Healthy Foundations Magazine 2021

Healthy Foundations BOOST YOUR MIND, BODY & SOUL!

Tips and tools to improve your Mental Health and Wellbeing Exploring Periods, Cervical Screening, the Menopause and more!

Learning when and where to get support for your Health Colouring, Word Puzzles, and Sharing Your Feedback

A HEALTH AND WELLBEING BOOKLET BROUGHT TO YOU BY WOMEN IN PRISON (WIP)'S HEALTHY FOUNDATIONS TEAM

Thank you so much to Nicola W for sharing her amazing artwork, including the front cover of this booklet!

She says: “I paint my paintings as they represent how I am feeling and what I have been through in life, whether it’ll be laughter, pain, upset or loss. My paintings mean the world to me.”

CONTENTS

INSIDE 4 Foreword

Illustrations by NW, Cover Illustration by NW

MIND

48 Breast Awareness 50 Cervical Screening 56 Trans Screening 60 Pregnancy in Prison

10 Mood and Food

62 Arthritis

15 Boost Your Mood in 20

64 Menopause

16 Yoga

68 Pelvic Floor Muscle Exercises

20 Personality Disorders

72 Give us a smile!

22 Choice 4 Change

74 Safer Sex

24 12 Steps

78 Meet Your Vulva!

28 CBT

80 Contraception

30 Address Your Stress

84 A&E Fact Checking

34 Mental Health Contacts

88 Talking about Miscarriage

BODY

92 Nutrition

38 Health Inequality

96 Physical Health Contacts

40 Hep C Trust

SOUL

42 Period Positivity

100 Colouring

46 Period Tracker

102 Crossword H E A LT H Y F O U N DAT I O N S 3

WELCOME

A Message from Kate Paradine, Women in Prison (WIP)’s CEO: We are so pleased that we are able to share this new booklet as part of Women in Prison’s National Lottery funded Healthy Foundations project. We know that this has been the hardest of years for those in prison - in terms of physical and mental health. As a team we want to do all we can to help make sure that recovery from the pandemic marks a turning point for women in prison to help support each of you to focus on a healthy future in prison and in communities after release.

The new Creating Community Connections project that we are running in partnership with Brighton Women’s Centre, Anawim, Together Women and Nelson Trust aims to connect every woman in prison to her local women’s centre. A new National Women’s Prisons Health and Social Care Review has been launched by the NHS and Prison Service, which will be asking you your views on what can improve on health and social care in prison - please look out for information about this so your voice can be heard.

Please take care and keep in mind the beautiful words of the brilliant activist and author, Angela Davis (a favourite of the Women in Prison team) - “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

Hello… And welcome to the WIP Health Magazine which has been put together by the Healthy Foundations team at Women in Prison. We hope you will find this magazine useful and informative. We also hope that it will help you feel a bit more in control of your health and inspire you to take care of your wellbeing. As there are so many things to cover under the umbrella of health, we have chosen to focus on some topics that have been suggested to us by the women we work with.

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Thank you!

We would like to say a warm thank you to all the women - across prisons and in the communitywho have helped with this magazine either through focus groups or direct contributions such as art or writing. Your ideas, advice and creativity have been crucial! We also want to extend a big thank you to the National Lottery Community Fund who funds our project, including the booklet you are holding in your hand.

…so who is WIP? Women in Prison (WIP) works in prisons and in the community to support women affected by the criminal justice system, as well as campaign for their rights.

…so what is Healthy Foundations?

After the success of Women in Prison’s Health Matters project which ran from 2016-2019, we were successful in securing funding for a new three year health project. Women in Prison’s Healthy Foundations project began at the end of 2019 and is kindly funded by the National Lottery Community Fund. We want to empower and support women to have a better understanding of their health. With so many other things to keep us busy in life and worry about, our health is sometimes forgotten about, or ends up being at the bottom of our list. We want to change that by encouraging women to think about their health and wellbeing and give it the attention it deserves. Healthy Foundations aims to do this by providing health and wellbeing related advocacy, support, and advice, working Through-The-Gate (this means helping to prepare and support women on the day of their release from custody) and in the community with women in, or returning to, London. We also provide health information and education; giving the women we work with the resources to make their own decisions around their health and wellbeing.

We work in a woman-centred, non-

judgmental, and trauma informed way to ensure that the women we work with feel safe, listened to, and supported as best as we can.

Here are some examples of what we do on the Healthy Foundations project: l Talk through women’s concerns around their health and wellbeing l Accompany women to medical and dental appointments l Support women to attend their health screenings appointments l Advocate for women at appointments l Provide Through-The-Gates on the day of release from prison to women who have physical health support needs l Help women to register with a GP in the community l Liaise with other healthcare professionals to ensure that women receive the service they are entitled to l Link women up with local women’s centres and hubs l Find local groups and workshops for women to attend l Help women fill out their PIP medical forms l Help find grants to support women with their health and wellbeing l Provide health resources to women to increase their knowledge around their health and wellbeing l Support women in helping address their substance misuse issues l Provide emotional support l Provide training to colleagues to increase their confidence when supporting women around their health and wellbeing l Create and publish this Health Booklet!

living in the community in London. If this applies to you and you feel you would benefit from Healthy Foundations then please do get in touch and write to us! Unfortunately we are only a small team, which is why we are not able to work across the country. BUT, we thought we would share some information and knowledge with all of you, by putting together this health booklet. That way, we can pass on some information and tips about health and wellbeing, no matter where you are!

...what about our campaigning work?

As an organisation, we do our best to support women with any problems they might have.

However, we also know that the system is unfair and needs changing. This is why we campaign for change. We tell politicians and other people in power what needs to change about prisons and society to give women a better chance.

Because we work in the prisons, we are able to speak to women directly to hear their views and can pass them on to those who make decisions.

This project is no different. We know that healthcare in prisons is not perfect; for example there are not enough staff and waiting times can be long. We also know that many women don’t get the support they need in the community.

If there is anything about health that you think those in power should know, please let us know by writing to us. We hope that we can help you directly through our work but also that we can help make the entire system a little better by sharing what we learn from you.

Warm wishes, THE HEALTHY FOUNDATIONS TEAM:

Jade Coulon, Robyn Eldred, Frederika Lorie

…so can Healthy Foundations help me?

The Healthy Foundations project works with women who have been affected by the criminal justice system in any way, and who are either in prison and returning to London, or already

Art direction & production

Henry Obasi & Russell Moorcroft @PPaint

Registered charity number 1118727 Company number 5581944

H E A LT H Y F O U N DAT I O N S 5

DISCLAIMER This health booklet is designed to give information, advice, and support around different health conditions and we hope that you find it useful. We are not trained medical professionals. The information presented in the booklet is accurate to the best of our knowledge but please consult with a trained medical member of staff for more extensive information and advice if you have any concerns about your health. Any suggestions in this booklet are purely suggestions and should not be taken as anything more than that.

6 H E A LT H Y F O U N DAT I O N S

Illustration by NW

MI H E A LT H M AT T E R S !

ND MARY SEACOLE (1805-1881)

A British-Jamaican nurse, healer and businesswoman. After the British War Office refused Mary’s application to become an army nurse during the Crimean war, Mary funded her own trip to the Crimea and set up the ‘British Hotel’ for sick and recovering soldiers.

H E A LT H EHAYLTFH O UMNAT DAT T EIROSN! S 9

MOOD + F OOD MOOD AND FOOD

There’s a lot of talk nowadays about mood and food, and the mind-gut connection. Scientists are discovering more and more about how the brain and the gut (our digestive tract) are intrinsically linked. Our mood and emotions can influence what we eat and our gut health. Research is increasingly showing how what we eat also influences mental health. Personal experience can be the biggest clue that your gut is intricately related to your feelings and emotions.

10 H E A LT H Y F O U N DAT I O N S

Illustration by PPaint

FOOD MATTERS RUNS FOOD PROJECTS IN PRISONS AND IN THE COMMUNITY, AND PRODUCES A MONTHLY HEALTH AND WELLBEING NEWSLETTER ‘HER WELLBEING’, AVAILABLE AS A PRINTED COPY OR AS AN E-NEWSLETTER.

H E A LT H Y F O U N DAT I O N S 11

MOOD AND FOOD

Consider situations where you might have had similar thoughts as these:

“When I first met him, my gut reaction was not to trust him.”

“If you want to know what my gut feeling is about doing this, it’s not worth the risk.”

“Call it gut instinct, but when she walked in the room, I felt she was up to no good.”

We listen to our guts to tell us how we’re feeling. When a situation produces a feeling in your gut – like your stomach lurching, or feeling sick, or a sudden urge to go to the toilet – you sense something is not right. These are all normal feelings, related to the body’s natural protective mechanism, termed the ‘fight or flight’ or ‘acute stress’ response. When the brain senses danger, it directs the body to prepare to defend against, or run from, a perceived enemy. The systems needed for this are hiked-up – heartbeat, breathing, adrenalin production, heightened sensitivity – while systems like digestion are shut down, sometimes to the extreme of expelling the gut contents. If we were antelopes fleeing lion predators, such a reaction would be beneficial. Quite often in a more protected environment extreme reactions are distressing and not helpful.

Fight or flight is all well and good in short bursts, in real situations of danger. Or when our memory bank relates a situation or person to a negative past event and sends a warning. But if your body continually

feels on alert, when chronically anxious, or constantly angry, it can affect gut health, giving rise to digestive disorders such as IBS (Irritable Bowel Syndrome).

Our gut and brain are constantly talking.

They send chemical messages back and forth to each other via neurotransmitters along the nerves, as well as via hormones in the blood. Incredibly, 95% of the moodregulating neurotransmitter serotonin is found in the nerve cells in the gut, where its main role is in normal gut function.

An imbalance of serotonin is linked to both mood and digestive disorders, such as IBS. The sensory cells of the gut, which include taste and smell, play a powerful role in our emotions. We might relate the smell or taste of a certain food with a bad memory – perhaps the taste of a particular meal eaten only in prison, might mean that you’re unlikely to eat that meal on release – just one whiff of it will make you feel sick, as your body goes on alert recalling a distressing memory.

Conversely the taste or smell of a meal produced by a favourite relative can bring on a feeling of wellbeing.

Your gut is your digestive tract, but digestion is not the task of your body alone – you have the help of trillions of microbes which live in your gut, especially in the intestines. The body’s population of microbes include bacteria, viruses and

“Our gut and brain are constantly talking.

Sending messages back and forth to each other.”

12 H E A LT H Y F O U N DAT I O N S

fungi, together called the microbiome.

In the gut, they digest substances that we can’t, like fibre. They also produce some vitamins for us, like some B vitamins and vitamin K. They help defend the body from harmful microbes and pollutants.

A healthy microbiome also keeps inflammation in check, which is at the root of many illnesses.

What’s more, it’s thought that the microbiome joins in the conversation between our brain and gut. Your gut microbes produce neurotransmitters and hormones similar to your own, which your brain picks up. Scientists are beginning to find out how important the relationship of our gut health and the health of the microbiome are to our mental health.

Over recent years, research has shown that a diet high in fruit, vegetables, wholegrains and fibre, and low in refined carbohydrates (sugar, white bread and other refined cereal products), red meat and animal fat can have a positive effect on mental health. Such a diet can reduce symptoms of anxiety and depression. It’s also thought to be the diet most favoured by our gut microbes.

It seems that a gut-friendly, microbiomefriendly diet is also a brain-friendly diet!

In reality, it’s one that’s also good for the heart, the liver and every component of the body. The early research around diet and mental health specifically focussed on the traditional Mediterranean diet which has often been described as one of the world’s healthiest diets. It includes: lots of fruit, vegetables, wholegrains, beans, pulses and nuts with small amounts of olive oil, dairy, eggs, fish and lean meat.

Whether living in an institution with most meals provided, or in the community trying to survive on a low income, the Mediterranean diet might sound out of reach. Reassuringly, if you focus on the basic components from the Mediterranean diet, it can be adapted to any circumstances by following simple guidelines:

1 2

Choose a mainly plant-based diet, based on vegetables, fruit, beans, pulses, and nuts.

Meat eaters, you can get by with small amounts of animal protein and supplement with plant-based protein like beans and lentils. Choose lean meat and oily fish – tinned fish is cheap but still nutritious.

3

Choose wholegrains wherever possible – even cheap wholemeal sliced bread is better than the white equivalent. Oats are a cheap and a very healthy wholegrain.

4

Choose olive oil if you can afford it, or a rapeseed-based vegetable oil, which is often the cheapest vegetable oil (look for a picture of little yellow flowers on the label.)

5

When you don’t have access to fresh fruit and veg, tinned, dried or frozen are fine. Tinned beans, even baked beans are a great source of fibre.

6

Reduce sugar in your diet - in fizzy drinks, sweets, biscuits, cakes and breakfast cereals. Replace with naturally sweet fruit if you want a sweet hit.

For more information Website: www.foodmatters.org Email: info@foodmatters.org Telephone: 01273 234781 Twitter: @FMInsideOut Write to: Freepost FOODMATTERS

H E A LT H Y F O U N DAT I O N S 13

B O O S T YO U R M O O D I N 2 0 M I N U T E S

FEELING BLAH? TRY THESE HELPFUL TECHNIQUES. Meditation can make us more patient and less stressed by uncomfortable situations and people we find difficult. All you need is somewhere to sit down and the commitment to be still for five minutes or so.

1. Find a comfortable seated position

You can sit on the floor or on your bed or a chair with your feet placed firmly on the floor. Keep your back straight and chin tucked in slightly. Gaze downwards at a spot in front of you (your vision might go blurry, which is fine). You can also rest your hands in your lap, left hand on top, if that’s comfortable.

2. Focus on the breath

Turn your attention to your breath. You don’t have to change how you are breathing, just watch. How does the breath feel as it comes in, and as it leaves? Is it warm or cool? Smooth or rough? How does your chest and belly move with the breath? Focus on feeling the breath, not thinking about it or changing anything.

3. Count the breath

Now, as you breathe in, silently count ‘one’.

As you breathe out, count ‘two’. Keep going to ten then start again from one. Don’t worry if your mind wanders off and you lose count, just return to one and start again.

Developing your practice

If you have a timer, set it for five minutes. Do 14 H E A LT H Y F O U N DAT I O N S

five minutes for five days, then ten minutes for five days, and build up to 25 minutes.

Tip: Some days, meditation will feel easy.

Other days your mind will feel busy and distracted. It doesn’t matter. Just keep sitting and go with whatever happens. This is all part of the practice, and of becoming present and accepting of yourself, your life and the people around you.

Want to know more?

The Prison Phoenix Trust supports prisoners by teaching simple yoga and meditation exercises. To start your journey, please write to us at The PPT, PO Box 328, Oxford OX2 7HF. You can also hear about other prisoners’ experiences of yoga and meditation by tuning in to ‘Freedom Inside’ on National Prison Radio on Friday afternoons at 3pm and Sundays at 8am and 5pm. Each episode also includes a practice that you can follow.

LOSE YOURSELF IN MUSIC...

and get dancing! It’s true! Dancing has been shown to reduce levels of cortisol - a stress hormone - in the body. It also improves our cognitive abilities, freshening us up.

MAKE A FRIEND THROUGH THE POST

Sign up for a penfriend from outside prison.

