One. Step. Beyond.

Stories on the TV that speak of the mental health impacts of COVID-19/other issues nearly always end with words to the effect of, “And if this has raised any issues for you help is always available. Phone Lifeline on 13 11 14.”

In keeping with Mindframe media guidelines, it’s good that help-seeking information is included in these stories, but it doesn’t cater for the full spectrum of mental health problems.

Lifeline, for example, is a crisis support line, akin to lifesavers plucking people from the dangerous surf. It’s vital, but it’s not a “one size fits all” service (nor should we expect it to be).

Anyway, most of us would rather early intervention/prevention rather than crisis intervention. It’s better to learn how to swim than rely on someone saving you from drowning.

 

The Stepped Care Model of Mental Health

Self Portrait 26/04/20

The Stepped Care model aims to ensure that people have streamlined access to the right services for their needs over time, and as their needs change. There is more information about this available from more reputable sources than my blog, eg:  Northern Queensland Primary Health Network, Connect to Wellbeing, or your local public health network.

A short, amateurish, overview is this:

If you’re on the lowest (blue) step, you’re doing OK. Keep those healthy relationships and habits going.

If you’re on the second-lowest (green) step you probably should be more intentional about protecting your social and emotional wellbeing. Chat to people you love/trust, and see if any of the digital resources at Head To Health match where you’re at.

If you’re on the middle (yellow) step it’s definitely time to connect with someone. If you’re a Nurse or Midwife that could be NMSupport in the first instance,  if you’re in North Queensland you may consider contacting Connect to Wellbeing. Elsewhere you may need to google or go via healthdirect re equivalent services.

If you’re on the second-top (orange) step, don’t muck-about: make a double appointment to see your GP. S/he won’t necessarily reach straight for the prescription pad. The GP may discuss making a Mental Health Treatment Plan, which should include your goals  and – if you and your GP agree it’s worth a try – a referral to a specialist mental health professional.

If you’re on the top (red) step you will almost certainly want to make contact with your local mental health service. In Queensland phone 1300 64 2255 (1300 MH CALL). Outside of Queensland you should be able to track-down your local service via healthdirect.

One. Step. Beyond.

This blog post was inspired by chatting with hospital colleagues who were not familiar with the Stepped Care Model of Mental Health. Many thanks to these terrifically impressive people who are definitely NOT heroes: they’re just everyday compassionate, creative, funny, clever and skilled health professionals who – in a crisis – will go one step beyond to support the people who need it.

One last thing. If, like me, you have a foot one step beyond your usual step, perhaps the jaunty Madness (1979) song “One Step Beyond” will provide temporary distraction and cheer. 🙂

End

Thanks very much for visiting. As always your feedback is welcome in the comments section below.

Paul McNamara, 30 July 2020

Short URL meta4RN.com/step

Scale Fail

Please do yourself a favour, and watch Old People’s Home For 4 Year Olds on ABC iView. Over five beautifully-filmed episodes, the program follows a social experiment that brings together elderly people in a retirement village with a group of lively 4-year-olds. It’s one of the most enchanting, life-affirming TV programs I’ve seen.

Words that make me cry. “Excuse me, he’s my grown up” Four year old Aidan declares when speaking about Eric. #OldPeoplesHomeAU

— Stephanie Borys (@StephieBorys) September 24, 2019

The kids and the grown-ups were equally adorable – each dyad (one older person and one 4 year old) seemed to bring-out the best in each other. It was delightful to watch. Fiona the kindergarten teacher/facilitator was incredible. She has amazing interpersonal skills. [BTW: does anyone know Fiona’s surname? – she deserves to be credited properly]

I only have one problem with the program: the way the 15-item Geriatric Depression Scale (GDS-15) was used/portrayed. It was a very good idea that there was some pre- and post-intervention testing, and it’s terrifically handy to be able to quantify the degree that people self-rate their mood. However, all the scales I’ve ever seen, including the GDS-15,  come with the disclaimer that they’re screening tools, not diagnostic tools. However, that’s not the way the GDS-15 was portrayed on this TV program.

Screenshot from approx. 47 minutes into Episode 5 showing the false dichotomy that 5 or below on GDS-15 = “not depressed” and 6 or above = “depressed”. Pfft! As if.

In the TV program the geriatricians referred to scores above 5 on the GDS as “depressed”. That’s not quite the way it works. The GDS-15 does not diagnose.

Four reasons why the GDS-15 is not a diagnostic tool:

