I was driven to the brink by the poor care my friend received. I finally left over pointless tasks
The first time I thought I should leave the NHS and never return was at my friend’s inquest. After struggling with mental health issues for many years he had taken his own life. At his inquest, I learnt that in the period leading up to his suicide his mental health appointments had all been with support workers and he had not once seen a qualified mental health nurse. I also discovered that his last five appointments had been with four different members of staff. The coroner asked about the level of the service he had received. The manager of the service cited difficulties with a large geographical patch and described the service he received as usual practice. As an NHS manager myself, I could see it may have been usual practice, but it was far from good enough.
As I drove home from the inquest my head was spinning with dissonant thoughts and questions. I was angry and upset. I was concerned for the service manager. I was furious with government cuts. I was worrying about the service I managed. I needed the noise in my head to stop. I found myself contemplating killing myself. I did not sleep that night. I knew I was unwell and so the next day I saw my GP. I needed three months off work for severe depression and anxiety. I had excellent talking therapy via my GP surgery and my counsellor continued to support me through and beyond my return to work.
Related: The NHS sets leaders up to fail – and then recruits more in the same mould
I was struck by their terrible experiences – the doctor who kept seeing a dead child and the person with an alcohol problem
When I began working as a psychologist at a large London teaching hospital I was fascinated and – a little overwhelmed – by the challenge of developing a new psychology service. I was employed solely for the 5,000 staff working in the hospital. Absolutely anyone could come and see me for psychological support, from the porters to the medical consultants. And they did. Over a 12-year period I saw many NHS staff.
Sometimes they were sent by managers who were worried about them. About their behaviour or their distress or the impact of a very traumatic event they had witnessed, for example. Others referred themselves in secret and hoped that no one would know they were coming. When they left they were always polite and thanked me but usually said that they hoped they would never see me again.
It sometimes felt like there was hope that staff could disappear for a bit and emerge intact and ready to work
Guardian experts give their view on the main parties’ public service manifesto pledges. Here, our health editor looks at what’s in store for the NHS
• David Brindle on social care
• Patrick Butler on social security
• Dawn Foster on housing
• Frances Ryan on disability
• Anna Bawden on local government
• Alan Travis on home affairs
• Jane Dudman on the civil service
• Damian Carrington on the environment
• Scotland, Wales and Northern Ireland
The NHS in England would receive “the resources it needs – a minimum of £8bn in real terms over the next five years, delivering an increase in real funding per head of the population for every year of the parliament”. A further £10bn is pledged in capital spending. It would ensure that the NHS and social care system had all the health professionals “it needs” and it would train more homegrown medics. Backing the NHS’s Five Year Forward View and local sustainability and transformation plans (STPs) would lead to the controversial rundown of A&E and maternity units and changes to the roles of many hospitals. Any “necessary legislative changes” would be made to finally give STPs legal status. In addition, it would “review the operation of the internal market and make non-legislative changes to remove barriers to the integration of care”. GPs would provide seven-day access everywhere by 2019.
It took ages to earn Sandra’s trust – she showed me how people’s lives can be consumed by the cruel fate of mental health problems
In medicine, psychiatry isn’t seen as glamorous. As a student and while training, you fight with your colleagues for the sexy jobs in cardiology, intensive care or on the frontline. When the crash call goes off, it’s dramatic; chest compressions, ventilation, trying to be the hero you see depicted on television. A job in psychiatry wasn’t my first choice, if there was a crisis, what would I do? Come running with my pen and notebook? Not exactly Oscar-winning stuff.
I had my reservations as I was about to embark on 91 days as a doctor in an adult inpatient psychiatric unit.
Related: The patient who showed me how to be a better doctor and person
I can refer people to mental health services and social care but they are overloaded and don’t provide much help
Recently a patient brought home to me how inadequate the help I can provide my elderly patients as a GP can be. Among more than 50 phone calls I fielded one day as one of the GPs dealing with urgent requests, there were two from a patient in her 80s who is the main carer for her husband who has dementia. She also has health issues and he is unaware of the problems they face. The receptionist learned far more about the difficulties they were having from the woman’s phone calls to the surgery and from observing them in the waiting room, than I did from my snatched telephone conversations and the scrawled note left for me. I found out later that the only way she could get to the surgery to bring the sample I requested was by locking her husband in the car outside. I knew that things were difficult, but this was a new low.
