Suicidal Feelings – How to get help

466px-depression-loss_of_loved_one

Sometimes painful feelings lead people to contemplate suicide. The pain can seem unbearable and life can seems pointless. Feelings of self loathing may make you think that you are useless, and that everyone would be better off without you.

You may be filled with thoughts of anger, guilt or shame. Sometime painful feelings such as loss can leave you feeling empty and that life is not worth living. Maybe you feel you are to blame and that there is no alternative but to end your life.

You may feel that suicide is the only solution, the only way you can take control. Perhaps feelings of anger, guilt or shame overwhelm you. You may start to think that suicide is the only way out.

Even if you don’t know why you feel the way you do, suicidal thoughts simply may just be so overwhelming that you can see no way out.

Please don’t despair. You may think that no one can help you, perhaps you are actively avoiding people and planning how you can take your life. Maybe you feel so deeply hurt or are filled with rage and turning your feelings inside, or perhaps so angry with another that you want to punish them and suicide seems a good option.

Please seek help. You are not alone, many people with suicidal thoughts do not go on to kill themselves. If you are reading this, you have already taken that important first step in getting help.

You may be filled with shame and think you are beyond help, but please reach out. Your doctor will be used to helping people in your situation. They will be able to get you the help you need.

There are a number of treatment options from medication to talking treatments, including counselling and psychotherapy to help you come to terms with your feelings and explore your thoughts. The aim of which is to enable you to make sense of what is going on, to help you to find a solution to your problems.

If you are reading this and are concerned about someone you know:

Make sure you tell them that you want to help them.

Make sure you tell them that you will help them seek help.

Don’t promise that you will be able to help them by yourself or without telling others. This is too big an issue for you to bear on your own.

Whether you may like it or not, the person that threatens suicide is responsible as to what they do with their life.

Tell them that you do not want them to do it.

Ask if they are angry with you or want to hurt you? Tell them that they do not need to act it out this way.

Enabling the other person to talk about their feelings can be a great relief to them, it will help diffuse some of the tension and is likely to give them “permission” to tell you if thoughts turn to intent.

When actual suicide intent is expressed, ask them how they plan to do it and if they can picture themselves doing it.

Remember, at this stage where the person may see no future, suicidal thoughts may appear perfectly logical and they may see no reason to live at all.

Try to get them to hold on, negotiate a window or time frame that they will hold off until.

Remove or hide all dangerous drugs or other implements that they may have expressed a desire to use in the act.

Get help straight away.

With best wishes,Steve

Other sources of help:

Your local hospital A & E Department.

Samaritans – Offer 24 hours support on 08457 90 90 90 or email: jo@samaritans.org.

Papyrus – Offer advice for young people at risk of suicide and can be contacted on 0800 068 41 41.

MIND – Can provide information and help can be contacted via the Mind Infoline on 0300 123 3393 or via email at info@mind.org.uk or via their website: http://www.mind.org.uk

Saneline – Offer advice and practical information and can be contacted on 0845 767 8000.

turn2me.org – Offer free online counselling.

Maytree Suicide Respite Centre – Registered charity supporting people in suicidal crisis in a non-medical setting. If you, or someone you know, could benefit from a one-off stay in a safe and confidential space, please call – 020 8038 3588 or email maytree@maytree.org.uk.

Main references:

“How to Cope with Suicidal Feelings”(2007) Mind information booklet.
“Overcoming Depression” 1987) Dr Richard Gilllett, Dorling Kindersley

Image: By Baker131313 (Own work) [Public domain], via Wikimedia Commons

Cutting Club

File:Schnittwunden.JPG

Many people reading this blog about cutting will understand just how others feel who cut. They may have cut themselves in the past, have a friend or family member who cuts, or be contemplating the next cut at this very moment.

