What happens in a Community Mental Health Team?

What is a Community Mental Health Team (CMHT)?

Community Mental Health Teams are multi-disciplinary
Community Mental Health Teams are made up of multi-disciplinary professionals

Have you ever wondered what happens in a Community Mental Health Team (CMHT)? Let’s take a look.

They were developed in the UK to deliver Care in the Community in the late 1980s. This was a British policy of deinstitutionalisation; treating and caring for physically and mentally disabled people in their homes rather than in institutions. 

A GP might refer an out-patient, but in-patients are generally allocated to a CMHT prior to hospital discharge. These CMHTs are made up of various multi-disciplinary professionals such as:

  • Community Psychiatric Nurses (CPNs) and unqualified support staff
  • Social workers and Approved Social Workers (ASW’s); social workers who’ve undergone specific training in mental health law; the Mental Health Act 1983. This then enables them to carry out Mental Health Act assessments with other professionals.
  • Consultant Psychiatrist, Senior Registrar and/or Senior House Officers (SHOs) who are Doctors undergoing their six months training in a particular area of medicine. In this case, Psychiatry.

Once referred to the CMHT, an assessment would be completed to build up an accurate picture of a person’s needs. The patient might get help from either one or two of the above professionals, depending on their needs.

My first placement at a Community Mental Health Team

How a basement CMHT might look
How a basement CMHT might look — Image by Washingtonpost.com

As a Mental Health Nurse student, I was allocated to Alan, a CPN who would be my supervisor during this placement. I arrived early so I had a coffee and introduced myself to a few of the team while waiting for Alan.

It was eight fifty-five and the team’s overall mood matched the weather that stormy Monday morning. Had they not been sitting at desks, behind the flexy-plastic window, I might have thought they were patients with depression — just staring blankly into oblivion.

I smiled as the front door opened and an older gentleman walked in. He was wearing a tatty tweed jacket, a moth-eaten jumper and a shirt so old, the collar was frayed. His creased trousers looked as though they’d had an argument with his ankles and his black plastic slip-on shoes squeaked as he walked.

Still, his gappy-toothed smile was welcoming. He stuck out his hand, pushed open the inner door with his backside and introduced himself as Javid, a Social Worker.

I explained who I was and he took me down to what looked like a fusty old storeroom. He pointed out his desk, Alan’s desk and the one opposite that I could use, and off he went.

Student nurse Practice Based Assessments

I went through my Practice Based Assessment (PBAs) to see which ones I might be able to meet — sooner rather than later. Students have a list of evidence-based tasks, to be carried during placements, which are assessed for competency by their supervisor. This was a lengthy process so I always liked to get a head start and not leave the PBA’s right ’til the end of placements.

While idly thumbing through a patient file, I happened to look up and saw a rickety old bike being chained to the railings outside. I watched from the basement window as a pair of green wellies marched up to the front door. The wellies stomped about a bit before thundering down towards the basement.

The office door crashed open and there stood Alan! He pulled himself up to his full six-foot-plus, puffed out his chest and glared at me. “What on earth do you think you’re doing?” a broad Glaswegian accent rasped. Think Billy Connolly!

“Javid said I could look through……..”

“Is Javid your supervisor? No, he’s not. I am. Javid is an ASW and you. are. a. mental. health. student. Are you not?” He turned on his heels saying “I’ll get a coffee and see you when I come back!”

And this was how Alan continued over the next few weeks; barking orders at me and ignoring any questions, or feeding me wee snippets about his patients.

Depot injections by Community Mental Health Team

Intramuscular depot injection administered by Community Mental Health Team
Intramuscular depot injection administered by Community Mental Health Team

I was surprised one morning when Alan told me I was to run the weekly Depot Clinic under his supervision. This is where patients come every 1-4 weeks to have antipsychotic medication via intramuscular injection.

Some patients prefer this as they tend to forget or refuse to take their daily tablets. Other patients must have medication by injection under a Section of the Mental Health Act 1983. If a patient is known to be non-compliant with medication, Depot injections are often recommended during Multi-disciplinary team (MDT) meetings.

“You know how to administer injections, I presume?” snapped Alan. And without waiting for an answer, “don’t forget to check which side they had their last injection. I’ll countersign the medication charts when you’ve done.” I’d observed several injections during my in-patient placement but I’d never actually administered one. I told Alan and all he did was nod; indicating me to just get on with it.

My first patient was due in soon so I checked her medication chart and spotted the small letter ‘L’ underneath the signature box. I gathered this meant that their last injection was on the left buttock so this time it would be on the right. Injections sites were alternated to stop the buildup of scar tissue on one side.

Administering my first depot injection

Preparing depot injection
Preparing depot injection — image by Pixabay

Sally, a 36-year-old female, appeared sullen and I wasn’t sure I’d be able to engage her in idle chit chat before stabbing her with the needle.

However, she chatted amiably about me being a new student and asked whether I liked football. The needle was out — and I told her I was an Arsenal fan. “Blinding. Me too. But I ain’t never been to a game.”

I did take her along to a match some years later, but that’s another tale. Anyway, there I was, scribbling my signature on her medication chart when she turned her head to me and chirped “Come on, ‘urry up mate!”

“All done Sally.” Ha! I’d given my first real injection and she didn’t even notice. Her eyebrows shot up then I got a wink and a smile of approval as she buckled up her jeans.

“You’re alright you are. She can come ‘ere again Alan.” She gave me a knowing look and glared at him as she left the clinic. Not a word from him, just another of his withering looks as I passed him the chart to countersign.

My first Community Mental Health home visit

Community Mental Health Teams work with patients in their own homes
Community Mental Health Teams work with patients in their own homes — Image by Pexels

A month passed and Alan continued to arrive late every day. One morning, Javid asked if I’d like to go out and visit some of his patients with him, and I jumped at the chance.

We arrived at Anne’s house to see her in the front garden barefoot and wearing a flimsy but colourful kaftan. She twirled around on the grass, head back and arms outstretched as she sang. Julie Andrews popped into my head and I fondly remember Anne whenever I hear “The sound of music”.

Anne grinned when she saw Javid and waved him in with a dramatic curtsey, then called the children in for lunch. Four skinny under-twelves trooped into the living room and hungrily snatched up huge doorstep sandwiches.

The kids danced, skipped and jumped all over the two mismatched sofas as they munched. They sang silly songs and clapped loudly, dropping crumbs everywhere. Their likeness to the much loved Von Trapp family didn’t go unnoticed.

They were clean, wearing all manner of clothing; some too big and some too small, all barefoot, but they looked happy and were both well-spoken and well mannered.

Bipolar disorder

Bipolar disorder and mood swings
Bipolar disorder and mood swings — Image by Crazyhead comics

Anne had a diagnosis of Bipolar disorder which used to be known as manic-depression. Someone with Bipolar has episodes of mania (feeling very high and overactive) and periods of depression (feeling very low and lethargic).

Unlike simple mood swings, each extreme episode (high or low) of bipolar disorder can last for several weeks, or even longer. Bipolar disorder is treated with mood stabilisers such as Lithium or Valproate, which were all originally made for treating epilepsy.

Community Mental Health Assessment

Javid asked Anne if it was okay for me to complete a mental health assessment, done by observation and direct questioning, assessing things like:

  • mood, behaviour and appearance
  • thought form for speed and coherence
  • thought content for delusions, suicide, homicidal or violent thoughts, obsessions and perception
  • cognition for orientation to time, place and person, attention and concentration

Finally, I assessed her insight to gauge whether Anne knew her incessant chatter, thought disorder and her behaviour wasn’t normal, given the weather and both her and the children’s appearance. However, she didn’t believe she was currently unwell “This is nothing.” she chirped. “You’ve seen me worse Javid.”

Javid smiled, then we stood to bid our goodbyes, and I couldn’t help but giggle when Anne and the children burst into song “So long, farewell, Auf Wiedersehen, adieu. Adieu, adieu. To you and you and you.”

Sitting in his car, Javid talked me through the visit and agreed that yes, he had seen Anne worse? “Really?” I asked. He nodded and chortled. However, he said he’d check to see if there was a bed so that he could plan a voluntary hospital admission over the next few days.

