Sunday, 27 December 2015

What is postpartum psychosis?

Regular viewers of Eastenders are full of questions right now.  Does Stacey have PND? Who is the dad, if it's not Martin or Kush? Why is she acting so strangely?

The Eastenders team have already revealed that Stacey is in fact suffering from a rare birth complication called Postpartum Psychosis (PP), which sadly is not all that unusual in women with bipolar disorder (such as poor Stacey).

As someone who has been through it, and come out the other side, I thought I'd gather some thoughts together on the subject.

This is not a dream
Hallucinations (auditory and visual) aren't like having a bad dream or being a bit trippy.  There aren't any blurred edges or ghost-like figures or spooky whispers in the dark.  Hallucinations were as real as the world around me today: I could see, hear, touch, people who I experienced as completely there.  I remember the situations now, just as I remember what I had for dinner last night.  I reacted to them as if they were happening to me, right there and then.

This is not a joke
I guess it is possible to have a "benign" or even quite pleasant psychosis.  That's not my experience, but it must technically be possible.  But psychosis seems to be rooted in trauma and distress.  So it manifests itself as brutally and as nastily as the innermost reaches of the brain can conjure up.  Unfortunately for me (someone who devoured horror novels as a teenager) my brain could conjure up plenty of darkness and depravity.  Worst fears, tortures, humiliations - they were all brought to the surface by psychosis.

This is it.
I fought the psychosis like a woman possessed - because that's what I was.  I wasn't going to take it lying down: being suffocated, burnt alive, alone forever, dragged to hell.  I fought it.  Because I had to. It isn't the psychosis itself that is dangerous (after all, it is all in the head) but it is the real, physical, reaction to it.  The natural human instinct to run, fight, escape.  Psychotic people have jumped from buildings, thrown themselves onto roads, lashed out at others, become so mentally distressed they make themselves physically sick.  This is why PP must be treated as an emergency, with intensive inpatient treatment (ideally in a specialist Mother and Baby Unit).

I was very lucky to have been admitted to the MBU relatively quickly, where I was safe from the physical effects of the illness.  The psychosis could run its course under careful clinical supervision, and there was absolutely no risk to my baby (who was being expertly cared for in the ward nursery).

I won't give any spoilers for Eastenders fans, but viewers will need to brace themselves: Stacey's journey will be raw and real and incredibly moving.

For lots more information (as well as support) please see Action on Postpartum Psychosis: www.app-network.org 

Wednesday, 23 December 2015

Ghosts of Christmas Past

With less than 48 hours to go, Christmas 2015 is looking like my first properly mental-illness-free festive period in my adult life. 
*Touch Wood*

I don't know if this counts as seasonal affective disorder, but for whatever reason my mood never fails to dip towards the end of autumn, just in time for full-blown depression for December 25th.  Merry Christmas!

Ways I have spent Christmases past: 
- in tears 
- in debt (having overspent on credit cards on loved ones' presents, to make up for my horrendous moods)
- in a state of numbness 
- in a mess (unable to summon the enthusiasm to wear something festive, or blow dry my hair, on slap on some make-up).

December 2012 shook all that up: I was on home leave from psychiatric hospital, my eight week old son in tow.  I was just grateful to be alive, to be lucid, to be a person in the world, to not be in hell any more.  Those few hours spent at home cemented in me what was important: health and happiness. Family and friends. Sanity.  Nothing else mattered.  Not the presents I bought, the clothes I wore, the smiles I offered. 

The following year, we relished the chance to be properly together, just the three of us.  It was low-key, but special.  I was still somewhat fragile, but on an even keel.  We got a tree, we cooked a big roast with all the trimmings, we lovingly prepared a stocking for The Boy.

The year after that, I was recovering from a spell of acute anxiety.  I had taken on perhaps one or two too many commitments over the summer and early autumn, which led to one or two restless nights, which led to a real fear of becoming psychotic again. This "relapse" shook me to my core, and I spent Christmas 2014 still reeling from it.

But this year - 2015 - I can honestly appraise myself as being OK.  I've been busy, for sure, but with The Boy now at nursery I finally have some regular "Me time".  I can tell very quickly when I'm becoming a bit over-anxious, or irritable, hypomanic, or down.  I have the tools (some of which learnt on Mental Health First Aid, some just through experience) to self-correct and stay on track.

