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.

The 'M' word

Mental health has been at the forefront of the media this last week, following the tragic Germanwings plane that was likely deliberately crashed by the co-pilot. The media is most interested in mental health when it involves celebrity or violence. I watched last week as the story unfolded from the initial reports of a tragic crash, to the slow realisation that this was not a technical error or human failure but a deliberate action of one man. And that is where the reports start to change, you can almost sense the excitement of the journalists uncovering pieces of an individuals life and medical reports, theorising and inferring where there was no solid information. The headlines included "Why was he allowed to fly?" and "Madman in the cockpit". A not very measured response from the media, attaching immediately to the possible diagnosis of depression, which in the first days referred to a period of time six years previously. Mental health violence, the "madman", the secret psychopath makes a good story, which is still being added to each day. And yet despite the revelation that the co-pilot may also have had eyesight problems, it is his depression and mental illness that continues to hold the attention of the media. I am certainly not going to deny that violence is sometimes a consequence of mental illness, but the data shows that a very small percentage (7.5%) of crime committed by people with mental illness is a direct result of the mental illness In fact people with mental illness are far more likely to be a victim of violence than a perpetrator. However due to media coverage of the mentally ill as crazed killers and out of control psychopaths, people typically associate random, unexplained violence with mental illness. Heather Stuart showed that people most fear violence that is "random, senseless and unpredictable" and they would prefer to know that a crime was committed as part of a robbery, which they can make sense of, than as a result of someone with a psychotic illness. Add to this a study that shows that the each widely publicised attack involving someone will mental health increases the public's real social distancing from mental illness, in other words and increase in stigma (Angermeyer and Matschinger in Stuart Apart from my love of studies and evidence this reassures me then that this stigma, this increase in discrimination is real, and only increases with the kind of media coverage experienced this week. I am certainly not suggesting that mental illness did not play a part in the actions of the co-pilot and understand the need to find answers and explanations for such tragic events. But it must be measured against the quick to blame mental illness attitude- he must have been mentally ill- must have? Must all inexplicable actions be written off as mental illness? The truth is most people with mental health problems are only of danger to themselves. The mentally ill are you teachers, police officers, nurses, train drivers, shop assistants, cleaners and care workers. As Alistair Campbell eloquently said this week

We may never fully understand why Lubitz crashed flight 4U9525. Despite that, the assumption that his mental health was the sole reason 149 others died will do nothing to diminish the stigma attached to mental health problems...if he had cancer we wouldn't be blaming that and banning people with cancer from working

What we need to do is demystify mental illness, not as a caricature of the psychopath or crazed killer, but as a very common, sometimes scary illness that can be very effectively treated. Because if the media demonise it as something that leads only to inexplicable tragedy, then less people will step forward and potentially receive treatment. I have Bipolar disorder, a sometimes psychotic illness, I'm a little bit strange but I'm not a danger to anyone.

The Ghost of the perfect Christmas

Christmas is recognised as not only a season of festivities and family, but a peak in mental health crisis calls and admissions. Many people find this time of year difficult for all manner of reasons. Existing emotional problems can be exaggerated by the pressure to feel festive; loneliness further highlighted in a season of socialising and family. The Samaritan's note an increase in calls at this time of year, and crisis teams often experience greater work load from existing service users, which seems at odd with with the season that should be jolly.

For me this time of year has always been a time of heightened emotions, often swinging from excitement and anticipation, to moods of glow and rumination. There is a huge amount of pressure around Christmas to be perfect. I can remember at least as far back as my teenage years, my constant evaluating of Christmas. Is this right? Is it christmassy enough? Is it perfect? Unsurprisingly this pressure didn't ease as an adult when organising my own family Christmas'. Surrounded by adverts, social media, pintrest and the like I was a ball of emotion, constantly disappointed in my efforts and experiences.

On my daughter's first Christmas I spent two hours walking around my village while she slept in pushchair, tearful and internally declaring myself a failure and Christmas a disaster. Ridiculous. A four month old baby who only sleeps in the pushchair, isn't going to change for one day. What I failed to see was the family I was surrounded by, the magic of Father Christmas reflected in my son's eyes and pure fact that I was alive.

That was last rubbish Christmas. That year I changed my perspective (with the help of some excellent CBT therapy). The following year I chilled right out, concentrated on my beautiful children, my family and enjoying the time. I went for a run on Christmas day, something I wouldn't have allowed myself in the past for not being Christmassy.

