Media still too quick and willing to stigmatise depression

This column was published in The Mayo News on Tuesday 31st March 2015.

It was difficult last week to miss coverage of the Germanwings plane crash that claimed 150 lives in the French Alps. A catastrophe of unimaginable proportions, it embodied every private fear we’ve all tried to bury when getting on a plane. The horror experienced by the 150 passengers on board as it dawned on them what was about to happen is the stuff of our worst nightmares, and the proximity of the tragedy undoubtedly cast a chill over us all.

Co-pilot Andreas Lubitz is now, sadly, a household name. Remarkable by his ordinariness, his Facebook page depicted him as a smiling, leather jacket-clad sportsman interested in travel, music, and clubs. Apparently popular, he appeared well-known and respected in his community. By all accounts, a perfectly normal young man who happened to fly planes for a living.

So what made Lubitz decide to commit, apparently out of the blue, such an abhorrent act of violence in such a calm and calculated manner?

The simple answer is that we don’t know. No-one could, at this point, claim to know with certainty. But at the time of writing, on Friday morning, the majority of the tabloid newspapers claimed to have the answer.

It was depression, they screamed. It emerged that Andreas Lubitz is said to have sought psychiatric help for “a bout of heavy depression” six years ago, which necessitated a break from his flight training. After he was cleared to resume he passed all subsequent tests – including psychological tests – with flying colours, and was subject to regular medical checks.

These last details appear to have been overlooked by many of the tabloids, who, high on outrage, published screaming headlines such as: “German who deliberately crashed Airbus had a long history of depression – so why was he let anywhere near a plane?”, “Why on earth was he allowed to fly?”, ”Depressed pilot crashed jet” and charmingly, “Cockpit maniac”.

While the families of the deceased should be prioritised and respected in the analysis of this disaster, responsible media reporting should not be overlooked, and the messages emanating from those headlines demonstrate that while we might think we have progressed when it comes to normalising mental health, ultimately, the willingness to stigmatise those with problems is never far away.

If depression is being touted as the primary reason for Lubitz’s actions, it any wonder there is still a reluctance to talk about mental health? In particular, is it any wonder that there is a particular reluctance to disclose mental health problems in the workplace? Nearly 6 in 10 people believe that being open about a mental health problem at work would negatively affect their career prospects. Reading headlines like this, is it any wonder?

Discourse like this perpetuates the damaging myth that those with mental illness are more likely to be violent. Should no-one who has suffered depression in their lifetime be permitted to hold positions with responsibility for the safety of other people? If that were the case, we’d have a lot of people sitting at home. As someone who has, should I be forbidden to get behind the wheel of a car, lest I get a murderous urge to plough it into someone? While everyone’s experience is different, many will understand that when depression strikes, it’s often about as much as you can do to get out of bed in the morning, let alone murder 150 people.

We can speculate endlessly on what drove Lubitz to do what he did. Mental health issues may have been a contributory factor, but it is impossible to attribute them as a cause.  Too frequently, when a violent act is committed, the tendency is to point to mental ill-health as the primary reason. And when the media presents it in such a way, it’s not just hurtful to those of us who have experienced problems, it’s damaging and it’s irresponsible. It’s also downright lazy.

At the time of writing, investigators claimed they had found a ‘clue’ in Lubitz’s home that might shed some light on why he did what he did. For the families and friends of the deceased, we can only hope that such answers are forthcoming. But they will be cold comfort.

 

Germanwings plane crash Alps memorial

A little note on #littlethings

Today sees the launch of the HSE’s new mental health promotion campaign, Little Things. The campaign is a new, positive wellbeing campaign, designed not quite as a suicide prevention measure, but rather, in order to help us to help ourselves and others through the normal, everyday dips in mood that most of us experience at some point in our lives. It’s about educating, empowering and equipping us to deal with tough times, and just as importantly, reminding us to reach out to others, who may be going through their own difficulties. Ultimately, the aim is early intervention, protection and prevention – stopping normal ‘dips’ from becoming more serious or long-term problems.

littlethings2

Disclaimer from the outset – I was involved in certain elements of the development of this campaign on a professional level. I found it a compelling and educational process, and speaking to members of the public about the new messaging and about mental health in general demonstrated beyond a shadow of a doubt that people really want to make their own difference when it comes to mental health issues in Ireland, but that they’re not always comfortable with doing so. Males in particular freely admit that this is an area they sometimes struggle with, and would like to see conversation around it becoming more normal and acceptable – and less of a big deal.

What was really striking was just how difficult the terms “mental wellbeing” or “emotional wellbeing” were to grasp. Any discussion of mental health invariably reverts to the traditional mental ILL-health narrative, and the concept of looking after your mind, as you would your body, and taking a preventative approach as you would with your physical health, is still alien to many. As a matter of urgency therefore, we need to change that, start educating ourselves and being more proactive in this regard.

Secondly, and this is evident from looking at the #littlethings stream on twitter last night, particularly after Enda Kenny broke a twitter hiatus of almost four years to lend his support to the campaign, there is real anger out there. Fury that the government can be seen to get behind this campaign, yet fail the country so utterly when it comes to the provision of services to those in difficulty who urgently need them. The government, in this year’s “giveaway” budget had a golden opportunity to reinstate the €15million in funding that they whipped away from the “ringfenced” budget last year, yet chose not to do so. €15million is a relatively small sum in the grand scheme of things, especially when you bear in mind that €68m was allocated to the Horse and Greyhound fund (wait for it) “in recognition of the significant shortfall in funding going into the horse and greyhound sectors in recent years as a result of the downturn in the economy”. Public anger is therefore completely and utterly justified, and not for a second should this campaign be deemed a solution to the problems of severe mental ill-health and high suicide rates.

