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ONEinFOUR Lifestyle, health, mental wellbeing

Winter 2009

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LIFESTYLE Master your moods

DEBATE Do we still love the NHS?

REAL LIFE Changing minds UK and US style

Staring debt in the face How to take on The Big D and win


ONEinFOUR Lifestyle, health, mental wellbeing Winter 2009

One in Four is a quarterly aspirational magazine for people with mental health difficulties, those who know them and for the community at large.

Contents Winter 2009

One in Four believes that information useful to people with mental health difficulty is useful to everyone and can bring about positive change. One in Four is committed to helping people to understand mental health difficulty from the point of view of those who experience it.

Cover Stories

ISSN 1754-064X

Dr Liz Miller explores ways to understand our feelings

ONEinFOUR is a registered trademark of Social Spider CIC, registered in England no. 4846529

12 We love the NHS?

www.socialspider.com Editor: Mark Brown Editorial Team: Stephen Gardiner, David Floyd Staff Writers: Laurie Penny, David Warrington Original Design: Mustafa Kurtuldu Production Editor: Martin Parker Advertising: If your organisation is interested in advertising in One in Four, call Stephen Gardiner, on 020 8521 7956 or email stephen@socialspider.com. You can download a media pack from: www.oneinfourmag.org Subscriptions: See page 32 for ways to get more copies of One in Four, including bulk subscriptions and single copies. News: If you have an idea for something we could put in a future issue, contact news editor, Stephen Gardiner, on 020 8521 7956 or email stephen@socialspider.com

One in Four welcomes letters and emails. We do not publish letters where only an email address is supplied; please include a full postal address and a daytime telephone number. One in Four needs people, especially those with experience of mental health difficulty, who can illustrate, photograph, write articles or provide interviews about their experiences for features and news stories. email: oneinfour@socialspider.com or send a letter.

9 Can we master our moods?

61 years on, what do we think of our health service?

15 A regular all-American guy Mary O’Hara speaks to US mental health campaigner Robert Villanueva

18 Staring debt in the face Sorting out your debt problems and keeping well too

24 “We need a Union!” The secret history of mental patients and protest

Features 23 Bright gift ideas Getting presents for that difficult person need not be hard

Real Lives 27 A week in the life of... Heather Payne, Media Action Worker, South Warwickshire User Forum (mental health)

Reviews

One in Four and Social Spider CIC do not take responsibility for any materials, including photographs or artwork, submitted unsolicited.

28 Understanding psychosis

One in Four thanks South London and Maudsley NHS Foundation Trust Charitable Funds, The Charlie Waller Memorial Trust, The Cooperative Bank and The Wates Foundation for the funding they have provided for this project.

29 Web Review

A new book putting people’s experiences first The voice of youth: Youthhealthtalk.org

Mythbusting 30 Mental health difficulty ISN’T a sign of weakness

One in Four Social Spider CIC 5 Hatherley Mews London E17 4QP oneinfour@socialspider.com www.oneinfourmag.org

Regulars 04 Editorial 05 News

Nothing in this magazine can be reproduced in whole or in part without written permission of the publishers. Opinions expressed in this magazine are not necessarily those of Social Spider CIC.

32 Acknowledgements

Selected content from this magazine is available online at www.oneinfourmag.org

34 Letters

© 2009 Social Spider CIC

35 Competition

Cover illustration: www.prozacville.co.uk

33 Directory


Editorial

Making it count One of the things we avoid at One in Four is making predictions. We’d rather look at things that have happened and explore ways that you can make the best of them, rather than spend precious pages talking about things that might not occur. There is, however, one thing that we can predict with complete certainty for 2010. It’s something that will affect all of us and in which we all have a potential role to play. What is this massive event? In 2010 there will be a general election. Soon, every party will be competing for the affection and allegiance of the public. You won’t be able to move for politicians making promises and talking about the kind of country we should have. And what role do we play? It’s we who have the power to elect one set of politicians over another, one government or another. And it’s we who have the power to make mental health a real issue both in the campaign and for whichever party forms the next government. The first step in doing this is to make sure that you take advantage of your vote. Make sure that you are registered to vote. Politicians always pay attention to people who might vote for them. The more they want your vote, the more they will listen to your concerns and ideas. If you don’t have a vote for them to chase, they’re likely to pass you by on their way to the next potential supporter. Don’t fall for the line that it doesn’t matter if you vote or not. It does. Whichever political party forms the next government will make decisions that will affect any health care you receive, how any support you receive works and potentially, how mental health difficulty is regarded. Contact your MP now and ask what she or he is doing to make life better for people with mental health difficulties and tell them that you would like to support policies that help people with mental health difficulties

to get on with life and not face discrimination and stigma. One in Four will be keeping tabs on the major parties in the next issue, telling you exactly what they think about mental health, giving you the information you need to help make up your mind. Like the National Lottery though, you have to be in it to win it.

One in Four Conference With financial support from Open Up, One in Four is excited to be staging its first ever conference in February 2010. Called ‘Talking about mental health – getting it right’, it’s a half-day event bringing together people with mental health difficulties and media and communication professionals to talk about just how we should talk about mental health difficulty, the mistakes we make and how we can do things better. It’s going to be a really exciting event with lots of space for debate. See page 11 for details and look out for a full report in the next issue of One in Four.

We’re twittering too You might be aware of the massive impact that social website twitter.com is having on debates about the NHS and healthcare. If you aren’t, we explain more on page 12. If that whets your appetite, why not come and find me on Twitter? Search for ‘Markoneinfour’ and follow me for regular mental health updates, links to interesting things and behind-the-scenes chatter from the One in Four office. ● Mark Brown Editor

What do we mean by mental health difficulty? Most people experience changes in their emotions or thoughts occasionally. A mental health difficulty is an experience of mental distress, upset or disorder, affecting mood, thoughts, physical sensations, actions or motivation that lasts over a period of time.

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News One in every two people who are in debt may be experiencing a mental health difficulty like anxiety or depression. That’s the finding of new research by the Royal College of Psychiatrists, which has reviewed 54 papers on the subject. The group says the higher a person’s debts, the more likely they are to have a mental health disorder, although it added that there was no conclusive evidence of a causal relationship. The report, Mental health. What do we know? What should we do? published with mental health charity Rethink and funded by the Money Advice Trust and the Finance & Leasing Association, found that people with mental health difficulties often do not seek help with their financial problems. At the same time, customers with debts often do not disclose they have mental health difficulties to their creditors, because of embarrassment or because they do not think they will be believed. People also say they do not think disclosing their situation will make a difference, while others worry that the information will be used against them.

Best practice The report calls for codes of practice for all areas of the financial services industry for dealing with customers with mental health difficulties. It says organisations owed money should also ensure that their practices comply with the statutory requirements associated with disability discrimination legislation. The report also calls for all health and social care professionals to ask patients about financial problems as part of routine assessments. Paul Corry, director of public affairs at the mental health charity, Rethink, says: “People with mental health problems sometimes have particular issues with money as a result of their illness. Those who are working may lose their jobs

suddenly if they become unwell, while others who live on state benefits may not have the funds available to cover one-off costs.” Stephen Sklaroff, director general of the Finance & Leasing Association, says: “One in four adults with a mental illness also report having unmanageable debt. Our lending code requires finance companies to take this into consideration when dealing with their customers.”

Debt counselling As a result of the recession GPs are being forced to act as debt counsellors to people with mental health difficulties whose conditions are being made worse by financial problems. The London Health Forum (LHF) has estimated that a quarter of a million people in the capital are experiencing debt and mental health challenges, costing the NHS up to £450m a year. The director of the LHF, John Murray, says: “The latest figures from the Consumer Credit Counselling Service show a 40% increase in calls to its helpline compared to a year ago. Unfortunately many people struggling with debt seek advice later than they should, becoming ill as a result” The situation is the same throughout the country and NHS Direct has set up a dedicated national helpline and signposting service to help people get the support they need. The Credit Crunch Stressline is available on 0300 123 2000 (open 8am to 10pm seven days a week). The mental health charity, Together, has launched Money

Illustration: www.prozacville.co.uk

The great depression

Matters, a national advice and counselling service for users of its services. Volunteers with experience of mental health difficulties are available to talk to people about managing their finances and trying to stay out of debt. Find out more at www.together-uk.org or by phoning Together on 020 7780 7300. The industry regulator, the Financial Services Authority, has launched a pilot scheme called Moneymadeclear, offering money guidance that includes special help for people with mental health difficulties. It’s available over the phone on 0300 500 5000 or online at www.moneymadeclear.fsa.gov.uk. In the north east and north west of England they are piloting face-toface sessions on a local basis.

Bosses warned The conciliation service, ACAS, has warned employers to be prepared for the long-term impact of the recession on the mental health of their staff and is calling for the training of managers on the effects of excessive pressures. ACAS chairman, Ed Sweeney says: “The economy may hopefully have seen the worst of the recession but the impact on workplaces will be felt far into the future.” See cover feature on debt and mental health that starts on page18.

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Hospitals report sparks disagreement A survey of people being treated in hospital for mental illness has revealed that they often feel ignored, not informed about their care and at times unsafe. NHS trusts are challenging the results but mental health charities say they are a cause for concern. The Care Quality Commission studied people’s experiences of acute mental health inpatient services in the biggest ever report of its kind, collating the opinions of 7,500 people from 65 NHS Trusts across England. According to the survey only a third of people questioned said they were involved in decisions about their care and treatment as much as they would like to be. Fewer than half said they always felt safe, 39% sometimes felt safe and 16% did not feel safe at all. Of those who were sectioned under the Mental Health Act, 27% said they did not have their rights explained in a way they could understand. Almost half of those who responded to the survey said the potential side effects of medicines prescribed to them were not explained in a way they could understand. Other patients reported a lack of activities and limited access to talking therapies. NHS trust chief executives say the findings unfairly exaggerate the negative feedback of patients. Steve Shrubb, head of the NHS Confederation’s Mental Health Network, says these statistics are unhelpful: “Clearly if you’re sectioned it’s not surprising you might have some concerns about how involved you were in your own care.” He recognises the need for such surveys to improve services but says: “The way the last survey was reported lacked context and wasn’t balanced.” He also said some patients may have felt unsafe as a result of psychosis. A spokesman from the Care Quality Commission defended the survey: “We believe that, rather than be alarmed about our

