Christmas is a time for getting together and celebrating with family and friends. However, it can also be a very difficult time. Lots of us feel under pressure during the festive period – to have the perfect Christmas, to buy the perfect gifts that our children and friends want, to please all our families. A lack of money, time or energy, credit card bills and the pressure of giving gifts might also contribute to stress during the holiday season.
If you begin to feel overwhelmed by problems, Christmas can turn from being a season of joy into a time of panic, loneliness, depression, anxiety and dread.
Anecdotally, it’s known, at least by anyone who has extended family, that more grudges are formed at Christmas than at any other time of year; old family rivalries, arguments, one-upmanship and even fights about your sister’s spoilt kids tend to rear their ugly heads. Split families and unresolved conflicts may also contribute to Christmas anxiety. Other sources of stress might be political (think Brexit) or cultural clashes caused by generational or even geographical differences, which result in tense atmospheres or furious rows over the dinner table.
Let’s face it, you’re already exhausted by your extra-heavy workload:
shopping for cards (particularly the special ones for mum and dad or sister etc), wrapping paper, crackers and presents (a few extra for surprise guests or someone you’d forgotten about altogether)
getting your tree down from the loft or buying a new one; making sure the lights work – before you put them on the tree, decorating it and tying tinsel everywhere
writing out cards in time for the last post and, if you’re like me, filling them with sparkling stars and glitter, which drives my family and friends nuts. Ha, they’ll miss me when I’m gone
perfectly wrapping presents with matching tags, ribbons and bows (unwrapping one without tearing it to throw in the aforementioned sprinkles that I’d forgotten)
planning the menu, shopping for the huge amounts of food (because the shops are closed – for one day) and loads of champagne – oh, and don’t forget Uncle Cedric only drinks Stout – do they still sell this stuff?
planning who’ll sit where – to avoid the old family feuds – I wouldn’t worry about it cos there’s always someone who’s not happy anyway!
table decorating – at Christmas is huge now – you see everyone posting their amazingtable on Instagram and Facebook – what’s all that about?
being all things to all people
Phew! I’m already shattered. So, having done all the above, you’d think you’d be able to relax on Christmas Day, right?
Nope! You’ve still got Christmas breakfast to cook………………..
Right, rewind……. let’s start again. Okay, so I’m a bit late posting this as Christmas is almost upon us and most of you will have done all your cards, shopping and preparation. But, and it’s big one, you still have a few days to get some self-care in so that you’ll be as relaxed as everyone else on the day:
if you haven’t already done so, enlist some help: write down who’s doing what and make sure the kids are involved – delegate, delegate, delegate
when the going gets tough, remember Christmas is a time for family, for friendship and spending time together – so what if you’ve forgotten the stuffing (tho I know my hubby would be desperately disappointed) or batteries for the kids’ most wanted gifts (they’ll have to join in the annual game of Monopoly)
enjoy some simple things like go for a walk somewhere calm and soothing -gentle activity such as a 15-minute walk helps your body to regulate its insulin production, which can be disturbed by stress
try yoga, meditation or do some gentle stretches to loosen those tight muscles, take time out to have a massage or even just get hubby to give you a ten-minute foot massage/shoulder rub
have yourself a long, luxurious bubble bath – small acts of self-care go a long way in helping us feel more positive and energised
have yourself a nice hot chocolate (with or without the marshmallows) and snuggle up on the sofa/bed with a good book for a few hours
listen to your favourite music and, if you’re feeling up to it, dance like no one can see you, sing along like no one can hear you
catch up with a favourite friend and have a good old belly-laugh, nothing better to get you in the mood and it’s well known that fun and laughter is a great stress reliever
go to the cinema, the theatre or a comedy show – sit back and relax
eat mood-boosting foods; a carbohydrate-rich meal can help to boost serotonin levels
wind down gradually before bedtime and get plenty of sleep; set an alarm for bedtime and go to bed at the same time each night – to regulate your sleep pattern
sniff some lemons (I’m not kidding) – according to researchers at Ohio State University, lemon scents instantly boost your mood
and breathe – deeply – out then in, half a dozen times or so – taking just a few moments each day to practice some deep breathing exercises can decrease stress, relax your mind and body and can help you sleep better. Deep breathing is, among many other things, a relaxant, a natural painkiller, it improves digestion and it detoxifies the body.
Go on – treat yourself – try out a few of the above and let me know how you get on.
What other stress relievers could we try (without reaching for the second bottle of Prosecco)? Any tips, please?
Some of you might want to crucify me for mentioning ‘fake’ patients but hold on. Wait until you’ve finished reading this post.
I was still in my six month preceptorship period when Pauline was admitted to Lavender Ward, an acute inpatient mental health ward. She was neat and tidy, her hair and nails were spotless, she appeared cheerful and engaged easily with the other patients while waiting to be assessed. However, during her admission assessment she relayed that she had been living on the streets, she was paranoid, depressed, anxious and suicidal – she’d actually been seen by passers bye running across a main road several times, without looking out for traffic, according to the paramedics who brought her in.
Pauline was articulate, she maintained good eye contact with me and smiled appropriately during the assessment. She said she had no family at all and had lost her friends since becoming ‘mad’ and homeless – though she couldn’t remember for how long. Pauline reported that she slept well although she had paranoid dreams, which didn’t wake her. The paranoia she described was that someone was after her and wanted to kill her but she couldn’t be clear about when this happened or who it was that wanted to kill her.
Once seen and admitted by a nurse, the patient’s baseline observations are taken i.e. blood pressure, temperature, pulse, respirations, height, weight etc. All of which were stable. After this, the patient would be seen by the ward doctor, normally an SHO, a junior doctor who is on their six month rotation and has little psychiatric knowledge.
We had a tall, handsome and smarmy (oops, I mean polite) young chap, Dr Wellar, who looked down his nose whenever a nurse approached him. This was only his second week on the ward and I did tell him one day, “these nurses know way more than you do, and you ought to treat them with the respect they deserve.” That marked my card with him, I’m afraid.
