Mental Health Help & Advice

IT IS WORTH NOTING, THAT WE ARE NOT MEDICAL PROFESSIONALS. THE INFORMATION LISTED BELOW IS FOR GUIDANCE & IS COMPILED FROM A RANGE OF TRUSTED SOURCES, SUCH AS NHS ENGLAND, MIND CHARITY & THE MENTAL HEALTH FOUNDATION. , THIS TOOL SHOULD BE USED TO ASSIST YOU WITH GETTING HELP IF YOU FEEL IT IS NEEDED.

Collapsible content

Depression

It’s normal to feel sad or miserable sometimes. But if your mood stays low for weeks at a time, keeps returning, or interferes with your life, it could be a sign of depression.

Depression is not the same as being sad, and is not a sign of weakness or a character flaw. It is an illness, and can have a serious effect on a person’s life and the lives of those around them. In severe cases it can make everyday life extremely difficult, and even lead to suicide.It can affect anyone, and is one of the most common mental health problems. It affects around 1 in 10 of us at some point.

Research has found that changes in brain systems or the chemical balance of the brain may be at the root of depression. These changes can be triggered by stressful events in life, such as bereavement, the breakdown of a relationship or losing your job. But for some people, the illness occurs for no apparent reason.

People with a family history of depression are more at risk of developing the illness, but not everyone in this situation will develop depression.

Some people are prone to suffering from depression at particular times in their lives. For example, some women may be particularly vulnerable to episodes of depression in relation to childbirth. Depressive symptoms are also a part of Bipolar Disorder.

Most people with depression do get better with the right treatment and support, but it can come and go.

Symptoms

Depression affects everyone differently, but there are some common symptoms:

Feeling sad or low for long periods of time.

Feeling hopeless or helpless

Feelings of guilt

Being anxious or worried a lot

Feeling irritable

Feeling tired all the time and having no energy

Having no motivation or being unable to concentrate 

Losing interest in things that you normally enjoy

Losing interest in sex

Changes in your appetite - eating too much or too little

Moving or speaking more slowly than usual

Thoughts of suicide or hurting yourself

In severe cases, a person with depression might experience symptoms of psychosis (e.g. hallucinations, such as hearing voices)

It’s important to note that a person with depression might not experience all of these symptoms - for example, someone can be suffering from depression without feeling particularly sad.

Getting help

If you or someone close to you has been experiencing low mood for a period of two week or more, speak to a GP or other health professional.

At first they may suggest some lifestyle changes and monitoring your mood for a short period in case it improves on its own. If this doesn’t happen, you may need to discuss other treatment options.

Treatments for depression

People with mild depression sometimes get better without any treatment, but in more severe cases they may need lots of help. Lifestyle changes are usually the first method of treatment to try. Getting more exercise, eating healthily and sleeping well can all have a powerful effect on our moods.

Self help websites can also be useful, such as LivingLifeToTheFull (llttf.com) and MoodGym (moodgym.anu.edu.au). These sites are recommended by medical professionals as a good source of information and practical advice on coping with depression.

Talking therapies such as counselling and cognitive behavioural therapy (CBT) are the next step. Group therapy, couples therapy or bereavement counselling can also be helpful depending on the root cause of a person’s depression. CBT is a treatment that helps change the way a person thinks and behaves. It identifies unhelpful ways of thinking and can help to break the cycle of negative thoughts.

In moderate to severe cases, antidepressant medication may be required. These medications work by balancing the chemicals in the brain that control our moods. Many people find them effective, but they can have their drawbacks. Some people experience unpleasant side effects, and they can take several weeks to work.

A combination of lifestyle changes, talking therapies and medication is often the most effective way to treat depression.

Tips for people with depression

Talking to people you trust about how you feel can be helpful, and may make it easier for you to talk to your GP.

Depression might feel like it will never go away, but in most cases it does get better with the right help.

Make an effort to stay connected to the people you care about. Keeping in touch with friends and family can help you to get perspective and avoid feelings of isolation.

Depression can become a cycle - you become depressed, then feel more depressed about being depressed. Remember that it is a real illness, and not your fault.

Keep occupied, and do things that you like. Whether you enjoy gardening, writing, making music or sports, doing something that helps take your mind off depressive thoughts.

Avoid using alcohol or drugs to get you through hard times. Alcohol is a depressant, and can stop medication from doing its job, and while it may seem to make you feel better temporarily, it will eventually make things worse.

Get plenty of exercise - even a 20-30 minute walk every day can make a difference. It releases chemicals called endorphins into your body, which are natural antidepressants. Eating well and getting enough sleep can also help.

If something in particular has triggered your depression, try to tackle the cause if you can.

Remember that treatment can take a few weeks to work - try to be patient and allow enough time for it to take effect.

Tips for partners, families and carers

One of the best ways to help a person with depression is to listen to their problems. This can help with tackling the root of their depression or just remind them that people do care about them.

If someone you care about is depressed, encourage them to get help rather than dealing with it by themselves. Don’t make them feel bad about taking medication or seeing a therapist.

Telling someone with depression to ‘snap out of it’ or ‘pull themselves together’ is likely to make things worse. Remember that depression is not just being unhappy, it’s an illness.

Remember that people don’t need to be depressed,it can help just to talk to them or spend time with them. It will make them feel cared about and help take their mind off their depression.

People who are depressed can sometimes be irritable or difficult to deal with. Try to be patient with them.

Look after yourself - if someone close to you is depressed it can be very hard on you too. It’s easy to fall into the same trap and become depressed yourself.

If someone with depression talks about hurting themselves or not wanting to live anymore, take it seriously. Encourage them to tell their doctor how they feel.

Useful websites

NCMH - ncmh.info/depression

This website has a dedicated depression section, including details on research, suggested reading and links to medication information

Mind - mind.org.uk

Information and support along with downloadable leaflets and real people’s stories. Search ‘depression’ from the homepage

Journeys - journeysonline.org.uk

This Wales-based organisation offers information and self help resources for depression, and runs support groups for people suffering with the illness.

Samaritans - samaritans.org

Available 24 hours a day to provide confidential emotional support for people experiencing feelings of distress, despair or suicidal thoughts.