However, that is not to say there isn’t a place for a campaign like this – in fact, quite the opposite. Fixing our problems with mental ill-health in Ireland shouldn’t just consist of implementing suicide prevention measures. Rather, we should be speaking to people who sit on all points of the mental health spectrum – i.e., every one of us, at any given time. As Alan says in one of the TV ads (below) “Thoughts can become feelings if you let them” – a line that succinctly sums up how mental health issues can develop over time, and a decline in mental health can be gradual. You don’t normally just wake up one morning in severe difficulty – it typically happens over time. This campaign is therefore designed to interrupt, to educate, to empower, and to make us aware that there are things we can do for ourselves and others – things that are scientifically proven to have a positive effect – at an earlier stage that can turn the tide before we reach crisis point.

And critically, it should serve as a reminder that every single one of us has a role to play by reaching out to others who may be experiencing their own tough times. And even if they’re not, a little kindness can make an immeasurable difference to someone else’s wellbeing without you ever knowing. Take it from someone who knows.

little things

The campaign is launching today, so you’ll probably see it on your screens at some point this week.  On social media, follow @littlethingshub,  like yourmentalhealth.ie on Facebook, and feel free to share the little things that help you to mind your mind – they may well help others. Check out the newly designed website yourmentalhealth.ie – a “one stop shop” for information on mental health, wellbeing, and also, importantly a directory of support services of all types available throughout the country.

We all need to help each other to prevent suicide

Wednesday 10th September was World Suicide Prevention Day. There are now lots of days and weeks designated for mental health awareness, so much so that it’s starting to become a bit confusing, but I reckon there’s probably never a bad time to be reminded to mind your mind. Next Friday October 10th is World Mental Health Day. With these two dates in mind,  I wrote this column for the Mayo News on Tuesday 16th September.

Last Wednesday was World Suicide Prevention Day, a global day designated for raising awareness of suicide and suicide prevention. Traditionally shrouded in silence and shame, the stigma with which suicide was traditionally regarded in Ireland is being slowly cast aside. But as welcome as that is, it makes the consequences no less devastating, and indeed it is an occurrence with which many of us are all too painfully familiar. Recent statistics from the World Health Organisation suggest that at a global level, someone dies by suicide every 40 seconds. Ireland has the fourth highest suicide rate in Europe, and 475 people died this way last year. Over one a day. That’s a lot of grieving families, partners and friends.

Suicide is complex, as are the reasons behind it. There is, however an established link between suicide and mental ill-health, and we are finally starting to talk about it. The conversation has developed significantly in recent years, and we are slowly but surely moving towards a point where it is just as normal and acceptable to talk about your mental health (or ill-health – there is an important distinction) as it is your physical wellbeing. However, it truly is a case of a lot done, a lot more to do.

Crucially, the question people are starting to ask is “What can we do?” This is a welcome development, given the countless campaigns to raise awareness of suicide and depression. At this point, I think it’s fair to say we’re all well aware of the problem. Now what we need are solutions, and the truth is, every single one of us can make a difference. To put it bluntly, it’s high time we all looked in the mirror, and stepped up and took some responsibility for suicide prevention.

It’s all very well advising people struggling with their mental wellbeing to “reach out”, “get help” and “talk to someone”. That’s the overriding message, and yes, it’s good advice – more often than not, it will help. But as someone who has suffered in the past with mental ill-health, the fundamental problem with telling people who are struggling to “get help” is that it places all the onus on someone who is unwell to take that first step. What if, for a change, those who are well started doing some of the reaching out? When you’re in that dark place, when you’re so unwell that you’re starting to believe that not being alive at all would be preferable to living with unrelenting darkness, it’s common to withdraw and isolate yourself. “Just talking” to someone can seem like a mammoth task. When I experienced my first bout of depression over fourteen years ago, I didn’t leave my house for nearly two weeks. I needed someone to reach out to me, and I was one of the lucky ones – somebody did. I will forever be grateful to that person, because I owe them my life.

If we are serious about tackling suicide, we all need step up to the plate, and start being kinder to each other. We need to be cognisant of the fact that 1 in 4 of the people around us will be suffering from a mental health issue (mild or major) at any one time. Every single one of us at some point will experience emotional difficulties. We don’t know what others are dealing with in their day-to-day lives, and there may not be any signs. But there are lots of little things we can all do. A phone call, an email to someone you haven’t spoken to in a while; even a kind word to a stranger can make the world of difference. When you ask someone how they are, listen to their reply. Remind your loved ones that you love them.

If someone comes to you for help, it can be daunting, but don’t panic – you don’t need to be a professional to help; neither do you need to solve the problem. Just listen. For as little or as long as it takes. Hang in there; don’t give up on them. Believe me when I say that simply being there can be enough. [Update: If you do wish to equip yourself, the HSE ASIST course is an excellent free resource – read my account of it here.]

Let’s look in the mirror and take some responsibility here. Let’s as a community educate ourselves and be more thoughtful, supportive and kinder to each other. And let’s end this scourge on our society for once and for all.

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Time to Talk

Today is National Time to Talk Day, and as such, it’s a good day to reflect on what it means to talk, but also what it means to listen. It’s important.

Time to talk

The national conversation around mental health often focuses on the message “Talk to someone”. But to talk, you need to have someone to listen, right?

It can be hard to know what to do if someone decides to talk to you about a mental health issue. They might just feel a bit down, or they might be more worried about themselves. And if they’ve chosen you to talk to, that responsibility can feel a bit daunting, or it may feel like too big a problem for you to take on.

That’s fine. We’re all human.

But if someone decides to talk to you, it doesn’t necessarily mean that they’ve chosen you in the hope that you’ll solve all their problems. They may simply need to put how their feelings into words, or share them with someone. Sometimes doing that alone can make all the difference, so having someone to sit and listen and empathise with how they feel can make all the difference.

If you do feel you need some tips on how to say something back, the Green Ribbon website has some really useful advice. And it’s just normal, everyday stuff, not out of anyone’s reach.

This poem by Robert Frost sums it right up.

“When a friend calls to me from the road
And slows his horse to a meaning walk,
I don’t stand still and look around
On all the hills I haven’t hoed,
And shout from where I am, What is it?
No, not as there is a time to talk.
I thrust my hoe in the mellow ground,
Blade-end up and five feet tall,
And plod: I go up to the stone wall
For a friendly visit.”

