Bulimia nervosa prt 2

Diagnosis

If your primary care provider suspects you have bulimia, he or she will typically:

  • Talk to you about your eating habits, weight-loss methods and physical symptoms
  • Do a physical exam
  • Request blood and urine tests
  • Request a test that can identify problems with your heart (electrocardiogram)
  • Perform a psychological evaluation, including a discussion of your attitude toward your body and weight
  • Use the criteria for bulimia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Your primary care provider may also request additional tests to help pinpoint a diagnosis, rule out medical causes for weight changes and check for any related complications.

Treatment

When you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder.

Treatment generally involves a team approach that includes you, your family, your primary care provider, a mental health professional and a dietitian experienced in treating eating disorders. You may have a case manager to coordinate your care.

Here’s a look at bulimia treatment options and considerations.

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling, involves discussing your bulimia and related issues with a mental health professional. Evidence indicates that these types of psychotherapy help improve symptoms of bulimia:

  • Cognitive behavioral therapy to help you normalize your eating patterns and identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
  • Family-based treatment to help parents intervene to stop their teenager’s unhealthy eating behaviors, to help the teen regain control over his or her eating, and to help the family deal with problems that bulimia can have on the teen’s development and the family
  • Interpersonal psychotherapy, which addresses difficulties in your close relationships, helping to improve your communication and problem-solving skills

Ask your mental health professional which psychotherapy he or she will use and what evidence exists that shows it’s beneficial in treating bulimia.

Medications

Antidepressants may help reduce the symptoms of bulimia when used along with psychotherapy. The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may help even if you’re not depressed.

Nutrition education

Dietitians can design an eating plan to help you achieve healthy eating habits to avoid hunger and cravings and to provide good nutrition. Eating regularly and not restricting your food intake is important in overcoming bulimia.

Hospitalization

Bulimia can usually be treated outside of the hospital. But if symptoms are severe, with serious health complications, you may need treatment in a hospital. Some eating disorder programs may offer day treatment rather than inpatient hospitalization.

Treatment challenges in bulimia

Although most people with bulimia do recover, some find that symptoms don’t go away entirely. Periods of bingeing and purging may come and go through the years, depending on your life circumstances, such as recurrence during times of high stress.

If you find yourself back in the binge-purge cycle, follow-up sessions with your primary care provider, dietitian and/or mental health professional may Dechelp you weather the crisis before your eating disorder spirals out of control again. Learning positive ways to cope, creating healthy relationships and managing stress can help prevent a relapse.

If you’ve had an eating disorder in the past and you notice your symptoms returning, seek help from your medical team immediately.

Lifestyle and home remedies

In addition to professional treatment, follow these self-care tips:

  • Stick to your treatment plan. Don’t skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable.
  • Learn about bulimia. Education about your condition can empower you and motivate you to stick to your treatment plan.
  • Get the right nutrition. If you aren’t eating well or you’re frequently purging, it’s likely your body isn’t getting all of the nutrients it needs. Talk to your primary care provider or dietitian about appropriate vitamin and mineral supplements. However, getting most of your vitamins and minerals from food is typically recommended.
  • Stay in touch. Don’t isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart and that nurturing, caring relationships are healthy for you.
  • Be kind to yourself. Resist urges to weigh yourself or check yourself in the mirror frequently. These may do nothing but fuel your drive to maintain unhealthy habits.
  • Be cautious with exercise. Talk to your primary care provider about what kind of physical activity, if any, is appropriate for you, especially if you exercise excessively to burn off post-binge calories.

Alternative medicine

Dietary supplements and herbal products designed to suppress the appetite or aid in weight loss may be abused by people with eating disorders. Weight-loss supplements or herbs can have serious side effects and dangerously interact with other medications.

Weight-loss and other dietary supplements don’t need approval by the Food and Drug Administration (FDA) to go on the market. And natural doesn’t always mean safe. If you choose to use dietary supplements or herbs, discuss the potential risks with your primary care provider.

Coping and support

You may find it difficult to cope with bulimia when you’re hit with mixed messages by the media, culture, coaches, family, and maybe your own friends or peers. So how do you cope with a disease that can be deadly when you’re also getting messages that being thin is a sign of success?

  • Remind yourself what a healthy weight is for your body.
  • Resist the urge to diet or skip meals, which can trigger binge eating.
  • Don’t visit websites that advocate or glorify eating disorders.
  • Identify troublesome situations that trigger thoughts or behaviors that may contribute to your bulimia, and develop a plan to deal with them.
  • Have a plan in place to cope with the emotional distress of setbacks.
  • Look for positive role models who can help boost your self-esteem.
  • Find pleasurable activities and hobbies that can help distract you from thoughts about bingeing and purging.
  • Build up your self-esteem by forgiving yourself, focusing on the positive, and giving yourself credit and encouragement.

Get support

If you have bulimia, you and your family may find support groups helpful for encouragement, hope and advice on coping. Group members can truly understand what you’re going through because they’ve been there. Ask your doctor if he or she knows of a group in your area.

Coping advice for parents

If you’re the parent of someone with bulimia, you may blame yourself for your child’s eating disorder. But eating disorders have many causes, and parenting style is not considered a cause. It’s best to focus on how you can help your child now.

Here are some suggestions:

  • Ask your child what you can do to help. For example, ask if your teenager would like you to plan family activities after meals to reduce the temptation to purge.
  • Listen. Allow your child to express feelings.
  • Schedule regular family mealtimes. Eating at routine times is important to help reduce binge eating.
  • Let your teenager know any concerns you have. But do this without placing blame.

Remember that eating disorders affect the whole family, and you need to take care of yourself, too. If you feel that you aren’t coping well with your teen’s bulimia, you might benefit from professional counseling. Or ask your child’s primary care provider about support groups for parents of children with eating disorders.

Preparing for your appointment

Here’s some information to help you get ready for your appointment, and what to expect from your health care team. Ask a family member or friend to go with you, if possible, to help you remember key points and give a fuller picture of the situation.

What you can do

Before your appointment, make a list of:

  • Your symptoms, even those that may seem unrelated to the reason for your appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, vitamins, herbal products, over-the-counter medications or other supplements you’re taking, and their dosages
  • Questions to ask your doctor, so you can make the most of your time together

Some questions to ask your primary care provider or mental health professional include:

  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available, and which do you recommend?
  • Is there a generic alternative to the medicine you’re prescribing for me?
  • How will treatment affect my weight?
  • Are there any brochures or other printed material I can have? What websites do you recommend?

Don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your primary care provider or mental health professional will likely ask you a number of questions. He or she may ask:

  • How long have you been worried about your weight?
  • Do you think about food often?
  • Do you ever eat in secret?
  • Have you ever vomited because you were uncomfortably full?
  • Have you ever taken medications for weight loss?
  • Do you exercise? If so, how often?
  • Have you found any other ways to lose weight?
  • Are you having any physical symptoms?
  • Have any of your family members ever had symptoms of an eating disorder, or have any been diagnosed with an eating disorder?

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.

Mask anxiety, face coverings and mental health

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Explains why masks can cause difficult feelings, and gives practical tips on how to cope. Includes information on exemptions for mental health reasons.

What is the law about masks?

The UK and Welsh Governments are making it compulsory for people to wear masks or face coverings in certain places, like on public transport. But the exact places and dates are slightly different in England and Wales. 

Why masks can cause difficult feelings

We all want to help stop the spread of coronavirus. And we know it isn’t easy. It means making big changes in our lives, like following social distancing guidelines, and now wearing masks.

