Tag Archives: Samaritans

An organisation which can help anyone with stress, depression, anxiety or any mental health problem for whatever reason by listening on the telephone , talking on- line, meeting at a centre or sign posting to a more appropriate service.


Are re you a carer?

If you look after your partner, or a relative or friend who is ill or disabled, you are a carer, even if you don’t think of yourself that way.

There are many ways that you might care for someone.

For instance you might:

  • be on hand 24 hours a day to provide care
  • arrange hospital appointments for someone
  • drop round each day to keep someone company or cook their dinner
  • visit a relative who lives far away once a month to see how they’re doing.
  • Whether you’ve cared for the person for a long time, are temporarily helping them (for example, while they recuperate from an operation), or have just become a carer, take time to review your options and find out what support is available to you.

To establish your rights as a carer refer to  Age UK on the following link

The Care Act comes into force in May 2015. It changes the way the social care system will work in the future.

You’ve probably heard about the biggest change: a care cap that means no-one will spend more than £72,000 of their own money on their care needs.

If you need care, or look after someone who does, you’ll need to know how care is changing.


Ways it may affect you from April 2015:

  • You will have a right to a free needs assessment from your council, even if it thinks your finances are too high or your needs are too low to qualify for help.
  • All councils will use a new national eligibility criteria to decide whether someone can get help from them.
  • If you get social care support, you will now have a right to request a personal budget if you’re not offered one. This is a summary of how much the council thinks your care should cost. This might be useful if you want to pay for your own care. This will become more important when you have a care account from April 2016 (see below).
  • If your needs assessment shows you don’t qualify for help from the council, they must advise you how the care system works and how to pay for your own care. So if you just need a hand with housework, for example, the council should assist you in finding this.
  • You can defer selling your home to pay your care fees until after your death.
  • If you’re paying for your own care, you can ask the council to arrange your services for you. It can only charge you as much as someone whose care they are funding.
  • If you’re a carer, you have a legal right to a care assessment from the local council. You can also get support services if you qualify for them.
  • If you find it difficult to communicate or to understand the issues being discussed, the council must provide an advocate to help you when discussing your care. They will represent your interests if you don’t have a friend or relative who can help
  • The council must provide preventative services that could reduce or delay your need for care. For example, intermediate care at home after a hospital stay could help keep you independent for longer.

Ways it may affect you from April 2016:

  • It becomes even more important to get a needs assessment, as the council will then set you up with a care account. This tracks the amount of money spent on your eligible care needs. The word ‘eligible’ is important as it only includes the needs covered by your assessment. So if you decide to hire a cleaner but the needs assessment doesn’t say you need this help, the cost of that won’t be included.
  • There will be a cap on how much you have to spend on your care needs. Anything you or the council spend on your eligible needs will be added up in your care account. Once it reaches £72,000, the council will pay for all your eligible needs. This excludes your daily living costs, which include things like your food and accommodation in a care home.
  • The council can reassess your care needs, even if you pay for your own care. This is because the council works out how much your care should cost to meet your eligible needs, and adds this up in your care account. It needs to check every so often that the amount it thinks you should be spending is still right.
  • New rules about top-up fees in care homes mean you may be able to pay them yourself. Top-up fees may apply if you move into a care home that costs more than the council can pay.
  • If you’re not happy about a decision, you have a new right to complain and appeal it, and for this to be independently investigated.


                         For more information:
Call Age UK Advice: 0800 169 6565

To all carers

You  can obtain local support at the Ealing Carers – details on a previous blog

When you’re caring for someone it’s easy to overlook your own needs. But looking after your health and making time for yourself can help you feel better and manage better with your caring role.

Your health

Tell your GP you’re a carer, and discuss the impact this is having on your own health. They will be able to offer you advice and support, and you may be entitled to additional health services such as a free annual flu jab if the person you care for has a serious or ongoing health problem.
Although it can be difficult, try to make sure that you eat healthily, stay active and get enough sleep.

Don’t feel like you need to do everything yourself. If you have relatives who live nearby, try to be honest with them if you need a hand or want to share the responsibility.

I’m Emotional health

Don’t overlook your emotional health. Family and friends, carers’ groups , your GP or counsellor, or organisations like Samaritans can all provide you with space to talk about how you’re feeling.


If you care for someone with dementia, it can be hard to share any feelings of guilt, sadness, confusion or anger with them, leaving you feeling isolated. It’s important to acknowledge your feelings, and remember there’s no right or wrong way to feel.


Your social life

It’s a good idea to take up a hobby or activity, such as going to an exercise group or an evening class, if you can. Taking part in an activity you enjoy will give you the opportunity to do something for yourself – it’s important that you have your own interests and make time to pursue them where you can.

Your local library can provide information about social activities, events, education and courses. The University of the Third Age (U3A) can also tell you about courses in your area.

Please refer to a previous blog


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Recently when I was choosing a book for my grandson I started to recall the many books I had read to my own children and then I stumbled on the book ‘We are going on a bear hunt’ by Helen Oxenbury’. I remember this story as one we used to tell each other around a camp fire when I was camping with the Girl Guides many years ago! We loved to build up that fear and scream out and then that that lovely feeling when all was well. Children love to feel fear when they know they are safe and can be reassured and know there will be a happy ending and I suppose that’s why so many popular children’s stories have an element of fear attached and why theme parks are so successful. It’s not just children as adults we sometimes get pleasure by experiencing a frightening experience as long as we are can somehow remain in or regain control.

