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Inner space for women’s mental health & wellbeing Issue

13

Autumn 2012

The benefits issue Who benefits?

MPs ‘fess up about mental health problems I’m in two minds

What’s your gut instinct telling you?


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This year

GPs in Scotland carried out a patient survey to find out how changes to benefits was affecting them. One issue dominated: the number of people presenting with deteriorating mental health. There were two groups; those in work and experiencing increased anxiety due to work overload and job insecurity, and those unemployed who had chronic mental health problems and physical problems as well and who were now being assessed as ‘fit to work’. Although doctors agree there has been no specific evidence to suggest suicide rates have gone up due to the new welfare reforms, they are seeing an accumulating rise in tragic stories and deepening despair. One doctor responding to the survey, wrote of

his discomfort at witnessing what he considered to be a “deluge” of “aberrant” fit-for-work decisions: “The last few months have been among the most depressing and disturbing times in my many years as a GP” he concluded. In this issue of Sanctuary we look at where the welfare system began, in 1945. The pioneers of a state that created a duty to the vulnerable, from the ‘cradle to the grave’ might turn in their own graves if they could see how their vision has been ‘reformed’. No-one doubts things have to change; there simply isn’t the money to go on as before, and wheedling out the fraudsters is every decent claimant’s wish. But this system, perhaps not the theory of it but the execution (by Atos the ‘healthcare’ provider running the

assessments) is deeply flawed when it comes to the ‘nuances’ of mental – and physical – disabilities. One size fits all appears to be the standard. There is hope. The number of successful appeals is one. They show how flawed the assessment procedure is. The growing barrage of objections from leading GPs, mental health charities and disability rights charities is another. Deep concerns, appeals, tribunals, sickness in the workplace and costs due to increased medication, crisis intervention and so on: all of that stacks up to an even more persuasive argument for changing the system – at present, it could be costing much more than it's saving, and that includes lives as well as money.

M egan

Editorial comment Tell us your news and views – we’d love to hear from you: Write to: Sanctuary magazine Let’s Link PO Box 533 Betchworth RH4 9FL Telephone: 07824 364703 Email: megan.aspel@sky.com Visit: www.letslinkmentalwellbeing.com

Sanctuary is free to everyone. Editor: Megan Aspel Assistant Editor: Louisa Daniels Sanctuary is commissioned by NHS Surrey

Design by Aspects: studio@aspectsgd.com www.aspectsgd.com Printed by Progression Print: www.progressionprint.co.uk No part of this magazine may be reproduced without prior permission of the publishers. Copyright © Aspects 2012.

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The Benefits Issue 4

The Work Capability Assessment (WCA) was introduced and set up by the New Labour government in 2008 through its Welfare Reform Act of 2007. The Work Programme is part of the Coalition government’s welfare reform. The two now form the basis to determine who is eligible and who is not, to benefits. The new system has attracted debate, criticism and concern. Some critics suggest the ‘shoe-horn’ 15 point scale that assesses people for work makes little economic sense. Sanctuary delves into the big benefits issue... The Welfare State as we know it had its roots in our early history. Welfare support was characterised by voluntary provision with mutual and friendly societies delivering a range of benefits. Poor Laws were introduced, but the way people were supported did not change extensively until a certain Liberal politician Beveridge wrote a strategy for a complete overhaul of the welfare system in 1942. Voters in 1945, having supported and hung on Churchill’s every word during the Second World War, wanted an end to wartime austerity. Any return to pre-war economic depression as well was unthinkable. In short, people of Britain wanted change.

Three years before the war ended the economist William Beveridge had synthesised the bravest visions of all important government departments into a single breathtaking view of the future. When the war ended, people wanted the future – now! The 1942 Beveridge Report spelled out a system of social insurance, covering every citizen regardless of income. It offered nothing less than a cradle-to-grave welfare state. Even though Churchill had in fact presided over the planning for radical social reform, even though he was a genuine hero of the masses, and even though the Tory pledges were not very different from Labour’s, it was the Labour opposition,

£££ £££ £££ £££

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dangling before the electorate, the new world that Beveridge had painted, who gained the people’s vote. The bedrock of the Liberal Beveridge’s (now Labour’s) vision which Labour were prepared to tackle and pool resources for was based on five key needs: Want – the need for adequate income for all; Disease – the need for access to health care for all; Ignorance – the need to access educational opportunities; Squalor – the need for adequate housing and Idleness – the need for gainful employment. The Welfare State of Britain was born. Throughout subsequent governments through to today, both welfare and health have been hot topics. Reforms, changes, re-‘visions’, all have exercised the thinking of politicians and people. Now we have the biggest shake-up in 60 years, with a system that requires all claimants of what was the Incapacity Benefit, and is now the Employment & Support Allowance, having to undergo the Work Capability Assessment (WCA).

What does it all mean for people with mental health problems?

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Many readers, or people you know, will already have gone through the WCA process. How was it for you? Within our knowledge/experience at Sanctuary we’ve heard little positive feedback. This is born out by the increasing number of people and organisations rallying to tell Government to re-think the computer based assessment form and decision making procedure that determines someone’s eligibility for benefits. MIND’s infoline has been inundated with calls from people suffering mental ill health or their carers, concerned about the Work Capability Assessment (WCA) and its implications on their lives. ‘Computer based assessments “inadequate” with “little regard to the nature or complexity of the needs of long-term sick and disabled”…’ is how GPs have described the process. They voted unanimously in favour of scrapping the WCA stating it is in real danger of harming “some of the weakest and most vulnerable in society”. GPs echo others concerns, including many in the voluntary sector, nationally and locally, that “The computer based assessments are carried out by a healthcare professional but one not necessarily trained in the field of the patient’s disability, which is particularly important when it comes to mental health issues.”

Demonstrations During the Paralympics disabled people stormed the Department for Work & Pensions (DWP) and other activists demonstrated at Atos healthcare headquarters in London. Atos are the prime providers of the WCA. It marked a week of demonstrations against the fitness for work assessors during the Paralympics of which Atos continue to be sponsors. A French owned IT company, Atos is not unfamiliar with demonstrations and accusations, some of which have reached the High Court. The most recent, in July this year, shone a light on mental health claimants. Two people who suffer with mental health problems were granted permission to bring a claim for judicial review by the Secretary of State for Work & Pensions to challenge how the WCA is operated.