But masks are not straightforward for everyone. Some of us may find covering our face very hard, or even impossible to cope with. And for those of us with existing mental health problems, masks may pose extra challenges.

For example:

  • Covering your mouth and nose might affect the air you breathe, which might make you feel anxious or panicky. This can then cause other symptoms as well, like feeling dizzy or sick, which you might associate with the mask.
  • You might feel trapped or claustrophobic.
  • Covering your face changes the way you look, which may cause negative feelings around your identity or body image.
  • Having certain materials touching your skin might feel very hard to cope with (sensory overload).
  • If you wear glasses, they might get steamed up so you can’t see clearly. This might add to feelings of being claustrophobic
  • Masks are a visual reminder of the virus, so seeing masks might make you feel on edge or unable to relax. It might seem like danger is everywhere.
  • Seeing people covering their faces might make you feel uneasy or scared of others. They might seem threatening, sinister, or dehumanised.
  • On the other hand, you might feel very anxious or upset around people who are not wearing masks in public. (Although many people are exempt from wearing them, and you won’t always know their reasons.)
  • If you are exempt from wearing a mask, you still might feel very anxious about being judged, shamed or stigmatised in public. Or about the possibility of being asked to pay a fine. This may feel especially hard to cope with if the reason you can’t wear a mask is also to do with your mental health.

Do I have to wear a mask?

If you feel able to wear a mask or face covering, then you must.

But there are some exceptions. The Government says you do not have to wear a mask if you have a ‘reasonable excuse’ not to. 

The exact guidance on how this applies to mental health conditions is written differently for England and Wales. And it’s being updated quite often. But in practice the meaning is similar.

In both nations, reasonable excuses to do with mental health include:

  • If you’re not able to put on, wear or remove a face covering, because of a physical or mental illness or impairment, or disability.
  • If it’s essential to eat, drink or take medication.

In England, the guidance also specifies that a reasonable excuse would be:

  • If putting on, wearing or removing a face covering will cause you severe distress.

(There are other exemptions besides these. You can find the full list of exceptions in England on the UK Government website, and the full list of exceptions in Wales on the Welsh Government website.)

What counts as ‘mental impairment’ or ‘severe distress’?

There is no clear-cut definition of ‘mental impairment’ or ‘severe distress’ in the mask regulations. These terms may cover a lot of different experiences.

For example, you might feel severely distressed or impaired if wearing a mask triggers acute symptoms of a mental health condition, like:

But even if you don’t have an existing mental health diagnosis, you might still feel overwhelmingly anxious, distressed or unwell when wearing a mask.

It can be difficult to judge if you feel unwell ‘enough’ to be excused from wearing a mask. But remember: you are the expert on your own experience.

  • If you’re not sure, look for a way to make covering your face feel more bearable. Try some of our tips for coping with masks and face coverings, and see if they help. You might be able to lessen your symptoms, so you feel less unwell.
  • If you’ve tried everything and nothing helps, you might decide you do have a reasonable excuse for not wearing a mask. That’s ok.
  • It might change. For example, you might have better or worse days, times or places. So you might feel exempt sometimes, but not all the time. That’s ok too. Use your face covering as much as you are able.

How do I prove I have a reasonable excuse?

You don’t need to. There’s no legal document or proof that you need to carry on you.

If you’re challenged about not wearing a mask:

  • You could tell the person: “I’m exempt for health reasons”, or “I have a good reason that you can’t see. Please be kind”.
  • Or you could write down your reason to show people, on a piece of paper or on your phone.
  • Various organisations have created optional exemption cards and badges that you can display. You do not need to buy or apply for one, and you do not need to carry or show one. But you may find having something like this to hand makes you feel more comfortable. It’s your choice. (You can find exemption cards to print or download on the UK Government website).

The Welsh Government is advising you to carry evidence of your condition if possible in Wales, but you do not have to.

Unfortunately, you might find that not everyone understands, or is supportive. This can be really hard to cope with. But you’re not alone. It might help to think about extra self-care ideas, to help look after yourself.

Tips for coping with masks and face coverings

You might not ever feel totally comfortable with masks. But there are lots of things you could try to help make the experience easier for you.

Anxiety, panic and breathing issues

If wearing a mask makes you feel panicky or like it’s harder to breathe:

  • Get some fresh air outside before and after you wear your mask.
  • Do something to relax you before and after you wear a mask. For example, you might do a short breathing exercise. (We have some tips on relaxation exercises).
  • Choose a face covering that hangs down your neck, rather than fitting around your jaw. This type of covering is called a ‘neck gaiter’. It might feel more breezy.
  • Keep your body as cool as possible. For example, by wearing loose-fitting clothes or sitting by an open window on the bus.
  • Add a comforting scent to your face covering. This might be a few drops of lavender oil, your own perfume or aftershave, or a smell that reminds you of someone else.
  • Reduce the time you spend having to wear your mask. For example, by planning your shopping in advance to help you keep browsing time down in shops.

Physical discomfort

If wearing a particular material creates sensory overload:

  • Experiment with different fabric types. You could try making a face covering from an old t-shirt that doesn’t bother you to touch. You can search for mask-making tutorials online. The Government also has some information on how to make your own mask.
  • Experiment with different ways to secure your mask. Some fit round the ears, some tie behind your head. You could try attaching buttons to a hat or hairband, so the mask does’t irritate your skin.
  • Choose another type of face covering that doesn’t touch your face in the same way, like a neck gaiter.

If wearing a mask steams up your glasses and makes it hard to see:

  • Wash your glasses with soapy water, and polish them with a tissue. A thin layer of soapy film may make it harder for the lenses to steam up.
  • Sit your glasses on top of the fabric by raising the top of your mask up onto your nose.
  • Line your mask with a tissue so it absorbs some of the moisture.

Body and identity issues

If covering a part of your face makes you feel uncomfortable in your identity or body image:

  • Think of your mask as a fashion accessory. Search for a mask or face covering with a design or pattern that expresses who you are. You could use a scarf or bandana. Or try to find a selection of colours that you can match in with your outfits.
  • Choose a transparent mask or see-through face covering, so it doesn’t obscure your face.

Anxiety around other people wearing masks

If seeing other people in masks make you feel uneasy or afraid:

  • Shift your focus away from someone’s face when communicating with them. Try switching the way your body is facing so that you’re side-by-side with the person you’re talking to, and both looking in the same direction.
  • Try to pay extra attention to your non-human surroundings. This might be trees, traffic, shop window displays, or the sounds and smells you notice. It may not be possible to avoid looking at people entirely. But by balancing it with other things that feel more usual, you might feel more calm.
  • Take a distraction out with you. For example, listen to music or podcasts through headphones, or call to someone you enjoy chatting to.
  • If someone you have to see often (like a friend or housemate) wears a mask that you find very scary, you could try gently letting them know how you feel. They might be able to change it or cover it up in your presence, to help you.

Being supportive to others

There are many ways we can be supportive to people who might be struggling with masks.

  • Don’t judge people who are not wearing masks. Don’t assume that someone not wearing a mask is ‘just being selfish’. Many people are exempt from wearing masks, and it might not be immediately obvious why.
  • Acknowledge people. You could say a friendly ‘hello’ or ‘good morning’ as you pass them, or wave your hand.
  • Communicate in other ways. Try using your voice, eyes, hands and body language to compensate for what you aren’t able to show through smiles or other facial expressions.
  • If you see someone regularly who is uncomfortable with masks on other people, ask them what would help. For example, you might be able to get a transparent mask to wear with them.
  • If you work in a place where masks are compulsory, make sure you fully understand the exemption rules. If someone tells you they are exempt, accept their word for it.

