The commute

She got in the car weary from another week at the frontline of NHS mental health care and muttered a quick prayer thankful for the strength to have made it to Friday once again. She used to refuse to say the term ‘front line’ as we weren’t at war but goodness some days this feels like war now, front line captures those clinicians wearing their NHS armour to help them protect themselves which in turn allows them to protect others.

Once in the car the radio goes on (along with the air con on full) and she tries to sing the day away, she has had some bad news today so that isn’t easy. Thoughts of each person she has met are punctuated with the drive time presenter introducing the next song or sharing a brain teaser which distracts her momentarily. What is the link between those words? Oh heck red light must stop!

Wow she is half way home, autopilot do you reckon? Her mind is going as fast as her driving; what will she cook for dinner? What’s her daughters school report like? Is it even today its due? Heck, did she write up that phone call that she fitted in earlier because she didn’t want that person to feel unsupported but simply couldn’t fit a visit in. She is bound to have written it up but wonders whether to turn the laptop on and check when she gets home? Bad idea, once it is on…

Her commute is long, up to an hour, but that time is precious. Her commute is time to process the day and plan for the next. Today she wonders what Monday will bring? Calm or chaos? She doesn’t mind really she just wants to help, she wants to support people the way they supported her when she was poorly.

Her husband rings, can she stop for veg on the way home? She quietly thinks hmmmm she could stop for wine (and veg!) so agrees readily. She looks around the supermarket and wonders if everyone else has had a commute like hers or if this is a commute special to CPN’s? Does everyone else worry on their way home about that phone call they wish they made or the conversation that didn’t feel right?

She didn’t relate to many people in that supermarket at all; nursing is an absolute privilege. And supporting people as a CPN well there isn’t a word for that.

And home, key in the front door, pick up the post (fingers crossed no speeding fine!) and the nurse is not left behind the door but certainly hung up with the coats until Monday. She is mum. She is wife. She is friend. She is Sunday school teacher. Like a stick of rock though cut her in half and it says nurse and come Monday she will hop in the car, turn on the radio and head in fresh to do it all again.

A Shocking Treatment – ECT

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I missed the @WeMHNurses chat the other evening but I thought I would share my experiences of Electro Convulsive Therapy (ECT). I don’t mind as I feel there are a lot of myths to dispel around this, in my humble opinion, amazing treatment.

Several things about ECT are controversial, one of the main things being no one is exactly sure how or why it works! It was explained to me in simplistic terms that if a computer crashed the first thing most of us would do would be to turn it off and back on, reboot it. If we think of our brain as a computer and with mental illness it ‘crashes’ then ECT reboots it. I liked that explanation, it makes it seem logical somehow. Continue reading

How are you today?

You would be bored witless if I answered honestly each time you ask. Wellness is the easy answer that everyone wants to hear “Fine thanks how are you” the British pleasantries which are acceptable greetings and part of the reason stigma still exists because generally people don’t answer “feeling a little bit poorly today but thanks for asking”. Can you imagine if society was a place where we were all honest about out well being? But then that would mean we would all have to engage in discussion about that once any differential has been disclosed. I can almost hear you screaming aaaaargh as you read this.

Folk are interested in the periods of illness whether depressed because that is worrying and risky or whether elated and manic because that’s often exciting and in my case sometimes quite fun to be around (with a side order of exasperation!). Folk are interested in your wellness, in recovery, because they care about you but also because it proves recovery is real. It is joy sharing and hope giving.

Then there is the other bit. The bit where folk expect the “fine thanks how are you answer”. Recently my answer would have been “I’m alright, not sleeping well and in constant pain with side effects of meds in addition to feeling really crap about myself due to the weight I have gained on previous meds” but I still generally go with “fine thanks”

I feel like shit. Not mood wise my mood is fine so I guess answering “fine” is a half truth. This is “normal feeling like shit but still functioning every day” which is not covered by the DSM.

Most days I want to cry at the muscle pain but GP will only give a tiny dose of meds needed to relieve this, I swear it would be easier to get crack off them yet ironically they have benzo’s on repeat! Go figure!

I climb the stairs at work partly because I need the exercise given the hideous size of me at present and partly because I am embarrassed to use the lift because people don’t see my ‘injury’ I know there is a current rhetoric not to compare mental health to a broken leg but in this case a plaster cast would be easier.

My colleagues know I am struggling with sleep, they see my exhausted face at times. That’s good though because no sleep but not exhausted well that’s another issue entirely isn’t it? I’m tearful tired now yet ironically since my meds were adjusted again I have slept the past two nights.

The daily toil of living with mental illness us exhausting, but no one sees it. They see the ‘episodes’ but not the inbetweens, sometimes I need a hand on my shoulder and told it will all be ok even on the fully functional in between bits cos no one realising makes these bits the most difficult in fact.

*Moan over; as you were*

Why I love the NHS #NHS707

I could go on and on here about the socialist ideals of the NHS and how this fits with my personal values but you all know that and chances are if you follow my blog you will have similar values. What I will share with you here is a story, my personal story of what the NHS means to me. The NHS is made up of millions of personal stories, stories played out each day. Stories which bring both laughter and tears, amazement and despair. This is just my story.

I was born in an NHS maternity hospital in 1980 and there’s are photographs to prove it, in the manner of Princess Diana and Charles stood outside cradling William even with similar haircuts and fashion choices I was introduced to the world, or to Newcastle at least. I wasn’t an easy birth apparently and needed lots of assistance, imagine if my parents had been expecting me pre NHS and had to fund all that extra support. Would I be here?

As I child I was about as clumsy as its possible to be and was always breaking bones or injuring myself in some other way. My mum was a single parent by now so money was tight, imagine if she had been forced to choose between me seeing a doctor and having X-rays against household essentials such as food or heating. The NHS was just there, always had been in my lifetime and I am guilty of taking it for granted, I think lots of us did/do though.

I was 16 when I first shared with my GP how low I felt, it was the mid 90’s and Prozac nation had arrived so I was handed my first prescription for antidepressants. I only took them for two weeks because I suddenly felt amazing which in hindsight was my first taste of hypomania. Fast forward a few years in which I learned how to manage my mood whenever it bounced which wasn’t too often so thankfully I could still study.

When I was 25 I became pregnant with our first child and wow I probably am solely responsible for the financial crisis in the NHS I used it so much! I had hyperemesis so was sick 25-30 times each day, I was in and out of hospital for fluids. Despite the horrors of how pregnancy left me my gorgeous daughter was quite comfortable and needed an NHS eviction notice (induction) to get her out. 24 hours labour and an emergency section later she was in my arms. Imagine that without the NHS? My Nanna is 91 and tells me how many births had sad outcomes before the NHS because people couldn’t afford an attended birth. When our daughter was born she was blue and needed 4 rounds of resuscitation followed by treatment in special care, again we took this for granted, its what she needed and it is what she got. As I look over the sofa at 5’3″ of lively 11 year old, good grief I am thankful. I am so thankful that in my lifetime healthcare has always been free at the point of need in this country but I am conscious of my Nanna’s memories of pre-NHS lets never go back there.

The NHS didn’t get rid of us once our daughter was born because I thin suffered with severe postnatal depression. I spent the first five weeks racing around manically then depression hit like a shovel in the face. Huge efforts by NHS staff to keep me at home but alas I needed hospital, five months later I was discharged after medication, talking therapy and ECT in a unit which cost nearly £1000 per night to look after me. This stay in hospital meant that my husband still has a wife and my daughter still has a mummy.

At age 82 my Nanna developed bowel cancer but no one said she was too old to treat, she was treated just as any other person with the disease and to the credit of the NHS doctors, nurses, OT’s, physio’s and all the other people she met she not only survived but she thrived. She is 91 and has nurses come in every couple of nights to give her fluids in her own home as her bag is over active but still runs her own home and does her own garden. I can’t imagine a Nanna less world just yet to another thanks to the NHS for keeping her going.

A few years later and I experienced another relapse in my mental health and was admitted again to hospital for four months and more ECT. The team on the ward didn’t just look after me but after my husband and daughter too, they played with her when I wasn’t able and actions like that were as important to any medication in my recovery. The true spirit of the NHS shone.

I have had further relapses of my mental health but thankfully have never been admitted again, daily visits from crisis nurses have ensured that. They even enabled me to have ECT again as an outpatient. Bipolar disorder isn’t easy to manage at all, in fact some days I wonder if I can but I can and I do with the support of the NHS mental health services I keep on keeping on.

Finally it offers me employment, the NHS not only offers employment but it offered a second chance after loosing my first career to mental health stigma. I have never felt so proud as the first day I said “Hello I am your staff nurse today”, nursing in the NHS is tough, it is under resourced and under funded but it is an absolute privilege every single day. It is a great British institution and one I for one am willing to fight for. I implore you not to believe the hateful vitriol shown on the front of some of our national press. The junior doctors are not asking too much, the nurses are not being greedy over pay, the brexit bus has not arrived with bucket loads of money. We are on our knees, tired and in need of resources but we do and will continue to hold our heads up high and uphold Bevan’s ideal for the most amazing health care system in there world. It is free at the point of delivery but it must be accessible at the point of need. Keep fighting folks, its what Bevan asked of us.

Fed up but not Depressed

I am fed up at the moment, fed up of medication that has side effects which mean I have to alter my usual routine. I am fed up of weight gained when on medication which means I am dreading our family holiday in 7 weeks which I should be excited for. I am fed up with my mindset that means I volunteer for too much because I am so afraid that people view my illness and my competence with a level of codependency meaning they see me as less able than if I didn’t have an illness; I should say I am on the waiting list for psychology to explore this issue though.

I am fed up with the small things like having to fight with my GP surgery for repeat prescriptions when they make a mistake and their response suggesting they see my mental health diagnosis and assume a co-morbid stupidity. “No I can’t wait an extra couple of days for the medication to relax my muscles I can barely walk.”

Fed up but I’m not depressed.

I want to be very clear about this as I am so afraid of expressing any sort of emotion in case those around me make assumptions of my wellness or indeed illness at any given time. I want to throw my head back and laugh until I cry tears of joy, I want to share my anger with a friend when circumstances leaving me feel cross, I want to let those around me know when I feel disenchanted with events. I want to feel normal and express normally whatever that is.

I changed my nail colour to something bright a couple of weeks ago and coupled with a colourful summer top a work friend told me, in a kind, caring way, that they were watching me in case this was a sign I was becoming poorly. I feel like I can’t do anything as I am being watched. I want to be like everyone else; I want to have good days and bad days without assumption of illness. I know this comes from kindness and I feel touched that they noticed I guess but it still makes me feel like I can’t leave my illness at the door. Ever.

Right now I am fed up, fed up too the point where if you ask me about it then I am likely to end up in tears but I am still not depressed. My muscles ache from the extra pyramidal side effects of one of my medications but the medication I have to relieve this is limited so I can only be pain free for part of the day. I want to use the gym more but some days literally climbing the stairs to my office leave me near to tears.

The weight I am carrying is like a visual representation of the traumas of this illness, each time I look in the mirror I am reminded of the very public manic episode I had earlier this year and the deep horrors of the depression which consumed me in 2016. My reflection reminds me of the ECT I had and of the psychosis I endured. It reminds me of the babies I will never hold because of the medication despite getting to the top of the list at the fertility clinic. You see overweight yet I see so much more.

I am fed up but I’m not depressed, I know this because I know depression intimately.

I have gone from medication which left me overly sedated to medication which keeps me awake for far longer than I wish, I am hoping like Goldilocks the next one may be just right. Both work well on my mental state but both in very different ways leave fed up.