Dr Smarmy stood to greet Pauline and, shaking her hand, he invited her to sit in ‘his’ office for a chat. She was in heaven, all smiles and giggling like a teenager. So I wasn’t sure why, when they’d finished her assessment, he announced to the team that she needs to be on close obs (There’s lots of circumstances where patients may require one to one nursing i.e. the patient is acutely physically unwell and/or requires frequent observations, the patient is acutely mentally ill and/or at immediate risk of serious self harm/suicide etc).
Depending on the level of risk, one to one nursing can be carried out by either a qualified nurse or a nursing assistant. Pauline was classed as high risk of suicide so needed to be observed by a qualified nurse 24/7, which includes when the patient goes to the loo. This takes one person from the staff numbers i.e. reducing the amount of staff by one. If you are nursing one to one, you cannot be expected to care for your five patients on top of this. Sometimes, the Trust allowed us to have an extra member of staff, more often a nursing assistant, to keep costs down.
As I’d done Pauline’s initial assessment, I was allocated as her 1:1 nurse so I spent the rest of that morning’s shift with her. We chatted about the weather, her dog and how she was worried about him – she didn’t know where he was. Pauline’s mum works “oh, I mean worked” as a teacher but she couldn’t remember the name of the school. I just kept the conversation light and said how proud she must have been of her mum etc. But something just didn’t sit right with me and I passed all this onto the afternoon shift.
On my next shift, I was allocated to Pauline, 1:1, as apparently she liked me and we’d built up a good rapport. Again we chatted amiably about her past – what she could remember of it – she said her depression was affecting her memory. Obviously I had to accompany her while she showered and went to the loo, but to give her some privacy and to maintain her dignity, I averted my eyes temporarily. However, she was inappropriate at times, dropping her towel, not able to find her knickers, could I pass her the toilet paper or her wet wipes – almost anything to keep my attention.
Let me tell you something now; it’s no fun being in a bathroom when someone else has to poop and it’s worse still when you have to get close enough to pass the toilet paper.
Towards the end of one shift, she told me how sad she was that I’d be off over the weekend as she really enjoyed out chats. At the end of my shift she really invaded my personal space when she threw her arms around me and planted a great big kiss on each cheek “Adios. Au revoir. Bye my angel nurse. I will miss you.” I kid you not.
I’d really enjoyed my days off but still looked forward to getting back to work. On my return, as I walked through the front door to the ward, I was almost past the Dr’s office when Smarmy called me in, “Can’t you even get one thing right? You only had to look after one person – how hard can it be?” he demanded and shook his head at me disdainfully. “Pauline said you left her in the shower for nearly 20 minutes and she tried to kill herself.” I shook my head back at him, I smiled and assured him that this was simply not true.
He continued berating and belittling me until he took a breath and I simply responded that I was off to see our Ward Manager. She believed and trusted me that it simply wasn’t true. He’d been ‘had’ but obviously this was the story he was re-telling the whole multi-disciplinary team, making me look incompetent. However, he took in what the ward manager said to him and conceded he might be wrong.
In the meantime, I felt like I’d been punched in the stomach. I was hurt by Pauline’s tale; I thought we’d formed a good professional bond. One of our senior nurses said not to worry, don’t take it personally and reflect on this; trust me, you will learn from it.
I had to work with Pauline a few more shifts and just kept up the banter but didn’t mention the ‘incident’ and nor did she. Had I been a bit more experienced I would have discussed it with her but right at that moment, I didn’t want to upset her – there was something going on for her? and I was still trying to work her out.
After a week, we had a phone call from her mother, asking if we had a Josephine on the ward. Yes, it turns out this is something Pauline does now and again. She frequents hospitals seeking admission because she said ‘she gets a bed and fed’. In the meantime, she saves up her benefit money while she’s in whatever hospital. Some might say that this is a mental illness in itself?
This young lad had been admitted voluntarily after he went to A&E saying he was paranoid and hearing voices. He was amiable and loved chatting with fellow patients and the staff. He could be heard asking other patients why they were in hospital and was interested in hearing about their symptoms. After a few days staff could see that he wasn’t displaying any symptoms of anxiety, paranoia or hearing voices and had hinted as much to Ronnie.
Late one night shift, we watched as he paced the long corridor outside the nursing office. He had his head cocked to one side, looking up towards the heavens’, and was saying out loud “Sorry. Say that again. I can’t hear you.” He gave the odd sideways glance towards the office to see if anyone was watching him and continued, “Don’t say that. I’m scared. You’re scaring me.”
Me and Billy, my favourite nurse, found this rather comical and went to sit outside to observe Ronnie and start a conversation with him. Billy asked “What are the voices saying to you Ronnie?” and Ronnie cocked his head to one side, looked upwards again and asked “What are you saying? Ah, ok, hold on.” and in all seriousness, he turned to Billy and said “They’re saying they don’t like you. They don’t want me to talk to you.”
I could barely keep a straight face as I probed a little further, “Okay, tell me Ronnie, how many voices are there?” He did the cocked head thing and the upward glance then cupped his ear, as though he was listening, then counting on his spare hand he looked at me and whispered, “two – and they said they like you.”
We continued in this vein for around fifteen minutes before Billy and I just laughed out loud. Ronnie’s utterances were becoming more ludicrous by the minute and Billy said as much to him, “Hey, soft lad. You look bloody stupid. You’re not hearing voices are you?” Ronnie knew the game was up and pleaded with us not to tell the doctors, “Anyway, they can’t send me home, I don’t have anywhere to go. They’ll have to find me a flat, won’t they?”
Emergency Treatment Team
I worked with the Emergency Team for a while. This was where people would come during daytime hours to be assessed and we, as nurses, would decide whether to admit someone or to refer them to another service i.e. home treatment team (HTT).