Over the last year I have been increasingly involved in the care of a man who is in his 80s and moved into my practice area to be nearer to his family. He enjoys telling me about his past when he gets the opportunity and I recall how his eyes sparkled as he told me that adopting his daughter was the best decision he and his late wife ever made. He knows his dementia is worsening and was the one who recognised the initial symptoms, well before these signs were noticed by others around him. He looks crestfallen as he recounts to me how he sees the frustration and sorrow in his daughter’s eyes when he asks the same question another time. He is annoyed by his failing health and memory and feels he is a burden to those around him. At times he is too proud to ask for help.
It’s time to challenge workplace stigma about mental health and to make it easier for those who need help to feel comfortable asking for it
Looking after the wellbeing of employees benefits everyone – no matter your role, seniority, and whether you have a mental health problem, or not.
Working with employers over the past six years means we have a good indication of what works to ensure a mentally healthy workplace. Those elements are incorporated into the Time to Change employer pledge, which gives organisations the opportunity to demonstrate their commitment to opening up the conversation about mental health. More than 500 organisations have made that commitment.
Social media can connect like-minded young people, providing vital support for those experiencing mental health issues, however, many sites can also promote harmful behaviour. Is there a solution?
For all the benefits to mental health a digital world can bring, such as a sense of belonging and information and support for those with problems, there are also myriad dangers associated with online activity. In the very worst cases, people have live-streamed their suicide and had people cheer them on in the comments section.
Meanwhile, cyberbullying and trolling, along with communities and groups on social media that foster, glamorise or even encourage self-harm are pervasive. Stephen Buckley, head of information at the charity Mind, acknowledges these risks: “It is vital to recognise the huge danger created by any site or social media trend that promotes self-harm, suicide or eating disorders. They can be hugely damaging and possibly dangerous to someone in a crisis.”
Aimee Challenor knew she was different aged 10, but after feeling isolated and depressed for years she finally found the support she needed to help her come out at her school prom
Growing up is tough enough for any young person approaching puberty. But for Aimee Challenor the challenges she faced as a 10-year-old were much harder: “It struck me when I was about 10 or 11 that I was a girl. I couldn’t put my finger on it but something wasn’t right. I was in year 6 and I left my parents a letter on their bed before I went to school one morning. When we talked about it later they were very supportive, but no one knew what trans was. So I went back into the closet.”
During the next six years Challenor, now 19, felt anxious, isolated, lonely and depressed. “I spent my time at secondary school feeling pressured by society to be somebody that I was not. I wasn’t able to be myself; there was always that nagging feeling at the back of my head, so I didn’t take opportunities and grab them. I didn’t reach my potential and my education suffered as a result.”
Related: Supporting LGBTI pupils: ‘It’s important a school is ready for anyone’
Schools today are much more receptive to students’ gender and sexual orientation, and are places where diversity is celebrated rather than scorned
It was not long ago that LGBT pupils at the Priory School in Hitchen, Hertfordshire, hid behind a mask of silence. Fellow students used the word “gay” to describe something that was rubbish. Faced with homophobic language, they felt unable to come out in the classroom and kept their true identities secret.
Three years later, dozens of students have come out thanks to a “massive culture shift” in school. Today, diversity and inclusion are celebrated across all aspects of school life: from the setting up of an LGBT drop-in group and appointment of an LGBT student champion, to changes in the curriculum and the building of gender-neutral toilets and changing rooms. Indeed, the school has established such a reputation for equality it is attracting transgender pupils from neighbouring areas.
Related: Growing up transgender: ‘I wish I could have come out younger’
Headteacher Tony Draper says that the ‘kaleidoscope programme’ used in his school to help children focus and deal with their emotions has had an ‘amazing impact’ on pupils’ mental wellbeing
There is a crisis in mental health for young people. Services are operating in silos and they are not working for over-tested, overstressed young people. Much emphasis has been placed on teenagers with low self-esteem, with behavioural and emotional issues and how we can support them.
At Water Hall primary school in Milton Keynes, we believe in the need to identify and address these issues early to be able to implement intervention strategies as soon as possible.