I am on a waiting list for psychology to consider the idea that my competency and my illness are not interlinked following how public my most recent episode of mania was but I wonder whether this will be the safe place I need to admit, in there manner of an introduction at a recovery meeting that I am fed up?

Is it ok to be fed up when folk are watching? Can someone with Bipolar allow themselves to express any extreme of emotion without this being seen through pathological eyes?

Please don’t see my laughter or my tears through a DSM, see me.

An ode to Jeremy Hunt from a tired Mental Health Nurse….

Here’s to our nurses who go the extra mile

Who want to do more but are stopped by exhaustion

Exhaustion which roars like a fast moving train

Only slowed by a love which helps them plough through the pain.

The pain isn’t physical, sometimes it is

The pain is saying no when we want to say yes

The pain is toeing the party line when we want to express

Express that we also don’t think it fair that their wait is so long when they are ready to share.

The pain IS exhaustion itself, missing family meals from staying to listen,

We want to listen we want to hear we want to make your pain disappear.

Your pain is in your heart and in your soul deep.

We want to stand with you a comfort as you weep.

We want to wipe away your tears and tell you all will be ok

To walk with you on a recovery journey but we are stifled by fear.

Our fear is about that fast moving train, the roar of exhaustion taking the blame.

The real blame lies with those in Westminster.

Blame is easy to portion and hard to shift but those saying speak out, talk, are not delivering the gift.

The gift of funding we need to unwrap to help us to nurse with our hearts and not simply shift.

Shift the blame to exhaustion and you blame the nurse

The nurse hears the roar of the train and tries to work harder the only thing helping being their NHS armour.

When I becomes we then illness becomes wellness…

What keeps me well?

I live with a diagnosis of Bipolar Affective Disorder and over the years have had a couple of episodes of anxiety too.

The first thing I can to to be kind to myself and maintain my wellbeing is accept that I have a relapsing and remitting illness and that sometimes no matter what effort I put in I may not stay well. That’s not being pessimistic in my opinion rather it is being realistic.

There are lots of things I do to maintain my wellbeing though…

I lean on my friends and family for support, I am blessed with the most wonderful husband and daughter and knowing their love is unconditional is the best pill I have ever swallowed.

I count my blessings; an attitude of gratitude goes a long way with my health. I try to find something positive in every day even if some days that is more difficult than others.

My faith, knowing I am loved both by Jesus and by my church family is important. I’m surrounded each week by other Christians who genuinely care for my wellbeing.

My writing, whether anyone ever read my writing or not I would keep going as it’s my way of emptying my brain. As it happens I have nearly 14,000 readers of my blog so that figure along with some of the emails/comments I receive kind of proves to me that maybe I am doing some good by exposing myself in this way.

By taking time to exercise which I am doing again. As I gained 5 stone in 4 months 6 and a half stone overall on a particular medication I certainly don’t look like I exercise but I am getting back into it and it does improve how I feel.

Talk. And I don’t mean my usual brain farts but just telling those around me when I’m struggling. I’m not great at asking for help when I need it so next best thing is at least trying to be honest when people as me if I’m ok and remembering it’s ok not to be ok.

A supportive workplace who don’t just tolerate me but celebrate me and my quirks. Who helped me ease back in after depression and prevented me feeling too embarrassed after mania by normalising what had happened. I couldn’t do this without a supportive work place it’s vital for me.

Medication. I don’t want to take it. I hate taking it. I hate the side effects. I want to stamp my feet like a petulant child and refuse to take it but I know that for me personally medication works and is imperative to keeping me well.

Accepting the help that is offered. None of us are super human (although sans meds there is a chance I may think I am!) I am getting better at this but sometimes just accepting myself for who I am and with that accepting that some modifications may need to come with that just like if I had a physical illness is difficult but the benefits of my productivity are so worth it.

My advance statement. It’s a bit like a WRAP plan and mine is uber comprehensive, I have given a copy to a handful of people who would be likely to notice if I were to deteriorate. It felt deeply exposing to share this document but I HAVE to do everything I can to stay well and by sharing that I give people permission to call me out if needed.

Eat well and sleep well. I generally eat well as I enjoy cooking but sleep is currently a battle for me. I changed meds and I am barely sleeping at all, every few nights I have a better night which carries me through but I’m starting to be aware it is taking its toll so need to keep an eye on it to stay well. Oh and having very little caffeine does make a difference but still to get my head around that!

To do things I enjoy; I enjoy music although I don’t have a tuneful bone in my body, I enjoy writing, I enjoy spending time with my daughter, I enjoy visiting National Trust properties and getting back to nature. All these things help me stay well.

Saying NO! I sometimes need to say no to offers to go out and do things simply because I have had a busy week. The things I say no to may be enjoyable ones such as going out for lunch with a friend or something else just as nice but I have to keep control of my wellbeing and not overwhelm myself with plans is vital to that.

Quiet time, I try to give myself some quiet time each morning to think, pray and read my bible. My favourite few minutes of the day are when my hubby and daughter are still sleeping soundly and I have time to reflect. It’s vital to my wellbeing and I am very aware how I miss that time when I don’t get it. When I was on sedating meds I never had time in the mornings so missed this time hugely.

These are just some of the things I need to stay well… what about you? Have I missed anything? I’d love to know…

Watch out Thief about

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I have written before about the big things mental illness has stolen from me. I have told you before how due to stigma I lost a career I had worked hard for and was qualified to Post Graduate level for, I have told before how mental illness removed people from my life that I had previously classed as friends because they didn’t understand. I have shared many times of the months and months mental illness has stolen from me when I have been admitted to hospital and of the periods of time which are missing from my memory as ECT took them away with the depression I was so thankful to lose. The main one being that it has stolen any hope of more children for me; I am thankful for the one I am blessed to have but I because of her I can’t risk becoming that poorly again. This was the hardest theft to accept.

There are probably many more examples of the sly thief that is mental illness creeping in and stealing from me but today it was nothing major which got me thinking, no career loss, all friendships intact, it was a small thing. One of the little moments that make life worth living, a family barbecue on a rare sunny day. “It stole her barbecue” I hear you smirk?

No it didn’t actually steal my barbecue but it did steal some of the good bits that go with that sort of afternoon. Or rather not this afternoon it didn’t because I looked the thief in the eye and said no but I am paying for it now.

I changed medication a couple of weeks ago due to the previous meds leaving me so sedated I began to wonder if I actually had a life at all as I was barely functioning. I was thrilled to change meds, hopeful of my personality returning from its slumber and for the most part they are lots better comparatively speaking but I have barely slept since taking them which is getting a bit annoying now.

Back to the barbecue though I knew my medication leaflet told me I should avoid direct sunlight and avoid alcohol but surely that is just excessive? I know better than that yeah?

So I sat myself in the sunshine absorbing its rays onto my skin, allowing the vitamin D to penetrate through to my bones and poured a lovely gin and pink grapefruit (hmmmm just writing this I wonder if grapefruit is allowed too?!?!?)… bliss. We had a lovely time chatting and laughing as we shared food and drink, we whooped and shouted as my daughter as practicing her bike riding up and down the street. Just fabulous.

I was warm though, wearing jeans wasn’t ideal but I have very little to fit at the moment after weight gain from medication. I feel utterly crappy about how I look at the moment, I have never been this colossal size before, the irony being that all I want to do is hide away so no one else sees me. Best way to cool down? pour another drink of course.

So I had a couple more drinks, enjoyed the sunshine and had a great afternoon. Then I came home and fell asleep annoyingly for two and a half hours which is the longest I have slept for since changing meds two weeks ago which I bet impacts on my sleep tonight aaaargh (or maybe I just need to increase my gin intake?)

My skin is now blotchy and my stomach is not feeling so great; I have learned my lesson, avoid direct sunshine (worrying when going to Morocco in a couple of months) and avoid alcohol. So you see something else it has stolen. I am furious, furious that as if living with Bipolar disorder is not bad enough I have to live with the side effects of medication too. I want to stamp my feet like a petulant child and shout about how unfair this is. I won’t though, I will just get on with it because I don’t have a choice to do otherwise but please don’t minimize these things and tell me they aren’t the end of the world or that people go through worse. I know that and the guilt just makes this worse in fact. I am trying to validate these feelings for myself so those around me doing the same is imperative.

I have too much to lose not to manage my illness with medication but I do appreciate why so many people choose to stop taking prescribed medication because some days dependent on how I am feeling I wonder which is worse the illness or the treatment? Even right now I could cry at the pain in my calves where my muscles spasm virtually 24/7. I google whether I can manage it on exercise and a diet of Kale – I can’t so please don’t suggest this to me.

So Bipolar Disorder prepare for a ‘Home Alone’ type scenario because I am boobie trapping my life, you are not stealing more from me. I refuse to cower in the wardrobe whilst you help yourself to my life, I know I can’t get back what you have taken but I can safeguard my own future.

Sitting on the fence – working with mental illness (Day 4 of my Mental Health Awareness Week blog posts)

My first degree and my post grad are aligned to my previous career as an HR manager. I worked really hard to get to where I was in my career when the thief that is mental illness crept up and stole it all. It’s been written about in previous posts but long story short is that after serious postnatal depression which left me five months in hospital I was made redundant and at this point realised I was utterly employable. Stigma meant as soon as any prospective employer realised I had spent half of the previous year in a psychiatric hospital they would noticeably put their head to one side and tell me they’d be in touch. They never called.

Whilst still grieving for my career I decided to open a bridal boutique (in hindsight maybe my judgement was impaired 😉) but when I had a relapse we couldn’t afford staff to cover me to I lost the business too.

By this stage I was grieving a list of things mental illness has stolen from me and it now had a career, a business, a couple of ‘friends’ so it was a bit of a if you can’t beat them join them sort of thought that led me to apply for my nursing degree.

Despite having lost so much to stigma I was still determined to keep fighting it so was very honest at university when they asked why I had applied. They thanked me for sharing, they embraced my honesty. These people were my tribe.

The three years at uni were hard, financially, academically, emotionally. I only had one short ish relapse though, a short episode of mania which led to me missing an entire placement, ironically since I am a CPN now it was the community placement!

Fast forward past graduation and started working as a staff nurse on an acute ward, I loved it and the team didn’t just tolerate my quirks and ultimately my mental illness they celebrated it. They accepted me for just who I am and will likely never know how much they all healed me and helped me ‘get over’ my previous losses to stigma. Nightshift though, that impacted my mental health hugely so it was time to move on after a year and a half to a life on the road as a CPN.

About a year into my role as a CPN I had a major relapse and fell into a deep depression (see previous post) which not only kept me off work but led to me having 22 ECT. When I came back to work my confidence was knocked, I was afforded the amazing opportunity to go and work on a non clinical secondment which meant I had time to build myself back up to clinical in a timely way.

When I returned to clinical a few months later I felt nerves that I hadn’t experienced before. I tried to cover them with humour but driving into the car park took a ridiculous effort some days. I began to worry that my colleagues, many of whom I class as dear friends, associated my competence with my illness and therefore thought I ought not to be there.

I could hear myself saying “yes go on I will take someone else on” and offering to go above and beyond as a way of proving myself but this just added to my workload and therefore stress levels, despite applying many of the psychological approaches I use with service users I was still trying to prove myself.

I have never really needed validation from anyone as I felt confident in what I was doing and the work I was producing in addition to, as a Christian, knowing that validation is not needed because it comes only through Him. Yet those first few months back at work I craved it like a child being super good to attract praise. I needed to know I was doing ok and I needed to know other people thought I was doing ok, hiding this anxiety was exhausting.