Cutting is the act of deliberately inflicting a wound, of self-harming and differs from a suicide attempt per se. It could be said that while cutting serves many purposes it is often a way of coping, a way of dealing with emotional distress. It may be that the person cutting feels deep sadness, acute anxiety or emotional numbness. Sometimes cutting can be a way of relieving stress or trying to feel in control. For some, “X” marks the spot, just like a cross on a map, it can signify the presence of something hidden or buried deeply. For some cutting can be a “ritual of purification.” This type of “blood letting” can release perceived “badness,” and it may be a way of inflicting punishment on oneself.

The term “Cutting Club” might be a good metaphor for what young people look for – a “connectedness” with others who may feel alienated from family, peers or society. Cutting becomes a statement and others may identify with them, perhaps forming a friendship group Alternatively, it might be the entry requirement to joining the group itself.

It is not just cutting itself that bonds members of this club together, other forms of self harm serve  the same currency. Scratching, burning, picking, tearing at skin, pulling out hair, swallowing poisonous or toxic substances, even breaking ones own bones, all share the same characteristics with often the same painful underlying themes.

In my experience as a therapist, cutting is frequently linked to underlying child abuse, in particular sexual abuse. It is more common in girls, but boys cut too. While I have seen boys and girls as young as 12 cutting, in my opinion the vast majority of those who do so, are in the 16 plus age group.

It may also be related to depression and anxiety. Quite often those, who cut may also turn to eating disorders or drugs as a way to cope. Sometimes it can be linked to conditions such as post-traumatic stress disorder. Sometimes, perhaps as a result of trauma, individuals feel ” dissociated” or ” numb” and this can be a way of feeling. For some people who have difficulty in regulating their emotions, cutting can be a way to cope when they do not have the personal resources to do so. It is not unusual for people to think about suicide when they are cutting, but it is not often meant as a suicidal act. The biggest danger is that the person cuts through an artery accidentally, seriously endangering their life.

I have seen cutting in all parts of the body including breasts and genitals, however, the most common injury sites are wrists, arms, thighs and sometimes stomach. I would not regard tattoos and body piercing as self- harm, unless of course, it is done deliberately to cause harm.

In most cases cutting is done secretly, often in the privacy of the home and mostly it is done where it can be covered up, perhaps by pulling down sleeves and hidden beneath layers of clothing.
Frequently, people who self- harm tell me that no one knows about this behaviour.

It can be very difficult for parents to deal with because they are so emotionally involved. Often they may blame themselves, sometimes they become angry, often because they feel both helpless and worried.

In my clinic I go to great lengths to try to understand what it is that underpins this behaviour. I know that it often signifies s deep emotional distress. It is a way of coping and I make sure to tell the person cutting that they are not bad and that this is not bad behaviour but merely a way of coping.

I explain that I am not judging them and neither am I going to take away this means of coping. Instead, I suggest that either working together to resolve the underlying conflict and/or providing them with a wider range of coping skills is really the best way to help.

It is very difficult to stop cutting because it can become a habit and ultimately an addiction. The very act of cutting releases “feel good” hormones known as endorphins, or to use the full medical name endogenous morphine.
Identifying the triggers is a key task and then teaching coping strategies other than cutting. Sometimes the addition of medication such as an antidepressant can help greatly. Having an opportunity to talk about the deep problems to a professional within a safe and confidential setting can really help. Sometimes having access to clean dressings and medical help may be needed, particularly if wounds are more than superficial.

If you are concerned about yourself or someone you know,make an appointment to see your doctor. Alternatively you  may find that there is a young persons counselling service near you, and if you are at school or college there may be someone you can talk to in confidence. Please feel free to email me in confidence via my website and I will try to find help in your area.

Until next time, Steve

You may wish to know that Steve is now offering therapy sessions via Skype Please contact us through our website @ www.stevecliffordcbt.com

Visit our facebook sites:

www.facebook.com/yourmentalhealthmatters

www.facebook.com/bexhillmindfulnesscentre

Steve Clifford Senior Accredited Integrative Psychotherapist.                                           Accredited Cognitive Behavioural Psychotherapist.                                                               Registered Mental Nurse.                                                                                                     Registered Nurse for Learning Disabilities.

