Positive Risk Taking – Trish O’Hara

Most of the choices that people make in life naturally involve some element of risk. Avoiding risks altogether can limit life opportunities, and impact negatively on quality of life.  People want choice and control for themselves and safety for those they care for. This is because risk is a concept that tends to have negative connotations, but people take considered risks all the time and gain many positive benefits.

People perceive risk differently, including people who use services, practitioners, and families. This can be difficult for social care practitioners and confusing for individuals and families. Therefore, adopting a balanced approach at a practice level can be a challenge. Balance and proportionality are vital considerations in encouraging responsible decision making.

In our work streams we have been considering:

  • What skills do staff need to properly develop positive risk taking in their practice?
  • How can learning programmes be developed that inspire and motivate practitioners to take a bold approach to positive risk taking?
  • What systems need to be in place to enable a responsive approach to positive risk taking?

Getting out of bed, and all that it entails – getting washed, dressed having breakfast, and taking the bus to work – carries risk. Though, staying in bed could still involve both psychological and physical risks.

Back in the mid 80’s the social care sector often ignored risk assessments.  There were risk assessments in place for health and safety of the building and staff. However, what was lacking was person centred risk assessments to support  the people using our services to positively live their lives.

I recall us supporting  extremely complex individuals to go to Glastonbury music festival.  We did this without a risk assessment, and this was back in the day when you could speak to Martin Eavis directly to get free tickets.   They were the days of ‘try it and see’.

By the late 80’s risk assessments were firmly and quite rightly in place to ensure staff were confident to support people to try new things, and live as full as life as possible.  Managers who would start a sentence ‘Yeah,  let’s try that,  let’s do a risk assessment’ with a smile.  It was as if doing the risk assessment itself was the incentive to make it happen.   Over time, I noticed that the sentiment of risk assessment changed.  The managers started to say, ‘oh no,  you  had better risk assess that’.   It seemed like the idea that risk assessment had become  a way of limiting people. The intention changed. Risk assessment should be used as a tool to support  empowerment, and innovation. It should also be used to listen to  those that need care and support.

Finding time to embark on meaningful co-production,  ensuring the person is an equal partner in the shaping of their services is likely to mean that people will be faced with more choice. Where people are faced with more choice this is likely to lead to options that introduce more risk.

So what is stopping our services effectively undertaking positive risk assessments, what are the barriers?

People perceive risk differently.   For instance,  it you ask nurses what is the main risk for older people in care homes,  they are most likely to say,  falls.  If you ask social workers,  they are likely to be concerned with risks to adequate housing or benefits.  If you ask their family, it is likely to be that they  are concerned that their loved one is treated badly. If you ask the person themselves,  they may be more concerned with losing their identity and/or purpose.  We come to the table with a bias based on role and relationship.

Getting the balance right requires professional competence,  partnership working and understanding that safeguarding is about improving quality of life as much as safety, and can only really work if we keep it personal.

Because risk assessment is considered a skilled endeavour,  we often see managers or team leaders completing the risk assessment from beginning to end from inside of an office,  rather than inside the life of the person.   Key-workers need to be trained to understand risk assessment and be part of the process, as they are often the people who know the person best.

There is also a real fear of being accused of neglect.   Staff also struggle to understand that what may be important FOR the person may be in direct conflict with what is important TO them.   A disproportionate response that infringes the rights of individuals to make their own,  albeit at times,  unwise decisions.   Often there is a lack of a working knowledge of the Mental Capacity Act and what it means to deprive a person of their liberty. A general lack of knowledge when and where to apply the law.

Ultimately,   risk is part of life and arguably the most successful people take many of them.   It is impossible to self actualise without taking risks.  It’s the only way to face the challenge of Everest.    Many of us would make it to the top if we were given the chance to do it at our own pace (maybe years),  using our own methods,  with the right people and with the adaptations required to help us along the way.     We would find our own peak and reflect on our own troughs knowing where we are,  where we have been and where we are going.

We will continue to challenge practice in our work streams, and get practitioners to really believe that positive risk taking is a fundamental core of practice.

Trish O’Hara

 

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Mental Health Awareness Week #MAW2017 – Read Sarah’s Story

Mental Health takes many forms and affects us in many ways, and it doesn’t discriminate between race, religion, colour or gender. It can gradually creep up on us or hit us like a truck. No 2 people will suffer the same.

 

I have struggled with mental illness for half of my life now.