I am blessed to work with some amazing people, friends as well as colleagues who again like those on the ward embrace the person I am. They have told me when they were worried about my wellbeing, in the office it’s an open dialogue. In varying degrees most mental health staff have personal experience of mental illness whether as an individual or as a support to someone else… Let’s face it no one comes into this job for the salary do they?!?!

My confidence was just beginning to improve when as luck would have it it didn’t stop improving and mania tapped me on the shoulder. This episode could be described in many ways, discreet is not a word I would use at all.

I was mortified to realise just how public this had been, how work friends had both expressed their concerns amongst themselves and to me. I had sent emails I wouldn’t usually send full of ideas and bought items I hadn’t even realised I needed. I had been speaking quickly and at times speaking nonsensical utterings. Nonsensical to everyone except me.

I can’t hide my diagnosis anymore even if I wanted to. I wear it daily, I wear it as a layer of fat from the excess weight gained from medication and I wear it in the rosy cheeks memories of that time.

And this is where I am stuck. My confidence as a nurse has never been so low. I don’t know where I fit any more. I worry that the trust I work for has invested heavily in peer support which is brilliant and works so well as a concept so “why would they want a nurse with the unpredictable diagnosis of bipolar affective disorder?”

My logical brain knows that this is not right but my emotional brain takes over at times. I’m certainly not poster girl for recovery given the relapses I have had. Who am I and how do I find my place again?

I am nauseous with fear when my lovely managers make offers such as a reduced caseload all because I worry that this sort of gesture will ‘prove’ I am incompetent.

When I returned to work I dressed for a funeral, so concerned that if I wore colour colleagues would assume this was a symptom of further relapse. Only now weeks later am I starting to wear colour again. I try not to laugh excessively in case people think mania or to display any negative emotion in case people think I’m depressed.

I find myself wondering what to do; do I stay with my lovely team where they know all about my illness but where I run an inner monologue of self depreciation or do I move to a new team where they have no knowledge of my illness and hope to feel more confident but where I don’t have my ‘tribe’ looking out for me?

Lived experience is the ‘in thing’ though isn’t it? On that basis maybe my illness is an asset to my nursing or maybe I will sit on the fence and watch. I will watch and try to fit where I got best whilst praying for me to be able to separate my competence and my illness.

Recovery -v- Mental Well being

expectations

What is Mental Health Recovery?

I can’t really answer that because it is so individual. I get cross when people use it as a buzz word “oh yes we work to the recovery model” No No No… Recovery is not a model it is a personal journey. Academics seem to have hijacked the word recovery but they do not own the term, the service user always owns that term because they own their own recovery. Actually though depending upon how you define recovery for you it can be possible but this blog post is just about my experiences.

I prefer to think about mental well being than recovery though. I have a life long condition which isn’t going away anytime soon so for me recovery is about achieving equilibrium and living well day to day, week to week.

For me recovery is about taking the medication which helps keep me well regularly, it is about not letting myself become too busy and too exhausted, it is about engaging with my care team, it is about noticing the small things and adopting an attitude of thankfulness, it is about avoiding excess stress, it is about listening to friends and family when they express concerns even if I disagree and for me personally it is about regulating my sleep pattern so for example I left ward nursing because night shift made me unwell.

It doesn’t take a huge amount to knock me sideways but it takes phenomenal amounts of effort to pull it back. Most of those I know, even loved ones would never see the energy I expel just to stay well or even just to appear well on a day to day basis.

Am I well today? I’m ok ish I guess. On a scale of 0 -10 where 0 is the most depressed I have ever been and 10 is the most manic I have ever been I am probably 6, maybe 6.5. Now this is where it gets complicated not 6.5 in that I feel amazing, although I do feel pretty good but 6.5 because I have the muscle twitches, fidgeting and speedy thinking which are all indicative of me not being fully myself. I know why though and that is half of the battle; I am in the process of changing medication and this has impacted my sleep which has in turn like mental health domino’s kept knocking down the next thing. I’m not worried about it, I have some short term medication which is helping me in the short term until my body gets used to the changes. You can read about the side effects in last nights blog post on medication.

Does this mean relapse though? Not as far as I am concerned it is part of my day to day mental well being. I lost so many years and hindered my own recovery by seeking out a return to the person I was prior to illness instead of embracing the life I was and am able to have.

I hope one day to feel able to embrace my illness, to fully accept that the experiences with it enhance the person I am, but like I said at the start of this post recovery is a journey of mental well being and I have my boots laced up ready to crack on with the journey and as long as I keep taking my meds and listen to my body.

Shake me and I Rattle – The Pros and Cons of Mental Health Medication. (Mental Health Awareness Week – Day 2)

I was sixteen the first time a GP handed me a prescription for antidepressants and sent me on my less than merry way.  It was the mid 90’s, it was Prozac nation and these magic pills were going to make me feel better. There was no questioning that I remember from the GP about my mood, no referral on to anyone who may have been able to teach me techniques to help me manage. I had a fair bit going on at that time, due to familial disharmony I was living away from the family home but I plodded on. I didn’t understand how medication worked and so when I didn’t feel great after a couple of days I stopped taking them, I think I had anticipated them working like paracetamol for a headache; instant cure.

Speaking with people who were around me back then it seems I had a lengthy period of unmedicated depression, we joked and called it my hermit phase because I didn’t leave the house.

Over the next decade I had a couple of periods of depression whereby my GP would prescribe an SSRI and after a few weeks I would feel fantastic so I would stop taking them and enjoy life for a bit, in hindsight periods of hypomania. I was the life and soul of the party and self medicated in the extreme. None of the antidepressants I was given had horrendous side effects that I can remember but I never took them long enough to experience this to be fair

When I was 25 I got married and we had our daughter soon after which is when I started with other medications which I had not taken before. The first five weeks after she was born I raced around manically for five weeks, I decorated every room, spent a fortune and even threw a dinner party each night for three weeks until I sank into the deepest of depressions. This was my first contact with secondary mental health services.

The depression was debilitating after the recent energised weeks so my husband and I sought help. I was prescribed an SSRI to little effect and my thoughts became darker and darker, to a place where ending my own life went from a terrifying prospect to my ‘only option’. Fast forward to a hospital admission and I was prescribed V20140227-231508.jpgenlafaxine which alongside ECT ensured my daughter still had a mum to grow up with. This wonder drug really helped my depression however there is as always the ying and the yang… my clothes all had to be black because the excessive sweating was horrendous. I was given medication for the sweating which helped but that made my mouth dry which meant I drank loads which meant in turn I had to pee loads but I couldn’t really ask for meds to combat the side effects from the meds I took to combat the side effects now could I?!?!?!

After a period of wellness it as time to come off the Venlafaxine… Oh. My. Word. It took me 10 months to withdraw from this wonder drug which had saved my life. I felt physically ill with sweats, shakes, nausea, head zaps and eye/balance issues. I was still thankful for the life it had given me back but goodness those 10 months were hard.

I have tried other drugs over the years to treat different symptoms, one particularly sticks in my mind that was for anxiety but left me feeling like I had insects crawling all over me. I have never been a fan of any medication which would sedate or slow me down hence never being a fan of benzo’s however I grew to know over the years when to use some diazapam when my thoughts would begin to speed up, I self managed through a combination of this and non-meds techniques. It was really flipping hard work but diazapam in that sense preserved my dignity and kept me going providing I was strict with myself. It was suggested I consider lithium at this point. No chance I wasn’t taking that I knew about the side effects.

During my last episode of severe depression I was prescribed an SSRI and an antipsychotic in addition to lithium and alongside ECT. I was too unwell to consent ether way re the lithium but wow it has been wonderful, life changing. Yes it is a bit of a pain having blood tests etc but it just takes away the need for me to ‘put the effort in’, I felt so relaxed in my mood.

The antipsychotic I was prescribed was given to me partly because my depression had left me in the frightening depths of psychosis but also as a mood stabilizer. The sedation caused by this drug was so intense I was desperate to stop it as soon as possible which with agreement I did and stayed on the SSRI and lithium. Aside from the sedation the main side effect I experienced was weight gain; I gained five stone in four months which I am still carrying and I hate it. I can’t bear my reflection. I can’t bear trying on clothes. I feel hidious, ironic really that medication to treat how I feel made me feel so bad.  All was good for a while with no significant side effects… I was living the psych meds dream!!!

Then the SSRI, along with some stressful situations found that the lithium was no longer enough to hold them in check and mania didn’t just creep up on my it jumped out the cupboard and shouted ta da with added jazz hands. The SSRI was swiftly stopped and a combination of antipsychotics, large doses of benzo’s, sleeping tablets and of course still the lithium. The pills did their job and the mania subsided but the sedation from the antipsychotic felt like it was ruling my life. I had bruises on the tops of both arms whereby my co-ordination was impaired through sedation that I kept missing the gap when walking through door frames. I went back to work and was literally putting every ounce of energy into functioning 9-5 Monday to Friday, outside of that I did nothing. My hubby did the cooking/cleaning/washing/ironing, I was useless and determined to get the consultant to stop it. She agreed to swap it for another antipsychotic which also acts as a mood stabilizer as a second to the lithium but is far less sedating so last week the I started the swap.

Aaaaaaargh I didn’t sleep properly for nights last week and don’t get me started on the nausea. My brain is still going fifty to the dozen but the nausea/sickness is subsiding. To have energy again is amazing. There is no way I could have considered blogging each day during Mental Health Awareness Week whilst still on the last meds. I feel a little shaky and tremulous but that seems a small price to pay for stability. There is a sense of relief that despite the cocktail of side effects I still experience my illness is being treated and therefore hopefully the big episodes can be avoided.

So you see shake me and I will rattle but it is about finding a treatment regime where the benefits outweigh the risk of not taking them and for me personally I have too much to lose by not taking them. It does give me a great insight I feel into why so many service users I come across at work choose to stop their medication ‘not concordance’ (or non compliance for those stuck in a Quantum Leap scenario in 1984) as it tends to be noted. The side effects are often an illness in themselves, mental health meds may be marvelous for treating mental illness but they make people fat, sometimes give diabetes, give anxiety at times, leave people nauseous and I’m not even going there with the bowel issues. I hope this insight into meds has given you food for thought especially if you are a prescriber.

Put on your own life jacket first… (Mental Health Awareness week – Day 1)

Over the years much of the management style in the NHS has had its origins in the aviation industry; from dynamic risk management to ‘the human factor’ lots of what we do can trace its ancestors back to the aviation industry. That is no bad thing, they have provided some great starting points for NHS leadership over the years but there is one I think we miss. For me this one is the most important.

“Please put on your own life jacket first before stopping to help others”

During Mental Health Awareness week one of the clear focus’ is stress and I can’t emphasise enough the currency of this issue. Resources are so stretched that we find ourselves managing risk more than distress on a daily basis and when fire fighting so often the raised cortisol levels leave those on the front line feeling anxious about what they perceive ‘their failings’ as a clinician. I used to refuse to use the line ‘front line’ nursing as we are not at war but that feels like an accurate description these days if I am honest.

I became a nurse because having been severely unwell with my own mental health and having received a mixed bag of care, some amazing but some quite frankly shocking. I wanted to help others in a holistic way, I wanted to walk side by side with people as they worked toward recovery, whatever that may be for them. Maybe I was idealistic? I even did my nursing dissertation on the changing role of the nurse as we move toward wholly co-produced mental health care. That shouldn’t be idealistic.

Getting to finish a day, even just once in a while knowing that we have made a positive difference, that shouldn’t be idealistic either. Tough days will always exist but should not be the norm. It scares me how many hugely experienced clinicians are due to retire in the next couple of years so without a major injection of cash things are only going to get worse not better.