Related: How schools are dealing with the crisis in children’s mental health
Bullying, problems at home or even the election Donald Trump – the world can be a stressful place for children. Fortunately, counselling services in schools are helping young people cope with such issues and more serious conditions
It could easily be a child’s bedroom. In the centre is a large mat, while a selection of dolls and soft toys line the walls. It is hard to believe that this nurture point in Plaistow, east London, aimed at helping children deal with their emotional problems, was once a school staff room.
Youngsters aged five to 11 can drop in three days a week and speak to a trained counsellor from the charity Place2Be. But as well as worries over friendships, bullying or problems at home, headteacher Paul Harris reveals that a growing number of children are suffering from anxiety as a result of Brexit and the election of Donald Trump.
Related: Five priorities for improving children’s mental health | Paul Burstow
A rise in prison suicides has cast a light on mental healthcare needs behind bars, which is why wellbeing programmes are being so eagerly embraced
Mental health problems in the prison population have long been a matter of concern. Suicide rates in prisons in England and Wales are at an all-time high; a record 119 people killed themselves in 2016 – an increase of 29 on the previous year, according to figures from the Ministry of Justice. The rise in prison suicides has been accompanied by a 23% increase in incidents of self-harm, to a total of 37,784.
“It’s a huge issue because lots of people in prison have mental health problems,” says Dr Steffan Davies, consultant forensic psychiatrist and co-chair of the Community Diversion and Prison Psychiatry Network at the Royal College of Psychiatrists. A study by the Prison Reform Trust found that 72% of male and 70% of female prisoners experience two or more diagnosable mental health disorders. Research by the National Institute for Health and Care Excellence found that 7% of male and 14% of female prisoners have a psychotic disorder – 14 and 23 times the level in the general population respectively.
Related: Government response to UK’s soaring prison suicide rate has been pitiful
After his playing career ended, Damian Hopley became depressed. Now, he helps other men discuss the issue
Damian Hopley knows from bitter experience that being a professional athlete can exact a heavy price on the mind as well as the body. Rugby players have always been in harm’s way and Hopley discovered this as a young man 20 years ago. Playing at centre for English Premiership rugby team Wasps, he won what looked like the first three of many England caps in 1995. Rugby union had just stopped being an amateur sport and the Cambridge graduate had given up his job in the City to ride this first wave of professionalism, but Hopley found himself in troubled waters.
In 1996, playing for England at the Hong Kong Sevens, Hopley injured his knee. He saw a surgeon but he injured the knee again and nine operations and two reconstructions later his professional career was over before it had really begun. “The hardest thing is the huge dent in your self-esteem and purpose and realising that you are not a rugby player. It was like a bereavement. Your sense of worth goes out of the window. I didn’t belong any more. Your personal life then goes into freefall because you become so self-obsessed. I had a girlfriend at the time and she walked out on me. Quite rightly, because I would have been a nightmare to live with.”
From online counselling to a texting service offered by school nurses and free wellbeing courses, providing support for young people needn’t break councils’ budgets. Sarah Johnson reports on a roundtable discussion
Public concern around child and adolescent mental health is at an all-time high. The prime minister, Theresa May announced in January her intention to better identify and help the growing number of young people in schools who are at risk of developing mental health issues. Prince Harry and the Duke and Duchess of Cambridge, meanwhile, are using their profiles to convince the public that “shattering stigma on mental health starts with simple conversations”.
And yet, despite growing awareness of the issue, child and adolescent mental health services (Camhs) are under an increasing amount of pressure. Healthcare professionals bemoan a lack of resources and staff while health secretary Jeremy Hunt has described Camhs as the “biggest single area of weakness of NHS provision”.
Related: Quarter of a million children receiving mental health care in England
Related: Psychiatrists attack ‘scandal’ of child mental health spending
The Campaign Against Living Miserably (Calm) is the leading UK charity dedicated to preventing male suicide. Simon Gunning, its chief executive officer, reveals what is being done to encourage men to open up about their emotions
We take a two-fold approach to changing and saving lives: firstly providing support for men who are down or in crisis, and secondly campaigning for culture change to tackle outdated stereotypes of masculinity that prevent men seeking help.
We do this in the face of a problem that is deeply entrenched. Many men feel forced to stoically “man up” (whatever that means) and grind through bad times without societal permission to open up or seek help. Calm’s research shows that while 67% of women tell someone about going through depression, only 55% of men do the same.