Looking Out for Men’s Mental Health

Men talking about emotions mental health — Men must ignore the outdated pressure to be strong and silent.

It’s only in recent years that men’s mental health has been readily talked about in the media. Statistics on male suicide have necessitated conversations about the stigma men face when talking about their mental health, and why so many men in distress don’t feel they can ask for help:

Suicide is the most common cause of death for men under 45 (according to the Department of Health).
Three-quarters of those who complete suicide are male (recorded by the Office for National Statistics, 2017).
In 2015, only 36% of referrals to the NHS’ IAPT (Increasing Access to Psychological Therapies) were for men.
In 2016, a survey for the Mental Health Foundation revealed that 28% of men had not sought help for their most recent mental health problem, compared to 19% of women.

Faced with this glaring evidence, it’s unsurprising there is now a media focus and medical focus on young and middle-aged men’s mental health.

Raising Awareness

Several charity campaigns have changed the rhetoric here, including:

CALM (Campaign Against Living Miserably) is a male-specific suicide prevention charity which runs a helpline, preventing an average of two suicides every day. CALM’s awareness campaigns are relatable and effective; these include ALAN, an acronym to get friends opening up to each other, and #ManYourLocal, with messages on beermats.
Lions Barber Collective involves barbers raising awareness of men’s mental health by encouraging their clients to talk openly, and training each other to spot signs of suicidal ideation.
Movember’s ‘Be a man of more words’ campaign called for men to talk about their worries, rather than stay silent.

These campaigns challenge the need for men to ‘man up’ (be seen as less emotional, vulnerable) and they challenge stereotypical images of manliness: the ‘strong and silent’ types, the testosterone-fuelled gym-goers and the ball-breaking City types who don’t seem to have the time or the inclination to feel sad.

We have sadly seen several male celebrities die by suicide in the last five years, including actor Robin Williams, rock stars Chris Cornell and Chester Bennington, and DJ and producer Avicii. Though each of these deaths is a tragedy, collectively they have shown the public that fame and fortune can’t prevent mental health crises, and appearing happy on the surface really doesn’t mean you aren’t struggling underneath it all.

Journalist and author Poorna Bell is one of the most prominent UK campaigners for men’s mental health awareness. Poorna’s husband Rob died by suicide in 2015; she has since written a book about his mental health issues and the aftermath of his death, called Chase the Rainbow. Poorna is vocal about the need for men not to bury their feelings or be ashamed to seek help. “Deep down inside he found it really shameful, and I can’t help wondering how things might have been different had he been able to ask for help earlier,” she told ITV News in 2018.

Changing Attitudes

A 2017 survey by mental health charity Mind found that work was likely to be the biggest cause of mental health problems for men; by 2018, it was reported in Personnel Today that 3 in 10 men have suffered a work-related mental health issue, yet 46% of men hadn’t reported a mental health problem to their manager (based on a study by Mynurva). These statistics raise the question: are we doing enough to help men in the workplace?

Alongside general male mental health campaigns, we need more sector-specific initiatives like Mates in Mind, which promotes mental health support for men in the construction industry. By 2025, Mates in Mind aims to have reached 75% of the industry.

Many of the UK and Ireland’s biggest employers now welcome Mental Health First Aid Training in the workplace, open to all staff. Others have offered to put mental health measures in place, with resources like a Wellness Recovery Action Plan (WRAP) available to anyone who wants one. This involves disclosing to your HR department a list of noticeable signs that you may be struggling with your mental health, and a list of steps you’d like them to take should things deteriorate. However, the WRAP scheme does have its limits – mainly that it requires you to self-disclose and employers to spot the warning signs and refer to the plan.

Starting Early

For long-lasting change to occur, we also need to promote good mental health to young boys, not just grown men. In 2016, Time to Change found that 46% of teenage boys in England wouldn’t feel comfortable enough to talk to their dads about mental health, but 57% would want their dads to talk to them. This means fathers must lead by example: start conversations, don’t refer to expressing emotions as being embarrassing or soft.

Schools can do their bit by promoting good mental health as early as possible. The Anna Freud Centre has downloadable resources for teachers, including animated videos and prompts for classroom discussion. These aren’t male-specific, but they invite the whole class to reflect on mental health and listen properly to each other’s concerns. The Charlie Waller Memorial Trust also has webinars for schools to use.