What does a Mental Health Nurse do?

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In this very insightful piece, find out what it takes to be a Mental Health Nurse and what you can expect from your role as one.

1 in 4 of us will experience a mental health difficulty at some point in our lifetime.

Whether that be feelings of anxiety or depression or experiencing low mood and emotional difficulties it is now widely accepted that mental illness is very common.

Nurses who specialise in supporting people with mental health issues are called Registered Mental Health Nurses or RMNs.

There are nearly 290,000 nurses registered with the Nursing and Midwifery Council (NMC) in England and 12% (34,000) of those are Registered Mental Health Nurses.

A similar percentage of the nursing profession are RMNs in Scotland and Wales.

There continues to be widely published concerns regarding the reduction of RMNs with recent media reports suggesting 2000 mental health staff are leaving their roles a month.

Working as an RMN it is impossible to ignore the impact of this reduction on our profession and the people we work with, yet it is still a highly rewarding and diverse career.

I have worked in a range of mental health settings for 17 years and have been an RMN for the last 12 years.

Throughout this article, I will outline how to become an RMN, what career pathways are open to you and consider how the changing landscape of modern-day healthcare may affect mental health nursing.

What does a typical day look like for a Mental Health Nurse?

The attraction for many who work as Mental Health Nurses is that no two days are ever the same.

Mental Health Nurses work in a vast array of inpatient and community settings, medical centres, schools, prisons, undertaking research or universities.

Mental Health Nurses work with individuals across the lifespan from specialist perinatal services, child and adolescent, working-age individuals, older adults and later life dementia care.

Some days will be structured with arranged appointments, others will be responding to emergencies and very much thinking on your feet!

The setting that you work in will, to a degree, provide variances in the role of a Mental Health Nurse.

A nurse working in the community may work in a more autonomous way than those who work in inpatient settings and once qualified the career as a Mental Health Nurse has the potential to be incredibly varied.

Across the UK there is a range of mental health services offered in the community.

Divided into Primary, Secondary and Specialist services there may be geographical variances in the way teams work, however, the core skills for a Mental Health Nurse remain the same.

Within Primary Care, Mental Health Nurses will receive referrals from GPs and A&E departments.

Following assessments, nurses will offer short-term interventions which may include anxiety management, support with depressed mood, advise on possible medications and work with a range of common mental health issues.

As a nurse, you will spend 1:1 time with individuals for a set, short period of time, 10-12 weeks for example. If a person requires longer-term support, you may refer them to Secondary Mental Health Services.

Mental Health Nurses working in secondary community services will work with people who have more complex or serious chronic mental health difficulties.

They may have been in a hospital or be diagnosed with an illness such as schizophrenia, mood disorders (serious depression or Bi-Polar Affective Disorder) or post-traumatic stress disorder.

As a Mental Health Nurse, you will carry a caseload of between 20-30 individuals and be responsible for coordinating their package of care whilst they are in the community.

You will build relationships with the people you support in order to monitor their mental health, watch for relapse signs, know what potential triggers they experience and support them to engage in meaningful activities.

By knowing the people you work with, you will be able to assess their ongoing mental health and adjust the input you offer them accordingly.

Some of the people you work with may be going through a crisis for example and you will increase your sessions, suggest adjustments in medications or arrange meetings with psychiatrists, psychologists or family members.

As a Community Mental Health Nurse, you will have received training in the Mental Health Act 1983, which is the legal framework for those who require admission to hospital.

Working in the community you may have to arrange assessments under the Mental Health Act in order to admit people to hospital.

Working in the community means you will often manage your own time and daily tasks.

You will support people to engage with other agencies and you will build close links with housing support, 3rd sector organisations, social services, education, and GPs.

Many areas of the UK have specialist community teams including memory clinics for those with dementia, assertive outreach services for difficult to engage patients, early intervention in psychosis services, crisis teams, mental health for the homeless, community forensic teams, police street triage and many more.

As you move through your training and career it is likely you develop an interest in a particular field of mental health.

Whether you work in the community or an inpatient unit will depend on your personal preference and local opportunities.

The national strategy for mental health, The Five Year Forward View published in 2016 places emphasis on preventive and early intervention for mental health issues with funding now focused on community services.

With a reduction in hospital beds, inpatient mental health units now admit people who are in acute stages of serious mental illness, with a high percentage being detained legally under the Mental Health Act 1983.

As a Mental Health Nurse working in an inpatient unit, you will work as part of a ward team to deliver care and treatment to those in crisis.

Inpatient settings often mirror services within the community, with child and adolescent units, working-age acute mental health wards, specialist dementia wards and Psychiatric Intensive Care Units.

There are also national units for psychosis, eating disorders, mood disorders and therapeutic communities for those with personality disorders and emotional difficulties.

There are longer-term inpatient settings for patients involved in the criminal justice system (forensic mental health) and rehabilitation units where people can stay for up to two years.

Historically, Mental Health Nurses would always begin their careers working in hospitals.

The skills you develop working in acute wards are transferable to all settings and help nurses build confidence and knowledge.

You will be required to assess people admitted to the ward and develop plans of support accordingly.

You will work closely with Psychiatrists and other professionals to establish pathways for individuals and maintain a therapeutic environment on the ward through group work, 1:1 time and facilitating time off the ward.

What kind of person and soft skills make a good Mental Health Nurse?

Working in mental health requires a level of emotional resilience and self-awareness.

As nurses, we walk alongside individuals in their darkest and scariest times.

Often people’s behaviour can be difficult to understand or explain and can cause distress.

Mental Health Nurses try and help individuals find meaning and understanding of their experiences and build coping mechanisms to prevent further relapses.

You will need compassion and empathy, qualities which you may have developed from your own experiences in life.

Although not always the case, many Mental Health Nurses have gone through experiences which have motivated them to want to support others.

Human beings are fragile and as a Mental Health Nurse, there will be a recognition that anyone at any time can be susceptible to vulnerability and mental illness.

Listening is a skill, we can all sit and have a conversation, but to actively listen to another person requires patience, a non-judgmental attitude and the ability to put our own minds and thoughts out of the way.

As a Mental Health Nurse, you will receive on-going supervision in order to support you developing these skills and help you make sense of your own mind and lives so that you can support others.

What hard skills and qualifications are required to become a Mental Health Nurse?

Alongside the soft skills required to be a Mental Health Nurse, which can often seem intangible, there are specific qualifications and quantifiable skills needed.

Nurse education has changed substantially over the last decade, with a move to university degree courses.

Undergraduate Mental health Nursing degrees are offered at most universities across the country with applications via UCAS.

You will usually need A Levels or complete an access course.

Previous experience in a healthcare setting is an advantage so it is always beneficial to work as a Support Worker or Health Care Assistant prior to applying if possible.

Mental Health Nursing degrees are three years long and are split between academic modules at university and practice placements in a variety of community and inpatient settings.

The first year of any nursing degree is a common foundation program (CFP) which all nurses do no matter what the speciality.

The final two years will be solely mental health and you will learn about mental illness theories, practical assessment skills, pharmacology, physical health and treatment approaches.

Whilst on placement you will be supernumerary, meaning you won’t be counted as part of the nursing numbers.

This gives you an opportunity to develop your interpersonal skills, write care plans, use assessment frameworks and learn how to document all interactions professionally.

