Schizophrenia
Schizophrenia is a diagnosis given to some people who have severely disrupted beliefs and experiences.
During an episode of schizophrenia, a person’s understanding and interpretation of the outside world is disrupted – they may:
- lose touch with reality
- see or hear things that are not there
- hold irrational or unfounded beliefs
- appear to act strangely because they are responding to these delusions and hallucinations.
An episode of schizophrenia can last for several weeks and can be very frightening. About one in 100 people will have one episode of schizophrenia, and two thirds of these will go on to have further episodes. Schizophrenia usually starts in the late teens or early 20s, but can also affect older people for the first time.
The causes are unknown but episodes of schizophrenia appear to be associated with changes in some brain chemicals. Stressful experiences and some recreational drugs can also trigger an episode in vulnerable people.
At least 26 million people are living with schizophrenia worldwide according to the World Health Organization, and many more are indirectly affected by it.
Symptoms
Doctors describe two groups of symptoms in people with schizophrenia: positive and negative. Although the positive symptoms are often the most dramatic and, at least initially, the most distressing, the negative ones tend to cause the most problems, as they tend to be longer lasting.
Positive symptoms
The three main positive symptoms are:
- feelings of being controlled by outside forces (ie. having one’s thoughts and actions taken over)
- hearing, seeing, smelling or feeling things which are not there (hallucinations)
- irrational and unfounded beliefs (delusions).
The delusions can often be very frightening – the person may believe that others are plotting to kill them or that their conversations are being recorded. Positive symptoms all tend to occur during acute episodes and can be particularly frightening.
Negative symptoms
The negative symptoms include tiredness, loss of concentration, and lack of energy and motivation, which may be exacerbated by the side-effects of drugs used to treat the positive symptoms. Because of these symptoms, people with schizophrenia are often unable to cope with everyday tasks, such as work and household chores. Suicide and self-harm are common in people with a diagnosis of schizophrenia: around one in 10 take their own life.
Misconceptions about Schizophrenia
There is more media misinformation about schizophrenia than about any other type of mental health problem. A diagnosis of schizophrenia does not mean ‘split personality,’ or indicate that someone will be calm one minute and then be ‘out of control’ the next.
Sensational stories in the media tend to present people with schizophrenia as dangerous, even though most people diagnosed with schizophrenia don’t commit violent crimes. Another misconception is that people who hear voices are dangerous, but actually voices are more likely to suggest that you harm yourself than someone else and people have a choice in whether they do what the voices say.
Treatments
Most people with schizophrenia are prescribed drugs to reduce the positive symptoms. The drugs may be prescribed for long periods and may have unpleasant side effects.
Some people need a great deal of help in managing the symptoms of schizophrenia. Others find ways to cope with experiences such as hearing voices and do not necessarily wish to receive any treatment.
Sometimes, people in an acute phase of the illness may need to be admitted to hospital under the Mental Health Act for their own, or other people’s, safety. People with schizophrenia are not usually dangerous to other people; they are more at risk of harm from others, or themselves. Many people who are at risk of relapse carry Crisis Cards or have written up Advance Directives stating how they would like to be treated and what they do and do not find helpful. Mental health professionals do not have to follow these instructions, but it is considered good practice to take the person’s wishes into account.
Getting Help
If you, or someone you care for, are experiencing the symptoms of schizophrenia you may wish to contact your GP who can prescribe drug treatments and refer you for psychiatric help. You may also be referred to social services and the local community mental health team who can support you at home.
If you need urgent support or you feel like harming or hurting yourself or anyone else, call 999 or go to the nearest hospital accident and emergency department.
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Seasonal Affective Disorder (SAD)
Seasonal affective disorder (SAD) is a form of depression that is estimated to affect approximately one in 15 people between September and April. It can be particularly severe during December, January and February. For some people, SAD is so disabling that they cannot function in winter without continuous treatment. Others may experience a milder version called sub-syndromal SAD or ‘winter blues’.
It occurs throughout the northern and southern hemispheres but is extremely rare in people living within 30 degrees of the Equator, where daylight hours are long, constant and extremely bright.
What are the symptoms of SAD?
SAD may begin at any age, but it most commonly starts between 18 and 30. Symptoms generally appear between September and November and continue until March or April, when there may be a sudden burst of energy and activity accompanying the longer, brighter spring and summer days. A diagnosis is usually made after you’ve experienced two or more consecutive winters of symptoms.
Common symptoms include:
- sleep problems – usually oversleeping and difficulty staying awake but in some cases disturbed sleep and early morning waking
- lethargy – lacking in energy and unable to carry out normal routine due to fatigue. Heaviness in the arms and legs overeating – craving for carbohydrates and sweet foods, which usually leads to weight gain
- depression – feeling sad, low and weepy, a failure, sometimes hopeless and despairing
- apathy – loss of motivation and ability to concentrate
- social problems – irritability and withdrawal from social situations, not wanting to see friends
- anxiety – feeling tense and unable to cope with stress
- loss of interest in normally pleasurable activities
- loss of libido – decreased interest in sex and physical contact
- weakened immune system – vulnerability to catching winter colds and flu
- mood changes – for some people bursts of over-activity and cheerfulness (known as hypo-mania) in spring and autumn.