They believe – and the judge agreed – that, because Atos healthcare professionals (HCPs) have little knowledge of mental health issues they should seek expert medical advice / reports on the claimant themselves, rather than it being left to the claimant to organise. To not do so is arguably a breach of the duty to make reasonable adjustments under the Equality Act. A secret televised film was undertaken by a GP who applied to become an Atos assessor. Subsequently shown on Channel 4’s Dispatches, it highlighted how staff are monitored to ensure they do not find excessive numbers of claimants eligible. The film also showed how much harder it is for even severely disabled people to qualify for support. The WCA has been subject to two independent reviews. Looking at the mental health descriptors (the questions in other words) there has been some detailed discussion and work carried out by a Scrutiny group of highly professional psychiatric and psychological experts, following recommendations made by mental health organisations, including MIND. In the first review in 2010, it was noted that mental and behavioural disorders make up the largest group of ESA claimants. However the first review found that many people believe that mental, intellectual and cognitive conditions are poorly accounted for under the WCA. This is true especially where people may be unwilling or unable to explain the extent of their problems.

What next? The concluding statement from the second review carried out in 2011 is: ‘The first independent review of the Work Capability Assessment (WCA) concluded that the assessment is the right concept. This remains the case. However, the first review also concluded that modifications at all stages of the assessment process were required to make it a fairer, more effective and more humane process. In this respect positive progress has been made over the last 12 months, and the Review expects this progress to be consolidated and built upon in the next year.’ It will be interesting to see the next review. As the groundswell of opinion and case studies mount, highlighting the pitfalls and personal anguish the WCA prompts, what will further recommendations recommend? Meanwhile, around 11,000 people per week are being assessed for ESA. Of those a high percentage suffers with mental health problems. WorK? Who needs it? Well, with very few exceptions, sufferers would gladly give up the pain and loss they feel every day due to a mental illness, for the chance to work and lead a life free from mental anguish. But the WCA, whilst in theory might be all well and good, simply lacks the nuance and ‘nous’ – or rather the assessors do – to recognise the life shattering and often life eclipsing elements of mental ill health with which an individual has to deal. The WCA providers could do with a reality check – and a little lesson in humanity perhaps. Then they might be worth some of those millions of pounds. (Sanctuary contacted Atos and Maximus which is the prime provider of the Work Programme to gain a balanced view of the situation. Neither responded) Continued page 7...

15 The Benefits Issue continued…

shades of grey?

Forget the book 50 shades of Grey; the WCA process will have you shackled and bound in no time! There is the 21 page questionnaire for a start, just to get you in the mood – the mood to spit feathers (and not from a satin encased pillow either!). On completion and return of the questionnaire, you may be called in for a face-to-face assessment. This is done via the WCA form. The questions ask the same things as the questionnaire but in a slightly different way, and the assessor may ‘tease’ out other information as they see fit. The big difference is the face-to-face questions have a score attached. A person has to ‘achieve’ 15 points on the WCA face-to-face assessment. Someone might score 15 on one question alone, or it might be on several. And some people score nothing at all. There has been criticism that the health assessors rush the process and may even have targets for the number of people they must find not eligible any more for benefits. The undercover film we mentioned, made by a doctor about training of healthcare assessors, showed one trainer suggesting no matter how serious claimants problems are, with their arms, for example, “as long as you’ve got one finger, and you can press a button,” they would be found fit for work. Anyone who has suffered a mental illness, or who is a carer, friend, colleague, knows that the nuances an illness can bring mean that nothing is black and white; everything is several shades of grey. Neither the system, nor apparently the

assessors recognise this. Here’s one example of a question on the questionnaire sent to claimants and on the WCA form itself, which you would complete if asked to attend a face-toface assessment. If you are considering appealing against a WCA decision, you can find the appeal process on the DWP website: www. dwp.gov.uk If you would like to talk to someone, please visit your local Citizen’s Advice Bureau If you have a story you would like to share, please send it to Sanctuary magazine, c/o PO Box 533, Betchworth RH4 9FL or email it to Megan – megan.aspel@sky.com All stories received will be treated in strictest confidence but may be used – anonymously – to highlight concerns about the WCA process to the relevant organisations. Question 13 on the WCA form completed at a face-to-face assessment – scores attached 13. Initiating and completing personal action (which means planning, organisation, problem solving, prioritising or switching tasks). Descriptor Points (a) Cannot, due to impaired mental function, reliably initiate or complete at least 2 sequential personal actions.

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(b) Cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions for the majority of the time.

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Question 13 on questionnaire ESA50 – no scores attached 13. Initiating actions This section is about whether you can manage to start and complete daily routines and tasks like getting up, washing and dressing, cooking a meal or going shopping.

(c) Frequently cannot, due to impaired mental function, reliably initiate or complete at least 2 personal actions.

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Please tick this box if you manage to do daily tasks without difficulty £ Can you manage to plan, start and finish daily tasks? Never Sometimes It varies

£ £ £

(d) None of the above apply You can download both forms to see in full – just search for WCA form and ESA50 questionnaire. And for more information generally go to www.rethink.org www.mind.org.uk www.dwp.gov.uk

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t

“There are over 100 million ‘brain’ cells in your gut, as many as there are in the head of a cat.”

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I’m in i n m d s o w

Our brain is the most accepted location for our mind. But did you know that your gut has a mind of its own? There is growing evidence that our digestive system can cause all sorts of problems, including mental health problems. It can even make us eat too much; it is our ‘second brain’. With 95% of the body’s serotonin (the ‘happy’ hormone/ neurotransmitter) located in the gut, it would figure that looking after our digestive system could be pretty important. But until recently, the gut has been – along with our mental health – the ‘Cinderella’ of medical science. Who cares about what is after all our rather boring ‘plumbing’ system when you can study the intricacies of the brain? Now, however, research is highlighting facts about our gut, with its stomach, intestines, colon, bowel and all in between or linked, that is making it a veritable ‘smorgasbord’ of interest. What’s been discovered is that our internal food combusting wheels and cogs form a highly sophisticated system of intelligence: which means that a healthy tummy could be far more important than we’ve ever imagined. It could even be the key to our physical and psychological wellbeing – or at least one very major key. A nutritionist at the Food Doctor London based consultancy says we are beginning to realise that ‘if the gut isn’t working well, nothing’s going to be working well.’ Diving into our internal workings and reaching into the depths of our gut ‘psyche’ is largely due to professor of anatomy and cell biology at Columbia University, New York, Michael Gershon. He says the gut qualifies as the ‘second brain’ because it is an autonomous nervous system ie. it can function on its own. It may be simplistic to blame our ‘second brain’ on our downfall when it comes to reaching into the biscuit barrel despite our ‘head’ telling us otherwise, but it may not be a far cry from the truth either. Gershon’s and other research can now claim that the gut will and can and does act completely independently from the brain. As he says, ‘While the “first brain” gets on with

religion, poetry and philosophy, the “second brain” deals with the messy business of digestion.’ Home to up to a hundred million neurons, as many as the spinal cord, and as many neurotransmitters as we have in the brain, our gut, through ‘memory’ and chemistry, assesses what we throw at it and decides a course of action from process to ejection (last night’s takeaway for instance!). But it doesn’t stop there – it sends messages to the brain.