Just to remind you of the emotions and feelings of fear take a look at this video of ‘We are going on a bear hunt’

How did that make you feel, how did you feel the characters feel? Did you see the fear on their faces, feel their heart thumping, their frozen fear, their legs and body shaking, breathing accelerate and become shallow and then witness their flight from the situation to find the safe haven of the bedclothes.

We have all been there whether it is before an examination, a job interview or an audition or going to experience something or someone unfamiliar. But sometimes there is feeling that flight is impossible and the safe haven does not exist.
This famous painting ‘The Scream by Edvard Munch’ (1893) portrays the sheer agony of his personal anxiety. He was taking a stroll along a path by the side of a beautiful fjord in Norway and instead of him finding it a pleasant, relaxing experience he became full of fear and indescribable anxiety.

The screamIn his diaries this is how he describes the event:-

“I was walking down the road with two friends when the sun set; suddenly, the sky turned as red as blood. I stopped and leaned against the fence, feeling unspeakably tired. Tongues of fire and blood stretched over the bluish black fjord. My friends went on walking, while I lagged behind, shivering with fear. Then I heard the enormous infinite scream of nature.”

I recall many patients who have attended surgery where fear has been so overwhelming that they feel frozen, unable to carry on, unable to face going to work or school even unable to get out of bed. One such patient came to me following a panic attack ( an extreme feeling of fear ) which occurred just before she about to sing a second Aria on Christmas Eve at the Chapel Royal. She had sung the first Aria beautifully then she became so overcome with anxiety she was unable to sing the second Aria.
She had graduated from Cambridge with a double First in Music and was about to launch on a career of being an Opera singer. She was devastated and felt her whole life had crumbled. Thankfully with treatment she overcame this anxiety and was a wonderful moment when I went to hear her sing in an Opera at St.Brides, Fleet Street. I think I was more anxious than she was! She then literally went off into the World to sing.
Other patients never make to the surgery but languish in there beds or at home too fearful to seek help.
These are the sort of patients that cannot wait in the waiting room and pace up and down the corridor or outside, desperate, on edge,trembling, asking for a glass of water or may simply walk out. Having talked to them I have shared their feelings, felt their anxiety and fears and now we try to arrange a time when they can come to be seen with a minimal waiting time, and we hopefully give them time to express how they feel because I know that if they are seen we can help treat this condition and they will ‘go off into the world and sing’
Ways we can signpost you to get help:-

    • We have an in-house counsellor Tony who sees patient on a relatively quiet time in the surgery and a chance to give space to talk.
    • a referral or self referral to IAPT
      You can phone or email as below
      Telephone 020 3313 5660
    • we recommend self help books such as:-
      A sequel to Danny Penman’s other book ‘ Finding peace in a Frantic World’
      These can be obtained from Amazon as a book or downloaded onto a kindle

‘Want a happier, more content life? I highly recommend the down-to-earth methods you’ll find in Mindfulness. Professor Mark Williams and Dr. Danny Penman have teamed up to give us scientifically grounded techniques we can apply in the midst of our everyday challenges and catastrophes,’ Daniel Goleman, author of Emotional Intelligence
Many patients have been grateful to having this book recommended to them. – this can be easily printed This has a useful podcast from someone suffering anxiety and how it was overcome and a booklet with information and ways to help anxiety

  • join a Yoga class or follow a class on YouTube or try the following 10 poses
    which I have re blogged to follow this blog.
  • finally if you are feeling too desperate to leave your home, phone a friend or seek help outside there will always be anytime day or night a sympathetic listening ear at the end of the phone from the Samaritans. Hence, everyone reading this I suggest that as Dr Livingston and myself have done make sure the number is on your mobile or near your phone as none of us know when we may need to phone that number.

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I  wrote in a blog last year with guarded optimism that the stigma of mental  illness was declining but sadly at the present time nearly nine out of ten people who experience mental health problems say they face stigma and discrimination as a result. This can be even worse than the symptoms themselves.
Feb 6 Today the programme Time to Change, England’s biggest programme has been launched to challenge mental health stigma and discrimination.

There are lots of simple, everyday ways you can support someone who has a mental health problem.


Read more tips about the different ways you can be there for someone with a mental health problem on the website below:-


Remember if you need to talk at any time of day or night any day of the year there is always someone at the end of the phone:-

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Posted by on February 5, 2014 in Training and Advice


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imageWell done all those runners who completed the half marathon and the mini marathon yesterday! I recognised at least 3 names amongst those who were amongst the runners. Congratulations on raising money for so many worthy charities. Training for this event has meant a lot of training and if you want to consider next years event and keep fit at the same time you may need to start now! The planning and preparation of the Ealing Half Marathon on race day was supported by Ealing Eagles Running Club image which is a friendly and social running club in Ealing, founded in 2009 for runners and joggers of all standards, from beginners and novices to expert racers, in the Ealing, Perivale, Greenford, Hanwell, Northfields, Brentford & Acton area. If you live, work or are just passing through the Ealing area,you can join one of the Ealing Eagles training sessions. Charities supported It was interesting to learn about those charities, most of which support local causes, that benefitted from runners who raised money by being sponsored. I am afraid I was not aware of several of these charities and felt it was an opportunity to promote their work in our community and beyond. The headline charity of the race supported was:- image Epilepsy Action exists to improve the lives of everyone affected by epilepsy. As well as campaigning to improve epilepsy services and raise awareness of the condition, Epilepsy Action offers assistance to people in a number of ways including a national network of branches, accredited volunteers, regular regional conferences and freephone and email helplines.

