All posts by Lol Butterfield

Lol, 51, is a qualified mental health nurse with a 30-year career in mental health services as a clinician. More recently, he has become involved with working towards eliminating the stigma and discrimination of mental health, which is his passion. Until recently Lol was an advisor for the ‘Time To Change’ national anti-stigma campaign covering the north east of England where he lives. His book, Sticks and Stones, is an autobiography detailing his childhood experience of stigma as a consequence of his father's mental ill health.

What an ex-gangster taught me about standing up to stigma

Reformed hardman Chris  (centre) with Lol and his partner Clair at the Ley centre
Reformed hardman Chris (centre) with Lol and his partner Clair at the Ley centre

What do a mental health nurse and an ex-gangster have in common?

That was the question I was asking myself as I visited the Ley Community, a residential drug and alcohol rehab centre, with Chris Lambrianou, former henchman to the Kray twins.

I visited the Ley at the invitation of Chris, who volunteers at the centre; his life now is about as far removed from his past as is possible. The Krays ruled London’s gangland in the 1960s and were imprisoned for murder. Chris was present on the night Jack ‘the hat’ Mcvittie was stabbed to death. His presence and silence that night in naming Reggie Kray as the murderer resulted in Chris being jailed for 15 years.

Whilst in prison Chris, now 78-years-old, reflected on his life and the mistakes he had made. He wondered how he had found himself to be in such a position. Like many other prisoners Chris ‘found’ God. But unlike many others who use this as a cynical ploy to seek freedom early, Chris knew his life had to change and was determined to make that happen. He wanted to make a difference to others. On his release in the early 1980s he began working at the Ley. His voluntary work there includes accompanying people to court and generally giving them the encouragement to try and turn their lives around.

I had read about Chris’s work in his autobiography, The Kray Madness, and contacted him to discuss our mutual interest in helping people to turn their lives around. After a few phone calls, he invited me to Oxfordshire to a look around the Ley. The centre initially struck me as quite regimented, but it has to be that way to encourage the residents to make the efforts to come off drugs and show self discipline and determination. There is a strong emphasis on group discussions, peer pressure and support, openness and self responsibility.

We have different backgrounds and seemingly different areas of interest – me with mental health campaigning and Chris supporting the rehabilitation of people with addiction issues. Yet we both have a desire to use our life experiences to make a positive difference for others.

Chris has an influential role among young men because of his Kray connections, with much recent interest in his life thanks to the Tom Hardy film Legend – Chris advised on the movie. Chris is not volunteering as much at the Ley due to his age, but when he does he accompanies people to court, and generally encourages them to try to transform their lifestyles and behaviours. They see him as a positive role model and he can relate to them.

Supportive networks are vital to recovery and a focus on relationships is the theme of Mental Health Awareness Week next week. Social contact is the best way of breaking down barriers, misunderstanding, and ignorance of mental illness. It is important for us to have good relationships for our own mental health in the sense of talking and listening to each other.

My own work, for example, has been aimed at encouraging men to seek help early for mental health issues and self-harm. My most recent media advisory role was advising the storyline involving the ‘macho’ character Zak Dingle in TVs Emmerdale during his depression storyline.

Tragically we have very high rates of self-harm among young men in my native north east. Much of this is a consequence of the damaging ‘Big boys don’t cry’ attitude among men, and the damaging misperception that men expressing their feelings is a sign of weakness. This is something Chris would relate to in his own work.

Challenging stigma and addressing feelings of shame is something Chris and I share as a common goal.

Through social media, Facebook, and social contact, we are both starting to chip away at the damaging defensive layering common to all tough guys. We are trying to convince men who think they are somehow immune from mental illness that nothing could be further from the truth.

We have discussed the idea of a joint project, perhaps a book, to try to reach out to men in particular who self harm and feel stigmatised because of having mental illness. Together we are determined to make a difference; we have more in common then we think.

* You can find Lol on Facebook

Mental health on TV: entertainment vs realism and sensitivity

If someone’s arm was broken on TV we would see it bandaged up. If someone had diabetes we would see them receiving insulin. If we see someone had a heart condition we would see them wired up to an ECG machine.

So why when we see people displaying symptoms of mental illness do we usually see this depicted as violent or histrionic, with a focus on the challenge and not the solution?

Christmas is next week – a time of year that can brings an unbearable pressure to people with mental health issues. We are all very familiar with seeing mental illness portrayed in cliched, negatively stereotypical ways on our TV screens. The storyline involving the character Steve McDonald’s unfolding depression in the TV ‘soap’ Coronation Street is generating much interest currently .

