LET`s GET PHYSICAL - Scottish Association for Mental Health

auTumn 2oo9
ISSUE 29
LET’s GET
PHYSICAL
Scottish Mental Health
Awareness Week 12
ALSO INSIDE
THIS ISSUE
John Beattie's Talking Points 4
Mental health in the
Western Isles 24
2
3
conTenTs
Welcome
4
Talking Point: John Beattie
6
News
8
Brain Bomb
10 Living Better
12 Scottish Mental Health Awareness Week
15 Make your Point – Survey
19 To the Point
20 Whose Evidence is it Anyway?
22
Why I Like to Dig Tatties
24 Mental Health in the Western Isles
26 Branching Out
28 The Facts
30 The Stories of our Lives
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3
weLcome
Mental Health Awareness Week runs from
4–10 October this year. In my job, it can feel as if it is
Mental Health Awareness Week every week of the
year. I talk about mental health all day, every day. So
do my colleagues, and so do the literally thousands
of people who work or volunteer in mental health
across Scotland, whether as healthcare staff, service
user/carer representatives or support workers.
So why bother with an awareness week at all,
if it’s already such a hot topic?
Because it’s not. People who don’t work in mental
health barely talk about it at all. It remains a taboo
subject. And the effect of all this silence is that it
continues to come as an enormous shock to people
when they develop a mental health problem. On top
of their illness, they have to deal with fear, uncertainty
and often shame: not only their own but often that
of their family, friends and employers too.
Awareness weeks can sometimes seem a bit
devalued. Throughout the year, we are exhorted to
devote whole weeks to raising our awareness of
subjects including sandwiches, chips and compost.
So it’s understandable that people can feel a bit
weary of the whole concept. But I urge you not to
ignore this one, because it really matters.
Too many people are living with the unwanted
baggage that comes with a mental health problem –
the sudden silences when you walk into a room,
the stilted conversations with once-dear friends,
the pressure to pretend that everything is fine
when that couldn’t be further from the truth.
And too many others are living in ignorance,
convinced that mental health problems only happen
to other people. That’s why, in this issue, we’re
delighted to showcase just a few of the events that
will be taking place during Mental Health Awareness
Week this year. And we’re also delighted to highlight
some other beacons of hope that flicker across
Scotland, from Catch 23 in the Western Isles to the
Forestry Commission’s Branching Out project in
Glasgow.
Elsewhere, we hear from Mark Fleming, whose
recent novel BrainBomb does much to combat the
perception that mental health problems don’t happen
to “normal” people. Pippa Coutts tells us about the
Living Well project which aims to help people living
with long-term health conditions to improve their
mental health and wellbeing. And former Scotland
rugby international John Beattie reflects on his mental
health Talking Points.
So please join everyone at SAMH in celebrating
Mental Health Awareness Week. It’s our once-a-year
chance to get everyone talking about mental health:
and start to drown out that perilous silence.
Carolyn Roberts
Editor
SAMH produces The Point magazine in order to promote discussion and debate.
The views expressed in The Point do not necessarily reflect those of SAMH.
5
Talking Point
In this regular feature, we talk to Scottish celebrities about their own
experiences of mental health. For this edition, we spoke to the former
international rugby player, John Beattie.
What does mental health mean to you?
Mental health is as important as physical health.
It means being relaxed inside my own skin, being
at ease with the world, and being able to function.
I seem to wake up happy each morning, which
infuriates my family, but it gives me an ability to
shrug things off. I think I am sane, which might
be worrying, but I know that at times I haven’t
functioned properly.
What do you do to protect your mental wellbeing?
I clear my head by exercising. I find that if I go to
the gym, or take a walk, or coach my rugby team,
or get up on stage with my band or play my guitar,
or watch or listen to music or comedy, then I can
retune my brain if it has been whizzing. It’s also
important to me to talk to people so that I can tell
them how I feel at times. I suppose I bottle things
up to myself a lot so I do have bits of my life I set
aside to recharge. I know I should take more
holidays as well because a good break can be
wonderful. I was sitting by a lake recently, listening
to the waves, and it was so good. I also try to enjoy
the work I do.
If you have ever experienced a mental
health problem (including stress or anxiety),
how did you deal with it?
I have felt stress a few times as various bits of my
work can be stress inducing. If things are going
pear shaped in relationships or work then I can
have a sleepless night and I have had a few of
those. Again, I consciously exercise or take myself
into a different environment to clear my head to
rationalise things and then come back to sort it.
I admit to being a typical man though, in that I
often can’t or won’t tell anyone how I really feel.
There have been times when I wished I had been
able to speak to someone.
Is being a celebrity helpful or harmful to
your mental health?
I am a fourth grade celebrity at best, but one
element of slight fame is that my wife gets
annoyed when I am recognised. None of the
issues get to me – it is, after all, my fault as
I wanted to be famous as a rugby player in
the first place. Plus, I have to accept that where
others can switch off in certain situations,
I can’t so I enjoy it anyway.
6
news
PSYCHIATRIC CARE
UNITS UNDER AUDIT
NHS Quality Improvement Scotland is auditing
Intensive Psychiatric Care Units (IPCUs) in Scotland.
This honours a commitment in the organisation’s
3-year strategic work programme, Improving
the Quality of Mental Health Services, and follows
a recommendation from Scottish Government
research that NHS Boards should standardise their
definitions of IPCUs. The audit aims to find out how
many IPCUs there are, how they are structured,
how they work with other mental health inpatient
units and what users and carers think of them.
