Mental Health | Essential Guide to Maintaining a Healthy Mind

As a society, we are getting somewhat better at recognising the importance of mental health. There is a growing awareness that looking after our mental well-being is just as important as monitoring our physical health, assisted by initiatives such as Time To Change, which campaigns against stigma or discrimination around mental illness. None the less, there are still misconceptions about what ‘mental health’ or ‘mental illness’ might actually mean.

The following guide aims to give our readers a full and informative picture of the meaning of mental health, the steps we can take to safeguard our mental well-being, and how to recognise the signs and symptoms of mental illness.

Contents

Depression
Anxiety disorders
Obsessive-Compulsive Disorder
Eating Disorders
Bipolar Disorders
Schizophrenia
Keeping healthy – 10 top tips
Societal Attitudes to Mental Health
Role models – celebrities who have spoken out about mental illness
Reading List and Further Contacts

What is ‘mental health’?

As the charity Rethink Mental Illness states, “there is often a lot of confusion about what we mean when we talk about mental health.” Most people understand “mental health” to mean mental illness or distress, whereas in fact we all have mental health. The charity Mind also says that “mental health is just like physical health: everybody has it and we need to take care of it.”

The World Health Organisation says that “Mental health is not just the absence of mental disorder” and that the following can be considered signs of good mental health:

• You can realise your potential
• You can cope with life’s stresses or “ups and downs”
• You can work productively
• You can contribute to your family or community in a meaningful way

Mind also suggests the following as signs of excellent mental health:

• You feel confident within yourself, and judge yourself according to realistic standards
• You can feel/express a range of emotions
• You are engaged with the world around you and enjoy positive relationships with others

As you can see, achieving good mental health is more complex and nuanced than simply not suffering from mental illness. Our chapter on Keeping Healthy will explore how to care for your mental health in more detail, but Mind’s booklet on how to improve and maintain your mental well-being is an excellent starting-point.

Despite this, there are many factors that can contribute to poor mental health or mental illness. Social isolation, poor housing, work or relationship problems and unemployment can all contribute to poor mental wellbeing. Equally, there may be no clear reason why someone experiences a period of mental distress or illness – mental illness is an equal opportunities affliction and affects people from all walks of life.

• Good mental health means feeling confident and resilient. You are engaged with the wider world and enjoy positive relationships with others.
• Many factors can contribute to periods of poor mental health, but you can experience mental health problems without there being any clear ‘reason.’

What is mental illness?

There are so many different forms mental illness can take that it is difficult to give a precise definition of poor mental health.

Our chapters on the different forms of mental illness will explore the particular symptoms and challenges of depression, bi-polar disorder, OCD (obsessive compulsive disorder), eating disorders and schizophrenia.

However, psychiatrists group mental illness symptoms into two groups: neurotic and psychotic.

Writing for No Panic, Professor Kevin Gournay explains that  neurosis covers a range of conditions, such as anxiety, moderate depression and OCD, where the sufferer may feel incredibly stressed about losing control or acting in a socially inappropriate way.

Psychosis, on the other hand, is used to refer to very specific conditions, such as schizophrenia and manic depression, where the sufferer may experience false beliefs, hallucinations or delusions.

It is therefore difficult to generalise about mental illness, as there are symptoms that are highly specific to each condition. The main thing to remember is that if you are concerned about your mental health, or have been diagnosed with a mental illness, you are certainly not alone. 1 in 4 adults in the U.K will suffer from a mental illness at some point in their lifetime. Mental illness is therefore incredibly common, and no one should ever feel afraid or ashamed of seeking help. In later chapters, we will explore whether the current focus on ‘mindfulness’ and talking therapies is always helpful – the writer Hannah Jane Parkinson has pointed out that, for sufferers of severe mental illness, the almost trendy focus on positivity and wellbeing is overly superficial – suffering psychosis, for instance, is “nothing like a broken leg.”

This is a really important point – mild anxiety has nothing in common with schizophrenia, and we do all sufferers of mental illness a disservice by brazenly lumping them together under a catch-all term. We will also consider whether the focus on sharing experiences of mental illness fails to address broader societal issues that have led to increases in rates of mental illness.

• There are a wide range of different kinds of mental illness, and individuals may experience conditions such as depression in different ways.
• If you are not feeling like yourself, it is very important to seek help from your GP, as well as friends and family.

Mental health issues are on the rise – why?

According to a report by the BBC, cases of severe mental illness have risen sharply since the 1990s, with 9.3% of people per week experiencing serious mental illness symptoms as opposed to 6.9% in 1993. Some of this can be attributed to a greater willingness to report symptoms, yet equally, the stresses of modern life are at least partly to blame. There has also a significant rise in mental health problems affecting young people, with a marked rise in referrals for children aged 19 and under in England. 1 in 8 young people now experience a mental health issue. Psychiatrists suggest that pressure from peers and the increased use of social media may lead to young people suffering from lower self-esteem and feelings of isolation.

Mental health disorders have also risen globally, with the WHO estimating that 300 million people worldwide suffer from depression, whilst a recent Lancet report found that mental health problems could cost the global economy $16 trillion between 2010 and 2030 if measures are not taken to safeguard public health. Approximately 1 in 6 people globally experience a mental health issue or substance abuse issue. In terms of why mental health issues may be on the rise, especially among young people and women, there may be a range of factors at play, yet it is known that education and employment are correlated with poor mental health. In an increasingly competitive global economy, people facing the effects of austerity or job insecurity are likely to feel greater levels of pressure, undermining their mental health.

There are undoubtedly a wide range of factors contributing to poor mental health. As a society, it is clear that we need to work out how to best support those who are suffering. For an overview of the different forms mental illness can take, see our chapters below on each condition, including symptoms to look out for and treatments available.

• Incidences of mental illness seem to be on the rise worldwide.
• The percentage of children and young people with mental illness has also risen.
• It is unclear why this, but the stresses of modern life and job insecurity can make people’s mental health worse.

Depression

Depression can often seem like a vague, poorly-defined type of mental illness. Just as the term ‘OCD’ has crept into common parlance to mean someone who just likes tidiness, people can use the word ‘depressed’ to mean that they are feeling a bit tired, are under the weather, or are just in a bad mood. While it might be advisable to be more careful with the language of mental illness, context is everything, and for an otherwise healthy person, saying they are ‘depressed’ may help them to express how they feel. Nonetheless, for sufferers of clinical depression, the illness is far more serious than occasionally feeling sad. Depression can affect every aspect of their lives, and involves both physical and mental symptoms. If you think you may be suffering from depression, there are various forms of help out there, from antidepressant medications to talking therapies. Seeking help is the first step on the road to recovery.

What are the key symptoms of depression?

The charity Mind defines depression as a ‘low mood that lasts for a long time, and affects your everyday life.’ If you are suffering from mild depression, you might experience:

• Feelings of sadness and low mood that persist over time
• Feeling more tired than usual
• Feeling tearful, upset or angry
• Feeling demotivated and finding it hard to enjoy work or leisure activities

With moderate or severe depression, you might experience other symptoms, such as:

• Feelings of worthlessness or guilt
• Low self-esteem – being overly self-critical or holding yourself to impossible standards
• Feeling numb or emotionally ‘empty’
• Difficulty sleeping or experiencing insomnia
• Feelings of isolation – finding it hard to communicate with others
• Experiencing aches and pains with no obvious cause
• Using alcohol or other drugs in excess to numb periods of low mood
• Feeling very fatigued with low energy
• Finding it harder to concentrate
• Thoughts of self-harm or suicide

If you find that you are experiencing any of these symptoms, especially if you are experiencing any thoughts of self-harm or suicide, it is very important that you seek help from your GP or local hospital as soon as possible. If you are worried you might act on these feelings, call an ambulance and go to A & E, or call 116 123 to speak to Samaritans for free.

With severe depression, there is also the possibility you could experience psychosis, where your symptoms might include paranoia or delusions. You might become convinced you have committed a terrible crime, or hear voices. These symptoms are connected to the severity of your depression, and it is very important that you seek medical help and support.

• Depression comes with a range of symptoms
• You do not have to experience all of these symptoms to suffer from depression
• Even if you think your depression is quite mild, seek help from your GP to improve your mood and quality of life

What kinds of depression exist?

As we have seen, depression can range from mild depression with a  prolonged period of low mood, to severe depression which might involve experiencing thoughts of self-harm. Depression can also occur at particular times of year or after significant life events.

For example, some people experience Seasonal Affective Disorder, or SAD, a form of depression that affects sufferers during the winter months. They will experience more severe symptoms of depression in winter, although some sufferers experience low mood in summer.

Sometimes depression can occur following the birth of a child. Post-natal depression affects parents after their child’s birth, and it is very common, affecting 10% of mothers within a year of giving birth. Fathers and partners can also suffer from post-natal depression. Many of the symptoms of post-natal depression are similar to those for major depression, including:

• Persistent low mood
• A lack of enjoyment in everyday activities
• Difficulty getting to sleep, or feeling sleepy during the day
• Difficulty in bonding with the baby
• Feeling isolated from others
• Poor concentration
• Experiencing distressing thoughts, for example that you might harm your child.

If you have recently had a child and feel that you are struggling to cope, remember that help is out there – talk to your GP or health visitor to access the help you need.

A further type of depression that some people experience is Dysthymia, a chronic period of low mood and poor self-esteem. The effects of dysthymia are particularly long-lasting, and the condition can be understood as a very persistent form of depression, lasting over several years.

While there are many forms that depression can take, including bi-polar depression, which will be explored in more detail in a later chapter, the most important thing to note is that everyone experiences depression differently. For sufferers of mild depression, societal attitudes towards mental health, such as being told to ‘snap out of it’ or that they have ‘first-world problems’ can be highly unhelpful. You do not need to be experiencing mental illness in its most severe form to seek help, and certainly should not judge yourself for feeling ‘down’: help is out there.

• There are many different kinds of depression
• People’s experiences of depression are individual and complex

What causes depression?