*************************** image Ealing Mencap provides a wide range of services and support to people with learning disabilities in west London, as well as their families and carers. *********************** imageC-A-P-E is an established registered charity offering a dynamic and flexible outreach and day service for people who experience severe and enduring mental health difficulties living in the London Borough of Ealing. Cape aims to improve the quality of life of the people who use the service by; * Enabling clients to access meaningful activity. * Facilitate clients to build relationships with others who may be isolated. * Offering support – emotionally, practically and socially. * Helping clients to access a range of health and social care provisions. * Helping clients make informed choices about their lives. * Promoting the principles of recovery. Visit their website for more information *********************** image Shooting Star CHASE is your local children’s hospice service, a charity caring for local families with a child or teenager with a life-limiting condition. We currently help over 600 families living in western London, Surrey and West Sussex. Our aim is to make every day count for these families. We are here for every step of their journey, sharing the good times and helping them through the tough times with practical, nursing and emotional support. ********************** image We work through local churches to unlock people’s potential, helping them to discover that the answer to poverty is within themselves. When disasters strike, we respond quickly. We won’t stop until poverty stops. At Tearfund, what drives us is a belief that the local church is a powerful force for transformation in communities living in every kind of poverty. Inspired by the example and teaching of Jesus, we recognise that people have deeply interconnected material and spiritual needs, and we seek to meet those needs by working through our local church partners. Churches are at the heart of their communities – full of dedicated, resourceful people who want to make a long-term difference. We work particularly in Africa, Asia and South America – and also across Eastern Europe and the UK. Right now, we’re focussing on some of the biggest challenges facing the world today. Find out more about what we do and where on our website. ************************ image Imperial College Healthcare Charity is an independent charity that raises and manages charitable funds for all five hospitals within Imperial College Healthcare NHS Trust: Charing Cross, Hammersmith, Queen Charlotte’s & Chelsea, St Mary’s and Western Eye hospitals. We work with Imperial College Healthcare NHS Trust to pursue three key objectives: Great Science – enabling clinical research and advances in healthcare. By supporting staff to deliver advancements in medical science, we can make improvements to the treatment patients receive. Clinical advancements can help reduce the time patients spend in hospital, reduce their discomfort and make improvements to their rehabilitation and recovery. Excellent patient care – making a measureable difference to the patient experience and delivery of care. Excellent staff are key to ensuring excellent patient care. We therefore provide grants to staff for training and personal development. We also support the Trust to recognise excellent staff through a range of recognition awards. The use of art has long been recognised as an effective way to improve the healing environment. We manage an art collection of more than 1,600 pieces that are displayed across all five Trust sites. A healthier community – supporting projects that tackle health inequalities in the communities served by the Trust There are huge disparities in the health of the communities where the Trust’s hospitals are based. By funding local community organisations and initiatives, the Charity is able to support the Trust, in accessing some of the hardest to reach communities, where health problems prevail. ************************ image In 2010 22 year-old Holly Bantleman set off on a soul-searching round-the-world trip, hoping to have that ‘life changing’ experience and during this trip she visited Kenya. Raise the Roof Kenya’ began after she visited a village on a dump site called ‘London’ in the town of Nakuru. The area had sprung up after the 2007/2009 electoral violence in which so many people were displaced. Over 250 people, many children, set up camp on the landfill and found themselves with no means of escape, relying on the rubbish truck for their food, with children playing in rags, barefoot and literally starving. Initially the the idea was to raise the money to buy tin roofing for the people living on the landfill without food or shelter and to eventually provide a long term solution for their plight. With that mission accomplished after raising money through UK donations, several more visits to Kenya, and many more eye opening experiences, Holly decided that RTRK would become a long term project. From school fees and medical bills, to housing and small businesses, RTRK have managed to support children and families in destitute situations. Now spending a third of her year in Kenya, Holly has noticed a lack of opportunity for the bigger teenage kids, (she was one herself not so long ago!) so has found another directions in which to take RTRK – the ‘Think Big’ Project is the Barut Development Centre build. The idea is for us to provide the community (the poorest in the area) with a sports ground, community centre and vocational school so people can gain education and training to go on and live sustainably in the future. ************************** image St Mungo’s opens doors for homeless people. Mainly based in London and the South, we provide over 100 accommodation and support projects day in, day out. We run emergency homeless services – including street outreach teams, and accommodation for rough sleepers and hostels. We support homeless people in their recovery – opening the door to safe housing, drug and alcohol support and physical and mental health care. We provide more help for homeless people in gaining life skills than any other charity – from job training to independent living skills in our ‘semi-independent’ houses. Preventing homelessness is very important to us. Our ‘complex needs’ housing provides safe and supportive homes for nearly 400 vulnerable people. Our community support teams work with thousands of people at risk – including former rough sleepers. By opening our doors, and by opening the doors to services within St Mungo’s and in the broader community, we are able to help thousands of homeless people change their lives for good every year. ************************* image TALKING GOT ME THROUGH Talk to us any time you like, in your own way, and off the record – about whatever’s getting to you. You don’t have to be suicidal. WELCOME TO THE SAMARITANS EALING BRANCH If something’s troubling you, get in touch: Telephone our branch: 020 8560 2345 Email Samaritans: Visit our branch: Samaritans London 26 Junction Road Ealing London W5 4XL Usual hours open to receive callers at the door: Phone for details Facilities for visitors with disabilities: Phone for details ************************ image ECIL is a membership organisation representing and supporting disabled people and carers, of all types and of any age, who live and work in the borough of Ealing and surrounding boroughs. We are proud to be part of the Independent Living movement and are one of a growing number of Centres for Independent Living (CILs) around the country. The government strategy paper Improving the Life Chances of Disabled People published 2005 recommends that there should be a CIL in every local authority area. ECIL was formed as an independent organisation in 2002. We gained our charitable status in that year. We are now funded by Ealing Council and the Ealing Primary Care Trust. ************************ image The Gabrielle Gray Foundation is a charity founded in the memory of my sister Gabrielle Emilie Gray Giam (Gaby) who passed away on the 16th of August 2012 at the age of 31. The Gabrielle Gray Foundation was inspired by the compassion that Gaby showed towards others throughout the 31 years of her life. Some of her last advice to us was to not be bitter, to be grateful for everything and no matter how bad things seem they can always be worse. These wise words remind us of how fortunate most of us are. The Gabrielle Gray Foundation will be helping young vulnerable adults between the ages of 18-24 in West London. Help us to help others who are less fortunate and continue her legacy. If anyone reading this may have benefitted from one of these charities or who ran the half marathon for another worthy cause it would be great to publish your story on this site, which aims to talk about health and related issues especially of local interest.

