Taking the 'PIP'

Two weeks notice then I lose a third of my welfare payments. It is the promised one third cut to disability payments as a result of the ongoing welfare reforms. Those who have followed this blog for any length of time will be aware that the first half of this year was dominated by the Work Capability Assessment (WCA) to decide whether I would be placed on the 'work' or 'support' version of Employment Support Allowance (ESA). The work based group received 33% less income and claimants are required to adhere to a punitive and cruel regime of seeking work and attending work related activity - as they have been deemed 'fit for work'. If they fail to adhere to arbitrary rules such as not being on time for appointments at the Job Centre ('on time' means even five minutes late, regardless of the circumstances) results in immediate 'sanction' - or suspension of payment of ESA ie the person being sanctioned has no income at all (it is estimated that thousands of individuals have died as a result of ill health following being assessed as 'fit for work' and nearly 60 suicides were attributed to the impact of the WCA and sanctions in the past three years).

Due to a deterioration in my mental health as a result of the pressures and anxieties around the inhuman WCA I was referred by my GP for assessment by the local Mental Health Services crisis team. Due to my presentation and the evidence presented from my medical records I was placed in the support group. This took place between February and July 2016.

By August I was beginning to stabilise and return to my recovery path, when I received a form to apply for Personal Independence Payments (PIP) as my Disability Living Allowance (DLA) was due to run out. Once again into the damaging cycle of trying to present the most accurate evidence of my condition and how it affects me on a day to day basis. To help those who are confused by this array of different 'benefits'. ESA is usually based on your national insurance contributions, and is a basic income. DLA was a payment (even if you were working) which was designed to help people meet the additional costs related to their disability. For me, it helped me remain in work for two years but on part time hours. It also meant I could maintain the cost of keeping a car which also enabled me to remain in work. PIP is designed to replace DLA.

When assessed for the WCA I was assessed by someone who clearly had training and experience of working within Mental Health Services. The questions related to my condition and the difficulties I faced in trying to get appropriate work. Although the process was highly distressing and resulted in a referral to crisis care, myself and my friend, who accompanied me felt the assessor did her best within a flawed system.

The PIP assessment was carried out by someone who by his own admission knew 'nothing about mental illness'. In particular when I asked him about his knowledge of mood disorders such as Bipolar and Personality Disorders and the similarity, differences and impact of their symptoms again he admitted his ignorance. But in the end it didn't matter because a PIP assessor's ability to deviate from the onscreen form which clearly is much more limited than necessary particularly in regard mental health conditions, is negligible. On the day of the assessment I had reached the end of a week long period during which I had suffered three or more severe migraine attacks due to the level of anxiety triggered by my receipt of the letter informing me of the date of the assessment. Given the levels of distress and relapse encountered earlier in the year I struggled to manage my worst anxiety symptoms. This included disrupted sleep through several nights of nausea and vomiting. Due to the threats of immediate loss of DLA payments if I missed the assessment and having used up my one opportunity to rearrange the original date so that my friend could accompany me, I had no option but to take all of the medication I needed to be able to at least function on a basic level.

Unlike the WCA assessment during which I was tearful and extremely distressed, I appeared, no doubt like a zombie in the PIP assessment. Despite myself and my friend explaining the impact of the WCA assessment on my mental health and my current consumption of beta blockers and migraine meds to manage anxiety symptoms, I was informed in the decision letter that he assessed me as 'presenting no visible signs of anxiety'!

I provided exactly the same level and quality of evidence in my written form as well as my answers to his questions, as the WCA interview, yet the outcome was not only vastly different, it actually resulted in an assessment of 'no need assessed'. This despite my explanation of the importance of being able to maintain access to my own transport in order to maintain friendships and stop isolation, as well as helping me to perhaps make money from tutoring when I felt well enough, as well as my concerns about creeping obesity as a result of my deteriorating emotional stability. I was unable to complete the cognition tests as a result of the migraine and beta blocker medication slowing my thought processes and as a result me becoming tearful and distressed because I couldn't complete a simple maths test. Instead of noting this down, he informed me that he had decided not to report my difficulties as it meant he would have to inform DVLA and could result in a loss of my driving licence. I accepted this at face value, but on reflection, this was a distortion of my presentation during the assessment and therefore, proved detrimental to my PIP application.

(Below is a graphic from information for candidates for PIP assessor roles published by Capita one of the larger private companies currently contracted to carry out assessments)

Initially, given that I have now spent the best part of a year dealing with the DWP assessing my mental health, a process which has severely disrupted recovery from long term mental health issues, I could not face anymore dealings with them. However, having found out the result and read the decision letter an NHS support worker has encouraged to go through the appeals process. This will be slow, probably take up to a year to complete and meantime I have to reduce my budget to an even lower level. I am in a better position than most, in some ways, as having a mortgage means that my monthly housing costs are lower than those who rent. However, ironically, if I were renting, I would have my house paid for entirely, so would not have to find monthly housing costs out of my much reduced income.

