Mental Health

Thesis getting you down? Read this! Help is here…

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It has been said that the letters Ph.D. really stand for Permanent Head Damage rather than Doctor of Philosophy.

Sadly it’s not uncommon for doctoral candidates to experience mental health related difficulties during their studies. Some of this can be down to the nature of the degree. Candidates have to spend a lot of time and energy self-motivating to create new knowledge. Their work is solitary, hyper-focussed and generally not well understood by those around them. They have very intense, unequal relationships with a supervisor who holds a lot of power over them and who may be over or under-involved. By its inherent nature research involves a lot of dead ends, false starts and the ever present spectre of rejection from journal reviewers. And that’s all before undertaking the small task of writing up a book the size of a telephone directory and having to face a viva in front of a panel of experts.

 

As someone who has gone through the doctoral process themselves, supervised several and then ended up working therapeutically with PhD students and academics here is my advice.

 

  • Anxiety, stress and uncertainty are common, but more common as is the dreaded “imposter syndrome” where your typical PhD student wanders around fearful that they will be found out or people will realise that they are not clever enough. It’s all lies. If you are here in the first place, you are good enough.

 

  • Faced with writing a thesis it’s an understandable response to feel one that may be better off dead/ running away/ drinking until oblivion. This isn’t often acknowledged and people suffer, thinking they are the only one that feels like this. If you do feel this way, do seek support because there are a lot of resources at university to help with this. The Students’ Health Service, Student Counselling service, the Student Union and Academic departments can all be possible sources of support when it comes to despair, fear or doubts.

 

  • A good thesis is a finished thesis. It doesn’t have to be perfect, world changing or the last word in your subject area- it just needs to be done. Your PhD is not your magnum opus, it’s really your driver’s licence into the world of research and academia. You may not even be in the same area in the future. I can barely remember what was in mine, and have to think quite hard to even recall the title. However, the research and analytic skills I learned finishing it I still use on a daily basis.

 

  • Get out more. It’s all too easy to spend all of your time in the library/laboratory and feel massive guilt for doing anything other than your thesis. However, balancing your work with friends/ relationships/ healthy eating/ exercise and interacting with the outside world is incredibly important. It also makes you more effective and is probably the best known defence against procrastination, as you have a shorter window of time where you will need to be focussed. It’s only too easy to spend 20 hours a day occupying yourself with not writing.

 

  • You are not your work. It’s only a small part of what you do and doesn’t reflect on your capacity for kindness, altruism, empathy or being a worthwhile human being. It doesn’t even reflect on your intellectual ability as your PhD is more a measure of your tenacity and resilience than it is about how smart you are. Others will love you for a variety of reasons, but your PhD is unlikely to be one of them.

 

  • Best of luck with it. It’s tough. Remember, a thesis is written a line at a time. Keep doing that and it will eventually get done.

SHS Consultant Psychologist Dr Ian Barkataki

Eating Disorders Awareness Week 2016 #EDAW16 by Dr Hugh Herzig

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Did you know that next week 22nd – 29th Feb is Eating Disorders Awareness Week? Perhaps you already feel bombarded by news bulletins about the rising incidence of EDs… or how these days younger and younger people are affected. So why the need to be made more aware of EDs?

At Student Health we have good reasons to want to raise awareness of EDs:
• Eating disorders are not rare and exotic illnesses. They are common in the UK population, particularly so in adolescence and early adult years, and particularly so in student populations.
• They have a profound effect upon mental health, eroding well being and self esteem, so that nothing the sufferer does is ever good enough.
• They have serious physical effects on pretty much every biological system of the body such as skin and dental damage, gastrointestinal and heart problems, bone marrow and liver damage, hormone suppression and hastening the onset of osteoporosis. In fact, EDs lead to greater mortality than any other group of mental illnesses.
• Living with an ED can make life very hard indeed… friendships and social activities are deprioritised, leading to people feeling more and more isolated, anxious and depressed.
• Concentration and stamina can be much affected, so the sufferer cannot perform physically and academically to her/his potential
• Family and friends often don’t know what to say, or worry they will cause upset or have their head bitten off if they express their concern
• Some of our patients at Student Health get so unwell that they need to take time out from university. For those such as medics, vets and dentists whose degrees lead on to accreditation with a national professional body, their ED may make them unfit to practice as a registered professional.

