(When You’re Struggling with Your Mental Health, Part 2)
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Content Warning: This article discusses mental health, anxiety, depression and suicidal thoughts, which may be sensitive to some.
Earlier in the summer, I wrote about how to actually ask for help when you’re struggling with your mental health, and a letter template to go with it. Building on that, I’ve interviewed Dr Natalie Ashburner (@thementalheathdoctor), an NHS psychiatrist, to ask her for more advice and information about the options your General Practitioner (GP) or doctor offers.
I started with one of the most commonly asked questions: “How do I actually describe how I’m feeling? I don’t know how to put it into words.” Dr Ashburner validated this struggle since “we don’t really get taught how to recognise our own emotions”. One of her top tips to tackle this issue is to use a mood diary and track your emotions throughout the day – emojis are welcome too, especially if it helps you communicate your feelings more confidently.
She explained that a common method used in psychiatry is to “ask people to rank their mood on a scale of one to 10. […] It’s up to you really what you want to make ‘one’ and what you want to make ‘10’, but try to be consistent about it and let other people know what that is.” With patients experiencing emotions on both ends of the spectrum, Dr Ashburner uses ‘five’ as a middle point (your normal mood), ‘one’ as the worst you’ve ever felt in your life, and 10 as the best.
If you worry about what to say, Dr Ashburner suggests writing down absolutely anything you want to tell the GP so you won’t forget. More importantly, “the GP will want to know what you think might be going on”. Dr Ashburner notes that sometimes patients will have an idea because of Google, “and it may be correct. And it may be completely wrong”. Ultimately, be “open and honest about what your thoughts are and what it is you are looking for from them”, whether it’s “reassurance that it is normal to feel this way” or to discuss “particular treatments that you were hoping to get”.
It’s normal to be a little intimidated not knowing what the GP will ask you. Dr Ashburner says it will be simple things such as “how long have you been feeling that way?” or “how exactly have you been feeling?”, as well as questions about your eating and sleeping habits, energy and motivation levels, etcetera. Most importantly, Dr Ashburner highlights: “Anytime you’re coming to talk about mental health, they’re going to need to ask you about any suicidal thoughts you might have had. We need to ask every person because we need to know about these thoughts.”
GPs understand that people might worry about “disclosing thoughts about ending your own life or harming other people.” Dr Ashburner explains that in reality, we’re used to hearing these scary or confusing thoughts all of the time. “If there’s a worry that’s really stuck in your head, and you can’t get rid of it. We want to know what that worry is.”
Another common question is, “what if the GP does not believe me, thinks it is a phase or judges me?” Unfortunately, this may be something you have experienced in the past (I know I have) and had your symptoms put down to puberty and fluctuating hormones, when what you are experiencing feels more than just that. Dr Ashburner explains that this is a difficult situation as it sometimes can be due to hormones, mental illness or a combination of both.
She says “there’s a lot of pressure in society nowadays, to be kind of happy all the time. And you see on Instagram, that everybody is happy, and everyone is perfect. And so if you are somebody who experiences a lot of fluctuations in mood, that actually might be quite normal, but you will see this and think that there must be something wrong with you”. However, Dr Ashburner emphasises that “it’s really important that that’s still your experience, and that somebody listens to and understands without making you feel that it’s not important, or it’s not real, or makes you feel judged.”
It is true that “some doctors might be better at this than others even though all GPs are trained in mental health.” I’ve had to go through a trial and error of GPs throughout my own treatment, and what is most important is finding a doctor that you feel comfortable to trust and confide in to start getting support.
Another common but perhaps the most upsetting question, as I’ve heard from several friends who are struggling, is “what if I’m not ill enough to get support”. This is rooted in a false rationalisation of not wanting to waste a doctor’s time, which could also be the result of underfunded mental health resources in the UK. But if you had to take away anything from this article, it’s that “your GP is never going to turn you away or say you shouldn’t have come or ‘you’re not ill enough, go home”.
Also remember that just because you’re not receiving a certain treatment, whether it’s medication or therapy, “doesn’t mean that one is not ill enough, it just means there may be other ways to manage it”. Crucially, do not compare yourself with other people to determine whether you’re “ill enough”. Dr Ashburner emphasises: “We all have our own different challenges, and there are different things that will help different people.”
If you’re thinking, “what if I can’t be helped or what if I’m too far gone?”, or you’ve tried a treatment that doesn’t work, don’t be discouraged – “this kind of thought is very common and derives from depression” (and can be experienced by people who aren’t depressed, too). Think about it this way: “One in one in four people have depression. That’s so many people, but imagine then how many people overcome it, and move on and do other things with their life.”
When it comes to getting treated, don’t be put off by self-help suggestions. “There are brilliant resources online that have a good evidence base behind helping people,” says Dr Ashburner. A treatment that you can self-refer to is the IAPT (improving access to psychological therapy) in your area, which can be “really good at treating anxiety and depression.”
Besides self-help, there are lots of other treatment options available, such as medication, therapy and cognitive behavioural therapy (CBT). To write to your GP, you can use this handy template. Bear in mind that you’ll always be asked about what you hope to get out of your treatment, so that the doctor knows exactly how to help you get there. Ultimately, be clear about your goals, “so you have something to work forward to.”
If you are struggling to cope but don’t feel you are ready to speak to someone such as a close relative or GP, or if you need more immediate support, you can call/ text any of these free helplines to access mental health/ emotional support.
- Samaritans: (phone) 116 123 – Free 24/7, 365 days a year support, or email firstname.lastname@example.org, www.samaritans.org.uk
- SHOUT: (text) SHOUT to 85258 – Free 24/7, 365 days a year support, giveusashout.org
- The Mix: (phone) 0808 808 4994 – Free helpline if you are under 25 and need help but don’t know where to turn, open 7 days a week from 3pm to 12am, https://www.themix.org.uk/
- Mind: (phone) 0300 123 3393 – Free helpline if you need non-urgent information about mental health support and services that might be available to you, open Monday to Friday (except bank holidays) 9am- 6pm, more information available at https://www.mind.org.uk/
- Papyrus: (phone) 0800 068 4141 – Free helpline if you are under 35 and are struggling with suicidal feelings, or concerned about a young person who might be struggling, open weekdays 10am-10pm, weekends 2pm- 10pm and bank holidays 2pm–10pm
- Beat: (phone) 0808 801 0677 or alternatively call the studentline at 0808 801 0811 – Free helpline if you are struggling with an eating disorder, open 365 days a year, 9am- 8pm during weekdays and 4pm – 8pm on weekends and bank holidays
- Switchboard: (phone) 0300 330 0630 – Free support helpline if you identify as LGBTQIA+, open 10am–10pm every day or email email@example.com or use their webchat service, Phone operators all identify as LGBTQIA+.
If you are experiencing an emergency or need urgent help, please do not hesitate to contact 999, 111, or go to A&E.
Article by Priya Joshi