The research group has visited all IPCUs in
Scotland and has also visited NHS board areas
without IPCUs. A report on local services will be
published in October 2009, while a full report
and account of users and carers’ views will be
issued in spring 2010. Phase two of the work will
be informed by the findings in these reports.
THE FUTURE OF DISABILITY
LIVING ALLOWANCE
A recent story circulating the internet has caused
anxiety for many disabled people by claiming
they have “100 Days to save DLA”.
The story is based on a government green paper
about how social care is funded in England.
The paper does discuss future options including
using disability benefits but at this stage there are
no plans to abolish DLA.
SAMH and other mental health charities in Scotland
will be highlighting to the government the value of DLA
in promoting recovery and MSPs have also signed a
motion on the need to protect disability benefits.
STRAW LAUNCHES
mENTAL HEALTH COURTS
The Justice Secretary for England and Wales,
Jack Straw, has launched new “problem-solving
courts” for offenders with mental health problems or
learning disabilities. Developed using the successful
model already in place for domestic violence courts
and drug courts, the Ministry of Justice says that
mental health courts will help the judiciary and
magistrates better respond to offenders with mental
health problems by helping provide timely access
to health services, offering tailored sentences and
ultimately reducing reoffending.
7
LANDmARK RULING
IN DEPRESSION CASE
A former council chief executive who experienced
depression has won her defence against a council
which sued her, alleging that she had withheld
details of her mental health problem in a job
application. Cheltenham Borough Council was
suing Christine Laird for £1m in London's High Court.
Appointed as Managing Director of the company in
2002, Mrs Laird left in 2005 on an ill-health pension
after being off for some time due to depression. The
council stated that Mrs Laird had been deceitful in
not disclosing her illness in a medical questionnaire
which included the question “Do you have a mental
impairment?” Mrs Laird argued that she had
previously experienced stress-related anxiety and
did not consider this to be a mental impairment.
She further argued that she had been bullied and
harassed at work. The judge ruled that Mrs Laird’s
responses in the questionnaire were not false and
nor, "given the terms of the questions asked, were
they misleading." Campaigners have said the case
highlights the difficulties that people who have
experienced mental health problems face when
deciding whether to disclose their health history
in job applications.
TWO mAJOR mENTAL
HEALTH CONSULTATIONS
UNDER WAY
The Scottish Government is currently
consulting on
the future of both the Mental Welfare
Commission
and the Mental Health (Care and Treat
ment)
(Scotland) Act 2003. The Mental Welf
are
Commission consultation follows the
Scottish
Government’s decision earlier this year
to step
back from its previous decision to abol
ish the
Commission and incorporate it into a
new body
to be created under the Public Services
Reform Bill.
The consultation puts forward proposals
for both
the governance and the focus of the
Commission,
and seeks responses by 25 Septemb
er. The Public
Services Reform Bill is now being cons
idered by
two Scottish Parliament Committees:
the Bill
proposes changes to the scrutiny of
health and
social care in Scotland, but has rece
ived early
criticism for appearing to give the Scott
ish
Government greater powers over scru
tiny bodies.
Separately, the Scottish Government
has issued
a consultation in response to the rece
nt limited
review of the Mental Health Act, led
by Professor
Jim McManus. The McManus report
proposed
changes to the Act in areas including
named
persons, advance statements and the
length
of time which can elapse between the
end of
a detention order and the date on whic
ha
Mental Health Tribunal must be conv
ened.
This consultation closes on 6 Novembe
r.
B
M
BO
bra n
Scottish author Mark Fleming writes about the facts and the fiction
behind his debut novel.
BrainBomb is a novel. But its background is real
and its protagonist, Neil Armstrong, is mostly me.
When I fell ill in 1987 I’d never heard of bipolar.
With hindsight I recognise the classic symptoms:
anxiety, guilt, isolation, hopelessness, apathy.
But my bipolar journey was one I didn’t realise
I was undertaking until it was too late to avoid
the trainwreck.
I was 24. I’d left college with a publishing
degree. Waiting for suitable vacancies, I joined an
employment agency. My colleagues were mostly
youths like myself, out for a quick buck. We worked
hard, socialised harder. I got used to this whirlwind
lifestyle, living like some rock star. Except I wasn’t: I
was a clerk, up at seven every morning, bleary-
eyed, hands quivering. I lived at home but went
partying straight from work. Late-night pubs and
clubs became my second home.
My parents saw me as an occasional wraith.
I began suffering massive mood swings, from
elation to despair. Mostly despair. I hardly slept.
Bipolar lurched into top gear. My whole perception
became warped.
I was signed off work with medical lines
euphemistically labelled ‘stress’. I became
reclusive. When friends phoned I refused to
speak. I had to be dragged to the doctor; then
the psychiatrist. I became delusional, convinced
my blood was infected and I was dying. Norman
Tebbit was on TV, banging on about shirkers.
B
I was adamant he was talking about me.
My doctor was a football thug. At one point
I thought I’d slipped through a time warp and
was reliving 1967.
Friday 13th November 1987. I experienced a lurid
panic attack. My parents discovered me taking
diving headers towards my bedroom wall. One
frantic 999 call later, an ambulance arrived with
a police escort. I was taken to the Royal Edinburgh
Hospital and sectioned.
