Monday, November 5, 2018

Real Talk: Anxiety, Depression and Getting Help



First things first - well done. If you are reading this post, it means you are trying to get help to get well. And that in and of itself is a most tremendous achievement, when the smallest thing can seem insurmountable. I am proud of you, and you should be proud of yourself. Even if you haven't felt that feeling in a while, allow that glow of pride to warm you now.

I'm not going to lie, getting help and getting better - it's tough. Of course it is. But the only thing tougher is staying ill. The only thing tougher is living with this beast on your back for God knows how long. It's a fight - but then is there anything more worth fighting for than your own mental health? No. There isn't. This is the most important fight. And while only you can possibly know how hard it is, and only you can really ask for help, help is exactly what you are going to need. Doing this alone will be harder.

This is a post about things I know after years of battling with my own mental health. Things I wish I had done years ago. Things I should be better at remembering to do now. It is a guide built just as much for me (someone with a long history of anxiety and depression) as it is for you. It is advice that has been battle tested - with my own tears and tantrums and desperation and fear. It doesn't always work, and everyone's battles are different. But since I started writing more openly about my mental health I have had a lot of people reach out to me for help. For advice on how to get help. For a promise that things will get better. So this is where I am choosing to start.

Letting people know...

You have to let people in. You need to share this burden with others. Give people a chance to understand, and a chance to help. The place to start is with the ones who love you. These are hard conversations to have. But you're going to need them. Be it a partner, a parent, a friend, a sibling. Someone you trust, someone who loves you.

I know that depression and anxiety like to drum into us that we are burdensome creatures not worthy of love and support. But that is absolute crap. Rubbish! Banish those thoughts from your mind this instant! You didn't choose this! This is an illness. An illness that causes much pain and suffering. And if there was anything you could do to alleviate that for someone you loved you would. In a heart beat. The people who love you are just the same - even if it is something hard for them to understand.

The other day I was panicking about this very thing. Allowing my guilt for needing help to ravage through me, and isolate me yet again. A wise friend pointed out that there were so many times I had helped people without thinking. Never considering them a burden. Even if it wasn't easy or convenient for me. Even if it was a struggle I didn't understand. Even if I was struggling myself. She pointed out that love isn't about balancing the scales, but even if it was I wouldn't have to worry because I had done and continue to do my bit for the people I love. So remember that, if like me you get those guilt pangs. You are worthy of help, love and support. And I bet you have loved and supported your team too.

When I first started having these conversations many years ago I didn't have half the words I needed to explain my experiences. I didn't have the vocabulary, the metaphors, the means to describe what it was I felt and what it was like to go through it. Some days I still don't. And I realise more and more that for those who don't experience this, comprehension of what these struggles are actually like is a big barrier. If you don't know how to put it into words, or can't manage to right now, there are lots of resources online that do a great job of this. I find the Blurt Foundation is particularly helpful for this. They have a whole section of resources, that will be useful for you and your loved ones.

One of the hardest things about telling people, is that they then want to help. Letting people in means dealing with a lot of well meant bumbling, that often is the last thing you want and does more harm than good. Awkward. First, I try to remember that this comes from a place of love. And a desire to help. People who don't understand this sort of thing are thinking about when they felt sad or nervous and are trying to do what they think is right. Even though it is very much not the same thing. And some people, even if they have had very similar experiences, are just terrible at this shit. And that's okay. However, their being terrible at this is not something you need to deal with right now.

We have to accept that they are going to want to help us because they love us. But that their idea of help may not in fact be helpful. And there are times that distance can be the best thing they can give you.

Before you explain how you are feeling to someone it's a good idea to have a think about how they can help you. What it is you need right now, and if they are the right person to do it. Everyone has different strengths - some people are good listeners, some people are excellent distractions, some people are organisers, some are action focused. I know from experience that as soon as I have to tell someone what I need I immediately can't think of anything. So I have been making a list of things that can be helpful, and I also asked my followers on Facebook and Instagram what they wished their loved ones could or would do to support them when they are unwell. So when you are faced with this dilemma have a look at the below list and see if there is anything on there someone in your life might be able to help you with / need to know. Then take the list with you, and tell them. Some of the below is contradictory, because we need different things from different people, and because not all of this applies to me as I got some great insight from those I asked online (these are in inverted commas)...