The vagus nerve What is of increasing interest is the function of the vagus nerve which runs from anus to brain. Through about 90-95% of its fibres it carries signals from the gut to the brain; not, as we have always been informed, the other way round. Whilst the obvious ones might be pain, discomfort or nausea, Gershon concedes that we don’t know about other more intricate messages. But he says, ‘some of it is very, very good and very unexpected.’ What is being discovered is that stimulating the vagus nerve to mimic signals from gut to brain can improve learning and memory and regulate mood. Because our gut contains some of our key chemicals (e.g. serotonin of which 90-95% lies in the gut, the brain has just 2-3%), mimicking those signals can be used to treat depression, epilepsy, even Alzheimer’s, Parkinson’s, migraine and tinnitus. From Sigmund Freud to modern day psychiatrists, the hot seat of all our psychological problems is within the brain. That is where our ‘psyche’ lies, where the mood control functions are such as the limbic system, and from where all genetic and chemical problems appear to emerge. So we think. Serotonin is one of the main chemicals we all need for our wellbeing and what makes life worthwhile. With so much of it within our gut, it is obviously very important to look after our digestive ‘eco-system’. Could therefore, your gut be making you depressed, forgetful, maybe losing sleep? These are the questions scientists, psychologists and nutritionists are asking. For instance evidence suggests that Irritable Bowel Syndrome (IBS) originates from a change in the serotonin system. Gershon believes that ‘intestinal antidepressants’ – serotonin based drugs – could be the answer.

Gut instinct? IBS and mood disorders are not unfamiliar companions. We know about food and mood, something Sanctuary has highlighted for some time. This research opens up trains of thought that some of us already have. Are our emotional / psychological ups and downs linked to our stomachs? It puts a whole new meaning on gut instinct. There are other areas of research linking how some people simply eat more than others because of what is going on in their digestive system. But answers (unfortunately for those of us who just can’t stop eating even when we know we are full) are not going to come overnight. Meanwhile, until more is known, we should just get on and eat our greens and lots of good fibre. And if nothing else, when you want to say you are in two minds about something, maybe you are not being indecisive, maybe you really are.

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Doing it like a dude? 10

In my email inbox today, news arrived of Lego’s new “Friends” range. Exclusively for girls, it seems the characters are more distinguishable as ‘female’ due to their smaller waistlines, and pink and purple clothes, and there are even a few horses for the girls to play with. Apparently the range has proved to be a huge success. My heart sank.

Now, I am not suggesting for one minute that a global toy giant should not try to expand their customer base, and make some extra cash. But what’s with the boring gender stereotype? Reinforcing the same old ideal female form, to an already bombarded age group, to me seems a little sad, and far too predictable. At this point, I want to mention that recently, while I was on the train, I saw something truly wonderful: a little boy playing with a doll in a toy push chair. It was so refreshing to see a male child play with the toys that are traditionally set for the female gender, and it made me cast my mind back to when I was a little girl, and how I loved to play with my cousin’s car mat, and how I thought nothing of it. We played with the cars blissfully unaware, until eventually one older male cousin kindly pointed out to me that “cars are for boys”. It was at that point that I first took stock of the toy situation, and I registered that my toys should be pink. I must have only been about six at the time and it was one of my first lessons in behaving like a girl - stick to the dolls! Obviously I am not denying innate maternal urges exist (females are said to have them even as children), but that can’t be said of all females. I know many women who do not want children, and have never felt the urge. In fact, one such friend argues that she only played with a doll because it was given to her. The same has to be said for boys; just because they are given toy cars to play with, it doesn’t mean they want to be mechanics. The point is that what society regards to be gender appropriate behaviour, affects lives, and yet we have never had so many reasons to question these old ideals. At the start of the summer, and in the run up to the Olympics, the British teenage athlete Zoe Smith received criticism on Twitter regarding her appearance. What a joke! Some nasty people even went as far as to question Zoe’s femininity. All because she challenges the gender stereotype and lifts weights. Zoe’s response to her critics has won her much respect because she was quick to hit back and say that she wouldn’t be dieting to reduce the size of her so-called ‘manly’ muscles for the benefit of such small-minded people. Not to rake over old ashes, but can we think back to last summer and

the 2011 riots. It’s worth pointing out that although the rioters were made up mostly of males, there were some of the ‘fairer sex’ involved, and according to government data, around 10% of the rioters were female. Though other reports reckon it was more like 20%. It seems that girls can throw petrol bombs just as hard as the boys, if they want to, and they can steal like the boys, too. Though apparently, those females who were involved were taking stereotypical products such as washing powder, nappies and sacks of rice, as well as handbags and lip gloss. Bringing it back to 2012 and the issue of rape has made the headlines again, this time it’s the ‘Is it a rape if a woman has consented once already that night?’ argument. At the same time as this, a very young woman, who at only 17 years-old has been found guilty for murdering another young girl over a comment made on Facebook, and in the background is the soundtrack from the girl band Pussy Riot, who recently held a very public protest in a Russian church. 2012 is also the year that Bic, the pen maker, launched their “For Her” range, and yes, you’ve guessed it, they’re slimmer bodied and come in pink and purple. I’m only speculating, but I doubt somehow that Angela Merkel, who Forbes have declared as the world’s most powerful woman, feels compelled to carry a slim, pink pen for fear her hands might crumble under the weight of a standard one. What do these conflicting events tell us? That it’s all being put out there; traditional views are joisting with modern freedoms. With so much about what it means to be female today being brought to the table, everywhere we look there are people commenting about how women and their bodies are being policed more than ever, and we’re all asking the question: What does it mean to behave like a girl/woman? Is it fair to say that the world is still working out what it means to be female? We would love to know your thoughts on this issue.