1. The GDS-15 asks for a “snapshot” of how the person has been feeling for the past week. As per the diagnostic frameworks used worldwide (DSM-5 and ICD-10) symptoms must be present for at least two weeks for depression to be diagnosed.
2. The GDS-15 is a dumb screening tool. It won’t (and can’t) take social circumstances into account. Many of the symptoms of depression are also symptoms of grief/bereavement/significant recent stress. GDS-15 questions include:
   • “Have you dropped many of your activities and interests over the last week ?”
   • “Over the last week have you been in good spirits most of the time?”
   • “In the last week have you been feeling happy most of the time?”
   • “In the last week, have you preferred to stay at home, rather than going out and doing things?”
   • “In the last week have you been thinking that it is wonderful to be alive?”
     If your spouse died 10 days ago, not only would these questions be terribly insensitive, but your answers probably wouldn’t be very positive. That doesn’t mean you’re depressed. That means you loved your spouse. The GDS-15 screens for symptoms, not context.
3. There’s more than one way to interpret the GDS-15 score. Which is the correct way? It depends who you ask:
   • As per the Royal Australian College of General Practitioners, “Although differing sensitivities and specificities have been obtained across studies, for clinical purposes a score >5 points is suggestive of depression and should warrant a follow up interview. Scores >10 are almost always depression.” [source]
   • As per an online version of the GDS-15 endorsed by the GDS-15 lead authors [source], the meaning of the scores are thus:
     0 – 4 = normal, depending on age, education, complaints
     5 – 8 = mild
     9 – 11 = moderate
     12 – 15 = severe
   •  As per the screenshot above, the geriatricians in Old People’s Home For 4 Year Olds set a cut-off line between “not depressed” and “depressed” at 5.5,
4. The model of a dichotomy of “depressed” or “not depressed” does not reflect reality. You don’t suddenly get labelled “depressed” because you scored 6 on the GDS-15, and you aren’t suddenly deemed “not-depressed” because you scored 5 the next time you’re screened. In reality, clinically significant changes in mood tend to happen over weeks or months. Minor day-to-day fluctuations are just part of the human experience – not something to be pathologised.
   When it comes to mood, you don’t cross a line between “depressed” and “not depressed”. There is a line, but it’s a continuum. It’s a continuum that we all slide up and down. It’s just that people who experience depression travel further along the continuum than they would like.

https://meta4RN.com/fineline

Closing Remarks

Please don’t let my critique of the use of the Geriatric Depression Scale deter you from watching Old People’s Home For 4 Year Olds. It’s a terrific program based on a wonderful idea, which is articulated further on the Ageless Play website [here].

Something I do in my paid job and as part of my [unpaid] social media portfolio, is to challenge the myths and misunderstandings that happen around mental health matters. As I’ve argued previously [here], all I’m doing in this blog post is articulating my argument why we should resist the temptation to interpret screening tools as diagnostic tools.

End

That’s it. As always, feedback is welcome via the comments section below.

Paul McNamara, 26 September 2019

Short URL: meta4RN.com/scale

Diabetes and Emotional Health

This page is in support of an education session I’m doing at EXPOsing diabetes Cairns on Saturday 9th June 2018.

About

EXPOsing diabetes is a one-day educational event for people living with type 1 and 2 diabetes.

This event will equip you with the knowledge you need to live well with diabetes.

The day consists of interactive and engaging presentations from health professionals who work closely in the area of diabetes. You will come away from the day feeling more confident, motivated and more empowered to live well with your diabetes.
[Source: www.diabetesqld.org.au/get-involved/what’s-on/2018/june/exposing-diabetes-cairns.aspx]

Intro

Paul McNamara is a Fellow of the Australian College of Mental Health Nurses. He has been working in Cairns since 1995. Paul’s day job is providing mental health support and education to general hospital patients and staff.

Presentation

The presentation itself can be accessed via prezi.com/user/meta4RN or by clicking on the image below:

Key Messages, References + Further Info

The session is an oral presentation, so I don’t intend to replicate all of the content here.

Collated below are some of the key messages of the presentation, the references/evidence I’ve used, and how to access further info.

.
“It’s a Fine Line” – Myth vs Reality meta4RN.com/fineline
.

About 20% of us will experience mental health problems in any given year [source: 2007 National Survey of Mental Health and Wellbeing].

About 45% of us will experience mental health problems in our lifetime [source: 2007 National Survey of Mental Health and Wellbeing].

Up to half of us with diabetes will experience mental health problems in our lifetime [source: Diabetes Australia].

Anxiety and depression are the most common mental health problems [source: Mindframe].

Depression, anxiety and other mental problems are usually multifactorial. A good way to understand this is to consider the biopsychosocial model of mental health [source: Engel 1977].

Australia has introduced the idea of “stepped care” to respond to mental health matters [source: Northern Queensland Primary Health Network].

For information about prevention or early intervention with mental health problems, often the “best fit” will be online info via headtohealth.gov.au and/or via one of the apps available via the same website [source: Northern Queensland Primary Health Network].

If the online/app route doesn’t help, or if you’re experiencing symptoms of mental health difficulties, you should chat with your GP about it. S/he will discuss treatment and support options with you, which may include medication and/or referral to one of the local speciality services. It’s a good idea to book a longer appointment with your GP to discuss mental health stuff: neither you or your GP will want to feel rushed [source: Northern Queensland Primary Health Network].

If the above options haven’t helped, the mental health problem is complex, severe or urgent, it’s outside of business hours, and/or your questions would best be answered by a local specialist mental health professional, phone the Cairns Acute Care Team on 1300 64 2255 (1300 MH CALL) [source: Queensland Health].

End

Many thanks to Claire Massingham, Events Coordinator @ Diabetes Queensland for inviting me to present at EXPOsing diabetes Cairns. Thanks also to Endocrinologist Dr Luke Conway for making the suggestion to Claire.

A quick clarification: although this web page has info about how to access mental health support, it’s my personal web site. I can’t offer direct support or referrals from here. Please access further info and/or support via the options listed above.

That said, I welcome comments in the comments section below.

Thanks for visiting. 🙂

Paul McNamara, 2nd June 2018

Short URL: meta4RN.com/diabetes

 

 

 

Mental Health and Cognitive Changes in the Older Adult

This afternoon I’m presenting at Ausmed’s Cairns Nurses’s Conference. The title of the presentation is “Mental Health and Cognitive Changes in the Older Adult”.