I am watching closely as this storyline unfolds, not least because we at Time To Change are advising on this to try to ensure as much sensitivity and realism as possible.

Although only in the early stages of the illness, Steve’s behaviour is causing both consternation and confusion for those close to him, and not so close. People are trying to make sense of it all at the moment. Classic symptoms pointing to clinical depression can often be overlooked in the early stages. The programme is cleverly highlighting this and showing the insidious nature of the illness.

I believe it is all around finding the right balance between providing drama for the viewers but also ensuring mental health is not further stigmatised through lazy, damaging scriptwriting. It is a win-win situation for everyone to have mental health storylines depicted with responsibility, authenticity and maturity:
• viewers will gain more awareness of symptoms and treatment
• the programme will receive positive publicity for the research and efforts made
• a powerful anti stigma message will be ultimately delivered.

It is critical to present as authentic a picture of mental health symptoms and treatment as possible to de stigmatise mental illness. The media plays a role that must never be underestimated. It will educate and challenge opinions, it will inform. The viewers opinions and impressions are often influenced by what they see and hear on their TV screens. In advising on the Zak Dingle depression storyline in Emmerdale, I was at pains to reinforce how the illness not only impacts on the sufferer but also the family and significant others.

This is the reality.

The person who is ill does not usually suffer alone, their families/partners have usually cared for them before they seek help and continue to provide care afterwards. I will be watching the Coronation Street storyline to see how those near to Steve are effected by his own deterioration. It must also be realistic in showing the time span of the illness. It would be ludicrous for the viewers to see a decline into severe clinical depression undermined by a miraculous recovery within weeks.

Unfortunately drama that portrays a swift recovery only serves to misinform and mislead. Realism and credibility is then left on the cutting room floor. This is why good research is the key alongside learning the lessons of the past. Lessons need to be learnt and I strongly believe this will be the case in the Coronation Street plot.

Recent research by Time To Change has shown that attitudes are changing as a consequence of responsible media portrayals of mental health. We must not become complacent though and continue to build on the good work so far.

Coronation Street is a very popular soap. Many will be watching for the drama and entertainment element, while others will be scrutinising closely to look for a positive, realistic depiction.

I want these reasons to combine.

I hope nobody is left disappointed or disillusioned. I am excited by this storyline and so should others be. Excited because the storyline will, if successful, leave a seed of hope and a motivation for change in everyone’s minds. That seed will eventually grow into a realisation that when covering the topic of mental health, it is crucial this is responsibly portrayed in the media.

My campaign to change attitudes, one event at a time

We have just ‘celebrated’ World Mental Health day (10 October). I, and many like me, hope that as each year passes so does the stigma and discrimination of mental health. Stigma impacts like a disease – if left untreated, the result is devastating.

Attitudes are certainly changing around mental health, although slowly. As pointed out by Time to Change, the mental health campaign I’m involved in, perceptions are changing. The National Attitudes to Mental Illness survey shows that since 2011, an estimated two million people – or 4.8% of the population – have improved attitudes towards people with a mental illness.
In addition, the data suggests that more people are acknowledging they know someone with a mental health problem (64% in 2013 compared with 58% in 2009). However nearly half (49%) of respondents said they would feel uncomfortable talking to an employer about their own mental health.

Anti stigma work has taken up a large part of my life in psychiatric nursing. And, although it sometimes feels like two steps forward and one back (as the research quoted above hints), the long and winding journey is worth the taking and the rewards are for the benefit of everyone.

I have seen the impact of stigma. I have also felt it. I have seen the destruction it causes people who experience mental illness and their loved ones. This is the motivation for my work.

The recent news about the impact of isolation underlines the need for more work along these lines. Both young people and older folk are affected by severe loneliness.

These issues provided the context for a talk I organised in my childhood village in July, and which I blogged about on these pages.

My talk was about the stigma of mental health and aimed to promote Time To Change. I wanted to raise awareness of the insidious impact of stigma and its long-term damage, and explore how we can all make a difference to the lives of others through our daily interactions. I wanted my message to reach across the village and, more personally, make a mark in the place where I spent my childhood years.

For me going back to my former home, which I left almost 40 years ago, was quite an emotional occasion. It had been the culmination of a life long ambition, a seed borne in childhood that had finally flowered. In the dark corners of my mind has sat the repressed thoughts from childhood of my father’s mental health issues, and the attitudes of others at the time to this.

Assembled in the room of around 50 people were faces from my childhood, alongside faces of the present. An eclectic range of people and experiences, young and old. Friends and family sat beside strangers. I will always be very grateful for the efforts they made to attend and help me to achieve my ambition.

