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.

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.

Playgrounds, pupils and promoting mental health

Positive mental health promotion should start in schools and we should teach all our children to be more mentally resilient. This approach means that, as adults, they will face the world with more confidence and have empathy and compassion for others. Currently 1 in 10 – or around 850,000 – children and young people are diganosed with a mental health problem, according to the charity Young Minds.

Research from Warwick University last week suggests that children involved in bullying – as both a victim and a bully – are three times more likely to have suicidal thoughts by the time they reach 11-years-old.

Four years ago when I worked for the Tees, Esk and Wear Valleys NHS Foundation Trust, myself and a non-clinical colleague, Marjorie Wilson, who worked in the Information Department, created a storytelling-based approach to mental health for use in primary schools.

We based our idea on Virginia Ironside’s book The Huge Bag of Worries. It seemed the perfect choice to deliver a powerful message in a creative and interactive way. Our Huge Bag of Worries Emotional Health and Wellbeing Project aimed to highlight the detrimental impact of bullying on a child’s emotional health and wellbeing and promote more understanding of mental health, thus challenging the stigma aspect.

Each session lasted approximately 45 minutes and we visited over 30 schools, fitting in at least four classes into the day

We started by introducing ourselves and asking the children what a nurse did. I then explained the role of a mental health nurse and we asked what the term “mental” meant? After a chat about this, Marjorie then read the book which we also had on a Power Point display so the children could see the beautiful graphics.

We then got a volunteer from the class to put balloons – each of them representing a worry – into a large, colourful sack one by one as we recalled the story’s key messages. The child then walked up and down with the bag to show how difficult it was to carrying around your worries.

We tried to emphasise that you don’t need to carry around your worries and often we have to take each worry out and hand it to our parents or teachers. Children don’t often realise they don’t have to be burdened by adults’ worries.

We specifically highlighted bullying as a worry and what we could all do to prevent and deal with this. At the end of the day 25 children, five from each class, would line up in the playground and one by one they would release the helium balloons. The rest of the school and the parents would stand around in a large circle and watch. Everyone would clap and cheer – that was one of the highlights of our day.

The project was funded for a year but we went on to deliver it voluntarily for a further two years. We still deliver it now voluntarily.

The project was successful as the book carries a simple yet powerful message. It has beautiful graphics and words and we used colourful materials in an informal, creative approach.

It seemed to resonate well with pupils in their final year of primary school who were apprehensive about starting a new school. We also found many of the children were also less judgemental and had far fewer preconceived ideas around mental health than adults.

The children would often say who their best friends were and that they would talk to them if they were being bullied or felt stressed. This was quite touching. One school had a “friendship bench” in the playground that a child could go and sit on if they felt alone so that others would know this and play with them.

We met a number of children who were caring for parents with ongoing mental health issues. Often, they enjoyed their caring roles and in a way they felt proud of what they were doing. I feel our project helped them to ‘normalise’ their circumstances and showed the other children in the class that because mental health affects one in four of us, they were not so different to their classmates.

The path to positive mental health and the shattering of stereotypes and stigma can start in the classroom and children. While the government’s new mental health strategy, No health without mental health, promotes more teaching of mental strength, or “resilience”, in schools so children grow up better prepared to face the stressors of the world, the caveat is that there will be no extra money to fund this.

We should be kind, while there is still time

Lol Butterfield, mental health campaigner
Over 30 years ago as a young man I first set foot in a psychiatric hospital. It was an old Victorian “asylum” in the rolling countryside of Bedfordshire. I had travelled to the south of England from my native north east to find work, and here I found myself.

I wandered down the endless dimly lit corridors and found myself surrounded by staring, pain-etched faces with wild curious eyes. It felt like I had stumbled onto the set of the film One Flew Over the Cuckoos Nest. There was a sense of unreality to it all, but also of mystique. It was so stereotypical of all I had previously read in books and seen on television about asylums – those places others and never ourselves, of course, will be sent to for being “mad”.

Next year, it will be 50 years since the first steps towards community care for mental health (see this useful mental health timeline on the Mind website) this “anniversary” has made me revisit my early experiences as a mental health care professional and look afresh at the history of mental health care.

