Feeling powerless over symptoms often goes with the territory when you live with mental illness. At least it can for me, particularly with anxiety and depression. This isn’t just the case for those of us diagnosed but also those who love and support us. They can feel at the mercy of these debilitating conditions when they’re at their peak.

Like a ragdoll in a tug-o-war between two kids or one in the washing machine (the ragdoll, not the kids) I can feel like I’m at the whim of my symptoms: negative self-talk, extreme fatigue, racing heartbeat, racing thoughts, incessant worry, rumination, lack of focus, aches and pains, hopelessness, emptiness – and those are just the pleasant ones. Kidding.

I enjoy feeling in charge of my mental health. Most weeks I am. But not always. Not by a long shot.

So what do I do? What can you do if you feel like this?

This is a strategy I’ve set up with my husband. It’s not a miracle solution, but it can help lessen the blows of bipolar disorder, psychosis and anxiety that I live with. It can help my husband better weather them too.

Let your loved ones help you. Enlist them into your wellness journey:

My husband knows me well. He catches signs of things shifting up or down better than (and before) I can sometimes. We all have our blind spots.

He’ll see me filling the Britta jug over the top line, or I’m getting up earlier (much earlier) than usual. Or like today, he’ll catch me making a grocery list and doing laundry at 5:00 in the morning. We’ve created a code word so to speak to signal I might be hypomanic. With kindness and enthusiasm, he’ll say ‘Oh. Spazzy Maginty is visiting us today!’

Another day, I fidget a lot in my favorite chair when we eat breakfast together. Or I won’t look him in the eyes when we talk. He might gently ask me ‘How are you doing?’ or more specifically ‘How’s your anxiety?’.

A different instance, he mentions my complexion looks grey and I’m sleeping longer than usual. Or he might recognize I haven’t run in a couple weeks. He’ll smile, look at me and ask if everything’s ok, knowing that likely it’s not.

His comments aren’t criticism but instead observation. Facts that I’ve changed from my baseline of wellness. It’s meant lovingly and delivered that way. It’s information I can use to my advantage. If I take steps to care for myself, I may prevent the anxiety, depression or hypomania from blossoming further. It’s not guaranteed, but it can reduce the intensity.

I’m not to blame for my conditions, and he’s not saying I am. I am however responsible for my health and reaching out for help when I need to.

My next steps are to be on the alert. Revisit and perhaps double up on my wellness tools. I check to make sure I’ve taken my meds and taken them properly. I’ll review and adjust my sleep patterns. Ask myself if I’m putting too much on my plate and if I need to, take things off. I’ll look at my exercise and aim to do a bit more, or do any if it’s fallen off the radar. I’ll call a friend and spend some quality time with them – phone or in person, doesn’t matter to me. As the incomparable Julie Andrews sings (sort of) these are some of my favorite (‘wellness’) things.

Ideally this will result in the levelling off of my symptoms. This isn’t rocket science. But it’s amazing how if I don’t see my warning signs early enough, and make the needed adjustment, how off course I can really go. And I’ve gone off course. Really off course in recent months. Think psychosis (twice) and major anxiety. But with the help and delicate diplomacy of my husband and my own willingness to accept assistance, getting back on more stable ground is possible.

3 Step to Help Prevent Relapse of Mental Illness

Note: Do these steps with your loved ones while you’re well, not when you’re struggling with acute symptoms.

To set the stage ask yourself:

What are your cues? Be specific. Ask your friends and loved ones to chime in about the warning signs they see. Compare notes.

Who do you want to be your ‘cue companion’? How do you want your loved ones or friends to approach you? Decide who and what’s most comfortable for you. You don’t need a husband, or even someone who lives with you. Just someone who cares.

What will your next steps be when they mention something? Have a list of your most effective wellness tools that you’re willing to commit to. Then pick one and do it. Be honest and clear about what you’re willing to do when warning signs start to rear their heads. Set yourself up for success Think tiny adjustments.

Then:

  1. When warning signs arise, your ‘cue companion’ has permission to mention what they see.
  2. Review your wellness tool list (with your loved one if you like)
  3. Take action: add, adjust said tools as needed.

Sometimes I worry, even feel ashamed at times, how much focus it takes to ‘manage’ my mental illnesses; that I might be a burden with all my mental health problems. But Gord has told me when he’s asking me about them, he wants to know. It’s ok, more than ok to talk about my mental health. Go figure?!

I’ve come to realize that this little 3-step system is as much of a sanity saver for him as it is for me.