None of us will have a perfect Christmas tomorrow. We don't live in a John Lewis advert, children may tantrum, food might burn, loved ones might be absent. But my advice is to find the joy in the Christmas you have. Not yearning the one you'd like, the one you had, the one that someone else has. And if you are struggling I cannot recommend the Samaritan's enough 08457 90 90 90

It's good to talk

Or so the saying (and BT advert) goes. It has been a message widely promoted in recent mental health campaigns as a way of improving our mental health and reducing stigma. I myself have run and taken part in Time to Talk events aimed at promoting talking as a fundamental step in tackling mental illness. I have written on this blog and on facebook on the importance of talking and being open myself. And yet I'm not sure it would be true to say that I do in fact, practice what I preach. I have a very distinct memory of my admission to the Mother and Baby unit. Sitting in a small office, a psychiatrist asks me how I am today. My reply? "um, ok, sort of". Not even an understatement. Luckily the mental health professionals I have worked with have mostly been able to see through this very British response and dig deeper. I was in fact at crisis point, hallucinating on the edge of psychosis. It could be that this state of mind was to blame for my understated reply, but in actually it is very common for me and for others to reply automatically to these everyday questions. Everyday you will be asked "How are you?", "How are you doing?" and many variations on these. How many of us answer truthfully? Consider for a moment how our day is, our home or work life at that instant. Most of us will answer automatically, with a practiced response or smile that indicates that everything is fine, even when it isn't. I've often wondered why this is, and whether it is inherently a British issue, uneasy at sharing the inner depths of our lives with others. Which would explain why you wouldn't want to share your despair or joy with a virtual stranger on a bus, or even a work colleague. But it doesn't really explain why some of us, me definitely, do it with our friends and family. There is one group of people who I have observed don't do this and are happy, in fact grateful to share the ups and downs of their day with others. Many older people when asked the simple "How are you?" will often unburdern themselves of the stresses and strains of their day, their health, their relationships with family. It isn't always aprecciated by the asker, and yet I think it should be admired. I'm not suggesting that we share our life story with everyone we meet on a daily basis. But perhaps we would all feel a little less burdened if we could answer truthfully and admit when things are so good, when life is stressful and hard work. One of the reasons I imagine that people don't always share the truth is that they are fearful of the other person's response. We don't want to make people feel uncomfortable, or make them think less of us. But we are overthinking the talking process. The 'good' from talking comes in the unloading, the putting into real words the things in our heads, the feeling of sharing a load with someone else. It isn't a problem solving. The older ladies I have talked to on buses haven't expected me to come up with solutions to their health problems or their relationship with their son. They just want another human being to listen, to care enough to take some of that burden. So the next time you are asked or ask "How are you?" think about what you are really feeling and what you could really do to help someone talk.

Just keep running

Running is listed as part of my care plan with my Psychiatrist and care team. I run for all sorts of reasons; to keep fit, lose weight and so I can eat more cake! It allows me time in my week just to be me, alone. My days are noisy and busy, constant calls of "Miss, miss, miss" and "Mummy, mummy, mummy"; the continuous questions of a four year old and the angry frustrated shouts of a toddler. My mind is constantly juggling washing, toys, lesson plans, reports, school dinner money, calendars and events. But when I run I am just me. All alone with my thoughts. Aside from the therapeutic benefits and endorphins running for me is an analogy for my experience with mental health problems. Often people say to me "oh I couldn't do that". What they mean is they couldn't run 5k, 8k or 10k etc. Which isn't true. Very likely they couldn't stand up at that moment and run a full distance at a good pace. But over a few weeks of running/walking and building up pace and distance they could. Almost anyone can run, it won't necessarily be easy or always enjoyable, but it is definitely possible. And that is part of the analogy for me. In the depths of depression especially, the future is almost impossible to imagine. Convincing someone who is depressed that it will get better and they will feel well again, will be met with the same level of disbelief as telling the average person they can run a marathon. The hardest part of running is getting out there, getting your trainers on and getting out the door. It is a slow process, with slow but steady results. Some days feel amazing and you feel like you could run forever, powerful and free. Other days (and more often) it feel hard, heavy and you push yourself round with all sorts of promises and motivational music. It is often one step forward and two steps back, a new personal best, followed by a period of heavy legs and slow trudging. Week by week you may not notice, but suddenly you are running without stopping, increasing distance and not always feeling like you might keel over. In the same way life with mental health issues is about small steps, more often than not forcing yourself out of bed, out of the house, small achievements that feel meaningless at the time. Over the weeks these small steps increase, the good days begin to outweigh the bad and you begin to recognise yourself again. Sometimes you can do it by yourself, but often, like with running, you need coaches and friends, helping you along. People are important in my running life and in my mental health. I belong to Sweatshop Running Community and benefit from the amazing support and encouragement they give. I love running with people, even when we can't talk, because sometimes it is enough to hear someone else panting alongside you and motivate you to keep going! Park run is another brilliant support, a weekly 5k run that manages to be fully inclusive as well as challenging. In my life it is my family and friends that support and coach me. Sometimes pushing me, occasionally dropping back and simply travelling with me. On 7th September I am running The Great North Run for Rethink Mental Illness. They provide helplines and crisis care, advice on everything from diagnosis to housing, support groups for sufferers and carers, campaign for better awareness and so much more. I am running to raise money for the very important work they do, mental health services have very recently been called the 'Cinderella' service. But I am also doing it to raise awareness and speak out about the realities of life with mental health issues. If you want to sponsor me my link http://uk.virginmoneygiving.com/LizClothier And if you want to try running- when I first ran I got to the end of the road, out of breath and thought I might be sick. Now I can run 8k and soon more. If I can do it, anyone can!

