STAYING SAFE

STAYING SAFE

Staying safe and learning to stay safe is so important.

Molly Russell  took her life aged only 14 after accessing graphic images of self-harm. Her father stated that Instagram had helped kill his daughter. As psychiatrists we are taught the importance of   thorough assessments of those who self-harm or are at potential risk of suicide, but the reality is that only one quarter of suicides had been seeing a mental health professional before the fatal event.

Recently I had the privilege of listening to a well-known expert, Dr Alys Cole-King talk on the topic of suicide prevention.

STAYING SAFE-THREE KEY MESSAGES

In three particular areas Dr Cole-King has helped to shape my thinking and practice. As a Consultant Psychiatrist working with the elderly, I frequently assess people who feel that life is not worth living or are having suicidal thoughts. In each case thorough assessment is vital, but what other messages does Dr Cole King bring?

Firstly, she emphasises the importance of Compassion. I am glad to see this being included in psychiatric practice.  Compassion is defined as sensitivity to the distress in others and a commitment to do something about it. If compassion is so important, to what extent can it be taught?  Do we have good role models for compassion? It is recorded several times that Jesus Christ  was moved with compassion and then met the particular needs of the people listening to Him. For example, He saw people as harassed and helpless, like sheep without a shepherd (Gospel of Matthew 9v36) and in response, on this occasion, He taught the people, as He saw and recognised their individual needs.

Secondly, Dr Cole-King emphasises the importance of helping people look beyond the crisis. Questions like,’ When you previously faced major difficulty in your life, how did you get through?’ help point people beyond the immediate crisis. We know from helping those at the very point of suicide, that very often people do not actually want to die; it is rather that they cannot find a way through their difficulties. The story of Kevin Hynes in ‘Hey, Kid are you OK? illustrates this. He jumped from the Golden Gate bridge but after he jumped he cried out, ‘God, please save me. I don’t want to die!’ A sea lion nosed him to the surface until the rescue boat arrived and his life was saved.

.Thirdly, she emphasises the importance of having a good safety plan. This is something the person at risk can work on together with the person helping them. The website http://www.stayingsafe.net/  gives a good example of a safety plan.

My book Mindful of the Light has two chapters on The person who is suicidal and Spiritual Help for the Suicidal Person

Although professional help is always advisable in the assessment of those who are suicidal, ASIST workshops help train people in suicide prevention.

STAYING SAFE is so important.

 

PTSD Post traumatic Stress Disorder

PTSD is common.  A recent survey in the Lancet  of 2,000 eighteen year olds in England and Wales showed that one in every 13  had evidence of PTSD.

Only a third or so of those who experience major trauma developed  PTSD. Of those who developed PTSD in this survey about a half had also had depression, a quarter had evidence of alcohol dependence and a fifth had harmed themselves.

‘THE TROUBLES’ NORTHERN IRELAND

The level of PTSD is high in Northern Ireland where I live.  Many who have lived through ‘The Troubles’ here have had horrific experiences and in clinic I have encountered fire fighters, policemen and prison officers who have been through harrowing times.  In PTSD people will often have flashbacks and nightmares of the experiences they went through. They will often be ‘on edge’ and want to avoid any reminder of the experience. They will usually try to bury the experience deep inside themselves and may find certain aspects of the experience difficult to remember. They may actively avoid ever going near where the incident happened.

Last Friday evening, I was continuing some of the talks I have recently been giving at Clonard Monastery.  (Previous talks on Anxiety, Suicide, Addictions and Depression were broadcast  live and can be accessed on the CLONARD MONASTERY FACEBOOK PAGE. Further talks on Psychosis and Bereavement will be on Fridays 22nd and 29th March at 7-30pm )

This last Friday I was talking on PTSD. In small groups people were able to talk about their experiences. We pointed out where more specific help was available. Trauma based cognitive behaviour therapy and EMDR (Eye Movement Desensitisation Reprogramming) are both valid and well attested forms of therapy and some of my colleagues have excellent results in this area.

