, in addition to attention to her injury, she undergo a full psychiatric assessment.

It was only that morning that I was advised of the events of the previous day. The psychiatrist relayed the facts as he had perceived them but I did suspect that he had been criticised for not sectioning my sister that evening in the police station. Later I realised that the lack of sectioning was linked to the lack of mental health beds in the area. Now it makes sense!

The following morning I was contacted by the A and E department of the local general hospital, the nurse telling me that my sister was refusing treatment and could I arrange for her glasses to be taken in so she could read what they wrote down. They had acquired a book of ‘signs’ they said and they were trying to use them. This, I told them, was useless as my sister is ‘oral’ ie she has been taught to lipread and speak, although her speech, especially when distressed, is not always clear. I spoke to a neighbour who went to ask my brother in law to take her glasses to the hospital. When I phoned later, she had received her glasses and had calmed down. They had managed to stitch her gash on her face but communication was still difficult. They were having difficulty getting her to stay on the A and E ward.

I immediately said I would travel up to Oxford to facilitate some interpretation. It appeared to me that interpreters had not been obtained for what was a very serious situation. The nurse was relieved to hear I would be arriving within a few hours.

When I arrived at the A and E ward, I saw my sister coming out of her side room. When she turned, her appearance was pitiful. Her face was black and blue and her clothes were blood spattered. But most alarming was the state of her wrists which were blackened, red and chaffed by, what she said, were the handcuffs she had been put in for several hours when she was taken away from the house.
The medics had been waiting for my arrival in the hope that I could keep my sister calm when they sectioned her. She has been resisting help via the inpatient system for several months and she has repeatedly shouted at me that she will not go into hospital. I warned the doctor that there may be a reaction. An interpreter had been obtained for the sectioning procedure so I was impressed that the communication was being assisted both by the interpreter and by me. It is a fact that my sister is calmer when I am present. By now it was early afternoon on the Friday.

What came next was a shock. There would not be a bed for my sister in a mental health unit until the Monday. We had 3 days to get through before she could be admitted to a psychiatric unit. Pressure on beds meant that they had to wait for someone to be discharged before she could be moved from the Accident and Emergency unit. I quickly realised that the staff in this emergency department would be hard pressed to cope with my sister in her manic state unless I was present. I stayed as long as possible with her, keeping her calm and talking down her angers and frustrations about family affairs and the health service. My partner drove me to a relative about 40 minutes’ drive away where I stayed overnight. The next day I travelled by train to Oxford and stayed all day in the emergency department providing support and calming my sister when she became agitated. I left in the evening on the Saturday, fairly nervous about how she would be in my absence. I explained she would have her dinner and then she could stay on her bed and settle down to sleep. I reiterated that she should not leave the ward – she had tried in my absence. I made her promise that she would stay on the ward while I was absent.
On the Sunday I arrived to find she had been moved to a mental health hospital but no-one was able to tell me where she was. It transpired her husband had been to the hospital and not found her so had gone home. I tracked him down at his son’s via mobile and by 2pm that day he knew where his wife was being held. To say I was disgusted at how this move had been handled and how he had been denied information is an understatement. I am speechless. I stood while sheafs of paper were shuffled with a multitude of names and their destinations written in barely decipherable handwriting. Whatever happened to computers?

Even worse was the fact that the foreign nurse who told me where my sister was could not pronounce the hospital name correctly and she offered no help as to how I could get there. Actually I don’t think she knew. A physiotherapist tried to help me by googling the mental hospital so that she could give me directions. After many google tries and her puzzled face, I gave up and said I would go to the taxi rank and get a taxi to the hospital by giving the name.
Which is what I did. When I arrived at the mental hospital no-one would tell me the ward my sister was on as it was private information. I wanted to scream. My brother in law had not yet arrived but he is profoundly deaf. How would he get directions? Eventually they did tell me, in a whisper, where she was but directions were sparse.

By now I was feeling faint with hunger. It was 2pm and I had spent the last three hours trying to find the hospital.

But it was Sunday!! The cafe was closed and the corridor leading to some self service machines was barricaded and out of use. I did get some directions to a nearby cafe which turned out to be a 45 minute walk into the nearby shopping centre. I eventually found a cafe and ordered some food and a coffee. Why this could not be available on site for visitors to the mental health unit I cannot understand.

When I eventually found my sister she was in a side room and calm. Surprising, as I expected she would be protesting but, like many with mental health problems, she knew the way to get discharged quickly was to be quiet, eat her meals and not cause any trouble.