Great expectations

For the first time in a long time I have been able to tell people that I had a great Christmas and New Year. No lying, no slight nod of the head with a strained 'ok'. Not that I don't like the season, in fact I love it, Christmas in particular- our decorations went up on 1st December this year. But perversely it is my love of Christmas and the new year season that leads me to have such a disappointing time each year. Not Christmas, but my expectation of all that Christmas and New Year should entail. Expectation, and in particular my expectations of myself have been something I have been working on for many weeks with my therapist. It is not just about Christmas, but my expectations invade many aspects of my life and leave me feeling like a failure. For many years I have felt like I have 'failed' at Christmas because it hasn't lived up to my ideal of what I think a family Christmas should be. What I have discovered, which is probably obvious to most people, is that it isn't necessarily my expectations that are the problem. There is nothing wrong with having high expectations of an event or yourself, in fact this outlook is encouraged by many in the life coaching business. No, the expectation is fine, it is the way I deal and process the reality if it doesn't live up to the vision that is causing the turmoil. It isn't much fun believing you are a failure at most things. It doesn't do much for your self esteem, and in my case it stops me from trying or continuing with new things. For much of my life I have simply not tried or quickly quit at anything that I am not immediately good or satisfactory at. That has ruled out musical instruments, languages, crochet and knitting- all things that require practice, little and often and at which most people start at a fairly low level. It means that I avoid situations where I might be asked to be 'creative' and make things, as I am useless at it and hate showing this. Not healthy. There are many other areas of life this trait has invaded, including Christmas, birthdays, holidays and days out. All deemed failures, and therefore me too, if they do not live up to the picture postcard ideal in my head. So what changed this year? I am going through the process of trying to reprogramme myself, so that I can deal with the expectation in a different way. It involves keeping a kind of journal, and constantly reminding myself of little phrases. This Christmas I did not get myself all knotted about what we did and when, and what is involved in a perfect Christmas day. Instead I let go, lowered my expectations; in fact made the expectations realistic. High expectations are good, unrealistic ones are just setting you up to fail. Which I was doing over and over. So I went for a run on Christmas day, because I wanted to and Christmas should be about doing things you like, not fitting in to a list of ideals. I watched TV and I hung out with my husband, sister and brother in law and didn't get twisted up about not playing a board game. Because it was fun chatting with them, and board games can be played any time. These might seem insignificant, or even a bit bonkers to many of you, but it has been so important to me. Not to over analyse everything and measure myself against what I am supposed to be or do. My only resolution for 2014 is to make my expectations more realistic, not lower, just achievable.

What does a mental patient look like?

This week two large corporations have been forced to remove Halloween costumes based on 'mental' or 'psycho' patients. Following a huge outcry on twitter and other social media, Asda and Tesco both removed these offensive costumes.

My initial reaction was one of complete disbelief. I couldn't fathom how such an idiotic and offensive decision could be taken today. But actually perhaps it isn't that surprising. On the face of it we are a accepting, politically correct society. We don't allow racism, we have laws against discrimination and we have certainly made significant progress on sexism. However, mental health still teeters on the line between offensive and acceptable humour.