I have lost my car, which means that my access to paid work which will allow me to continue to manage my symptoms is even more limited as a result of this decision.

Given that I struggle on a daily basis to maintain a level of emotional stability, the uncertainty of nearly a year with my income being threatened has been unhelpful to say the least. Most of all, I am weary of the struggle. Yet, I know that having been able to work for nearly forty years, I have more resources than some. I have supportive family and friends who do not belittle me or ignore my value, because I have been struggling with this condition. I am aware that such understanding is a small oasis in a desert devoid of compassion or care for those we used to consider our neighbours. I have observed as the country I live in has descended into a morass of fear induced bigotry and ignorance of the needs and lives of others, particularly those in need.

It is painful to realise that the impact of Brexit has not caused much of a ripple in our wider media debate until people's own pockets and personal comfort was threatened by price rises to Marmite and Pot Noodle. My biggest fear was the loss of a protector bigger than the current cabinet and previous cabinet who have been prepared to impose austerity on the most vulnerable in our nation, in the name of paying down the deficit. Something, they have failed singularly to do. Without the EU there is nothing to stop the current government from pushing through the abolition of the Human Rights Act so that they cannot be challenged legally over erosion of disability rights.

Brexit was always more complex than the puerile sound bite farago which was foisted upon us as a nation. Unfortunately, some of those who hope that leaving the EU behind will solve all problems of poverty and inequality in this country will be sorely disappointed. The government voted into power in 2010 have deliberately targeted disabled people, over those of pension age, £9,000,000,000,000 is the current state pensions and other age related benefits bill. IDS stated in a recent documentary that it was a deliberate political and electoral decision. Think about that, we have voted twice for a government which has deliberately and carefully CHOSEN to take money from the most vulnerable in order to obtain and retain power. I know I need to be cynical, I know I need a thicker skin, but it actively hurts to think that the majority of fellow voters have also CHOSEN to vote for self preservation over collective good and battling the winds of economic and national storms together.

In order to manage to cope with the prevailing mood and rhetoric from the UK and the USA I have to retreat into box sets and pray for a change of heart in our government and nation.

I know I have written a long piece, and I am grateful if you have read this far. It is a way of explaining my lack of posts over the past year. I hope that it gives some small window into the reality of so many people. Not everyone has the platform or skills to be able to articulate the impact of PIP and WCA. Very easy for some newspapers and political party to dismiss. All I ask is for someone to speak up on our behalf. Surely our country is better than this?

Words (and their impact on Recovery)

'The verb is 'to crown'!' As I write I am shouting at a journalist, supposedly an artful practitioner of our language, telling me that someone is on in the process of being 'coronated'! Grrrrr. I would not call myself a grammatical tyrant, but really folks, English is so difficult to learn as a foreign language, precisely because we can carefully choose the words we want to use in any given context. I used to liken grammar to a train. It makes sense if you label in a very specific way... anyway I'm not about to launch into a Year 7 parts of speech lesson, although I have had a hankering for teaching recently. Anyway, the main thrust for my imagery was to convey to the children that how we structure our words is vital to helping us become really good at communicating what is in our heads to the world around us.

Of course as we grow older we find that not only have we left the childish belief that 'words can never hurt me' behind us, but we realise there are certain words which not only convey an idea, but can be loaded with judgement. Words like, 'unemployed', 'mentally ill', 'immigrant'carry with them sometimes very dark judgements, mostly about people who have a different background or experience to us.

One thing I have noticed as I have continued on my recovery journey, is that I am now more sensitive to certain words and, as a result, they can have a devastating impact on my emotions, often triggering feelings of failure. Sometimes it's a single word, at others it's a well worn phrase, or a sentence. Here is a selection:

Relapse. When I was working with drug users in recovery there was much discussion around 'lapses' and 'relapses'. Our mantra was 'a lapse is not a relapse...' I have found that when I face struggles in recovery from my emotional issues everyone refers just to a 'relapse' which to me means failure, going back to square one, letting myself and everyone else down. One word, but so much weight of judgement. I have combatted this by dropping the 're' and saying to myself 'a lapse is not a relapse' A lapse means that I have been overwhelmed by a moment, it is a temporary setback, recoverable. I can reset myself from a lapse. To me, for a relapse to happen means I have needed more extensive outside help to recover from out of control emotions and/or I have reverted to using self defeating coping mechanisms. It may seem a small thing, but the addition of a prefix totally changes my reactions and/or actions to recover again.