Getting to know someone new gives you a chance to share how you’re feeling whilst

Illustration by Ulla

MEDITATION

also giving you a helpful new perspective on life and any challenges you’re facing.

Write to Penfriends, PO Box 33460, London SW18 5YB with your name, prison number and name of prison to be sent the application forms.

SELF-SOOTHE WITH A MASSAGE

Give yourself a neck, shoulder and head massage. Start with your shoulders and gently massage the knots away. Work up your neck to your scalp and then give it a gentle massage with your fingertips.

FEAR SETTING

Stop your fears getting the better of you.

Try this ‘fear setting’ technique: Define: What are the worst things could happen? Write these down in a list.

Prevent: What steps can you take to prevent each fear from happening? Write these down in a list.

Repair: If the worst happens, what steps can you take to fix the damage? Write these down in a list.

Having done these three things it is common to feel less anxious and more in control.

H E A LT H Y F O U N DAT I O N S 15

YO G A

LET’S TRY YOGA Many people find it difficult to connect with their body; this can be for reasons including trauma or low self-esteem. Breathing exercises and yoga, which work both the mind and body, are a gentle way to connect to yourself, feel sensations and movements, and understand what our mind and body needs.

These practices also help to reduce stress because they allow us to slow down our breathing, which then increases our Heart Rate Variability (HRV- the time between heartbeats), and this is why people who may be experiencing a panic attack or anxiety are asked to take deep breaths.

Yoga Instructor Jayde, from Tree Pose shares some postures and exercises to help you to connect to your body, de-stress and soothe, no equipment needed!

What is Yoga?

Yoga includes a series of postures, breath work and 16 H E A LT H Y F O U N DAT I O N S

meditation. It’s not about having the perfect pose, it’s about connecting the mind and body to reduce stress and improve physical and mental wellbeing.

Can I practice Yoga?

Yes! Anyone can practice Yoga. Yoga is for everyone regardless of life experience, injuries to your body or your body shape. You do not need to have access to classes - you can practice by yourself.

Is there anything I need to do before I start practicing Yoga by myself?

Make a clear space for you to practice in.

Place a mat or towel on the floor if you have one, but don’t worry if you don’t.

Try to wear clothing that allows you to move freely.

Remember you know your body best - be careful of any injuries and listen to your body. Yoga shouldn’t hurt so if you experience any pain stop.

Yoga Postures and Breathing Exercises For You To Try

1. STRETCH AND SOOTHE THE BODY WITH CAT/COW Start on your hands and your knees with your wrists directly under your shoulders and your knees directly under your hips.

Point your fingertips forward. Centre your head and soften your head down.

Move into the cow position by dropping your belly towards the floor. Lift your chin and chest and look up.

Inhale as you do this.

Move into the cat position by drawing your belly into your spine and rounding your back towards the ceiling. Exhale as you do this.

Repeat this as many times as you feel your body needs.

»

H E A LT H Y F O U N DAT I O N S 17

2. FIRE UP YOUR CORE WITH HALF BOAT Sit with your knees bent and lean your torso back.

While keeping your knees bent, lift both feet until your legs are parallel to the floor and reach your arms towards your feet.

Inhale and exhale whilst holding this pose for 30 seconds.

3. FINDING BALANCE WITH TREE POSE Stand with your arms by your side and distribute your weight evenly across both feet.

Shift your weight to your left foot and bend your right knee and draw your right foot to your inner left calf. To make this pose more difficult you can bring your foot to your inner thigh.

Press your palms together to a prayer position at your chest, with your thumbs resting on your sternum.

Fix your gaze forward and inhale and exhale whilst holding this pose for 30 seconds.

Release the pose and repeat for the same amount of time on the opposite side.

18 H E A LT H Y F O U N DAT I O N S

YO G A

4. REST WITH CHILD’S POSE Kneel on the floor. Touch your big toes together and sit on your heels, then separate your knees as wide as your hips.

Bring your torso inbetween your thighs and put your forehead on the floor.

Stretch your arms in-front of you with your palms towards the floor.

Inhale and exhale in this position for as long as your body needs.

Breath Exercises to Try Find a comfortable seated position with a straight back and try the breath exercises below. Start by trying them for two minutes each, then add a minute each time you try until you are doing them for 10 minutes each.

Exercise 1: Breathe in through your nose and count 1, 2, 3. Breathe out through your mouth counting 1, 2, 3.

Exercise 2: Take a deep breath through both nostrils and fill the lungs with air, then exhale with a hissing sound. Inhale and exhale completely.

What next?

Yoga Challenge!

Try to do one or two postures and breathing exercises once a week.

If you already practice yoga, try and hold a posture for longer or extend your breathing practice. The below resources may also help you further your practice: More postures for beginners - https://www. nytimes.com/guides/well/ beginner-yoga

Gentle trauma sensitive yoga sequence - https:// www.youtube.com/ watch?v=V1OtxPbFAec NHS breathing exercises for stress - https://www.nhs. uk/mental-health/self-help/ guides-tools-and-activities/ breathing-exercises-forstress/ H E A LT H Y F O U N DAT I O N S 19

PERSONALITY DISORDERS

LET’S TALK ABOUT PERSONALITY DISORDERS Cat MacGregor, Female Enhanced Engagement and Relational Support Worker from the Bluebird Service at Women in Prison, introduces us to personality disorders.

Personality Disorders (PD’s) are hugely varied, and like all mental health difficulties they are completely unique to each individual. It’s estimated that around 1 in 20 people in the UK have a personality disorder of some kind and there are several categories of PD’s. Some of the most common are: Emotionally Unstable or Borderline Personality Disorder, Antisocial Personality Disorder, Narcissistic Personality Disorder and Paranoid or Schizoid Personality Disorder.

BUT WHAT ARE PERSONALITY DISORDERS AND HOW DO THEY DEVELOP?

Our personalities and sense of selves develop from when we are born, through our childhood, and into adulthood.

Many external factors affect how we come to see ourselves and others.

20 H E A LT H Y F O U N DAT I O N S

ATTACHMENT AND TRAUMA

From when we are born, our caregiver is meant to be our main source of safety, nourishment and connection to the world.

If we are brought up in a safe environment where our needs are met, we relate to the world and the people within it in a more trusting way with a general sense that things will be OK in times of difficulty.

For some people, however, this process is disrupted and their attachment to their caregiver can become disordered, with their general sense of safety broken. This could be the result of traumatic experiences such as abuse, neglect, witnessing violence, or losing a loved one. These experiences are then programmed into our development and affect how we come to see the world.

We now know that trauma has a huge impact on us and can cause the brain to develop in lots of different ways. For example, for some people, experiencing trauma as a child can cause the ‘fight or flight’ part of their brain to become overactive. This is the mind’s way of trying to protect that person, but it can also mean that when they grow up into an adult, they may respond to situations in a reactive and instinctive way. It can be hard for us to think clearly in emotionally stressful situations if our minds connect a current experience to an earlier stressful and traumatic situation.

RELATIONSHIPS TO OTHERS

Attachment difficulties and trauma can also make it harder for someone to regulate their emotions.. This means that someone’s emotions can become very intense and change very quickly in response to difficult feelings because their previous negative experiences have altered their brain to

respond in this way. It can be very difficult to be on the receiving end of this kind of response, but it’s important to remember that difficulties with emotional regulation are a sign of distress, and that these responses often come from a place of pain, fear and self-preservation.

If we are taught as a child not to trust our loved ones because they haven’t kept us safe, it is very hard to re-wire the fear that you will be hurt by other people in later life. If you have experienced previous trauma, you may grow up to expect traumatic things to happen to or from people you care about. This means that personality difficulties can develop as we struggle to relate to ourselves and to others.

As we get older, our patterns of behaviour, ways of relating to others, and emotional regulation become so in built that they shape who we are and we don’t even notice them. However, for people with Personality Disorders, hearing others describe them as ‘manipulative’ or ‘demanding’ can be hard to hear, as they are just acting on the ways they’ve learnt to protect themselves from danger.

If we think about how all our behaviour is a mirror of the past, we can understand that there is often more being communicated in our responses than is seen on the surface.

For example, Maya experienced a lot of neglect as a child. Maya is now an adult and her friend has suddenly changed plans at the last minute. To some people this may seem like no big deal, but for Maya this ignites a fear of being abandoned or unloved; feelings she felt at times as a child. In response, Maya may react in a way which to her friend, may seem extreme, but to Maya, this is a learned reaction to protect herself from the emotional pain of past experiences.

TREATMENT AND SUPPORT

Alongside medication, there are a number of different therapies that people can access: l Mentalisation Based Therapy (MBT) – focuses on the way we create our thought patterns, reactions, and emotional responses to situations and other people. l Dialectical Behavioural Therapy (DBT ) - Focuses on the triggers to difficult or painful situations and helps develop useful coping strategies to apply when they happen. l Art therapy - Uses art making to explore and express emotions, thoughts and experiences by externalising them in a way that can make it easier to reflect on, and ignite creative thinking. l Group Therapy - Shared and unique experiences can be explored in a way that allows for thinking about the dynamic between individuals and the group.

SELF CARE

l Recording your moods in a diary can help you spot patterns in what triggers difficult experiences for you, or help you notice early signs that they are beginning to happen so that you can get help. l You could also make a note of what is going well and is helpful to you. It is really important to be kind to yourself, and recognise the difficult steps you’ve taken, or new things you’ve tried. l If you are feeling less well, you might not be able to tell people that you need help or the kind of help you want, so it can be helpful to plan ahead. Inform people you trust about the methods that help you when you are struggling.

The Bluebird Service is a Women in Prison project funded by NHS England and HMPPS. For women to access this support they need to be returning to a London Probation team and either be on the Offender Personality Disorder Pathway or have criteria where they can be screened in. For more information, please contact your probation officer, or contact us at Women in Prison.

H E A LT H Y F O U N DAT I O N S 21

CHOICE4CHANGE

CHOICE4 I HAVE THREE HOLES IN MY HEART NO SURGEON COULD REPAIR THEM NO SCAN COULD SEE THEM BUT I HAVE THREE HOLES IN MY HEART

A Choice4Change client is above all, a mum; a separated or bereaved mum, but always a mum.

Celia Wyatt (MBACP) tells us about the work of Choice4Change One of the most abiding themes for women in prison is grief and guilt over lost or separated children. Choice4Change (C4C) exists to help women with such heart-breaking losses. Through one-to-one sessions, C4C’s counselling aims to build a better understanding and acceptance of the past and to resolve some of its pain, to identify and acknowledge strengths, and to grow in self-respect, confidence and resilience. C4C is a project of Choices Islington, a Christian charity with an ethos of compassion, care and respect. The counselling is non-judgemental, accepting 22 H E A LT H Y F O U N DAT I O N S

and respectful offered with warmth and care.

C4C uses its own bereavement programme called Time to Heal, which works through identifying deeper feelings, often pushed down and denied, and finding healthy expression of emotions of anger, guilt and shame about losing children. It has a strong focus on enabling grieving, especially where children have not died but are permanently separated. The programme moves on to consider issues of responsibility; how did this happen? Often, there’s a long and complex process of helping a mother to see she was not solely to blame and to recognize that others bear responsibility for what happened too. Forgiveness is used to help resolve anger towards others and the self, and as a long-term solution to feelings of guilt and shame. The end focus is on understanding acceptance and letting go in order to move on.

Although C4C is primarily a counselling programme, the service does include advocacy and practical support with re-establishing contact with separated children, including letterbox contact with adopted children. This is often a necessary step to set minds at rest about the child’s well-being; because a C4C client is above all, a mum; a separated or bereaved mum, but always a mum.

C4C loves working with women in

CHANGE prison and walking the road with our clients. We watch with awe as women face up to their losses with courage and humility, voice the pain inside and start to find healthy, life-affirming ways of moving forward. It’s such an honour to be trusted with the pain and the sadness but also the hope.

To see a separated or bereaved mother rediscover their selfrespect and hope for the future is deeply rewarding.

Currently, C4C is offered in three women’s prisons in Surrey: HMPs Bronzefield, HMP Downview and HMP Send. It operates as part of the psychological therapies service under the Mental Health Team and the NHS. In response to the pandemic, the C4C counselling service usually provided in prisons is now also available for women recently released from prison. Counselling is offered remotely by telephone or online video. For more information please contact 07736 950345.

WHAT OUR CLIENTS SAY

“C4C helped me because I feel like I’ve offloaded something I’ve never been able to before. Before, whenever I spoke about losing my children I always used drugs, but this time I’ve learned to speak without using to block out the pain. The counselling’s helped me understand how my life growing up has made me as a mother. I have also learned to see things how my daughter may see it.”

“I feel like I’ve offloaded something I’ve never been able to before.”

“The counselling has helped me focus on positives rather than negatives. I have talked honestly and openly and this has lightened my burden and helped me move forward to a positive future. I’m no longer depressed. I feel more at peace with my son’s adoption and I’m definitely moving in the right direction to achieve my goals. I feel a lot happier, proud of myself, and feel like I’ve set the wheels in motion to achieve the future I want.”

“Amazing to have a safe space where I can trust and tell the complete truth. I felt safe and understood which is hugely important to me and above all, not been judged.”

H E A LT H Y F O U N DAT I O N S 23

12 STEP

TWELVE STEP

LIFE

RECO

24 H E A LT H Y F O U N DAT I O N S

PROGRAMMES

IN

THE OPPOSITE OF ADDICTION IS CONNECTION

VERY

H E A LT H Y F O U N DAT I O N S 25

12 STEPS

WHAT ARE TWELVE STEP PROGRAMMES? Twelve Steps Programmes have helped millions of people around the world find and support a life of Recovery. Twelve Steps Programmes are support groups that exist for the purpose of recovery from substance addictions, behavioural addictions and compulsions. People who attend Twelve Steps Programmes strive to follow some basic principles of honesty, open-mindedness and willingness in order to live a life of Recovery.

At the groups (which are called ‘meetings’), people are able to share how they are feeling and get things off their chest.

Attending a group can help people to find strength in knowing that others have experienced similar things and are there to support them. The groups can be very inspirational, especially when someone gives a ‘share’ and talks about their life experiences and how they found Recovery.

26 H E A LT H Y F O U N DAT I O N S

WHY ARE THEY CALLED TWELVE STEP PROGRAMMES? They are called Twelve Steps Programmes because they follow 12 Steps, which have been designed as a plan of action to help people find and support their Recovery. Although the 12 Steps are based on some spiritual principles, many non-religious people have also found the Twelve Steps Programmes very helpful.

Each person works through the 12 steps with the help of their sponsor, who is someone else in Recovery who can guide you when you have questions or challenges in your life.

l Understanding that ‘acting on self-will’ has not served us well and we need help and support from something outside of ourselves l Turning over our self-will to a Higher Power (this idea can sometimes put people off who are not religious but a Higher Power doesn’t have to mean God, it can be anything that feels greater than us- e.g. the universe, a lost loved one who has passed away, the love and support of others, nature etc.- something that is outside of ourselves that wants the best for us) l Looking at our past mistakes and making amends l Working to become the best version of ourselves l Helping others who are in similar situations

WHAT ARE SOME OF THE KEY DO I START THEMES IN THE HOW ATTENDING 12 STEPS? MEETINGS? SOME KEY THEMES IN THE 12 STEPS:

l Surrendering to the fact that we have an addiction problem that is more powerful than ourselves and that life has become very unmanageable

Anyone who struggles with an addiction can attend these meetings. There are websites that show you exactly when and where a meeting is in your local area.

