Football pitches light up at both ends, candles shouldn’t

Some regular readers of this blog will know I am not a great football fan. Snooker and climbing are the only two sports I have any interest in. I’ve never supported a football team in my entire life. I have only ever been to one football match; that was in Swansea, when I took a group of service users, as part of my nurse training – we did things differently in the 1970’s. That said, I have been inside both Manchester’s football teams’ stadiums, fairly recently for a Coldplay concert and the other occasion was an earlier Rolling Stones concert. The latter I also saw play at Liverpool’s Anfield stadium on their return to the UK last year.

However, some things do change. I still don’t have any interest in football, but J does, and her football team is Liverpool; a team she has supported all her adult life. This came in handy when we went to the Rolling Stones concert at Anfield, as she knew all the cheap, easy, and safe places to park the car. So, over the past few months, on a regular basis I have found myself watching a Liverpool football game on TV. I’m fortunate as J can provide 90+ minutes of non-stop running commentary on what is happening, who has taken a dive, missed an easy shot at goal, whether a tackle was a foul or not, and interestingly (apparently) who might be offside.

Sprinkled through these football-related observations, will be comments about some of the players’ abilities, but more often, there will be a comment about the Liverpool manager Jurgen Klopp. Now I know next to nothing about football, but I can recognise the transcendental leadership approach inherent in all that Klopp does. Once you get past those larger than life, whiter than white teeth, the man is simply an incredible inspirational person. Under his leadership, Liverpool FC has won many competitions, he has rebuilt the faith of fans in their club’s ability, and developed a strong squad of players, both for today and for the future. He’s a man who epitomises a compassionate and a kindness-oriented approach to relationships. To say that J has the upmost admiration for Klopp would be an understatement.

So, I wasn’t surprised that our entire household went into a deep shock when, late last week, Jurgen Klopp announced his retirement from the game and Liverpool FC at the end of this season. We are all currently wearing black armbands and talking in hushed tones, the drawing room curtains are closed and our Union Jack flag is flying at half-mast. A cloud of gloom has descended upon the house.

I’m not sure why. Klopp has done great things for many others, something we can celebrate and be grateful for. Now he is doing something for himself. And for that we should also be grateful. His given reason for leaving now is that he’s running out of energy and is becoming burnt out. Burnout is not in itself a mental health condition, nor is stress. Most of us have experienced the impact of stress in our lives. Indeed, in some circumstances, stress can serve a helpful purpose.

Burnout is not just feeling exhausted after a busy day at work. Many of us have experienced that kind of tiredness. Burnout is a state of total mental, physical, and emotional exhaustion. You can literally grind to a complete halt. Speaking from personal experience, it is not a great place to find yourself at. I have been there a couple of times in my life, and so perhaps understand where Klopp is coming from. My admiration for Klopp’s decision is that he has taken it, before he found himself in that dark place. In his words ‘we are not young rabbits anymore, and we don’t jump as high as we [once] did’. Pausing and reflecting on what might be causing you stress in your life and exposing you to burnout, is a hard thing to do. But as Klopp is demonstrating, it is critical if we are to enjoy continued good mental health and wellbeing.

Bringing together four charities from across the UK, who collectively have been supporting people with their mental health for over 50 years, Mental Health UK last week published their benchmark report on Burnout in the UK – you can find their excellent report here. The statistics are sobering. Some 91% of the participants reported that they experienced high or extreme levels of stress and/or pressure in the past year. Sadly some 24% of folk felt unable to manage the stress and pressure they experienced in the workplace. Some one in five adults took time off work due to mental health problems caused by stress and pressure they experienced in the previous 12 months. Reading the report and thinking about Jurgen Klopp’s decision has made me more determined to ensure we are doing everything we at GMMH to recognise and support colleagues, who might be struggling with stress and pressure.  

One of the things that I sometimes find stressful is the daily commute. Depending on my week, I can drive up to 500 miles. So, imagine my delight upon reading a great little article from the Queen’s Nursing Institute last week: The Power of Example – Small Sustainable Swaps for Big Impact – have a read here. There was one contributor to the paper who was reducing her carbon footprint by eating no meat. She noted that having just one vegetarian meal a week is the equivalent to not driving your car for 348 miles! As a long-time committed vegetarian, eating at least one vegetarian meal a day – I might now be in danger of travelling back in time, and doing away with my commute, enjoying a completely stress-free life.     

Knock, knock, knocking on heaven’s door once more

Apart from the art classes, I can’t say that I enjoyed my school days. English lessons passed me by, other than, as were all the boys in the class, I was in love with Miss V, our teacher. Maths was spent learning the fine art of Contract Bridge, I had no interest in sports and both woodwork and metalwork were unnecessary evils that simply had to be endured week after week. No, it was the art classes that captured my attention and imagination. I loved the way in which we were supported to find our inner creativity. Nothing was off limits and, even if I say so myself, I was very creative!