The only real point of this blog post is to leave a copy of the powerpoint presentation online, so that those attending the conference can revisit the slides PRN. Here it is:

And here’s the spiel from the Ausmed website
www.ausmed.com.au/course/cairns-nurses-conference

Mental Health and Cognitive Changes in the Older Adult

As we get older, the likelihood of undergoing alterations to brain function is high. This may include normal neurodegenerative changes as well as abnormal deteriorations. Separating normal from dysfunctional degeneration when screening and assessing an older adult is essential for quality nursing care planning. This session will look at:

• What are normal age-related changes to the brain and consequent behavioural signs?
• How are these changes different to the onset of mental health disorders such as schizophrenia, psychosis or bipolar disorder?
• Age appropriate assessment tools for effective mental health assessment
• Benefits of brief psychosocial interventions
• What practical behavioural strategies may improve outcomes for a person with a mental health disorder and cognitive changes?

About the presenter:

Paul McNamara has extensive experience providing clinical and educative mental health support in general hospital and community clinical settings. He holds hospital-based, undergraduate and post-graduate qualifications, is Credentialed by the Australian College of Mental Health Nurses (ACMHN), and has been a Fellow of the ACMHN since 2007. Paul is a very active participant in health care social media, and is enthusiastic about nurses embracing “digital citizenship” – more info via his website http://meta4RN.com

End

That’s it. Short and sweet.

I hope this is of some use/interest to those who are attending the conference, and (maybe) some people who are not able to get along.

As always, feedback is welcome in the comments section below.

Paul McNamara, 15 December 2016

Short URL: https://meta4RN.com/Ausmed16

 

Hand Hygiene and Mindful Moments

Nurses and other health professionals are expected to attend to hand hygiene about eleventy seven times a day. The WHO and HHA recommend 5 moments for hand hygiene: before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching a patient, and after touching patient surroundings. 57.4% of Australia’s nurses/midwives are hospital/ward-based [source], they’re doing A LOT of hand hygiene. 

On top of that, while they’re going about their business and busyness, ward-based nurses are interrupted 10 times an hour [source]. Yep, every 6 minutes there’s something or somebody distracting us from our tasks and thoughts. Dangerously disorderly much? Hopefully that doesn’t happen to neurosurgeons, commercial airline pilots, tattoo artists or Batman.
Especially Batman. 

Pro-Tip: most of us can not do this at work. Only respond to distractions with face-slapping if you are Batman.

So, here’s the idea: if you’re going to do hand hygiene dozens of times a day anyway, don’t just do it for your patients: do it for yourself too. We’re not cold callous reptilian clinicians, we’re educated warm-blooded mammals who do emotional labour. We need to nurture ourselves if we are to safely continue to nurture others.

5 moments for hand hygiene & head hygiene!

Turn the 5 moments of hand hygiene into mindful moments. Make the 5 moments for hand hygiene 5 moments for head hygiene too. Yes, clean hands save lives – let’s not forget that clear heads save lives too!

Come up with a process/script that works for you, maybe something a bit like this: 

Mindful Moment (The 30-Second Handrub Version) 

1. Step towards the pump bottle with intent. This is my mindful moment. I’m taking a brief break. 
2. Squirt enough to squish. 
3. The rub is slippery at first. Frictionless fingers feel fine.
4. Feel the product texture and temperature. The rub is cooler than the air. The rub is cooler than my fingers. It feels nice. 
5. Start with cleaning. The first half of my hand hygiene routine is about rubbing stuff off. Let the stuff I want to get rid of float away. 
6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
9. Smile.
10. Breathing slowly, its time let the air rinse off the residue. 
11. One more slow breath. Its time to get back to work. 

Mindful Minute (The 60-Second Handwash Version)

1. Step towards the sink with intent. This is my mindful minute. I’m taking a brief break. 
2. Let the water flow.
3. Feel the water flowing over both hands. The water’s warmer than the air. The water’s warmer than my fingers. It feels nice. 
4. Add soap. It’s slippery. Frictionless fingers feel fine.
5. Start with cleaning. The first half of your hand hygiene routine is about washing stuff away. Let the stuff you need to get rid of flow down the drain. Let it flow away. 
6. Move on to restoration, healing. The second half of my hand hygiene routine is about rubbing in resilience and health. Let the stuff that sustains me seep into my skin. 
7. Check in on the breathing. The slower and deeper the better. If the breathing or the brain are running too fast, slow down and repeat steps 5 and 6. 
8. There’s no rush. Slowly scan the surroundings. With any luck someone from infection control is watching. 
9. Smile.
10. Breathing slowly, its time rinse both hands. 
11. Breathing slowly, its time to thoroughly dry both hands together. 
12. Throw the towel in the bin.
13. One more slow breath. Its time to get back to work. 

Clean hands save lives. Clear heads save lives too!

Acknowledgements & Context

This is not my original idea. I first stumbled across the idea of combining hand hygiene with head hygiene via Ian Miller‘s November 2013 blog post “mindfulness during handwashing”: http://thenursepath.com/2013/11/18/mindfulnurse-day-8/. I’ve been using the idea myself and suggesting it to colleagues and students ever since. When I left the clinical environment for a few months, I found myself really missing intentionally punctuating my day with mindful moments. Since returning to clinical practice I’ve come to appreciate the strategy even more than I did when I first started using it 3 years ago.