Louisa

Please write to Louisa at Sanctuary c/o Let’s Link, PO Box 533, Betchworth RH4 9FL. Or email Louisa c/o megan.aspel@sky.com

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Sanctuary magazine started in Surrey, commissioned by Surrey PCT. With extra help from Care Services Improvement Partnership in the south east, the magazine has a small circulation across Kent, Sussex, Hampshire, Isle of Wight, Berkshire, Buckinghamshire and Oxfordshire and Milton Keynes, as well as Surrey. We will continue to list organisations and help lines in Surrey in this directory but we’ve added each mental health trust in the south east and will include other important contact details as we can and space permitting.

Mental health NHS trusts across the south east................................................

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• Sussex Partnership NHS Foundation Trust. T: 01903 843000 • Kent & Medway NHS Social Care Partnership Trust. T. 01732 520400 • Isle Of Wight Healthcare NHS Trust. T. 01983 524081 • Hampshire Partnership NHS Foundation Trust. T. 023 8087 4300 • Berkshire Healthcare NHS Foundation Trust. T. 01344 415 600 • Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust. T. 01865 778911 • Milton Keynes PCT. T. 01908 243933 • Surrey & Borders Partnership NHS Foundation Trust. T. 01883 383838 • Age Concern Surrey – 01483 458732 www.acsurrey.org.uk

Alcohol and drugs........................................ • Drinkline, 0800 917 8282 • Al-Anon, support for family and friends of alcoholics, find a local group 020 7403 0888. • Alcoholics Anonymous, find a local group – 0845 769 7555 • Drugscope, for information, www.drugscope.org.uk • Frank (for young people and parents) www.talktofrank.com • Surrey Drug & Alcohol Action Team – for local services, www.surreydat.org.uk

Anger................................................................. • British Association of Anger Management, 0845 1300 286 www.angermanage.co.uk

Anxiety............................................................. • No Panic, 0808 808 0545. www.nopanic.org.uk; • National Phobics Society, 0870 7700 456 www.phobics-society.org.uk; • First Steps to Freedom, 0845 120 2916 www.first-steps.org; www.anxietycare.org.uk (enquiries@anxietycare.org.uk to find out about accessing free advice and support)

We are building on this directory all the time. If you have anything to add that you think will benefit women’s mental health and wellbeing in Surrey, please let us know. You can contact Santuary magazine c/o Let's Link, PO Box 533, Betchworth, RH4 9FL. Tel. 07824 364703; email; megan.aspel@sky.com

Bereavement and loss................................. • Cruse 08701671677 www.crusebereavementcare.org.uk

Counselling.................................................... (please note, waiting times can be long) • British Association of Counselling & Psychotherapy, 0870 443 5252 www.bacp.co.uk (for details of local practitioners) • Heads Together (young people 14-25) 01737 378481. No fees • Croydon Pastoral Foundation, 020 8760 0665. Negotiable rates according to means • North Surrey Community Counselling Partnership, 01932 244070 www.nsccp.co.uk A sliding scale fee basis operates (up to £40.00 per session) • Pathways Counselling Centre, Epsom, 01372 743338. Professional counselling, normal rates apply • Redhill Counselling Centre, 01737 772844. Negotiable rates • RELATE, relationship counselling, 0845 4561310 www.relate.org.uk, for a local branch. A fee is charged for appointments. • Relateen, Epsom (part of RELATE but for young people disturbed/worried about parent’s relationship problems) 01372 722976 • Seastone Possibilities, Trauma Resolution Treatment 01306 640073 / 01737 249364 email: seastone@talktalk.net

Debt counselling........................................... • Christians Against Poverty; freephone 0800 328 0006 www.capuk.org

Domestic abuse............................................... • Surrey Domestic Abuse Helpline (24hr) – 01483 776822 • East Surrey Domestic Abuse Services (covering Reigate & Banstead, Mole Valley & Tandridge) - 01737 771350 Email: support@esdas.org.uk Website: www.esdas.org.uk 9am – 4pm, Monday to Friday, confidential answer phone out of hours. • North West Surrey Outreach Service (covering Woking, Runnymede & Surrey Heath) run by Surrey Women’s Aid 01483 776822 (24hr) • North Surrey Outreach Service (covering Epsom & Ewell, Elmbridge & Spelthorne) run by Walton & Hersham Citizen’s Advice Bureau - 01932 260690 Email: nsdvoutreach.walton@cabnet.org.uk Website: www.waltonadvice.demon.co.uk 9.30 am – 4.30 pm Monday to Friday, confidential answer phone out of hours • South West Surrey Outreach Service (covering Guildford & Waverley) run by CAHA - 01483 577392 9.00 am - 3.00pm Monday – Friday, confidential answer phone out of hours

• Rethink, 020 8974 6814 www.rethink.org

Post natal depression pregnancy and birth issues...................... • Association for Postnatal Illness, 0207 3860 868. www.apni.org; www.surrey.nhs.uk; www.babycentre.co.uk; www.netmums.com

Self harm......................................................... • www.selfharm.org.uk; www.lifesigns.org.uk; • www.rcpsych.ac.uk/cru/auditselfharm • Bristol Crisis Service for women (national helpline); 0117 925 1119. Friday/Saturday evenings 9pm – 12.30am. Sunday 6-9pm

Other useful contacts................................

• C.I.S.‘ters for adult women sexually abused as children Run by survivors for survivors – helpline Saturdays 10am – midday 023 80 338080

Crisis numbers; • Samaritans, 08457 909090 www.samaritans.org.uk • Sane Line (12noon – 2am daily) 08457 678000. National out of hours helpline for anyone coping with mental illness – sufferers, carers, relatives or friends. • Surrey & Borders Partnership NHS Trust, 0300 456 83 42; text for hard of hearing – 07717 989024 (24hrs) • Childline; 0800 1111

Eating disorders...........................................

Depression....................................................... • Depression Alliance, 0845 123 2320 www.depressionalliance.org

Employment.....................................................

This is money allocated directly to a patient/service user to enable them to have more choice and independence about the support/facilities they can access in the community. For more information contact: • Surrey Independent Living Council (SILC), Astolat, Coniers Way, Burpham, Guildford GU4 7HL. T. 01483 458111

Hearing Voices...............................................