Mental Illness/Condition/Issues: I could call what I battle with, 'bagel', that way I can totally avoid judgements being loaded on me by others who have interpreted what suffering from a Mental Health Condition means. The problem is that without giving you my history and context the word is out of place and therefore fails to convey the ideas I am seeking to communicate. Hence it is problematic if I launch into my story by telling you that 'I was diagnosed with 'bagel' in 2011'. Sometimes I have the choice to ignore other people's judgements and values applied to certain labels and choose to redefine them for myself. If I believe that mental health conditions are just the same as physical health conditions, then why wouldn't I be willing to use commonly used phrases which are basically descriptive. The best way to tackle stigma is to introduce the ignorant to human reality. It is powerful to stand in front of a room and be able to admit that I struggle with my emotions and sometimes my thinking becomes clouded as a result. Particularly in recovery this can be more productive for me than focusing on trying to change people's use of specific words - why not simply introduce them to the person they avoid behind the labels?

Vulnerable v Fragile. One thing I heard through the DBT (dialectical behaviour therapy) programme was that although I may be emotionally vulnerable at times, I am not fragile. There is a song by Julia Fordham called 'Porcelain' and it expresses that frustration women often have when treated as 'weak', needful of protection. I know there is a paradox here. It is nice to be looked after, to know that people care for our needs. I guess there is a line, maybe it's similar to the one some relationships cross when 'protective' becomes 'possessive'. There is a sense of smothering, of not being trusted to be an adult, a loss of independence. I think there is an element of seeing patients as 'fragile' which contributes to the environments in Mental Health services which create dependence and that thorny little issue of 'learned helplessness'. Granted there are times when it would lovely to have a white knight swoop me up into his strong arms while he whisks me away from my daily grind and struggles. Except, those moments are really meant to stay in my childhood stories and now, sometimes in the cinema. Most importantly, for my ongoing recovery, to see myself as having vulnerabilities without being 'fragile' is important to giving me a sense of control over my life and more especially, my emotions. My goodness, if my experiences in life have not shattered me, there must be a core of steel in there somewhere. I may be a product of my past experiences, but I am no longer their prisoner.

The issues around Mental Health Stigma are part of a wider demonising and marginalising of certain groups nationally and internationally. I do listen to Donald Trump and worry that he is so oblivious to the power of words, particularly when conveying vacuous and bigoted ideas. In the end no word is an empty vessel, I need not only to take heed of my internal judgements, but also the fact that those who hear my words carry their own history which affects their interpretation of what I am saying.

Perhaps, the conclusion to my reflections here is that I should remind myself to hear what is behind others' words, as much as I expect others to move beyond their own (narrow) definitions of mine. Maybe we all need to take time to get to know people as people, take the pre-judgement out of our interactions. I know, I am Canute and the waves of words flooding our public spaces is the sea coming in around my feet. Only place I can start is here.

On Elections, Weather & Other things I can't Control

I started writing this post a few days after the Election Results. I broke off as I realised I was wholly in emotion mind and focusing on my emotional response to the whole campaign was not helpful in managing my emotions. Wise mind decision! Since then, I along with most of the country, have been trying to make sense of the re-election of a deeply unpopular government and waking up to the realisation that really so many felt they had no choice - despite being offered a choice of arguably the most varied range of political parties with a realistic prospect of gaining seats in parliament.

I will leave the politics to others who enjoy such things, but I need to make sense of some deeply troubling effects on my mental health from feeling helpless and hopeless about a process which is supposed to make me feel a part of society.

Don't get me wrong, I have encountered many people, including, presumably, those who voted for the current government, who have felt anything but optimistic and happy about the result. For me as someone with BPD (Borderline Personality Disorder), emotions are heightened and extended by the atmosphere around me, in addition to connecting with pre-existing feelings of despair and helplessness based on my life experiences. I am aware that Radical Acceptance is the right skill to use to move forward without becoming bogged down by my own self igniting feelings. Before I am able to do that I need to be able to identify the feelings that are affecting me most deeply.

1) Frustration - It has taken me three weeks, but I recognise that throughout the six weeks of campaigning I was in a near permanent state of frustration at the lack of real debate.

I was brought up in Northern Ireland, where political debate was highly emotive and strongly argued. No matter which political point of view was being represented it was always from the heart. Irish rugby teams are renowned for the 'fire in the belly' and relentless fight until the final whistle. I was weaned on such fight and passion in my politicians, whether I agreed with them or not.

Throughout this year's election campaign I was constantly dismayed by the lack of challenge from opponents of the government. More than that, there seemed to be a lack of real feeling for the impact of decisions on real people. I feel that important issues weren't aired in a truly Northern Irish level of debate - fiery and insulting, yes, but at least giving vent to strongly held opinions as well as based on facts. Another frustration was being well informed on important issues such as Health, Education and Justice and realising that, either by omission or design, the media allowed itself to be sidetracked into unimportant fripperies instead of pressing home on key points with all parties.

I felt no one was hearing my voice - and there in my frustration is where my past has met my present. As someone with BPD who for all my life has believed that I am to blame for every fault in life, either my own or others, the sense that I could not make my voice heard echoed back to the most painful moments of my life.