We also need to shy away from stereotypes of certain mental health conditions being seen as ‘female’, such as eating disorders. The number of young boys in England, Scotland and Wales admitted to hospital for eating disorders has sharply increased – from 235 boys in 2010 to 466 boys in 2018. A report from BBC Newsround contains videos discussing this often-overlooked topic.

As you can see, there is a lot of groundwork needed to change perceptions of men’s mental health, but many grassroots organisations are heading in the right direction. We can all do our bit to break stereotypes and to encourage more men and boys to be honest about their wellbeing, without fear of being judged.

Written by guest contributor Vikram Das for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).

Mental Health in Rural Communities

Rural mental health in countryside community with lake and trees — Some rural idylls can leave you cut off from mental health support.

If you’re lucky enough to live in the countryside, you’ll know it can literally be a breath of fresh air; that’s why there are so many television programs, books and travel stories about getting away from town life and heading to the fields, the mountains, the woods, or the quieter parts of our coastline in the UK and Ireland. But dealing with a mental health issue in rural communities can present additional problems for you and your support network of family, friends and colleagues.

Statistics abound on rural mental health and wellbeing:

In 2018, Anglia Ruskin University found that LGBT teachers in rural areas are more likely to experience mental health issues than their peers in urban areas of the UK.

In a 2017 survey by Scotland’s Rural College, nearly two thirds of people in rural Scotland said they had experienced depression.

Also in 2017, Solent MIND revealed that one in five people living in rural areas will have mental health problems.

We must remember that, however idyllic the picture of rural life, the reality is that mental services are patchy in many areas, and your sense of isolation can increase because of environmental factors.

Rural Transport Problems Can Jeopardise Wellbeing

People who live in cities take it for granted that a bus, train or taxi can usually be found at the drop of a hat. Those in rural areas know how annoying it can be when an hourly bus service is cut to once a day, or a taxi from the train station costs a small fortune.

The scarcity of transport affects how often you can attend medical or therapy appointments, and how easy it is to meet friends, commute to work or take children to school. With so many hurdles in the way, it’s all too easy to isolate yourself without meaning to. It can also impact the treatment of your loved ones – in 2018, the Care Quality Commission’s review into child and adolescent mental health services across England found that ‘geographical factors contributed to fragmentation. All of the larger counties with more rural areas that we visited had problems with travel distances’. In one specific case, the CQC reported that a Child and Adolescent Mental Health Services team ‘ rarely did home visits because the amount of time spent travelling would impact on the number appointments they would be able to offer.’

Fewer Talking Therapies Nearby

Whatever your mental health concern, it’s important to find the right therapist for you. There is no ‘one size fits all’; therapists have different ways of working, and often specialise in treating certain issues – for example, they focus on addiction or on eating disorders. The nearest therapist may not be the best for your needs.

You’re likely to have to travel further to therapy if you live in a rural area, which means factoring in more travel time and those pesky transport issues. Just bear in mind that seeing the wrong therapist who lives five minutes away will do more harm than travelling for half an hour to see a genuinely helpful person.

Lack of Face-to-Face Peer Support

The internet is brilliant at bringing like-minded people together, but there’s no substitute for real human connection, especially when it comes to mental health. At Christine Tizzard Psychology, we not only provide individual treatment where you can benefit from face-to-face interaction, but we’re also experienced at running group therapy sessions, bringing you together with others in a similar situation. Mental health conditions such as anxiety can make it difficult to open up to strangers, but group therapy provides a non-judgemental and therapeutic environment for you to explore your thought patterns using Cognitive Behavioural Therapy (CBT). However, living in a rural area can make it harder to find and access group therapy; groups provided by charities or local authorities are based in built-up areas and may have long waiting lists.

You may be prone to heavy self-criticism (‘I’m a terrible driver’; ‘I always mess things up’) and catastrophising (‘What if I can never be happy again?’; ‘If I mess up that presentation at work, I know they won’t give me the promotion. They might even sack me’). By exploring these thoughts with other anxiety sufferers and a therapist, you’ll realise that thinking something doesn’t make it true. Whether you live close to our head office in West Sussex or you’re further afield, talk to us about the possibility of group therapy, which could help reduce your sense of isolation. As you progress with group therapy, you could even start lift-sharing with people who live nearby.

Tourist Season Brings Additional Pressure

Anyone living in a tourist-dependent village will know it’s a case of feast and famine – those who work in the industry are stretched to the limit in summer and during any school holidays, but winter is eerily quiet for them. If you’re a business owner or casual worker, the money you earn in busy periods may have to keep you going for months. This means you risk getting burned out during seasonal peaks, and you might be tempted to ignore mental health issues that arise at this time, to keep money coming in.

