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…
For the last eight weeks or so I have been a busy bee, putting together, recruiting for, and running our Green Days course of sessions. This was six sessions of outdoor activities in partnership with Active Neighbourhoods (a partnership between Plymouth City Council and Devon Wildlife Trust), which works to get more people outside into the beautiful green spaces around Plymouth through volunteering to restore and maintain these spaces. The aim of Green Days was for participants to meet new people, learn new skills and build confidence. This was a pilot to see whether participants would feel benefit from the outdoor sessions – otherwise known as ecotherapy. While I was out and about in green spaces, an analolgy came to mind…
Over the six sessions, we walked at Efford Marsh to see the new art installation called ‘Searching for Silence’ and to try out parabolic sound amplifiers; we explored the site at Poole Farm with its ancient woodland and resident sheep, pigs and bees; we upcycled old pallets, making them into chairs; we made some frames for the beehive, and donned our protective gear to visit the bees in the apiary; and we walked along Ernesettle Creek, looking at wader birds, bees and butterflies amid the spectacular views of the Tamar estuary and the Tamar Area of Outstanding Natural Beauty.
It got people out into the open, with a shared purpose, but with the focus not on them
We were very lucky to have excellent weather every session, which meant not only were none of them cancelled, but we really got to profit from each of the sites we visited. What was great about these sessions is that it got people out into the open, with a shared purpose, but with the focus not on themselves. The focus was on our surroundings, the new information and the task at hand. Very soon, people started talking to each other – but equally some people walked quietly and that was ok too. It was a great mixture of concentrating, talking, and (I hope) relaxing.
When we were visiting the apiary, watching the forager bees flying about at speed, on a mission to collect nectar to turn into honey, it felt chaotic. It wouldn’t be to them of course; what they were doing made sense to them and their grand plan as a hive, using predetermined flight paths for common gain; but to a clueless onlooker, you didn’t know what was coming next, it was hard to take them all in, and to predict where was safe to stand.
The honey created in the bottom hive serves as reserves – taken by the beekeeper
We looked inside the hive, and got to hold a frame of honeycomb, full of honey – it weighed a lot more than it looked! We were told about different types of hives and how they were arranged – the ones we were looking in were Langstroths which meant that the queen and her eggs were in the bottom section of the hive – the brood box, and the frames of honey were above.
Only queens lay eggs, and queens are larger than other bees, so this type of hive with a ‘queen excluder’ keeps the queen in the bottom section with a hole other bees can fit through except her. This prevents her from laying eggs in the top section, so that when honey is collected from the frames, the eggs and larvae are not disturbed or harmed. The honey created in the bottom of the hive near the queen is food for the larvae and other bees, and the honey at the top serves as reserves – taken by the beekeeper.
I put an enormous amount of effort every day to stay well. Rarely do I see results
Lily told us that over its lifetime, one single forager bee produces approximately one 16th of a teaspoon worth of honey. That’s an awful lot of work. It immediately gave me empathy for the bees – imagine working so hard all day long towards a goal you never see because someone takes all your efforts away from you when you’re not looking. It brought my mental health to mind; I do just that. I put in an enormous amount of effort every day to stay well, to keep my week, my month, my year on track, enjoyable, progressing. And usually several times per week, I wonder what difference any of it made. Rarely do I see (or at least perceive) results. It does feel like someone undid all my hard work whilst I was asleep. It’s both frustrating and discouraging.
I have progressed. I just can’t always see that at the time
On reflection, I know that what I just said isn’t true – because I have progressed. I felt better, I started socialising again, I tried new things, I went back to work, the nature of my relationships changed, how I spent my time changed, my values became clearer, and I progressed in both my career and my personal life. I just can’t always see that at the time, especially when it’s been a difficult day or week(s).
Just because you can’t see it, doesn’t mean it’s not there
So even though I’ve come this far, I still need reminding; it’s not about the energy you put in today and whether you can see the results now or later – it’s about the amount of work you put in, and consistently. Just because you can’t see it right now doesn’t mean it’s not there. I’ve started thinking of my ‘honey’ collecting up in a jar somewhere, which I’ll notice more as it gets fuller – then I’ll go looking for it, and I’ll want to open it.
Queens are not born, but made
As a closing pause for thought – each bee hatchling starts out the same, but when a queen is needed, one will be fed only royal jelly, which shapes it into a queen by changing a DNA process, disrupting the expression of genes that would turn the bee into a worker. In the world of bees, queens are not born, but made.