It will tell you online if a meeting is ‘open’ or ‘closed’.

A ‘closed’ meeting is only for those who struggle with the addiction/behaviour/ compulsion. An ‘open’ meeting is for absolutely anyone, so if you would like to go to a meeting with a friend or family member who does not struggle with addiction, then an ‘open’ meeting is the best place to do this. During the COVID-19 restrictions, most meetings have had to close or have been transferred to online meetings. It will tell you on the website which meetings you can attend in person and which are online and how to access them.

WHAT ARE SOME EXAMPLES OF TWELVE STEP PROGRAMMES? There are many examples of Twelve Steps Programmes. Each one focuses on a specific area of life that might be a challenge for someone.

They are all called something ‘Anonymous’ because an important feature of these groups is anonymity, i.e. anything said in a meeting and anyone you see in a meeting is kept confidential.

HERE ARE SOME EXAMPLES OF 12 STEP PROGRAMMES ALONG WITH THEIR CONTACT DETAILS ALCOHOLICS ANONYMOUS: support for people struggling with alcohol addiction Website: https://www.alcoholics-anonymous. org.uk/ National helpline: 0800 9177 650

NARCOTICS ANONYMOUS: support for people struggling with narcotics addiction (e.g. heroin) Website: https://ukna.org/ National helpline: 0300 999 1212

COCAINE ANONYMOUS: support for people struggling with cocaine addiction Website: https://cocaineanonymous.org.uk/ National helpline: 0800 612 0225

SEX AND LOVE ADDICTS ANONYMOUS: support for people struggling with sex or love addiction Website: https://www.slaauk.org/ National Telephone Voicemail: 07984 977 884

DEBTORS ANONYMOUS: support for people who often get into debt and find their debts difficult to manage

Website: http://debtorsanonymous.org.uk/ National Telephone Voicemail: 0207 1177 533

GAMBLERS ANONYMOUS: support for people struggling with gambling addiction Website: https://www. gamblersanonymous.org.uk/ National Information Line: 0330 094 0322

CO-DEPENDENTS ANONYMOUS: support for people struggling with having healthy relationships Website: https://codauk.org/ CoDa UK does not have a phone line

OVEREATERS ANONYMOUS: support for people struggling with food addiction Website: https://www.oagb.org.uk/ General Enquiries Phone line: 07798 587 802

AL ANON: support for family members or friends of people struggling with addiction Website: https://www.al-anonuk.org.uk/ National helpline: 0800 0086 811

H E A LT H Y F O U N DAT I O N S 27

COGNITIVE BEHAVIOURAL THERAPY (CBT) Cognitive Behavioural Therapy (CBT) is a talking therapy that can help you manage your emotional difficulties by changing the way you think and behave.

It is most commonly used to treat anxiety and depression. CBT is based on the concept that your thoughts, feelings, physical sensations and actions are all linked, and that negative thoughts and feelings can trap you in a vicious cycle.

CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. The aim is to change negative patterns to improve the way you feel.

CBT deals with your current problems, rather than focussing on issues from your past; it looks for practical ways to improve your state of mind on a daily basis. Even if 28 H E A LT H Y F O U N DAT I O N S

you don’t have your own CBT therapist, you can help make a difference to your life by using the key ideas of CBT yourself.

The Thought Record on the right can help you to reflect on how you emotionally and practically respond to situations, and find different ways to think about things which can then improve the way you feel and act.

Look at the examples given in the “Alternate Thoughts” column. If you open your mind to other possibilities, for example that the person that you said ‘hi’ to just didn’t hear you, or that they were in their own world and didn’t see you, or they were having a really bad day themselves, there is more chance you won’t feel such strong negative emotions and won’t behave in the way you would have done that probably wouldn’t benefit anyone, including yourself.

Why don’t you give it a try? You can make your own once you fill this one up.

C O G N I T I V E B E H AV I O U R A L T H E R A P Y

THOUGHT RECORD SITUATION

THOUGHTS

EMOTIONS

BEHAVIOURS

ALTERNATE THOUGHT/S

e.g.

You say ‘hi’ to someone as you pass them in a corridor but they don’t reply

“Why are they ignoring me?”

“What is wrong with me?”

“Do they think they are better than me?”

Upset Angry Frustrated Helpless

Take my emotions out on other people Doubt myself and lower my self esteem Start a fight with them?

“Maybe they didn’t hear me?”

“Maybe they were in their own world and didn’t see me?”

“Maybe they are having a really bad day?”

H E A LT H Y F O U N DAT I O N S 29

STRESS

ADDRESS YOUR STRESS Stress is everywhere and it’s directly linked to our mental health.

Stress is the body’s natural response when it senses danger. We all experience it. But too much stress, left unchecked for too long, can interfere with our lives and make us ill. In Britain, 1 in 6 adults will experience depression, anxiety or problems relating to stress at any one 30 H E A LT H Y F O U N DAT I O N S

time. Understanding what causes us to feel stressed, and taking action to manage our stress levels, is therefore a key part of looking after our mental health and wellbeing.

We want you to imagine that every person in the world is carrying within them, their own stress container, just like the one on the next page.

»

Illustrations by PPaint

Mental Health First Aid (MHFA) England are a social enterprise that offer expert guidance and training to support mental health, in the workplace and beyond. Their vision is to improve the mental health of the nation.

Stress container Stress container

H E A LT H Y F O U N DAT I O N S 31

STRESS

We all experience stress differently, so each person’s stress container will be a slightly different size, and this reflects how vulnerable they are to stress. Someone who is vulnerable to stress will have a smaller stress container, that will overflow more quickly compared to someone else who is less vulnerable to stress and therefore has a larger stress container. Factors like your genes, your unique life experiences and your environment all impact how vulnerable you are to stress, and so how large or small your stress container is.

As you experience different sources of stress, stress will flow into your stress container. The more stress you’re under, the faster your container will fill up. When your stress levels build up, the container overflows and issues develop. This looks different for everyone, but some common signs that someone’s stress container might be overflowing include; feeling irritable or tearful, finding it difficult to concentrate, consuming more caffeine, alcohol, substances or cigarettes, experiencing tiredness, headaches or stomach upsets.

How big do you think you’re stress container would be? n Big (not vulnerable to stress) n Small (vulnerable to stress)

What does it look like when your stress container overflows?

There are many different things that can cause or be a source of stress, from big life changes, to factors in our everyday lives.

Potential sources of stress include; money problems, work or unemployment, housing problems, difficult relationships or social isolation, illness or health issues, accidents or bereavement, legal issues like arrest or imprisonment, and trauma. And positive events, like starting a new job, getting married or having a baby can also cause stress.

…………………………………………

What sources of stress are you experiencing at the moment?

What are some of your helpful coping methods?

…………………………………………

…………………………………………

…………………………………………

…………………………………………

……………………………………………

……………………………………………

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…………………………………………

……………………………………………

Helpful coping methods can act as a tap to let stress out of our stress container, and stop it from overflowing. Some helpful coping methods include; being active and getting exercise, taking time to practice hobbies, learning a new skill, talking to a friend, family member or Listener, or sharing your feelings and asking for help.

Your Stress container

Hobbies Being Active

Stress container

Talking to a friend

Excessive drinking Over working Bottling up feelings

On the other hand, unhelpful coping methods can block these taps, and prevent stress from flowing out of the container. If we use these unhelpful coping methods too often, then our container will fill up and be at risk of overflowing.

Some unhelpful coping mechanisms include; drinking too much alcohol, using substances, overworking, spending too much time in front of a screen, or bottling up your feelings.

Do you have any unhelpful coping methods you’d like to work on? ………………………………………… ………………………………………… ……………………………………………

Stress container We hope that thinking about the stress

container has helped you to reflect on your own stress levels, and given you some ideas on how to better manage them!

H E A LT H Y F O U N DAT I O N S 33

C O N TAC T S

MENTAL HEALTH

EACH YEAR, 1 IN 4 PEOPLE IN THE UK WILL EXPERIENCE A MENTAL How to access Mental Health services: l Free on NHS but will most likely need a referral from GP l Some services may allow you to refer yourself

Useful numbers and information: RETHINK MENTAL ILLNESS 0300 5000 927 (Mon-Fri, 9.30am-1pm) Support and advice for people living with mental illness.

ANXIETY UK 03444 775 774 Mon-Fri 9:30am - 5.30pm Works to relieve and support those living with anxiety disorders by providing information, support and understanding via an extensive range of services, including 1:1 therapy.

MIND 0300 123 3393 (Mon-Fri, 9am-6pm) Provides information on a range of topics relating to mental health.

NO PANIC 0844 967 4848 (daily, 10am-10pm) A charity helping sufferers of panic attacks, phobias, OCD and anxiety.

OCD ACTION 0845 390 6232 (Mon-Fri, 9.30am-5pm) Support for people with obsessive compulsive disorder (OCD). Includes information on treatment and online resources.

SAMARITANS 116 123 (free 24-hour helpline) Confidential support for people experiencing feelings of distress or despair.

PANDAS FOUNDATION 0843 28 98 401 (every day 9am-8pm) provides support and advice to any parent experiencing a mental

34 H E A LT H Y F O U N DAT I O N S

illness, during or after pregnancy.

YOUNG MINDS 0808 802 5544 Provides information and advice for anyone with concerns about the mental health of a child or young person.

AGE CONCERN 0800 055 6112 Infoline on issues relating to older people.

For info & advice about money, care, health or housing.

SWITCHBOARD LGBT+ HELPLINE 0300 330 0630 10am-10pm every day Provides information, support and referral services.

CRUSE BEREAVEMENT CARE 0808 808 1677 Monday-Friday 9.30-5pm (excluding bank holidays), extended hours on Tuesday, Wednesday and Thursday evenings until 8pm

Useful contacts: HOUSING

SHELTER HELPLINE: 0808 800 4444

NACRO INFORMATION AND ADVICE LINE: 0300 123 1999

DOMESTIC VIOLENCE

REFUGE 0808 2000 247 (24-hour helpline) Advice on dealing with domestic violence.

WOMEN’S AID HELPLINE: 0808 2000 247 FAMILY SUPPORT National Prisoners Families' helpline: 0808 808 2003

LEGAL & GENERAL ADVICE

PACT (PRISON ADVICE & CARE TRUST) HELPLINE: 0808 808 3444

ADVICE AND INFO

HEALTH PROBLEM. . . GET THE HELP YOU NEED AND DESERVE! PRISON REFORM TRUST ADVICE AND INFORMATION SERVICE: 0808 802 0060 Freephone information line 0808 802 0060.

Open Monday 3.30pm - 5.30pm Wednesday 10.30am - 12.30pm Thursday 3.30pm - 5.30pm

PRISONERS’ ADVICE SERVICE (PAS): Prisoners’ Advice Service, PO Box 46199, London, EC1M 4XA. 0207 253 3323 Open Monday, Wednesday and Friday 10 am-12.30 pm and 2-4.30 pm

SUBSTANCE MISUSE SUPPORT

Illustration by PPaint

FRANK HELPLINE:

0300 123 6600 24 hours, 7 days per week

ACTION ON ADDICTION HELPLINE: 0300 330 0659

BO H ENRIETTA LAX (1920-1951)

An African-American woman who died aged 31 years from cervical cancer. A cell sample taken from Henrietta’s cervical cancer are the source of the HeLa cell line, still one of the most important cell lines in medical research today. Her descendants now campaign for more awareness around consent, as her cells were actually taken for research without her permission.

H E A LT H M AT T E R S !

DY H E A LT H EHAYLTFH O UMNAT DAT T EIROSN! S 37

H E A LT H I N E Q UA L I T Y

Have you ever noticed that different groups of people in our society have different experiences when it comes to their health? Not sure? Well, have a look at the below facts… l The life expectancy for women living in the most deprived (poorest) areas of England is 7.6 years less than for women living in the least deprived (richest) areas. l 41% of homeless people have long term physical health problems compared to 28% of the general population. l Women in prison are 5x more likely to have mental health concerns than the general female population. l Black women are four times more likely than white women to die in pregnancy or childbirth in the UK, and women from Asian ethnic backgrounds are twice as likely.

Doesn’t seem fair right? That’s because it isn’t.

Health inequalities are the unfair, avoidable and systematic health differences we see between different groups of people.

38 H E A LT H Y F O U N DAT I O N S

l Our health status (e.g. how long we live or how likely we are to experience a specific health condition). l Our access to healthcare (e.g. how easy it is to get the treatment we need). l The quality of the health care we receive (e.g. patient satisfaction). l Our health behaviours (e.g. how likely we are to smoke). l Wider determinants of our health (e.g. the quality of our housing).

And all of these health differences are often determined by our personal life experience, for example;

l Our socio-economic background (e.g. whether or not we’re employed, and how much income we have). l Our location (e.g. where in the country we live, and whether we live in a city or the countryside). l Our identity (e.g. our age, gender, sexuality, ethnicity, religion, ability, etc.) l Our vulnerabilities (e.g. whether we’ve experienced homelessness, been affected by the criminal justice system, or someone who lives in a different country to the one they were born in).

The good news is, now that we know about and understand what health inequalities are, we can focus all our energy on overcoming them and making sure that everyone, no matter what their personal life experience, has equal health experiences.

How do you think your personal life experience has affected your health?

Is there any specific care and support you think you need around your health?

Don’t be afraid to ask health professionals for help around your unique health needs.

We all deserve equal opportunities to have good health.

Illustration by PPaint

WE ALL DESERVE GOOD HEALTH

These health differences include things like;

H E PAT I T I S C

HEPATITIS The Hepatitis C Trust is a national patient led organization, Julia and Jane are the women’s prison team. We cover all twelve female prisons, encouraging women to get tested and treated. Both of us have experience of using class A drugs, contracting hepatitis c and curing it. We also both know how it feels to be in jail with hepatitis C. As women we want to encourage other women to come forward and get help. If there was ever a ‘good time’ to have hepatitis c in jail, that time would be now. The new treatment is classed as a CURE, side effects are minimal and the course of tablets is just eight to twelve weeks.

JULIA’S STORY I was first diagnosed in 2006/7 on an all too frequent hospital admission. I remember being told “you are positive for the hepatitis C virus” but given no more information on treatment or even what hep C actually was. I had often heard of hep C within my circle over 40 H E A LT H Y F O U N DAT I O N S

the years and I was aware as an injecting drug user I was at risk but I still found the diagnosis a shock. I guess it’s that thought of “it’s not going to happen to me”. It did.

Facing and dealing with my hep C was not a priority at that time. My life was chaotic and denial pretended to be my friend so to the back of my mind it was pushed.

In 2015 I was given a prison sentence and sent to HMP Holloway. Whilst there I started engaging with healthcare and met the hep C doctor. It was not like it is today - I was released before I could get any help.

The game changer for me happened a few months later when a good friend of mine lost his battle to hep C and died. I didn’t want that to happen to me. My ability to bury my head in the sand and ignore it disappeared, I was filled with an urgency to face it and see how I could get rid of it. Somewhere between prison and losing my friend, a new treatment had become available…a cure! So I did the new treatment.

JULIA AND To me it was a miracle.

JANE I was cured of hepatitis

C TRUST C with a few tablets a day for 12 weeks with no side effects.

Women in prison today have the amazing advantage of fast access to treatment and I would encourage every woman to get tested.