I remember aged 17, being in the bath after another argument with my parents, thinking how easy it would be to just stick my head under the water and end it all.

 

Every teenager has their struggles and will say that their parents just don’t understand them, but this was especially true of mine. Even now, 15 years later, I still look back on my teenage years as a very traumatic time.

 

From the age of 18, I spent 7 years in an emotionally abuse relationship. It started with the odd accusation here and there, until eventually, it became an every day occurrence. Every time my phone pinged, he demanded to know who it was. If the person wasn’t female, then clearly I must be cheating. When I was 25, we finally separated and I was left alone with a house and all the bills to pay for.

 

My counsellor recently told me a saying that they use in her sector: “The road is full of potholes”. This was very true of this point in my life, only they weren’t potholes, they were an abyss that I was circling and about to fall into at any moment.

 

I recall driving home from work one afternoon and all I wanted to do was drive my car flat out into a brick wall. I knew then that I needed help, so I made an appointment with my doctor and was prescribed antidepressants and signed off work for 2 weeks. I will never forget my manager’s reaction to that note: “you could always just rip it up and get on with it”. Words failed me and I hurriedly left the office and didn’t return for 2 weeks.

 

Things got a little better as the tablets started to take effect but it wasn’t just the feeling low, it was the insomnia, the numbness and the anxiety that can accompany Depression. I didn’t sleep properly in weeks and this only hampered my recovery.

 

Over the following months, I became stronger and began to like living on my own, it was then that I very unexpectedly met my husband.

 

Within a few months of meeting him, I had weaned myself off the antidepressants and I felt amazing. We were married 9 months after meeting and shortly after we were posted overseas with the military. Moving away was the fresh start I needed, we made some great friends and had our two children.

 

So how can I still feel sad?

A question I have asked myself so many times. After all; I have the perfect marriage to my best friend and soul mate and we have two healthy and wonderful children.

So what can I possibly have to feel depressed about?

The answer is nothing. But Depression doesn’t need a reason.

 

My latest battle with Depression really started last year. I knew I was struggling so I went to the doctors and requested to go back on antidepressants. But as the year went on, my mental health continued to decline and after the loss of a close friend to cancer last July, things just got worse.

 

The thing with Depression though is that it doesn’t just affect you, it affects everyone around you. I became less and less tolerant with my children and I withdrew from my husband- some days feeling so angry with him just for sitting down on the sofa next to me. I wanted to scream at him, even though he’d done nothing wrong.

 

My husband thought it was all his fault that I felt this way, like he wasn’t enough to make me happy anymore. But it wasn’t anything to do with him or our children. The truth is; I still don’t know what caused it.

 

It wasn’t just my home life that was suffering, but my job too. I struggled to complete every day tasks and made so many mistakes.

I’m very fortunate to have a boss who understands and helped me to get back on my feet. I now know that if I’m having a bad day, I only have to let her know and she will support me as much as she can. This makes all the difference to my struggle.

 

By September last year, things were back at their very worst. I didn’t have the suicidal thoughts that I’d had previously because of my children, but I knew I needed more help. The doctor had doubled the dose of my antidepressants but this was not helping, so I sought a counsellor. I found her listed on the Counselling Directory website and instantly liked her from her photo.

 

I’ve lost count of how many sessions I’ve had with her, but every single one has helped to get me back on track and feel better. We’ve been through the ‘nitty gritty stuff’- the abuse etc. but I have left every session feeling a million times lighter.

I don’t have regular weekly sessions anymore, I just go when I feel like I need a bit of support or help. For me now, it’s a bit like an MOT for my brain when I need it.

 

Mental Health takes many forms and affects us in many ways, and it doesn’t discriminate between race, religion, colour or gender. It can gradually creep up on us, or hit us like a truck. No 2 people will suffer the same.

 

I’ve been lucky to make many new friends since my eldest started school last year, and I have been very surprised to learn how many of those other parents have been effected by their own mental health- some just the once, for others it’s ongoing. And it always seems to be the parents who are (sometimes rather annoyingly!) always happy. It just proves that, despite appearances, you never know what personal battle someone is fighting.

 

Don’t ever be afraid to ask for help; more people understand than you realise.

 

 

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Dementia in Nature

nature-in-dementia_new_web

What a delight to offer this info graphic about dementia in nature, as the first for 2017. Inspired by the brilliant Garuth Chalfont, who has made an excellent contribution to the field. Being outdoors, and connected to nature bring many benefits, and particularly to those living with dementia.