For Mental Health Awareness Week this year, the theme is stress, and Mental Health First Aid England are using the hashtag #addressyourstress to make us think about what we are actively doing to limit and manage our stress levels.
I’m one for words and immediately saw a second and third meaning, which got me thinking about the idea of my stress having an address, and how I would address my stress, were it stood before me. Externalising feelings is often a helpful way of considering them from a different perspective, and problem solving them without being overwhelmed. I’m also one for tangents…
My stress is like an unattended child in an aeroplane cockpit
Location – where does my stress live? In my head? In my body? Geographically speaking? My stress is something of a serial home-owner. It largely lives in my head, lurking in the background and often leaping suddenly in front of the controls; pressing buttons and turning cogs wildly, like an unattended child in an aeroplane cockpit.
Having said that, it also has a residence in my body – this is more of a holiday home, where it packs up all its reserves and invades the quiet suburbia of my body with a whirlwind of chaos often familiar to large families. I usually only notice one symptom (such as a headache), before another (feeling nauseous) will start and it’s not always easy to see how they are related at first, but once they’re all singing, I realise it’s the same (out of key) tune.
Geographically, my stress lives alone inland, in a small cluttered space, shunned by its neighbours as antisocial. It rarely turns the lights on, and will start rummaging through its hoards at any hour of the night. When it gets bored, it comes over to see me.
I concede that my stress helped my motivation, but it flooded me with too much all at once
Speech – if I could let off steam at my stress and tell it what I really thought of it, what would I say? I would definitely chastise it for not giving me space to breathe a lot of the time. I would probably tell it to move out so I can change the locks. It would argue back, telling me that if it weren’t for my stress, that I’d have achieved nothing in my life, and no doubt call me lazy. I would concede that it helped my motivation, but tell it that it went overboard and flooded me with too much all at once. I would tell it all the other things I could have achieved, had it regulated itself and not inundated me with thoughts and feelings I just didn’t need.
I’d like my stress to be as far away as possible in the woods
Dwelling – if I could create a ‘house’ of some kind for my stress, leave it there, only visiting when I chose to on occasion to give it a tidy up and some maintenance, what would that building look like? This was the tangent that brought me to this blog post; as much as I’d like this building in many ways to be as far away as possible in the woods, overgrown with moss and weeds so I could forget about it, I know that wouldn’t actually be good for me as I know too well I rely on a delicate dose of stress for motivation and efficiency.
However, there was another reason I would want my stress to hide inconspicuously in the woods, and that’s down to stigma. Wouldn’t it be great if it seemed like I was coping all the time? If no-one could see the moments I crack under pressure, snap through frustration or want to hide under my duvet? If I looked well-slept every morning, and carried with me an air of calm. If the sorry state of my car, the papers on my desk and my chaotic diary were invisible because they were all housed in a ramshackle cabin in the woods? How great that would be… no-one would know I was human after all!
There is a pressure to perform even once we’ve got home and put on our pyjamas
The pressures of our modern and digital society mean that not only can people see us when we’re with them, but they can see us – or can expect to see us – when we’re without them, via numerous online channels. This means there is an extra pressure to perform; to keep up appearances even once we’ve got home, shut the curtains and put on our pyjamas. We’re constantly driven to show how exciting our lives are, in picture, video and text form. But, as I often say to friends, Facebook life is not real-life. Just because I might seem to be having a ball through the heavily biased lens of Facebook, it doesn’t mean that’s how things are – I’m afraid you’ll need to meet up with me in real life and have a conversation face to face, or at least on the phone to know what’s really going on.
We have to invest in a false digital self… bring back the authentic basics!
We have somehow learned to keep comparing ourselves to each other, racing to compete for the most digital attention and likes; social media in our pockets has made this excruciating. It’s almost, to me, like we have to develop and invest in a false digital self alongside our real-life self. We are battling against each other trying to create the most acceptable, amazing or shocking portrayal of ourselves. Physically, this is damaging enough with the amount of photoshopped ‘beauty’ out there we are led to aspire to, but when this comes down to life choices, personality and character, this false, virtual ‘world’ we inhabit through our phones is painfully unrealistic and unobtainable. It’s baffling trying to work out how to dispel it and bring back the authentic basics.
So perhaps I shall not keep my stress in a clandestine location in the woods at all, but let it live alongside me, allow it to be seen – for whilst I need to make an effort to mitigate it for my wellbeing, stress is also human.
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!