Kat Dyke -Relationship dynamics and depression

 

The 16-22th May 2016 has not been like any other week. It has been Mental Health Awareness Week; a much needed occasion designed to raise awareness and tackle the stigma still attached to mental health. This is something I’ve always been passionate about, but in all honesty I am not always as open about my own struggles as I could be. The thing is that as much as I encourage others to share their experiences, I still have apprehensions about discussing things so openly, and I’m not alone.

We live in a time where an estimated one in five of us will experience depression at some point in our lives, but despite this we are still not particularly good at talking about it. Understandably, talking about mental health with a friend or family member who is unwell can be difficult and it can be hard to know what to say, but this doesn’t mean that silence is the answer.

The focus of this week’s campaign is relationships; the wonderful connections that we all make (and all too often take for granted) which are so important in maintaining good health and well-being.  Relationships are fluid and during times of illness these dynamics can change. I’m hoping that by sharing a few of my own experiences I can shed some light onto how depression can impact relationships, and how they can also be key to recovery.

My personal experiences have taught me two key things. Firstly, that even good strong relationships can be strained by issues like depression. Caring for someone who is ill can be difficult at the best of times, and when this illness has invisible causes it can be particularly challenging. Secondly, and most importantly, good relationships are invaluable to recovery and to maintaining good mental health.

I’ll start with the first more gloomy point. One of the things I discovered during the depths of a depressive episode was that I was unable to fully appreciate the kindness of my friends and family. During that period my thinking and self-esteem were disorganized and negative and as a result there were many instances when I felt that I deserved to be isolated and alone. I’ve come to think that this is one of the most cunning tricks of depression and also one of the reasons that small acts of kindness are so important in supporting someone who is unwell. Although at times I felt undeserving, I also felt various other emotions (albeit slightly muted). During this time things like receiving post, borrowing lecture notes or being cooked for were invaluable. These small things gave me the chance to feel valued and normal, and although these feelings didn’t always last long, they provided glimmers of light in what was otherwise a dark place.

Another cruel trick of depression was to make me exhausted and apathetic, which meant that the things I would usually do to repay kind favours went out the window. This put a strain on my close relationships as things became very one-sided, and eventually led to unhelpful but understandable comments from those around me. In a moment of exacerbation someone incredibly close to me once said ‘I just don’t understand why you can’t be happy’. This was heart breaking as I really didn’t know. I knew the answers to many questions, but that one was, and remains out of my grasp. Although everyone’s experiences of depression will be different, it’s important to remember that no one chooses this and given the option we would all surely chose health and happiness.

Fortunately, in spite of all the challenges my wonderful friends and family stuck around to help me crawl slowly back to health and happiness and as my thinking became clearer I was increasingly grateful to those around me. I also came to realise that sometimes we need to refocus and really appreciate what we have. It’s clichéd, but when it comes down to it the most valuable thing you will ever have is the love and support of others. Be kind to yourself, give yourself time and above all value those close to you. And if you ever notice a friend who seems down, don’t be afraid to ask ‘are you ok?’ and then to listen patiently for an honest answer.

Kat Dyke (@kat_s_dyke) is a PhD student within the School of Psychology. (lpxksd@nottingham.ac.uk)

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If you need someone to talk to Samaritans are available round-the-clock (and free to contact) on 116 123 (UK & ROI)

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Mental Health Awareness Week

 

This week is Mental Health Awareness Week.  Find out more here:

#KEIAwards2016 – Knowledge Exchange and Impact Awards 2016

Recently this wonderful blog was nominated for a Knowledge Exchange and Impact Award 2016, in the media category. Sadly we didn’t win, but we did have the opportunity to attend the awards night, and what a fantastic night it was.

The awards celebrate some of the University’s biggest achievements across all departments and campuses, including China and Malaysia. This makes it a really inspiration place to be and we felt very honoured to be able to be part of it. Of course this would not be possible without our readers and contributors, and for that we are hugely grateful to you all. We really do value all the contributions we receive and are proud of what we post.

Thank you to all those who have joined the conversation so far. Here’s to even more conversations to come…

Kat and Emma
(IMH Blog Editors)

Stephanie Sampson – Improving Lives in Nottingham: Practical and research challenges faced by essential third sector services

‘Improving Lives’ (IL) (formerly Integritas) is a small, independent charity that delivers both one to one case support and advocacy services to adults with complex health and social needs within the city of Nottingham. The service was formed as a community interest company in November 2006 and became a registered charity in February 2012.  IL is led by a Board of Trustees, which is made up of a mixture of mental health service users and professionals. Working for the charity are five support-workers (including two social workers), highly committed to providing person-centred, compassionate support.

Their message and aim is clear: to provide free one-to-one support for some of the most vulnerable adults across the city of Nottingham and work towards current policy aims to reduce health inequality. All of the people whom Improving Lives work with have mental health issues or learning difficulties, often undiagnosed, and come to attention either due to repeated calls to emergency services or through instances of anti-social behaviour.

Fundamentally, Improving Lives promotes individualised, wide-ranging case support and services for people, in order to promote a more effective way to empower individuals and the problems they face in society. In recognition of the complex and fluctuating nature of mental health issues and complex needs, the charity has a broad focus and is striving to promote this model of pragmatic support in the community in order to bridge the gap (and catch those who fall in) between ‘single-issue’ service provision and individualised services.