Within weeks, rest, relaxation, family support and
strong medication retrieved something I’d long
abandoned. Optimism. I was allowed home for
Christmas and discharged at New Year.
The employment agency had kept me on their
books. Explaining the CV gaps was harder: between
January 1988 and March 1989 I worked for a total
of 23 days. I eventually got full-time employment,
in what was then called the Scottish Office.
In 1990 my bipolar graph swung into the red again.
I’d moved into my first flat, was enjoying a new
job and meeting a lot of new friends, especially
girlfriends. I found my confidence soaring.
Constantly up, I was unable to concentrate. I had
delusions about politics, and especially religion.
I embraced a furiously hedonistic social life as if
my 1987 experience had been a figment of my
imagination. But my parents recognised mania.
I was hospitalised for another month.
April 2009 marked my 20th anniversary in full-time
employment. But bipolar isn’t something I’ve
outgrown. I will take Lithium medication for the
rest of my life.
I have always enjoyed creative writing. In hospital
the psychiatrists encouraged me to write poems,
stories. But I always shied away from autobiography.
A lot of this was to do with the stigma. A recent
survey revealed that a majority of people would
sooner holiday with a criminal than someone with
a mental health issue. Twenty years ago such
ignorance was even more rife. But some headway
has been made, and mental health features in
film storylines, is discussed in internet forums
and has its own websites and helpline numbers.
What really prompted me to write about my
experience was a TV interview (not with Tebbit!)
Jason Pegler, after having experienced severe
depression, had set up Chipmunka: a charitable
foundation and publishing house. With missionarylike zeal, he had established a platform to promote
a positive view of mental ill-health. I emailed a
synopsis of what was provisionally titled BrainBomb,
to Chipmunka. They were extremely supportive,
and the novel was commissioned.
In BrainBomb we watch Neil burning the candle
at both ends. But the bipolar episode is seen in the
overall context of his youth. There are other, equally
traumatic, incidents. Child abuse. Violence at punk
gigs. Experimentation with drugs. Binge drinking.
Joy riding. Promiscuity. Rather than a linear diary,
events reverberate, triggering flashbacks.
During my breakdown I suffered severe insomnia.
In BrainBomb, this experience leads to Neil
fantasising about parallel lives amidst razor gangs,
medieval warfare, Nazi street riots. There is explicit
violence but a crucial point: for all that the mentally
ill are scapegoats, an infinitely bloodier trail has
been left in history by the supposedly “normal”.
BrainBomb is about a condition that is many
things. But not abnormal.
Available from www.chipmunkapublishing.co.uk
Living Better
Pippa Coutts of the Scottish Development Centre for Mental Health
and Dr Edward Donaghy from the University of Stirling look at the
mental health of people with physical health problems.
Throughout Scotland, the number of people
living with a long term condition (LTC) is increasing.
Typically, these are conditions that limit what a
person can do, are likely to last longer than one
year and can affect any aspect of a person’s life.
Examples include asthma, diabetes, epilepsy,
cancer, coronary heart disease; and various
mental health problems.
Although physical long term conditions may
be more common in older people, they are
increasing in all age groups. People from black
and minority ethnic communities and people living
in deprived areas are more likely to have a long
term condition. If you have a long term condition,
you are more likely to develop a mental health
problem: approximately 30% of people with long
term conditions develop anxiety or depression.
Arguably, long term conditions have previously
been treated in silos with specialist networks for
diabetes, heart disease etc, and different routes
for mental health and social support. However,
recently in Scotland there has been a commitment
to take a more holistic approach to the treatment
and support of people with long term conditions
Focussing on the whole person means that health
staff need to pay attention to how people feel,
both when individuals are diagnosed with a long
term condition and when they are living with it.
This is what sparked the Living Better project,
which promotes the mental health and wellbeing
of people with diabetes, heart disease and chronic
obstructive pulmonary disease. The project was
developed by the Scottish Primary Care Mental
Health Research and Development Programme
and The Royal College of General Practitioners
Scotland. These partners have developed Living
Better with Diabetes UK Scotland, British Heart
Foundation, Chest Heart and Stroke Scotland and
Depression Alliance Scotland. The project is funded
by the Scottish Government until April 2011.
The project has a national steering group but works
at Community Health Partnership (CHP/CHSCP)
level, with physical health service providers, patient
groups and people who have diabetes or heart
disease. It operates in five pilot areas in Scotland –
Angus, North Lanarkshire, South East Glasgow,
East Dunbartonshire and the Western Isles.
Over the last 10 months the project has held
12 discussion groups on mental health and
wellbeing with people living with heart disease
and/or diabetes, as well as discussions with
over 40 health care staff working with people
with diabetes or heart disease.
People living with long-term conditions spoke about
“frustration”, “strain of lifestyle re-adjustments”,
“feelings of stress in lead up to annual or 6 monthly
review”. People felt “isolated”, “worried”, and “angry”
and some spoke of the stress of “financial concerns”
as a result of their condition/s.
When asked about the type of support people
would like, most expressed a desire for more
social support through; “a person to confide in”,
“talking with a person who understands what
I’m experiencing”, “exercise classes”, “dietary/
cooking classes” (especially for diabetic patients).