However, when your mental health is suffering and you don’t act to tackle it, you put your mind and body at risk. It may help to imagine a friend telling you they have a similar mental health issue. Wouldn’t you ask them to seek help, rather than tell them to carry on being distressed?

With therapists in many parts of the UK and Ireland, Christine Tizzard Psychology can reach into those under-served rural areas, unlike other psychology practices tied to one town or city. Contact us from your piece of countryside and we’ll do our best to help.

Written by guest contributor Polly Allen for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).

New Year Diet? How to save 1000 calories a day

The BIG NEWS. You do not need to join a weight loss club

Statistics tell us that people who sign up to diet clubs do lose weight. The gutting fact is that their weight loss is often short lived.

An even more depressing fact

Within three years of ditching the diet, 97% people weigh more than they did before they started. Why is this? They have tried to save calories. Well, the answer is surprisingly simple.

Traditional dieting means once the calorie counting is over – it’s back to square one. Dieting can become a yo-yo process.

A diet means counting calories or counting points. It always means counting the hard-earned cash you are forking out.

Counting calories totally misses the need to change your thinking about eating.

The take home message

When you change your thinking about eating everything changes for the GOOD! The cyclical yo-yo approach ends.

When you change your eating habits, staying slim becomes a piece of cake? It is easy to do.

People come to Christine Tizzard Psychology to lose weight for many reasons. Medical issues or to feel better are just two examples.

We don’t arm clients with diet sheets, regimes or fat free fryers. The truth is, weight loss is about changing your relationship with food rather than just cutting calories.

We use Cognitive Behavioural Therapy to reduce weight. As the New Year approaches, here are a few of our best and simple tips for lasting and natural weight loss.

Top tips that work

Always sit down to eat. Save 350 calories

Can you estimate how many extra calories you eat while preparing, serving or clearing away food?

How many calories in that slice of pizza and half bowl of ice cream you ate while clearing the kid’s plates. approx.

2. Focus on eating. Save 300 calories

Put away the smartphone while you eat.Distracted eating stops you from tasting food properly or recognising when you are full.

How often do you need another chicken tikka sandwich because you are still hungry?

3. Use a slightly smaller plate. Save 300 calories or more

It’s a bit of a psychological trick. A slightly smaller plate saves calories. You won’t even notice.

4. Set regular mealtimes spaced evenly

Meals spaced 4 – 6 hours apart is a good interval guide. Whether it is 4 or 6 depends on your own tummy clock.

5. Think why you are eating. Is your craving mood based? Save 200 – 800 calories

Can you work out what is wrong? Try sticking ‘post it’ notes on the biscuit tin. Am I sad? Am I bored?or Am I fed up? Eating 5 Jaffa cakes between meals adds about 200 calories.

6. Drink more water

Many of us believe we are hungry when we are actually thirsty.

There is lots more information on the cognitive approach at diet@beckinstitute.org or email CTP at info@ctpsy.co.uk.

These simple tips when paired with sensible food choices will reduce the pounds easily and keep them off.

Written by CTP

PTSD and Possible Connections with Immune Disease - Upcoming Research at Christine Tizzard Psychology in 2019

Man holding hand to forehead in pain and stress

A pilot research study on the link between Post-Traumatic Stress Disorder (PTSD) and immune conditions, conducted by psychologists at Christine Tizzard Psychology, has been extended to further explore this issue, starting in spring 2019.

An immune disease is where the body’s defence system attacks itself. Debilitating immune conditions, including Lupus, Sarcoidosis and Sjogrens, are loosely labelled as connective tissue diseases. These diseases often cause serious disability and damage to internal organs. Interest has already been expressed by Sarcoidosis UK in assisting with the emerging research planned at Christine Tizzard Psychology for Spring 2019.

The new study will investigate a possible relationship between psychological trauma or PTSD (as defined by DSM-V, the diagnostic manual for mental health conditions) and the later development of auto-immune disease.

The Study: PTSD and Immune Disease

A small-scale pilot study was conducted on 149 previously healthy individuals. It was found that 125 of those in the study had been subject to psychological trauma (categorised into two different types) before their diagnosis of immune disease:

They experienced one catastrophic trauma and were diagnosed with an immune condition 18-36 months post-trauma.
They had suffered repeat psychological injuries that had resulted in a diagnosis of complex PTSD (C-PTSD).