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Posted by on September 30, 2013 in Training and Advice


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EALING HALF MARATHON – 29th September 2013


Come and cheer on the ECIL All Stars, who are running to raise funds for disabled people and carers in Ealing. The Half Marathon starts in in Lammas Park from 9.15am. If you’d like to sponsor us, contact Wendy on 020 8840 1566 or

Ealing Centre for Independent Living. ECIL is an organisation of disabled people working to eliminate the barriers preventing disabled people from living full and independent lives.
Come to ECIL for everything you want to know about Disability, but were too afraid to ask. We offer advice, information and we can help you get what you need to live an independent life. It’s FREE to join, so why not become a member.

The 2nd Ealing Half Marathon will take place on Sunday 29th September 2013 in Ealing, West London
One of only three fully road closed half marathon events in London the race will start and finish in Lammas Park, one of West London’s most picturesque parks and take in parts of Central Ealing, Montpelier, Pitshanger, West Ealing, Hanwell and St Stephen’s before returning to Lammas Park.

Ealing Mini Mile
Ealing Half Marathon are pleased to announce the Ealing Mini Mile for 2013. It’s our new race open to children aged 6 – 11 years of age with the route taking place in and around Lammas Park.

The children’s race is run over a course of approximately 1 mile and starts at 9:30am (after the runners have left Lammas Park at the start of the Half Marathon). Entry is £5 with prizes up for grabs for different age categories plus a medal and t-shirt for all finishers.

The race is well supported and will become a popular feature of the day with many children from local schools competing as will the offspring of the Ealing Half Marathon runners and junior members of local athletics clubs.

Free workshops for carers return!

Supporting carers is something that we as a practise, part of a network and the ECCG want to strongly support. Many people of all ages act as carers without payment, unconditionally giving all-round help and support to a friend, neighbour, relative or another person.

Many people who are caring for someone do not necessarily see themselves as a ‘carer’. Rather they are mothers, fathers, daughters, sons, partners, husbands, wives or neighbours. However, being identified as a carer by the council can help you get the right support you need to look after the person whom you care.
The Carers’ Centre is a resource and support centre for all unpaid carers, of any age, in the borough. The centre is managed, in partnership with Ealing Council, by Carers Connect, a consortium led by the Ealing Centre for Independent Living and including Ealing Mencap, Dementia Concern Ealing and Crossroads Care West London.
Following the success of the pilot course for carers earlier this year, Ealing Carers’ Centre is once again running a series of FREE workshops at the Carers’ Centre in November.

The aim of the course is to improve the skills and confidence of people who are caring for a family member or friend at home, and to help them find ways of making more time for themselves.  It is NOT designed to train people to become paid care workers. Twelve places are available and the aim is for participants to attend all the workshops. The workshops are open to all carers who live in Ealing and/or care for someone who lives in Ealing.  The closing date for reserving a place is 7th October.

For more information, please contact Cecilia Coleshawat or on 020 8840 1566.

If anyone reading this blog has taken part in the half marathon or wants to make a comment about any of the organisations for which money has been raised please make a comment or email


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What is ‘mental health’?