 

Image ref:http://commons.wikimedia.org/wiki/File%3ASchnittwunden.JPG

Managing really upsetting thoughts and feelings

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As a CBT practitioner I would be the first to point out that avoidance of upsetting thoughts and feelings only serves to perpetuate and strengthen the power they have over you. There are times however, when the sometimes overwhelming nature of these thoughts and feelings can simply be too much. Having intrusive and upsetting thoughts while your taking your child to school, or when faces around you become distorted, due to a painful flashbacks, is not to be recommended. I hope to give you a few tips to help you manage, so that you can go about your life with relative ease, until such time as you can address the causes of these upsetting thoughts and feelings safely in therapy.

The first technique I would like to share is adapted from the “Drop Anchor” exercise by Russ Harris (Harris, 2009).

This exercise will help you centre yourself and connect with the world around you.

1. Place your feet firmly on the ground.                                                                                   2. Now push them down firmly.                                                                                                 3. Become consciously aware of the floor beneath you, feel it supporting you.                       4.Notice the muscle tension in your legs as you push your feet down.                                 5. Become aware of your whole body, as if your whole body now is engaged in pushing.     6. NOw look around you, notice what you can see and hear.                                                  7. Notice where you are and what you are doing.                                                                     8. Breathe!

Grounding techniques

These are very helpful techniques to learn, particularly if you are prone to upsetting intrusive thoughts, memories and images. THey are also good to employ if you are feeling detached and unreal.  Rather like mindfulness, focusing all of your attention on sounds in the environment e.g. birds in the trees, waves on the beach or even the sound of your breathing can be very helpful.

There are many different grounding techniques and I have listed some of my favourite “sensory” grounding techniques below:

Visual: Select an object or perhaps a photo, picture or landscape to focus on.  Study it intently; describe what you see out loud or in your head.  You may choose to focus on something around you, like the wallpaper or even a spot on the carpet or ceiling. Really focus on the detail, shape, colour and pattern.  Counting the grain in wood or fabric will really heighten your “in the moment” awareness.  Use flashcards, with a message to yourself such as, “these dark days will pass” or “I can tolerate this.”

Touch: Carrying round a stone or crystal that you can get out of your pocket when you need to ground yourself is an easy way to bring yourself back to the present. Find yourself a special object to use at such times.Look at the colour, the shape, how solid it is, the temperature of the object and its texture, and whether it is rough or smooth.  You can even use foodstuff like a sultana, banana or mushroom.

Look to your environment, for example by feeling the grass under your feet or the bark of a tree. Take a shower and become aware of the stimulation of the water on your skin, or perhaps slap your hand on the surface of bathwater.  Pinging an elastic band on your wrist, rubbing a comb over your arm or an ice cube over your face can be helpful.  The latter are particularly helpful as an alternative to acts of self-harm.

Sound:  Use your voice, making different sounds and shapes with your mouth.  Select a piece of music, preferably something up-beat, and listen to the sound, in particular, paying attention to the beat, rhythm, the different instruments and vocal harmonies and become aware of any feelings evoked.  Listen to the sounds of birds, the ticking of a clock, or simply listen to the sounds around you, noticing how loud or soft they are.  Notice those in the foreground, mid-ground and distance – now categorise these into groups.

Scent: Scented candles, oil burners and incense are all good for grounding.  I burn incense before I see my first clients each day to help me to focus and put me in the “zone”, ready to attend to the issues they bring me.  It can be helpful to carry round a small bottle of perfume, or putting a dab on your wrist to smell.  A particular favourite of mine is the scent of patchouli, however, my Granny used to carry round a bottle of smelling salts to ward off the “vapours.”  I can only think that this latter, rather pungent scent would be good for managing panic attacks!

Taste: Take a glass of water (with or without ice cubes) and drink it very slowly, savouring the taste, imagining it cleansing and washing away your tension or distress.  A selection of herbal teas with different flavours can stimulate the taste buds.  Be aware, however, that herbal teas have certain therapeutic properties and so should be taken with this in mind.  If you want to find out about the beneficial effects of herbal teas consult your local health food store.