11
All people reporting a chronic condition
(note, data from 1998 is weighted)
36%
35
35
34%
33
32%
33
31
30%
29
30
31
32
32
2000
2001
28%
26%
24
24%
22%
21
20%
1972
1975
1981
1985
1991
1995
1996
1998
1998
2002
Drivers for Change: The Increase in Long Term
Conditions in Scotland 1972 – 2002 (Source: ISD)
Asked why they wanted these levels of support,
typical responses were; “occupy the mind”,
“gets us out the house”, “chance to share
experiences”,” the chance to really express how
I feel”, “the exercise classes after my heart surgery
were great, the people there were all in the same
boat, it was good, a cup of tea and a blether after
it... the group had a good social side.”
The discussions with health professionals revealed
that they often don’t feel comfortable asking
people with long term conditions about their
mental health. Practice nurses and diabetes/heart
disease specialist nurses said they’d like to know
more about mental health and wellbeing. They
said that when they administer a mental health
questionnaire and the score indicates depression
or risk of depression, they aren’t always sure how
to support the individual or what support that
person goes on to access.
This information is fuel for the Living Better project,
which is working to develop an increased
understanding of the mental and emotional
health issues of people with long term conditions
and possible local responses to this.
It is supporting local areas to promote holistic
care for individuals, for example through joining
up mental health and long term condition services.
It is promoting the involvement of third sector
organisations, including self management and
peer support groups, in partnership working at
primary care level to integrate services for people
with LTCs. For example, the project is providing
practice nurses and diabetes or heart disease
specialist nurses with more information on mental
health and on services.
The project aims to implement mental health
and long term condition training with practice and
specialist nurses, to emphasis the links between
physical and mental health problems and that
much can be done to support people’s mental
health and wellbeing. The partners have produced
information leaflets about mental health and
wellbeing for people with diabetes and heart
disease.
For more information on Living Better visit:
www.livingbetter-scotland.org.uk
13
What will you be doing in October 2009?
Hopefully, you’ll be taking part in one of the many
discussions, events and celebrations of mental health
that will be going on up and down the country. Mental
Health Awareness Week is almost upon us, and from
4-10 October, people across the nation will be taking
the opportunity to highlight the importance of mental
health.
And it is a much-needed opportunity. We know that
one in four people in Scotland will experience a mental
health problem at some point in their lives. We also
know that people with mental health problems are less
likely to be employed and are more likely to experience
harassment.
What’s more, nearly nine out of 10 people with mental
health problems have been affected by stigma and
discrimination, with two thirds saying they have
stopped doing things because of the stigma they face.
Mental Health Awareness Week presents a chance to
draw attention to mental health and to combat some
of this stigma. But it’s also a chance to highlight more
positive information: like the fact that most people
who experience mental health problems do recover.
continued over
14
So if you’d like to play your part in improving
Scotland’s awareness of mental health, here are
just a few of the events that will be taking place.
Wednesday 7 October
Safe to Say
DVD Launch, Filmhouse, Edinburgh
SAMH will be launching a new DVD about adult
male survivors of childhood sexual abuse at the
Filmhouse in Edinburgh.
Thursday 8 October
What’s in a Word?
6–8.30pm Clarkston Halls, Clarkston
ACUMEN will be looking at the language of mental
health, using crafts and workshops to explore the
words that best express our individual experiences
and identity. Free. Open to the public. Phone or
email Aileen or Shena on 0141 887 9103,
[email protected] or
[email protected]
Friday 9 October
Let’s Get Physical!
SAMH will be holding its biannual Forum in
Edinburgh, focusing on physical and mental health.
We’ll be discussing the barriers that people with
mental health problems may encounter as they
become more active and the links between lifestyle
and mental health. We’ll ask why people with mental
health problems can experience poorer physical
health than others and hear from people who have
taken steps to become more active.
Attendance at this event is free for SAMH
members and costs just £40 for non-members.
See www.samh.org.uk or email
[email protected] for details.
Saturday 10 October
The Mudlarks
Bonar Hall, Dundee
Musicians from the SAMH Chrysalis service,
will be at Bonar Hall in Dundee as part of
World Mental Health Day Celebration.
Throughout the week
Mental Health Arts and Film Festival
Led by the Mental Health Foundation and
its partners, the festival will be running from
1–22 October. The full programme is available
at www.mentalhealthfestival.dreamhosters.com
and will include the winners of the Festival Film
Competition, an opening concert on 1 October
at the Fruitmarket Gallery in Glasgow and art
exhibitions across the country.
North Ayrshire libraries
SAMH Community Horizons will be contributing
to information stalls to be held at libraries in
North Ayrshire throughout the week.
Check www.samh.org.uk for up to the minute
information on events that will be taking place
throughout the week.
Organising an event?
Make sure you let SAMH know, so it can be
added to the website.
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WHAT DO YOU THINK?
Want to comment on something in this issue?
Send us your views, comments or suggestions for future articles to:
The Point, SAMH, Cumbrae House, 5 Carlton Court, Glasgow G5 9JP
Email: [email protected]
E
C
N
E
D
I
V
E
E
S
O
H
W
We often hear th
at there is not suffi
cient evidence to
treatments, but w
fund non-drug
e think the eviden
ce
is
ou
t there in the form
experiences. In ea
of people’s
ch edition, we take
a
lo
ok
and ask: just who
at a different trea
se evidence is it,
tment
anyway?