The staff member I spoke to told me that they thought there was more than just a Bi Polar episode and they were going to have her assessed by the elderly care unit. A week later she was interviewed with an interpreter and other staff and discharged.

Three months later and after a brief ‘high’ when she faxed me good news every day, she has descended once more into deep depression. I have emailed her GP twice asking that she be seen. I was amazed that, having been seen by a doctor who deemed her needing ‘help’, she was not told to return if she did not feel better. At my practice a depressed person is asked to come back in a week or a fortnight so that their condition can be monitored. This does not seem to be happening in Oxford.

I am at a loss as to what to do. I do not live in the Oxford area and do not understand how things work there but from what I have seen I am not impressed.
Two years ago my sister was referred for BSL counselling. BSL (British Sign Language) is a medium my sister can work with although she was not taught by this method at school. She has learnt sign language since leaving school and this counselling would help her immensely. No-one seems to be chasing this up and we go on with no help.

My brother in law does not understand depression and both he and my sister are in a state of denial inasmuch as they do not want to talk about the difficulties that have caused the police and ambulance service to be called several times. In fact, only the police have been called, when, actually my sister required paramedics, an ambulance and admittance to a mental health unit immediately. Not to be kept in a police cell and then allowed to go home, get distressed and take a tumble out of the garden doors on to the patio sustaining severe injury.

So when I heard a 16 year old girl had been kept in a police cell because a mental health bed was not available I was not entirely surprised.

David Cameron!! What are you doing about mental health? I shall be asking strong questions of our Conservative candidate on this matter but, then, he never replies. His last reply came in October to an email I sent in July about the Disabled Students’ Allowance restrictions. How disgusting is that?
What next? I visit my sister and find a tearful, depressed individual who is lonely and getting no help. In our area there are courses for those with depression or Bi Polar Disorder which help those sufferers to cope with their conditions. Surely this should be possible for my sister with an interpreter present.

I know interpreters are thin on the ground and I do feel more funding should be available to encourage people to train in this area. I was pleased that every day while an inpatient my sister did have an interpreter for doctors’ rounds and consultant interviews. For that I am thankful but I should not have to be thankful. It should be the right of every deaf person to have this facility. They provide interpreters for the Poles and other East Europeans who come to this country so why not for a deaf woman who has lived all her life here and contributed to the health service via national insurance.
I know there are cuts to mental health services. This is an example of a situation which became quite bizarre because of lack of help. The scar on my sister’s face should not exist. She should not have been allowed to go home that Wednesday night from the police station. She should have been detained for her own safety.

I would like the luxury of time to ask the authorities to explain the events of July 2014 but my time is taken faxing encouraging messages to my sister, finding information on the internet, printing it and sending it by post.

PLEASE PLEASE OXFORD Mental Health Services DO SOMETHING!!

#

Standard
Uncategorized

Cognitive Behavioural Therapy (CBT)

Following other blogs and reading about how other people challenge their experiences of depression and bi-polar is helpful and one of the best websites and blogs is that written by Natasha Tracy http://www.natshatracy.com who has achieved recognition as an excellent mental health blogger. Indeed she has received awards for her work in raising awareness and fighting the stigma that still exists in our society. A recent post raised several questions about CBT so it is worth discussing the value of this here and how it can be accessible to all, not just for those referred by GPs or psychiatrists. Resources are still scarce for mental health intervention and the cuts cannot be helping. Somehow we all have to be our own mental health expert, our own doctor, our own psychiatrist. The afore-mentioned will not be there with you in the middle of the night or on a bad day. One has to wait for appointments and things often look different then. So what can be do for ourselves?

CBT is a method of changing the way we think about our experiences. Depression arises from negative thinking or what is sometimes known as unhelpful thinking styles. Those with depression have low self esteem and see their life experiences as black and white. For example, if someone you know passes by on the opposite side of the street without acknowledging you, the negative unhelpful thought will be that they ‘don’t like me’ or ‘don’t want to talk to me’. An alternative, more positive, thought could be ‘perhaps she did not see me’ or ‘perhaps she had something on her mind’ and, even more helpful, ‘next time I see her I will speak first’. This is the essence of CBT replacing negative thoughts with a more positive alternative – thought or action. It can be habit forming and before long you will realise you are doing it without thinking. To help me over a difficult phase I made some cue cards with my most usual negative thoughts written on one side and an alternative (even two) on the reverse. By reviewing these cards at low times I am reminded of how I can change my thought in the same way that I might use revision cards prior to a written examination.

