Slow and steady wins the race

Following Sunday night’s government briefing and the further guidance on Monday, many of us are once again left feeling very uncertain about the weeks and months that lie ahead.  When my daughter was born almost 8 years ago, I became very ill in the first few weeks of her life with postnatal psychosis and postnatal depression.  The severity of my illness meant I was admitted to a secure psychiatric mother and baby unit with my daughter, to allow me to be treated and cared for safely, without separating me from my baby. 

At this point I had no idea how long I would be there, with only a loose idea of being discharged when my mental health improved- there was no SMART action plan I could follow!  Mother and Baby units are fantastic, set up with separate bedrooms, communal living areas, brightly coloured play rooms, all designed to remove the feeling of hospital. 

But they are locked, your everyday life is significantly restricted (for your own safety) and you have a lot of time inside the same four walls and on idea when this might end.  Whilst this all sounds quite dispiriting, those restrictions and that time saved my life, of that I am absolutely clear.  And taught some things that I am using to help me cope with lockdown.

Routine- It’s not for everyone but having some predictable parts of the day helped to mark out the time more easily.  Being an NHS hospital ward lunch was 12 and tea (dinner to the southerners) was at 5pm every day. You chose your food the day before.  In addition there were some set appointments and groups that helped mark out the week.  I wouldn’t suggest a minute by minute timetable, but having structure to your day can help ground you.

Staying in the present- At the beginning I spent a lot of time anxiously deliberating on when I would go home, what goals I would have to achieve, how long it would take to get there.   A very wise nurse suggested that only consider today and tomorrow to start with.  Then maybe the current week, but never any further into the unknown.  Because, she said, you can’t control that time, it’s too unknowable.  You can have a relative amount of control on the present and immediate future so stick to that. 

Exercise- I was allowed out for a walk, whatever the weather (I was admitted in October).  The fresh air, the exertion, it definitely helped and to start with I set a time every day and stuck with it so it was harder for me to shirk off. 

Talking/reaching out- It was almost impossible to hide feelings and emotions on the small ward, and that is intentional.  Because talking helps, it doesn’t always solve anything, but it does help.  And the staff were well trained to go beyond the usual “yeah, I’m fine” and ask again and probe.  I talked and cried and laughed and talked with many staff and it was vital to me coping and recovering.  Talk to someone, tell them that you are fed up, frustrated, grumpy- they might not be able to change anything but I guarantee you will feel better. 

Be productive- I am not going to promote that you learn a language or take up yoga or write that novel, however being able to be active in a way that produces something is very satisfying and helpful in these circumstances.  We created a “cooking club” and made simple things together with the staff.  But even creating the simplest lasagne to share can give immense satisfaction when everything feels so restricted and uncertain.  There is a reason that basket weaving is short hand for mental health- creating, making, building is good for our mental health.  You aren’t trying to win Masterchef or the Turner prize, so don’t get hung up on that. 

Self care- I hate the term self- care, but it probably is the best description here. I was offered an Indian Head massage by one of the therapists and to this day was probably one of the best hours of my life!  Because with everything going on the focus was just on me, I had permission to switch off everything else in my head and relax.  Now we can’t visit therapists but it is important to take time for yourself, to switch off the worries, the other demands on your time in whatever way you can. 

Finally, some days will not work out- write them off-every day is a new day.  In the end I spent 8 weeks as an inpatient on the ward and was an outpatient until my daughter was almost 2.  If these tips make it sound like I was winning at being a psychiatric patient, I definitely wasn’t.  A lot of the time it was 2 steps forward, 1 step back, occasionally 3 steps back.  I had terrible days where I thought it might never end, that I would never be well again, but it did and I was.  And although we don’t know when, or how, or anything much at all about the end of lockdown, it will end and in the meantime we need to concentrate on getting through with our mental health intact. 

I hope this helps  if you are struggling. Reach out to a friend, an organisation if you need to talk.  I’m only here because I let people help me, you aren’t incapable or useless if you ask for help.  You will feel better, take care of yourselves. 

What a difference a year makes...