So today on Time To Talk day, in your conversations , make a point of really listening to what the other person has to say, without distractions. Give them your full attention – give them five minutes or half an hour of your time.  When you ask “how are you?” be aware that the answer may not be “I’m grand”.

And that’s grand.

Donal Walsh and Suicide: What’s missing from the debate, and where do we go from here?

Donal Walsh

There has been lots said and written on the subject of the late Donal Walsh over the past 48 hours. Rarely has the passing of a young man evoked so much emotion and passion among the public, but then, Donal was without a doubt an exceptional young man, who displayed remarkable courage, dignity and bravery as he faced his future knowing he was dying from cancer.

On Wednesday night, RTE 1 showed a documentary entitled “Donal Walsh: My Story”, which followed Donal and his family throughout his last few months as he came to terms with the fact that he was dying. Knowing that he had very little time left, Donal, his friends and family spoke eloquently and earnestly about his treatment, his feelings, his aspirations, and his frustration that he would never get to achieve many of his dreams and goals. The public was already familiar with Donal’s story, having witnessed his candid interview with Brendan O’Connor on the Saturday Night Show in May 2013, where he implored teenagers to think twice before they considered suicide.

RTÉ tends to excel in the genre of documentary making, and as a human interest story, this was an exceptional, evocative and heart-breaking piece of film-making. Donal’s courage, and that of his and his family – mother Elma, father Fionnbar and sister Jema –  and his loyal bunch of friends is one of the most inspiring stories of our generation, and a story worth telling. There are lessons to be taken from the way in which Donal faced his illness, and it’s hard to imagine that anyone watching it could fail to be moved.

A central focus of the documentary was Donal’s opinion on teen suicide, as broadcast on the O’Connor interview in May. Statistics had shown a consistent upward trend in recorded suicides in Kerry in previous years, many of those deaths occurring among young people.

“I just didn’t want them to see suicide as a solution to any of life’s problems. It hurts me to see them think about it… to see it among their friends. But it kills me because I’m here fighting for my life for the third time … I’ve no say in anything, and I’m still here waking up every day. And they think that they have a problem, and this might be a solution. That does make me angry, and I’m not going to lie about it. I’ve nothing against people with mental illness. But these people have to realise that there is help.”

His words triggered a nationwide conversation on suicide, and widespread media coverage. Young people claimed that his message had touched them, had changed their outlook, and had resonated in a way that the voices of adults – parents, teachers – had not.

During the documentary, his father, Fionnbar, read from a letter received from a student in Waterford.

“Your story was so powerful and moving. I’m 16 myself, and the thought of going through what you have gone through at the same age is just hard to believe. Many people would have been afraid to say what you’ve said about suicide. It wouldn’t have been politically correct, and all that bullshit. You tell it how it is, and I respect that”.

The words of another student:

“Young people shouldn’t be thinking of dying so soon. They should be just growing up, thinking about what they want to be, what jobs they want to have … that kind of stuff.”

Donal himself said:

“If I’m meant to be a symbol for people to appreciate life more in general, he said, then I’ll be happy to die, if that’s what I’m dying for.”

His father put it in starker terms.

“There is no comeback after death”.

The HSE’s National Office for Suicide Prevention (NOSP) adopted Donal’s message, rolling it out to schools, and embarking on a programme to educate young people on appreciating life before they considered dying by suicide.  It’s a good video. But as a strategy to tackle youth suicide, it is lacking. And it is here that the discussion becomes problematic.

There has been much debate raging online since the documentary was aired on the merit of Donal’s message. There is little doubt that it had resonance. It spoke to young people at their level, it moved people of generations older than himself and it made probably anyone who encountered it stop and think. It potentially saved lives. Was it worth saying? Yes, I think so. The phenomenon of suicide clusters and copycat suicides is well documented, and the theory that some suicides are decisions made, not after months of depression, but on the spur of the moment or as a knee-jerk reaction to a traumatic occurrence cannot be discounted. I can’t quote the prevalence of such happenings, nor am I sure what statistical evidence is there to back it up, given the difficulty of collecting such information on suicide. But I do think there was an audience for and a merit to Donal’s message. I’m not convinced we can argue that there was not.

But there are a number of things that are deeply alarming, both within the documentary, and in the way that Donal’s message has been perpetuated by adults almost as a universal truth. What is not acknowledged  is the fact that that this fails  – and fails utterly – to address the fact the suicidality is just not that simple, and that the factors contributing to any one person’s suicidal intent can differ greatly to the next. Suicidality is also strongly linked with depression. At no point in either the documentary or in the wider campaign has depression been acknowledged as an illness, has its nature been explored, nor has the fact that suicide is very rarely a decision made with a clear and rational mind.

No professionals working in the field of mental health were interviewed during the course of the documentary. No account has been taken, either within or outside of the documentary of the fact that a one-size-fits-all message is not an appropriate way in which to go about formulating a suicide prevention strategy – even a youth suicide prevention strategy.

There have been a number of pieces written in the past 48 hours on depression and suicidality from the point of view from those who have themselves been there , and I urge you to find them, read them, absorb them and think about them. The point has been made that we are now at a stage where people feel supported enough to be able to disclose their experiences, and this alone is evidence of the strides that have been made in this debate.

However, it is absolutely crucial to remember that there are two levels of understanding of suicidality. The understanding of those who have been there, and who have felt that despair, and those who have not. The latter, if they are serious about wanting to help to address this problem, need to take responsibility for learning about the state of mind in which a fellow human being  finds themselves to not want to exist anymore. From my own experience, it is born out of a desperation to escape a hellish existence in one’s own mind, where nothing exists but self-loathing, darkness and a sense of being trapped. When I felt suicidal, and contemplated dying, it wasn’t because I wanted to die. I just wanted to escape. I didn’t want to live like that any more, and the only way in which to achieve that was to stop living. To a healthy mind, that’s almost incomprehensible. There is no rationality involved in that particular state of mind. None. But I urge you, try to contemplate it.