Often overlooked, this simple accessible treatment may bring opportunities to manage symptoms, engage with others and improve quality life. Being outdoors may connect people and trigger memories in a powerful, and potentially more sustainable way. I attended the MIND project conference recently where I was reminded that being in nature may evoke mindfulness, an effective treatment in its own right.

Last year we did a scoping review of relevant research in exercise and dementia. Here I discovered the role of ‘green exercise’ and if combined with others, in a social situation, may bring additional benefits to the brain. As we walk and talk, our brains literally grow!  At dementia congress one year I remember hearing about a CST project that was delivered completely outdoors, supported by the sensory trust. I am not sure what happened to this, but think it’s utterly brilliant. We need more projects and more research into social engagement outdoors.

However, the utopia is far from the reality. There are many barriers in the way to achieving optimum access to outdoors. There are practical challenges around building design, and/or accessibility in our communities. Many individuals in paid care still do not understand the therapeutic value, so do not support or provide access. Being outdoors can be too cold or too hot, and these practical challenges sometimes seem unsurmountable.  There are physical barriers too such as mobility challenges, fear or falling and/or pain.

Whilst we work hard in our training sessions, and info graphics to raise awareness of the benefits of access to nature, what is needed is more funding, and more opportunities. We need to spend public money wisely, and engender community support where possible. I am constantly in awe of the excellent work of dementia adventure and all those other excellent projects big and small going on. We would love to hear about them.

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Home Truths to Home Spirit

Last week the Kings Fund and Nuffield Trust produced a report, ‘Home Truths’, demonstrating the impact of the local authority spending cuts over the last six years on social care. The report highlights the combined pressures on services, such as maintaining Fundamental Standards (CQC), working towards achieving the Living Wage, dealing with contract cuts, as well as coping with significant staffing shortages. Cumulatively these pressures have meant that many services have fallen short of demand and for some there have been serious failings. However, for the majority, the shortcomings are visible in delayed discharges from hospital, which has a negative fiscal impact.

The report highlights some of the strategies adopted by services to compensate for these cuts. For example, some providers are relying more heavily on privately funded clients to subside their local authority contracts. Some are actively identifying options for support in the wider communities and using volunteers to bolster their service.

The report warns that the social care sector will not cope against the continued planned cuts and additional sector pressures, and recommends three possible options to address the dismal outlook:

 

  • achieving more with less
  • a different offer
  • long term reform

 

Whilst the latter two can be debated over the longer term by politicians and senior social care figures alike, providers need to be getting on with the ‘what can we achieve for less’ more imminently. There is an urgent and critical need to think outside the box about how we can do things differently.

As part of the ongoing strategic review many services have been actively reviewing their resource input against their outputs and outcomes in an attempt to get more for less. Good business strategists understand that the skill lies in leveraging resources effectively to create a comfortable operating profit. This isn’t always about cutting back but rather doing things differently. Training is one example of a resource that can be manipulated for different outcomes. There has been a growing reluctance to spend on training, with more services opting instead to develop independent capabilities or deliver E learning in the hope that this widens the profit margin. However, in reality some of these ‘cutting corner’ decisions can impact on quality, leaving services ill prepared to ‘fire fight’ issues such as safeguarding incidences, health and safety concerns, complaints and/or poor service outcomes. Many of these matters often rear their ugly head at a time when services are logistically challenged, forcing the focus on resources toward just covering the job instead of on maintaining and improving outcomes.

On a more strategic level, within our local area some excellent joined up thinking has been going on. Integrated projects have developed, which have been supported by the pooling of NHS funding  (Better Care Fund), aiming  for smarter working through integrated practice. Our organisation has been involved in one of these projects, working with care homes to reduce hospital admissions. Hospitals are very disabling places for people living with dementia, and poor outcomes are typically observed; economic and individual. Clearly there is a lot of work to be done to upskill staff to ensure that there is a timelier reporting of health concerns through better quality observations, and ensuring that preventative measures are put in place to avoid unnecessary admissions.

One of the areas that has seen the largest cut in funding is community based services, such as support at home (homecare). Spending is down a whopping 30% despite policy objectives to support more people in the community. This is a significant cut in comparison to residential and nursing services which were only cut by 4 – 6%. Home care services now are delivering more hours for less money.  So what solutions are there available for our home care services?