I hope you find these helpful.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist.

Visit us @  www.steveclifford.com

Ask us your mental health questions anytime @ www.facebook.com/yourmentalhealthmatters

 

Image ref: http://commons.wikimedia.org/wiki/File%3AGl%C3%BChwendel_brennt_durch.jpg

Sources:

Russ Harris – “Simple Ways to Get Present” – 2009. www.actmadesimple.com 

Steve Clifford – “50 Tips to Beat Depression” – http://www.amazon.co.uk/Tips-Beat-Depression-Steve-Clifford-ebook/dp/B00ILV965A

Make a Comfort Box – Beat #Depression

50Tips 

Tip 3 – Extract from “50 Tips to Beat Depression” available on Amazon

It’s often hard to remember the good things in life when you are feeling low in mood.  At such times happiness and positive memories can seem far away.  Stimulating positive memories and associations can be invaluable in helping to keep us grounded in the real world and help lift the spirit.  Creating a “capsule” containing mementoes from the past can help to evoke feelings of comfort, warmth and personal security during difficult times.

A shoebox, biscuit tin or similar can be used to house objects to inspire hope.  I have a comfort box and mine includes a variety of objects: photographs and even “thank you cards” which I can use as “evidence” to support my being a worthwhile person.  I recommend any of the following:

CD, LP, MP3 of favourite music, chill-out, relaxation, etc.

DVD of favourite film with uplifting, or feel good theme, etc.

Photograph of a loved one or of something or somewhere of importance

Memento of a holiday, postcard, seashell, souvenir, foreign money, flight ticket stubs, booklet or programme from places visited

A note, card or letter from a loved one or write a letter to yourself when feeling well, offering encouragement and re-assurance that you will come through this difficult time

A favourite poem, statement, prayer or article that inspires hope

A favourite book, magazine or colourful picture

A favourite object, i.e. a small stone, crystal, lucky charm or something that is tactile

A sketchpad with crayons or watercolour paints

Aromatic oils for massage, scented candles, bath bombs or bath oils/salts

Herbal teas such as Chamomile, known for its calming properties

Favourite item of clothing, warm jumper or a blanket

A hot water bottle

Vouchers for a massage or beauty treatment

A list of telephone numbers, e-mail addresses of family or friends to whom you can turn for support (try to look for support from more than one person).

A list of national help lines e.g. Samaritans, Sane, MIND, etc. .

Any object associated with feeling happy and well.

With best wishes, Steve

Please feel free to email your blog posts for “Your Mental Health Matters” to stevecliffordcbt@gmail.com                                                                                                Steve Clifford, Cognitive Behavioural Psychotherapist

Visit us @  www.steveclifford.com                                                                                      Ask us your mental health questions anytime at: www.facebook.com/yourmentalhealthmatters                                                                  Tweet us @ cbt4you

It’s good to talk

File:Camila.jpg
Sometimes life can seem very overwhelming,  especially if you’re suffering with a mental health problem. For years I have suffered with anxiety and depression. It has affected every aspect of my life from my relationships with partners, friends and family, to my work and even my physical health. My chronic low self esteem has led me to walk with my head down for so many years that my neck and back have slowly deformed and I now have a small hunch. It’s just one more thing to hate about myself, and another reason why I felt I couldn’t live anymore, why I felt I didn’t deserve life.
When I planned my suicide the first time I was at an all time low, but strangely I didn’t recognise that. I felt calm and in control. I made meticulous plans and took my time stockpiling prescription and over the counter drugs. I cheerfully strolled into the supermarket and purchased alcohol. The checkout girl could be forgiven for thinking I was having a party, because in my head I was. I was finally going to be free of all the agonising feelings, the torturous thoughts and the confused state my mind was in. I had been looking forward to this day for weeks and had all my affairs in order. I went home, made sure I left the door unlocked, fed my cat, put on my favourite album and poured myself a large glass.
When I woke up in hospital initially I was devastated, how could it have gone wrong? But as I looked around at the tear stained worried faces I began to realise that maybe people did care about me. Maybe their lack of warmth and comfort towards me was really lack of knowledge and understanding. The question I was continually asked was “why didn’t you tell us that you felt so bad?” Well I thought it was obvious! But apparently it’s not obvious.
When you suffer from depression for a long time you can get very good at keeping your brave face on in public and the inner turmoil you’re feeling may not show on the outside. It’s only once you express that turmoil that people can begin to understand and maybe even help.
Unfortunately this revelation was not the end of my depression and I did wake up in hospital on another 3 occasions. However it did start my journey onto talking, writing and expressing the pent up feelings I had inside of me, which helped other people understand more. I am still suffering with my mental health but I am on the road to recovery. Letting the thoughts and feelings out rather than keeping them hidden in my head has taken the weight off and I feel a little freer of my illness every day.

