4 years ago ·

Things I Learned in Lockdown

Lockdown has been a challenging, confusing and strange time for everybody, and I think that we’re all faced new challenges with our mental health. But if we look for it, there are also positives and things that we can take away from the experience that will make us stronger. One of our service users wrote a blog about his experience of lockdown, and I think it captures the rollercoaster ride of emotions that we’ve all felt over the last few months. 


After about four months of lockdown we are finally easing out of it like carefully getting out of the bath and the relief most people must feel is enormous. We have been shaken out of our routines and forced to examine things in our lives that otherwise would have gone unnoticed. What sort of world do we want? What do we expect from ourselves? And what to do differently. Living with bi-polar I am astounded that I managed to get through the whole thing (and it isn’t over yet) with mental health intact and almost thriving. Now seems to be an opportune time to reflect on how I managed to live on my own and cope without much human contact in the hope that maybe you might recognise similar things in your own version of the lockdown and to be able to take away things from my own experience.

What I have found, and only realised recently, is that my experiences in hospital being sectioned were not wasted. Indeed this year it felt like the whole world turned into a mental health ward with no visitors and although it felt like my past was chasing me I was prepared to deal with it. Being at home in my own flat was infinitely easier to deal with than being at hospital. For one there is no one else to deal with, only yourself to look after. Being a writer I am a solitary creature that is good company for myself so I can manage not getting bored. Being in hospital has meant that I am good at waiting, and learning to wait is no mean skill as it takes practice and patience. Even if there is no discernable end to it all I tried not to wish my life away but enjoy the moment as it was. This way I was able to get some enjoyment out of the small tasks and little achievements that I pursued in my limited means.

I learned that I was more of an extrovert than I thought I was. I deeply miss my writing groups at the hospital and in town, hearing their stories and discussing writing techniques, the poetry groups with people’s poetry being read and enjoyed. Writing for me is part solitary but also part social and without other people sharing in with their work I felt at a loss as it had become so much part of my life.

The extreme individualisation has thrown me onto my own resources to a degree that I have never experienced before and I have learned that I have a far deeper inner strength than I imagined. In fact realising this has given me greater confidence that I can achieve the things in my life that I want to achieve and I have real grit and determination to help me to do just that. It’s been a once in a life time spiritual exercise to grow and become more resilient through this tough learning process. As R.S. Thomas says ‘Living takes courage’ and just keeping my own routines and inventing new ones has taken just that to do day after day without prospect, without knowing, just putting one step in front of the other.

I enjoyed the peace when the cars weren’t so much on the street. Birds were singing in town, a silence so rarely known that it was beautiful to behold. Seeing that the world was as good as I thought it would be without cars was a wonderful bit of knowledge to actually witness. It gives me a harmonious world to fight for against modern brutality.    

Ultimately, and most importantly, I found that my values survived the onslaught and in fact my whole way of life was confirmed to be right as, because of being in hospital so often, I never took anything for granted and took risks and chances when I could and took opportunities when I could, working and partying hard and living life mindfully. These were just the things that I was glad that I had done after the lockdown put a stop to a lot of these things. The things I value; building a community, writing, working for the NHS and striving after greater projects and long term ambitions, are thing I will be carrying on with even more vigour and lust than before. The best thing about this lockdown is that it’s made me a lot less complacent and giving me a much needed sense of urgency about my life and the life of the world. It’s given me the fuel to take on these things head on.    

This is just a brief glimpse into some of the things that I have learned through this time like no other. Thankfully technology has made all of this far, far, easier, with Zoom and Netflix helping to get through one moment to the next. The benefits of a well stocked mind greatly helps with situations like this and the time to read so many books doesn’t really exist outside Universities so it’s been amazing to get through so much and really feel like you are making progress with making sense of things.

You may have come out of this with different things, different insights and perspectives, but no matter how you feel take a deep breath and think to yourself that you have survived, and that makes all the difference.  

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5 years ago ·

Six Months On

Six months ago one of our service users wrote a post about his time with Arch Care Services. In this blog post we’ll check back in and see how much has changed. 

It’s been over six months of moving out of the Arch Care supported accommodation and moving into my own flat; how’s it gone?

Moving in was a little insane; from not knowing when I would get a flat from the Homechoice system I had finally moved into my new place within two weeks. It was a fast paced move with the viewing, handing over the keys, and painting and decorating the place (with the help of my family) all done lightning quick. My head was spinning when I had the flat to myself. It was so dislocating moving from housemates and staff to no-one. I don’t know how other people cope with this but I definitely found it a very stressful process.

Then the second month in I felt very depressed. I was meant to be getting support from the Arch Care staff but because it had to go through a time-delaying system I had to wait until later. And this is where it could have gone all so very wrong for me. I had no routines set up other than my volunteer work at the Hospital facilitating creative writing and I felt floating in the air, blown by the breeze and struggled to see a way through.

Fortunately the month after I did get support from Arch Care and other opportunities have been afforded me. These opportunities have come at the right time. One is getting a studio to write in on the High Street, where I have finished writing a play, and being part of the artistic community in the town. Another is going to free drama workshops and now being the dramaturge to a theatre piece. And I found out today that I might be going to Plymouth to speak at an event about social prescribing. And two micropubs have opened up in town, which is very important.

In my darkest moment of this year I confided in a friend online and he said to me a very sensible thing, which is that living on your own is one of the hardest challenges that anyone can undertake, so it’s all very well to point at the social context and political context for your problems but you need to cultivate your own garden in the hope that it spreads out everywhere else. It was very reasonable and did save me from a lot more anguish, so I thank him.

I also thank Arch Care who have really helped me to build a solid routine for myself and have made it so that the transition from supported accommodation to independent living was a relatively easy one. And such a success that has been that I now finally feel ready to relieve them of their services and live fully independently and filling more of my life with that which I love.

The flat itself is perfect for me, perfect location and even an old friend is about to move round the corner near our local where we can chew the cud over a pint. Now I have a decent hit rate of great days and all of this has been achieved in a relatively short amount of time. Give me another six months and it’ll be even better.

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5 years ago ·

Priory School Mock Interview Day 2019

This week, one of our Managers visited Priory School to take part in their Mock Interview day.

The young adults that took part were all fantastic, they arrived dressed to the nines, had taken time to research their chosen job roles and were obviously very well prepared. We were honoured to have been given the opportunity to meet with them and help them on their journey, and we’re sure that they’ll all go far.