Anxiety & Panic Attacks

It is normal to feel anxious or worried in situations that we see as threatening. In fact, a certain level of anxiety can be helpful in making us prepare for important life events, such as exams or job interviews, or by helping us escape from dangerous situations.

Anxiety becomes a problem when it lasts a long time, becomes overwhelming, or affects the way we live our day to day lives.

Problems with anxiety are common, affecting around 1 in 10 of us at some point in our lives. In fact, mixed anxiety and depression is the most common mental health problem in the UK. People of all ages and backgrounds can experience problems with anxiety.

People who have problems with anxiety may experience a number of different psychological and physical symptoms.

Physical Symptoms Psychological Symptoms

Muscle tension - Feeling worried

Lightheadedness - Fearing the worst

Dry mouth - Feeling irritable

Sweating - Finding it difficult to concentrate

Trembling

Hyperventilating 

Nausea

Everyone experiences anxiety differently. There may be feelings or physical symptoms listed here that you have never experienced. On the other hand, you may have experienced anxiety in other ways than these.

For some people, feeling anxious is a symptom of an anxiety disorder. Some of the most common of these are:

Generalised anxiety disorder (GAD)

Feeling anxious for a long period of time about nothing specific. The feelings are often overwhelming and they may stop you from doing things you would like to do.

Panic disorder

Experiencing panic attacks that may come out of the blue. This can cause fear of having more panic attacks and make you avoid certain situations.

Obsessive-compulsive disorder (OCD)

Anxiety leads to obsessions (repeated unwanted thoughts) and compulsions (repetitive behaviours or mental acts). These obsessions and compulsions can stop you from living a normal life.

Phobias

An intensive fear of something specific. The feared object or situation is usually harmless. A phobia will often make you go to great lengths to avoid the feared situation.

Panic attacks

A panic attack is an intense rush of psychological and physical symptoms that comes on suddenly. Experiencing a panic attack can be very frightening and uncomfortable. Panic attacks cause an overwhelming sense of fear, as well as physical sensations such as nausea, sweating and trembling. It is common to feel as though you can’t breathe, that you are choking, or as though your heart is beating too fast. Panic attacks usually last between 5 and 20 minutes, with a peak at about 10 minutes. During a panic attack, it is common to fear that you are dying or losing control.

Getting help 

If you think you or someone close to you are experiencing problems with anxiety that have not resolved themselves, speak to a GP or other health professionals.

Anxiety might feel like it will never go away, but in most cases it does get better with the right treatment.

Lifestyle changes are usually the first thing to try. Getting more exercise, eating healthily and sleeping well can help you feel much less anxious and more able to cope.

Using self-help tools can be a useful next step. Many of these are available as workbooks or as internet-based programmes. These can often be prescribed by your doctor.

Talking therapies such as cognitive behavioural therapy (CBT) have been found to be effective for the treatment of anxiety. CBT is a treatment that helps change the way a person thinks or behaves. It identifies unhelpful ways of thinking and can help break the cycle of negative thoughts.

In moderate to severe cases, medication may be required. Many people find them effective, but they can have their drawbacks. Some people experience unpleasant side effects, and they can take several weeks to work. A combination of lifestyle changes, talking therapies and medication is often the most effective way to treat anxiety.

Tips for people with anxiety

Take some time out of everyday to do something relaxing, such as listening to music, gardening or going for a walk.

Avoid using alcohol or drugs to calm yourself down when you are feeling anxious. These can make symptoms worse and can interfere with any medication you may be taking.

Look after yourself. Getting enough sleep and eating a healthy diet can make you feel better.

You may find it helpful to keep a diary to monitor how you feel and try to identify possible triggers of anxiety and panic attacks.

Stick to your usual routines. Set yourself small daily goals and reward yourself for what you achieve.

It may be tempting to withdraw from social activities and stay at home. This will not help in the long run. It is important to stay engaged with other people and try to keep doing the things you enjoy.

Talking to someone you trust about how you are feeling can be helpful, and may make it easier to talk to your GP.

Do not be afraid to ask for help. Make an appointment with a GP. There are lots of different treatments available that may help you feel better.

Tips for families, partners and carers

One of the best ways to help a person with anxiety is to listen to their worries. Try to be patient and understanding.

Avoid being judgemental or telling them to “snap out of it”

Anxious people can sometimes be irritable or difficult to deal with. Try to be patient and not take their reactions personally.

Encourage the person having problems to stick to normal routines. Help them establish small daily goals and recognise each success.

If someone you care about is feeling very anxious, encourage them to get help rather than dealing with it by themselves. A good place to start is by discussing things with a GP.

Useful websites

Royal College of Psychiatrists - rcpsych.ac.uk

This site provides a detailed patient information leaflet about anxiety as well as other mental health information. Search “anxiety” from the homepage.

Mind - mind.org.uk

Information and support along with downloadable leaflets and real people’s stories. Search “anxiety” from the homepage.

Samaritans - samaritans.org

Available 24 hours a day to provide confidential emotional support for people experiencing feelings of distress and finding it difficult to cope.

Depression in Young People

It is normal to feel down and not enjoy things sometimes, but when these feelings are severe, long lasting, or keep coming back and begin to affect your day-to-day life, this may be a sign of depression.

Depression is very much a real illness, and can affect your moods, energy, thoughts and behaviour. Depression can be treated.

It can affect people of any age, and is common in teenagers and young adults.

Each year as many as 1 in 20 young people suffer with depression. Both boys and girls can be affected, although girls are twice as likely to experience it as boys.

Many things have been linked to depression. It can run in families, although many children whose parents have had depression do not go on to have problems themselves.

It can also occur after a very traumatic event, such as the death of someone close to you, or in response to life stresses like bullying or problems with family or friends. Sometimes depression can occur for no obvious reason.