Try this out with your loved ones and let me know how it goes. Or, if you have a similar system already in place, let me know how that works for you!

© Victoria Maxwell

Some of you know my story. Many of you don’t. Every experience is unique and equally valuable.

Though our stories are ours and ours alone, it always amazes me how similar our journeys can be sometimes:

I’ve met more than a handful of people who have run down the street naked in a psychosis. Psychosis seems to prompt a shedding of clothes. Funny (or maybe not) depression doesn’t inspire the same behaviour.

Other shared experiences include traumatising incidents in the emergency room for both loved ones and those of us with mental illness. Damage done usually due to underfunded and understaffed hospitals, lack of services and overworked health professionals.

I also realize how lucky I have been and still am.

When I was diagnosed, it was the 90’s. I was a 20 something, middle class, white woman, living in one of the most affluent countries in the world boasting universal medical care – Canada.

There were treatments available: pharmaceutical and psychological. Though far from perfect, these treatments were more humane than anything that existed in the 30’s, 40’s, 50’s, 60’s and even the 70’s when my Mom was diagnosed.

I also wasn’t struggling with addiction along with bipolar disorder, anxiety and eating disorder.

Addiction complicates accessing help and achieving recovery.

Incomprehensible as it is to me, addiction treatment, is largely still siloed and separated from other mental illness help.

Now, I’m a middle-aged, middle class, white woman in Canada. I am still very lucky and that luck is part of the reason why I have fared so well.

Others are not so fortunate. The social and economic inequities many individuals face, have a powerfully negative effect on mental health. Long lasting and intractable at times.

It’s not a fair fight for them. As such recovery is more difficult. 

I’m also lucky because my conditions responded to treatment well – medication and different forms of therapies and lifestyle changes. Yes, I put effort into my recovery.

But, effort and trying alone does not determine if recovery happens. I know people who try really, really, REALLY hard and are very proactive in their mental health yet wellness eludes them, through no fault of their own. These illnesses are confounding.

Every person who has mental illness and everyone who loves someone with a mental illness has a story that is unique and important.

This is a very brief description of mine.

Warning: humour ahead. The humour I use is not to minimize the very real suffering that mental illness causes. Humour is one of my wellness tools. Feel free to laugh along with me and about me.

I was diagnosed with bipolar 1 disorder with psychosis, generalized anxiety disorder, mild temporal lobe epilepsy and an eating disorder when I was 25. Not really something you run and put on your resume under achievements. Well, actually, nowadays I do.

I didn’t initially embrace the idea of having a mental illness.

No, I flat out denied it, for 5 years. Even after four psych ward stays, multiple suicidal depressions, psychotic episodes, countless manias. Even after having to move in with my parents, losing my car, career, friends and money.

Even after running down the street naked in a psychosis, I wouldn’t accept I had a mental illness.

Eventually however, I did. With the guidance of caring (and extremely patient) parents and healthcare professionals and friends and support groups and peers, I did.

But it was still another journey of 5 more years to get back on my feet living independently, working,  enjoying the company of friends and in a loving relationship.

I laugh when I think of how life works. I would never have the career I do, had I not gone crazy in the first place!

I was originally trained as an actor. But my career derailed – untreated mental illness has a way of doing that. When I returned to work, I got a job as a receptionist. It was good, stable and healthy.

But, I craved more creativity in my life. I needed creativity in my life.

I started writing about my experiences. I submitted to a disability arts festival to “read from my book”. I was accepted. But, I didn’t a have a book. I didn’t even have excerpts.

So, I got to work, and wrote. Wrote not a book, but a monologue for the stage. Acting was what I knew. People liked it and asked “Is it part of a one-person stage show?” I said “Sure.” Ummm.. it wasn’t, but I know opportunity when it knocks.

From there I wrote a full keynote show. I started presenting it at organizations and conferences locally, then across North America, then internationally.

Since then I’ve written four more theatrical keynotes. Now I have a career speaking about mental health, smashing stigma, and leading wellness and creativity workshops .

I love what I do. I get to talk openly about what I used to be ashamed of. People want to hear about it. People want to feel comfortable talking about mental health. When I share my story and I see faces in the audience nodding in agreement back, it’s like finding brothers and sisters I never knew I had. And for an only child, that’s pretty cool.

Staying well is an ongoing process. I don’t take my mental health for granted. I can’t. I need to do certain things everyday to stay well. Exercise, meditate, take medication, eat well, sleep enough – to name a few.

My life is very different from what it was when I struggled with severe depression, suicide, anxiety, psychosis and my eating disorder. It’s taken a long time but I’ve got pretty good at managing my conditions. But, I’m always learning.