I was a teacher for 12 years and in that time I had several periods of ill health associated with my Bipolar Disorder. By the time I left a year ago I had become very despondent with education and was having significant doubts about my abilities as a teacher. A year on another period of depression, but this time when employed outside teaching, has made me look back as reassess the role that employment and employers can have when someone is unwell. Stress is a known trigger for most mental illnesses including Bipolar disorder. Much of my care and crisis prevention planning is about managing stress and my life so as to minimise excessive stress as much as possible. Teaching is a stressful job and has only become more so in recent years. When I started teaching I was keen and enthusiastic and threw myself into the job, loving the creativity of planning lessons and working with teenagers. I did struggle with the all encompassing nature of the work, but I was young and had no other responsibilities in my life. At the start of my second year a change in school, with a complete lack of support, as well as moving across the country triggered a depressive episode. I never returned to that school and left after a term. Then came two years a private school and my confidence began to build again and I began to enjoy teaching once more. I put this down to the amount of planning and preparation time I was given- over double the amount given in the state sector. Added to this a long lunch break (70mins) and an understanding that I had a life outside of my teaching. As my confidence built I started to look around for a move up and moved to a state school as a head of department. Once again the stress hit. I was building a department from nothing and despite my willing and enthusiasm I began to feel the strain. Towards the end of my teaching career I had dropped to three days a week and relinquished my head of department role. All for the aim of reducing my workload and associated stress. The last year has been eye opening. I was completely up front with my employer regarding my Bipolar Diagnosis. I requested and was granted some reasonable adjustments to enable me to cope better with the working week. Because this involved an outwardly obviously change I shared my diagnosis with colleagues. It was a revelation for an employer to genuinely listen and try to adapt the working situation so that I could do my best. Despite now working full time, I was never brushed off with "its a stressful job" and never was it suggested that I reduce my hours (and therefore pay) unless it was what I wanted. This was very unlike my previous career in teaching. The biggest difference was shown most recently. At the end of August we moved house, a sale and purchase that was anything but straightforward. Moving house is listed as one of the most stressful things a person experiences (divorce and death are the top ones). I made changes, enacted my wellness plan and tried to cope with the stress as well as possible. However it was too much and triggered a depressive episode, which to some extent I am still experiencing. The response of my employer was phenomenal and has meant that I have not been signed off and instead have only taken 4 days sick leave throughout the whole period. This is significant period of depression, equal to the whole term (13 weeks) I took off in my second year of teaching or even the postnatal depression I suffered after the birth of my children. The difference was how it was handled. I spoke to my managers about how I was feeling, but also explaining that although daunting, being at work was actually good for me. It meant I was out of the house, interacting with people. We agreed some small changes to my working- staying off the phone if I needed to, I was offered a change in working hours if needed, and some time off to allow my increase in medication to take effect. At the same time I felt able to tell friends and colleagues how I was feeling and they were supportive and sympathetic. All this has made a huge difference to me getting better and as not resulted in a long period off sick, as I believe would have happened were I still in teaching. On reflection I wonder whether I should just accept that teaching wasn't for me because of my inability to cope with stress and teachings inability to be flexible in the way of other jobs. But then I also consider if that would be acceptable with other conditions. Should we simply tell people with certain conditions and disabilities that some careers are closed to them? The Equalities Act attempts to resolve this, allowing people to request reasonable adjustments to enable disabled people to continue working, to adjust their working so that they can compete at the same level as their peers. At the moment teaching is way behind other careers in dealing appropriately with mental illness and in fact any kind of change from the standard. Everyone is held to the same standards, and the attitude is often keep up or get out. But it may have to change, teachers are leaving the profession in droves. Mental illness in teachers in on the rise year after year. I now work with teachers as an Adviser, and speak to far too many in tears, depressed and unable to cope who think their only choice is to leave. Looking back there were certainly other things my teaching employers could have done to enable me to stay in work and feel useful and productive- so important to someone suffering from depression. Rather than guilt laden conversations around letting children down, and useless reminders that everyone is stressed, there could be real conversations on how this job could be made more mental health friendly- for all teachers, not just those with underlying mental illness. My mood is lifting, slowly. I have increased my medication and I am employing lots of self help tools. I am getting there!

Discharge- the good kind!