So why am I blogging about it too? Why now? Well, on Monday I attended the Australasian College for Infection Prevention and Control 2016 conference to chat about Twitter [link to that presentation here. Also, check-out the #ACIPC16 hashtag here and here]. Luckily I was there for the opening plenary sessions, and was pleasantly surprised at the emotional/psychological literacy that was being displayed and advocated for. The opening presentations by Peter Collignon, Mary Dixon Woods and Didier Pittet all went to some lengths to emphasise the importance of emotional intelligence, constructive communication and building relationships. It was really impressive stuff; giving the hand hygiene and mindful moments idea a remix is my way to give recognition/thanks to the #ACIPC16 conference delegates and organisers.

How to win friends and influence people: https://twitter.com/emrsa15/status/800495292642508801

Just so you know, a quick google search reveals that others have also thought of using hand hygiene as a mindful moment, eg this paper:

Gilmartin, Heather. (2016) Use hand cleaning to prompt mindfulness in clinic: A regular prompt for reflection could reduce distraction. BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i13 (Published 04 January 2016)

and this video:

There are others too. Do you think using hand hygiene as a mindful moment could become mainstream?

End

That’s it. As always your comments are welcome via the space below.

May you hands be clean and your head be clear! 🙂 

Paul McNamara, 26 November 2016

Short URL: meta4RN.com/hygiene

The Art of Mental Health

Sigmund Freud is purported to have said, “Everywhere I go I find that a poet has been there before me.” Not every nursing speciality has this advantage of being informed and sustained by artists. Can those of us interested in supporting mental health consumers and carers look to art to improve our understanding and empathy of the experiences of others? 

I have created a Prezi as a seed for others to use art as an adjunct to our other sources of learning (courses, colleagues, peer-reviewed journals, text books etc). Please see the Prezi by following the link here.

The examples I have collated in the Prezi are listed below, and credit is given to the sources that were used in the Prezi.

Veronica by Elvis Costello is a beautiful song and film clip, that improves our understanding and empathy of nursing the person with dementia. The YouTube video is here: youtu.be/zifeVbK8b-g The lyrics were sourced from this website: www.azlyrics.com/lyrics/elviscostello/veronica.html I’ve written about this previously: meta4RN.com/dementia and have self-plagarised. Again. 

Dog by Andy Bull (with vocal support from Lisa Mitchell) is a fantastic song that captures some of the difficulties of the experience of depression. In the Prezi I used this YouTube link youtu.be/bBOe660BYjI and the lyrics were sourced via www.songlyrics.com/andy-bull/dog-lyrics

Dog is a poignant, wonderful song. Listen to it here:

I had a black dog, his name was depression is written, illustrated and narrated by Matthew Johnstone. It is a very accessible way think about depression and would resonate with a broad age group, I think. Here is the YouTube video used in the Prezi:

To improve understanding and empathy for the family/carers of those who experience schizophrenia I use a song called Neighbourhoods #2 (Laika). This takes a bit of explanation. First though, lets get the credits out of the way. The lyrics were sourced here: www.azlyrics.com/lyrics/arcadefire/neighborhood2laika.html The YouTube video linked in the Prezi is from here: youtu.be/8Wq917ucGaE

“Laika – First Dog in Space” by Belgian artist Paul Gosselin. Source: http://cultured.com/image/4063/Laika_First_dog_in_Space/#fav

Laika by Arcade Fire may not have been written about mental illness at all. However, as with all art, interpretation is an individual experience. I have had a few years experience as a community mental health nurse. In that role I provided direct care and support to the person experiencing mental health problems (nearly all of my clients at the time had schizophrenia) and, when family were still around, support for them too.

Much of the word imagery of Laika fits with that experience. Carers often described their frustration at the lack of insight and empathy that their family member seemed to have. Carers would oscillate between deep concern and desperate frustration about their family member. More than a few times carers expressed a nihilistic outlook – an almost complete lack of hope. The line “Our mother should’ve just named you Laika” expresses that poignantly: Laika was the name of a stray dog in Moscow who became the first living creature to orbit earth. She was never expected to return to earth safely, and died a few hours after launch. Families I have worked with have, at times, expressed that level of despair about their family member.

I also like how Laika’s story has been taken-up by the art community. I love the Arcade Fire song, and my favourite visual representation of Laika – First Dog in Space is the painting above by Belgian artist Paul Gosselin.

The last piece of art I used in the Prezi was The Scream by Edvard Munch. The source of the picture is here: www.ibiblio.org/wm/paint/auth/munch/munch.scream.jpg I’ve read that this picture has been associated with other health problems including  trigeminal neuralgia, psychosis and depersonalisation. To my eye, The Scream looks like acute anxiety and/or a panic attack. It serves as a graphic visual reminder that the first step is to assist the person to contain their distress, to be and feel safe. It shows distress that must feel overwhelming and rallies us to help: let’s think “safety first” kids.

The Scream by Edvard Munch. Source: http://www.ibiblio.org/wm/paint/auth/munch/munch.scream.jpg

So, that’s it for this little weekend project: if you haven’t visited the Prezi yet please do so now: The Art of Mental Health

What songs, poems, books, music and visual art will inform and sustain your clinical practice?

Paul McNamara, 7th December 2014

These words have been in my head and they needed to come out (a blog post about suicide)

Trigger Alert – this blog contains info re suicide which may be unsettling for some people.

Guest Post: Stevie Jacobs has contributed this guest post to meta4RN.com

Stevie Jacobs is the pen name of a newly-minted Enrolled Nurse. The person behind Stevie is smart, experienced in life and has some awesome insight into the world of the student and new graduate nurse.