Natasha refers to the process of re-wiring the brain and likens it to the negative thoughts making a groove in the brain which, when repeated, increase the depth of the groove until it is a ditch you can fall into. Negative thoughts can bring you down very quickly and none of us wants to fall into the pitch black ditch.

CBT requires no therapist  as you can work from books and websites and, if you understand the underlying theories and practice, you can work through it yourself. Of course, a face to face person will help and the more skilled the practitioner the better. I was referred for CBT about six years ago but found the counsellor let me indulge in free association and ramble through my life and present problems without any guidance. Because I was about to visit relatives in Bavaria, he told me I had  a really good life which showed his assumptions and lack of understanding of bi-polar and depression. These illnesses affect poor and rich alike, the lonely as well as those with families. His view and expressing it was unhelpful. He did eventually give me homework (this should have been from week 1). He asked me to list what I was proud of about myself. At last, I thought, we re getting to CBT but positive affirmations and raising self esteem is not CBT. He did not encourage me to make a diary of negative thoughts. In the end I did it myself after working through a DBT book.

You can borrow books on CBT from the library and also googling CBT will bring up websites. Make sure you choose a website which does not ask you to pay. There are plenty of websites which offer worksheets and information on the technique. All of this is free.

Here is one website. You will see it does advertise some books which cost money but it gives useful information for those seeking to understand more about themselves and their symptoms.

http://www.get.gg/cbtstep1.htm

WebMD is a good website. This is the US link to CBT and makes good reading.

http://www.webmd.com/depression/guide/cognitive-behavioral-therapy-for-depression

A book I now have on my bookshelf is Brilliant Cognitive Behavioural Therapy by Dr Stephen Briers.

Standard
Uncategorized

THE LEARNING JOURNEY OUT OF DEPRESSION

HOW FAR HAVE I TRAVELLED?

I have journeyed far since my diagnosis in 1991, following a second breakdown. It was called manic depression in those days and I thought it would go away. It never occurred to me it was here to stay and would shadow me through life tripping me up when I was off guard. No-one told me anything about the nature of the condition, its causes, symptoms, signs and treatments. After both spells off work I ploughed my way back into normality through a black cloud, feet wading through treacle and my stomach tied up in knots.

There was no help outside of hospital in 1989 or 1991 – well not where I was living. Both times I was discharged home to an empty house where I sat in the same chair in the kitchen for 12 hours a day. It was what is now fashionably called ‘a dark place’. My only outings were to buy a few items of food to cook at night and to walk our dog in a nearby large park. My colleagues at my college were busy and some shied away from contact with me. It was a desperately lonely time – a drab existence with a failing relationship and the belief that any good life was over forever, that I was unworthy and deserved little. My weekly GP visits brightened my life not because of the doctor but the lovely Receptionist who greeted me warmly, the first time saying how nice it was to see me out and about. She could not have known how I treasured that statement. Few said the same preferring to treat me as an odd ball.

When out of the house, I avoided people, frightened they might ask why I was not at work or might sense I was a mentally ill misfit. I was scared most of the time. Scared of losing my marriage, my job or my home or all three. After all I had met patients in hospital who had fared much worse than me in all three areas.

Luckily I returned after both breakdowns to resume teaching. Perhaps mistakenly but I knew no other way to earn my living. No-one suggested the stress could make me ill again. There were no CPNs (Community Psychiatric Nurses) visiting me at home, no day centres to offer occupational activities, no home visits from the GP. There was just one follow up Out Patient appointment six weeks after discharge. Five minutes to say if I was feeling better. No advice, my only medication a mixture of anti-depressants and Lithium.

I look back in horror at a NHS mental health system that was so lacking in care and information. No-one sat me down and explained what manic depression was so I continued a rather frenetic lifestyle, working late at night marking assignments, planning lessons and writing. I failed abysmally to nurture my inner self, take care of myself properly or do my relaxation exercises – these were the only technique used at my hospital. Once home I had no tape to use although after the second breakdown I was given one but using it was impossible as my husband objected to me shutting myself away in solitude and quiet. I still smoked 20 cigarettes a day and drank more than I should. I had not conquered the essence of a healthy diet and when I did take longer shopping one week when I decided to read all the labels and consult a healthy eating magazine my longer than usual absence was criticised.

