This month’s article, by Community Psychiatric Nurse, Karen Kirk, considers strategies to tackle common mental health conditions (those in the milder range of severity) to coincide with National Stress Awareness Day on the 3rd of November.
Stress is so common to all of us that learning how to deal with it effectively is a sound investment every single calendar day. The difficulty with stress is that it can work for you and against you, and our susceptibility to stress varies so much from one person to another. Often, depending on the circumstances, when we notice strain, we react to it by doubling our efforts, thus increasing our stress levels, worsening our performance, and eventually affecting our day to day ability to function as usual.
Firstly, you will need to understand what the symptoms of stress, anxiety and low mood are, and how they affect you. The full understanding of problems is the first step to overcoming them. This article will signpost you to relevant sources of self help information, and guide you through what are called “low intensity psychological treatments” which are available to you as part of something called the “matched care approach”. An explanation of the match care approach will be provided in conjunction with a brief overview of the current policy context influencing your mental health care within NHS Lothian (for those common conditions within the mild range of severity). If you are unsure about how to rate the severity of your symptoms then it would be important that you arrange to see your GP or other health professional for an assessment.
Understanding the symptoms of stress, anxiety and low mood
There are a few very helpful information sources which will provide you with relevant leaflets to get you started.
NHS Inform is a health information service from NHSScotland. This service will provide you with information in different language too, as will The Royal College of Psychiatrists website, Mental Health Info section: rcpsych.ac.uk. Check online at www.nhsinform.scot for information leaflets about stress and how to tackle it. Alternatively, telephone NHS Inform on free phone 0800 22 44 88 to speak with a healthcare worker everyday between 8am and 10pm, and they will send you information in the post.
Edspace is an up-to-date mental health information website which provides a directory of mental health services in Edinburgh, mental health fact sheets, and links to mental health information. www.edspace.org.uk. You will find self help information leaflets about stress and other common conditions, which have been developed by NHS Lothian’s Psychological Interventions Network (LPIN). Alternatively, you could telephone the Edspace team on 0131 225 8508 and somebody will help you to access the information. You will find up to date information about all of the low intensity psychological interventions discussed in this article on the Edspace website.
The Mental Health Information Station is a one stop shop acting as a source of support, information and sign posting. Lead by NHS Occupational Therapists, input is drawn from health and social care staff, peer support workers, volunteers and key third sector partners. The service runs every Thursday from 11am-3pm and is based at ‘A Sense of Some Place’ in the Walpole Hall (next to St Mary’s Cathedral), Palmerston Place, Edinburgh, EH12 5AW. For more information see the leaflet below.
In addition you could read the Healthier Scotland, Scottish Government, Steps for Stress booklet, linked below.
The Matched Care Approach and Low intensity Psychological Interventions (NHS Lothian)
If you arrange to see your GP or other health care professional they may initially discuss low intensity psychological interventions with you, if they seem appropriate to your individual circumstances. Put simply, a matched care approach involves matching your care to psychological treatment interventions that are likely to be effective and helpful to you. If the current treatment is not achieving a good response, the aim is to “step up” to a more intensive form of psychological treatment. However, it is important that you still retain regular contact with your health care professional so that they can assess your progress, and it may be that you “step up or down” with your treatment interventions. I would suggest that low intensity interventions are a valuable resource because they reach and serve many more people much more quickly, than perhaps traditional pathways for psychological therapies do. Furthermore, they enhance self management techniques, early intervention and offer good basic education about common conditions.
Where does Matched Care come from? If you would like to look in more detail at the national clinical guidelines and documents with influence mental health and wellbeing provision, and particularly in terms of understanding NHS Lothian’s commitment to increasing access to psychological therapies in line with the Scottish Government’s commitment to improving good mental health, you may find the clinical guidelines referenced at the end of this article of interest.
What treatment interventions are available?
The NHS Lothian matched care model of service delivery has four main “steps” for psychological therapies. It is important however to acknowledge that NHS Lothian works in partnership with a range of services in the local community to promote positive mental wellbeing and good mental health, including the voluntary sector, Edinburgh city council, local libraries, adult education, Edinburgh Leisure, counselling agencies, and Scottish Government funded projects. These steps include:
- “Pure” self help e.g. computer aided packages, self help booklets, book prescribing scheme (Low intensity psychological interventions).