Ways to help - 
  • Acknowledge that everything is not okay. I might not want to talk about it all that much, but it's not a dirty secret. Ask me how I am doing and be okay when I say 'not great'
  • Help with chores, cook for me, make sure I have basic groceries, do an online shop so I just have to put in my card details. 
  • Put a load of laundry on or empty the dishwasher.
  • Help me plan / plan something for me to look forward to.
  • Help me to find services in my local area (more on this below)
  • I get bad at responding to texts, because so many people will ask how I am. And I don't know what to say to everyone so I hide. But keep texting me letting me know it's okay and you're still there. 
  • Come over and run me a bath - sometimes it's hard to get motivated to do even the simplest things. And it's good to know I will have company after
  • Just keep trying, don't give up on me when I am like this
  • Watch something with me that makes us both laugh
  • Take me to the cinema, or come over and watch a movie - basically anything where we don't have to talk.
  • Make me go outside in nature, somewhere pretty (public transport gets really hard for me when I am like this so fetching me helps)
  • Check that I am getting my prescriptions when I need them (anti depressants need to be taken on time, and when they're not it really fucks you)
  • "Just listen to me verbalise my random inner monologue. Without trying to rationalise or fix things. Sometimes just saying things out loud really helps."
  • "Lots of cuddles if I am up to it, of if not give me space for a day or two so I can hide and work my way through it"
  • "My mom helps with my housework as I live alone. She also sends me cute dog videos / pics"
  • "Pick up the slack without making a fuss"
  • "Make me a balanced meal"
  • "Leave me alone, and don't make it about yourself when I feel like this"
  • "A cuddle always helps"
  • "Listen when I want to talk, without trying to suggest ways for me to 'feel better'"
  • "Respect my boundaries without arguing"
  • "I like to be left alone, but I am not mad at a message or whatsapp, just no phone calls"
  • "When I am struggling I might be snappy and irritable. Don't take it personally"
  • "Just a big hug. And let me cry."
  • "Sometimes I'd like for them not to ask questions and just be with me"
  • " Sometimes just a cup of tea helps. I don't always find talking helpful, there's always an expectation that things can be fixed. But just being with someone and a nice mug of tea, can make things seem less rough."
  • "See through my brave face"
  • "Watch my kids so I can sleep without interruptions. So often just being tired can trigger depression."
  • "Listen and let you talk, no matter what it is you're talking about, just let you talk."
  • "I wish I could *talk* to them more, but when I start to talk about anxiety or depression I get "you've got nothing to be sad over," or "you can be anxious later, just get through it!" 
  • "Supply wine, chocolate and a shoulder to cry on and listening ear. I’m lucky as my husband suffers too, so ‘gets’ it."
  • "Drop everything and come round to just give me a hug and hold my hand."
  • "Just actually keep in touch..."

Seeking medical help...

For better or worse, any NHS help is going to start with your GP. Not just that, but if you need to be signed off work, or you need to claim ESA. Many of the messages that I get start with people saying they don't feel comfortable talking to their usual GP, or they have and he/she seems clueless, or doesn't seem to believe them, or isn't offering solutions. This is not good enough! I am going to remind you of two things if you are faced with this shit show of a situation.
1) You are worth it. This is an illness. You deserve treatment and to get better.
2) Sometimes this stuff is waaaaaaay harder than it bloody should be, but it's necessary. Other people have trod this path before you - you've got this!

So if your GP is shit / not approachable / unhelpful, then you need a new one. I know, what a ball ache! Not what you feel like at this moment. But this is your right! You need the best chance at getting better and that won't be well served by a crap doctor. You may find there is someone brilliant at your own surgery, so moving won't be too tough, or you may have to look further afield.

The best place to start is with reception. I know GP front office staff can be a little daunting (can you blame them - not an easy job!) but with a bit of charm and politeness, they will always be willing to help. Ask if there is anyone in the surgery who specialises in mental health, or is particularly sympathetic to this sort of thing. Finding someone who knows what is going on is paramount. You may find you need to look further than your current surgery. Which is not ideal, but again it is imperative in the search for wellness. If taking these actions feels a little overwhelming, it may be a way a friend of family member can help - they can look into doctors / services in your area that might be suitable.