Today we had a team stress risk assessment review and I won’t go into details because that is a local issue for my team but I was struck by how tired my colleagues and I are and how photo’s were popping up all day of people holding up pictures about managing stress for Mental Health Awareness week but that unless the staff put on their life jackets first and consider their own mental well being or we won’t be able to support others.

When I nursed on the refugee camp a couple of years ago it tested me to my absolute limits clinically, I was exhausted from long hours and I was working with deficits in resources even bigger than the NHS (I know right!) but stress didn’t hit us because we knew we were making a positive difference. I wonder what we could learn from that? Staff I work with are incredibly resourceful and supportive of each other and I wonder whether for a short time whether it is worth taking the emphasis away from the negatives and trial looking at ‘in an ideal world’ what would staff change at little or no cost… Kind of Solution Focused Brief Therapy for a team if you will?

So just a short blog but I hope you agree an important issue to start Mental Health Awareness Week so whether orange is your colour or not get your flipping life jacket on to enable you to keep helping others.

#MentalHealthAwarenessWeek #Stress #AreYouCoping

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Formulating formulation

As a CPN I am frequently reminded that we provide episodic care, that those on my caseload should be recovered to the point of no longer requiring secondary care within a desired number of sessions. Now that is a lot of pressure on both me and the service user, with an overwhelming feeling of failure when we don’t manage that. I sometimes think we have gone beyond austerity and that this is me simply applying a dressing on the wound until the person is re-referred back in to the team. I don’t want that, I don’t think any nurse wants that, we want to walk side by side along a journey of recovery then wave the person we have nursed off into their future stronger than ever.

We CPN’s all work in different ways but I think despite knowing the time pressures it is impossible for me to walk into a persons home and say ‘Hi my name is xxxxx and could you please start engaging in this treatment plan I think is right for you’, the person and I need to build a therapeutic relationship. Maybe one or two sessions whereby we get to know each other a bit, where I tell them their dog is cute and ask them about the pictures on the fireplace, if we share a love of reading I may recommend a novel to them. I need to put them at ease, they need to be able to trust me if I want them to feel comfortable to off load their deepest and often darkest thoughts.

So the first session or two are ‘get to know you/build a therapeutic relationship’ type sessions and during the time over these couple of sessions I would try to build up a picture of risk and document this on the FACE risk which is the tool my trust uses, I’d get them to complete a consent to share document so we both know and understand where the restrictions lie. Get the basics done from a documentation point of view.

Next thing I probably ought to document is care plans but I am of the mindset that we can’t produce a care plan until we have a decent formulation. How can we decide a plan of treatment if we aren’t even 100% sure where the main issues are?

I use the 5P’s formulation which includes considering:

  1. Presenting problem(s)
  2. Predisposing factors which made the individual vulnerable to the problem
  3. Precipitating factors which triggered the problem
  4. Perpectuating factors such as mechanisms which keep a problem going or unintended consequences of an attempt to cope with the problem
  5. Protective factors

It is important for the person to know that what is important to them is important to me. As you may have noticed if you read my last blog was that I plan on having a few sessions of talking therapy myself to consider my current all encompassing worry that my work place and colleagues will connect my illness and my competence. As I plan on only having a couple of sessions to talk it through I thought it would save time if I arrived with my formulation already done… so because I am living the rock n roll life I thought I would make a start on it tonight. A Saturday night on formulation.

Whilst sat wondering if there was anything else to add to my precipitating factors list I began to realise that maybe I am more than a list (who knew?!?!?). We are all more than a list. Now I am not saying here that the 5P’s formulation is not a great tool because it is a fab way to capture what is sometimes a difficult narrative to grasp in the minimal time we as clinicians have. I always do the 5P’s formulation with the person but attempting to produce my own made me acutely aware that maybe I need to consider how I capture this vital background in a less formal and more human. I was reminded also this evening how emotional it can be to see all of this written down in black and white, reminded not to underestimate that because these formulation sessions are not ‘therapy’ as such they can still be difficult for the person I am working with and depending upon their level of distress and how much they are able to tolerate may take more than one session to complete.

It is not until now that we can even begin to produce care plans. Again this is something I do with the person I am nursing, in a session. it makes sense to co-produce them, why would someone be invested in care done to them rather than care done with them?

So now if we consider that on average with a caseload of 35 people are seen 3 weekly and taking just the above into account at roughly five sessions, which in itself is conservative as some people may take much longer to engage then this is around 15 weeks, add a couple of extra weeks for annual lave of the CPN and without any other hiatus this is four months before any actual therapeutic intervention takes place. Those four months will hopefully have helped to build trust and to have aided the person to have hope once more.  They certainly aren’t wasted weeks but they don’t fit neatly with the episodic care model as comfortably as most trusts would like. Whilst I absolutely agree that the days of the Community Mental Health Team CMHT are over and the new player is the Community Treatment Team CTT and this is a good thing however (you didn’t think you would get away from me without a however did you?) for some people the rational unbiased support and the sharing of hope that comes with that is vital and is treatment in itself. Lets never minimise the role of hand holding, sometimes we all need our hand held to get us through.

Too often we declare people as ‘treatment resistant’ when actually maybe we just need to rethink the treatment we offer rather than absolve ourselves of guilt by referring to our episodic model of care. Illness is not always neatly episodic. People are not episodic. If we explore the formulation with a solution focused approach then this in itself could be the most appropriate treatment going. I will never rush a formulation, strange that it took producing my own in a bid to save time to realise that.

That sounds like fun. Mania.

But mania, that’s brilliant isn’t it? That’s the fun part. The compensation for the horrific, crippling lows of bipolar disorder. Let me set that particular record straight; this episode has not been fun.

Getting there ‘the ascentthat felt fun and coming back down ‘the descent’ well that journey was pretty fun in parts too. The middle bit though, not fun at all. I felt afraid, terrified even and at that point I was no where near even having to face the embarrassment and destruction I had caused.

I do remember feeling afraid of my own brain, it was almost like I had several brains and each of them was stuck on a speed I could no longer keep up with like a dysfunctional record player with the vinyl record being unsure if or when it will ever stop.

Just a week prior to this my brain going faster held a mild irritation that everyone and everything seemed to be going particularly slowly. This was hideous but manageable, if it had stayed here I may have just embraced my productivity levels but it didn’t. The ascent had barely begun.

At its height though I could hear my myself talking and I was aware that this inconsistent monologue was coming from my mouth however I had no more knowledge than anyone else in the room as to what I would say next as I hadn’t processed it.

Just a week before this conversely everything made total sense and I mean everything. The words that rolled off my tongue and the tongues of others were connected, not everyone understood the connections but this simply confirmed what I was already beginning to realise that I was a superior being destined for great things. I could hear the poetry.

I wonder, in hind sight, if it was this ridiculously inflated sense of self that led me to start writing a sitcom (based in an office of CPN’s) then being certain, I can’t say pretty sure because I was certain that it would be such a hit so much so that I actually penned my resignation and put it on my bosses desk. Maybe?

I heard myself swear at people in a seemingly deliberate, verbally abusive way, which is so far from my norm that this added to my being afraid of myself. What was I going to do next?

This time it had gone beyond baking cakes at 3am, it had gone beyond deciding to decorate and starting to impulsively strip wallpaper at 11pm when I ought to be heading to bed, it had even gone beyond the time that I was unable to decide which bunch of flowers to buy in Sainsbury’s so I bought them all. These things made me slightly unpopular in my marriage but they weren’t the end of the world.

I have nearly always been able to pull it back before, I have too much to lose not to and I am rather cross with myself that I didn’t spot this in time. Accepting that this wasn’t my fault may take some time. Self compassion and time.

When I feel my thoughts getting faster and my senses becoming enhanced I know it is time for extreme self care. I cancel everything in my diary, even the good stuff like meeting friends or going to the theatre and take medication that I keep in the house to make me sleep and sleep I do. No TV, no music with lyrics, nothing, I create a beige mundane world where my brain has the opportunity to rest. To fulfil its obligation to rest.

A few years ago the last time I had one of the occasions when I missed the opportunity to get a handle on my ever elevating mood which my husband was putting up with as patiently as ever even when I struggled to decide between all the wonderfully colourful and beautiful flowers in Sainsbury’s so I bought them all, my dear husband embraces my eccentricities, he always has so the line between that and illness is sometimes blurred. I was probably just getting to the stage whereby I needed an intervention when I had a nasty accident and hurt my back, I was put on opiate based painkillers and huge doses of diazapam for my back pain and the combination of those two forced my body to sleep and therefore resolved over time my high mood.

Once many years ago and long before I gained enough knowledge and insight into my patterns very nearly ended up married to someone I had only known for a couple of weeks, we were turned away from the registry office for being intoxicated (big phew!). The ‘episode’ seemed to last for months but I felt great, it never ended up like this. I rode the wave and enjoyed every minute. I was young and had nothing to lose, people saw me as the life and soul of the party. They probably thought I was on drugs to keep going but I wasn’t. I even have a couple of tattoo’s from periods of elation… hidden ones mind!

The temptation to ‘ride the wave’ is more than just temptation it is a powerful force, this offer of bubbling excitement and an overwhelming feeling of happiness. What’s not to love? Who wouldn’t want to feel like that?

To medicate and try to rest my brain with sleep and low stimulation is not easy, it goes against everything I am feeling in that moment.

The ascent is seductive.

Inevitably what goes up must come down and with a little encouragement (read medication!) from the crisis team my descent started.

A few people had tried to tell me they thought I was poorly the previous week and I thought they were ridiculous, I kept telling them “I feel great, I’m not depressed” they agreed with me that I absolutely wasn’t depressed but I didn’t understand or want to understand what they meant. I felt great how could I be poorly? Insight was slowly seeping away…

By the weekend my dear friend and my husband decided it was time to ring the Crisis team. Even the ascent was gaining speed now so by the Monday when I was assessed I was irritable and agitated, as much with how I was feeling as with the Crisis clinicians who were there to assess me. I wondered why on Earth they could not see that I just needed a couple of good nights sleep?

I agreed to the Crisis team giving me some medication and coming to see me at home partly to get rid of them, it’s pointless arguing; experience has taught me that any disagreement as a patient in mental health services becomes a symptom of something (a whole other blog for a whole other day!). And partly because I was becoming increasingly afraid of where my own thoughts were going to lead me next.

The Crisis team were great, once they realised I was being concordant with medication they gave me control of how often I saw them (as little as possible!). After a few nights where I slept a bit better and took significant doses of sedating medication during the day which barely touched me we moved on in that after a few decent hours of medication induced sleep I felt rested, energised in my brain but my body felt rested and this was apparent with my thoughts being a bit slower and my speech certainly being slower and more comprehensible. I was still flirting from subject to subject and folk were still talking in rhymes here there and everywhere but it was slightly slower which was a relief.

As the day went on and I became more stimulated by the world around me the speed went up a gear but this lessened as the days and weeks went on.

Eventually I began to feel ‘normal’ whatever that is, but normal for me however was still aware how this could alter rapidly with my environment as I was still very vulnerable to elation. I think that’s gone now although maybe don’t ask me about the pay deal 😉

I hate the medication I am on. Last time I took it I gained five stone in four months which I am still carrying and which upsets me greatly. But it works. Laughably after recent weeks I am now complaining to my hubby I feel so tired all of the time because of the meds!

Then came the apologies. The red cheeked conversations were I have expressed my regret over things I have said and done recently, I feel so mortified over some things. The late night texts ‘because I had a brilliant idea’ to the knowledge I have sworn at people and shouted in church and that’s only the tip of the iceberg called mania that I was climbing. When I reflect I can see how close to the top of the hypomania scale I came and how easily it would have been to leap over that hurdle into full mania.

