The Working Cure

A few months ago Julie started a new job, which for the first time meant going out of the house to work.  It was not the first employment she had had, but it was the first time she had had to leave the house, arrive at a certain time and work with other people on a daily basis. 

In this job, for the first time, her bipolar condition is not the first thing that her colleagues know about Julie.  In fact most of them do not know about it at all, and may never know about it.  She is just Julie.  The first thing they know about her is the job she is doing for them, in their team.  The second thing they generally get to know is that she does the job well.  She's honest, open and reliable.  Her initial casual employment status was quickly exchanged for a permanent contract.  She's popular in the team, making friends.

This job is the best medication for her illness that Julie has ever had.   In those few short months she has grown hugely in confidence.  The usual cycle of ups and downs, that used to swing wildly from boom to crash, has become a manageable gentle ocean swell.  She enjoys herself in her evenings and weekends, rather than enduring hours of frustrating loneliness.

I know why the chorus of professionals that have dominated her life to date - the mental health nurses, the social workers, the psychiatrists - have discouraged her from work in the past.  There's no doubt that there have been times in the past when it would have been hard to sustain.  But there is also no doubt in my mind that work now is very very good for her.  When times are hard - and there are still hard times - the last thing to go should be the job.

Of Feet and Things

My partner Joe has just snapped his Achilles' tendon.  It's very painful and totally disabling.  He will be wearing a cast for months, unable to drive and barely able to walk.

In an ideal life there would be plenty of spare capacity, so that this sort of disaster could be quickly accommodated, with good grace and a sense of humour.  Of course none of us actually live with that sort of capacity to spare.  For most of us, new demands mean an awkward period of readjustment, often affecting things that seem unrelated.

For example, there is a knock-on effect for Julie of her dad being suddenly incapacitated.   We have been spending a lot of time with her over the last few months, first as she recovered from a long hospital visit, and then supporting her into work.  There have been walks and meals, and long phone conversations.  Joe has done a great deal of the practical support, and kept the ship afloat while I was giving her emotional support.

Now concern for Julie has to compete with sorting out Joe.  There are a lot of practical concerns if you are sick and can't drive: getting to hospital, or work or having any sort of social life suddenly all require careful coordination.  Our world has suddenly become much more complex and demanding; it simply isn't possible to visit Julie as much, or spend quite as much time helping her.

And perhaps it will be a good thing in the long run.  Julie is really very capable, and wants to live independently.  Now that she has been working for a while, and successfully keeping out of hospital, it is not impossible that having her parents hovering around her is holding her back.  Perhaps it will be liberating: we will just have to hope so.

Of Needles and Things

Julie is dependent on the medicines she takes. She’s taken them for so long – all through her adolescence and early adult-hood – that we can’t always tell what is Julie, and what a side-effect of her medicines.  A few days without them rapidly leads to disaster.  This doesn’t necessarily mean that she can’t function without them at all – but it does mean that if she comes off them suddenly, the powerful withdrawal symptoms are overwhelming.

The last two admissions to hospital were triggered by inadvertently coming off her medicines, so Julie opted to have monthly injections.  This is working reasonably well, though it may need some fine tuning.   Just after the injection, Julie feels great.  She’s cheerful and funny, and her old self.  As the month wears on, she slowly winds down.  The old worries start to surface, and she becomes more withdrawn, harder to motivate, and increasingly odd.   We suspect she would benefit from a little more of one of her drugs, but she hasn’t seen the community psychiatrist in six months.  

There is one unexpected problem with logistics: GP surgeries only allow you to book 3 weeks in advance.  This means that if you have treatment at 4 week intervals, like an injection, you can't book the next appointment before you leave the surgery - you have to remember to phone back a week later.  Given that the huge benefits to everyone of keeping Julie out of hospital by giving her these injections, this rigid bureaucracy seems a false economy.  A patient who has recognised problems with memory, and who struggles to take medication regularly, is expected to remember to make an extra phone call every month.  It seems odd that we are the only people checking that she makes and keeps her appointment, and nobody following up to make sure that the treatment is effective.

Now We Are Twenty Something

When things are going well, I often don't hear from my children for days or weeks.  They are too busy getting on with living.  My son sends me an occasional text, usually asking for money.

Then the other day he sent me a one-line text to say that he would have to repeat a year at university.  Nothing else. No indication why.  I can guess the reasons, but I will have to wait until he is ready to talk.

When he was small, my son never held back when he had a problem.  His meltdowns were legendary, and he was capable of going for nights on end without sleep.  We were exhausted and at the end of our wits.  But it was often quite hard to work out what the root of the problem was or how to solve it.  It was slightly easier once we had a diagnosis of autism for him: it brought a whole new raft of ideas to try.  We looked for "sensory issues" or worked on planning and preparation.  No idea if they really worked, but they kept us all busy.  He says they were waste of time. He has always been a vigorous non-conformist, and it's no surprise at all to find that he doesn't fit into the pigeonhole of "autistic" any more than he fits anywhere else.

I thought parenting him when he was six was quite hard.  But it's not really any easier now he's twenty something.  It's just as much of a guessing game.

Going Out to Work

At the beginning of this year, the one question on everyone's mind was, would Julie manage to start her new job?

She had interviewed successfully for the post just days before she became seriously ill.  Then she had to spend the whole of the next month in hospital and came out looking very shaky.  As the start date of the new job approached, it was touch and go whether she would be fit enough to take it up.