Literature reviews reveal an absence of research in this area. Specifically, the possible correlations between the development of PTSD, a simultaneous raise in C-Reactive Protein in the blood (CRP) and the later development of debilitating immune conditions.

The Chemicals

Scientists are aware that exposure to traumatic incidents often causes a sudden large chemical release, which fuels a ‘fight or flight’ response. Clinicians are not fully aware to what extent the release of chemicals such as noradrenaline and epinephrine affect levels of CRP (a marker of inflammation) in the body. Patients who have a diagnosis of PTSD often remain in a state of hyperarousal – that ‘fight or flight’ mode. It is crucial to know if this lasting heightened state found in PTSD is related to the development of systemic inflammation in the body.

This is a very important piece of research and potentially could influence earlier intervention to reduce or turn off inflammation before systemic damage occurs.

Currently research is being carried out with military personnel. It is investigating the presence of high CRP levels as a possible predictor in the development of later PTSD.

Possible Further Research

What is not so evident and needs investigation is the absence of a baseline to determine a soldier’s prior exposure to trauma. A possible research area could investigate whether the soldiers with high CRP levels were exposed to civilian trauma, such as road traffic accidents, suicide or rape, before starting active service.

If you would like to learn more about this area of research, please contact Dr Chrissie Tizzard, Chartered Consultant Psychologist and Chartered Scientist, at info@ctpsy.co.uk.

Family Break-Ups at Christmas

Did you know that Christmas is a peak time for couples to end their relationships? The most wonderful time of the year for some can be a time of family disharmony for others.

In the celebrity world, famous people tend to announce their divorces between Christmas and New Year – firstly, because there is less focus on the news cycle, and secondly, because Christmas has been the last straw for them (something non-famous couples are just as likely to experience).

Heading for Divorce in the Holiday Season

The first working Monday in January is known as ‘Divorce Day’ for some law firms, as it’s when couples are statistically most likely to start divorce proceedings. Think about it: either you’ve bottled up emotions throughout the season for the sake of children and the extended family, or it’s been an openly miserable holiday period for everyone involved.

The idea of starting again in a new year is also tempting for many unhappy couples, as you assess your achievements and failures from the past 12 months, and plan for the year ahead. Ending a difficult relationship at the close of 2018 means you can begin 2019 with a clean slate.

Starting a new year in therapy may seem grim to those who’ve never tried it before, but the pain and disorientation of a family break-up can often be eased with family therapy or individual treatment. Rather than fighting over the DVD collection or deciding who keeps the car, therapy is a chance to focus on emotional resilience rather than material things. It also teaches you practical ways to cope with whatever may come your way.

The First Christmas after a Family Break-Up

Of course, there will be some children facing their first Christmas spread across two homes, with two sets of parents, and this comes with its own pressures for everyone involved. Mums and dads can feel torn between wanting to shower their children with gifts and feeling those tightened purse strings. Though your child will have written a long Christmas list, the most important gifts can’t be bought with money: time, attention and love truly matter more to a child than the latest gadget. Attending their school concert, taking them carol singing or watching Christmas films on TV aren’t grand gestures, but they mean a lot.

This festive season gives separated parents the perfect opportunity to shelve their squabbles with each other and focus on their children’s needs. Many parents find it helps to take it in turns to host their child for Christmas Day – whoever has the kids this year will have them on other days when Christmas 2019 comes around. Though the focus will always be on 25^th December, there’s nothing to stop you having an earlier or later celebration with the kids.

Remember that the first few years of breaking away from familiarity will feel strange for a child, having built up memories of Christmas in a certain house, with a certain routine. Establishing a new routine will take time and patience, but remind them it’s okay to remember past Christmases and share happy memories whilst making new ones. Eventually there may be new partners and step-children to add to the mix as well, and the festive period will evolve as the whole family gets older. All you can do is be flexible and create the kind of holiday season that works for your family, remembering that the best presents can’t be bought.

School Bans Designer Coats: Poverty Shaming or Affluent Antagonising?

The decision by the head teacher of Woodchurch school in Merseyside to ban Canada Goose, Pyrenex and Moncler jackets for school children has been met with mixed reviews.

Some believe that preventing the wearing of these jackets, that can cost up to £1,000, will reduce poverty shaming. It has been said that children whose parents are unable to afford these jackets are feeling left out in the cold, inadequate and marginalised.