I am now continuing to air my views on mental health along with ideas that I have extracted from the Slovenian psychiatrist Andrej Marušič I mentioned in my last blog about depression
I have often wondered what we mean by Mental Health and was interested in his ideas but then when I read the news today proclaiming that one third of children under the age of 16yrs contemplate suicide I realised that the mental health of the nation is a serious problem and stretches deeper than one could imagine.
Mental illness accounts for 23% of the UK’s total burden of disease (compare this to cardiovascular disease or cancer which each account for 16% of the total burden of disease). Yet only 13% of current NHS health expenditure is on mental health. The World Health Organisation estimates that depressive disorders were the third biggest global health problem in 2004 and by 2030 they will be the largest.
What is important is, that when we talk about ‘mental health’ we take into account everything we see – appearance, behaviour, the way the person moves and what they say. Based on this we can assume what we think and guess which mood someone is currently in. If I was crying five minutes ago and then yelled at you in the next five minutes you would probably think my mood very unstable and would benefit from seeing  a psychiatrist.

This is mental health, as we see.  Psychiatrists frequently make assumptions – GPs do the same – and, actually, this is not a big deal. Firstly,what we see and assume about mental health, about the health of someone’s mind, is captured between two very important determinants – one is genetics and the other is environment.

Genetics may appear less important when it comes to mental health, but that’s not true because two thirds of our genes determine our brain function, whilst the remaining third determines all our other organs. Hence, genetics is very important when it comes to mental health, but clearly it is not the only thing that is important. Each and every one of us is like a book – full of genes that only express themselves if we allow them to do so. If you spent all your life in the same town and had the same job as your father who also lived and worked in the same town all his life, it is clear, that you will be more likely to suffer the same diseases as your father. But if you move from one town to another , or even another country, you would probably be experiencing something else as different genes would appear in your book.
But we must remember that we should never underestimate the role of genetics in mental health. For instance, have you ever heard of two elderly people in care homes been accidentally “swapped”? I doubt it. Babies, however, have been accidentally swapped. This implies that our unique genetic fingerprint becomes more defined each day and with every day we become more and more who we are, and those of you who would like to be as different as possible from your parents should be aware that we become more and more like our parents every day.
I have to say when I worked in a community in South Wales where extended families stayed in the same village or town and rarely moved away the genetic element of disease was very more obvious but when I came to London I have been aware of how the environment has more of an impact on health. I remember a type of woman who functioned reasonably well and then periodically took to her bed unable to open her eyes or respond to anyone and was often married to a doting, caring husband who waited on her hand and foot but was descibed as ‘just like her mother or aunt’ implying a genetic element. Everyone feared that if the husband died as to how she would cope but as often happened the husband did die first but surprisingly enough the woman thrived in more ways than one. If I speak to anyone from that community they know exactly what I mean. Is it depression? Is it unhappiness but whatever it is the person often female needs to withdraw or opt out to survive and in my experience survived to a good age. However,in London most people troubled by mental health problems associate it with stress or change of environment with perhaps some genetic factors.
The second very important thing to consider when assessing ‘mental health’ is that it is ‘captured’ between temperament and behavioural habits. What is temperament ? when a person attends surgery they adopt very similar behavioural pattern on each visit and it makes it virtually impossible for to say anything about a persons temperament when they are seen in surgery.
We all have a temperament which should be tested frequently to determine to what each of us is prone. When I was in a family practise with may be four generations of a family in a close community it was easier to establish the temperant as receptionists or other people gave you the ‘gossip’ “she is always the life and soul of the party” or “he nevers goes out, never has!”

We also have behavioural patterns, this is what we do during most of our waking hours depending on what our role or work is and different behavioural patterns are prone to different diseases.

The third most important thing is the fact that mental health falls somewhere in between mental health in a very narrow sense and mental illness. Whenever someone develops a mental disorder, or mental illness they can be restored to full health. When famous athletes injure themselves, their performances drops that season, but in the seasons to follow they can improve their results.
Or for example, when a manager gets depression, if he recovers he will manage his company better, I believe, because he starts to understand other people and empathises with them better.
I remember being in conversation with GP colleagues and telling them that there were some days I could get full score on depression assessment and some colleagues agreed but one colleague said “I never get depressed”. Not only were we surprised but wondered how she managed to empathise with most of her patients.

When you go to the gym you learn to lift increasingly heavier weights for longer periods of time without developing aches in your muscles. You can use the same principle to practise psycho-fitness.
In the same way that someone who regularly goes to the gym can say “I have been practising this for six months now. I can run for quite some time, I don’t feel at all tired and I am in very good shape”, someone who practices psycho-fitness can develop their abilities to put up with 8Mb of stress instead of 4Mb, or even 12Mb and still go to bed without any worries on their mind.

This makes sense as I am aware when you have a stressful job alongside personal stresses I is imperative that you practise psycho-fitness.

The best thing our mothers and teachers can give us while we are growing up is self-confidence. Self-confidence strengthens our psycho-skeleton which can then put up with more, which means that we can live more easily and are less likely to develop different mental disorders. Italian and Jewish mothers constantly build up their children’s self-confidence by telling them that they are the best looking, the smartest and so on. Whilst it can be difficult to work with such people, who are so full of themselves, you must admit they never suffer mental health problems.
You may be familiar with the phrase ‘nervous breakdown’ for depression. The best way to describe what really happens: the psycho-skeleton breaks, the psycho-muscularity breaks, and this expresses itself on the monoamine level.
Our ability to deal with problems diminishes, our hardware becomes soft. The bottom line is something breaks under the burdens we carry in our backpack, for example physical disability, diabetes or cancer. Sometimes the trigger can be a physical or mental illness which one of our parents may be suffering from.