After 1962’s Hospital plan for England and Wales, large psychiatric hospitals closed and local authorities developed community services. That was, of course, the theory – not all local areas had adequate community services as we know, so there were still long-stay patients in hospitals up and down the country.

So it was more than three decades ago in that psychiatric hospital that my understanding and awareness of mental illness grew. I came to realise that the staring faces and wild eyes were ordinary people who had found themselves in extraordinary circumstances. They had been incarcerated many years before.

As a consequence of the debilitating illnesses they had, such as schizophrenia, and the horrendous medication side effects, they were displaying mannerisms that drew unwanted attention. Mannerisms that perpetuated the stigmatising process further. They had lost their self confidence, their motivation, and probably more importantly their daily living skills to function independently outside of the hospital confines. They had become institutionalised. The hospital was their home and they would eventually die there. Within the walls of the hospital the behaviour became normalised, the wandering up and down corridors, the staring at strangers and the shuffling gait. Outside in the local town it was polarised.

In the early 1990s many of the old asylums were closed. They had become anachronistic. More people were now being rehabilitated with the government’s proposal for care in the community, a radical shift in policy and approach essentially moving most of the care emphasis from the hospitals into the communities. People were discharged from the hospitals back into their communities with follow up planned support and care (in most cases).

Sadly some slipped through the safety net of care. And in the years that followed the medication improved and the stigmatising side effects became less. There was an increased acknowledgement of the importance of social inclusion, of recovery from illness, and of empowerment – treating people as individuals with informed choice and promoting equality.

Flashforward to 2011 and yet we still have stigma. We still have misunderstanding and we still have inequality in many sections of society for those 1 in 4 of the population who experience mental illhealth.

What is my long term vision of stigma and discrimination and where we will be in the next 50 years? I believe that stigma will have been eradicated completely following the success of campaigns such as Time To Change. I hope for a realisation that both our physical and mental wellbeing work in correlation and, as such, cannot and must not be split. I believe the strength and vision of those who have fought so hard will be acknowledged one day and in schools across the country their stories will be lesson material. Leading figures in the anti-stigma movement will be seen more positively as vehicles for social change. Mental health stigma will be seen in the same unacceptable light as racism and homophobia.

I have campaigned for many years, most of my adult life even, and no doubt ruffled a few feathers in the process. But I would rather stand up and be counted for saying something I passionately believe in than silently watch and do nothing. This I cannot do alone and I am always motivated by the support I get from others, more so from the victims of stigma and discrimination themselves.

As Philip Larkin wrote in The Mower, “We should be kind while there is still time”. In the case of mental health and tackling stigma and discrimination this kindness will hopefully continue through campaigning. We have come a long way, but we are not there yet.

Depression: when a bad day becomes a nightmare, and a wish list for youth mental health

To mark World Mental Health Day, two bloggers with experience of mental health issues share their thoughts on action. Here, campaigner Lol Butterfield writes about the fine line between “a bad day” and something more serious, while below, youth mental health campaigner Carrie Holroyd shares her 10-point wish list to boost youth mental health.

Lol Butterfield, Social Issue blogger, mental health campaigner
We all have mental health as well as physical health. They both work in correlation, two sides of the same coin. It’s World Mental Health Day today and I wanted to explore the question of when our mental health become mental ill health? When does having a bad day become a living nightmare? If our having a ‘bad day’ becomes more frequent, as sure as night follows day, we have reached what I call “my dark place”, clinical depression. It is a fine line between having the “blues” and clinical depression but once you have crossed that emotional line, you know where you are.

My own experience of depression seven years ago would have been not different to many other people’s experiences. Maybe the difference was that I was in denial for most of my decline into severe depression? With the benefit of hindsight now I was probably no different from many other men in that aspect, denial was my coping mechanism, I masked my symptoms thinking it would all go away. If only (it’s worth pointing out though, that often people do of course seek help when they experience the initial symptoms, men included).

There are a range of common symptoms associated with depression such as difficulty sleeping, poor concentration, not eating regularly or over eating (comfort eating) Our thoughts become very negative, we feel guilty over our words and our actions, we worry unecessarily. With depression the world around us becomes very dark and seeing the ‘light at the end of the tunnel’ as the cliché goes is far from easy. In fact it is nigh on impossible to see any light when you have reached the stage of severe depression, darkness is everywhere. The world feels like a dangerous place, it gives no quarter and does not take prisoners.