Six Treatments For SAD
1 Maximize your exposure to daylight. Make your house brighter—trim the bushes around your windows and keep your blinds and curtains open during the day. Use bright colors on walls and light-colored upholstery. Get up early to take advantage of as much daylight as possible. If possible, sit near a window at work.
2 Engage in activities that you enjoy. Take some time off in the winter, instead of using all of your vacation time during the summer. Volunteer or participate in activities that make you happy. Spend time with friends and family members who are caring, supportive, and positive.
3 Practice healthy habits. Exercise, get enough sleep, eat a well-balanced diet, and reduce stress. Spend time outdoors if possible—skiing is an excellent way to get lots of light and exercise in the winter. Practice good sleep hygiene and make time to relax. Eat healthy foods for more energy and limit caffeine and alcohol.
4 Take all medicines as directed. Talk to your GP about prescription and over-the-counter (OTC) drugs and diet supplements (including vitamin D), as well as any herbs you may take. Follow directions carefully and watch for interactions and side effects. Avoid alcohol and illegal drugs.
5 Consider light therapy. There are several devices available—from battery-powered visors, portable light boxes and special light bulbs, to dawn simulators (lamps that switch on before dawn and gradually light your room, like the sun rising)— You should talk to your GP before trying light therapy.
6 Watch for early signs that SAD is getting worse. If you suffer from severe winter depression, consult your GP immediately. A qualified health care provider can help determine if your symptoms are related to SAD or may have another cause. Additional treatments available include psychotherapy, behavioral therapy, stress management techniques and prescribed medication.
”I get this bubble of rage. I go wild. I feel like crying cos I don’t know how to control myself. It happens too quickly.
”I get this bubble of rage. I go wild. I feel like crying cos I don’t know how to control myself. It happens too quickly..
Self Harm
Self-harm describes a wide range of things that people do to themselves in a deliberate and usually hidden way. In the vast majority of cases self-harm remains a secretive behaviour that can go on for a long time without being discovered.
The National Registry of Deliberate Self-Harm indicates that in 2013 there were 11,061 presentations to hospital due to deliberate self-harm. International evidence confirms the presence of mental health issues; particularly depression and anxiety and also co-morbidity with drugs and alcohol are factors which significantly increase the risk of suicidal behaviour amongst individuals.
Self-harm can involve:
- cutting
- burning
- scalding
- hitting or scratching
- breaking bones
- hair pulling
- swallowing toxic substances or objects.
Although some very young children and some adults are known to self-harm and it often continues from childhood into adulthood, the majority of people who self-harm are aged between 11 and 25 years.
Why Young People Self Harm
Self-harm is a symptom of underlying mental or emotional distress. Young people who self-harm mainly do so because they find it helps relieve distressing feelings and helps them cope with problems in their lives. It is rarely about trying to end their life.
A wide range of factors may be involved. Very often there are multiple triggers, or daily stresses, rather than one significant change or event. Factors can include:
- feeling isolated
- academic pressures
- suicide or self-harm by someone close to the young person
- family problems, including parental separation or divorce
- being bullied
- low self-esteem.
But self-harm is not a good way of dealing with such problems. It provides only temporary relief and does not deal with the underlying issues.
How Common is Self Harm Among Young People?
There is relatively little research evidence about the prevalence of self-harm among young people. Hospital records show only part of the picture. The majority of young people who self-harm will either not harm themselves in a way that needs medical treatment or they will deal with it themselves.
Can Self Harm Among Young People Be Prevented?
There are ways to prevent self-harm among young people. Anti-bullying strategies and whole-school approaches designed to improve the general mental health and well-being of young people appear to have a positive effect, though there is no specific evidence as yet on their impact on self-harm.
Evidence from young people themselves suggests that social isolation – and believing that they are the only one that has self-harmed – can be a key factor in self-harm for some. It is likely that better information for young people about self-harm would increase their understanding and might help reduce or prevent self-harm. Similarly, better awareness and understanding among parents, teachers and others who come into contact with young people is also likely to have a positive impact.
There is stronger evidence – mostly direct from young people – that finding ways to distract from, or alternatives to, self-harm can be very important for many young people. Distraction techniques that are reported as being effective for some young people include using a red pen to mark rather than cutting, rubbing with ice, hitting a punch bag or flicking elastic bands on the wrist.
Conclusion
Self-harm among young people is a serious public health challenge. There is a need for much better data about prevalence. There is also a need for better awareness and understanding of self-harm and its underlying causes both among young people themselves and those who come into contact with them. Stronger and clearer evidence about what might prevent self-harm and about effective responses to self-harm among young people is also needed.
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Self Management
Many people with physical health problems already use self-management to help them control their symptoms but the technique has proven to work as a strategy to control things such as bi-polar disorder and schizophrenia.
Taking a self-management course helps you understand how your own mental health problems affect your life and how to recognise the early signs and prevent or minimise the impact of an episode of ill health.