ED Awareness week may provide an opportunity to break the taboo that surrounds EDs.

You may feel able to bring up this sensitive topic with that friend you’ve been worrying about, but who seems always to want to keep herself to herself. It is likely that doing so will help her… even if she seems not to appreciate it at the time.

If you have severe eating and weight anxieties yourself, this week may be the time to tell someone a bit about it, allow a friend to support you, maybe even seek help from your doctor. All the staff at Student Health are experienced in helping people with EDs, and in Bristol we have good services to treat eating disorders, including the First Step service which offers psychological treatments in our very own Health Centre

We are here to help YOU!

World Mental Health Day 10th October 2015

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Every year the WHO leads a day of awareness on mental health related topics, and the theme this year is ‘Dignity in Mental Health’.
The aim is to campaign against discrimination and marginalisation, as well as stigmatisation, and to educate people as to what can be done to preserve the dignity of those with mental health conditions.
Here at Students’ Health Service we are proud to have recently been awarded a grading of ‘Outstanding’ by the Care Quality Commission (CQC) for our care of students with mental health conditions.
The whole team has worked really hard over the years to create a safe and welcoming environment for students who are struggling with emotional and psychological health conditions, and we have built up a solid network of services within the practice, which will support our students through their academic careers.
We provide a weekly visiting psychiatrist clinic, in-house Cognitive Behavioural Therapy (psychological support) for a variety of conditions, self hypnosis for anxiety, eating disorders referrals to a specialised local clinic, and we are soon to have our own team psychotherapist, to support our students with the most complex mental health needs.
We really believe that mental health is as important as physical health, and we will see a person with a mental health crisis for an appointment the same day, as we would see a person with chest pain, or difficulty breathing.
We work closely with the Student Counselling Service, and liaise with them, with patient consent, if it will help improve the student’s care.
We want our students to know that if they are worried about their mental health they can book an appointment to see a GP, and we will be non-judgmental, supportive and caring, will listen to their worries and discuss the situation, and we will do our best to help move things forwards, including liaising with academic departments, if requested by the student.
Don’t suffer in silence. Please talk to us.

The following links may also be of interst on World Mental Health day 2015.
http://www.who.int/mental_health/world-mental-health-day/2015/en/
http://www.mentalhealth.org.uk/our-work/world-mental-health-day/world-mental-health-day-2015/
http://www.mentalhealth.org.uk/get-involved/as-a-fundraiser/teaandtalk/

 

 

Antidepressants; a GP ponders the urban myths…

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I’m writing this blog purely as a GP who, every day, sees patients who take antidepressants. So these are my thoughts, based on experience, as well as evidence.

I also see patients every day who should consider taking antidepressants, because they clearly have all the signs and symptoms of significant clinical depression, anxiety, obsessive compulsive disorder or social phobia. Up to one in three of my consultations is for a mental health problem, and I suspect most of these people have finally come to see a doctor because they have reached a crisis point, or no longer know how to cope. They do not come lightly, and I understand that. They will often have already tried sensible measures, though we usually discuss those anyway, such as minimising alcohol or drug use, better sleep and eating routines, and exercise.

I always suggest counselling or other talking therapies, though again, many have had unsuccessful experiences of these. I will probably mention giving them another go…a different approach or technique perhaps?

But finally we come to medication, always approaching the subject gently, knowing that everyone comes with preconceptions and concerns.

“But they’re addictive”

“I don’t want to feel like a failure, needing medication”

“They’ll make me fat”

“They’ll make my acne worse”

“My parents won’t approve”

“I’ll be on them forever”

 

I have heard all of these, and many more, hundreds of times in the 15 years I’ve been a GP.

And it takes time and patience to pick my way through the concerns, which are mainly based on hearsay/myth (especially because they are NOT addictive or dependency inducing, and only one specific antidepressant is classically associated with possible weight gain. They have no effect on acne!).