Javid said that Anne would use all kinds of delaying tactics but would eventually agree to voluntary admission. “She knows she has a chronic (long-term) diagnosis and she’s well known to services. She’s aware that if she doesn’t go voluntarily, she’d be admitted under Section 3 of the MHA 1983”. This means patients can undergo coercive interventions, such as enforced medication, seclusion and restraint.

Mental Health documentation to be completed

CPNs have to complete lots of documentation
CPNs have to complete lots of documentation — image from Pexels

After a few more less-exciting home visits Javid and I returned to the CMHT around four-fifteen, just in time to complete our documentation.

Alan threw me a look of utter disdain as he snapped his briefcase shut and headed for the door. Thank God for the weekend!

Alan’s lateness carried on, his behaviour remained erratic and his lack of interest or guidance was getting me down. There were days I was in tears, despite the admin girls telling me to ignore him, and making me laugh.

Every day Alan was late I went out on visits with Javid or other staff who’d asked if I’d like to accompany them. I was gaining so much experience as some staff were supportive and fed back to me my strengths and small areas that I could build on.

My Practice Based Assessment

Most of my PBA’s had been completed I and was pleased with the evidence I’d attached. I’d made sure there were no names or numbers that could identify individual patients.

The staff I’d worked with wrote on my PBA’s that I was really intuitive and empathic, that I had excellent communication skills, and had been proactive in achieving the high standards I’d set myself. Overall they said they were impressed. All I needed now was for Alan to sign them off as having been completed.

The arrogant shit refused! He hadn’t seen me complete any of the tasks listed on my PBA’s so he would not sign them! He couldn’t possibly! Aaarrgghh!

Over to you

But it got worse……….. I’ll do a short follow-up. But in the meantime, I’m happy to answer any questions and look forward to hearing what you think about care in the community. Does it work? Or even, just say “Hi.”

Self-help for my mental illness

Living with mental illness and the self-help methods I tried

Anxiety and psychosis felt like being in Hell
Anxiety and psychotic depression scared me — Image by Pixabay

This is the 3rd in a series of “My journey through anxiety, depression and psychosis.You can read Part I and Part II if you want to find out more.

Let me tell you, I know all about mental illness and self-help, both from my personal and professional experiences.

Some of you will already know a bit about my journey, but after recent personal trials and tribulations, I thought I’d revisit this post.

I wanted to remind myself how bad that period of my life was, how far I’d come, how I got through it, and what helped. Having re-read the post I realise now that no matter what life throws at me, I will never let myself become that low ever again. I will seek out support way before it gets to that level.

See, I know how deep that black hole can be and, once you go down there, it’s truly not easy to climb your way back out! Mental illness is so hard to live with.

If you see anything of yourself or your own experiences in this post, perhaps you’ll feel relieved that you’re not alone, and you’ll seek support.

While reading my story you might gain new insight into different mental health problems, and understand how difficult it is for people who experience mental illness? Maybe you’ll recognise some of the symptoms in a friend or family member and learn how you might be able to help them?

Okay, let’s look at the self-help methods I tried for my anxiety, depression and psychosis. What worked, and what didn’t work so well.

Who said I had a mental illness?

One day I took the boys to see our GP about their asthma and after he’d seen them he sent them out to the waiting room. He turned to me and, with his hand resting lightly on my arm, said “Tell me, what’s the problem? You so thin and though you smile, I think you very sad.”

The floodgates opened and out it all tumbled; I sobbed, wiping the tears and snot on my hand as I explained how the boys’ dad had been cheating and we’d broken up around eighteen months ago.

My GP told me to take the boys home, he would make some telephone calls and I was to come back to see him in an hour. When I returned to the surgery he’d called a Psychiatric Consultant colleague who agreed to see me; like — now, at our local general hospital, and Dr Nga was going to drop me off!

Now let’s go back a bit………..

Self-help for my mental illness started here

Anxiety and psychosis was HELL --- Image by Unsplash
Anxiety and psychosis was HELL — Image by Unsplash

……….I’d been struggling desperately. I couldn’t see an end to the pain. I felt scared, worthless, hopeless, and suicidal.

That was when I had my own ‘breakdown‘………….. and that’s exactly what it felt like. Both physically and mentally, I was broken.

I had panic attacks throughout the day and particularly at night, keeping me awake.

It was torturous; twenty-four-seven, week on week and, with no end in sight, I wished I was dead!

At that time, I couldn’t talk to anyone but I knew I needed help. I was desperate so I got books from the library (pre-wi-fi) and tried to learn some self-help techniques for my anxiety, depression and psychosis. It went something like this:

Natural Stress Relief

Natural stress relief as self-help for anxiety and depression. But psychosis?
Natural stress relief as self-help for anxiety and depression. But psychosis?

I tried every natural stress relief, sleep-inducing, over-the-counter remedy known to man, without effect.

As an aromatherapist, I made up bottles of stress relief oils then bathed in them and sprayed them around liberally.

However, despite all the lovely citrusy, spicy and fruity oils, all I could smell was the overwhelmingly floral lavender, reminiscent of my grannies old underwear drawers. This didn’t work either.

Soothing massage

Massage can help relieve anxiety and depression
Massage can help relieve anxiety and depression

As a qualified massage therapist, I was aware of the benefits so I booked myself in for a few sessions. However, the first masseuse pecked at me like a small bird trying to feed itself for the first time; it was more irritating than soothing!

massage seated

The second time, I went for a seated massage which involves sitting on the chair with your upper body leaning forward, your arms on armrests and your face peeking through a hole. Looks comfortable, right?

Well, this lady (who’d attended the seated massage course with me) had me sit on a swivelling office chair! My muscles tensed more as I had to use my feet and legs to keep the chair from spinning!

Exercise

running machinejpg
Exercise is known to relieve anxiety and depression

I used the local gym seven days a week, twice on Sunday; pounding the treadmill and pedalling like fury on the exercise bike.

If I couldn’t get to the gym I made up for it by jogging on the spot and running up and down our stairs.

I tried almost everything to relieve the constant anxiety and to wear myself out so I could sleep, but even the excessive exercise proved fruitless.

Hallucinations and paranoia

After three nights without sleep, I started to hear, see and feel odd things. I heard people (I didn’t recognise the voices – but they were real) talking to me and about me; saying I was no good and I was dirty.

I saw mice scurrying over my wooden floorboards, and felt something crawling under my skin; it itched and I scratched. I got up, tore off the bedsheets and put them into the washing machine on a 90 degree wash to get rid of anything that might have been crawling on them.

Worse still, that night I was wide awake, sitting curled up on my kitchen floor, and it came to me — with a thud-like a blow to my stomach — I’d killed someone!

Mental illness made me remember that I’d killed someone

I remembered it! OMG! My heart pounded and I felt the colour drain from my face as it all came flooding back.

How and where I’d buried that someone; by a huge tree outside my aunt’s flats. But I couldn’t remember who the someone was. I felt sick and tortured myself trying to figure out who it might be.

After that, whenever I saw a police car my stomach did somersaults, and I thought ‘This is it. They’ve come for me.’ I was terrified. However, there was no knock at the door.

At times I wondered if I should just hand myself in, and let them find out who I’d killed.

Mad, nuts or crazy

Although close friends and family were aware of my break-up with the boys’ dad and knew how devastated I was, I couldn’t tell anyone what was going through my head. I was afraid they’d think I was mad, nuts, or just plain crazy and that I should be locked away.

I certainly felt like I was going mad!

Seeing rats and the unknown ugly faces frightened me, but if I closed my eyes at least I would get some temporary relief.

However, the voices were incessant and unbearable; the constant rabble of people talking out loud about me and my inner fears. They spoke of all the bad things I’d ever done, and what should happen to people like me! They played tricks, and they were cruel.

Relaxing music

Anxiety, panic attacks, and voices kept me awake
Anxiety, panic attacks, and voices kept me awake

The voices kept me awake with their irrepressible verbal abuse. So, I bought a cd player, earplugs and a few (out there) CDs with relaxing music. The sound of water, the waves, and dolphins in the background helped me sometimes — if I really concentrated on them.

I replayed these throughout the nights but still, my heart pounded in my chest and thundered in my ears. I could barely breathe, and the panic attacks raged.