I knew what was coming the day the psychiatrist mentioned hypomania and bipolar, it’s a conversation I have avoided for just over a decade which was my first ever contact with mental health services after I had our daughter. I even tried making up a diagnostic term and telling the Dr I simple have a Hyperthymic Personality Structure… which I still think is a great diagnosis and it should be included in DSM 6!

I am ashamed of the self stigma I have shown since being branded with this diagnosis. I say branded because I feel like it has been written on my forehead with hot irons, for all to see and me to feel.

I lost so much to stigma when I was diagnosed with severe depression and hospitalised after I had my daughter. I lost my career which laughably was in HR and employment law and I lost some friends who just ‘didn’t get it’. I can not lose anything else to stigma, I just can’t.

Even last year it was suggested to me that maybe someone with a history of mental illness should consider a less stressful job than nursing. Stigma ladies and gentlemen is still alive and well. I am a good nurse, a competent nurse. When I am well I like to think I make a difference, I am a good nurse because of my lived experience not in-spite of it.

This recent episode has knocked my confidence which I was only just regaining after the last episode of depression I experienced. I am wearing greys and blacks as I am afraid if I wear colour people will assume I am ill, I am leaving the room when something funny is said to ‘go to the printer’ because if I laugh they may think I am hypomanic again or if I don’t laugh people might assume I have crashed into a deep depression.

Rock. Hard place. Yeah that’s me stuck in the middle.

I am so worried that colleagues will relate my illness and my competence, it’s matterless how many people try to reassure me that is the internal monologue I am running at present, I’m hoping a couple of sessions of talking therapy may help me work through that.

Mental Illness has taken so much from me but I refuse to be subservient. I am wearing my armour which consists of family, friends, Jesus and medication and then I am ready to fight, or I will be, just not yet. First I need to heal.

Depression is like needing your ears syringed – A reflection on my experiences.

Depression is a word we hear a great deal these days, which in some respects is great as mental health has held its stigma like a shield to keep us from the rest of society for too long. In other ways however it has become over used for example “I’ve got to work this weekend I’m so depressed” which over time minimises and on occasions ridicules what can be a disabling and debilitating illness which sadly sometimes proves fatal. It is that narrow view of depression which leaves so many sufferers delaying seeking help as they don’t want to be seen as weak, I’m a mental health nurse and fear of that view from those around me certainly influenced me seeking support and I ought to know better.
Here I shall outline my personal experience of depression, this isn’t from a textbook and it isn’t from my work as a mental health nurse this is my experience. My life.

Depression is more than sadness and tears.

It is a brain so slow that a simple ‘yes’ or ‘no’ response feels more pressured than a post graduate dissertation deadline even when the person waiting for the answer is a patient loved one who repeats the question until you can process with a kind smile on their face.

It is eating tins of sweetcorn or tubs of glace cherries as decisions over food mean making a sandwich becomes simply too challenging and that is without the lack of motivation which becomes all encompassing.

It is having thoughts which are so far removed from your usual belief system yet being really angry when the lovely nurse suggested they were symptoms of psychosis in your care plan. I’m a nurse, I’d know obviously.

It is legs so hairy that never mind the worry over being detained under the Mental Health Act the worry should in fact be being taken by the local zoo or animal park.

It is, in the early stages, when motivation is beginning to dwindle but some ability to process thoughts still exists putting sugar in coffee to save the energy of making a meal.

It is staying for the whole day in pyjamas as no motivation to wash or dress and further through the recovery process still staying in pyjamas as now no clothes in the wardrobe fit due to a combination or medication, inactivity and the kindness of friends bringing treats.

It is seeing that ‘light at the end of the tunnel’ that folk talk about but then looking in the mirror and seeing the physical damage this mental illness has done to your body; googling teeth whitening as you think it may be weeks since you last brushed them.

It is starting medication which makes your mouth really dry so drinking more and therefore in turn never being able to be far from a toilet.

It is your feet seemingly growing but when the light of recovery begins to shine realising it is simply your toe nails having grown so long that they are on the verge of needing minor surgery rather than a pedicure.

It is having to sell items of sentimental value as your period of full salary from work runs out whilst reminding yourself that health and family are what is important not jewellery.

It is, whilst in the depths of despair, seeing messages with scrabble tile fridge magnets written by your hubby to try and encourage you to wash or even brush your hair then a friend having to spend hours brushing the tangles through when you don’t manage that.

It is a head which is itchy and hair which looks wet as it is so unclean.

It is skin peeling off as you are so dehydrated due to forgetting to drink.

It is not realising you are even cold until your husband comes home and wraps a blanket around you and puts the fire on as you are a pretty shade of blue but are still sat in the same position he left you in earlier.

It is not remembering Christmas Day due to ECT treatments and knowing you can’t get those memories back.

It is finding the jar of coffee in the fridge.

It is four inch roots and natural nails when you are usually known for beautiful nail designs.

It is family and friends arranging a rota to be with you after treatments to enable you to stay at home and to be in touch throughout the day to prompt drinking and visits to the toilet.

Its questioning your faith even though in hindsight that same faith is exactly what brought you through when you felt like giving up.

It is putting every ounce of hope in each person I see taking me in their arms and holding me to put my brokenness back together. It never worked for more than one magical second but still craving it with each person I saw and I am the sort of person who hates feeling or appearing to feel needy when well.

It is being told that this new medication which is working well and has you believing in the future again means that despite reaching the top of the list at the fertility clinic you should give up on your hope for another baby.

It is watching the same programme again and not even realising until your husband points this out.

It is wanting to be able to read again as recovery progresses but still not being able to do this with a concentration of no more than 140 characters. Thank you twitter for reintroducing me to the real world.

It is being exhausted and tried of living but equally being terrified of dying.

It is having to exfoliate your entire body once feeling better and watching several layers of skin come away as it is months since you have showered properly, you have stood under the water because hubby told you to but not had the energy to wash.

It is over a year later still having to set a reminder on your phone for taking your medication each evening because you owe it to everyone including yourself to do everything possible to stay well.

It is having tremulous hands because the previous day at work you were so busy you forgot to drink enough and the wonder drug that is lithium also kicks in with its side effects.

It is feeling like you have to prove yourself a little bit more than your colleagues to show how well you are.

It is feeling heartbroken at the reminder when you see three magpies that to have a fighting chance of staying mentally well that nursery rhyme will never fulfill itself.

It is remembering to take days just to be still and remembering that life is not an emergency.

It is being kind to yourself about being a mental health nurse who became so poorly and remembering that an RMN who has ECT is no different to a midwife who gives birth.

For me the decent into the depths of depression and the climb out of this vast quarry is like needing an ear syringe, its gradual; you know you are not right but have no idea how deaf you have become until your ears are syringed. Recovery is as terrifying as the illness for me as looking back it took me months to accept just how ill I had been. I am blessed with a tremendous circle of friends and family around me and a faith which means I believe that God never wastes a hurt and that I will be able to use my experiences to the benefit of others in the years to come.
The examples above aren’t in any sort of order, certainly not chronological, some were early in my period of illness, some were in the depths and some were as I was moving on in my recovery. Some I remember and some I have been told by friends and family as I have a period of time missing from my memory whether from the depression or from the ECT, either way I am stood stronger than ever and so glad every day to be alive.

Writing for Well Being

I was afforded the opportunity to attend a ‘Writing for Well Being’ workshop on Saturday and although I have blogged for years now which I do credit with being a prophylaxis in my own sense of well being but this workshop encouraged me to re-examine my sense of perspective. I LOVED this workshop, such a different way of writing for me.
We were encouraged to write with specific prompts given but then the freedom to let words flow as they entered our brains and exited via our pens.

The first task we were given was to think about a word we like, a favourite word maybe. I chose pomegranate, I just like the way it sounds.

We then had some discussion which led to a three minute task of starting with the words “In the garden…” this is what I penned:

In the garden there are flowers and grass and a slide for all of the children. This is my dream, I wish I had a garden. We are fortunate in so many ways but we don’t have a garden, or ‘outdoor space’ as all these property porn type tv shows refer to it these days.
I would like a garden filled with children but I know I am blessed with the one child I have. Some people will never know the joy of hearing a child shout ‘watch me mum’ on a slide at the park so why should I lust after a garden and more children?

The next task was to use the favourite word of the person to our right, and we passed our word on. The word I was given was ‘Blackbird’, so I had to use this word to inspire me to write for three minutes:

Listen to the blackbird singing. Its tune sings summer over and over. Its real; summer is here and my eyes know that as they are blinded by the bright daffodil yellow of the sun. The sun is just rising up from spring and venturing into summer. The blackbird wants to make sure everyone knows that by singing its song. It wants you to know summer brings hope, the cold of winter is past and summer brings more than the blackbirds song.

Again we had some fab discussion about where the prompt had taken us although thankfully we were never asked to read aloud what we have written. Our next task was a little longer, five minutes I think and our prompt was to start with ‘I feel happy when…’

I feel happy when I hear my daughter laugh. Not just a quiet smile but a raucous giggle. I feel happy when my husband and I get time just to be. We don’t have a lot of money at the moment but I feel happy when this makes me realise money doesn’t buy happiness. It does pay the mortgage however and knowing that is paid makes me happy too!
I feel happy when I am reminded how loved I am and when I am held in strong arms. I feel happy when I am well. Not every day because life is not linear it has ups and downs but when I stop to appreciate what I have. I am happy but happiness can be elusive.

The next task I found very difficult. I had to imagine I was an object in a room and write as that object about an emotion I was experiencing. Write from the view point of an inanimate object? What the heck?

I can’t say I picked because it was more like my pen picked as the thoughts flowed through the ink of my biro and I found myself writing from the point of view of a clock hanging on my living room wall:

I am ticking. Tick tock tick tock tick tock. She keeps looking over, I think she thinks I am getting louder. I think I am all she can hear. She has zoned out, she looks like she stopped listening as the nurse described how poorly she had found her upon first assessing her. Tick tock tick tock tick tock.I can see her almost processing her memories, trying desperately to put them in some sort of order. I have watched her for years hung on this wall but never seen her as distant or vacant as she has been in recent weeks. She usually runs the household looking at me but now she doesn’t even shower.
Tick tock tick tock tick tock… She can’t look at me and shout ‘come on we are late’ because she no longer goes anywhere.
The nurses visit and they glance over at me too. They see her desperation and try, try so hard to give her hope but they hear my call also, tick tock tick tock. She understands though, she is a nurse too.
As the weeks go by the nurses get to know her. She is more able to talk freely and without the delay which cursed her for weeks. One day she laughs and it drowned out my voice tick tock tick tock. I wish I could tell her not to count the minutes but to count the moments.
Moments are priceless and it is moments which give happiness which is what she craves. It is that we all crave. Tick tock tick tock tick…

The next task was to imagine we were a detective walking into our own homes and making a judgement about the person who lives there. I was to write from the perspective of this detective:

This person has so much to remember, no wonder they have a white board on the back of the front door. Nurse appointments, Doctor appointments, occupational health appointments and reminders about non-uniform days and money needing to be paid for school trip, Guides trip and Sunday School trip. I move through to the living room to see photos of a happy family, the mother looks so different to the tired looking woman who let me in.
I see a bible and a Christian book beside the fire. A tired woman but a woman with faith and therefore hope lives here. I see a basket of paste eggs on the side board, all brightly coloured. Maybe the mum did these with the daughter? Maybe she is feeling a little better?
I see a pile of paperwork next to a laptop; I am well and it looks overwhelming to me so how must this mother feel looking at this?
Cards on the fireplace suggest she is loved by many and that her colleagues hope she will be back at work soon, coupled with the letter half written on the open laptop which would suggest she wants to return too.
I thought the woman had gone out but wandering through this home I hear her breathing heavily and realise she is asleep.