Now my focus is on healing, creativity, flourishing and gratitude. It’s also about sharing those things with others.

What is your story? Send me an email or comment below and let me know.

© Victoria Maxwell

Happy 2019! I don’t know about you, but I have mixed emotions about the New Year.

Yes, yes, it’s a chance for redos, starting over, goals, the blank page spread out before us. But I also love the idea of doing absolutely nothing different for the coming year, except for one thing.

This one thing was inspired by  listening to one of my favorite podcasts: CBC Radio’s ‘Now or Never’.

This particular episode was all about New Years and resolutions. Let me be accurate, it was about saying NO to New Year’s resolutions. They posed this question: “January brings with it a lot of pressure to change. But what if the thing you need to do in 2019 is just… Be you?” I loved it immediately.

Just. Be. Me. O.M.G. Yeeeessss! What a relief! Relief. I could use me some of that. I think my husband, Gord, could use some of that. I was up and down and all around in 2018 and he was, well, a rock for me.

Not having to do anything, but be ourselves? What a great forkin’ concept! (TY to the TV show “The Good Place” for my new fave euphemism).

Being in recovery from mental illness (or life for that matter), living with mental illness, and managing my mental health, sometimes feels like I’m supposed to be doing more, better, different. Always growing. Also expanding. How exhausting!

We are inundated by messages from society and the media to focus on growth and personal development.

Whether it’s for a small business you run, a family you take care of, a job you have, a home you keep, a relationship you’re in, your fitness level and health, the quality of your friendships, the hobbies you partake in, your chakras, your yoga practice (ok wait maybe I’m taking this a bit far). But, generally, ours is a culture that has an insidious but pervasive bias on improvement.  

I’m not saying self-improvement is bad. I’ve read my library-sized share of self-help books and gone to counselling for years. And it helps. Most of the time.

What I AM saying is personal growth can backfire and do the exact opposite of what I’m trying to accomplish.

Uhem – like a couple months ago. I was trying so hard to find inner peace. But all the things I was doing, all the things I was trying to change about myself and my life, kept the goalpost of serenity moving further and further down the field. The more I TRIED to find peace, the less I had it. I was constantly seeking with no finding (so to speak).

I ended up feeling less happy, more worthless, really tired and combustibly anxious.

So when I heard the call to arms, or rather the call to lay down the arms, from the hosts I jumped at the chance!

TY CBC Now or Never and you fabulously honest hosts Trevor Dineen + Ify Chiwetelu!

I loved hearing on radio (that’s NATIONAL radio, folks) a host admitting he too has a (sometimes not so) little voice that says “I’m not enough”.

A radio segment that rings in the New Year by celebrating our unique messy lovely selves with a particular partiality on self-acceptance. That’s my kind of resolution.

My no-resolution resolution: the only thing I need to do this year is be me.

Write me and let me know how it relates to you and how it changes how you see this coming year.

© Victoria Maxwell

Every month I receive emails from parents (just like you perhaps) of adult children who have serious mental illness. You tell me many things, but the one on which you all agree is how painful it is to see your son or daughter in anguish yet at the same time not accept help. She’s angry with you, blames you, yells at you, yet needs your help desperately. You tell me how helpless, how lost and how hopeless you feel. It is a journey of great pain. But there is also great hope. I know. My parents were on this very same journey. For 5 years, I was in and out of the hospital because of psychotic episodes. I not only refused help but refused to accept the diagnosis of bipolar disorder with psychosis and generalized anxiety disorder.

“H.O.P.E.: Hang On Pain Ends” ~ Unknown

There are myriad reasons a person refuses treatment. They can (and for me did) include: denial, anosognosia1 (ie: the inability to recognize you are ill), shame, emotional overwhelm, stigma, lack of access to good treatment, insufficient education about mental illness, fear of change and lack of skills or support to move through change.

But there are steps you as a parent or support person can take, at least initially, if you are facing this situation.  The suggestions may help you feel a little less powerless, a little less alone and a little more hopeful.

Know this: change is inevitable, recovery is possible and your adult child can get her life back; maybe not the exact life she had before she got ill, but a life worth living.

 

“Recovery is a way of living a satisfying, hopeful and contributing life, even with the limitations caused by illness…(it’s developing) new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” ~ Bill Anthony

 

I’m not a parent of someone who has a mental illness. But I am someone who saw what my parents went through as I struggled to make sense of my own psychiatric disorders and find my road to recovery. (On this  previous post on my Psychology Today blog my dad offers advice to parents trying to help their adult child. This post describes strategies to help someone with a mental illness who doesn’t want help.)