I volunteer for Improving Lives one afternoon a week, as a befriender to an individual (let’s call him ‘Keith’) living in Nottingham who has a recent diagnosis of autism, complex social and personal needs, no family and no one to help with day-to-day activities that he sometimes finds challenging. We usually grab a cup of tea and talk about 1950’s rockabilly music – a valued weekly step away from PhD writing to see how Keith is (and what’s going on in the outside world generally). However, for the people working all day every day to keep the charity afloat, raise awareness, as well as provide support services, things are tough, and largely unpredictable. The service is small and relatively low profile (although some publicity has been achieved with a recent spot on BBC East Midlands today and in the Nottingham Post ), with insecure funding. Improving Lives is not big enough to dedicate resources to fundraising, and in the past some charitable funders have refused support since the work undertaken and services offered are considered to be in need of delivery or funding by statutory services. The majority of costs for the last two years have come from a combination of NHS and Nottinghamshire Police Commissioner resources. It’s not yet certain where, or if, further funding will come from to take the charity into 2017. There’s a lot of work to do, and potential for collaboration across sectors.

In keeping good to their word being tenacious and determined, independent and person-centred, Improving Lives undertook their own research with their clients to get their take on the value and impact the service has on their lives. They have run focus groups within their offices, as well as undertaken telephone surveys to assess client satisfaction with services, and their general wellbeing. The outcomes of this qualitative research largely reinforces Improving Lives as an integral source of advocacy, advice, and support with anything from paperwork, debt management, benefits, teaching new skills (e.g. IT) and befriending to help combat isolation. However clients feel that more can be done to improve socialising opportunities, and to improve staff knowledge of different physical and mental health conditions. These perceived gaps in the service are not met with surprise. This organisation has limited resources and strives to provide individualised, one-to-one support for people from potentially any background. Therefore it is an on-going challenge to meet both individual and broadly collective needs.

This research is important, and helps third sector services find out ‘what works’ for them and the community. However the dissemination of findings to academic audiences is challenging, particularly where fundamental ethical codes of informed consent, safely and securely handling data, and protecting participants from harm have undoubtedly been adhered to, but a formal application to a research ethics committee (REC) has not been made, either because of lack of resources to write applications or due to time constraints. The fact that included participants would have a current or background of mental illness or learning disability would be flagged in a research ethics committee application, as a vulnerable population group requiring additional protection and safeguards to research practices and potential power conflicts (which can take this blog post into an entirely different discussion, but for those interested see Bracken-Roche et al., 2016).

Academic research has been known to be retracted from publication due to lack of ethical approval, and the BMJ, for example, states that research submissions will not be considered for publication unless a statement is made that ‘the study obtained ethics approval (or a statement that it was not required), including the name of the ethics committee(s) or institutional review board(s), the number/ID of the approval(s), and a statement that participants gave informed consent before taking part’. There is an expectation to obtain ethical approval when undertaking any type of research with human participants, even if it’s not considered overly intrusive, and this principle rests on those laid out by the lynchpin of ethical guidelines, the Declaration of Helsinki, the principles of which are implemented into domestic legislation and policy (for us, the upcoming EU Clinical Trials Regulation ), as well as regional research ethical guidance, including the Economic and Social Research Council (ESRC) Framework, and more locally, the University of Nottingham’s inter-faculty research ethics committees.

For third sector organisations, the ethical rules are a bit more ambiguous, with some guidance available online, but no formal way of ensuring that research output is driven towards influencing policy. Collaboration is key in this circumstance; the Nottingham Community and Voluntary Service (NCVS) in which Improving Lives is based, has previously published a report showing a contribution of £227m of the voluntary and community sector to Nottingham’s economy, as well as the equivalence of £14m in wages through non-paid volunteers working the equivalent of 649 full-time jobs.

For small charities like Improving Lives, there is constant need and expectation to justify their purpose, and research is one way to do it; cut-backs in funding have been exponential over the past decade (more than £3.8bn) and it doesn’t look like things are going to improve any time soon. This current structure in research capability, however, puts third sector organisations at a disadvantage, and serves to keep academic research in the ivory tower. In our current age of tackling social and income inequality, shouldn’t academia be more concerned with engaging with the not-for-profit services (particularly those that offer support to people with mental health difficulties [13]) in order to investigate their challenges, successes and their overall effectiveness? It is undoubtedly the third sector that holds much expertise and insight that is capable of shaping the way in which services are delivered in the community to improve lives.

What clients have said:

“They offered to escort me to appointments. They took me to my PIP court hearing. I don’t think I would have gone without her”

“I was able to speak to my worker about some personal issues. I had no one to discuss it with. I was able to get over that stage. He gave advice and encouragement and helped me to be open. I had no one else to speak to.”

“I was absolutely suicidal when I first came here.”

“If it wasn’t for something like this I don’t know what I would have done when my wife died. I would have turned to drink or drugs, I would have committed suicide.”

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You can find the Improving Lives offices on the first floor of the Nottingham Community and Volunteer Service (NCVS) building, 7 Mansfield Road, Nottingham, NG1 3FB

Website: http://www.improvinglivesnotts.org.uk

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Stephanie Sampson (@steph_samp) is an Associate Fellow of the Institute of Mental Health and PhD candidate (Mental Health and Wellbeing) in the School of Law (llxsjsa@nottingham.ac.uk)
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Kate E. Pickett, Richard G. Wilkinson (2010) Inequality: an under-acknowledged source of mental illness and distress, The British Journal of Psychiatry, 197 (6) 426-428; DOI: 10.1192/bjp.bp.109.072066