One in Four magazine

ONEinFOUR Lifestyle, health, mental wellbeing

Spring 2011

GETTING SORTED Just what does recovery mean anyway?

REAL LIFE Using your story to help others

DEBATE Who cares for carers?

As bright as a button?

Making spring cleaning a breeze not a chore

Mental health information for all

Leaflets include

Find out about common mental health problems and therapies with the Royal College of Psychiatrists’ award-winning evidence-based leaflets.

One in four of us will suffer from a mental health problem at some time in our lives. This can be a difficult experience for family and friends, and it is important to have access to up-to-date and unbiased information.

The Royal College of Psychiatrists’ illustrated leaflets cover a wide range of topics, providing clear information to aid communication and understanding between healthcare professionals, patients and their carers. We have recently been awarded The Information Standard quality mark, which means you can be confident our information is reliable and up-to-date.

Anorexia and bulimia, Anxiety and phobias, Bipolar disorder, Depression, Bereavement, Obsessive compulsive disorder (OCD), Personality disorder, Post-traumatic stress disorder (PTSD), Schizophrenia, Self-harm... …and many more.

“Very helpful for me to understand my illness”

‘Get well’ cards

“Clear, positive and encouraging”

All materials can be downloaded for free from our website: www.rcpsych.ac.uk/info Translations into other languages, including Arabic, Bengali, Chinese, French, Polish and Urdu are available online. Our award-winning Help is at Hand leaflets are also available in paper form, and can be ordered in bulk.

For a free catalogue listing all our mental health information, or to purchase the College’s ‘Get well’ cards, please call 020 7235 2351 x6259, or email: leaflets@rcpsych.ac.uk

www.rcpsych.ac.uk/info

Research shows that people with mental health problems receive far fewer ‘Get well’ cards than people with physical illness, even though receiving kind messages support would of ofsupport greatly help their recovery.

The Royal College of Psychiatrists has launched a range of cards to send to people unwell with mental ill-health.

Public access training for 2011 Journey through the basics of mental health on a one day course with our fully qualified trainers. This is an ideal course for: •

staff working with clients experiencing mental distress,

•

individuals with little or no knowledge of mental health who want to understand it better,

•

carers of individuals experiencing mental distress,

•

service providers – particularly those working in front line services including housing, education, health and

•

human resources professionals.

We have various dates available throughout 2011 but book early to avoid disappointment as spaces are limited!

In house training • •

Do your staff need training on mental health issues?

Would you like to benefit from a cost-effective package tailored to suit the needs of your organisation?

If so then Mind's In house training service can deliver a unique course for you and your organisation. We bring the course and our experienced trainers to you and run them for a fixed price no matter where you are in the UK! In house training offers flexibility, value for money and a tailor made training package for up to 15 staff per session. You tell us the subject, we provide a trainer; it is that simple!

Contact us today to make an enquiry or visit our website www.mind.org.uk/conferences for more information.

Book before the end of March 2011 and quote the promotional code ‘Training10’ to receive training at 2010 prices.

ONEinFOUR Lifestyle, health, mental wellbeing Spring 2011

One in Four is a quarterly aspirational magazine for people with mental health difficulties, those who know them and for the community at large.

Contents

One in Four believes that information useful to people with mental health difficulty is useful to everyone and can bring about positive change. One in Four is committed to helping people to understand mental health difficulty from the point of view of those who experience it.

Cover Stories

ISSN 1754-064X

What should you expect if you become a carer?

ONEinFOUR

is a registered trademark of Social Spider CIC, registered in England no. 4846529

Spring 2011

8 Who cares wins 12 Doing it the write way The delights and dangers of telling your own story

www.socialspider.com Editor: Mark Brown Editorial Assistants: Isha Prashar, Heike Kroll Editorial Team: Stephen Gardiner, David Floyd Original Design: Mustafa Kurtuldu Production Editor: Martin Parker Advertising: If your organisation is interested in advertising in One in Four, call Stephen Gardiner, on 020 8521 7956 or email stephen@socialspider.com. You can download a media pack from: www.oneinfourmag.org Subscriptions: See page 32 for ways to get more copies of One in Four, including bulk orders and individual subscriptions.

News: If you have an idea for something we could put in a future issue, contact editor@oneinfourmag.org

One in Four welcomes letters and emails. We do not publish letters where only an email address is supplied; please include a full postal address and a daytime telephone number.

One in Four would like to hear from people, especially those with experience of mental health difficulty, who can illustrate, photograph, write articles or provide interviews about their experiences for features and news stories. Email: editor@oneinfourmag.org or send a letter.

One in Four and Social Spider CIC do not take responsibility for any materials, including photographs or artwork, submitted unsolicited.

One in Four thanks South London and Maudsley NHS Foundation Trust Charitable Funds, The Charlie Waller Memorial Trust, The Cooperative Bank, The Wates Foundation, Open Up and Comic Relief for the funding they have provided for this project.

18 Spring into action Get on top of your cleaning even when you aren’t feeling your best

24 What does recovery mean?

We all think we know what it means to recover from illness, but do we?

Features 16 Mental health – the government view The new government mental health strategy examined

22 US exports Does North America’s view of mental health over-influence the world?

Real Lives 15 Can you spare five quid?

One in Four speaks to a group trying to create a safety net for people who lose their benefits

Reviews 27 Not just funnies A review special: Comics and mental health

Mythbusting 30 Doing something odd that’s difficult for others to understand DOESN’T automatically mean someone is ill

One in Four Social Spider CIC 5 Hatherley Mews London E17 4QP editor@oneinfourmag.org www.oneinfourmag.org

Regulars

Nothing in this magazine can be reproduced in whole or in part without written permission of the publishers.

Opinions expressed in this magazine are not necessarily those of Social Spider CIC.

32 Acknowledgements

Selected content from this magazine is available online at www.oneinfourmag.org

34 Letters

© 2011 Social Spider CIC

35 Competition

04 Editorial 05 News

33 Directory

Editorial

Bad news v hope There’s no doubt about it, these are worrying times. It’s difficult to open a newspaper or turn on the news without hearing about this being cut or that being scaled back.

We’ve always known that the effects of economic downturn would have a large impact on the money available for the provision of public services, but it’s becoming clear that the problems we’re facing now are some of the most serious we’ve seen in a generation.

It is into this situation that the current government launches a new mental health strategy for England, No Health Without Mental Health, an attempt to set down the principles by which mental health should be considered across all of government, not just within health services.

Despite an understandable level of cynicism from many, the strategy includes many things which are positive for mental health if the challenges of putting them into action can be overcome.

And it is those challenges of converting fine sentiments into practical actions taken in the lives of people on which we must focus.

Those of us with disabilities, including those of us with mental health difficulties, often rely far more than others on public services to help us to live the lives that we’d hope to live. Any disability means that we have to expend far more of our energy, time and resources just to get to the point at which someone who doesn’t face the same challenges begins.

It’s important to make sure that any discussion about cuts or realigning services doesn’t move from the question of how do we use what we have to meet the needs that we know exist to a debate about whether those needs exist in the first place. The first is a discussion where we all can contribute our ideas, experience and knowledge; the second ends up as an enthusiastic pantomime where the sides involved holler at each other while people’s needs go unmet.

Protest is extremely important, and it has been heartening to see that the time has passed where

decisions could be made about policy without any effective way of voicing opposing views. Campaigns like The Broken of Britain, as we saw in our last issue, signal a change. None of us have to be passive recipients.

What we want is for everyone to get the services and support that they need to be as well and as comfortable as it is possible for them to be. We also want the mental wellbeing of individuals to be considered across the spectrum of life.

A person experiencing mental health difficulties is not just a set of symptoms to be treated. We are people with lives, with homes, with families, with jobs. We are far more than a series of contacts with services.

Similarly, our mental health does not exist in a bubble.

It’s affected by our housing situation, the range of support we can access if we need to, the decisions made by our local councils, the discussions that take place in government and parliament. Improving mental health services is essential to helping people with mental health difficulties, but it’s only one element.

Avoiding despair is one of the most important tasks for those of us able to do so. We all must learn to carry hope with us, especially for those we know who find it difficult. This does not mean we should ignore bad news, but that we have a duty to focus on what’s important.

With such pressure on resources we need to be asking the question ‘what is it that people need in life to be well and how can they get it?’ l Mark Brown, Editor

What do we mean by mental health difficulty?

Most people experience changes in their emotions or thoughts occasionally. A mental health difficulty is an experience of mental distress, upset or disorder, affecting mood, thoughts, physical sensations, actions or motivation that lasts over a period of time.

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News

Photograph © Alexander Raths

Too much, too fast?

The much talked about reorganisation of the health service has won few supporters outside coalition ranks as senior mental health professionals, GPs, health managers, unions, campaigners, activists, service users and politicians all line up to voice serious concerns. Embarrassingly for the government, these critics have been joined by coalition MPs and a member of the prime minister’s own family.

The scrapping of Primary Care Trusts (PCTs), handing commissioning of £80bn a year of care for their patients to GPs from April 2013 and the sheer pace of the changes have drawn most flak to health secretary Andrew Lansley’s Health and Social Care Bill.

The government says the reorganisation will modernise the NHS and enable it to deliver truly world class care for people. The

prime minister said of the Bill: “Running right through it is a new deal: we want to give the professionals much more freedom to care for patients in the way [they] decide is best.”

He said it would remove two whole tiers of infrastructure which will free up more money for patient care and provide a system that answers much more strongly to patients. Mr Cameron said: “By empowering patient choice, opening up competition and introducing new ways local people can get involved in shaping services, we want to give people, not politicians, the power to shape and improve the NHS.” But even while the Bill was being drafted, two mental health charities warned the government about GPs’ ability to commission mental health services. A Rethink survey revealed that only 31% of GPs feel equipped

to take on the commissioning role for mental health. And Mind gave written evidence to the Health Select Committee saying: “Many GPs do not have sufficient understanding even of mental health in primary care, and may not be best placed to commission secondary care. The expertise of those involved in the delivery of services – e.g. psychiatrists, social care professionals, nurses and occupational therapists – should be utilised, as should the expertise of the third sector and, most importantly, mental health service user groups and individual service users themselves.”