You can follow Stevie Jacobs on Twitter: @SJWritesHere

Stevie has contributed to other nurse blogs, including the excellent site Injectable Orange, by Jesse Spurr.

These words have been in my head and they needed to come out
(a blog post about suicide)

I am ‘Pro choice’.

I am a patient advocate.

I am a person advocate.

I support euthanasia.

I am pretty much of the opinion that if you have all the facts, figures and feelings figured out then you can go ahead and do pretty-much whatever you like. Even if it’s ‘bad’ for you. I can provide you with action plans and phone numbers and personal support, however ultimately, the choice my friend, is yours.

So when someone wants to kill themselves/suicide/take their own life (however you want to put it) what does my head feel about that? I’m not talking about obligations as a Health Care Professional, I’m talking about obligations as a human being. I can provide you with an ear to bend, a shoulder to lean on, I can find you professional help if you want, I can tell you that I don’t think you’re in a safe space and I want to get more support. For both of us. I can do all that. What I am stuck with is that if euthanasia is assisted suicide and I’m OK with that (OK meaning I won’t physically stop you nor judge you), does that mean I am ‘OK ‘ with someone’s suicide? Both have the same ending:, the removal of pain through the death of a person. I don’t know how my heart or my head feel about that.

Robin Williams was 63. That’s a long time to be living in pain. Yes, there are medications and therapies and support groups, but what if that starts to feel just all too much? That living is just all too much, a bit like ‘diabetic burnout’, where the person with diabetes basically gets fed up with ‘managing’ their diabetes and becomes unwell. That can happen with all chronic diseases. That can happen with mental health issues. Yes, some people have a depressive episode, it’s self-limiting and then they never have another one. Wonderful. For others, it just keeps on coming back, more painful than before.

To someone who is experiencing suicidal thoughts, suicide I can seem to be a rational method of pain relief. It’s the ultimate pain reliever for the person experiencing the thoughts.

For those left behind it can be devastating.

I can’t make up my mind. Do I have the ‘right’ to stop someone from suicide? I’m on the fence. The boundaries get blurred. I’ve experienced anxiety & depression, I’ve experienced suicidal thoughts & been ‘suicidally depressed’, I’ve had a family member suicide and I’ve known someone I followed on Twitter suicide. Which is a really fucking weird experience, quite frankly. Grief for someone who you ‘know’, but don’t ‘know’. 101 ‘What ifs?’. I could ‘see’ that something wasn’t right, but aside from checking in and offering an ear what else could I do? I’m at peace with those choices now, no longer haunted by ‘what ifs’. I’m sure that is not the same for their family and friends. I realised that what has stayed in my head is a photo of themselves they posted shortly before it happened. It’s their eyes. Their eyes haunt me. I can see something in their eyes I’ve seen time and time again. In my face. In the faces of others. I know those eyes so well. However good your mask is it’s in the eyes.

So, what to do? Who am I to tell anyone what to do? There isn’t really a clear answer. I think it’s really important to keep checking in on people: RU OK? I have RUOKed a few people and I will keep doing it. If it’s a ‘No’, and they express some ideas that worry you, it’s OK to ask “Do you have a plan?” If it’s a ‘Yes’, what then? Especially if you just don’t believe them. That’s trickier ground to navigate. I’m no expert on this. There are links at the end of this from people who are.

RU OK? It’s just a simple question. A simple, lifesaving question. I was on another planet from OK, and someone who barely knew me asked me that question.

It was like a thunderbolt.

It made me stop and think and choose to get help to make living less painful. Choosing to get help is hard. Getting help can be harder. What’s even harder is acknowledging that choosing to live is a conscious effort. It’s an effort. Accepting that medications and therapy and exercise and diet changes and avoiding triggers are now part of your life is an effort.

In time I hope that life will once again become effortless, but it might not.

Finally, after years of effort, I now think I am OK with that.

.

Post Script 1:

I wrote the above post a little while back. Normally when I have said all I have to say on a subject it doesn’t pop back in to my head. This post did. If I am honest, I have only scratched the surface. I have more to say. The way I write usually is like a good vomit on a night out: it all comes out in one go and it’s done and dusted and you’re up and dancing again. The other way I write is a bit more like a gastro bug: on and off with a bit of dry retching when you just can’t get it out. Then you’re done and you feel better.

Paul told me the ‘meta’ point of meta4RN is ‘talk about what you’re talking about’. So I guess that’s what I’m doing here. Rereading the above, reflecting on it and trying to work out quite what it is that I still feel I want to say.

We need to talk about mental health. We need to talk about suicide. We need to do it in a safe, appropriate and open way, but we do need to talk about it. Talking about it is hard. Talking about it can be terrifying for anyone. Talking about it when you’re a health professional is really damn hard. There are so many ‘what ifs’. What if they ‘lock me up’? What if they don’t? What if they think I’m not fit to practice? What if I lose my job? What if my colleagues find out? What if I have to be treated in the same hospital that I work in? What if…

I want to talk about how it feels to have suicidal thoughts. I want to talk about how it feels to be suicidally depressed. I’m not sure how to do that. I know that there are media guidelines for discussing suicide. As someone who is trying to describe a ‘lived experience’, I decided the best way for me to write was to let it all come out uncensored, and then give it to Paul to edit it using some of those guidelines and make it ‘safe’. I am in a safe enough space now to be brutally honest about how those suicidal thoughts feel, and far away enough from those thoughts to be able to talk about them without feeling ‘triggered’.