 

But it’s worth the time, and listening to the concerns, because often a patient will then agree that it might be worth ‘giving them a go’, and that there is little to lose by trying them. Side effects are usually minimal for most people, especially if started at a half or low dose, and we always like to review how things are going at 2-3 weeks. And then when they have given them a go, and they return 4-6 weeks later, I have lost count of the number of people, but it is the vast majority, who have noticed an improvement, and as time goes on, at 8-12 weeks, say “I wish I’d tried these sooner”.

 

So all I would say is this; if you’re struggling and unsure about medication, then talk to a GP, sooner rather than later, and discuss your concerns, so we can see if antidepressants might help you too. And if they’re not right for you, we will still support you, and meet with you, to discuss other options and therapies.

You are not alone, and we are here to help.

 

Medical students and mental health

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The view from the Faculty Support Office;

Medical students present with a range of conditions, both mental and physical in all years of the programme.

Some of the mental health conditions that our students currently present with are Generalised Anxiety Disorders, Eating disorders, Asperger’s, OCD, Bipolar disorder, Depression and PTSD.

Some of the physical health conditions that we are currently supporting are diabetes, epilepsy, prosthesis, arthritis, CFS, restricted mobility, hearing and sight impairment, asthma, MS and temporary disabilities such as fractures and musculoskeletal injuries etc.

We also have a number of students with Specific Learning Difficulties such as dyslexia, dyspraxia and dyscalculia.

These conditions range from mild through to moderate and severe.  Affected students develop a relationship with our pastoral team and receive regular personal support ongoing throughout the programme and also during periods of crisis.  Emma, the Faculty Student Advisor is in regular communication with individual students, to ensure mental and physical wellbeing, especially those who are particularly vulnerable or at risk.

Students disclosing a health condition or disability in their application, or for the first time after the start of the programme, are offered an opportunity to meet with a member of the pastoral support team.  Emma then often liaises with the Disability and Health Panel and Occupational Health and Disability Services teams in order to discuss support measures.

The Faculty holds a Disability and Health panel on a monthly basis in order to consider the support requirements of students.  Previously, some of the alternative arrangements and ‘reasonable adjustments’ that have been put in place to assist students in continuing with their studies are: extra time in examinations, a separate room for examinations, specialist equipment for examinations, placements local to personal therapeutic appointments, adjustment to unit timetable within an academic year to accommodate personal need and on programme support.

Emma also works with students by simply providing a listening ear when students’ health or personal problems get them down.  This is a confidential service, unless there is a requirement to share information to ensure student and patient safety.  This can often be part of a student’s network of support that may prevent a deterioration.  Advice is also given on absence and extenuating circumstances procedures and the GMC requirement for medical students to address their own health issues.

Lastly, short periods away from the programme, or an entire academic year, is a support measure that is often agreed.  It is very common for students to suspend studies in order to address health issues without the pressure of academic study.

For support contact med-support@bristol.ac.uk

 

 

A word from our friendly local addiction specialist dr

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Hello there, a brief update from my world as an Addiction Psychiatrist.

 

There have been big changes to how NHS services are providing support to people with alcohol and drug problems in Bristol over the last year. We are now providing services as part of ROADS (Recovery Orientated Alcohol and Drugs Service). This is a partnership between organisations in Bristol and aims to provide a seamless service so that when a person contacts ROADS they should not notice that the element of support they need can be provided by one of 5 different organisations. The aim being that all providers focus on the care provided rather than being passed between different organisations.

 

One of the big aims for ROADS was to improving the numbers of people receiving treatment for alcohol problems. Alcohol is the substance that causes the most harm in the UK but it has not had equivalent resources as traditional services focused on illicit drug treatment. There is no distinction between alcohol and drug services now in terms of funding and where people are seen. This is particularly important for young people as many more young people die or come to harm as a result of alcohol problems than for all other substances put together. We have seen a massive increase in the numbers of people referred for alcohol problems, in fact this has been such a success we are struggling to meet the extra demand which has exceeded our expectations.

 

We are still closely monitoring changes in patterns of substance use locally and nationally. An important area is Novel Psychoactive Substances (NPS), sometimes called ‘club drugs’ or ‘legal highs’. Although these substances are often less harmful than alcohol or other more traditional drugs, there are new substances emerging to exploit legal loop-holes which are often more harmful that substances that have just been made illegal. Also we are seeing problems as drugs are not being sold correctly. For example we have several people running into problems, and some deaths nationally, with substances sold as MDMA/ecstasy which in fact contain other more harmful substances such as PMA or PMMA. This is particularly a problem as people take a substance they think is MDMA but think it’s week so take more and then overdose on these more harmful substances.