As the health proposals were being laid before the Commons, an all-party committee of MPs warned that the decision to go for rapid root-and-branch restructuring has made the plans more risky and more expensive. They

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News acknowledged that the challenge in 2009 to NHS chief executive, Sir David Nicholson, to make £15bn£20bn in savings is central to the reforms. But the politicians don’t like the way the coalition is going about it. The committee report said: “The failure to plan for the transition is a particular concern in the current financial context. The Nicholson challenge was already a high-risk strategy and the white paper increased the level of risk considerably without setting out a credible plan for mitigating that risk.”

Former Conservative health secretary and chairman of the committee, Stephen Dorrell, criticised “the surprise proposal” to scrap PCTs and hand commissioning to GP consortiums that appeared in the white paper last July but was omitted from the coalition’s programme published two months before that. He said: “We share the government’s objectives. We also say that this is in several respects not the most effective way to deliver them.”

Former GP and now Tory MP, Sarah Wollaston, who in general terms supports the bill, said there is so much uncertainty at the moment that there is an uncontrolled exodus of experienced people out of the NHS. She said: “If the expertise is not there in the remains of the PCT clusters, inevitably [GP commissioners] are going to have to turn more to the private sector.”

Liberal Democrat MP, Andrew George, also on the committee, told the BBC: “Most of the informed and authoritative commentators on this all agree this might result in a race to the bottom, and it certainly will. I think there is a big risk it could compromise quality as well.”

Dr Laurence Mynors-Wallis of The Royal College of Psychiatrists agrees: “There is a danger that, in the new system, services will go to the cheapest provider at the expense of quality. There is also a danger that, if a multiplicity of providers are delivering different aspects of care, that care may be

6 ONE in FOUR

fragmented and patients may fall between gaps in services.”

More than half of the country’s family doctors disagree that GP commissioning will create a patient-led NHS. In a survey by the Royal College of GPs (RCGP) more than 70 percent of the doctors also said they disagreed or strongly disagreed that the concept of services being commissioned from ‘any willing provider’ will improve healthcare outcomes. Dr Clare Gerada, head of the RCGP said: “We must guard against fragmentation and unnecessary duplication within a health service that is run by a wide array of competing public, private and voluntary sector providers, that delivers less choice and fewer services, reduces integration between primary and secondary care and increases bureaucratic costs.” The respected medical journal, The Lancet, ran an editorial saying that for the Tories to call themselves “the party of the NHS” is “a commitment that seems pretty hollow now”.

The general public have given a distinctly lukewarm response to allowing profit-making companies a greater role in the NHS. Only 27 percent backed giving GP consortia the ability to commission from ‘any willing provider’. Exactly half of the nearly 2,000 respondents to a YouGov poll said they opposed the change.

Paul Hammond, who has bipolar disorder, told One in Four: “I get a 10 minute slot when I go to my GP. Is that long enough to take commissioning up to the next level? Key to these changes is having coherent and robust evaluation to see if the commissioning is working and the level of patient care is achieved.”

Chris Ham, chief executive of The King’s Fund, a charity seeking to improve health services in England, said progress in NHS performance over the past decade is now under threat: “These gains are at risk from the combination of the funding squeeze and the speed and scale of the reforms as currently planned.” His theme was

taken up by Paul Farmer, Mind’s chief executive, who said the quality of current mental health care must not be jeopardised: “There is a real risk that valuable mental health knowledge and skills could be lost in the transition process and that some mental health services will be vulnerable to closure or disruption. We know from past experience that mental health services often bear the brunt of health budget cuts and we cannot allow history to repeat itself. GPs have limited specialist knowledge on mental health and we’re worried that this lack of understanding will affect commissioning choices.”

As parliament was debating the reforms, Dave Prentis, general secretary of the public sector union, UNISON, said the government was taking “another step down the road toward the destruction of the NHS”. And Gail Cartmail, head of the Unite union, said the changes would “shove NHS patients to the back of the queue, as private greed will leapfrog health need every time”.

The prime minister says the changes are absolutely necessary: “Pretending that there is some easy option of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction.”

However he had to admit that his own brother-in-law, a cardiologist at an NHS hospital, is not convinced by the changes, telling the PM he’s giving too much power to the GPs. The Department of Health says 141 GP consortiums covering half of England have already signed up as ‘pathfinders’ to trial the new commissioning arrangements. This was music to health secretary Andrew Lansley’s ears: “It is clear that GPs and nurses are ready and willing to take on commissioning responsibilities. The pathfinders to date demonstrate this, but most importantly, the changes will enable them to make the decisions that better meet the need of their local communities and improve outcomes for patients.”

News

The closure of the only instant access crisis centre in Leeds has quickly turned into a vivid example of the potential of grass roots activism in the digital age. It has also shown how hard it is to stand against relentless march of public spending cuts.

When Leeds City Council announced that the Leeds Crisis Centre, which helps about 2,000 people every year, would have to shut its doors as part of the £90m savings in the city’s 2011-12 budget, a group of anonymous supporters set up a blog and invited people to voice their opposition. In the space of a month and a half the selfstyled “home-made campaign”, became something of a modern model for user-led activism.

Local newspapers and television took up the case of the 365-days-ayear, free crisis counselling service with celebrities including Alastair Campbell, Baroness Helena Kennedy QC, Susie Orbach,

On side newsreader Jon Snow and Coronation Street actor Steve Huison adding their support. A single tweet by Stephen Fry to his 2.2m followers pushed the blog-based protest up to a higher level of prominence.

Mental health professionals, people who used the centre over more than 20 years, GPs, unions, city councillors, MPs, social workers, students and volunteers who have worked at the centre, the chief executives of Rethink and Mind and charities providing services in the mental health arena in Leeds all piled in with their support.

Some leant their emotional backing while others used argument and reason to counter the council’s justification of the closure. The campaign widened to include two other day centres in Leeds similarly consigned to closure.

None of this was enough to stop the city council subsequently confirming its decision and as One in Four went to press campaigners were concentrating their efforts on challenging the decision under human rights law, equality legislation and case law on consultation processes.

See the blog at http://saveleedscrisiscentre. wordpress.com

Speak out, loud and clear Open Up, the grassroots activism part of the anti-stigma campaign, Time to Change, has launched an online guide to starting your own project challenging mental health discrimination.

In a series of web pages, Speak Out provides a series of factsheets and short videos on all aspects of planning a project and putting it into practice: what are the basic questions to ask yourself at the outset; finding a mentor with practical experience; writing a constitution; setting up a social enterprise; handling the paperwork; dealing with money;

and how to fund your activities.

Brigid Morris, Open Up Project Manager, told One in Four: “We’ve learnt a huge amount over recent years from helping people with mental health difficulties developing their own ideas on challenging discrimination. The idea with Speak Out is to share this learning and inspire and encourage more people and give them the tools and the confidence to put their own plans into action.”

To find out how to start your project, go to: www.time-tochange.org.uk/speakout

Photograph © David Howlett

Photograph © Nathan Cook

Online activism

Former England rugby international, Danny Cipriani, who has spoken out about the depression he experienced when he was dropped from the national team, is warning others against trying to get through it on their own.

The player says he is feeling better now and he pays tribute to the counselling and close friends who helped him: “The worst thing you can do is bottle everything up inside. You end up feeling more lonely and frightened and then the problem gets bigger and bigger.

Talking to a counsellor is nothing to be ashamed of because it’s their job and they understand, and having people who love you supporting you also makes a big difference.”

Cipriani is not the first person from the sport to speak out about mental health difficulty; several years ago the star All Black winger, John Kirwin, became a central part of an anti-stigma campaign in New Zealand and is credited with changing entrenched attitudes about mental health within the tough, male environment of top class rugby and its supporters.

Cipriani, who burst onto the international stage for England two years ago, is now playing club rugby in Australia but says he would love to play for his country again one day.

ONE in FOUR 7

Cover Story Illustration by Martin Parker

Who cares wins What would you expect if you became a carer for someone? Karin Machin examines some of the issues surrounding looking after others If your partner broke her leg, would you tell your work colleagues?

Of course you would. You might be able to arrange a day or two of compassionate leave, possible flexible working arrangements, maybe even some sympathy.

Perhaps some colleagues have met her and they’d send a get well card.

8 ONE in FOUR

But would you tell them if she experienced a mental health difficulty?

Maybe she’ll recover before anyone needs to know.

Of course, you’ll have to find some way to accompany her to appointments if she can’t go alone, or to get to your GP for the

prescription before the pharmacist shuts. And then there’s all the shopping and housework, the previously shared responsibilities.

How much annual leave do you get?

And what if you’ve been up all night, providing emotional support, talking her down or out of a crisis for the last four nights? Can you still keep it a secret? Is it your fault?

Have you done something wrong?

Would the worry affect your work?

And that’s just the adults. These questions apply to young carers too.

Bullies like to pick on differences.

And what a choice selection of names they can throw where mental health difficulties are involved.

Would you tell your school friends?

Your teachers?

No wonder that nine out of 10 carers say their own health is affected by their caring responsibilities. Or that a third of carers don’t even identify themselves as carers for the first five years that they are caring.

Sometimes the people we care for don’t necessarily accept that they are service users and may not like to think of us as carers. Many people don’t agree with the label, don’t want people to know, or are in recovery. The stigma of mental health forces us all to keep secrets.

Is anyone helping carers?

In 2004, the Department of Heath’s The national service framework for mental heath – five years on admitted that: “We have too little to report on improving the support we provide to carers, in line with Standard 6 of the NSF. Carers want prompt access to help when the person they care for is becoming ill. They want information, practical advice, emotional support and occasional respite. Most of all, they want decent care for their loved ones.”