This is not only your adult child’s journey, the entire family embarks on it together. Mental illness becomes a whole family condition – chaotic and frightening. You know this.

But I also know this:

  • You can do it. But you can’t do it alone.
  • You can’t change your loved one. But things will change.
  • Recovery (for the adult child AND family) is possible.

Here are seven suggestions to help make your current difficult situation a little more tenable.

7 Steps for Parents who Love an Adult Child with Mental Illness

1. Stop the power struggles with (or judgements you have) of your daughter or son.

How do you do this? Listen to what your adult child is telling you. Don’t correct her, don’t try to change her or convince her. Just listen. Summarize what you hear her saying. Just because you are listening and reflecting back what she says, does NOT mean you agree with her. It does mean you are doing everything you can to understand her and her experience.

Like anyone, someone with mental illness wants to be heard, wants to be understood. And frequently for someone with a mental illness, this doesn’t happen. Really understanding what she is feeling (ie: empathizing) can rebuild trust. It’s not easy. Believe me. But it can build bridges where bridges were previously imploded. Check Dr. Amador’s website and book (I Don’t Need Help! I’m Not Sick) for more instructions on what it means to empathize and actively listen.

2. Remind her (and yourself) you are both on the same team.

But don’t just tell her, show her. Show her by working collaboratively: listen without an agenda; partner in decision making, set boundaries when necessary. Telling your adult child what she needs, what she should do, or what YOU know will help her will only make her dig her heels in more. You’ve probably already experienced this.

3. Recognize you might not be the best person to help her.

It may not be fruitful to say you are on the same team. Sometimes there’s too much animosity, so much trust broken (on both sides) that your adult child only see you (at the moment) as an enemy. Because of the current (yet temporary) volatile nature of the relationship it may be best to find out who, if anyone, she does connect well with. Is there someone who she will listen to; who she does trust or confide in? That person needs to be someone who has her best interest at heart (obviously), not someone who enables her or aggravates the situation. For example, not a person who she drinks with or who encourages her to believe you are an interfering parent.  A close friend, a trusted Uncle, a former teacher she admires, are options.

4. Ask your adult child what she needs to feel safe.

She may not know. She may not be able or want to calm herself down in order to express what she needs. It may be about helping her learn to calm her anger. Is she willing to go to counselling , not for mental illness but to sort out some life dilemmas; to solve some issues or secure some essential basics (housing, sleep, friends). Even if she blames everyone else for her problems, you can mention counselling can be a place to talk about that. And with that, a good therapist can help her gain insight and learn problem solving skills.

5. Let her know you are there for her.

Sometimes the only thing left to do (but also the most important) is letting her know you are there and not going anywhere. When or if she wants to reach out, you’ll be there, without judgement, with love and curiosity.

The most important element for me was to know that my parents (even as I pushed them away and argued with them), loved me unconditionally, and would be there. They might not like how I was behaving, but I knew they loved who I was. Even as I refused their help there was a part of my consciousness, a part of my soul that heard them, that registered how much they cared. This is true for your son or daughter.

6. Set boundaries.

You do not need to nor should you tolerate verbal or physical abuse (nor should your adult child). You may have to say ‘I love you. I’m here if you want help, but I will not allow you to berate me (yell at me, swear at me, threaten me etc). It might be about giving her space, you taking space or telling her she’s needs to leave. Always ensure she is safe and not at risk of suicide or harming someone else.  If she is at risk, then taking her to the emergency ward (or in the worst case scenario, the calling the ambulance or police) will be necessary.

For further excellent strategies watch Dr. Lloyd Sederer’s Chief Medical Officer, NY Office of Mental Health video ‘When mental illness enters the family’. https://www.youtube.com/watch?v=NRO0-JXuFMY

7. Don’t do this on your own.

Make sure you get help for yourself. The old airplane emergency adage applies: take care of yourself first, before you help someone else. You are no good to anyone if you are overwhelmed. There are other families willing to help and talk with you. Find a support group for parents of someone with a mental illness. The expertise in those rooms is invaluable, life saving even. Check with your local mental health clinics, your doctor, your community resources and local mental health organizations (DBSA, CMHA, SSC, NAMI)2. These connect you with people who have similar challenges, link you to community resources, and offer you emotional support and encouragement. The resources and support groups are usually offered at no charge.

This path may be long. It may be arduous. But it gets better. It’s not your fault. There is help. There is hope. You are not alone.