Survivors of childhood abuse..................

anorexia, bulimia • Eating Disorders Associations, 0845 634 1414 www.eduk. com

Direct Payments............................................

Richmond Fellowship covering the whole of Surrey: • Mid Surrey (and queries re West Surrey) RF, Manor House, 19 Church Street, Leatherhead KT22 8DN. T. 01372 363934 • East Surrey RF, Rawlinson House, 9 London Road, Redhill RH1 1LY. T. 01737 771 282

For people who do or have suffered mental ill health: • Employment, Support, Re-training Agency (ESRA) for East Surrey area: 2nd Floor, Rawlinson House, 9 London Road, Redhill RH1 1LY. Tel/Fax: 01737 772115

We are currently updating information on CMHRCs and psychotherapy services.

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Don’t whisper... There’s something to shout about in a Library near you From laughter workshops, domestic abuse and healthy living drop-ins to lessons in philosophy for life and a range of author events, Surrey Libraries isn’t just for book worms. Here’s some of the highlights for the coming months.

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As part of Epsom Mental Health Week 7-13 October:

As part of World Mental Health Day 10th October

Epsom Library

Epsom Library

Out of the Box – a look at the unconventional personality with Alexander Masters, 8th October, 7.30-9pm Stuart Shorter and Simon Philips Norton are both unconventional characters who many would consider odd and difficult. Stuart was a violent, homeless person with a chaotic lifestyle and troubled background. Simon is a faded Cambridge University maths genius now obsessed with bus timetables. Refusing to pigeonhole either of them, Alexander Masters enjoyed true friendship with both men. In Stuart: A Life Backwards and The Genius in My Basement, Masters has applied a new approach to biography in which the lives of these unusually engaging characters and the biographer become entwined.

Laughter for well-being, 10th October, 7.30-8.30pm We all know laughter is the best medicine and, with nights drawing in, what better way to avoid a dip in mood than a regular dose of laughter? Therapist Tonya Stewart will offer some daily laughter exercises which you can practise at home to keep your sense of well-being topped up throughout the winter months. She will also reveal the latest research on the importance of laughter and its positive effects on mind, body and spirit. Tonya Stewart has a psychology degree and has trained in a number of holistic therapies such as Reiki and holistic massage. She works as a co-counsellor, therapist and workshop facilitator helping individuals and groups on selfdevelopment issues. She is also a magazine editor and journalist. The intended age group of the audience is age 16 years plus.

Redhill Library Richmond Fellowship - information and support drop-in 10th October, 1-3pm. Richmond Fellowship (RF) specialises in integrated mental health care. RF Redhill offers advice and guidance to support people with mental health issues to access employment opportunities, education, training, voluntary work, leisure activities, social groups and lots, lots more. Drop in and meet RF’s friendly staff for more information. This event is part of World Mental Health Day.

Other events Domestic Abuse awareness Woking Library - Monday 15 October, 11am-2pm Woking Library -Tuesday 16 October, 11am-2pm Staines Library - Tuesday 16 October, 2-4.30pm Redhill LIbrary - Wednesday 17 October, 10am-3pm Epsom Library - Friday 19 October, 2pm-4.30pm Walton Library - Friday 19 October, 2-4.30pm Domestic abuse represents one quarter of all violent crime. East Surrey Domestic Abuse Services (ESDAS) will be in the library to provide information about where and how to seek help and support for domestic abuse related incidents. Creative work by local survivors will also be on display in the library. This event is part of Domestic Abuse Awareness Week.

14th November, Woking library, 7.30-9pm Philosophy for Life and Other Dangerous Situations A talk-come-workshop with Jules Evans Were the ancient Greek philosophers the first to embrace the concept of Cognitive Behavioural Therapy? Can twelve of the greatest thinkers the world has ever known teach us techniques we can use today to transform ourselves and improve our lives? Jules Evans thinks so and has the personal experience to prove it. After struggling with his mental health throughout his time at university, Jules had a breakdown after graduating. While researching treatments for depression and anxiety Jules came across Cognitive Behavioural Therapy (CBT). He tried it and found it worked for him. As a journalist he was able to interview Albert Ellis, the pioneer of CBT, who told him he had been directly inspired by the ancient Greek philosophers’ view that our emotions follow our beliefs about the world. Jules’s book, Philosphy for life and Other Dangerous Situations, examines the philosophical origins of CBT. At a time when the art of living well is becoming a political issue, join Jules for an exploration of practical techniques based on a fusion of ancient philosophy and modern psychology. Jules Evans is policy director at the Centre for the History of Emotions at Queen Mary, University of London and coorganiser of the London Philosophy Club.

25th January 2013, Redhill library, 11am-3pm Heathy Living - Information and advice at Redhill library Start the New Year with a look at your lifestyle. Drop in for information and informal advice on nutrition, eating disorders and exercise.

23rd March Oxted Library, 10.30am-12.30pm Mindfulness: An Introductory Workshop at Oxted library What is mindfulness and how can it help you? It is the art of learning to pay attention to the present moment in a nonjudgmental way. It has been used in Buddhism for over 3000 years and encourages us to appreciate our lives now instead of always trying to be somewhere else. It has been shown to be an effective method of reducing stress, anxiety, negative thinking and even depression and pain. Mindfulness is now recommended by the National Institute for Clinical Excellence to help prevent relapse into depression. If you are in a state of transition, facing a difficult time or simply feel the need to slow down, this workshop will show you a series of simple mindfulness exercises which you can easily follow up at home. The facilitator will be Tessa Watt, author of An Introduction to Mindfulness A Practical Guide (Icon Books, 2012) and codirector of Being Mindful. A former BBC radio producer, Tessa is also co-presenter of Be Mindful Online, the Mental Health Foundation’s online mindfulness course. Ticket information: Some events have a cost of £5 per ticket including refreshments. For more information, call in at your local library or book online at www.surreycc.gov.uk and go to Health and wellbeing events booking form. Also in your local library you can find a range of booklets and information about emotional health and wellbeing. You can call 01483 543599 for credit/ debit card sales

Meet the authors Throughout October, a number of author events are planned. Listening to writers’ journeys about becoming authors and the trials and tribulations they experience to get a book written, let alone published, can inspire us all, whether we hope to follow on that path or just like a good read. Look out for the fiction and non-fiction writers visiting a library near you. Find out more at www.surreycc.gov.uk (see authors events) and pick up the latest Writers Booked brochure in any library. And why not browse the bookshelves while you’re there?