We also encouraged the audience to believe that the Lord Jesus Christ can bring healing to the traumas they had suffered. We had a good time of prayer for individuals  who had been through traumatic experiences.  We have been delighted to be involved with Clonard Monastery with these talks, particularly since Clonard were instrumental in helping to bring reconciliation during ‘The Troubles’.

When healing occurs, through various means, people are able to look back on their painful experiences without the distress and fear that they had become accustomed to with PTSD.

The Royal College of Psychiatrists have an excellent leaflet on PTSD

FAITH SHINES THROUGH DEPRESSION

This article was published in November 2018 in Nucleus the journal for students published by the Christian Medical Fellowship

Some Christian teaching has given the impression that if you are depressed then the problem must be spiritual: you must have sinned or failed in some way in your Christian walk. Unfortunately, this can lead to feelings of guilt which can compound the underlying depression. Depression often leads a person to spend much time by themselves resulting in isolation. This kind of teaching can lead to avoidance of church and Christian friendships, resulting in further isolation.

Jesus always sought to be inclusive. He was frequently moved with compassion when facing human need. Stigma is still a huge problem in mental illness. We can seek to overcome this by being welcoming and compassionate as Christ demonstrated.

 What is clinical depression?

These are the common features of clinical depression that one would look for in seeking to establish a diagnosis:

Two weeks or more experiencing symptoms 1 or 2, plus at least four of the other symptoms (3-9) for most or all of the time.

1. Feeling low and down nearly all the time

2. No interests or pleasure in anything

3. Unable to sleep properly

4. Loss of weight (sometimes gain in weight)

5. Agitated or very slowed down

6. No energy, tired all the time

7. Feeling worthless or guilty

8. Unable to concentrate

9. Recurrent thoughts of death or suicide

(DSM IV Classification) (1)

Depression, as above, is not uncommon and between two and three percent of the population suffer from depression like this at any one time. There is good evidence that those who practise their religious faith tend, as a group, to have less depression than those who do not. This comes out strongly from the work of Professor Patricia Casey. (2)

 Depression in the Bible

The Bible is very real about personal experience. We see people’s struggles as well as their joys and successes. In their low times, we may not necessarily say that they suffered from clinical depression (through lack of sufficient evidence) but it certainly seems likely. Who were these people?

Job

Job was one of the leaders of his city who sat at the gate giving judgement. (3) However, there came a fateful day when in quick succession he lost everything. All his herds of animals and then all of his children were suddenly taken from him. His wife responded by turning against him. His health was broken. He sat on the ground scratching his itching skin with a piece of broken pottery. We read:

‘”May the day of my birth perish'” (Job 3:3) and

‘”Why is light given to those in misery…who long for death that does not come?'” (Job 3:20-21)

Job wants to die and wishes he had never been born. Job had lost so much that was precious to him and could not understand the reason why. In my experience, many people with severe depression have been through similar losses which they may not understand. In Job’s situation, despite no material change in his circumstances and despite the poor advice of his friends, his faith shines through when he exclaims, ‘”I know that my redeemer lives!”‘ (Job 19:25). In difficulties that we may not understand our faith can still triumph. In the end Job receives back double for all that he had lost. (4)

Jeremiah

The prophet Jeremiah had the onerous task of warning the people for the final time to turn from their wicked ways or else risk deportation to Babylon. Jeremiah became extremely unpopular and he and his message were widely rejected. The prophets, the priests, the king and the court and even his own family turned against him. During this experience of overwhelming rejection he cries out:

‘Cursed be the day I was born!’ (Jeremiah 20:14)

Yet in the midst of the storm of rejection, we read of a deep and tender relationship growing between Jeremiah and his God. For example, the Lord says to him, “‘I will make you a wall to this people…they will fight against you, but will not overcome you, for I am with you to rescue and save you” declares the Lord.’ (Jeremiah 15:20)

Like Jeremiah, many people today experience major rejection in their lives but what does Jesus promise?