It used to be thought that depression stemmed from a chemical imbalance in the brain, yet current research suggests the reality is more complex. There may be a chemical component at work, where the brain does not regulate moods effectively, but the causes of depression are diverse, including genetic vulnerability, stressful life events and medical problems.

A Harvard article on the causes of depression has found that a possible biological explanation for depression lies in the hippocampus, the part of the brain responsible for forming memories and controlling emotion – women with depression are found to have smaller than average hippocampi. This may explain why antidepressants take several weeks to improve mood, as they improve the growth of nerve cells in the hippocampus. Rather than curing a chemical imbalance, antidepressants may help by stimulating the growth of neural networks.

How many people suffer depression?

Depression is one of the most common mental illnesses. The WHO estimates that over 300 million people worldwide suffer from depression, whilst in 2014, the Mental Health Foundation found that almost 20% of people in the UK over the age of 16 suffered from depression.

According to the WHO, depression is one of the most prominent causes of disability and it is the 10^thleading cause of early death. Rates of depression do vary between countries – the United States has the highest rates of depression, while Nigeria and China have some of the lowest rates. Although some argue that this suggests depression is a ‘first-world problem’, most countries have similar levels of depression. Lower rates in the developing world can also be explained through a lack of infrastructure to collect data on depression.

Similarly, in some countries, cultural factors may also be at play – Japan, for instance, has low reported rates of depression but a high suicide rate, suggesting that while the condition is not widely recognised, many people in Japan do suffer serious mental health problems. Depression was only recognised as a condition in Japan in the 1990s, so there may be a history of under-reported rates of depression where people felt unable to speak openly about mental health.

Treatments

There are a range of treatments for depression, such as the use of antidepressants or talking therapies. The most common antidepressants are SSRIs (Selective Serotonin Reuptake Inhibitors) which work to increase the overall levels of serotonin, a chemical in the brain that regulates emotions. The efficacy of antidepressants has been disputed, and it is true that they do not work for everyone. Nonetheless, a recent study has proven that they are more effective than placebos, although their impact can still be quite modest. Some patients also experience unpleasant side effects when taking anti-depressants, such as feeling agitated or nauseous.

If you feel you might be suffering from depression, it is important to recognise that taking antidepressants could be a means of alleviating your symptoms. Myths around antidepressants, for example the notion that they are simply ‘happy pills’ are unhelpful and misleading – antidepressants do not work to produce excess serotonin but to ease the symptoms of depression so that sufferers can function. For those with severe depression, antidepressants can also be the ‘boost’ they need to make other forms of help, such as cognitive behavioural therapy, or exercise, more effective. Evidence suggests that a combination of antidepressant medication and talking therapies is the most impactful way to combat depression.

One of the most common talking therapies is Cognitive Behavioural Therapy (CBT) which enables patients to break down problems into smaller, more manageable steps. CBT allows patients to break the cycle of negative thinking through assessing and questioning their reaction to events. For example, many sufferers of depression engage in ‘black-and-white thinking’, or catastrophizing in reaction to stressful situations. For example, a sufferer of depression might be unsuccessful at a job interview. While most people would feel somewhat disappointed, a sufferer of depression might engage in ‘black-and-white thinking’ where they leap to conclusions about how this one setback suggests they will never get the job they want, or that they are a failure. CBT is a very practical course of therapy that aims to break down distorted thinking into stages, encouraging patients to counteract negative thoughts by writing down alternatives. This can be very useful for patients with depression, as it helps to break the cycle of negative thoughts.

The NHS has found that talking therapies are as effective as antidepressants in combating depression, although the Royal College of Psychiatrists advises that in severe cases of depression, antidepressants are necessary to fully engage with therapy. One issue with CBT is that, while it is effective, it is not widely available – a BMA investigation in 2018 found that some patients were waiting for up to two years to access talking therapies. Although access has been improved through the Improving Access to Psychological Therapies programme (IAPT) there are still wide discrepancies in provision across the UK, with young patients in Croydon with severe mental illness waiting for over six months to access treatment.

• Treatments include antidepressants and talking therapies
• A combination of both can be effective in treating severe depression
• There can be long waiting lists to access CBT

Societal attitudes to depression

Societal attitudes to depression and mental health overall have improved in recent years, but there is still work to be done. Both the Duke of Cambridge and Prince Harry have spoken out on behalf of mental illness through their Heads Together charity, and seeing leading public figures openly support mental health initiatives can help to reduce any stigma or sense of shame for sufferers of depression. There is more acknowledgement that depression is an illness and that people should be able to seek help openly.

Nonetheless, people with depression continue to face stigma and misunderstanding of their condition. If you feel you might be depressed, seek help and support from your GP as well as speaking to trusted friends and family. Attitudes are changing, and there is no shame in recognising you might be ill and trying to get better. Avoid listening to anyone who tells you to ‘just get over it’, as ultimately you are in charge of your health and must prioritise getting well again.

Anxiety disorders

What are anxiety disorders?

Anxiety disorders cover a group of specific conditions, such as Generalised Anxiety disorder, Social Anxiety disorder, Panic disorder and phobias. Individual patients experience symptoms differently, as the term ‘anxiety disorders’ covers a broad range of conditions.

While it is natural to worry at times, sufferers of anxiety find that their feelings of fear and panic disrupt their everyday lives and can be very debilitating. Anxiety is also often comorbid with depression (meaning that patients often suffer from both conditions at the same time) which can make effective treatment more complex.

Types of anxiety disorders and their symptoms

Generalised Anxiety disorder

The charity Mind defines Generalised Anxiety disorder, or GAD, as “having regular or uncontrollable worries about many different things in your everyday life.” This is a relatively broad diagnosis, and it is important to note that not all sufferers of anxiety will experience symptoms in the same way. None the less, GAD patients can suffer from some of the following symptoms:

Mental symptoms

• Uncontrollable worrying and ‘overthinking’
• Trouble concentrating
• Feelings of dread and fear
• Feeling irritable
• Racing thoughts
• Feeling as though you want to ‘escape’
• Dissociation

Physical symptoms

• Feeling dizzy or light-headed
• Feeling restless
• A sensation of ‘pins and needles’
• A ‘churning’ feeling in your stomach
• Feeling nauseous
• Sleeping problems
• Sweating or feeling unusually hot
• Breathing faster
• Thumping or irregular heartbeat

Panic attacks

Some sufferers of GAD may also experience panic attacks. During a panic attack, you may feel your heart pounding. You can also feel dizzy and lightheaded, or might experience a choking sensation and find it difficult to breathe. Some people can also feel sweaty or sick during a panic attack.

Panic attacks can be incredibly frightening, especially if you have never experienced one before. Sufferers worry that they might be dying or having a heart attack, because the physical sensations of the attack are so intense. The novelist Matt Haig, who has written evocatively about his struggles with depression and anxiety, describes his experience of a panic attack in an interview with The Times:

‘It began as a sense that something wasn’t right. Just that. Fear detached from a reason. Then I had a sensation in the back of my skull. A fluttering, as if a butterfly was trapped inside. And then a rush of thoughts, like commuters crowding onto the Tube before the doors close.”

As this account shows, panic attacks are very difficult and scary to deal with. Haig writes that “even a short panic attack doesn’t feel short when you are trapped inside it.” Sufferers of anxiety can even experience derealisation during an attack, where they feel detached from their body or surroundings, which can also be symptomatic of dissociative disorders.

• During a panic attack you may feel dizzy and lightheaded, or feel as though you are choking
• Panic attacks are very frightening to experience

What should you do if you have a panic attack?

During an attack, it can help to tell yourself that however frightening the symptoms might feel, they are caused by anxiety – you are not in any physical danger. Professor Paul Salkovskis, a clinical psychology expert at the University of Bath, recommends that sufferers try to remain active during an attack and distract themselves by focusing on their surroundings.

Breathing exercises can also help. The NHS advises you to:

• Breathe in slowly and deeply through your nose
• Breathe out slowly and gently through your mouth
• Focus on counting from 1 to 5 as you breathe in and out
• Close your eyes and focus on your breathing.

The website No Panic also has a recording of a meditation and breathing exercise to follow during a panic attack.

If you experience a panic attack:

• Remember that you are not in any physical danger – however scary it may feel, the attack is caused by your anxiety
• Focus on your breathing, or listen to the No Panic meditation to help moderate breathing
• After a panic attack, find somewhere quiet to rest, drink some water or eat something.

Treatments for GAD

There are a range of treatments you can use to help manage your symptoms of anxiety. Some patients find it helpful to use workbooks from the Reading Well scheme, many of which are available from your local library or on prescription.

There are also a variety of apps that you can use to monitor your mood. However, if self-help resources are not proving effective, you may wish to seek talking therapies through the NHS, such as cognitive behavioural therapy (explained in more depth in Chapter 1) and applied relaxation therapy, which involves breathing exercises and muscle relaxation.

There are some medications that can also alleviate symptoms of anxiety, such as:

• Antidepressants, or SSRIs (Selective Serotonin Reuptake Inhibitors). These are not always effective in treating anxiety and can make some patients feel more anxious than they did before, so it is important to keep your doctor informed of any side-effects if you are prescribed these.
• Beta-blockers, which can treat the physical symptoms of anxiety, such as a rapid heartbeat. They are not psychiatric drugs so may not address the underlying causes of anxiety, but can be helpful for patients with phobias.
• Pregabalin is an anti-seizure drug used to treat epilepsy, but can also be helpful in managing the symptoms of anxiety.
• Benzodiazepine tranquillisers, which are only suitable for patients with severe symptoms, as they are powerful sedatives and can be addictive.

Social Anxiety disorder

Social anxiety disorder, or social phobia involves feeling an intense dread of social situations. You might experience anxiety when meeting new people, speaking in front of an audience, eating or drinking in public, or when dating. Although most people might feel nervous or uncomfortable in these situations, sufferers of social anxiety may experience physical symptoms, such as sweating, feeling shaky, a thumping heartbeat or blushing. These symptoms can be very debilitating, and those with social phobia may avoid certain situations in an attempt to control their anxiety.