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Stop Press:

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Standing up for mental health In July

this year, four MPs stood up in Parliament and told the world about their own mental health problems, as part of a wider discussion about the need for a revision of current mental health legislation, and as a way to address the stigma and isolation that many people feel. As it stands, a person is ineligible for jury service if they are in receipt of any psychiatric medication, and finally there is a call to remove such discriminatory and unfounded restrictions. It is agreed that in order to address the issue of stigma about mental health, there needs to be changes to the law; for how can the people of this land be made to respect people with mental health problems if the law doesn’t respect

them first? And how can we all better understand mental health if stigma prevents the conversation? First to take to the stand, was the Conservative MP Charles Walker. Charles got up and described his obsessive compulsive disorder, which he has lived with for over 30 years. Charles was soon followed by Labour MP, and former defence minister, Kevan Jones, who declared that he had a history of serious depression. Then another two conservative MPs, Sarah Wollaston and Andrea Leadsom, both talked about their post-natal depression and anxiety attacks. History was certainly made that day. For never before had MPs talked openly about their own mental health problems in Parliament, despite the

estimation that 1 in 4 people are directly affected by mental ill health. Well, ignoring such common and largely treatable conditions couldn’t last forever. Of course MPs have mental health problems- they are just as susceptible as anyone else, and based on the estimated statistics, there should be more than 4 affected people considering there are 650 MPs who make up the House of Commons alone. The debate was opened by Conservative MP Nicky Morgan, who started by informing the chamber that mental health problems account for 23% of the “disease burden” on the NHS, and yet only 11% of its budget is spent on it. As well as discussing stigma and disproportionate funding, MPs also

talked about other key issues such as access to support and benefits, including work capability assessments and Criminal Record Bureau (CRB) checks. Of course, any changes to the law will be agreed before being passed, and no doubt this will take time, and many revisions to be put completely right. But the important thing is that Parliament is talking about it, and openly talking about it by MPs using their own, personal stories as a way to validate some of the experiences of the voting public. The MPs that disclosed their personal lives also described how many people were coming to their weekly surgeries struggling with their mental health due to the stigma that they experienced. It is reported on

At the time of going to press, the second reading of the private members’ Bill, Mental Health (Discrimination) (No.2) had just taken place. It calls for three changes to the law around what people suffering a range of mental health problems can and can’t do: one –it would allow anyone voluntarily receiving regular treatment for a mental health disorder who is not in hospital, to sit on a jury; two - currently any MP under section of the Mental Health Act 1983 is automatically removed from their seat, this would no longer be the case; and three, a provision would be removed from the standard articles that many companies adopt which allow the sacking of a company director if they have a mental health problem. Presented by Gavin Barwell, the Bill builds on the work of Lord Stevenson of Coddenham, who launched a similar bill in the House of Lords in the previous Parliamentary session. Following the second hearing, the Bill looks set to become law (more information on www.politics.co.uk).

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the Time to Change website that four out of five people with mental health problems have experienced prejudice and discrimination. As we know, stigma prevents people from living full lives because issues such as finding and retaining work, and relationships with other people are greatly affected by the negative views held by our society. And enough is enough. By taking a stand, those MPs have opened up the discussion and enabled the issue to be brought to a wider stage: it’s no longer just an issue discussed by mental health charities and campaigners. With the door being blown open, now there is an opportunity for people to reach out, to listen to each other and

be heard. It is certainly a step in the right direction towards a day when anyone with a mental health problem can talk about their experiences without fear of being devalued or misunderstood. Since that day in Parliament, the MPs involved have written many articles and taken part in lots of interviews, and in one Kevan Jones has commented about the after-effects of opening up, saying: “Whether it affects how people view me, I do not know. And frankly, I do not care, because if it helps other people who have depression or who have suffered from it in the past, then good.”

Louisa


Let’s make a week of it! The spotlight turns on mental health in Epsom and Merstham, Surrey in October 2012. During the week of World Mental Health Day, October 10th, both towns will be running a range of events to raise awareness of mental health and the work done by various providers to support people with mental ill health and their carers.

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Epsom mental health week has been running for many years and each year it gets bigger and better. This year’s theme is ‘Living the Pain, Living the Joy’ with inspiring events to cater for everyone. Much of the week’s activities which run from 7- 13 October will take place at St. Barnabus Church, Temple Road, Epsom Coming up are: Beginning the week – BBC radio 4 Sunday Worship live from St. Barnabus church Throughout the week there will be themed days with various talks about different aspects of mental illness and mental wellbeing, given by a number of qualified speakers. Monday headline is ‘The local community – help or hinder?’ with a focus on aspects of mental distress, community support and drop-ins; Tuesday looks at Journeying through life – and introduces aspects of mental ill health such as dementia and depression; Wednesday is all about new thoughts, new ideas and new hope and some fun as well with a ‘laughter for wellbeing’ session in the Ebbisham Centre; Thursday focuses on those hardest times in our lives, such as bereavement and palliative care; Friday raises the tempo with dance and activities to boost health and wellbeing including how to lift your mood with food, and on Saturday the week is brought to a celebratory close with the approximate 5 mile Walkathon, beginning at 10am at St. Barnabus. Some of the experts speaking include nutritionist Nikki den Hollander; Reverend Michael Preston; Sue Bond from Love Me Love My Mind charity; Suzette Jones, health and wellbeing adviser; Sarah Mitchell, director of adult social care and health, Surrey County Council; author Alexander Masters; Fiona Edwards, chief executive of Surrey & Borders Partnership NHS Trust and a host of people bringing their specialist knowledge and insight into a wide range of mental health topics. For more information contact www.epsommentalhealthweek.org.uk Pick up a programme at St.Barnabus church or in the Ebbisham Centre, Epsom

 