2) Injustice - because of the lack of real debate many who have suffered greatly in the past five years of austerity politics, again had no voice. All my life I have felt deeply inequality and injustice. As a survivor of CSA (Childhood Sexual Abuse) and in observing the scape-goating of some of our most committed public servants, I feel deeply any sense of injustice. I need to recognise when my own emotional sensitivity builds the sense of injustice to the point of being unbearable. Radical Acceptance seeks to take the sting out of that by acknowledging that actually, I cannot carry the sense of injustice for whole parts of society, on my own. Nor am I the only person who feels that injustice. Hard to hold on to when such a government has been returned to power. However, in seeking to manage the effects of these emotions there is a point where I must stop feeding the rising emotional stress and anxiety about the national situation and allow that I am powerless against it. Without wanting to fall into the cliche of 'Frozen' to 'let it go'.

Some years ago I had the privilege to work with displaced people in Northern Sudan. I don't think it is possible to find a better living example of injustice than the African tribes who were facing systemic genocide, and indeed, still do. As someone on the ground, it was impossible not to feel overwhelmed. Again, my emotional sensitivity meant that I automatically identified and joined my own suffering with the suffering around me. It resulted in me contending with culture shock alongside crippling emotional paralysis. Six weeks in, a colleague working for UNICEF spoke to me about how she coped. I now recognise the wisdom of Radical Acceptance. She said, 'Alma, you cannot change the world, but you can try to change the world for one person.' This along with the relationships built up with some war widows allowed me to see, that even the presence of outside observers able to point out the injustice was a boost to those we were working alongside. In essence the realisation that someone had just noticed there was an injustice, was a relief. I know a little of that from the moments when people have persisted with the message that it was okay to feel that what was done to me as a child was unacceptable. I also know how many times you have to hear it before you accept that it is true.

Back to the injustice apparent in the UK, I have a choice. Remain in my emotional paralysis. Or seek support from others of like mind and join together to make our voice heard. I have considered joining a political party, but I need to be free to vote according to my conscience rather than imposed party political ideas. So, I have decided to keep speaking as I am able about issues that matter to me. When I am stable and when it is unlikely to affect my emotional and mental health.

3) Fear - This week, I have suffered my most disruptive panic attack in months. In reality I have been living with a low level anxiety since the turn of the year. Most of my anxiety connects to my belief that I am worthless, something which has been reinforced by the divisive rhetoric which went on for over two months during the election campaign. At times I felt stabs of fear, as politicians divided human beings into groups of 'them' and 'us'. Having fought my mental illness over my lifetime and only been given a diagnosis which helped me access appropriate help at the age of 42, I have been dependent on state payments for three years now.

Having belonged to the 'hardworking' for most of my life - and paid into the state welfare system through tax and insurance for over 35 years, I now find myself vilified and disregarded by those in power. No major party spoke up for me effectively. At any point, because people in this country believe that the working poor, the disabled and those of us with mental health issues are 'undeserving' I could see the means to keep my head afloat pulled from under me. I am grateful for the provision that has been made for me, although would point out I have paid towards my own needs for many years. I am afraid to let people know that I am in receipt of benefits. I am afraid that I cannot keep up with my house repayments. I am afraid that the best option is for me to regress towards relapse than keep struggling to manage my condition. Having my basic needs provided for allows me space to do that.

The current 'new' government wants to increase the cuts to welfare, so that I don't become 'comfortable' on 'state handouts'. It believes, as do those who have voted for them, that all I need to be well is a job. I had a job for 35 years. I had excellent, well paid jobs for years. Finally, I was a shell of a person, because they did not address my underlying emotional and mental health needs. Because I have struggled to keep up with payments on all bills I have now fallen into fuel poverty. That means that 25% of my income is taken up with maintaining heat and light. Don't get me wrong, I have made major cut backs in an attempt to cut my costs. The fuel company has acknowledged that I have reduced my indebtedness and my annual energy costs are less than a third of those of an average household. Nonetheless the roll over deficit from winter to summer has not been cleared for the past three years, so here I am being told that I am in fuel poverty. That is hard for someone who has pride in self sufficiency to take. Such emotional struggles weary me. I am doing my best to find work that is sustainable and realistic. I cannot at present work five days a week. I am expensive for some employers due to my professional qualifications and work experience. However, the reality of managing my condition means that I need space in between periods of work - spaced out part time hours in order to prevent relapse. I have learned this over a long period of time (nearly 20 years) when I was most unstable.

What hope do I have of being allowed the time and space to fully manage my condition, when people who have terminal illnesses with a longer life expectancy of six months are being required to seek work? (one proposal from our caring government).

Behind these personal, practical fears is another more instinctive fear that as a nation we have moved beyond caring for one another, simply for being fellow human beings. Without being over dramatic I recognise in the dehumanising nature of some rhetoric and the blaming of specific groups for societal ills, historic echoes of the most heinous crimes against humanity from Germany, to Cambodia, to Rwanda. If you consider me as less than you, simply because I belong to a group 'other than' you, then that gives you permission to treat me as you will. It is hardly surprising that I have allowed this fear to grow as it has connected with the fears and realities I have already experienced as a survivor of CSA - a number of people in my life before have considered me as 'less than' and therefore given themselves permission to treat me in ways they would not wish to be treated themselves.