Let’s all support each other and eliminate hepatitis C. What We’ve Been Up To This is an exciting time, there is an elimination goal for the women’s estate!!!

So far, we have successfully eliminated hep C in HMP Foston Hall and HMP Low Newton.

It was an amazing experience to be a part of the elimination - the conversation about hep C is finally out in the open. For the elimination to be a success, this is how it needs to stay. Our next focus is eliminating in 5 more jails; HMP New Hall, HMP Askham Grange, HMP Bronzefield, HMP East Sutton Park and HMP Drake Hall – eventually the whole estate. During our elimination work, anyone testing positive will be fast tracked on to treatment. There is no need to be scared - no one needs to live with or die from hepatitis C any more.

What is Hep C Hepatitis C is a virus that is caught only through blood. The blood from an infected person must get into your bloodstream via a direct route. Risks include:

l Sharing someone’s razor l Being tattooed l Piercings l Sharing self-harm tools l Sharing nail clippers l Sharing injecting equipment Hepatitis C is not passed on through saliva, urine or sweat. It is not sexually transmitted, although rough or anal sex can be a risk if skin is broken. You cannot catch hep c from: l Blood on a toilet seat l Blood in the shower l Blood on floor/walls.

However If you do have a cut or wound, cover it up.

Antibodies When someone is exposed to the hepatitis c virus their body produces antibodies to try to fight it off. Once you have them, these antibodies will always be present if you have a test. They are not the virus lying dormant (this is a myth), they are just a marker showing you have come into contact with the virus at some point. You will need to take a further test to show if you have the virus.

We look forward to meeting anyone who needs our support. If you would like any further information, please contact healthcare and ask for one our booklets.

Julia and Jane H E A LT H Y F O U N DAT I O N S 41

PERIODS

IT’S NORMAL

TO TALK ABOUT PERIODS PERIOD. There is a huge amount of stigma surrounding periods, but it’s vital that we break this silence and empower everyone who experiences a period to manage it with confidence and dignity!

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H E A LT H Y F O U N DAT I O N S 43

PERIODS

or once a month, but some people can experience periods that are more or less frequent than this. The period itself will usually last between 3 and 8 days.

NOW WE’VE COVERED THE BASICS, LET’S LOOK AT SOME QUICK PERIOD FACTS!

LET’S START BY GOING RIGHT BACK TO BASICS… WHAT EVEN IS A PERIOD? Periods happen as part of the menstrual cycle. To understand the menstrual cycle, it helps to know about the internal reproductive organs of women, girls and people who were assigned female at birth.

If you’re not sure what we’re talking about, have a look at the diagram above.

The menstrual cycle is controlled by hormones. At the start of the cycle, rising levels of the hormones oestrogen and progesterone cause the reproductive organs above to prepare for a potential pregnancy.

This involves the endometrium, which is the lining of the uterus/womb, becoming thicker.

If a pregnancy doesn’t happen, then the levels of oestrogen and progesterone will fall. This change in the hormone levels then causes the endometrium to come away and leave the body through the vagina as a period.

Most people who experience a menstrual cycle will have a period every 28 days, 44 H E A LT H Y F O U N DAT I O N S

Fact 1 A person will usually experience their first period around the age of 12 years old, but it can happen earlier or later than this too.

Fact 2 Once you’ve experienced the menopause, you’ll stop having periods.

Most people usually start going through the menopause between the ages of 45 and 55 years old, and the average age in the UK is 51 years old.

Fact 3 Between the ages of 12 and 52 years old, you can expect to experience around 480 periods. You might experience less periods than this if you use certain forms of contraception, experience any pregnancies, or have any health conditions or take certain treatments that affect your menstrual cycle.

Fact 4 During a period most people will lose between 5-12 teaspoons of blood, although some people can bleed more heavily than this.

Fact 5 For most people, their period will tend to be heaviest during the first 2 days of their period. When a period is at its heaviest, the blood will be red, but on lighter days it may be pink, brown or black.

Fact 6 Period products soak up or collect the blood released during your period.

There are different types of period products for you to choose from, including tampons, menstrual cups, disposable sanitary pads and reusable sanitary pads and period underwear.

SO WE’RE PRETTY SURE WE KNOW WHAT YOU’RE ABOUT TO ASK NEXT… PERIOD PAIN, WHAT’S THAT ALL ABOUT?!

Period pain is caused by the myometrium, which is the muscular wall of the uterus, contracting. It’s a common and normal part of your menstrual cycle. Period pain is usually felt as muscle cramps in the tummy, which can spread to the back and thighs.

You may find that the pain can change from intense spasms to a dull ache, and that some periods are more painful than others.

There are lots of things that you can do to manage your period pain, and you may have already found some techniques that work for you. Maybe your techniques are even on our list? l Painkillers, like ibuprofen and aspirin. l Heat, like putting a heat pad or hot water bottle on your lower tummy. l Warm bath or shower (this is a great way to relive pain, relax and help you to keep clean during your period). l Massaging. Why not try a light, circular massage around your lower tummy? l Exercise. It might feel like the last thing you want to do during an uncomfortable period, but being active can reduce pain.

You can always start with a gentle walk or yoga! l Stop smoking. Did you know that smoking can increase the risk of period pain?

Our bodies are all unique to us, which means that our menstrual cycles and periods will also be slightly different, and they may even change throughout our lives.

What is normal and healthy for one person, may not be the same for someone else.

Having said that, many people do experience problems with their periods.

For example, there are around 1.5 million women in the UK who are currently living with endometriosis. This is a condition where cells similar to those in the lining of the uterus are found elsewhere in the body, and it can lead to severely painful or heavy periods, problems with fertility (having children), fatigue, and bowel and bladder problems.

If problems with your periods are affecting your day-today life, help and support is available. The best place to start is by talking to your GP or prison doctor.

“Our bodies are all unique, so our menstrual cycles and periods will also be slightly different.”

Turn the page to find your very own period tracker! By tracking your period, you’ll be able to better understand your unique menstrual cycle and the patterns of your body. You’ll also be able to pick up on any changes that might happen over time, and if you are struggling with your periods this tracker will help you to keep a diary of your symptoms to show your doctor.

H E A LT H Y F O U N DAT I O N S 45

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PERIODS

H E A LT H Y F O U N DAT I O N S 47

BREAST AWARENESS

WITH COPPAFEEL! Keep in mind that we use the words breasts/chest/boobs interchangeably.

Whatever you call your breast tissue, this article applies to you…

At CoppaFeel! we know that knowing your boobs can save your life. Our founder, Kris Hallenga, set up our breast cancer awareness and education charity 12 years ago, when she was diagnosed with breast cancer at just 23 years old. Kris was initially told that she was ‘too young’ for her symptoms to be breast cancer, and by the time her symptoms were investigated, the cancer had spread and she was diagnosed with incurable cancer. Kris wanted to make sure that no other young person would go through her experience of being told they are ‘too young’ for breast cancer, so she created CoppaFeel! Kris just celebrated her 12th ‘cancerversary’, and our charity is in its 12th year of existence.

Over our 12 years we have made great

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progress educating people about breast cancer signs and symptoms, and empowering them with the knowledge and confidence needed to get to know their bodies. One way we do that is by sharing real stories from our Boobettes – young women who have a close relationship with breast cancer – who hold webinars for workplaces, schools, universities etc. We also work with doctors, nurses, teachers and corporate partners to increase awareness and education of breast cancer signs and symptoms and early diagnosis. Our work is always motivated by one simple fact: early diagnosis saves lives.

1 in 7 women in the UK will be diagnosed with breast cancer in their lifetime. The good news is that if breast cancer is caught early, it is curable. Early detection is the best form of defence against breast cancer. With the pandemic affecting diagnostic services in healthcare, breast awareness is more

B R E A S T AWA R E N E S S

crucial than ever. However, we know from our research that only around 30% of women check on a monthly basis, and there is still a lack of confidence around boobchecking. So, we are here to tell you that breast awareness is easy!

It’s just about getting to know your normal. The best way to get to know your boobs/chest is to check, so here are our top 5 boobchecking recommendations: l Check whichever way feels comfortable for you. Remember to look at your boobs as well as feel them. This could be lying down in bed or in the shower.

Whatever works for you. l Get to know what normal looks and feels like for you.

All boobs are different. Some people have inverted nipples and that’s perfectly normal for them. You might have lumpy boobs around the time of your period and that’s normal for you. No one knows your boobs better than you. l Check roughly once a month.

You might find it helps to check around the same time every month, so you can get used to your monthly fluctuations. l Your breast tissue goes up to your collarbones and under your armpits. Make sure you check all this area. l If you notice any changes or anything that seems unusual for you, monitor it for a week and then get it checked out with your GP or prison doctor.

LOOK

Changes in skin texture, e.g. puckering/dimpling

FEEL

Lumps and thickening

LOOK

Nipple discharge

LOOK

Swelling in your armpit or around your collarbone

FEEL

Constant, unusual pain in your breast or armpit

Get to know your boobs but don’t go looking for breast cancer!

We don’t want you looking for signs and symptoms of breast cancer because we hope you’ll never have any. Just get to know your normal and be aware of the signs and symptoms of breast cancer.

Your boobs will naturally change over your life, and that’s perfectly normal. Sometimes you will need to get to know your ‘new normal’, for example if you are pregnant or have just had a baby. Breasts can change in pregnancy due to hormonal fluctuations, but you should still be checking them as always. If you notice something unusual for you, it’s important you don’t ignore symptoms. Talk to your doctor and get it checked out.

If you want a reminder to check your boobs, let your doctor know that they can order free resources from our website at coppafeel.org/ at-surgeries – we have posters and handy waterproof shower stickers, which prompt you to check and remind you of the signs and symptoms.

Remember that your body is yours and yours only. You only get one body – so be proud of it and take care of it! Make coppin’ a feel a part of your routine - it could save your life.

LOOK

A sudden, unusual change in size or shape

H E A LT H Y F O U N DAT I O N S 49

C E RV I C A L S C R E E N I N G

NOT A FAN OF CERVICAL SCREENING APPOINTMENTS?

YOU’RE

NOT ALONE.

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H E A LT H Y F O U N DAT I O N S 51

C E RV I C A L S C R E E N I N G

We know that lots of people don’t like to think about or attend cervical screening appointments for lots of different reasons, and that’s okay. We’re hoping this article will give you the information you need to make the best decision for you and your health.

amazing, eh?

Well we thought so, and that’s why everyone with a cervix, between the ages of 25 and 64 years old, is eligible for regular cervical screening.

What is cervical screening?

Cervical screening, previously called a smear test, is a free test available on the NHS which checks the health of your cervix. It involves a trained healthcare professional taking a sample of cells from your cervix.

Cervical screening appointments will usually follow the below 5 steps: You’ll be given a private space, usually behind a curtain, to undress from the waist down.

Next, you’ll be asked to lie back on an examination bed, with your legs bent, feet together and knees apart.

You’ll also be given a paper sheet to cover your lower body.

Sometimes you may be asked to change position during the test.

The professional will then gently insert a tool called a speculum into your vagina, and a small amount of lubricant may be used to make this easier.

The professional will open the speculum so that they can see your cervix, and using a small, soft brush, they’ll take a sample of cells from your cervix.

This part can feel uncomfortable, but it shouldn’t be painful.

“Everyone with a cervix, between 1 the ages of 25 and 64, is eligible for regular cervical 2 screening.”

So what is the cervix?

A good place to start is with the internal reproductive organs of women, girls and people who were assigned female at birth.

If you’re not sure what we’re talking about, have a look at the diagram back on page 44.

Good to have you back!

So the cervix, sometimes called the neck of the womb, is where the lower part of the uterus (womb) joins to the top of the vagina. You can think of the cervix as the gateway between the uterus and vagina, and here’s a fun fact for you, during pregnancy the cervix will close to keep a baby inside the uterus, and it will only open again during labour, when it dilates and widens to allow the baby to leave the uterus and pass through the vagina. So the cervix is pretty 52 H E A LT H Y F O U N DAT I O N S

3

4

SPECULUM AND BRUSH

5

Once this is done, the professional will then close and remove the speculum from your vagina, and leave you to get dressed in private.

How often are cervical screening appointments?

If you’re registered with a GP, you should automatically receive letters in the post inviting you to make your cervical screening appointments. These letters will tell you where you can go for cervical screening and how to book the appointment. Most cervical screenings are done in a GP surgery, but in some areas you may be able to go to a sexual health clinic instead.

How often you’ll be invited to cervical screening depends on your last cervical screening result. In general, you’ll start receiving these invite letters from 6 months

before your 25th birthday, then every 3 years up until your 49th birthday, and then every 5 years up until your 64th birthday, and you’ll only be invited after this if one of your last 3 tests had an abnormal result.

If you do the math (or get a calculator to do it for you like we did!) this means that everyone with a cervix will be invited to at least 12 cervical screening appointments in their lifetime.

Why is cervical screening done?

Well, the truth is that cervical screening is done to save lives.

The cells taken from your cervix are sent to a lab and checked for high-risk types of human papillomavirus (HPV), and if you have HPV, any changes to these cells. (If you’re wondering whether or not cervical screening is still important for people who

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H E A LT H Y F O U N DAT I O N S 53

C E RV I C A L S C R E E N I N G

have had the HPV vaccine, this is a great question and the answer is yes!)

Around 2-4 weeks after your cervical screening appointment, you’ll be sent a letter to let you know the results of your test, and to explain what happens next. For most people, the letter will say that their cervix is healthy, and that they don’t need to do anything until their next cervical screening appointment. But for some people, the results will show that they have high-risk HPV and cervical cell changes. If this happens, they will then be invited to a specialist colposcopy department for further tests and an examination of the cervix to diagnose and treat any cell changes.

54 H E A LT H Y F O U N DAT I O N S

Many cell changes go away on their own, but some may develop into cervical cancer.

In the UK, sadly around 3,000 women are diagnosed with cervical cancer every year.

One of the best ways that you can protect yourself from cervical cancer is by attending regular cervical screening appointments, as this will mean that any cell changes can be picked up as early as possible and treated before they turn into cancer.

But if we’re all honest, cervical screening is not exactly anyone’s idea of fun...

Whether it’s your first time, or you’ve attended these appointments many times

before, we know that cervical screening can make people feel anxious for many different reasons, and that’s okay.

Here are some helpful tips for making your cervical screening appointment a little bit easier: l When you book your appointment, let

the service know what time of the day you’d prefer to have your appointment, whether you’d like a longer or double appointment, and if you’d like a male or female professional to carry out the appointment. l If you have any worries or concerns, talk to the professional carrying out your appointment so that they can give you the right support. l Bring someone you trust to your appointment, like a partner, friend or family member. l Remember that you are always in control and can ask the professional carrying out your appointment to stop at any time. l Wear something you can leave on during the appointment to help you feel more covered, like a skirt, dress, or long jumper.

You can even bring along a blanket or scarf if this helps. l Ask for a smaller speculum, or maybe put the speculum into your vagina yourself, or even have your partner do this for you. l Try a different position, if you’re uncomfortable lying on your back you can try lying on your left hand side with your

knees bent instead. l The menopause can cause changes to the vagina that might make cervical screening more uncomfortable than before. If this affects you, talk to the professional doing the test as you might benefit from being prescribed a vaginal oestrogen cream or pessary. l Visit a specialist cervical screening clinic.