So, this Christmas, I will be raising a glass to Good Health and giving thanks for what has been by all accounts a great year.  I'm grateful for every day of good health I have.  But with a super-excited three year old in the house, I am especially grateful for a happy and healthy Christmas day.

❄️ Merry Christmas! ❄️

Tuesday, 17 November 2015

Working the room


I couldn't let yesterday go by without jotting down some thoughts.  16 November 2015 has got to go down as one of the more eventful days in my adult life!

It started with a 9am deadline, to submit a tender for a small piece of consultancy work for a large mental health charity.  This work (if I am lucky enough to get it!) would be a fantastic start to my fledgling business, Out Of My Mind.  I didn't have long to respond to the Invitation To Tender, but I was relatively happy with what I managed to produce over the weekend (mainly because I persuaded an amazing lady with fabulous credentials to partner with me on the bid!).

The day then continued with a visit to the illustrious Royal College of Psychiatrists for their perinatal annual forum.  I was hosting a workshop on peer support and third sector services in perinatal mental health, alongside my patient representative colleague Cath Beard.  Cath was instrumental in setting up the Friends of the Birmingham MBU, as well as volunteering with MaternalOCD.

The whole day was really interesting, with a brilliant keynote speech from Heather O'Mahen of Exeter University (on adapting IAPT for perinatal women) and a lively debate on the merits of extending perinatal services to families of children up to age 5.  Our peer support workshop was incredibly well attended, and the audience (of perinatal psychiatrists, psychologists and other health professionals) seemed really engaged with what Cath and I were presenting.


Anyone who has read this blog recently will know how passionate I have become about good quality peer support.  I hope we managed to convey both the amazing opportunities and potential risks of these services.  The feedback we got afterwards certainly seemed to suggest so.

After a quick glass of wine and a catch up with my favourite team from the Bethlem, it was home in an Uber to quickly change into my glad rags for the Mind Media Awards.  My beautiful friend Eve and I had been invited by the Mind Media team, as we are both currently working with them on a TOP SECRET popular TV show (watch this space, around Christmas time).  After some agonising over what to wear I was soon dolled up in my floor-length metallic gold dress, with full make-up (a rarity for me) and full Spanx for good measure.

Eve and I arrived at The Troxy (a spectacular Art Deco theatre in East London) to find the place already crammed with media types quaffing the free booze.  Help, we didn't know anyone!  How does one schmooze at this sort of event?!?

I quickly spotted the talented Victoria McDonald - health correspondent for Channel Four News, one of the award judges, and a shortlisted nominee herself for work including an interview with yours truly last year!  She was happy to chat for a while and I soon relaxed.  


Before taking our seats for the ceremony, Eve and I had a chance to promote the #PNDFamily cause in the photo booth:
I have never been so pleased with a photo of myself before!

The ceremony was hosted by former psychiatric nurse and now national institution herself, Jo Brand.  She gave us some hilarious anecdotes from her time on a psychiatric emergency ward, dealing with over-zealous police recruits and tyrannical matrons.  There was also many serious messages in her introduction: about the "theme" of the evening (suicide) and how there is still plenty work to be done to remove the stigma of mental illness.

The winners, and to be fair all the shortlisted nominees, were all inspirational: putting out difficult messages, tackling taboo subjects, smashing stigma and speaking out.  I was delighted to see 24 Hours in A&E pick up a prize, as well as Victoria in the current affairs category (she was even kind enough to give me a wee shout out from the stage!).  

Nothing could beat the final award of the night however: a special "Making A Difference" award to Jonny Benjamin and his "Mike", Neil Laybourn.  Jonny and Neil spoke so brilliantly about what happened on Waterloo Bridge seven years ago, and how their lives have changed since.  I am so grateful to Neil for stopping Jonny jump that day, and for everything he continues to do to raise awareness and get people talking.  And Jonny.  Well Jonny is just my hero.  One of the nicest guys I've ever met, and so generous with his time and his heart.  ❤️

The rest of the night was just a warm fuzzy blur of free-flowing wine, not much food, and ensnaring any vaguely famous or well-connected person in Eve and I's vicelike perinatal pincer grip.  Here are just a few of the people we met, and talked to about postpartum psychosis and maternal mental health:
Myself, Dr Ranj from CBeebies, and Eve
Myself and David Robb aka Dr Clarkson from Downton Abbey!!