In the end my proactive nature saved me. I scoured bookshops for books on depression – the internet was in its infancy – and spent hours walking my dog trying to work out what had gone wrong in my life. It was hard work but I learnt a good deal. I read much and used exercises in the books such as making a list of five things to do each day that I would enjoy. I did crosswords, took up knitting and began writing a diary.

I was, in effect, my own therapist and in the end that is what we all have to be. Recovery has to come from us. No-one can do it for us. But when everything in your head and body is broken and your world is in a state of upheaval, it is practically impossible to take action. Only those who have suffered clinical depression understand how hard it is to drag yourself out of the mire.

I did emerge from the dark place and the mire gradually became a clear calm lake on which I could sail my boat of life. I hope to write about those dark days and how I brought myself back to the land of the living. It won’t do me much good but it may help others.

A card from a true friend contained the following phrase which I try to remember when the clouds darken my mind from time to time. She wrote ‘you will soon be back in the swing of things’.

And I was.

 

Standard
Uncategorized

WRITING AS THERAPY FOR DEPRESSION

What came first? Writer’s block or depression?

So I said to my psychiatrist that I am now wondering whether it was Writer’s Block that brought on my latest bi-polar depression. Of course, the depression may have caused the block. But when I think back, a rejection in October hit me hard and I distracted myself with a manic decorating spree. When the depression hit me in January, I thought that was the reason that I was no longer writing but now I look back, I stopped writing prolifically before the depression struck. Yes the occasional blog but not what I call ‘real’ writing. Even the blog posts became less frequent.

In Issue 61 of Mslexia, Roselle Anguin discusses the therapeutic effect of writing but her statistics and research throw more light on the link between writing and depression. As a group, writers have a high incidence of mental health issues but writers are also better equipped to cope with these issues, even to heal from them. A previous survey in Mslexia suggested that 69 per cent of women writers have been treated for some kind of mental health problem, in contrast with 29 per cent of women in the general population. The survey discovered writing could make women feel more positive, relieve depression and alleviate the symptoms of stress and anxiety.

Writing, of course, has therapeutic benefits for non-writers too. But if you suffer from mental illness and you are not a writer, you are missing a vital strategy to engage with your feelings and express emotions such as fear and anxiety.

Fortunately my depression has lifted and I have started writing again but I have been thinking about the ‘chicken and egg’ situation of whether depression causes, or is caused by, writer’s block. All writers have days when the words don’t flow but when even a pen and notebook do not stir ideas and the computer stays switched off for no explicable reason, it is clear that the block has taken over your life.

Julia Cameron, in The Artist’s Way, suggests several tactics for releasing your creativity and dealing with the inner critic who repeatedly tells you that you cannot write and, if you do, what you write is rubbish. One of her methods is the ‘morning pages’. Just take your notebook and write three pages of drivel after which you should be able to write the ‘serious’ stuff.

This could work with depression too. That is, once you can stay out of bed for sustained periods although I have tried taking the notebook to bed and it has worked. Just write anything that comes into your head without worrying about it being part of your next or present Work In Progress WIP) could ease anxiety and is immediately liberating. Writing down your fears can make them seem quite trivial which can be enlightening. After all, in your mind your fears are mammoth and sufficient to stop you undertaking normal daily activities. So they must be real. But the truth is most will be much less than you had imagined. Your fears, once written down, will not seem so dire. If they are grounded in fact and you have problems that will seriously affect your life, writing them down may help you find a solution even if this is only temporary. Redundancy, for example, is a real threat to your income and the house, bills and food but being proactive and listing a few plans such as visiting the Job Centre for a Careers interview could ease the dread.

Writing can also be used in other ways. Writing down five ways to make yourself better, five things you like about yourself, five strengths, five things you want to do in the next six months. All of this is using the power of the pen to empty the mind. This in turn will allow in more positive thoughts – probably one or two of your plans will reach fruition.

For those with Bi-Polar, keeping a diary of activities, meetings with friends, reflective thoughts on the past day and an indicator of mood can help track mood levels and, if there are changes, you can look at what you were doing a few days before the mood changed. This has been one of the most helpful strategies I have used since being diagnosed with BPD. The diary can be useful when seeing professionals too as you can, prior to the appointment, overview what has been happening in your life.

But I never write, I hear you say. Forget that, take a positive stance and promise yourself that you will start writing. Just a few words is all it takes. A shopping list, a few nice menus and a sentence or two about your feelings that day. Then start planning, making lists and writing more reflective accounts.

It is worth it so give it a try.

Standard