Here are ten things you should know about self-management to help you understand it better:
It's Not Rocket Science
It’s simply about acquiring the necessary tools and techniques to empower individuals to take control of their lives, to put themselves back in the driving seat and regain the initiative. Learning to manage your mental health effectively is a fundamental prerequisite to experiencing and sustaining long-term recovery from mental ill-health.
Self-management of a long-term mental ill-health is a means of encouraging an individual to help themselves
With the relevant support towards establishing a good routine of self-care, it involves setting goals to achieve personal hygiene; regular sleeping patterns; healthy eating plans; building relationships both on a personal and professional level; taking regular exercise; establishing voluntary or paid employment; gaining an understanding of how to deal with money and finances and having a say in their medical and associated treatment, and in doing so, bringing stability, a sense of self-worth and hope for the future with quality of life and ultimate recovery.
Recovery is a journey through which an individual learns to manage their problems or condition more effectively
The word recovery is widely used these days and denotes different things to different people. Recovery may take place over a longer period of time. The key to recovery has to be around the realisation that the person with mental ill-health must learn to help themselves.
A key principal of self-management is hope
The individual can themselves take necessary steps to still move forward and enjoy life, in spite of the problems which they might be experiencing. Experiencing mental ill-health need not be the end of meaningful life.
Goal setting is really important in self-management
The individual with the problem needs to appreciate that they must do everything in their power to help themselves. At the same time those that are tasked with helping the individual need to have in place the necessary tools and techniques to be able to help that person on their journey into recovery. Goals enable you to look forward and focus on the future.
It helps us to develop healthier and more meaningful relationships
Humans are not equipped to travel on the journey of life in isolation from one another and so the key to good mental health is the ability to nurture and sustain healthy relationships with others. With effective self-management comes the realisation that life is not all about an individual’s needs but also about seeking to meet, as best as possible, the needs of others, of sharing and taking as full a part as possible in family life and friendships.
It can help some people back into work
Another important aspect of self-management is re-establishing and sustaining worthwhile activities and occupations. That may not mean, depending on the degree of severity of illness that a person has gone through, paid employment, but may well mean participating in voluntary work. Research has shown that meaningful work can be therapeutic too.
Routine is the key to stability in a person’s mental health
A routine where both physical and emotional needs are being met on a regular basis offers the opportunity for greater stability. In addition, that all-important sense of health and wellbeing is reinforced, as well as that sense of self-worth which is so vital in giving meaning, hope and purpose in a person’s life.
It's not about throwing away the tablets
Appropriate medication can still play a large part in the effective management of long-term mental ill-health for some people.
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Sexuality
Lesbian, gay, bisexual and transgender people are at higher risk of some mental health problems and alcohol and substance misuse. This can be related to the discrimination and lack of understanding they face in society.
Being gay, lesbian, bisexual, transgender, transsexual or transvestite is not a mental illness – although the World Health Organisation only removed homosexuality as a formal psychiatric diagnosis in 1992.
But coming to terms with an identity that is different to that of most of your peers, or coping with ignorance, prejudice and discrimination, can be confusing and distressing. People who are lesbian, gay, bisexual or transgender are at greater risk of some mental health problems and alcohol/drug misuse.
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Sleep
Sleep is not just ‘time out’ from our busy routine. Most of us need to sleep well to help our bodies recover from the day and to allow healing to take place. But with increasingly busy lives it’s estimated that we now sleep around 90 minutes less each night than we did in the 1920s. If you add to this the large numbers who are known to have problems sleeping, it’s obvious that many people are now functioning in a permanently sleep-deprived state.
Lack of sleep can make us feel physically unwell as well as stressed and anxious, and scientists also believe that it contributes to heart disease, premature ageing and road accident deaths.
What are the most common sleep disorders?
There are more than 80 different sleep problems listed in the medical textbooks, ranging from the inability to get to sleep (insomnia) to the inability to stay awake (narcolepsy). Many sleep problems are temporary, and you may find the self-help measures below help get you back to more normal sleeping pattern. But sleep problems can also be a symptom of other conditions, such as a problem with your thyroid gland or depression, so it’s worth seeing your GP if your sleeping problems continue.
Insomnia
Insomnia is the most common sleep disorder, affecting an estimated 20% of people.
Typical symptoms are:
- problems falling asleep
- problems staying asleep (so that you wake up several times each night)
- waking up too early
- daytime sleepiness, anxiety, impaired concentration and memory and irritability
Short-term insomnia, lasting for a few nights or a few weeks, generally affects people who are temporarily experiencing one or more of the following:
- stress
- change in environmental noise levels
- extreme change in temperature
- a different routine, perhaps due to jet lag
- side effects from medicines
Chronic insomnia, lasting for a month or longer, often results from a combination of factors that sometimes include underlying physical or mental health problems. It can also be due to behavioural factors such as too much caffeine or alcohol or a long-term disruption to your routine such as shift work.
Narcolepsy
Narcolepsy is a brain disorder that upsets how the body regulates your sleep patterns. One of the main symptoms is excessive sleepiness – sufferers can fall asleep at work, talking or driving a car. These ‘sleep attacks’ can last from 30 seconds to more than 30 minutes, regardless of how much sleep you are getting at night.