And now, for the very first time….. Merstham Mental Health Week Initiated by Merstham Community Facility Trust, a group of organisations got together to organise the very first mental health week for Merstham, near Redhill, Surrey. An informal service at the Café Church, Epiphany church will be held on Sunday 7th October. An open day and information market place will be running in the Epiphany church hall from 1.30 – 3.30pm, Monday 8th October. People attending can find out more about and sign up for activities during the week which include: Tuesday 9th Volunteer Drop-In: 10am – 12noon at Merstham Community Facility Come and see the variety of opportunities that are available to volunteer in and around Merstham, and see the difference you can make. Wednesday 10th – World Mental Health Day IT Taster Sessions: 12.30pm ‘til 4pm at Merstham Community Facility ½ hour introductions to IT at 12.30pm, 1.30pm, 2.30pm and 3.30pm with the Richmond Fellowship Salsa Taster Session: 1pm – 3pm , Church of the Epiphany Hall Stepping Stones Social Group: 1pm – 3pm at The Venue, Weldon Way A social group run by Reigate Stepping Stones in a relaxed environment Employment Support Working Lunch: 12-2pm at L2 Rawlinson House, 9 London Road, Redhill, RH1 1LY Thursday 11th Sand Mandalas: 11am OR 1.45pm - the relaxing art of creating beautiful designs using coloured sand with Art Matters. Places are limited, to book call Tracey 01737 645217 or pop into the Community Facility Chill Out Session: 10am – 12noon at MCFT 28 Portland Drive Soothe your senses with alternative therapies provided by Holistic Harmony Mental Health Awareness Workshop: 9.15am – 12noon at Merstham Community Facility For anyone working or volunteering locally who wants an understanding of how mental health issues can affect the people you support. Provided by First Steps. Limited places, to book call Tracey at Merstham Community Facility on 01737 645217. Depression In Men: 2pm – 4pm at Church of the Epiphany - A drama based session to explore how depression affects men, with audience participation. A Let’s Link/Holistic Harmony production. Friday 12th October Emotional Health at Work: 9.15am – 12noon at Merstham Community Facility For anyone who wants to make sure they look after themselves in the workplace. Provided by First Steps & ESRA. Limited places, call Tracey at Merstham Community Facility to book on 01737 645217. The following organisations were involved in the creation of Merstham Mental Health Week: Art Matters www.artmatters-richmondfellowship.org.uk Employment Support & Retraining Agency www.esrasurrey.co.uk First Steps www.firststeps_surrey.nhs.uk Holistic Harmony www.holisticharmonycic.org.uk Let’s Link www.letslinkmentalwellbeing.com Merstham Community Facility Trust www.mcft.org.uk Reigate & Banstead Voluntary Service & Volunteer Centre www.rbcvs.org.uk Reigate Stepping Stones www.reigatesteppingstones.org.uk Richmond Fellowship www.richmondfellowship.org.uk For more information contact Tracey at Merstham community Facility, 44 Portland Drive, or call 01737 645 217. See the facebook page: www.facebook.com/MersthamMentalHealthWeek

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Can you stomach it? With benefits cuts, food prices rising and hungry mouths to feed, making ends meet is becoming a daily challenge for many families. But how many of us are contributing to the 80,000 tonnes of uneaten food that gets thrown away each year in Surrey? If food gets thrown away (uneaten or leftovers) yet you are struggling with the weekly food shop bills there is imbalance somewhere. Why not take the challenge and start changing eating habits now?

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How do you shop? In a supermarket, kids pulling on your clothes, ‘Can we have this mum?’ ‘I want that’? You have a list, do you stick to it? Or do you find ‘extras’ sneeking into the trolley? And are you so exhausted with tears, tantrums (your own or the kids!) that you just give in and buy more than you should? With the inevitable consequence: overspending and food going to waste? The campaign ‘Love Food Surrey’ (ww.lovefoodsurrey. com) is highlighting how much food we waste. The diligent amongst us dutifully put our waste in the little caddies we all have now (the waste gets turned into fuel for farm machinery amongst other things) but unfortunately, for whatever reasons, some still just chuck everything in the general rubbish. Whichever way you deal with it, very few of us have no wasted food at all. We could all do with learning from those who manage to ‘sort it’ in every respect. Even if your priority is not the planet, saving money probably is. Where to start? A good place is to look at your food buying habits, and your food shopping list. What makes you buy the things you do? Family pressure, convenience (bung it in the microwave) or cost – or all of those and more? But then why are you left with stuff going off, ignored at the back of the ‘fridge, and why do we buy mountains of bread, before a Bank Holiday for instance, ‘just in case’! Breaking habits can be very difficult. When demands are made from the family as well (‘I’m never going to eat a

vegetable – give me chicken nuggets or else’!) there is no doubt you might have a fight on your hands, and lets get real; you may not feel like fighting in the first place. But by looking at what you buy and how much it costs, and then at the weekly budget, there are probably good reasons to make a few changes. Replacing a few meals a week with a hearty vegetable soup or broth, with bread or dumplings to add bulk, is a good way to start. You’ll cut cost but not quality with a highly nutritious and tasty meal. Any meal that cuts down or cuts out meat is good on three levels: it’s cheaper; there’s less fat and calories and it’s kinder to the environment and animals. Look up Compassion in World Farming – www.ciwf.org.uk – if you need any persuading. Eat poultry and meat less than you do – including the chicken nuggets kids! Stock up on tinned vegetables and soups – baked beans are always a winner. The fresh fish counters may look enticing but if you are counting the pennies, tinned fish is just as good. We may not be in a dreadful war like the Second World War but there can be something satisfying about taking on a ‘rations’ mentality. Just for a while, think about what you need rather than what you want. You may find it isn’t only your food bill that shrinks; waists have a nice habit of reducing too when processed foods, a lot of meat and too many chocolate biscuits are limited.

Give it a go!

The mental health challenge If you suffer mental distress caused by depression or another psychological illness, motivating yourself to think about changing eating habits, let alone doing it can seem impossible. The author Marian Keyes gives hope: she discovered that baking lifted the deep depression she had suffered for years. What started as a desire to bake a cake for a friend resulted in creating recipes, finding solace and strength and – naturally – producing a recipe book, ‘Saved by Cake’ (Amazon £9.25 as at going to press). We know cooking can be very therapeutic. The whole process is satisfying. Deciding on what to cook, getting the ingredients, creating the meal; it is very likely that you can think of little else when you are immersed in a recipe!