Young people with depression each experience the illness in their own way, but there are some common symptoms:

Feeling unhappy or miserable most of the time

Losing interest in activities you once enjoyed

Being less able to concentrate and make decisions

Loss of confidence or self-esteem

Being too hard on yourself or feeling very guilty

Feeling low on energy and easily tired

Trouble sleeping, or sleeping more than usual

Feeling agitated/on edge or feeling slowed down

Changes to your appetite or weight

Thinking about death or any suicidal thoughts or behaviours

Children with depression may also feel very irritable and short-tempered instead of, or as well as feeling sad. Persistent feelings of hopelessness and that life is not worth living can be a warning sign of severe depression.

Sometimes with depression you can have other problems such as stomach aches or headaches, feeling anxious, difficulties controlling your behaviour, or you could develop problems with drugs, alcohol and food.

Occasionally young people with depression will not show obvious signs of the condition, but have problems focusing on school or college work, their social life, or their relationships with family and friends.

Getting help

If you are suffering with depression it can be difficult to talk about how you feel, but it is important to try and get help as soon as possible. Getting help is important whatever your age and can have a positive impact on both yourself and those who care about you.

The first step is to contact your GP or go to see a school counsellor or nurse, who will be able to provide support and treatment locally. Many volunteer groups, like Mind (mind.org.uk) also offer valuable advice. There are many different treatments available including psychological therapies and medication. Learning more about depression and treatments can also be helpful. The treatments you receive will vary depending on the exact type of the illness you have and how severe it is, and also on which types of treatment you and your family prefer.

Psychoeducation and psychological or “talking” therapies will often be the first treatments recommended. Cognitive Behavioural Therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. It teaches you ways to cope better with negative thoughts and feelings, and actions you can take to break the cycle of feeling down.

Interpersonal Therapy (IT) concentrates on improving your relationships with other people in your life. This aims to help resolve some of the stresses that can trigger depression. Family Therapy is another type of treatment that works in a similar way.

Counselling, where the person with depression discusses their problems and feelings, can also help.

Creative therapies including art and music are suitable for some people, and there are even some specially designed online games that can help.

For some young people, especially those dealing with more severe forms of depression, medication also plays an important part. Not all medicines which work well for adults with depression are suitable for young people, but some have been shown to be effective.

Tips for young people with depression

If you’ve had depression in the past, or have a close family member who has had depression, it’s especially important to get help early. Keep an eye on your mood and watch for the symptoms mentioned earlier.

Talk to other people you trust about your problems - friends, parents, even teachers or lecturers may be able to help. It can be difficult, but try to be honest about how you feel. Keeping it bottled up can make it worse, and it is important not to feel alone with these problems.

Try to live a healthy lifestyle - exercising regularly, eating properly and getting a good night’s sleep can make you feel better about yourself, and help with depression.

Finding ways to deal with stress, for example, using breathing exercises can help with your moods.

Spend time with friends and family doing things you enjoy. You might not feel like it sometimes, but it can help.

Avoid alcohol and drugs - it may seem like they help in the short term, but they will only make things much worse.

Tips for parents and families

If you’re worried that your child could be depressed, talk to them. Be sure not to trivialise their problems, and remember that issues that seem small to you might be very important to them.

Encourage them to talk to others - for example school counsellors, their GP or even close friends that they trust. Let them know that it’s ok to talk about feeling low and that help is available.

If you have suffered with depression yourself in the past, be aware that your child may be more prone to the illness. Watch out for the warning signs, but at the same time remember that a history of depression in the family does not mean they will definitely have problems.

Spend time with your child doing things you both enjoy. This can help to lift their mood.

Don’t assume that every small mood change or disagreement is related to depression - some of the symptoms are very similar to the normal behaviour of teenagers, and may just be a normal part of growing up.

Useful websites

Royal College of Psychiatrists - rcpsych.ac.uk

Information on depression in young people including downloadable leaflets, details on treatment and real people’s experiences of depression. Search “depression in young people” from the homepage.

Depression in Teenagers - depressioninteenagers.co.uk

This site presents key facts about depression for young people in an interactive format including quizzes, exercises and audio clips.

Depression Alliance - depressionalliance.org

Help on living with depression, recovery and wellbeing, useful contacts and support for family and friends.

YoungMinds - youngminds.org.uk

This organisation provides information and advice, a guide to mental health services for young people, and information for parents of young people with mental health problems.

Hopeline UK - papyrus-uk.org/more/hopelineuk

This organisation offers telephone support for depression, particularly for children and young adults - especially for those with suicidal thoughts.

StudentMinds - studentminds.org.uk

University based student mental health charity with a focus on peer support. Student Minds facilitators work in many UK Universities

Sleep

Around one in three of us will experience occasional sleep problems at some point in our lives. Longer lasting sleep problems are also common and affect around one in every ten people. These problems come in many shapes and sizes. For some serious problems you may need to work out what the underlying causes are and the type of treatments that could work for you.

Different types of sleep problems

There are lots of different types of sleep problems. Insomnia is the most common sleep disorder.

Insomnia - trouble falling asleep or staying asleep

Sleep breathing disorders - sleep disrupted by difficulty breathing when sleeping eg sleep apnoea 

Sleep-related movement disorders - Abnormal movements that occur while falling asleep or during sleep eg restless leg syndrome (RLS)

Parasomnias - these can include sleep walking, acting out of your dreams, and night terrors

Hypersomnias - Excessive daytime sleepiness or excessive time spent sleeping e.g. narcolepsy. People with sleep apnoea can also experience hypersomnia

Circadian Rhythm Disorders - Sleep disorders where there is a mismatch between the body clock and the times a person wants to sleep ie sleeping well but just at ‘the wrong time’

Insomnia

Insomnia is the most common sleep disorder. Symptoms of the disorder include:

Difficulty in falling asleep

Waking up in the middle of the night or waking too early

Being very sleepy during the day

Not feeling refreshed

Having difficulty concentrating the next day

Insomnia is sometimes divided into primary and secondary insomnia.

Primary - no clear underlying cause of insomnia

Secondary - related to an underlying cause

These causes include mental health disorders, chronic pain and sometimes also other sleep disorders. However, sleep disorders are best viewed as separate conditions as they need specific treatments.

The reasons why we experience sleep problems can be complex. There are two psychological sleep processes that control your sleep: your body clock or circadian clock, and your sleep drive. In insomnia there is also thought to be a third process, high levels of arousal, known as hyperarousal.