For most, dare we say, ‘normal income’ families with 2 school-age children, these jackets would not be affordable. Most of the population can’t afford to go out on an autumn weekend and ‘splash’ the cash on these warm and trendy coats.

So, is wearing a certain label to school actually poverty shaming those who are unable to afford the jacket (which is most of us)? It could also be argued that the child who is lucky enough to own the jacket is now being discriminated against for having affluent parents. They could become labelled a ‘rich toff’ or worse.

The school approach could be considered a knee-jerk response: yet another flight into schematic and polarised opposites: rich/poor, good/bad, ugly/beautiful, and so on. The trouble with polarised opposites is that the opportunities of the middle ground are lost.

The middle ground often offers a solution-focused response – for example, a school uniform jacket (I hear you cringe) could be introduced. Would it work? It wouldn’t – it would still be relatively simple to work out which children were wearing new ‘regulation’ coats and those that had hand-me-down or second-hand coats.

The solution is far simpler, cost-effective and lasting: poverty shaming must be actively tackled, beginning in primary school through the mediums of understanding, compassion and tolerance.

These key values need little explanation. When these values are present, a child automatically develops a social conscience and a sense of ‘the other’.

The child will develop a growing awareness that it may not be appropriate to wear the jacket to school, simply because it makes someone else feel uncomfortable and marginalised.

Let’s not be puritanical; it’s absolutely fine to wear an expensive jacket or to drive a high-end car. You shouldn’t be ashamed. What you should feel shame about is when privilege has been wielded or worn in such a way to make someone less fortunate – or indeed more fortunate – feel inferior or uncomfortable.

The big message here is not about polarised opposites like affluence or poverty. It is about tackling discrimination through developing a perspective of the ‘other’. In that development of a perspective of the other enters the maxim: ‘There’s a time and a place for everything’.

Written by Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).

Ways to Support a Friend with Antenatal and Postnatal Depression

Having a baby is a life-changing event, but it isn’t plain sailing. Along with the usual ups and downs of new parenthood, and the hormone-charged ‘baby blues’ that can appear for a few weeks, many mums and dads will suffer from more intense lows that need proper mental health treatment, and support from friends.

You don’t need to be a parent to spot the signs that someone may have antenatal or postnatal depression (collectively known as perinatal depression). Being there for your friend means looking out for their mental health, as well as basking in the joys of a new baby.

Understanding Antenatal and Postnatal Depression

We’re lucky that today’s internet age gives us a huge range of tools at our fingertips, making it easier to connect to the right resources for any mental health condition, but the person experiencing symptoms may find it hard to reach out for help. That’s where you come in.

One in four expectant mothers will have a mental health problem, according to a study from King’s College, London; 15% of those will have anxiety, and 11% will have depression. Symptoms of antenatal or postnatal depression include:

Lack of enjoyment in things you used to like
Persistent low mood
Feeling unable to look after your baby or keep them safe
Difficulty bonding with your baby or contemplating having your baby
Thoughts of self-harm or suicide
Avoiding other people

A short video called Perinatal Positivity is a good starting point for you: it includes voiceovers from women and men who have experienced perinatal depression. The blog PND and Me (voted Blog of the Year at the Mind Media Awards 2016) offers another first-person perspective. Its author, Rosey, also hosts a weekly Twitter chat called #PNDHour, every Wednesday from 8-9pm.

It’s important to get your friend to talk honestly about how they feel. Midwives, health visitors and doctors are all trained to spot the signs of antenatal and postnatal depression, but your friend may need support to open up. Parents can feel a lot of pressure to be perfect, and to pretend they aren’t struggling.

If you take a friend to be clinically assessed for perinatal depression, you may find the appointment involves filling out the Edinburgh Postnatal Depression Scale (EPDS), which was developed in 1987 to identify key thought patterns in women with PND. This questionnaire has to be accompanied by a proper discussion with the patient – it doesn’t give a diagnosis on its own.

Finding Treatments

Treatment will vary, but typically includes talking therapy. Cognitive Behavioural Therapy (CBT) is the most common approach, and will help to break down the thought patterns contributing to the depression. Medication may also be recommended, and a doctor will make sure any anti-depressant is suitable if the mother is breastfeeding.

Getting your friend to support groups and parenting groups can also help them to adjust; for example, mothers in East Lothian can access a new befriending programme. Meanwhile, in January 2018 the British Journal of Psychiatry published a study from the Centre for Performance Science that recommends group singing as an alternative therapy for moderate to severe symptoms of PND.