Whilst outright discrimination may be taboo, there is an underlying sense that purveys humour and language that speaks of mental health issues in terms that are stereotypic.  'Crazy', 'psycho', 'going postal', amongst others, as well as a common assumption that extreme violence must mean an underlying mental health problem. The media often makes mention of the existence or not of mental health issues in an assailants history. Between the lines, although not said, we are supposed to assume that there must be a mental health problem to explain the atrocity. Recent cases in the US, for example the navy yard shooting, do exactly this.

I am not asserting that mental health conditions do not play a part in many violent crimes, but statistics show that people with serious mental health conditions are much more likely to be the victims of violence than the perpetrators. And yet films, books and TV continuously portray the bad guy with mental breakdown or condition. Some people with mental health conditions commit violent crime, but so do many men, many single people, many blonde haired people. To assume on these grounds would be seen as ludicrous.

There is a fear of mental health, but also an attitude of 'its only a joke'. It used to be acceptable to make jokes about the Irish, women, or the physically disabled. This attitude allowed discrimination and prejudice to pervade society and effect the treatment of these groups. These costumes passed through buyers and managers, they were deemed acceptable because of this humour rule. But this attitude causes serious damage to the view and treatment of people with mental health issues. Not on the surface, deeper; in throwaway comments, assumptions made about friends and employees. It makes people with mental health problems less likely to speak out in case they are seen as 'mad'.

The positive is the outrage, although I was deeply offended, I was also cheered with the outrage of others. It led to an opportunity to talk again about the stigma of mental health and photo campaign by Time to Change called "this is what a mental patient look like". And open conversations about mental health are always a good thing

One year on

This weekend is my daughter's first birthday.  With all the celebration there is another side to this important date for me.  The perinatal mental health team only looks after women who are pregnant and up to the first year of the child's life.  So I am bring discharged to the back to the community mental health team.

This handover is somewhat of a double edged sword for me.  On the one hand this is a good thing, it means that I am better, well on the way to being stable and well again.  However the perinatal team have been the the very best mental health service I have ever encountered, in fact possibly the best NHS service I have ever used.  They have kept all appointments, visited me regularly, looked after me with care and sensitivity during my inpatient stay.  Between them they rebuilt my confidence, got me back to work and helped me rebuild some normality in my family life.  They have laughed with me and cried with me, and got me psychological therapies that I have been waiting for for over three years.  I cannot express in words how wonderful they are and how grateful I am to them and all they have done for me and my family.

On the flip side community mental health services have been somewhat hit and miss.  There was the time that I was first referred to mental health services and spent months being pushed back and forward between different services- one claiming that I was too unwell to be seen by then and the other saying I wasn't ill enough.  I was referred twice for CBT and therapy and was lost on the list when the service reshuffled from South to South East to East.   At 32 weeks pregnant I changed Psychiatrist (after another reshuffle) and it was only then that I was referred to perinatal (despite the guidelines stating I should have been referred immediately).  And finally there was the community psychiatric nurse (CPN) who was brushed off my comments about hallucinating (it would cause a lot of paperwork) and reported me (wrongly) to social care against the advice of my perinatal CPN and psychiatrist.

In many ways I will be glad that this 'year' is over.  It is been the hardest I have ever known and has tested the limits of my mental and emotional strength, as well as my relationships with family and friends.  What I do know is that the year wold have been made much worse without the wonderful work of the perinatal team at The Mount.  They do amazing things every day with very little in the way of resources.  In the whole of Yorkshire there is one mother and baby unit which has five beds.  Five.  The next nearest is Newcastle of Manchester.  They didn't just hand out pills and feed me.  They nourished me, they supported me and they gave me the confidence to drag myself out of depression.  Mental health services are often described as the 'Cinderella service' and if that is true they are the fairy godmother, because they made so much our of very little. If only all mental health services could be so good.

Medication's what you need...