Our top candidate was Ashley, who really impressed us with his professionalism, relaxed approach and knowledge of his industry. He is clearly a very talented, conscientious young man, and there’s no doubt that he’s going to make a success of himself in the future.

Special mention also goes to Lucia who we awarded our Special Recommendation to. She was clearly nervous at the start, but displayed a real passion for her chosen industry and gave really honest, genuine answers.

We also met with Louie, Dan, Corbyn and Jack, all of whom were excellent candidates. We’re sorry that we couldn’t give everyone an award, but you definitely all deserved it.

If any of our six candidates are reading this, give us a call when you turn 18 and there will definitely be a job interview waiting for you with Arch Care Services!

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5 years ago ·

Understanding: OCD

Obsessive Compulsive Disorder, or OCD, is one of those mental illnesses that everyone has heard of. This is partly because society tends to use the term as shorthand for someone who is quite clean, or who likes things to be organised, or who is very particular about how they fold their t-shirts. The phrase ‘I’m a bit OCD’ has become so commonly used that most people probably think that they have a good idea of what it’s like to suffer from OCD, but the reality is very, very different, and often much more difficult to live with, than just enjoying a neat and tidy kitchen. In fact, individuals with OCD and organisations that represent them have asked that the term not be used so casually to describe general preferences that most people experience.

In this blog we’re going to talk about what OCD actually is, how it manifests in different people, and what treatment options are available.

What is OCD?

Well, as the name suggests, OCD is made up of two different kinds of symptoms; Obsessions and Compulsions.

Obsessions are defined as intrusive or unwelcome thoughts, feelings, anxieties or images that appear in the mind seemingly without cause. Lots of people will experience this kind of thing, if you’ve ever felt anxious or nervous then you almost certainly know what it feels like to get stuck on a particular thought that you can’t seem to shift, or to have negative feelings appear in your mind suddenly. Sometimes these obsessions are called Intrusive Thoughts. The vast majority of people have experienced intrusive thoughts to some degree, if you’ve ever been in your car and have had a sudden urge to steer into oncoming traffic then you’ve had an intrusive thought, and usually they’re totally manageable and easy to ignore. What sets OCD aside from this kind of every day experience is their intensity, but also that they appear alongside Compulsions. Compulsions are defined as repetitive or ritualistic actions that are taken in an attempt to reduce or manage the anxiety associated with these obsessions.

Obsessive cleaning is one of the more common symptoms of OCD.

You’re probably aware of concept of compulsions. Whenever OCD is portrayed in the media, compulsions are generally expressed in one of two ways; hand-washing or flicking light switches. It’s true that these are common compulsions for people with OCD, but they are far from the only compulsions. Generally, compulsions fall into one of the following categories:

  • Washers are afraid of contamination, and will wash or clean themselves or their surroundings compulsively.
  • Checkers repeatedly check and confirm things, such as locks or ovens, to confirm that they are safe.
  • Doubters and sinners are afraid that if everything isn’t perfect and completed in specific ways then bad things will happen.
  • Counters and arrangers will attempt to organise and arrange things in their lives and often display obsessive behaviour or superstitions relating to coordination, counting, numbers and structure.
  • Hoarders fear that something bad will happen if they throw anything away, and will often collect large quantities of items or belongings.

As you can see, some of these types of compulsion have a kind of logic behind them. We can understand the anxiety associated with feeling dirty or messy, and we can see why someone would check locks and appliances. Others, such as counting or obsessively organising objects, are more superstitious in nature, and may be trickier to comprehend if you don’t suffer from OCD yourself. It’s important to understand that compulsions are real to sufferers of OCD, and that just because they don’t make sense to us doesn’t mean that they can be dismissed or ignored.

Completing compulsive behaviour usually doesn’t lead to any pleasure, but may reduce anxiety temporarily, providing some brief relief from the obsessive thoughts. This can lead to a vicious cycle, whereby obsessive thoughts lead to anxiety which leads to compulsive behaviour, which then results in temporary relief followed by further obsessive thoughts.

What is the impact of OCD?

Usually there wouldn’t be a need to include this section. Most people can inherently understand the harm caused by anxiety or depressive thoughts or hallucinations, those things are obvious. But it can be harder to truly understand the experience of someone with OCD and all the myriad of ways that it can impact on their life. Take a second to consider how long it would take to check and double check the light switches, doors and windows in each room in your house before you could leave, and what changes you would need to make to your life in order to accommodate this behaviour. It can be easy to see how the condition can end up dominating every aspect of your life, and how the obsessions can end up spiralling out of control.

Checking locks is a way of controlling the physical environment.

And control is a very important aspect of OCD. Scroll back up and look again at the categories of compulsions from earlier on. What do they all have in common? They all relate to attempts to impose control over things in our lives that are chaotic, unmanageable, unknowable or outside our sphere of influence. They all relate to a sense that if we do not complete these very specific actions, or take measures to reduce risk, that bad things will happen to us or people that we love. We all understand this to some degree, we’ve all sat at home at night on our own and heard a noise and been freaked out, and maybe we’ve then gone and checked all the doors and windows even though we know that they’re all closed and locked. We’ve all got halfway to the car before suddenly wondering whether we remembered to turn the oven off, even though we’re sure that we did, and had to go back to double check so that we can relax. Our brains are wired in such a way that we tend to assume the worst so that we can plan effectively, and we instinctively attempt to impose order and control over things in our lives. Well, people with OCD experience these very same feelings, they just experience them more often and at a much greater intensity, often to the point that they may struggle to function, and may become overwhelmed with their compulsions.

If you have time, this is a really interesting documentary about individuals living with OCD:

How is OCD treated?

If you’ve read any of my other blogs about specific mental illnesses, this will be a familiar section to you, because OCD is treated in a very similar manner to other mental health conditions; with a combination of medication and psychological therapy.

The primarily kind of medication used to treat OCD is the same kind of medication used to treat most kinds of depression and anxiety; Selective Serotonin Reuptake Inhibitors, or SSRIs. This kind of medication treats OCD by reducing general levels of anxiety, and therefore reducing the obsessive thoughts that drive the compulsive behaviour. For relatively mild cases of OCD, this may be all that is needed, but in more serious cases a course of psychological therapy may be required. This therapy is usually Cognitive Behavioural Therapy, and is particularly effective at treating OCD as it teaches sufferers practical techniques that can be used to manage the intrusive, obsessional thoughts. This will generally include mental exercises, tactics for reducing anxiety and verbal prompts and reminders that help to move the mind away from the cyclical thinking that can lead to compulsive behaviour. These methods are built around the concept that the mind is a muscle that needs to be exercised and trained, and that with discipline and repetition we can build new connections so that anxiety doesn’t automatically lead to compulsive behaviour. This can include carefully encouraging sufferers to engage with their anxieties and take action that makes them feel uncomfortable, or acknowledge anxiety caused by inaction, in a controlled setting without seeking relief via compulsive behaviour. It isn’t a quick process, and can be very stressful and difficult for people seeking treatment, but success rates are good.