Social contact and interaction is a powerful weapon in challenging ignorance and the myths surrounding mental health. Breaking down the invisible barriers we put up and accepting people as people, rather than defining them by their mental health condition is critical. The two-hour event was informal and interactive thereby providing the ‘safe’ space for those who wished to be open and share their personal experiences, or the experiences of others they hold close.

I started with a mythbusting quiz about mental health to highlight the misconceptions that exist, then spoke about my work in mental health nursing, my anti-stigma initiatives, and also my own experience of depression. I covered my work in the media with the TV soap Emmerdale, advising on the award winning depression storyline of one of the main characters, Zak Dingle.

I stressed it was my hope to encourage the viewers to empathise with Zak’s plight, to see him as being vulnerable and a victim of his circumstances rather than a danger to others, and criminalized

To contrast with this I also explained my advisory role with the character Darrell Makepeace in BBC Radio 4 The Archers. This character had not been received positively by listeners because the producer had decided to criminalise this character. Despite this, I stressed this at the very least ensured people were talking about mental health.

It was a success. I was at pains to ensure it went well because it meant so much to me. I have delivered many talks and presentations previously to large and small audiences but this one was more personal.

Since that summer’s evening I have spoken to people to gauge how things went. Did it make a difference? Has it changed their views? Inspired them? Where do we go from here? The responses have enthused me.

I intend to arrange a follow up event to build on this and plant another seed for the future. A seed for the young people, some who, sadly, will inevitably grow up with the same experiences I had.

Hopefully there will be some changes in attitudes resulting from that evening. It might seem to many just a single, small event, but if it can change just a handful of attitudes and encourage people to talk about mental health, it will be a success. Change drips slowly, but it will come all the same. One day.

Campaigning in my community for mental health

Each time I return to my childhood village the memories come flooding back.

Memories of football in the street and endless walks along rugged cliffs that are some of the highest in the country. A sense of innocence from another era now gone forever.

My native town is Staithes, a small fishing village nestling beneath cliffs on the north Yorkshire coast. A tourist attraction in summer, Staithes is synonymous with Captain James Cook who worked and lived there prior to setting sail to discover Australia.

My childhood growing up in the village was mostly uneventful but rocked by my parents’ separation and my father’s mental health issues. Mental illness was very much misunderstood in the village and this was no different to any other village in England at that time.

Over 50 years later, and nearer to the grave than the cradle, I now want to return to my roots to try to bring about change, however small, around attitudes to mental health. I want to raise awareness in the village of the stigma of mental health and how it impacts on the sufferer and their families. A stigma as dangerous as the high cliffs I would climb as a child and the raging sea that batters the village in winter.

Stigma and discrimination of mental illness exists in all villages and towns. Time To Change, England’s largest mental health anti-stigma programme seeks to change all that. I volunteer for Time To Change and use my qualified psychiatric nurse knowledge and and personal ‘lived experience’ to try to bring about more awareness, understanding and tolerance of mental health.

I feel confident that the event next Thursday (24 July) will be successful. Why? A sense of community exists to this day in Staithes, which I believe is part of being from North Yorkshire and who we are as a people. A down to earth friendliness, community spirit, and willingness to help others in time of need.

What I have organised is an informal evening in the village hall to raise awareness, educate, and de- mystify some of the negative and damaging misconceptions of mental health; SOS Staithes Opposes Stigma of mental health (the title “SOS” reflects the international distress signal ‘Save Our Souls’ which the village, a once thriving port, uses so I thought that would be an apt title).

I will also talk about my advisory work with Steve Halliwell, who played the character Zak Dingle in the television soap Emmerdale , to help craft the award winning depression storyline. This was done with the aim of making mental health depictions on TV more realistic and sensitive. People here in identify with Zak Dingle as the programme is Yorkshire-based.

So far the response to my evening event has been very positive. I have visited the village and left posters everywhere. I have spoken to some people I already knew and strangers who I can now call friends. They have been very open and honest about their own mental health issues or spoke of people they know and care for. This has enthused me all the more. I appreciate their being so open and trusting very much.

I wish I had possessed the same feelings of acceptance, understanding, and trust all those years ago as a child around my fathers illness. Small rural communities such as this are more isolated than the larger towns and cities and as a consequence people are often left feeling more alienated and lacking support. I often say as a child I did not understand the word stigma but I certainly knew how it felt.

My aim is simple. I would like the people in the village to be more aware of mental health issues and how mental illness it is indiscriminate. How it effects one in four of the population and that nobody is immune.