By the time I got the boys up for school, I was a wreck; I was sluggish and jittery, but I somehow managed to hide it from the boys. Even now, thankfully, they tell me how they always remember me being cheerful and smiley.

Fortunately, my part-time but demanding job at a fashion company helped abate the voices for a few hours but the anxiety, depression, and panic remained.

Hypnosis

Can hypnosis be used as self-help for anxiety, depression or psychosis?
Can hypnosis be used as self-help for anxiety, depression or psychosis?

I even tried expensive hypnotherapy but I couldn’t relax enough to go into a trance-like state.

I bought a hypnosis video to use when the boys were in bed. After watching it many times I did eventually doze off. Then if I kept my eyes closed when I ‘came to’, I was able to climb the stairs, get into bed and sleep for a while. Sometimes it didn’t work but I was so grateful for the times it did.

Did self-help work for my mental illness?

In hindsight, and before I studied mental health for three years +, I didn’t know that what self-help methods worked for anxiety or depression most certainly didn’t work for psychosis.

“Hindsight is not only clearer than perception-in-the-moment but also unfair to those who actually lived through the moment.”

Edwin S. Shneidman

Asylum

Stratheden Hospital housed patients with severe mental illness
Stratheden Hospital housed patients with severe mental illness

During my unwell years, I often remembered how, as kids, we’d all say stupid things like “The men in white coats will come to get you.” or “You’ll end up in Stratheden, (our nearest asylum)!

I recalled one day mum said my stepdad was taking her to hospital for a short stay and I asked if I could go with them. Dad said no, mum said, “Aye; she’ll be fine.” So off we went and I didn’t think too much of it when we passed our local hospital — until I saw the massive sign — Stratheden Hospital.

I assumed and hoped we’d just drive past that too. But then we pulled up at the foreboding buildings and the grounds surrounded by high metal railings. I was petrified, and felt a certain shame; my mum was going into the Loonie bin. Oh my God!

From the car park, I could see people roaming around; some were stooped or walked oddly, others made strange noises. A lady with long scraggly grey hair, wearing odd clothes, waved at me frantically then cackled like an old witch. Not sure if it was designed to frighten me, but it did!

Mum and dad got out of the car but I wasn’t allowed to go with them so I was left sitting in the car and told not to open the doors to anyone. Ha, as if.

Back to the future

Fortunately, although I had suicidal thoughts, the Consultant Psychiatrist and the Psychology team were confident that I had no intention of killing myself. I’d said that even though I felt suicidal, I could never leave my sons with that legacy.

Hence, there was no need for admission, and three years of weekly gut-wrenching counselling followed — on and off because at times I was too afraid of the feelings it all evoked.

I hope you’ll continue to read My story, Part IV. You’ll learn about my suicide attempt and more of the hell I went through as I lived with mental illness.

Over to you

In the meantime, can you relate? Have you tried any of the self-help methods for anxiety, depression and/or psychosis? What worked or didn’t work for you? I’d be interested to hear your thoughts and I’m happy to answer any questions.

Is lockdown making you feel irritable

Do you feel more irritable since lockdown?

Is lockdown making you feel irritable?
Is lockdown making you feel irritable? —Photo by Pexels.com

Do you feel irritable, particularly since lockdown? Are you feeling more irritable than usual?

It might be lockdown, but there could also be a health condition, medical reason, or medication that’s causing your irritability. More of that later.

I’m so easily irritated these days. Anything from hubby leaving three pairs of footwear in the living room to the lady in the post office who appears to be paying all her bills in pennies…….. and I’m tetchy!

It can’t just be me? Surely? I don’t know if it’s the lockdown; not having the freedom to do as I wish or am able to. Like going to visit family (though I have been known to bend the rules a few times), just going out for a coffee or to the pub for a glass of wine.

Okay, I can drink coffee, and wine for that matter, at home. But I’m a people person, a people watcher and a social butterfly — I like to be doing.

While I continue to do things, it’s mainly cooking and baking. But this is having an adverse effect on my weight, and that’s making me irritable. Not to mention how hubby’s lip-smacking, slurping and chomping on these homemade goodies is making me even more cranky.

What is this irritability

Irritable, bad tempered, cranky
Feeling more irritable since lockdown? Photo by Pexels

Irritability is the tendency to get upset for reasons that seem – to other people – to be pretty minor. We might not even be able to explain it or know what we can do to reduce our snappiness. But we know it’s there. We might feel, or come across as:

  • bad-tempered
  • short-tempered
  • quick-tempered
  • agitated
  • put out
  • peeved
  • tetchy
  • snappy
  • angry
  • cranky
  • moody
  • impatient

Most of us have been snappy with others at some time or other, which is often followed by a wave of guilt because we’ve upset someone.

Address your irritability

Irritability at work can cause problems
Irritability at work can cause problems — Photo by Pexels

But, if we’re not careful, our being constantly tetchy could cause massive issues in our lives. If we’re always saying things we don’t mean it can harm our relationships. We might become unproductive at work because we’re easily ticked off by our colleagues, so it’s essential we begin to address our irritability.

If someone calls you “grumpy” or “moody” there’s no point in snapping back “No I’m not!” That’s your opening, they’ve given you a chance to recognise how you’re coming across. You can accept it and apologise with “Yes, you’re right, and I’m sorry. I’m having a bad day,” or “Sorry, I’m feeling tetchy because……”

Maybe you don’t want them to know why you’re “grumpy” so you could just say something like “I’m sorry I snapped at you. I didn’t mean to upset you.”

Instead, hubby puts out the cutlery, and you remind him (again) that the knives go on the right-hand side! He takes a huge breath and swipes all the cutlery to the floor, yelling “do it your effin’ self then!”

Yes, an ex of mine did this! It was a really minor criticism and technically I was right. But he just erupted! He was cranky and angry. Still, I felt guilty for having criticised him in the first place.

Stressful situations like lockdown make us feel irritable

Times of uncertainty can make us feel irritable
Times of uncertainty can make us feel irritable — Photo by Pexels.com

In times of uncertainty, it can be easy for emotions to run high and you may feel like you’re at the end of your tether; like a volcano ready to erupt!

Stressful situations, like the USA Presidential election, Covid and lockdown or economic hardship etc can trigger feelings of dread, anger, and anxiety, which can also increase your risk of irritability.

I think most of us are feeling the effects of lockdown and all that goes with it. Even our little ones are fed up, not being able to see their friends, have birthday parties or go out to the cinema or old McDonald’s.

Friends report having moody teenagers, slamming doors and being more obnoxious than usual. Some say their little ones are fed up constantly sitting in front of the t.v.; they’re bored with the cartoons, and they’re cranky. Meanwhile, mum’s in another room trying to work from home, and she’s also tetchy.

What’s really going on for the agitated person

Couples can become defensive and irritable with each other, for no good reason
Couples can become defensive and irritable — Photo by Pexels.com

I love this excerpt from The School of Life — Behind most outbursts are cack-handed attempts to teach the other person something. There are things we’d like to point out, flaws that we can discern, remarks we feel we must make, but our awareness of how to proceed is panicked and hasty.

We give cack-handed, mean speeches, which bear no faith in the legitimacy of the act of imparting advice. And when our partners are on the receiving end of these irritable lessons, they of course swiftly grow defensive and brittle. Our suggestions seem more like mean-minded and senseless assaults on their very natures rather than caring, gentle attempts to address troublesome aspects of joint life.