We had so many ‘fake’ patients asserting their mental illness rights, looking for admission so we could find them a home with a garden. Or they needed housing application forms completed, saying that they had a mental illness, which they hoped would put them near the top of the the already groaning housing list or benefit forms so they could access Disability Living Allowance.
Many reported being depressed but when asked to explain, some would say they’ve got a bad back and needed a ground floor flat as the stairs were difficult. Or excruciating headaches due to noisy, antisocial neighbours and it’s driving them mad so they need to move. As though getting a new home would somehow magic away their pain and depression. While I appreciate that decent housing is beneficial to everyone, admission to a mental health ward is not. Furthermore, housing lists are stretched to their limits and London now requires around 66,000 new homes a year to provide enough homes for current and future Londoners.
Given that our hospital served the local population which was approximately 52% non white-British, we had patients from nearly every country and many of them needed interpreters. When they mentioned housing or benefit forms, I always asked them via the interpreter “Do you know where you are right now?” and “Do you know this is a mental health emergency department?” And often told them “This is not a housing services.” or “This is not a benefit office.” before signposting them to the appropriate services
The thing is, we had thousands of patients with chronic mental illnesses who desperately needed our support and mental health intervention or treatment. Moreover, Mental Health is like the Cinderella service of the NHS and we don’t get lots of money so what little we do get is needed for ‘real’ patients.
Do you think I was harsh in turning patients away?
This is the 3rd in a series of “My journey through Anxiety, depression and psychosis.” If you haven’t read Part I and Part II and you want to, you can find them here (Part I) and here (Part II).
If you see anything of yourself or your own experiences in this post, perhaps you’ll feel relieved that you are not alone. Maybe you’ll even recognise some of the symptoms in a friend or family member? Or it’s feasible you’ll gain insight into different mental health problems and see how difficult it is for people who experience mental ill health?
……….I was struggling desperately. I couldn’t see an end to the pain. I felt scared, worthless, hopeless and I honestly felt suicidal. It was then that I had my own ‘break down‘. And that’s exactly what it felt like; both physically and mentally, I was broken.
I was having panic attacks throughout the day and particularly at night, keeping me awake. Alongside the huge purple sacks under my eyes, the weight loss, dizziness and nausea, I looked bloody awful and felt even worse. It was torturous; twenty-four-seven, week on week and, with no end in sight, I wished I was dead.
Natural Stress Relief
I tried every natural and herbal stress relief, sleep inducing, over-the-counter remedy known to man, without effect.As an aromatherapist, I made up lots of pretty little bottles of stress relief oils then bathed in them and doused myself liberally. However, despite all the lovely citrusy, spicy and fruity oils, all I could smell was the lavender, reminiscent of my grannies old underwear drawers. This didn’t work either.
As a qualified massage therapist, I was aware of the benefits so I booked myself in for a few sessions. However, the first lady almost pecked at me like a small bird trying to feed itself for the first time; there was no pressure applied and she missed areas of my body out! The second time, I went for seated massage, which ought to involve sitting on the massage chair with your upper body leaning forward, your arms on armrests and your face peeking through a hole. Looks comfortable, right? This lady, who’d attended the seated massage course with me, had me sit on a swivelling office chair! With my muscles tensing, I tried using my feet and legs to keep the chair from spinning, to no avail so told her to stop. She couldn’t understand why I refused to pay?
I joined the local gym and went seven days a week, twice on Sunday; pounding the treadmill and pedalling like fury on the exercise bike. I got so wound up if I couldn’t go to the gym for any reason but made up by jogging on the spot and running up and down our stairs. I tried most everything to relieve the constant anxiety and to wear myself out so I could sleep, but even the excessive exercise proved fruitless.
Hallucinations and paranoia
I was permanently exhausted and after three nights in a row without sleep, I started to hear, see and feel odd things. People (I didn’t recognise the voices – but they were very real) were talking to me and about me, saying I was no good, I was dirty, together with lots of other negative comments and expletives. I could see things; mice running along my wooden floorboards and unidentifiable faces at my windows. Worse still, one night I was wide awake curled up on my kitchen floor, with my back against the heater and it came to me – I’d killed someone.
I remembered how and where I’d buried that someone; by a huge tree outside my aunt’s flats, but I couldn’t think who it was that I’d killed. The next day, I saw a police car and thought ‘This is it. They’re coming for me.’ Jeez! I was terrified. For months, if I saw a police car down our street, I’d turn and retrace my steps or go round to my back door. If the police were in the square at the back, I’d whizz round the front. I sometimes wondered if I should just hand myself in and let them find out who this someone was that I’d killed. In hindsight, obviously if they were after me, they would have got me.
Mad, nuts or crazy
Although close friends and family were aware of my break-up with the boys’ dad and knew how devastated I was, I couldn’t tell anyone what was going through my head. I was afraid they’d think I was mad, nuts, crazyand that I should be locked away. Seeing mice or rats scurrying under my sofa and the unknown ugly faces frightened me, but if I closed my eyes at least I would get some temporary relief. However, the voices were incessant and unbearable; the constant rabble of people discussing what only I knew as my fears. They played on them, they were cruel, repeating the negative thoughts I’d so often had myself. They knew which buttons to push.
When I attempted to sleep in my bed the voices seemingly delighted in keeping me awake with their constant and irrepressible verbal abuse. One day, after work and before picking up my youngest, I bought a cd player, ear plugs and a few ‘out there’ cds with relaxing music, water sounds and dolphins in the background. I played these throughout the nights but still, my heart pounded in my chest and thundered in my ears, my breathing was irregular and the panic attacks raged.
By the time I got the boys up for school, I was a wreck; my eyes were red-rimmed and it felt like there sand in them. I was sluggish and jittery, but I somehow managed to hide it from the boys. My job at a high end clothing company was demanding, which helped abate the voices for a few hours but the anxiety, depression negative thoughts and panic remained. Colleagues at work noticed the 4 stone weight loss and saw how my clothes fell from my gaunt body. It certainly wasn’t a good image for the brand. Fortunately, a good friend in the sewing department kindly offered to take them in.