"Just keep taking the pills" is what my Dad says to me regularly.  Few people are surprised that I take medication for my Bipolar, it seems the obvious option.  Why wouldn't you?  If your brain chemicals are unbalanced, simply straighten them out with some drugs- balanced brain equals normal life.  It isn't quite that simple however, firstly because there are no specific drugs for Bipolar Disorder or in fact many of the psychotic mental illnesses including Personality Disorders and Schizophrenia.  In fact many, if not all the drugs used to treat and manage these mental health conditions were originally developed for other uses. Anti-convulsants, developed in the main to treat epilepsy, are still the most commonly used drugs used to treat Bipolar Disorder.  Medication for Bipolar Disorder is often a case of trial and error, and many sufferers will try several drugs and often end up with a combination of drugs to control their symptoms.  The most commonly used and oldest drug is Lithium, which is in fact an element rather than a compound.  It was first discovered to have behavioural effects on subjects in the 1950s, and yet we are still not entirely sure how or why it works for Bipolar Disorder.  And this is the same for many of the drugs used to treat Bipolar and other mental health disorders.  We know they work for some or all symptoms, for different people, but we are still unsure why.  What all the drugs have in common is that they all come with pretty significant side effects.

Side effects of drugs are common place, nearly all prescribed drugs have some other, often unwanted or unpleasant effect on the taker.  However the majority of us will only take medications for short periods of time, and for the most part side effects are manageable or avoided. Most people with Bipolar disorder will take a combination of medications their entire lives, from the point of diagnosis.  For me that was when I was 29.  So I potentially have another fifty years of medication to control and manage the symptoms of my condition.  It is the side effects and the impact they have on a sufferer's life that lead many people to stop taking the medication.  That might sound crazy (ha, ha!) to most people, to stop taking a drug that prevents significant mental illness.  But many of these drugs are physically damaging and cause side effects that day in day out are difficult to tolerate.  I can only talk of my personal experience, but three years in I am struggling with balancing the side effects with the benefits of the drugs.

On the surface many of the side effects may seem inconsequential, but added together, over a period of time they become frustrating.  I take two drugs at the moment, the first lithium which I started taking after my diagnosis, and venlafaxine, which I began in hospital after my daughter was born.  Lithium is my mood stabiliser, there is no set amount prescribed, as different people metabolise it at different rates.  In fact the line between therapeutic and toxic is narrow.  Lithium toxicity can cause kidney and liver damage, as well as thyroid disease.  For this reason I have regular blood tests to check my levels and my organ function.  It is unlikely I will take it for my whole life because of the damage it does.  It also make me very thirsty, because it is a salt; it makes my hands tremor slightly, especially in the mornings and itchy skin.  Venlafaxine is an antidepressant, it causes me to be hungry all the time.  By that I mean I eat a large, healthy meal and an hour later I am ravenous, a real craving hunger.  This means that if often causes weight gain.  It makes me sweat more (nice!), have very vivid and strange dreams, and if I am even an hour late taking it I get dizzy, brain shocks and feel sick.

These are manageable, except at the moment I am trying to lose weight.  My drugs mean the only way to do this is to be really, really hungry most of the time.  It is hard to concentrate when so hungry!  I am eating enormous amounts of fruit and low fat yoghurt, but it doesn't touch it!  These drugs meant I couldn't breastfeed my daughter, couldn't even really consider it.  I have to be very careful with alcohol, I get drunk much quicker and if I get too dehydrated I can go into lithium toxicity.

Soon I will hopefully be reducing the venlafaxine, and perhaps even consider a change all together.  But unfortunately for me most of the drugs come with the side effect of weight gain.  Which might seem a vain worry, but when you are overweight already, facing a lifetime of these drugs it becomes more than an irritation and yet another kick in the teeth from this diagnosis

What's in a word?

Do you consider yourself to have a disability? A simple question for most people, it appears on most equality monitoring forms.  From dentists to libraries, sports groups and employers, everyone wants to know your race, gender, sexuality and if you consider yourself disabled.  I imagine most people find this question straightforward, its obvious right?  Well, I always hover over that question, my pen moving from yes to no, my mind contemplating what it is exactly I feel, do I feel disabled? And more importantly, what will the impact be if I say yes or no?

Bipolar Disorder is, or can be, defined as a disability under the Equalities Act of 2010 (formerly the Disability Discrimination Act) if it impairs the sufferer in carrying out daily tasks.  For example getting dressed, interacting with people, making decisions.  But Bipolar Disorder is a broad diagnosis and so it must be evaluated for each person, it isn't enough simply to say Bipolar Disorder is a disability- it can be, if it effects an individual in a way that prevents them carrying out normal activities.  On that level then I am disabled.  There are periods of my life when I cannot carry out normal tasks, like dressing, or deciding what to eat.  Or even eating at all.