Small things that can make us me irritable

discontented black couple arguing in kitchen at home
Small things make us irritable — Photo by Pexels

When I haven’t slept for two or three days and when I’m in pain I become really cranky and I’m quick to snap at people. I can’t stand:

  1. Those damn unsolicited phone calls
  2. Waiting on the phone for ages, then the line goes dead
  3. Those phone calls that tell you to “press no.1 for sales, press 2 for accounts, 3 for……. and after you’ve pressed the number for whatever service you need, you’re told, “press number 1 for …………………….” Aarrgghhhhh!
  4. The smarmy receptionist who tells you “No we don’t have any NHS patient appointments for three-four months” I’ve called back and said I’ll go private and I can hear her smarminess, “Oh, that’s great, we have an appointment this afternoon!”
  5. When you call large companies and they play their favourite music while you wait — there’s a picture developing here! I hate phones
  6. My wi-fi going off for no apparent reason
  7. My parcels get lost in the post or the postman leaves a note saying I wasn’t in! I’m always in!
  8. Forgetting the millions of passwords or the new second authentication needed these days
  9. People eating with their mouth open, and making lots of chomping, lip slapping or slurping noises
  10. Trying to open the sellotape
  11. People rattling sweet packets or whispering loudly in the cinema
  12. Those drivers that think we’re all mind readers so they don’t use their indicators
  13. That person in front of you paying all their monthly bills with loose change
  14. When people allow their kids to misbehave in theatres, the cinema or restaurants — then they smile at you like “aren’t my kids so cute!”
  15. Sales assistants chatting away to their colleagues, pretending that you’re not there
  16. Hubby talking all through my programmes, asking inane questions when he’s not even remotely interested
  17. Hubby putting yummy foods in front of me when I’ve already said I’m not hungry or I’ve had enough for today — see I have this terrible habit of eating whatever’s in front of me — you’ll always find me by the food at parties. That irritates me too
  18. Hubby slurping hot drinks and soup, smacking his lips and trying to talk with his mouth full
  19. Hubby leaving the top off the toothpaste and the bathroom mirror all smeared
  20. Hubby shoving sweet packets or socks down the side of the sofa? What’s all that about?

Maybe it’s just me who finds hubby’s quirks odd?

Irritability can be caused by many things

Transverse Myelitis is a chronic disorder that causes me lots of pain and makes me irritable :(
Transverse Myelitis is a chronic disorder that causes me lots of pain and makes me irritable 🙁

But sometimes, feeling irritable may have nothing to do with life’s challenges according to Thehealthy.com. Everything from a lack of sleep to certain medications could be to blame.

So, the next time you ask yourself “why am I so irritable?” understand there could be a medical reason for your moodiness. You could contact your doctor who’ll ask you some questions and let you know if there’s an underlying issue for your irritability.

I’m in constant pain due to Transverse Myelitis and I get tetchy easily and quite often 🙁 So I’m constantly having to apologise to hubby. But what irritates me is that, even when he knows he’s in the wrong, he won’t apologise! He’s a sulker 😉

Next time, let’s take a look at ways to relieve our irritability.

Over to you

You’ve seen how tetchy I get, so what makes you irritable? Can you share with us? And how do you relieve it?

I look forward to hearing what you think and I’m always happy to answer any questions. In the meantime, stay safe and well.

Caz

How to stop Automatic Negative Thoughts (ANTs)

Automatic negative thoughts and how to stop them

Stop the Automatic Negative Thoughts (ANTs) dancing around your brain — Image by Pixabay

Do you get lots of automatic negative thoughts, just popping into your head, and don’t know how to stop them?

I know I get them. More so just recently because, like lots of others, I’ve been unable to get my hair done, I’m a deathly white due to the lack of sunlight, and I’ve put on weight.

Okay, that might be because I’ve stopped smoking, for over three months now, and I’m snacking more. Anyway, I digress….. the ANTs….. they seemingly come from nowhere.

I was busy making chocolate lollipops for our grandchildren, which always makes me happy……….. when lo and behold “I look so damn ugly,” the ANTs screamed, and “I feel like a right old state.” Followed by “That’s it fatty! Yes, you! You need to lose some weight,” as I licked yet another chocolate covered spoon.

On and on with the ANTs, ffs! Stop!!

After reading my previous post How to support young people with mental health problems, you might find this post helpful too. These tips will be useful for both adults and young people.

ANTs and cognitive distortions

Cognitive distortions can cause emotional distress
Cognitive distortions can cause emotional distress — Image by Shemazing

Unfortunately, during this damn lockdown, once again I’m having lots of ANTs and I’m making horrible thinking errors. These are known as cognitive distortions ((processing information inaccurately), which skew our perceptions of reality.

Cognitive distortions tend to occur when we experience distressing events in our lives — an argument with our partner, a disagreement with our colleagues, poor test results — and we think about it in a way that reinforces negativity and feeling bad.

These ANTs assault us involuntarily, thudding around our brains, going in circles and eventually become more destructive and unhelpful. We start to feel distressing emotions and these prevent us from doing things we need/want/wish to do.

Now the procrastinating gives us even more time to consider all the ANTs, which help to confirm them……………… on and on, and on…… Aaarrghhhh! Stop this vicious circle!

They’re negative interpretations of situations based on poor assumptions i.e. I feel awful so I must look awful! They’re exaggerated or irrational thoughts that cause us to perceive reality inaccurately. It feels like they’ll never stop…..

I think “there’s no way I’m popping out to the shops looking like this.” So……… I stay in and isolate myself from my local community, those who’ll judge me negatively because of my hair, my weight or ……….

Cognitive distortions can lead to mental health problems

Fortune telling is a cognitive distortion
Fortune telling can be a cognitive distortion

Here’s the thing, we all blow things out of proportion or jump to conclusions at times, but constantly distorting becomes problematic.  For me, and many others, these cognitive distortions can cause intense emotional distress.

Studies show self-defeating thoughts like “I look disgusting” can trigger self-defeating emotions like low mood. This, in turn, causes self-defeating actions such as isolating, hiding, avoiding. Left unchecked, this habit can also lead to more severe conditions, such as depression and anxiety, or Obsessive-Compulsive Disorder (OCD).

Some common cognitive distortions

Self-labelling is one of the common cognitive distortions
Self-labelling is one of the common cognitive distortions

The 10  cognitive distortions listed below are categories of automatic negative thinking, and are to be distinguished from logical fallacies:

  1. All or nothing thinking, black and white with no grey areas.
  2. Overgeneralization – using words such as “always” or “never” i.e. “he never takes the bin out” when, in reality, he probably does — sometimes.
  3. Mental Filtering– out of the many positives of your presentation, you pick out a single negative detail and dwell on it exclusively.
  4. “Should” statementsI should have passed all my exams. Try I’d like to pass my exams, I know I’m capable.
  5. Mind Reading – Like, I know they’re only being polite, telling me I look good today. Try thinking Perhaps they like my new suit and think I do look okay.
  6. Disqualifying the positive – you did well at your interview and got the job, but all you remember is the one question you stumbled over.
  7. Emotional Reasoning I feel sh*t so I must be. Or I feel bad, therefore I am. Confusing feelings with facts. Feelings are not facts!
  8. Fortune Tellinghe’s going out on Friday night, I bet he’s going to cheat on me.
  9. Personalisation and self-blameshe’s in a bad mood, I must have upset her.
  10. Self-labelling – calling yourself “a fool” or “a failure” or “a jerk.”

For a more comprehensive list of cognitive distortions and definitions, check out these 10 thinking errors.

Fortunately, in a few steps, we can learn how to stop these negative distortions. It’s time to ditch the idea of positive thinking and introduce the tool of accurate thinking.

Some simple steps to conquer your ANTs

ANTs in Depression and Anxiety
ANTs in Depression and Anxiety — Image by Manchesteranxietyhelp.co.uk

Psych Central wrote that cognitive distortions — also known as “stinkin’ thinkin’” — can be undone, but it takes effort and lots of practice, every day.

If you want to stop the irrational thinking, you can start by trying out the exercises below.

 Try this method developed by GoZen! called the 3Cs:

  • Check for common cognitive distortions. You might find you’ve developed a particular pattern i.e. when your partner starts going out with friends every Friday, you might notice your constant fortune-telling “he’s going to cheat”.

You might also find yourself consistently thinking in black and white — there’s no grey bit for you. “He mustn’t fancy me any more,” and “he wants to be with someone else” when really, he just wants to wind down with his pals after a tough week at work.

  • Collect evidence to paint an accurate picture. As far as you’re aware, he’s never cheated before. You know where he’s going and who with. You could try asking your partner if everything’s okay between you, or ask can you go too as you’re feeling a bit left out. He might think you wouldn’t enjoy a lads night out. If you don’t ask, you won’t know.
  • Challenge the original thoughts. Now you’ve checked for the accuracy of your original negative thoughts that he wants someone else — he doesn’t want to cheat and he’s explained his nights out are just to let off steam………….. He’s said you’re welcome to join them but you know it will all just be about football and rugby.