Underlying these processes are factors such as our gees, age and environment eg what’s going on around you, other health problems, the medication you take.

How much sleep do we need?

How much sleep you need is difficult to determine. Your age and your genes have some influence, but other factors still remain unknown.

As a rough guide the National Sleep Foundation has produced a useful chart, which you can find here.

As you can see, there is a wide variation in the amount of sleep that may be appropriate depending on your age. Teenagers, children and infants generally need a lot more sleep. Following our teenage years, the sleep requirement generally remains steady but the pattern of how this sleep is attained may vary (e.g napping as an older adult)

You can get an idea of how much sleep you need by filling in a sleep diary. Work out the number of hours you have slept each night and how you feel the next day to help determine the optimum number of hours for you.

You can download a free sleep diary here.

How harmful is lack of sleep

In experiments where researchers deprived people of sleep for a short period of time, they found that participants generally experienced problems with concentration, attention and memory.

Long-term poor sleepers seem to partially adapt to sleeping less, so short-term problems from not enough sleep are not always as obvious. 

Insomnia has been associated with being overweight and with increased risk of diabetes, high blood pressure and heart disease.

However we can’t say for sure whether these conditions definitely arise because of long-term effects of poor sleep due to the following reasons:

Many people with insomnia are unaffected in these ways

The need to sleep varies so much between people

Reported sleep is often not accurate (whether using sleep diaries or activity monitors)

Links between sleep and other health problems often either share a common cause, such as genes that affect sleep and mental health, or the mental health problem and quality of sleep may have a effect on one another

Sleep problems in young people

Sleep in young people is a particular issue as young people report higher levels of mental health issues as well as sleep problems.

Young people have a later shifted bodyclock and high levels of physiological and environmental stressors (e.g. puberty, school changes, exams, social contexts), which interfere with sleep processes.

They are also heavier users of electronic devices. Use of these devices late at night can disturb sleep due to:

Light emitted from devices interfering with our body clocks - blue light filters can help but don’t stop all light stimulation.

Social communication keeping us alert late at night.

However, there are many useful calming apps which might be helpful to aid sleep. Some encourage mindfulness and relaxation, such as Headspace and Insight Timer. So if you are using electronic devices in the evening, try switching to applications that can aid sleep before bedtime.

Sleep in mid-life and beyond

Sleep problems tend to increase again during mid-life and during older age. This can often be due to a variety of biological changes as well as life stresses such as:

Changes in your body clock - as you get older, your body clock gradually changes to a morning pattern. This means feeling sleepier earlier and waking up earlier.

Hormonal changes due to menopause

Conditions that disrupt sleep that are more likely to occur in mid-life such as sleep apnoea (symptoms include snoring) pain and prostate problems.

The link between sleep and mental health

Sleep problems are common in people with mental health difficulties such as depression, anxiety and ADHD, and they are often difficult to cope with.

It can be difficult to know how these are related - sometimes there is a common cause, such as genes that affect sleep and mental health. And sometimes, the relationship is two-way - the mental health condition worsens when the person is unable to sleep.

It is particularly important to properly deal with sleep problems if you have coexisting mental health difficulties and you should seek health professional advice or advice from a mental health charity.

The use of alcohol to aid sleep should be avoided as this can worsen mental health problems.

How to deal with sleep problems

You should see your GP if you are having persistent problems with sleep (problems that have lasted more than one month) that are affecting your everyday life. If your sleep problems are due to an underlying condition (e.g. menopause, thyroid problems), your GP will address that first.

Some people may have problems because they feel sleepy much earlier than other people. Others feel sleepy much later and wake much later than most people.

If either of these sound familiar, your problems may be related to your body clock. Therapies such as bright light therapy and melatonin therapy may help.

If your sleep problems are linked to hyperarousal (e.g. stress) then stress reduction strategies, increased time unwinding before bedtime, mindfulness, and yoga may be helpful.

For most types of insomnia, Cognitive-Behavioural Therapy for Insomnia (CBT-I) is the recommended treatment.

Cognitive-Behavioural Therapy for Insomnia (CBT-I)

For some people, insomnia can become chronic and last for months or more. CBT-I primarily focuses on encouraging behaviour to improve sleep quality but also includes strategies to deal with thoughts that may be interfering with sleep problems (e.g. excessive worries about the consequences of poor sleep)

CBT-I aims to regulate your body clock, maximise your sleep drive and reduce hyperarousal by bedtime and during the night. It usually also includes sleep hygiene advice as well as muscle relaxation techniques. These techniques include: 

Improving your body clock and sleep drive

Keep a regular sleep schedule - get up at the same time even on weekends!

Avoid naps during the day if possible - otherwise limit to less than 20 minutes and not after mid-afternoon.

Stimulus Control

Only use your bedroom for sleep and sex - not for working or watching or watching TV.

Only go to bed when sleepy.

15 minute rule - This technique ensures that you associate your bedroom with sleep, rather than lying awake at night. If you cannot get to sleep within 15 minutes, leave your bedroom then only return when you are sleepy. Make sure you just estimate 15 minutes, don’t clock watch!

You can access CBT-I through:

Referral by your GP (at present this is only available in particular areas of the UK)

Referral to IAPT services (England only)

Private sleep clinics

Online CBT-I - providers include: sleepstation.org.uk/nhs_options

www.sleepio.com/

Sleep restriction

This technique aims to maximise the amount of time you are asleep when in bed, your ‘sleep efficiency’. For example, someone who goes to sleep at 10pm, falls asleep immediately, and wakes up at 6am has a sleep efficiency of 100%.

In the sleep restriction technique, you wake up at the same time each day and set your bedtime depending on the total hours you normally sleep (from your sleep diary).

Useful resources

Books on managing sleep problems

Colin Espie - An introduction to Coping with Insomnia and Sleep Problems (2nd Edition, 2017, Robinson, London)

Use a sleep diary

If you are concerned about your sleep, you may want to consider completing a sleep diary. This may help improve your sleep and flag up a health condition such as a sleep apnoea. A sleep diary will also be a helpful reference if you seek medical advice.