Imagine,a newly retired lady who resolves to go to her holiday home, everyweek-end, with her husband. But then her mother develops dementia and, she has to become her mother’s carer and something she has looked forward to doing is thwarted. In short, burdens like this can break us, and when we get hit; from the left or from the right – it doesn’t matter from which direction – this hit is like a loss and when we lose something the chance of developing depression increases.
If we are afraid of something the chances of us getting anxious are greater. This is scientifically proven and this breaks us, and when it breaks us we develop depression, which usually manifests itself via biological symptoms, so even though this is a psychiatric disorder it manifests with typical biological symptoms, i.e.a person wakes up every two hours and cannot sleep and if he sleeps for six or eight hours he is just as tired because he lacks the REM (rapid eye movement) dream phase, which helps him reorganise his thoughts. Then he develops psychological symptoms, such as guilt feelings or other distressing feelings. Or the other way around: there are people whose psychological structure is so inclined to depression that they push themselves into depression. The explanation is that they have loads of negative thoughts; that they are inclined to think negatively.
In 1952 Norman Vincent Peale wrote a book ‘Power of Positive Thinking’ which was created a significant following for many years. He quoted
“The way to happiness: Keep your heart free from hate, your mind from worry. Live simply, expect little, give much. Scatter sunshine, forget self, think of others. Try this for a week and you will be surprised.”
However, as Andrej Marušič suggested it could be argued whether there are such things as negative or positive thoughts. “If I tell my children they are not going out until they have finished their homework, this is a positive thought for me, because I am raising them up to be good citizens, although it is a negative thought for them as they are not allowed to go out.
So who will be the judge of what’s positive and what’s negative? The Prime Minister? I don’t consider anybody able to judge what is negative and what is positive.”
Let me illustrate how people think. Basically, we think all the time and our thoughts usually follow the same pattern. Every initial thought is followed by a second thought, usually associated with the first, and so on – moving around universe of thoughts, quite healthily thinking both positively and negatively. This is completely normal, but what happens if a “short circuit” occurs? A short circuit can even occur with completely positive thoughts. Let’s imagine the thought “If I stop going to work, I’ll be fired”. This is a positive thought, in general, since someone who thinks like this is smart and can anticipate consequences. But if this thought is so disturbing and causes so many worries that this person actually stops going to work then this thought – due to its monotony – bears potential for depression.

Now, let’s see how I – and a few others – distinguish between the different types of depression by dividing them into three groups: Blue depression, Red depression, Yellow depression.
Blue depression is the most prevalent and this is why the circle is the biggest and that is the so-called serotonin depression, which is characterised by sleeping disorders, people wake up two hours earlier, they are tired, their appetite is weak and their libido low. A weak appetite doesn’t mean less food intake and a low libido doesn’t mean less sex.
But to me sexuality is not just lying back and thinking of England, it should be joyous.
In short, lack of serotonin reduces libido. In this picture dreams are coloured blue. Dreams are very important but not because you are explaining what you were dreaming while lying on the couch. Dreams are nothing other than recollections of what you experienced through the day put into perspective against your past experiences. This enables us to store only relevant data, as if cleaning up our computer desktop and we place these files into different directories and, according to how much we save, our day may appear long or short.

For example, if you go to Taiwan for a week, this week will appear much longer to you because you will store more data during your dreams than you would during a week at work where you’ve been employed for the last 10 years. We accumulate our memories from our dreams. As we age we experience things we have already experienced before, so time appears shorter. There is a big difference between four years at school and four years at work, when we are 40 years old. We think time passes quicker as we age, because we don’t store memories we have already laid down – we are not travelling to Taiwan.


Red depression is a lack of will, a lack of motivation and a lack of energy. This is a very important depression, so-called noradrenergic depression, and doctors know, that when they give a patient noradrenalin in intensive care, the patient suddenly wakes up, gets up and this is what a noradrenergic depression patients is lacking.

Patients with yellow depression related to levels of dopamine lack enthusiasm and “joie de vivre” or motivated behaviour- “get up and go”. This type of depression is more complex and there are still no specific antidepressants for this type of depression although those on the market do help in some situations. It can be drug induced or in diseases such as Parkinson’s disease which is classically due to severe lack of Dopamine.

With all three types of depression people develop specific psychological symptoms
People with blue depression feel emotionally empty, people with red depression become sad, I know that about I wanted you to see; and people with yellow depression feel extreme hopelessness.

All these people can develop feelings of guilt, low self-esteem and so on. A good psychiatrist, or GP, will listen to you to understand when and how your depression started. If he/she puts you on an antidepressant before you stop talking, turn around and walk out. What’s the target? Every good psycho-pharmacologist must know what he is treating. However. sometimes it is more obvious and the target is reached immediately but in more complex depression which may involve a mixture of more than one types it may changing medication until the appropriate target is met.When the correct medication is found biological depression disappears automatically within four weeks, while psychological symptoms remain. Feelings of guilt are usually the last to disappear.
In summary mental health falls somewhere in between mental health in a very narrow sense and mental illness. It must take into account – appearance, behaviour, the way the person moves and what they say. It is determined partly by genetics and partly by environment depending on where a person spends their life , either remaining in the family circle or moving away. It is also captured between temperament and behavioural patterns.
The type of depression if diagnosed properly medication can treat it effectively. Healthy mental health can be maintained by psycho-fitness which will be my next blog!