Please email me with your own strategies and feedback about my suggestions. I’d like to put them into a future post (anonymously of course, if you wish) because there is strength in numbers and wisdom comes from diverse and multiple perspectives.

© Victoria Maxwell

  1. If you’d like more information about anosognosia please watch this video which includes a talk from Dr. Xavier Amador, an expert in the area.
  2. Depending on where you are located, check with your local Depression Bipolar Support Alliance (DBSA) or National Alliance on Mental Illness (NAMI) chapter or if you are in Canada: your Canadian Mental Health Association (CMHA) or Schizophrenia Society of Canada (SSC) branch.  The SSC helps families dealing with ALL types of mental illness.

Bird Nerd I am.

I’m a bird nerd. They make me happy. Just watching them hop around, flitting here and there, puts a goofy smile on my face. I really love watching the ones in those small wee groups, like juncos, sparrows and robins. Oh and chickadees! Who doesn’t like chickadees? They’re so plucky!

And how cool is that to be named after the sound you make! Chick-a-dee-dee-dee, chick-a-dee-dee-dee. Wait that wouldn’t be so good for us humans, would it? The sounds we mostly make are burps and farts. Yes we talk, but our ‘organic’ noises aren’t our voices.

Anyway, moving on… I found this scientific tidbit about watching birds (see below to geek out on the research). It confirmed something I was already experiencing.

Simon Science Says: Just Add Birds!

Watch birds – any kind – from a window, in a garden or around your neighbourhood. Doing so is associated with lower levels of depression, anxiety & stress, according to a study from the University of Exeter in England.1

Everyday I work at my desk in my home office. I’ve purposely positioned it near a window that overlooks our back porch and old growth trees. Each morning I dribble a little bird seed on the railing. The aforementioned juncos, and others, enthusiastically gobble it up. See photo. Each time they jostle, doing their version of bird sumo wrestling to get access to the best feeding point, I smile. I feel like they’re my feathered co-workers. I don’t have to do anything except watch. I get this happy, present-moment-kind-of-feeling seeing them. Life feels simple and that feels good.

Try it out and see if you get the same benefit.

What does Simon Science Really Say?

According to a University of Exeter study which involved hundreds of people from both urban and rural settings, being able to see birds from windows, and on a daily basis around their neighborhoods, was associated with reduced rates of depression, anxiety and stress.

Drawing from the ‘attention-restoration theory’ which posits that being in nature, and even simply watching nature, promotes healing and lessens stress, researchers explored the potential benefit of nature to improve mood.

The researchers found no correlation between the species of birds seen, but instead the number, indicating that seeing common birds such as robins, crows and blackbirds on a regular basis is a key factor.

Evidence shows it’s not about identifying bird types, but instead, interacting with birds.

The UK Health Spectator rightly cautioned that “while the correlation between mood and nature was highly significant….(doesn’t explain) the cause of the relationship. For example, do happier people actively seek nature more or does a lack of exposure to nature lead to higher rates of depression, or is there some other factor?”2

As a fairly low effort and no-cost tactic that potentially could reduce anxiety and depression and boost mental wellness, it’s worth a shot, I’d say.

Do you already do this? What’s your experience? If you haven’t, try it out and see if you get any benefit. Email me or comment below and tell me!

For more Mental Health resources, tips & tools, sign up for my newsletter.

© Victoria Maxwell

References

1 https://academic.oup.com/bioscience/article/67/2/147/2900179

2 https://health.spectator.co.uk/just-looking-at-birds-may-help-to-keep-you-happier/

When I was a kid, Halloween scared me. Don’t get me wrong, I loved trick or treating (mini Oh Henry Bars in particular). I loved creating costumes from scratch. I loved making multitudes of Kleenex ghosts and hanging them in our front window.

What I didn’t like was walking home the weeks before and after the day. Why? Firecrackers. Those freakin’ things seemed to be everywhere. Local bullies took no small pleasure at lighting them near me and threatening to throw them my way. I didn’t have any confidence to stand up to these blokes. Nor did I have friends or siblings who walked home with me to help stave them off or at the very least to reassure me and steady my nerves. Nope. It was one long scramble uphill – the whole entire way no less – back home. If I had even one friend with me during the traipse back to our rented house, the string of those lightning snaps that gave me such panicked pause would have been easier to face.

Super Fan Steve

That’s why when I read an article in our local paper about Steven Guinter-Plank, also known as Superfan Steve, I was moved.