The Sleep Council - sleepcouncil.org.uk

This website offers educational leaflets, 30-day sleep better plan, a useful sleep diary, and guides to solving different sleep problems

National Sleep Foundation - sleepfoundation.org

An American website, it offers lots of discussions around sleep issues, educational resources and a useful sleep diary for CBT

ADHD

ADHD

Attention Deficit Hyperactivity Disorder (ADHD) or Hyperkinetic Disorder is a complex condition that is mainly diagnosed in childhood, but it can persist into adolescence and adulthood.

Symptoms of ADHD

ADHD is characterised by symptoms of hyperactivity, impulsivity and inattention.

Hyperactivity can include being unable to sit still, or finding it difficult to to participate in activities quietly. Sometimes, people with ADHD can appear to be “on the go” all of the time, or act as if “driven by a motor”.

Impulsivity might include interrupting or intruding (e.g. butting into conversations or games), having difficulty waiting one’s turn or talking excessively.

Inattention related symptoms might include finding it difficult to pay attention to details (making careless mistakes), being unable to remain focused on a specific task or having problems following instructions and organising activities.

While all of these behaviours can be seen as part of normal behaviour, (we can all be impatient, over-enthusiastic, lose our concentration or find it difficult to focus), for a health professional to make a diagnosis of ADHD, these symptoms have to be severe and cause problems for the individual across their home, school/work and social life.

ADHD symptoms start in childhood, but are not always recognised and treated at this age. For some, symptoms reduce or are less obvious by adolescence, but for others symptoms and impairment continue into adulthood.

ADHD is a complex disorder and can affect individuals in different ways - while most children with ADHD will have difficulties in hyperactivity, impulsivity and inattention, some may have problems only with attention.

The disorder affects some children more severely than others, and other problems can occur alongside ADHD such as Autistic Spectrum Disorders (ASDs), conduct problems, tics and learning difficulties such as Dyslexia.

Some people with ADHD may also have emotional problems such as anxiety or depression.

Getting help

If parents become concerned about a child, their GP will be able to offer advice and may be able to refer the child to a specialist. Schools may also raise concerns and may be able to refer to a specialist or suggest visiting the GP.

Getting a diagnosis of ADHD requires a full and detailed assessment, usually by a specialist paediatrician or child and adolescent psychiatrist - unfortunately, there is no quick and easy test for ADHD.

Assessments often gather information from a number of different sources and may include observations and reports of the child’s behaviour at home and school.

Treatments for ADHD

There are a number of different approaches to helping people with ADHD, which can be effective in managing the condition. 

Following an ADHD diagnosis, UK guidelines suggest that families or carers are given information about ADHD.

Environmental changes to minimise the impact of ADHD on day to day life are also recommended. These may include social skills training, or small changes at school, such as moving children with ADHD to the front of the class to eliminate distractions and help them focus.

At home, parents can adopt different ways of dealing with behaviours associated with ADHD, such as introducing reward charts.

If symptoms are still causing significant difficulties after these changes have been made, then medication may be offered. Medication has also been shown to alleviate symptoms of ADHD, enabling children to concentrate and focus more effectively and reducing hyperactivity. Common medications used to treat the condition include Ritalin, Equasym, Methylphenidate, Stattera, Concerta and Atomoxetine. These medications generally start to work shortly after each dosem and do not have a long lasting effect. They can be very effective, but as with any medication, there is a chance of side effects. Not all children with ADHD will need medication, whilst those taking medication will also need educational or psychological treatment.

Tips for parents and carers

Remember that your child isn’t being wilful or deliberately difficult - try to keep in mind that ADHD is a disorder and these behaviours are part of it.

Praise your child for good behaviour and look for their strengths - it will boost their self confidence and also make you feel better.

Get support - many parents and young people find joining groups where you can discuss issues with others are very helpful.

Use rewards and discipline - reward charts for positive behaviour and effective, consistent discipline for misbehaviour can help address behaviour.

Keep instructions simple and consistent - children with ADHD find it difficult to process many things at the same time. Try to break up long strings of instructions.

Write things down. Stress the importance of writing down homework tasks - and bringing homework books home too. It will make it much easier to keep on top of tasks and what’s required.

Try to be organised yourself - if everything has its place and your child is encouraged to use that place, it will be easier for them to remember where things are and be more organised.

Useful websites

National Centre for Mental Health (NCMH) - www.ncmh.info/adhd

Contains more useful information and resources on ADHD

The Royal College of Psychiatrists - www.rcpsych.ac.uk

Information on ADHD in children and adults, including downloadable leaflets. Search “ADHD” from the homepage

NHS Choices - www.nhs.uk

A comprehensive guide to ADHD from the NHS. Search “ADHD” from the homepage.

Adult ADD UK (AADD-UK) - www.aadduk.org

Information and resources for adults with ADHD

Self-Harm

Self-harm is when someone intentionally damages or injures their body. There are many different ways people can intentionally harm themselves, such as cutting or burning their skin, punching or hitting themselves and poisoning themselves with tablets or toxic chemicals.

In most cases, people who self-harm do it to help them cope with overwhelming emotional issues, which may be caused by:

Social problems - such as being bullied, having difficulties at work or school, coming to terms with their sexuality, debt or unemployment.

Trauma - such as physical or sexual abuse, the death of a close family member or friend, or having a miscarriage.

Psychological problems - such as having repeated thoughts or voices telling them to self-harm, disassociating (losing touch with who they are and with their surroundings), or borderline personality disorder.

Self-harm is more common than many people realise, particularly among young people, where it is estimated that 1 in 10 self-harm at some point. This figure is likely to be much higher, as many people who self-harm do not seek help. With time, space and support people often find other solutions to cope with how they feel, or these feelings are resolved.

Self-harm is a risk factor for suicide, and over half of people who die by suicide have a histort of self-harm. However, many more people self-harm than die by suicide, and it is important to note that many people who self-harm do not want to end their lives.