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Is mental illness still a stigma?

When I blogged  a couple of weeks ago I implied that I wanted to revisit this subject.
At that time I seemed to be overwhelmed in the media and in the surgery with patients that felt hopeless and were finding it very difficult to go on. One busy surgery on aTuesday morning I could feel the atmosphere of tension and anxiety that sometimes pervades the surgery and indeed during that morning 4 people got up and stormed out. On this occasion because of the way I perceived the vibes I decided to phone each one to see if I could give a telephone consultation or arrange to see them later. What shocked me was the fact that all 4 said they had been feeling desperate and that life was not worth living and waiting was the final straw. Interestingly each person was pleased I had phoned and in 2 cases the act of waiting then storming out angrily had made them feel much better and in effect had  ‘snapped’ them out that of deep feeling. The other 2 wanted to talk and happy to reschedule an appointment at a quieter surgery time but felt better for the phone call.
That night I re-read a paper I had recently read on depression and decided to blog some of the ideas I thought would be good to share.

Following my stumbling across his secretary and family whilst at a gathering in France I was given the privilege of reading some papers written before 2008 by a Slovenian psychiatrist,Professor Andej Marušič  who also worked at Kings College London before he  died tragically from bowel cancer aged 43yrs.
He was brought up in the downtown area of the city Port of Koper,Slovenia  and had been aware from an early age that the incidence of suicide in Slovenia was one of the highest in the World and most of his childhood friends from that time had become either dependent on alcohol or illegal substances, or had already died a violent death. He was the only one who somehow made it through. He made the point that if it wasn’t for his upbringing he had had, he probably would have been a good drug dealer. He made it his life’s work to research ways to prevent this tragic end of life.

He presented this paper to at least 2000 health professionals in a very humble, unassuming manner. He was passionate about de stigmatising mental health, making the point that if someone had been in hospital with pneumonia or a heart attack friends and family would be keen to visit enquire about jprogress but if someone had been in John Connelly wing, St Bernard’s there would not be so much interest and people would keep away and not get involved.

This rung a bell as from an early age I had a fascination for medicine and the workings of the body aswell discovering books about the ancient Egyptians and medicine. I also found myself listening in to conversations about ill members of the family or friends. Moreover, I always wondered what was the matter with those people who always came out of hospital with wooden trays displaying a chocolate box picture (a hunting scene or thatched cottage) and woven around the perimeter (the image of one below was found on eBay and being sold as a retro vintage tray!). image
Years after this I then realised making the trays was occupational therapy following a nervous breakdown – and my observation was a display of the stigma of mental illness to cover up what the problem was which as a child seemed strange and somehow not right. It would be good to think that attitude like the tray has become retro and a vintage idea.

Professor Andej Marušič then gave the following example:-
A man; 47 years old; married, with problems, or married to problems; a father with worries –  employed or waiting to be employed; low back pain; irregular heart beat; feeling low; no appetite but not losing any weight; a warning for those who want to loose weight with depression; no libido; using sleeping tablets; no hobbies; drinking too much, and sports – our Slovenians are losing!  We will now try to diagnose the profile of our patient.  What do you think his doctors will diagnose? Burnout? The cardiologist will say “arrhythmia”, as the patient is experiencing irregular heart beats; the orthopod will say “lumbago”; the psychiatrist “depression”; the psychologist “neurotic structure with interpersonal relationship problems”; the sociologist “weak social network”; the employer “if it wasn’t for Employment Tribunal law you’d have been fired a long time ago”: his wife “I can’t reach him” because he has lost his libido and his children will say “the old man is bothering us again”. That’s probably more or less the way his therapy would also go, although sometimes the therapies overlap, for example the general practitioner and the cardiologist would both prescribe sedatives.   One would prescribe a benzodiazepine, the other a tranquiliser, while I must stress that these two are as similar as whisky and cognac – sedatives don’t cure. The orthopod would prescribe analgesics and give him back strengthening exercises, to which he would respond “I don’t have the time to do these”; the psychiatrist would prescribe antidepressants, as this is almost the only thing we know how to do; the psychologist would say “Be positive” – I am allowed to make jokes about psychologists, because I am one – The sociologists would say “If we had a left wing government you would probably feel better”; the employer would say “Place him somewhere I don’t have to deal with him”’; his wife will say nothing, until she starts talking about the divorce, while his son and daughter are too young to have acquired a treatment licence.

What is the main problem here?

The main problem we are witnessing here is that different people see health from different perspectives. One is looking at just the ground plan, another at just the elevation, while a third just sees the cross section. Nobody sees the whole picture – the overall health of one entire body. Have you heard the saying “When you are healthy, you have a thousand wishes, when you are ill you have just one wish” This unfortunate 47 year old, who is supposed to “Be positive”’ couldn’t care less who treats him, as long as he gets his health back.