- Guided self help (Low intensity psychological interventions).
- Brief individual psychological therapies (mild to moderate conditions).
- Longer term individual therapy (for moderate to severe health conditions).
To enable you to manage symptoms of stress, mild anxiety, and low moods more effectively, a range of evidence based easily accessible and free psychological interventions are available (forming Steps 1 and 2 of the matched care model).
PATIENT INFORMATION BOOKLETS
A range of self help booklets are available to download free from the Edspace website, or by contacting the Edspace team on 0131 225 8508 or from your health care professional. These booklets are divided into 3 levels of information. Level 1 provides you with basic information about common mental health issues. Level 2 provides help with signposting you to sources of further support and basic advice about coping. Level 3 booklets comprise of basic cognitive behavioural interventions guiding you through a structured self help plan for specific common mental health conditions.
BOOK PRESCRIBING SCHEME/LOCAL LIBRARIES
You can access a variety of self help books to deal with a range of psychological conditions at your local library. Further information is also available on the Edspace website, or by contacting the Edspace team on 0131 225 8508. These resources have been written by lead clinicians in the field and are generally based on cognitive behaviour therapy (CBT).
A book prescribing scheme is also available for adults with mild to moderate mental health conditions via your GP. However, you can obtain a recommended self help book from the library without a prescription. A copy of the recommended book list is available here and further information is also available from your health care professional.
COMPUTERISED SELF HELP
The Living Life to the Full course is a computerised life skills course based on CBT techniques, accessable at livinglifetothefull.com. It has been written by a Consultant Psychiatrist/Cognitive Behaviour Psychotherapist and is free to access, but you must register with the course online. The site is supported by the NHS and the Depression Alliance Scotland (www.dascot.org). A list of self help websites for mental health issues is available here. If the information provided there is insufficient for your needs, please do seek the advice of your GP or other health professional.
LIVING LIFE TELEPHONE BASED CBT
NHS 24 offers a specialist telephone support service for people using the online Living Life to the Full computerised CBT life skills course. Living Life is open from Monday to Thursday 10am to 9pm and Friday 10am to 6pm on free phone 0800 328 9655. You could discuss the service with your GP or just self refer. Further information is available at www.nhs24.scot or from the Edspace website.
POSITIVE MENTAL HEALTH TRAINING
This is a free 12 week self help programme approved by NHS Lothian for treating mild to moderate depression in Steps 1 and 2 of the matched care model. It is available from your GP, or other health professional. The programme has been devised by an Edinburgh GP called Dr Alastair Dobbins. It comprises of a DVD and 3 audio CDs, which you listen to over 12 weeks of the course. CD1 covers the foundations of good mental health and relaxation self hypnosis skills. Should you consult with your GP about stress and anxiety symptoms, CD1 would be a good resource to enquire about. These CDs are easily available and free of charge. Further information about the course is available on Dr Dobbin’s website at www.foundationforpositivementalhealth.com
GUIDED SELF HELP SERVICE
This service offers Guided Self Help for mild anxiety and mild to moderate depression conditions, and is available to you via GP referral. The service is provided by trained Guided Self Help workers using cognitive behavioural interventions, whom are supervised by experienced psychologists from NHS Lothian. Further information is available here.
HEALTHY ACTIVE MINDS – PHYSICAL ACTIVITY REFERRAL PROJECT
This service is available for adults aged 18 and over with mild to moderate mental health conditions (including stress, mild anxiety and low mood) and operates in partnership with Edinburgh Leisure. Referral is via your GP, whom will have knowledge of your medical history and current physical health. Your options include walking, swimming, gardening, gym and fitness classes. Further information is available here.
STRESS CONTROL CLASSES
You can just self refer to these free classes which run over 6 weeks at different venues across Edinburgh throughout the year. They are delivered by NHS Lothian Psychologists, Adult Education Tutors and partnership colleagues, and are helpful to anybody who is seeking to learn how to control stress more effectively. The course is educational and CBT based. Each of the 6 sessions is complimented with a summary handout and relaxation materials which you keep. You can book a place on the course by contacting Health in Mind on 0131 225 8508. Further information is available on the Edspace website or on the NHS Lothian website.