From having had numerous discussions with GPs over the years there are a couple of things to remember. Firstly, don't understate the problem. That is a terribly British thing to do. But it's not helpful. If you can't get out of bed, if you can't go to work, if you struggle to leave the house, if this is having an impact on your relationships, then say that. Don't say it's not that bad. You wouldn't be there sitting in this person's office if it was just a bad couple of days. Be honest with your doctor about the very worst days you are having. This is something I really struggle with too. In fact, I took my mum with me a few years ago. I was in a crisis and didn't know how to get the help that I needed. A wonderful counsellor I was seeing lit a fire under my arse - she told me I deserved better and emboldened me to go and find a better doctor. I was struggling terribly with anxiety, and knew that time and time again I had not quite managed to explain just how much of an impact my mental health was having on my life. So I took my mum with me - to combat the nerves, and because I knew she wouldn't allow me to understate the situation. She also remembered all the things I needed to tell or ask the doctor - which was really helpful, as when I am struggling my memory just goes to shit. So if there is someone in your life you could take with to your appointments (maybe even just the first couple) then do that.

I am going to be honest with you. The level of support we can currently get from the NHS for more common mental health problems, such as anxiety and depression, is woefully inadequate. Despite growing discussions about the prevalence of mental health problems and how many people this issue effects, the growth in funding just hasn't been seen. Services are chronically overburdened. And mental health provision has truly become a post code lottery, with access to services varying widely depending on where in the country you live. Generally, GPs essentially have two options - to give you medication, and to refer you for psychological therapies (most likely CBT). The first happens pretty much immediately. The second can take a very long time.

Medication

My experiences with anti depressants have been varied. I have been medicated in some form or another for the last 12 years. At the moment I can't imagine a time when I might not be medicated and that's okay with me. This is what my mind needs. This is one of the ways I treat my illness.

My medication has needed quite a few tweaks over the years. And has worked with varying degrees of success. But without medication I don't think I would be here today. And that says a lot. That doesn't make it an easy option - the side effects are myriad and especially in the beginning they can be tough to deal with. The early days of going onto any medication can be particularly tough, and you will want to make sure you have your support system around you for the rough few weeks when you start. And sometimes it can take a while to find the right dosage, or indeed the right drug. So prepare to dedicate yourself to a process that can be tricky. Knowing about the drug you are on - such as potential side effects, what you can and can't mix with your medication (alcohol etc), the importance of taking it regularly and promptly (this is key) is really helpful preparation. But be warned - there is a lot of scaremongering online about anti depressants. Be careful what you read - because anecdotal experiences of anti-depressants can be worrying and inaccurate. At the end of the day you have to do what you and your doctor feel is right for your treatment.

Personally, I definitely think that medication can be a really important part of recovery, and is not something that anyone should be ashamed of. Remember that it's okay to need a pill to help you control or conquer an illness.

Counselling and Therapy

The other option your doctor will have is to refer you for some kind of psychological therapy. As I stated before, the standard offer is Cognitive Behavioural Therapy (CBT) which is an evidence based therapy that works to change thought patterns and therefore change the behaviours that may be fuelling your illness. Ordinarily you will be referred to something called IAPT (Increased Access to Psychological Therapies - a misnomer if ever I've seen one), or you can refer yourself. You will then undergo a phone assessment which lasts about an hour, and will basically place you in the queue for treatment. 

Unfortunately as funding gets tighter and need gets greater, waiting lists are growing for these kinds of treatments. Depending on where you live you could be waiting a very long time (6 months plus). Within London I know someone who had to wait a mere couple of weeks for her CBT to begin, while I have had to wait a year without any therapy yet, and had to undergo phone assessments and a face to face assessment where it seemed the only criteria was whether on that day I had any plans to take my own life.

I know people who have worked for the IAPT assessment service, trained counsellors, who felt they had to leave because they were aware that they couldn't really help anyone. And that a lot of what they did was brush people off. And from experience I know that in areas where the waiting lists are long it seems that the only way to get seen is to keep pestering - which is incredibly unhelpful, because seeking help when you have mental health problems feels near impossible. So having to repeatedly plead for it will be a massive barrier to some, if not most, people. But if you are in one of these over subscribed, under funded areas, alas pester you must! Again, this is something that those who are supporting you might be able to help with - to phone up for you. Or to remind you to do so. Keep reminding the services that you are there and you need help. Once you actually get onto the radar it is easier to continue to get support.