Having done the above exercise, and with all your evidence, you’re now able to dispute your original negative and distorted thoughts. You’ll note that this type of self-disputation increases accurate thinking and improves emotional well-being.

Self-study with books

Cognitive Behavioural Therapy Techniques in books can be helpful
CBT techniques in books can be helpful

There are many books about cognitive behavioural therapy (CBT) techniques that are definitely very effective support tools. However, not all of these books are useful so it is necessary to be very careful in selecting a book. I am happy to offer up some of my favourite CBT books, those that I’ve found useful both personally and professionally with patients.

Younger people might need some support in using the CBT techniques either from yourself or a qualified professional.

Computer assisted cognitive behavioural therapy

Applications are becoming increasingly widespread in recent years. Computer games designed for young people and children are also effective. These programmes include cognitive behavioural therapy techniques. See my Resources page here.

Over to you

Any questions? Image by Clipart.com

Do you get unwanted ANTs at times? Are you able to challenge them or stop them? What helps you with your ANTs and do you have any tips for readers? I look forward to reading your thoughts, and I’m always happy to answer any questions. In the meantime, I hope you’re staying safe and well, despite the lockdown.

Caz 🙂

How to support young people with mental health problems

Practical tips for families and friends of young people experiencing mental health problems

Young people experience mental health problems and need support too --- Image by Unsplash
Young people experience mental health problems and need support too — Image by Unsplash

Would you know how to support young people experiencing mental health problems? I’ve just watched a short video on Twitter where a young boy of 11 spoke about his mental health and how the pandemic has led to depression. To be honest, I really hadn’t thought about people as young as that having mental health problems.

Young Gary told how the pandemic restrictions made him feel angry towards the world and everyone in it. He spoke of not being able to play football with his friends, or have them stay over, and how the constant isolation made him think too much. He also mentioned having bad thoughts and being unable to talk about them because he felt he would be judged.

However, eventually and fortunately, Gary was able to open up to his parents and they sought advice from their GP. He was able to refer the family to online counselling and they received the help he needed — quickly. While he’s not out of the woods yet, Gary feels confident that therapy is helpful and he’ll continue to accept this support.

While Gary is extremely young, many young people of all ages are feeling the negative effects of the pandemic. It’s likely that many of them either don’t know how to articulate their feelings, are unable to open up to their parents, families or friends, or wouldn’t know where to get help.

Did you know

Most lifelong mental health issues begin in childhood. But talking about wellbeing early on can help them cope better with life’s challenges (Mental Health Support, Action for children).

Not all mental illnesses are visible

Underage drinking and mood changes
Underage drinking and mood changes — Image by Charisma Magazine

Not all mental illnesses are obvious in the beginning, but you may notice some changes in a young person, such as:

  • lack of self-care, looking bedraggled, unkempt, or uncared for
  • loss of interest in activities/hobbies they used to enjoy. Okay, we have lockdown but hopefully they have interests at home that they can continue
  • mood swings, angry outbursts, spiteful towards and bullying siblings, lashing out verbally or physically
  • being disruptive or even destructive, kicking, smashing or damaging things
  • shouting, swearing and being very argumentative
  • change in eating habits, either not eating or eating too much
  • stealing either at home or in shops
  • becoming secretive, isolated, withdrawn
  • change in sleeping pattern, like too much, too little, or not at all
  • smoking cigarettes, using illegal substances, or drinking alcohol — which may lead to changes in mood

While this list may be long, there are other changes you might notice and want to keep an eye on.

Family and friends can support young people with mental health problems

Secretive and isolative behaviours in young people
Secretive and isolative behaviours in young people — Image by Pixabay

If you know a young person who’s experiencing mental health difficulties, you may find the following tips useful:

  • encourage them to talk to you or another family member or friend. Ask them open-ended questions like “Tell me about your day.” or “How did you feel when ……….?” to get a conversation going. Asking closed questions like “Did you have a good time?” will only receive a “yes” or “no” answer.
  • make yourself available to listen to your young ones, even if you have to schedule a time, and stick to it. Let them know they will be heard. You’ll lose their trust if you don’t follow through.
  • talk to your youngsters about current affairs such as the pandemic and lockdown. Be as open as possible. Ask their opinions, and respect their views, however much they differ from yours (apart from anything illegal obviously).
  • ensure they always have the means to contact you, say if you work or go out, let them know where you are and when you’ll be back.
  • have a designated person they can contact if they cannot get hold of you
  • if you must leave them alone, make sure they have food and drinks available to them. Their favourite, but healthy, food always helps 😉
  • keep the home warm and welcoming with electricity and hot water available to them.
  • help them maintain their living space, and to keep it clean, like changing their bedding together or helping sort out their drawers (if they’ll allow it).
  • help and support them in good grooming like teeth brushing, clean nails, and haircuts.
  • arrange and be aware of appointments, say with the dentist or their pastor.
  • monitor their intake of any prescribed medication-taking.
  • provide appropriate clothing for the changing seasons.
  • always remember their birthdays and other anniversaries such as “the date his dog died” or the date school results are due. Celebrate (or commiserate) with them, however simple.
  • where possible and within reason, let them have access to their laptops, phones, video games, arts and crafts etc
  • have them involved in family decision-making, like rules. and the consequences of not following them.
  • reinforce the need for physical activity and go with them on outdoor walks, where possible.
  • don’t just tell, show your love for them. Eliza Doolittle in My Fair Lady said “Don’t tell me. Just show me how much you love me.”
  • encourage your youngsters to write down things that are bothering them. Perhaps let them have a journal and if they wish to keep it private, then you mustn’t sneak a look.

Find out how your youngsters are feeling

Negative thoughts and feelings may be just the tip of the iceberg for your youngster --- Image by Pexels
Negative thoughts and feelings may be just the tip of the iceberg for your youngster — Image by Pexels.com

Your youngster’s behaviour is a communication about how they’re feeling. If they’re behaving differently or acting out, it might be useful to think of an iceberg. The changing behaviour is the tip, but there’s likely to be a whole range of emotions hidden under the surface.

By regularly opening up conversations with your youngsters, you can find out more about how they’re feeling and what’s going on for them. Effective listening skills will help them open up further. Don’t interrupt, don’t judge and don’t assume you know what they’re going to say. Often, all they want — is to be heard.

Young people need to feel safe

Children need to feel safe --- Image by Pexels.com
Children need to feel safe and supported— Image by Pexels.com

I often remember my youngest son when he was about 11 and we were driving home from school, “Mummy, I like it when you tell me what to do. It makes me feel safe and I know you care about me.”

Okay, just making them feel safe isn’t the answer to everything. But it certainly helps. Let them know it’s safe to talk about their emotions. In fact, encourage them to talk about their thoughts and feelings, both positive and negative.

Explain that it’s normal to have negative thoughts and feelings sometimes, particularly during times like the pandemic and lockdown. My wee old mum used to say “Ye cannae get sent to the jail for your thoughts.”

Teach youngsters different ways to deal with their emotions and if you’re unsure how to do this, seek professional help.

Over to you

Any questions? Want to know more about young people and mental health problems?
Any questions? Want to know more about young people and mental health problems?

Has any of this been useful, and do you have any more tips you think I could add? Do you know of any young people who experience mental health problems and need support? I’m happy to let you have details of professionals who can help.

For those of you who know me and my blog, I’ve stayed away for almost three months, just resting, and now I’m back. Not with a bang, unfortunately, more of a whimper. But at least now, I’ve found the will to continue writing.

I’ve mentioned many times — mental health knows know boundaries, and it can attack at any time. I’m only too aware. But I’m feeling better and look forward to catching up with my blogging friends.

Caz 🙂

Merry Christmas

Wishing you love, peace and happiness

I haven’t been around much lately and I’ve just come online to wish you all the very best during the festive season.

The magic of Christmas never ends, and its greatest gift is being with my family and friends……….

Me

I hope you enjoy the festive season as much as I do and that the new year brings us all much peace and happiness. I’m not sure how much I’ll be online, typing, as I just don’t have the energy right now. But honestly, I am reading and enjoying all your blogs.