Now picture someone telling you “Sure you’ve loads to be thankful for. There are people dying through no fault of their own and you want to kill yourself.” Consider how, in a mind full of despair, hearing those words would make you feel. Would you feel any better about yourself? Already, you can’t find anything to make you feel grateful for living (as illogical as it may be, but remember, there is no logic left). Now, the implication is that you’re selfish, too. Which, in turn, reinforces every negative thought you’ve already had about yourself, and increases that sense of self-loathing. How is that helpful? How?

Above, we had a student dismissing public discourse on suicide as “politically correct” and “bullshit”. This assertion remained unchallenged within the documentary. Suicidality is so complex. It IS delicate. We are still learning how to talk about it in a responsible way. Treating it with sensitivity is not politically correct bullshit. I have no issue with this young man saying it as he sees it, from the point of view of a teenager who has in all likelihood experienced suicide by peers. But I do have an issue with this viewpoint not being challenged by adults, or those who deemed the documentary an appropriate commentary on suicide. Again – it’s just not that simple.

So why, at no stage, has no-one in the public eye, the media, the health professions,  while this campaign has been running, and documentary been airing, strongly and explicitly acknowledged that this message, while extremely laudable in one sense, is absolutely not applicable to everyone out there who is contemplating suicide? Why has the negative impact that this message may have had on those in a depressed and suicidal frame of mind not been acknowledged?  Why are we consistently fed a strategy of soundbites that may resonate with some, but may alienate others? While NOSP claim that they had the input of a number of professionals in producing the Donal Walsh video on their website to ensure it was appropriate for young people, why did they not acknowledge the complexity of suicidality, the fact that each sufferer is dealing with their own individual struggle? They tell young people about the “value life” message, yet do not acknowledge the difficulties involved in doing so when struggling with a mental illness like depression.  This “scratching the surface”, one-size-fits-all approach doesn’t cut it anymore, and if anyone should be acknowledging that, it is one of the few – if not the only – public bodies currently tasked with suicide prevention.

The issues I raise in this post aren’t with brave, dignified Donal Walsh. They are not with his tremendously courageous and generous family and friends. I hope that is absolutely clear. They have lost a son, a brother, a close friend. They have given magnanimously of their time, their privacy and shared their grief with a nation, in order to spread the message of Donal’s courage and dignity. There is hardly a person watching RTÉ 1 on Wednesday night who didn’t want to put their arms around them and take their grief away, or could fail to be inspired by their appetite to inspire massive societal change, as evidenced in the setting up of Donal Walsh Live Life. Donal’s words – which his family explicitly acknowledge were said in anger, by a dying child who never claimed to be an expert on mental health – inspired a wave of emotion, and injected impetus into a conversation we are only starting to have at a national level. And for that, I am certainly grateful.

But they should not be perpetuated as an all-encompassing strategy, nor do they speak to everyone. It is now the responsibility of public policymakers, mental health bodies and organisations (starting with the Minister for Mental Health), medical professionals and indeed, ourselves as a mature, responsible society to continue that conversation, while striving to educate ourselves and others on the nature of suicidality, mental ill-health and depression in a meaningful way.

Soundbites aren’t enough. Platitudes aren’t enough. We’ve all heard messages at this stage like “talk to someone”, “get help”, “there’s always someone out there willing to listen”. They are just not sufficient anymore. We can’t just dump them out there and expect people in distress to find their own way.

Let’s look at this in real, practical terms.

If you were desperate, in the frame of mind where the only relief you could contemplate was not living any more, where would you turn? Who would you talk to? If you make the (difficult and brave) decision to “talk to someone” and seek help, where would you go first? Would you get the support you needed from your family? Friends?  Would your employer support you if you need to take time off? Would you even feel comfortable telling your employer? Would you receive the best advice on embarking on the path of medical support such as taking anti-depressants?  Would you be able to access the right therapy for you, with a therapist you felt comfortable with? Would your health insurer pay for you to get all the therapy you need? If you don’t have health insurance, how would you go about accessing that therapy? How long would you have to wait to access that therapy? Bear in mind here that you are desperate, and need help quickly. And not just any old help. The right help and treatment for you, as an individual, with individual needs.  If you dial 999 in the middle of the night, or contact an out-of-hours GP service, will you get the help you need?  We need these assurances.

What if someone came to you in desperation, telling you that they couldn’t cope with living any more, and didn’t know where to turn, would YOU know what to do? Would you know where to go to get help? Would you know what to say, what not to say, how to listen?

Make no mistake, this conversation is merely in its infancy. Donal Walsh and his family have played a huge part in building that conversation. This is not a battle for them to fight alone. What is the HSE doing to address the above questions? What is the Minister for Mental Health doing? What are you and I doing, as members of a mature society with a collective responsibility to each other other than repeating platitudes that make us feel better about ourselves? Are we educating ourselves on how to recognise the signs, how to react?

It’s time to stop paying lip service to suicide prevention, and start coming up with real solutions, fast.

On World Suicide Prevention Day, what can YOU do to prevent suicide?

It’s World Suicide Prevention Day today, Tuesday 10th September. The day, is an awareness day observed annually in order to provide worldwide commitment and action to prevent suicides.

It’s unlikely many of us here in Ireland lack awareness of what is one of the largest killers of our young people. Recent CSO statistics indicate that 507 people took their own lives in Ireland in 2012 – however, as per any suicide reportage, this figure forms only a very small part of the picture. Not all suicides are recorded as such; there are many unreported accepted suicides, and the overall figure masks the occurrence of severe suicide blackspots in certain parts of the country, like Limerick, Wexford, Mayo, Leitrim and Cork, with Limerick numbers the most alarming at 26 in every 100,000. The statistics, though they are only a snapshot, speak for themselves. However, a lack of proper recording and accurate data to work with, particularly to use to spot clusters and trends, is one of the key challenges facing those who fight every day to try and turn the tide of suicide

Regular visitors to the blog will know that I touch on the topic of mental health here the odd time, sometimes in relation to my own experiences, sometimes at a more general level, and occasionally referencing the influence of things like alcohol on our collective mental health. It’s great to see frank, open discussion of mental illness on social media and in the newspapers today; however in the course of the debate, we’re constantly hearing about “breaking down the stigma” as if it’s some big mystery. Stigma is born of ignorance and breeds fear, yet the reality is, each and every one of us has the key to breaking down that stigma, by just learning a little more about the nature of mental ill-health, and by taking small but meaningful steps to challenge it. Yes, you too. It’s not rocket science, and we can all do it. Some thoughts below.