Getting help

If you have felt like harming yourself or are harming yourself, it may feel as though you don’t have anyone to talk to - even friends or family. But there may well be someone who can listen to you. It may help to:

Tell a friend or relative

Contact your GP (or mental health team if you have one)

Go to the emergency department

If you are self-harming your GP can refer you to healthcare professionals at a local community mental health team, or a team based in the hospital with the emergency department for further assessment. This assessment will result in your care team working out a treatment plan with you to help with your distress.

Health professionals know it is not always possible to stop straight away. You may feel ashamed of self-harming. Just talking about your worries, fears and distress with someone you can trust can make you feel better. It can also help you get things clearer in your mind, to feel more hopeful, and to think about possible solutions.

Treatments for self-harm

Treatment for people who self-harm usually involves seeing a therapist. They will help you to discuss your thoughts and feelings, and to understand how they affect your behaviour and wellbeing. Your therapist can also teach you coping strategies to help prevent further episodes of self-harm.

If you’re badly depressed, or have any other mental health problems then you may be advised to take antidepressants or other medication. Self-harm is often linked to anxiety and depression.

Tips for people who are self-harming

Self-harm is often a way of dealing with emotional pain, so it is worth trying to identify what feelings make you want to hurt yourself. Once you are aware of your triggers, you can take positive steps to reduce or stop the urge to self-harm.

Distract from the urge to self-harm. Once you know your triggers, you can try and express your feelings in other ways. For example, hitting a pillow can help cope with anger, or having a cold shower can help you stop feeling numb.

Write a ‘safety plan’ for yourself. This could include details on what you can do for yourself, and who you can speak to if you need support. It can help to have something written down, and it is more likely to work because you choose the kind of support you feel most comfortable with.

Look after your physical health as well as your mental health. Getting enough sleep, eating healthily and exercising regularly can help you feel more positive.

Ask for help and support. You don’t have to cope with all of your problems alone. It is important to find support. If you’re under 18 speak to an adult you can talk to and trust.

If you feel like you need support outside of your immediate family, think about speaking to another relative, your teacher, school counsellor, school nurse or your social worker (if you have one), or contact and organisation like Childline (0800 1111)

In the longer term, try different techniques to build your self-esteem. Practising positive self-talk can help, as can identifying and challenging any negative beliefs you may have about yourself.

Tips for families, partners and carers

People often try to keep self-harm secret because of shame or fear of discovery. It’s often close family and friends who first notice when somebody is self-harming, and approaching the subject with care and understanding is very important.

If you think a friend or relative is self-harming, look out for any of the following signs:

Unexplained cuts, bruises or burns, usually on their arms, wrists, thighs and chest.

Keeping themselves fully covered at all times, even in hot weather

Signs of depression, like low mood, tearfulness or a lack of motivation or interest in anything

Self-loathing and expressing a wish to punish themselves

Not wanting to go on and wishing to end it all

Becoming very withdrawn and not speaking to others

Signs of low self-esteem, like blaming themselves for any problems or thinking they’re not good enough for something.

Signs they have been pulling out their hair.

They may also have problems with drugs or alcohol, or have issues with eating. People who self-harm can seriously hurt themselves, so it is important to try and encourage them to speak to a GP about the underlying issue.

Useful websites

The following organisations may be able to provide support to people who are distressed, experiencing suicidal thoughts or who self-harm and their families:

Samaritans - samaritans.org

24/7 service which gives you a safe, confidential space to talk about how you are feeling, your life and how to find your own way forward.

Papyrus - papyrus-uk.org

A professionally staffed helpline (0800 068 4141) provides support, advice and information to young people worried about themselves or a friend. There are also many vulnerable resources on their website.

Mind - mind.org.uk

Provide information on a range of topics, including self-harm, depression and anxiety. They also provide information on advocacy and getting help.

Heads Above the Waves - hatw.co.uk

A not-for-profit organisation working to raise awareness of depression and self-harm in young people by promoting positive ways of dealing with bad days.

Young Minds - youngminds.org.uk

A charity committed to improving the emotional wellbeing and mental health of children and young people.

Bipolar Disorder

Bipolar disorder is a complex illness which can vary a great deal in nature and severity between people.

People with bipolar disorder have problems with their moods, experiencing extreme highs and lows.

If you have bipolar disorder, you will experience periods or ‘episodes’ of highs known as mania or hypomania and usually periods of depression.

You may also have problems with thinking and perception, which can include symptoms of psychosis. This can include thinking things that are not true (delusions) and seeing or hearing things that are not there (hallucinations).

Research suggests that bipolar disorder runs in families, and genes can influence whether someone develops the illness. We also know that the brain systems involved in controlling our moods work differently in people with bipolar disorder.

Factors such as stress, lack of sleep and recreational drugs can trigger mood episodes.

Bipolar disorder can cause a great deal of distress, but there is a lot that can be done to stay as well as possible. This includes lifestyle changes, medication and talking treatments.

Getting help 

If you think you might have bipolar disorder you should first see your GP who will perform an initial assessment.

Depending upon the outcome of this, your GP will decide whether you need a referral to a primary care mental health worker, your local Community Mental Health Team (CMHT) or another service, depending on your needs.

If you are referred to your local CMHT you will receive a further more detailed assessment, and they will work with you to plan the right treatments for you.

Treatments for Bipolar Disorder

For many people with bipolar disorder, medication is a key part of staying well.

There are a large number of medications that can help. Some work by preventing extreme highs or lows caused by the condition; these are known as mood stabilisers, and often need to be taken daily for long periods. Other medications may then be used to treat episodes of high or low moods when they happen.

Different medications suit different people, and finding the best medication for an individual can take time, and trials of different medications and doses.

You can find out more about mental health medications at ncmh.info/medication, including how different drugs work, their potential side effects and the way they interact with other drugs, food and drink.

Talking treatments such as psychoeducation can also be helpful. This approach helps people understand their illness, learn to recognise early warning signs of highs and lows and develop the skills needed to stay as well as possible. Bipolar Education Programme Cymru, also known as BEPCymru, is one example. A combination of medication and psychoeducation is often most effective.

Tips for people with Bipolar Disorder

The key things that are known to help in bipolar disorder are medications, education and following the right lifestyle.

It is crucial to take medication regularly as prescribed, stopping and starting suddenly can make things worse.