Different areas also have different services available beyond IAPT - some have charities or social enterprises that offer therapy or counselling. Some have support groups and classes. This is all very specific to your area. Some of it may require a doctor's referral, some might not. But it is important to know what is available. Again - when this task feels too huge it might be something really simple and helpful to ask a well friend to help with. Google local services and find out what is on offer.

The NHS is incredible. I have worked in the health sector for much of my professional life and I am still in awe of this incredible institution that helps so many. But as I mentioned before - mental health provision is just rubbish. The bottom line is there is not enough money. And the outcomes and interventions are not as clear cut as they are for many other illnesses. So funding continues to get squeezed as the whole health service battles to balance to books.

This is absolute bullshit. Of course it is. It breaks my heart that money wise we are so incredibly far away from mental health being treated the same as physical health. And it's short sighted too - because from a purely fiscal point of view, poor mental health and stress accounts for so much absence, lost productivity, and people being unable to work entirely. I completely and utterly believe that you and I should not be begging for help from the NHS to manage our conditions. And I will continue to fight this battle. Endlessly. However, for the moment, this is the world we live in.

Finding a (private) counsellor or therapist

Many do not have the luxury of being able to afford any kind of treatment for themselves. But many do, it just doesn't occur to them. We are used to having the NHS for all ailments, so private practice is a bit of an anathema to us. And it seems expensive. But then is there anything worth more than your mental health? That's how I think about it. Again, not everyone is in the position where they can afford private counselling (more below on pricing) or has someone who can help them fund it. But if you do want to go down the private route, where you even start? Do you need a referral? How do you find people? What do you say? How much does it cost?

Counselling usually costs anywhere between about £30 and £80 per session. However many counsellors do offer special rates for those on lower income or benefits. There is no referral needed. And just like looking for anything else, Google is your friend here. There is counselling directory which lists accredited, professional therapists and counsellors in you area (and there are many other resources like this online). You can usually search via area, and subject like talking therapy or CBT. Each counsellor has a bio and talks about their approach. You can also check if they do appointments via Skype (I prefer this as leaving the house is often a barrier for me). Most will have contact details, or you can contact them via a contact form. [Creating a short list of people for you to look at / contact could again be something that one of your loved ones could do - you could give them your parameters, like say you were looking for a woman, in your local area, who did Skype calls and specialised in CBT, or eating disorders, or trauma.] I usually write a generic email which explains where I am at the moment, what the problem is and what I am hoping for treatment wise, and then ask if they would be open to having a phone call for 10 minutes. This helps you get a sense of one another and might make it easier to decide whether this is someone you can work with. Because that relationship is important. And if you have taken a dislike to someone, or just feel they don't get where you are coming from, this is going to be tough. Hopefully you can have a couple of phone calls and find someone you are comfortable with. [I might write a post at a later date about what to expect from counselling - let me know if that would be useful]

Phew! I think that's it for now. I know this is a lot of information. And some may not be relevant to your battle. Or you may have been through this process and feel I have left some vital stuff out (please let me know - I want this to be a useful resource!) I just know that when I have been at my most hopeless, I had sometimes wished there was a manual. Or a procedure to follow. Some way to know what to do, or how to even start. This is by no means exhaustive. It's just the little pieces of knowledge I have managed to scrape together over years of war with this beast. Sending you love and light. You got this!
SHARE:

2 comments

  1. Thank you so much for writing this. I have always battled with anxiety/depression and wish i'd realised years ago that its okay/normal and had sought help sooner. As it stands, having a good support system (mostly online) and just somebody to talk to has worked wonders for me as well as counselling. It's always good to talk.

    Hannah x
    www.fabfatmama.com

    ReplyDelete
  2. Comprehensive post. We need to talk about this stuff.

    www.somethinginthewayshemoves.me

    ReplyDelete

© Curves & Curls. All rights reserved.
Blogger Designs by pipdig