I can only speak for myself. For me there is a distinction between having suicidal thoughts and being ‘suicidal’ or ‘suicidally depressed’, as I have referred to it in the past. The thing about ‘suicidal thoughts’ is that the longer you have them the more rational they seem. For me suicidal thoughts are more of a hypothetical notion; it’s not something I am going to carry out. It’s an icy calm IF. IF things don’t get better, IF that was to happen, IF there isn’t another way out, IF the pain becomes unbearable, IF.

I know exactly how I would kill myself. I know exactly how I would spend the jackpot from a lottery win. I know exactly what I would get done if I had free access to plastic surgery. It’s all hypothetical.

It’s hypothetical. Until it’s not. Until I am suicidally depressed. Until I am in pain. Until the self-loathing I carry around with me every day takes over. Until I truly believe that the people in my life would be better off without me. Until I can’t see any way out aside from that way. And that place is not icy calm. It’s a messy, clinging on to something, anything to get through hour after hour, painful, emotional swamp. I feel emotionally swamped. I can’t think in a straight line. I can’t sleep. I can’t eat. The anxiety eats at my stomach. The panic attacks feel like I am dying of a heart attack. The after effects of which last for days. And nothing, nothing stops the pain. That’s how suicidal feels like for me. I know, however, that it is not what it looks like to other people. People see what they want to see. Even people who are trained to see more. I am brilliant at hiding it. I know how to put on my mask and polish up my armour. It is exhausting.

There are cracks in my armour, sometimes the mask slips. My fellow walking wounded can see though them, but for the most part the people I see every day wouldn’t know. I can make people feel so good about themselves. I can make people cry with laughter. Then, the second I am alone, the pain floods over me and I can barely breathe. I keep coming back to pain. It’s about pain. Not control, nor attention seeking, nor escape; in that moment it is about wanting that pain in my heart to stop. To. Stop.

It’s a horrendous place to live to be honest. It’s a half life. I had to choose to live better. To live for me. To get help – medications, counselling, CBT, exercise, diet. It’s a conscious choice. And what helped me make that choice was being asked ‘RU OK?’

.

Post Script 2:

So, turns out it’s not a verbal gastro bug. It’s verbal C.Diff. The words just keep coming out.

I think I need to make it clear that I am talking about a period of over 10 years. I need to make it clear that I am talking about the past. I might write ‘I know’, but I suppose really it is ‘I knew’. Deciding to share this is a decision that has been easy, but it is a decision that I have made because these words have been in my head and they needed to come out. There are more things I could say, about specific attempts, specific feelings. However, I don’t want to share them. I think that’s OK.

I need to make it clear that I support ‘RUOK’ & WHO suicide prevention strategies. I need to make it clear that if you judge me negatively based on what I have written or if it changes your opinion of me, then that’s your thing, not mine. I’m not asking for agreement or understanding, but I do ask for kindness.

I was asked recently what the best thing in my life is right now. Aside from Nursing, the answer is the people in it. I know that my people love me, and accept ‘me’, and that’s enough.

Black Dog Institute Healthy Living Study is a program to help those experiencing suicidal thoughts manage them: http://www.blackdoginstitute.org.au/public/research/participateinourresearch/index.cfm

End.

Short URL:  meta4RN.com/guest02

Many thanks to Stevie Jacobs for sharing this gutsy piece of writing. Your sensitive, constructive feedback is welcomed in the comments section below.

It’s also important to acknowledge that talking and thinking about suicide can be distressing. People in Australia can access support via:

Lifeline – 13 11 14

Suicide Call Back Service – 1300 659 467

MindHealthConnect www.mindhealthconnect.org.au

Outside of Australia and not sure where to get support? Google usually displays a red telephone icon and your country’s suicide support phone number when searching for a suicide-related topic.

This guest blog post has a companion piece, which I have imaginatively called “A Blog About A Blog About Suicide” – the link is here: meta4RN.com/mindframe

Paul McNamara, 23rd September 2014

Stay connected, stay strong… before and after baby

Copy of Stay connected, stay strong… before and after baby DVD on YouTube (33 minutes):
Update as of 12/10/16: video deleted as requested (scroll to bottom of page for further info).

From the back cover of the DVD:

Pregnancy, birth and parenting can be a very positive time, but sometimes it may not be how you expected it to be. Adjusting to life as a mother can be hard and make women feel down and distressed. In Australia, one in every six women experience depression during this time.

This DVD has been created to support Indigenous women, men and families understand the importance of good social and emotional wellbeing during pregnancy and beyond.

Going to get help might feel like the hardest part, but it is the best thing you can do for yourself, your baby and your family. Getting help early gives the best chance of a strong and healthy future.

YouTube URL: http://youtu.be/CLsjgw8pvOA

.

Why is the Video Online?

The video is online so that it can easily reach the target audiences: Aboriginal and Torres Strait Islanders families, and those who support them. It is a great little video: not only does it have a very clear message that there’s no shame in asking for a bit of support, but it also looks and sounds great. My favourite thing is how the narration by Jasmin Cockatoo-Collins ties the whole thing together: even though a couple of dozen people appear on camera, Jasmin’s voice weaves the whole thing together so it kind of seems like one story. Well done to Jasmin and film-maker Jan Cattoni (Jan’s a nurse who became a film-maker).

Knowing that the video is so good that it should be shared is one thing, getting it shared is another.