There are many medications for Bipolar and finding the one that works the best for you can take time - try to be patient.

Learn as much as you can about the condition and how to stay well. There are many Bipolar Disorder websites, self-help books and education groups. Find details for some of these at ncmh.info

Look after your physical health as well as your mental health. Getting enough sleep, eating healthily, avoiding recreational drugs and moderating your alcohol consumption can all help you to avoid becoming unwell.

Even if you are well now, you may have more episodes of low or high moods in the future. Try to have a plan in place in case you become unwell again.

Talk to other people who have bipolar disorder. Their knowledge and experience can be helpful. Organisations such as Bipolar UK (bipolaruk.org) can help you to do this.

If you have bipolar, are female, and planning a family, you should discuss it with your doctor. There are many important issues to consider around bipolar disorder and pregnancy.

Try to remember these tips to help you to keep your mood stable:

STABILITY

Sleep - make sure you get enough

Treatment - don’t miss taking your medication

Avoid - recreational drugs, and overdoing it with alcohol

Be positive - there is lots you can do to keep well

Intervention - get help sooner rather than later

Lifestyle - following a regular routine

Inform - yourself and your family that you have bipolar disorder

Triggers - learn what makes you more likely to relapse

You - can take control of your illness

Tips for families, partners and carers

A loved one with Bipolar Disorder may need your help to stay well. Try to be open and understanding about their condition. Ask them about their concerns and how you can help.

Talk to the mental health professionals who are looking after them. Don’t be afraid to ask questions and for advice.

Don’t assume that every small mood change or disagreement is related to the illness.

Have a plan for what to do if your relative becomes unwell in the future.

Learn as much as you can about Bipolar Disorder and possible treatments. 

Talk to others who care for people with Bipolar Disorder. They may have experienced similar situations and have useful tips. Organisations like Bipolar UK (bipolaruk.org) can help you to do this.

Useful websites

NHS Choices - nhs.uk/conditions/bipolardisorder

Detailed information on Bipolar Disorder, including symptoms, treatments and where to get your help.

Royal College of Psychiatrists - rcpsych.ac.uk/expertadvice/problemsdisorders/bipolardisorder.aspx

Information on many aspects of Bipolar Disorder, including downloadable leaflets in several languages.

Bipolar Education Programme Cymru - ncmh.info/bepc

Details on the psychoeducation programme which aims to help people with Bipolar to better understand and manage their condition.

Bipolar UK - bipolaruk.org

This organisation provides information and advice, and runs support groups and an online community for people with bipolar and their loved ones.

PTSD

PTSD is the name given to a set of symptoms that some people develop after experiencing major traumatic events. The traumatic event can be a single incident or take place over many months and years.

Many people think of PTSD as something that affects people who have had traumatic experiences whilst serving in the military, but it can affect anyone who has experienced a traumatic situation.

The condition can be brought on by events such as serious traffic accidents, rape or sexual abuse, domestic violence, physical assault, traumatic childbirth, witnessing a violent death or virtually any other situation that is exceptionally threatening or catastrophic and likely to cause distress in almost anyone.

Up to one third of people who have experienced a traumatic event develop some PTSD symptoms. Studies estimate that around 7% of people will suffer with PTSD at some point in their lives.

Other problems such as depression and anxiety disorders are common alongside PTSD. Increased alcohol use and drug use can also become a problem for some people.

Symptoms of PTSD

PTSD sufferers often experience repeated and intrusive distressing memories of the event. There may also be a feeling of reliving (or ‘re-experiencing) the event through ‘flashbacks’ or ‘nightmares’, which can be very distressing and disorientating. There can also be physical reactions such as shaking and sweating.

Because these memories can be very intense and upsetting, some PTSD sufferers may avoid people or situations that remind them of the trauma, or try to ignore the memories and avoid talking about what happened. Some people may also forget significant parts of the traumatic event.

Other people will think about the event constantly, which stops them coming to terms with it (they may, for instance, ask themselves why the event happened to them or how it could have been prevented)

PTSD sufferers may have emotions or feelings that are difficult to deal with, such as guilt or shame, or they may feel that they do not deserve help.

They may also feel anxious or irritable, and find it difficult to concentrate or sleep. Increased jumpiness and vigilance can also be present. For some people, it can mean that doing ordinary things like going to work or school or going out with friends become very difficult.

Getting help

If you think you might have PTSD you should first see your GP who will perform an initial assessment. Depending on the outcome of this, your GP will decide whether you need a referral to a primary care mental health worker, your local Community Mental Health Team (CMHT) or another service, depending on your needs.

If you are referred to your local CMHT you will receive a further more detailed assessment, and you may then be referred on to a specialist traumatic stress service or receive help within the team.

Treatments for PTSD

Psychological therapies are considered to be the most effective treatments for PTSD. In particular, there is good evidence that two types of psychological treatments which focus on the traumatic event called Trauma Focused Cognitive Behavioural Therapy (TFCBT) and Eye Movement Desensitisation and Reprocessing (EMDR) are effective.

Both techniques have been shown to reduce the symptoms and the distress experienced by PTSD sufferers.

The term TFCBT ecompasses a number of forms of Cognitive Behavioural Therapies (CBT). Broadly speaking, these treatments help the sufferer to confront their traumatic memories often through talking and writing about the event. TFCBT helps individuals to identify and challenge negative feelings and thoughts, including ideas related to feelings of guilt and shame. The treatment can also involve gradually returning to avoided activities that have become frightening because they are connected in some way with the trauma.

EMDR techniques can help people with PTSD to confront their traumatic memories. The individual is asked to focus on memories, thoughts, feelings and sensations associated with the trauma, whilst also focusing on something else at the same time. Usually the other focus is on following movements of the therapist’s finger. 

Other treatments such as medication and stress management techniques are sometimes used to treat PTSD and can be helpful, although these have not been shown to be as effective.

Tips for families, partners and carers

Try to be patient and understanding with the person with PTSD.

Avoid being critical of how the person is coping. Remember that they have been through some extremely distressing experiences.

Try not to take symptoms like emotional numbness, anger, and withdrawal personally. If the person with PTSD seems distant, irritable, or closed off, remember that this may have nothing to do with you or your relationship.