The experiential learning which occurs whilst on practice placements is invaluable and as the course progresses you will discover which area of mental health interests you and help you build an idea of the career ahead of you.

You will have a combination of academic essays to complete alongside practice portfolios which match your placement skills with the Nursing and Midwifery Council competencies.

The Nursing and Midwifery Council (NMC) are our professional body and once you have completed and passed your degree you will join the NMC professional register.

Once on the register, you will receive a unique pin number, allowing you to legally work as a Mental Health Nurse.

Keeping your nursing registration up to date Mental Health Nursing is a journey of lifelong learning.

It is both a professional and personal responsibility to keep up to date with the ever-changing evidence base in nursing practice.

You will be required to pay a registration fee yearly to the NMC and you will be asked to provide evidence of continuing professional development (CPD) every three years when you revalidate.

CPD can be the range of essential training your employer requires such as intermediate life support, moving and handling, health and safety, infection control and information governance training.

It is a good idea to keep your own records of any training completed so you can provide evidence to the NMC if requested.

As a Mental Health Nurse, you can develop more specialist advanced assessment skills, undertake courses in the Mental health Act 1983, specific treatment approaches such as cognitive behavioural therapy or dialectical behavioural therapy or return to university to undertake a Masters or PhD.

Becoming a registered mental health nurse or RMN is often just the beginning.

It is an excellent qualification to have and often provides the foundation for many other career pathways.

Many Mental Health Nurses undertake further training to become therapists, teachers, lecturers, managers or researchers.

Stress

Stress can be defined as the degree to which you feel overwhelmed or unable to cope as a result of pressures that are unmanageable. 

What is stress?

At the most basic level, stress is our body’s response to pressures from a situation or life event. What contributes to stress can vary hugely from person to person and differs according to our social and economic circumstances, the environment we live in and our genetic makeup. Some common features of things that can make us feel stress include experiencing something new or unexpected, something that threatens your feeling of self, or feeling you have little control over a situation.1  

When we encounter stress, our body is stimulated to produce stress hormones that trigger a ‘flight or fight’ response and activate our immune system 2. This response helps us to respond quickly to dangerous situations.

Sometimes, this stress response can be an appropriate, or even beneficial reaction. The resulting feeling of ‘pressure’ can help us to push through situations that can be nerve-wracking or intense, like running a marathon, or giving a speech to a large crowd. We can quickly return to a resting state without any negative effects on our health if what is stressing us is short-lived 3, and many people are able to deal with a certain level of stress without any lasting effects. 

However, there can be times when stress becomes excessive and too much to deal with. If our stress response is activated repeatedly, or it persists over time, the effects can result in wear and tear on the body and can cause us to feel permanently in a state of ‘fight or flight’ . Rather than helping us push through, this pressure can make us feel overwhelmed or unable to cope. 

Feeling this overwhelming stress for a long period of time is often called chronic, or long-term stress, and it can impact on both physical and mental health.

Stress is a response to a threat in a situation, whereas anxiety is a reaction to the stress.

What makes us stressed?

There are many things that can lead to stress. The death of a loved one, divorce/separation, losing a job and unexpected money problems are among the top ten causes of stress according to one recent survey 5.  But not all life events are negative and even positive life changes, such as moving to a bigger house, gaining a job promotion or going on holiday can be sources of stress. 

What are the signs of stress?

Emotional changes

When you are stressed you may experience many different feelings, including anxiety, fear, anger, sadness, or frustration. These feelings can sometimes feed on each other and produce physical symptoms, making you feel even worse. For some people, stressful life events can contribute to symptoms of depression.6 7   

Work-related stress can also have negative impacts on mental health 8.  Work-related stress accounts for an average of 23.9 days of work lost for every person affected 9

Behavioural changes

When you are stressed you may behave differently. For example, you may become withdrawn, indecisive or inflexible. You may not be able to sleep properly 10. You may be irritable or tearful. There may be a change in your sexual habits 11.Some people may resort to smoking, consuming more alcohol, or taking drugs 12.  Stress can make you feel angrier or more aggressive than normal 13. Stress may also affect the way we interact with our close family and friends.

Bodily changes

When stressed, some people start to experience headaches, nausea and indigestion. You may breathe more quickly, perspire more, have palpitations or suffer from various aches and pains. You will quickly return to normal without any negative effects if what is stressing you is short-lived, and many people are able to deal with a certain level of stress without any lasting adverse effects.

If you experience stress repeatedly over a prolonged period, you may notice your sleep and memory are affected, your eating habits may change, or you may feel less inclined to exercise. 

Some research has also linked long-term stress to gastrointestinal conditions like Irritable Bowel Syndrome (IBS), or stomach ulcers14 as well as conditions like cardiovascular disease15

Who is affected by stress?

All of us can probably recognise at least some of the feelings described above and may have felt stressed and overwhelmed at some time or another. Some people seem to be more affected by stress than others. For some people, getting out of the door on time each morning can be a very stressful experience. Whereas others may be able to cope with a great deal of pressure.

Some groups of people may be more likely to experience stressful life events and situations than others. For example, people living with high levels of debt, or financial insecurity are more likely to experience stress related to money16, 17, people from minority ethnic groups or whose who are LGBT (lesbian, gay, bisexual and transgender) may be more likely to experience stress due to prejudice, or discrimination18,19,20, and people with pre-existing or ongoing health problems may be more likely to experience stress related to their health, or stress due to stigma associated with their condition.

How can you help yourself?

There are some actions that you can take as an individual to manage the immediate, sometimes unpleasant, signs of stress and identify, reduce, and remove stressful factors that may cause you to feel overwhelmed and unable to cope. If you feel comfortable, talking to a friend or close colleague at work about your feelings can help you manage your stress.

However, sometimes individual actions on their own are not enough to reduce long-term stress for everyone. We can often be affected by factors that are beyond our direct control. Communities, workplaces, societies, and governments all have a role to play in tackling these wider causes of stress.

1. Realise when it is causing a problem and identify the causes

An important step in tackling stress is to realise when it is a problem for you and make a connection between the physical and emotional signs you are experiencing and the pressures you are faced with. It is important not to ignore physical warning signs such as tense muscles, feeling over-tired, and experiencing headaches or migraines. 

Once you have recognised you are experiencing stress, try to identify the underlying causes. Sort the possible reasons for your stress into those with a practical solution, those that will get better anyway given time, and those you can’t do anything about. Take control by taking small steps towards the things you can improve. 

Think about a plan to address the things that you can. This might involve setting yourself realistic expectations and prioritising essential commitments. If you feel overwhelmed, ask people to help with the tasks you have to do and say no to things that you cannot take on. 

2. Review your lifestyle

Are you taking on too much? Are there things you are doing which could be handed over to someone else? Can you do things in a more leisurely way? You may need to prioritise things you are trying to achieve and reorganise your life so that you are not trying to do everything at once.

3. Build supportive relationships

Finding close friends or family who can offer help and practical advice can support you in managing stress. Joining a club, enrolling on a course, or volunteering can all be good ways of expanding your social networks and encourage you to do something different. Equally, activities like volunteering can change your perspective and helping others can have a beneficial impact on your mood.  

4. Eat Healthily

A healthy diet will reduce the risk of diet-related diseases. There is also a growing amount of evidence showing how food can affect our mood. Feelings of wellbeing can be protected by ensuring our diet provides adequate amounts of nutrients including essential vitamins and minerals, as well as water.

5. Be aware of your smoking and drinking

 If possible, try to cut right down on smoking and drinking. They may seem to reduce tension, but in fact they can make problems worse. Alcohol and caffeine can increase feelings of anxiety.