The new mental health strategy No health without mental health (see page 16) echoes exactly the same needs six years later, also acknowledging that: “Families and carers, young and old, often receive limited help and too often report

that they are ignored by health professionals on grounds that they need to protect the confidentiality, and respect the wishes, of the service user.”

In the last five years, there has been more emphasis on the needs of all carers, including a Carers’ Strategy from the Health Department that provided more funding for carers’ breaks, Carers Direct, the telephone helpline for England and Caring with Confidence training courses.

It’s known what carers need, and also understood that there are specific difficulties for mental health carers. The Department’s Recognised, valued and supported: next steps for the carers strategy says: “The onset of mental health problems and the process of seeking help can be particularly traumatic for families. Those supporting people with mental health, personality disorder or substance misuse problems can be wary of seeking help outside the family because of the stigma, discrimination and bullying that are still too often associated with these conditions.”

Campaigns, like Time to Change in England and See Me in Scotland, are inclusive of carers and aim to end this discrimination. The NHS report, A better future in mind in the north west of England, recommends that service providers use these campaigns to raise awareness of stigma within their own services.

The latest mental health initiative is Triangle of Care which is supported by the Princess Royal Trust for Carers (PRTC) and has been holding a series of launch events across the country. This programme suggests six key elements which organisations should audit so that they can ensure that they are developing well practice (see box). The title refers to the central three-way relationship between service users, carers and staff. Paul Rooney, the PRTC’s national acute care programme lead, said “We want to improve the dialogue with carers in order to deliver better outcomes for service users.”

What is the reality for people experiencing distress themselves?

I often get the impression that service providers think that service users and carers are two sides, each with a completely separate agenda, rather than people in relationships and wanting the best for each other.

A minority of people don’t want their family involved or have lost touch with family and friends.

Services do need to be clear that they are not forcing people into contact with relatives. But too often, that can still be the default position – services assume that they should hide behind confidentiality rather than work hard to help people develop their relationships.

The lack of support for families can cause additional stress when we are in crisis. Bobby Baker, in her recent book Diary Drawings: mental illness and me, said: “One of the most harrowing aspects of being ill was witnessing the frustration and confusion of my husband when he was excluded from a closer involvement in my care plan and when I was in hospital.” Most service users welcome support for their family, especially if young carers are involved, as it takes another pressure off us.

Paul Rooney emphasises: “It is a fallacy to think that most service users don’t want their carers involved. Even if they don’t want their family involved during a time of crisis, they do want their family involved on discharge.” He described how not talking to carers could mean that no one feeds your cat at home, or that no one pays the rent: “Not talking to carers is not doing any favours to a service user who is in hospital.”

Services often refer to service users and carers as if they are either/or labels: it confuses their tick boxes to suggest that you’re both. I have spoken to many service users over the years who can describe a childhood as a young

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carer or who are actively supporting a partner or child with their own mental distress or other disability.

Hopefully carers’ initiatives will highlight these carers and enable them to access carers’ support services.

John (not his real name), who had used services for many years, supports his wife with her own physical health issues. He had never been identified as a carer. When I asked if he’d been offered a carer’s assessment or a carer’s break, he kept telling me that he was a service user. It took a while to help him understand that being a service user didn’t automatically stop him from getting support as a carer. He is in touch with many organisations that could easily have identified his caring role – various mental health support services, their family GP or his wife’s support services. But not

one of them did it. After our chat, he went to his local Carers Centre himself. He now receives carer’s support including carer’s breaks and help with benefits.

What can you do?

If you have a mental health difficulty make an advance statement or advance directive – write down your choices such as who you want to be included in information sharing. It makes it far simpler if you have prepared a statement outlining what you want to happen, who you’d like to be included in any information sharing and what information you’d like them to be able to know. Do this when you are feeling well. The major mental health charities (see page 33) will be able to advise you on this process.

What should carers expect?

If you support someone who needs your help because they are ill, frail, disabled, has mental health problems or substance abuse problems, you are a carer.

You can get support from a variety of organisations including PRTC (www.carers.org). You can find details of local services and groups from your GP or local library. In England you can telephone Carers Direct on 0808 802 0202 for free, confidential information and advice for carers. l

Carer Statistics • There are about six million carers in the UK and an estimated 175,000 young carers.

• Every year over two million people become carers, 42% of them are men.

The latest government mental health strategy No health without mental health (see page 16) mentions a “Triangle of Care: Carers included” which sets out six key elements of good practice for services working with carers.

1. Carers and the essential role they play are identified at first contact or as soon as possible thereafter.

• Three million carers combine working and caring roles.

2. Staff are ‘carer aware’ and trained in carer engagement strategies.

• 25% of carers support someone with a mental health difficulty

3. Policy and practice protocols regarding confidentiality and sharing information are in place.

4. Defined post(s) responsible for carers are in place.

5. A carer introduction to the service and staff is available, with a relevant range of information across the acute care pathway.

• 65% of carers did not identify themselves as a carer in the first 12 months.

• There are no available statistics for the number of people who use mental health services who have a caring responsibility.

6. A range of carer support services is available.

In addition, services need to assess and check regularly to ensure these six key elements of carer engagement exist and remain in place. This fits alongside the National Carers Charter (2010) which identified the priority areas as: Supporting those with caring responsibilities to identify themselves as carers at an early stage, recognising the value of their contribution and involving them from the outset both in designing local care provision and in planning individual care packages.

Enabling those with caring responsibilities to fulfil their educational and employment potential.

Personalised support both for carers and those they support, enabling them to have a family and community life.

Supporting carers to remain mentally and physically well.

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Further reading The Triangle of Care: Carers Included: A guide to the best practice in acute mental health care is available from The Princess Royal Trust for Carers and can downloaded here: http://bit.ly/gAZJTk Recognised, valued and supported: next steps for the Carers Strategy is published by the Department of Health and is available here: http://bit.ly/fXDjX1

Cover Story Photograph by Martin Parker

Doing it the write way They say that everyone has a book inside them. Maxine Frances Roper explores some of the delights and dangers of getting your experiences out there for others to see The experience of mental distress inspires many towards creative forms of expression.

From straightforward memoirs to more oblique, concept-based stories, mental health is a common theme in literature and art. Sharing life experiences through the medium of novels, films, plays or artwork can help people affected, both in

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coming to terms with their difficulties and in increasing awareness of them. As someone with a novel in progress, I have spoken keenly to fellow writers, film makers, and to mental health professionals who use creativity in their therapy, about the benefits and challenges this brings.

Sharing experience Ten years ago, writer and broadcaster Rae Earl began reading excerpts from her teenage diary on a radio show she presented with her husband, who persuaded her to share rather than destroy them. At the time of writing the diary in 1989, she was a severely overweight sixth-former from a small town in Lincolnshire who’d recently been discharged from a psychiatric ward following a breakdown and played the clown in public in order to hide her vulnerability – a vulnerability she expressed in her diaries.

Sandwiched between 80s popculture and fun school yard anecdotes are troubled references to her weight, her struggles with unrecognised Obsessive Compulsive Disorder and her desperation to find a boyfriend who could see past her size.

“I was taken aback by it really – you always assume you’re the ‘only one’ who has ever felt that way,” she says of the feedback she received from listeners. Encouraged by their empathy, she published the diaries in full and My Fat Mad Teenage Diary was released in 2007 to wide acclaim.

“It was very cathartic,” says Rae, who is currently working on her second book. “Not many people get to exorcise their teenage selves in such a positive way. Plus I’ve discovered that it still has an absolute relevance to what many teenagers go through today.”

While this is certainly true, a greater culture of openness among today’s young people has arguably produced awareness much earlier in life of how creativity functions as a coping tool. 21-year-old writer Mareilla Agapiou was diagnosed with bipolar disorder at 19 and subsequently studied psychology alongside creative writing at university: “One course taught me more about my disorders and the other allowed me to vent it,” she says. “We would discuss our creative voice in class and the question of benefits from writing about mental health brought about many opinions.

“Writing about mental health makes people see we are all different people dealing with things in different ways.”

I believe that others with mental health issues can be helped from reading people’s accounts; what they have been through and the way in which they live now. Writing about mental health makes people see that although we may come under one of the labels of ‘depression’, ‘bipolar’ or ‘schizophrenia’ we are all different people dealing with them in different ways. It helps loosen the stigma.”

Voice to others Others have interpreted this more directly, using their own creativity to give voice to others. New York-based film maker, Sheryll Franko, found her own experience of mental health difficulties drew her into her work and towards others with similar experiences. While studying photography at a local community

college after dropping out of university because of depression, she was approached by Drew Horn, founder of the Turn-A-FrownAround foundation, a non-profit organisation whose objective is to ‘Collect smiles for people who could really use one’. This is done by approaching passers by and asking them, quite simply, for a smile. Despite his eccentric appearance – he wore yellow trainers and a hula hoop and had smiley face patches stuck to his clothing – she was charmed by the simplicity of his request and, after they spoke, pledged to make a film with him. The result was Crazy Enough to Care, a documentary in which the pair visited psychiatric units and nursing homes – “places nobody else was going” – to talk to and film residents.

Says Franko: “When I interview subjects who are open about their mental illness, I find myself talking about my experience with depression and it’s like ‘I’ll tell you mine, you tell me yours.’ There’s solidarity.” She describes her filmmaking as having leant legitimacy to a man dismissed locally as an oddball, while at the same time allowing her to find a career niche, propelling her from a student who had barely held a video camera to an award-winning figure in US mental health advocacy.

In 2009, following the success of Crazy Enough To Care, she received the Voice award, a US governmentsponsored award for directors and producers who portray mental health sympathetically. A follow up documentary on mental health stigma, How to Touch a Hot Stove, is currently in production and features leading US celebrities and academics.

What about other people?

For all the rewards of creativity, it can be problematic too. Most creative works involve other people, whether as subjects or those implicated in the life of the person being portrayed. This leads to questions around how writers and

ONE in FOUR 13

artists should balance their right to freedom of expression with others’ right to privacy. Both Rae and Mariella had concerns about how their parents would react to their material and both their mothers opted not to read their work so as not to jeopardise their relationships.