Don’t put pressure on the person with PTSD to talk about their experience, but do allow them time and space to talk about it if they want to.

People with PTSD sometimes feel hopeless or ashamed of how they are coping. Try to help the person to recognise their strengths and positive qualities.

Try to encourage the sufferer to establish normal routines; this helps to restore a sense of order and control in their life. Help them to start with small daily goals and to recognise each success.

If they haven’t already done so, try to encourage them to seek professional help. A good place to start is discussing things with your GP.

Tips for people with PTSD 

Give yourself time and space to acknowledge what you have been through, and that you are having strong emotional reactions to it.

Avoid being self critical about the problems that you are having. Many people experience similar problems, and it is not a sign of weakness.

You may be tempted to withdraw from social activities and your loved ones, but it’s important to stay involved with the people who care about you. Support from other people is vital to your recovery from PTSD.

Avoid using alcohol and drugs to make you feel better. Although these may make you feel better in the short term, it can cause serious problems for you and your loved ones. They can also worsen symptoms and interfere with treatment.

Try to be healthy. Do what you can to eat a balanced diet and get some regular exercise - even if it’s just going for a walk.

Stick to normal routines as much as possible. If you have problems with sleep try to keep to a regular time when you wake up and get up, and avoid caffeinated drinks after 4pm.

Set yourself small daily goals and challenges to confront the things that you avoid.

Remember the strengths that you have. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times.

Don’t be afraid to seek help. Discuss your problems with someone that you can trust. Make an appointment to see your GP. There are a range of treatments that may be able to help you.

Useful websites

National Center for PTSD - ptsd.va.gov

Tools and information to help with a range of PTSD related symptoms and problems

NICE - guidance.nice.org.uk/CG26

Information on recommended treatments and downloadable leaflets.

Royal College of Psychiatrists - rcpsych.ac.uk

Information about PTSD with versions in other languages. Search ‘PTSD’ from the homepage.

All Wales Veterans Health and Wellbeing Service - veteranwales.co.uk

Support for military veterans and those trying to help them.

International Society for Traumatic Stress Studies - istss.org

Information and resources for the public, for professionals and those involved in research.

Addiction

Addiction

Addiction is a common problem, but help is available. Addiction is defined as not having control over doing, taking or using something to the point where it could be harmful to you.

Addiction is most commonly associated with gambling, drugs, alcohol and nicotine, but it’s possible to be addicted to just about anything, including:

Work - some people are obsessed with their work, to the extent that they come physically exhausted. If your friendship, family and social life are affected and you never take holidays, you may be addicted to work.

Internet - as computer and mobile phone use has increased, so have computer and internet addictions. People may spend hours each day and night surfing the internet or gaming while neglecting other aspects of their lives.

Solvents - volatile substance abuse is when you inhale substances such as glue, aerosols, petrol or lighter fuel to give you a feeling of intoxication.

Shopping - shopping becomes an addiction when you buy things you don’t need or want to achieve a buzz; this is quickly followed by feelings of guilt, shame or despair.

What causes addictions?

There are a lot of reasons why addictions begin. In the case of drugs, alcohol and nicotine, these substances affect the way you feel - both physically and mentally. These feelings can be enjoyable and create a powerful urge to use the substances again.

Gambling may result in a similar mental ‘high’ after a win, followed by a strong urge to try again and recreate that feeling. This can develop into a habit that becomes very hard to stop.

Being addicted to something means that not having it causes withdrawal symptoms, or a ‘come down’. Because this can be unpleasant, it’s either to carry on having or doing what you crave, and so the cycle continues.

Often, an addiction gets out of control because you need more and more to satisfy a craving and achieve the ‘high’.

The link between addiction and mental health

When you have both an addiction and a mental health issue such as depression, bipolar disorder, or anxiety - it’s called a co-occurring disorder or dual diagnosis. Dealing with an addiction is never easy, and it’s even more difficult when you’re also struggling with mental health problems.

In co-occurring disorders, both the mental health issue and the addiction have their own unique symptoms that may get in the way of your ability to function at work or school, maintain a stable home life, handle life’s difficulties, and relate to others. To make the situation more complicated, the co-occurring disorders also affect each other. When a mental health problem goes untreated, the addiction problem usually gets worse. And when the addiction increases, mental health problems usually increase too. Co-occurring addiction and mental health issues are more common than people realise. According to reports published in the Journal of the American Medical Association:

Roughly 50 percent of individuals with severe mental disorders are affected by substance abuse.

37 percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.

Of all people diagnosed as mentally ill, 29 percent abuse alcohol or drugs.

While addiction problems and mental health issues don’t get better when they’re ignored - in fact, they are likely to get much worse - it’s important to know that you don’t have to feel this way. These are things you can do to conquer your demons, repair your relationships, and get on the road to recovery. With the right support, self-help and treatment, you can overcome a co-occurring disorder, reclaim your sense of self, and get your life back on track.

Getting help for addictions

Addiction is a treatable condition. Whatever the addiction, there are lots of ways you can seek help. You could see your GP for advice or contact an organisation that specialises in helping people with addictions.

You can use the following online directories to find addiction information services in your area:

Alcohol addiction services - https://www.nhs.uk/nhs-services/find-alcohol-addiction-support-services/

Drug addiction services - https://www.nhs.uk/service-search/other-services/Information-and-support-for-drug-misuse/LocationSearch/339

Stop smoking services - https://www.nhs.uk/service-search/other-services/Stop-smoking-services/LocationSearch/1846

To speak to someone anonymously about any type of addiction, you can call the Samaritans free on 116 123.

Treatments

Medicinal advances and progress in diagnosis have helped the medical community develop various ways to manage and resolve addiction. Some methods may include:

Medication-based treatment

Behavioural therapy and counselling

Medical devices to treat withdrawal

Treating related psychological factors, such as depression

Ongoing care to reduce the risk of relapse

Addiction treatment is highly personalised and often requires the support of the individual’s community or family. Treatment can take a long time and may be complicated. Addiction is a chronic condition with a range of psychological and physical effects. Each substance or behaviour may require different management techniques.