‘In this world you will have trouble. But take heart! I have overcome the world.’ (John 16:33)

‘And surely I am with you always, to the very end of the age.’ (Matthew 28:20)

Elijah & David

Similarly recorded in the Old Testament, we read about Elijah who had an episode of severe low mood, which may well have been related to near total exhaustion. (5) Also, in Psalms 6, 32 and 38 we read of many features of depression experienced by King David. Psalm 32 relates this to a sin issue in David’s life. We should be aware that physical factors (Elijah) and sin issues (David) can be related to depression.

depression amongst Christian leaders

Leadership brings additional responsibility and the possibility of increased isolation. The mantle of Christian leadership may bring attack and persecution, adding to the risks of depression.

Judson

Adoniram Judson was one of the first ‘modern’ missionaries who went to Burma (known today as Myanmar) in 1813. During his time there, he became profoundly depressed. It is not difficult, however, to track some of the factors that lay behind this. During war in the country, he was severely mistreated and imprisoned. He then had to leave his wife and child behind to try and help in the aftermath of the conflict. In his absence, sadly both his wife and child died. He could not forgive himself for not being with his wife and child when they had needed him most. He tried to bury his grief in his work of Bible translation, but this did not help. Instead his grief became worse. He retreated into the jungle where he dug a grave and walked around it for several days in a suicidal state. He could not feel God’s presence with him. However, his fellow missionaries prayed constantly for him and he gradually recovered. Following recovery, whilst previously he had preached to little effect, now thousands embraced the Christian message.

Spurgeon

The story of the depression endured by the famous preacher Charles Haddon Spurgeon is quite well known. He himself had considerable insight into some of the related factors. (6)

what may we conclude from studying these ‘case histories’?

  • First, there are many different factors which may lead to depression. People are very different and a commitment to understand each individual is vital.
  • Second, God remained very close to these people and brought them through.
  • Third, God showed himself to be gentle and loving, treating each person with respect and dignity.
  • Fourth, prayer by fellow Christians proved to be very important.
  • Fifth, we might also say, as we observe these historical cases, that we wish that certain effective treatments had been available. Modern treatments such as antidepressants, cognitive behaviour therapy (CBT) and even electro-convulsive therapy (ECT) could have been helpful in both reducing suffering and the length of their depressive episodes.

 How can we advise and help a person with depression?

medical assessment is necessary

This helps to identify possible underlying factors (including physical factors) and enables the severity of the depression to be gauged and permits the formulation of a treatment plan.

support & help for the depressed individual

We can try to encourage the depressed person to take regular meals, a normal sleep pattern, and remain socially involved. We should be compassionate and caring and seek to remain involved with the person. We can pray with them or for them as appropriate and encourage Christian fellowship.

What other ways can we help? Accurate information about good local resources can be very valuable. Booklets on all aspects of mental health are freely downloadable from the Royal College of Psychiatrists’ website. (7)

Some churches, with help and advice, have started drop-in centres which can offer friendship, structure, support and practical help.

 Seminars for the general public

Over the last few years I have been conducting seminars on mental health issues for the general public. I have, for example, given a series of three or four talks over a weekend, or as a weekly series, generally concentrating on the topics of depression, anxiety, suicide and addictions. With each topic, I like to give an overview followed by spiritual and biblical input for those who wish to remain to hear this (usually at least 80%). Many of these have not had a strong Christian connection and it has been a joy to point people towards the Lord. (8)

More details of this, including the talks themselves, are on my website: www.stephencritchlowmentalhealth.com, along with synopses of the talks and other issues are covered in my recent book: Mindful of the Light: practical help and spiritual hope for mental health. (9)

Stephen Critchlow is a retired consultant psychiatrist and author in Northern Ireland

references

1. Diagnostic and statistical manual of mental disorders, 4th edition. American Psychiatric Association. Washington DC. 1994:327