“Counselling” is a word which is used with
increasing frequency in the media, but rarely if
There are many counsellors trained in this model
ever defined. You could be forgiven for thinking
practising throughout Scotland, in GP surgeries,
that it describes one uniform approach, but in
stress centres and a variety of different projects.”
fact there are many different types of counselling.
The British Association for Counselling and
Psychotherapy defines integrative counselling
as an approach in which several distinct models
of counselling and psychotherapy are used
together in a converging way rather than in
“Over the years I have worked with many people
with a wide variety of predicaments. It has always
been an honour and a privilege to accompany
them on their journey to greater self knowledge
and self determinism. I have seen people change
their relationship with themselves and their lives
separate pieces. We spoke to Janice Jamieson,
to increase their wellbeing and to enjoy life more.
a counsellor who has been practising in both
That’s a great experience!”
Scotland and Ireland for 15 years, to find out more.
So can integrative counselling actually help?
She told us, “The particular model of integrative
One client talks about their experiences.
counselling that I practise is the core capacities
I was referred for counselling by my GP as I was
model and its goal is to develop the client’s own
depressed and suffering from Irritable Bowel
capacities and thereby increase their realism and
Syndrome (IBS) which my doctor thought was
capacity to respond rather than react in their lives.
due to stress.
If you have a suggestion for a future "Whose Evidence Is It Anyway?"
contact us at: [email protected]
?
Y
A
W
Y
N
A
T
I
S
I
I was unhappy, my relationship with my husband
I realised that life and people, including me,
was difficult and I had fallen out with my family.
are rarely perfect. I still aim high, that’s a part
I worked part time but I found it really difficult
of me, but now I am able to appreciate the
as I felt worn out so much of the time. At home
parts that are right and accept that I can’t control
I spent most of my time cleaning my house,
everything and it’s OK for things not to go to plan.
rushing around after other people, or in bed,
In fact sometimes that can even be fun or lead
exhausted and with digestive problems.
to something new. I listen to myself and pay
attention to my feelings and now my IBS flares
I was nervous about counselling and couldn’t
up much less often. When it does I realise that
really see how it could help me but I felt so
I’m getting stressed and make sure to take
desperate that I decided to have a go. At first we
some time for myself.
focused on how I was feeling and I was shocked
to realise that under my depression I felt angry
Now, I feel so much better. I have more energy
and disappointed and really blamed myself and
and am enjoying my job. In fact I’ve recently
other people for what was wrong with my life.
started my own small business and that’s going
Talking about my feelings was hard but it made
well too. I’m getting on better with my family
a difference and I began to feel less depressed.
and my relationship with my husband is much
However the biggest change really came when
improved. It sounds like a small thing but now
I realised that a big part of my problems was
my husband and I can sit down on a Saturday
caused by my own expectations about how
evening with a nice meal and watch a film and
everything and everyone should be. I was
enjoy ourselves. Before I had counselling that
disappointed and angry because I thought if
was impossible, I was either rushing around
I tried hard enough things should be perfect
clearing up or in my bed feeling rotten.
and I was continually disappointed when they
didn’t turn out like that. At times the counselling
was challenging but I always felt supported
rfect.
rely pe reciate
a
r
e
r
a
app
me,
able to ything...
cluding
in
m
,
a
I
le
p
r
w
nd peo f me, but no
trol eve
a
n
o
e
f
c
li
’t
t
part o
t I can
ed tha
ept tha
I realis high, that’s a
c
c
a
d
im
ht an
I still a
are rig
t
a
h
t
s
rt
the pa
and that helped me be honest with myself.
David Strathearn provides a personal
perspective on mental health, beans
and battling aphids.
It comes as no surprise to many that gardening is good
for your physical health. What could be better than
spending time in the fresh air and getting some exercise?
Furthermore, if you grow your own vegetables then a
healthy diet can follow. Many people also realise that
gardening is good for your mental health. Increasingly the
connection between good physical and good mental
health is being made in the popular media. But is the
mental health benefit of gardening limited to the endorphin
or adrenalin release from the physical activity or are there
more fundamental psychological factors?
To answer this you have first to think about what is meant when
someone says, “That is good for my mental health”. More and more
you will hear people using this type of expression, perhaps as
perceived taboos are gradually fading away from the whole subject of
mental health. These taboos have probably been brought about largely
as a result of confusion between mental health and mental illness. It may,
therefore, be helpful to bust some widely held myths and separate out the
terms mental health and mental illness.
We all have “health”, both physical and mental. Our state of health can be good,
bad or indifferent. What makes for good mental health will be explored in a
minute, but it helps to distinguish mental illness by thinking of it in terms of specific
conditions: depression, bipolar disorder, schizophrenia. So, poor mental health is
not necessarily mental illness!
Studies and theories abound when it comes to mental
health promotion, but I can best understand the concept
of mental health promotion when I consider not only what
makes for good mental health but also what happens
when these factors are removed.
Mentally healthy people tend to have a clear sense of
belonging – knowing who they are and their place and
role in their community. Well, a garden does not tick all
these boxes, but people often tell you that their garden is
their sanctuary; a place where they belong. Gardens,
especially in the case of allotments, and gardeners in
general are often a distinct community, sharing a common
experience; so perhaps a box is ticked here after all.
Mentally healthy people tend not to be too stressed – bearing
in mind that challenge and stimulation is good for mental
health. On these fronts, gardening definitely scores. Yes, there
may be some stress when the aphids demolish your roses, but
the benefits of the relaxation and the challenge of the ever
changing seasons must surely outweigh any stress.