Steve travels to countless minor league hockey games and there, cheers on every kid by name – on both teams. He flips through the program or gets a roster from the manager to make sure he doesn’t leave any player out. He even cheers for the refs.

You’ll find him switching jerseys throughout a game and shouting chants for each side. He started in his hometown and was motivated to continue because of the Humboldt Broncos bus tragedy that claimed 16 people’s lives and injured 13. In an interview, he says as he shouts “Good job! Here we go everybody!” he can see a little more jump in their step.

His enthusiasm is contagious. Hockey parents, supporting only their son’s or daughter’s team, once witnessing what Superfan Steve does, often start cheering for both sides.1

It’s this kind of social support that was key to my recovery from mental illness. It continues to be key to maintaining my mental health.

The benefits of social support to mental and physical health

Numerous studies show the benefits of social support to mental and physical health and the consequences of poor social support.2 Generally speaking, social support refers to the different ways in which we’re helped by others, both physically and emotionally and in particular, during times of need.  

Superfan Steve shows the big impact small but specific gestures of support can make.

When I was in the deep throes of depression early in my struggle to find recovery, it was spending even just an hour with my friend Kerry that made a difference. Having him walk alongside me, so to speak, talk about things other than how to feel better and instead talk about our favorite TV shows. THAT’S what helped me. I didn’t need any fancy answer or new fangled resource. I just wanted a friend to hang out with for a bit.

Recently while experiencing bouts of intense anxiety, it’s been my husband who’s stalwartly and lovingly had my back. Grocery shopping together, a short walk around the neighborhood, a spontaneous hug during my workday, a surprise cup of coffee: these small deeds kept me glued together when I felt like I was falling apart.

The gestures don’t have to be grand or costly. Simple and personal work best – at least for me. Like Steve calling out the name of each individual kid – that’s what makes it special.

Imagine how I might have felt if I had a Superfan Steve of my own shouting ‘You got this Victoria! You can do this!’ on the sidewalk sidelines as I walked home while those firecrackers were exploding? I think I would have felt like a champion.

If you’re stymied as to how to show your support for someone keep it simple, keep it small, and personalize it. Does your friend love dark chocolate? A tiny bar left on her doorstep might be a good pick me up. Is your sister an avid science buff? Pick up a few National Geographics at your local thrift store. Does your neighbor enjoy hiking? See if they would like to walk through a local park. Maybe it’s saying hello and introducing yourself to the elderly man on the motorized scooter. You may be the only person he talks to today.

Your simple but powerful acts of kindness offer social support that has positive ripple effects in people’s lives. Science proves it. I’ve experienced it. Recovery, wellness and resilience are born from these small seeds of attention.3

Superfan Steve shows how easy it is to be a super fan and how important it is as well. You don’t have to travel to countless towns. It may just be knowing someone’s name. After hearing about Steve I’m now a superfan of his! I guess that makes me a ‘Superfan Steve’ Superfan.

How are you going to show your support for someone today?

For more Mental Health resources, tips & tools, sign up for my newsletter.

© Victoria Maxwell

References

  1. Bantam Bauer interview
  2. Ozbay, Fatih et al. “Social support and resilience to stress: from neurobiology to clinical practicePsychiatry (Edgmont (Pa. : Township)) vol. 4,5 (2007): 35-40.
  3. Southwick, Steven M et al. “Why are some individuals more resilient than others: the role of social supportWorld psychiatry : official journal of the World Psychiatric Association (WPA) vol. 15,1 (2016): 77-9.

For all the talking we’re doing, for all the well-meaning campaigns, I still believe we are woefully under-trained (or untrained for that matter) in how to effectively and comfortably talk to someone about their mental health, particularly in the workplace.

This was the focus of a workshop I facilitated at the recent, successful Working Stronger conference hosted by the Canadian Mental Health Association – Alberta provincial branch.

The heart of this annual event is to bring together leaders and staff from various sectors and companies to acquire skills and engage in dialogue to increase the psychological health of their workplaces.

I performed my “Funny, You Don’t Look Crazy” about my lived experience with mental illness and my eventual return to work. Then I led an enthusiastic group of individuals in an interactive breakout entitled: “Ready, Set, Recognize: Detecting Mental Illness and How to Help”.

To be quite frank, I was nervous. I had several years employed in the not-for-profit health sector. But my corporate experience has consisted of a two-year stint in a small company (really small – 6 people including me!). 20 years ago.

I was hired as a marketing-assistant-slash-receptionist. Heavy emphasis on the receptionist part. Well, actually, heavy emphasis on the slash part. It was my first job since getting my “sea legs” back after being in the psych ward several times over the previous 5 years. Handling conversations, let alone their phone system, was going to take courage.