6 ONE in FOUR

presentation of the survey results, what would worry patients and relatives is if we played down the views that were expressed.” Mental health charities are alarmed at the findings. Paul Farmer of Mind says: “We already know that there is a fundamental problem with communication between staff and inpatients, with the latter feeling ill-informed about their rights and the side effects of treatments”. Rethink director of public affairs, Paul Corry, calls the figures “shocking”. He says: “If they were applied to people receiving treatment for diabetes, cancer or heart disease there would be a national outcry. These figures highlight just how far we have to go to bring mental health care up to the standards found in physical health care.” Roya Ireland

One in Four in the high street One in Four is now available in high streets all over England as a result of a grant from The Wates Foundation. They are providing £30,000 over the next three years that will be put towards the production and distribution of the magazine, including supporting the distribution of One in Four in the 110 Mind charity shops in town and city centres around the country. Chairman of The Wates Foundation, Rev John Wates, says: “One in Four fulfils two aims of our current programme: to treat mental health as an ‘everyday’ occurrence in the same way as physical health, and to build on the concept of recovery which gives people hope in having a say in their own health problems.” Managing director of the Mind shops, Robert Monteath, says: “By being able to offer a national network we are sure One in Four will be read by more and more people”

Diet supplements a ‘waste of time’

A leading nutritionist says millions of people in Britain are wasting their money and risking their health by taking popular fish oil and vitamin supplements often recommended to people with mental health difficulties. Professor Brian Ratcliffe, an expert advisor to the Food Standards Agency, says the popular supplements are completely pointless for the majority of people who have a healthy diet. He says topping up on vitamins can be dangerous. Professor Ratcliffe, from Robert Gordon University in Aberdeen, says safe levels of vitamin A can easily be exceeded, for instance, by taking both multivitamin pills and fish oil supplements. Excess vitamin A accumulates in the liver and causes headaches and nausea and over time can increase the risk of osteoporosis. Manufacturers of fish oil products say they help people with stress, depression and schizophrenia, but scientific opinion is largely dubious about their effectiveness in treating mental illness or any other ailments. Professor Ratcliffe told the British Festival of Science: “Large numbers of ‘worried well’ take the supplements as part of a ‘belt and braces’ approach to health. If you take a fish liver oil supplement then it has vitamins as well as the fatty acids that you may be unaware of. The safety limit for vitamin A can be passed if you take a multivitamin supplement plus fish oil.” He suggested that people would be better served talking to their doctor or a dietician or nutritionist about choosing healthy foods rather than bolting on a safety margin by just taking a supplement. (See Eat yourself healthy, (page 8)


News

On the road again

Laurie Penny adds her photo to the campaign

Time to Change has attracted national attention to its campaign to reduce the stigma and prejudice associated with mental health difficulty. But what do the public think of the campaign? One in Four sent Laurie Penny along to their roadshow to find out. As Time to Change set up its stall outside Surrey Quays Shopping Centre in south London, visitors were immediately attracted by its sleek, well-designed appearance. “It looks like they’re selling a product, with the open tent in the sunshine and all the laptops everywhere,” said Mark. “It’s really inviting.” “I work in sales myself and the presentation is excellent,” agreed Belinda Padbury. “I have three friends who suffer from depression. There’s a huge cross section of

Snipping away at stigma Hairdressers in the east of England are doing their bit to cut the stigma and discrimination around mental illness. 3000 salons and barbers across six counties are being asked to display promotional material from the national Time to Change campaign and to chat to

people coming over and that makes you wonder if there might be more people with these problems than you think.” Local people with mental health difficulties were on hand to answer questions and explain more about mental health difficulty. “I’m volunteering here for a day because I want to make mental health awareness a positive experience for people,” said Jason Harris, a local service user. Many who visited the stall to pick up leaflets and have their picture taken for Time to Change’s ‘visual promise pledge’ had personal experience of mental health difficulty. “I have ADHD, so I was happy to have my photo taken for their Facebook page,” said Harry. “If you’ve got customers about mental health issues. They will demonstrate that talking about the subject is just as easy and as natural as a conversation about a physical illness. Karen Bell, the chief executive of Cambridgeshire and Peterborough Foundation Trust, one of the seven mental health trusts involved in the project, told One in Four: “People with a mental health illness often

something wrong with you, people do tend to look at you funny. I reckon this campaign is great.” “Normally I wouldn’t have my picture taken for anything, but for this, I’ve made an exception!” said Joyce Johnson. “I have two people with mental health issues in my family. They don’t feel they can tell anyone what’s wrong with them, and with anything else that wouldn’t be the case. This campaign makes people more aware of the problem.” Some visitors who had mental health difficulties themselves or who worked in mental health said they found the event less helpful. “The video was really good, and the volunteers were friendly but they didn’t tell me anything I didn’t already know,” said Julie who works for a disability rights group. “I went to the stall because I thought they might be able to advise me about some problems I’m having,” said Tommy. “They didn’t seem very keen to talk, and that’s a shame as I really just wanted someone to talk to. But they did give me a self-referral form for the local NHS.” “The event is a really good idea but there could definitely be more information about where to go if you need help,” agreed Leon. “None of us are doctors, but we sometimes have an on-site psychiatrist in case anyone does need help. We don’t have one today,” explained Laura May, the Time to Change team leader. experience social isolation and discrimination in many areas of their lives. We know that it’s easy to talk to our barber or hairdresser and if they can help us to get rid of this final taboo we will be doing a great thing for the one in four people (and their families) who suffer with mental health issues. We hope hairdressers will help us spread the message: ‘it’s okay to talk about it.’”

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News

IAPT is alive and well

The government says the training of 3,600 new therapists to increase the availability of Cognitive Behavioural Therapy (CBT) is on track, and recent reports in a national paper saying it was faltering are completely wrong. The Observer ran a story in early October headlined ‘Flagship mental health scheme faces cutbacks’, saying the Improving Access to Psychological Therapies (IAPT) programme, set up to treat 900,000 people in three years, is unlikely to meet its targets and only 400 of the therapists had been trained so far. Investigations by One in Four suggest this is not the case. The Department of Health has told us that The Observer was “completely misinformed”, the recovery rates for those completing treatment are in line with expectations and the 900,000 treatments target will be achieved. It says IAPT’s “success has been proven” and “its future is assured.” And mental health trusts we have spoken to say IAPT is working well for them. Care services minister, Phil Hope, says in the first nine months of the programme 73,000 people were treated and the funding will be “mainstreamed so that these funds are transferred in the normal way in which resources are allocated within the NHS.” The NHS Stressline, which was established as part of IAPT, to help those experiencing financial stress is averaging 330 calls per month, not 25, as claimed in The Observer. Jon Willows, psychological therapies lead at Sussex

8 ONE in FOUR

Partnership NHS Foundation Trust, is very proud of the service now in place in Brighton and Hove: “It’s an excellent service but there’s a lot more potential in it yet.” He says the main challenges to establishing the programme are getting the information out and getting used to a service that is rapid access. IAPT is meant to support people in work and those returning to work, make sure effective treatments are available and reduce waiting lists. It was set up in response to guidelines set out by the National Institute for Health and Clinical Excellence (NICE). NICE recommends that both psychological therapies and medication can be beneficial for people in different circumstances and has found CBT to be highly effective as a treatment for a range of psychological disorders. Simon Lawton-Smith, head of policy for the Mental Health Foundation says: “There is much to be welcomed in these guidelines, especially with the recession creating extra pressures and anxieties for millions of people across the UK. But a real commitment will be needed by all concerned to make sure NICE’s recommendations reach the frontline. For example, talking therapies such as CBT have been recommended by NICE for many years but their availability is still limited in many areas.” There is overwhelming demand for people to have access to talking therapies, with people currently waiting up to two years for CBT. Professor Lord Richard Layard, has claimed in a report that after fewer than 16 CBT sessions, at least half of people with depression or clinical anxiety will see significant improvement in their mental health. Roya Ireland

Say it with flowers You can now send get well soon cards especially for people with mental ill-health. The Royal College of Psychiatrists has brought out the cards as a simple way of supporting people when they are unwell and helping boost their recovery. Research shows that far fewer mental health inpatients receive cards than people in hospital with physical ill-health. The greeting inside the cards reads: “Thinking of you at this time. Hope things improve soon”. They have been produced in collaboration with people who use mental health services and come in two designs – ‘Flowers’ and ‘Grapes’. They are available at www.rcpsych.ac.uk/ getwellsooncards

Eat yourself healthy

A Mediterranean diet may help prevent depression as well as its other recorded benefits like protecting against heart disease and cancer. Spanish scientists from the University of Las Palmas studied 10,000 people over four years and concluded that those eating more vegetables, fruit, nuts, olive oil, cereals and fish and less red meat, dairy products and alcohol were more than 30% less likely to develop depression. A similar study by researchers at University College London and published in the British Journal of Psychiatry has come up with exactly the same percentage benefit from the Mediterranean diet amongst 3,500 people it monitored over five years.


Cover Story

Can we master our moods? Dr Liz Miller, a GP who experiences mental health difficulties herself, explores a new method of understanding your feelings A psychiatrist once said to me, “You won’t know how you feel, only I know how you feel, and therefore you have to come and see me.” “Oh, really” I thought. That was the last we saw of each other and the last time I went to his clinic.

How much do we know about how we feel and how much can we do about it? More perhaps than we give ourselves credit for. In many ways, our lives are about making ourselves feel better, even if we do not always succeed. We spend money, go on holiday, go on dates,

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go to concerts, talk to friends, get a better job and if all else fails, head for the fridge. We do all of this in an increasingly desperate attempt to feel better about ourselves, our future and the world. People have large numbers of ways to help themselves feel better and when these fail, they turn to their friends, the pub, the doctor or illegal drugs. Because we like easy and convenient ways to feel better, we do things to feel better in the moment that might be bad for us, such as eating ice cream or grabbing a pizza.

Staying well takes practice The first step to managing mental health is to become more aware of how you feel, so you can sort problems out while they are still manageable. This is, of course, easier said than done. Too often we let something build up, for example bad feelings between oneself and a co-worker, instead of sorting them out while there is still a chance to kiss and make up. Instead of tidying up once a week, we tidy up once a month and for three weeks we can’t find anything and it takes longer to sort the mess out. Just like the fact that if it was easy to be rich, everyone would be, equally if it was easy to stay healthy, everyone would be too. Like every skill, staying well takes practice. Some people start off with a bad hand, other people throw their cards away and some people squander every opportunity. When I was diagnosed with bipolar disorder, it came with a mixed hand, good and bad. I had a good education and a useful qualification – medicine. But I was in the wrong job, I didn’t have much insight and was far too driven for my own good. The first step for me was accepting the diagnosis – and that in itself was intensely depressing. I then had to solve the problem the psychiatrist had identified; I had to learn how I felt. I needed to learn to be aware of my mood, understand

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“With time, I saw the links between how I felt and what I did...”

what had caused it and what I could do about it. To begin with, I wrote a diary, two or three times a day. I recorded what I ate, drank, did, how much I spent, how much I slept, even how much of the crossword I completed. I also read everything I could about mood, bipolar disorder, mental health, medication and psychology. With time, I saw the links between how I felt and what I did, and during this I developed mood mapping.