If you experience the above symptoms, or others such as becoming over emotional, irritable, having panic attacks, then seek help. Thoughts of self harm, or even suicide, will set alarm bells ringing louder than St Paul’s Cathedral. These are warning signs that help is required – and required quickly. Unfortunately when it comes to mental health men have a tendency for self denial.

As a consequence we have twice as many women then men visiting their GPs for mental health concerns even though both experience the same problems. With men it is often the outdated and totally ludicrous “big boys don’t” cry attitude. If more men had cried, and sought help sooner, we would have fewer cases of male depression. And frankly men would now be living meaningful lives instead of dying without hope as a consequence of taking their own lives, particularly young men. This is the tragedy.

So where do men seek help? The GPs surgery, as has been well-documented, is not frequented as much by men as women so we have to be creative in seeking alternatives. There are many different projects looking at mens health in particular around the country, these are usually organised and run by Primary Care Trusts. These will focus on “wellness” and “wellbeing” and promote eating a healthy diet and exercise, alongside checking blood pressures and weight. Again the important link between good physical health and mental health is being recognised.

Locally where I live on Teesside we have a Mens Health Day once a month at the Riverside stadium, home of Middlesbrough football club. These sessions are free. Men are more likely to go to an environment they feel comfortable with such as a football club, or even a social club, to discuss mental health issues because of the shame, fear and stigma.

As for me, part of my recovery involved attending my local gym. This is something I would recommend to anyone. The exercise combined with the social aspect of meeting friends and talking significantly lifted my mood and confidence level.

I would liken acknowledging you have depression to carrying an umbrella in a rainstorm. By acknowledging you have this problem you are prepared and protecting yourself from its effects. You are accepting it is there and needs to be addressed. You are proactively dealing with the problem. There are certain things we can all do to protect ourselves from poor mental health such as eating healthily, having a good regular sleep pattern, social contacts with friends, and physical exercise. These are all protecting factors against depression. And what I would see as probably the most important is sharing our worries, our feelings, with others close to us.

As the old adage goes “A problem shared is a problem halved” – in the case of depression this cannot be reinforced enough. I have survived to tell the tale, but sadly many others don’t.


Blogger and mental health activist Carrie Holroyd
My 10 wishes for youth mental health, by Carrie Holroyd
1. The government should increase access to and availability of psychological therapy for young people with mental health problems. Prescribing psychiatric medication may be a quick and cheaper solution but doesn’t always help young people with complex problems.
2. More support in schools; with three children in every classroom having a diagnosable mental health problem, I believe there should be more in-school counsellors and training for staff on how to best support young people with mental health problems.
3. Empower us! Being young and having a mental health problem can be very disempowering, involving us in our own mental health care and increasing participation can make a huge difference.
4. Not everything is a symptom. When you have mental health problems everything you say, do, believe in can be inappropriately construed as a symptom of your illness. Having friends, family and professionals scrutinise you constantly can get very frustrating.
5. Don’t lower your expectations. Just because I have a mental health problem doesn’t mean I can’t work, study, socialise and have a fulfilling life. Things may be a bit more difficult for those of us with mental health problems but it doesn’t mean people have to lower their expectations of what we’re capable of. Many of my peers have been told by friends, family and professionals that they can’t pursue a certain career or study because of a mental health problem. Imagine how horrible it is to be told that at a young age.
6. I’d like to see people ‘open up’ about mental health problems. Don’t be so afraid to talk about it, it’s not as scary as the media can make out.
7. Don’t believe everything you hear. There are many myths surrounding mental health problems that are frankly ridiculous and increase stigma. Read up on mental health and educate yourself.
8. Early intervention is important. So many people find they don’t receive adequate support until they reach crisis point, this has to change. Early intervention can cut down on hospital admissions and prevent problems escalating into more severe forms of mental ill health.
9. Bridge the gap between child and adult services. In some parts of the country young people must leave child and adolescent services (CAMHS) at 16 and cannot use adult services (AMHS) until they reach 18.
10 . Treat young people who present at A&E for self-harm with respect and dignity, don’t dismiss them or deem them “attention seeking”.