2. Casey P. The psycho-social benefits of religious practice Iona Institute 2009

3. Job 29:7

4. Job 42:10

5. 1 Kings 19:4

6. Spurgeon CH. The Minister’s Fainting Fits. Haven Today bit.ly/2NuFKnT

7. Royal College of Psychiatrists. www.rcpsych.ac.uk/expertadvice.aspx

8. If you are interested in having such a talk in your area, please contact Stephen on stephen@ stephencritchlowmentalhealth.com

9, Critchlow S. Mindful of the Light: practical help and spiritual hope for mental health. Watford:Instant Apostle, 2016

 

STUDENT MENTAL HEALTH

STUDENT MENTAL HEALTH

Student mental health was the subject of a report by Grace Spitzer-Wong published on BBC NEWS ENGLAND  on 29th October 2018. It indicates that students are seeking mental health support more than ever before.  Numbers have increased by more than fifty per cent in five years.

 There is evidence that students are under much more pressure than before. The survey shows that  almost eighty thousand students sought help in 2016 to 2017, as reported by  eighty two universities. Some of these students can find it difficult to  admit to a problem and then look for appropriate help. Many students have major struggles with anxiety.  One student said that the drinking culture at university allowed him to numb his pain and  so normalise being exhausted in the day and hyperactive at night. Accessing mental health help may not be easy  because of long waiting lists, particularly for counselling.

 The STUDENT MENTAL HEALTH  budget for universities has increased by more than forty per cent in the last five years. Why has there been this growth in demand? The report suggests that the pattern of study in the UK has changed considerably. Fees are very high and many are balancing work, study and caring responsibilities. The job market can be very competitive with students feeling that they have to continually push themselves, perhaps more now than ever before. 

Although these reasons may be the most obvious, one wonders too about deeper unresolved issues. I wrote before about ‘The Epidemic of Loneliness’. In my personal contact with a number of overseas students over the last two years, this has been a fundamental issue. Others lack a clear sense of purpose and question what life is really all about. It may be difficult to quantify the increase in such factors as these, but one suspects that societal change has led to a  sense of feeling lost and alone in the world.

STUDENT MENTAL HEALTH

I have personally enjoyed teaching students on the theme of ‘Anxiety and Stress Management’. (This talk and other talks on Addictions, Depression and Suicide can be listened to on this website. Similar and further material is available in my book ‘Mindful of the Light – practical help and Spiritual Hope for Mental Health.‘)

The talk on Anxiety and Stress Management was included on a programme called  iLIVE LEADERSHIP led by Lenny Konschewitz (pictured below) which is for students in Belfast. This programme teaches students management and personal skills and provides mentoring of students in small groups. This programme which he has developed is now being extended to at least two more universities in the UK.

 

When I interviewed him, Lenny told me that iLIVE LEADERSHIP can help students find a balanced approach in leading their own lives and making healthy decisions. Students are encouraged  to navigate their way through life and develop self motivation skills without being controlled by the expectations of others. Small group mentoring helps students to express themselves and find support in a confidential environment. All of this is valuable in the area of STUDENT MENTAL HEALTH. 

 

 

Sent from my iPhone

 

Sri Lanka

I enjoyed my first visit to Sri Lanka over these last few weeks. Ros, my wife, with pastors George and Joshua from Cyprus made up our team of four who attended the wonderful wedding of Nuwan and Sithara, friends we had made in Israel and Cyprus. We then arranged special meetings in various parts of the country attended by many who had been in Cyprus.

It was also very special for Ros and I  to meet friends, Ivor and Judy, who had been a tremendous help to us when starting a church in Cyprus in 1993-94 and we had not seen for over twenty years.

We were so grateful to Chethi and Sriyani who became great friends and made most of the practical arrangements for us.

Steve with Ivor and Judy                        Pastors George, Joshua, Nuwan and Sithara Ros and Steve        Chethi, George and Sriyani

Sri Lanka

What were our impressions of the country? Well Colombo is hot and sticky and the traffic is horrendous! Kandy however is beautiful and we enjoyed visiting the tea plantations and a tea factory.