Mood mapping Mood mapping is a simple tool that shows you how you feel at a particular moment (see illustration). Mood has two parts, energy and how good or bad you feel. This gives four basic moods, high-energy positive (action), highenergy negative (stress and anxiety), low energy negative (depression), and low energy positive (calm). There are of course gradations of these moods. Mark how much energy you have on the vertical axis and how good or bad you feel on the horizontal axis. By combining the two you can mark a point on the map that shows you where your mood is.

A mood map of the four basic moods


Mark how you feel on the map

Making changes By mapping how you feel two or three times a day, you can start to understand what makes you feel the way that you do and then you can start to make changes. An example: If you are feeling anxious, you might work out why you feel anxious. It may take a little while to work out what the problem is but anxiety rarely comes out of the blue; there is almost always a reason for it. The next step is to work out what you can do about it that you are not already doing. Try

asking yourself something different: ‘What would my brother, mother or uncle suggest?’ Then ask: ‘What is good about what they might suggest and what would I do differently?’ This helps get a different perspective on the problem. Equally, you can ask a friend and then take their advice. There are times when the anxiety is so bad that it is impossible to act. Yet there is usually something you can do and when you do one thing, it gets easier to do the next thing. For example, if you go for a walk the exercise, sunlight and changing scenery might help you to feel better, so you can start to do what you need to do to solve the problem. Even easier, you could start with something as simple as a drink of water, then take the next step and so on. Map your moods so you can see which strategies help you most. The purpose of mood mapping is to make sure you spend more time on the positive side of the map than the negative. If you can spend more time feeling good than bad, and you develop plenty of resilience, so even if you do start to feel bad, you can bounce back quickly! ●

Mood Mapping by Dr Liz Miller is published by Rodale and will be reviewed in the next issue of One in Four

ONEinFOUR Talking about mental health – getting it right A conference about how to communicate sensitively and appropriately about mental health Encouraging us to reconsider the way we represent mental health difficulty by talking about the issues and hearing from speakers and panellists with direct experience in mental health and of working in media and communications. For professionals who communicate with the public, for journalists, for people in public bodies and for people with mental health difficulties.

Monday 1st February 2010 12.30pm – 5.00pm, Euston, London. To book a place, email conference@oneinfourmag.org and keep in touch with updates on www.oneinfourmag.org Please note: This conference is being supported financially by Open Up, part of the national anti-stigma campaign, Time to Change, and they, and One in Four, want as many as possible to be able to benefit from it. Attendance is free but to ensure that people who book do turn up and we are not left with empty seats that others would like to have had, a deposit cheque will be asked for in advance to secure a place. It will be fully refundable on the day.

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Cover Story

WE NHS? Do we love the NHS like we used to? Recent events suggest that it’s still as close to our hearts as ever says Laurie Penny Since its foundation in 1949, the National Health Service (NHS) has provided care and support to the majority of people in the UK. It is always there, ready for us to use when we need to. The people of the UK have had a 61-year relationship with the NHS, and for all that we complain about it, there are few who would like it to disappear completely. In August of this year, political events in the US sparked an impassioned outpouring of feeling about our NHS that surprised many, on both sides of the Atlantic.

US versus UK? In the United States, healthcare is not free (see page 15). Millions of Americans cannot afford any treatment when they are physically or mentally unwell. August 2009 saw president Barack Obama’s first attempts to reform the US healthcare system. His proposals included the introduction of a form of public health insurance that opponents suggested had some similarities to our NHS. These American opinionformers and politicians used the NHS as way of arguing against health care reform, saying the failures of the NHS should act as warnings against the dangers of a socialised healthcare system. Some of the media, such as Fox News, labelled the NHS “evil”, claiming that it allows the elderly to die untreated.

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Unsurprisingly many Brits were offended by this negative portrayal of the NHS and some showed it in an unlikely way.

Twittering proudly The global social networking site Twitter allows people to share messages of 140 characters, similar to text messages. After the controversy was covered in the UK, Twitter was flooded with messages of support for the NHS and personal stories of good NHS treatment, all tagged with the phrase ‘#welovethenhs’. Twitter was overwhelmed by hundreds of thousands of messages (known as ‘tweets’) from ordinary people and celebrities, including the prime minister and his wife – so many that on the 13th of August, the website broke down. People are still contributing now. Go to Twitter.com and search for ’#welovethenhs’ to see what people have been saying.


Do #welovethenhs? But do we feel the same about NHS mental health services? One in Four asked people involved in the Twitter campaign to share their stories of mental health treatment on the NHS – the good, the bad and the weird. Here are just a few of the responses we received.

I’m a novelist and this year I found myself barely able to get off the settee, never mind attempt to write anything. Eventually, I went to my doctor, although deep down I didn’t expect to be taken seriously. What I received was a revelation. My GP asked questions that made sense, and he treated me seriously. He explained the different approaches I could take, and asked which I was comfortable with. I was prescribed a low dose of medication, which has been gradually increased over several consultations, and a meeting with a therapist, which has led to Cognitive Behavioural Therapy. It’s the little things that have made most difference in my NHS treatment. I return to my GP every few weeks so we can evaluate my progress. He checks how my work is going. At every appointment, I feel like my quality of life is being looked at and taken into account. – Steve Mosby, 40

There comes a time when you realise that you’re vulnerable and in danger. In my case, it happened when I attempted suicide. I arrived at A&E early on a bright Saturday morning. I was afraid I was going to be laughed at and told to go and pull myself together. I felt ashamed that I was wasting everyone else’s time. I felt I didn’t really deserve any help, but help was what I got from the NHS that day. Finally, I was being listened to, and there were no stern judgements. I received real care from that moment on. When I was most in danger, when I was least capable of looking after myself, there was a safety net for me. It’s not going too far to say that knowing it was there saved my life. Finally, I could embark on a path to recovery. Instead of being nothing, I am something. And I owe that to those people who devote their lives to helping others. – Richard, 35

I was relieved when my GP agreed to get out of my way and give me medication. When I see the same doctors for physical health problems, I get much more of a sense that they are willing to work with me. – Sam, 32

The NHS is very well-meaning, but over-stretched. I’ve been trying to access services for some time now, and I have had to tell my entire story from start to finish about five times already. Sometimes I’ve found GPs very helpful as gatekeepers – the GP at my university was very sensitive, but the service she referred me to had a very long waiting list. Waiting lists are a real problem, because circumstances can change very fast and sometimes what you need is immediate help to stop a decline rather than waiting six months for longer-term help. The crisis teams are great, but they’re so over-stretched. – Toby, 23

I had a breakdown at university in 2005, in my final year. The NHS was brilliant. We went to my family doctor because I wasn’t sleeping or eating, and I was drinking too much. She gave me some mild sleeping pills to see how I got on. When this didn’t work either, she put me on temazepam for about four months. She didn’t just fob me off. She got me an appointment with a psychiatrist, who diagnosed depression and put me on anti-depressants. I ended up on these for about six months. I also had follow-up home visits from a counsellor. The treatment I received from the NHS was quick and effective and did its job well. As far as you can make a ‘recovery’ from depression, I did. – Kate Limond, 26

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My anxiety reached uncontrollable levels last year, and I went to my GP who referred me to the mental health service for professional assistance. They got in touch very quickly for the initial assessment, then I didn’t hear from them again until I had my first face-to-face appointment with a psychiatrist. There was then a lengthy delay of seven months before I began a course of 10 CBT sessions. I’ve been really happy with my therapist, who’s been nothing but nice, understanding and helpful, and I’ve certainly noticed a difference to the way I’m thinking and behaving. I do wish I’d been able to see her earlier. I guess that’s what’s going to happen when you deal with the NHS. Apart from that, I have no complaints at all. – Helen, 29, journalist

The NHS has always been there when I’ve needed it; it’s far from perfect, but I love it anyway. When I was 14 I went to the doctor to ask for help, because I struggled with social situations and anxiety and I felt miserable all the time. At first I was dismissed. When I was 18, I repeated the same complaints, and was prescribed anti-depressants, which did not seem to work. After many years of trying and failing to find effective treatment, I finally saw a doctor who referred me to a local computerised Cognitive Behavioural Therapy course. I start this soon, and for the first time in my life I feel like I’m actually being listened to by the NHS. – Alex, 26

Some years after seeking basic mental health treatment on the NHS, I worked as a temp for a local care in the community centre. That made me realise just how stretched the system is. The NHS is full of amazing counsellors, therapists, social workers and nurses who have gifts for making a positive difference in people’s lives - but they are overwhelmed by paperwork and just don’t get time to do their jobs, because funding for administrative staff is being cut as bureaucracy increases. – Helen, 25

I’ve been treated for depression, anxiety and an eating disorder by both private and NHS services. The worst thing about the NHS is the waiting lists. If I have a referral from my psychiatrist to see a psychologist or to another doctor it typically takes weeks or months for it to come to fruition. A few years ago I booked an appointment with my GP and told him I was relapsing and needed help. Eventually I was referred to a counsellor, who referred me on to a psychiatrist; I was told to expect a letter with an appointment time. Six weeks passed, by which time I was so low that I took an overdose and ended up in the local A&E. After an angry phone call from the A&E’s psychiatrist to my GP, I was eventually ‘rushed’ through the system. Despite all this, the care I receive is genuine and helpful. It’s a stuffy, overly bureaucratic system tied up with red tape but I truly believe it is doing its best. – Laura, 23 Experiences you’d like to share? Why not write to One in Four? Details page 34.