This is not Julie's first job, but the other jobs were often more casual, with negotiable hours, and no fixed location.  This is the first job where she has to get up early to catch a bus, the first job where she has to work a fixed shift, and the first job where other people are reliant on her.  Going out to work was something Julie wanted to do so much, but the barriers are high: she is afraid of letting everyone down, her drugs make her tired and unfocussed, she feels overwhelmed by new environments.

But she made it. The first few days were tough, but her new colleagues were welcoming, her manager fantastically supportive - she soon began to get the hang of things.  I keep her freezer full of good nutritious meals, and she spends a night or two with us every week.  She's now well into the second month, starting to feel like an old hand, and managing some social life on her days off.

Working is really good for her.  Financially it's hardly worth the effort - frankly, it would be a lot easier to stay at home and claim benefits.  But getting out, doing a normal job of work, meeting people, belonging and contributing - it does more good than any psychiatrist could ever do.

It's not going to be plain sailing all the way.  She's still only working part-time; her goal is to work up to full-time.  I expect there will be times in the future when we'll be wondering if she's going to keep going.  But she has got this far, and I'm so proud of her.

Tea Breaks

Office life can be quite strange sometimes.  When I was Julie's age, working in temporary posts, some offices were great fun, some offices were dire.  You never stayed in one place long enough to find out what the feuds were about.  It was all just a great game.

I'm older now, been in my current role for quite a while, and I have a team of people reporting to me.  It's a quiet office: everyone is very good at what they do, resources are tight, and there's more work than we can possibly handle, but we all care about our work, so we all work very hard.  A lot of people in the team have heavy family commitments outside work, and tight schedules.  They have to leave work on time: to collect small children, take elderly parents to clinics, or in my case, sort out something to do with Julie.  It can lead to a lot of tensions, and occasional frayed tempers.

All of us understood the risk of working as hard as this - most of the team have been in the business for years - and at one time we all made a concerted attempt to socialise and defuse tensions - fundamentally, we all like one another, and have no reason to fall out.  But the pressures are so intense, that our attempts slowly fell by the wayside.  And then recently I realised that one of the younger members of the team had become seriously depressed. She came to work, she said good morning, she sat at her desk and worked through her mountain of work.  When she asked for help, she got brusque replies, and sometimes none-too-positive feedback.  At the end of the day, she said good night, and went home.  The one member of the team without dependents, she found it hard to understand why we were all so strained all the time.

I'm ashamed to admit that at first I tried to deal with it in my usual office manner.  I know perfectly well what depression feels like, but I would hurriedly take her aside to ask her how she was feeling, allowing her perhaps no more than 5 minutes to discuss her problem.  My goal was, I think - and the fact I had a goal at all speaks volumes - to solve the problem and move on.  I didn't mean to be unkind, I just found it very hard to switch gear from the fast pace of our technical discussions to the much slower pace of normal human conversation.

Eventually I paid attention and pulled myself up short.  I blocked out a morning in my diary, the two of us had a good long talk, and I really listened properly.  I knew I couldn't solve her problems - there was a huge amount there, of which work was only one part - but we could look at what we could do in the office to improve the atmosphere.

So began the tea breaks.  Every day in the middle of the afternoon, if I'm not in the middle of a meeting, I grab my mug, announce that I'm going to the kitchen, and encourage my team to come with me.  Sometimes they do, sometimes they can't spare the time.  But when they do, they talk and relax, and those brief conversations make a huge difference to the rest of the day.   I can see what a difference it makes to the wellbeing and confidence of my younger colleague, and I have to admit, it improves life for me too.

Mental Health First Aid

Like a lot of people, the idea of mental health first aid appeals to me, and I wanted to know more. When my company announced that they were going to run a MHFA scheme and were looking for volunteers, there was a lot of interest. Eventually a batch of us were sent on a two-day MHFA course run by MHFA England (mhfaengland.org). It was a pretty good course, and I’m glad I went on it, but it wasn’t to everyone’s taste.

A few of our volunteers were upset by the course, and decided not to go ahead with the role. It was not at all what they’d imagined, they said. They had probably imagined it as more of a counselling role – that they would be learning about depression and anxiety. We certainly did cover these, but MHFA is directed at crisis – by analogy with physical first aid – so there was also a lot of discussion about illnesses that most people don’t encounter so often, like schizophrenia. Just as physical first aid courses have to cover electrocution or drowning or heart attack, rather than more familiar conditions, the MHFA course covered suicide prevention, psychotic experiences, and self-harm. Mental illness is unfamiliar territory to most of us, some of our volunteers had no prior expectation of what they were going to hear, and they didn’t much like it. I think I could fairly describe them as “appalled”: appalled at the prospect of having to deal with these situations at first hand. “I just couldn’t bear it if I saw that.” one of the people sitting next to me muttered.

Grouping all mental illness under one umbrella inevitably leads to problems. We talk about reducing stigma – we say its time to talk. But what most people actually mean is that its time to talk about mild to moderate depression. In general, people don’t ask what goes on inside the local mental hospital, they’re not curious to know what it’s like to hear voices, and they certainly don’t want to see your self-harm scars. Time to talk is a fantastic and important initiative, but a lot of people don’t even realise that it has limitations.

I found the MHFA course helpful. I doubt if I will have to use it much at work. Statistically, people with serious mental illness are much less likely to be in work, and if they do have a crisis, they may well have it outside office hours. But obviously I do have situations outside work where I have to deal with mental health crises, and I think it has improved my skills. I’m not sure I could really talk someone down from a suicide attempt, or calm someone down during a psychotic episode, but I have a better chance than I did.