I held jobs both when I was struggling and in denial of my mental illnesses and also after when I was learning to manage them. It wasn’t easy for me. I know it wasn’t easy for my bosses or co-workers either.

4 simple steps to make the conversation easy and effective.

Working with well-meaning but misguided managers, and exceptionally talented ones, I’ve learned some strategies about what works and what doesn’t when it comes to addressing mental illness in the workplace.

The result is the framework I created called: O.A.R.S. (Observe, Ask + Actively Listen, Refer and Support). A simple protocol to support an employee or co-worker who may be facing a mental health issue.

The steps of O.A.R.S. are simple, but not necessarily easy. We aren’t used to having these conversations. The only way we’ll get confident is by practice.

One solution for companies is to offer safe learning opportunities and ‘rehearsal’ time for these dialogues in low-stake/no-stake situations.  We can be as awkward and unsure as we need to be and gain experiences of success that we can take into real-world scenarios.

I call the framework the Wizard of O.A.R.S. because, well, who doesn’t like a nice play on words? (Actually, I do know several people who don’t. But that’s beside the point.) And because oars bring balance, stability and direction to a boat. Just like oars, people can give support and guidance to those around them who may be facing mental health issues.

This is not a quick fix. The steps don’t work instantaneously. They can in rare cases. But they will gradually, over time, make a difference.

Observe – Changes in behaviour, length present + document

Ask + Actively Listen – Discuss concerns in terms of behaviour, its impact + needs

 Ask open-ended questions

 Mirror + validate

 Be patient + wait

 Be curious

 Discuss impact of behavior

 Focus on collaborative problem solving + actions

Refer – To resources in the workplace and/or community

Visit my resource page to download a Mental Health Resource Guide for additional tools.

Support – Continue to communicate and encourage; find agreement + set healthy objectives

Click here to download the detailed step by step O.A.R.S. e-guide with links to a fun video of Everyone Loves Raymond using active listening!

Observe, Ask & Actively Listen, Refer and Support: the Do’s & Don’ts

Before you have a conversation with someone at work about their mental health, here are some do’s and don’ts to keep in mind.

DO…

  • Set the conversation up for success
  • Check in with yourself: is it a good day for YOU to speak to them?
  • Check in: is it a good day for THEM?
  • Play it out: where, why now, how, what will you say, what might they say, how will you respond?
  • Have the facts: make sure the facts you have are correct
  • Determine your objective
  • Focus on building trust, rapport, safety + open dialogue so they feel free to talk
  • Speak to them as early as possible
  • Document behavior changes + note impact
  • Be clear about what you need from them
  • Prepare for own internal emotional reactivity
  • Plan + prepare for resistance
  • Listen without judgement
  • Use an icebreaker

DON’T…

  • Avoid talking about impact of behavior
  • Make assumptions about the behavior or jump to conclusions
  • Interrupt
  • Minimize or dismiss feelings
  • Try to fix or offer advice
  • Enable

Please note: The O.A.R.S. framework is for non-urgent situations. If you feel the individual is at risk of harming themselves or others, immediate care should be sought at the nearest emergency ward. If the individual refuses help and is actively suicidal or at risk for harming others, the police should be called to assist. Please consult your company policies and guidelines.

Do you want to make a positive impact? Have that conversation NOW.

Effectively talking to someone who you think may be struggling with a mental health condition at work can be fiddly and unclear. As a result, managers and supervisors postpone or avoid these conversations, especially if we think the person is going to respond with resistance. Maybe we hope the issue will resolve itself. It almost invariably doesn’t though.

Sometimes individuals dealing with mental health issues aren’t ready to admit it to others or themselves. I certainly wasn’t. It’s not an easy thing to accept. The stigma of mental illness, especially in the workplace, has decreased but it still exists. This can lead people to refuse assistance or refuse to acknowledge the problems directly.

Unfortunately, if left unaddressed, behavior resulting from mental illness may cause difficulties at work and result in discipline, termination or other negative workplace consequences.

As a manager, co-worker or ally you can be proactive and discuss the behavior with the person before it escalates into discipline or termination. The earlier you speak with someone, however uneasy this may be, the higher the chance for optimal outcomes. Early conversations also offer the best opportunity to prevent a condition (if present) from escalating or becoming chronic.

Letting a person who you’re concerned about know you’re willing to listen without judgement, support them and problem solve can open the door for discussion.