Stay connected, stay strong… is available for free in Queensland and for $20 elsewhere, all you need is this PDF order form from the Queensland Centre for Perinatal and Infant Mental Health:

Click to access resource-order-form.pdf

Far North Queensland residents can borrow the DVD from Cairns Libraries: link.

Queensland Health staff can access the DVD through the Queensland Health Libraries Catalogue: link

However, as accessible as all that sounds, the truth of the matter is that YouTube is the world’s largest video-sharing portal and the world’s second largest search engine. A video is not really accessible until it is online.

Now we can share the video using this link: http://youtu.be/CLsjgw8pvOA

Eek!

This is by far the riskiest thing I’ve done with my professional social media portfolio. I am not the copyright holder of this excellent short film: the Queensland Government is. Although I won’t make any money out of hosting the video, I might be subject to legal action. If there is a credible threat of legal action I will take the video down immediately. Another risk is that I might be inadvertently causing offence or distress to some person or organisation. This may mean that I will not be considered for future work in perinatal and infant mental health (perhaps funding for services will return to pre-July 2013 levels one day).

So, why take these risks?.

My agenda is simple: to demonstrate that social media can be leveraged as another channel for health promoting information. It’s something I started when working in perinatal and infant mental health in October 2011, as evidenced by this from my now-mothballed Twitter handle @PiMHnurse (now I use a less job-specific name: @meta4RN).

 

My big hope is that hosting Stay connected, stay strong… before and after baby won’t get me in too much trouble, but will serve as a spur for a more legitimate stakeholder to host the video on their YouTube or Vimeo site.

When that happens I will update this blog post.

End

That’s it. I’m feeling scared now.

Paul McNamara, 8th June 2014

Important Update 12/10/16

The copy of Stay connected, stay strong… before and after baby that was uploaded to YouTube in June 2014 has now been deleted. Today I was advised that I was breaching copyright, and was requested to take the video down ASAP. In the 28 months that the video was available on YouTube it was viewed 280 times.

I’ll add a link if an official online version becomes available.

My intention in knowingly posting a video that I am not the copyright-holder of was to act as an agent of change. If I have caused harm or distress to any person or organisation I am genuinely sorry. That was not my intention.

Paul McNamara, 12th October 2016

Perinatal Mental Health Workshop Links and Resources

Previously for Perinatal Mental Health Workshops I have trickled-out the links and resources we refer to during the workshop via Twitter and Facebook.  It’s a nice idea, and has worked pretty well (for more information about this experiment in social media enhanced education please see the video below and/or this link: meta4RN.com/workshop).

However, it is pretty labour-intensive to pre-schedule each individual Tweet and Facebook post every time I facilitate a Perinatal Mental Health Workshop, so to save some mucking-around I’ll list the links and resources here.

The headings in red are not mutually exclusive – some links cross boundaries. The list/links will be updated PRN:

Guiding Clinical Practice

2014 Cairns Perinatal Mental Health Workshops (follow the link for info about the workshops and for free registration) pmh.eventbrite.com.au

Australia’s Perinatal Mental Health Clinical Practice Guidelines www.beyondblue.org.au

Promoting Perinatal Mental Health Wellness in Aboriginal and Torres Strait Islander Communities (PDF from the book Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice; chapter 16 by Sue Ferguson-Hill) aboriginal.childhealthresearch.org.au/media/54907/chapter16.pdf

Perinatal Jargon Busting (get your head around the lingo) meta4RN.com/jargon

Using the Edinburgh Postnatal Depression Scale (tips for midwives, child health nurses, Indigenous health workers and other clinicians) meta4RN.com/epd

Edinburgh Postnatal Depression Scale  (this version is online, anonymous, free and self-scoring) justspeakup.com.au/epds

Perinatal and Infant Mental Health Libguide (a very handy for researchers and clinicians) tpch.qld.libguides.com/PIMH

Queensland Centre for Perinatal and Infant Mental Health (QCPIMH have some great resources) www.health.qld.gov.au/qcpimh

Perinatal and Infant Mental Health Nurse eNetwork (an email network hosted by the Australian College of Mental Health Nurses for nurses and midwives interested in perinatal and/or infant mental health) lists.acmhn.org/wws/info/perinatal-infant-mh

ACMHN Perinatal Mental Health Online CPD Program (a 3 module continuing professional development program which is open to Australian College of Mental Health Nurses members [free] and non-member nurses and midwives [$33 including GST]) www.acmhn.org/perinatal-elearning

Nurturing the Nurturers (info about guided reflective practice/clinical supervision as a self-care mechanism for health professionals) meta4RN.com/nurturers

For the Parent(s)

Cairns Perinatal Mental Health Support Options google.com/?q=perinatal+cairns

Stay Connected, Stay Strong: Before and After Baby (cool DVD featuring Aboriginal and Torres Strait Islander parents). Borrow: lib.cairnslibrary.com.au Buy: www.health.qld.gov.au/qcpimh YouTube: http://youtu.be/CLsjgw8pvOA

Behind the Mask: The Hidden Struggle of Parenthood (DVD preview) http://youtu.be/FjqOqJLkyFs

PANDA – Post and Antenatal Depression Association (for info and phone support) www.panda.org.au

How is Dad Going? (for fathers affected by perinatal anxiety/depression)  www.howisdadgoing.org.au