Unlike in many other areas of medicine, discharge is a good sign in psychiatry. Yesterday I was discharged from the care of the psychiatrist and community mental health team (CMHT), back to GP care. It was such a low key conversation, some admin to be sent to my GP surgery, but for me in real terms it was a momentous moment. Because the reason for the psychiatrist suggesting it, the reason I could confidently agree, is because I am well. I have been reasonably well for a period of time and there is no indication that I will not continue to be well in the future. I have been under the care of a psychiatrist and CMHT since 2009, so this is a big step for me, like taking the stabilisers off a bike for the first time. In reality this has been coming for a while. I haven't had a regular community psychiatric nurse for about a year, after it was agreed that I didn't need that aspect of care and my psychiatrist appointments have gradually got further apart, like a parent gradually releasing the hold on the bike seat. And to continue the cycling analogy, I feel equally excited and anxious, worried that I might wobble and fall at any moment. I can always contact the service, and re-refer myself if I need to. One of the most telling parts of the discharge conversation with my psychiatrist, was her observation on how much better I was since leaving teaching. She's not the first person to comment on this, I've even been told that I look younger by a few people! I've been out of teaching for seven months now and the difference to my mental and physical health is amazing. I sleep better, my relationships are better, I feel like a totally different person. There are wistful moments where I wish I could have made teaching work, at the core it was a job I loved and I was passionate about. I never imagined I wouldn't be doing it until retirement. However, I couldn't make it work with my bipolar, and considering the number of teachers leaving the profession at the moment, it isn't just people with mental health issues struggling to cope. I will probably always wonder if I had to sacrifice my teaching career because of my mental health or whether even without bipolar it would have become untenable as a job. In the meantime I will keep on practising without my stabilisers, trying not to get to anxious about the wobbles, knowing that if I do fall off there are people able to lift me back up and start again with me I need them.

One day at a time

Today (30th March) is Bipolar awareness day. There is an abundance of awareness days and months, for all sorts of conditions and diseases. In mental health I think it can only be a good thing, to raise awareness, get people talking, reduce stigma.  In an effort to move away from simple social media sharing as awareness, this year mental health charities have asked people with Bipolar (and hopefully other mental illnesses on those relevant days) to share what it is actually like living with the illness. So here is my account of life with Bipolar.

Definitions and descriptions of Bipolar focus firstly and mainly on the mood changes, the highs and lows and how these can be characterised. In reality that is such a small part of the illness in actual terms. What I mean is that those events over shadow everything in a kind of 'what if' way. I live day to day doing my upmost to avoid those extremes, even though the actual amount of time I have lived with those types of extreme are short when compared to 'inbetweens'. That's not to reduce the impact of those periods, they are terrifying and life changing, but it is the fear of them, rather than them themselves that overshadows daily life.

Bipolar Disorder is with me everyday, every decision I make- big and small. In the mundane it is the importance of me keeping routine in my life, regular sleeping and eating patterns. Spontaneity and wellness do not go together with this mental illness. Sometimes it drives me crazy, I've never been one for schedules, other times I accept it as a mild annoyance as a price for staying well.

It's there every morning and evening when taking medication, when I forget because I'm rushing, and suffer the side effects. I have a love/hate relationship with my medication. I know it keeps me well, but I don't enjoy the necessity of it, nor the side effects. The small side effects that seem inconsequential to being well, but over time irritate so much as yet another consequence of this damned illness. Sometimes I am exasperated by the unfairness of having bipolar disorder and having to deal with excessive sweating, night terrors, heartburn, gut problems and weight issues caused by medication.

Occasionally there are the big regrets, the realisation that your life has probably take a very different route because of Bipolar Disorder. When I started teaching in 2004, I had excelled in my teacher training and was selected as a Fast Track teacher. I never really succeeded due to periods of illness and ultimately because I couldn't work the way teaching needed me to- bursts of high intensity, long hours and then periods of complete rest. I was good at teaching, I enjoyed it. But I couldn't sustain it. Many people with Bipolar have similar stories of some success in their career, until illness brings them out or down in their career goals. I'm very lucky that I can maintain work, many people can't. However I can't reach to a higher level in any job or career without the pressure defeating me. It doesn't matter most of the time, but occasionally I get a feeling that I could have been really successful if it wasn’t for the bipolar weight around my ankle dragging me down.

Relationships can be strained when a person suffers from a mental illness. I know my illness has impacted all my relationships, with my husband, my children, friends and colleagues. I know I've lost friends as a result, I know my marriage has been seriously tested from it, time will only tell what effect t it might have had on my children.

I didn't always want this blog to be a purely negative account of life with Bipolar, but I do need it to be honest. I'd exchange it in a second if I could. For me the awareness that needs to be shared this Bipolar day is the everyday drudgery and difficulty that is living with this illness. The highs and the lows are what defines it psychologically, but the everyday impact is the draining reality of the illness for me.