Sleep Apnoea
Sleep apnoea is a breathing disorder during sleep, typically accompanied by loud snoring. The person will stop breathing briefly at intervals during the night, which wakes them up briefly – constantly interrupting their rest. People with sleep apnoea wake up to breathe hundreds of times during the night, which makes them very tired during the day. Usually they aren’t conscious of these brief awakenings. In one form of sleep apnoea, called Obstructive Sleep Apnoea, the upper airway is restricted, making this a potentially life-threatening condition needing urgent medical attention.
Helping Yourself
There are many things you can try to help yourself sleep well.
- Exercise regularly, but at least three hours before bedtime.
- Avoid tea and coffee and don’t drink a lot of alcohol before bed.
- Try to go to sleep and wake up at the same time each day.
- Only use your bed for sleep or sex. Your bed should be associated with sleep.
- Establish a regular, relaxing bedtime routine that lets you unwind and sends a signal to your brain that it’s time to sleep.
- If you can’t sleep, don’t worry about it. Get up and do something relaxing like listening to music or reading until you feel sleepy.
Treating Sleep Disorders
If sleep problems don’t respond to the life-style changes or behavioural approaches suggested above, you need to see your doctor. It may be worth keeping a sleep diary for the 10 days before your visit so you can explain the problem. Doctors will generally look for any underlying medical or psychological reason for the problem and may suggest further changes to your routine or lifestyle to help improve your sleep.
If these don’t work, a doctor may suggest sleeping pills for insomnia problems. Sleeping tablets can help in the short term but quickly become less effective and can even make your sleeping problems worse. They can also be very addictive. For all these reasons, sleeping pills are generally prescribed at the lowest dose and for a short period of time until you are able to restore a healthier sleeping pattern. If your problems persist, your doctor may want to refer you to a specialist sleep disorder clinic.
There is no cure for narcolepsy, but the symptoms can be controlled by medication and by lifestyle adjustments such as changing your sleeping routine, improving your diet and more exercise.
Losing weight and sleeping on your side can usually help mild sleep apnoea. You can also be prescribed a device to put in your mouth to help keep your airway open during sleep. Sufferers with more severe sleep apnoea may need to use a special machine that blows air into your nose to keep the airway open while you sleep.
Sleep Disorders in Children
A good night’s sleep is also important for children’s physical and emotional health. Children need long periods of uninterrupted sleep for optimal growth and development, but sleep problems are very common – especially among younger children. Sustained periods of disturbed sleep have enormous impact on the whole family – on parents’ ability to function during the day and on other children. Problems with sleep may include a reluctance to go to sleep, waking up in the middle of the night, nightmares and sleep walking. Some children with special needs, such as those with autism, seem to have particular difficulties establishing consistent sleep patterns.
Some of the self-help measures suggested above can also be adapted for children, and it may also be a good idea to keep a sleep diary for children to show your doctor. Medication is generally seen as a last resort in treating children’s sleep disorders because it can be habit-forming and doesn’t treat the root cause of the problem. Excessive sleeping or a child’s continued reluctance to get up also needs to be investigated as this could suggest depression or other psychological problems.
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For Further Support Contact The Samaritans
Samaritans is a unique charity dedicated to reducing feelings of isolation and disconnection that can lead to suicide. Every six seconds they respond to a call for help. They’re there 24/7, before, during and after a crisis and they make sure there’s always someone there, for anyone who needs someone.
Smoking
The idea that people smoke cigarettes to help ease the signs and symptoms of stress is known as ‘self-medication’. Stress is very common, affecting us when we feel unable to cope with unwelcome pressure. It can cause physical symptoms like headaches or breathlessness as well as making people feel irritable, anxious or low. These feelings can alter our behaviour and feeling stressed often makes people drink alcohol or smoke more than usual. Long term stress is also related to anxiety and depression.
Smoking and Stress
The idea that people smoke cigarettes to help ease the signs and symptoms of stress is known as ‘self-medication’. Stress is very common, affecting us when we feel unable to cope with unwelcome pressure. It can cause physical symptoms like headaches or breathlessness as well as making people feel irritable, anxious or low. These feelings can alter our behaviour and feeling stressed often makes people drink alcohol or smoke more than usual. Long term stress is also related to anxiety and depression.
Smoking and anxiety
Research into smoking and stress has shown that instead of helping people to relax, smoking actually increases anxiety and tension. Nicotine creates an immediate sense of relaxation so people smoke in the belief that it reduces stress and anxiety. This feeling of relaxation is temporary and soon gives way to withdrawal symptoms and increased cravings. Smoking reduces nicotine withdrawal symptoms, which are similar to the symptoms of anxiety, but it does not reduce anxiety or deal with the underlying causes.
Smoking and Depression
Smoking rates among adults with depression are about twice as high as among adults without depression. People with depression have particular difficulty when they try to stop smoking and have more severe withdrawal symptoms during attempts to give up. Nicotine stimulates the release of the chemical dopamine in the brain. Dopamine is involved in triggering positive feelings. It is often found to be low in people with depression, who may then use cigarettes as a way of temporarily increasing their dopamine supply. However, smoking encourages the brain to switch off its own mechanism for making dopamine so in the long term the supply decreases, which in turn prompts people to smoke more.