6. Exercise

Physical exercise can be an excellent initial approach to managing the effects of stress. Walking, and other physical activities can provide a natural ‘mood boost’ through the production of endorphins. Even a little bit of physical activity can make a difference, for example, walking for 15-20 minutes three times a week is a great start.21

7. Take Time Out

One of the ways you can reduce stress is by taking time to relax and practicing self-care, where you do positive things for yourself.  Striking a balance between responsibility to others and responsibility to yourself is vital in reducing stress levels. 

8. Be Mindful

Mindfulness meditation can be practiced anywhere at any time. Research has suggested it can be helpful for managing and reducing the effect of stress, anxiety, and other related problems in some people22. Our ‘Be Mindful’ website features a specifically-developed online course in mindfulness, and details of local courses in your area.

9. Get some restful sleep

Sleep problems are common when you’re experiencing stress. If you are having difficulty sleeping, you can try to reduce the amount of caffeine you consume23 and avoid too much screen time before bed24. Writing down your to do list for the next day can be useful in helping you prioritise but also put the plans aside before bed25. For more tips on getting a good night’s sleep read our guide ‘How to  sleep better’.

10. Don’t be too hard on yourself

Try to keep things in perspective and don’t be too hard on yourself. Look for things in your life that are positive and write down things that make you feel grateful. 

If you continue to feel overwhelmed by stress, seeking professional help can support you in managing effectively. Do not be afraid to seek professional help if you feel that you are no longer able to manage things on your own. Many people feel reluctant to seek help as they feel that it is an admission of failure. This is not the case and it is important to get help as soon as possible so you can begin to feel better.

The first person to approach is your family doctor. He or she should be able to advise about treatment and may refer you to another local professional. Cognitive Behavioural Therapy (CBT) has been shown to be helpful in reducing stress by changing the ways we think about stressful situations26, this might include focusing on more positive aspects of a situation and reassessing what their likely impact might be. Other psychosocial interventions that can be helpful include brief interpersonal counselling, which can give people the opportunity to discuss what causes them to feel stress and develop coping strategies; and mindfulness-based approaches27.

The COVID-19 pandemic, financial inequality and mental health

Photo by Anna Shvets on Pexels.com

Introduction

We all can experience mental health problems, whatever our background or walk of life. But the risk of experiencing mental ill-health is not equally distributed across our society. Those who face the greatest disadvantages in life also face the greatest risk to their mental health.

The distribution of infections and deaths during the COVID-19 pandemic, the lockdown and associated measures, and the longer-term socioeconomic impact are likely to reproduce and intensify the financial inequalities that contribute towards the increased prevalence and unequal distribution of mental ill-health.

This briefing discusses the mental health effects of these financial inequalities in the context of the COVID-19 pandemic. It draws evidence from the “Coronavirus: Mental Health in the Pandemic” research – a UK-wide, long-term study of how the pandemic is affecting people’s mental health. The study is led by the Mental Health Foundation, in collaboration with the University of Cambridge, Swansea University, the University of Strathclyde and Queen’s University Belfast.

Since mid-March 2020, the project has undertaken regular, repeated surveys of more than 4,000 adults who are representative of people aged 18+ and living in the UK. The surveys are conducted online by YouGov. They shed light on people’s emotional responses to the pandemic, the key social drivers of distress, coping mechanisms and suicidal thoughts. A diverse Citizens’ Jury is contributing qualitative information, personal insights and comments on the data generated by the study. Ethical approval has been obtained from the Cambridge Psychology Research Ethics Committee.

To contextualise our findings, first we review existing knowledge on the links between financial inequality, employment and mental health; then we review what official figures are telling us about the financial consequences of the COVID-19 pandemic. This review provides the backdrop to our own survey data and Citizen’s Jury findings. We conclude with recommendations to UK central and national governments.

Financial Inequality, Employment and Mental Health: what did we already know?

The link between poverty and mental health has been recognised for many years and is well evidenced. In general, people living in financial hardship are at increased risk of mental health problems and lower mental wellbeing.(1) It is well established that people in the lowest socioeconomic groups have worse mental health than those in the middle groups, who in turn have worse mental health than those in the highest. This ‘social gradient’ means that mental health problems are more common further down the social ladder.(2)

The evidence of this social gradient in the UK is clear and has been established repeatedly. For example, the Health Survey for England has consistently found that people in the lowest socioeconomic class have the highest risk of having a mental health problem.(3) As another example, a 2017 survey commissioned by the Mental Health Foundation with participants from across the UK found that 73% of people living in the lowest household income bracket (less than £1,200 per month) reported having experienced a mental health problem during  their lifetime, compared to 59% in the highest household income bracket (more than £3,701 per month).(4)

The mental health risk of economic hardship starts early in life. Socioeconomically disadvantaged children and adolescents are two to three times more likely to develop mental health problems.(5) The World Health Organization (WHO) has concluded that material disadvantage “trumps” emotional and cognitive advantages.(6) In other words, people from poorer economic circumstances are still more likely to have worse mental health, even if they have been supported to develop good personal coping and cognitive skills. People with an existing psychiatric diagnosis are also at greater risk of financial inequality and less likely to be in employment, fuelling their experience of multiple disadvantage.

Furthermore debt itself is an issue: people in debt are more likely to have a common mental health problem,(7) and the more debt people have, the greater is the likelihood of this.(8) One in four people experiencing a mental health problem is in problem debt, and people with mental health problems are three times more likely to be in financial difficulty.(9)

Employment is one of the most strongly evidenced determinants of mental health.(10) Lack of access to either employment or good quality employment can decrease quality of life, social status, self-esteem and achievement of life goals.(11) In the Mental Health Foundation’s survey across the UK in 2017, 28% of people who identified as unemployed reported current experience of negative mental health, compared to 13% of people in paid employment, 20% of people in full-time education and only 9% of people who had retired.(4)

Studies have found that unemployment has a range of negative effects, including  relative poverty or a drop in standards of living for those who lose a job, stresses associated with financial insecurity, the shame of being unemployed and in receipt of social welfare and loss of vital social networks.(12) The Organisation for Economic Co-operation and Development (OECD) has described how job loss has a traumatic and immediate negative impact on mental health and noted that there is further damage where unemployment continues into the long term.(13) A meta-analysis has shown that unemployment is associated with varieties of distress including mixed symptoms of distress, depression, anxiety, psychosomatic symptoms and drops in subjective wellbeing and self-esteem. The same study found that 34% of unemployed people experienced mental distress, compared to 16% of those in employment. Importantly, the analysis showed that unemployment causes this distress.(14) Research also consistently shows that unemployment has been associated with lower wellbeing.(15) Furthermore, job insecurity and restructuring also have negative impacts on employee wellbeing over time.(16)

It is not only having a job that can benefit mental health; the OECD has recognised that the quality of employment also matters for supporting mental wellbeing.(13) In its 2008 Employment Outlook report, the OECD found that work-related mental health problems occur more often for employees with detrimental working conditions (e.g. toxic stress, discrimination, and bullying).(13) The conclusion that good quality work is important for fostering good mental health has been affirmed by successive UK policy reports and was emphasised by Farmer and Stevenson in their 2017 review of mental health and employment.(17) In their report, they incorporated good working conditions (e.g. fair pay, job security, education and training, and staff consultation and representation) as one of their proposed mental health core standards.(17)  Some groups of self-employed workers are also vulnerable to lower mental well-being. One quarter of self-employed workers in Europe are in situations characterised by economic dependence (i.e. dependent on a single employer for their source of income), low levels of autonomy and financial vulnerability, and people in this category have reported lower levels of mental well-being than self-employed workers with more stable work.(18)