Look after yourselves and stay well. I look forward to catching up with you in the New Year 🙂

Caz

Self-care during the festive season

How to get in some self-care during the holiday season

Look after your self-care during the holiday season
Look after your self-care during the holiday season — Photo by Pexels

Most of us know how stressful and exhausting the festive season can be, and we tend to forget about our much-needed self-care.

Anecdotally, it’s known, at least by anyone who has extended family, that more stress-inducing grudges are formed during holiday seasons than at any other time of year. Old family rivalries, arguments, one-upmanship, split families and unresolved conflicts can all contribute to holiday anxiety.

Other sources of stress might be political (think Brexit or Trump) or cultural clashes caused by generational or even geographical differences, which can result in slightly tense atmospheres or even furious rows over the dinner table.

Fortunately, my family has managed to avoid any of the above and boy am I glad. I’m not sure how I’d cope. Let’s face it, we don’t need any of that, we’re already exhausted by our

extra-heavy workload prior to the festive season

Take time to relax during the holiday season -
Take time to relax during the holiday season — Photo by Pexels
  • writing lists and cards before the last post. Buying and wrapping lots of unwanted gifts – tho’ I’m told I good at getting them right.
  • planning the menu, the huge unnecessary food and drinks shop because the stores are all shut for — uh, one day! Oh, and not forgetting that Aunt Annie’s a vegan, little Guy’s gluten-free and niece Natalie is allergic to nuts.
  • planning who’ll sit where to avoid any old family feuds, tho’ I wouldn’t worry about it too much — they’ll have to pull crackers, wear silly hats, and smile — like everyone else.
  • table decorating – is huge now – you see everyone posting ‘my amazing Christmas table on Instagram and Facebook – what’s all that about? While I love my table to look festive and special, not sure my pals want to see ten photos of it – all from different angles.
  • being all things to all people at all times i.e. “Mum, while you’re out will you pick up a gift for Aunt Annie from us? Then wrap it and put a gift tag and a ribbon on it too? You’ve always got loads of that stuff.”

Phew! I’m already shattered. So, having done all the above, you’d think you’d be able to relax on the day, right?

Nope! You’ve still got the kids to get ready (remind them about their manners and “yes, you must give bearded Aunty Annie a hug) ………………..”

Right, rewind……. let’s start again. Okay, so I’m a bit late posting this as Christmas is almost upon us and most of you will have done all your cards, shopping and preparation.

What self-care is — and what it isn’t

Good self-care includes taking in a balanced diet and adequate fluids
Good self-care includes taking in a balanced diet and adequate fluids — Photo by Pexels

What is self-care?
Self-care is any activity that we do deliberately in order to take care of our mental, emotional, and physical health. Although it’s a simple concept, in theory, it’s something we very often overlook. Good self-care is key to improved mood and reduced anxiety. It’s also key to a good relationship with oneself and others. Self-care tops up our tank and keeps us fuelled.

What isn’t self-care?
It isn’t a selfish act or only about considering our needs; it’s rather about knowing what we need to do in order to take care of ourselves. Thereafter, we’re more able to take care of others too. That is, if we don’t take enough care of ourselves, how can we be in the place to give to loved ones.

How to look after your self-care during the festive season

Aromatherapy oils are great stress relievers
Aromatherapy oils are great stress relievers — Photo by Pexels

But, and it’s a big one, you still have a few weeks to get some self-care in, so that you’ll be as relaxed as everyone else on the day:

  • if you haven’t already done so, enlist some help: write down who’s doing what on Christmas and Boxing Day, and make sure the kids are involved — delegate, delegate, delegate.
  • when the going gets tough, remember the holidays are a time for family, for friendship and spending time together — so what if you accidentally throw out your stock for the gravy (like my mum did at ours one year, to her horror) – use a packet! If you burn the roasties, cut the burnt bits off and hide them with the stuffing or Brussel sprouts – no one will notice 🙂
  • enjoy some simple things like go for a walk somewhere calm and soothing —gentle activity such as a 15-minute walk helps your body to regulate its insulin production, which can be disturbed by stress.
  • try yoga, meditation or do some gentle stretches to loosen those tight muscles.
  • take time out to have a massage or even just get hubby to give you a ten-minute foot massage/shoulder rub.

For an extra boost during the festive season

Visualisation can help reduce anxiety
Visualisation can help reduce anxiety — Photo by Pexels
  • Dot your favourite aromatherapy oil around the house — lavender is great for stress. In aromatherapy, essential oils are inhaled using a diffuser, or diluted with carrier oils and applied to the skin for soothing benefits.
  • have yourself a long, luxurious bubble bath – small acts of self-care go a long way in helping us feel more positive and energised.
  • have yourself a nice hot chocolate (with or without the marshmallows) and snuggle up on the sofa/bed with a good book for a few hours.
  • listen to your favourite music and, if you’re feeling up to it, dance like no one can see you, and sing along like no one can hear you.
  • catch up with a favourite friend and have a good old belly-laugh, nothing better to get you in the mood and it’s well known that fun and laughter are great stress relievers.
  • go to the cinema, the theatre or a comedy show – sit back and relax
  • eat mood-boosting foods; a carbohydrate-rich meal can help to boost serotonin levels.
  • wind down gradually before bedtime and get plenty of sleep; set an alarm for bedtime and go to bed at the same time each night – to regulate your sleep pattern.
  • sniff some lemons (I’m not kidding) – according to researchers at Ohio State University, lemon scents instantly boost your mood.
  • and breathe – deeply – out then in, half a dozen times or so – taking just a few moments each day to practice some deep breathing exercises can decrease stress, relax your mind and body and can help you sleep better. Deep breathing is, among many other things, a relaxant, a natural painkiller, it improves digestion and it detoxifies the body.
  • Mindfulness reduces anxiety.
  • Acupuncture or hypnosis are great for anxiety and stress reduction.
  • Practice visualisation for 20-30 minutes.
  • a few minutes of gratitude.

Go on – treat yourself – try out a few of the above and let me know how you get on.

Over to you

What other stress relievers could we try (without reaching for the second bottle of Prosecco)? Any tips, please? Perhaps you’re just going to relax all by yourself during the festive period?

Me? I’m looking forward to seeing family, especially the little ones. They’re still only 5 and 3 so they’ll be excited and I can’t wait to see them opening their gifts and playing silly games with us all.

Oh, and what’s your take on gift-giving? I love it- I don’t give to receive, I just enjoy buying and giving gifts.

Not all disabilities are visible

Watch out for invisible disabilities

Does this little boy have and invisible illness?
Does this little boy have and invisible illness? Image from IDPWP

The International Day of People with Disabilities (IDPWP) theme for 2020 is “Not all disabilities are visible.” The IDPWP is held every year on the 3rd of December. I know I’m a day late but I’d like to share my experience of living with invisible disability.

This year’s theme focuses on spreading awareness and understanding of disabilities that are not immediately apparent, such as mental illness, chronic pain or fatigue, sight or hearing impairments, diabetes, brain injuries, neurological disorders, learning differences and cognitive dysfunctions, among others (IDPWP).

Raising awareness of invisible disabilities

During the COVID-19 pandemic, isolation, disconnect, disrupted routines and diminished services have greatly impacted the lives and mental well-being of people with disabilities right around the world. Spreading awareness of invisible disabilities, as well as the potentially detrimental— and not always immediately apparent— impact on mental health is crucial as the world continues to fight against the virus. 

I live with invisible disability

What Transverse Myelitis looks and feels like

As many of you might know, almost ten years ago, I was struck down with a rare disorder – idiopathic (cause unknown) Transverse Myelitis (TM). It’s normally caused by a virus but, despite the hundreds of tests, mine wasn’t, hence the idiopathic.

TM is a rare neurological disorder, a “neuroimmunological” disease of the central nervous system. It’s an inflammation of both sides of one (or more) section of the spinal cord.

TM involves inflammatory attacks in the central nervous system which damages the insulating material covering nerve cell fibres (myelin). In short, it creates lesions on the spinal cord that interrupt the messages that the spinal cord nerves send throughout the body.