The course content can also be helpful for mild to moderate sleep problems, mild anger management issues, and mild to moderate anxiety conditions.
Your GP may be a good first point of contact if you feel that you would like to speak to somebody. There are a wide range of different psychological therapy approaches and a number of counselling services across Edinburgh within both the voluntary and private sector. A summary information leaflet about the different counselling modalities is available here. If you are considering a self referral to counselling, please refer to the linked Counselling Psychotherapy Making Safe Choices leaflet below, which is produced by the professional body for Counselling & Psychotherapy in Scotland (COSCA).
Further information about local counselling services is available on the Edspace website. Your GP or other Health professional may also be able to suggest services to you. Counselling services in the voluntary sector are generally low cost, with charges often based on the person’s income.
Lay the right foundations for looking after your health
Feeling stressed is a danger signal and a sign that you are approaching the limits of your resources. It is bad for your physical health as well as your mental health. Thus it is important to not only focus on the causes of your stress but also on looking after yourself and your overall health. The key is to keep your strategies straightforward, simple and regular. Remember the basics and follow the R rule – anything beginning with the letter R is likely to be very helpful to you.
Regular nutritional meals, reduce your alcohol consumption, regular exercise, regular rest, relaxation and recreational activities. Relationships and keeping regular connections with supportive companions, or with your professional support networks are important. Aim to seek out people whose company you enjoy too and those who you can talk to about your feelings. The following leaflets have practical tips which may be of help to you:
The Food Standards Agency publication, ‘Your guide to the eatwell plate’, which can be downloaded below, is based on the five food groups and offers guidance on eating a healthier diet. You can read more about it at the Food Standards Agency website. See attached Eat More Fruit and Vegetables leaflet for further tips.
Reduce your alcohol consumption
Current advice on the recommended safe limits of alcohol can be found within the attached leaflet. If you are drinking above the suggested units of alcohol per week, please seek advice from your GP or health professional.
Moderate daily activity is a good stress buster. The attached leaflet provides information about suggested amounts of daily physical exercise. Remember Edinburgh’s green spaces for local walks and exercise. You could also ask your GP about a referral to the Healthy Active Minds Physical Activity programme.
If you are having trouble sleeping, the Royal College of Psychiatrists website has a helpful leaflet called Sleeping Well. Self referral to the Stress Control Classes could be beneficial to you. If simple approaches appear unhelpful then do arrange to see your GP for further assessment.
Relaxation and recreation
If your work, studies, home life, role as a carer, or your relationships are at times a source of stress to you, find something outside of these daily domains that unwind you. Recreational activities come in infinite varieties. Ideally, find a hobby that is markedly different from your work routine or usual commitments and skills. Remember to take a holiday or a regular short break if you can.
What to do in a crisis
Others can help you if you are feeling significantly stressed and your problems feel overwhelming. Do not cut yourself off from people. If your symptoms are continuing despite trying low intensity psychological interventions outlined in this article, it is important to arrange to see your GP or health professional for further help. Feelings of hopelessness can be a symptom of a depressive illness which can cause depressed people to believe incorrectly that they can’t be helped. It is important to realise that treatment and help is available. Outside of normal business hours telephone advice is also always available. The attached leaflet Help lines & Web addresses for use in a crisis provides details of services to contact.
Butler G and Hope T (2008) Manage Your Mind The Mental Fitness Guide Oxford University Press.
National Institute for Health and Clinical Excellence (2004) Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalized anxiety disorder) in adults in primary, secondary care and community care. Clinical Guideline 113 (amended 2011). http://guidance.nice.org.uk/CG113
National Institute for Health and Clinical Excellence (2004) Depression: Management of depression in primary and secondary care. Clinical Guideline 90 (amended 2009). http://guidance.nice.org.uk/CG90
SIGN Scottish Intercollegiate Guidelines Network (2010) Non-pharmaceutical management of depression in adults. A national clinical guideline 114. http://www.sign.ac.uk/guidelines/fulltext/114/index.html