It’s very important to remember that simply refusing to indulge OCD symptoms, or dismissing them as silly or pointless, will not work, and can even make things worse. Some people believe that if someone with OCD would just stop washing their hands or checking the windows that this would prove that everything is fine and would ‘cure’ the compulsive behaviour. OCD treatment is not that simple, and any attempts to encourage individuals to engage with their anxieties or face their fears should only be made in controlled environments by professionals. This kind of therapy is generally known as Exposure Therapy, and may be used in place or, or in conjunction with, CBT.

Exposure therapy works by encouraging the individual to confront situations or objects that cause anxiety without relying on ritualistic behaviour. Typically this is done in a slow, controlled manner, starting with small amounts of exposure for short periods of time which is tolerated for as long as possible, and moving on to longer and more intense exposure once this is manageable. For example, someone who has rituals related to cleaning may be encouraged to touch or handle dirty objects for short periods of time. In the past this form of therapy was done in a much faster and more sudden manner, typically by introducing the individual to high levels of stress and anxiety quickly in the hope that this may have a similar effect to pulling a plaster off quickly. Nowadays this is not generally advised, as it can cause levels of stress that are difficult to tolerate. 

A good way to think about exposure therapy is to think about getting into a cold swimming pool. Getting into the pool slowly, bit by bit, and waiting for your body to acclimatise to the new temperature is a lot less shocking and uncomfortable than jumping in quickly. It takes something that could be very stressful and upsetting and makes it manageable by doing it slowly in a controlled manner, and as we know maintaining control is often very important for people with OCD. 

Exposure therapy is complicated and requires professional guidance and should never be attempted without proper training and supervision, as if done incorrectly it can actually make the symptoms worse. 

If you or anyone you know is suffering from OCD, or you are worried that you are developing symptoms, you should always contact a GP. OCD rarely gets better on it’s own, so you should always seek help if you are concerned. If you need immediate help, or are worried that you may harm yourself or someone else, you should call 999 immediately.

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5 years ago ·

What Arch Care Services has given me.

The following was submitted by one of our service users, who has asked to remain anonymous.

I’ve been asked to write a little something for the Arch Care website, something that I am very happy to do since they have given me my life back.

Since my adulthood I’ve had to deal with the condition of bi-polar, formerly known as manic depression, something which has wrecked large parts of my life throughout my 20s.

Though having obtained an English Lit degree from the University of Aberstywyth when I came out of it to return back to life in Weston with my parents I struggled to cope.

Before I went off to Uni I had won first prize for a one-act drama I had written in an arts competition held at the Blakehay Theatre, something that I did more of when I was at Aber and was particularly successful at.  But when I returned to their actors company I was told that they had lost their funding due to arts cuts and in thinking of trying to further my writing I was struggling to know were to turn.

Things broke down between me and my parents and I was put into accommodation with a housing company called Curo, which I didn’t like much as I felt very isolated.

I spent years with Curo until I was evicted by them and spent a terrible couple of months in hospitals and temporary accommodation in Bristol.  But when I went back to hospital some people from Arch Care said they could take me on in their new place in Clevedon.

When I visited the place I couldn’t believe it.  An actual house!  With a garden!  And no CCTV!  I moved in and soon got a book case, a telly, a typewriter and a comfortable chair from the Changing Lives charity shop across the road and soon I was settling in with the place and living with the others people in the house in a way I couldn’t have done before.  I was really happy that everything had worked out.

Things kept on working out, soon after I moved in I was offered a involvee job at the hospital to facilitate creative writing, I self-published a long poem called The First Man In Space, which I’ve sold a few copies of, sent off a play to a London theatre, done a short teacher training course, been volunteering with the Theatre Shop and seeing lots of plays, read twenty books, and now I’ve been offered another job at an art gallery running a course on how to write about art.

This success has been largely due to the comfortable space I’ve been offered as well as the help and support I’ve been given by the live-in staff.  It’s been transformational.  And I’ve stayed well.  It’s an understatement to say that this has been one of the best years of my whole adult life and I’ve partly Archcare to thanks for it.

Now I am about to view a place in Weston and I now have the confidence to tackle living on my own and continue my writing career to take me into more and more interesting places in the future.  I feel I have a better handle on my illness thanks to mood diaries and mindfulness as well as medication and feeling more stable within myself.

What a result!

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5 years ago ·

Understanding: Postnatal Depression

Having a baby is the most incredible, magical, awe-inspiring thing that we will ever do. The first time you see your child it’s like your heart grows ten sizes and you’ll feel nothing but love and happiness. Or so we’re told! In reality, having a baby is a wonderful experience, but it’s also exhausting, stressful, confusing, complicated and frightening. It’s the biggest responsibility that you’ll ever take on, and it’s also one that you’re never going to be prepared for, AND you have to do it all while you’re more sleep deprived than you’ve ever been in your life! Yet we’re still not great at acknowledging that some people struggle with the process, and that for a lot of people it isn’t the amazing Hollywood experience that they have been taught to expect. Most of the images we have in our head when we think of having children are like this:

or this:

But I think we all know that in reality there’s also a lot of this:

and this:

Having just come back to work from paternity leave myself, this topic has been on my mind a lot, so this week we’re going to be thinking about postnatal depression, how it affects new parents, how it can manifest, and what we can do to help.

What is Postnatal Depression?

Postnatal depression is a form of mental illness that affects new parents, particularly women. Around 10% of new parents will experience some form of postnatal depression, so it’s a very common illness. It’s very different to the ‘baby blues’, which is a period of around a week after birth where women are likely to feel teary, overwhelmed and emotional. This is totally normal and most women will experience it. It only starts to become a concern and something that needs extra attention if those symptoms last longer, start later, or are of increased intensity.