Only 1 in 4 mothers with PND still identify as being depressed a year after childbirth, and more help is out there than ever before. Most mothers find it takes 3-6 months for symptoms to ease. Remind your friend they will get better – as the saying goes, ‘This too shall pass’.

Postpartum psychosis can also affect a much smaller proportion of new mothers (1 in every 1,000) and this requires more specialist treatment, with patients suffering delusions and hallucinations. It is very important to seek urgent medical help if you suspect your friend has postpartum psychosis; call 111, see a GP, visit A&E or call 999 if you believe your friend may harm themselves or their baby.

People often assume perinatal mental health issues only affect the woman giving birth, but their partners can also experience them. You may have heard of a ‘sympathetic pregnancy’, where the partner of an expectant woman starts to feel typical pregnancy symptoms, such as back pain, tiredness and tearfulness, despite not carrying the child themselves. Perinatal depression can similarly stretch to affect partners, so try to be mindful of their mental health as well. Earlier this year, the BBC covered a story of one father’s postnatal depression that sadly led to him completing suicide. With awareness being raised about men’s postnatal depression, hopefully other men in distress can find the help they need to recover.

How to Spot a Toxic Relationship

Toxic relationships occur when an unhealthy power dynamic develops between two people, and one dominates the other: what they say, do and feel can be controlled or diminished by the person in control. However, knowing how to spot a toxic relationship isn’t inherent, because we often look for visible signs or recorded evidence of behaviour, whereas toxic relationships thrive on subtle manipulation.

Though physical violence may not be part of the pattern, a toxic relationship is bad for your mental and physical health, which is why you cannot let it continue.

You may recognise the feelings described below as something you experience, or something you see in a friend, relative or colleague’s relationship with another person. If so, it’s time to get help and break the cycle.

Signs of a Toxic Relationship

You have to monitor your thoughts, words and actions around this person, because there are lots of things that make them angry or upset.
Conversations revolve around them, not you, and when you try to change the subject it always reverts back to their narrative.
Seeing them or hearing from them leaves you feeling physically and/or mentally drained.
They aren’t happy for you when something goes right in your life.
You stay in contact in the hope they will give you attention or approval.
Problems in the relationship are blamed on you.
They encourage bad behaviour you wouldn’t contemplate otherwise, such as stealing, abusing drugs or alcohol, or bullying.
You don’t feel safe around them, or your friends and family don’t feel safe around them.
They have become co-dependent, relying on you for constant emotional and practical support, and they fear being abandoned by you.
Your relationships with other people have suffered because this one always takes priority.

Can You Work Through a Toxic Relationship?

If both parties are committed to improve the relationship, and it hasn’t become dangerous or threatening, you could potentially work through some of your issues together – for example, if a difficult colleague or mother-in-law sees the error of their ways. The solution will usually involve a combination of talking therapy, interventions from mutual friends, setting ground rules, and a lot of patience.

But in most cases, the person being toxic may not even want to change their behaviour and will see anyone but themselves as the problem. The way they act will have developed over years or decades and may never have been called out before – or if it was, the people who stood up to them were punished. Because of this, you must remember it isn’t up to you to ‘fix’ this relationship: if both parties can’t be mature about the issues at hand, it’s safer to walk away, even if that person is a blood relative, the love of your life, or a fixture in your dream job. You may also benefit from CBT to come to terms with the after-effects of that relationship, as it is a positive step to leave but a huge shift in your mindset. Don’t be afraid to want something better and to take action. Your health and happiness must come first.

Why the Phrase ‘A Little Bit OCD’ is Damaging

Have you ever heard someone describe themselves, or someone they know, as ‘a little bit OCD’? Thought so. This phrase has become a lazy way for people to explain their love of neatness, order or hygiene, but it’s hugely offensive to anyone who lives with a diagnosis of OCD (Obsessive Compulsive Disorder), which they must manage day after day, and isn’t something they experience mildly.

We can all help dispel the myth that OCD is a joke. In fact, until sufferers find the right treatment and are able to manage their compulsions, it can be highly debilitating. Let’s put you in the shoes of someone with OCD to show you how.

What is OCD?

Obsessions are recurring thoughts, images or fears connected to danger – either believing you are in danger, or you are a danger to someone else. Importantly, these thoughts are unwanted, but they can last for hours or days at a time. You might be at work, in the supermarket, giving a presentation or on a sunny holiday, but the obsessions don’t care; they appear regardless.