I would like the young people to see me as a positive role model and for them to be influenced to try to bring about change themselves in whatever way they can. I would like everyone to understand that Time To Change is a social movement for change and they can all play a part, no matter how small, in this ground breaking campaign.

The young people are the future of the village. They can all make a difference to the villagers of tomorrow as well as today by their words and their actions.

• SOS: STAITHES OPPOSES STIGMA of mental health. Thursday 24th July 7 – 9pm held in Staithes village hall – An informal evening of interaction and discussion around mental health. Free entry by ticket. Refreshments available and free promotional Time To Change materials. Tickets from Lol Butterfield on 07958064025, Veronica Foster on 07891607786 or members of the village hall committee.

Radio raises awareness: The Archers mental health storyline

I recall listening to Radio 4’s The Archers as a teenager on long hot summer afternoons; the “heatwave” summer of 1976 springs to mind. As with listening to cricket, the radio soap helped me to relax and I warmed to its quaint and easy listening style. I would not have envisaged all these years later that I would be involved with the programme – and with such a controversial storyline.

I’ve been advising The Archers on the storyline about the depression experienced by the character Darrell Makepeace. The Archers is moving with the times. It remains a quintessentially English portrayal of village life, but also has to echo the modern age and remain current. Just yesterday, new figures were published on use of the Mental Health Act in England, showing that the number of detentions, which has increased by 12 per cent in the last five years, exceeded 50,000 in 2012/13.

Controversial, contemporary plotlines will appeal to the listeners, but Radio 4 must get the balance right by keeping its traditional support base whilst acquiring a younger audience. The Archers is the world’s longest running radio soap opera and the station’s most popular non-news show with more than 5 million listeners.

With this in mind, I began offering advice on the character Darrell and his spiralling fall into depression about three months ago. As part of the Time To Change media advisory service, my role was to try to add as much realism and sensitivity to his presentation. This differed so much from my previous advisory role for the character Zak Dingle in the soap Emmerdale. Why is this so?

Well, Darrell is a character who has hit rock bottom and, in doing this, has not only caused much pain to himself but also to those around him. Chaotic and unpredictable would be just two words to describe this. He is also very manipulative. The Archers’ listeners appear divided in their opinions about this. I remain very enthused that we have highlighted the devastation of depression, its indiscriminate nature, and the “loose cannon” impact.

Emmerdale’s Zak endeared himself to the viewers as he was deemed a “loveable rogue” The fans empathised with his plight. But Darrell is not so endearing and his manipulative behaviour has only served to isolate him from most fans.

Therein lies the challenge for me, and the producers themselves – to promote more understanding and acceptance of mental illhealth, and its indiscriminate nature. I received praise and criticism – in equal measure – from listeners, and that’s fine. I no longer lose sleep at night worrying about criticism; it opens up a debate and encourages more dialogue around mental health that so far there is a reluctance to do.

This work is challenging because, by my very nature, I am a sensitive person. I have had to grow a thicker skin since to take the blows but the praising comments helps to ease the pain. The criticism at times to my role and advice taken has been quite personal, but I can only give advice from my own perspective.

I have a passion to promote more understanding of mental health and eradicate stigma from society. I hope The Archers’ storyline will help transform people’s attitudes to mental health.

* The first national Time to Talk Day takes place on 6 February, aiming to spark a million conversations about mental health. Part of Time to Change, it highlights how little things – sending a text, a chat over a cup of tea- can make a big difference to someone with mental health problems.

Social networks and mental health: supportive environment or a stalking ground for cyber-bullies?

Bullying crushes a child’s self esteem and confidence. It can leave a child feeling alone, totally helpless, and with no one to turn to. In their childhood innocence and naivety some even blame themselves for their torment. Many schools now have robust anti bullying policies in the form of bullying charters.

We live in an age where teachers acknowledge widely the emotional needs of children more than ever before. Resources such as SEAL (social and emotional aspects of learning) provide increased emotional support in many schools.

As a consequence bullying has now left many classrooms, but not all. This is commendable but, not only do schools’ attitudes and actions in response to bullying vary considerably, is it enough?

And now in the age social networking sites it has insidiously entered the sanctuary of children’s bedrooms. Running away from the school environment and threatening bullies now leads straight to the bedroom, a once safe haven where a child’s computer suddenly provides no way of escape. Computers are the contemporary child’s toy and some may say the innocence of youth has died as a result. This year’s forthcoming Anti-bullying Week, for example, has a special focus on cyber-bullying.

