Out and About

Zoe is taking Plymouth Mind out on the road, bringing mental health information and advice to the forefront of the community, but encountering stigma along the way…

The QOF Factor

Our World Mental Health Day panel discussion seems like a while ago now, but something David said, gave me food for thought when he pointed out how people often describe the psychological symptoms which come as a result of abuse as a mental health problem, rather than a usual and understandable response to trauma.

He also spoke about the how way we’re treated in/by services can re-activate negative experiences from our past/past traumas – this phenomenon is known as iatrogenic trauma – compounded by experiences of services/healthcare professionals, such as being left to fend for oneself, being made someone else’s problem, being labelled.

Why do we see the person as the problem?

These both resonate with me. But why do we see the person as the problem?  We see the person, who is really a victim of trauma (often inflicted maliciously by a perpetrator), as the person with the issues, as a benefit claimant, as an angry person, or as strange/odd. All these perspectives are quite blaming and almost make a perpetrator out of the victim. However, I‘m not in the habit of victimising people either, as that can be damaging too; it suggests that the person is lacking strength and further divests that person of their power when the abuser has already done this.

If we start allocating blame where it is due as a society, perhaps there would be less shame

As a society our language around abuse and trauma is very passive. I recently read an article on this, highlighting how we talk about victims of abuse – we talk about the number of women who have been assaulted, the rates of children who have been abused, the number of women who have been in abusive relationships (there also seems to be a gender bias in our speech). All this talk of ‘people who have had things done to them’ subtly, but very clearly suggests these faceless people had no power in the first place and were subjected to events. It places no accountability on the abuser – we don’t talk about the number of rapists, the increase in perpetrators of child abuse and statistics of domestic abusers, and perhaps we should. If we start allocating blame where it is due as a society, perhaps there would be less shame around the topic of abuse and it would be easier for the victims to talk more openly about it more early on.

Mental health is not the only stigma; there are further words evoking stigmas within this – abuse, victim, trauma, for example all bring with them their own shame and stereotyping, and in turn, present barriers to seeking help, finding appropriate help and overcoming these experiences.

David also mentioned how, when presenting to a health care professional with symptoms of anxiety and depression in the context of a story of past abuse, this would usually result in a response of either a prescription for medication, or a bewildered response as to why you are there in front of them. Occasionally it will result in being signposted to a specific organisation which supports people with those experiences, or a referral for generic talking therapies.

David went on to further explain that our hardworking and pressed-for-time GPs have (as do most clinical staff) targets to meet. These fall under what’s called Quality Outcomes Framework, or QOF, which is a voluntary annual reward and incentive programme, detailing practice achievement and resourcing and rewarding good practice. ‘Put simply, the higher the score, the higher the financial reward for the practice.’ (NHS). The QOF indicators for mental health cover only Bipolar, Schizophrenia and other psychoses.

So when you’re in front of your GP with symptoms which are not immediately explicable, or which cannot simply be solved by a prescription – or indeed you do not wish to solve them through the means of medication, the GP cannot fit you into or tick off the QOF box. In short, with an ambiguous presentation of psychological symptoms, you are lacking the QOF factor.

I can see why many GPs who have often not received mental health training, can come across uninterested… I can understand their overwhelm, frustration and fear.

Add to the mix that GPs are highly pressured by targets, only have ten minutes allocated per patient, have x-rays, blood results, referrals and other paperwork to chase, our booming population and the rise in mental health problems, and I can see why many GPs who have often not received mental health training, can come across uninterested, and/or puzzled by the presence of people in front of them who want answers to their psychological problems. I can understand their overwhelm, frustration and fear.

However, the question remains; if I don’t have the QOF factor, what do I have, and who wants to know?

The podcast of our Panel Discussion on ‘Where Does Madness Begin?’ will be uploaded soon… watch this space!

Families, fish, and far from home

I’m at a busy local tourist attraction today. I arranged to be here during the height of the summer holidays, aware there were people from different places. I won’t just be catching local people today, as there will also be tourists. This was always fine by me, as getting out and about to break stigma and barriers is the ultimate goal. It may be easier for some to speak up and ask for information or advice if no-one knows them, and they won’t see me again. If someone on holiday feels comfortable to come up to me and talk about an aspect of mental health which either helps them there and then or gives them the confidence to seek help back home, then I’m winning.