The Financial Inequalities of the COVID-19 Pandemic and Mental Health

The Institute for Fiscal Studies (IFS) has stated that the economic downturn resulting from the COVID-19 pandemic “will have significant consequences for people’s health outcomes in the short and longer term.”(19) There is no health without mental health and the negative effects of economic recessions on people’s mental health are already well-evidenced.(20)

In April of this year, the IFS pointed out that: “Groups that are vulnerable to poor health are likely to be hit hardest even if the crisis hit all individuals equally, but evidence is already emerging that the economic repercussions of the crisis are falling disproportionately on young workers, low-income families and women (Joyce and Xu, 2020).”(19) The Breugel agency has also noted that among workers across Europe, the self-employed are being hit hardest by the work-related effects of social distancing measures.(21)

In terms of the scale of potential need, the IFS cites Janke, et al. (2020) in stating that if the economic downturn were similar to that after the 2008 financial crisis, then the number of people of working age suffering from poor mental health would rise by half a million. Research in England on the 2008-10 recession showed that each 10% increase in the number of unemployed men was significantly associated with a 1.4% (0.5% to 2.3%) increase in male suicides.(22) We know that the mental health impacts of job loss and economic or employment uncertainty, compounded by financial worries about housing, heating and food, can be serious. They can also contribute to feelings of hopelessness. This may be what lies behind the high rate of suicidal thoughts and feelings among unemployed people. We don’t know yet whether the COVID-19 pandemic will affect suicide rates but we do know that suicide is potentially preventable, if we take action to mitigate those effects early rather than waiting for the number of suicides to rise.

In May this year, the Office of National Statistics (ONS) published statistics on COVID-19 deaths broken down by local area and socioeconomic deprivation. These revealed that the age-standardised mortality rate of deaths involving COVID-19 in the most deprived areas of England was 55.1 deaths per 100,000 population, compared with 25.3 deaths per 100,000 population in the least deprived areas (see  ons.gov.uk/releases/spatialanalysisondeathsregisteredinvolvingcovid19), showing that people living in deprivation are bearing the brunt of the pandemic in the UK.

The report further showed that for most socio-economic groups, the number of COVID-19 deaths broadly maps the existing social gradient of health, with the proportion of COVID-19 deaths much worse in the three most deprived deciles when compared with overall deaths. In mental health terms, this further suggests that the burden of excess bereavement and trauma will fall most heavily on those who are already most disadvantaged.

Our Survey Data

The impact of financial inequalities on mental health during the pandemic is becoming evident in our longitudinal research.

Worries about employment:

  • One in five people surveyed (20.55%) – and more than one third (34.01%) in full-time work – are concerned about losing their job.
  • One fifth (19.70%) of people surveyed who identified as unemployed have had suicidal thoughts and feelings in the last two weeks – this is compared to 8.64% of people in employment.
  • People most worried about financial concerns are people in middle age.

Coping:

  • Twice as many unemployed people (25.85%) surveyed say they are not coping well with the stress of the pandemic compared to people in employment (12.25%).
  • Over one in 10 (10.93%) unemployed people surveyed say nothing has helped them cope with the stress of the pandemic.

Worries about finances, debt and having enough:

  • Whilst the overall picture for many is improving, one third (32.66%) of UK adults say they are worrying about their finances, such as bill payments and debt.
  • Using a broad categorisation, people in lower socioeconomic groups (c2de) (35.11%) are more likely to have financial concerns than people in higher groups (abc1 – 30.81%).
  • Almost half of people surveyed who are unemployed (44.7%) say they were worried about having enough food to meet their basic needs in the past two weeks, compared to 29.32% of people in employment). Since early April, unemployed people are the only group for whom worry about this issue has not reduced.

The Verdict of Our Citizens’ Jury

Our Citizens’ Jury stressed that although the coronavirus pandemic is felt across most of the world, and the UK lockdown measures apply across the country, not everyone experiences its consequences in the same way. The Jury expresses the need to view health and financial security as equally important.

While there will be generic worries about the future across the population, the detailed picture is far more nuanced. People are affected in different ways depending on their age, demographic background, employment sector, type of job and contract, geographical area, membership of at-risk groups and more. Self-employed, small businesses, people with disabilities, people from Black, Asian and Minority Ethnic background, domestic abuse survivors and informal carers were considered high risk groups in this context.

“I think, to some extent, it depends where people start. Because, you know, many people were in insecure jobs, gig economies, part-time jobs, etc, to begin with. And, you know, this has had a massive impact on them. I think the other different impact is people who thought they were in secure positions, so they were in full-time jobs, you know, and generally had enough money to survive, however that was defined, and suddenly find themselves in a very different position. Or, I know some people, to give another example, who are currently furloughed on 80 per cent, or 100 per cent wages, and therefore, in the short term, are okay, but worry whether they will ever have a job to go back to […]  So there are so many nuances to this for so many different people.” (Citizens’ Jury member)

They also felt that financial security and related worries and mental health problems are also an evolving situation (dynamic not static). In other words, someone might be fine now but perhaps not in three or six months’ time. They expressed worries that these shifts have been happening since the start of the pandemic and other factors – such as Brexit – might further exacerbate financial insecurity and inequality in the UK.

“We’ve got Brexit that’s still in the background, and how is that going to affect the price of food, the availability of food? Personally, I need fresh green, it’s very helpful for my condition, where is the guarantee that the prices of simple foodstuff isn’t going to go through the roof?” (Citizens’ Jury member)

The voluntary sector is crucial in the coronavirus response, because it supports and safeguards large parts of the population (including those who may be digitally excluded), and the level of financial and other support from the government should reflect that. Any government support should be equitably distributed and should safeguard the diversity of the sector.

“I think it’s worth remembering that, like, within charities, we’re all humans, too, and a lot of the charities are paralysed because of the sheer number of demands upon them. So in terms of what Government and large charities can do, it’s actually supporting that specialist work, to make the community based stuff happen. Otherwise, yeah, a lot of really small specialist places are going to go, I think, unfortunately”. (Citizens’ Jury member)

Overall the Citizens’ Jury validated the view that protecting people’s mental health is of critical importance during this period.   A fear was expressed that if the lockdown is very prolonged and/or repeated – the UK might lose more people to the social and economic consequences of the lockdown than to the virus itself.

“It really links in around trauma, and that a lot of people we support, they are dealing with ongoing, quite difficult mental health backgrounds, and different experiences. And I think it’s not so much that people are suddenly plunged into destitution, but that, I think our concern is around, if they start to struggle financially, that’ll be kind of the straw that broke the camel’s back. And that you might see more people in sort of mental health crisis, where it’s been really quite seen as medicalised, or as a disorder, when in fact, it’s really about their financial situation that they have been put in. […] And that I think it’ll be hard, but I think it’s quite important to stay quite focused on social causes of the crisis and difficulty at this time.” (Citizens’ Jury member)

Recommendations

Before the pandemic, it was already evident that higher national levels of financial inequality are linked to a higher prevalence of mental health problems, and that as countries become richer but remain unequal, the rates of mental health problems increase. This is an important risk for the UK government to take into account as the recovery from the pandemic begins. We can expect that the financial inequalities that lead to the increased prevalence and unequal distribution of mental ill-health will be intensified and the benefits of recovery will not be reaped equally by everyone. To address this, we need to see immediate and concerted policy action based on evidence. We recommend the following actions:

Economic security: As a first step, the Universal Credit advance payment should immediately be made a grant, removing the current requirement to repay it over the following 12 months. For the duration of the pandemic and the follow-on economic downturn this grant should be given to all applicants, regardless of their circumstances. In the medium term the Government should convene an expert Taskforce to consider the learning from the Covid-19 crisis and develop proposals for reducing economic insecurity on a long-term basis.