If the healthcare professional is finding it difficult to see your cervix, they may suggest that you go to a specialist colposcopy department for your cervical screening appointment instead.

There are also some specialist cervical screening clinics that can meet specific needs, such as if you have experienced sexual violence, or if you are trans man and/or nonbinary person with a cervix.

“You are always in control and can ask to stop at any time.”

So how are you feeling about cervical screening now?

Well whatever you think about it all, we thought we’d let you know that if you did miss your last cervical screening appointment and would like to rearrange it, you don’t need to wait for your next letter to book an appointment, you can just give your GP a call and book it whenever you’re ready. Equally, if you’d rather not have cervical screening, you can ask your GP to be taken off the invite list, and you can always be added back on if you ever change your mind.

H E A LT H Y F O U N DAT I O N S 55

TRANS SCREENING

I’M TRANS DOES THAT AFFECT

ROUTINE SCREENINGS? Trans is an umbrella term that refers to the many diverse and unique ways that someone may describe their gender, in particular someone whose gender-identity is not the same as, or doesn’t sit comfortably with, the but is not limited to, transgender, trans woman, trans feminine, trans man, trans masculine, gender-fluid, and non-binary.

56 H E A LT H Y F O U N DAT I O N S

Illustration by PPaint

sex they were assigned at birth. It includes,

H E A LT H Y F O U N DAT I O N S 57

TRANS SCREENING

Trans people have the same health needs as everyone else, but are less likely to seek treatment for health problems or attend preventative screenings. There are many reasons for this, and one of them is that healthcare services do not always meet the specific needs of trans people. For example, many trans people experience discrimination and social stigma when accessing healthcare, such as not being able to find a doctor with knowledge about trans health, being judged by healthcare staff, or even completely refused healthcare. For many trans people, healthcare services and appointments can also potentially trigger ‘gender dysphoria’. This is a feeling of discomfort and/or distress that happens when a person experiences a mismatch between their biological sex and gender identity. Linked to this, routine screening appointments can be particularly distressing for some trans people as they involve intimate examinations and discussing body parts.

In the UK, people are routinely invited by the NHS to four main screenings – one of which, cervical screenings, has already been discussed in this magazine.

It’s important to be aware that the NHS system is still based on binary genders (male/man or female/woman) so if your GP service is not aware of your gender identity, or if you’ve had gender affirming surgery or hormone therapy, you may not be routinely

invited for the right screenings. For example, if you are a trans woman who is registered with your GP as ‘female/woman’, you won’t be automatically sent routine screening invites that are important for people who were assigned male at birth, but that may still apply to you and your body. If you’re not sure whether you’re being invited to the right screenings, book an appointment with your GP or prison doctor, who will be able to talk everything through with you and refer you to the right screening services.

“Many trans people experience discrimination when accessing healthcare.”

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[Side Note:] It’s also important to note that anyone who is not registered with a GP, or who hasn’t updated their address with their GP, won’t receive invitation letters. To avoid missing your screening invites, remember to register with a GP and keep your address updated on their records.

HERE’S AN OVERVIEW OF THE 4 MAIN ROUTINE SCREENINGS: l Breast Cancer Screening- available to everyone between the ages of 50 and 74 years, who have breasts, either due to naturally-occurring oestrogen or oestrogen hormone therapy. l Cervical Cancer Screening- available to everyone between the ages of 25 and 64 years, who have a cervix. If you’ve had a full hysterectomy (an operation to remove your womb and cervix) you do not need to attend cervical screening.

l Bowel Cancer Screening- available to

everyone between the ages of 60 and 74 years, regardless of their gender. This screening is done via a home test kit which is sent out every two years. l AAA (Abdominal Aortic Aneurysm) Screening- available to everyone aged 65 years, who was assigned male at birth. An AAA is a bulge in the blood vessel that runs from the heart to the tummy, and you are more at risk of developing an AAA if you were assigned male at birth compared to female at birth.

TIPS TO MAKE SCREENINGS MORE COMFORTABLE BEFORE THE SCREENING

Let them know that you’re worried

When booking your screening appointment, if you feel able to, let the service know that you’re worried about it. This way the staff can provide you with the right support, like ensuring that the nurse or doctor carrying out the appointment is of a gender you feel most comfortable with, or maybe you would prefer it if when you’re in the waiting room the healthcare professional calls your initials only rather than your full name when they’re ready to begin the appointment.

Clothing

Cervical and breast screenings require you to remove clothing during the appointment.

If this feels uncomfortable, wear clothing that allows you to feel more covered. For example, cervical screening appointments involve undressing below the waist, so why not take a towel or blanket that you can place over the top of your legs. And for breast screenings, which involve undressing above the waist, why not wear clothes

that come in two pieces, like a t-shirt and trousers, rather than one, like a dress.

Appointment time

If waiting rooms make you feel uncomfortable, ask to book the first appointment of the day as this can minimise waiting times and sometimes means that the waiting room will be less busy. You can also ask for a double appointment time so that you can take the appointment at your own pace and go through any questions you might have.

Attend a specialist service

If you’ve had a bad experience with your local health service in the past, or you experience feelings about your body that make screenings difficult, you may prefer to visit a specialist clinic where your needs may be better met. Contact details for some of these services, like 56 Dean Street, Clinic T, cliniQ, and My Body Back, can be found on page 96 towards the back of this booklet.

DURING THE SCREENING Take a friend

It may be comforting to have someone you trust with you, and to help ask any questions you may forget if you’re nervous. If a friend or family member isn’t able to come with you, ask if another staff member can be with you for support, this is called a chaperone.

Stop

Remember that you are always in control of your screening appointments. So if at any point during the appointment you experience pain, discomfort or you feel overwhelmed, let the nurse or doctor know so they can stop the screening and either help you find ways to make the experience more comfortable, or leave it for another day.

H E A LT H Y F O U N DAT I O N S 59

B I RT H C O M PA N I O N S

PREGNA KATE CHIVERS, ENGAGEMENT MANAGER AT BIRTH COMPANIONS, TELLS US ALL ABOUT THE WORK THEY DO… Your Inside Guide to Pregnancy, Birth and Motherhood in Prison

“Pregnancy in prison can be emotional and overwhelming. It is good to find out about what help and information is available and to get as much support as you can.” – a woman supported by Birth Companions Birth Companions is a charity that has worked with pregnant women and new mothers in prison since 1996. We began by working at HMP Holloway and we currently run services in three prisons, HMP Peterborough, HMP Foston Hall and HMP Bronzefield. Over the years we have supported more than 2000

women in custody.

We offer support to women in the perinatal period, which is pregnancy, birth and early parenting. We make regular visits to the prisons we work in and offer groups for pregnant women to come together, talk about their pregnancy and access information and support. We also meet with women on Mother & Baby Units to offer support in early parenting. We have a dedicated team of staff and volunteers who are passionate about providing women with clear, up to date information and non –judgemental, trauma-informed support. Through our work, we identified a need to offer detailed information about all aspects of pregnancy and early parenting in prison in one booklet and in 2016 we were awarded funding to develop this resource.

“Your Inside Guide to Pregnancy, Birth and Motherhood in Prison” was designed and written by the Birth Companions staff team and by women who had been in prison

“Pregnancy in prison can be emotional and overwhelming.

It’s good to get support.”

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NCY themselves and are now part of our Lived Experience Team. Our Lived Experience Team at Birth Companions is a group of women who have been supported by us, and now work with us to highlight the needs of women in prison and work to bring about change. The team supported us through writing the guide, to ensure it is supportive and covers all the questions women may have. We also held workshops with women in prison and women in the community to ask about what to include in the guide.

The guide is for anyone who is pregnant and in prison or facing a prison sentence, is currently living on an MBU with their baby, or has given birth in the last 18 months and been separated from their baby.

It has information about making decisions about your pregnancy, what support is available to you, birth and what to expect.

It covers Mother and Baby Units in prison and how to apply, and the experience of being separated from your baby. It also has sections on preparing for release, and includes information on who you can speak to for support.

IN PRISON

To get a copy of the guide, please write to us at; Dalton House 60 Windsor Avenue London, SW19 2RR (please note this is only a postal address and not an office) Or email Info@birthcompanions.org.uk Or Call 020 7117 2824 and leave a message with name, location and prison number.

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A RT H R I T I S

ARTHRITIS WHAT IS IT?

Arthritis is a common condition that causes pain and inflammation in a joint.

There are many types of arthritis but the two most common types are: l Osteoarthritis l Rheumatoid arthritis Osteoarthritis is the most common type of arthritis in the UK, affecting 8 out of 10 people with arthritis. Osteoarthritis initially affects the smooth cartilage lining of the joint. This makes moving around more difficult than usual and leads to pain and stiffness. Once the cartilage lining starts to roughen and thin out, the tendons and ligaments have to work harder. This can cause swelling and the formation of bony spurs, called osteophytes.

Rheumatoid arthritis occurs when the body’s immune system targets affected joints, which leads to pain and swelling. The outer covering of the joint is the first place affected. This can then spread across the joint, leading to further swelling and a change in the joint’s shape. This may cause the bone and cartilage to break down.

People with rheumatoid arthritis can also develop problems with other tissues and organs in their body.

62 H E A LT H Y F O U N DAT I O N S

WHAT ARE THE SYMPTOMS?

The symptoms of arthritis you may experience will vary. Therefore it’s important to have an accurate diagnosis.

See a doctor if you have: l joint pain, tenderness and stiffness l inflammation in and around the joints l restricted movement of the joints l warm, red skin over the affected joint l weakness and muscle wasting

WHAT CAN BE DONE? There is no cure for arthritis but there are many treatments that can help slow down the condition.

For osteoarthritis, medications are often prescribed, including: l analgesics (painkillers) l non-steroidal anti-inflammatory drugs (NSAIDs) l corticosteroids In severe cases, a surgical procedure may be recommended.

Treatment for rheumatoid arthritis aims to slow down the condition’s progress and minimise joint inflammation or swelling. This is to try and prevent damage to the joints.

Recommended treatments include: l analgesics (painkillers) l disease modifying anti-rheumatic drugs (DMARDs) – a combination of treatments is often recommended l physiotherapy l regular exercise

Photo: Unsplash

Ever felt stiff and achy in your knees or elbows? Feel like your body could do with a good old oiling? You may (or may not!) suffer from arthritis.

ARTHRITIS TRUE OR FALSE 1. Arthritis only affects old people

losing weight can really help you cope with arthritis

2. Osteoarthritis can develop in children and young people as a result of an injury

9. Being active can help reduce and prevent pain

3. Arthritis is very rare 4. Arthritis is more common in women than men 5. All in all, there are more than 10 types of arthritis and related conditions 6. Gout is a type of arthritis 7. The most commonly affected joints are those in the hips, hands, knees, and spine 8. If you’re overweight,

10. You should try to reduce the stress on your joints while carrying out everyday tasks like moving and lifting ANSWERS 1. False. It affects people of all ages, including children.

However, it usually develops in adults who are in their 40s or older 2. True 3. False. In the UK, around 10 million people have arthritis

4. True. In fact, women are 3 times more likely to develop rheumatoid arthritis than men 5. True 6. True 7. True 8. True. Too much weight places excess pressure on the joints in your hips, knees, ankles and feet, leading to increased pain and mobility problems.

9. True - as long as you do the right type and level of exercise for your condition 10. True

Source: NHS Choices

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M E N O PAU S E

THE CHA

We go through many changes in life, both good and bad. The menopause, often referred to as ‘The Change’, has mixed reviews (if we’re being honest). But the best way to face any change is with a bit of preparation. So here’s some information to help you prepare for whatever kind of change the menopause is planning on throwing at you!

To understand the menopause, it helps to know about the internal reproductive organs of women, girls and people who were assigned female at birth. If you’re not sure what we’re talking about, have a look at the diagram back on page 44.

Now you know what these organs are, and where they are in the body, let’s have a closer look at what they do!

The ovaries produce the hormone oestrogen. This is important, as oestrogen controls the regular monthly cycle of changes within the reproductive organs, as they prepare for a possible pregnancy, and if that doesn’t happen, then experience a period.

Still with us? Great!

So as we get older, our ovaries gradually stop producing as much oestrogen, and this change in the balance of the body’s hormone levels is what causes the menopause. Once you’ve experienced the menopause, you’ll stop having periods and your ovaries won’t release an egg each month, so you won’t be able to get pregnant naturally.

So when can you expect these changes to happen to you? Well, most people usually start going through the menopause between the ages of 45 and 55 years old, and the average age in the UK is 51 years old.

However, around 1 in every 100 women experience the menopause before they reach 40 years old, and this is called premature menopause or premature ovarian insufficiency. Premature menopause can be caused by surgery, cancer treatments, or an underlying heath condition, but for some people the cause is unknown.

Most people will know when they’re

“Every person’s experience of the menopause is unique.”

64 H E A LT H Y F O U N DAT I O N S

NGE going through the menopause because they’ll experience menopausal symptoms.

These symptoms usually begin months or even years before your periods actually stop, and this period is called the ‘perimenopause’. On average, most symptoms last for around 4 years after your last period, but some people can experience them for much longer than this.

The main thing we want you to know is that every person’s experience of the menopause is unique. For some people, menopausal symptoms can last for many years and be severe enough to impact on their everyday lives, whilst for others, they may not experience many menopausal symptoms at all.

Here are some examples of the most common menopausal symptoms: l Changes to your mood or mental health (including depression and/or anxiety) l Problems with memory and concentration l Headaches l Difficulty sleeping and/or fatigue l Hot flushes (short, sudden feelings of heat, usually in the face, neck and chest,

which can make your skin red and sweaty) l Night sweats (hot flushes that happen at night) l Racing heartbeat (palpitations) l The first sign of the menopause is usually a change in the normal pattern of your periods and eventually you’ll stop having periods altogether l Vaginal dryness and/or discomfort l Pain, itching, or discomfort during sex l Reduced sex drive (libido) l Problems controlling your bladder (incontinence) l Joint stiffness, aches and pains l Muscle stiffness and pain l Reduced muscle mass So much change, we hear you cry! Well, have no fear because help and support is out there.

If you suspect that you might be experiencing menopausal symptoms, book an appointment with your GP or prison doctor. They’ll be able to confirm whether or not you’re going through the menopause, either just by talking to you about your symptoms, or by also doing

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M E N O PAU S E

a blood test to measure your hormone levels. They’ll also be able to offer you lifestyle advice and potential treatments for any troubling menopausal symptoms or complications you might be experiencing.

The doctor can also refer you to a menopause specialist if your menopausal symptoms aren’t improving after treatment, or if you’re unable to take certain treatments.

The main treatment for menopausal symptoms is Hormone Replacement Therapy (but you probably know it better as HRT). HRT involves taking oestrogen to replace the decline in your body’s own levels of this hormone. It’s available in tablets, skin patches, a gel to rub on the skin, or implants. HRT can be very helpful for lots of people, but there are some potential side effects and risks that come with it.

If you’re thinking of taking HRT, make sure its the right choice for you by going through all the pros and cons with your doctor first.

And don’t forget that there’s also lots you can do to help yourself through the menopause too!

Lifestyle choices that can really benefit your health and wellbeing at any point in your life, but especially during menopause, include; keeping active with regular exercise, getting plenty of sleep, eating a healthy and well-balanced diet, quitting smoking and cutting down on alcohol. But to be honest, the most effective thing that you can do during this time is

“Whatever changes the menopause may bring, you are still you.”