I even tried extortionately priced hypnotherapy but I couldn’t relax enough to go into a trance-like state. However, I’d bought myself a Paul McKenna relaxation video and when the boys were I bed I’d get it out. I’d half sit, half lie in one of my padded beach chairs, directly in front of the t.v so I could get the full effects of both the visuals and the sounds. Amazingly, I managed to relax and as the video ended, I’d carefully take this relaxation up to bed with me and finally managed to get a few good hours sleep. Sometimes it didn’t work and I suffered the torture again but I was so grateful for the times it did work.
What’s the problem?
After a while, not sure how long as I was in a constant haze back then, I took the boys to see our GP about their asthma. Once he’d seen them he sent them out, turned to me and, with his hand resting lightly on my arm, he said “Tell me, what’s the problem? You so thin and though you smile, I think you very sad.” The floodgates opened and it all came tumbling out; I sobbed and wiped the tears and snot on my hand as I explained how the boys’ dad had been seeing someone else and about the breakup around eighteen months ago. He told me to let the boys go home, he would make some telephone calls and I was to come back in to see him.
Having spoken to a colleague who agreed to see me, like – now, at our local general hospital, Dr Nga was going to drop me off! I knew it was a general hospital, rather than a mental one, but I soon found out that there was one mental health ward there.
I thought back to how, as kids we’d all say stupid things like “The men in white coats will come to get you.” or “You’ll end up in Stratheden, (our nearest asylum) you will.” We were all terrified just at the mention of the asylum.
Well, one day mum said my stepdad was taking her to hospital for a few days and I asked if I could go with them. Dad said no, mum said “Yes; she’ll be fine.” So off we went and when I noticed we’d gone past the hospital, I didn’t think too much of it – until I saw the huge sign looming up – Stratheden Hospital.
I assumed and hoped we’d just drive past that too. However, when we pulled up at the foreboding buildings and the grounds surrounded by high metal railings – and gates that were opened by the porter who otherwise sat in his wooden lodge, reading a paper. I was petrified and felt a certain shame; my mum was going into an asylum. Oh my God!
From the car park I could see people roaming around, some with an odd gait, others making strange utterances. A lady with long scraggly grey hair, wearing unusual clothing, waved at me frantically then cackled like an old witch. Not sure if it was designed to frighten me, but that she did! Mum and dad got out of the car but I wasn’t allowed to go into the building with them so was left sitting in the car and told not to open the doors to anyone. Ha, as if.
In later years I would learn that mum had been in an asylum once before and on both occasions she had ECT (Electroconvulsive therapy), which is given under general anesthesia. Doctors use a course of ECT
if you have severe or life-threatening depression where your life is at risk so you need urgent treatment
and to treat severe depression where there’s a lack of response or intolerance to medication.
I’d say it looks barbaric but ECT is said to be one of the fastest and most effective ways to relieve symptoms in severely depressed or suicidal people. Some people find ECT helpful while others don’t and repeated ECT is only recommended if you have previously responded well to it, or if all other options have been considered.
Back to the future
Dr Nga had dropped me off at the hospital and fortunately, although I had suicidal thoughts, the Consultant Psychiatrist and the Psychology team were confident that I had no intention of killing myself – I’d said even though I felt suicidal, I knew I couldn’t do that to my sons. I couldn’t possibly leave them with that legacy. So, no admission was necessary and three years of weekly painful, gut-wrenching counselling followed – on and off, because sometimes I was too afraid of myself and my responses to the psychologist. I didn’t want to hear what I had to say, so how would the counsellor feel?
I do hope you’ll continue to read My story, Part IV (The finale) which will follow shortly. You’ll learn about my suicide attempt and the hell I went through during my Psychotic Depression. Thank you for staying with me.
In nursing you’re supposed to treat everyone equally and not have favourites. However, we are all human and some people we just click with, for whatever reasons. I loved all my patients, well 99.9% of them, but some are more memorable. Out of the thousands of patients I had the honour and pleasure to work with, these are just 3 of them. I think you’ll like them too.
You’d have loved Jackie, you couldn’t help but adore her. This four foot nothing Scottish pocket rocket had a diagnosis of Bipolar disorder and often had me in hysterics as we enjoyed the same dry Scottish sense of humour. She’d use sayings I’d heard old aunties use when I was growing up like “I’m no as green as I am cabbage looking.” meaning I’m not stupid or “Do you peel oranges in your pocket too?” if you were eating sweets/cakes and didn’t offer her one. I’d said to her one day “I bet you were gorgeous when you were young,” and she shot back as she raced past me “Aye, I still am ye cheeky wee coo and I bet you were still offending people when you were young.” Another time she’d just returned to the ward, in her sopping wet slippers, from a few hours leave and told me what had happened as she was coming back through the hospital gates, “A cheeky wee b*stard asked me did a have a spare fag. I opened the box and counted 1, 2, 3, 4 ……16, 17, 18! 18 fags a telt him and not one of them’s spare!” Leaving me smiling, she speedwalked down the corridor to her room, chuckling all the way.
Bipolar is a mood disorder and can be a life-long mental health problem. It used to be called manic depression and can cause your mood to swing from an extreme high to an extreme low. Manic symptoms can include increased energy, excitement, impulsive behaviour, racing thoughts and agitation. Depressive symptoms can include lack of energy, feeling worthless, low self-esteem and suicidal thoughts. Jackie spoke the above when she was well so in no way am I making a fool of her.