Myself, the beautiful Frankie Bridge, and the equally gorgeous Eve.

I really hope all this great work, and the amazing connections made at the event, continues into 2016.  Well done to Mind Charity and especially their fantastic media team for all their hard work in 2015.

Wednesday, 28 October 2015

Peer support: How to make it Effective, Safe and FUN.

From very early on in my recovery from postpartum psychosis, I felt a strong compulsion to try and help others.  Not only by sharing my story openly and honestly, but also by sharing the lessons of experience.  I knew that such support would have helped me enormously in the dark days of psychiatric care, depression and overwhelming anxiety.

But where to begin?

I'd spent my pre-psychosis life as an economist and management consultant.  I was used to solving problems, yes, but had no experience of caring for or supporting others.  I wasn't a "people person".  

My first foray into the world of peer support was not a great success.  I was seduced by a charity's promise of instant support group set-up, advertising material and name recognition.  My group was hence born overnight.  I received a large (and no doubt expensive) pack of promotional posters and pamphlets and proceeded to call in to all the GP surgeries in the local area.  I excitedly booked a community hall for my first meeting, and went about baking cakes and purchasing coffee supplies.  What more need I have done?

Within a few short weeks it was hopelessly apparent that much, much, more needed to be in place.

Simple things, like my criminal record check, had not been verified.

I had received no training, or even basic guidance.

There was no oversight in place.

Women - often very vulnerable women - were being referred to me through the charity's website, with no inkling that I was completely unprepared and unsupported to help them. 

I had received no training or advice in children's and vulnerable adults' safeguarding.  Or in how to enforce healthy boundaries between my role as peer supporter and the rest of my life.

There were other concerns too, but these were the glaring ones.

Luckily, a month or two later, I came to meet an inspirational peer supporter and charity founder Jessica Warne.  Jessica was a few years' ahead of me in terms of her own recovery and journey as a peer supporter.  What had started as a simple coffee morning in her own front room had transformed into a registered charity, with a committed and experienced board of trustees, good working relationships with other local organisations, and a clear programme of peer and professional support.

Jessica and I met over coffee near Oxford Circus (our halfway house, given her base in North London and mine in South) and it soon became clear our visions matched.  

Jessica asked me to come aboard Cocoon Family Support formally, and become the South London operation.  Immediately I felt relief.  Things fell into place very quickly.  A third member, Rosie, joined our little gang and there was no stopping us.

Cocoon Family Support operates with a "whatever works" mentality.  We offer peer support (one-to-one and group), individual counselling sessions (usually in six week blocks), mindfulness groups, art therapy, drama and music therapy, guided walking groups and complementary therapies such as Reiki.  The groups are well managed and all peer supporters are trained and supervised by professionals.

We are an ambitious small charity, but we do not run before we can walk.  We offer only what we know we can deliver.  Geographically, this means only operating within certain London boroughs.  As a practice, it means we only offer therapies we are qualified to deliver.

"But peer support should be informal! A chat over coffee and cake!  Why all this procedure and officiousness?!" I hear you cry.

The answer is that, yes, some peer support can be very informal indeed: a kind word from a fellow inpatient.  A chat with an old friend.  A walk in the park. 

But the moment you set yourself up as a Peer Supporter, the moment you press Publish on a website, set up those official-looking social media handles, design a convincing logo, you are promising something else entirely.

Families - often vulnerable, desperate and let down by official health and social care services - come to these charities and peer support groups because they promise something.  Not necessarily a cure, but understanding and empathy at the very least.  These families see the logo, the website, the Twitter account, as an official resource.  To pretend otherwise is disingenuous. 

So by all means, carry on being a supportive friend or relative.  Offer those coffee mornings and walks in the park.  But be aware that formal peer support is very different.

A word on the mechanics of peer support.

A wise tutor told me recently that
"Advice is MY solution to YOUR problem."

What she meant was that simply offering advice can be counterproductive.  You know what you would do in a certain predicament, but you can never fully understand another's plight.  

Peer supporters should instead use their own experiences (and hopefully also their training and knowledge) to offer guidance, information and SUPPORT.  Support, in this context, means:
- an awareness and assessment of any RISKS (if in doubt call 999)
- non-judgemental LISTENING 
- SIGNPOSTING to other appropriate services 
- And ENCOURAGEMENT: either to seek professional help, or to practice self help.