  • The key message we’re hearing is “If you’re in difficulty, talk to someone”. Sounds easy, doesn’t it? Just reach out, and everything will be okay. Well, you know what? It’s not that bloody easy. Firstly, when you’re in a place where you’re struggling, or convinced that no-one gives a damn about you, and that you might be better off dead, it’s incredibly difficult, nigh impossible, to reach out and talk to somebody. If you do reach out and talk to someone, you may not get the response you hope for, or need. What then? We need to stop placing the onus on people who are suffering to make that first move. This is a collective, worldwide responsibility. It starts with you and me, showing real human kindness to the people around us. Look around you, at your family and friends. If you think that someone is struggling, talk to them. Pick up the phone. Let them know you care. Even if they’re not visibly struggling, tell them anyway. It can be that simple.
  • Telling people to “just talk about it” is all well and good. But in a country where we’ve been bred for generations not to talk about things, talking is something not something we’re all very good at. And if you’re the person chosen to talk to, you might have no idea how to handle it. If you do see someone struggling, and you’re not sure what to do or how to talk to them, that’s totally fine. It’s natural. We’re all human; we’re not all counsellors. Sometimes indicating that you’re willing to listen is all that’s needed. And if you need some help, the folks over at See Change have some very practical tips on how to talk and listen. And there are services available to help both you and the person in difficulty – you can call them yourself, pass the details on, or offer to accompany them while they seek help.
Green Ribbon 1

Some practical tips on talking about mental health

  • We all have mental health, and we all have a responsibility to look after our own mental health. We are not victims of our minds. Prevention is better than cure, and there are countless things we can do to mind our minds.  Exercise, fresh air, spending time with friends, eating well, taking a break from online activity, are all small steps that can have an incrementally positive effect  on our own mental – and physical –  health.
  • Just like most physical ill-health, mental ill-health is not a permanent, unevolving state. Sometimes we’re in good mental health, sometimes, less so. That’s normal. For various reasons, people can go through difficult times where they struggle to cope. Depression can be all-consuming, and for the person experiencing it, it’s hard to believe that this feeling will every pass or that things will get better – but things can and do get better. Depression may be something that will always be part of your life – but it can be managed, in many different ways. Equally, if someone you know is experiencing depression now, with the correct help, there’s every chance they can and will recover.
  • It’s heartening to see so many people sharing their experiences online. Sometimes writing things down is therapeutic, and reading those stories from people you might know is oddly reassuring. Let’s start taking the next step, and talking about it face-to-face, with our friends and family. It doesn’t always have to be a big deal. Experiencing mental health difficulties during life’s journey is perfectly normal, and a simple acknowledgement can go a long way. This was the thing I found hardest to do, but was the one helped me the most.

I experienced my worst depressive experience in my 20s, and at the time felt in despair that things would never get better. They did.  I learned some valuable things over the course of that time that I carry with me every day,

  1. While depression might always be a feature of my life, it doesn’t define me. I am far more than that.
  2. Depression can be managed. Proactively and reactively, there are things I can do to combat it. It’s not always easy to react, which is why I try to be proactive.
  3. Asking for help is not a sign of weakness. In fact, the very act of doing something about it made me feel stronger.
  4. “This too shall pass” became my motto For me, accepting that I wasn’t well was important, and sometimes I just needed to put my head down and let it pass, rather than fighting against it. Pass it did, and pass it will, if and when it happens again.

These are lessons I learned on my own journey, but maybe they’re things than can help non-sufferers understand the nature of the illness and remove some of the mystery about it.

Today is World Suicide Prevention Day. Preventing suicide isn’t something for “other people” to do. It’s up to you, and you, and you, and me. So do something. Pick up the phone, knock on that door, send that message. Speaking as one who knows, it could make all the difference.

Mental Health, Mixed Messages and the Green Ribbon

It’s May, a new summer season is upon us (apparently), and around us a new conversation is finding its feet. Discussion of mental health issues and suicide, in particular, has never been more prominent than in recent times, yet rarely has the conversation been so intense and the messages been more mixed.

We’ve had weeks of robust debate around abortion, where the term ‘suicide’ has been bandied around frequently, carelessly. Public discussion is hugely important in shaping perceptions of mental health, and regardless of the abortion issue, suggestions of large teams of professionals having to ‘verify’ the state of mind of a suicidal pregnant woman arguably sent a subtle, but potentially very damaging message.

We’ve witnessed also the late Donal Walsh’s impassioned campaign against suicide. At 16, Donal knew he was dying, and spoke eloquently of his anger that some of his peers were choosing to end their lives, when he so badly wanted to live. There is little doubt that Donal’s brave handling of his illness earned him respect and admiration. While he may not have fully acknowledged the mindset that drives someone to take their own life, nevertheless if his sentiment, ‘suicide is a permanent solution to a temporary problem’ resonated with just one young person and made them think twice, then it hit the mark.

Another to add his voice to the discussion has been musician Niall Breslin, who’s spoken candidly about the crippling panic attacks he suffered for years. The significance of someone like Bressie – likeable and popular among the younger, more vulnerable demographic – talking openly  about his own mental health simply cannot be underestimated.  He is also an active campaigner who insists that suicide should just not be an option; it “should not even be part of the conversation”.  Instead, he focuses on the practical, and is adamant that young people need to know exactly where to turn. While there are many options, he says, quite correctly that they are not always clear or obvious, and they need to be so. Bressie has also highlighted the negative effects of excessive alcohol consumption – something that for various reasons is routinely ignored in mental health discussions but undoubtedly contributes in no small way to the problem.