It may be easier for some to speak up and ask for information or advice if no-one knows them

My venue today is the aquarium. With such a mix of people, I’ve had very mixed interest and responses. Some parents don’t notice me because they are running after their excited toddlers. Some take their time to pass, with an extended glance at the leaflets. I hope it reminds them that information is out there and available to all. One parent was gestured over by their child of about 11, who was curious about the information. The parent asked their child if they had any difficulties relevant to the leaflets, talked about another family member and took some information away. That is what I like to see – non-stigmatised, open conversation with children about their own and others’ mental health, and mental health in general. I’ve seen this approach a couple of times today, which has happened to be with men / dads.

That is what I like to see – non-stigmatised, open conversation with children about their own and others’ mental health

I much prefer it to the alternative approach I’ve seen, where a child has been interested and actually asked their parent ‘what’s this all about?’ and was told to ‘come here’ and pulled away from the table, with no explanation at all. That’s when I started feeling stigmatised again. As though my table was infectious and the parent feared the child may catch something.

A mix of wonder and sensory deprivation

Aquariums have been shown to help mental wellbeing, and I can see why – especially when the room I’m in is quiet; the low-lit, moody lighting, the sounds of the sea playing through the speakers, and the slow-moving fish. It’s calming, and also magical – as I found scuba diving to be, when I tried it once on holiday. A mix of wonder and sensory deprivation. The movement of the water and the light on the water is hypnotising.

The fish are my thoughts, some drifting, others darting, new ones appearing round the corner

At the same time, it reminds me of my mind – especially the fish/sharks – they never stop moving. The tank’s movement is incessant. It’s so busy. The fish are my thoughts, some drifting, others darting, new ones appearing round the corner. There’s never an empty space for long. At the same time, maybe we ought to strive for a fluidity of mind, without fixation on one thing, or blocked from new ideas and experiences. There is a metaphor too, for the aimless wander of the fish in the tank; a lesson not to get carried away with an idea so fast that we miss everything else; instead to be mindful. But perhaps also to have a direction or purpose, rather than lingering unguided.

What is it about aquariums that helps our mental health so much? Is it the dark? The colours? The fish themselves? Let me know your thoughts…

‘Out’ and About

I just looked the other way so that someone could take something without being seen. It was a leaflet about mental health. I haven’t experienced stigma about my mental health for several years now. Since I ‘came out’ about them, all I’ve really found that happens is other people come out about theirs. In my social circle, mental health is normal. We mention it most days, whether in passing or a deep and meaningful.

No-one wants to make eye-contact with me… most look straight through me.

My work in mental health keeps me aware of it, but I haven’t felt stigma for a long time – until today. I’m sat in a big coffee shop in town, holding a mental health stand. I have a banner and a big table of information booklets and leaflets.

No-one wants to make eye contact with me. I’m poised, smiling, ready for a ‘hello,’ but the opportunity rarely arises. Some people look at the floor, or their coffee, some turn their back, but most look straight through me.

I know why. I used to do it too. Anything associated with mental health made me panic. An alarm would literally sound in my head. I felt exposed. How did they know I had mental health problems? It must be obvious. Everyone can see it. I understand the need to ignore me and run away, I just haven’t felt it for a long time, and hoped things had got better.

Some people look at the leaflets from afar. Often, people who are interested will ‘pass’ my stand several times, taking covert glances, before stopping, taking a leaflet and walking away, more often than not, without even looking at me.

I understand the need to ignore me and run away… I used to do it too.

While I was writing this, I noticed someone approach the table and looked up to greet them with a smile, but then I realised they were doing a ‘grab and go.’ I saw them heading back and looked the other way so they could take another.

I’m glad they were able to take some information, but it saddens me that people still feel this way 10 years on from my own experiences of stigma. Just because I’m next to a banner with the Mind logo, people feel like they can’t/shouldn’t talk to me, acknowledge me or even look at me. It’s such an alienating feeling. It makes me feel like there’s something wrong with me, and it actually makes me feel nauseous.

People feel like they shouldn’t talk to me… it makes me feel nauseous.

At the same time, this shows me how necessary it is for me to be out and about, trying to break down these old-fashioned, but seemingly ever-present barriers. I feel so invisible here at my stand, that it’s made me realise I need to be proactively ‘out’ and about. I’d like a t-shirt that says ‘I have mental health problems – it’s ok to talk about it!’ Because it is. I just wish everyone felt that way.

I will be ‘out’ and about in the community with information stands across Plymouth – from supermarkets and GP surgeries, to tourist attractions. If you see me, please say hello!