The final task we did was a reflective piece of writing based upon a graded visualisation the leader of the workshop read out to us:

I found this more difficult than I imagined I would. I dislike sitting with my eyes closed in a room full of people. I don’t feel comfortable with that, I don’t know why. My discomfort with this took me a little by surprise. My dislike of this task overtook my thoughts and I missed the first part of the graded visualisation task. When I re-engaged with the teachers voice I heard her describe walking through a rocky cave or cavern and my mind wandered. I found myself thinking about the 1980’s film ‘The Goonies’ and about the characters walking through the underground cave and caverns. I was waiting to hear the teacher describe an opening leading to an amazing aqua blue lagoon with a traditional wooden pirate type ship. I desperately tried to bring my mind back but I was lost in this happy memory of a thirty odd year old film. Maybe I shall try to watch it with my daughter this Easter holidays?
I heard the teacher say that through the next cave was an opening with light pouring in and a luscious green hill in front of me. I was back engaging with the exercise. The green hill was so vibrant against the pale blue with only a scattering of bright whilte clouds of the sky. I could smell the grass, not the urban smell of grass recently cut but a natural smell of grass which has grown there for centuries and which is home to all manner of creatures. Lots of creatures including the ladybird I just saw, it had four spots and was the brightest scarlet red I have ever seen. The ladybird spread its wings and flew away; maybe it didn’t like being looked at?
I was stood still breathing in deep lungfuls of country air and feeling quite blessed by the absolute glory of God’s creation when I heard the teacher remind us this was an exercise and bring us back in the room.

It was time to go home.

I have never done anything like this before so these short writing tasks were a totally new experience for me. Whether it is any good or not I shall leave to the readers but I did enjoy it and I shall absolutely book on another workshop of writing for well being, it really got my brain ticking over in a way it haven’t for so many months whilst I’ve been ill.
Anyway I have typed this as it was hand written quickly in 3 minute bursts so feel free to ask if anything doesn’t make sense.

I really recommend the Writing for Wellbeing workshops Laura does… check out her website: 

http://www.writingforwellbeing.co.uk/

Circus Skills… CPN Life.

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Oh my word by anyone’s standards 2016 has been difficult for me in so many ways with family illness then subsequent bereavement with one of those family members, our ongoing infertility issues, a cancer scare and a change of job with pressures which have left me questioning my own capabilities daily. I feel like I have spent months walking a tight rope with my own mental well being. I have written recently about how I have felt here

I’m a mental health nurse, not a circus acrobat, so walking an emotional tight rope has felt dangerous. I have stumbled and nearly fallen on so many occasions, arms outstretched with a wobble and a dance the one we all do until just at the last moment we correct out footing and just about manage to prevent the fall. My colleagues and I are all mental health professionals; nurses, psychiatrists, psychologists and social workers to name but a few and whilst we are acutely aware our own well being and that of each other what we aren’t overly good at is being kind to ourselves and looking after our own well being, we are for each other but rely on coffee and a couple of custard creams so sustain ourselves. Turns out that is not enough. Continue reading

The leaves are falling…

I look out of the office window as I write up my notes from the five service users I have seen that day, knowing I won’t get finished and that I will start tomorrow already behind. I look out of the window at the tree lined residential street where our team is based and note the blast of autumn in the colours on the trees. I feel sure they were still green last week but maybe I just didn’t notice? 

I do remember being shocked by the drop in temperature earlier this week as I went directly from air conditioning in the car to heating. No in between, all or nothing. That’s kind of how I feel about my job, it’s a love hate relationship. I love nursing but I hate what it is doing to me. 

I look at those changing shades on the trees outside my office with a sense of achievement. I survived another season. The trees were bare of leaves last winter when I moved to this role, then they blossomed a beautiful pink and white ‘snow’ which covered the road like God’s confetti. Those same trees have provided a stunning green contrast against the blue of the summer skies and now they are sporting all the reds, oranges and bronzes of autumn. Soon they will fall and the circle will be complete, the branches will be as bare as the day I first looked out of that window. 

Each change in colour is a sign I have survived a little bit longer when I thought I couldn’t possibly, my track record for survival therefore is pretty good. Winter is bleak though, the leaves fall and the branches look harsh and sharp against the low seasonal sun. The energy of the summer sun in providing the green of the leaves is gone and the tree is exhausted. I, like the trees, am exhausted. 

I am desperate for spring already, I yearn for my leaves to grow again and yet I wonder whether I will survive winter. 

Choose Life… (Trigger Warning – Suicide)

TRIGGER WARNING – TALKS ABOUT SUICIDE IN A GRAPHIC AND DESCRIPTIVE WAY, PLEASE DO NOT READ IF THIS IS LIKELY TO TRIGGER YOU.

 

The night I tried to end my own life I was as calm as I had ever felt, I was sure that taking my own life was my only option. I had a new baby, a great husband, a well paid job and a home in a lovely village lined with blossom trees. You get where I am going with this? Suicidal thoughts are often, not exclusively, but often a symptom of mental illness and mental illness does not discriminate, it can affect anyone at any time. It affected me and it nearly cost me my life, my daughter her mother and my husband his wife. Continue reading

Waiting for the rain to fall…

I weep in the shower so no one will see my tears fall,

I scream silently so as not to make people feel uncomfortable,

I smile broadly when people ask how many children I have and I reply “just one beautiful daughter”

I cry when I chop onions and I cry when the wind blows against my face. I cry when no one will ask me why. 
I watch our daughter blossom and smile at the young lady she is becoming,

She doesn’t see my tears in the swimming pool as she says “watch me mum” knowing she won’t seek my approval for much longer.

Once again my tears are hidden by the water, yesterday the shower and today the swimming pool. I have enough love in my heart to have two children shout “watch me mum”, I can’t bear this being how the story ends in my journey of motherhood. 
My smile when I talk about my daughter is so genuine but my eyes remain sad. My eyes tell the story of a journey of motherhood different to the one I always anticipated I would have. 
I envisaged a big table with several children all doing their homework whilst I stood chatting asking them about their school day and cooking something nourishing for their dinner. 
Making the decision to have another child after such serious postnatal depression that left me hospitalised for 5 months last time was huge for us as a couple. We made the decision then decided I must complete my nursing degree first and establish my career again. So long before we were trying, which seems like forever now, we were planning therefore in the years since we made the choice we always anticipated our desire to have a baby would come to fruition quickly. We had an appointment with a perinatal psychiatrist a year ago now and formulated a plan which we anticipated we’d need before long, it hadn’t entered our head we might still be waiting. 

Some women are not as fortunate as me, some women will never answer “yes one beautiful daughter” and I can only imagine the torment they feel. I don’t feel worthy of the tears that fall when I remember the blessing of our daughter. God blessed me with a daughter and my tears are disrespectful. My tears show I don’t trust His plan for my life. 
I pray that one day I will hold another babe in my arms, the thought of not becoming a mum again is too much to bear. We haven’t planned anything this year, no holidays, no weekends away, I didn’t even enter the Great North Run. Why? Because we assumed I’d either be poorly with sickness (I had hyperemesis last time) or that I’d be hugely pregnant and not up to going far. Neither are true and yet our lives are still on hold. 
Each month it gets harder, each month I stand in the rain to disguise my tears for a little bit longer and peel a few more onions. Next time you go to make small talk and ask someone if they ever thought about having another baby or indeed whether they want children at all; don’t. Please don’t. It’s the hardest lie in the world to retain ones composure when waiting for the rain to fall. Hold my hand and stand with me in the rain please. 

Being patient being the patient… 

I offer a disingenuous smile as I accept directions from the nursing assistant to the xray department in our local hospital. I smile to stop tears from falling as I am so afraid. I found the lump in my breast on the bank holiday weekend we had at the end of last month so it was a few days before I could see my GP. I kept telling myself that it was ok and felt sure that my GP would say it was nothing, just fibrous tissue maybe?

My GP was lovely and smiled kindly as she said that usually at my age she would ask me to return in a couple of weeks at a different point in my cycle but that my new found lump was ‘so significant’ she didn’t want to wait and that she would refer me to our local hospital. My ears pricked up at that point when I heard her tell me that she was referring me on the two week pathway. I knew what she meant, she hadn’t said the words but I heard her questioning breast cancer loud and clear. 

I am a nurse, I’m used to examining the evidence base of my actions therefore that’s what I did with the help of Google when I got home. So now full possession of the evidence would tell me that statistically I am in a really low risk group for breast cancer, that most lumps in women my age are harmless but I could still close my eyes and see visions of my daughters graduation and her wedding day without me in it. 

My appointment came through in the post within a couple of days and as per the pathway was within two weeks of seeing my GP. 

As luck would have it, and I say that in the loosest sense of the word, we had a CQC inspection at work during those two weeks so I was left with little time to think about the lump and the implications which could come with that. 

My husband took the morning off work to come with me and my boss told me to take as much time as I needed today and not to rush back to the office, I had told a few friends and they text me to tell me they were thinking about me and praying for me. They reminded me my strength is always in Christ which never fails to make me feel stronger to face whatever challenge life throws at me. 

I arrived for my appointment and was seen by a consultant and a nurse who asked me about family history and my own medical history. The consultant then examined me, he agreed he could feel a lump so gave me a slip of paper to take to another department where I was to have a mammogram and an ultrasound scan. He spoke warmly with a reassuring tone in his voice which was exactly what I needed to hear at that moment. I attended for my mammogram first and realised in the small room how alone and how vulnerable I felt. As I undressed I was struck by how naked I felt, not just physically but emotionally. The radiographer sensed my nerves and talked me through the procedure. She asked me to sign a form to confirm I wasn’t pregnant and as we have been trying to become pregnant for a year now this stung more than a little as I signed to confirm not. The harsh clamp of the mammogram made me hold my breath, I wondered in those seconds whether I would ever breathe again. I felt like I was drowning, not in water but in a lust for life I was terrified I wouldn’t get to experience. I was drowning in moments I found myself wondering if I would maybe never have. 

I was then returned to my husband who knowingly squeezed my hand, we have seen off worse challenges than this as a couple. His hand squeeze told me it would be ok whatever the result. After a short wait I was called through to ultra sound where again I was asked to remove my clothes and felt so painfully vulnerable again. The consultant radiographer and her assistant were both wonderful putting me at ease, they talked me through what could have been a deeply dehumanising process whilst ensuring my dignity at all times. As I lay on my back in the ultrasound room I felt a lone tear roll down the side of my face, the emotions of the day beginning to escape without my permission. The radiographer noticed and offered a caring smile, I explained how long we had been trying to conceive and how I had envisaged being in an ultrasound room for such a different reason this year. I hide my disappointment over that behind a smile daily as people as questions such as how many children I have. I scream silently and try never to show that emotion other than to a select couple of people yet today it spilled out of my eyes and I told a complete stranger in the radiographer. 

Back to the clinic I went clutching an envelope which I knew sealed my fate, she she passed it to me the nurse said to use the walk back round to think of any questions and to use the time with the consultant to clear my mind of any worries so I can go home with less weight on my shoulders. Good advice I thought. It’s a strange thing to be the patient when so often I am the nurse, it’s a good reminder how the small comments of care and compassion make such a difference to a patients journey. I shall think on that this week as I plan the care I deliver. 