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The NHS and mental health The National Health Service was set up to give everyone the right to see a doctor, and to receive health care if they need it, whether or not they can afford to be treated privately. When the NHS was created in 1949, there were already large asylums in many areas of the country. The NHS oversaw the central administration of these asylums. From the mid-1950s, as the British economy improved, the NHS also invested large sums of money in building new, smaller day-care centres and residential hospitals. By the 1960s, opinion turned towards giving patients more control over their lives and their treatment. At the same time, effective psychotropic drugs had been invented, making most conditions more treatable. The number of beds in mental hospitals reduced from 150,000 in the mid-1950s to 80,000 by 1975; today there are under 25,000 beds in mental hospitals, despite the growth in the overall population. The Mental Health Act of 1983 gave patients the power to refuse compulsory treatment. The Act also advised that people be treated in their own homes where possible, a policy that came to be known as ‘care in the community’. Now seen as the brainchild of Margaret Thatcher’s first government, the idea originally dates back to the 1959 Mental Health Act, which abolished the distinction between psychiatric and other hospitals and discouraged the isolation of people with mental health difficulties in asylums. Many people were critical of care in the community, believing it would leave people with mental health difficulties uncared-for in the community. The Community Care Act of 1990 contained legal sanctions to make sure that local authorities carried out proper assessments of local people’s needs. Today, if you have a mental health difficulty you will probably be treated in the community, and an admission to an inpatient unit is normally short and voluntary. See page 24’s interview with Andrew Roberts for more about how mental health treatment has changed.


Cover Story

A regular all-American guy The American health system is very different from our NHS. Mary O’Hara meets Robert Villanueva, ‘ordinary guy’ and US mental health campaigner Robert Villanueva is the picture of Californian health. Bronzed and relaxed with an easy smile and even easier laugh, he recalls with pride and affection his time as a school wrestling coach, as a garbage worker and as a husband and stepfather: “I bought my own home at 21. I had a wife and a stepdaughter. I was a blue-collar worker with a pension and a union. I ate good. I worked out at the gym. I went to every soccer game my stepdaughter had. I was pretty much the all-American guy.” Just back from a two-day trip to San Diego where he had been training 15 people with mental illnesses ranging from schizophrenia to obsessivecompulsive disorder and depression on how to be public speakers, Villanueva has the demeanour of a person who can’t quite believe his luck. Over the past six years he has spent numerous weekends in towns

“I met a lot of people from other countries and was asking them what their countries did to care for people with mental illnesses and they all looked at me as if they didn’t understand the question.”

and cities across the United States working for the campaigning organisation, Nami, the National Alliance on Mental Illness’s programme, ‘In Our Own Voice’. He started out as a public speaker in the programme talking about his own experiences but quickly moved on to training others to do the same and eventually to “training the trainers”. As part of this work he has addressed “all kinds of people” in venues including churches and community halls about living with a mental illness. “I’ve met some incredible people. Some may have grown up knowing they had a mental illness and some didn’t know ‘til later. Some have been homeless for seven years and are now back on their feet. Some have had family support and others haven’t. Some people have had 30 hospital stays and some people have had none.”

ONE in FOUR 15


An unlikely advocate Mental health advocacy was never what he envisaged himself doing but Villanueva is now in demand as a highly regarded communicator and champion for service users or, as he and others in the US tend to say, “mental health consumers or customers”. He describes himself as “a kind of open book” and says that despite the sometimes “pitying” reaction he gets when he tells people he has a mental health difficulty, being up front is invariably the best thing to do. “I realised at one point that if I wasn’t honest with myself, how could I expect other people to understand?” Candidly the 41-year-old recollects how in his late 20s he was catapulted from the “all-American blue-collar guy” holding down two jobs and looking after his family to someone he didn’t recognise. “At about the age of 29 I started having racing thoughts. I couldn’t sleep at night or I’d be waking up every 15 minutes in a panic. This went on for about two years. I began missing work I was so exhausted.” The last thing he thought it might be was mental illness. “I thought it must be something else, a brain tumor, cancer. It was always something else.” His ordinarily organised family life began to unravel. “I wouldn’t pay the bills even though there was plenty of money in the bank and my wife would ask me why. I wouldn’t have an answer.” There are many aspects of the time leading up to the day Villanueva walked in to a doctor’s office and declared: “I think there’s something wrong with me” that remain opaque or are fractured memories. However there are plenty of things he remembers with clarity. Like selling his house during a manic phase of what he would learn was bipolar disorder and using the money to set up a business for which he hadn’t properly planned. “I thought it was a wonderful idea at the time but obviously I hadn’t thought anything through. I

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had no business plan and no business background. During the manic episodes I got into writing poetry and hiding it in the closet. Then I had a delusion I was running for mayor of the city.” He was prescribed a number of different anti-depressants with varying degrees of success. Therapy helped a bit, but nothing helped enough. Things became so difficult that eventually his wife left him. Narrowly avoiding destitution by accepting a friend’s offer of a spare room to live in, he soon realised he wasn’t getting better and breaking point arrived. “I called my doctor, made an appointment, went in and told him ‘today I’m gong to jump off the Bay Bridge unless we fix me.’ It was my crisis point.”

Small Steps He finds it difficult to explain, why instead of jumping off the Bay Bridge, one of the main commuter routes between the city of San Francisco and east of the bay, he went to the doctor. “I suppose something in me just said ‘you’ve done all the right things in your life so something must be wrong’”. He spent a week in a mental health unit “being stabilised” and while he had many set backs after that – including worries that he would run out of insurance cover and no longer be able to afford his monthly $600 medication bill – Villanueva says he got by with small steps. “I got up every day and made the bed,” he says chuckling a little. “I knew that if I had made the bed in the morning I would be less tempted to get back into it.” It was small steps that led him to the local Barnes and Nobel bookstore every day for two years. “I read every book I could find about mental illness. I kind of self-educated. It was a nice place. I could sit. I could read. I could even get coffee refills. It got me out of the house.” During this time Villanueva joined a peer support group and began to question the “bigger picture” around mental health in a way that would, implausibly, propel

him to the national stage as a mental health advocate. “For me it was a personal focus at first. It was: what happens if I meet somebody? How long do I have to wait before I tell them? I think it was for myself at first and then I realised that there was a lot to gain by helping other people.”

Why don’t you go to hospital? Travelling the country as an unlikely speaker and trainer (he also gives talks at conferences and meets regularly with academics and mental health professionals) has furnished Villanueva with a unique insight into how mental illness is both perceived and treated in the US. He is acutely aware in particular of how a healthcare system reliant on private insurance policies can be a hindrance. “We don’t have a national health care [system] in the US. I met a lot of people from other countries and was asking them what their countries did to care for people with mental illnesses and they all looked at me as if they didn’t understand the question.” Trying to explain that the concept of a safety net didn’t exist was “tough” Villanueva says. “They would say what do you mean? Why don’t you just go to the hospital? And I’d be like ‘well you can’t’. I’d try to explain: because you won’t get treated. When your insurance runs out that’s it.” Another issue that needs to be addressed, he argues, is the number of people in the US prison system who have a mental illness. “Basically the Los Angeles county jail is the biggest mental health system in America.”

I just want a discussion The vastness of America can make it difficult to feel part of some kind of service user ‘movement’ Villanueva suggests. “I’ve heard the word ‘movement’ used but I’ve never really experienced it.” There have been notable


victories in recent years for mental health rights groups such as the law passed last year (spearheaded by the late Ted Kennedy) to grant parity of access to health care for people with mental illness. It was widely seen as a landmark victory against discrimination by insurance companies by stipulating that they cover physical and mental illnesses equally. But it is far from enough according to Villanueva. And it goes way beyond issues around access to appropriate care. It is clear that he is often frustrated by ingrained negative perceptions of mental illness and the people who live with them. There is a long way to go he suggests before people like him are no longer regarded as “different in a bad way”, something made worse, he believes, by stigma being reinforced by mass media makes. “Take one example. In the latest

Pixar movie a teenage girl says ‘why am I in a psycho ward? Do I have to take my medication?’ This is five minutes into the film and I’m there with my nine-year-old niece.” People with mental illnesses are regarded as “fifth class citizens” Villanueva suggests, but believing that this is the case does little to dampen his enthusiasm. Whatever the country he says, “an open dialogue” is needed to shift attitudes. People need to be able to tell their “employers, coworkers, family and friends” about their diagnosis if they wish to without the reaction being pity or fear. “Before my diagnosis I was stigmatising,” he admits. “I didn’t understand and so I can see why other people don’t either.” “I want there to be a discussion,” he adds. “I’m not out to fix it or cure it or invent something new. I want a discussion, whether that’s in

a church or at a union meeting or on a graduate program. Just a discussion.” If Villanueva never anticipated the change of direction his life would take he seems even more disconcerted by what might happen next. He is being courted by some of the most prestigious colleges on the west coast including Berkeley. He has gone back to community college (the US equivalent to further, or adult education institutions) to beef up his academic credentials so he can take advantage of the opportunities opening up to him. “Who’d have thought huh?” He says chuckling softly. “I’m just a regular blue-collar guy.” ● Mary O’Hara is a Gardian writer and 2009/10 Alistair Cook Fulbright Scholar, based at the University of California at Berkeley.

Cognitive Behaviour Therapy Introductory Training Weekends CBT Explained and Performed by Expert Psychotherapist Mark Haith Birmingham February 27th–28th Brighton March 20th–21st Leeds April 17th–18th Cardiff May 22nd–23rd London June 12th–13th Liverpool July 17th–18th Aberdeen August 14th–15th Edinburgh September 18th–19th Newcastle October 16th–17th

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ONE in FOUR 17


Illustrations: www.prozacville.co.uk

Cover Story

Staring debt in the face More people each year face the problem of debt. Dan Holloway explores ways you can sort it out and look after your mental health too. Additional research: Alex Williams I’ve known Danny Gillan as an award-winning author for about two years. What I didn’t know until I mentioned I was writing this article was that he’d suffered for years from crippling debt and from depression that had left him with suicidal thoughts. Danny’s story is a familiar one to many. The realisation that he was experiencing difficulties was a gradual one. “I noticed I was becoming withdrawn and avoiding social contact,” he says. “I’ve never been a big talker at the best of times. This became far worse. I could go entire days without uttering a word to anyone. The thought of having to interact with

18 ONE in FOUR

anyone became terrifying.” So Danny hid from social contact. He was also taking more and more frequent sick days from work, without quite knowing why. It wasn’t until he began having suicidal thoughts regularly that he sought help. By then there was another problem. Danny was £20,000 in debt. The job he relied on to stop him sinking further was making his depression worse. Eventually he was forced to quit and take a job on half the salary. It wasn’t long before even that was unmanageable. The worse his debt problems got, the worse he felt and the less he could do to sort them out. Danny’s


Debt Problems? There are no quick solutions to debt, but taking these steps will get you started • Seek help at the earliest opportunity. • If you can’t face speaking to your creditors directly, speak to an advisor at your local Citizens Advice Bureau, National Debtline, or one of the other places listed in this article • If you can’t face doing that, speak to your GP or your primary care worker, and ask them about the Final Demand booklet, produced by the Royal College of Psychiatrists. It gives a range of information about whom you can contact and what you can do. See http://bit.ly/otnuD for copies • If all else fails, ask someone else to make first contact on your behalf • If your mental health difficulty is having a serious effect on your ability to handle your finances, speak to your primary care worker or Citizens Advice Bureau about the Debt and Mental Health Evidence Form, which compiles evidence of your mental health problem and helps creditors understand its impact on your ability to handle your finances increasing financial hardship made his depression worse; his worsening depression decreased his ability to earn the money to prevent him getting further into debt.