If you suffer from social anxiety you may find that you:

• Worry that people are looking at you or criticising you
• Feel extremely nervous about meeting new people
• Worry about eating, drinking, or undressing in public (so might avoid the beach on holiday)
• Fear that you will embarrass yourself in some way
• Find it hard to enter shops or restaurants

Social anxiety can prevent people from living life to the fullest, as they may avoid unfamiliar situations or challenges to protect themselves from feelings of fear or embarrassment. It can also intensify feelings of low self-esteem, as sufferers believe they are ‘boring’ and unlikeable.

Treatments for Social Anxiety

If you feel you are suffering from social anxiety, there are ways to improve your self-confidence so that social situations feel less overwhelming. You could try some of the following suggestions to boost your self-esteem:

• Join a local assertiveness course to build up confidence
• Try out a new hobby or skill to meet new people in a relaxed environment
• Practise relaxation techniques and meditation
• Ask your GP for help – they can refer you to a mental health specialist for treatment. You can also refer yourself directly for talking therapies on the NHS without a GP appointment
• Try out activities you might usually avoid, such as going to a party or large gathering on your own. Break down your targets into small, manageable goals: for example, you might start off with a goal of staying at a party for half an hour and talking to at least one new person
• Try to think about social situations logically and calmly. For example, if you think a social situation went badly, try to analyse whether it was really as bad as you think. Is there any evidence that someone you met disliked you? It can be easy to jump to conclusions and assume the worst

• Social anxiety can make sufferers feel very nervous about meeting new people
• If you think you are suffering from social anxiety, seek advice from your GP and practise relaxation activities to ease your symptoms

Phobias

A phobia is defined by the NHS as ‘an overwhelming and debilitating fear of an object, place, situation, feeling or animal.’ Many sufferers will arrange their lives so that they never confront the source of their fear, but in some cases even thinking about the phobia will make them feel anxious.

Phobias can be simple or complex. Simple phobias centre around a particular situation or object, such as animal phobias (such as a fear of spiders), environment phobias (for example a fear of heights), situational phobias (such as a phobia of flying), bodily phobias (such as a phobia of blood) and sexual phobias (such as a phobia of contracting an STI).

Complex phobias are more debilitating. The two most common form of complex phobia are social phobia (see our section on social anxiety above) and agoraphobia, where sufferers feel anxiety about being in a place or situation from which they cannot escape. Sufferers of agoraphobia may therefore avoid being alone, going to a crowded place or travelling on public transport.

• A phobia is an intense and debilitating form of fear
• Phobias can be simple or complex

Treatment for phobias

If you are struggling with a phobia, you should know that most phobias can be cured successfully. For simple phobias, treatment often involves gradual exposure to the object or situation provoking the anxiety, a process known as desensitisation.

Complex phobias can take longer to treat, but can involve talking therapies such as psychotherapy, counselling or a course of CBT. Medications such as beta-blockers or tranquillisers may also be prescribed to help alleviate the symptoms of anxiety.

Post-Traumatic stress disorder

PTSD is often associated with war, as it was known as ‘shell-shock’ during WWI and ‘combat stress reaction’ during the Vietnam War. WWI poets such as Wilfred Owen and Siegfried Sassoon described the symptoms of Post-Traumatic Stress disorder in stark detail in their work. None the less, it is not only veterans who suffer from PTSD. PTSD occurs when someone has experienced a frightening or traumatic event, which could include witnessing a crime or being the victim of an assault.

Those suffering from PTSD may relive their traumatic experience through flashbacks or nightmares. They may also experience feelings of guilt or isolation related to the traumatic event. Other symptoms might include:

• Distressing images and thoughts
• Insomnia
• Feeling sweaty or nauseous
• Trembling

For some people living with PTSD, their symptoms will manifest soon after the traumatic experience, while for others there can be a delay of months or even years before they have any symptoms. There are different kinds of PTSD, such as:

• Delayed onset-PTSD, when symptoms only emerge over six months after the traumatic event
• Complex PTSD, which can be the result of early childhood trauma, or trauma that lasted for a number of years
• Birth trauma, which occurs as a result of a difficult and traumatic childbirth

What treatments are available for PTSD?

Treatments for PTSD include talking therapies, such as Trauma-focused Cognitive Behavioural Therapy, a form of CBT specifically designed for sufferers of PTSD. It is recommended that patients have 8-12 sessions of 60-90 minutes with the same therapist at least once a week.

A new treatment, Eye movement desensitisation and reprocessing (EMDR) focuses on making rhythmic eye movements as the patient recalls the traumatic event. This is intended to recreate how the brain processes memories during REM (rapid eye movement) sleep.

If you find you are suffering from insomnia or depression as a result of your traumatic experience, your GP may prescribe medications such as paroxetine (an SSRI antidepressant) or mirtazapine (another form of antidepressant). Specialists can also prescribe amitriptyline (a tricyclic antidepressant) or phenelzine (an MAOI antidepressant, or monoamine oxidase inhibitor, which works to prevent serotonin and noradrenaline being broken down in the body, allowing them to stay active for longer to regulate your mood).

If you feel you may be suffering from PTSD, the first port of call should be your GP, who can advise you on further treatment through medication or talking therapies. Mind also provide a list of useful contacts for therapists and helplines for PTSD sufferers.

• There are a variety of treatments on offer for PTSD
• If you feel you may be suffering from PTSD, speak to your GP or local Mind to find out about trauma services in your area

Conclusions

The term ‘anxiety’ covers a very broad range of specific mental health conditions. If you feel you are suffering from intense feelings of panic and anxiety, whether related to a specific event you experienced or through other causes, seek help from your GP or NHS psychological therapy services (IAPT). Any form of anxiety disorder can be very difficult to cope with, but talking therapies or medications could dramatically improve your symptoms. While everyone suffers from anxious thoughts or worries from time to time, if you find your feelings of fear and panic are having a debilitating impact on your life, it is important to seek help as soon as possible. Talking through your worries with a trusted therapist can help you overcome this.

Obsessive-Compulsive Disorder

There are a range of misconceptions about Obsessive-compulsive Disorder. ‘OCD’ is often used as a shorthand term to mean that someone is scrupulously neat and tidy – people will readily describe themselves as a “bit OCD”, meaning that they simply like to colour-coordinate their wardrobes, or line up the contents of their desk. None the less, Obsessive-compulsive Disorder has nothing to do with tidiness – it is a serious, highly distressing mental health condition. OCD is also often viewed as an obsession with hygiene or hand-washing – while the condition can manifest in this way, there are a wide variety of forms OCD can take. Furthermore, not all sufferers will perform compulsions (repetitive activities to alleviate their anxiety) as part of their condition.

What is OCD?

Obsessive-compulsive disorder is an anxiety disorder where the sufferer experiences obsessions and compulsions. The obsessions take the form of unwanted intrusive thoughts or urges that are extremely distressing. These obsessions significantly disrupt a person’s ability to function in their daily life, producing intense feelings of anxiety.

The focus of obsessions can include:

• Contamination, for example fearing you will contract a terminal illness from germs or dirt.
• Losing control, for example experiencing intrusive thoughts where you fear you might harm yourself/others or blurt out insults. Sufferers may also experience intrusive violent images.
• Harm, in which the sufferer feels they will inadvertently hurt others, for example by causing a fire or accident.
• Unwanted sexual thoughts, which can relate to incest, children, or acts of sexual violence.
• Blasphemous thoughts, where sufferers experience intrusive thoughts that offend their religious beliefs.
• Fears related to symmetry and order, where sufferers might feel that something terrible will happen if things are unclean or untidy.

These obsessions are very painful to deal with, as people with OCD may feel they are a bad person or a danger to society. Their intrusive thoughts will disgust and horrify them, but they may come to believe that there is something profoundly wrong with them, making it all the more difficult to seek support. Having experienced OCD myself, where obsessions focused on a fear of losing control, I know that people living with OCD find it very difficult to ask for help. They may not even recognise that their intrusive thoughts are symptoms of an illness.

• Obsessions can take a range of forms – OCD is far more complex and distressing than an obsession with cleanliness or hygiene
• People living with OCD experience intrusive thoughts that they find upsetting and disturbing

The model and writer Lily Bailey has written about her experiences of OCD in her book, Because We Are Bad. She describes how sufferers of OCD can feel an intense sense of shame:

“As I got a bit older, I started to have frequent obsessions that I might have done something bad and that I needed to compulsively make lists of what those things might be. I had bizarre thoughts that I could cause someone to haemorrhage just by brushing against them, or kill someone just by thinking it.

“I’ve had lots of different obsessions but the primary one that has always come back to haunt me is that I am a bad person.”

Lily’s book counters the myth that OCD is simply an amusing personality quirk. Her intrusive thoughts eventually led her to attempt suicide while studying at university. In fact, adults with OCD are ten times more likely to commit suicide than the general population. Her account of how upsetting it was to live with OCD has helped to change public perceptions of the disorder. Similarly, the journalist and writer Bryony Gordon has chronicled how OCD affected her in her memoir Mad Girl. Gordon suffers from a form of OCD known as ‘Pure O’, whereby a person experiences distressing intrusive thoughts without performing compulsive behaviours (although they may perform mental rituals). She writes:

Because when people think of OCD, they think of hand-washing and cleanliness and order, no one ever talks about “Pure O”, an incredibly common […] form of the illness that makes people obsess over intrusive thoughts about blasphemy, abuse, sex, even murder. While most people have occasional weird thoughts but let them go, the person with Pure O feels such discomfort at [their] thoughts that they obsess until they become convinced they must be a potential serial killer or stalker or paedophile.

In truth, everyone experiences intrusive, shocking thoughts from time to time – imagining for a split-second that they might push a stranger towards an oncoming train, or blurt out a terrible insult to a friend or partner. For those with Pure OCD, they feel that simply by having the bizarre thought, there must be something terrible about them as a person – they are consumed by the fear that they will somehow act on their unwanted thoughts.