I adored this tiny cockney lady like I did my nana, who she reminded me of. She was about four foot six and no more than 5 stone but boy could she put up a fight. She’d been brought in by her Community Nurse when they said they’d found her depressed and sitting alone in her dirty flat. As Manager of Juniper Ward, Older Adults, I’d arrived one morning and immediately I knew Jeannie was nearby because the stench smacked me right in the face. I wondered which cubby hole I’d find her in today; waiting for me, as she did most mornings. The poor thing had been on the ward ten days and we still hadn’t managed to get her into the bath or shower. She’d screamed and cursed furiously when the word wash was mentioned, more often taking it out on “all the effin foreigners” who “ain’t touching me.” She’d growl in their faces “Learn effin English.” or “Go back to where you bloody come from.” I soon found her and as I bent to give her a hug, I whispered “Jeannie, Sweetheart, I think we need to help you into a shower today, cos I know if you were well enough to look after yourself you wouldn’t want to smell this bad.”
“Smell? Me? You cheeky fucker. It’s you, your nose is too near your own effin arse.” she scowled up at me but I caught her sly grin. I smiled because, despite her fearsome outer shell, I knew she was beginning to trust me. Assuring her all the way, Jeannie let me inch her towards a bathroom and, before she changed her mind, I quickly grabbed another nurse who could help. It was pitiful as she wept when we were undressing her and saw her frail ravaged body. She cried out in shame and my heart bled for her. However, we’d finally managed to shower her and get her some clean clothes and I could have cried when she stood ten feet tall, shimmying into day area like a peacock spreading its wings.
Now there’s no way that smell was only ten days old; even Jeannie’s silver grey hair stank, it was matted at the roots and had clearly not been washed or managed for years. So why had the community team rang the ward, miscalling our team, saying that Jeannie’s been on the ward ten days now and she’s still in a state.Huh! What had they been doing for the last year or so? I asked them. And why did her family come storming onto the ward, thundering at my door, complaining that we hadn’t done anything with their mum’s hair. “Oh, I agree Jeannie’s hair is in a terrible state Sir, but your mum’s only been with us ten days, and you can see her hair hasn’t been touched for a long time.”
I explained to the buffoon of a son that his mum had the capacity to make an informed decision about bathing/showering or having her hair washed and she’d decided not to accept nursing support in attending to her hair. The Royal College of Nursing (RCN) 2017* states “If a person has capacity to make decisions independently then their decision is binding and the proposed examination, treatment, care or support cannot proceed, even if you think their decision is wrong.”
Eyes rolling. Pft! He tutted and sighed heavily, not quite sure what to say. So I saved him the bother and said “Look, if you’d like to make a formal complaint, I can let you have the appropriate forms -” Ptf! more heavy sighing and “No, it’s alright. No problem and thank you for looking after her anyway. She thinks a lot of this ward and I wouldn’t want to upset her; she can easily fly of the handle.” Really?
This thirty-nine year old lady had a Borderline Personality Disorder (BPD). People who suffer from BPD struggle to regulate their mood and emotions, which results in them being unstable – sometimes for long periods at a time. It can cause problems in relating to other people, and often makes controlling impulses difficult. Unfortunately, some people with BPD are more at risk of experiencing suicidal thinking and self-harm attempts.
Many, though not all, patients who have BPD are known to have experienced parental neglect or physical, sexual or emotional abuse during their childhood. The symptoms of a personality disorder may range from mild to severe and usually emerge in adolescence, persisting into adulthood (NHS 2019).
Andrea had suffered many of the abuses at the hands of her mother and the men she took home. She had known her mother had given birth to several other children, both before and after Andrea, most of whom were adopted. Her young life had been chaotic, frightening and devoid of any love or kindness from her mother.
At the age of sixteen she met and fell in love with a young man and they ran away to Gretna Green in Scotland to get married. (In England you have to have parental consent if you wish to get married. However you can get married in Scotland at 16). Andrea felt loved, happy and secure, feelings she’d never known existed.
The young couple managed to get a one bedroom council flat and their happiness continued until one day her mother came to visit for the first time. She stank of cheap alcohol and cigarettes, as always, and she still treated Andrea with utter contempt saying she’d only come to get a look at her flat and this new fella.
She’d barged past Andrea into the sitting room, took one look at Andrea’s husband and said “Ere, you ain’t adopted are ya?” When he said yes she chuckled and asked his date of birth. “Oh my gawd! ‘Ere Andrea, I think you’ve only gone and married your flippin’ bruvver.” she said, laughing . Neither Andrea nor her husband could speak so her mother continued unabashed and guffawing “Everyone’s been tellin’ me how alike you looked and it got me thinkin’ -.”
It was true. Andrea’s world was turned upside down, the reality sank in and their marriage was annulled. The first of many suicide attempts followed and in between them her behaviour was erratic, she self-harmed and had many hospital admissions. She was given a range of diagnosis over the years and had been described a variety of antipsychotics and mood stabilisers which either didn’t work or the medications weren’t being managed correctly.
I first met Andrea on an acute ward where I initially thought her rather threatening and sullen, responding to any communication with one word answers. She was left alone for days by the staff and I wondered how this could be therapeutic, but nurses just said “She’s always here. She’s only on the ward for respite, she doesn’t need anything.” So I watched as Andrea stomped from her bedroom to the smoking room and back, to the dining area and back and to the medication room and back, glaring at everyone she passed and talking to no one.
I’d always said good morning or afternoon to Andrea, as I did with every patient, and wasn’t sure what else to say to her. I knocked on her open door one morning and asked if I could come in. “Everyone else just walks in anyway.” she muttered. I told her I wasn’t quite sure, as a new nurse, what to say to her but I’d like to get to know her. “At least you’re honest.” she smiled a little “No one else bothers.” I was sad but shocked and angry, I suppose. I asked her about the myriad of scars trailing like train tracks all the way down from her shoulders to her wrists and she showed me her legs which were also ravaged by years of cutting and slicing.