Thank you anonymous

With all good wishes

Steve

Please email your submission posts to stevecliffordcbt@gmail.com                                Steve Clifford, Cognitive Behavioural Psychotherapist

Visit us @  www.steveclifford.com                                                                                      Ask us your mental health questions anytime at: www.facebook.com/yourmentalhealthmatters                                                                        Tweet us @ cbt4you

image ref: http://commons.wikimedia.org/wiki/File%3ACamila.jpg

Cutting Club

File:Schnittwunden.JPG

Many people reading this blog about cutting will understand just how others feel who cut. They may have cut themselves in the past, have a friend or family member who cuts, or be contemplating the next cut at this very moment.

Cutting is the act of deliberately inflicting a wound, of self-harming and differs from a suicide attempt per se. It could be said that while cutting serves many purposes it is often a way of coping, a way of dealing with emotional distress. It may be that the person cutting feels deep sadness, acute anxiety or emotional numbness. Sometimes cutting can be a way of relieving stress or trying to feel in control. For some, “X” marks the spot, just like a cross on a map, it can signify the presence of something hidden or buried deeply. For some cutting can be a “ritual of purification.” This type of “blood letting” can release perceived “badness,” and it may be a way of inflicting punishment on oneself.

The term “Cutting Club” might be a good metaphor for what young people look for – a “connectedness” with others who may feel alienated from family, peers or society. Cutting becomes a statement and others may identify with them, perhaps forming a friendship group Alternatively, it might be the entry requirement to joining the group itself.

It is not just cutting itself that bonds members of this club together, other forms of self harm serve  the same currency. Scratching, burning, picking, tearing at skin, pulling out hair, swallowing poisonous or toxic substances, even breaking ones own bones, all share the same characteristics with often the same painful underlying themes.

In my experience as a therapist, cutting is frequently linked to underlying child abuse, in particular sexual abuse. It is more common in girls, but boys cut too. While I have seen boys and girls as young as 12 cutting, in my opinion the vast majority of those who do so, are in the 16 plus age group.

It may also be related to depression and anxiety. Quite often those, who cut may also turn to eating disorders or drugs as a way to cope. Sometimes it can be linked to conditions such as post-traumatic stress disorder. Sometimes, perhaps as a result of trauma, individuals feel ” dissociated” or ” numb” and this can be a way of feeling. For some people who have difficulty in regulating their emotions, cutting can be a way to cope when they do not have the personal resources to do so. It is not unusual for people to think about suicide when they are cutting, but it is not often meant as a suicidal act. The biggest danger is that the person cuts through an artery accidentally, seriously endangering their life.

I have seen cutting in all parts of the body including breasts and genitals, however, the most common injury sites are wrists, arms, thighs and sometimes stomach. I would not regard tattoos and body piercing as self- harm, unless of course, it is done deliberately to cause harm.

In most cases cutting is done secretly, often in the privacy of the home and mostly it is done where it can be covered up, perhaps by pulling down sleeves and hidden beneath layers of clothing.
Frequently, people who self- harm tell me that no one knows about this behaviour.