What’s great about Bressie’s input is not just the way he normalises mental health, but his reassurance that mental ill-health is treatable, and that we have the power to make positive changes. Too often these conversations focus on negative outcomes like suicide, but it’s vital to show that frequently outcomes are positive, people do recover and that we can and should take steps to mind our minds like we do our bodies.

Last Saturday, the spectacularly poignant Pieta House Darkness into Light walk saw 40,000 people in parks nationwide rising before dawn, donning yellow t-shirts and walking together towards the sunrise in a powerful show of solidarity, remembrance, and hope. The emotion was palpable – unsurprising considering that pretty much every participant had in some way been touched by suicide. All were walking to send a powerful message that change is needed, and quickly.

May is Green Ribbon month. Like pink ribbons are synonymous with breast cancer, the green ribbon is an international symbol – of challenging the stigma of mental health problems. See Change, the National Stigma Reduction Partnership has launched a month-long campaign to get people talking openly.

We are however, already doing that, and often the advice given to those who are struggling is to “talk”. What we don’t acknowledge is that often, starting conversations is the hardest part, and that many of us simply don’t know how. Even harder is knowing how to listen, without necessarily offering solutions which may not be helpful. The Green Ribbon campaign offers helpful, practical tips. Simple things. Ask someone how they are. Don’t feel the need to jump in with a solution – just listen. Be patient. Sometimes, tiny things like a text message make the biggest difference.

Above all, we must realise that collectively we all have responsibility. An act of kindness costs nothing, while simply looking out for those around you can be priceless. This is the season of hope. Let’s make it a mission to spread some light this May. And get talking.

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Published on Newstalk.ie on Friday 17th May 2013

Mental Health and Alcohol – the elephant in the room

This post was published on thejournal.ie on the 6th March 2013.

At a time when mental health is finally well and truly a ‘hot topic’, firmly embedded in the public consciousness, I can’t help feeling that we’re quietly omitting a vital part of the discussion – our relationship as a nation with alcohol, and how it affects our mental wellbeing.

The term “mental health” is a wide-ranging one, and it can be argued that at the moment it has somewhat negative connotations and is almost synonymous, in public discourse, with mental ill-health and suicide – something that needs to quickly change. Slowly but surely, however, we are witnessing a realisation that preventative measures and positive mental health promotion, particularly among young people, are ultimately excellent and necessary long-term strategies on which we need to focus as a matter of urgency to tackle the current suicide epidemic.

In the wake of an abrupt economic crash, attitudes have changed rapidly in an adjusting Ireland. While it can be argued that a return to more prudent values is to be welcomed, there is an ongoing struggle to adapt. We have not adequately dealt with the practical reality of the economic fall-out that has decimated employment, household income and consumer confidence. There is evidence to suggest that pressure resulting from economic difficulties is a contributory factor to the increase in the number of suicides we have seen in recent years. To attribute the rise purely to this, however is to simplify the issue greatly. There are biological, sociological and psychological factors at play, and these are often intertwined – just as everyone is different, the individual causes of suicide vary greatly.

But let’s pull back from suicide for a moment, as that’s just one element of mental health we need to look at. Mental “wellbeing” is a term I’d prefer to focus on for now. And while most of us at this stage know that there are steps we can take to look after our emotional health, it’s apparent that our alcohol consumption behaviour and attitudes often directly contradict this. While it’s been touched on by aspects of the media in recent weeks, notably by Breda O’Brien in the Irish Times on Saturday January 26th and also as part of the Frontline discussion on mental health on Monday January 28th, it remains the elephant in the room when it comes to the national conversation we are attempting to have about mental wellbeing.

Our drinking habits and our attitudes towards alcohol in Ireland are what can probably fairly be classified as “extreme”. A recent study conducted by Millward Brown Lansdowne on behalf of Drinkaware.ie, indicated that while Irish people drink less frequently than our EU counterparts, our consumption is three times higher than the EU average. (Drinkaware.ie, interestingly, is an initiative developed by MEAS, a group comprised of various players in the alcohol industry, under the guise of social responsibility. The site contains lots of eye-opening information about the effects of alcohol, including its impact on relationships and mental health.)

In particular, attitudes among our young people are telling. The cross-border survey, “Alcohol Consumption and Alcohol Related Harm in Ireland” published by the National Advisory Committee on Drugs (NACD) last year found that a third of drinkers aged between 18 and 24 consumed the equivalent of nine standard drinks on a typical night out, and regard having at least five standard drinks on a night out as the “norm”. The Department of Health’s recommended weekly low risk drinking limits are 17 standard drinks for a man and 11 for a woman. So right there, that’s half your weekly intake, in one night.

So it’s clear that our attitudes to alcohol and alcohol consumption are somewhat skewed. The vast majority of our social occasions centre around the consumption of alcohol. Take,for example the prevalance of holding nearly every celebration in a licenced establishment, or if it is held in the home, accompanying it with carry-out alcohol. While there is a marked growth in outdoor, health-based activities, it’s not uncommon to celebrate a physical achievement such as a marathon or a triathlon in the pub. Even childhood occasions like christenings and first communions are commonly hosted in pubs.

There’s nothing wrong with this (I’m not writing this to judge) but why not ask why this is? Why the inherent dependence on alcohol to have a good time? Are we lacking so much in confidence in ourselves and our own personalities that we need use of alcohol as a social lubricant in order to let our hair down and truly enjoy ourselves? Alcohol consumption is pervasive. It’s everywhere. It’s practically impossible to avoid it. And the evidence indicates that we actively depend on it. Why, more importantly, are we so uncomfortable admitting this? And why are people who call it out and suggest that it might not always be healthy, dismissed as killjoys?