Debt and your mental health As we enter year two of the current economic crisis, and more people find themselves without a job, the complex relationship between debt and poor mental health is becoming more of a concern. The Department of Health’s New Horizons

“If you are going to get out of the debt pit, it can be a tall ladder to climb. What you need is help.”

strategy for mental health provides official recognition at last that debt is a public health issue. The good news is that increasing recognition means more organisations, from the government down, are trying to find more ways to help.

Not so scary? More than ever, the financial services industry is looking for ways to help people with mental health difficulties handle their debt issues. Many companies understand that they must act more responsibly

when recovering money that is owed them by individuals who may be facing other challenges. It’s a picture that’s developing all the time. Even if you had a bad experience with a bank or a credit card company several years ago, things are very different now. In recent years, several credit industry codes of practice have referred explicitly to customers with mental health problems. The Finance and Leasing Association told One in Four, “[we have] long recognised that managing debt can be a huge worry for people with mental health problems (see News, page 5). Finance companies are always willing to work with any customer in difficulties. It is very important that you tell your lender because if they don’t know about your circumstances, they can’t give you the right kind of help.” The same is true for many organisations or companies to which you may also owe money. For Danny, telling someone was the moment everything changed. Danny sought help for his depression from his GP and assistance with dealing with his debts from a debt advisor and encourages others to “seek help, both practical and medical.” Once you’re in touch with someone who specialises in helping people with debt problems, they can talk you through your options and can act as go-between with your creditors (see box ‘Getting sorted’).

Not a dirty secret Even when you’ve made contact with someone, and started talking to your creditors, either yourself or through an advisor, that’s not the end of the story. If you are going to get out of the debt pit, it’s going to be a tall ladder to climb. One of the most important things you’ll need is help. General support is vital. Debt can become a ‘dirty secret’ that you are too embarrassed to talk about, increasing your chance of getting stuck or putting off taking steps to find ways to sort out your problems. Finding help can often be

ONE in FOUR 19


Getting sorted Debt may build up over a long period of time so it may also take a while to sort out. You will make headway if you take it bit-by-bit, get all the help and advice you need and watch what you are spending. There are two important steps to overcoming debt. The first is to identify which of your debts you need to pay most urgently and the second is to make agreements with the companies and organisations to which you owe money. If you can’t repay money you owe on time then let your creditors know as soon as possible that you are having problems. Don’t ignore letters that demand payment - debt won’t go away, it will get worse.

Who should I pay first? Getting straight in your head which debts are the most important is key. It can be easy to get confused about this. The information in this article should help you to work out which debts you should deal with as soon as possible. These are debts relating to the place where you live, your utilities or those which have the possibility of legal action attached to them. The toughest sanction for non-payment is prison. This applies only to a few debts, such as Council Tax and TV Licence and does not happen very often. Non-priority debts are more likely to be credit and store cards, unsecured personal loans and money borrowed from family or friends. While you may want to pay these off soon, try to sort out the most important debts first. Talk to your landlord or housing association if you get behind with your rent. If your mortgage costs are your main problem contact your lender and get independent advice. Some utility companies have charitable trusts that can help with lump sum grants towards fuel debts. Your local Citizens Advice Bureau (CAB) should have details.

Sorting stuff out You should never have to pay for advice or guidance about dealing with debt. An advice agency such as a local CAB will help you work out your income and expenditure (the money you receive and the money that you pay out) as well as your level of debt. This will show the amount you have left, if any, to pay to your creditors. In general, most non-priority creditors will be happy to receive an offer to pay what you can afford if supported by evidence, rather than receiving no repayment at all and having to take you to court. The advice workers will be able to help you put together a financial statement that can be sent to your creditors with your offers. An adviser will usually ask creditors if they are prepared to freeze interest and charges on credit debts. Your repayments need to be affordable and realistic, and shouldn’t leave you unable to budget for essentials such as food. There are options such as bankruptcy and administration orders if your debts are very high – talk to a debt adviser about these. It’s important that you do keep up any payment agreements you make with your creditors. If these agreements can be put in place, they are the best way of sorting your problem. It’s essential that you get independent advice before borrowing more credit, including consolidation loans to repay your debts. Far from bailing you out this credit may cause further debt and interest payments. If you feel harassed by your creditors then get advice, as you shouldn’t have to put up with this. Many people worry about the prospect of bailiffs at the door. However, this doesn’t happen unless the debt has already gone to court.

20 ONE in FOUR


complicated, especially as your relationships can be tied up with your mental health problems. A failing relationship contributed to Danny’s depression. Some people can turn to family for support, but for Stef that’s not an option. Stef lives in the countryside. Not the English countryside, 10 miles from a town, but the Australian countryside. The problems that she faces are similar to rural parts of the UK. Lack of local jobs, coupled with her own depression, mean her working possibilities are limited, and so she, like Danny, finds herself in the spiral of debt and mental ill-health. Finding a support network has been problematic for Stef, in part because of her geographical isolation, but also because of her money problems which mean that she cannot easily do things like eat out or go for coffee. Stef found a network of friends through the Internet. It’s an easy and cheap way of keeping in touch with people. She uses e-mail, and she’s an active member of the blogging community. And together they provide her the support she can’t get locally.

This means more people with mental health difficulties, like Danny, will end up debt-free. And a far larger group of people will have made arrangements to deal with their debts in a way that doesn’t have a negative effect on their mental health and wellbeing. ● For more cartoons about existential discomfort and other things that go bump in the night: www.prozacville.co.uk

Get your priorities right If you are in financial trouble, these are the debts or bills you need to sort out first to keep your life on track, in order of importance. 1. Rent / Mortgage payments 2. Magistrates court fines 3. Council tax 4. Child support maintenance 5. Fuel/utility debts (gas and electric bills – there is no right to disconnect for water rates though you should include payments for your supply in your outgoings and any arrears as non priority debt) 6. Income tax 7. Hire purchase on essential items (e.g. for a car you need to keep) 8. Benefit overpayments 9. TV Licence

Practical help There is a lot of practical help available to stop you sliding back into the debt cycle. The mental health charity Mind produces a leaflet called Managing Your Money, designed to be pinned to the back of your door. It provides a weekly checklist of practical steps you can take to ensure you stay on top of your finances. This is something you can not only put on your door, but also give to someone you know so that they can give you a reminder each week of the things you need to do. Debt will continue to cause, and be caused by, poor mental health. The increasing climate of support and understanding of the impact this pair of issues has on people’s lives means that it is easier for people to address the problem, and to do it within a supportive environment.

Useful contacts Citizens Advice – www.adviceguide.org.uk To find your nearest CAB look at their website or in your local telephone directory under ‘Advice’ The Royal College of Psychiatrists has an extensive list of places to go for advice on its website. Go to www.rcpsych.ac.uk/debt and click “getting help” at the bottom of the page National Debtline 0808 808 4000 www.nationaldebtline.co.uk Community Legal Advice (CLA) 0845 345 4345 www.clsdirect.org.uk Mind provides a number of excellent resources about mental health and money – Mindinfoline 0845 766 0163 www.mind.org.uk/money The Mental Health Foundation booklet, Banking on good decisions, is available from www.mentalhealth.org.uk/publications Disability benefits helpline 0800 882 200 THe Department of Heath’s Credit Crunch Stressline is 0300 123 2000

ONE in FOUR 21


Mental health information online

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What readers say:* • 75% learned more about the challenges faced by people with mental health difficulties • 90% rate One in Four eight out of 10 or higher • Over 90% say there is a need for One in Four

One in Four is written for people with mental health difficulties, primarily by people with mental health difficulties. It is intended to be available to them free. One in Four is sold in bulk subscriptions to organisations like PCTs, mental health trusts, counselling services, local mental health charities and community advice centres so it can be picked up in clinics, surgeries, drop-in centres or staff canteens. For example, your organisation can take out a subscription for 30–50 copies, four times a year, and make them available to people who visit your premises or use your services. Alternatively you can order, say, 100 copies and distribute them, each quarter, directly to your service users, members or stakeholders.

www.oneinfourmag.org 22 ONE in FOUR

ONEinFOUR – a lifestyle magazine that inspires and informs people with mental health difficulties. It shows readers how to manage their condition and points them to sources of help and advice. It gives hope by showing positive, real-life examples. It combats stigma and discrimination by increasing understanding.

For example: • To receive 10 copies, four times a year, costs £45.00 (£1.12 a copy) • To receive 100 copies, four times a year, costs £240.00 (60p a copy) • To receive 1,000 copies, four times a year, costs £2,000.00 (50p a copy)

For a free trial copy, email stephen@socialspider.com * From readers responses


Feature

Bright gift ideas Buying gifts for that difficult someone is always a challenge. Mark Brown, a difficult person himself, offers some advice

Dear Diary

As the festive season rolls round once again, throughout the land goes up the cry: “What do I buy for the difficult person in my life?” And few are more difficult than we people with mental health difficulties. While it’s true that even people with mental health difficulties need socks and hankies, what might you buy that might actually make life a bit easier for us?

People with mental health difficulties are disorganised. It’s what we do. We forget stuff, miss appointments, forget to take our medication. People without mental health difficulties do this as well, so it’s not just us. Diaries, organisers and planners are brilliant gifts, as long as you don’t make a point when you give them. Do say: “I’ve bought you a lovely diary”. Don’t say: “I’ve bought you a lovely diary, so now you won’t forget your appointment / medication / meetings / wedding”. We’ll know you’re trying to help, but we still might find it difficult to smile appreciatively if you can’t resist pointing out that we’re disorganised. Even if it’s true.