 

Best wishes for Christmas and the New Year, stay safe, and be respectful of any substances that you put into your body,

 

Dr Tim

Five Ways to Wellbeing at Exam Time

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Exam time is a difficult time for everyone, though for some more than others.

So it’s important to remember that you can do things to help yourself remain calm and in control, throughout those weeks when your adrenaline can be flowing a little more rapidly.

 

Here are some evidence based ways that we can look after our mental health, a bit like a ‘5 a day for the mind and soul’.

 

  1. Keep Connected; stay in touch with the people around you, the people who care about you and who can support you in life
  2. Be active; go for a walk/ run/ swim, breathe in some fresh air. Exercise on the Downs. Release that adrenaline in a positive way
  3. Take Notice; notice the world around you, the changing seasons, walk around and observe what is happening. Be aware of your feelings
  4. Keep learning; learning new things can be fun if you make time for it, and for yourself too
  5. Give; do something nice for someone else. Cook a meal/ help out your community/ volunteer. It is scientifically proven that being nice to others releases a happy hormone (oxytocin) and makes you feel better too!

 

However, if doing all these things isn’t enough to support you through a difficult time then remember we are here to help, as are the Counselling service, and other services in the university, like the Multifaith Chaplaincy.

It is normal for exam time to be stressful, that adrenaline can help focus the mind and bring your performance up a notch, but if it feels out of control, and overwhelming then please ask for help sooner rather than later.

Good Luck!

Mental Health Awareness Week 12-18 May 2014; Anxiety

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As a GP I really like it when a student comes to see me about their anxiety. Not only because it means they are keen to get help and get better, but also because there are so many things we can offer to ease their symptoms. In the last few years, here at Students’ Health Service, we have tried really hard to provide a variety of treatment options for what is the commonest mental health problem that we see; anxiety.

Anxiety affects people differently (about 1 in 20 people will have it at some time), but in general it makes you feel afraid and tense. It can lead to physical symptoms, as your adrenaline rushes around more than usual. People complain of palpitations (fast heart beat), sweating, nausea (feeling sick), chest pains, and shaking. You can also get headaches, and feel out of breath. It can be normal to feel like this, eg before an exam, but when it starts to interfere with everyday life it can become very challenging. Some people get panic attacks, where the symptoms feel overwhelming, and it can feel like the world is closing in on you, or that you might die. Please ask for help if this is happening. Ideally, please see a GP before it gets this bad.

So what can we offer you?

A variety of psychological (talking based) therapies are available. Relaxation techniques and Mindfulness can be learnt, and the Student Counselling Service provides very regular groups. Just sign up on their website.

http://www.bristol.ac.uk/student-counselling/

Self Hypnosis has been shown to be effective, and a GP can refer you for this; a one off free session provided by Matt Edwards in a confidential environment. Here is a blog written by a student who saw Matt last year;

I tried self hypnosis for my anxiety! You could too… a student writes…

 

Online CBT (cognitive behavioural therapy) is available for those who would prefer this method; sign up via the SCS website.

Free NHS groups, and 1 to 1 therapy are accessed via the LIFT Psychology service; no GP referral required, just contact them on

http://lift.awp.nhs.uk/bristolandsglos/

However, if psychological approaches are not enough, or might take too long and your symptoms are too challenging to manage daily, then medication can be extremely helpful, and can work within a few days of starting it. Any of the GPs will be happy to discuss this option with you.

So remember, anxiety is normal and common, but sometimes it can become overwhelming or a daily stress, so get help and talk to us soon!

The Succeed Foundation’s Vision is “A World Free From Eating Disorders”

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The Succeed Foundation has a simple mission to free the world from eating disorders. Through fundraising and investment in innovative research, and the promotion of ground-breaking evidence-based treatments and preventions, the charity aims to tackle eating disorders in measureable ways.

Every individual with an eating disorder is unique. They will not all respond to the same treatment. In partnership with researchers and clinicians, we develop a broad range of approaches and transform the science into practical tools that sufferers can beneficiate in their daily life as a self-help tool. We want to move from awareness to action.