Some of the most common symptoms of postnatal depression are:

  • A persistent feeling of sadness and low mood.
  • Lack of enjoyment and loss of interest in the wider world.
  • Lack of energy and feeling tired all the time.
  • Trouble sleeping at night and feeling sleepy during the day.
  • Withdrawing from contact with other people.
  • Problems concentrating and making decisions.
  • Difficulty bonding with your baby.
  • Frightening thoughts – for example, about hurting your baby.

Can you spot one reason why postnatal depression can be difficult to identify and diagnose? If you look at any new parents you’re likely to find that they’re tired, withdrawn, find it difficult to concentrate and lack energy. A lot of the symptoms of sleep deprivation, along with the emotional stress of taking on such a huge new responsibility, are going to be very similar to the symptoms of depression, and so the illness can be masked or hidden. Also consider how difficult it would be for a new parent to admit to a medical professional that they’re having violent thoughts about their own child, and it starts to become clear that a lot of people with postnatal depression fail to seek help. Society has to take some responsibility for this. We have created and maintained unrealistic expectations of parenthood, and admitting that you’re struggling or that you’re not 100% happy all of the time can be a very shameful experience, particularly for women. Yet we also know that having a baby is one of the most difficult times of our lives! No wonder it’s so confusing!

It’s also possible for new parents (again, usually women) to develop a condition called postpartum psychosis. This condition is a lot less common, but has much more serious symptoms and needs to be taken very seriously. Some of the more common symptoms of postpartum psychosis include:

  • Hallucinations.
  • Delusions – thoughts or beliefs that are unlikely to be true.
  • A manic mood – talking and thinking too much or too quickly, feeling “high” or “on top of the world”.
  • A low mood – showing signs of depression, being withdrawn or tearful, lacking energy, having a loss of appetite, anxiety or trouble sleeping.
  • Loss of inhibitions .
  • Feeling suspicious or fearful.
  • Restlessness.
  • Confusion.
  • Behaving in a way that’s out of character.

Postpartum psychosis can lead to situations where the person is no longer aware that they may be unwell, or may be suspicious or reluctant to seek help. That’s why it’s so important for partners, friends and family members to be aware of the symptoms and be ready to act if they have any concerns. Click here for more information about postpartum psychosis.

What causes Postnatal Depression?

We don’t really know for sure, but it seems likely that it’s exactly the kind of things that you would expect. It appears that a history or family history of mental illness, social isolation, a poor relationship with a partner or other stressful life events can all act as triggers and bring on postnatal depression, but even without any of these other factors having a baby is a huge, life changing event, and this is exactly the kind of thing that we would expect to be a cause of depression in general.

One thing that we’re fairly sure of is that there isn’t much that anyone can do to avoid it. There are some general lifestyle decisions that will help to maintain good mental health in general, such as the suggestions found in one of our previous blogs, and you should always speak to your GP if you have a history of mental illness and are expecting, but all the available evidence suggests that it’s largely outside of our control. Despite this, many people struggle with a lot of guilt and shame when they are diagnosed, and some feel like they have failed as parents. Nothing could be further from the truth! All it means is that we are all human, and we all need some help and support sometimes.

How is Postnatal Depression treated?

Postnatal depression can be a very lonely and distressing illness, and as we’ve said, it can carry with it a lot of shame and guilt. But there are treatment options, and as long as you seek help then it’s a completely fixable condition.

Possible treatment options can include:

Self-help – Opening up to friends and family and talking about your concerns, leaning on those close to you and asking for practical help when needed, trying to get sleep whenever possible, and taking time to do things that you enjoy can all be beneficial. Remember, these things will not always be effective on their own, so if you need additional support then that’s nothing to be ashamed of.

Psychological therapy – As with most other mental illnesses that we’ve spoken about, the most common kind of therapy is Cognitive Behavioural Therapy, otherwise known as CBT. This is generally prescribed by a GP.

Medication – Medication will usually only be used if the other kinds of treatment have not been effective. Don’t worry about breastfeeding, anything you are prescribed will be safe.

Local and national organisations, such as the Association for Post Natal Illness (APNI), and Pre and Postnatal Depression Advice and Support (PANDAS), can also be useful sources of help and support.

If you know someone that has had a baby recently you should make an extra effort to help out wherever you can. Don’t just go round and coo over the baby and leave, take round a home cooked meal, give the kitchen a quick clean or offer to watch the baby so they can have a nap. Keep an eye on each other, and if you have any concerns then ask if they’re ok or if they want to talk. And most importantly, never shame a new parent for expressing concerns!

Remember, postnatal depression is absolutely normal and natural, and if you do struggle then there is nothing to be ashamed of! It’s ok to find parenting hard and to need some help, it’s alright to not feel happy 100% of the time, it’s ok to be angry and tired and sad and frustrated and overwhelmed and exhausted, and it’s ok to admit that you’re not a perfect parent immediately. With the right help and support you will be absolutely fine and can enjoy all the amazing things about having a new baby.

If you are a new parent and have any concerns about your mental health you should contact your GP. If you think that you are at immediate risk, or feel like you may harm yourself or someone else, you should always call 999 immediately.

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6 years ago ·

How should we talk about mental health?

By Andy – Arch Care Services

It can be very confusing, knowing what we should and shouldn’t say. Certain words that we use all the time can accidentally end up offending someone, or may be old fashioned or out of date, and it can be difficult to keep track. People who suffer from a mental illness or people like me who work in the industry use these terms all the time, and it can sometimes be difficult for us to remember that not everyone knows the right thing to say, or what words they should avoid. Well, today I’m going to give you some advice about how to talk about mental illness without accidentally putting your foot in your mouth!

Let’s start by considering the most important thing of all; how do we describe a mental illness in the first place? There are lots of words that used to be used all the time but that we would advise everyone to avoid, as they sound quite old-fashioned and out of date, and in some cases are actually quite offensive! The one that we hear most often is that someone suffers with ‘mental problems’.

I can only assume that it comes from all the American media that we consume, because in America ‘mental problems’ is a fairly common phrase. We tend to avoid the use of words like ‘problem’ when it comes to describing a mental illness for the same reasons that we wouldn’t describe someone with diabetes as having a glucose problem, or someone with asthma as having a windpipe problem; it’s a little simplistic and vague. It also suggests that people who are mentally unwell have a ‘problem’ of some description, which is the kind of thing that we try to avoid. We also hear the term ‘mental disability’ quite regularly, which makes sense but is quite old fashioned. It also suggests that someone with a mental illness has reduced abilities of some kind, which isn’t always the case. Not the most offensive thing in the world, but not very accurate and probably best avoided.