Compulsions

Many people living with OCD perform compulsions in an attempt to control these intrusive thoughts – repetitive actions to reduce their feelings of anxiety. These compulsions can include:

• Rituals, such as repetitive hand-washing, touching things in a particular order or arranging objects in a certain way
• Checking, for example that you did not cause an accident on the way to work, or checking your memory to ensure an intrusive thought did not really happen
• Correcting thoughts, such as repeating a name or word in your head, or attempting to replace an intrusive thought with a different image
• Reassurance, where you might repeatedly ask other people if everything is ‘alright’ to make sure you did not act on an intrusive thought

Some people with OCD will also practise avoidance, where they avoid a particular situation that might trigger their OCD. For example, someone who fears they might cause an accident would try not to drive. However, this does not help them to combat the OCD long-term and can have a significantly detrimental impact on their lives.

Sufferers of OCD are convinced that without performing these compulsions, terrible things will happen. None the less, these compulsions only strengthen and reinforce the intrusive thoughts. Treatment for OCD therefore works to break down the cycle between obsessions and compulsions.

• Sufferers will perform compulsions (repetitive actions or thoughts to reduce their anxiety over intrusive thoughts)
• The compulsions do not help and work to strengthen the intrusive thoughts
• For those with ‘Pure O’ OCD, they may experience unwanted thoughts without visible or physical compulsions, but they may perform mental rituals, such as repeating a word or phrase in their head, or counting silently

Treatments for OCD

Treatments for OCD include Cognitive Behavioural Therapy (CBT), exposure and response prevention (ERP) and medication. CBT can be highly effective in treating the disorder, as it works to challenge the links between obsessions and compulsions. Sometimes this can be presented in a form of a diagram, allowing sufferers to explore alternative explanations for their intrusive thoughts. For example, if someone has a fear of hurting their child, CBT would encourage them to challenge the intrusive thought by arguing against it. They might think their anxiety through, telling themselves ‘I have never hurt a child before,’ and analysing the intrusive thought objectively. For mild OCD, ten hours of therapy (available through the NHS) can be helpful in combating intrusive thoughts.

When I received CBT for my OCD, my therapist also used a helpful analogy to explain intrusive thoughts. She asked me to think of intrusive thoughts as being rather like unwanted guests arriving at a house. If the guests arrive and you barricade the door (by trying to suppress the thoughts), they will make a lot of noise outside, becoming as disruptive as possible. In a nutshell, attempting to control intrusive thoughts only makes them stronger, and there is plenty of research to back this up. However, accepting the intrusive thoughts minimises their power. Allowing the guests to enter the house, and then simply ignoring them can reduce feelings of anxiety over time.

Another form of treatment is exposure and response prevention. This encourages sufferers of OCD to confront their fears in a safe environment with their therapist. They will put themselves in a situation that might trigger their OCD but refuse to do any compulsive behaviours, reducing their anxiety over time. Effectively, ERP is a way of challenging the ‘logic’ of OCD – by refusing to complete the compulsions, you are lessening the power of the obsessive intrusive thoughts.

Some people may also take medication to manage their OCD. Your GP may prescribe SSRI anti-depressants, which can help ease some of the symptoms.

• The most effective treatments for OCD include CBT, ERP and medication
• If you feel you are suffering from intrusive thoughts, seek help from your GP or through the NHS Improving Access to Psychological Therapies (IAPT) page.
• The NHS also has a list of useful contacts for OCD treatment which can be found here.
• In more severe cases where your OCD is difficult to treat, your GP can refer you to a national specialist service (see the link above for more details).

Conclusions

Despite public figures speaking out about the condition, OCD continues to be very poorly understood. This is a great shame, as it is a very distressing mental illness, and can have severe consequences for sufferers’ quality of life. However, attitudes are changing slowly, thanks to some brilliant books and TV series that explore the disorder in more depth. Lily Bailey and Bryony Gordon have both written evocatively about what it is like to suffer from OCD, while the recent Channel 4 series Pure(based on the memoir by Rose Cartwright) was a brave and compelling look at ‘Pure O’ OCD.

If you feel you might be suffering from OCD, try to seek help, as CBT can be very effective in treating intrusive thoughts. Experiencing OCD can feel very isolating, but with the right support you will be able to manage your symptoms and reduce anxiety over time.

Eating Disorders

What are eating disorders?

Eating disorders are a form of serious mental illness that involve disordered eating habits. This can include limiting food intake, binge eating or purging. Some people suffering from eating disorders may also exercise to an unhealthy degree.

There are many misconceptions about eating disorders. It is often thought that someone must be extremely under or overweight to suffer from an eating disorder, which can stop people of a supposedly ‘healthy’ weight from getting help. Equally, eating disorders such as anorexia are viewed as a condition that only affects teenage girls, yet rates of anorexia and other eating problems are on the rise amongst men and boys. Eating disorders are also rarely about food – as the charity Beat points out, a person’s relationship with food is really about their emotions: “The way the person interacts with food may make them feel more able to cope, or may make them feel in control.”

Eating disorders are also relatively common. The charity Beat believes that 1.25 m people in the UK suffer from an eating disorder, and 25% of those affected are male. There has also been a 34% increase in hospital admissions related to eating disorders since

Types of eating disorder

Anorexia

Anorexia Nervosa is an extremely serious mental illness, with the highest mortality rate of any mental health condition. It has an estimated mortality rate of 5.9 per cent, caused not only by complications from starvation but also because sufferers are at a higher risk of suicide.

Anorexia is a condition where the sufferer will severely limit their food intake, and also exercise excessively to burn calories. It is not, as is sometimes assumed, a ‘fad diet gone wrong.’ The disorder is connected to low self-esteem and poor self-image, as well as an intense fear of gaining weight.

Sufferers of anorexia may:

• Think obsessively about their food and restrict their calorific intake to a very low level
• Feel as though they want to disappear
• Fixate on the idea of perfection and ‘never being good enough’
• Feel isolated, especially if they hide their symptoms from family and friends
• Feel depressed or suicidal
• Hide food or dispose of it in secret
• Avoid certain foods, especially foods that are high in fat or calories
• Have rules about which foods they can and cannot eat, such as only eating food of a certain colour
• Weigh themselves constantly
• Have distorted body image, feeling they are ‘fat’ even at a low body weight

These symptoms can have damaging consequences for their health, putting sufferers of anorexia at risk of osteoporosis, as well as amenorrhea in women and girls (where periods will stop as a result of low body weight). Sufferers can also experience feeling cold and weak for much of the time, poor concentration and lanugo (fuzzy hair that develops on the arms and face). In young people and children, the disorder may also cause them to be physically underdeveloped. It can be difficult for sufferers to seek treatment as they may not recognise that they are ill.

If you feel you or someone you know may be suffering from anorexia, seek help from your GP, who can refer you for specialist support.

• Anorexia is a very serious condition that can be life-threatening
• Starvation and excessive exercise can cause long-term health problems such as osteoporosis
• Anorexia can affect anyone, no matter their age, weight or gender

Treatments for anorexia

Talking therapies are one of the most effective treatments for anorexia. They can help sufferers to recover through encouraging healthy eating and developing coping mechanisms to address negative thoughts and feelings around food. If you are referred for specialist talking therapies, you may be helped by some of the following treatments:

• CBT-ED (Cognitive Behavioural Therapy for Eating Disorders). This helps you to address problems by breaking them down into stages, and is a recommended treatment for many forms of eating disorder. It helps you to challenge your thinking and reaction to particular situations, breaking the cycle between stress or anxiety and disordered eating. Sufferers of anorexia should receive up to 40 sessions of CBT, seeing their therapist twice a week for the first few weeks.
• Cognitive Analytic Therapy (CAT). CAT explores early experiences that might underlie unhealthy relationships with food, encouraging you to identify negative coping mechanisms. It is a collaborative form of therapy where patients take an active role in the recovery process.
• Interpersonal Therapy (IPT). This form of therapy explores your relationships with others and their effect on your mental health, encouraging you to develop healthy coping mechanisms.
• Focal Psychodynamic Therapy (FPT). FPT explores past events that might have led to poor mental health, such as unresolved conflict or trauma. It helps you to find better coping mechanisms to dealing with negative emotions.
• Family intervention. Family therapy is often offered to children and adolescents with anorexia. The family work through issues with a therapist, helping relatives to understand the illness and support their child or sibling more.

Anorexia is treatable, and if you fear you might be suffering from this disorder, book an appointment with your GP for guidance. You could also try one of the confidential Beat helplines for further guidance, or speak to other people experiencing eating disorders on their online forums.

• There are a variety of different talking therapies that are effective in treating anorexia
• With severe symptoms, some sufferers of anorexia may be admitted to an in-patient clinic
• Talking therapies may be combined with supervised weight gain or a healthy meal plan to address the physical effects of the illness, such as malnutrition and low body weight
• With the right help and support, you canget better and go on to live a full and active life

Bulimia

Sufferers of bulimia are trapped in a cycle of bingeing (where they consume too much food) and purging (through vomiting, taking laxatives, fasting or exercising excessively). These cycles of bingeing and purging can be highly disruptive to the sufferer’s life, and can cause physical problems, such as tooth decay as a result of vomiting, or heart problems caused by laxative misuse. Those with bulimia often maintain a healthy body weight, so it can be very difficult to diagnose, especially as sufferers may feel ashamed of the disorder and unwilling to seek help.

Those with bulimia may experience some of the following symptoms:

• Feelings of shame and guilt
• Feeling out of control or isolated
• Using bingeing or purging to numb your feelings
• Bingeing a lot of food in one go, then purging through fasting, vomiting or laxative misuse
• You might remain at the same weight, or you might experience fluctuating weight
• Having a sore throat or enamel erosion from vomiting
• Irregular or stopped periods (amenorrhea)
• Feeling bloated or constipated

Someone with bulimia may not experience all of these symptoms, yet they could still be suffering from an eating disorder. If your symptoms do not match the diagnostic criteria for bulimia, you could be suffering from OSFED (Other Specified Feeding or Eating Disorder). This is just as serious as other forms of eating disorder, and a large percentage of eating disorders fall under this diagnosis.