These issues have been on my mind since the death of 14-year-old Hannah Smith who suffered relentless bullying online. Her death was not a stark reminder of how vulnerable our children are not protected from bullies even in the supposed safety of their own homes. There has been intense speculation and much knee-jerking as a result of her death, but the bottom line is that social media played a part in her suicide. Whatever happened, she was a vulnerable child.

But social networking sites can be so liberating for many providing an outlet for those who lack self confidence in face to face interactions and who might have smaller social networks than usual. Many can make friends and form relationships online that they would otherwise struggle to in school.

These sites can be very helpful, especially for those who lack social contact, or may have poor social skills, agoraphobia etc, but the flip side of the coin is the bullying issue. Reaching an acceptable compromise regarding social networking will not be easy because the genie has now been let out of the box, so to speak.

When experiencing low moods, your reality becomes alien to that of everyone else. I have always advised people to seek help at the earliest opportunity to prevent depression reaching this critical stage. And this is where social sites that support mental health can help.

There is the social site launched by comedian Ruby Wax, for example, Black Dog Tribe, “a place in which like-minded people can find their own ‘tribe’ and share experiences in a supportive online community through forums, blogs, daily news and mental health information”. Another example is Kent and Medway NHS Trust, for example, which is piloting Buddy, an online system that records mood changes. And there are a raft of support-specific online forums linked to various charities and support groups which can make all the difference to vulnerable people.

This is the positive aspect of these sites.

Yet it is too simplistic an argument that social media and networks alone can help prevent depression. An holistic approach can include talking therapies, physical exercise and medication, if appropriate. These therapies can support each other – medication, as I know from personal experience and from my nursing career, has its down side. It can also make your mood fluctuate wildly, become disinhibited and even suicidal. Having easy access to online support can, at times like this, be vital. These issues are brought into sharp focus by the news today that the number of people needing treatment for mental health issues will have increased by more than 2 million by 2030.

We should look closely at both the negatives and positives about social media and networks in relation to mental health – and ignore them at our peril. While it is also wrong to assume that social media alone can push someone towards mental health problems, excessive use of social sites, as is often reported, can itself lead to problems.

Children sitting for hours in front of a screen removes them from the social contact of others that will improve their face to face communication skills and confidence in later life. Effective communication involves eye contact, body language, and gesturing. All ignored when lying in bed hitting a keyboard in silent and lonely surroundings.

Cyber bullies and unpoliced social media sites populated by children (or those posing as children) are not part of a civilised society. We must make it all stop. Now.

How the media must mind mental health

Stephen Fry’s recent disclosure of his attempted suicide last year highlights that mental illness does not discriminate between the “haves” and “have nots”, the famous and the “ordinary”. None of us are immune from the feelings Fry described.

The representation of mental illness in the media in recent years (you need only think of Frank Bruno’s treatment by the tabloids), in television dramas and soaps has not, over many years been empathic. People with mental health issues seem to be either suicidal or mostly violent and dangerous – the two extremes of mental health geared more towards boosting viewing figures than portraying realism and authenticity.

These exaggerated displays of mental health only perpetuate the stigma and stereotypes. In fact it would be fair to say media representation has often been ignorant, discriminatory, and at times criminalising towards the mentally ill. In fact earlier this month, the actress Glenn Close apologized for her depiction of a mentally ill woman in Fatal Attraction.

Sensationalistic storylines and stigmatising stereotyping have only served to misinform and cloud the viewers image of someone who is ill and needing help – but that someone could be any one of us at any time of our lives.

The Time To Change media advisory service, which I am involved in, was set up to change negative perceptions and offer advice and guidance to promote more realism and sensitivity when covering mental health storylines. Advising the soap Emmerdale on a storyline featuring Zak Dingle, the popular loveable rogue, felt like living a double life for a year as the programme documented how his mental ill health spiraled downwards. Emmerdale provided me with a unique test: to positively influence a popular soap storyline. It afforded me the opportunity to use my own personal experience of depression, and lifetime working as a qualified mental nurse, to bring realism and authenticity for a change. I took on the role with a gusto I had not felt for many years.

I immersed myself in the role to the point of drowning. I knew that only by doing this could I truly empathise with Zak’s plight and engage the viewing public. I read countless scripts going over each one with a fine toothcomb burning the midnight oil. I spoke for hours on the telephone with Fiona, the researcher, and my mobile phone was constantly in use for texting and talking over the scenes. I so wanted this to be right.