While logically I can look at the criteria for disability and read all the information provided by mental health charities about mental health disability, I find it hard to reconcile that with myself.  I don't feel disabled, I don't see myself as disabled.  But perhaps that is more to do with my perception of disability, or more likely connected to my need to be independent, to not need help from anyone.  Because that is the issue. Ticking that box, especially in the context of employment leads to the second question- do you require any assistance/help for your disability.  I am still coming to terms with the idea of asking for help, admitting that perhaps I can't do everything everyone else does without a little extra support. Disability for me means admitting that I need help sometimes, not something I find easy.

There is also an element of worrying about the consequences of ticking that box, of saying I am disabled.  What will an employer think when they see that, and worse that it is a mental health problem?  A probable assumption will be that I will have lots of time off, that I won't be able to handle stress, that I might "flip out". Technically employers aren't allowed to ask you medical questions until after interview, but they are allowed to ask the disabled question because it relates to interview. So what do I do- say yes and hope they don't just chuck my application in the bin?  Or no and worry that when it comes to the medical they don't question why I didn't say yes earlier?  I just can't believe that many employers wouldn't discriminate against a mental health disability.

Ultimately the problem with this question is that it is so closed.  A small tick box that requires a yes or no answer.  It doesn't allow for an explanation, all the positives that come from it, what I can do, as opposed to the things I struggle with.  Disability is a much bigger concept than a simple yes or no, it is a broad spectrum of identity, one that I am slowly beginning to accept applies to me.

Won't someone think of the children

Last week I was on Woman's Hour, well my experience was.  It was part of a piece on mental health and parenting prompted by a call from the Care Quality Commission and Ofsted that doctors and health care professionals treating parents with mental health conditions should automatically and statutorily refer them to social services.  The report states that children whose parents have mental health problems are often poorly supported and therefore susceptible to harm.  Mental health conditions are considered to be the same as substance and alcohol abuse and are recommended to be dealt with by social services in the same way.

This recommendation is ridiculous, dangerous and insulting.  There is already an obligation by health care professionals to report anything that they think my be a child protection issue.  This requirement will not help support children, instead it will isolate women right at the point they need help and to talk.  The fact is very few women, or parents, with mental health problems are a risk to their children. Unfortunately, the few terrible instances there are of parents (usually mothers) harming their children due to mental health problems are widely covered in the media.  The reality is that 1 in 10 women will suffer with postnatal mental health problems, but the numbers that will harm their baby are tiny.  However, many women with postnatal depression and psychosis are terrified of speaking out and telling someone how they feel, for fear that they will be deemed an unfit mother and the baby will be taken away.  This is far more dangerous for the mother and baby than the mental illness itself.  Putting a statutory requirement on doctors to report women for mental illness will surely just make women more afraid to speak out about how they are feeling.

After my daughter was born and I began to become unwell, the perinatal care team were excellent in their care for me.  They understood the complexities of postnatal mental health, monitored me, and asked all the right questions.  They considered me in no way a risk to my children.  However an inexperienced Community Mental Health Nurse, without visiting me or talking to me, referred me to social services.  The anxiety and stress this caused us was enormous, and social services agreed that I was not a risk to my family.  Social services are the demon child snatchers that people often portray, but until you have been there, considering the idea that your every parenting decision, emotional state, and love of your children will be monitored, it is difficult to understand the fear.  I have always had a good understanding of social care, I have worked with them supporting families.  But when I got that phone call, in the midst of my unwell mind, I was paralysed with panic and fear.  I had always worried that people thought I shouldn't have children, because of my Bipolar, and now it was going to be tested.  A quick conversation and the worry was over. There was nothing social services needed to do or could do.

And that is another issue.  After the shock and panic had subsided I asked for their help and support.  I was on the verge of being admitted into the Mother and Baby unit, my family could do with any support that could be offered.  Except there was none.  Social care couldn't do anything for us, we qualified for nothing.  My deteriorating mental health was not a factor in deciding support for our family, income and employment was.  Because my husband works full time is a reasonably well paid job (above national average, but still quite a bit below higher tax rate) we were entitled to no help with childcare for my son, no support for mu husband as my carer.  If he had not worked then we would have been entitled to much more.  One argument  for the automatic referral to social services is that children and families receive the support and care they need.  But unless there is a planned injection of money into social care services, this is not going to happen.  They are an overstretched service as it is, unable to support all but the families most in crisis, the ones where children are in danger of harm or neglect.  If you care for your children and are trying your best, but simply need extra help in coping they cannot help as they do not have the funds. Therefore the referral is a pointless exercise which will only lead to women hiding their feelings and worries through fear of losing their children.