Pregnancy, Birth & Baby (24 hour info and support) www.pregnancybirthbaby.org.au

beyondblue (lots of resources, including booklets regarding emotional health in pregnancy and early parenthood, some multilingual booklets) www.beyondblue.org.au

Mind the Bump is a free Mindfulness Meditation App to help individuals and couples support their mental and emotional wellbeing in preparation for having a baby and becoming a new parent www.mindthebump.org.au

Black Dog Institute (info and resources re perinatal depression for women and men; presented in a different style to beyond blue’s info) www.blackdoginstitute.org.au

Doc Ready (for those not sure how to start a conversation about mental health with your midwife, nurse or doctor? maybe building a checklist will help) docready.org

MindHealthConnect (good place to find trusted mental health programs, fact sheets, and to access urgent support via the red “Need Help Now?” button on each page) www.mindhealthconnect.org.au

Puerperal Psychosis

Information on Puerperal Psychosis (2010) by Dr Anne Sven Williams and Sue Ellershaw (be alert, not alarmed: a self-downloading DOC; the target audience for this is women/families affected by puerperal psychosis,  but many of us clinicians have also found it a useful adjunct to our formal education) www.wch.sa.gov.au

Puerperal Psychosis: A Carer’s Survival Guide (PDF by Craig Allatt: Craig’s partner experienced puerperal psychosis) www.wch.sa.gov.au

Keeping Baby In Mind

A Monster Ate My Mum (a children’s book looking at postnatal depression through a child’s eyes) amonsteratemymum.wordpress.com

Still Face Experiment (Edward Tronick’s demonstration of how infants respond to changes in interaction from primary caregivers is often cited in infant mental health education) youtu.be/apzXGEbZht0

Baby Cues Video Guide (trying to work-out what newborns are trying to communicate can be tricky; these video guides might help) raisingchildren.net.au

Circle of Security (re attachment theory and affective neuroscience) circleofsecurity.net

Raising Children Network (an Australian resource for parenting, covers newborns to teens) raisingchildren.net.au

That’s all I have on my list for now. Please add your suggestions for valuable links and resources to share at my Perinatal mental Health Workshops in the comments section below.

Paul McNamara, 7th February 2014

Perinatal Mental Health: A Good News Story

diabetes, for instance

Most health messages are such a downer, surely there are many people who will either switch-off from the message, or become unduly alarmed. Compare health marketing to commercial marketing and it’s no wonder obesity is rising. Put frankly, Coca-Cola and McDonalds have better ads: they’re full of fun and optimism:

Things Go Better With Coke!  

McDonalds – I’m Lovin’ It! 

Don’t get me wrong: depression is a bugger of a thing, and perinatal mood disorders are especially poorly timed. Looking after a pregnancy/baby is tricky enough without tossing in anxiety and/or depression.

However, at the risk of sounding all Pollyanna about it, there are some good news stories we can talk about when discussing perinatal mental health. Here’s a small list of things I’d like mentioned in every antenatal class/similar forum for parents-to-be/new parents:

[1] 6 in 7 new mothers and 19 in 20 new fathers will not experience perinatal depression. Are there any other gambles that give you better odds?

[2] Symptoms are usually easy to recognise. There’s even a free online anonymous self-scoring tool available: justspeakup.com.au/epds

[3] If somebody is not sure how to start a conversation about mental health with their midwife, doctor or child health nurse, there’s a handy online tool to help build a checklist of things to mention: docready.org

[4] Information and resources are easy to find. In Australia the “big five” are:

• panda.org.au
• beyondblue.org.au
• blackdoginstitute.org.au
• howisdadgoing.org.au
• mindhealthconnect.org.au

[5] Support is easy to find too:

• via any GP with ears
• via any Midwife or Child Health Nurse with ears
• PANDA 1300 726 306
• beyondblue 1300 224 636
• Pregnancy, Birth & Baby 1800 882 436

[6] There are a range of treatment options: it’s not a matter of  “one size fits all”.

[7] If required, there are some medications that can be used in pregnancy and/or breastfeeding.

[8] Recovery rates for postnatal depression are very good.

[9] Some places have access to specialist perinatal mental health clinicians.

[10] Mental health clinicians are not interested in stealing the baby. In fact, mental health clinicians seem quite pleased with themselves when they get to see parents and infants connecting and communicating with each other.

[11] If attachment between parent and baby does not happen as easily as expected (this happens a fair bit with anxiety and/or depression), there are video guides to help, for example: Baby Cues Also, in some towns and cities (especially those with a perinatal and infant mental health nurse), there are clinical staff who can help with this communication/attachment/bonding stuff too.

What’s This About Exactly?

During the week a couple of new mums declined referral to see a nurse (me) from the consultation liaison psychiatry service because they had preconceptions about how negative the experience would be. It’s not absolutely necessary for every parent to see a mental health specialist, of course, but I think we (that’s “we the health professionals”) should start fishing-around for ways to better describe the good news stories about perinatal mental health.

diabetes, that is

If Coca-Cola and McDonalds can convey a sense of fun and optimism out of the products they sell, surely we can convey a sense of fun and optimism out of the services we provide. We have something that’s much better than the offerings of either Coca-Cola or McDonalds, so let’s reorientate the language and recalibrate expectations by using positive language.

Maybe when perinatal and infant mental health (PIMH) services in Queensland are re-established, we can re-launch with an upbeat attitude and slogan:

 PIMH for a healthy head-start!

End

What are your ideas for upbeat slogans and messages? Please add them in the comments section below.

Paul McNamara, 25th January 2014