A sense of achievement or the potential to achieve and being in control of
your future are all vital for mental healthiness. The opposite is a sense of
hopelessness. Gardening meets these positive criteria extremely well. The
hope and expectation that the beans will be the best ever and the satisfaction
gained when they are, all contributes to your mental health.
Add to all this the fact that nature is innately beautiful and humans are programmed
to respond to natural shape and form and you can see that really it should not
come as a surprise that gardening is good for your mental health.
Del Gunn is the Centre Manager at Catch 23 in the Western Isles. When asked to provide a
brief biography, Del replied “I would rather give special mention to the volunteer team and
all those who have supported the project: they are the real lifeblood of this organisation”.
Less than five minutes walk from Stornoway’s
town centre is the Catch 23 Drop-in Centre.
Catch 23 was set up by the Western Isles
Association for Mental Health (WIAMH), a small
local charity, just over six years ago. The Association
has always prided itself on being led by those who
use the service and on making key decisions in full
consultation with the groups’ membership.
WIAMH was formed in 1996 by a very small
number of interested people, most of whom had
experienced problems themselves, to promote
awareness of the issues surrounding mental
health and to break down the barriers and stigma
that people in the Western Isles were experiencing.
It has been a long struggle to gain full acceptance
and recognition of what the service is actually
worth to the local community but WIAMH now
work in close partnership with both the Local
Authority and Health Board. They also receive
invaluable financial support from Lloyds TSB
Foundation for Scotland and The Robertson Trust.
The Centre offers a wide range of activities
including:
– Arts, digital photography and
creative writing sessions
– Training
– Free internet access
– Gardening
– Support & representation
– Refreshment and meals
– Evening events and day trips
– Hand, neck and shoulder massage
25
The Centre had almost 170 clients in 2008, which
equates to almost 1% of the population of the Isles
of Lewis and Harris. This number doesn’t look
very high but if a city the size of Glasgow had
just one centre experiencing a similar percentage
of drop-ins, they would be providing a service
to approximately 6500 people!
When asked what Catch 23 means to them,
the client group give numerous and quite varied
responses. Some are quite minor and don’t seem
much in the great scheme of things. Others really
show the real need for what we provide.
“You don’t ask me loads of questions and take
me for what I am”.
“The company is great, I have made friends
through this place”.
“Everyone at the Centre listens to what I am saying.
I have never experienced this in my life before”.
“I can talk about my illness without fear of
being judged”.
“You see the person not the illness and have
helped me get back my confidence”.
“You saved my life!”.
Living in one of the most remote and rural areas
of the UK creates a number of issues that impact
on a person’s health. This has been magnified by
the recent credit crunch and the knock-on effects.
Cost cutting has forced the local authority to
reduce bus services to the rural areas, making
it difficult for some people to attend the centre.
There is also a shortage of available affordable
housing and recent government cuts have meant
a big reduction in the planned new home building
budget. Those who do have their own transport
have the highest petrol prices in the UK to think
about before they even consider leaving the
house. To counter this WIAMH is always looking
to assist people to attend Catch 23 where possible
and will access funding to enable a client to travel
to and from Stornoway.
Most of the mental health services are based in
and around the Stornoway area due to the fact
that half of the Western Isles population live in
this small area. Catch 23 has visitors who will
often make a 90 mile round trip in order to stay
in contact.
The Western Isles economy is also recognised
as one of the most fragile in Scotland, with one
of the lowest levels of average earnings in the
UK. The two main employers are the NHS and
the Council and to date they have not seen large
job losses. Those outside the statutory sector
haven’t been so lucky. The fish processing plant
in Stornoway which was the biggest non statutory
employer shut down with the loss of over a
hundred jobs. Woolies, our biggest shop, shut
their doors at Christmas and construction work
has almost ground to halt. Numerous smaller
companies have also paid off staff and many of
the travelling offshore workers have also found
it harder to gain regular work since the price of
oil began falling.
Having spoken to other agencies in the Islands,
we know reduced income, job losses, associated
debt, travel problems, etc will have a knock-on
effect on people’s mental health and wellbeing
and we have to prepare for new faces dropping
in and be ready with a warm welcome.
www.wiamh.org
Greenspace and Conservation on Referral
Kirsty Cathrine has been running the Forestry Commission’s Branching Out project for
the last two years. She has a background in both ecology and science communication
and previously worked as a ranger in the Cairngorms.
Branching Out is an innovative service development
offering conservation and greenspace on referral
for people experiencing mental health problems
in the Greater Glasgow and Clyde area. A range
of partners have come together to drive this
development, including Forestry Commission
Scotland, NHS Greater Glasgow and Clyde,
Glasgow and Clyde Valley Green Network
Partnership, Glasgow Centre for Population
Health and Glasgow City Council.
The concept of using greenspace to promote and
maintain mental health predates the development
of almost all current treatment methods. In the
19th century mental health institutions were often
situated in natural green landscapes, which was
thought to help people relax and recuperate.
More recently, research has found that exposure
to greenspace has beneficial effects on our ability
to pay attention, stress, aggression, depression,
self-esteem and physical health.
Branching Out client, “I’m lacking in confidence that’s something that I’m very, very short on at the
moment. Coming here is like slowly, but surely,
I’m starting to think about things differently.”