Compulsions are actions or reactions you feel you must take to stop something bad happening to yourself or others. To the outside world, these actions can seem strange and disproportionate, but to you they feel realistic.

People with OCD are driven to extreme lengths to try and stop the obsessions, but these coping mechanisms can often make things worse: for example, you may break all contact with a friend because their brain tells you you’ll physically attack your friend. However, you have no history of attacking your friends, or being violent towards anyone.

What drives the compulsion to break contact is the stream of unwanted thoughts and images of attacking your friend, and the worry that this will come true, despite knowing deep down you aren’t a violent person.

Certain situations, places, objects or images can become a ‘trigger’ for obsessive thoughts. In the case above, OCD makes you believe that seeing or hearing from your friend will trigger obsessive thoughts about attacking them. You might also feel triggered by watching violent scenes on TV and in films, or reading news reports of violent crime.

OCD in Children and Young People

OCD can affect children and young people, but parents, carers and teachers may find it hard to pinpoint, being more likely to assume a child is ‘a worrier’, ‘tidy’ or ‘careful’. The Royal College of Psychiatrists estimates that 130,000 children and young people in the UK may be living with OCD, so it’s nothing to gloss over, especially as many people’s OCD symptoms appear in childhood but aren’t diagnosed until years later.

You may find specific resources for young people useful, such as Ellen’s OCD Blog, which won a Mind Media Award in 2014, or a New York Times article on a mother living with her daughter’s OCD and Tourette’s Syndrome (the two conditions can often coexist).

What is ‘Pure O’?

A lesser-known type of OCD is nicknamed Pure O, where obsessive thoughts are the main symptom, and compulsive behaviour might not be as obvious from the outside. However, it is a misconception to say that Pure O sufferers don’t exhibit compulsions. Some support organisations believe the Pure O label is inappropriate and misleading, and they prefer not to use it, but sufferers often prefer to identify themselves as having Pure O to explain the differences they feel in their condition.

Many people with Pure O have described unwanted thoughts and mental imagery connected to sex – for example, worrying you might become a sexual abuser, experience unwanted and distressing sexual thoughts, cheat on your partner or change your sexual orientation. As with all forms of OCD, these obsessions aren’t driven by facts, but the intensity and frequency of the thoughts makes them seem more plausible. This can be confusing and lead to feelings of guilt, anxiety and stress.

Misconceptions Around OCD

Fear of contamination or illness can be a big obsession for some – but not all – OCD sufferers. You might dread physical contact, being convinced you have a disease; you might avoid hospitals for fear of getting sick; you might stop going to restaurants, convinced you’ll get food poisoning. Yet the popular media image of contamination obsessions is someone repeatedly washing their hands or cleaning their house, and people without mental illness who are known for neatness or hygiene can often be jokingly labelled ‘a little bit OCD’.

To make things worse, there was even a television programme a few years ago called Obsessive Compulsive Cleaners, which matched messy homeowners with people either diagnosed as having OCD or exhibiting traits of it. With the houses being in absolute disarray, and the owners often having hoarding tendencies, the cleaning compulsions were normalised and viewers didn’t see the extreme consequences of living with OCD.

The programme was entertainment-focused and therefore didn’t spend much time discussing the mental health implications of OCD, but depicted it as a skill rather than a debilitating condition. The issue of hoarding, as seen in some of the homeowners, can also be a type of OCD in its own right, but this was also not addressed.

How is OCD Treated?

Cognitive Behavioural Therapy (CBT) is the most common treatment for OCD. It is effective because you are able to analyse your thought patterns and work back to the origins of your thoughts, which can usually be linked to core beliefs you’ve held about yourself for years, if not decades.

Triggers for your OCD can be explored, and your therapist can work on gently adjusting and reducing your compulsions, to be replaced with mentally healthy coping strategies that don’t reinforce your obsessions. Someone who describes themselves as ‘a little bit OCD’ won’t need talking therapy, because their thoughts are fleeting and their so-called OCD cleanliness is a habit, not an unwanted behaviour.

OCD UK suggests you don’t need your therapist to specialise in your particular type of OCD – therapists use techniques that work for any type, and they will tailor CBT to your specific obsessions and compulsions. Because Christine Tizzard Psychology covers a wide range of the UK, including South East England, the Midlands and parts of Northern England, you may find CBT treatment is available closer to home than you thought.