I have worked hard against these fears and against the labels that seek to push me down. In short, I have overcome more than anyone will ever know and I have the strength of recognising that I am more than, that I am precious because I am loved. I am not measured by how much in financial terms I can contribute, but in the person I am, the value I bring to my relationships, whether I have strength to help others less fortunate than me.

Despair - It is easy to despair and I fight against that. I need to relearn the art of hearing the positive in good relationships around me. I need to see the positives in the number of people dissatisfied with the election result. To know there are others close to me and unknown to me who recognise the injustices and the same fears for our nation.

My starting point has to be to accept the situation as it is. Just as I have to live each day in either rain or sunshine, without being able to determine or control either, so my task is to live my day to day as best I can in the society and circumstances I find myself.

Why am I not Employable?

It creeps up on me. It's a radiating paralysis. The day to day routines I have developed as part of my recovery go on, reinforcing a sense of progression, making me feel part of something... and yet. There are days when I am seized by unassailable anxiety, by a sense of foreboding, by fear that my recovery will result in having the financial rug pulled from under me. I am unable to scan job ads without triggering intensely negative thoughts and feelings about the prospects of any employer wanting to give me even the most menial of jobs.

I have never before encountered this feeling of being disposible, of not being any earthly use to anyone. My working life consisted of thirty plus years of different roles; from my first Saturday job in the local Baker's to my final role as a Probation Officer. In total between 1990 and 2012 I applied for ten posts. I always progressed to interview and was only unsuccessful in securing a post on four occasions. That is a good record - I think. I have gained qualifications and significant experience in Education, Communications and the Criminal Justice system.

The trouble with me is that, throughout my life, I have struggled with mental illness. All but my final employer were unaware of the extent of my struggles. At no point have I ever been warned over the quality of my work. If anything, as way of coping with my emotional storms, I have been a chronic over achiever. Hence the brick wall I hit every time I try to move forward in finding meaningful employment which allows me to be fulfilled, provide for myself financially, as well as maintaining management of my mental health.

Most agencies who are in place to help those with mental health issues back into work are limited in what they are able to offer me. Not all of those who suffer from mental illness have never worked. In fact any casual scan of social media discussions among the mental health community indicates that many people not only remain in employment, but are also employed in highly skilled and highly challenging careers. Without wanting to be crass I reckon I would be better qualified than most employment advisers in these agencies, particularly in my knowledge of the careers which are suited to my qualifications and experience. I don't have a problem getting interviews or even getting a job. What I need is advice and support about roles which can take account of the ways I need to manage my condition.

Most of all, the biggest hurdle I need to overcome is the suspicion in the back of a prospective employer's mind, that by employing me they risk harm to colleagues and those they may work with. My biggest challenge is in finding and maintaining consistency and stability in my moods. Ironically, steady employment is a key factor in helping me to maintain that stability.

I cannot battle mental health stigma in all its forms and fight my own corner in a competitive jobs market. Certainly not on my own. One of the biggest learning curves for me has been to accept the reality of an environment which denigrates the vulnerable and those who are perceived as 'weak'. All I can do is try to plead the case for an employer to take me on and trusting that I am applying for work at a time when I feel I am in control of my condition. Unfortunately, there are no guarantees that this will always be the case. I would point out though, that unpredictability applies to everyone. No employer can guarantee that their most healthy, go ahead, uncomplicated employee, will not succumb to a virus, an accident or some other physical or mental illness, rendering them unable to fulfil their role within the company. At least if I start to struggle with my condition, I am now skilled in recognising warning signs and taking action to prevent myself from slipping further into dysregulation. Am I really saying that I am the devil that it is better to know? Perhaps. At least the risks of employing me are knowable and therefore can be planned for.

The conclusion I have reached is that I am probably better to take on the risk of an employer by working for myself. It is sad that I don't feel there are any agencies who could help me beyond advice about CVs and interview techniques (been there done that, actually got the jobs!). It grieves me that employers find it easier to adapt buildings and other aspects of the physical environment for the physically disabled, than to engage in an intelligent discussion about the impact of the working environment and culture on those with mental health conditions.

We are caught between a rock and hard place. On the one hand I am constantly reminded by populist TV such as Benefits Street, that I am one of the drains on the nation's coffers. On the other hand, I am reminded of the fragility of my situation by employers who frankly would rather have a mediocre employee who is able to guarantee mediocrity 100% of the time, than the highly motivated and skilled 100% employee whose life could be disrupted 25% of the time. It takes investment of effort and resources to help me with the 25% of the time I may struggle - sadly few employers are prepared to do that for those with mental illness.