Smoking and Schizophrenia
People with schizophrenia are three times more likely to smoke than other people and they tend to smoke more heavily. One of the most common explanations of this is that people with schizophrenia use smoking to control or manage some of the symptoms associated with their illness and to reduce some of the side effects of their medication.
Does Smoking Improve Mental Health
Although many people with mental health problems say that they smoke to reduce their symptoms, they usually start smoking before their problems begin. Heavy smoking does not necessarily lead to fewer symptoms of mental health problems in the long term. Any short term benefits that smoking seems to have are outweighed by the higher rates of smoking-related physical health problems, such as lung cancer, that are common in people with mental health problems.
Ways To Help You Quit
Stopping smoking suddenly through willpower alone (‘going cold turkey’) is the least effective way to quit. Stopping is more likely to be successful if you plan ahead, have support and choose the right time to try. Your attempt is less likely to work if you are feeling unstable, experiencing a crisis or undergoing significant changes in your life.
To prepare for change, think about your relationship with smoking. Understanding the effect that it has on you can boost your motivation to quit. Think about what you will gain by not smoking, for instance better physical health, fresher breath, improved concentration and more money in your pocket to spend on other things. You may find it helpful to write this down as a reminder of why you want to stop.
Finding other ways to cope with stress
Because smoking is often used as a way of coping, smokers need other ways of dealing with stress, anxiety or other problems if they want to stop smoking. Methods that people have found helpful include meditation and breathing exercises, regular exercise, cutting down on alcohol, eating a well-balanced diet, acupuncture and clinical hypnosis. Counselling or talking things through with a supportive friend or family member and religious or spiritual activities can also help.
Making changes takes time and effort – progress is often slow. Be patient. You may not be able to control all the factors that contribute to your stress, but identifying the source of your anxiety and trying to find ways to reduce or overcome it are as important as finding new ways to cope with it.
Getting Support from Family and Friends
Stopping smoking can be easier if you talk about it to family and friends and let them support you. If other people who live with you smoke, it may be harder for you to give up. You could try to get other household members who smoke, or friends who smoke, to stop smoking at the same time. At the least, encourage them not to smoke around you or leave their cigarettes, ashtrays or lighters where you will see them.
Avoiding triggers linked to smoking
The mind is very sensitive to associations, so removing all tobacco products from your home can help lessen some of the cravings of nicotine withdrawal. Smokers are accustomed to smoking in certain situations like in the pub or after a meal. If you can identify your trigger situations and avoid them, the chances of relapse will be much lower.
Being prepared for withdrawal symptoms
Likely withdrawal symptoms include headaches, nausea, irritability, anxiety, craving cigarettes, feeling miserable, difficulty in concentrating, increased appetite and drowsiness. Drinking more fresh fruit juice or water, eating more high fibre foods and reducing the caffeine and refined sugar in your diet all help some people cope with withdrawal symptoms.
Talk Therapies
Individual, group or telephone counselling can help people to stop smoking. Talking therapies can help people change their behaviour by thinking and acting more positively. Many counselling programmes use the techniques of cognitive behavioural therapy (CBT) and social skills development. Research has shown that CBT may be particularly effective in smokers with or without mental health problems.
Nicotine Replacement Therapy and Medication
Nicotine replacement therapy (NRT), anti-depressants and other medication have all been shown to help smokers without mental health problems to stop smoking and they may also be helpful for people with depression or schizophrenia. NRT appears to be more effective when combined with a talking therapy.
For advice on stopping smoking and which treatments might be suitable for you, talk to your doctor, a pharmacist or a health visitor. They will also be able to point you to services for smokers in your area.
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”I don’t believe in a God – a divine being of any description… But I do have a great wonder at the workings of the world and the universe. I suppose you could call that a spiritual response.
”I don’t believe in a God – a divine being of any description… But I do have a great wonder at the workings of the world and the universe. I suppose you could call that a spiritual response.
Spirituality
Spirituality can play an important role in helping people maintain good mental health and live with or recover from mental health problems. Although some organised religions can be experienced as harmful.
What is spirituality?
Spirituality means different things to different people and people express their spirituality in varied ways. It may be:
- their religion or faith
- meaning and direction in their life, sometimes described as their ‘journey’
- a way of understanding the world and their place in the world
- belief in a higher being or a force greater than any individual
- a core part of their identity and essential humanity
- a feeling of belonging or connectedness
- a quest for wholeness, hope or harmony
- a sense that there is more to life than material things.
Spirituality is often seen as broader than religion. Some spiritual beliefs are particular to an individual, whereas the beliefs attached to a religion are shared by large groups of people who follow established teaching.
How people express their spirituality
People may develop and express their spirituality through:
- religious practices such as worship, prayer and reading religious texts
- coming together as a spiritual community
- living by certain values
- rituals such as burning incense
- wearing particular clothes or eating particular foods
- cultural or creative activities such as making music or creating art
- getting closer to nature
- activities that develop self-awareness or personal control such as contemplation or yoga
- physical activity
- friendship or voluntary work.