Minister Roisin Shorthall, during her time in government prioritised a strategy to tackle alcohol intake and abuse, including placing restrictions on alcohol sponsorship of and advertising at sports events, yet met with resistance both from within government and the alcohol industry. Minister for Transport, Tourism and Sport Leo Varadkar expressed concern that banning sponsorship would impact negatively on sports performance across the country – and incredibly, in this he is correct, as we now find ourselves in the questionable situation where our sporting bodies have become heavily reliant on the alcohol industry for funding. It can be argued that this is something of a double-edged sword, given that evidence demonstrates that young people are more likely to be influenced by the advertising of alcohol.

The bottom line in the debate around alcohol and mental health is that alcohol is, beyond a doubt, a recognised depressant. Research has demonstrated that it can have an adverse effect on our mental health, affecting our ability to cope with everyday challenges and bigger traumas. Critically, the connection between alcohol and suicide has been highlighted, and the fact that suicide victims are frequently found to have alcohol in their bloodstream points to a concern that alcohol can lower inhibitions enough for a person to act on suicidal thoughts that they may not have, otherwise. In one of the most damning statistics on alcohol you will ever read, the World Health Organisation estimates that the risk of suicide increases EIGHTFOLD when a person is abusing alcohol, compared to a person who is not.

Yet we continue to blithely ignore this enormous elephant in the room, because, the truth it, it’s easier to blame other factors than it is to look inwards and examine our own attitudes and behaviour. In continuing to place alcohol at the centre of our social interactions, we are all, each and every one of us, complicit in the problem. Harsh? Perhaps, but it’s an uncomfortable truth. We may not all drink to excess; neither might we all abuse alcohol but in failing to question the status quo or actively engage in alternatives to alcohol-reliant social occasions, we are all contributing to this problem. Every time you question someone who is not having a drink, or try to persuade them to “leave the car” when they choose to drive on a night out, or indeed, accept without question the behaviour of a friend who is clearly consistently drinking too much, we are contributing. And crucially, we are propagating and reinforcing these attitudes, because this is what our young people witness as they grow up. Not to mention perpetuating the “drunken Paddy” stereotype abroad, in countries where people mange to live with licensed premises that remain open through the night without turning into rabid binge-drinkers and functioning alcoholics.

So what can we do to change this culture? (Because this is what it is – a culture.) I don’t personally believe that measures such as restricting sales of alcohol, either at pubs and off-licences ultimately tackle the issue. And why should you or I not have the choice to buy a bottle of wine to enjoy at 10.30pm on a Friday night if we want? Or why should I have to leave the pub at 12.30pm on a Saturday night, because the law dictates that at this stage, I’ve had enough to drink? Rather, this change is an attitudinal one and needs to come from within – from within ourselves and our society. I’ve come up with a few suggestions – feel free to add your own in the comments below.

Firstly, let’s think about our reactions. Don’t judge a friend or acquaintance for not consuming alcohol. Don’t make them feel they have to invent an excuse for not drinking, once they make that choice. Don’t ridicule them, or make them feel that they ‘re not actively partaking in the occasion, just because they’re not drinking alcohol. Language is powerful.

Secondly, let’s think outside the box a little. Why the need to celebrate every little event or hold every single get-together in the pub? It’s a little unimaginative, frankly. A friend of mine organises a weekly social run in the Phoenix Park. He extends an open invitation to friends, and it’s well-attended. He doesn’t even go to the pub afterwards. And it’s fun. Imagine! And do occasions that focus on children really need to involve alcohol?

Thirdly, let’s learn to have a little more confidence in ourselves and our personalities. We’re great, we Irish. We have a wit that is rarely equalled, but excessive alcohol consumption doesn’t always make us wittier, or more confident, or more attractive. (Usually the opposite, in fact.) Often, it doesn’t even enhance our enjoyment of a night out. Or the following day, for that matter. I myself can confirm this beyond all shadow of a doubt, having tested the theory more times than I care to recall.

Fourthly – and I say this conscious of the sanctimony it may indicate, but does not intend – let’s embrace moderation. Alcohol consumed in moderation is enjoyable (and sometimes, depending on what you read, pretty good for you). It’s also more inclusive and conducive to drinkers and non-drinkers enjoying a night out in each others’ company.

Let’s look at alcohol a little differently. Rather than a mere inebriant, alcohol’s pretty nice with food. A nice red with a steak being the obvious example, but there are independent brewing companies who are marketing their craft beers as food accompaniments, and it’s another way to enjoy a tipple without making it the focus.

Lead by example. Sure, we’ve no obligation to do so, but our young people are watching, and it’s more important than you think.

Pubs – how about offering some appealing alternatives to alcohol? I’m done with Rock-more-expensive-than-a-pint-Shandy, and there are only so many sparking waters one can drink. How about some decent non-alcoholic beers? Palatable ginger ale? And less of a visible sneer when I ask for a non-alcoholic drink, thank you – smile, be polite and think of the often extortionate mark-up.

If you do want to check out alternatives, check out http://hellosundaymorning.org/ – an international initiative aimed at changing and recreating attitudes to alcohol that has just been launched in Ireland by comedian Des Bishop in conjunction with his RTE TV series, Under the Influence. Hello Sunday Morning is an initiative that says it’s perfectly fine not to drink lots all the time, and while you may not want to give up alcohol, it allows you to take some some “time out” – periods of three or six months are recommended in order to give you time to reflect on your drinking behaviour and reclaim the Sunday mornings that are frequently lost to Saturday night alcohol consumption. Most people return to drinking alcohol afterwards, but ultimately the time out can assist you if you want to change your drinking patterns.

Finally, let’s face up to the truth. If we genuinely do give a damn about the problem that is mental ill-health in this country, and want to be the change, we need to do more than simply call on the government to address the issue. While we urgently need to channel resources towards education and prevention, it’s all too easy to deflect responsibility. Like it or not, most of us are part of the problem, and we need to start taking some ownership – and fast. Examining our own contribution to the problem doesn’t necessarily mean rejecting alcohol, or seeing it as the enemy – merely becoming a little more thoughtful in our attitudes, behaviour and discourse around alcohol consumption. Then, and only then will we start to turn the tide and tackle one of the root causes of the suicide plague that blights our society today.