Treatments for bulimia

Treatments for bulimia include talking therapies, which can involve:

• CBT-BN (Cognitive Behavioural Therapy – Bulimia Nervosa), a form of CBT adapted for sufferers of bulimia. This works to address the unhealthy pattern of bingeing and purging to help you develop different coping mechanisms. You should be offered at least 20 sessions to treat bulimia.
• Evidence-based self-help, with support from your healthcare team
• Interpersonal Therapy (IPT)
• Bulimia can be difficult to diagnose, but support is out there if you are worried about your eating patterns
• The eating disorder charity Beat also runs online forums to support you.

Binge eating disorder

Binge eating disorder can affect anyone regardless of age, gender or background. Sufferers experience a loss of control where they binge eat large quantities of food, and find this very distressing. They may not remember what they have consumed during a binge. If you are suffering from binge eating disorder, you may use compulsive eating as a way to cope with difficult feelings. You might:

• Plan to overeat when you are feeling unhappy or stressed, for example by buying ‘special foods’, although some sufferers binge eat spontaneously. You may feel a sense of guilt and shame following a binge.
• Feel as though you have lost control over what you eat
• Eat until you feel nauseous or uncomfortably full
• Binge eat in private and hide your symptoms from others
• Suffer from low self-esteem
• Feel very unhappy about your body
• Gain weight and develop associated health problems, such as diabetes, irritable bowel syndrome (IBS), high blood pressure or heart disease

Treatment for BED

If you think you may be suffering from binge eating disorder, the first port of call should be an appointment with your GP. Some GPs may not fully understand binge eating disorders, so Beat provides a list of questions and answers you can use to prepare before your appointment.

NICE (the National Institute for Health and Care Excellence) advises that the best treatment for binge eating disorder is a program of guided self-help, using materials based on CBT to address the pattern of low mood and bingeing. NICE also recommends group or individual CBT focused on eating disorders to assist in your recovery.

• Binge eating disorder is a serious condition, but you can recover through accessing treatments such as guided self-help or CBT
• If you are worried about seeing your GP, use Beat’s list of questions and answers to help you prepare for your appointment

Causes of eating disorders – is it the media?

Eating disorders are thought to be caused by a range of factors, including low self-esteem, genetic predisposition, problems at school or work, or as a response to trauma or bereavement. They are a very serious form of mental illness and are not caused by a desire to be thin or through exposure to skinny models.

None the less, cultural factors can perpetuate eating disorders. Professor Anne Becker has found that Western popular culture influenced the rate of eating disorders in Fiji, a culture that traditionally prizes fatness. Although photoshopped images of surgically enhanced, ‘perfect’ bodies will not cause an eating disorder, Beat’s media guide argues that they can work to prolong illnesses for those who are already struggling:

“Being surrounded by images of hyper-perfect bodies when one’s own body image is distorted by a mental illness just reinforces the view that your body is disgusting, shameful and must be punished and controlled.”

Who gets eating disorders?

Anyone, no matter their age, gender or body type, can suffer from an eating disorder. In particular, eating disorders are on the rise amongst men and boys – the number of men admitted to hospital with an eating disorder rose by 70% from 2012-2017, with the same increase seen among women. The increase was slightly higher for older men, contradicting the myth that eating disorders primarily affect young women and girls.

The writer Samuel Pollen has recently published his debut Young Adult novel, The Year I Didn’t Eat, based on his own experiences of anorexia as a teenager. In an interview with The Times, he challenged societal stereotypes around who suffers from eating disorders:

“Our picture of eating disorders is still dominated by a powerful stereotype — of a teenage girl, usually privately educated, who is under great pressure to perform (at school, on stage) and desperately searching for a way to assert control. The truth is, eating disorders are as varied as people: they affect accountants and builders and police officers.”

Eating disorders are also on the rise, both worldwide and nationally. The number of hospital admissions for eating disorders in the UK has doubled over the last six years. 16,000 people suffering from an eating disorder were admitted to hospital in April 2018. While this increase can be partially explained through more awareness of eating disorders, it may also be caused by a lack of out-patient support, as well as increasing societal pressures on young people.

• Anyone can suffer from an eating disorder, no matter their age or gender
• Eating disorders are on the rise

Conclusions

Eating disorders are incredibly serious. If left untreated, they can have long-term health repercussions, and in some cases they can even be fatal. If you think you may be suffering from an eating disorder, speak to your GP, as well as confiding in a trusted family member or friend. Eating disorders exacerbate feelings of shames and isolation, so it can be very difficult to admit you might have a problem. None the less, seeking support is the first step on the road to recovery.

Bipolar Disorder 

What is bipolar disorder?

Bipolar disorder is a mood disorder where the sufferer experiences extreme highs and lows. During a manic or hypomanic episode, you might feel very excitable and energetic, whilst during a period of low mood you are likely to experience depression. Some people with bipolar disorder also suffer from psychotic symptoms.

Bipolar disorder is a serious and debilitating condition, and people suffering from the illness are at a greater risk of suicide. People also face stigma when they are diagnosed with bipolar disorder, as the condition is poorly understood. Mind’s page on coping with stigma can be a useful resource to share with family and friends to address any misconceptions they might have.

None the less, while coping with bipolar disorder is challenging, with treatment you can learn to manage your symptoms and lead a full and active life.

Symptoms of bipolar disorder

Manic episodes

If you are suffering from bipolar disorder, you may experience a manic episode. In severe cases, you may require hospital treatment. During a manic episode you might feel unusually happy and energetic, and may experience some of the following symptoms or behaviours:

• Feeling excitable and euphoric
• Racing thoughts
• Talking more quickly than you usually would
• Restlessness and irritability
• Feeling as though you cannot be harmed, or have special abilities
• Losing social inhibitions, or behaving in ways that are socially inappropriate or out of character
• Making impulsive plans or decisions, for example to quit your job or travel around the world
• Spending more money than you usually would
• Making risky decisions, such as abusing alcohol or drugs, or having unprotected sex
• Being rude to others

Some people experience hypomanic episodes, which are a less severe form of mania, although they can still be very difficult to cope with. Symptoms of hypomania include:

• Feeling unusually happy or euphoric
• Being easily distracted
• Feeling very confident, as though you can accomplish many goals all at once
• Losing social inhibitions
• Making risky decisions, such as spending a lot of money
• Functioning on very little sleep

Hypomania does not last as long as a manic episode, and does not involve any psychotic symptoms. None the less, people may feel ashamed and embarrassed after a hypomanic episode, or worry about commitments they made during the episode. They can also be very tired following an episode.

People with bipolar disorder also experience emotional ‘lows’ in the form of depressive episodes. During depressive episodes, people may experience:

• Feeling down, or very tearful
• Feeling unusually tired
• Finding less enjoyment in activities
• Low self-esteem
• Feelings of guilt or worthlessness
• Sleeping too much or too little
• Abusing drugs or alcohol
• Feeling suicidal

Some people with bipolar disorder also suffer from mixed episodes, or mixed states, where your mood fluctuates rapidly between the highs and lows of mania and depression. Mixed episodes can be especially distressing, as managing your emotions can feel exhausting, and you also might be more likely to act on suicidal feelings. During manic episodes, you also might experience psychosis, which can include suffering from hallucinations or delusions.

• Bipolar disorder is a mood disorder. Sufferers experience emotional highs (during manic episodes) and lows (during periods of depression)
• Some people experience mixed episodes where their mood swings rapidly between mania and depression
• Some people with bipolar disorder also experience psychosis, where they suffer from hallucinations or delusions

Types of bipolar disorder

Your doctor may diagnose you with a particular form of bipolar disorder. Depending on the severity of your symptoms, you could be diagnosed with:

• Bipolar I – you will be diagnosed with Bipolar I if you have experienced a manic episode lasting for longer than a week. Not everyone with Bipolar I has depressive episodes.
• Bipolar II – if you have had at least one episode of severe depression, as well as symptoms of hypomania, you could be diagnosed with Bipolar II.
• If your symptoms are not severe enough to meet the diagnostic criteria of Bipolar I or II, you could be diagnosed with cyclothymia. You are likely to be diagnosed with this if you have experienced hypomanic and depressive episodes over the course of several years.

Causes of bipolar disorder

Experts are unsure as to what causes bipolar disorder, but it is thought that a range of factors contribute to the illness. It can be triggered by experiencing traumatic events as a child, stressful life events, brain chemistry or genetic inheritance.

Treatment for bipolar disorder

The treatments for bipolar disorder you receive will depend on the episode you are currently experiencing. During depressive episodes, you may be offered medication to manage your symptoms and stabilise your mood.  These need to be taken long-term in order to be effective.

You might also be offered talking therapies to help you cope with depressive symptoms. Over time, your treatment should aim to help you manage the triggers of depression and mania. Your community mental health team (CMHT) or GP should also work with you to identify how a healthy diet, regular exercise and good sleep patterns can assist you in managing the disorder.

Coping with social stigma

As with many mental illnesses, sadly there is still a lot of stigma and misunderstanding surrounding bipolar disorder. The journalist Hannah Jane Parkinson has written evocatively about her experiences of bipolar disorder, including a guide on ’10 things you should never say to someone with bipolar disorder.’ She has also explored how the current zeitgeist for having a ‘conversation’ or improving ‘awareness’ around mental health is less helpful for people who suffer from illnesses with more severe, challenging or frightening symptoms. In her brilliant article, ‘It’s nothing like a broken leg’, she writes about the limitations of the public ‘Conversation’ regarding mental health:

“The Conversation tends to focus on depression and anxiety, or post-traumatic stress disorder. It is less comfortable with the mental illnesses deemed more unpalatable – people who act erratically, hallucinate, have violent episodes or interpersonal instability.”

Hannah argues that stigma can come ‘from a place of real fear’, and that education is needed to highlight the most distressing and difficult symptoms of bipolar disorder. For someone experiencing psychosis or depersonalisation, a cute hashtag isn’t going to provide the support they need. Equally, as a society we need to face up to the fact that not all mental illnesses are solved by simply talking, or ‘opening up.’ Bipolar disorder is a lifelong condition, and while people living with it can flourish and be successful, it is probably more helpful to acknowledge just how challenging and scary living with the illness can sometimes be. As Hannah writes, ‘celebrity awareness-raising selfies’ that suggest all one needs to do is ask for help can feel particularly frustrating ‘when you’ve been asking for help and not getting it.’ In many ways, the most serious mental illnesses exemplify a paradox within society, where we are all too ready to talk about mental health but less willing to devote the necessary resources and funding towards effective treatment. A focus on raising awareness can also trivialise mental illness, reducing complex problems to a series of unhelpful slogans. This issue will be explored in further depth in the chapter on societal attitudes to mental health.