Some people may consider these activities central to their lives, but they may not think of themselves as ‘spiritual’, or associate these activities with ‘spirituality’.
Being able to express and explore our spirituality is a basic human need and a universal human right. This right applies to everyone and is enshrined in European and UK law, based on the Universal Declaration of Human Rights.
How people express their spirituality
People may develop and express their spirituality through:
- religious practices such as worship, prayer and reading religious texts
- coming together as a spiritual community
- living by certain values
- rituals such as burning incense
- wearing particular clothes or eating particular foods
- cultural or creative activities such as making music or creating art
- getting closer to nature
- activities that develop self-awareness or personal control such as contemplation or yoga
- physical activity
- friendship or voluntary work.
Some people may consider these activities central to their lives, but they may not think of themselves as ‘spiritual’, or associate these activities with ‘spirituality’.
Being able to express and explore our spirituality is a basic human need and a universal human right. This right applies to everyone and is enshrined in European and UK law, based on the Universal Declaration of Human Rights.
Can spirituality protect mental health?
Spirituality can help people maintain good mental health. It can help them cope with everyday stress and can keep them grounded. Tolerant and inclusive spiritual communities can provide valuable support and friendship. There is some evidence of links between spirituality and improvements in people’s mental health, although researchers do not know exactly how this works.
Can spirituality help people with mental health problems?
Spirituality can also help people deal with mental distress or mental illness. Spirituality can bring a feeling of being connected to something bigger than yourself and it can provide a way of coping in addition to your own mental resilience. It can help people make sense of what they are experiencing.
“I’m quite happy to live with the idea that… in a fallen world there are things that happen to people just… through chance and circumstance. But what one does need to believe is that all of that is happening in an ultimately meaningful framework.”
Having a spiritual life can give people strength and improve their well-being. But some people’s experiences of spirituality may be damaging to their mental health. They may find certain belief systems repressive and their followers judgemental.
Occasionally, people’s past experiences can be unhelpful to their recovery from mental health problems, even if they felt comfortable with those spiritual influences at the time. Their beliefs may disturb or frighten them and that can lead to behaviour that other people find challenging.
How can spirituality be part of mental health services?
If you’ve got PND it’s very beneficial to be able to talk about your illness and its symptoms. Chats with friends and family can be helpful, but it’s also worth asking your doctor, midwife or health visitor about professional counselling.
How can spirituality be part of mental health services?
Mental health services should respect service users’ spirituality as a human right. A mental health service culture that responds to spiritual needs:
- acknowledges the spirituality in people’s lives
- gives service users and staff opportunities to talk about spirituality
- encourages service users to tell staff their needs
- helps service users to express their spirituality
- uses person centred planning and incorporates spiritual needs.
People express their spirituality in many different ways. Spiritual beliefs can influence the decisions service users make about the treatment they receive or how they want to be supported. Taking the spiritual needs of service users into account can support their recovery and help them live with their mental health problems in the best way for them as individuals.
Encouraging service users to explore what is important to them spiritually can be a valuable self help strategy as people often want to talk about their spirituality.
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Stigma
People with mental health problems say that the social stigma attached to mental ill health and the discrimination they experience can make their difficulties worse and make it harder to recover.
Mental illness is common. It affects thousands of people in Ireland, and their friends, families, work colleagues and society in general.
- One in four people will experience a mental health problem at some point in their lives.
- Around one in ten children experience mental health problems.
- Depression affects around one in 12 of the whole population.
- 450 million people world-wide have a mental health problem.
Most people who experience mental health problems recover fully, or are able to live with and manage them, especially if they get help early on.
Discrimination
But even though so many people are affected, there is a strong social stigma attached to mental ill health, and people with mental health problems can experience discrimination in all aspects of their lives.
Many people’s problems are made worse by the stigma and discrimination they experience – from society, but also from families, friends and employers.
Nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives.
We know that people with mental health problems are amongst the least likely of any group with a long-term health condition or disability to:
- find work
- be in a steady, long-term relationship
- live in decent housing
- be socially included in mainstream society.
This is because society in general has stereotyped views about mental illness and how it affects people. Many people believe that people with mental ill health are violent and dangerous, when in fact they are more at risk of being attacked or harming themselves than harming other people.
Stigma and discrimination can also worsen someone’s mental health problems, and delay or impede their getting help and treatment, and their recovery. Social isolation, poor housing, unemployment and poverty are all linked to mental ill health. So stigma and discrimination can trap people in a cycle of illness.
Media
The situation is exacerbated by the media. Media reports often link mental illness with violence, or portray people with mental health problems as dangerous, criminal, evil, or very disabled and unable to live normal, fulfilled lives.
This is far from the case. See headline.ie for how to communite responsibly about mental health in the media.
Stigma Reducing Campaigns
Research shows that the best way to challenge these stereotypes is through first-hand contact with people with experience of mental health problems. A number of national and local campaigns are trying to change public attitudes to mental illness. These include the national voluntary sector campaign organised by See Change and the Green Ribbon Campaign which takes for the month of May each year.