Myth: Self-harm is attention seeking
One of the most common stereotypes is that self-harm is about ‘attention seeking’. This is not the case. Many people who self-harm don’t talk to anyone about what they are going through for a long time and it can be very hard for people to find enough courage to ask for help. https://www.mentalhealth.org.uk/publications/truth-about-self-harm
Andrea explained how the cutting started as a way to alleviate the disgusting thoughts and feelings she gets. She told me she enjoys the pain and watching the blood trickle because it gives her something else to think about for a while.
We started spending more therapeutic time together and it wasn’t long before Andrea and I had built a great professional and therapeutic relationship. After a while, we disregarded her ancient care plans and developed new ones which involved Andrea in the planning, risk management and reviewing of her care. We developed goals specific to her to maximise coping mechanisms, medication management, engagement with services and social integration prior to her discharge but to be continued in the community. She began to engage more with her peer group and attended a variety of therapeutic groups. She even joined me on the hospital’s mixed football team and proved to be a terrific goalie.
Once I’d left that ward I often bumped into Andrea and always had time for a ciggie and a cup of coffee with her. On one of these occasions she quipped “This is all we all need; a ten minute dose of Nurse Nancy on the NHS each day.”
Could you be that nurse? The one that makes a difference. Could you be non-judgemental, kind, caring, compassionate and be a real listener where you actually hear the patient behind their story? We desperately need good mental health nurses to work for the NHS in the UK.
*Royal College of Nursing (RCN) 2017 Principles of Consent Guidance for nursing staff
As a former mental health nurse and ward manager for many years in one of London’s busiest mental health settings I was used to the many misconceptions people (including carers, visitors, family and friends) had. Here are my top 10.
Mental illness won’t affect me.FACT – Mental illnesses are surprisingly common; they do not discriminate—they can affect anyone. Approximately 1 in 4 people in the UK will experience a mental health problem each year. InEngland, 1 in 6 people report experiencing a common mental health problem, such as anxiety and depression, in any given week. (mind.org.uk)
People with mental illness are just weak.FACT: Mental health disorders are not a personal choice nor are they caused by personal weakness. Mental illness is a combination of biological, psychological, and social factors. Research has shown genetic and biological factors are associated with schizophrenia, depression, and alcoholism. Social influences, such as loss of a loved one or a job, can also contribute to the development of various disorders.
You can tell when someone has a mental illness.FACT: Many people think you can see when someone has a mental illness—maybe they think that a mentally ill person looks different, acts crazy, or always comes across as depressed or anxious. This is not true. Anyone can have a mental illness, even if they look completely normal, seem happy, or have a lot of money, a great job and a big house. (redbookmag.com)
People don’t recover from mental illnesses. FACT: Recovery is absolutely possible. The illness might not go away forever but lots of people with mental health problems still work, have families and lead full lives. Recovering from mental illness includes not only getting better, but achieving a meaningful and satisfying life. Being told that you have a mental illness is not the end of the world. With help and support, people can recover and achieve their life’s ambitions.
People with mental health issues can’t work.FACT: With one in four people affected by mental illness, you probably work with someone with a mental health problem. Many people can and do work with mental health issues, such as depression or anxiety, with little impact on productivity. However, like any illness, there are times when the person isn’t able to work due to the severity of the condition.
People with schizophrenia are violent. FACT: Modern media has been guilty of regularly portraying people with mental illness as violent. In truth, this is rarely the case. People with mental health problems are much more likely to be the victim of violence. While research has shown there is an increased risk of violence in those living with schizophrenia and anti-social personality disorder, in general, mental health sufferers are more at risk of being attacked or harming themselves. Official statistics consistently show that most violent crimes and homicides are committed by people who don’t have mental health problems.
People with mental health problems are lazy and should just snap out of it. FACT: This is certainly not true. There’s lots reasons why some people might look lazy as many experience fatigue and lethargy as side effects of their medication but this is not laziness. People cannot just snap out of a mental health problem and lots of people may need help to get better. This help might include medication, counselling and lots of support from their care team, friends and family.
People with mental illness rely on medication. FACT: Medication can be used on a short-term basis, especially for depression and anxiety, but for other mental illnesses, medication is used long-term. Mental illness is not like a physical illness because it can’t always be treated with one single medication. Often, a group of medications is needed for someone with a mental health disorder i.e. antipsychotics and antidepressants together with antiemetic medication to treat the side effects of antipsychotics.
Mental illness is “all in your head. It’s not a real medical problem. FACT: There’s still a common belief that someone with anxiety can “just calm down” or someone with depression can “snap out of it” like they can pick how and when to have an episode come or go. That’s simply not true. There are very real physical symptoms. Someone who has depression may see changes in appetite, libido and sleep pattern and someone with anxiety might feel breathless, have palpitations and feel nauseous or dizzy.
Asking someone about suicidal thoughts and feelings might make them do it. FACT: If someone says they are thinking about suicide, it can be very distressing. You might not know what to do to help, whether to take talk of suicide seriously, or if your talking about it will make the situation worse. However, asking about suicidal thoughts or feelings won’t push someone into doing something self-destructive. In fact, offering an opportunity to talk about feelings may reduce the risk of acting on suicidal feelings (Mayoclinic.org).
Unfortunately these mythsabout mental health problems often contribute to the stigma that many people still face. It’s so important that we challenge these myths so we can understand the real facts around a mental illness.
If you have had any of the feeling or described above, please find someone to talk to. You can always talk to your GP in confidence or look up your local branch of the Samaritans. You don’t have to suffer alone.
Do you have any questions about any of the above? I am always willing to offer support and information.
Have you ever had to and how would you challenge a friend or family member about these myths?
As I parked up my first morning, even above Slade’s Noddy Holder screaming “It’s Chriiiiiistmass”, I could hear a female screeching “Medication. I want my medication. Where’s my medication? I need my medication.” The poor neighbours either side of the building must have been well p’d off. It was six forty-five, pitch black outside and the streets were eerily quiet — other than the high pitched screeching coming from the Mental Health Rehab Unit piercing the air.