Rae’s present-day introduction to her diaries sets the scene and puts into context many of the events, including her teenage antipathy towards her mum: “I wanted people to see that this was a woman who really wanted her daughter to do well in life because she believed in me,” she explains.

Not everyone’s creative work allows for such context. Parts of my own novel-in-progress allude to frustration I felt toward someone not putting their communication with me into context or understanding its effects. Though the plot is fictional, the characters are drawn from life, and expressing such feelings without being seen as acrimonious or blaming can be hard.

Sheryll experienced the opposite dilemma of representation when approaching psychiatric patients for her documentary.

Despite her obvious bond with participants she admits she worried about exploiting them: “They’re my buddies, not my subjects. They were telling me they can’t get out of bed, they can’t go to work, that nobody understands them. And you know, this wasn’t some, high-gloss, ‘I’m a tortured artist, this is how I’m going to justify it’. These were people in genuine pain and I would ask myself, ‘Do I even belong directing this film? Where is it my place to tell this person’s story?’ I interviewed a family whose 17-year-old son committed suicide. It’s such a private experience. And yes, they’re open about it. Yes, it’s therapeutic for them to tell their story so that more people will have more communication about something like this. But it seemed like; this person who passed away, who took his own life, he’s not being given a voice here. How do I tell his story and not trivialise his experience?

That was very difficult.”

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Ready to be read?

Of course, all these scenarios presuppose having an available audience in the first place. Getting your work noticed is the greatest difficulty faced by anyone in the creative industry, and dealing with rejection is difficult, let alone when experiences and/or characters presented in the work are close and distressing to you. You need to have healed sufficiently from the experiences you have presented before submitting your work for public consumption.

Says Anita, a counsellor who has recently begun submitting articles to magazines about aspects of her work: “We have to get ourselves in a place of acceptance before we can put ourselves into a vulnerable position attracting other people’s comments. Because obviously once you go public with anything you’re never going to please everyone.

“Looking at my own stuff, I now feel

I believe in myself enough to put something out there and have it rejected but not go into a crumpling wreck in the corner.

Whereas if I’m not in a good place myself, it’s not the right time to start sending out. I need to get myself in a place of acceptance. Mental health isn’t so different.”

When writing a book you also should be aware of the difference between a biography and a story and not sell a memoir as a novel (a memoir is some writing about your own experiences; a novel may draw on your own experience but it is a piece of creative writing with a plot). Despite the huge commercial success of so-called ‘misery memoirs’ there is now something of a backlash in the book publishing industry, and many agents are now wary of the genre.

Linked to issues around plot is how significantly a person’s mental distress should figure in the wider scheme of a piece of creative work.

Despite appearances, Rae Earl’s diary is far from ‘misery-lit’. It celebrates the many close, vibrant friendships she had despite her difficulties and is at times extremely funny (an entry about hunger pangs for fisherman’s pie followed by a jubilant, philosophical entry on the fall of the Berlin Wall, to name one example). Similarly, Crazy Enough to Care does not dwell entirely on the mental distress aspect of participants’ lives. For Sheryll and Drew, the film’s greatest strength was that they sought a common denominator – even something as simple as being attracted to the same gender or liking the same music. Just as a person in real life shouldn’t defined by their illness, nor should they be in fiction or memoir. Above all, creating any kind of work, whether or not it’s directly therapeutic, should be enjoyable. l

Want some tips to get started?

See www.oneinfourmag.org for exclusive web only content ‘The One in Four guide to writing from your own experience’.

Real Lives

Can you spare five quid?

2011 might well be the year of people doing things for themselves. Mark Brown speaks to a group that’s doing just that One of the most interesting aspects of the current political and economic situation is that it has seen an increased focus on people doing things for themselves. Another one to add to the growing list is 5 Quid for Life, a UK-based, non-profit organisation dedicated to supporting those with mental health difficulties who may be adversely affected by changes to the benefits system.

Brought together by social networking website Facebook, 5 Quid for Life began as an attempt to raise some money to help a mutual friend who was experiencing financial difficulties but soon took on a broader focus.

There’s a lot of this in the air.

The current government has been pushing the idea that people should take more responsibility for solving problems in their communities and that the state should not be the only means of making sure that people have their needs met.

However, this idea of taking responsibility for our own communities and solving our own problems has taken an interesting turn. Campaigning organisations built from scratch by people with disabilities such as The Broken of Britain and various local campaigns have come together to try to sort out some of the problems they see arising from government decisions.

5 Quid for Life has a very clear aim: “To provide support for people with mental health difficulties who

are adversely affected by changes to the UK benefits system and may thus be in danger of losing their incomes, homes or lives as a consequence of those changes.”

They want to do that by asking people to commit to regular giving of £5 per month so that they can offer what they describe as “a lifesaving safety net beneath the benefits system”.

More than just waiting for answers “5 Quid for Life is about more than just knocking on doors waiting for answers,” says Kate White, 5 Quid for Life’s compliance officer. “The core team comprises 12 talented individuals, each with personal and/or professional experience with mental ill health. Fronted by Karita Razzell and David Warriet Edwards, founded by Phil Groom, we are friends as well as skilled, stubborn advocates for people over pence.”

“Having received over £1,500 in donations during our first week there is every reason for optimism, and elbow grease,” she says. “February 2011 marks alterations to the benefits system which mean still fewer mental health service users are eligible for any government aid. It is an economic placebo, and a bitter pill for some of the most marginalised members of the ‘big society’. For too many it means imminent bankruptcy,

putting them at risk of eviction, homelessness and suicide.”

5 Quid for Life are finding out how to do things as they go along, drawing on advice and experience of others.

They’re still working out exactly how the organisation will work.

5 Quid for Life is an interesting example of the ways that people with mental health difficulties are feeling the need to respond to events. 5 Quid for life say that they are by people with mental health difficulties, for people with mental health difficulties. They didn’t ask permission to start their campaign, or even spend long planning it.

Things happened in the world and they came together to do something about them. “Mental health services are not a luxury,” says Kate. “People with mental health difficulties cannot do without them, and no one should have to struggle to afford them. Our goal is to offer practical, available solutions to those for whom mental health problems are life problems – daily decisions over what is more important: therapy, medication, their child, shelter, warmth?

“For the price of a decent coffee and croissant each month we can save lives.” l For more information about 5 Quid for Life visit their website: http://5quidforlife.org.uk

ONE in FOUR 15

Feature

Mental health – the government view A new strategy sets out government plans for mental health in England. Mark Brown sees what it has to say February 2nd 2011 saw the publication of the new government mental health strategy, No health without mental health, the replacement for the previous mental health strategy, New Horizons, which was published in December 2009.

The new strategy and its supporting documents set out just how the government will seek to approach mental health, how it’ll measure if it’s being successful and what people with mental health difficulties should expect from the services provided. Unlike the Health and Social Care Bill (see page 5), the strategy isn’t something that has to be debated in Parliament or which has to pass a vote. It’s something that sets out the approach that the government wishes to take. Its important not only because it indicates what practical suggestions the government has in the area of mental health but also because it shows how mental health will be considered.

What’s in the strategy?

The first thing that’s noticeable about No health without mental health is its commitment, to place mental health in the mainstream of government policy. Indeed, the subtitle is A cross-governmental mental health outcomes strategy for people of all ages. Rather than suggesting that mental health is an issue only for mental health services, the strategy is at pains to point out that mental health and wellbeing is something to which most government departments can contribute. It states that it wishes to take a

16 ONE in FOUR

broader approach, tackling wider social determinants and consequences of mental health difficulties. It stresses very strongly that mental health is everyone’s business. It places great stress upon Big Society ideas such as greater community involvement in helping everyone to to stay well. It is also very much weighted toward prevention.

The strategy has six main objectives, which are worth looking at individually, alongside the suggestions for achieving them set out in the supporting paper, Delivering better mental health outcomes for people of all ages, also published in February.

More people will have good mental health The strategy describes this objective as more people from all ages and all backgrounds having better wellbeing and and good mental health and fewer people developing mental health problems. It divides plans into the same five areas used in in the public health white paper, Healthy Lives, Healthy People, published in November 2010. These are starting well, developing well, working well, living well and aging well.

The supporting paper makes a number of suggestions for how these changes might be made, mainly focused on helping families.

‘Starting well’ focuses on children and suggests that interventions such as home visiting, peer support and parenting programmes might help reduce maternal depression. It repeats a pledge to increase the

health visitor workforce by 4,200 and introduce a new model of practice including a stronger focus on maternal and infant mental health. It also states that the Department of Education has established a new cross-government programme to support families facing multiple, complex needs, introducing a new area-based Early Intervention Grant which will bring together a number of early intervention and prevention services.

This focus on parenting carries over into the ‘developing well’ strand, which focuses on young adults. The strategy suggests that particular groups of young people are at risk of developing mental health difficulties: those who have experienced negative parenting; those who have experienced abuse and neglect; those in contact with youth and adult criminal justice systems; those under-achieving at school; looked-after children (those in care); early school leavers; young lesbian, gay and bisexual people; and young homeless people. It claims that experiencing four or more of these situations leaves a young person at particular risk. To help young people with mental health problems the Department of Health is expanding access to talking therapies for children and young people and the paper mentions a forthcoming review of the model for school nursing. In a more general sense the government is looking to partnerships between the public, private and voluntary sectors to deliver better family outcomes.

The ‘working well’ strand carries

on much of the thinking we are familiar with already, with much stress upon the benefits of being in work and of the Work Programme as a way of supporting people into work. It commits to greater numbers of people with mental health difficulties being in work as a key indicator to measure success.

The ‘living well’ strand focuses on promoting wellbeing by promoting things like volunteering, physical activity, getting involved in your community and similar. The government claims it will support stronger communities, try to reduce barriers to training and education, promote better solutions to drug and alcohol dependency and support access to better financial advice.