Dark Nights of the Soul

Ireland. The land of a thousand welcomes. Where the grass is green, the sun is rare, the Guinness is black (or ruby red, if you’re a purist) and the craic is mighty. Sure it’s a great little country altogether we have. Isn’t it?

Well, it is. For the most part. Unless you’re suffering from mental ill-health, that is.

Ireland, for all its warmth and revelry, its friendliness and humour, struggles to deal with mental health issues. As a population, we don’t really like the thought of anyone being “not right in the head”. We regard those who are “a bit touched” with pity, suspicion and even fear. We exude patronising pity for those who “suffer with their nerves”. We don’t talk about mental ill-health in the same way as we talk about physical ill-health, and if someone shows signs of mental “frailty” they are labelled, for life.

Come to think of it, talking about feelings on any level, apart from the most superficial, tends to be a challenge, particularly if you’re male. And especially not with other males.

Something I’ve noticed over the past couple of years in Ireland is the big increase in media coverage of mental health – and mental ill-health. Be it blogs, websites, articles, newspaper reports dealing with depression and other mental illnesses, this is an area which is generating more conversation than ever before – and not before time. Organisations like Spunout.ie, Headstrong, Grow, and Shine to name but a few of many, have been working to push these issues into the the public arena and popular discourse, and are slowly but surely building conversation, knocking down walls and very, very gradually reducing the stigma around mental illness. An initiative which has really pushed the boat out in terms of working to reduce stigma around mental health problems is
See Change, an alliance formed by over 40 voluntary organisations, state agencies, universities and youth groups including those named above. Their work has really impressed me so far, particularly their ‘Make a Ripple’ campaign, which comprised of stories by real people who have been affected by these issues, serves to remind us that mental ill-health is not solely the preserve of people we don’t know.

This isn’t a post about my own experiences of depression. I’m one of the luckier ones. In my lifetime, I’ve dealt with two pretty bad bouts of the blues, both severe enough to necessitate time off work and both harsh enough to make me wonder through the darkness of despair if life would ever look any brighter again and if I would be better off dead. I’m not going to write at any great length about how waking up in the morning during a period of depression is almost a disappointment… nor about the way it saps your energy and motivation, how broken sleeps provide no respite, contributing only to sustained exhaustion. I don’t intend to dwell on the guilt you feel for your lack of enthusiasm when nothing moves you. Neither will I write much about how, during a period of depression, you become your own worst enemy, locking yourself away, isolating yourself, distancing yourself from the people around you and focusing helplessly on the negative thoughts, feeding the selfishness of the illness until you are trapped in a spiral of misery so intense that all you want to do is go to sleep and not wake up.

No, for those who want to read about the experience of depression in depth, there are plenty of accounts out there, written by those souls courageous enough to share.Like I said, I’m one of the lucky ones. I’ve learned to deal with it. Every so often, another wave will appear, out of nowhere to wash me under, but as any bad surfer knows, sometimes it’s easier to duck beneath the wave and let it roll over you than standing up and trying to fight it. Acceptance has been half the battle, for me.

It does sometimes feel like a constant, exhausting fight, keeping the darkness at bay. A feeling I’m sure many a sufferer will identify with… but to live in fear is to let it dominate your life and I will absolutely not allow that to happen.

Sometimes though, it’s hard.

Everyone deals with things differently, and for me, I’ve always found the internet a ‘safe’ place to share. (That’s why I think Aware’s online support groups are a fantastic initiative.) As per the bio, I don’t much like talking about myself. I like asking questions more than I like giving answers, and I would struggle,  face-to-face to talk to many of my friend about this. Only a handful know that I ever suffered with depression, and it’s never really mentioned. I feel this is partially because, I think, having never suffered it themselves, they cannot empathise. Harsh? Yeah, probably.  And a bit unfair – given that we just don’t know what anyone else is dealing with in their own head.

But it’s no way meant to be derogatory. In my experience, there is a divide between “them” and “us”. Anyone who has ever suffered from depression will comprehend, and those with no experience simply cannot understand. They can sympathise, but can’t empathise with the despair. There’s nothing wrong with that. It’s a good thing, for them. I find however, if I say I’m feeling down, it’s awkward. After a while when it doesn’t lift, people become impatient, or bored. I’m not saying it’s their fault. Naturally, it’s frustrating for them too when they’re getting nowhere. But I sense the impatience, and knowing I am the cause stresses me and upsets me even further. Therefore, I just find it’s easier not to talk about it.

And I couldn’t, in a million years, begin to imagine telling my current employers. I don’t think there is any place for mental “weakness” in business, and I have unfortunately seen very real evidence of this.  I have imagined the conversation in my head once or twice, for laughs. A couple of recent initiatives which have approached the issue from the ‘preventative’ side though, like stress management courses and an emphasis on fresh air and exercise, are positive and ones that I hope are not just tokenism, and will contribute in a small meaningful way to the mental health of all employees who participate, whether they realise it or not.

It’s my hope that all the work being done at the minute by the organisations above can somehow bridge the gap between ‘published’ experiences and real life, and that the conversation can become relevant to all of us. That’s where the real challenge lies. And this is a challenge that needs to be taken on – from the top down. Any politician who actively promotes the issue of mental health is worth their weight to this country in gold. It’s all very well to say that it’s good to talk about these things. We can say that til we’re blue in the face. We know it’s good to talk.

It’s translating the rhetoric into reality, and dealing with mental ill-health in a positive manner when it affects you, or me or someone close to us, and actually talking about it when it happens – that’s what will ultimately show that we are winning this battle, and my fear is that it’s easier to talk the talk than walk the walk. These organisations need to position themselves in such a way that they are accessible to those who have very little strength to actively reach out. And let’s encourage those of us who are stronger to look out for others. I fear that the disconnect remains, but only by working together (and looking out for one another) can we erode this “strong, silent” mentality and help make those dark nights of the soul a little less lonely.

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(Image: Morguefile.com)