These tea workers are very poor and it was good to meet a great church in Nuwara Eliya who are particularly helping the workers’ children. Nuwara Eliya is over six thousand feet high and is often referred to as little England. It was so pleasant to spend time there in 18 degrees Celsius (the usual daytime temperature there) after the heat of Colombo.

Little England Nuwara Eliya                                   Tea plantations

In Colombo Sriyani introduced us  to the work of  LEADS , who do a great work for many needy children.

 

There is no doubt that many children suffer in Sri Lanka. Many people take up jobs in Cyprus, Israel and the Middle East  to try and support their families in Sri Lanka, to purchase a home or start a small business. Mothers often leave children behind to be brought up by relatives. Children  suffer for all kinds of reasons and LEADS has many committed and dedicated staff helping these children.

Another very big problem in Sri Lanka is the high suicide rate. It has been listed as number one in the world. However, it is likely these statistics may be at fault. Recent figures are lacking and the banning of toxic pesticides such as paraquat seems to have significantly reduced the rate.. Good work is also being done by Sumithrayo who offer over the phone, face to face and on-line counselling. There is still a problem of stigma, however, and it remains difficult to talk about personal mental health issues.

What can be done to help? Well to be honest in a short trip, not a huge amount. However, it was a privilege to be able to preach in various churches and on two occasions I took as my theme, Depression in the Bible. I pointed out from the stories of Job, Elijah and David how people became extremely low in mood, often to the point of being despairing of life itself. I showed how God graciously met them in their difficulties. You might like to listen in to one of these talks on youtube. My book ‘Mindful of the Light’  also discusses depression and similar mental health issues, pointing out how God can help us  as well as acknowledging support from mental health professionals.

Having been once, in a few weeks, I am actually going back a second time to Sri Lanka.

DANGERS OF CANNABIS

Dangers of Cannabis.

Last Saturday Home Secretary Sajid Javid granted a special licence for the use of cannabis oil to help control the severe epilepsy of Billy Caldwell aged 12.

This has led to considerable debate on the benefits or otherwise of cannabis based treatments for certain medical conditions.   A cannabis based product, Sativex, has been licenced as a possible treatment for spasticity in Multiple Sclerosis and Nabilone, a cannabis related product, is available for the treatment of nausea and vomiting following chemotherapy.

However, there is a difference between giving these products in defined situations and extending the use to epilepsy where treatment may be for many years in quite young individuals. It is wise  to reflect on the dangers of cannabis and below I give a short extract from my book, Mindful of the Light-practical help and spiritual hope for mental health. In the book I look more widely at the problem of addiction and talk about the help that is available through mental health channels as well as considering some excellent Christian initiatives in this area.

DANGERS OF CANNABIS

‘Cannabis is available as dried vegetation called grass or marijuana, or as a resin. The effects of it are that the person will often feel happy and sleepy. There is often a sense of distortion of space and time. There may be red eyes and increased appetite. The individual may, however, become anxious and agitated or show disturbed behaviour. They may have hallucinations and become paranoid (an extreme or irrational fear or distrust of others).

When I first went into psychiatry, one of my initial experiences was working as a doctor in the East End of London. Here on an average weekend I would admit several people to hospital, usually young males, who had severe cannabis intoxication and were very paranoid. I would find that on future admissions some of these people, who had initially presented with a paranoid state and marked intoxication as a result of cannabis, would have an illness that was indistinguishable from schizophrenia. There have now been several studies which show that cannabis (particularly skunk – a strong-smelling and more potent form) is a risk factor for the development of schizophrenia. It can also result in somebody becoming very apathetic and unmotivated. We refer to this as an ‘amotivational’ state. Cannabis can cause dependence in some people. Others may become depressed. There can be a withdrawal state with anxiety, sweating and muscle aches.’

The Royal College of Psychiatrists have an excellent booklet available on Cannabis and mental health

It is important to consider the dangers of Cannabis.