Someone in the office by the front door pressed a button to let me in and I was greeted by this tiny little lady who grabbed both my hands and panted “Help me. Help me please. I need my medication. You’re new. Are you an Agency Nurse?” Will you help me? Please?”
I spoke calmly but firmly, “Listen to me, I can’t help you right now…” I was trying to placate her enough so that she could hear me and take in what I was saying. At the same time I was trying to get her to take a breath as she was panicking and was as white as a sheet. I really felt for her.
“Please, please. I’m begging you,” she continued to screech, now in my face, as I tried to disentangle myself from the tight grip she had on my wrists. The office door opened and a nurse yelled “Cindy, stop it, leave her alone. Cindy!” I’d now managed to get myself free but Cindy had grabbed the nurse and was pulling on her cardigan, all the while screeching “You’re a bitch. You’re a fucking bitch! Get my medication you fucking black bitch.” The nurse eventually pushed me into the office and she followed, turning to slam the door in Cindy’s face with a kiss of her teeth “Oh Lordy Lord. That Cindy. She will be the death of me. I am Ayo. Who are you?”
I breathed a sigh of relief and introduced myself as the Student Nurse. “I don’t know. See how it is here. I pray to God for her sins,” humphed Ayo. “Hmmm. Take a seat. Ah! Here come the staff.” and I turned to see two females and one male puffing away outside, the ciggie smoke belching through the office window. “Tsk, Tut. I don’t know. Smokers, heh!” moaned Ayo as she reached to slam the offending window shut.
Seven o’clock on the dot the three members of staff traipsed in, throwing their coats on top of a filing cabinet. Lisa was first to introduce herself as the RMN, the shift coordinator and my supervisor, and said “That’s Lorna, she’s a qualified (RMN) and that’s Graham the NA (Nursing Assistant).” Where’s the fourth member of staff? I thought to myself.
“Okay.” started Ayo, above Cindy’s screeching. “The lady herself. Cindy, she slept and now she has been shouting before six thirty. Lord help me! Everybody still in bed. Only Sasha, she awakes all night but she stay in her room. Somebody needs to clear her room. I saw the mouse there.” My feet moved on their own, up off the floor as I sat on a desk, and I shuddered involuntarily when I was looking around for the said mouse.
Ayo continued and ended with “Moses needs to see a Doctor and his toenails need to be cut. It’s in the diary for this morning. Now I’m going home. Goodbye!” She pulled off her slippers and put them in her bag then huffed and puffed as she bent down to put her shoes on. She grabbed a large woollen blanket and shuffled out of the door.
Lisa went through the diary, handed out tasks to the other two and said she was doing medication and that I should shadow her. Lorna went off to wake up the other nine patients that lived in the ten bedded unit and Graham wandered off to the kitchen to prepare for breakfast.
With our coffee, Lisa and I went to the medication room, we were met with Cindy who was still gulping in great lumps of air, wringing her hands and saying “Thank you Lisa.” and “Thank you nurse.” to me. Yes, I could get quite used to being called Nurse.
“Right Cindy. You know we start titrating down your Diazepam today.”
“No, please Lisa. Not today. I can’t cope. I can’t cope!” Cindy screamed.
“Nought point five milligrams Mandy. You won’t even notice it.” Lisa tutted and turned to me. “She’s been on thirty milligrams three times a day for years and you can see it doesn’t reduce her anxiety. So we’re going to try titrating down while she’s in Rehab.” Cindy lived in a one bedroom flat and had apparently relapsed over a period of six months prior to admission to an acute ward. Once stabilised she was transferred to rehab.
Cindy had generalised anxiety disorder (GAD) which is a long-term condition that causes you to feel anxious about a wide range of situations and issues, rather than one specific event.
People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue. Titration looked like it would go on forever, reducing her Diazepam by nought point five mg three times a day. However, Cindy eventually accepted the reduced dose and greedily swallowed down all her medication, followed by gulps of water, then scurried off to the dining room.
We continued until each patient had had their medication then joined everyone for breakfast in the dining room because, on rehab, we were encouraged to eat with the patients each mealtime. Lisa waffled something about nurses having a responsibility to role model table manners and eating with the patients was supposed to encourage healthy eating. I wasn’t sure that this was an evidence-based intervention but I went along with it anyway.
Coffee and toast with jam was just what I needed but as I sat to eat I was immediately struck by an offensive odour. One older lady to my left had obviously not washed or brushed her teeth, yet there was another disgusting smell.
Graham screwed his nose up and said “She’s just sat there and shit herself and carried on eating!” to nobody in particular. “That’s Elsa.” he whispered with an Aberdonian accent. “She normally goes to the toilet but she uses her clothes to wipe herself and then hides them down the back of the toilets, eh Elsa?” he now boomed. “Elsa, say hello to Nancy, she’s our new student.” Elsa’s face was buried in the huge breakfast she was picking up with her teeth. She raised her head and gave me a toothless grin.
None of the staff got up to help Elsa so I offered, but Graham told me “No. Wait til after breakfast!” And this is rehab? I wondered — does it really work?
Around the table, there was belching, farting and one young chap was trying to snort back the snot that was threatening to hit his top lip. He eventually gave up and wiped a huge glob on the sleeve of his t-shirt leaving a silvery snail-like trail.
Coffee finished and my toast in the bin, I helped clear the table and took my time in the kitchen. I was hoping someone would deal with Elsa, as I was already feeling queasy. Fortunately, she’d gone by the time it took me to do the dishes but she’d left wet poop dribbling down the chair legs. Gloves and apron on and ten minutes later the chair was scrubbed and left outside in the back garden to dry.
Activities of daily living
To the bedrooms on the first floor now where I tried encouraging patients to wash and dress before attending any appointments or activities. Oh my word! I’d knocked and opened the door to Sasha’s room and was aghast at the cereal boxes piled as high as the ceiling. At a guess I’d say there must have been over two hundred boxes and the only other floor space was filled by her bed and two or three black sacks.