This is what Liz, my boss at the marketing company did when I went to her for help. Even before that, she prepped the ground for positive interactions. From the start of my time there, she focused on building a personal rapport with me. One based on trust, respect and active listening. She was frank, firm, fair, kind and honest. When I had difficulties, I knew she was the person I could go to and receive wise counsel and fair treatment.

My experience with Liz gave me confidence that has influenced me to this day. THAT is the kind of impact you can make.

 

 

© Victoria Maxwell

Could your workplace benefit from learning how to comfortably address mental health issues? Contact Victoria to discuss the Workplace Mental Health Awareness package: a performance of ‘Funny, You Don’t Look Crazy’ followed by the ‘Ready, Set, Recognize’ workshop. You’ll learn the simple O.A.R.S. protocol to make those awkward conversations easy and effective. Contact me.

For the past month, I’ve been practicing a breathing meditation my Chi Kung teacher, Renate, gave me.

Each time, I’m amazed how calm, relaxed and alert I feel after about 5 minutes of this controlled deep breathing. Like really peaceful. And for someone who’s recently been as anxious as a hummingbird on cocaine, this is pretty cool.

Then just last week I went to see my GP, Dr. Yee, to get my medications renewed. While there, she also reminded me about Box Breathing (also called 4 square or tactical breathing).

“Tell me about it again.” I said.

“Pretty simple. Breathe in through your nose for 4, hold for 4, exhale through your nose for 4, hold for 4. And repeat it a few times. There’s good evidence it kicks your parasympathetic nervous system into gear and you’ll feel relaxed.”

Huh? A little light bulb went on for me. That’s almost identical to my 9 Breathings Tibetan Meditation.

I got home and went on ‘the google’ (as my husband and I like to call it).

Box Breathing, or controlled deep breathing, activates the parasympathetic nervous system (the ‘rest and digest’ system) and regulates the autonomic nervous system.

In other words, it helps get me out of the stress response when my anxiety is high, my trauma is triggered or I’m heading into a challenging work project even.

It’s called tactical breathing because, get this… Navy Seals are trained to use it. 1 Special forces, law enforcement and first responders use it when there’s a crisis or a threat is perceived. When their stress response is activated they need something that will bring them back to calm, and clear their head, so they can act effectively.

You’re probably quite familiar with the fight or flight response, yes? Or the lesser known “fight, flight or freeze” response. Heart rate increases, adrenaline and cortisol flood the body, eyes dilate, muscles tense and senses sharpen.

Military personnel, even athletes, learn box breathing to calm their system so they can think more clearly and operate effectively in high stress situations.

Who knew ancient yogis and Navy Seals shared a common practice to reduce anxiety?

The Mayo clinic has found deep breathing effectively helps with PTSD, generalized anxiety, depression, even insomnia and pain management.2, 3 It’s also been shown to decrease the release rate of cortisol, trigger the release of pleasure-inducing neurochemicals and eliminate toxins by bringing more oxygen into the bloodstream. 4

Box Breathing in a nutshell:

After some practice, it can be used anywhere, anytime if you’re feeling stressed, say before giving a presentation, about to have a difficult conversation, if you feel a panic attack coming on or feel yourself triggered.  Do this while seated comfortably.

  1. Close your eyes or soften your gaze. Inhale through the nose for a count of 4 until your lungs and belly are full.
  2. Hold for a count of 4. Try not to clench your jaw or muscles.
  3. Exhale through the nose for 4, emptying your lungs and belly.
  4. Hold for 4.
  5. Repeat at least 3 times or as much as you like.

Tip: If counting to 4 is too difficult, use a count of 3. If it’s too easy, increase to what feels right. As you get practiced, increase the length of the breath and hold.

My meditation includes additional elements: hand and finger postures (mudras) and visualization with colour, but the basic framework is the same. As are the results: clarity and calm.

I highly recommend using this practice when you feel generally stressed, or for more acute stress if a traumatic memory has triggered reactivity or panic.

Try it yourself or share it with your clients. Tell me if you found it effective. I’ll be practicing most mornings as part of my meditation and prayer practice (and if my computer crashes or I can’t find my cell phone! 😊).

For more Mental Health resources, tips & tools, sign up for my newsletter.

© Victoria Maxwell

References:

1. https://thepreppingguide.com/box-breathing/

2. https://www.medicalnewstoday.com/articles/321805.php

3. https://ritualize.com/box-breathing-military-secret/

4. https://unbeatablemind.com/7-tangible-benefits-of-breathing-exercises/

Watch Mark Divine, former Navy Seal, teach his version in this video here.