Equality Acts in Ireland
The Employment Equality Acts, 1998- 2011 protect people from employment discrimination. This includes discrimination in finding a job, keeping a job or doing work experience or vocational training. They also include advertising, equal pay, promotion and dismissal.
The Equal Status Acts, 2001-2011 protect people against discrimination when buying or accessing goods and services. This could include discrimination when accessing healthcare, education, social opportunities or while looking for accommodation.
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Stress can be defined as the way you feel when you’re under abnormal pressure.
All sorts of situations can cause stress. The most common involve work, money matters and relationships with partners, children or other family members. Stress may be caused either by major upheavals and life events such as divorce, unemployment, moving house and bereavement, or by a series of minor irritations such as feeling undervalued at work or dealing with difficult children. Sometimes there are no obvious causes.
Stressful events that are outside the range of normal human experience, for example being abused or tortured, may lead to post-traumatic stress disorder (PTSD).
Some stress can be positive. Research shows that a moderate level of stress makes us perform better. It also makes us more alert and can help us perform better in situations such as job interviews or public speaking. Stressful situations can also be exhilarating and some people actually thrive on the excitement that comes with dangerous sports or other high-risk activities.
But stress is only healthy if it is short-lived. Excessive or prolonged stress can lead to illness and physical and emotional exhaustion. Taken to extremes, stress can be a killer.
What are the symptoms of Stress?
Physical Changes
When you are stressed, your body produces more of the so-called ‘fight or flight’ chemicals which prepare your body for an emergency. Adrenaline and noradrenaline raise your blood pressure, increase your heart rate and increase the rate at which you perspire. They can also reduce blood flow to your skin and reduce your stomach activity. Cortisol releases fat and sugar into your system (but also reduces the efficiency of your immune system). All these changes are our body’s way of making it easier for you to fight or run away.
Unfortunately these changes are less helpful if you are stuck in a busy office or on an overcrowded train. You can’t fight and you can’t run away. Because of this, you can’t use up the chemicals your own body has produced to protect you. Over time these chemicals and the changes they produce can seriously damage your health.
For example, you may start to experience headaches, nausea and indigestion. You may breathe more quickly, perspire more, have palpitations or suffer from various aches and pains. Longer term you may be putting yourself at risk from heart attacks and strokes.
Emotional Changes
When you are stressed you may experience many different feelings, including anxiety, fear, anger, frustration and depression. These feelings can feed on each other and can themselves produce physical symptoms, making you feel even worse. Extreme anxiety can cause giddiness, heart palpitations, headaches or stomach disorders. Many of these symptoms may make you feel so unwell that you then worry that you have some serious physical conditions such as heart disease or cancer – making you even more stressed.
Behavioural Changes
When you are stressed you may behave differently. For example, you may become withdrawn, indecisive or inflexible. You may not be able to sleep properly. You may be irritable or tearful all the time. There may be a change in your sexual habits. Even if you were previously mild-mannered, you may suddenly become verbally or physically aggressive.
Who is affected by stress?
ll of us can probably recognise at least some of the feelings described above, and may have felt stressed or anxious at some time or other.
Research has shown that around 12 million adults in the UK see their GP with mental health problems each year. Most of these suffer from anxiety and depression and much of this is stress-related. 13.3 million working days are lost per year due to stress, depression and anxiety.
Some people seem to be more affected by stress than others. For some people, just getting out of the door on time each morning can be a very stressful experience. Others are more relaxed and easy going and seem to cope better with pressure. If you think you are prone to stress there are various things you can do to help yourself.
How can you help yourself?
An important step in tackling stress is to realise that it is causing you a problem. You need to make the connection between feeling tired or ill with the pressures you are faced with. Do not ignore physical warnings such as tense muscles, over-tiredness, headaches or migraines.
If you find yourself becoming angry or upset you may find it helpful to take time out, even if it’s only for five minutes. Get yourself a drink of water or take a walk around the block until you feel calmer.
Learn To Relax
If you notice you are becoming stressed, try to relax your muscles and calm yourself down by slow, deep breathing. Start by taking a deep breath, hold this for a count of three and then slowly breathe out. Continue this slow breathing until you feel more relaxed and then go on with what you were doing.
Mindfulness has been shown to be extremely helpful for managing and reducing the symptoms of stress, so you could also consider taking a course, either online or locally, to learn some techniques for practicing mindfulness in your daily life.
Identify The Causes
Once you have recognised you are suffering from stress, try to identify the underlying causes. Sort the possible reasons for your stress into those with a practical solution, those that will get better anyway given time, and those you can’t do anything about. Try to let go of those in the second and third groups – there is no point in worrying about things you can’t change or things that will sort themselves out.
Some problems may be more complicated and need to be dealt with head on. If you are going through a bad patch in your marriage, for instance, you have to begin to talk things through. This might be difficult to do unaided, so you may need to call on outside help from an organisation like Relationships Ireland.
Make Lifestyle Changes
Once you’ve started to deal with the immediate causes of stress, try to review your lifestyle. Are you taking on too much? Are there things you are doing which could be handed over to someone else? Can you do things in a more leisurely way? You may need to prioritise things you are trying to achieve and reorganise your life so that you are not trying to do everything at once.