A recent Mind report advocated ‘ecotherapy’
(interventions involving greenspace) as a clinically
valid treatment option for people using mental
health services. In response, Branching Out was
developed to provide an adjunct form of treatment
to improve the quality of life for adults experiencing
severe and enduring mental health problems in
Greater Glasgow.
This free service offers a 12-week programme of
activities including health walks, environmental
art, conservation, bushcraft skills and relaxation.
The sessions are run by an experienced Forestry
Commission Ranger, an Assistant Ranger and
with the input of sessional workers such as an
environmental artist and a tai chi instructor.
27
At the end of the 12-week block groups are
brought together for a joint awards ceremony, at
which further volunteer and training opportunities
are highlighted. Some Branching Out participants
have progressed on to further greenspace
activities such as walking groups, conservation
projects and riding for the disabled.
Occupational Therapist, mental health resource
centre, “They (Branching Out clients) have noticed
that they are capable of things and they’ve now
moved on to volunteering, and they are doing
that reasonably independently. That’s a big,
big step for them.”
A typical session involves walking into the woods
and building a campfire from tinder gathered
nearby. Clients then take part in activities such
as tai chi, clearing invasive species or plant
identification. After a lunch break further activities
could include willow weaving or creating art
sculptures. Each session lasts up to three hours
and all equipment, including waterproofs and
tools, is provided. Staff from the mental health
services also attend Branching Out, and are fully
involved in all of the activities.
Occupational Therapist, mental health resource centre,
“I think me being one of them made the team stronger
instead of that feeling of ‘them and us’ which there is
sometimes... I think people felt very equal and that
would be one of the big assets of (Branching Out)”.
A wide variety of mental health services have
accessed Branching Out over the first two years
including forensic services, recreational therapy,
employment services, mental health charities and
resource centres. SAMH has been highly involved
with Branching Out, and has referred 5 groups
to the service from Glasgow South Integrated
Training, Glasgow North Training and more recently
the SAMH Men’s Activity Group in Dumbarton.
During the initial 12 months of the project, a full
evaluation was carried out to investigate the impact
that the service had on those who were referred.
The initial literature review that formed part of his
has already been published in the Journal of Public
Mental Health,Vol 7,no 3,p23-35. The full evaluation
report will be available in the next couple of months
long with an executive summary.
The main findings of the evaluation include:
– Low attrition rates (70% of people completing
the 12 weeks).
– Significant increase in physical activity levels.
– Self-reported improvements in confidence
and self-esteem.
– Strong trends towards improvement in
health and wellbeing measures for high
severity groups.
Funding has been secured from Forestry
Commission Scotland and NHS Greater Glasgow
and Clyde to continue the project until March 2010.
Forestry Commission Scotland is committed to
continuing the service development, and is in
discussion with both NHSGGC and SAMH to
explore future funding options.
For more information about Branching Out
please contact Kirsty Cathrine, Community and
Environment Ranger, on 01698 368 557 or
email: [email protected].
In each issue of The Point, we look at one of the most common queries
received by the SAMH Information Service.
Q. What happens when a young person becomes unwell with mental health problems
and has to go into hospital?
A. Last year 57 children under the age of fifteen were admitted to psychiatric care
in hospital. 2,056 people between the ages of 15-24 were admitted. 1
When a young person has to be admitted either
voluntarily or compulsorily there are legalities
to be considered. Just as with adults, doctors
must respect a young person’s decision to refuse
treatment if they have the capacity to make
that decision, unless the doctor thinks that the
Mental Health (Care and Treatment) (Scotland)
Act 2003 should be invoked. Section 2 of the
Act makes specific provisions to safeguard the
welfare of any child. For the purposes of the
Act, a child is any person under the age of 182.
If a young person is unable to consent or
refuses to give consent to treatment, their
parents (if the person is under 16) or guardians
can make that decision on their behalf. A parent
has a duty to safeguard and promote the health
and welfare of his or her child until he or she
reaches the age of 163.
A young person can be made subject to an
emergency or short term certificate and also a
compulsory treatment order in just in the same
way as an adult. Where possible though, the views
and wishes of the child or their guardians should
be taken into account: in fact, one of the principles
of the Act is that the welfare of a child who is
treated under the Act should be paramount.
29
One of the most important issues for the doctor
involved with the child is whether he or she is
capable of understanding what the treatment is,
how it will be administered and what the effects
of it may be. If the doctor thinks that the child is
able to understand, then his or her consent should
be gained first, just as it should for any other
treatments, such as dental work. The parents are
usually involved in this process. The Age of Legal
Capacity (Scotland) Act 1991 would be applied in
such cases if the child is twelve or over: a doctor
would look for the ability to give consent and
would comply with the Act in this respect.
Their environment should be carefully
considered such as:
– A separate room with facilities
– Visiting times
– Specialised nursing staff
If a child is admitted to an adult ward, the Mental
Welfare Commission should be notified in order
for them to monitor the condition and treatment
of the child, when they are likely to be discharged
and liaison with children’s services on discharge.
One of the most important issues for the doctor involved with the child
is whether he or she is capable of understanding what the treatment is,
how it will be administered and what the effects of it may be.
If the child refused to give consent, the doctor
would consider whether the Mental Health
(Care and Treatment) (Scotland) Act 2003 should
be implemented and compulsory measures taken.