It goes without saying that you should completely avoid terms like crazy, schizo or insane. They are very offensive and unpleasant and are used as a way to make fun of people. No one in the industry would ever use those words to describe the people that we support, and you shouldn’t either.

So, what is the correct thing to say? Well, you may have noticed that I’ve been using it all the way through this blog. We would always say that someone has a mental illness, they are mentally unwell, or they struggle with their mental health. Some people use the term psychological health instead of mental health, and that’s fine as well. These terms are used because they incorporate a number of different conditions and diagnosis’ and don’t lump everyone in together, and they also highlight the fact that it is an illness, and therefore something that is out of our control, can happen to anyone, and can be treated. This might change at some point in the future, but for now this is the best thing to say.

Now lets consider some things that you might say casually and innocently that are actually quite offensive to some people, and should probably be avoided if possible.

Enjoying having a clean house doesn’t mean that you have OCD!

Have you ever described yourself or someone you know as being ‘a bit OCD’? Maybe they’re quite a clean person, or they like things to be organised. Maybe they like to use a specific font when they type up a documents, or they alphabetise their DVD collection. I imagine that most of you have, I imagine that I’ve done the same thing at some point, but I make a deliberate effort to avoid using this term incorrectly, as Obsessive Compulsive Disorder is actually a very serious condition, and one which can have a massive impact on the lives of those that suffer from it. The symptoms of OCD can ruin lives, and are far more than just wanting things to be neat and tidy or not liking it when things aren’t organised properly. And how about bi-polar? Have you ever heard someone describe themselves as being bi-polar because they have mood swings, or because sometimes they feel annoyed for no identifiable reason? As with OCD, bi-polar disorder is a serious illness that can have serious symptoms, and is far more than just feeling like your mood is changeable. Organisations and individuals with these conditions have asked that these terms not be used casually as they may minimise the experiences of suffers, and we should do all we can to respect this. This isn’t to say that we should belittle experiences or assume that people are exaggerating when they use these terms, we should just try to be mindful about when we say them and whether they are really appropriate descriptions.

It’s also vital that we understand the difference between a mental illness and a learning disability. Sometimes people use the two terms as if they mean the same thing, or are parts of the same category of condition, and this couldn’t be further from the truth. Anybody can develop a mental illness at any time in their life, and it may be treated and then go away, whereas people will have a learning disability from birth, and it cannot be cured. The symptoms, behaviours and experiences of people who suffer from a mental illness are very, very different to those who have a learning disability, and confusing the two is quite offensive to some. It’s a bit like confusing asthma with blindness, the two are not comparable and it would be strange to suggest that they are.

Some of you may remember this encounter from the news:

As you can see, the woman approached Theresa May to ask what steps she planned to take to support people with learning disabilities, and in her response the Prime Minister made reference to planned changes to mental health provision. She was criticised following this incident specifically because she seemed to fail to understand the difference. Maybe this was nothing more than a slip of the tongue, but it feeds into a common misconception and is quite damaging to public perception when the Prime Minister is making such an easy mistake.

I know that this can sound complicated or difficult to understand. You may even be wondering what the big deal is, they are just words after all! Well, the words that we choose have power, and if not chosen and used carefully they can be hurtful, rude or thoughtless, even if that isn’t our intention. A small amount of effort can make a big difference, and can contribute towards tackling the stigma that people with mental illnesses face on a day to day basis.

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6 years ago ·

Understanding: Schizophrenia

By Andy – Arch Care Services

Is there a more misunderstood mental illness than schizophrenia? Be honest, when you think of the term schizophrenia, or think of a schizophrenic person, what comes into your mind? I bet that at least some of you thought of someone with a split personality, someone like Jim Carrey from the film Me, Myself and Irene. I bet that a few of you imagined a murderer, someone who is dangerous and needs to be locked away so they don’t hurt people. It’s ok, it’s not your fault, the media has done a fantastic job of making you believe those things, almost everywhere you find the word schizophrenia in pop culture it’s accompanied by one of these images, but I’m here to tell you that it’s not the case. In fact, the most common symptoms of schizophrenia are:

  • A lack of interest in things
  • Feeling disconnected from your feelings
  • Difficulty concentrating
  • Wanting to avoid people
  • Hallucinations, such as hearing voices or seeing things others don’t
  • Delusions (which could include paranoid delusions) – strong beliefs that others don’t share
  • Disorganised thinking and speech
  • Not wanting to look after yourself

Not very dramatic, right? Also, did you notice that there’s no mention of split or multiple personalities? That’s because this has nothing whatsoever to do with schizophrenia, and is actually a completely different, and very rare, disorder, now known as Dissociative Identity Disorder. Again, you can thank Hollywood for that misconception!

Difficulty concentrating is one of the most common symptoms of schizophrenia.

So what actually is Schizophrenia then? Well, as you can see from the list above, schizophrenia is actually lots of different things and it can be difficult to define it properly. There are a lot of conditions that have very similar symptoms, and some people even believe that schizophrenia isn’t actually a single diagnosis, but is instead a collection of different disorders and illnesses all presenting at the same time and overlapping. It can develop slowly and in stages, or can appear suddenly and seemingly without warning. Around 1% of people will suffer from schizophrenia at some point in their lives.

Like most mental illnesses, schizophrenia can look and feel very different depending on the person who suffers from it, but one of the more common and distressing symptoms, and the one that makes people the most nervous, is hallucinations. Hallucinations can come in a variety of different forms, and are mostly broken down into the following categories:

Visual – Seeing things that are not present. Visual hallucinations can take the form of objects or people, but sometimes is more like shapes or lights or flashes of colour.

Auditory – Hearing things that are not present. Sometimes people hear voices and sometimes they hear random noises or jumbled sounds. When they hear voices, sometimes those voices appear to be coming from objects or spaces surrounding them and sometimes the voices are inside their heads. Sometimes the voices talk to them, and sometimes they talk to each other or just chatter.

Olfactory – Smelling things that are not present. This could be smells from objects, the environment or the person themselves.

Gustatory – Believing that food or drink has an odd or unexpected taste.

Tactile – Feeling things that aren’t present, such as tickling, stroking or poking.

The categories of hallucinations all relate to one of our five senses.