66 H E A LT H Y F O U N DAT I O N S

to simply be kind and patient with yourself, in fact, why not make a point of being your own best friend!

Any change in life can be challenging, and throughout the menopause you may experience a range of strong, changing and even confusing emotions. It’s important to remember that whatever changes the menopause may bring, you are still you, and that is pretty amazing, don’t you think?

SARAH’S* TOP TIPS FOR HANDLING A HOT FLUSH! 1. Sit down somewhere quiet and comfortable.

2. Take some deep breaths in and out.

3. Count to 10.

4. Have a refreshing and cool drink.

*Not her real name. Sarah is an older woman who previously accessed support from the Women in Prison Healthy Foundations team.

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P E LV I C F L O O R

3,2,1 AND

This article will change your

life! … or at least give you some seriously helpful information about one of the simplest ways that we can all boost our health and wellbeing, through regular pelvic floor muscle exercises.

68 H E A LT H Y F O U N DAT I O N S

So what are the pelvic floor muscles anyway? The pelvic floor muscles are a group of muscles that sit in the base of your pelvis, and like a hammock, they hold and support the organs of your pelvis, including the bladder, bowels and uterus (womb). Healthy and strong pelvic floor muscles help us to control our bladder and bowels, and can even increase our sensitivity and pleasure during sex. All good stuff so far right?

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Illustration by PPaint

SQUEEZE!

Uterus

Bowel

Sacrum

Bladder

Pubic bone

Tailbone (Coccyx)

Pelvic floor muscles

H E A LT H F O U N DAT I O N S 69

P E LV I C F L O O R

But did you know that many of us will experience a problem with our pelvic floor muscles at some point in our lives? In fact, studies have shown that pelvic floor muscle problems affect around 1 in 3 women.

That’s right, just like any other muscle in the body, our pelvic floor muscles can become damaged and injured. And you’re more likely to be at risk of these problems if your pelvic floor muscles have to deal with unique experiences, such as pregnancy, childbirth or the menopause.

The most common pelvic floor muscle problems are urinary incontinence and pelvic organ prolapse. Urinary incontinence is leaking any amount of urine when you don’t mean to, and pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and put pressure on the vagina. Both of these problems are common, manageable, and definitely nothing to be embarrassed about or ashamed of.

If you think you may be experiencing problems with your pelvic floor muscles, or if you experience any pain during or after pelvic floor muscle exercises, then it’s important that you seek advice from your GP, prison doctor or a specialist physiotherapist. Sometimes these issues can feel difficult to talk about, but there are lots of healthcare professionals out there who are waiting to listen and offer their help and support. They’ll be able to talk things through with you, identify the problem

and work out a suitable management plan.

In many cases, problems with the pelvic floor muscles can be prevented and even solved by doing regular pelvic floor muscle exercises, sometimes called Kegel exercises.

You heard it, just like doing regular sit-ups will give you rock hard abs, doing regular pelvic floor muscle exercises will help keep your pelvic floor muscles strong, active and ready to face (almost) anything!

But before we can exercise the pelvic floor muscles, we first have to find them... In a comfortable lying or sitting position, take a few deep breaths in and out, and allow the muscles of your body to relax. Now squeeze and lift the muscles around your bottom as if you are holding in wind, but keep your legs and buttocks relaxed. Next, bring this sensation forward as if you are squeezing around a tampon, and forward again as if you are stopping the flow of urine.

Congratulations, you’ve found your pelvic floor muscles! Now let’s put them to work!

On the next page you’ll find instructions on how to do two different types of pelvic floor muscle exercises- short and long squeezes. The trick with these exercises is little and often, try to do them at least once a day and do as many as you feel able to.

Overtime you’ll find it gets easier as your pelvic floor muscles become stronger.

Anyway, that’s enough reading let’s get squeezing!

“Pelvic floor muscle problems are common, and nothing to be embarrassed about.”

70 H E A LT H Y F O U N DAT I O N S

STEP 1 To begin with, you might find it easier to do these exercises whilst lying down or sitting, and you can always progress to standing once you feel more confident.

STEP 2 Take 2 deep breaths, in through your nose and out through your mouth.

Allow the muscles of your body to relax.

SLOW SQUEEZES STEP 3

FAST SQUEEZES STEP 3

Squeeze your pelvic floor muscles, and feel them tighten and lift upwards. Remember to keep all the other muscles of your body relaxed and continue to take deep breaths in and out. Try to hold this squeeze for 10 seconds.

Squeeze your pelvic floor muscles as fast and hard as you can, and feel them suddenly tighten and lift upwards as high as they will go.

Remember to keep all the other muscles of your body relaxed.

STEP 4

STEP 4

Now relax your pelvic floor muscles, and feel them let go and drop down. Continue your deep breaths and relax for 5 seconds.

Now immediately relax your pelvic floor muscles, and feel them suddenly let go and drop down. Continue your deep breaths and relax for 5 seconds.

STEP 5 Repeat this 10 times, or as many times as you feel able to.

If you’re still struggling to get the hang of it, why not try these guided YouTube videos delivered by a specialist physiotherapist?

Slow Squeezes- https://www.youtube.com/watch?v=Qn3d9q7S_xA Fast Squeezes- https://www.youtube.com/watch?v=Wbd5r2nXx8I

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TEETH

GIVE US A SMILE! Katie Langford, Director of People at Groundswell, shares information and tips for looking after our mouths.

When our mental health is poor, or life spirals out of control, it can mean we don’t look after our mouths as well as we should.

The healthy mouths project spoke to over 260 people across London about their mouth health, including people who are homeless, living in hostels or insecure accommodation. Findings found:

Katie served a prison sentence in Australia from 2013 to 2016. On returning home to l 90% of participants had an issue the UK one of the first steps to rebuilding with their mouth health since becoming her life was volunteering at Groundswell, homeless. a national charity that offers people with l 27% of participants have used alcohol to experience of homelessness opportunities help them deal with dental pain and 28% to create solutions to homelessness. have used drugs.

Katie volunteered as a Peer l Only 23% had been Researcher on the Healthy to the dentist in the “When I got my teeth Mouths Project in 2017, sorted it was amazing. It took last six months. which aims to promote me ages to stop putting my hand l 58% were not clear over my mouth. Even just seeing good oral health and on their rights to NHS the look in peoples’ eyes. I don’t know dentistry. increase access to if they sensed that I was more at ease l Despite the dental services for with myself when I smiled. They could many difficulties, people experiencing smile with me. I actually feel that participants clearly social exclusion. getting my teeth sorted has helped valued good oral health me to turn a corner.

They don’t hurt Keeping our teeth and believed dentists anymore and I’m not drinking now. and mouths healthy were there to help.

I’m not embarrassed. I can is about much more start looking to the future.” than enabling us to chew We found that many - Research Participant food; teeth help us speak people relied on sugar to clearly, give our faces shape and get them through the day, but a healthy smile helps with confidence frequently eating or drinking sugary and self-esteem. Dental discomfort can treats can cause tooth decay, which left be extremely painful and prevent us from untreated can cause nerves to become living our best lives. infected and die, leading to painful abscesses.

Smoking, drinking and drugs can have As someone who has spent time in a damaging impact on our teeth, but our custody, I know it can take weeks, or more mental health can also affect our teeth. likely months, to access a dentist. In my 72 H E A LT H Y F O U N DAT I O N S

TAKING CARE OF YOUR MOUTH

prison it wasn’t uncommon to see women desperately searching for black market clove oil to treat their pain. It isn’t always easy to keep teeth healthy in prison, or when you are in the community trying to get back on your feet, but this article has some simple steps you can take to ensure your mouth stays healthy.

Accessing treatment post release

You should see a dentist at least once a year.

Lots of people get nervous about this and put it off especially if it doesn’t feel like much is wrong, but dentists are there to help and its best to get things sorted before you’re in pain.

If you’re worried speak to the dentist and agree on a sign you can make at any time in your treatment to say STOP! Finding a dentist If you don’t have a dentist, the easiest way to find one is to call 111. They will ask your name, date of birth and the postcode for the area you are in. They can search for local dentists who are taking NHS patients.

Cost and access to treatment

If you’re on most benefits or you’re an asylum seeker (even if you’ve been refused) you can get NHS dentistry for free. You need to fill out an HC1 form which is easy to get online, and most dentists and homelessness services can help. Having proof of your benefits or immigration status may help when signing up.

l Brush your teeth twice a day, and it's especially important to do it last thing at night. l Brushing last thing at night is really important. l Don't rinse your mouth with water after you brush your teeth, as this washes away the toothpaste. l If your gums bleed brush again. l Clean between your teeth every day using floss or small brushes. l Visit the dentist regularly to check that both your teeth and mouth are healthy, even if you don’t have any natural teeth left. l If you use methadone, brush your teeth before and rinse your mouth with water after you take it. l If you smoke or drink alcohol going to the dentist is even more important. l Toothpaste must have fluoride in it, only use the one meant for adults. l Cut down on sugary food and drinks and try to have them only with meals.

Did you know using drugs can have an impact on your mouth?

Cannabis: increases the risk of decay and gum disease.

Crack: can cause oral sores increasing the risk of spreading of blood born infections.

Cocaine: can lead to damage to the roof of the mouth and when rubbed into the gums can cause decay. It has anaesthetic properties making dental procedures dangerous if you have recently used.

Heroin: can lead to the loss of teeth, decay, and inflammatory diseases.

Methadone: usually contains a high sugar content increasing the risk of dental damage. You can request sugar free options which have less impact on your teeth.

To find out more about Groundswell and the work they do visit their website www.groundswell.org.uk/

H E A LT H Y F O U N DAT I O N S 73

SAFER SEX

Safer sex is all about protecting yourself and your sexual partner(s) from Sexually Transmitted Infections (STIs). An STI is an infection that can be passed from one person to another during sexual activities.

74 H E A LT H Y F O U N DAT I O N S

There is often a lot of stigma and taboo surrounding STIs, but being diagnosed with an STI is common, often manageable, and definitely nothing to be embarrassed about or ashamed of. It doesn’t matter how many times you’ve had sex, how many sexual partners you’ve had, or who you’ve had sex with, anyone who is sexually active can get an STI. In fact, did you know that in 2019, there were 468,342 diagnoses of STIs made in England?

The best way to prevent and manage STIs is by having open conversations about them with our sexual partners, friends and family. But we can only start doing that if we shake off any stigma and shame we might feel around STIs. So have a quick shake, and let’s get learning!

Illustration by PPaint

LET’S TAL (SAFER) S

K ABOUT EX, BABY! SO WHAT DO WE MEAN WHEN WE TALK ABOUT SEXUAL ACTIVITIES? All sexual activities carry some risk of passing on an STI, but those with the highest risk include: l Vaginal penetrative sex, or vaginal intercourse- When a person’s penis enters another person’s vagina. l Anal penetrative sex- When a person’s penis enters another person’s anus. l Sharing sex toys- Sex toys include things like vibrators and sex dolls. However, any object used for sexual stimulation can be called a sex toy, whether it’s designed for this use or not. l Oral sex- When someone uses their mouth to stimulate another person’s genitals (penis, vulva, or anus). l Genital contact- When one person’s genitals (penis, vulva or anus) touch or rub against another’s.

TYPES OF STIS

There are different types of STIs, including: l Chlamydia l Genital Herpes l Pubic lice or ‘crabs’ l Trichomoniasis l Mycoplasma Genitalium (MG) l Syphilis l Gonorrhoea l Genital warts l Hepatitis l HIV

Many people who get an STI won’t experience any symptoms. Because of this, lots of people don’t even realise that they have an STI, and you can’t tell by just looking at someone (including yourself), whether or not they have an infection.

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H E A LT H Y F O U N DAT I O N S 75

SAFER SEX

If someone with an STI does get symptoms, these commonly include: l Painful or increased passing of urine. l Itching, burning or tingling around the genitals. l Painful swelling of the genitals. l Blisters, sores, spots or lumps around the genitals or anus. l Black powder or tiny white dots in your underwear. l Unusual discharge from the vagina, penis or anus. l Bleeding between periods or during/ after sex. l Pain during sex. l Lower tummy pain.

Most STIs, like chlamydia, can be cured with the right treatment. Some STIs, like HIV, never leave the body, but if you're diagnosed early then there are treatments available to keep you healthy. Being on HIV medication can even stop you passing on HIV to future sexual partners, so getting an HIV test is really important if you've had unprotected sex. If left untreated, STIs can permanently damage your health and may affect your fertility (ability to have children).

SO HOW DO WE PRACTICE SAFER SEX?

Practising safer sex means using a barrier to cover parts of your genitals when you have sex, or covering sex toys if you are sharing them with someone else.

If you’re not in a committed sexual relationship where everyone involved has had a recent sexual health check-up confirming that they don’t have any STIs, then it’s very important to use barriers.

76 H E A LT H Y F O U N DAT I O N S

Barriers include: EXTERNAL CONDOMS. A thin latex or synthetic latex cover worn over an erect penis. Prevent STIs passing from one person to another during vaginal and anal penetrative sex and oral sex.

INTERNAL CONDOMS OR ‘FEMIDOMS’.

A thin latex or synthetic latex cover worn inside the vagina. Prevent STIs passing from one person to another during vaginal penetrative sex. Some people also use internal condoms to prevent STIs during anal sex, but there is currently no research to support this.

DENTAL DAMS. A soft plastic latex or polyurethane square (about 15cm in size). Some people use dental dams to prevent STIs by covering the vulva or anus during oral sex, but there is currently no research to support this.

Don’t forget to always dispose of a used barrier after use, and open a new one each time you have sex. Never reuse a barrier, as this will make them less likely to protect against STIs. Practising safer sex also means regularly getting tested for STIs. This is especially important if you or your sexual partner(s) have symptoms of an STI, or if you're worried after participating in any unprotected sexual activities (e.g. without using a barrier).

In the community you can get tested and treated for STIs at a sexual health or genitourinary medicine (GUM) clinic. In prisons, sexual health screening tests are routinely offered, and you can also talk to your prison doctor about your sexual health. All sexual health services are free and confidential, and many of them will be able to give you barriers, like external condoms, free of charge.

WHAT DOES SEXUAL HEALTH MEAN TO YOU? Hello from the whole team at Brook! We’re a national charity that provide free and confidential sexual health and wellbeing services for young people under 25 years old (and for all ages in Blackburn, Cornwall and Southend).

When most people think of sexual health, they probably think of things like Sexually Transmitted Infections (STIs), contraception and pregnancy. These are all really important aspects of sexual health, but we also know that sexual health includes so much more than just this. Sexual health is also about people’s relationships, lives and choices, sexuality, and who you desire. It’s about having the knowledge, rights and power to make decisions about your body and being able to choose the number and spacing of your children. It’s also about being able to have pleasurable, safe and enjoyable relationships free from coercion, pressure and violence.

On top of this, when we talk about 'Sex', we don't just mean vaginal penetrative sex, we mean every and any form of sex!

Many people enjoy other forms of sex, for example, lots of women and people with vulvas can’t orgasm just from penetrative sex, because most of the nerve endings that make their bodies feel good and cause

orgasm are not inside the vagina, but mainly in the clitoris and right down the vaginal lips (labia). So, focusing attention on those parts of the body and taking as much time, stimulation, and lubrication as is needed can be what makes sex feel great.