Courses such as Mental Health First Aid (which I am soon to become an official instructor of), and more specialised courses such as suicide prevention and perinatal mental health, can all play a part.  However your charity decides to train its peer supporters, the most important thing is that they ARE trained, and that they have the right foundations in empathy, openness and a willingness to share their experience.

Finally - the fun part.  What makes peer support fun? And rewarding and a fantastic vocation in life?  The answer, for me, is two words: Jessica and Rosie.  Working with two like-minded individuals, who encourage and inspire me on a daily basis, is what makes me so certain that this fledgling career in peer support is for me.  So if I can leave you with just one piece of advice it is this: find your own Jessica and Rosie, treasure them, hitch your dream to their dreams and watch them take off.



If I can help other peer supporters in any way (whether informally, or through provision of the MHFA course) please do not hesitate to get in touch!

Thursday, 1 October 2015

What's going on?

A long overdue update from me.

In a nutshell, things are good.  At times, excellent. 

The Boy is a delight, and continues to amaze us every day with the funny things he says and does.  His current obsession is TRAINS, and particularly Thomas and Friends.  He knows the names, colours, numbers, carriages, and freight of dozens of engines.  I'd never even heard of Stephen, or Mavis, or blinking Rheneus (sp?!).

He has settled in brilliantly at his local nursery, with only a few incidents of stray toys being thrown or snacks tipped over. He's learning new things every day, and it's lovely for example to hear him sing songs that someone else has taught him.  The Boy is growing up, and that's just as it should be.

The precious free time I now have is spent catching up around the house, and  working on my various projects.  I have so many irons in the fire I feel like I am running a metaphorical smiddy!  

I have an arrangement now with Dads Matter UK, to provide project management support across their work.  This means I get to work with some inspirational people and build on my skills.  I also get plenty of opportunities to "network" and build up my contacts within the industry.  I was at a fabulous event last week, the launch of Elaine Hanzak's new book in Manchester, where I got to meet many friends and colleagues.  The buzz in the room was palpable and it was amazing to witness so many people from all over the UK working towards a common goal.

I am now an official director of the Perinatal Mental Health Partnership, and am very excited about what the future holds for this organisation.  There is a huge opportunity coming up, to dramatically increase public awareness of perinatal mental illness, and we will be working hard on that over the coming months.  The PMHP has not been an easy "baby" to give birth to, but it has enormous potential.  

More locally, Cocoon Family Support (of which I am now a Trustee) is going from strength to strength as it builds up its peer support groups and counselling service.  I'm honoured to count founder Jessica and director Rosie as good friends.  It does not feel like work with those two in the team!  We are busy planning our reception at the Houses of Parliament later this month, working out who to invite and what to treat them to!

Finally, I am about to embark on my training to become a Mental Health First Aid (MHFA) instructor.  Once qualified, I plan to roll MHFA out to peer supporters across the maternal mental health industry.  I then plan to target corporates, to train MHFA champions in workplaces.  I am fortunate to be working with a dedicated training team at Dads Matter who are also committed to this vision.  I am quietly ambitious about the scope for MHFA.  The time for it is certainly now.

With all these projects to keep ahold of, I decided recently to take the plunge and set myself up as a sole trading enterprise.  Out Of My Mind was born in September 2015 and I have a nascent website and social media presence.  Our tag line is "mental health consulting and training - from a service user's perspective".  I find, for my own sanity's sake, it is good to think of all the different projects (as well as various media appearances and related work) under this one umbrella.  It is the embodiment of my "portfolio career"!  Do check it out at
www.oommconsulting.com 

So there you have it.  There is plenty more I could mention, from a more personal perspective, but perhaps I will leave that for another time.  

Rosey, myself, Jessica and Eve at the Manchester event
Myself and the wonderful Elaine Hanzak
Tracey, Eve, Beth and Myself





Wednesday, 12 August 2015

Staying Still


A short update from me.  We have been back from our extended stay in the Caribbean for over two months now.  The transition back to London went as well as we could have hoped for.  We have caught up with family and friends, The Boy has settled incredibly well into his part-time nursery place, and I have been increasingly busy in the world of maternal mental health.  So much so that I must stop a moment and catch my breath.

It is tempting, when things are going well, to cram in as much as humanly possible, to say "Yes!" to every request and generally make hay when the sun shines.  