I felt duty bound to make a difference having been given this opportunity. I advised that showing Zak’s vulnerability and fragile emotional state, rather then the often stigmatising “Mad axeman is dangerous” image, would encourage the viewer to also empathise more. This worked well and delivered the right message to the viewers.

I was made redundant halfway through this work and understandably my self-confidence and esteem was badly dented. In fact it became non-existent. Conversely my work with Emmerdale helped me regain this. I felt I could empathise more with the Zak character as my mood plummeted. I became Zak, or at least this was how I felt at the time. We walked the same troubled path for a while.

The advisory service will continue to influence and craft storylines around mental health. We will continue to provide personal advice and information to researchers, directors, journalists and the stars themselves to make mental health depictions credible. We will provide guidelines and key tips such as to try to allow the characters storylines time to develop. And that recovery can be a long process.

We will encourage the listening of peoples personal stories, and encourage careful thinking about how the other characters in the soap will react. The use of humour is not necessarily a bad thing and bringing in some humour and warmth will challenge peoples often misinformed stereotypes of mental health.

Mental illness doesn’t make people bad so by reinforcing this we can discourage programmes using a mental health storyline to try and explain bad or strange behaviour. For far too long criminalisation of the mentally ill has existed on TV and Radio and this misperception must change.

We have a long road to walk in our media advisory work to get this right. Or as near to accurate as we can. It is crucial that we walk this long and no doubt winding road together. Through collaboration and mutual respect we will make damaging stereotyping of mental illness a distant memory in the media. It is a win-win situation for all concerned.

* Read more thoughts from Lol on the Emmerdale storyline here

* Tips for storylines featuring mental health issues that create dramatic and interesting narratives without alienating audiences, resorting to stereotypes or using a mental illness to try and explain “bad behaviour”:
– to make a charactor plausible and accurate, speak to as many people who have mental health problems as possible. They are the best consultants available and most want to see accuracy on screen
– think about your camera shots. Certain mental health conditions can lead people to feel isolated or to experience altered reality. This can be reflected through close up shots, POV shots or hand held
give the storyline enough time to develop. It is common that symptoms of mental health problems will manifest over a period of time and build in intensity, rather than develop and explode in the space of one episode
think about how other characters react. Stigma and discrimination can be as bad as the mental health problem itself for many people. Can you show any empathy from others?
get expert advice from mental health charities and experts to ensure that the symptoms you are showing on screen are relevant and realistic
think of your dramatic climax carefully. Most people with mental health problems are not violent so it is unrealistic for a storyline to always end in violence or homicide

Based on information from the Time to Change media advisory service. Read more here.

On loss and learning

Lol Butterfield, mental health campaigner
Lol Butterfield, mental health campaigner
I have lost too many friends and service users through suicide over the past 30 years.

We examine our consciences to see if we could have done more to prevent such deaths, that’s a normal human reaction. It’s what empathy and compassion is about. Being a nurse, as I am, is irrelevant, it is about being human. We consider those left behind to face the future and what support they need. It becomes a tragedy that spreads a pond like ripple of despair and pain. Nobody is immune from this rippling effect.

Often in our hour of need we turn to those who we know can provide support. Those who can help us to work our way through the grieving process. Sometimes just a listening ear or supportive approach by anyone is suffice. Sometimes more professional help is required. Everyone is different. We are all unique. We all deal with the inner pain following a death in the way we know best, our resilience levels dictate our strengths and coping abilities in times like these.

Recently, the All-Party Parliamentary Group (APPG) on suicide and self-harm prevention called for councils to develop and implement suicide prevention strategies. The APPG report revealed that more than a quarter (27%) of English authorities do not have any such specific strategy. As the APPG said: “The existence of any such plan is open to chance rather than determined by any national policy.”

The APPG wants councils to be obliged to develop a suicide prevention plan led by the director of public health or senior member of the public health team: “The plan should include provision for self-harm prevention and those bereaved by suicide.” As the group stressed, more than 5,500 people die by suicide each year in the UK and for people aged 15-24 it is the second largest cause of death after road accidents.

While I support anything that raises awareness of self-harm and suicide, I strongly feel that the responsibility for suicide prevention should not just be down to the passion of area ‘champions’ who have a particular interest in this. I believe all local authorities must seriously address suicide awareness, and prevention, as a matter of urgency. This is of particular relevance with increasing self-harm and suicide rates taking into account the recession and how this impacts on peoples lives at a personal level.

Mental health promotion is now under the control of local authorities, although personally I believe we all have a responsibility if working in social or health care to positively promote mental health.