Tackling the debt crisis: Many households will face a financial cliff-edge unless urgent action is taken on debt. According to the Office of National Statistics, the average UK household credit card and personal loans debt in 2019 was £9,400. Importantly, the poorest households have the highest debt-to-income ratio. This means that households will not be in a position to borrow their way out of this crisis; substituting wages with loan debt will only make people’s finances worse given the medium to long-term economic uncertainty.

Government and all private sector providers should pause all debt collection, bailiff visits, interest accrual on debt and deductions from benefits during the pandemic. This will provide a degree of security for people who fall behind on their bills.

We are also calling on the UK’s energy suppliers to immediately halt their use of debt collectors to retrieve unpaid bills and uphold the agreement they have signed with Government to help households during the pandemic.

Finally, with the support from central government, local authorities should ensure that payment holidays on rent and council tax are being offered to those who need them.

Action on Child Poverty: The sharp increase in foodbank use, particularly among families with children, is a real cause for concern. Those who relied on community and school resources such as breakfast clubs, or grandparents to help with childcare, are suddenly having to cope on their own. More time spent at home means higher bills and fewer opportunities to shop around for affordable food. The Government should temporarily increase Child Benefit, the child element of Universal Credit and Child Tax Credit Payments to help low income families weather the storm.

We are also calling for the two-child cap and the benefit cap to be lifted to prevent households being pushed further into poverty.

In-work poverty: The immediate priority must be to guarantee economic security for all. However, research shows that more than half of people in poverty now live in a working family. Too many people are being trapped in poverty by low wages, zero-hour contracts and job insecurity. Key workers such as social care staff have been paid less than the Real Living Wage for too long. Governments across the UK must ensure that all key workers are paid the Real Living Wage. On a medium-term basis, governments across the UK must honour their commitments to tackle low pay across the board.

Prevent stress due to the risk of eviction: The Government should extend the current prohibition of evictions for at least another three months after the end of any lockdown period, and keep this under review with potential for further extension.

Ensure business changes are working for vulnerable customers: Government should monitor the measures being undertaken by businesses to support their vulnerable customers (including those with existing mental health problems) during the pandemic to ensure that these measures are effective.

Targeted outreach to people who are unemployed: The Department of Work and Pensions should make free psychological support available to all unemployed people and inform them of how they can access it.

Improve infrastructure for social connectedness: National governments should provide a designated funding stream for local authorities to support community development initiatives, including peer support, to promote public mental health. This should be available to all communities and include targeted initiatives for vulnerable communities.

A Whole-Government COVID-19 Mental Health Response and Recovery Plan: The UK Government and devolved governments should ensure a cross-governmental approach to mental health and reducing health inequalities during the COVID19-crisis and in the recovery phase by drafting a Whole-Government COVID-19 Mental Health Response Plan.

Conclusion

The COVID-19 pandemic is putting a huge strain on people’s mental wellbeing. Our longitudinal study on the mental health effects of the pandemic shows that the burden of mental distress is borne disproportionately by those with less economic security. In some cases, these are people facing considerable existing challenges, such as those with existing mental health problems surviving in a destructive cycle of poverty and mental distress, or those facing structural inequalities due to belonging to an ethnic minority group.

Unless action is taken to protect vulnerable people’s economic security and support them in dealing with the resulting stress, mental health inequalities are likely to be exacerbated as the pandemic and the ensuring economic downturn proceed.

There will be no vaccine for these population mental health impacts of the COVID-19 pandemic. Instead, we should urgently invest in meeting our fundamental and complex human needs, starting from addressing the key issue of financial inequality in our societies.

© Mental Health Foundation, May 2020

The misconceptions surrounding SAD

Vicky talks about her experience of Seasonal Affective disorder (SAD) and the misconceptions that surround it, how getting a diagnosis has made a big difference and things she does to support her own mental health.

Vicky is from Cardiff. She enjoys keeping fit and spending time with her family.

Imagine spending half the year happy and then one day waking up and feeling different.

You can’t work out why and you try and continue on with your day. The next few days seem darker, longer and the overwhelming sense of ‘why is everything such a struggle?’ it hangs over you like a dark cloud.

“Then it hits you, it’s the time of year.”

Seasonal Affective Disorder or SAD affects thousands of people every year but it is clouded in misconceptions and a lack of awareness and understanding. I have SAD and have struggled with it ‘officially’ for the last four years, although unofficially I have probably experienced the disorder for a lot longer.

I think that SAD has always been a part of my life. As some of my family members suffer from the same disorder it makes it easier to admit to feeling down and I have people who understand what it feels like and know it’s real.

I love the summer, I love the sun and warm weather. Winter, on the other hand, fills me with dread. Even though I love fireworks, Christmas and other winter festivities  I will never understand how people can love the winter months and find the nights cosy. For me, SAD creeps up on me during October and begins to ease in March…

“During this time I feel down, upset and ready to cry at even the tiniest thing.”

Depressed and  anxious , I don’t see the fun in anything. I have a lack of appetite and getting out of bed every morning feels like climbing a mountain. 

Things I would normally do, like going to a gym class and socialising with friends, are a struggle. Putting on a mask every day at work to try and act ‘normal’ and ’ok’ is tiring.

So what has helped me? There have been numerous ways I have learnt to control my SAD. The biggest being accepting that I suffer with it and becoming more aware of when it hits so I can get help.  

A wake up lamp, which gradually lights up the room before my alarm goes off so I wake up to a bright environment has worked wonders at making the darkest of morning bearable and helping me to start the day with a positive mindframe. Staying active, not isolating myself and trying to keep to the same routine as summer has also been key.

Before I was diagnosed with SAD, I attended the odd exercise class but wasn’t exactly active. But SAD has completely changed this.

“The year I got diagnosed I was at my lowest and I didn’t want to do anything involving leaving the house.”

During this time my mum told me if I joined a gym she would help pay for the membership. This changed my life.

I started going to classes a few times a week and not only did it push me to live a healthier and active life but it became a hobby I love and became a mental release.

For me that hour in the gym became an escape, I didn’t worry about anything and once I was there I felt more positive and optimistic thanks to the endorphins.I’ve never looked back.

“SAD doesn’t have to be negative, it can also be a positive.”  

Now I keep this up in the summer months and push myself to stick on my trainers and go even when all I want to is lie in a ball and feel sorry for myself.

Something else that I have had to accept is the use of anti-depressants. There is such a stigma around these tablets and this was the hardest part for me to come to terms with. I didn’t want to take them and truthfully still don’t feel 100% happy about the fact I do or other people knowing I do.

My GP understands my problem and has helped me gain access to counselling. The best advice I was given about SAD was the Dr’s analogy:

“If you had winter asthma then we would give you an inhaler, you have SAD so we give you tablets to help for a few months”

There are many misconceptions surrounding SAD, I’ve heard them all and have outlined 5 of my favourites.

Misconception #1: “The weather can’t affect you that much” and “SAD isn’t real”

Whilst it is correct to say the weather doesn’t affect me, the changing  seasons do. SAD is often triggered by the short days and less exposure to sunlight rather than the rain or cold – although this I find doesn’t help.