I think a lot of people perceive mental illness with suspicion because no one outside can see evidence of the illness, unless I am in absolute crisis. Do we need to wonder that self harm and suicidal ideation is so prevalent - dramatic it may be, but it gets more of a response than me describing my distress.

Here I sit, continuing with voluntary work in the hope that it will help me rebuild my confidence sufficiently to begin to apply for paid work again. I fear the consequences of having to work part-time, of needing to balance the reduction in benefits against work which pays the minimum wage. Above all, I am paralysed by the question, 'am I employable at all'?

Do Staff need to be Taught Compassion?

Sometimes I need time for blog posts to 'percolate'. The reasons vary, from me recognising that I need to consider the possible impact of what I am putting out there on others, to needing time to formulate my thoughts and feelings on a subject. I wanted to write about compassion in Mental Health settings since an incident before Christmas, but hesitated because my initial response was purely an emotional response to the distress of a friend. Before putting my thoughts in the public domain I needed to allow time and perspective before putting my thoughts down in black and white.

My friend is a diagnosed Schizophrenic who battles against his labels and the medicalisation of him as a person, who is more than his often disputed diagnosis. A few weeks before Christmas he suffered a major 'meltdown' - in his words. The first I knew of it was when he phoned me from the ward and asked me to visit him. This article could deal with the ongoing battles he has with his mental health team regarding his view of his auditory and other hallucinations or of his need for ongoing medication, but more than that I needed to highlight the lack of compassion he told me about on his admission to the PICU.

Over a period of some time he had been struggling with the increasing belief that he was a psychopath and therefore a major threat to those around him. He was terrified because he was convinced by these beliefs. Instead of understanding how terrifying these beliefs must be to him and the fears that they created in him about the threat he posed to those around him, some staff started to tease him, laughing about him being a 'serial killer' and even using the term 'path' when talking to him. 'Alright, path', 'harmed anyone recently, path?'.

It is a single individual incident involving one person that I know. What has concerned me most is the basic lack of human understanding and compassion for an individual clearly in distress and need. By definition, to be admitted to inpatient care in this day and age, indicates that by all clinical standards, this person is in urgent need of help. In the world outside I would expect the usual level of ignorance about mental health in general and Schizophrenia in particular, but inside a specialist Mental Health unit, surely even a modicum of professional pride and self respect dictates a better response than taunting a mentally ill man?

I try to be balanced in my consideration of such troubling incidents. I have tried to find reasons for members of staff responding in this way:

1) Stress and pressure - under-staffing, ongoing constant change and cutbacks, bring a weariness and cynicism, probably unthinkable in the early days of most of these staffs' careers?
2) Lack of adequate training about the symptoms and perceptions of Mentally Ill people who are in crisis?

Unfortunately, neither of these reasons adequately provides any acceptable rationale for the appalling lack of empathy and understanding displayed. I know in my twitter feed I can be political in my responses to the current state of the NHS, but I do believe that there is an ideological and moral battle going on for all of our public services. When patients, services users and others in need, stop being people and become units and target statistics, then the raison d'etre of our social care and health services is under severe threat.

If a person ceases to be a person, but becomes an obstacle to completing paperwork, or sitting in an office 'getting through a shift', it stands to reason that it is only a small step to not being able to see why you should 'waste' any human compassion on 'them'. And there it is: 'Them' and 'us'. There has been a rhetoric in public life which has separated us into 'camps' of rival 'tribes' of the 'deserving' and 'undeserving'. We are not in this together - or at least that has been the effect of much of the discussion in public around Benefits and other cuts to services. So the ironic comment that 'my job would be ok if it weren't for the people I work with.', ends up being a default which in turn

informs our actions towards 'those' people.

What most of the political rhetoric forgets is that for most staff in public services; NHS, Education, Criminal Justice, they did not enter a 'career path' or to seek 'progression', but most felt a vocation. Vocation cannot be conjured up, nor can its root motive, compassion, be taught or trained. I may attend any number of Mental Health Awareness training events, with input from service user perspectives, but if I fail to see the people I work with as worthy of compassion, then there is no magic bullet which will allow me to tick this off in my professional development portfolio.

Pity cries and walks away, it looks down on those in need. Compassion enters into the experience of the person in need and seeks to understand its causes and, in time, the actions which can be taken together to meet that need.

Don't get me wrong, compassion in public services costs those for whom it is the primary motivation. I would argue that the heart of compassion in many staff is why the NHS is the envy of the world. Day in and day out, committed, compassionate staff come along side the vulnerable and most hurting people in our society. This kind of response to need cannot be trained or imitated. You know it when you see it. I know when staff working with me are seeking to understand the roots of my distress. I know when staff are motivated by more than a pay packet or are just going through the motions. I know when someone, despite the limits of the system, sticks with me until, together, we find a way through to recovery.

