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.

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)
 

Simple pleasures in sunshine

This weekend just gone, I spent a day with a dear friend, driving and walking through the very best that North Mayo can offer. We walked for miles on the beautiful Enniscrone beach. We walked for mere steps on the smaller, peaveful cove at Ross Strand:

Just look at how clear the water is.

We drove through the rugged coastline of Lacken and Ballycastle, stopping to marvel at the wild, deserted beauty of Kilcummin Back Strand:

We topped it off with a visit to the most savage edge we could find:

The Twelve Apostles? We only need one.

And there we sat for hours, watching the sun dip in the sky. A perfect day.