On Mental Health Awareness Day, some thoughts. Having at times had very visible physical impairments, I know how enthusiastic people are to offer advice, osteopath recommendations and pirate-based jokes, often when knowing very little about the situation. And yet it strikes me that we are much less willing to interject when mental health concerns become visible in those we know. The phrase “I won’t probe” seems apt here, given that medical professionals also don’t probe in the literal sense of the word. Whereas we are often squeamishly keen to hear the details of a friend’s progress with treatment for physical health, it is more tricky to enquire after developments with a friend’s mental health. We worry about being overly personal, about ‘triggering’ something, about potentially making the problem worse: so often we say nothing, or say something bland and non-specific.
And here’s the catch. Many GPs are careful not to rush diagnoses of mental health conditions – as they should be. A wrong diagnosis or a rushed treatment suggestion without careful follow-up monitoring can indeed make things worse. But for many patients, such a first encounter can therefore be interpreted as a let-down, a sign that you are not worthy of the GP’s time, or that you and your problems are too abstract to be helped by ’the system’. It takes A LOT of courage to make that first appointment with a doctor or other professional, and it’s not uncommon to attend with unrealistic expectations about immediately getting a ‘label’ for one’s difficulties, and a magic solution. It’s also likely that perspective on what is healthy has become quite warped by the time that step is made, meaning that you don’t think to mention things that are actually a significant symptom.
Now we all know that Googling health symptoms is a quick route to panic, but it can be a useful starting point with mental health concerns. For depression, the NHS online self assessment (http://www.nhs.uk/Tools/Pages/depression.aspx) and this article about concealed depression (http://awarenessact.com/15-habbits-of-peoplle-with-concealed-depression/. )are both non-terrifying. Take a screen shot of your responses or note down the things that such articles make you realize, and take this written information to an appointment, not as a self-diagnosis but as a communication aid. Ask a trusted friend or colleague how they are perceiving your behaviour and mood, since they may be aware of things that you are currently unable to articulate. And also consider taking someone with you to that first appointment: it might not ‘be the done thing’, and I certainly wouldn’t suggest taking your mum along to CBT or psychotherapy, but if you’re likely to find it difficult telling the GP how you really are or distort what they say back to you, having an ally there can help. If you are the friend of someone who’s making those first steps to recognizing and finding help with a mental health difficulty, offer to drive them to the appointment and go in with them if they’d like you to. If they refuse your offer, still ask them clearly what that first appointment involved. If the GP or other professional advised them to return for a follow-up, make them do it! Sometimes the disappointment at not finding a ‘quick fix’ overshadows the routes towards further help.
A few weeks ago, I wrote about self-labelling. The phrase “not all who wander are lost” is somewhat appropriate to those of us who abandoned professional, grown-up lives to move abroad and do a PhD! Like many of my friends here, I am taking the opportunity to wander and wonder. Making these changes in my own life has made me much more aware of those people whose lives are very stable, but who do not seem to be happy and healthy. Maybe not all who are lost will wonder about what they could change, about what help is available, about what they are worthy of. I really believe that regular attention to mental health (which everybody has) can help many people to avoid mental illness (which is often so much harder to recover from). Please, wonder about the people you know. Do they need you to probe? Do they need you to organize them into finding help via the increasingly complex and cash-strapped NHS? Do it. Please probe. Please help them to realize that that they deserve to wonder.