The ‘aging well’ strand focuses on how people get on in later life.

The outcomes plan has few mental health-specific governmental actions for this period of life.

£400 million over four years to make sure a choice of psychological services are available for those who need them in all parts of England”.

It states that people with severe mental health difficulties who need to spend time in hospital “require high quality care in the least restrictive environment”.

The outcomes paper suggests that there is need for more robust ways of measuring recovery. It suggests local commissioners might be measuring the number of inpatient stays by diagnostic category, the proportion of those with first onset psychosis taken on by early intervention services and average level duration of untreated psychosis.

It also says that quality standards are in development for the treatment of conditions including, schizophrenia, depression in adults, long-term conditions/people with comorbidities and bipolar in adults.

More people with mental health problems will recover

More people with mental health problems will have good physical health

No health without mental health sees recovery as having a good quality of life after a period of mental illhealth. It stresses that while some people experience “long-term and severely debilitating effects, many recover fully, including from severe mental health problems”. It says that for a good quality of life people need: “greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education, better employment rates, and a suitable and stable place to live”.

In general the strategy undertakes to find ways of intervening more quickly when someone becomes unwell to prevent their difficulties worsening and it undertakes to provide services that are better. It stresses that providing a range of services in appropriate forms is important and also reiterates that the coalition government is investing “around

This area of the strategy is much the same as the plans for good physical health for everyone, though it does raise the issue of how many people with mental health difficulties smoke tobacco.

mental health services offer the same standards and outcomes to all people, recognising that some groups are more likely to have poor experience of services.

Fewer people will suffer avoidable harm The strategy states: “People receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service.”

This aim covers the government’s wish that fewer people will suffer avoidable harm from themselves, that fewer people will suffer harm from people with mental health difficulties and that fewer people will suffer avoidable harm from the care and support services they receive. It states that mental health services should protect people from further harm, have an honest and open culture that promotes the reporting of incidents and that they should learn from mistakes.

Notably, it also calls for a greater recognition and understanding of self harming behaviour, the increase in the number of rape crisis centres and the development of a new national suicide prevention strategy.

Fewer people will experience stigma More people will have and discrimination a positive experience The strategy recognises that stigma and misunderstanding around of care and support mental health can stop people No health without mental health makes clear the government’s commitment to greater choice and personalisation in mental health through things like being able to choose which people provide your services and through individual health budgets for long term conditions. In line with the NHS White Paper, it does not foresee that this will happen until 2013/14 and is sketchy on the details of what this will mean for people with mental health difficulties. Alongside this is a commitment to make sure that

seeking help and can also lead to discrimination. It stresses that the government should lead by example and also commits it to working with anti-stigma campaigns like Time to Change to challenge and change attitudes. l

To read No health without mental health and its supporting documents visit the Department of Health website at http://bit.ly/galExR

ONE in FOUR 17

Cover Story Illustration by Martin Parker

Spring into action As the days lengthen and brighten, thoughts turn to the dreaded spring clean. Linda Jones looks at ways you can sort out the clutter even when you aren’t feeling your best When you’re feeling low, a messy living environment can be an added headache and a mountain of ironing may be the last one you want to climb. Or perhaps unkempt surroundings can be a trigger in making you feel bad in the first place. ‘A tidy home means a tidy mind,’ is a message we hear all too often while decluttering experts or

18 ONE in FOUR

home interiors gurus urge us to spring clean our lives.

Many of us are good at making excuses about why we let things slide or get into a mess around us (I know I am). It doesn’t have to be such a big deal. Don’t panic, there are lots of steps you can take to help you get on top of things – even that pile of ironing.

Mounting clutter Peggy Melmoth lives on a narrowboat with her partner and two children. She’s currently being treated for anxiety and depression.

She says: “I find that I have to tidy up otherwise our home just will not function. However, when I am stressed, anxious or depressed I find the thought of tackling the cleaning overwhelming. I see all the jobs that need doing and just don’t know where to start. Then of course the dirt – there are even cobwebs – is embarrassing and I do not invite other people to my home.

“It has become impossible to tidy everything away now that there are four of us on board and I do find this clutter depressing. I struggle with time management. It seems to me there is not enough time in the day to clean when there are children to care for, a job to go to, a run to the launderette and the dishes to do.

“It also makes day-to-day living impracticable because I am forever moving things from one space to another just so that we can do daily tasks.”

You may not have Peggy’s experience of living on a narrowboat but if you recognise her feelings of despair at mounting clutter then her tips for tidying may be helpful.

Peggy says: “If housework seems unmanageable, break it down into manageable chunks. Make lists, prioritise. Don’t give yourself a hard time. Start somewhere. Congratulate yourself for what you’ve achieved in a day. Reward yourself by scheduling time out, for example a coffee and a cake when you can.

I also use self-hypnosis to build my self-confidence and improve mental calmness.”

Peggy sees that finding the right support has been important: “My GP has been fantastic. I have found anti-depressant medication made life more manageable and somehow increased my confidence.

“It stopped the incessant selfcritical internal monologue. My GP arranged a short course of cognitive

“Reward yourself by scheduling time out, for example a coffee and a cake when you can.” behavioural therapy too, which focused on practical ways I can change my life and mental attitude in the now.

“On an even more practical level, when I had post-natal illness I paid a professional cleaner to spend a day completely spring cleaning my boat. It was money so well spent because I felt much better about my environment and myself once that was done.”

Easier said than done Staffordshire-based counsellor, Frances Weston, says anxious people can become obsessively tidy.

“Their environment may be one of the few things they can control when everything else feels overwhelming and out of control,” she says.

“People who suffer with depression are possibly likely to be untidy and let mess occur because extreme tiredness can be a symptom of depression and this can

cause a person to perhaps become untidy and disorganised.

“To help sort this out they should ask for help from friends and family, and ensure they are receiving appropriate treatment for their mental health problems.”

But like many things in life, this can be easier said than done.

Dance teacher, Karen Hollins from Birmingham, says: “The untidiness of my house has been my main depression trigger for a long time. It’s a constant reminder that I am not on top of everything. I look at it and feel that, if I can’t keep the clutter under control, how can I control the rest of my life?

“And that in turn makes me feel too down to even make a start. I feel overwhelmed in mess and my husband and children seem oblivious to their clutter’s effect on me.

“I have lack of concentration and it is hard enough to do other usual daily routines that I need to do, such as going to college or work.

Then the housework gets left and dishes pile up.”

‘I don’t invite anyone home’ For Kate Whitely, bipolar disorder has a direct effect on her inclination to clean.

“I am either full of energy or have none at all. I am always behind in any housework unless I am in a manic phase, then I will sometimes go on a mad cleaning phase and the whole house gets done if I don’t have to leave the house all day. But then I will leave it for ages as the mania takes over and my thoughts are too rapid.

“If I am in a non-energy phase, then I just concentrate on basic things that I need to do in daily life.

Different jobs have a different level of priority for me. The kitchen is first and I feel successful if I can keep that tidy above the rest of the house – mostly I do,” says Kate.

“The main thing is that I have piles of paperwork, books and clutter that need sorting out but I don’t know where to start so I leave it in plastic boxes and pile them up

ONE in FOUR 19

instead. The bathroom and toilet are not a problem to keep clean, but my bedroom is a work in progress at the moment as I have only just got some furniture to put in it.

“I don’t invite anyone home unless I have enough notice to do a couple of days of clearing up – so mostly I don’t have visitors.

Unfortunately, the more I live in the mess, the more I feel messy in my head and less able to do anything about it.

“Being on the right medication is a contributing factor and that can fluctuate too as I sometimes lose days either in mania or by having chronic fatigue. It would help if I had someone to help me go through stuff occasionally so I could eventually end up with the house in a nice minimal environment and much easier to live in and keep clean.”

Kate’s experience highlights another key consideration; money matters can also play a part in how good you feel about your surroundings.

She says: “I have spent the last few years with huge financial issues; this is typical of bipolar sufferers – this has meant that although in the last year I have finally being allocated a permanent home – I

20 ONE in FOUR

have not had money to buy basic household items such as carpets, curtains, or furniture. So my living environment deeply impacts how I feel about how I live.”

Tidy and untidy people, well or ill Sometimes cleaning too much can be a difficulty. For people who experience Obsessive Compulsive Disorder (OCD), household cleaning can become a compulsion.

Obsessive cleaning can be something that people experiencing OCD feel they need to perform regularly to relieve their anxiety.

People with OCD battle against such feelings, but repeatedly washing, cleaning or checking things at home can be common.

India Haylor, from the London OCD Centre, says the illness invades all parts of a person’s life and can lead to exhaustion and feelings of stress and shame.

To counter this, India suggests the key to taking control of OCD is to understand that anxiety is generated within you rather than by your surroundings or other people around you.

Michael Andrews, a mental

health nurse with Woking Mind, says it’s important to find out what a friend or family member’s lifestyle was like before they became ill to check out how much their living environment is influenced by their state of mind.

He says: “Across the population there are tidy and untidy people, well and unwell. We have a depressed female client with a family. Her house could be described as very untidy. Her husband is urging to her to do better but she wouldn’t have won tidy housewife of year before her mental health difficulties.”

Anyone worried about how much a mental health difficulty is adversely affecting their surroundings in terms of untidiness or mess, may be able to seek help from support organisations.

Or do what Kate does: “See if you can get someone you trust to help clear through with you on a regular basis and sort out the clutter. Don’t beat yourself up if you haven’t done any housework; it is more important to get through the day doing whatever you feel capable of doing rather than feeling a failure because of things you couldn’t do.” l

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Feature Illustration by Martin Parker

US exports When we think about breakthroughs in mental health, we often think about the US. But what if US ideas about mental health treatment and diagnosis are having a more complicated effect on the rest of the world? Mary O’Hara investigates American journalist, Ethan Watters, poses a question it is impossible to ignore. What if a group of shamans had turned up in Manhattan knocking on doors in the wake of 9/11 offering to counsel traumatised survivors? The idea might sound ludicrous but according to Watters’s latest book, Crazy Like Us: The Globalisation of the American Psyche, it is no more ridiculous than the hundreds of western therapists and trauma counsellors who descended on Sri Lankan citizens following the catastrophic Tsunami of 2004

22 ONE in FOUR

offering assistance for, among other things, Post Traumatic Stress Disorder (PTSD). Well meaning?