Waiting to be called back in to see the consultant my heart was beating so hard I thought my rib cage was at risk of bursting. What if it was bad news?

I suspect the consultant is an incredible poker player because I scanned his face for clues as we entered the room but nothing was disclosed by his face. He quickly told me that he had seen nothing sinister on the scan or the mammogram but as he can feel a lump he would like to do a needle biopsy. I have a blood clotting disorder so a needle biopsy would need clotting factor treatment beforehand therefore given the probability of risk after seeing the scans etc we decided to wait a few weeks and see if the lump disseminates on its own or if it is still there in 8 weeks when he has asked me to return to clinic he will do a biopsy then. 

I didn’t know whether to laugh or cry, my heart was going almost as fast as my brain which has been like a hamster wheel for the past week. I headed to work almost on automatic pilot, trying to process the morning. I felt such relief at what he had told me but with a much reduced but still evident sense of foreboding at the fact he may still do the biopsy in 8 weeks if the lump is still there. 

I usually do well to mask my emotions from the world so today was difficult for me to admit my vulnerability. The nursing and medical staff were to be highly commended for putting me at ease, for making a difficult day a little easier. As I reflect upon today I an reminded how frightening being the patient can be. Being a patient today will influence the nurse I am tomorrow with the care I deliver. Those who cared for me today personified the values we all aspire to hold in the NHS, I hope I do that for others. I’m so tired now yet my brain won’t switch off. Hopefully I will rest soon. Good night folks. Xx

Micro Managing

I consider myself blessed to have been able to remain mentally well without medication for while now but this doesn’t mean it’s all plain sailing. There are blips. Last week was a ‘near blip’ and although upon reflection it was a bit of a worry it is also a boost to my confidence that I was able to manage it. Now please don’t mistake the message in this blog, I am not anti medication; absolutely not, at times medication has been absolutely necessary and has saved my life, in fact Thursday evening last week it was medication which helped me avoid a bigger blip. This blog post is about me explaining how I manage on a day to day basis to stay well (or well-ish!), I know it likely won’t always be like that but I also know from experience that the correct medication works really well for me to aid my journey to remission.

Looking back on last week I am able to see how I caught my mood in the absolute nick of time and that even one day later and I may not have been able to recognise how damaging the effects could be. Let me put into context how I think I came close to a blip… Two weeks ago I worked Tuesday through to Friday which were busy in the way an acute ward is the always busy but actually were lovely shifts where I felt good about the amount of time I actually got to spend with patients that week. I was asked to do some overtime on the Saturday which is something I deliberately rarely do as I am very aware of my need for rest days with low stimulation but was swayed by the thought of weekend enhancement plus overtime rate so agreed. Continue reading

Self Worth

Self worth is a difficult thing to quantify, it is not defined by the possessions we have around us or even by the love others feel for us. I know this as I am loved beyond measure and have everything in a material sense that I actually need and yet most days I feel like a stain on society. To those looking from the outside I have it all, a nice home in an affluent area, a good husband and a wonderfully spirited little girl. I have a new career which I love and which affords me the opportunity to enjoy time with my loved ones but I worry every day that I don’t deserve this life. Let me start by saying how settled my mood is, I am not experiencing any symptomology of depression despite how negative some of this blog post may seem. My self esteem has been better than this and I hope this will once again be achievable. Self depreciation has always been my default setting but throughout my life I have had periods of being better able to challenge this. Right now I am struggling with this. Continue reading

Broken Vases…

Last year I published a blog post about my thoughts on the Rotherham report, I received some very kind feedback but also some heart wrenching disclosures from people about their own experiences. One person telling me that I was the first person she had ever told about what she had endured. That blog post was written in anger and not even proof read, I just knew I needed to get it out of my head via my laptop before I would be afforded the luxury of sleep that night. Continue reading

Another chance

So I graduated yesterday, I wore my cap and gown feeling so incredibly proud. Not necessarily because I got a degree but because of what that degree stands for. My BSc Honours in Mental Health Nursing means I get to register as a nurse and do a job I love every day and this means so much more than the qualification itself. It means even more than this to me though, it means society has given me another chance, having already lost a career and a business to my own mental health difficulties this made my graduation yesterday especially poignant.

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Celebrate Recovery – A reflection

You may remember I blogged a while ago about starting to attend a group at church called ‘Celebrate Recovery’. It’s a Christ focussed twelve step programme which helps people with their hurts, habits and hang ups. You can find more details about Celebrate Recovery and whether it runs in your area from the link at the end of this blog. A standard introduction at celebrate recovery is “Hi my name is… , I am a Christian and I am in recovery from…” Which seems simple or so you’d think. Not to me it seems who over analyses everything I say and do. As a nurse I pride myself on being a reflective practitioner, which is a vital part of nursing, yet can’t help but berate myself for taking this too far and obsessing over my inadequacies. I have managed to skirt the introduction thing thus far and it has been without issue but tonight I was asked if I would be willing to read out the beatitudes which would involve an introduction in front of the whole group. I was happy to read out the beatitudes but quickly had a moment of realisation that I didn’t know what to say in my introduction. I could have confidently said I am in recovery from mental illness or childhood sexual abuse or even promiscuity if I go far enough back but however true those statements are they do not reflect why I am attending CR.

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Playing the swan…

The transition from student nurse to registrant is something I spent the final furlong of my nursing degree preparing for however nothing could have prepared me for that day when I introduced my self as a staff nurse.

My main concern is that the person I say “hello my name is Claire and I am your staff nurse” to has no idea whether I have been qualified for ten minutes or ten years and as they don’t know this they have high expectations of me. I worry all the time that I won’t be able to meet those expectations but I’m conscious to try to never show that worry as whether a patient or a family member they need to have faith in their nurse. The people I come into contact with must feel able to have confidence in my knowledge and ability and hopefully one day I may share that confidence!

By the end of my degree I was a fairly confident student who trusted my knowledge base and my skill set so have been surprised how this has changed and my internal monologue runs a mantra of ‘am I good enough?’
I question everything I do ten fold and I haven’t even take responsibility for meds rounds yet so goodness knows what I will feel like then! The feelings that registering with the NMC and its associated accountability generate are quite phenomenal.

I receive positive feedback from patients and from their families which is great as I am able to recognise that maybe I’m not the incompetent fool I manage convince myself I am. Staff on the ward are great too, they offer informal supervision each time I shout ‘help’ in a slightly hysterical tone in the nursing office, guiding me with their experience and nurturing my newness.

My first staff nurse job is on the ward where I did my management placement so I am fortunate to know the team well enough to lean on them when I need to and for them to pick me up when they recognise me struggling. The NHS trust I work for has a comprehensive, year long, preceptorship scheme so I know I am supported amazingly well as I fumble my way through my first year as a qualified mental health nurse. My preceptor is an experienced band six nurse who offers me reassurance and her experience as I need it with her also offering challenges of which she believes I am capable knowing it will boost my confidence when I achieve what she has asked of me.

Each time I think I am moving forward a new experience sets me another challenge to get through and my anxiety levels reduce a little when I achieve it. When I first started I was lucky if I slept for a couple of hours the night before a long shift but this has settled somewhat thank goodness!
A couple of weeks into the job and an incident knocked my confidence it left me wondering if I was capable of nursing at all, I dwelled upon it and worried to obscene and totally unnecessary levels making myself nauseous with anxiety but I can look back and realise that this will be the first of many situations which will come up over my career leaving me wondering ‘what if’. What if doesn’t have to be a negative thing if learning comes from it.
Throughout university we were encouraged to reflect and I would describe myself as a reflective practitioner as this is something I now do without hesitation however if anything I need to practice reflection without always being critical of myself something I am unconsciously prone to doing. I reflect daily as I make my 1.5 hour journey home from work and can sometimes have convinced myself I’m incompetent before I even leave the car park! I think those I work with would be shocked to hear how nervous I feel at the moment as I do my best to ensure for the most part that I at least look like I know what I’m doing!

Yesterday I was given positive feedback about how I handled a situation which escalated quickly and how I remained calm which was great to hear however I struggled to receive that praise, she pointed out that I had deflected back to debriefing over what had happened rather than simply accepting the praise. I wasn’t even aware I had done that until she pointed it out. I used to be able to graciously accept praise when it was offered and have no idea why I have lost this ability over recent years.
I lost so much to my own experience of mental illness, I lost my last career then I lost my business so I struggle to accept that this career which I have worked so hard for will not be taken in a heart beat also. I have a fear roaring away in the pit of my stomach which I hope will disappear eventually. Everyone assures me that as a new nurse a level of anxiety is normal and that I will not feel like this forever so I hope that one day I will just suddenly have a moment of awareness that I am no longer afraid and that I feel confident in my decision making. My preceptor who is very supportive is also very perceptive and I think she has begun to realise that I am playing the swan; gliding along gracefully on the surface and paddling away in a permanent state of utter panic underneath. She gave me a piece of advice that just about everything can wait so I should pause and take a moment if I find myself caught up in the hustle and bustle of the ward. An acute ward is a fast paced environment where decisions often seem to need making quickly but her words gave me the permission I need to tell myself it’s ok to wait a minute and take stock. Better to make the right decision than one I make in haste and regret later. I think this is a piece of advice I will value for years to come.
Today I co-ordinated the whole shift from 7.30am until 8.30pm and other than a couple of small oversights like writing the staffing allocations on the board in the main ward area for example I did ok. Some tasks I did came naturally and others felt more forced but the one thing I do feel confident in is that the patients and for the most part the staff did not register my nerves. Today felt like an achievement, a significant moment in my nursing career as a whole day’s co-ordination went without major issue, there were hic ups but then it’s an acute mental health ward so that is to be expected when nursing 16 very unwell people. Some people even had a good day, a board game mid afternoon generated laughter and friendship amongst ladies thrown together in illness.

The over arching thing I have learned since qualifying is how much I love being a nurse and how blessed I am to be doing a job I love in a team many of whom I class as friends as well as colleagues.
It’s terrifying and humbling in equal measure but it’s the best thing I ever did and I hope I will have a long, happy nursing career over the coming decades.

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Self Sabotage

So this is more of a brain fart than a blog post, a bit of a diary entry marking the start of an important change in my life. I hope so anyway.
I spent my late teens and early twenties losing and gaining weight at a rapid pace, sometimes having gone between where a size eight hung off my frame and where a size eighteen was stretched across my vastness, I would sometimes go between these two extremes up to twice each year sometimes maintaining a ‘normal’ size for a few months but mainly expanding or decreasing with only my subconscious aware of why I was doing this.

My body was younger so could take the abuse I threw at it in the form of bulimia or periods of restriction and excessive exercise but when I became pregnant eight years ago I knew that I could not pass my issues on to my child. Ironically I developed hyperemesis gravadarium and vomited between 25-30 times each day for my entire pregnancy but thankfully I managed to kick the habit not having using my previous behaviours since having our daughter in 2006.

Whether coincidence or not but when I gave up my coping tool I experienced a depression severe enough to have hospitalised me. I had experienced mood episodes prior to this but not to this intensity. Since this period of severe depression and another one a few years after that with treatment from medication which added to my weight gain and an inability to leave the house due to fear and anxiety my weight crept up and up. I am able to remain light hearted publicly re my weight but I feel repulsive alone. I am repulsed by my own reflection which is a huge shame as I have reached a point in my life where I actually like me as a person!

Over recent years I have tried a couple of times to lose the excess weight and for a while I do well, loosing a stone or two each time hindsight has taught me that this is the point when I seem to self sabotage. As soon as I get to the stage whereby friends and family begin to notice and complement me I struggle to accept that and my weight goes back on.