Misconception #2: “Winter never made you sad out when you were younger so it can’t do now”. 

I have been suffering for around four years and had my first onset in my early twenties. This is typical for most sufferers and I’ve always felt down in winter, I may just not have be aware of it at the time.

Misconception #3 “Everyone experiences low energy during the winter months you can snap yourself out of it.”

Yes, the winter months can be a gloomy time of year but suffering from SAD is a lot different to just feeling sad and is something which impacts lives, relationships, careers and for some can be as debilitating as a physical illness.  SAD is just as bad as depression. The only difference is SAD is a version of depression that happens at a specific time of year. 

Misconception#4: “You’re still showing up at work on time every day, so you must be fine”.

I am a prime example of how this is untrue. In the four years I have taken medication for my SAD, I have not had one day off relating to it. Putting on a smile and acting cheerful and happy can be what I’m best at. There are no external symptoms and most people would say that they would never think I suffered from any mental health problems but just because it doesn’t show and I’m functioning doesn’t mean SAD isn’t real or should be ignored. 

Misconception #5: “There is no cure you just have to ride it out”.

SAD is treatable and can be managed. I do numerous things to lessen the severity of my symptoms which can range from talking about my feelings, staying active, keeping a gratitude journal, mindfulness, using light boxes and seeking help from a doctor.

SAD can make you sad and it is a hard concept to grasp that you feel fine for half the year and depressed, at what feels like the click of a finger, for the rest. Knowing there are other people out there who suffer and understand has been a huge help. So whilst I embark on another dark winter, I can see the light at the end of the tunnel. 

Autism

What is autism?

Autism is a lifelong developmental disability that affects how people perceive the world and interact with others.

Autistic people see, hear and feel the world differently to other people. If you are autistic, you are autistic for life; autism is not an illness or disease and cannot be ‘cured‘. Often people feel being autistic is a fundamental aspect of their identity.

Autism is a spectrum condition. All autistic people share certain difficulties, but being autistic will affect them in different ways. Some autistic people also have learning disabilitiesmental health issues or other conditions, meaning people need different levels of support. All people on the autism spectrum learn and develop. With the right sort of support, all can be helped to live a more fulfilling life of their own choosing.

How common is autism?

Autism is much more common than most people think. There are around 700,000 autistic people in the UK – that’s more than 1 in 100. People from all nationalities and cultural, religious and social backgrounds can be autistic, although it appears to affect more men than women.

How do autistic people see the world?

Some autistic people say the world feels overwhelming and this can cause them considerable anxiety.

In particular, understanding and relating to other people, and taking part in everyday family, school, work and social life, can be harder. Other people appear to know, intuitively, how to communicate and interact with each other, yet can also struggle to build rapport with autistic people. Autistic people may wonder why they are ‘different’ and feel their social differences mean people don’t understand them.

Autistic people often do not ‘look’ disabled. Some parents of autistic children say that other people simply think their child is naughty, while adults find that they are misunderstood. We are educating the public about autism through our Too Much Information campaign.

Diagnosis

diagnosis is the formal identification of autism, usually by a multi-disciplinary diagnostic team, often including a speech and language therapist, paediatrician, psychiatrist and/or psychologist.

The benefits of a diagnosis

Getting a timely and thorough assessment and diagnosis may be helpful because:

  • it helps autistic people (and their families, partners, employers, colleagues, teachers and friends) to understand why they may experience certain difficulties and what they can do about them
  • it allows people to access services and support.

How autism is diagnosed

The characteristics of autism vary from one person to another, but in order for a diagnosis to be made, a person will usually be assessed as having had persistent difficulties with social communication and social interaction and restricted and repetitive patterns of behaviours, activities or interests since early childhood, to the extent that these “limit and impair everyday functioning“.

Read more about diagnostic criteria and the triad of impairments theory.

Persistent difficulties with social communication and social interaction

SOCIAL COMMUNICATION

Autistic people have difficulties with interpreting both verbal and non-verbal language like gestures or tone of voice. Many have a very literal understanding of language, and think people always mean exactly what they say. They may find it difficult to use or understand:

  • facial expressions
  • tone of voice
  • jokes and sarcasm.

Some may not speak, or have fairly limited speech. They will often understand more of what other people say to them than they are able to express, yet may struggle with vagueness or abstract concepts. Some autistic people benefit from using, or prefer to use, alternative means of communication, such as sign language or visual symbols. Some are able to communicate very effectively without speech.

Others have good language skills, but they may still find it hard to understand the expectations of others within conversations, perhaps repeating what the other person has just said (this is called echolalia) or talking at length about their own interests.

It often helps to speak in a clear, consistent way and to give autistic people time to process what has been said to them.

Social interaction

Autistic people often have difficulty ‘reading’ other people – recognising or understanding others’ feelings and intentions – and expressing their own emotions. This can make it very hard for them to navigate the social world. They may:

  • appear to be insensitive
  • seek out time alone when overloaded by other people
  • not seek comfort from other people
  • appear to behave ‘strangely’ or in a way thought to be socially inappropriate.

Autistic people may find it hard to form friendships. Some may want to interact with other people and make friends, but may be unsure how to go about it.

Read more about communication and social interactionsocial isolation and social skills.

Restricted and repetitive patterns of behaviours, activities or interests

REPETITIVE BEHAVIOUR AND ROUTINES

The world can seem a very unpredictable and confusing place to autistic people, who often prefer to have a daily routine so that they know what is going to happen every day. They may want to always travel the same way to and from school or work, or eat exactly the same food for breakfast.

The use of rules can also be important. It may be difficult for an autistic person to take a different approach to something once they have been taught the ‘right’ way to do it. People on the autism spectrum may not be comfortable with the idea of change, but may be able to cope better if they can prepare for changes in advance.

HIGHLY-FOCUSED INTERESTS

Many autistic people have intense and highly-focused interests, often from a fairly young age. These can change over time or be lifelong, and can be anything from art or music, to trains or computers. An interest may sometimes be unusual. One autistic person loved collecting rubbish, for example. With encouragement, the person developed an interest in recycling and the environment.

Many channel their interest into studying, paid work, volunteering, or other meaningful occupation. Autistic people often report that the pursuit of such interests is fundamental to their wellbeing and happiness.

SENSORY SENSITIVITY

Autistic people may also experience over- or under-sensitivity to sounds, touch, tastes, smells, light, colours, temperatures or pain. For example, they may find certain background sounds, which other people ignore or block out, unbearably loud or distracting. This can cause anxiety or even physical pain. Or they may be fascinated by lights or spinning objects.

Read more about repetitive behaviour and routines and sensory processing.

Different names for autism

Over the years, different diagnostic labels have been used, such as autism, autism spectrum disorder (ASD), autism spectrum condition (ASC), classic autism, Kanner autism, pervasive developmental disorder (PDD), high-functioning autism (HFA), Asperger syndrome and Pathological Demand Avoidance (PDA). This reflects the different diagnostic manuals and tools used, and the different autism profiles presented by individuals. Because of recent and upcoming changes to the main diagnostic manuals, ‘autism spectrum disorder’ (ASD) is now likely to become the most commonly given diagnostic term.

Read more about different diagnostic profiles, terms and criteria.

Causes and cures

What causes autism?

The exact cause of autism is still being investigated. Research into causes suggests that a combination of factors – genetic and environmental – may account for differences in development. Autism is not caused by a person’s upbringing, their social circumstances and is not the fault of the individual with the condition.