If you or anyone you know can relate to the OCD information described above, don’t hesitate to get in touch with us and arrange an initial consultation, because OCD is a real condition that deserves to be taken seriously.

Parity of Esteem for Mental and Physical Health Services: Are We Making Progress?

As we reflect on the highs and lows of World Mental Health Day 2018 (held on 10 October), it’s always a chance to analyse how close UK society is to achieving equality between mental and physical health provision. Known as parity of esteem, uniting these two branches of health with equal budgets, staffing levels and community care seems like a pipe dream at times, but politicians, health workers and campaigners continue to strive for it.

So are we moving any closer to parity of esteem in the UK?

Moving Towards Parity of Esteem

There is now a Minister for Suicide Prevention: Jackie Doyle-Price has become the first person to hold this role, following her previous title of Minister for Mental Health and Inequalities.
Time to Change, led by Mind and Rethink Mental Illness, continues to roll out local support hubs, consisting of stigma-busting champions and private and public organisations working in the community. Eight of these hubs are funded, and a further 25 are ‘organic’, receiving support and official status from Time to Change, but no funding. The application process to launch a funded hub in your area runs until 16 November 2018.
Matt Hancock, Secretary of State for Health and Social Care, announced the government’s “commitment to achieving equality between mental and physical health” at the Global Ministerial Mental Health Summit in London this month.

Moving Away from Parity of Esteem

The National Audit Office noted this month that government progress on supporting children and young people’s mental health is too slow. Jenny George, the NAO’s Director of Local Service Delivery and User Experience, highlighted ” slow progress in the NHS managing to recruit more staff so they can see more children,” and government “aims to increase access from a quarter of young people with mental health conditions able to access services, up to a third.” That leaves two thirds of children and young people without the services they need.
In a survey published last month, the Royal College of Nursing discovered 57% of mental health nurses think the UK had been unsuccessful or very unsuccessful at achieving parity of esteem between mental and physical health. 38% reported their workplace was unsuited to meeting the physical needs of those with serious mental illnesses.
The Big Mental Health Survey, completed by 8,000 people trying to access GP support for mental health issues, revealed uncertainty and booking difficulties. 32% of those making a mental health-related appointment found their health deteriorated between booking and actually seeing their GP. 33% waited six days or more, and a further 14% weren’t sure if seeing a GP was the right course of action.
The number of consultant psychiatrists in NHS England has only risen by 3.3% in the last five years, compared to 21% for the rest of the health service, the Royal College of Psychiatrists has announced this month. With such a gap between the wider health service and psychiatry, it’s unsurprising that patients can wait for months or even years to see a specialist.
A report by the Care Quality Commission (CQC) noted that the number of children attending A&E for mental health treatment has doubled since 2010. It also drew attention to the lack of service provision for children with complex additional needs as well as a mental health condition, revealing there are no mental health unit beds for learning disabled children in London, the South East or the South West of England.
Universal Credit, the single benefits system set to cover traditionally separate benefits like child tax credits, housing benefit, income support, jobseeker’s allowance and working tax credits, continues to threaten the mental wellbeing of claimants. The Mental Health Nurses Association called for an end to Universal Credit in an open letter to Work and Pensions Secretary Esther McVey, referring to the policy as ‘punitive’ and citing the ‘damage to lives of people living with mental illness’. Major mental health charities such as Mind and Rethink have campaigned hard to show the negative effects of Universal Credit and benefits assessments on those with mental health issues.

Parity of Esteem Between Mental and Physical Health: The Verdict

Though there are many calls for parity of esteem in physical and mental health, there is still a long way to go. Whilst private mental health services and talking therapy have shorter waiting times and can adapt quicker to patients’ needs, we realise private treatment isn’t an option for everyone, and it may only be possible short-term or for talking therapy rather than medication and any inpatient care. But when people of all ages are faced with endless waiting lists, bed shortages and even difficulty in seeing their GP or a psychiatrist, resorting to A&E visits, private referrals or support from charities, it’s clear there is a major service shortfall.

This delay in services, along with other pressing factors like money worries, unemployment or co-existing physical issues, can make someone’s mental health deteriorate faster or further than if they received timely and appropriate treatment – ideally a combination of medication (where necessary) and talking therapy, perhaps group CBT, individual treatment, or family therapy.

We hope for major steps towards parity of esteem in 2019 and beyond, so the whole of society can benefit.