I consider myself to be quite an insightful and self aware person so when I looked back over and realised this was a pattern I was forming I began to explore why this may be the case and wonder what I could do to travel beyond this stage. That is when my epiphany took place and I realised I wear my weight like a mask. I use it to try and hide my emotions and to protect myself. I ought to explain that when I say protect myself I think that goes back further than me sabotaging my dieting efforts right back to my early life experiences. I think a psychoanalyst would have a field day with my theory here that my weight is there to shield me from unwanted attention, the sort of unwanted attention which shaped my early life in such a negative way. 

Now that I have realised where my weakness lies and how I self sabotage my attempts to lose weight and gain control over this one aspect of my life which remains out of reach I feel I owe myself the time and attention to concentrate my efforts on changing this. I am worthy of self acceptance over self sabotage and I will lose this weight.

In the past four weeks I have lost a stone in weight so know that soon I will reach my vulnerable time so must keep this self awareness at the fore and refuse to acknowledge the self depreciating thought patterns I am familiar with. I know everyone deals with things in differing ways but for me I plan on using a combination of self awareness and faith to hopefully succeed this time where I have failed before. I am joining a year long programme with church called ‘Celebrate Recovery’ some of you may have heard of this programme and I’d love to hear success stories if any of you have used it as a guide. If you haven’t heard of it then google it, it is a programme to help people work beyond their hurts, hang ups and habits and learn skills to aid them with this in the long term.
The programme covers everything from addiction, relationships, self harm, self esteem to weight management and even hurts from past abuse so I feel hopeful that it will help me.

I would never have had the confidence to go alone to this group but a chance conversation with a dear friend about our individual battles with our weight was what led me to my moment of realisation as we discovered that we both struggle with our weight for the same reason and vowed to support each other on this journey. So on Monday we will both go to our celebrate recovery group and we hope that this will be our final journey of weight loss. It was a chance conversation which led us to realise that this is why we hold on to our weight when we hate it so much, I wonder how many other women this is relevant to. I will likely share my weight loss with you via this blog and twitter and hopefully will make it beyond the point I usually get to… wish me luck!

Rotherham Report – My Thoughts

Trigger Warning – This post discusses childhood sexual abuse using language which some people may find deeply upsetting so please consider this before you continue reading. Helpline details are given at the bottom of this post should you read it then find you feel vulnerable.

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The news of the Rotherham Report has deeply saddened me but I’m afraid not surprised me. Childhood sexual abuse is something which goes on in the undercurrent of our society, in your street and in mine every day, but this is something society chooses to erase from its consciousness. Society does not feel comfortable talking about something so abhorrent. It is something the vast majority of people are appalled by, appalled by the repeated news articles, written daily, outlining the prevalence of this in
our modern, so called, civilised nation.

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My Journey…

I gave a talk tonight at the Annual Members Meeting of the Mental Health trust for which I am a governor, my talk was about my journey of recovery and what it meant to me as I made the transition from service user to staff nurse, the words that follow are what I read:

My first contact with mental health services was in 2007 following the birth of my daughter, Eve. After she was born I knew straight away that I didn’t feel right. I spent the first five weeks after she was born racing around, I decorated my entire flat and held a dinner party every night for three weeks! When my daughter was five weeks old depression hit me like a shovel in the face, I didn’t just slow down, I stopped. Continue reading

Lived experience?

The issue of self disclosure in mental health setting is a controversial one and one to which I have given much thought. As I have blogged about previously I am a mental health professional who has lived experience of mental illness and the stigma which comes along with that. Continue reading

Happy Fathers Day!!!

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So you’d have to be walking around in a bubble to have failed to notice all the father’s day posts across social media today, my facebook and twitter feed have been full of posts varying from those who are expressing their thanks and love felt towards their father to those saying how much they miss their now passed father. Lots of other variations were added to the mix too including the fathers who have posted how much their miss their children who their ex partner refuses to allow them access to and then the single mums posting how they do the job of both parents. All very valid and appropriate points to make. Continue reading

Recovery is a Process not a model

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You may have noticed my tweets recently asking about whether your local mental health NHS trust has a recovery strategy or recovery policy statement in place. I’m asking because I am part of a working group within my local trust considering this but it has got me thinking when I have had lots of retweets but not one person has been able to confidently reply and say that their trust has one in place.

So maybe I ought to start by asking myself what recovery is? I’m a third year student mental health nurse so often hear people talk about working with a ‘recovery model’ but I dispute this; recovery is not a model it is a process. Continue reading

Nearly a statistic; Postnatal depression

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Trigger Warning re childhood abuse/birth trauma/suicide

I have been involved with a piece of work with the midwifery education school at my local university, the same one incidentally I am due to graduate from this summer with a BSc Hons Mental Health Nursing although this is totally separate to my academic studies.
What started as an email saying ‘you’ve talked about having had postnatal depression haven’t you?’ has evolved over the past 14 months into something I am exceptionally proud of. The email was from someone I have come into contact with in a service user voice worker capacity and on behalf of a senior midwifery lecturer at the uni, we agreed to meet for a coffee in December 2012 to discuss what was being asked and how it could work. Continue reading

Tightening the student belt..

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I knew that financially being a student again was going to be tough, I had been a student before I knew that there was always likely to be more month left at the end of the money than the other way around. Nothing prepared me for the hardship and sacrifices this past three years have brought us. Continue reading

Coastal therapy anyone?

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I was sat at home preparing a presentation I have to give tomorrow at university dipping custard creams in my coffee and wondering whether I could provide myself with sufficient excuse to not go to bootcamp class tonight. It’s only my excuse for me, it’s only me I need to justify it to but still it needs to be a good reason or I’d have to force myself to go.
My brain was dulled and my eyes sore from staring at the laptop screen so I decided I needed some fresh air. I needed to blow the cobwebs away and the gale force wind out here has certainly done that! Continue reading

The 6 C’s of being a Student Nurse

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All student nurses you will be familiar with the 6 C’s, the areas which the Francis report said nursing should concentrate upon. To be able to look after others though us student nurses must treat ourselves with those same 6 C’s that we afford our patients. This blog post is about how we can use those aspects of nursing we practice for others daily to get ourselves through the three gruelling years of nurse training. Continue reading

Nature or Nurture?

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I have just watched the Kerry Katona documentary on catch up for Channel 5, it’s called ‘My Secret Past’ and is worth a watch. I have long believed that my battle with mental illness is a combination of the two, that I have a genetic predisposition but that trauma I experienced during my childhood triggered it off. I guess it’s no different to someone having a genetic predisposition to heart disease but whether that person eats a fry up for breakfast then sits on their backside everyday makes a difference to whether they trigger those heart problems off or not.

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Medication reduction…

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had an appointment today with my GP who is exceptionally supportive with my mental health. I know at times she has been as frustrated as I have been with secondary mental health services on my behalf. To have the support of someone who truly believes in the concept of recovery is vital to achieve mental well being. My appointment was booked several weeks ago to discuss my next drop in dose of my Venlafaxine. Continue reading

Letter to my younger self…

Ten things I wish I could tell my younger self:

1. To always have hope. Through both mental illness and via situations I have faced I’ve felt hopeless at times in my life. I can’t necessarily change how I think or feel when in the grips of mental illness but I can change how I deal with situations that life will invariably throw at me in the future. I have ‘Dum vita est spes est’ tattooed around my ribs which means whilst there is life there is hope in Latin. I truly believe that no matter how utterly hopeless you may feel at any given moment if you just keep on going moment by moment it can get better. So no matter how low one feels it is important never to take a permanent action to solve a temporary feeling. Continue reading

It’s beginning to feel a lot like Christmas…

Christmas; the most wonderful time of the year? Or is it?
Not for everyone it isn’t. Three years ago I spent Christmas in a psychiatric ward away from my husband and daughter and that will always be at the back of my mind as the shops begin to fill with glitter and the TV adverts show perfect family Christmas’.

I can tell myself I ‘forgive me’ for missing that Christmas with my daughter and build lots of new happier memories in the years since then. What’s not to forgive? I was ill. Continue reading

“Gosh aren’t you getting tall?”

Yesterday was my daughters seventh birthday party and although I knew I was stressed trying to arrange it along with working full time and writing university assignments nothing prepared me for the reaction that this party provoked in me yesterday. Continue reading

Cost per use reduced…

Today I feel lighter. I feel like the honesty I entrusted upon someone today was the right thing to do.

Being open today also reduced my cost per use of the phrase “I’m no longer ashamed about my past” as that cost me around £4000 in therapy to be able to say out loud!!! Continue reading

Sickening stigma

Mental health stigma is not a new issue. What is new is how blatant it seems to have become of late.
Over recent months supermarkets Asda and Tesco both sold costumes for Halloween depicting the popular press’ vision of what a they believe a ‘mental patient’ looks like. The response to this on social media was phenomenal with lots of us within the service user movement posting pictures of ourselves on twitter showing that ‘This is what a mental patient looks like’, showing how fabulously boringly normal we all are.
Power to the people prevailed and the supermarkets withdrew these appallingly named costumes from sale. Continue reading

Happy Campers

Well another summer over and another family camping holiday had, good cheap family fun.
The very first time we went camping as a family I had to really persuade my husband to try it, he had no desire to leave his home comforts.
I had been unwell with a severe depression, been hospitalised for several months and during that time some dear friends had a collection to send flowers. They sent some gorgeous flowers but realised they had around £100 left and decided to buy me some leisure vouchers so we could do something nice as a family once I recovered. The leisure vouchers could be spent on a day at a theme park, or an over night stay in a hotel or at a small selection of retailers. One shop had an offer on a camping starter set including a tent and with that those friends have us the most amazing gift ever, the gift of memories being made for years to come.
We bought that tent set and never looked back, we have added to the kit we take over the last couple of years.
Once the tent is pitched and I sit in my folding chair admiring my hard work I literally feel my mental health improve. In the same way a dose of Valium can be felt lifting anxiety I can feel my body letting out a sigh in relief of the opportunity to regenerate with relaxation.
The flowers those friends bought were beautiful and yet the years of memory making that the tent the paid for has given us is priceless really.

Was Larkin right?

Did Phillip Larkin have it covered when he penned his famous poem which was entitled ‘They fuck you up your mum and dad’?
I know that my own father emigrating and sending me a post card to say he had moved and my mother choosing her emotionally abusive husband over her child who was already vulnerable did have a profound impact upon my adult life but I feel comfortable that I have processed the emotions linked to my own childhood. I have enough insight to know that whether someone has the seemingly perfect childhood or if someone has some dreadful experiences those experiences all help us from the person we become. Continue reading

Stop the Victim Blaming!

64166_10151526939649417_996056550_nToday April 3rd 2013 is International day against Victim Blaming. I have posted this on my social media accounts today and been amazed by the responses I have received, in both a positive and negative way. Continue reading

Is a mental health diagnosis a modern day equivalent of a straight jacket?

27521_103617956343859_280_nIs a mental health diagnosis a modern day equivalent of a straight jacket? I began to wonder this after a few conversations recently where the subject has come around to the different way people react to a person once they discover a diagnosis of mental illness. Continue reading

The best mum in the world…?

Mother’s Day, like Father’s Day, is a day which until I had my own child I dreaded. It has its own meaning now I am a mother and receive a card and treat, it’s a day to make me smile widely to show my pride at being a mammy.
Nearly all of the cards address ‘The best mother in the world’ and when that is not how you feel it seriously narrows the choice available to choose one. It’s not that I don’t love my mother, I do love her I just don’t feel that she deserves the title of Worlds Best Mother. Continue reading