It’s also really normal, safe and healthy to touch yourself, to masturbate and to bring yourself to orgasm, and touching yourself can be the best way to find out what feels nice for your body. For anyone who has had negative sexual experiences, touching yourself (including with sex toys if that feels good) at your own pace and reconnecting with your own body may be an important part of (re)learning to enjoy sex; and can help with communicating what feels good if you do want to have sex with a partner.

When it comes to sexual health, there is so much to think and talk about, and the more we have these conversations, the more empowered we’ll all feel to promote our own sexual health and wellbeing.

“It's also about being able to have pleasurable, safe relationships free from coercion, pressure and violence.”

For more information on all aspects of sexual health, why not visit our websitehttps://www.brook.org.uk/

H E A LT H Y F O U N DAT I O N S 77

V U LVA

HOW WELL DO YOU KNOW

YOUR

VULVA? The vulva is the outer part of the genitals of people who were assigned female at birth. The vulva includes the opening of the vagina, labia majora and minora, clitoris and urethra.

See if you can label these parts on the opposite. ››››››››››››››

78 H E A LT H Y F O U N DAT I O N S

This page was put together using images and information from the ‘So what is a vulva anyway?’ information booklet, developed by BritSPAG in collaboration with Brook.

(Answers: 1. Clitoris, 2. Labia majora, 3. Vagina, 4. Labia minora, 5. Urethra)

Everyone’s vulva is unique, they come in endlessly different shapes and sizes, and will change throughout your life. We aren’t always encouraged to talk about or explore our vulvas, but your body belongs to you and this is a completely normal and healthy thing to do. Why not have a look at your vulva in a mirror and see if you can spot the 5 parts?

1 ...................

THE TIP OF THIS PART IS SUPER SENSITIVE AND PROVIDES SEXUAL PLEASURE. IT VARIES IN SIZE FROM PERSON TO PERSON AND CAN GET BIGGER WHEN YOU’RE TURNED ON AS BLOOD RUSHES TO THE AREA.

5 ...................

THIS IS A SEPARATE HOLE WHERE YOUR URINE COMES OUT.

2 ..................

THESE ARE THE OUTER LIPS THAT ARE THERE TO PROTECT YOUR VAGINA. THEY HAVE PUBIC HAIR GROWING ON THE SIDES.

4 ...................

THESE ARE THE INNER LIPS THAT ARE THERE TO PROTECT YOUR VAGINA. THEY ARE SOFT AND WITHOUT HAIR. THEY CAN BE BIGGER OR SMALLER THAN THE OUTER LIPS, STRAIGHT OR WAVY, SMOOTH OR BUMPY, AND ONE MAY BE A BIT LONGER THAN THE OTHER. LIKE NUMBER 1, THEY ARE ALSO VERY SENSITIVE AND CAN SWELL WHEN YOU’RE TURNED ON.

3 ...................

THIS PART GOES INSIDE YOUR BODY AND CONNECTS THE UTERUS (WOMB) TO THE OUTSIDE.

H E A LT H Y F O U N DAT I O N S 79

WHEN IT COMES TO

CONTRACEPTION,

IT’S ALWAYS GOOD TO HAVE

OPTIONS! Contraception, sometimes called ‘birth control’, aims to prevent pregnancy. A person can get pregnant if another person’s sperm fertilises one of their eggs, usually during sex. There are lots of different methods of contraception available, and they all work in slightly different ways to stop fertilisation from happening.

80 H E A LT H Y F O U N DAT I O N S

C O N T R AC E P T I O N

HORMONAL METHODS Hormonal methods of contraception prevent pregnancy by using artificial versions of the hormones, oestrogen and/or progesterone. l COMBINED ORAL CONTRACEPTIVE PILL or ‘the pill’.

A pill containing artificial oestrogen and progesterone. Taken every day for 3 weeks, then stopped for 1 week, and then restarted after the 1-week break.

99% effective*.

BARRIER METHODS Barrier methods of contraception prevent pregnancy by physically stopping sperm from meeting an egg. These methods include: l EXTERNAL CONDOMS. A thin latex or synthetic latex cover worn over an erect penis.

98% effective*. l INTERNAL CONDOMS or ‘femidoms’.

A thin latex or synthetic latex cover worn inside the vagina.

95% effective*. l VAGINAL DIAPHRAGMS and CERVICAL CAPS. A thin, silicone, circular dome inserted into the vagina alongside a gel/ cream that kills sperm (spermicide).

92-96% effective*.

l PROGESTOGEN ONLY PILL, ‘POP’ or ‘the mini pill’.

A pill containing artificial progesterone only. Taken every day at the same time, with no break between packets of pills.

99% effective*. l CONTRACEPTIVE PATCH. A small, sticky patch worn on the skin (a bit like a nicotine patch!) that releases artificial oestrogen and progesterone. Each patch is worn for 1 week, and after 3 weeks of wearing patches, you have 1 week off without a patch, and then restart after the 1-week break.

99% effective*. l VAGINAL RING. A small, flexible, plastic ring inserted into the vagina that releases artificial oestrogen and progesterone. Each ring lasts for 3 weeks, and after the 3 weeks you remove the ring to have 1 week ringfree, and then restart with a new ring after the 1-week break.

Oral Contraception99% effective*. »

H E A LT H Y F O U N DAT I O N S 81

C O N T R AC E P T I O N

LONG-ACTING REVERSIBLE CONTRACEPTION (LARC) Long-Acting Reversible Contraception does what the name says; it works over a long period of time! l THE INTRAUTERINE DEVICE (IUD), ‘the coil’ or ‘the copper coil’.

A small T-shaped plastic and copper device inserted into the uterus by a trained healthcare professional (e.g. doctor or nurse). Lasts for 5-10 years.

99% effective*. l THE INTRAUTERINE SYSTEM (IUS) or ‘hormonal coil’.

A small T-shaped plastic device inserted into the uterus by a trained healthcare professional (e.g. doctor or nurse) that releases artificial progesterone. Lasts for 3-5 years.

99% effective*. l THE IMPLANT. A small, flexible, plastic rod placed under the skin in the upper arm by a trained healthcare professional (e.g. doctor or nurse), that releases artificial progesterone.

Lasts for 3 years.

99% effective*. l THE INJECTION. An injection given by a trained healthcare professional (e.g. doctor or nurse), that releases artificial progesterone. Lasts for 8-13 weeks.

99% effective*.

82 H E A LT H Y F O U N DAT I O N S

NATURAL FAMILY PLANNING Natural family planning, sometimes called ‘fertility awareness’ is a method of contraception where a person monitors and records different fertility signals during their menstrual cycle, to work out when they are likely to get pregnant.

Fertility signals include things like the length of a person’s menstrual cycle, daily body temperature, and changes to the cervical mucus.

On days when a person is fertile, they would avoid pregnancy by either not having sex (abstaining), or using another method of contraception like a barrier method.

To use this method effectively it needs to be taught by a qualified fertility awareness teacher, and it takes between 3-6 menstrual (monthly) cycles to learn this method.

99% effective*.

PERMANENT CONTRACEPTION Permanent contraception, or Hormonal IUS sterilisation, is an operation that’s carried out to permanently prevent pregnancy. It works by stopping sperm from meeting an egg. Once it’s done, sterilisation is very difficult to reverse, and because of this it’s only for people who do not want to ever have children afterwards.

There are two types of permanent contraception:

1

TUBAL OCCLUSION closing the fallopian tubes that carry an egg from the ovaries to the uterus.

2

VASECTOMY closing the tubes that carry sperm from the testicles to the penis.

99% effective*.

EMERGENCY CONTRACEPTION Emergency contraception can be used to prevent pregnancy in situations where one person’s semen (which contains sperm) may have come into contact with another person’s genital area, which could then lead to an egg becoming fertilised. This includes after unprotected sex or if someone suspects that their contraception might have failed (e.g. a condom has split or a missed contraceptive pill).

There are two types of emergency contraception:

1

THE EMERGENCY CONTRACEPTIVE or ‘morning after’ pill.

A pill which works by stopping or delaying the release of an egg from the ovaries

2

(ovulation). The pill needs to be taken within 3-5 days after the contact with semen occurs, and the sooner it’s taken the more effective it will be.

Copper IUD THE EMERGENCY INTRAUTERINE

DEVICE (IUD).

The IUD (please see LARC) can be inserted up to 5 days after contact with semen occurs, and can then be left in as an ongoing form of contraception. It’s the most effective method of emergency contraception.

So there are many contraceptive options available, but which one is the best one?

Well, it all depends on you! Everyone is unique, and what works for one person, may not work for another. Things you might consider when choosing which method of contraception you want to use, include; how effective each method is, as well as personal factors like your age, health, lifestyle and personal preference. A good place to start is to book an appointment with your GP, prison doctor or local sexual health service. All contraceptive services are free and confidential, and the trained healthcare professionals at these services will be able to talk everything through with you, so that you can make the best choice for you. Try not to be put off if the first method of contraception you try isn’t quite right, you can always stop and try a different method when you’re ready.

Remember, you’ve always got options! *This is how effective each method is when they are always used correctly.

H E A LT H Y F O U N DAT I O N S 83

YOUR

A & E QUESTIONS

ANSWERED! Dr Kaladerhan Agbontaen (BA Hons, MBBS), an Emergency Medicine Specialty Doctor, answers some of your questions about Accident and Emergency (A&E)

84 H E A LT H Y F O U N DAT I O N S

A&E

1

WHEN SHOULD I GO TO A&E, CONTACT NHS 111 OR CALL MY GP?

Emergency departments in A&E are there to deal with genuine life-threatening emergencies. These include: trouble breathing, loss of consciousness, fitting, chest pain, strokes, severe allergic reactions, severe burns or scalds, and major trauma such as a road traffic accidents. If you experience any of these problems please call 999 immediately.

Most A&Es also have an urgent care centre (walk-in centre or minor-injury unit) that you can attend when you feel you require urgent, but not life-threatening attention. This includes treatment for conditions such as sprains and strains, bites and stings, stomach pain, ear and throat infections, coughs and colds, emergency contraception, etc.

However, for most other health conditions, or if you’re in doubt about the urgency of your problem, or maybe you’re just really unsure where to get the right help, the best thing to do is call the NHS on 111 or go to 111.nhs.uk. This is a free and confidential service, available 24 hours a day, 7 days a week.

the situation, the next steps will involve you: l Being given self-care advice on how to manage your symptoms at home. l Being given advice on what local service is best able to help you, or how you can get the medicine you need (for example you may be advised to contact your GP directly). l Being connected to speak to a nurse, pharmacist, GP or emergency dentist. l Getting booked into a face-to-face appointment if you need one. l Being given an arrival time if you need to go to A&E (which might mean that you spend less time in A&E overall).

The NHS 111 service can also offer translators as well as a specialist NHS 111 British Sign Language service for deaf people.

“The NHS 111 service is free, confidential, and available 24 hours IF I HAVE AN 2 EMERGENCY a day, 7 days WITH MY TEETH IS A&E THE BEST PLACE TO GO? a week.”

The NHS 111 service involves you answering questions about your symptoms, either by talking to a fully trained advisor over the phone service, or filling out an online form through the website option. Depending on

If you have any concerns about your teeth, the best health professional to see is a dentist.

If you are unable to contact/get an appointment with your dentist or do not have one, you can contact the NHS 111 service and they will provide advice as well as help you to find a local dentist to book an emergency appointment with. You can also visit the www.NHS.uk website which gives a list of dentists near you and provides self-care advice for you to look at whilst you’re waiting to be seen.

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H E A LT H Y F O U N DAT I O N S 85

A&E

However, A&E do provide treatment for potential dental emergencies, so please go to A&E if in addition to your tooth problem you also have: l Swelling around your eye or neck. l Swelling in your mouth or neck that is making it difficult for you to breathe, swallow or speak. l Heavy bleeding. l An injury to your face, mouth or teeth.

3

I THINK I’M EXPERIENCING A MENTAL HEALTH CRISIS, IS A&E THE BEST PLACE TO GO AND WHAT WILL HAPPEN WHEN I GET THERE?

and support if you think you might be experiencing a mental health crisis include: l Calling a crisis line number. l Calling a 24-hour local NHS urgent mental health helpline (you can find these on the www.NHS.uk website or by calling the NHS 111 service). l Have a look at the advice and information around how to cope and calm down during a crisis, provided by the mental health charity MIND on their website- https://www.mind. org.uk/need-urgent-help/what-can-i-do-tohelp-myself-cope/ l Have a look on page 34 (mental health services directory) of this booklet for more contact details of useful mental health organisations and resources.

“Looking after mental health is just as Looking after your important as looking mental health is just as important IT SAFE TO after physical 4 ISCOME as looking after your TO A&E physical health, and a WHILST COVID-19 health.” mental health emergency is just as serious as a physical one.

If you feel unable to keep yourself or someone else safe during a mental health crisis, then please always call 999 or go to A&E immediately. The staff at A&E will first provide any care you need around your immediate mental and physical health needs, and then will refer you to one of their specialist psychiatry teams for further assessment and treatment. You will always be kept safe in A&E whilst you wait to be seen by the psychiatry team.

Other services that can provide advice 86 H E A LT H Y F O U N DAT I O N S

IS STILL AROUND?

If you think that you need medical help, it’s always really important that you get it. For example, the risks associated with you not accessing the healthcare you need will often be much higher than the risk of you getting and becoming seriously ill from Covid-19 whilst visiting an NHS service.

So please don’t let Covid-19 stop you from coming to A&E. Despite the ongoing Covid-19 pandemic, the NHS is still open, and the same services are available to you if you feel you need medical help. During the Covid-19

pandemic NHS services are continuing to make specific changes to the way that they work, to ensure that you are as safe as possible whilst you are receiving any medical care or attention.

For example, all staff are required to wear the necessary Personal Protective Equipment (PPE) to keep all patients and staff safe. On top of this, often the NHS 111 and 999 services are trying to book hospital arrival times in advance so that strict social distancing between patients is maintained.

The staff at A&E are here to help and will keep you as safe as possible whilst we care for you.

5

WHAT HAPPENS WHEN I ARRIVE AT A&E, AND HOW LONG WILL THE WHOLE PROCESS TAKE?

When you first arrive at A&E you’ll be asked to register at reception, where they will record your personal details and the reason for you coming to A&E. After you’ve been registered you’ll be seen by a triage nurse or doctor, who will ask questions about why you’ve come to A&E, and also do a few simple checks such as measure your blood pressure, heart rate and oxygen levels.

The triage process helps to identify which part of the A&E department you need to be seen in, and ensures that people with the most serious problems are seen first.

After triage, depending on your particular situation, one of the following will happen: l You’ll be asked to wait for a further assessment and treatment by an A&E nurse or doctor. l You’ll be sent directly to be seen by

another specialist department at the hospital (e.g. the obstetrics department for any problems related to pregnancy, labour or childbirth). l You’ll be sent to an on-site GP at the hospital for further management.

If you’re brought to A&E by an ambulance, the process is very similar but with a few differences. For example, the ambulance crew will provide your details to reception for you, and if you’re seriously ill the ambulance crew will have alerted the hospital staff ahead of your arrival to make sure that you are triaged faster. However, arriving by ambulance doesn’t mean that you will always be seen sooner than if you had walked into A&E by yourself, this all depends on how serious your situation is.