It can be very difficult for parents to deal with because they are so emotionally involved. Often they may blame themselves, sometimes they become angry, often because they feel both helpless and worried.

In my clinic I go to great lengths to try to understand what it is that underpins this behaviour. I know that it often signifies s deep emotional distress. It is a way of coping and I make sure to tell the person cutting that they are not bad and that this is not bad behaviour but merely a way of coping.

I explain that I am not judging them and neither am I going to take away this means of coping. Instead, I suggest that either working together to resolve the underlying conflict and/or providing them with a wider range of coping skills is really the best way to help.

It is very difficult to stop cutting because it can become a habit and ultimately an addiction. The very act of cutting releases “feel good” hormones known as endorphins, or to use the full medical name endogenous morphine.
Identifying the triggers is a key task and then teaching coping strategies other than cutting. Sometimes the addition of medication such as an antidepressant can help greatly. Having an opportunity to talk about the deep problems to a professional within a safe and confidential setting can really help. Sometimes having access to clean dressings and medical help may be needed, particularly if wounds are more than superficial.

If you are concerned about yourself or someone you know,make an appointment to see your doctor. Alternatively you  may find that there is a young persons counselling service near you, and if you are at school or college there may be someone you can talk to in confidence. Please feel free to email me in confidence via my website and I will try to find help in your area.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist.

Visit our health blog – www.stevecliffordcbt.com                                                            Like us at Facebook – www.facebook.com/yourmentalhealthmatters                            Tweet us @ cbt4you

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Proposed A & E Changes.. will they benefit mental health?

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A huge shake up of A & E provision was announced this week by Professor Bruce Keogh, the top doctor in the NHS. Will these proposed changes be any more effective than a sticking plaster in terms of the actual benefit for mental health service users?

Given that rapid decline of a person’s mental health should be recognised as a mental health emergency, what of emergency mental health services? It is hard enough for people in mental health crisis to know where and how to access urgent healthcare, without this proposed tiered system adding to the confusion. How will patients who are mentally unwell know where to turn for help if they are unable to access out of hours mental health services? New super A & E, standard A & E, evening/night GP surgery, 111, paramedic? The list of options is mind boggling. I ask myself the question,if I were psychotic, paranoid, manic or deeply depressed, would I be able to adequately access urgent help when I may need it most?

The solution is to improve access to specialist support, to lessen distress and prevent crises; by this I mean 24/7 crisis resolution and home treatment teams in all parts of the country. In particular, rural communities and areas where the demand stretches existing resources such as inner cities, and at weekends and public holidays. Improvement need to be made to existing services such as A & E to provide a seamless net to ensure immediate access is available. Really, we need to be looking at improvements to the urgent care system for both physical and mental health, for young and old alike.

I do hope that thought is given to this sector of the public and their specialist needs. I really do not want to see mental health relegated to a “bolt on” or simply a sector that will have to “fit in.” Any redesigning of the infrastructure of the NHS ought to be reconfigured to meet the needs of this often overlooked and vulnerable sector of our society.

Your thoughts and comments on this subject would be most welcome.

According to Steve Duggan, Chief executive at the centre for Mental Health, the quality of care that mentally ill people receive when they are at their most vulnerable is “unacceptable”.A report from four national inspectorates found that police cells were used under section 136 of the mental health act, some 9.000 times as a “place of safety.” Surely, they are only meant to be used as a last resort?

When it comes down to accessing care; The Health and Social Care Information Centre estimate that mental health service users attended A & E departments at twice the average rate, compared to the general population. So where are the dedicated psychiatric A & E departments?

Until Next time, Steve Clifford, Cognitive Behavioural Psychotherapist
Visit our health blog – www.stevecliffordcbt.com                                                              Like us at Facebook – www.facebook.com/yourmentalhealthmatters                              Tweet us @ cbt4you

Main Ref:

*Duggan, S (2013) Leadership in Mental Health, Health Service Journal. June. www.hsj.co.uk/opinion/blogs/leadership-in-mental-health/2007653.bloglead [Accessed 13/11/13]

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