Not tomorrow, next week, sometime never: go for it now! Count your weekly food bill and see where you can save – never by going without but by thinking more creatively about what you cook. Buy a book or borrow one from the library that gives easy recipes for low cost meals or go online for hints and tips about nutrition on a budget and cutting waste. Go veggie two or three times a week. Check out Jamie Oliver’s Food Revolution – wonderful recipes for little cost. What may surprise you is the feel good factor you get – and increased energy (don’t forget food and mood are interlinked). So go on, eat your greens (and cake – homemade of course); you can stomach it!

your t r a t s k ic k e to Try this recip habits: n io it r t u n h low cost hig glorious bread and butter pudding

“Every day we (in Surrey) throw away enough bread to fill a doubledecker bus” (Love Food Surrey)

d to make a Use stale brea

Ingredients: other breads ft butter or any of the so ss ro oz 2 ac / ly al g 50 cut diag on white bread, 10 slices so ft ove mentio ned ab ltanas lden raisins/su 50g / 2 oz go eg grated nutm 1/4 tsp fres hly on 1/4 tsp cinnam oz milk 350 ml / 12 fl y cream do ub le / heav oz 50 ml / 2 fl rang e eggs 2 larg e free ite sugar lo w) 25g / 1 oz wh e (see note be tract or past ex 1 tsp vanilla Serves 4 as 4. d each of the butter. Sprea 355°F/180°C/G e en th ov e of e th tl t Hea dish with a lit nt/1 litre pie Grease a 2 pi er. les with butt bread triang tter s of bread, bu pping triang le la er then ov Method d, th ea wi br dish over the se of the pie ltanas evenly su s/ in mo re Cover the ba is e ra on r en go ld at this laye kle half the nnamon . Repe ci d an side up. Sprin eg tm e nu s on to p. le with a littl th the raisin lig htly sp rink d, finishing wi lle fi is BOIL. sh T di the cream - DO NO time or until tract the milk and at the vanilla ex he d ly an nt ge 3/4 sugar th wi In a saucepan and gs gs eg e eg th milk over the king bo wl beat ur the warm Po In a larg e ba r. lo co in le d airy and pa d. until lig ht an uid is e milk is adde th l al l til al l the liq ti un g in at be the bread un ue er in ov ly co nt the en ev to d in d an push the brea mixture slowly yo ur hand to side Po ur the egg th e wi on e to ac e rf then leav y press the su the surface er ov added. Gentl r ga su g in e the remain liquid. Sprinkl ace is until the surf 40 - 45 mins, r fo r 30 mins. fo t. en ho ov ve t ho g is set. Ser dding in the n and the eg Bake the pu se ri ll we g in and the pudd go lden brown foil in a hot with aluminum d re ve co ll nch box. g reheats we rfect fo r a lu utter Puddin e wedg es - pe Bread and B rg la to in t ve it co ld cu oven, I also lo

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Serendipity 22

Having suffered the wettest summer in years, I can’t be the only one to feel a tad grumpy that we are now faced with autumn and winter. With the darker days and longer nights not too far away, now is the time to prepare so that, with a bit of luck, we can all have the sunniest, happiest winter ever. As we know, food is fuel, and just because the colder weather sweeps in, it does not give us an excuse to gorge on stodgy food full of salt and sugar, which only leaves us feeling sluggish, and is proven to deepen depression. It’s important to keep fruit and vegetable levels up, so try swapping the salads for warmer options such as soups and stir-fries. In the winter, even when it’s cloudy, it is really important to try and make the most of any kinder weather, so as to get as much vitamin D and fresh air as possible (Vitamin D has a strong link to cognitive function, mood and overall mental health). It can be all too tempting to stay inside and watch TV, but too much of this can be damaging. Even in the snow, a walk outside in nature can be really beneficial for mood,

and so try to get out as much as possible, starting now. It is really important to have a project of some kind in the more reclusive months. There are times when we may have to, or want to, batten down the hatches. Having something to work on can be a great distraction from boredom, and any bouts of over-thinking that tend to occur at such times. It could be anything: perhaps there’s a room that needs decorating, or you’d like to take up a new hobby. Have a think about something you’d like to achieve, and plan to accomplish it. What you will find is that when you are absorbed in something you enjoy, there is little if any room for dwelling on problems. If I try and remember to keep to these three simple tips, then I think there’s nothing wrong whatsoever with – alongside my strategy to keep well - curling up on the sofa with a cup of cocoa and my favourite film!

Louisa

There are various websites that offer suggestions, help and advice – look at the Mental Health Foundation: MIND: Re-think – you will probably find your own. If you have any tips that have helped you keep well and out of crisis, please let us know. Write to Sanctuary, c/o Let’s Link, Betchworth, RH4 9FL or you can email Megan and Louisa at megan.aspel@sky.com

“I put my hand around his tiny neck, not yet strong enough to hold up his own head, and began to squeeze. I wasn’t trying to harm him. I knew I mustn’t do that, but I wanted to know if I was capable of it.” Coming up in the next issue: Women are more at risk of severe mental illness after giving birth than at any other time in their lives.

Our next issue will focus on mental wellbeing and motherhood. Apart from what can happen after giving birth, we also want to explore the heart-ache and mental distress suffered trying for a baby with IVF that doesn’t seem to be working and we will look at when, having given birth, the terrifying illness that is postpartum psychosis strikes. Postpartum psychosis (PP) is less common than post natal depression. It occurs in one – two women in a 1,000. The quote is from a woman who spoke up about her own illness. It leaves no-one in any doubt of the severity of PP. It is particularly frightening as it comes out of the blue, with sufferers rarely having experienced a mental illness before. Symptoms include those similar to bipolar disorder or borderline personality disorder. A sufferer may feel high and manic or low and tearful; changes in mood may be rapid, there can be confusion, racing thoughts; someone might be over talkative or withdrawn; paranoid suspicions abound and might include delusions and hallucinations. It is terrifying for victim and her family. A sufferer may not be able to look after herself or her baby and she may not even be aware she is ill. As in the case of the woman quoted here. After the birth of her second son, she became very ill. She was terrified (in those moments she was lucid rather than psychotically delusional) that her two sons would be taken away from her. Her ‘solution’ was to kill them, their dog (couldn’t leave him to fend for himself) and herself. She didn’t, she sought help and can now tell her story. Now recovered she – and others like her – are helping the world of psychiatry and mental health understand more about PP. It is still a relatively unknown area of psychiatric illness. The experts are still learning. If you have a story, we would like to hear from you. But please don’t write anything unless you feel strong enough to do so, and you have someone near you can talk to. We know your story may be very painful and telling it might trigger memories and feelings. Please write or email or telephone for a chat. Sanctuary c/o Let’s Link, PO Box 533, Betchworth RH4 9FL Email: megan.aspel@sky.com Telephone Megan on 07824 364703

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Š Aspects 2012

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Issue 13 (Winter 2012)