“Get out of my room.” stormed Sasha as she pushed me and slammed the door. I stood for a few seconds, stunned, then knocked and called out “I’m a student nurse Sasha. Is there anything I can do? Would you like me to help you clean your room.”
“Get lost.” Sasha muttered. I went to find Lisa and asked what I could do to help Sasha. “Not a lot,” Lisa laughed. “Her room’s been like that forever. She won’t let us in.” That can’t be right. Surely we have a duty of care? I went to the office to look through Sasha’s file and her painstakingly completed but outdated care plans to see if I could find ways to engage her.
I read that she was single, had no children and had been in care since the age of eleven when her mother couldn’t cope with her chaotic behaviour. She was thirty one and was diagnosed with Schizophrenia at eighteen. Sasha heard voices and was often heard talking back to them when alone in her bedroom. Apparently Sasha had no insight and didn’t believe she had a mental health problem. She’d been on the unit for six months and was awaiting housing but it was proving difficult to find a place that would meet her needs.
I decided then that I’d be really firm with Sasha right from the start, telling her that we have a duty of care to ensure that her environment is habitable. If she wouldn’t clean it herself, then we would have to do it! It annoyed me that staff had let her live like this for months. Even if Sasha had refused to let them clean it, surely the staff could have come up with a plan between them.
It was exhausting and often thankless, but I worked hard with Sasha for the next twelve weeks, updating her care plans and engaging her in meaningful activities; things that would both interest and help her rather drum banging or painting by numbers. I appreciate that one of her care plans previously stated ‘Engage Sasha in activities.’ But, while these particular activities may help with dexterity and fine finger/hand movement, I wasn’t sure they would support her development. It was clear that certain staff had intermittently tried to push Sasha into any activities and wrote in her notes ‘Declined to attend.’ I wondered why!
I’d eventually learned more about Sasha, along with the other patients on the unit, and had managed to form a professional bond with each of them. As I got to know them better, often by engaging them in friendly banter, I was better informed about their likes and dislikes. It was easy to see they weren’t interested in particular activities and that they had their own ideas about how to spend their time.
Mark liked football so I’d have a kickabout with him in the gardens – he was quite good – so encouraged him to attend the local leisure centre where he could access different types of exercise and look out for a local football team to join.
Jenny loved knitting so we bought her knitting needles, a few patterns for baby clothes (that she requested), and some wool. She wasn’t great, dropping more than a few stitches, but that wasn’t the point. She enjoyed it. Other staff who could knit helped her unpick and start again. Eventually, with the help of staff, she started her own small weekly knitting group on the unit.
We also got a group of patients to go swimming once a week, with a member of the team. We also went to the local pub once a week so that some of the young lads could have half a pint and a game of pool. They’d never felt comfortable going into a pub previously, because they were worried about what other people thought. We quite often did get some odd looks but as a rule, the regulars were great – helping the lads with their game and showing them trick shots.
At the end of my placement I loved seeing Sasha and the others laughing, smiling, engaging and growing in self-confidence and once again, I was sad to leave.
I would later bump into some these patients in various settings i.e. in the community or on the wards and I was either saddened by their relapse or delighted by their continued improvement.
Note to self: “Public service must be more than doing a job efficiently and honestly. It must be a complete dedication to the people and to the nation.” Margaret Chase Smith.
How are you? if you don’t have time to listen to their answer. How often have you had someone ask that same question as they rush on by, not waiting for an answer? If you must say something or if you want to acknowledge that person as you walk away, say something like ‘Good morning, nice to see you.” or “I like your hair/dress/your outfit etc.
You look well or you look alright to me. Perhaps they do on the outside but on the inside, they might be feeling suicidal. And your comment just might come across as insincere. When I was depressed and anxious, every time someone told me I look well, I just felt like punching them.
What have you got to be depressed about? You’ve got a good job, husband, a lovely home etc. A person can have all these things but still be depressed. Depression can occur for a variety of reasons and it has many different triggers.
If someone is suicidal don’t say What about your children/husband etc? Unfortunately, this doesn’t work either. If a person is feeling suicidal you might want to ask if they have a plan, how will they kill themselves, do they have the means i.e. gun, knife, tablets, when will they do it i.e. is there an anniversary/birthday coming up? Asking these questions does not make a person feel suicidal but by asking them, it shows you care and that you are taking their concerns seriously.
There are people way worse off than you. Do you really think they care? I know I didn’t! I was in such a deep and dark place, I couldn’t think about anyone else.
Just think happy thoughts or you need to snap out of this. While practising positive thinking is known to be beneficial, it’s not enough to cure someone of depression. If this was so easy, we’d have nobody with mental health problems. You might want to say something like “I’m here if you want to talk.” or “Is there something I can do to help?” It could be something simple like doing the dishes, making them a cup of tea or a light lunch if they’re not eating.
It can’t be that bad. It obviously is for that person. Minimizing the pain of another person is not helpful and, for people who are dealing with depression, can be very hurtful and harmful. However much you think think you are empathising, you can never know for sure how it feels to be them. You might choose to say “Do you want to tell me about it?” or you might just stay silent, just being with the person often helps.
It’s all in your head. This sounds dismissive at best and at worst it could sound like the person is making it all up or that they’re ‘mad’. My ex loved this one! “It’s all in your head, you nutter.” How I could have swung for him, if I had the energy.
Cheer up! Your well-meaning “cheer up” might sound cheerful and supportive to you, but this oversimplifies the feelings of sadness that go with depression. People living with depression cannot just decide to feel happier. If I had a £ for every time someone said it to me…………
It’s always about you. A person who is depressed can appear preoccupied with their own life and problems, which is normal under the circumstances and it doesn’t mean they are being selfish. The pressure to explain or justify why they feel this way can make depression worse and stop them asking for help.
However well-meaning, do not give unsolicited advice, give information such as where to get professional help.