Sounds pretty unpleasant doesn’t it? Suddenly starting to experience things that no one else is experiencing can be terrifying, and most people who start to develop these symptoms find it incredibly distressing. And remember, it’s not just the experiences themselves that are distressing and frightening, it can also become very difficult to know what is real and what isn’t and trusting your senses would become increasingly difficult. This is why a lot of people who start to develop schizophrenia can isolate themselves inside, struggle to keep working or spending time with friends, and may become suspicious or confused or frightened of seeking help; they don’t know whether the things that they can see and hear and feel are actually happening.

What Causes Schizophrenia?

I get the feeling that this section is going to be the same every time we talk about causes of a particular mental illness! Just like with depression nobody really knows for sure, but there are some things that appear to make it more likely, and in most cases it is a combination of lots of different things. In order to understand the process by which someone starts to develop schizophrenia, we need to think about two separate things; causes and triggers. Causes are things that make someone more susceptible to schizophrenia, triggers are events that can cause schizophrenia to emerge.


Genetics – There is no ‘schizophrenia gene’ that we’re aware of, but there is strong evidence to suggest that a combinations of various genes make people more vulnerable to the condition. If one twin develops schizophrenia the other twin is much more likely to develop it as well, even if those twins are raised separately. The chances increase if the twins are identical.

Brain Development – Brain scans have shown that people with schizophrenia have subtle differences in the structure of the brain than those without the illness. The evidence is a little messy on this one, as not everyone with schizophrenia has these differences, and not everyone with the differences has schizophrenia, but there is some evidence to suggest that they may be connected.

Neurotransmitters – There is some evidence to suggest that an imbalance between serotonin and dopamine, or the level of sensitivity to these chemicals in the brain, may cause schizophrenia. When schizophrenics are given medication that alters the levels of these chemicals they find that some of their symptoms may decrease.

Pregnancy and Difficult Births – Studies have found that infants who are born with a low birth weight, are deprived of oxygen during birth or who are born early have an increase chance of developing schizophrenia later in life, although we don’t necessarily understand why this is.


Stress – Stressful situations such as breakups, house moves, job loss or bereavement are a significant trigger for the development of schizophrenia. It’s important to note that stress on its own won’t cause schizophrenia, but it can cause schizophrenia to develop in individuals who are vulnerable to the illness in the first place.

Drug Use – The use of drugs, particularly cannabis, cocaine, LSD or amphetamines, has been shown to trigger schizophrenia in individuals who are already susceptible. Again, it is not believed that the use of these drugs on it’s own will lead to schizophrenia or related symptoms, but can act as a trigger.

Drug or alcohol use can act as a trigger for schizophrenia.

Three major studies have shown teenagers under 15 who use cannabis regularly, especially “skunk” and other more potent forms of the drug, are up to four times more likely to develop schizophrenia by the age of 26.

Are People with Schizophrenia Dangerous?

Admit it, when we got to the section above where I told you that schizophrenics sometimes hear voices, you probably assumed that these voices were telling them to hurt people. Again, it’s alright if you did, this is another huge misconception that has been propagated by Hollywood for years now. Sometimes you’ll even see it on t-shirts or stickers; “The Voices told me to do it!”. Well, this is another example of a poor understanding of how this stuff actually works. When someone hears voices, they can be positive, negative or completely neutral. They can give instructions or engage in conversation or just make random sounds and noises. I once knew a man who heard voices, and he described them as his ‘affirmations’ because they were always so positive!

So, is there any truth at all to the idea that schizophrenics are more likely to hurt people? Well, that’s slightly more complicated, and depends on which study you’re reading. But the important thing to remember is that even if the chances are slightly higher, the vast, vast majority of people with a diagnosis with schizophrenia will never be violent or hurt anyone. In fact, alcohol intake, gender and age are much better predictors of violence than schizophrenia.

However, there is one person that schizophrenics are much more likely to harm; themselves.

The sad fact is, around 40% of people with schizophrenia will attempt suicide at least once in their life, and around 10-15% will succeed. Compare this to the general population, where around 6-7% of people will attempt suicide at least once, and you start to see that in reality people with schizophrenia are much more likely to harm themselves than they are to commit a violent act against someone else.

How is Schizophrenia Treated?

As with most mental illnesses, schizophrenia is usually treated with a mixture of medication and talking therapies.

Anti-psychotic Medication – Anti-psychotics work by blocking the effects of dopamine in the brain. They can reduce symptoms of aggressive or anxiety very quickly, but generally take longer to start to tackle other symptoms such as hallucinations. This kind of medication is usually only prescribed following a thorough physical check up, because they can have a lot of side effects. More detailed information about anti-psychotic medication can be found by clicking here.

Cognitive Behavioural Therapies – I’ve already spoken about CBT and how it works, so you can find full information on our Understanding: Depression blog. Alternatively you can click here for more information.

There is also some evidence that shows that art therapy can be very effective as a way to alleviate the negative symptoms of schizophrenia in some people, although this should only be carried out by a trained art therapist with experience working with individuals with the diagnosis.

I hope that this blog has been useful, and that you now feel more able to correct some of those harmful stereotypes that we mentioned at the start! It’s important to remember that people with schizophrenia are suffering from an illness and need our support and empathy, and that we shouldn’t always rely on the media and Hollywood to give us an accurate representation of how people with schizophrenia feel, act and relate to others.

If you have any concerns about your own mental health, or if you believe that you are suffering from any of the symptoms of schizophrenia, you should contact your GP straight away. If you feel low and need someone to talk to, you can contact The Samaritans 24 hours a day, 7 days a week on 116 123. If you need immediate help, or are worried that you may harm yourself or someone else, you should always contact 999 immediately.

For more information, you can check out these links:

Mind – Schizophrenia

Information about Hearing Voices

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6 years ago ·

Understanding: Mental Capacity

By Andy Ryan – Arch Care Services

Something that we get asked a lot is whether people with mental health concerns are able to make decisions for themselves, or whether someone else makes their choices for them. It’s an interesting question, but it’s also a lot more complicated than it seems! This week, we’re going to explore the concept of Mental Capacity, including things to watch out for if you’re concerned that someone might lack capacity, how capacity is assessed, and what happens if someone isn’t able to make their own decisions.

Making decisions can be tough, but does that mean that we lack capacity?

First, we need to understand what we mean when we talk about capacity. Simply speaking, mental capacity refers to an ability to make decisions. We all make decisions all the time, whether those decisions are big, like where to live or whether to seek medical treatment, or small, like whether to have tea or coffee or what t-shirt to wear. We are all constantly making decisions throughout the day, and most of the time it is so mundane that we don’t even realise that we’re doing it, but this process is vitally important and without it we can find every day things to be a real struggle.