Yes. Appropriate? That’s another question entirely.

The central thesis of Crazy Like Us, that ‘Western’ ideas about mental health difficulties are radically altering not only the understanding and treatment of mental ill health around the world but the prevalence of specific conditions, is a compelling one. The West (and in particular the US), Watters contends, has been engineering the wholesale export of a biomedical

view of mental illness with profound consequences for cultures unaccustomed to the contemporary medical orthodoxies of countries like Britain and America.

“The ideas we export to other cultures often have at their heart a particularly Western brand of hyper-introspection and hyperindividualism,” Watters explains in the book. This perspective he suggests contrasts – and in some instances conflicts – with how other cultures understand the mind and mental health difficulty. It fails utterly to grasp the significance of social and

cultural factors on how individuals process mental suffering.

Exporting ideas “Behind the promotion of Western ideas of mental health and healing lies a variety of cultural assumptions about human nature itself,” Watters writes. “What is certain is that in other places in the world cultural conceptions of the mind remain more intertwined with a variety of religious and cultural beliefs as well as the ecological and social world.”

In Crazy Like Us he also discusses how within Western culture the definition, type and prevalence of mental disorders (think the trend for ‘hysteria’ among women in Victorian England or more recently anorexia or the emergence of PTSD as a condition a couple of decades ago) have varied over time. However his core assertion is that something unprecedented and “disturbing” is happening now in terms of trends in the transmission of Western ideas around mental illness.

The increasing speed of globalisation, Watters suggests, has unleashed a disproportionate transfer of narrow Western ideas about mental illness to the rest of the world.

He sums it up thus: “In teaching the rest of the world to think like us, we have been, for better and worse, homogenizing the way the world goes mad.”

It is a sweeping claim (and Watters acknowledges it as such) but it makes the book a riveting read.

Crazy Like Us is a relatively short book but what it lacks in length it more than makes up for in polemic.

Watters’s approach is at once an analytical and a geographical odyssey (or “intellectual travelogue” as he likes to refer to it). Readers are taken with him around the world to Sri Lanka, Hong Kong, Zanzibar and Japan with each country presenting an opportunity to test a different aspect of his thesis on the global homogenisation of mental illness.

Around the world In Japan Watters details how by deploying its colossal marketing

might to sell the antidepressant drug Paxil (generic name Paroxetine, commonly known as Seroxat in the UK), pharmaceutical giant Glaxo Smith Kline introduced a version of depression into the culture that had not previously existed. He traces how the company cunningly saw an opportunity to capitalise on an upward trend in suicide that, coupled with economic instability had caused Japanese society to question its own response to crises. (Sales of Paxil shot up from $100 million dollars in 2002 when it was first prescribed in Japan to over $1bn in 2008). Says Watters: “You know Glaxo, at the same time as it was promoting depression in Japan, it was promoting ‘anxiety’ in Argentina. The company found it more culturally easy to promote that there.”

It would have been easier perhaps had Watters focused exclusively on the influence of drugs companies. As he says in the book: “These multi-billion dollar conglomerates have an incentive to promote universal disease categories because they can make fortunes selling the drugs that purport to cure those illnesses.”

Instead he presents a much more ambitiously eclectic proposition.

In Zanzibar Watters explores why, in ‘traditional’ cultures unexposed to the Western notion of schizophrenia as ‘brain disease’, people with the disorder tend to have a better prognosis than their counterparts in the US. And after investigating the relatively recent rise of anorexia in Hong Kong he concludes that the condition increased not because of the influence of Western ideas about body image as is usually suggested, but because the condition itself was introduced by the West.

The chapter on Sri Lanka in which he probes the dubious effects of well-meaning if culturally insensitive Western trauma counsellors parachuting in after the tsunami (most of whom neither spoke local languages or understood the culture) is especially illuminating. He uses the example as a springboard to chart

the emergence and honing of PTSD as an officially recognised disorder in the US to its near-ubiquity in the international trauma lexicon.

A journalist’s eye Watters is not a mental health professional; he is a journalist and author albeit one with a sterling track record writing about mental health. His previous books include one that debunks the ‘recovered memory’ movement (False Memories: Psychotherapy and Sexual Hysteria) a theory that for a while enjoyed widespread credibility in the US. Crazy Like Us is not an academic analysis nor is it intended to be a comprehensive evaluation of the cultural relativism of mental illness.

Indeed Watters points out in fact that there are many books “much better” at tracing the tendrils of how specific conditions – for example self-harm or ADHD – have become entrenched in the public consciousness. One of its flaws is a slight tendency towards melodrama.

Words like ‘contagion’ and ‘virus’ are used liberally to describe the spread of ideas it identifies.

But the book was written to have popular appeal and to provoke a reaction (it has received considerable attention in the US from The Daily Show to The New York Times) and Watters accepts that there is plenty about it that professionals, academics and others interested in mental health may take umbrage with.

Indeed he admits toward the end of it that his wife (a psychiatrist) was worried that mental health professionals “who are doing their best to heal troubled minds” would feel unfairly disparaged by his theories.

Either way, Crazy Like Us is about as accessible as a book of this kind of scope gets and is worthy of debate. “I tried to make the book as smart as I could make it,” Watters says when asked if it might be a tad too ambitious. “I never once intentionally left an idea out that I thought was relevant. It’s as good a product as I could make.” l

ONE in FOUR 23

Cover Story Illustration by Martin Parker

What does recovery mean?

We all think we know what recovery is and what it would look like, but do we?

Seaneen Molloy explores We are told that recovery from mental health difficulty is possible – probable, even. The people we are exhorted to admire, from Stephen Fry to Ruby Wax, are people who

24 ONE in FOUR

have recovered from mental illness.

“Look!” they seem to say (and by they I mean everybody; from the medical profession to mental health charities). “Their lives are great now!

Yours can be too! You can recover!”

Recovery. It’s the buzzword. I believe recovery is possible, too. But what does recovery actually mean?

That is a question I have been exploring in my own life.

Recovery isn’t just about symptoms Almost five years ago, when I was first diagnosed with bipolar disorder, I remember the doctor giving me a reading list. It was filled with inspirational memoirs whose dust jackets were emblazoned with the smiling healthy faces of their authors. I understood that he was trying to encourage me. However, at that time, I simply could not conceive living a normal life ever again. It felt less like an incentive and more like “Look what you could have won!” My illness had devoured my life and everything in it, from the inside out.

When people spoke to me of recovery, I struggled to understand what they meant. I had heard of clinical recovery; getting rid of the symptoms of a particular mental illness. As some mental health difficulties such as bipolar disorder, depression and schizophrenia can be episodic and recurrent; the statistics can make for grim reading.

When recovery is judged upon the clinical definition of freedom from symptoms, around 60% of people with schizophrenia had a mediumpoor outlook. Bipolar disorder fares better, however, with 40% of people who have been hospitalised for mania experiencing another episode within two years. I had certainly expected too much from clinical treatment. I thought the second I took medication, I would be cured. Pop! All gone.

A journey not a destination Social workers and mental health nurses expressed the idea of recovery differently. Throughout my time with them, the focus was on helping me do more with my life.

Like charities such as Mind they espoused the recovery model (see box), which promotes the view that to recover from a period of mental illness one must step out of the sick role, to make goals and empower yourself to live a meaningful life. It is a journey, not a destination.

Developed by mental health service users, this to me at the time smacked of “will to power”, and the idea that you could get better if you really wanted to. It still does sometimes. Such a mantra can be downright dangerous. There are people who are incredibly unwell, who relapse often, and who do not have a home or support. They cannot become well by wishing alone.

And what is a meaningful life and who judges? Meaning could be

a nine-to-five job and a home, or, it could be creative endeavours. Even the experience of mental health difficulty can be itself meaningful.

As far as the recovery model goes, I was lucky. Thanks to the support I did receive, I gained the things that the model proposes as core elements. While I claimed benefits I had somewhere to live and enough to live on. I had supportive relationships in the form of my partner, family, friends, social worker and the mental health blogosphere. I had, by being involved with charities and with writing in some way, a feeling of empowerment and of purpose. I learned ways to cope and I took medication. Hope – and my sense of self, damaged by the ravages of illness – took longer to find.

What is recovery?

Recovery has two meanings in mental health. The first is clinical recovery, which is being free from any symptoms and being able to get on with life much as you did before you became unwell. While this happens for some people, it's not a common experience for many people with mental health difficulties.

The second is personal recovery. This is finding a meaningful and satisfying life after a period of mental health difficulty, whether you are still experiencing symptoms or not. It was developed by people who had experienced mental health difficulty as an answer to the clinical recovery model.

Definitions of this form of recovery differ but most agree on the following four components: • • • •

finding and maintaining hope the re-establishment of a positive identity finding meaning in life taking responsibility for one’s life

This form of recovery is not about returning ‘to normal’ after a period of being unwell but finding new ways of being and living that take into the fact that your experiences might have changed you and how you feel about life.

The first and most important aspect of this form of recovery is hope.

Without hope, nothing else works. The next is finding an identity for yourself that isn’t just as an ‘ill person’. This goes hand in hand with finding meaningful ways to use your time, taking responsibility for the things that happen to you in life and making decisions for yourself.

The whole idea behind this kind of recovery is that you should be aiming to have the best life you can have, defined by you, not medical professionals or other people.

Personal recovery is not without its critics. Some see it as reducing the responsibility of services to provide help, support and treatment. Generally personal recovery is seen as a more realistic way of measuring your progress. It is seen as more positive than the more impersonal and, for many, impossible to achieve clinical recovery from mental health difficulty.