• Bipolar disorder is a lifelong condition – treatment focuses on learning to manage the condition, as there is no cure
• Some mental health awareness campaigns can erase the most severe and distressing forms of mental illness, choosing to highlight mild depression and anxiety
• Mind’s page on coping with stigma can be a useful resource for challenging misconceptions about bipolar disorder

Conclusions

Bipolar disorder can be an incredibly challenging condition to live with. Effective treatment involves learning to manage your fluctuating mood states, as well as taking medication long-term. Talking therapies can also help you to understand your condition and identify early symptoms or triggers to stay well. With the right support, you can develop strategies to cope with the illness. If you feel you may be suffering from periods of depression or mania, seek advice from your GP, who can then refer you for specialist support.

Schizophrenia

Schizophrenia is a serious lifelong mental illness where sufferers experience psychosis, involving hallucinations (where people will see or hear things that don’t exist) and delusions (beliefs not based on evidence in reality). In her TED talk, Dr Elyn Saks, who suffers from schizophrenia, describes how schizophrenia, contrary to popular belief, is not a split personality disorder, saying ‘the schizophrenic mind is not split but shattered.’

It is estimated that approximately 1% of people suffer from schizophrenia. There are still many unhelpful misconceptions about the illness that prevent people from receiving proper support. For example, people with schizophrenia are portrayed as violent or dangerous by the media, yet people with mental illness are far more likely to be the victims of violence than the perpetrators, and the rates of violence among people with schizophrenia are usually as a result of drug or alcohol abuse and in line with the general population. The mental health charity Time to Change points out that people living with schizophrenia can lead fulfilling, healthy lives with the right support from family and friends.

Symptoms of schizophrenia

If you are suffering from schizophrenia, you may experience some of the following symptoms:

• Feeling less interested in things
• Feeling disconnected from your emotions, or experiencing ‘flattened’ emotions
• Hallucinations, which could include hearing voices or seeing things that aren’t there
• Delusions or paranoid thinking
• Disorganised thinking or speech
• Losing your train of thought in conversation and making loose associations between topics
• Not wanting to look after yourself, for example not eating properly or washing

Coping with schizophrenia can be very isolating. Experiencing beliefs that others do not share is frightening and can lead people to withdraw from society or to stop taking care of themselves. You might feel very worried about seeking help, or feel suspicious of authority figures. If you think you may be suffering from schizophrenia, see your GP as soon as possible – the NHS advises that ‘the earlier schizophrenia is treated, the better.’

• If you think you may be suffering from schizophrenia, and are experiencing hallucinations or delusions, seek help from your GP as soon as possible

Causes of schizophrenia

The exact causes of schizophrenia are unknown, but it is thought to be caused by a combination of factors. Genetic predisposition, brain development and the effect of neurotransmitters in the brain are all thought to contribute to the illness. Experiencing traumatic and stressful life events such as bereavement, homelessness or abuse can also trigger the development of schizophrenia. Using certain drugs such as cannabis, cocaine, LSD or amphetamines can also trigger symptoms of schizophrenia.

Self-care

If you are diagnosed with schizophrenia, there are ways you can manage the condition through self-care. Mind recommends:

• Trying to get enough sleep, as if you feel tired it can be harder to manage your symptoms
• Eating a balanced and healthy diet, and eating regularly to avoid changes in blood sugar that could trigger psychosis
• Quitting smoking, as cigarettes can interact with antipsychotic medication
• Cutting down on stress by making time to relax through gentle exercise such as walking or yoga
• Doing something you enjoy, such as baking or gardening. Some people find that creative activities can ease their symptoms and help them to express themselves
• Staying connected with others by reaching out to friends and family. Mind also offers a peer support directory and useful contacts to help you connect with other people who have experienced mental illness
• Monitoring your health – for example, noticing if you start to experience sleeping problems, feel stressed and anxious or hear quiet voices. You could also ask a trusted friend or relative to let you know if they notice a change in your behaviour
• Attending any medical appointments regularly, even if you are feeling better

You could also try to develop a crisis plan with the help of friends and family, to make sure you get the right support if you become unwell.

• Practising self-care can help you manage your condition and access the right medical support to help you

Treatment for schizophrenia

The recommended treatment for schizophrenia involves a combination of Cognitive Behavioural Therapy and antipsychotic medication. During CBT, your therapist will work with you to help you cope with some of the symptoms of psychosis, such as  delusions or hallucinations, as well as helping you to avoid stress, which can make your symptoms worse. You may also receive daily support from a community mental health team.

Your doctor may also prescribe antipsychotic medication to ease symptoms of psychosis. These can help reduce your symptoms and make them easier to manage, although they do not cure them completely. Some patients on antipsychotic medications experience side effects, so if you find you are experiencing these it is important to discuss this with your GP. Everyone’s experience of schizophrenia is different, and some patients will only need to take antipsychotics for a short while, while others may need this medication to manage their condition long term.

You may also be offered psycho-education, which helps you to understand your illness in more detail and identify any early symptoms of psychosis. NICE (The National Institute for Health and Care Excellence) also recommend family therapy for your close relatives, as this can help your family to work with you to manage your condition, as well as improving family relationships overall.

Some people with schizophrenia also find arts therapies useful, such as engaging with crafts or baking as a way of expressing themselves. You might find practising dance, drama or painting with a trained therapist can help you to reconnect with your emotions. NICE suggest that arts therapies should be offered to everyone with a diagnosis of schizophrenia.

• Treatments for schizophrenia involve a combination of CBT, medication and family therapy
• Arts therapies can help you to express your emotions
• Early diagnosis can help you to manage your symptoms with effective support

Early intervention teams

When you are diagnosed with your first episode of psychosis, your doctor should refer you to an early intervention team, a specialist NHS service made up of psychiatrists, psychologists, mental health nurses and support workers. NICE recommend that you start treatment within two weeks of referral, as getting help in the early stages of psychosis improves your chances of getting better.

Advice for friends and family

If a friend or relative is suffering from schizophrenia, it can be difficult to know how to help. One of the best ways you can support your loved one is through offering practical help, such as assisting with shopping or household chores. You might also remind them to take their medication, or draw up a schedule together to help them remember to do this.

Mind suggests you should avoid arguing with your loved one about their delusions, or pointing out they are false, as they will feel very real to the person experiencing them. It is more helpful to focus on how they are feeling.

Educating yourself as much as possible about schizophrenia is also very important, as research suggests people with a strong family support structure can manage their symptoms more effectively. Being more knowledgeable about the condition can also help your friend or relative to avoid relapse, as you are best placed to spot early symptoms of psychosis and help them to access support. NICE also provide a list of questions for families to ask their GP.

You could also work with your friend to develop a crisis plan in case their health deteriorates.

• Try to offer practical support
• Focus on your loved one’s feelings
• Educate yourself as much as possible about schizophrenia and its symptoms
• Develop a crisis plan with your loved one to help support them if their health gets worse

Conclusions

Although schizophrenia is a serious and long-term illness, the condition can be managed effectively over time. With a combination of talking therapies and medication, as well as support from friends and family, you can lead a fulfilling and active life. If you think you may be suffering from psychosis, the most important thing is to seek help from your GP as early as possible, as you will need specialist support to manage your symptoms. Experiencing delusions or hallucinations can also be very distressing, so use Mind’s list of useful contacts to reach out to other people who have experience of living with schizophrenia.

Keeping healthy – 10 top tips

For many serious mental health conditions, people will need long-term treatment and medication in order to manage their illness. None the less, we all have mental health, and there are ways we can look after our minds in order to stay healthy over time. Good mental health does not mean that you feel constantly happy – we all experience periods of sadness and distress, and sometimes these emotions are healthy reactions to the stresses and strains of life, or to bereavement and trauma. What good mental health doesmean is that you will feel able to cope with life’s ups and downs and maintain a sense of well-being. Below are some top tips for looking after your mental health, inspired by guidance from the Mental Health Foundation and Mind.

1. Express your feelings – connect with others

Human beings are social animals, and isolation can be a trigger for episodes of mental illness. We live in a world where we feel increasingly ‘connected’ by the internet and social media, yet these are poor substitutes for human interaction. The Mental Health Foundation advises that opening up to a friend or relative about your feelings can improve your wellbeing. If you’re feeling worried or anxious about something, sharing the problem with a friend can help you put the issue in perspective.

Mind has also published advice for improving wellbeing from the New Economics Foundation, which encourages you to connect with others to maintain good mental health. This might involve speaking to someone new, sharing your commute with a colleague, or catching up with an old friend.

• Connecting with others can boost your mood
• If you’re feeling anxious or worried about something, sharing the problem with a friend can help

2. Exercise

As the Romans had it, ‘mens sana in corpore sano’, or, if, like me, you never got very far with Latin, a healthy mind in a healthy body. There is a wealth of evidence to support how  exercise can improve mental well-being. Regular exercise is linked to lower rates of anxiety and depression across all age groups. Exercise boosts endorphins, a natural feel-good chemical in the brain, and can improve your self-esteem.

The writer Bella Mackie explores how running helped her to cope with anxiety in her book Jog On: How Running Saved My Life. Even gentle forms of exercise, such as taking a walk in the park at lunchtime, can improve your wellbeing. A study in The Lancet Psychiatry found that people who walked regularly reported around ten per cent fewer ‘bad mental health days.’ You could also join an exercise class or organise an informal football team at work, helping you to connect with others.

• Exercise has been proven to reduce anxiety and depression
• Even gentle exercise can improve your mental wellbeing

3. Eat a healthy diet

Eating a healthy, balanced diet can also boost your mood. Mind suggests eating slow-release energy foods, such as wholegrain bread, nuts and seeds to maintain blood sugar and avoid tiredness and irritability. Following a Mediterranean-style diet rich in oily fish, vegetables and grains has also been shown to reduce the risk of depression.