This key question has been the driving force behind the development of Home Spirit, a platform developed for home care providers. The platform equips services with the tools to literally think differently, be proactive and add value to their service.

 

The portal consists of a number of tools. The person centred planning tool has several potential domains which are selected by the client, and are based on their specific identified outcomes. It is easy to use and prints and uploads reports, making sharing easy. It avoids duplication, or having to write anything out so saves time. It can be completed on mobile while at the client’s home, and, with an easy to use navigation system, it has sensory appeal. The tool helps agencies to reduce operational costs in assessment and reporting. It can highlight risks easily, both those that are determined by the individual as well as the care agency. The report can be produced in a shorter version (similar to a one page profile) which informs busy workers in a simple snapshot HOW to provide the support. At £19 per month for as many reports as required, it is also excellent value.

The environment audit is intended to be a proactive tool. It may reduce hospital admission and risk of falls through environment assessment. It can be used by families and individuals to identify potential assistive technologies (a requirement of the NICE Home Care guidelines 2015), which include health monitoring options, safety and activity monitors, and leisure and communication technologies. These technologies now have a much wider scope and can promote human connection and tackle loneliness. Loneliness has been linked to poor health outcomes, leading to additional financial burdens on community and NHS services. Tackling loneliness through supported use of assisted technologies is only one of the many benefits that can be introduced by the tool.  The environment audit tool also makes simple recommendations for environmental adaptation to improve independence. The environment tool will also make recommendations around how an environment can be adapted around a specific task for a person with dementia, and therefore informs and educates, offering a tailored support plan.

The ‘still my life’ post diagnostic tool is completely FREE to access and helps families to plan together to take proactive steps to manage the condition; this aims to reduce anxiety. One of the first questions asks the person to consider the difficulties they face and what actions they plan to put in place to mediate these challenges. The design of the tool aims to encourage people to rehearse their own strategies, helping them recall them with more proficiency, as well as have very clear goals on how to compensate for their difficulties. Another question prompts the person to consider aspects of life that they appreciate and value (positive psychology), this can have a direct therapeutic value. One of the questions guides individuals to complete appropriate legal planning. Local authority resources spent making ‘best interest’ decisions could be avoided by documenting decisions in a timelier manner. The planning tool provides accessible guidance on how these measures can be put into place. The tool also asks individuals to consider early interventions for nutrition and sleep. As 72% of people living with dementia are also living with another condition (co-morbidity), early strategies to support sleep and nutrition can have a positive effect, reducing risks of delirium and inappropriate admissions to hospital. The post diagnostic planning tool can be easily downloaded and completed on paper. This additional tool is potentially an asset to home care providers, as providing access to this resource as part of your service shows that you provide added value. Perhaps more importantly a tool like this provides hope, and motivates families and individuals to think proactively.

The circle of support tool helps to identify communities of support to build upon existing community networks and engender a sense of belonging and affiliation to the wider community.

The learning resources (infographics) available through the portal support staff, through bite-size learning, to observe better, develop better relationships, and improve reporting.  The flexible resource reduces the need for staff to be removed for training at critical pressure times. Community services are now working with higher levels of need and the skills sets required are reflective of this. Appropriate investments need to be made in knowledge management. The resources available on this portal are specifically designed to work well in busy environments.

Therefore, while services are scratching their heads considering their next move to survive this hostile environment, we have been actively developing a solution. The benefits of the Home Spirit tool are potentially far reaching and offer a legitimate opportunity to services to do things differently and to achieve more for less.

www.homespirit.org

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Types of Depression

Depression

“If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather.
Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.” Stephen Fry, actor, comedian, writer, TV celebrity

“Friends have suggested that I am the least qualified person to talk about happiness, because I am often down, and sometimes profoundly depressed. But I think that’s where my qualification comes from. Because to know happiness, it helps to know unhappiness.” Alastair Campbell, journalist, political adviser, writer.

What is depression?

As a starter when thinking about depression, here’s a question for you. How often do you say, “I feel a bit depressed today”, or “a bit low”, “I’m feeling fed up”, or find a similar way of expressing that you are having a ‘down’ day? I’d argue that, at times, we all have moments of feeling low. Sometimes we may be able to identify why – we are tired or a bit run-down, we’ve had an argument with someone close, we’ve had a difficult day at work – but sometimes we just don’t know. What we do know, though, is that we’re just having a low day and that, from experience, tomorrow it will have passed and our mood will have picked up. This is ‘normal’ and usually nothing to be concerned about.