ONE in FOUR 25

Being boring When I began treatment, I thought that thereafter I would be – if not cured – then at the very least able to live a life where I could forget I had a mental health difficulty. That hasn’t happened. Recovery, for me, has entailed focusing my efforts almost entirely upon the fact I do have a mental health difficulty and finding ways of getting on with it.

This has its own challenges.

If the recovery model encourages patients to step out of the role of ‘being ill’, then what do they have to gain from constant awareness that they have an illness? Immersion in the identity of somebody with a mental health condition was a necessary part of my journey. I no longer define myself as ‘mad’ or ‘mentally ill’, but I can never get back to the person that I was before – she doesn’t exist anymore. That in itself was hard to accept. I had to change my lifestyle.

I started small. I bought a chalkboard and wrote five things a day I had to do, no matter what. Brush teeth.

Wash my face. I took on an evening class.

It’s not a way of life I’m used to. I became unwell as a teenager, and I’m now in my mid-twenties. I’m now the world’s most boring person.

I’ve discovered – through the admittedly risky process of trial and error – that maintaining some sort of sleeping schedule is the crux of managing my illness. If I sleep too much, I tend to become depressed, too little, and my mood escalates. My natural predisposition is towards wakefulness, so I take medication to sleep.

One late night destabilises me, so I’m not a party animal. I tend to avoid alcohol when I can. I have to reduce stress in my life as much as possible because it makes me unwell. I know I

26 ONE in FOUR

“I consider myself someone who has recovered from a mental health difficulty. I don’t mean that I no longer have one.”

can’t avoid stress completely, but my ways of dealing with it have to be, well, boring once again.

Not the same as when I began Illness can linger in unexpected ways. In my case, my concentration seems to be permanently affected. I have not read an entire book in over four years. I’m currently studying and I need to record my lectures because I simply cannot focus long enough to take them in.

I write with more difficulty, which saddens me greatly as it was one thing I found easy most of the time.

I am a much shyer, more reclusive person that I had believed myself to be. In some ways hypomania (an ‘up stage’ in bipolar depression where you feel full of energy, positivity and sociability) and depression took care of my socialising for me. Without those moods, or without them to the same degree of intensity, I find socialising difficult. My relationships were damaged in the process of my condition.

Now I find myself in the hinterlands of the mental health community. I don’t particularly align myself with the survivor network, but nor do I feel at home with those who are still experiencing the more severe aspects of mental illness. Nor am I someone who wants to dismiss or deny my mental health difficulties.

I’m the one at the other table, nursing a diet coke, feeling unable to join in with either conversation.

I consider myself someone who has recovered from a mental health difficulty. I don’t mean that I no longer have one. I do. I still have some symptoms of a mood disorder, and I still have to manage living with one. These days, I can just do more with my life than I could when I was very unwell.

I’m currently job hunting and have applied to what feels like a thousand universities. In some ways I feel as though I have been asleep for half a decade. In others, I feel refreshed after my nap. So this is my recovery. However it’s defined. l

Review Excerpt From 32 nd Session PAT, I’VE HAD SUCH A STRANGE DREAM AND JUST LIKE SOMETIMES I DON’T KNOW WHY A DREAM FEELS BAD – I DON’T KNOW WHY THIS ONE FEELS SO GOOD.

HI JAMES.

D’YOU WANT TO TELL IT TO ME?

More than just funnies Couch Fiction: A Graphic Tale of Psychotherapy Philippa Perry with artwork by Junko Graat 152 pp Palgrave Macmillan, 2010 ISBN: 978-0230252035 Psychiatric Tales Darryl Cunningham 120 pp Blank Slate Books, 2010 ISBN: 978-1906653088 Depresso or: How I Learned to Stop Worrying and Embrace Being Bonkers!

Brick 264 pp Knockabout, 2010 ISBN: 978-0861661701

Comics: Something for kids, you might think, and certainly nothing that might be good for your mental health apart from providing an escape into a world full of speech bubbles and ‘Pow!’ and ‘Zap!’ Not so, says Mark Brown When you hear the word ‘comics’ the chances are you’ll think back to Saturday mornings spent hungrily consuming the latests adventures of super heroes or the latest antics of children with odd shaped heads causing mayhem in three colour streets.

Or at least you might do if you haven’t looked at any comics since you were still young enough get to get pocket money. In fact, the last year has seen the publication of three graphic novels or books of comic strips that will be of interest to anyone with even a passing interest in mental health. It seems that comics might actually be the perfect medium to explore mental health.

2010 saw the UK publication of Couch Fiction: A Graphic tale of Psychotherapy by Philippa Perry and Junko Graat. It’s the story of one psychotherapeutic relationship. Pat is a psychotherapist. James is an ambitious barrister who wants to overcome his guilty habit of stealing.

ONE in FOUR 27

James comes to see Pat and together they work on finding a way to overcome his difficulties. Told in large uncluttered panels, we get to see not only what is being said, but also what both Pat and James are thinking. We get to watch, session by session, the interaction between the two of them and the way that James makes sense of Pat’s suggestions as a therapist and the way that Pat’s training as a therapist makes her think in response to what Pat says.

This on its own is a wonderful insight into the way that psychotherapy works, but running

28 ONE in FOUR

along the bottom of each page is a commentary explaining exactly what techniques Pat was using and why, and raising questions and points about what is occurring.

What would have been incredibly complicated to represent in normal prose, and incredibly irritating and drawn-out to represent on film, becomes clear and accessible through the use of comics. Not only can we see what is being said and thought, we can also see the intricate interweaving of fantasy, memories and dreams that the therapy creates.

Darryl Cunningham’s Psychiatric Tales is very different. The style of drawing is simple, with sharp line work and large black and white panels. With very little text per page you’d think it would be difficult to do the job that the book sets itself: clearing away the misunderstandings that surround mental health. In fact, Psychiatric Tales packs an incredible amount of wisdom and insight into its deceptively simple pages. It’s possible to read it from cover to cover in half an hour, in which time you’ll pick up more about the experience of mental health difficulty than from hours and hours of training. Cunningham uses his own experiences as a psychiatric nurse and his own mental health difficulty to focus on people’s experience of conditions and situations. In many of the chapters, Cunningham appears as a bespectacled narrator guiding us through other people’s experiences, trying to understand what it’s like to be those people. Psychiatric Tales is a challenge to people who don’t think comics can convey important information and for anyone who thinks they can’t understand what mental health difficulties actually feel like.

Another 2010 publication was Depresso or: How I learned To Stop Worrying And Embrace Being Bonkers!

by Brick, formerly best known as a cartoonist producing cartoons for various political and humanitarian causes. It’s a ‘semi-fictional’ memoir of Brick’s own experience of depression and is easily one the

Two pages from Brick’s Depresso

most complete feeling memoirs of what it actually feels like to live with the condition. Depresso is a very different type of book to Couch Fiction. Where Couch Fiction is calm and measured, Depresso fizzes with ideas and information. Where Darryl Cunningham’s style is almost austere in Psychiatric Tales, Brick fills most of his pages with sly nods to other comics, to films and bits of pop culture, littering pages with caricatures or visual references.

Somehow, taken altogether with the story of how he found himself depressed and his journey to finding ways to get around it, this hyper-active cartoon world captures with great clarity the physical and mental symptoms of depression, especially that feeling of the world just being too full with things and meaning. Also brilliantly capturing the internal monologue of being depressed, the ‘voice’ of Brick’s depression is a great big sarcastic dragon that pops up at inopportune moments to get in the way. It’s easily one of the most detailed and most accessible depictions of depression published in a long time. l

One in Four managed to grab Psychiatric Tales creator Darryl Cunningham for a quick chat “A cartoonist is only limited by his or her imagination” Why do you think the comic is such a good medium to talk about mental health?

Comics are a really good way of presenting complex information quickly.

Often by the time you've decided to not read a comic, you’ve read half of it.

It's a medium that creeps in under the radar and delivers its information almost effortlessly, straight into the subconscious. The power of words and pictures together make comics the cinema of the printed page. It is a medium that can do anything film or literature can do, and not only that, but the sets are much cheaper. A cartoonist is only limited by his or her imagination.

What sort of responses have you had to Psychiatric Tales?

Very positive from both people suffering various illnesses and from those working in mental health. I have a comic strip running in the March issue of the Student British Medical Journal, and you can't get much more establishment than the BMJ. Have you got any other mental health comics coming up?

Originally Psychiatric Tales was meant to be a bigger book, but as is often the way with these things, I ran out of time. I am planning a second volume, which will go on to cover subjects like substance abuse and Obsessive Compulsive Disorder.

ONE in FOUR 29

Mythbusting

Doing something odd that's difficult for others to understand automatically means someone is ill Reality: Everyone seems odd to someone. It’s difficulties that matter Myth:

W

e are all familiar with headlines talking about public figures as being ‘mad’ for holding a certain belief or ‘potty’ for doing something that seems difficult to understand. Sometimes we talk about people with minority views being ‘batty’ or ‘insane’.

We might say about a friend or family member that they have ‘gone loopy’ because they have made as series of, what seem to us, odd choices. We might even accuse someone with whom we are debating of being ‘deranged’ or ‘deluded’.

What we’re doing when we do this, whether we realise it or not, is questioning the sanity of someone with whom we find it difficult to agree or whose motivations we find difficult to understand.

Much more seriously, when we read or hear about an atrocity or crime that seems to go completely against all of the things that we feel make us civilised, our first reaction can be to say that the person or people involved ‘must be wrong in the head’,’insane’ or ‘psychotic’.

Or if we do not, our newspapers and television broadcasts might.

It sometimes feels like we are culturally programmed to try to divide all of the people in the world into either sane or mad. This can often get in the way of talking about mental health.

Everyone is odd in their own way We live in diverse times in a diverse country. For all that we share in common with each other, we all have lives

30 ONE in FOUR

that are filled with points of difference. More than ever we are free to make choices about how we spend our time, who we spend time with, how we live our lives and what we believe in.