Let there be light Lightboxes are something that can make a particular difference during the dark days of winter. Put very simply, lightboxes are very powerful high lux (the measure of brightness) lamps that simulate the intensity of natural ‘white’ light, fooling the body into thinking that it is a sunny spring morning, rather than a dark and grim January afternoon. To get an idea of how bright they are, a 60W bulb is about 50 lux at 1 metre away. An average light box might give out light equal to over 1000 lux. Lightboxes are not the same as sunlamps, so the person receiving one won’t get a tan, but, the thinking goes, they will feel less like they want to hibernate when there isn’t much sun around. Lightboxes are recommended for Seasonal Affective Disorder, a kind of mood disorder which occurs when people have less natural sunlight. Many people with mood disorders find things more difficult during the winter, the lack of light making it harder to concentrate, finding themselves lethargic, depressed and unable to get up in the mornings. You can even get alarm clocks that slowly light the room, mimicking a bright sunrise. A lightbox is literally a bright idea for a present.

“We know it’s a minefield, which is why we’ll be really chuffed when you buy us something useful...”

Help Yourself Self help books can be an excellent resource, providing useful and pragmatic information in an easyto-digest style. There are a number out there that will be particularly helpful for the person in your life who experiences mental health difficulties. How do you choose a good one? As a general rule, try to avoid anything with the word ‘cure’ in the title, anything that suggests that the secret to overcoming a particular condition is ‘easy’ or ‘simple’ and certainly avoid any book that suggests that mental health difficulties are a ‘scam’, a ‘conspiracy’ or don’t exist. Especially important is avoiding giving any book that implies that the only thing that stands between us and happiness is a lack of willpower. We know it’s a minefield, which is why we’ll be really chuffed when you buy us something useful, informative and which tells stuff we don’t already know. Or there are always socks. ●

ONE in FOUR 23


Cover Story

“We need a Union!” Laurie Penny speaks to veteran campaigner Andrew Roberts about the many changes he has seen in the way people with mental health difficulties are treated in Britain Andrew Roberts, 65, has had depression since childhood. In the 1970s he was a founding member of the Mental Patients’ Union, and he now runs The Survivor History Group, bringing together stories of the fight for patients’ rights over the past half-century. “What happens in psychiatric units today is dramatically different from what happened in the old asylums. In 1957, when I was thirteen, I was referred to a local mental hospital in Essex to have a machine called an encephalogram used on me – things shaped like hair curlers were attached to my head to measure my brainwaves. It worried me because there was a lady doing it, and I was wondering if she was reading my thoughts! “The range of treatments depended on the hospital and the ward. In some areas of the country you couldn’t get much apart from electro-convulsive therapy. Some hospitals, like Belmont asylum, specialised in brain surgery. The idea was that if you cut or damaged the fibres of the frontal lobes of the brain, it was supposed to result in the patient getting better.” Roberts received excellent care at the Ingrebourne neurosis centre in the 1960s, but his future wife, Valerie, was less fortunate. “When she was fourteen, Valerie was found wandering in a zombie-like state on a beach, and she was taken to Essex Hall, a hospital for people with learning difficulties – although the term then was ‘mental defective’. She was put in the ward for ‘the vegetables’. That was what she was called by doctors, in her hearing, a ‘vegetable’. She wasn’t spoken to except by slaps. “Valerie became withdrawn, and was unable to communicate except with her hands – a result of the treatment as much as anything else.

24 ONE in FOUR

She was given electro-convulsive therapy and the doctors wanted her to have brain surgery. Fortunately, a doctor got her transferred to Ingrebourne, where she began to improve. I met her there, and we married two years later in 1965, when I was 21 and she was almost seventeen.” Roberts and Valerie started a family, and remained married until her death in 1994.

Enter the Mental Patients Union

“...we wanted patients to be able to support one another and bargain collectively.”

In 1973, as students, the couple got involved in mental health activism. “A hundred mental patients attended a meeting in London, and we decided to set up a Mental Patients’ Union. Our aim was to represent all mental patients wherever they needed to be represented – we wanted patients to be able to support one another and bargain collectively.” Roberts explained that the idea of mental patients supporting one another had been growing for some time. “In the 1950s, Tommy Richie was a detained patient in a Scottish asylum. He volunteered to be a shaver for the old men in the hospital, which meant he had access to the locked wards, so he was going around shaving the men and talking to everyone. One day, an elderly patient called Archie Meek, who had been a trade union organiser, said ‘we need a union, Tommy, you ought to set one up.’ So Tommy used his position as a shaver to collect stories from all the patients and they put them together and wrote a collective grievance, even though they were in locked wards and never able to meet. Tommy sent it to the hospital authorities, and slowly, things began


to change. Tommy told me that he spent ‘years putting in my individual grievances and nobody did anything. When we started doing things together, then we started to be heard’.”

Changing treatment One of the first demands of the Mental Patients’ Union was for the abolition of compulsory treatment. “We wanted to work towards treatment being made voluntary. In those days, if you were detained in hospital any treatment that was available might be given to you without your consent. Compulsory treatment wasn’t defined legally in the way that it is now – the controls over treatment came in with the 1983 Mental Health Act, partly as a result of the Mental Patients’ Union. In practice many treatments were compulsory even for voluntary patients. Some treatments like ECT required a consent form, so the nurse would come over to a heavily sedated person in bed, and take their hand and guide it to sign the consent form. If you see that happening in front of you, you think twice before refusing to take a tablet when you’re given it.” Roberts believes that life has improved for people with mental health difficulties in Britain. “The biggest change for the better in the

last 40 years has been the change in the culture. In the 1940s, the culture was still dominated by eugenic thinking – the idea that anything to do with disability was shameful. It wasn’t just a problem for people to admit that they were a mental patient – it was even hard for people to admit that they might be related to a mental patient!” Roberts has seen many changes in the treatment of people with mental health difficulties and feels that change is an uneven process: “I don’t think people with severe mental health difficulties have enough support at the moment – but then, I don’t think they ever did have enough support, not even in the asylums.” “Each time something changes in mental health treatment some people suffer, and certainly there are people today who might have been better off in one of the old asylums. “In general, though, whatever the problems are with their present situations, people are happier now.” ● The Survivors History Group is working towards a comprehensive history of the contribution people with mental heath difficulties have made to history. See www.studymore.org.uk/mpu.htm

One in Four is looking for journalists, researchers, illustrators and photographers If you have a mental health difficulty and would like to be involved in the production of a high quality magazine, One in Four would like to hear from you.

One in Four works by commissioning writers. To help us do this you should send samples of your work and an outline of the kind of things you are interested in writing about. We are looking for factual writing and are extremely interested in personal experience. We are less likely to commission people to write opinion pieces. We are interested in original illustrations and photographs. You should contact One in Four in writing before sending any samples of your work. If you have any ideas for issues or stories we should cover, please contact us by letter or by email to oneinfour@socialspider.com.

One in Four is produced by a small team. Please allow at least six weeks before following up any submissions of artwork, writing or other contact. One in Four also conducts workshop sessions where our journalists work with people to develop stories for the magazine and pass on research and journalism skills. If you, a group to which you belong or an organisation that you work for or attend might be interested in one-off or regular sessions, contact One in Four with information about your activities and we will try to arrange sessions.

ONE in FOUR 25


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Real Lives

A week in the life of… Heather Payne, media action worker, South Warwickshire User Forum (Mental Health) It’s official. I have the best job in the world. I am passionate about raising awareness of mental health issues and fighting discrimination. I am equally passionate about the media, marketing and communications. Put these together and you get my current post: Media action worker. A post that has enabled me to utilise my learnt skills along with my lived experience. Bliss. I’m employed by South Warwickshire User Forum (Mental Health)(SWUF) to manage a three year, Comic Relief-funded mental health anti-stigma project, known as the Awareness, Media and Information (AMI) project. SWUF is a user/survivor-led organisation which exists to empower mental health service users and survivors (and the occasional refuser!). One of the joys of my job is that there is no typical week. Another joy of the job is the people I work with on the project who are full of enthusiasm and energy. A Monday might see me taking part in one of our ‘Wild Warwickshire Walks’. These are advertised to those within the mental health community and the wider community, to enable us all to get some exercise, enjoy each other’s company and learn something about the people we’re walking with. Not just their diagnoses. Once a fortnight, on a Tuesday, we hold a media watch group meeting at the Old Art Gallery in Leamington Spa. We discuss how mental health has been portrayed in the media and how we would like to respond – either positively or negatively. For example, we recently complained about The Sun’s use of the word ‘schizo’ in one of its headlines, but also praised our local newspaper for its coverage of sensitive issues. At the request of the group, I also produce a weekly mental health TV and radio alert.

“I have the best job in the world” This sees me sitting at my desk, hunched over a copy of Radio Times each Tuesday afternoon, searching for any programmes which may have a mental health theme or content. This is then loaded onto our website and Facebook group, and emailed out to a rapidly growing mailing list. I usually try to plan workshops or events on a Wednesday. Last week saw the premiere of our participative video films. These were produced by service users and survivors in South Warwickshire and tell the stories they want to tell. We were lucky to get the support of Open Up area coordinator Lyn Jenkins to run these workshops and we’re hoping to run more in the future. One of the aims of the AMI project is to establish a ‘Talk Bank’

of people who are willing to share their stories with the media. We want to increase the number of positive representations of people with mental health difficulties within the local press. One of our ‘Talk Bank’ members, Denny, very bravely talked to a local journalist about his life with a diagnosis of schizophrenia. It appeared in a local paper on a double-page spread, with ‘schizophrenia myths and facts’ listed as well as descriptions of the recent Time to Change anti-stigma adverts. We are keen to show that we’re not something ‘different’ – we eat, sleep, live and love in exactly the same way as other people, but we may need extra support when we find life difficult. I’m lucky in that I currently work four days a week but this will be changing in the near future. We have secured funding for a Positive Images and Voices arts campaign from Warwickshire County Council which will enable me to spend a day a week co-ordinating photography, video, radio and publishing workshops for the mental health community across the whole of Warwickshire. We hope that by equipping people with skills and providing them with experience, we can work towards the day when service users and survivors are empowered to run their own organisations. ● Heather can be contacted at South Warwickshire User Forum (Mental Health), 44 Holly Walk, Leamington Spa, CV32 4HY (01926 335569). To be added to Heather’s TV and radio alert emailing list, send an email to: heather@swuf.org.uk. You can find out more about SWUF and about the AMI project at www.swuf.org.uk and www.stopstigma.org.uk

ONE in FOUR 27


Reviews

Understanding psychosis What is psychosis?