Clinical depression, however, is an illness that can be persistent and difficult to deal with. It is defined by features such as hopelessness, profound sadness, self-hatred, feelings of worthlessness; loss of motivation and sometimes suicidal thoughts, plans and acts.

One problem with depression is that on the outside we may appear to be fine. It isn’t a physical illness so we can’t see any signs such as a rash, spots, or a broken limb to shoe that something is wrong. We may get told, “Just pull yourself together”. We may hide the symptoms because, without anything physically wrong, we don’t realise that we need help.

However, as the quotes above indicate, there is a growing social awareness that may encourage us to seek the help we need – talking therapies, medication, stress reduction, the improvement of physical wellbeing.

Symptoms and signs
 Feelings of helplessness and hopelessness.
 Loss of interest in hobbies, work, social activities, sex.
 Loss of ability to feel joy and pleasure.
 Significant appetite or weight changes.
 Insomnia, especially waking in the early hours of the morning, or oversleeping.
 Anger, agitation, irritability.
 Feelings of fatigue, sluggishness, heavy body.
 Self-loathing, feelings of worthlessness or guilt, self criticism.
 Reckless or escapist behaviour, substance abuse.
 Trouble concentrating, making decisions, or remembering things.
 Increased physical complaints – back pain, aching muscles, headaches, stomach pain.

Some examples of causes

 Loneliness
 Lack of social support
 Recent stressful life experiences
 Family history of depression
 Marital or relationship problems
 Financial strain
 Early childhood trauma or abuse
 Alcohol or drug abuse
 Unemployment or underemployment
 Health problems or chronic pain

Risk of suicide

Depression is a major risk factor in suicide – the person feels that it is the only way to escape the pain. If you know someone with depression, take suicidal talk or behaviour seriously.

Warning signs to watch out for include:

 Preoccupied with death
 Letters or calls to friends and others saying goodbye
 Sudden changes in mood
 Talking about killing or harming oneself
 Expressing strong feelings of hopelessness
 Feeling trapped
 Acting recklessly or dangerously
 Putting their affairs in order
 Statements such as “Everyone would be better off without me”

Types of depression

Major depression – also called major depressive disorder, clinical depression, unipolar depression or just depression. Symptoms include very low mood, loss of interest and pleasure in usual activities and other symptoms, which are experienced most days and last for at least two weeks. These symptoms interfere with all aspects of someone’s life, including work and social relationships. Depression may be further defined as mild, moderate or severe.

Melancholia – a severe form of depression with many of the physical symptoms of depression. A person will be seen to be moving slowly and to have totally lost loss of pleasure or joy in most things, and maybe everything.

Psychotic depression – sometimes people lose touch with reality and experience hallucinations (seeing, hearing, smelling, tasting, feeling things that are not there) or delusions (false beliefs that are not shared by others) – e.g., believing they are bad or evil, or that they are being watched or followed. This can include paranoia – feeling that everyone is against them or that they have caused the bad events occurring to them or around them.

Antenatal and postnatal depression – Women can experience increased risk of depression during pregnancy and in the year following childbirth.

Bipolar disorder – also known as manic depression. This will be dealt with in more detail in a later blog. The person experiences periods of depression and periods of mania, with periods of normal mood in between. Current ideas around this condition vary and include a range of different presentations of the illness.
Treatment for depression

Treatments include anti-depressants (effectiveness varies according to research); talking therapies (counselling, psychotherapy, CBT); mindfulness; EMDR (Eye Movement Desensitisation and Reprocessing Therapy) for trauma-related condtions.

Seasonal Affective Disorder (SAD) – a mood disorder with a seasonal pattern. It is thought to be related to the variation in exposure to light in different seasons. Depression starting in winter and fading when the season ends is most common. Symptoms: lack of energy, sleeping too much, overeating. It appears to be more common in countries with shorter days and longer periods of darkness, e..g., the Northern Hemisphere.

Useful sites:
MIND – www.mind.org.uk
The Mental Health Foundation – www.mentalhealth.org.uk
Bridge Mental Health – www.bridgementalhealth.org
Sane – www.sane.org.uk
Time To Change – www.time-to-change.org.uk
Young Minds = www.youngminds.org.uk
Rethink – www.rethink.org.uk

Next blog: Stress and Anxiety

Malcolm Couldridge

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Mental health myths and facts

Myth: Mental health problems are rare.
Reality: 1 in 4 people will experience a mental health problem in any one year.