Some of those things we will share with lots of people and some we will share with few if any at all. What seems ordinary and commonplace to us might seem odd or even disturbing to someone else.

The fact that we do something that isn’t done by huge numbers of other people doesn't make us unwell or say anything about the state of our mental health. Nor does the fact that we may chose to do or think things that don’t seem to make sense to other people.

Being unwell because of your mental health is something else entirely.

What does it mean to be unwell because of your mental health?

Being unwell because of your mental health means that you are experiencing changes to your mood, your motivation, your thoughts or sensations that are causing you difficulties over a period of time. The measure of whether someone is unwell or not is the extent to which the things that are going on within them are getting in the way of them doing things that they want or need to do.

Sometimes these experiences might be difficult to understand, or might make you behave in ways that you wouldn’t normally. An example might be staying in bed all day. Experiencing depression can make it extremely

difficult to get up in the morning and can take away your ability to face what the day might bring. Staying in bed all day when you were meant to be doing something else that you have to do, like going to an important appointment, might mean that you are experiencing difficulties, especially if that keeps happening.

The question ‘what is normal?’

In itself, doing things that other people wouldn’t or don’t do is no evidence of anything. In fact, the debate about ‘what is normal?’ has got in the way of many people moving forwards with their mental health.

When people are talking about mental health, they often raise the issue of who has the right to judge what is normal. Mental health treatment and support should

not be a debate about whether something you do or feel is ‘normal’ but whether that something causes you problems.

Similarly, when we cannot understand the motivations of others we should avoid reasoning that they must have some sort of mental health difficulty.

We will often use the fact that someone has done something that seems incomprehensible, or which we couldn’t ever see ourselves doing, as the ‘evidence’ that they must be ill, especially if we find their actions shocking or frightening.

This doesn’t help anyone who is experiencing mental health difficulties because it perpetuates negative stereotypes, and it stops us from really trying to understand why people choose to do things that they do. l Mark Brown

What do we do now?

Mental health, user leadership and communities

A one -day confe rence prese nte One in d by Four

Monday 16th May, 2011 at the Education Centre, the University College London Hospitals , Euston, London

For people who want to work out where mental health fits into Big Society, find out how to get things done and bring about positive change for people with mental health difficulties.

Speakers will include people with mental health difficulties, campaigners, activists and others at the cutting edge of new developments in mental health.

The conference is designed for those who want to lead activism and change and for those who want to take part in it.

It will bring together people who use services, people who provide services and people who would like to provide services, whether professionals or not.

To register an interest in attending and to receive updates on the conference, please email: onference@socialspider.com

ONE in FOUR 31

Acknowledgements Contributors: Mary O'Hara, Linda Jones, Karen Machin, Seaneen Molloy, Maxine Frances Roper.

Photographs/Illustrations: Martin Parker.

Thanks go to: Wil Joseph, Pauline Edwards, Gregor and Ian, Willow Tomkins, all of our twitter followers and debaters.

One in Four advisory group: Steven Allen, Robert Ashton, Andy Bell, Naomi Garnett, Liz Gray, Catherine Grinyer, Katherine Hall, Mira Khreino, Andy Koumi, Simon Lawton-Smith, Claire Monger, Brigid Morris, Jonathan Naess, Liz Nightingale, Tracy Simpson, Georgina Wakefield.

Friends of One in Four: We thank the following who have generously supported this project by becoming a Friend of One in Four: Judith Haire, Open Up, Mary Heavin, Peter Barham, Alison Faulkner, Mental Health Providers Forum, Helen Rayner, Jeremy Foster.

How to get copies of One in Four: The publishers of One in Four want the magazine to be available free to anyone with mental health difficulties so we sell bulk subscriptions to organisations which can then give it to their members, service users etc. This could be, for example, your mental health trust, hospital or other clinical setting, public library or university counselling service. If they don’t have it available, ask them why!

Grant funding also enables us to distribute the magazine free in all the 110 Mind charity shops throughout England.

Organisations who want to order in bulk can use the form at the bottom of this page or download the form at www.oneinfourmag.org or simply phone us on 020 8521 7956.

We know that it can de difficult for many people to find a free copy of One in Four so in response to public demand we now sell individual subscriptions for £10 a year (four issues). You can also buy a gift subscription to One in Four for someone else for £10. You can get even better value by naming a friend to whom you would like to give a copy and it’s just £15 for the two of you for a year. We also sell bundles of back issues, while stocks last. For details of all these offers, see the advertisement on page 2.

For bulk orders of One in Four tear out this form and send it to: Stephen Gardiner, One in Four magazine, Social Spider CIC, 5 Hatherley Mews, London, E17 4QP I would like to order One in Four magazine for one year (four issues).

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32 ONE in FOUR

Directory Organisations that provide useful information Mind Mental health charity working to create a better life for everyone with experience of mental distress

Mind infoline – Monday to Friday 9.00am – 5.00pm Tel 0845 7660 163 Website www.mind.org.uk

British Association for Counselling and Psychotherapy (BACP) Publishes directories and other information to enable those seeking counselling and training to make an informed choice

Tel 01455 883316 Email bacp@bacp.co.uk Website www.bacp.co.uk

SANE Improving the lives of everyone affected by mental illness

British Association for Behavioural and Cognitive Psychotherapies (BABCP)

Helpline 0845 767 8000 Email info@sane.org.uk Email sanemail@sane.org.uk Website www.sane.org.uk

Publishes a directory of all its accredited Cognitive Behavioural Psychotherapists

NHS direct

Tel 0161 797 4484 Email babcp@babcp.com Website www.babcp.com

Provides no-nonsense health information

Relate

Website www.nhsdirect.nhs.uk

Charity providing counselling, sex therapy, relationship education and training to support couple and family relationships throughout life

Mental Health Foundation

Tel 0300 100 1234 Website www.relate.org.uk

Provides information, and carries out research and campaigns, working to improve services for anyone affected by mental health problems

PAPYRUS Prevention of Young Suicide

Tel 020 7803 1101 Email mhf@mhf.org.uk Website www.mentalhealth.org.uk

Provides support and practical advice to young people worried about themselves or their friends

Rethink

Helpline HOPELineUK 0800 068 41 41 Admin 01282 432555 Email admin@papyrus-uk.org Website www.papyrus-uk.org

Aims to help everyone affected by severe mental illness recover a better quality of life

Tel 0845 456 0455 Email info@rethink.org Website www.rethink.org National advice service Tel 020 7840 3188 (10am to 3pm Monday, Wednesday & Friday; 10am to 1pm Tuesday & Thursday) Email advice@rethink.org

Employers’ Forum on Disability (EFD) Enables companies to recruit and retain disabled employees and to serve disabled customers

Tel 020 7403 3020 Email enquiries@efd.org.uk Website www.efd.org.uk

Citizens Advice

MDF The BiPolar Organisation

Helps people resolve their legal, money and other problems by providing free information and advice

Helps people affected by bipolar disorder. Includes UK Self-help groups, information, advice and publications

Website www.citizensadvice.org.uk

Tel 08456 340 540 Email mdf@mdf.org.uk Website www.mdf.org.uk

Samaritans

Royal College of Psychiatrists

Provides confidential non-judgemental support, 24 hours a day for people experiencing feelings of distress or despair, including those which could lead to suicide

Produces information leaflets on a wide range of mental health difficulties and the available treatments

Tel 08457 90 90 90 Email jo@samaritans.org Website www.samaritans.org

Tel 020 7235 2351 Website www.rcpsych.ac.uk For leaflets or a free catalogue, tel 020 7235 2351 ext 259 or email leaflets@rcpsych.ac.uk

National Self Harm Network

Anxiety UK

Helps people who self-harm or injure

Offers advice, information and support as well as quick access to therapies for sufferers of phobias and anxiety-related conditions

Tel 020 8772 9900 Email nshncg@hotmail.co.uk Website www.nshn.co.uk

Helpline 08444 774 775 Website www.anxietyuk.org.uk

Consumer Credit Counselling Services

Mindful Employer

Provides confidential, free counselling & money management assistance

Provides employers with access to information and local support for staff experiencing mental ill health

Tel 0800 138 1111 8.00am – 8.00pm, Mon – Fri Website www.cccs.co.uk

Tel 01392 677064 Email info@mindfulemployer.net Website www.mindfulemployer.net

ONE in FOUR 33

Letters Can’t see forest for trees?

Imagine this. A newly-formed Government issues plans to change a much-loved national institution, not having previously mentioned it, and certainly not in their election manifesto.

Very quickly, there’s a huge outcry from people who say the proposals haven’t been thought through, and stem purely from the party’s ideology of privatisation. Petitions and marches take place up and down the country; even the Archbishop of Canterbury weighs in. The Government realises they’ve lost the argument, and backs down.

That’s what happens over the nation’s forests. So why hasn’t the same thing happened about the Coalition’s ill-advised and rushed health reforms? Are trees really more important than the NHS? Vince McGarry, London START LETTER: Vince wins two flower Growboxes

Write to: One In Four letters Social Spider, 5 Hatherley Mews, London, E17 4QP editor@oneinfourmag.org Please supply a postal address and an email address if you have one. We will not publish these details unless you ask us to. We may edit letters.

The best letter will receive a year's subscription to One in Four.

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Now we are 3 Doing things for ourselves, friends, newspapers and more!

34 ONE in FOUR

Enter our prize draw by filling in the questionaire opposite and returning it to One in Four to win one of three one subscriptions to One in Four.

Alternatively, go to www.oneinfourmag.org and complete the questionnaire online for a chance to win.

Competition Tell us what you think of One in Four and win!

Fill in the questionnaire below, cut it out and return it by 9th May 2011 to: Feedback, One in Four magazine, Social Spider CIC, 5 Hatherley Mews, London, E17 4QP. If you prefer, you can also answer online at www.oneinfourmag.org First two entries selected at random on 12th May 2011 will be winners.

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* From 60 responses to the survey of readers of Issue 1 of OneinFour