And as to the categorisation with substance abuse, I find this insulting and a further opportunity to stigmatise mental health conditions.  I am not disregarding alcohol and drug abuse as something that requires help from health professionals or blaming people addicted as "bringing on themselves", but mental health conditions are different in the ways in which they effect families and the sufferers and should not be lumped together in this way.  If anything the children of mental health sufferers should perhaps be seen as young carers, in the way that other children of disabled parents are. As often is the case this report shows that mental health concerns are given less support than physical health concerns.  Families coping with mental health conditions do need more support, but a automatic referral to social services is likely to be counterproductive and in fact deter women from coming forward and seeking help for their conditions. Had I thought I would be referred I would have said nothing of my feelings, my hallucinations and my need for help.  And that would have been a very bad thing.

Pain is temporary, giving up is forever

Sometimes you have to admit that you need help.  I am a fiercely independent person, I like to be in control and I very rarely admit that I need help.  But, I have to admit defeat and say that once more this illness has weakened me.  I won't say beaten, as there is still some fight in me, although it is diminishing by the day.

Eight weeks ago I gave birth to my beautiful daughter.  Her birth was wonderful, and initially I rode on a high of hormones. I did everything by my plan, carefully managed by my team. I started my lithium five days post delivery, I met regularly with CPNs and attempted to manage my sleep as best as possible. But sometimes even when you do everything right the darkness slips in.

Gradually at first, I started to feel the signs of a low.  Hopelessness, crying, inability to make even small decisions.  To begin with everything was blamed on tiredness, on the responsibility of looking after a toddler and a baby.  But the feelings took hold of me, the sadness overwhelming.  Finally a visit to family, where meals were cooked for me, the baby held, sleep had.  And yet the sadness prevailed.  On the journey home, when the tears were still trying to come, I realised that I could no longer blame these feelings on tiredness, relentlessness or the normal feelings associated with caring for children.  I am good at hiding these feelings, and it is possible that no one noticed to begin with.  But despite the best efforts of my team, the intrusive thoughts are taking over and the illness is gaining momentum.

And so today I will be admitted to the Mother and Baby unit with my daughter.  Hopefully it will be a short stay, where I can rest, get stabilised on additional medication and start to get well again.  I am anxious and scared at what to expect.  At having to relinquish some of the control to a team of people I don't know. But I have to do this, not only so that I am no longer a danger to myself, but more importantly because my children deserve a well mother.  Not one weighed down with misery and tears. I want to be able to laugh with my son again and delight in my daughter smiling.

A part of this feels like defeat, like admitting weakness.  That I can't do what thousands of other women do everyday.   I have to acknowledge that I am ill and I need help getting better.  If I had broken my leg I would get it fixed, and I so badly want to be fixed. Suicide is the number one cause of maternal death in this country, and I cannot be part of that statistic. I will not let this illness beat me.

The title comes from Lance Armstrong (despite the drugs scandal I like the quote).  In full he says  "Pain is temporary. It may last a minute, or an hour, or a day, or a year, but eventually it will subside and something else will take its place. If I quit, however, it lasts forever."  This may last weeks or months, but with help it will subside.  I cannot and will not give up. 

Living with the consequences

Within writing about mental health there is a lot about symptoms, feelings and experiences when a person is ill.  What it feels like to be depressed, to live with mania or stress.  There is less discussed about the consequences of these periods of time on the rest of your life. I mean the long term consequences of periods of mania and depression, that leave scars in your everyday life long after you are well and healthy again.

There is a legacy of emotions from both these periods that can impact on your work and relationships.  Depression and mania can mean long periods of time off work, leading to absence reports and constant monitoring of your attendance.  In turn this may lead to judgements on your ability to do your job, or a nervousness amongst employers over "what if" you were to be ill again.  This inevitably has effected my choices in terms of work and I am fairly certain influences my employers judgements of me.  I can never shake off the periods of absence, no matter how much my attendance improves when I am well.