Voicing Psychotic Experiences – a reconsideration of recovery and diversity edited by Ruth Chandler and Mark Hayward 196 pages Pavilion Publishing (Brighton) Ltd 31 Jul 2009 ISBN: 978-1841962504 Psychosis is perhaps one of the most stigmatised aspects of mental illness, with those who experience it often feeling written off as lost causes. Voicing Psychotic Experiences – a reconsideration of recovery and diversity aims to destigmatise psychosis and to promote that most important of concepts: hope. In the book, people who experience psychosis share their experiences and explore the meaning in them. These individuals detail the effects these experiences had on their lives, as well as on their families, friends and colleagues. This book attempts to challenge the assumptions that surround psychosis. It views psychosis less as an illness and more as a unique way of perceiving the world around and inside us. Through the narratives of those who have experienced psychosis, it probes the idea that the traditional model of treatment – the divisive us/them structure that places one as ill and one as sane – may not be helpful. It tries to illustrate that, rather than ‘treating a problem’, those who care for people who suffer from psychosis should instead consider the value of the experiences and not try to enforce a model of recovery that is one-size-fits-all. The contributors share what they have found helpful, and unhelpful, in their treatment and management, with some accounts being quite shocking to read. These stories give a human voice to psychosis, and the intricacies and detail in them is extremely valuable when, by and large, there exists only

28 ONE in FOUR

The word psychosis is used to describe a mental health problem that can affect the brain, distorting how someone sees and experiences the world, making it very difficult for them to tell what is real from what is not real. Psychosis can form a part of a number of different mental health difficulties and is treatable like any other illness. According to Rethink, three people in every 100 will experience a psychotic episode at some point in their lives making it more common than diabetes. cold medical texts, written in frigid generalisations. As the book is a collaborative effort, its freestyle manner might be irritating and difficult to follow for some. Although it’s fascinating reading for the layperson, it is mostly aimed at mental health professionals, so it does have an agenda to push. It’s a positive agenda, however. Because psychosis is seen as the most severe form of mental illness, those who experience it are often treated differently by the psychiatric profession to those with other mental health difficulties. Voicing Psychotic Experiences tries to show that this is unintentional, and institutional, marginalisation. It proposes a different approach that doesn’t involve trying to get inside the world of psychosis or diminish its distressing and destructive powers, but instead understands the psychotic experience within the context of a person’s life. The approach that the book advocates means building a relationship with the person as they are – by listening without judgment – rather than the person you think they should be. Seaneen Molloy

A psychotic episode, where someone experiences losing contact with reality, can be extremely frightening and confusing. Someone experiencing a psychotic episode might have confused thinking or hallucinations where they see or hear things that others don’t. They might have beliefs, called delusions, that are not true, even though they feel completely true to the person having them, who might then behave in extreme ways that make sense to themselves but not to other people. Rethink has excellent information to help you understand psychosis: www.rethink.org/about_mental_ illness/early_intervention/ understanding_psychosis/ what_is.html


Reviews

The voice of youth Youthhealthtalk Youthhealthtalk.org As a teenager, making sense of your mental health can be tricky; feelings of pointlessness, apathy and the overwhelming injustice of life are an adolescent standard. And talking about it is even harder. There’s a good chance you’ll be told to stop moping around and snap out of it. It’s just not fair. One in 10 young people in the UK experience depression, persistent low mood or anxiety: intense emotions, thoughts and physical symptoms that won’t go away. Youthhealthtalk is an awardwinning charity website for young people in their teens to midtwenties that covers issues like sexual health, teenage cancer, epilepsy and other long term health conditions. It focuses entirely on people’s real experiences, barely gives advice beyond what is given by the young people themselves, and is agenda free. A new section of the website gives young people a chance to watch, listen to and read other young people talking honestly and frankly about their own experiences of depression and low mood. Thirtynine young people aged 16 to 27 talk about the early signs and symptoms, bullying and feeling different, coping strategies and treatments. “I’ve always heard these voices,” says Erika-Maye, 17, speaking on the

site. “I can’t remember not hearing them, and for as long as I can remember I’ve always felt like I’m just draining people, and being a waste of people’s time. And when they told me that the voices were depression-related, then I was saying I’ve heard them for as long as I can remember, so…”

Using stories to cope Commitment to letting people tell their own stories means the site can tackle difficult or controversial subjects, like being discovered selfharming by parents, why someone might be wary of contacting support aimed at young Muslims, or not being able to get any sensible advice: “I’d look at things and it almost seemed like you were in some kind of video game,” says university student Tom, 21, speaking on the site. “I was thinking, ‘Well there’s something wrong with my eyes or something…’ I literally didn’t know anything about depression. So I rang up like NHS Direct and they were like, ‘Drink lots of fluids, you know, make sure you do this and

have you had a heart attack in the last five weeks, have you... whatever…?’ And I was just like, ‘This is useless. They haven’t got a clue what’s going on’.” Although the site is aimed at young people and their families and carers, its refusal to hide the difficulties some people face getting help or treatment has led to it being used for teaching and training in schools and the NHS. Youthhealthtalk has a simple purpose: it is a place where you can find out how other people have coped with whatever you might be going through. It’s a useful alternative to the prescriptive format favoured by most websites because, as Thom Yorke from Radiohead says in his video introduction, “Other people’s stories are how we cope.” Verdict: 9/10 A revealing and reassuring insight into other people’s real experiences. David Warrington

ONE in FOUR 29


Mythbusting

Only people who are weak have mental health difficulties Reality: Anyone might develop a mental health difficulty Myth:

We all, from time to time, experience things that upset our normal way of thinking or behaving. Sometimes we might feel sad, upset, stressed or unable to deal with things that we normally would. We also might sometimes hear things or see things that are not there or have thoughts that seem unusual, especially if we are very tired or distracted. This is a normal part of life. Most of the time we will be able to shrug these things off or work out what has caused them and do something about them. This is just getting on with life. It is normal for us to feel sad if we lose a loved one or experience a setback in life. Similarly, if we have not rested enough or are very busy we can feel unfocused and find it difficult to concentrate on what we are doing. If we rest and take time to collect our thoughts we can usually move on and feel better and more productive. When someone is experiencing what might be called a mental health difficulty or mental health condition or problem, they might be experiencing some of these things but in a different way.

What is a mental health difficulty? When someone has a mental health difficulty, they are experiencing things that last far longer than short disruptions to everyday moods or sensations. Mental health difficulties are disturbances of mood, thinking, emotions or perception that last over a period of time and get in the way of doing things that you want or need to do. Although they may sound similar to things that are common experiences, all mental health difficulties

30 ONE in FOUR

share in common the fact that they are far more difficult to overcome, last for a far longer period and pose more challenges in overcoming them. They are more than simple ups and downs.

What are the different kinds of mental health difficulty? Mental health difficulties fall into three main categories: Some mental health difficulties affect your mood: People who have depression, an anxiety disorder or a combination of the two can find it very hard to feel contented, stable and calm, no matter what they do and no matter what is happening in their lives. Someone who has a bipolar disorder may experience extreme ‘highs’ as well as low periods. They might experience moods swing between times when they feel extremely energetic and excitable, which can lead to them losing insight into their behaviour and lacking their usual judgement and times when they feel depressed and lacking energy. Some mental health difficulties affect your behaviour: Some conditions, such as personality disorders, eating disorders and Obsessive Compulsive Disorder affect the way that people interact with the world. People with personality disorders have very fixed understandings of the world and their place in it, which can lead them to make decisions and respond to situations in ways that interfere with their life, work and relationships. People with behaviour-affecting mental health difficulties may feel strong compulsions to behave in certain ways.


Some mental health difficulties affect your thinking: Conditions like schizophrenia, schizoaffective disorder and dissociated identity disorder affect the way in which people think and perceive the world around them. They may experience distressing thoughts and ideas which they cannot control, for example, or they may have hallucinations seeing or hearing things that other people cannot see or hear, or finding it more difficult to think clearly. Many people with mental health difficulties experience more than one kind of difficulty at the same time – for example, people with schizophrenia may also feel very depressed and lacking in energy and some people with bipolar disorder can also experience hallucinations.

Why do people develop mental health difficulties? Medical researchers have found that there are physical, social, environmental and psychological factors that contribute to mental health difficulties. Some conditions, such as schizophrenia, can be inherited genetically and can be aggravated by things that happen in your life such as substance misuse, severe injury or vitamin deficiencies. Along with our genetic and biological makeup, social and

environmental factors can affect whether or not someone develops a mental health difficulty – for example, where a person lives or how much stress or disruption they have in their life. Some people who develop mental health difficulties have suffered traumatic events in their lives.

Overcoming challenges Different mental health conditions pose different challenges. People with mental health difficulties may have to work hard to do some things that other people take for granted. To understand how this works, it can be helpful to think of mental health difficulty in the same way as we think of some chronic physical illnesses, like asthma, arthritis or allergies. All of these are conditions make it harder for people to overcome daily challenges and mean that it takes extra physical and mental strength. Mental health difficulties are the same. It can often take more strength to face up to a mental health difficulty than it does to hide it. It is important to remember that being open about having a mental health difficulty is not a sign of weakness but of courage. ● Laurie Penny

Coming Next Issue … Talking about mental health – How do we get it right?

Weight and see? Medication, weight and health

What's next? Mental health, political parties and the next election

Plus: Interviews, opinions, reviews, lifestyle tips and more… ONE in FOUR 31


Acknowledgements Contributors: Dan Holloway, Dr Liz Miller, Seaneen Molloy and Mary O’Hara. Illustrations: Martin Parker. Thanks go to: Stewart Cameron, Ryan Davey, Chris Fitch, Megan Charles, Maria Jacovides, Dr Kay MacDonald, Karen Machin, the Money Advice Liaison Group, Sarah Murphy Michele Smith, Bridget Gardiner and Beccy Wilks.

One in Four advisory group: Steven Allen, Robert Ashton, Andy Bell, Naomi Garnett, Liz Gray, Catherine Grinyer, Katherine Hall, Mira Khreino, Andy Koumi, Simon Lawton-Smith, Claire Monger, Brigid Morris, Jonathan Naess, Liz Nightingale, Tracy Simpson, Georgina Wakefield.

Friends of One in Four: We thank the following who have generously supported this project by becoming a Friend of One in Four: Judith Haire, Open Up, Mary Heavin, Peter Barnham, Making Space Warrington, Sam Robinson, The Spectrum Centre for Mental Heath Research (Lancaster University), Mental Health Providers Forum, Freemind Wellbeing CIC.

How to get copies of One in Four: Social Spider, the publisher of One in Four, produces this magazine with the intention of having it made available free for people with mental health difficulties. Subscriptions are on the basis of multi-copy, one-year orders, over four issues. The price includes delivery which is a substantial part of the cost and the bigger the order, the cheaper the magazines. For example, a small order is £1.12 per copy but for bigger orders the price comes down to 50p per copy. You can download an order form from www.oneinfourmag.org/subscription.pdf, telephone Social Spider on on 020 8521 7956 or use the form at the bottom of this page. If you cannot find a copy of One in Four at your GP, mental health clinic, library, Mind charity shop, university counselling service, drop-in or similar venue you may like to encourage them to subscribe and show them the form below.