As well as the personal costs to each family of a suicide the financial costs through lost earnings etc for a lifetime run into many thousands of pounds. As a compassionate and humane society I believe we have a moral duty to have in place coordinated strategic approaches to address the issue of suicide prevention involving all stakeholders. The NHS, local authority, the Police, The Samaritans, Cruse Bereavement counselling, community mental health support groups, and so on. In fact the list could be endless because in reality so many people are potential victims of suicide, directly or indirectly.

From a personal perspective, following my redundancy last summer my mood dipped. In fact it plummeted. Voluntary work at that time ensured my self esteem and confidence would stay above the water. I experienced ‘dark’ thoughts myself brought about by feelings of worthlessness and hopelessness finding myself unemployed after a lifetime of work.

The adjustment to the situation I now found myself in did not come easy. My intensive role in advising Zak Dingle in his depression storyline in the Soap Emmerdale conversely helped lift my own mood. I felt valued because I knew I was making a difference. I knew that I was raising awareness of mental illness to a large viewing public in a sensitive and non stereotypical way. Winning the Mind Media Awards a few months ago for this storyline further boosted my self-esteem even more.

Zak’s symptoms were intended to educate, encourage empathy, and promote more understanding of depression and how people can reach the point of suicidal ideation. They were intended to highlight how mental illness not only affects the person but also the loved ones of that person. I invested much time and effort to try to get this right and confess it wasn’t perfect, but nothing is. It helped me considerably as much as it helped others I had hoped to understand more and assume less about mental health.

I was also asked by a good friend to consider becoming more involved with Stamp Revisited, a wonderful, life changing for some, advocacy service on Teesside for those affected by mental illness. I had been a member for many years and applied to be on the group’s executive comittee. I was accepted.

This also boosted my self-confidence and esteem and played no small part in helping to lift my mood to a more acceptable level. Stamp Revisited is a charity and, as such, relies heavily on donations and the generosity of its volunteers. its aim is simple. To help those who struggle with mental ill health, any one of us at any time in our lives could be in this position. It would be fair to say their work has at times saved lives.

Knowing someone is there in your darkest hour can help to steer you away from the depths of despair. Specialist support can offer a more objective view on improving your personal situation that may have been lost in the spiral of depression. Insight can be lost in severe depression. Taking your own life can then become an option you would not have considered, ever. Knowing people are there to listen makes such a difference and words cannot explain how life saving this may be.

* The Samaritans’ Media Guidelines aim to promote the sensitive reporting of suicide and self-harm incidents

Self-harm: the power of talking face to face

Self-harm has always been a taboo subject and in my many years of mental health nursing probably provided more challenges than anything else for me.

It touches at the very core of who we are and how we deal with stress. Our mental strength, or resilience to cope when under pressure, will prevail in many cases but not all.

Recently, new research by the charity YoungMinds suggested that many doctors do not know how to support young people who self-harm. And today comes the news that mental health patients are to be given the right to chose their consultant. As reported today, this will help end what can be a “like it or lump it” service – unlike patients with physical health issues, mental health patients can’t currently chose which psychiatrist they see.

Back to primary care; self-harm is still very much misunderstood by many, and the wider general public. As a mental health nurse, I confess at times to having felt at a loss myself as to how to respond to repeated self harm behaviours. You question your own approach if the problem remains despite intense nursing intervention.

But given that 10 per cent of 15 to 16 year olds are thought to have self-harmed, usually by cutting themselves, if GPs are offering a lacklustre response to the issue (not referring for counselling or for more specific mental health support), this is woefully inadequate.

The mental health charity Mind, suggests that if your GP doesn’t help, you contact the Patient Advice and Liaison Services – and you have a right to change your GP. Mind has some useful practical information on where to get help.

I have worked with some excellent professionals. However, I have also seen others who are in a privileged position to help but who try to look the other way. Or dismiss this as attention seeking behaviour.

In a profession known for its primary focus on the treatment of physical diseases, being presented with a self-harming patient provides an emotional litmus test for many GPs. Why do they get this so wrong sometimes?

Although I don’t want to generalize, I believe that some view this behaviour with frustration and a sense of hopelessness. By this I mean some medical professionals might not feel confident of their own training or understanding to be in a position to deal with things effectively.

Some GPs are too dismissive or refer to mental health services in the knowledge that more specialised knowledge will be available to plan appropriate treatment. Or they automatically reach for the prescription pad to prescribe medication without really asking themselves if a psychological approach would be the more helpful first option.

And yet all too often, just a listening ear will help, to allow the person to “offload” within the surgery. This is where the therapeutic relationship between the GP and patient is pivotal to treatment and recovery.