My life is now full with family commitments (The Boy has a busy social calendar, and we are always mindful of needing to research his options when it comes to starting school in 2017), and catching up with friends.  I have a new trustee role at Cocoon Family Support (our local peer support organisation that I am now affiliated with), and a new part time job at the Perinatal Mental Health Partnership.  To complement this, I have signed up to do Mental Health First Aid instructor training, so I can teach MHFA to all our local peer supporters, as well as take it to the corporate market.  

Besides this work, I have been almost inundated with various media requests.  It's fantastic that mental health (and especially perinatal mental health) is getting great coverage.  I think I have reached the end in terms of telling my own story.  In the last two months, I have been interviewed by a documentary filmmaker, an educational video charity, a national newspaper, a daytime TV show and ITN news! 

I have learned in recent years not to give in to the "Yes impulse".  I'm more likely now to spend the odd hour lying still, cooking a favourite recipe, going for a solitary walk, or watching a bit of quality TV drama.  I know that these pauses give my brain a chance to catch up on itself.  I can tell, when my thoughts and plans are running 19-to-the-dozen, that I need to slow down.  That I need to escape the constant stimuli of modern life.  Mindfulness has helped with this realisation, for sure.  But it is also just getting a bit older and wiser.

There's no special secret to living happily.  It's just learning to know your own rhythms and moods, and how you respond to day to day life.  I guess in the Dark Ages we naturally had to shut down, when the sun went in and there was little to do but watch the stars and the moon.  Now we can be passively entertained 24-7, and I'm not sure that's progress.  It's up to us to learn how to be still, and benefit from the calm to be found there.


Tuesday, 4 August 2015

Talking... Therapy.

Here is a primer on different therapies you may be recommended or offered, for perinatal mental illness.  This is not an exhaustive list.  Much more information can be found on the British Association for Counselling and Psychotherapy website at www.bacp.co.uk.  

Before we begin, it is worth mentioning a few things that (in my opinion) therapy is not:
- a path to happiness (it can only teach you how to respond more positively to life's vagaries.  It cannot make life better for you!)
- a one-off treatment (you need to commit to what therapy has taught you, often for the rest of your life)
- something that is "given" to you (the patient is the most important participant in the therapeutic relationship - it is not passive, like most other medical treatments)
- a miracle cure for mental illness (it is entirely possible you might still need that medication... )


Cognitive Behavioural Therapy (CBT)
CBT is commonly prescribed for depression, as well as many other mental illnesses.  It is the therapy associated with the NHS "Improving Access to Psychological Therapies" programme (and is therefore the easiest to access, albeit with the usual waiting list hurdle).  I have been offered CBT in a number of different formats, with various degrees of adherance and success: book-based CBT, online and face-to-face.  I understand it as a way of encouraging the patient to put their Actions ahead of their Thoughts/Feelings.  That is, instead of "I feel sad therefore I cannot possibly get out of bed and get dressed" the person is encouraged to challenge that negative thought process and instead get out of bed regardless of how they feel, in the likelihood that getting dressed will make them feel better.  Don't think, Do.  CBT doesn't require any raking-over of the past, or analysing feelings.  It is a forward-focused process which emphasises coping skills and strategies.

Acceptance and Commitment Therapy (ACT)
This is a process of better understanding our negative feelings and emotions, but learning not to act on them.  It is a process of behaviour change, the goal of which is not necessarily "happiness" but a more positive cycle of feelings--behaviours.

Dialectical Behavioural Therapy (DBT)
DBT grew out of CBT and is designed to encourage even those who are reluctant to change their negative behavious.  The client is helped to "accept" their unhelpful behaviour, as a way of coping with life events and emotions in the short term.

Psychodynamic psychotherapy
Unlike CBT, this method stresses the importance of past events and the unconscious mind in shaping current behaviour.

Family therapy 
As the name suggests, this form of therapy involves the whole family unit.  It focuses on the "transactional" dynamics within the family.

Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a very specific therapy to resolve symptoms from very traumatic past events.  It works with the memory function of the brain to reprocess damaging associations.

Mindfulness-based Therapy
Mindfulness is a hugely popular therapy (and activity in general) which guides the person through various exercises in "intentionally paying attention".  It is a way of catching negative thoughts (which are not the object or sensation in which one is supposed to be focused) before they become a vicious cycle.