Symptoms of Transverse Myelitis

Muscle weakness in the legs can cause stumbling
Muscle weakness in the legs can cause stumbling — Image from Pixabay

The main symptoms of Transverse Myelitis are:

  • muscle weakness mainly in the legs – so I can stumble and trip and appear drunk to others. My arms are weak too and I’ve dropped the kettle, pots and pans and many cups of coffee causing severe scalding.
  • change in sensation (unusual feelings) in the lower half of the body. Mine occurs from just under my arms to my toes. It feels like a tight banding all the way down to my feet so even wearing shoes hurt. I do get odd looks wandering around in flip flops in the rain or cold.
  • numbness, and pins and needles from the torso down
  • heightened sensitivity to touch i.e. the feel of clothing on the skin might cause pain (allodynia). Even a single hair can cause me pain, like one unshaved leg stabbing the other! A light breeze blowing on my legs can be agony and a cold wind blowing on my torso feels like a hot water bottle in the area. All this can change each day and it’s never the same feeling every day.
  • heightened sensitivity to temperature i.e. extreme heat or cold. My normal body temperature is now anything from 32.3 to 35.9° (even in the sun) which is really low compared to others at approximately 37°. This causes extreme perspiration (I do not sweat buckets, rather I perspire gracefully 😂) if the temperature rises due to any activity i.e. showering or cooking.
  • losing the ability to tell the temperature of water or objects. This happens mainly on my left side but does occur on both sides. It’s really odd when I’m in the shower or the bath because different areas of my body feel different temperatures. And say when rubbing my hands together I don’t know which one is cold and which is hot. Common sense should tell me, but perhaps I’m missing that 😂 .
  • pain (nerve and muscle). The nerve pain feels like I’m burning and tingling with sharp stabbing shooting around all my nerves. And the muscle pain — well, that feels like I’ve done 12 hours in the gym. I ache all over and any movement is painful.
  • tiredness and extreme fatigue. Just showering and drying, together with brushing my teeth, or ten minutes of housework feels like I’ve done a days work already. Some days I have to lie down before I fall or faint with exhaustion and, trust me, this is no exaggeration.
  • muscle spasms and twitching muscles. The twitching in my muscles feels like that twitch you get in your eye – painless but irritating. The muscle spasms can be more painful and can make my hands and fingers contort and I can’t hold a pen or cutlery properly.
  • a general feeling of being unwell i.e. just not with it and my body feels like it doesn’t belong to me, it’s separate from my mind — that’s literally how it feels even though that common sense thingy tells me it can’t be.
  • problems with the bowel and bladder. Suffice to say I’ve had many an accident both at home and in public. And please, don’t suggest those big uncomfortable incontinence pants — it’s just not happening! I’m 59, not 89.

The unusual feelings (paraesthesia) that we experience generally starts from the spinal area where the lesions are. My lesions started at C5-6 and L5 so areas like my arms, wrists and hands are affected. Imagine a horizontal line or band drawn around the torso i.e. from just under my arms, and that’s where the unusual sensations begin – so that, for me, is all the way down! Aaarrgghhhhh!

Mental health symptoms can be invisible

Mental health symptoms can be invisible
Mental health symptoms can be invisible — Image from Pixabay

That’s TM in a nutshell. So, please try to understand how invisible illnesses can affect people, how difficult life is for them and for those around them i.e. their families and carers can have it tough too. I know mine do and sometimes I wonder how or why they put up with me. It’s not just the physical side but also the

  • mental health side like depression and/or anxiety, suicidal ideation, hallucinations due to extreme fatigue, and
  • sleepless nights
  • sadness for the loss of the life I used to l used to live, the loss of the job I loved, and the friends who just moved on — without me.
  • anger at not being able to do the things I used to and having to be cared for, cleaned up behind or helped to shower and dress
  • loss of confidence makes me upset, feel useless, worthless and sometimes hopeless
  • annoyance when people laugh if they think I’m drunk when stumbling or when people glare if we park in a disabled bay, like we don’t belong there…….

“You can’t understand someone until you’ve walked a mile in their shoes.”

Unknown

Have a little empathy and compassion and treat people with respect — always. Treat everyone you come across in the same manner. You never know what’s behind someone’s smile.

Okay, I’ve shared my experience of invisible illness……..

Over to you

ClipArt

Do you or someone you know have an invisible disability, or are you a carer? How do you cope with your disability or someone else’s? What’s been your experience with how people treat you or others with invisible illnesses? I’d love to hear your thoughts and I’m happy to answer any questions.

Poor practices within my NHS Mental Health Trust

I should have reported poor practices within my NHS Mental Health Trust to the media
I should have reported poor practices within my NHS Mental Health Trust to the media — Photo by Pexels

In my last two posts I wrote about dangerous practice on mental health units here and here. I said I should have reported the poor practices within my NHS Mental Health Trust to the media. I wish I’d had the courage to report my concerns outside the Trust — but the bullies stopped me!

The RCN says “Knowing if a situation should be raised as a concern can be difficult. Ask yourself whether it has caused harm or distress, or, if you let it continue, is it likely to result in harm or distress?

And the Nursing and Midwifery Council (NMC) Code is also clear: “you must act without delay if you believe there is a risk to patient safety or public protection.

All Trusts must have policies in place for such things as ‘Raising concerns’ or ‘Whistleblowing’ and they must state how they will support you through the process. While our Trust did have this policy, the processes were never followed through and my concerns weren’t dealt with appropriately.

Disturbingly, I had several concerns dismissed after going through the correct channels. And after verbally reporting many incidents of poor practice by my manager, I was sent to mediation with him. We were to be seen by a Consultant Psychologist (Sue) for ten one hour sessions to “sort out our differences.”

Staff mediation in my NHS Mental Health Trust

Staff mediation in the NHS Mental Health Trust
Staff mediation in the NHS Mental Health Trust — Image by Pexels

I should have walked out after the first session but I was intrigued to see where this mediation process would go. I could see the look of horror (she tried to hide it) on Sue’s face as I recounted how Perry had given out unauthorised antipsychotics.

She coughed almost embarrassed and asked him to reflect on the situation, sharing how he would do things differently the next time.

I would have laughed out loud if it wasn’t so serious. And this is how mediation continued.

Sue also raised her eyebrows at me when Perry told her I let a junior co-worker (Mal) live in my home for a short period of time. I explained how nurses and health care workers are known to flat-share and that there are no regulations to the contrary.

Manager propositioned junior staff

Manager propositioned and bullied junior staff
Manager propositioned and bullied junior staff — Image by Pexels

But Perry wouldn’t let up. He continued along the lines that it showed favouritism and that I was splitting the team….. Oh dear! He’s digging a deep hole…..

I explained how Mal had been propositioned by Perry many times and was afraid because Perry was using blackmail to get him to engage in a relationship with him. Perry was threatening to tell the team about our Mal’s confidences that he’d shared when he was an in-patient on Perry’s previous ward.

I continued with how Mal didn’t feel comfortable living in his own home because Perry was near-stalking and bullying him. Sue’s eyes were on sticks, and it was clear she wasn’t sure what to say.

During each mediation session, I was enabled to share all my concerns about Perry under Sue’s inquisitive and watchful eye. He’d put me in this damn situation, and now it was payback. I admit, I enjoyed watching him squirm and redden as I explained each incident of his poor practice.

The only good thing I know is that she would have discussed how wrong it all was with the Director who I’d complaint to. But I still wonder, why didn’t our Director or this Senior Psychologist deal with my concerns appropriately? They ought to have thrown the book at Perry. The guy was a maniac and they were allowing his behaviours to continue.

Senior nurse sleeping with junior staff

At almost the end of our penultimate session Perry chose to disclose a concern of his. He puffed out his chest, grinning like he’d just won the lottery and stuttering with excitement said to me “Kwami (another junior coworker) said that you and him were sleeping together. It’s not good as it shows favouritism within the team.”

“Okay, well I’ll sleep with all of them shall I?” I thought, and almost laughed, “Will that even it out?”

More raised eyebrows as Sue turned to me and said “I know this must be difficult for you and I can sense some incongruence. You’re smiling but I’m sure you’re angry. I’m sorry but this is the end of the session, can you hold onto this until next week?”

“I am angry but yes, I’ll hold it ’til next week.” I smiled as I stood and left, not before noticing Perry’s excited nod and grin at Sue. We both returned to the ward, Perry obviously pleased with himself, and I happily got on with the day.