I have been on both sides of public service and I know that when I meet staff who recognise our shared humanity, then there is a strong foundation on which therapy and medication can be built. Rather than mock the beliefs of someone in the throes of psychosis, humanity asks, 'What would I want someone to do if it was me?' Relationship depends on trust, therapeutic relationships begin with a compassionate assessment of another human being and their needs - some of them shared by all people, even me. If you view the people you work with as 'them' rather than 'us', maybe it's time for a change of career, or a holiday?

In the Lion's Den

There are many lions to face in life. The challenges and difficulties that, if left unchecked, could devour me. The most fearsome of these for me and many with Borderline Personality Disorder (BPD) is the one called 'rejection' or, more accurately, 'fear of rejection'. Given that as a child my parents could ignore my needs and, my very presence, it is logical that, as an adult, I will have an almost unshakeable belief that there is something in me which causes people to ignore or reject me - out of hand, automatically, simply because I am me.

So, for me the very process of job hunting and applying for jobs feels like launching myself, bowed and bloody, into the den of the biggest, fiercest of all my lions.

Along with Simba, in the Lion King I proudly shouted 'Hah, I laugh in the face of rejection' as I recently launched myself into the once familiar process of CV writing and application letter preparation. I seem to do this well as I manage to get myself to interview stage quite often, and this is where I meet another of my lions. Hope. If job hunting ends at the application stage, then this smaller, possibly more sinister lion remains sleeping peacefully in the background. However, the period leading up to interview always results in him awaking and growing in stature.

A little something about me. My stuggles with depression and BPD aside, I am an eternal optimist. Hence, year after year, I would put all my efforts into constructing the perfect Christmas, overspending wildly in an effort to reconstruct my dysfunctional family into my version of the 'The Waltons'. So when it comes to any little shred of encouragement ie an invitation to attend interview for a hoped for job, I will become my optimistic twin sister, who has absolute self belief. Sham. All this does is build me up for a fall. Then again, I need to be able to summon from somewhere the wherewithal to keep job hunting and moving forward somehow. I guess this may be one of my flawed coping mechanisms, although I suspect I am not altogether different from most people. I mean if you can't see yourself in the role you're applying for, then how can you possibly sell it to any prospective employer?

So far, so average. The problem for me lies not in this side of the application process, but in the emotional fall out from such investment when I am unsuccessful. Apart from natural disappointment, the million and one hurts from all the rejections of my life add up to make for one massive cold, wet, Trout in the kisser! Along with mental tiredness and disappointment following the delivery of the bad news, the rejection lion roars out his 'told you so's'. I am reduced to a quivering wreck before him. Of course he's right, every time I try to move forward, I am bound to fail simply because that's what has always happened. I mean who would want to employ me, I am after all 'unemployable'. Along with this crushing sense of self defeat, I am also assailed by the roars of derision from Rejection and his pal, Hope, 'ha, fooled you into believing that you could be valued.' Again, the overwhelming realisation that of course there's no point in my ever trying to get a job, because no one wants to have me around them, full stop, let alone working for them.

There I am on the floor of the lions' den, with Rejection and Hope (or as he has now become), his alter ego, Despair, circling me, licking their lips. I have a choice at this point, I can either allow all the missiles coming from the ghosts of my past looking on with glee to keep me down, or I can stand up and face the lions.

It's either this or give up on ever finding an occupation which can provide me with an adequate income. There are enough obstacles to my satisfying any prospective employer, given my history of mental health, without me having to overcome my own emotional and historical 'lions'as well.

This is where my reasonably newly acquired DBT Skills need to be used in earnest. I need to manage my emotional distress, because it is not nice, after all when someone doesn't choose me for a job I obviously had thought I wanted. I need to acknowledge the disappointment and hurt, that's natural and understandable. I need to make myself control the negative thoughts that are my natural default - thought diffusion exercises help with this (Mindfulness). This is where my determination and fight need to begin, otherwise I have no hope of ever re-entering the workplace. I need to learn to validate myself, unlike other rejections a work rejection is not personal - hard when I am in the thick of it to grasp hold of, but I need to remind myself that my skills were not what they wanted. It is not me as a human being who has been rejected. This, again is hard for me, as most of my sense of validation in the past came from being a high achiever in work environments. I could manage my emotions when my mind was allowed to focus on the task in hand. At the moment in my life, I don't need to be validated as a person - I have people who love me who do that. So far so very DBT, reality is that I have to repeat the use of my skills over and over as waves of self condemnation wash over me, followed closely by cycles of anxiety about my future and my ability to provide for myself.

Right now, in between the crash of the waves, I am aware that I'm no longer in the lion's den. I have begun to stumble from the grasp of my lions. The emotional waves that are crashing on me, resemble the sound waves from their roars of derision. I need to grab hold of my bottle of lemonade, and prepare myself for the next time. There is no point in me feeling sorry for myself. Yes, I've had a lot to overcome, yes it feels as if I am due some good fortune, but that's not life as it is. For me to constantly expect that life should be fair, is the real definition of insanity. After all, I just wasn't right for THIS job.