The Succeed Body Image Programme

 The charity has a wealth of sound scientific research behind it thanks to its association with a number of academic institutions; including the University of the West of England; their Centre for Appearance Research is monitoring the Body Image programme in the UK, headed by research fellow and Doctor Phillippa Diedrichs.

The Succeed Body Image Programme (SBIP) is a cognitive dissonance-based intervention.

Dissonance theory suggests that if individuals act in ways that contradict their beliefs then they will typically change their beliefs to align with these actions. The Succeed Body Image Programme therefore, actively engages its participants in of a series of verbal, written and behavioural exercises that critique the unrealistic, ultra-thin-ideal standard of female beauty.

The SBIP is designed to help individuals across all spectrums to establish and maintain a positive body image. Using highly interactive, peer-led, small groups, it is a two-day, intervention program designed by experts and implemented through trained peer leaders on college campuses throughout the UK.  As the first peer-led, evidence-based eating disorders prevention program shown to truly work, The Body Image Program does not specifically focus on eating disorders; rather, it emphasizes creating and reaffirming positive and healthy personal body image through a variety of structured discussions, activities, and exercises. The phenomenal program has a proven track record – not only on improving body image issues, but on encouraging healthy confrontation and communication skills as well. It is the first scientifically supported evidence-based eating disorders prevention program designed.

Fat Talk Free

Fat Talk describes all of the statements made in everyday conversation that reinforce the thin ideal and contribute to women’s dissatisfaction with their bodies. We want to raise the nation’s consciousness about the danger of fat talk and our initiative is to eliminate that kind of talk from our lives and stop appearances critiques and accept the way we are.

This can be achieved by simply changing our conversation.

Our Success depends on collaboration and monitoring our work we want to focus in what works.

to access the support contact the Succeed Foundation Directly

www.succeedfoundation.org

Carers may find this link helpful too;

http://www.succeedfoundation.org/work/skillsforcarers

 

 

When you hear the word ‘counselling’ what do you think of?

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Two people in a room; one talking and the other just nodding and listening? 
Films have a lot to answer for, and for me that image conveys nothing of the aliveness of the relationship that counselling offers.

For instance, when was the last time that a friend or someone in your family really listened to your experience, without confusing it or comparing it with their own? 

The real trick of counselling is that it creates the circumstances that mean you can fully be yourself. By providing relational sounding boards and mirrors it allows you to see and hear the self you are in this moment. Sometimes someone else can see you changing when you can’t see it yourself.
Most people emerge from experiences of counselling feeling better than they did at the start, more able to function and on a positive trajectory in terms of their mental health, but the chances of this are much increased if they can come along with some openness to the process, some belief it could help in some way. This is one of the reasons we ask people to refer themselves, rather than being required to come: they need just a tiny bit of belief, and it can be just tiny.

The other surprise to some is that counselling is not just about two people in a room, in fact increasingly this is less and less so. The Student Counselling Service now offers about 300 students direct support each week and whilst some of them will be in individual appointments, most of these are either initial assessments to establish the best pattern of care for someone, one off follow ups to these meetings to support a person’s self help, 20 minute initial meetings to establish support choices, or 20 minute ‘Drop ins’ to offer immediate triage and signposting to support, or to help keep them on track with ‘Beating the Blues’ (our online CBT support programme). Even our regular sessions tend to be for fewer than 6 weeks.

Over 100 of the total seen are accessing our regular closed groups or coming just this week to an open group, or attending one of our workshops. And that’s without keeping a count of the number of people who use our resource library and website self help pages.

Because of the range of what we offer we registered over 1600 students last academic year, and so far this year we are experiencing a 20% increase on that. We can’t work with everyone but we have a number of useful contacts in the wider community of Bristol, so that no one needs to feel alone with their concerns.

And just one little plug for group work. If counselling helps you see aspects of yourself you can’t yet see , imagine what it might feel like if other students just like you provided the sounding board, or if someone in the group told a story that made you feel you were not the only one struggling with similar things. It is a powerful moment, and every group sees it, when someone says, ‘it’s such a relief…I thought it was just me’.

http://www.bristol.ac.uk/student-counselling/