The power of talking openly about concerns face to face cannot be underestimated. A prescription for anti-depressants may be helpful in the long term but we should not rule out even a basic “talking and listening” opportunity as a first option (given GP’s have to stick to set consultation slots, I can see why this might seem an impossible idea – but an approach that encourages people to talk is the right one).

If a person with low self esteem tells the GP they are a “bad person” or “unloved”, the GP can use a simple cognitive behavioural approach of questioning the evidence to support this there and then, of which there is usually very little. And stress to the person that a thought is just a thought, not a fact. Simple but effective initial intervention to encourage someone to question their own negative thought processes.

So what to do?

Going back to my opening thoughts, while professionally I’ve found self-harming behavior extremely challenging, one thing I’ve never doubted is my empathy to try to look beyond the physical act of self harm to try to identify its underlining cause.

A behaviour as challenging as self-harm can distract you from seeing the person behind the behavior; what is the emotional conflict driving this kind of behaviour. People can change self-harming behaviours. Being positive and maintaining hope is the starting point of any intervention – and that goes for the professional as well as the individual.

Why I always had time for George: older people and mental health

I’m walking across the grounds of the psychiatric hospital on a very wet winter evening and a patient, let’s call him George, steps out from behind a bush to talk to me. He needs to tell me something that he feels is important and can’t wait.

We both stand for quite a while talking (he’s a staunch socialist and wants to talk politics) and both get soaked to the skin. I think to myself that it’s more respectful to hear what he wants to say then hurry on and seek shelter. As we eventually walk back to the ward together, he is calmer, seemingly content to have got his feelings off his chest.

This scene took place more than 20 years ago (I mention it in my book, Sticks and Stones) but I believe now what I thought then, that my exchange with George is what real empathy is all about. It’s what being non-judgmental is about, what being human is about, what being a nurse is about.

I have nursed enough people during my time as a mental health nurse to understand that life is a bit of a lottery. I have seen the elderly lose their dignity in nursing homes and in hospitals. This is not always through dementia. This could be depression or psychosis, or other debilitating illnesses depriving them of their confidence, self worth, and esteem.

But as the recent figures about suicide rates rising among the elderly show, mental health issues may be overlooked in older people as society mistakenly presumes dementia is the only condition older people experience. Another assumption is that depression is a normal part of ageing, because the elderly have more of a sense of their own mortality.

I hope that whatever befalls me in my old age I am shown the same respect and compassion as I believe I have shown others. There’s often a failure of respect not just because of deliberate neglect or a lack of compassion, but through ignorance – through not treating people as individuals or not meeting their emotional needs.

So how do we prevent this? Essentially it is around searching for the person behind the illness and stepping back for a second and thinking “how would I like to be treated if this was me?” or “would I like to be looked after in this environment?”

Of course I’m not arguing against the completion of care plans, but I do worry that the increasing onus on form-filling and box-ticking can deny care staff more time to spend with those they support. A care professional might be spending hours on admin, or typing up a care plan – but how does the person in their care know this is part of them being cared for? They’d rather have our face-to-face time I’m sure.

Person-centred care, as the name suggests, is meant to put the client at the heart of the care planning process. This care is collaborative and negotiated with the client (theoretically). However, often when someone is acutely psychotic and lacks all insight, nurses then become the advocate and the care must be planned depending on what is required to get the person well again. As for personalisation and personal budgets, the take up is sadly not as high as it should be; people worry about risk management and general funding pressures that can put people off.

Compared to when I was in a clinical setting, today’s care world involves a far more litigation and risk-averse culture which takes staff away from the client. At the time I knew George, I could spend longer in one to one sessions with clients, so could my colleagues, but more often than not, today’s staff are only allocated a set amount of time each shift to spend in one to one, face to face therapeutic sessions on the wards.

Staff cutbacks on the wards and in the community will also reduce the time staff can spend with clients in face to face interventions. However staff should still show empathy and be non judgmental in all approaches, because this is the essence of their roles.

Clearly, organisations promoting older people’s issues have a role to play in raising awareness and educating. We stigmatise the elderly as much as we stigmatise the young people, so we need more positive promotion of what the elderly can offer society. Countries like China and Japan, for example, revere the elderly and yet in this country I think some people view them as an afterthought, a burden.

The hospital where I met George has long since been converted into a block of expensive flats while the man himself, already in his 80s when we had that long rainy chat, will have passed away many years ago. But the memory of that evening stays with me as a reminder of the underlying principle of care as I see it; listening to, respecting and having the individual – not “the system” – as your main focus.