But for me the greatest consequences are personal and financial.  These are the things that hang over me, that continue to influence my life long after any period of illness.  During one now diagnosed manic phase I ran up close to £20,000 in debt over about one to two months.  I have very little to show for this, except four years of a debt management plan, a destroyed credit rating and very little confidence in my ability to ever get credit again.  This financial legacy has had lasting consequences for me (and my husband) in the seven plus years since it happened.  Our mortgage is high and not particularly favourable; the years spent paying off the debt were lean and stressful; our honeymoon was four days in the UK and a family holiday seems years away.  It meant only six months maternity leave with my son, and will mean the same this time round as we have never really recovered enough to save and invest like other thirty somethings.  It means I cannot go part time to spend time bringing up my children, or even consider a lower paid job.

In personal terms, no matter how much people try to understand your condition, depression and mania can destroy and damage relationships.  High spending, alcohol and drug misuse and sexual promiscuity are common in mania and not conducive to maintaining relationships.  I have burnt many bridges in my time through my behaviour and often still feel shamed at the things I did.  Depression is draining for all involved and often leaves lasting resentment for partners and family.  The unpredictability of living with someone with mental health issues, such as Bipolar must be exhausting at times and inevitably has an impact on how that person is viewed.  I have talked before of separating the illness from the person, but when the illness creates personality changes it is hard to do.

I am eternally grateful for the support and love that my husband and family give me when I am ill, but more than that I am in awe of their ability to live with the long term consequences of my behaviours and forgive my discrepancies.  

Better late than never

I have changed Psychiatrist as part of an NHS reshuffle (read-money saving attempt).  My meeting with the new doctor seems to have highlighted some issues with the old one.  As I had already thought I should have been referred to the Perinatal Mental Health team at the beginning of my pregnancy so that they could cover my care, liase with midwives and consultants to ensure I stay well both during and after my pregnancy.  Apparently they have been awaiting a referral from my previous Consultant that never materialised.  Unfortunately if you have ever accessed mental health services, this won't come as much of a surprise.  I have slipped through the net many times, in fact would likely have been diagnosed a year earlier had another NHS reshuffle led to a referral being lost.

However, this meeting at 32 week pregnant has thrown me into a bit of emotional turmoil.  My new Psychiatrist has outlined (as should have been the case) the risk factors and dangers of pregnancy and postnatal for women with Bipolar.  We have a 40-70% chance of relapse in the first 12 weeks.  This could be either mania or depression, added to this a 1 in 2 chance of developing puerperal psychosis (this is compared to a 1 in 500-1000 chance in women without a history of Bipolar).  These are scary statistics.  The depression experienced postnatally by women with Bipolar has a much more rapid onset than postnatal depression, and more frequently leads to suicide.  Mania is very common in postnatal women due to sleep deprivation and is very much more disruptive and dangerous than depression.  Psychosis is the scariest.  A complete block from reality, hallucinations, believing that your baby or family are in some way dangerous to you. 

My appointment involved a discussion of all these, and a worst case scenario outline of what might happen (admittance to a mother and baby unit, psychiatric ward, crisis care team).  Explained in the first trimester it may have been easier to here.  With eight weeks to go it has left in a some what emotional state of anxiety.  I will write a postnatal plan with the Perinatal team, which will be shared with all my carers.  This will involve plans for all eventualialities and how the postnatal period will be managed. Top of this list is the question of medication. I have taken lithium for nearly two years before this pregnancy, an anti-psychotic drug that works very well in Bipolar, but no one knows why or how.  I have been stable and functioning.  But it is not compatible with breastfeeding, it is a metal and harmful substance that can casue serious damage to liver, kidney and thyroid.  It takes six to eight weeks to work as the levels are based on individual's metabolism.  I have some difficult decisions to make.  I want to breastfeed, I want to be able to feed my baby and do what my body was designed for.  My medical team want me to formula feed and take medication from the outset.  For me it feels like another way that this condition has impacted me and at best seems unfair at worst has made me sob with grief at having this taken away from me. 

Mental health in pregnant and postnatal women is still a very much neglected area of medicine. Some NHS trusts do not have any dedicated mother and baby units, Perinatal teams or specialists midwives.  And yet suicide is the biggest cause of maternal death in the UK.  Women are twenty times more likely to be admitted to a psychiatric unit in the 12 weeks following birth, than in the two years before or after.  The last few weeks of my pregnancy are likely to be filled with medical appointments, care plans and anxiety.  I want to be well, look after my baby, have happy memories of becoming a family of four.  But overshadowing this is a long list statistics and possibilities of what might happen.