Myth: People with mental illness aren’t able to work.
Reality: It is likely that we all know someone experiencing a mental health problem.

Myth: Children and young people’s changes in moods are a part of growing up, nothing to worry about.
Reality: 1 in 10 young people will go through problems with their mental health.

Myth: People with mental health problems don’t experience discrimination
Reality: 9 out of 10 with mental health problems experience stigma and discrimination.

Myth: It’s easy for people to talk to friends about their feelings.
Reality: Many people worry about how friends or family will respond if they talk about their mental health difficulties. They also worry about what will happen if they open up.

Myth: People with mental health illnesses are usually unpredictable and likely to be perpetrators of violent acts..
Reality: People with a mental illness are more likely to be victims of violence and are usually more dangerous to themselves than to others: 9 out of 10 suicides in the UK are due to mental distress. In 2009, out of a population of around 43 million, it is estmated that over 7 million will have a significant mental health problem. Around 50-70 homicides a year are committed by people with mental health problems (around 0.0000016% of the total population and around 0.000007% of those with a significant mental health problem)!!

Reality: The majority of violent crimes and murders are committed by people who don’t have mental health problems. In 2009-10, a total of 704 homicides were recorded in England and Wales alone, which bears out the reality that the risk of someone with a mental health problem committing a murder is a small proportion of the total risk.

In 2013, media reported that 1200 people had been killed by someone with mental health problems in a decade. In fact, this figure included people who had been assessed as not having mental health issues. The true figure was 738, around 10% of the total homicide figure for 2001-2010, highlighting media distortion of the truth. In TV drama also, mental ill-health can be distorted in the interests of storylines. Research showed that, in a 3-month period, programmes with mental health story lines overstated violence and self-harm. Although around 50% showed sympathetic characters, they were often shown as sad victims, with terms such as “crackpot”, “psycho”, “basket case” , “looney tunes” being used.

Next time, we’ll be starting to think about strategies for supporting someone who has a mental health problem…

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What is mental health?

Mental health? What do we mean by that? Something we take for granted, something that we don’t become aware of until, through a particular incident, or set of circumstances, or ongoing difficulties (lack of family support, loneliness, isolation, money problems, loss of someone close…) we realise that something is wrong, that we don’t feel right. We feel confused, in pain, with thoughts that seem out of control, worry, anxiety, low mood…

If we are fortunate, we are all born with mental and emotional health, we are born with physical health. Most of us? Sadly, some children are born into addiction, or have learning or physical disabilities, etc. But let’s assume, for today, that we are talking about a healthy birth.

Sooner or later, though, life starts to have its impact and our mental, emotional and physical health, being vulnerable to changes and to injury, can change. Our bodies, our minds, and out ‘hearts’ can become unwell.

Statistics suggest that one in four of us will be affected by mental illness during any one year. Perhaps, given that many people don’t speak about or share their difficulties but live with them in quiet pain or desperation, those statistics are conservative and it has occurred to me that maybe the figure is higher. The impact of poor mental health is as real as a physical injury in terms of the pain we feel and the disabling effect on us. The problem is that we don’t wear a sling or a plaster so, to the casual observer at least, it can’t be seen.

These statistics, disturbing as they are, challenge us to recognise the myth that mental health problems are what happens to others, those who are ‘mental’, ‘bonkers’, ‘nutcases’, ‘loonies’, ‘abnormal’, ‘psychos’. The reality is that, given a particular set of circumstances – a close bereavement, unemployment, debt, the end of a relationship, a a traumatic accident – can happen to any one of us at any time. The philosopher Ortega observed that “life is fired at us point blank”, that so often circumstances can conspire to erode our mental well-being through uncertainty, fear, anxiety, grief, trauma… Individual resilience can vary but, given enough pressures, each of us is vulnerable. So it is essential that we challenge these myths so we can understand the real facts about what mental health problems are and how they can affect people, including ourselves. Given that understanding and acceptance, we can support others more effectively and also learn how to support ourselves, learn how to manage stress, anxiety and low mood as well as put strategies in place to reduce the risks of poor mental health.

Next time, we’ll be thinking more closely about the gap between myth and fact. – Malcolm Couldridge

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