One in Four can be bought online in single copies of this issue for £2.50, a bundle of 10 copies of this issue for £20 or a bundle of one copy of each of the previous six issues for £12. Go to www.oneinfourmag.org/getacopy.html and click the appropriate button.

To order copies of One in Four tear out this form and send it to: Stephen Gardiner, One in Four magazine, Social Spider CIC, 5 Hatherley Mews, London, E17 4QP I would like to order One in Four magazine for one year (four issues). Please tick no. of copies of each quarterly issue

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32 ONE in FOUR


Directory Organisations that provide useful information Mind Mental health charity working to create a better life for everyone with experience of mental distress

Mind infoline – Monday to Friday 9.00am – 5.00pm Tel 0845 7660 163 Website www.mind.org.uk

British Association for Counselling and Psychotherapy (BACP) Publishes directories and other information to enable those seeking counselling and training to make an informed choice

Tel 01455 883316 Email bacp@bacp.co.uk Website www.bacp.co.uk

SANE Improving the lives of everyone affected by mental illness

British Association for Behavioural and Cognitive Psychotherapies (BABCP)

Helpline 0845 767 8000 Email info@sane.org.uk Email sanemail@sane.org.uk Website www.sane.org.uk

Accredits therapists who practise Cognitive Behavioural Psychotherapy (CBT) and publishes a directory of all its accredited Cognitive Behavioural Psychotherapists

NHS direct

Tel 0161 797 4484 Email babcp@babcp.com Website www.babcp.com

Provides no-nonsense health information

Website www.nhsdirect.nhs.uk Mental Health Foundation Provides information, and carries out research and campaigns, working to improve services for anyone affected by mental health problems

Tel 020 7803 1101 Email mhf@mhf.org.uk Website www.mentalhealth.org.uk Rethink Aims to help everyone affected by severe mental illness recover a better quality of life

Tel 0845 456 0455 Email info@rethink.org Website www.rethink.org National advice service Tel 020 7840 3188 (10am to 3pm Monday, Wednesday & Friday; 10am to 1pm Tuesday & Thursday) Email advice@rethink.org Citizens Advice Helps people resolve their legal, money and other problems by providing free information and advice

Website www.citizensadvice.org.uk Samaritans Provides confidential non-judgemental support, 24 hours a day for people experiencing feelings of distress or despair, including those which could lead to suicide

Tel 08457 90 90 90 Email jo@samaritans.org Website www.samaritans.org National Self Harm Network

Relate Charity providing counselling, sex therapy, relationship education and training to support couple and family relationships throughout life

Tel 0300 100 1234 Website www.relate.org.uk PAPYRUS Prevention of Young Suicide Provides support and practical advice to young people worried about themselves or their friends

Helpline HOPELineUK 0800 068 41 41 Admin 01282 432555 Email admin@papyrus-uk.org Website www.papyrus-uk.org Employers’ Forum on Disability (EFD) The EFD’s mission is to enable companies to become disability confident by making it easier to recruit and retain disabled employees and to serve disabled customers

Tel 020 7403 3020 Email enquiries@efd.org.uk Website www.efd.org.uk MDF The BiPolar Organisation Helps people affected by bipolar disorder. Includes UK Self-Help Group Network and Self Management Training Courses

Tel 08456 340 540 Email mdf@mdf.org.uk Website www.mdf.org.uk Royal College of Psychiatrists Produces information leaflets on a wide range of mental health difficulties and the available treatments

Tel 020 7235 2351 Website www.rcpsych.ac.uk For leaflets or a free catalogue, tel 020 7235 2351 ext 259 or email leaflets@rcpsych.ac.uk

Helps people who self-harm or injure

Tel 020 8772 9900 Email nshncg@hotmail.co.uk Website www.nshn.co.uk Consumer Credit Counselling Services Provides confidential, free counselling & money management assistance

Tel 0800 138 1111 8.00am – 8.00pm, Mon – Fri Website www.cccs.co.uk

Would you like to be involved? One in Four is looking for journalists, researchers, illustrators and photographers. See page 25 for more details. ONE in FOUR 33


Letters First step I would like to respond to the review by David Floyd of Doctoring The Mind by Richard Bentall by broadening the debate about the use of diagnostic labels, psychotropic drugs and treatment strategies for individuals with mental health difficulties. My views would broadly concur with Richard Bentall, but I think the debate needs refining rather than polarising. To suggest that there is no bio-chemical or genetic association with mental illness is as absurd as asserting that medication alone is the long term solution. The truth is very complex. My clinical experience as a psychotherapist over the years and more recently a student counsellor tells me that there are certain circumstances where both diagnosis and medication may prove containing and helpful. Naming is often the first step on the road to recovery. On the other hand, labels and medication can reinforce illness by having the effect of summing up an individual’s identity. In my view, only counselling or therapy can effectively navigate a way through this by offering an understanding of mental illness as part of an individual’s life experience, rather than a kind of disease that somehow invades a person. I find using this approach often leads individuals to greater personal insight, enabling them to reach healthy parts of themselves, leading, in many cases, to sustained recovery. – Bev Gold

Best intentions An anxiety attack just after leaving my office a few days ago got me thinking about how I’d deal with my work situation should I have a depressive episode. I suffered from fairly debilitating depression a few years ago but thankfully at the time I was not in full time employment and 34 ONE in FOUR

was able to work around it. I now work full-time in a very friendly, small office and if I were to have an episode it would be pretty obvious to everyone I work with. At the same time, the occasional anxiety attack wouldn’t affect my work in any real way and I don’t want to have to face the questions, looks and doubts about my ability that come from admitting you have mental health issues. I fear that even with the best intentions I would be ‘protected’ from high stress situations by colleagues and therefore unnecessarily held back in my career by well-meaning discrimination stemming from a lack of knowledge. – Will Hoyles

Charity burlesque I only found out about One In Four by accident last month when a friend suggested that I come along to a charity burlesque event. I was surprised to find that the charity was Mind (I’d naively assumed it would be a breast cancer charity) and even more stunned by the quoted fact that one in four adults will experience mental health problems! The title of the event, Naughty Sorts presents One In Four, inspired me to do a little more research which was when I found this magazine. Throughout the show they asked us to raise our hands if we’d done some very common things – more hands were raised when we were asked if we’d ever been depressed than for anything else. Before now I’d not even considered that something as jolly as a burlesque event could help to publicise mental health issues but it really seemed to work – perhaps in the same way that making lessons fun always did at school. I, for one, am far more likely to remember things told to me by a ukelele-playing ex-teacher in a kilt than by someone in the street handing out leaflets. Naughty Sorts presents One In Four made us think about the inappropriate language we all

Write to: One In Four letters Social Spider, 5 Hatherley Mews, London, E17 4QP oneinfour@socialspider.com Please supply a postal address and an email address if you have one. We will not publish these details unless you ask us to. We may edit letters. The best letter received will win a selection of books, including a copy of The Compassionate Mind, by Paul Gilbert courtesy of Constable.

Tell us what you think of One in Four and win! Enter our prize draw by filling in the questionnaire opposite and returning it to One in Four to win one of two selections of books, including copies of The Compassionate Mind by Paul Gilbert, courtesy of Constable. sometimes use and the way the subject matter is treated as taboo within society in general. We realised that most people are, or know someone who is, affected by these issues. I can only hope that more events like this will be organised in the future to help continue the good work. – Lorraine Smith


Competition Tell us what you think of One in Four and win! Fill in the questionnaire below, cut it out and return it by 19th February 2010 to: Feedback, One in Four magazine, Social Spider CIC, 5 Hatherley Mews, London, E17 4QP. If you prefer, you can also answer online at www.oneinfourmag.org First two entries selected at random on Friday 19th February 2010 will be winners. 1. Where did you find One in Four? Health care setting (hospital or place of treatment) At your GP’s surgery At the library At university At an organisation or group you attend (eg Mind, a support group) In a charity shop I received it by post I requested a sample / received a sample Other (please specify) .......................................................... 2. What region of England do you live in? East Midlands East of England Greater London North East England North West England South East England South West England West Midlands Yorkshire and Humber I don’t live in England 3. Do you think there is a need for One in Four? Yes No 4. How interested are you in reading future issues of One in Four? Interested Might or might not be interested I’m not interested 5. Do you consider yourself to have a mental health difficulty? Yes No 6. Are you: A mental health service user A carer A mental health care professional None of the above 7. Do you know more about mental health difficulties after reading One in Four? Yes No I already know a lot about mental health difficulty

Name ………………………………………………................

8. Thinking about One in Four, do you agree with any of the statements below? (tick as many as you like) As a result of reading One in Four… …I have learned more about the challenges faced by people with mental health difficulties …I have learned more about my own condition …I am more likely to seek treatment …I feel less worried …I am less worried about debt …I feel less worried about my mental wellbeing …I know more about ways to overcome debt …I feel more likely to continue with treatment …I understand mental health difficulties better …I feel better informed …I feel more able to access help …I feel more confident about my finances …I feel more included …I feel less like I am a failure …I am more aware of sources of help in general …I am less likely to judge people with mental health difficulties …I feel more hopeful for the future …I have found out practical changes I can make in my own life …I feel inspired to try new things

One in Four Magazine… …has given me new ideas about my life …has told me things I didn’t know about mental health difficulty …has made me see people with mental health difficulties differently …has helped me understand mental health difficulty …is a new way of looking at mental health difficulty …is worthwhile 9. Will you show One in Four to other people? Yes No 10. On a scale of 1 to 10, with 10 as like a lot and 1 as don’t like at all, how would you rate this issue of One in Four? Don’t Like 1 2

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Like a lot 9 10

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Stressline

Worried about money, your job or losing your home? So much you can’t sleep? Or fear the worst? Talk to us. Are worries about money, your job or maybe losing your home causing you to feel stressed and affecting your health? If so, you can call the NHS Stressline. Trained health advisers will listen to you, provide you with immediate support and offer encouragement to help you access the resources and services that can help. Whatever your problem, no matter how big or how small, we will offer you practical advice and point you to where you can get help to address your worries about money, debt or employment.

Call 0300 123 2000 8am to 10pm, 7 days a week

Calls should cost the same as those to standard landlines and may be part of your call package. Costs from mobiles may vary.

www.nhs.uk/financialstress


Sample - One in Four Winter 2009