Oh, I’m angry

Nursing colleagues having dinner
Nursing colleagues having dinner — Image by Pexels

Later that evening I invited Kwami round for supper with me, my partner, my parents, and my two adult sons. Over dinner I asked him “Did you ever, even in jest, tell Perry that you and I were sleeping together? Even if you said it in fun, just tell me.” Everyone almost choked on their dinners and stared wide eyed at Kwami.

“No way! Why would I say something like that? You’re all like family to me, you’ve fed me, invited me to family parties. No, I did not say it. Ever!” Again, later in the kitchen and alone, I said I wouldn’t be angry if he told me the truth, but just to tell me. “No. I give you my word.”

Next mediation session I sailed in happily and Sue started “Look, I know we had to end the last session at an awkward moment and that you must have been angry. How do you feel now?”

“Oh, I’m angry…….” I nodded.

“Yes, I’m sure you’re very angry with Kwami,” Sue appeased, and Perry sat there arms folded, all chuffed with himself.

“I am angry, my partner, my parents, and my sons are angry too. But not with Kwami,” I replied, turning towards Perry, “It’s you we’re all angry with. Kwami said no such thing to you. What is wrong with you?” I told him about the open conversation I’d had with Kwami…….

He reddened ‘cos he knew he’d been caught out and he spluttered….. “Well, it wasn’t Kwami, it…. it was someone else that told me and I’m not going to name any more names……” I knew all I had to do was wait………

Time for a formal written complaint

Mental Health Ward Manager raging
Mental Health Ward Manager raging — Bigstock.com

Then, as expected, he showed his true colours — raging, “Anyway, mediation. is. private. and. personal. between. us. It’s not supposed to leave this room. You shouldn’t have told anyone else what’s been talked about.”

Sue tried and tried to stop him as he yelled and counted on his fingers – 1) How I had no right talking about this, 2) how he’s putting in a complaint about me breaching confidentiality rules, and 3) having me moved to another ward…….

I just shook my head, stood and told Sue I wouldn’t be returning for the final session as there was obviously no point. I smiled, relieved that it was all over, and returned to the ward to call the Director.

This time I was putting in a formal written complaint about Perry’s behaviour and about every single incident of poor practice. I’m glad I had everything neatly filed away, safe — at home.

Over to you

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I’m really interested to hear your thoughts on the situation. Would you put in a written complaint? I’ll let you know what happened in my next post. In the meantime, I hope you’re all staying safe, happy and well under the current restrictions.

While I’ll never actually be physically well, I feel relatively stable mentally and all’s good at this end. Had a sneaky visit (with masks) to watch our gorgeous grandchildren in the park this weekend. What a treat.

Dangerous practice on mental health units ignored

Dangerous Practice and ‘whistleblowing’

Dangerous practice on mental health units ignored. Whistleblowing
Who wants to whistleblow? Image by Freepik.com

Dangerous practice on our mental health unit was ignored on more than one hundred occasion. And that was just the incidents I knew about.

Take Perry, my former dangerous ward manager, from my previous post. He’d been working with a patient (Craig) who had schizophrenia and was struggling with telling his parents he was gay. Craig regularly told staff he was feeling lonely and really anxious, and we all knew how vulnerable he was. So what did Perry (our manager and Craig’s nurse) do?

After noticing that Craig had missed counselling twice a senior nurse, Mal called to see if he was okay. Craig said didn’t feel so good but he didn’t feel comfortable coming to the ward any more and asked to meet him elsewhere.

When Mal returned to the ward he informed the team that Craig had been on holiday with a member of staff but he didn’t want to say who. This member of staff had tried to engage him in some sort of relationship but Craig hadn’t been interested. There was a falling out after this and Craig reported spending the last three nights wandering the streets, afraid to return to the hotel.

It wasn’t difficult to put 2 and 2 together as Perry had returned to work a darker shade of pink than normal and his hair a paler shade of ginger.

Mal was the same grade as me so he should have been the person to speak with Perry or someone more senior but he refused to. So, now the whole team knew — yet nobody felt comfortable raising or reporting the incident.

Raising concerns

Choose to look away
Choose to look away

All NHS trusts and primary care organisations in England must have a raising concerns policy. This policy will include the type of concern you can raise, how you can raise it, who you can raise it with, and your organisation’s commitment to supporting you through the process.

Unfortunately, despite all the available policies, there was a culture of ignoring or dismissing concerns within our unit. And much of the time managers turned a blind eye. I know! I’d previously relayed concerns to my managers or modern matrons who chose to look away when:

  • I mentioned one nurse’s regular drug errors and was told “Oh, look, she’s been here for years and that’s just the way way she does things sometimes.” Right, that makes it okay then?
  • a male member of staff helped a patient back into bed one night after she’d fallen out, but didn’t call the doctor to assess the patient. In the morning, it was clear that the lady had actually broken her arm, and she’d been left in pain all night. When I mentioned it to our manager he shrugged his shoulders “she’ll live.”
  • another manager would allow staff on night duty to sleep for 2-3 hours but I was instructed to “ignore it, he’s the manager and if it’s okay with him……” Really? Until there’s an serious untoward incident (SUI) or fatal accident.
  • or when I told of my manager giving out whole boxes of unsubscribed medication, his boss (a Modern Matron) asked me “are you trying to get him sacked so you can have his job?”
  • and when I eventually had to inform a senior Director of the above, he huffed “Look, now you’ve involved Daisy, the modern matron, it gets difficult….. Just leave it with me.”
  • Eventually, during a counselling session (organised by the Director) between me and my manager, the therapist asked me “Why does all this bother you?”

Should we dismiss concerns

Drug errors must be documented
Drug errors must be documented

Look, we all make mistakes and I’ve made many. I made a drug error once but I noticed quickly and let my mentor know immediately. I followed the 5 rights of medication administration before completing my documentation and an incident form.

I’d given the patient the right medication but at lunchtime rather than in the evening. It was a minor mistake, in this instance, and easily rectified.

However, the above incidents were neither mistakes nor minor errors. Some would be classed as critical incidents or SUI’s and could have been fatal.

I was starting to think I was going mad. I couldn’t be the only one who had concerns about the above behaviours? Why did nobody want to deal with it? It seemed the further up I went, the more they tried to dismiss any concerns.

I mean we all knew who was sleeping with who on the unit, literally. Yes, some colleagues did have clandestine meetings in various offices on the wards. And, of course, some were married — to other people i.e. someone in or outside the unit. Where these people were having relations with their lovers colleagues, it made it difficult for them to address any concerns appropriately.

So, what should I do? Ignore it, don’t pass concerns on, and dismiss them as some sort of eccentric nursing foibles? Should I just allow vulnerable patients to be taken advantage of?

Shut me up already!

This nurse cares

It was horrible. All I wanted was just to do my job. I didn’t want to have to deal with senior nurse’s poor practice or other people’s bloody extra-marital affairs.

These damn situations were making me anxious because I couldn’t ignore them and just couldn’t shut up. I wish I could have. But I loved working with patients and I cared about them and what happens to them. Why would I ignore poor practice?

It was wrong. So wrong. And it was unfair to expect me to turn a blind eye! It was unethical, immoral, unprofessional and not just poor but dreadful practice. Every time I witnessed bad practice, I completed electronic incident forms as soon as possible after the act, and before I was told not to. That way, at least there was a record of everything.

Understand when and how to escalate a concern

NMC The code
NMC The Code

NHS Employers say “If you are unable to raise your concern within your organisation, or your employer has failed to adhere to policy requirements, or the issue you wish to raise is so serious that there is a wider risk to patient or public safety, you may need to escalate your concerns to a prescribed body.”

It goes on to say “Prescribed bodies do not have the power to investigate individual concerns but can hold organisations to account in meeting their legal responsibilities to address concerns appropriately.”

Heaven forbid I went down that route?

It’s not how it should be, but can you imagine if I’d escalated my concerns outside of the Trust? I wish I’d had the courage to report it to the newspapers — now there’s another post – honestly, it’s just reminded me of an incident!

Over to you

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I’d be really interested to know what you think about any of the above incidents and how you might have dealt with them. Trust me though, it’s not as easy as the policies make it out to be. Would you want to be that person at work?