'Tis the season

The Christmas period often sees a spike in mental health crisis calls, as the season can make people feel the pressure of loneliness, the enforced happiness, the need for a perfect and magical time. Christmas is sold in adverts and films as a magical period of music, food, family and cheer; a time of traditions that must be adhered to and treasured memories that must be made. I have always put a lot of pressure on Christmas, and on myself to ensure the best and most perfect Christmas. I would fret about traditions, no TV, perfect food and board games. Which was exhausting enough, and then my son was born. On his first Christmas he was almost four months old and I was in the grips of postnatal depression. I can clearly remember the anxiety in the lead up to Christmas day over how the day would pan out- when we would eat, how I would cope with the newborn drudgery on a day that was supposed to be full of wonder and excitement. I was dreading the day, because I knew that my son would still cry a lot, might not sleep, and that it was unlikely that we would eat dinner together as he would not be put down. The shadow hung over me in the lead and the day itself. I don't really remember much from that first Christmas as a family, a walk in the snow and some presents. But I don remember being so upset tat it essentially felt like any other day with a baby- nappies, crying, jiggling, pushchair walks for sleep. And it made me feel like I had failed at Christmas, failed to live the magical experience sold to me by advertisers and the media. And yet there were no disasters, I had family, a Christmas dinner and beautiful baby. It wasn't the failure of the day, but my excessive expectations that had ruined my Christmas experience. As he got older Christmas improved as his excitement and understanding replaced the newborn fog of crying and feeding. History repeated itself wen I my daughter was born. Her first Christmas came only a few weeks after I was discharged from the Mother and Baby unit that I had stayed in for 8 weeks. Although better and more stable than I had been, I was by no means well and the anxiety started creeping in again. This time the added pressure to ensure that my son had a magical time, full of family and presents and excitement. That Christmas day I spent two hours walking my daughter in the pushchair around our village, crying on and off at the fact that this was my Christmas and I ate my Christmas dinner standing up holding her and in shift with my mum. I had family around me, a roof over my head and all that jazz, but I was still unhappy. Mainly because I was depressed and anxious, and because I felt an enormous pressure from the 'pintrest' culture of Christmas to have new traditions, Christmas eve hampers, elves on shelves, and numerous complicated side dishes for the dinner. I'm not ashamed of how I felt, that I should have somehow felt grateful for all that I had. In fact that is part of what was contributing to my despair- the concept that I was in fact very lucky to have two healthy children, a loving family and a roof over my head- and I was still so unhappy. It was another stick to beat myself with. It wasn't what I had or didn't have that was fuelling my depression- depression can happily fuel itself without any outside factors- but my unrealistic expectations of what Christmas should be. A few months later I started therapy as part of my treatment, and one of the overriding themes of my sessions was my unrealistic expectations and how I dealt with what happened when these expectations weren't met. It helped me to practice 'failure' in meeting expectations and how to change my expectations to make them manageable. Because of this I dislike the constant Christmas pressure on social media, instagram and pintrest. I am wary of 'elf on the shelf', elf school, gingerbread house traditions, hampers of any kind and anything that created pressure for magic and joy. Christmas day will come and there will be magical moments when Santa arrives, when longed for gifts are opened. And there will be everyday moments of cooking, tantrums and TV. And that's ok, because no matter what the blogs and the pintrest trends would have you believe, it is just another day and amongst all the magic and excitement, the ordinary still has to happen. When you see all the pictures of cheeky elves and reindeer food, remember that nappies still need changing, washing up is still being done and children will still tantrum and squabble. And actually the magic is often in the mundane or the unexpected- the most loved present might be cheapest, tattiest least likely gift and the magic might come in the quiet, ordinary moments. The last few Christmases have been great, no newborn tears, rainy pushchair walks with screaming baby, but most of all just relaxed and not full of anxious of what it should be. I don't have anything to do with elves and hampers, traditions and timings. I am excited to see the magic of Santa in the eyes of my children, and to relax with my family. But I imagine someone will cry because they are tired/hungry/three and the mundane things that are life with small children will remain, but this year I will be looking for the magic in the small things- the smiles, the hugs, the giggles and not worry that the whole season isn't a magical wonderland. And if I have moments of sadness or boredom or frustration that is ok too. If know someone depressed or suffering with mental health problems, don't over egg the points that are good in their lives, as if this will be enough to lift them from the fog- instead of bringing appreciation it will likely bring further guilt, such is the cruelty of mental health. Instead be there for them, tell them its ok to be sad, to be upset, to find Christmas a struggle. And rather than force the magic with elves and reindeer and stressful traditions, bring the magic to them in the small things, the everyday- a smile, a hug a favour- show them that the pleasure in Christmas can be in the ordinary not the over the top.