Most of my medical career we have always assumed that patients are suffering from physical illnesses even contemplating it is ‘in the mind’ and patients want it to be physical and would be offended if it was implied that it was’ in the mind’ but now for some time as doctors we are following a biopsychosocial model and when we are assessing a patient we are taking into account all three aspects of a patients health and welfare.When I visited the nursing home a week or so ago I was asked to see 2 or the residents both unable to express themselves due to dementia. One Dorothy was quiet, not eating , withdrawn and it was thought that perhaps she had an infection or was going into a decline might have even had a small stroke. Had she had a stroke, or an infection or another physical problem she would she have to leave the home to be looked after elsewhere. Inevitably, the nurse in charge and myself pondered over physical reasons. Lets check their blood, start them on antibiotics ,get an ECG, call in the Palliative care nurses etc. Then  we both said together could they be depressed and looking at it logically it was reasonable to consider that along with everything else. Indeed they were both started on antidepressant medication accordingly having examined possible physical and other mental problems and alerting staff to be attentive to their social needs within a few days they were both in the lounge chatting calmly sipping tea and enjoying a piece of cake!  The nurse manager and myself just sat and watched them with sheer delight and the ambiance  was now peaceful and calm. This wavs a demonstration of holistic care and it works!!

I feel we are making progress and I would love to have been able to tell Professor Andrej Marušič that progress is being made. I have seen a real difference in the way employers treat patients that are depressed and I hahve no difficulty in writing ‘anxiety and depression’ or ‘stress related illness’  as a cause of sickness absence. Also, most employers work actively with their employees to address issues that may be contributing or causing the problem and create good back to work plans. I now see patients who have had time off with mental illness and see them return to work and blossom handling their lives in a much healthier fashion.
In these cases we made the decision for the patient as they were lacking mental capacity:it is different when both the doctor and patient with insight and capacity are trying to make that diagnosis. It’s also a bit more than  medication, cups of tea and cake but we have made some progress from secret hideaways and woven trays!

Yesterday, I read in the News the following proposed pilot scheme :-

Nurses are to go on patrol with four police forces across England to improve responses to mental health emergencies.
The pilot scheme aims to ensure fewer people with mental health problems are detained in the wrong environment, the government says.
Street triage teams are to be tested in the Derbyshire, Devon & Cornwall, North Yorkshire and Sussex force areas.
The patrols are part of an initiative funded by the Department of Health and backed by the Home Office.

Have you heard Ruby Wax’s take on this- yes another TED talk Stop the stigma of mental illness
I would like to be optimistic and feel that progress is being made in pdestigmatising Mental Health but I am sure there are cynics who are very guarded about that impression – lets watch this space!

image I will continue a further blog on his ideas of managing depression.


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Is Life worth Living?

image“Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad.”
― Henry Wadsworth Longfellow

When I was first in general practise the one sort of patient I dreaded coming through the door was someone saying. ” I feel fed up, I’m depressed, life’s not worth living, I wish I was out of it, life’s hell, I’m down, I’m b……” How could I understand, I was the happiest woman in the world:I had a lovely little cottage,a wonderful job with great staff and easygoing patients who never complained , more than enough money to live on, lots of lovely friends, a man to go out with but no commitments,no children(only borrowed) fit and healthy parents and family – life was rosy
Memories of working in the psychiatric hospital and looking after patients on intensive care having overdosed on the old fashioned drugs with horrendous complications came flooding back. But I was now in a position where I had to try to prevent these people going down that route….
Years have passed and my personal life has had many challenges and my understanding of depression has changed beyond measure- I now understand what it is like to feel in despair, hopeless and is life worth living? Fortunately I have been blessed with good friends, understanding people nearby, a strong faith and plenty of things I have been able to turn to to give me hope and worth and purpose to continue living.
When I was away someone emailed me and said “why don’t you do a blog on depression as there is lots in the news at the moment regarding bi polar (in view of Stephen fry’s recent admissions of suicide attempt) and depression / suicide (Paris jackson attempt suicide yesterday and famous Bollywood movie start Jiah Khan committed suicide this week too due to depression)

I felt that heart sink feeling again but a need to let people who are despairing that there is somewhere there for you and you have a right to be in this world and part of this world as much as anyone else. But somehow I couldn’t get around to writing anything about this subject.
However, the day before market day I had met Ann for the first time.She had recently retired and had been a PA to a Slovenian professor of Psychiatry who sadly had died at the age of 43yrs from Bowel Cancer. What’s more he had been one of the world’s experts in suicide prevention. She then proceeded to show me some of his lecture notes that she had been translating from Slovenian for future publication.

Next day we went to market ( to buy the apricots) and the local cathedral was cordoned off and we were later to hear that a 50 yr old advocat(barrister) ruuner up for mayor in 2012 had committed suicide and many hundreds of people were gathered for the funeral service.

I now feel very motivated to write on this vast subject of depression and will be continuing to review these Slovenian papers which have some very interesting thoughts ……..
***look out for further blogs

Meanwhile, if you are depressed and need someone to talk with the surgery will always accommodate you with a longer appointment -please ask at reception or by by phone- you need not disclose why you want a long appointment.
If you need to know more about depression
image in Ealing

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