A common misunderstanding is that anyone with a mental health issue, learning disability or other impairment of the mind or brain will automatically be unable to make decisions, and that isn’t the case at all. In fact, the vast majority of people that we support have complete capacity, and make all of their decisions themselves, and that is exactly the way that it should be! After all, taking away someone’s ability to make their own choices is serious, and it shouldn’t be taken lightly. How would you feel if I told you that you weren’t allowed to drive to work any more, and instead I was forcing you to take the bus? Not very happy I would assume!

A second assumption is that only people with serious or ongoing impairments can lack capacity. Also untrue! Have you ever been drunk, unconscious or on strong painkillers? If so, then during those periods of time there’s every chance that you lacked capacity, if only for a short while.

We have the right to make bad (but delicious) choices about our diets!

A third common misunderstanding is that we either have capacity or we don’t, and that if we aren’t able to make one decision then we are automatically unable to make all decisions. Using this logic, someone who is unable to understand and sign a complicated legal contract would also be unable to decide what to eat for breakfast, which is obviously not the case. In reality, capacity constantly changes, and will be different based on the specific decision itself and when it has to be made. In fact, someone can lack the ability to choose what to have for lunch at 12pm, but regain the capacity at 1pm!

The most common misunderstanding that we face is that someone who makes bad decisions or poor lifestyle choices must automatically lack capacity, and we are often asked why we would allow people to make those kinds of choices. Well, it’s usually because we don’t have a choice! Most people make poor decisions on a regular basis, otherwise nobody would smoke, drink or eat junk food and we would all be running 5 miles a day. Even deciding to stay up late watching one more episode of Game of Thrones instead of getting your eight hours of sleep is a bad decision, but no one kicks down your door and turns off your television if you make that decision! A fundamental principle of mental capacity is that we are all allowed to make poor decisions if we want to.

If this all sounds very complicated and messy, it’s because that’s exactly what it is! Fortunately we have devised a test that we use when we’re trying to work out whether someone can make specific decisions, which is conducted by a trained capacity assessor and is based on the following questions:

Does the person have an impairment of the mind or brain?

In this context, an impairment could be a mental illness, physical damage, a learning disability, dementia or even something temporary such as intoxication or unconsciousness. If the answer to this question is yes then we can move on to the next stage of the test. If the answer is no, then the person has capacity.

Is the person able to understand, retain and use the available information in order to make a decision?

If the person does not understand what is being said, cannot keep the information in their mind for long enough to assess it properly, or is unable to draw on that information in order to come to a conclusion then they may lack capacity.

Can the person communicate that decision?

If the person is unable to express the decision in some way, they may lack capacity.

This test will often take a long time and be presented in multiple ways and at different times in order to make sure that everything has been done to help the person to make the decision themselves. Often this might mean using pictures, sign language or gestures, or asking the question in multiple different ways based on what is known about the individual, and this is vitally important. Just because someone is unable to speak does not mean that they cannot make decisions, for example, so we always have to do everything we can to help someone through the test.

There are lots of factors to consider when assessing capacity.

Now we have reached the point where we have established that someone is unable to make decisions, what happens next? We just start making choices for them, right? Wrong! It’s not that simple. First of all, who gets to make those decisions? Often it will be a family member or a friend, someone who knows the person well and who the person trusts to make good choices. This person then needs to apply to become a deputy. There are two kinds of deputy, a Property and Financial Affairs Deputy (someone who manages finances, income, bills and things like that) and a Personal Welfare Deputy (someone who makes decisions about health or care arrangements), and the type that the person applies for will depend on the outcome of the capacity assessment and discussions with everyone involved. Once the paperwork is complete and has been sent and signed off, this person will then be given the authority to make certain decisions on behalf of the person who lacks capacity (Click here for more information about becoming a deputy for someone who lacks capacity). If there is no one who is willing or able to take on this responsibility, it will usually be given to someone who works for the local authority and acts as a deputy for lots of people.

Even then, there are more rules and guidelines that the person must follow whenever they make decisions on behalf of another person. They must:

  1. Always make sure that all decisions are made in the person’s best interests. Sometimes this is simple and easy to establish, and other times it may require meetings and discussions with professionals. It is not acceptable for a deputy to make decisions based on the outcome that they want or is easier for them to achieve.
  2. Always make decisions that create as few restrictions as possible. For example, if someone regularly falls out of bed, it wouldn’t be appropriate to tie them down. Instead you might consider a bed rail or other device.

Also, just because someone can’t make the decision themselves, it doesn’t mean that they shouldn’t be involved! Someone without capacity can still express preferences and these preferences should always be taken into account and all efforts should be made to respect what they would like, even if it is more complicated or requires more work.

As you can see, mental capacity is a very complicated concept that requires a great deal of consideration, effort and sensitivity. But when it comes to taking away someone’s ability to make choices about their life, it’s vital that we get it right.

If you have any concerns that someone you know may lack capacity you should contact their GP or Social Worker.

If you’re an organisation and you’re interested in setting up some Mental Capacity training for your staff, we provide training courses at your place of employment. For more information, please send us an email or call us on 01275 342266 and ask to speak to Andy.

For more information about mental capacity, you can check out the following resources:

The Mental Capacity Act

Becoming a Deputy

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6 years ago ·

Living with Anxiety

The following blog was submitted by a member of staff at Arch Care Services. They have asked that they remain anonymous.

I had a very normal upbringing with loving, supportive parents, but everyone always described me as an anxious child. I remember distinctly worrying about the end of the world when I was 4 or 5 years old, and I developed a form of social anxiety at a relatively young age which manifested as a profound fear of looking stupid or annoying people. I didn’t really know what it was at the time, I just remember monitoring my words and actions closely and being hyper aware of how other people responded to me. In fact, one of my earliest memories of childhood was being driven home from school by a friend of my Mum. She was having a conversation with a friend in the front seat while I sat in the back and I attempted to join in, which made them laugh. Looking back I can see that it wasn’t malicious, they were finding humour in a child making an adult-like comment, but that stayed with me, and I felt nervous about making comments in adult conversations from that point onwards. That should tell you what kind of child I was!

School was always a challenge for me.