You can help protect yourself from stress by in a number of ways. For example, a healthy diet will help prevent you becoming overweight and will reduce the risks of other diet-related diseases.
If possible, try to cut right down on smoking and drinking. They may seem to reduce tension, but in fact they can make problems worse. They can put you at more risk of physical consequences of stress because of the damage done to the body. You may also find it helpful to reduce the amount of coffee you are drinking as the effects of caffeine on the body can be very similar to the effects of stress and anxiety.
Physical exercise can be very effective in relieving stress. If you are feeling angry, for example, it can be really helpful to play a game of bitter squash in which you take out your anger on the ball (but not on the player). Even moderate physical exercise, like walking to the shops, can help.
Take time to relax. Saying ‘I just can’t take the time off’ is no use if you are forced to take time off later through ill health. Striking a balance between responsibility to others and responsibility to yourself is vital in reducing stress levels. Relaxation classes can help you learn how to control muscular tension and breathe correctly. Alternatively you could try to spend more time on leisure activities such as sports, hobbies or evening classes.
Sleeping problems are common when you’re suffering from stress, but try to ensure you get enough rest. Try not to take sleeping pills for longer than a night or two.
One of the best antidotes for stress is enjoying yourself so try to bring some fun into your life by giving yourself treats and rewards for positive actions, attitudes and thoughts. Even simple pleasures like a relaxing bath, a pleasant walk, or an interesting book can all help you deal with stress.
Try to keep things in proportion and don’t be too hard on yourself. After all, we all have bad days.
Seeking Help
Do not be afraid to seek professional help if you feel that you are no longer able to manage things on your own. Many people feel reluctant to seek help as they feel that it is an admission of failure. This is not the case and it is important to get help as soon as possible so you can begin to get better.
The first person to approach is your family doctor. He or she should be able to advise about treatment and may refer you to another local professional. Cognitive Behavioural Therapy and Mindfulness based approaches are known to help reduce stress. There are also a number of voluntary organisations which can help you to tackle the causes of stress and advise you about ways to get better.
See MHI’s Manage and Reduce Stress Booklet for more advice.
Suicide
Central Statistics Office (CSO) data shows that between 2007 and 2011 there was an increase in the suicide rate in Ireland, specifically among men. Recent figures point to a reduction in the rate of suicide. CSO confirmed figures for 2012 indicate that 541 people lost their lives by suicide. Provisional figures for 2013 (475 deaths) and 2014 (459 deaths) indicate a decrease in the numbers of deaths by suicide.
Ireland’s National Strategy to reduce Suicide 2012-2020 can be read here
Risk Factors
Certain factors are known to be associated with increased risk of suicide. These include:
- drug and alcohol misuse
- unemployment
- social isolation
- poverty
- poor social conditions
- imprisonment
- violence
- family breakdown.
People with a diagnosed mental health condition are at particular risk. Around 90% of suicide victims suffer from a psychiatric disorder at the time of their death.
Those at the highest risk of suicide are people suffering from alcoholism, clinical depression or schizophrenia. Previous suicide attempts are also an indication of particular risk. Up to 20% of survivors try again within a year, and as a group they are 100 times more likely to go on to complete suicide than those who have never attempted suicide.
For young people, bullying, family turmoil, mental health problems, unemployment and a family history of suicide can play a part in increasing the risk of suicide. Amongst the young, 80% of suicides are male, and one in three young people who take their lives are intoxicated at the time of death.
For older people, poverty, poor quality housing, social isolation, depression and physical health problems are factors which can increase the risk of suicide.
Prevention
Feeling suicidal is often a temporary state of mind. If appropriate and timely help and emotional support is offered to people who are experiencing deep unhappiness and distress, this can reduce the risk of them choosing to end their own life.
Following a focused campaign in recent years, numbers of suicides among younger men aged 25 – 34 – previously the highest – have fallen.
Attempts at suicide are often preceded by certain signs. These can include evidence of deliberate self-harm and the person in question expressing their thoughts in the year before the act to relatives, partners, peers or professionals. These offer potential opportunities to intervene and save lives.
Despite this, three-quarters of all people who end their own lives are not in contact with mental health services.
Prevention of suicide is not the exclusive responsibility of any one sector of society. Schools can create cultures in which young people feel it is healthy to talk through emotional and other difficulties. General practitioners can restrict the number of tablets prescribed to those at risk of overdose. Accident and Emergency staff can ensure all young people who have attempted suicide receive specialist mental health assessment. And each of us can pay close attention to the overall mental health of our loved ones to reduce the risks of them taking their lives.
Recovery From a Suicide Attempt
The attitudes we hold toward people who attempt to take their lives can influence the course of their condition. The isolation that suicidal people feel can be reinforced by a judgmental approach in which their behaviour is viewed as manipulative or selfish. By stepping beyond our personal assumptions, and showing care and respect for the people behind the behaviours, we can help them talk about their feelings and help prevent suicide taking place.
U Can Cope
In 2012 the Mental Health Foundation collaborated in the production ‘U Can Cope‘, a film which was made to raise
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