A child under sixteen can have a named person
be involved in their care and treatment. This is
normally the principal carer of the child. If that
child is in care, the local authority will be
deemed the named person automatically.
When a child has to go into hospital, certain
provisions have to be made. Local authorities
and health boards have a duty to ensure that
the particular needs of the child are being met.
A child should be admitted to a unit which
specialises in child and adolescent psychiatry.
If this is not possible and they have to be admitted
to an adult ward, risk assessments must be
carried out to ensure that the child’s needs are
prioritised and they are not at risk.
The child should still receive an education
whilst unable to attend school and the education
authorities should make provisions for this if
the child is detained under the Act.
Useful contacts
The Mental Welfare Commission
for Scotland: 0800 389 6809
www.mwcscot.org.uk
1. Admissions to mental illness specialties in Scottish Hospitals,
Source: ISD Scotland.
2. Mental Health Care and Treatment (Scotland) Act 2003 code of
practice Vo. 1.
3. Mental Health, Incapacity and The Law in Scotland et al H. Patrick.
SAMH’s James Dalrymple explains why he spent much of 2008 telling stories.
In April 2008 SAMH began working with staff,
patients and carers in Dykebar, Royal Alexandria
and Ravenscraig Hospitals to create Life Story
Books for patients who were about to be
discharged. Life Story Books capture the life history
of an individual, creating a valuable resource both
for the person concerned and for any future carers.
Life stories are a simple but powerful mechanism
to put the person at the centre and articulate their
individual perspective on particular issues. The
simplicity of the process and the recovery focus
are the key features of this kind of work. The
benefits of collecting people’s accounts in this way
are that they are unique records which are shaped
by the individual and that the methods involved
are limitless (dependent on budget obviously),
which supports creativity and imagination.
There are few restrictions and parameters as to who
can participate in narrative projects, which extends
the inclusive nature of the project. This obviously has
significant advantages for the project manager, the
teams involved and the participants.
The planning and preparation prior to commencing
the work in the hospitals was critical to ensuring
that any anticipated problems were identified and
systems put in place to tackle them. Where there
are people making themselves available to openly
talk about potentially sensitive issues, delays and
poor processes would not be appreciated and
would probably have negative results.
This was especially important when working in
the wards, as the routines, staffing structures and
availability of service users and carers did not
allow for much flexibility.
31
I wasn’t sure how we would be received by the
patients and staff in the wards. Given that some
staff and patients may have been in these wards
for 20 years or more, an outside team coming in
to talk about people’s lives might not have been
appreciated. To tackle this we tried as much as
possible to promote the project and involve
anyone who was interested. We made a DVD
and distributed leaflets for staff and patients/
carers. We also held a launch event at Dykebar,
with music and short stories to generate interest.
Life stories were created in various formats
dependent on the requirements of the individual
on the ward. This included compiling and
designing photo albums, scrap books and photo
frames. The content was based on a template
which included prompts on schools attended,
first job, romance, hobbies and favourite items,
but again it was entirely directed by the person
at the centre and/or their family or carers.
Working with carers has been especially
successful as in some cases people cannot
participate fully because of capacity issues.
Involving relatives in exploring positive memories
from the past has provided an exciting opportunity
to re-engage with the person in the ward.
The story book project received prestigious
recognition in the shape of a good practice award
from the Scottish Nursing Forum. It has also been
chosen as an example of good practice by NHS
QIS (which leads the use of knowledge to promote
improvement in the quality of healthcare for the
people of Scotland) and features on its Piramhids
good practice website.
Narratives (especially life stories) are not exclusive
to particular client groups or individuals. There
has been a positive organisational and personal
response to the work undertaken and shared
learning between parties. Learning from the
project has helped others interested in collecting
narratives, either as a care provider or an
individual in understanding themselves or others.
As well as organisational learning there has been
a positive reception from carers’ forums that have
attended information sessions about the life story
books. Often excluded from meaningful input
towards recovery planning, some carers have
grasped the integral role that they can play in
developing life books for their relative and have
sought information about developing this.
I believe the work offers a certain freedom and
flexibility which is universal and not restricted
by resources or bureaucracy, which are often
barriers to new projects.
SAMH is pursuing opportunities to increase
and build on the use of narratives in other areas.
Veterans’ stories formed the basis of SAMH’s
recently launched Life Force – a Guide for
Working with Scotland’s Veterans.
Anyone interested in developing life stories
to support recovery should contact
James Dalrymple at SAMH on 0141 568 7201
or email: [email protected]
IF YOU ENJOYED THIS mAGAZINE,
wHY NOT GET INVOLVED wITH
SAmH?
SAMH works to support people who experience
mental health problems, homelessness, addictions
and other forms of social exclusion. We provide direct
services, including accommodation, support, training,
employment, outreach and structured day services.
good practice in service user involvement,
commissions research and challenges stigma
and discrimination. The Centre needs your support
in order to achieve SAMH’s ambition of mental
health and well-being for all.
The Point is produced by SAMH’s Centre for
Research, Influence and Change. The Centre works
to shape and influence mental health legislation,
policy and practice. It also provides a national
information and welfare benefits service, promotes
You can help us to do this:
• By making a donation
• By getting involved in fundraising
• By becoming a member of SAMH
For more information, to join SAMH or make a donation, please call: 0141 568 7000,
email: [email protected] or visit: www.samh.org.uk