This continued throughout my childhood, and my overriding memories of school are of feeling anxious, uncomfortable in my own skin and intimidated by kids my own age and how easily and smoothly they seemed to socialise and make friends. I wasn’t miserable by any means, I was generally quite positive and cheerful in most aspects of my life, I had friends and was doing fairly well academically, there was always just this nagging sense that I didn’t quite fit in, which led to a couple of years of over-compensating, acting up and behaving badly in an attempt to make friends. I thought that if I could be loud and funny and disruptive then this would cover up my insecurity, but really it just made me feel worse. Knowing what I know now about mental illnesses, I can see that I was suffering from an anxiety disorder, but I didn’t have the language or the experience at the time to identify exactly what it was that I was feeling, I just kind of assumed that everyone felt that way.

I spent a lot of time alone in my first year of university.

When I reached university at age 20 my mental health really started to decline. I suddenly found myself in a huge city for the first time, surrounded by new people who all seemed so much older and more comfortable than I was. For someone with some hang-ups around fitting in and making friends this was a terrifying situation, I was overwhelmed by the constant need to be social and present this image of myself that was polar opposite to the way that I was feeling. The pressures of the course and my studies were fine, I could handle that, but having to constantly present myself in the way that I wanted to be seen by my peers, living in the same building as a collection of loud, drunk strangers, having no retreat where I could go to hide and recharge at the end of the day, that was a struggle. And to make things worse, I suffered from an unexpected bereavement at around the same time, which only exacerbated my blossoming mental illness. I started to find it difficult to spend time with people, which led to me finding it difficult to go outside, which eventually led to me finding it difficult to leave my room at all. My laptop and my DVD’s and my bed all became my comfort blankets and my safe space, which I became reliant on in unhealthy ways.

It all reached a tipping point one day around exam time. When I was anxious I found revision comforting because it allowed me to lose myself in a world of logic and facts for a few hours, which blocked out some of the cyclical negative thinking that had become my normality. I also used to gravitate towards a nocturnal lifestyle, staying up later and later each day and sleeping for longer and longer, or managing on very little sleep when I had lectures to go to, all so that I didn’t have to interact with people. During exams these two factors coalesced into manic revision sessions, hours spent hunched over a textbook in my poorly lit room in the halls of residence scribbling notes and drawing mind-maps, downing cups of black coffee until my hands shook and I felt sick. On this particular night I had been writing for what felt like a couple of hours and decided to take a short break, but when I looked at my clock I found that I had been scrawling notes in my exercise book for 9 hours without stopping. The sun was starting to rise outside, and I hadn’t even noticed that it was night time. I went into the bathroom to splash cold water on my face and caught sight of myself in the mirror, and for a terrifying moment I didn’t recognise the reflection staring back at me. I had gained weight, my face was grey and drawn and I had been wearing the same clothes for two days. Which also meant that I hadn’t been outside or spoken to anyone in two days. Before this I had always taken a lot of care of my appearance, and I was shocked at how terrible I looked, and how far I had allowed things to decline.

I found it difficult to make friends and fit in.

I skipped my lectures that day and went for a long walk along a river near to my student accommodation. For the first time I stopped and examined my thoughts and my behaviours and started to understand that this wasn’t normal, that I wasn’t doing alright. Up until that point I had never really considered that there might be something bad happening to my mind, I just assumed that this was what life felt like, but as I watched the other students walking to lectures, looking fresh and well rested and chatting happily to their friends, I realised that this wasn’t the case. They were carefree, relaxed and happy. It didn’t look like they were struggling to speak to each other. They were wearing clean clothes and smiling, and I couldn’t remember the last time that I had felt how they looked. I went home and showered and changed my clothes, and then I booked a doctor’s appointment. When they asked what the appointment was for, I told them that I thought that I might be depressed.

I actually ended up being diagnosed with an anxiety disorder, and was given a prescription for Citalopram, one of the most common kinds of SSRI based anti-depressant. It was a relatively low dose, but I was told to take it daily and to come back in six months. I had the usual reservations about medication, and was worried that it would lead to personality changes or would make me dull or zoned out, but once I had been taking them for a few weeks I started to notice the changes. I didn’t feel any different in ways that I could easily identify, but I wasn’t worrying as much. Spending time with people was still tiring, but it wasn’t an anxiety minefield in the way that it once was. I could go shopping again without having to spend hours working myself up and mentally preparing. I would deliberately test myself by sitting and thinking about all the things that used to make me feel nervous and twitchy, but they didn’t have the same impact, it was like the part of my brain that had caused me to overthink and obsess and worry had been switched off. The knock-on affect of this change was significant. My sleeping improved, I started eating better and spending more time outside. I made friends and chose to leave my room because I wanted to, rather than because I felt like I should. It felt like a grey fog had been lifted from my eyes and everything suddenly seemed clearer and brighter, and I had the sudden realisation that this is what life is supposed to feel like, this is how other people experience the world!

Things aren’t always perfect, but i’m happier than I’ve ever been.

A lot of people have some negative impressions of anti-depressant medication, but they gave me my life back, and gave me the mental freedom that I needed to identify problems and make changes in an effective way and with a clear head, changes that would have been impossible a few months prior. When I decided to stop taking the medication around a year later (with help from my doctor, you should never stop taking medication suddenly and without seeking medical advice), I found that the feeling persisted, because I had made changes to my life and thought patterns that stayed with me.

That was a long time ago now. I’m older and wiser and have a career and a family and that dark patch seems like it was a lifetime age. Don’t get me wrong, I still have bouts of anxiety, I still struggle with social situations sometimes, and I’m still prone to obsessive, circular thinking when things get stressful. Once I even had to take some time off work and go back onto the medication for a while. But nowadays I can understand my anxiety, and generally we’ve found a way to co-exist peacefully. I think that I’ll always suffer with it in one form or another, and part of me thinks that it has taught me some really important lessons about myself and given me insight that I wouldn’t have without it. I’m now confident that I have it under control; I know my triggers, I know when I start to feel low and the steps I can take to manage it, and I’m conscious of when I need to practise some self-care. Anxiety may be a part of who I am, but it’s not the main part.

If you think that you may be suffering from anxiety, depression or any other mental illness, you can speak to your GP and ask for help, or contact the Samaritans on 116 123 if you need someone to talk to. If you ever feel suicidal or like you may harm yourself or other people, you should always call 999 immediately.

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Arch Care Services and Arch Care Rehab Services are limited companies registered in England and Wales.
Company numbers: 06777576/03763819. Registered office: Unit 3, Avalon House, Stileway Business Park, Lower Strode Road, Clevedon, BS21 6UU.