Sharing is caring

Sharing is caring, or so I say to my children when I want some of their chocolate! Except sometimes sharing is scary, no matter how much you believe in openness. I'm passionate, evangelical in fact, about reducing the stigma surrounding mental health by talking about it, opening up, refusing to hide my diagnosis, my experience. But that doesn't make sharing easy for me, doesn't mean I do it freely and without worry of consequences. I had become quite complacent at sharing my experiences, talking openly about mental health. If I'm honest this was because everyone I was talking to already knew, those doors had already been opened, those shaky bridges tested. I was sharing in an echo chamber, with no danger of repercussion. And then recently I started a new job and with this came new colleagues, new Facebook friends and a whole new set of people who didn't know. Here was my opportunity to preach my message again, prove my openness. And it terrified me. What if the slightly odd glances started, the 'are you ok' looks. What if once it came out any chance of friendship and working relationship was ruined along with future chances of promotions and progression? I'm ashamed to say I hid some new colleagues on a Facebook post, changing the settings so they couldn't see. Not really in the spirit of transparency that I have been so vocal about. And so I took a leap, a stumbling, clunky chance during a conversation about having babies. I admitted that having another baby would probably break me, and explained what had happened to me. But our conversation was cut short, and I worried all that night, convinced that I'd made a mistake, that I'd return to work to find my colleague moved away. I hadn't. And I've since shared more via a fundraising event that I'm doing. And it feels like a weight has been lifted, and now I can be more honest about who I am. But I imagine this will happen again in the future and I hope I am less fearful and able to be honest without worrying about what might happen, how people might perceive me differently. And every time I do share with someone new and they are supportive I get a little bit closer to that reality.

It's not all in the mind

"People with severe mental illness die on average 20 years younger than the rest of the population, largely owing to physical health. People with severe mental illness are more likely to develop preventable conditions like diabetes, heart disease and some cancers." (Rethink mental illness) This statistic shocked me when I first saw it as part of the Rethink campaign "20 years too soon". However, recently I am beginning to associate this trend with my own treatment by doctors. Rethink assign four main reasons as to why this might be the case: medication side effects, life style factors, lack of physical health checks and most interesting to me, diagnostic overshadowing. Many of the medications prescribed for serious mental illness include some very serious side effects. One of the drugs I take is lithium. It is the most effective mood stabiliser used for people with Bipolar disorder, a salt originally designed for epilepsy and whose workings are not fully understood. There are potentially many weighty side effects to lithium, including kidney failure, thyroid malfunction and lithium toxicity. These are tested regularly through blood tests, and in my experience taken very seriously. In a similar manner once a year I have a full check up, in theory. In reality I have my blood pressure checked, height and weight measured and a nurse asks me bizarre questions about my family support, crisis help knowledge and work situation. Not exactly a full MOT, but it ticks the boxes. I have written before on the issue of being defined by your mental illness and this includes by health care professionals. Diagnostic overshadowing is when any physical symptoms you report are associated or dismissed as being a symptom or manifestation of your mental illness. On many occasions I have explained a physical symptom (headache, stomach pain, muscle pain) to be immediately asked "and how are YOU?" The emphasis on the 'you' designated the social shorthand for- you know, mentally? Another favourite is "are you stressed at the moment?" (I'm a teacher and have two small children, stress is relative!) It is entirely possible and likely that some or all of these symptoms may be a response to stress or mental health issues, but even when I am entirely well and can discount any extra stress I can sense that I am not believed. And on most occasions no further physical tests or investigations can take place. Today I experienced this dismissal in its fullest, leaving me feeling angry, ignored and still suffering symptoms. It was also a great example of the strange bureaucracy that slows down treatment. My most recent blood tests show that my lithium level is below the therapeutic level, meaning I am effectively unmedicated at present. Not good, and understandably triggering an appointment with my GP. Sadly, my GP can't actually alter my dosage, I have to contact my Psychiatrist for that. I'm waiting for the call back, and the letter to GP which will allow them to alter dose. However, the main issue for me (I'm so used to the bureaucracy) was the way my other physical issues were dismissed. Along with lithium, my kidney function, thyroid function and haemoglobin levels were checked because I have been unnaturally tired recently and I need to urinate very frequently (every 15 mins and 4-5 times a night!) When the tests were reported as normal I asked the GP about these symptoms. I was simply told these were probably 'just' a side effect or perhaps next time I could get my blood sugar tested. Next time, so in about 2 weeks minimum. It is very possible that these are side effects, perhaps from medication or low lithium levels. It could be something simple like an infection. But for me these are real physical symptoms causing me daily problems and potentially something completely unrelated to my mental illness. I and other sufferers deserve to have these physical issues taken seriously even if they are side effects, but especially investigated in case they are not.