Kindness, Please!!

I have been musing on kindness this week. It's not been about a nebulous benevolence to all 'mankind', but rather in regard to the way that people debate with one another online. I am new to tweeting and blogging. I keep telling my friends who are sceptical about all the good that can be achieved when communities of likeminded individuals come together to support and encourage one another. Never is this more important than when publicly highlighting issues around Mental Illness.

Since I was diagnosed with Borderline Personality Disorder (BPD) over four years ago, I have faced stigma and ignorance from employers, erstwhile friends, family members and through the media. Over and over again I have had to find the strength to 'explain' my symptoms and why people can't identify me as struggling with psychological and emotional distress from some kind of 'red letter' brand on my forehead. It has been a relief therefore, to have found online a community of people who have or are going through similar experiences as me and to know, ultimately that I am not some kind of alien stranded on a planet far from my home, that there is a community I can belong to and know that when I have had a difficult distressful day, I can come online and find understanding and support. Who knows maybe the online MH community is a colony of aliens on earth! Which is why it is so important that we are good to one another.

I know others with a more articulate plea have tackled this issue, but I felt I needed to add my own voice to the requests for us not to bring one another down. As a community, we have so much to overcome, either we need one another's support or we are not a community. I have not been on the receiving end of much abuse online, most debates I have had with people have been considered and helpful in the main. I have observed a number of negative interactions with people who have achieved so much good for the MH debate and community and mourn over the distraction, as well as the distress which is added to people who have been brave enough to become a public face of Mental Health issues.

I have experienced the lashing out of fellow sufferers in real situations which have caused me real distress. I know that I have done the same when feeling out of sorts and distressed. In real situations, however, my regrets mean that I am able to seek out the injured party and repair the relationship. Online victims of abusive interactions only have one remedy and that is to block the person being abusive to them. There is no chance to repair relationships. Added to this is the fact that online arguments and debates are word limited by the applications themselves, therefore, are open to significant misinterpretation.

A long time ago, before Facebook or Twitter, I was on a weekend residential with a group of Sixth Form girls. At 2.00 a.m. on Sunday I was forced to confiscate a mobile phone from the quivering hands of a sobbing, drunken (yeah we didn't search their bags on entering the hostel!) 17 year old girl who was in the middle of a text row with her (equally) drunken boyfriend. Immature and laughable, huh? Let's look at the key factors, emotional instability, substance related fogginess and word limited communication. The next morning, I returned the phone - after the epic hangover wore off she and her boyf actually spoke to one another on the same phones - with no word limit. They broke up completely a couple of weeks later...

But you get my point. Sometimes when someone from the MH online community expresses their distress or an opinion about their treatment etc, consider one or two factors before you press 'Tweet':

1) Have you earned the right to comment on someone else's experiences? If you have not followed someone for long enough to know the context in which their comments are made, maybe you will not have the full picture - remember 140 characters when you are emotionally distressed is not a lot of space in which to adequately provide a medical or psychological history.

2) When you read your comments back, do they offer something to the original tweeter that is positive? Sometimes if I am emotionally distressed I can easily misread someone else's tweet and respond to my own pain rather than the content of their comment.

3) Are you emotionally stable? If not, should you take a break from twitter or facebook? Often, when I am feeling vulnerable and raw I tend to avoid going online, because I know I have misread emails from friends in the past and ended up feeling hurt with no reason. Take care of yourself and don't get involved in unnecessary arguments with someone online.

4) Is what you are saying helpful or kind? Think about what you would feel like if you had posted about feeling highly distressed and then received your tweet? Would it cause you emotional damage? If the answer to any of these questions is 'yes', you have no right sending that to someone else especially if you do not know them outside of the 'twittersphere'.

5) Given the character limit, is your comment open to misinterpretation? If yes, then, think twice before hitting 'tweet'.

6) Above all, ask yourself, the purpose of the original tweet - was it just an expression of someone's experience or were they really asking for you to solve things for them? Very often when people tweet their distress, all they need is understanding and the knowledge they are not alone. You don't have to solve their distress, just show you care.

7) Ask yourself, are you this person's CPN or therapist? If not, then maybe offering solutions or advice on medication is not appropriate. Again, if you don't know someone's medical history then you may be offering dangerous or misleading advice.

8) My experience of BPD is different from everyone else's experience of it. There may be similarities particularly in regard to symptoms, but I need to respect your right to tell me that things that might have worked for me, may not be right for you. If someone tells you that a treatment or medication is not right for them, please respect their right to know themselves and what works for them.

Don't forget behind those 140 characters is a three dimensional, hurting, person. If you would be kind and considerate towards that sort of person in real life, then please apply the same principles to your interactions online. After all, we have so many other battles to fight against MH stigma and ignorance. Let's direct our energy into the right battles.