Unfortunately, the total time you can expect to spend in A&E varies daily and is impacted by several different factors, including; how busy the A&E department is, how busy the whole hospital is and how many staff are available. The current national waiting time target for patients in A&E is 4 hours from arrival to a decision to either discharge (send you home) or admit (keep you in hospital), and this includes any treatment you may receive in the department. However, every person’s experience of A&E is different, and you may be seen much sooner or later than 4 hours.

We know that it can be very difficult to wait in A&E for long periods of time, especially when you aren’t feeling well, but the A&E staff will always get to you eventually and give you the highest quality of care possible.

Written by Dr Kaladerhan Agbontaen BA Hons, MBBS (GMC 7527156) H E A LT H Y F O U N DAT I O N S 87

BREAKING THE SILENCE AROUND MISCARRIAGE

Tommy’s is a national charity dedicated to reducing the rates of miscarriage, stillbirth and premature birth in the UK. Tommy's research centres and clinics across the country work to understand why pregnancy goes wrong so that these issues can be prevented, and its midwives support families at every stage of their journey with information and advice.

Tommy’s wants to make pregnancy safer for all and ensure that excellent maternity care is available for every family, every baby, everywhere.

A miscarriage is the loss of a pregnancy during the first 24 weeks. It’s hard to say exactly how often this happens, as miscarriages aren’t recorded nationally and may not always be reported by those who experience them.

However, research suggests that 1 in 4 women

88 H E A LT H Y F O U N DAT I O N S

miscarry at some point in their lifetime, with 1 in 100 women experiencing recurrent miscarriage (3 or more in a row).

Despite being sadly common, miscarriages are not often discussed, and are still seen as taboo in many parts of society. It’s important to break down the stigma around miscarriage so that anyone affected knows how to access the practical care and emotional support they may need. Without that help, people can experience lifelong physical and mental health problems after losing a baby; for example, a study from Tommy’s National Centre for Miscarriage Research last year found that 1 in 6 mothers and 1 in 12 partners were left with long-term symptoms of post-traumatic stress.

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H E A LT H Y F O U N DAT I O N S 89

TO M M Y ' S

SIGNS AND SYMPTOMS OF A MISCARRIAGE

The most common miscarriage symptom is vaginal bleeding. It’s common to have light bleeding or spotting without pain before 12 weeks of pregnancy, so this isn’t always a sign of miscarriage, but it’s important to get it checked out anyway. If you have any bleeding in pregnancy - with or without pain - contact your GP, midwife or hospital straight away.

Other warning signs include cramping and pain in your lower stomach, discharge of fluid or tissue from your vagina, or sudden loss of any pregnancy symptoms you were experiencing before such as nausea and breast tenderness (although these can gradually lessen after the first trimester).

Miscarriage symptoms can also vary depending on the type of loss; for example, a missed miscarriage (also known as a delayed or silent miscarriage) is when a baby dies in the womb but there is no bleeding or pain.

It’s usually diagnosed at a routine ultrasound scan, and following this the pregnancy may need to be physically ended using medication or surgery.

Rarer types of miscarriage also show themselves in different ways. A chemical pregnancy (when you have a positive pregnancy test but can’t see anything on an ultrasound scan) may be mistaken for a period, and symptoms of a molar pregnancy (when the egg isn’t properly fertilised, either because it had no genetic material or two sperm got into the same egg, so it starts growing but can’t survive) like severe morning sickness and an extremely swollen stomach can be part of healthy pregnancies too. An ectopic pregnancy (when a fertilised 90 H E A LT H Y F O U N DAT I O N S

egg somehow finds itself outside the womb lining) often causes stomach and shoulder pain on one side of the body, because the baby is growing in the wrong place and putting life-threatening pressure on the mother’s body.

MEDICAL CARE FOR MISCARRIAGES If you think you may be having a miscarriage, your GP or midwife can do some tests to confirm what’s happening and explain treatment options if needed.

In some miscarriages, the pregnancy comes away from the womb naturally – but if not, you can either wait for this to happen by itself, or you may decide to have medication or an operation to speed the process along.

You may need to go through labour.

Surgery could be advised if you’re bleeding heavily or showing signs of infection, but otherwise treatment is a personal choice which can take some time to think about.

Each treatment may cause some temporary side-effects such as chills, nausea, diarrhoea and skin rash. Surgery will involve local or general anaesthetic, which can lead to dizziness and headaches as well as bruising or pain from the needles. Any miscarriage can have painful side-effects like bleeding and cramps, and the change in hormones can lead to mood swings and sleep problems. Seek help if these last for a long time, or if you start experiencing fever and flu-like symptoms.

While avoiding cigarettes, alcohol and drugs in pregnancy can reduce the risk of miscarriage, we don’t always know why it happens so there’s no guaranteed way to

prevent it. Since most women go on to have a healthy pregnancy after a miscarriage, tests aren’t usually offered until someone has experienced 3 losses in a row. This lack of answers can make it harder to process the loss, and many people unnecessarily blame themselves in the absence of a medical explanation.

EMOTIONAL SUPPORT FOLLOWING A MISCARRIAGE

about feeling sad, or force yourself to act happy; complex emotions are a natural part of the grieving process. If you’re worried about your health or struggling to cope, talk to your doctor about how to access support locally or get a referral for specialist help. You can also refer yourself on the NHS Improving Access to Psychological Therapies (IAPT) service.

And of course, Tommy's is also here to help you. Although baby loss can feel incredibly lonely, you are not alone. We offer information, advice and support through every stage of pregnancy, from conception to after the birth of your baby, no matter what your experiences have been.

You can talk to a Tommy's midwife for free, 9am-5pm MondayFriday, by calling 0800 0147 800 or emailing midwife@tommys.org. All our midwives are trained in bereavement support and will be able to talk to you about what you're going through. For more information please visithttps://www.tommys.org.

“In the absence of a medical explanation, many people blame themselves.”

Miscarriages are often referred to as early (first trimester) or late (second trimester) but losing a baby at any time can be devastating. It’s a deeply personal experience that affects everyone differently; some prefer to grieve privately, while others find it helps to share thoughts and feelings, but either way support is available to help you to come to terms with what’s happened.

There are many supportive online groups where people who have been through similar experiences can connect with others who understand. Tommy’s Baby Loss Support Group on Facebook is a private safe space for people to ask questions, offer advice, share stories, or just take comfort in seeing that they’re not alone.

Try not to push yourself, feel guilty

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NUTRITION

HOW CAN WE

USE FOOD TO SUPPORT

By Dr Michael Barnish (MBChB) specialist doctor in preventative health , Head of Genetics & Nutrition at REVIV. 92 H E A LT H Y F O U N DAT I O N S

Illustration by Lucy

OUR HEALTH?

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NUTRITION

You may have heard the phrase ‘We are what we eat’. It goes back generations and there’s actually a lot of science behind it!

For your body to be able to do the thousands of activities that it needs to do each day, it needs substances called nutrients. These nutrients are the reason we have to eat. Eating is a way of getting nutrients, which we cannot make ourselves, into our body. Vitamins, minerals and antioxidants are all examples of good nutrients that the body needs to support its daily functions. For example, vitamin C is needed to make collagen in the skin, a supportive molecule that gives structure to the skin and other supportive tissues. So we truly are made up of, and use the components of, the things we eatWe are what we eat! It is important that we remember this when considering how to improve and maintain our health.

Unfortunately when it comes to food, convenience is often favoured over nutrition. Having fast options like readymade and processed foods can be cheap, easy and helpful for supporting busy and distracted lifestyles, but these foods usually offer low levels of good nutrients and high levels of sugars, harmful fats, preservatives and additives. By choosing these foods regularly, our body will not have all the

good nutrients it needs to complete all our thousands of daily activities, and this can potentially lead to lots of physical and mental health problems.

When we don’t feed our bodies correctly, or when our bodies are faced with too much stress, either in the form of mental stress or over exposure to toxic substances (e.g cigarette smoke), or even from consuming too much sugar, it can begin to get overwhelmed and not work properly. This can lead to many different symptoms, like tiredness and low energy, poor sleep, and achy joints. Even our mental health can be affected, like feeling anxious or irritable. Eventually, our bodies can experience illness and disease.

Therefore, it is always important to consider our food choices carefully, especially if your body is sending you messages that it’s in need of some TLC. So, how are you feeling today? Are you a little under the weather, low in energy, or feeling a little more anxious?

Maybe you feel a little achier than you usually do? Perhaps food can provide the solution?

What health supporting foods should you be looking for? Here are some of my suggestions to match items usually available on the prison canteen list to common symptoms or feelings.

“Eating is a way of getting nutrients, which we cannot make ourselves, into our body.”

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LOW ENERGY

LOW MOOD

Low energy is a common problem and can occur when certain vitamins and nutrients are low. Canteen items rich with energy boosting nutrients include: l Eggs l Almonds l Garlic l Avocado l Sardines in tomato sauce or oil l Crunchy peanut butter l Red Lentils l Baked beans

Good nutrition can help to balance brain chemicals that influence our mood.

Studies have even shown that mood can change pretty fast after we eat, so making sure we get the good nutrients over the bad ones can really help us support our mood.

Canteen items rich in mood supporting nutrients: l Eggs l Chickpeas l Dried Mango l Sunflower seeds l Blackeye beans (not peas!) l Mushrooms

POOR SLEEP Sleep is so vital to human beings and a good night’s sleep is often the best thing we can do to support our health and keep our body refreshed and working well. Sleep can be easily disrupted though, and certain nutrients can help support sleep.

Canteen items rich in sleep supporting nutrients: l Carrots l Coriander l Spinach leaf l Sweetcorn l Baked beans l Cinnamon l Wholemeal pita bread

ACHY JOINTS Achy and painful joints, as well as back pain, are common problems. Your bones, muscles and joints need good nutrition to help keep them strong and working properly. Canteen items rich in joint, muscle and bone supporting nutrients: l Turmeric Powder l Garlic l Ginger l Avocado

TO SUPPORT GOOD OVERALL HEALTH Sometimes we will feel good and do not experience any symptoms.

On these days it is important to think about building up the reserves of the essential nutrients we need every day. This could help keep us feeling healthy and well for longer.

Canteen items rich in overall health supporting nutrients: l Garlic l Ginger l Turmeric Powder l Eggs l Cinnamon l Red and white onions l Spinach leaf

NOTE- Always make sure you consult your doctor if your symptoms are long standing or severe.

Doctors can also help guide you on what food and/or supplements you may need to support your health.

Sometimes supplementing with vitamins can also help where food choices are limited.

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C O N TAC T S

USEFUL SERVICES IF YOU’VE BEEN AFFECTED BY ANY OF THE TOPICS COVERED IN THIS CHAPTER AND NEED SUPPORT AROUND THIS, YOU CAN ACCESS HELP FROM YOUR GP OR PRISON DOCTOR, AND WE’VE ALSO PUT TOGETHER THE BELOW LIST OF USEFUL SERVICES. NHS Free and confidential help around urgent medical problems, available 24 hours a day, 7 days a week.

Telephone: 111 Website: 111.nhs.uk

BLADDER & BOWEL UK Information and advice around bladder and bowel issues.

Free Helpline: 0161 214 4591 (Mon-Fri 9:00am-4:30pm) Email: bbuk@ disabledliving.co.uk Website: https:// www.bbuk.org.uk

JO’S CERVICAL CANCER TRUST Information, advice and support around HPV, the HPV vaccine, cervical screening and cervical cancer.

Free Helpline: 0808 802 8000 (opening hours vary)

Email: info@jostrust.org.uk Website: https:// www.jostrust.org.uk

ENDOMETRIOSIS UK Information, advice and support around endometriosis.

Free Helpline: 0808 808 2227 (opening hours vary) Website: https:// endometriosis-uk.org

BREAST CANCER NOW Information, advice and support around breast health and breast cancer.

Free Helpline: 0808 800 6000 (Mon-Fri 9:00am-4:00pm and Sat 9:00am-1:00pm) Website: https:// breastcancernow.org

NATIONAL SEXUAL HEALTH HELPLINE Information, advice and support around sexual health.

Free Helpline:

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0300 123 7123 (Mon-Fri 9:00am-8:00pm)

TERRENCE HIGGINS TRUST Information, advice and support around sexual health and/or HIV. Free Helpline: 0808 802 1221 (Mon-Fri 10:00am-6:00pm and Sat-Sun 10:00am1:00pm) Email: info@tht.org.uk Website: https:// www.tht.org.uk

56 DEAN STREET A sexual health clinic specialising in reducing infections and promoting sexual wellbeing amongst the LGBTQI+ community.

Call: 020 3315 5656 Website: https://dean.st/

CLINIC T A sexual health and wellbeing service for anyone who identifies as trans, nonbinary or gender variant.

They also offer cervical screening.

Call: 01273 523388 Website: http:// brightonsexualhealth. com/service/clinic-t/

CLINIQ A trans-led sexual health, mental health and wellbeing service for trans, non-binary and gender diverse people.

Call: 07545 143797 Email: admin@cliniq.org.uk Website: https:// cliniq.org.uk/

MY BODY BACK A London and Glasgow based service that offers cervical screening, contraception, STI testing, maternity care and therapeutic workshops for people who’ve experienced sexual violence.

Website: http://www. mybodybackproject.com/

Illustration by PPaint

SO F RIDA KAHLO (1907-1954)

A Mexican artist, best known for her bold and colourful self-portraits.

Frida survived many health problems in her life, including polio and a serious bus accident, which lead to severe disability. She often used her experience of pain as inspiration for her powerful paintings.

H E A LT H M AT T E R S !

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COLOURING

100 H E A LT H Y F O U N DAT I O N S

H E A LT H Y F O U N DAT I O N S 101

CROSSWORD 1 3

2

4

5

6 7 8 9 10 11 12 13 14

15 16

17

19

20

ACROSS 2. slowing this down can reduce stress 4. our physical structure made up of bones, flesh and organs 6. a natural response to mental pressure 8. managing your health and wellbeing 10. a technique which can help manage period pain 12. a method or device to prevent pregnancy 14. a mental health difficulty that can affect how someone relates to themselves, and to others 16. an area of the body affected by arthritis 17. a sexually transmitted infection 18. the outer part of the female genitals 19. an oval shaped cavity inside the skull 20. a practice that can help connect mind and body 102 H E A LT H Y F O U N DAT I O N S

DOWN 1. a virus spread only through blood 3. a term used by some people whose gender identity doesn’t sit comfortably with the sex they were assigned at birth 5. a hormone produced by ovaries 7. one of the 12 step support programmes 9. can be a common symptom of the menopause 11. a subject or action prohibited by society 13. the age you are when you begin to be routinely invited for bowel cancer tests 15. may prevent STIs during oral sex

ANSWERS: ACROSS 2. Breath 4. Body 6. Stress 8. Self Care 10. Exercise 12. Contraception 14. Personality Disorder 16. Joint 17. Trichomoniasis 18. Vulva 19. Mouth 20. Yoga DOWN 1. Hepatitis C 3. Transgender 5. Oestrogen 7. Debtors Anonymous 9. Incontience 11. Taboo 13. Sixty 15. Dental Dam

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H E A LT H M AG A Z I N E E VA L UAT I O N

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H E A LT H Y F O U N DAT I O N S 103

FREEPOST WOMEN IN PRISON