If you are feeling anxious or depressed, Mind suggests you cut down on caffeine and alcohol. Too much caffeine from coffee, tea or energy drinks can increase feelings of anxiety, as well as disturbing your sleep patterns. Drinking too much alcohol also affects your mood, as alcohol is a depressant and can exacerbate underlying mental health conditions. The Royal College of Psychiatrists has a useful guide with more details about eating well to safeguard your mental health or manage existing mental illnesses.

• Eat a diet rich in complex carbohydrates and oily fish to maintain good mental health
• Avoid consuming excessive amounts of caffeine or alcohol

4. Learn something new

Learning something new can improve your self-esteem, and anecdotal evidence suggests this can be especially helpful for older people suffering from depression. Learning a new skill can give you more confidence – setting yourself achievable goals gives you a sense of purpose and direction. You might try taking a formal course in a foreign language, but you can also seek learning outside of formal classroom environments. For example, you could try cooking a new recipe, going to an art gallery or tackling a difficult crossword or jigsaw puzzle. Keeping mentally active can work wonders for your mental health.

• Learning a new skill is a fantastic way to keep mentally active and stay healthy

5. Participate in your local community

As the Mental Health Foundation says, ‘doing good does you good.’ Helping others can improve your mental wellbeing, whether this means volunteering at your local charity shop, mentoring a young person in your community, holding a fundraiser for a good cause, or a simple act of kindness such as getting the shopping for an elderly neighbour. Being kind to others can reduce feelings of stress and isolation, and helps to put your own problems in perspective.

• Being kind to others helps you connect with your community and can boost your self-esteem

6. Practise mindfulness

Mindfulness is a practice that  helps you to become more present in your surroundings. It can reduce feelings of anxiety and depression, and improve your coping skills when facing difficult situations. Essentially, mindfulness involves paying closer attention to the world around you, and reconnecting with your body through appreciating your physical, sensory experiences. Professor Mark Williams, the former director of the Oxford Mindfulness Centre, says that mindfulness is “about allowing ourselves to see the present moment clearly. When we do that, it can positively change the way we see ourselves and our lives.” The website Be Mindful has further details about how to start practising mindfulness.

• Mindfulness encourages you to focus on the present moment and take notice of your surroundings, improving your wellbeing

7. Do something you love

Whether it be watching an old and much-loved film, going for a long walk or baking a cake, doing something you love can be very therapeutic. Crafting has been shown to be particularly good for mental wellbeing – Oxford University have helped to set up the Yarnfulness Project to try and find out why. You could even run a Crafternoon with friends to fundraise for Mind.

• Setting aside time to do something you love can boost your mood

8. Relax!

If you are feeling overwhelmed by work or relationship stresses, your mental wellbeing is likely to suffer. Try to do something relaxing to calm your mood, such as listening to a favourite album, drawing a bath or using a mindfulness colouring book. Even taking a short break to read a magazine can give you a moment to decompress during a tense situation. You could also check out Mind’s animation with suggested relaxation techniques.

• If you’re feeling overwhelmed, take a moment to relax. Giving yourself short breaks is important for good mental health

9. Avoid comparing yourself to others

It’s all too easy to compare yourself with other people, especially in an age of constant social media use. However, this habit is really unhealthy and can contribute to poor self-esteem. Comparing your own weaknesses to others’ apparent success is likely to make you feel demotivated and unhappy. Try to accept yourself for who you are, acknowledging your strengths in a positive way.

• We are all different – avoid comparing yourself with other people

10. Sleep!

Practising good sleep hygiene is really important for maintaining good mental health. Sleep deprivation has been linked to anxiety and depression, so getting into a good sleeping pattern is very important for our wellbeing. The Mental Health Foundation has a useful in-depth guide to maintaining good sleep hygiene. They advise avoiding excess caffeine, nicotine and alcohol before bed, as well as preparing a quiet place to sleep (for example by using earplugs). Using screen devices shortly before sleep can also make you more wakeful, so try to leave your mobile or tablet outside the bedroom.

• Sleep ‘ravels up the sleeve of care’ and helps us to cope with daily life. Going without sleep has detrimental effects on your physical and mental health.

Societal Attitudes to Mental Health

In the UK, societal attitudes to mental health have improved over time, and there is thankfully less stigma towards mental illness than there used to be. The mental health campaign Time to Change, for example, estimates that 4.1 million people have improved their attitudes towards mental illness since 2007. High-profile initiatives to prevent stigma, such as the Royal Family’s support for the Heads Together campaign, have no doubt helped people understand that there is nothing shameful about mental illness.

None the less, many campaigners challenge the efficacy of simply raising ‘awareness’  when funding is at an all-time low. Whilst anyone suffering from mental illness should always feel able to seek help, the reality is that once they do, they often face a long wait before receiving  treatment. At the start of this Mental Health Awareness Week, Prime Minister Theresa May tweeted an image of Downing Street lit up in green, to highlight how ‘looking after our mental health is as natural and positive as looking after our physical health.’ Yet, as many writers with personal experience of mental health issues have noted, raising awareness is of very limited help without adequate funding for support services. As a mental health worker said to me earlier this year, without money for targeted support, ‘it’s like raising awareness of cancer when there are no scanners.’

• Attitudes have thankfully changed for the better towards mental illness, but a lack of funding is preventing people from accessing the timely support they need

Where is the funding for services?

Despite renewed commitments from government to fund mental health provision, as a 2018 BMA report points out, ‘there appears to be no obvious uplift in spending in recent years.’ This includes a low level of perinatal mental health care (mental health of parents before or during the first year after the birth of a child), with less than 15% of CCGs (clinical commissioning groups) providing the recommended level of services.

Equally, given that mental health problems are on the rise among young people, it is shocking to note that research by Young Minds found that less than 1% of the total NHS budget is spent on CAMHS (child and adolescent mental health services), while only 8.7% of the mental health budget is spent on under-18s. While the government committed to a ‘parity of esteem’ between mental and physical health back in 2012, there are still wide geographic disparities in the types of support available. The BBC has reported that while budgets are increasing, funding levels vary throughout the country, with South Yorkshire and Bassetlaw spending £220 per person on mental health each year, while Gloucestershire spent only £137. GPs have also expressed concern over long waiting times for young people with mental illness in some areas of the country.

Furthermore, the introduction of benefit changes, such as the rollout of universal credit, are exacerbating mental health needs. In March, The Guardian reported that 9 out of 10 mental health trust bosses in England believed benefit changes had increased the level of need, while 63% of bosses felt the changes had had a ‘high impact’ on levels of anxiety and depression.

In January, the government made a further commitment to parity between mental and physical health, when the NHS Long Term Plan committed to an increase of £2.3 billion in funding for mental health. Despite this, staffing shortages, especially amongst mental health nurses, could make the plan unworkable in the future. Furthermore, the level of provision isn’t changing quickly enough. Research by Anne Longfield, the Children’s Commissioner, found that a third of health trusts had cut funding for children’s mental health, with just £226 million allocated for low-level services in 2018-2019, just over £14 per child. In the East of England, local authorities spent just £5.32 per child, with 60 per cent of areas seeing their funding for children’s mental health cut in real terms.

Given these statistics, the government’s public commitment to prioritise mental health funding seems like empty words. The austerity measures implemented by May’s government have had the worst impact on the most vulnerable members of society, putting them at greater risk of anxiety and depression.

• The government has committed to parity of services between mental and physical health
• Despite this, a lack of funds and staffing shortages mean many people with mental illness struggle to access treatment

Issues around awareness

A further issue around the idea of ‘awareness’ has been raised by writers with experience of the most severe forms of mental illness. The journalist Hannah Jane Parkinson has written a moving account of her experiences of bipolar disorder, It’s nothing like a broken leg in which she criticises the public ‘Conversation’ around mental illness, which reduces serious problems to a set of glib celebrity hashtags. As she points out, people with severe mental illness often face long waiting lists before receiving treatment, however much understanding or ‘awareness’ there might be.

But another issue is that awareness risks normalising mental illness, as though it is simply the common cold of the mind, or, worst case scenario, a broken leg. If, as a society, we start to feel that everyone might be ‘a bit depressed’, it trivialises mental illness as a whole, and makes it even harder for people with the most challenging symptoms to get help. This is borne out by a National Social Attitudes survey of 2016, which found that 71% of people would be willing to move next door to someone with depression, compared to 45% who said the same about someone with schizophrenia. When we talk about mental health, we often highlight conditions with the least distressing symptoms – mild depression or anxiety, for example. This is not to say those illnesses are not upsetting or difficult for the people who suffer from them, but it is true that we rarely talk about experiencing depersonalisation, or delusions, or hallucination. A conversation about mental health that diminishes and erases the most severe forms of mental illness isn’t one that’s really worth having.

Mental health awareness campaigns can also give rise to tropes that are simply not true in the case of severe mental illness. Sathnam Sanghera writes that while it is often claimed that ‘people with mental illness can and do recover’, this is not true in the case of schizophrenia. The relentlessly positive nature of awareness campaigns, and their underlying suggestion that recovery is possible in all cases, can be very unhelpful for people suffering from chronic conditions.

As a society, we also tend to talk about mental illness in the past tense. Saying you have suffered from depression in the past is, socially speaking, pretty much risk-free. This represents a positive step forward in terms of how we view mental illness as a society, yet it also implies how we tend to think of mental illness as a passing phase in someone’s life, something they look back on from the vantage point of ‘recovery’. If we only accept the easily cured forms of mental illness, where people can talk of having battled depression and won, we risk leaving the most vulnerable without proper help and support.

Ultimately, we still have a lot of work to do as a society to properly support people living with mental illness. More funding is needed for effective mental health services, especially for young people. Equally, we need to change the public conversation around mental health to avoid trivialising mental illness. Awareness of how we can improve our mental health is a good thing, but we need to avoid seeing ‘mental illness’ as a catch-all term, and acknowledge how severe and debilitating some conditions can be.

• The public ‘conversation’ around mental health has been positive in some ways, as it has raised awareness about the importance of looking after our mental health
• More openness about mental illness is a good thing, but some writers have raised concerns that the focus on ‘awareness’ can trivialise the most severe forms of mental illness
• Not all forms of mental illness can be cured. There needs to be more understanding of chronic conditions such as bipolar depression or schizophrenia, and the particular challenges individuals with these conditions face

Role models – celebrities who have spoken out about mental illness

One of the worst aspects of suffering from a mental illness is feelings of isolation, guilt and shame. It can be inspiring to hear from role models and public figures about their own struggles with mental illness, as it helps to show that anyone, no matter how outwardly successful they might be, can suffer from a mental disorder. In this section, we look at some brave people in the public eye who have chosen to speak out about their experiences of mental illness.

Nadiya Hussain

Nadiya Hussain won the nation’s heart with her incredible culinary creations on The Great British Bake-Off. This week, she appears on the BBC programme Nadiya: Anxiety and Me, exploring her history of anxiety and severe panic attacks. Her struggles stem from difficult childhood experiences – the programme explores the racist bullying she was subjected to at primary school, as well as her brother and sisters’ life-threatening illnesses as children. Nadiya’s condition had never been formally diagnosed until making the documentary – on camera, she attends her first ever CBT (Cognitive Behavioural Therapy) session for the first time. Nadiya has been praised for her bravery in confronting her anxiety head-on in the film – the fact that such an inspiring person has also suffered from mental illness will be heartening for anyone struggling with their anxiety.

Alastair Campbell

Alastair Campbell has also spoken out about his struggles with depression. The former Labour spin doctor has been open about his experiences of low mood and how this has impacted his partner and family. He has appeared in the recent BBC programmeAlastair Campbell: Depression and Me exploring new treatments for depression, as he has battled his condition with a combination of anti-depressants and therapy, but wonders if further medical research could provide sufferers of depression with more effective ways to cope.

David Harewood

The actor David Harewood has taken part in a powerful new BBC documentary exploring his experiences of psychosis. He looks back at an early period of his life, when he experienced hallucinations and delusions as a young man, analysing possible triggers for his condition, such as the stresses of trying to make it as an actor, as well as experiencing racial stereotyping as a young black man. The film, David Harewood: Psychosis and Me, is a powerful portrait of severe mental illness. The programme also explores how attitudes to people suffering from psychosis have changed – Harewood was physically restrained by six police officers when he was admitted to hospital. He meets young people with psychosis who now have access to more support to help them manage their illness.

Demi Lovato

Singer Demi Lovato has spoken out about her struggles with an eating disorder, bipolar depression and addiction. She says that society still needs to take mental illness more seriously, saying “I think it’s important that people no longer look at mental illness as something taboo to talk about. It’s something that’s extremely common, one in five adults has a mental illness, so basically everyone is essentially connected to this problem and this epidemic.”

Prince Harry

Both Prince Harry and Prince William have been active in campaigning for better mental health support, and Harry has spoken about the panic attacks he experienced after the death of his mother. He eventually sought counselling twenty years later, and spoke to Bryony Gordon on her podcast, Mad World, about the importance of seeking help when struggling with grief and anxiety.

Adele

Adele has spoken out about her experience with post-partum depression after the birth of her son, and she also shared her friend Laura Dockrill’s experience of post-partum psychosis to raise awareness among new mothers. On her Instagram page, Adele said, “Mamas, talk about how you’re feeling, because in some cases it could save yours or someone else’s life.” Discussing post-natal depression or traumatic childbirth experiences can still be quite taboo, so Adele’s bravery in openly sharing how she felt while she was unwell could help new parents identify the signs and symptoms of post-natal depression.

Hearing these testimonials from celebrities can help those who are struggling to realise they are not alone. It is really common for people with a mental illness to feel isolated, but the recent BBC programmes on mental health are really useful in educating the public about the symptoms of severe mental illness. While better funding is also needed, awareness is vital in helping to change societal attitudes over time.

Reading List and Further Contacts

If you are struggling with your mental health, you can feel very isolated, finding it difficult to talk about your experience. Reading about other people who have battled different forms of mental illness can be very inspiring – it helps you to realise you are not alone, and can give you a fresh perspective on how to look after your mental health. Equally, you might be worried about a friend or relative and want to educate yourself about their experience. The following is a selection of some of the best memoirs and novels about mental health, as well as a list of useful links to mental health organisations for more information and support.

1. Mad Girl, by Bryony Gordon

In Mad Girl, the writer Bryony Gordon chronicles her struggles with clinical depression and OCD in her twenties. On the surface, Gordon was a phenomenally successful young woman, travelling the world as a journalist and attending glamourous celebrity parties. In reality, she had been suffering from mental illness since childhood. At age 12, she struggled with an OCD, becoming convinced she might die of Aids, and her low self-esteem and chronic depression led her to struggle with bulimia and drug addiction as a young adult.

None the less, Gordon describes her experiences with a light touch, nicknaming her OCD ‘Jareth the Goblin’ after David Bowie’s malevolent character in Labyrinth. Gordon’s book is a warm and moving testament to how anyone can be suffering in silence, no matter how successful they might be.

2.  Jog On: How Running Saved My Life, by Bella Mackie 

In her late twenties, Bella Mackie is devastated by the sudden end of her marriage, grappling with the anxiety she has suffered from throughout her life. She has never tried running before, but one day she pulls on some old leggings and jogs for 30 seconds in a dark alleyway near her flat. She manages a few minutes of running, and doesn’t feel better, but she notices she hasn’t cried for 15 minutes, ‘and that was good enough for me.’

Mackie returns the next day, and the day after that. She finds that running is a powerful antidote to her anxieties and fears – as she says, ‘My mind, accustomed to frightening me with endless “what if” thoughts, or happy to torment me with repeated flashbacks to my worst experiences, simply could not compete with the need to concentrate while moving fast.’ Throughout Jog On, Mackie explores her own experience of getting better, drawing on research and inspirational stories to show how exercise can support mental health.

3. The Boy With The Topknot, by Sathnam Sanghera

In his mid-twenties, Sathnam Sanghera is a successful journalist, enjoying the trappings of life in London. Yet on returning to his family home in Wolverhampton, he is shocked to discover a powerful secret that has been kept from him – both his father and sister suffer from schizophrenia. A moving and often very funny account of growing up in a Sikh family in the 1980s, Sanghera’s memoir details how he comes to terms with his family’s  history of mental illness. He also unpicks the nuances of the immigrant experience in Britain, from arriving on his first day at school unable to speak English to matriculating at Cambridge.

The book has since been adapted into a film starring Sacha Dhawan for the BBC. A powerful portrait of how mental illness can affect family relationships, but also strengthen them, The Boy With The Topknotis also a poignant tribute to Sanghera’s mother Surjit and her love for her family.

4. Because We Are Bad, by Lily Bailey

The model and writer Lily Bailey has suffered from OCD since childhood, and her condition eventually led her to attempt suicide at university. Throughout her early life, Bailey is plagued by doubts that she is responsible for terrible things, including the death of her cousin. The ‘we’ of the title relates to the internal voice of her OCD, which convinces her she must make mental lists of her wickedness to prevent harm coming to her loved ones. Working with a therapist, she learns to overcome the worst aspects of her illness. The book is a powerful exploration of a mental illness that is often poorly understood, and reveals just how severe and distressing OCD can be.

5. Queenie, by Candice Carty-Williams

25-year-old Queenie is having a difficult year. A bright and thoughtful young woman, the break-up of a relationship leads her into a series of traumatic and sometimes abusive sexual encounters, while the casual racism she encounters as a black woman leaves her emotionally tired. This is partly a brilliant exploration of millennial womanhood, and the ways in which dating culture can both fetishize and disempower young women, yet it also portrays Queenie’s struggles with anxiety, and the stigma she faces from her Afro-Caribbean family when she seeks help.

6. Reasons To Stay Alive, by Matt Haig

In Matt Haig’s compelling memoir, he explores his struggles with major depression during his twenties. Living with a girlfriend in Ibiza, 24-year-old Haig is overwhelmed by a sense of panic that feels like ‘an intense flickering’ in his head. Haig’s accessible and forthright style gives readers a remarkable insight into living with depression, and while this is ostensibly a self-help book, it is also a highly personal account of Haig’s experience of mental illness.

The book is peppered with facts about depression, as well as tips on how to cope with low mood. Haig partly structures the book as a conversation with his former twenty-something self, exemplifying how recovery is possible.

7. The Year I Didn’t Eat by Samuel Pollen

Based on his own teenage experiences of anorexia, Samuel Pollen’s young adult novel is an original and much-needed look at the effects of eating disorders on boys and young men. 14-year-old Max feels isolated, but the one person he can speak to is Ana, his eating disorder, who he writes to every day. When Max is given a geocache by his brother Robin, he receives a mysterious note from ‘E’, the new girl at his school. A family crisis draws Max further and further into his illness, yet the book ends on a positive note. This would be a brilliant recommended read for young people, as it challenges common stereotypes around eating disorders, reflecting how anyone, regardless of age or gender, can struggle with anorexia.

8. The Noonday Demon, by Andrew Solomon

The Noonday Demon is a scholarly yet readable exploration of depression, drawing on science, philosophy and literature to understand the nature of depressive illness. Both a memoir of Solomon’s own struggles with depression and a fascinating study of how different societies throughout history have viewed ‘melancholy’, this is a highly informative and thought-provoking read.

Suggested links

If you are worried about your mental health, you could also get in touch with mental health charities and organisations for further support and guidance using the links below:

• Mind offers a range of resources to help you understand mental illness, as well as guides to support and services and useful contacts
• The Mental Health Foundation
• Samaritans are available for anyone who needs to talk – call free on 116 123 or email jo@samaritans.org.uk
• Rethink Mental Illness including crisis contacts
• Find mental health services in your area though Hub of Hope
• Sane (includes a helpline on 0300 304 7000)
• Time to Change has a list of helpful contacts
• In a crisis, call 999 or go to your nearest A & E department