I’m not sure what I learnt at school. I’m especially poor at spelling, although good at arithmetic. I have no idea where apostrophes should be used, but I can construct a great sentence. More often than not, J beats me at University Challenge, whereas I’m better able to describe and deconstruct the zeitgeist. Most of my life skills, I learnt from my parents (as Aristotle said, give me a child for seven years and I will show you the man) and I guess the rest was honed at the university of life. Against this back ground, I sometimes wonder where my love of words has come from.

I’m fascinated by the power of words. A few ill-chosen words can hurt and cause long lasting harm. Likewise, a simple thank you and an expressed appreciation can lift someone and help them feel valued. The use of ‘please’ and ‘thank you’ can make such a difference to how people are viewed. These are words we might use in our everyday interactions. Other words can be used to motivate, to inspire, to create interest and promote support and to do so across groups, communities, and populations. Of course, words can also be intentionally (and sometimes unintentionally) used to deceive.

However, my fascination with words also extends to how a single word can be used to convey sometimes complex ideas or beliefs. My use of the word zeitgeist above is an example. It comes from the work of the influential German philosopher, Friedrich Hegel, and its literal meaning is the ‘sprit of the age’ described as an ‘inviable force or influence that dominates the characteristic of a particular point in time in world history’. Hegel’s work provided the foundation for the leadership debate polarised around whether leaders have leadership traits and are ‘born’ to be leaders or whether individuals become leaders in response to the social circumstance of the time.

Like most things, there is probably a third way. I have long held the view that ‘leadership’ can’t be taught, and is best caught – that is we learn to become great leaders through experience. It is these experiences that help promote self-confidence, resilience, humility and compassion.

There are other words that have caught my attention over the years. Folk in Japan use the word ‘genki’ meaning a general state of wellbeing, feeling healthy, lively, and full of happiness. I’m not sure we have a single word that captures all these feelings. There are descriptive words that capture familiar experiences, for example the German word for when you have a tune or song that goes around and around in your mind all day and you can’t get rid of it, is ‘Ohrwurm’. Last week, there was another German word that perfectly captured my feeling and sense of where I was in the world. The word was ‘Gemutlichkeit’. It is a word that captures and conveys the idea or feeling of warmth, friendliness and good cheer, of belonging and of social acceptance.

Last week was week three in my new role at GMMH, and it was a good one. On Tuesday we had snow. Up here on the Fylde coast this is a rare event, so I was excited to see it first thing and my commute in was slow, but without any problems. Imagine my delight on arriving at the car park to find I was the first to drive over the thick snow. I must confess to regressing to my childhood, as I drove around in circles before finally parking my car. It was a great start to the day.

Later in the day, I was able to visit two of our CAMHS inpatient units. It was a visit tinged with just a little sense of nostalgia, as both units were services that I was very familiar with 40 years ago. I was able to meet colleagues and some service users too. I came across one young man having a guitar lesson. I asked him what he was learning and he said knock, knock, knocking on heaven’s door. I asked if I could have a go, and picking up the guitar managed a passable rendition of the famous Bob Dylan/GunsN'Roses classic. I think my colleagues were somewhat surprised, but I did get a round of applause.  

On Thursday, I was able to visit some of our adult inpatient services and it felt wonderful to be able to walk around meeting colleagues and service users. My yellow and blue clogs were a great source of amusement and of interest and either way, helped spark conversations. I felt very comfortable at home, and pleased to be able see compassionate care being delivered. Gemutlichkeit indeed.

Now regular readers will know I try and steer clear of politics, but it feels almost irresistible to not mention our Therese Coffey’s struggle with words she used last week. She was trying to hold Yvette Cooper (Shadow Home Secretary) to account over her reference to the ‘Kigali Government’. She said she was ‘astonished’ that Yvette couldn’t correctly name the country they were talking about. Parliament was discussing Rwanda, and the Rwandan Deportation Bill. Rwanda's capital, and where their parliament lives, is Kigali. Therese Coffey thought that Yvette Cooper was talking about a completely different country. As for me, I remain astonished that Therese Coffey has been Secretary of State for three departments and was also, once our Deputy Prime Minster. Words fail me! 

The Snake Pit Remembered

Back in 1998, I started teaching medical sociology and cultural anthropology to nursing students in Finland. These were students undertaking their nursing degree which, predominately, they were doing speaking only the English language. The university valued natural English speakers as teachers. I have to say it was a unique experience, and something I was privileged to do a once or twice a year for five years. I have many fond memories and have maintained the friendships made during that time to this day.

Now I was prompted to think about these memories by an article I read last week about Bartley Green School in Birmingham, and its attempt at providing mental self-help advice to its pupils. It was generally good, except one of the pieces of advice was to suggest struggling pupils smoke a cigarette to help them deal with their mental health issues. My heart went out to whoever was responsible for developing the self-help leaflet.

The connection with Finland? Well one of my anthropology sessions was built around the 1948 film, the Snake Pit. It was a black and white film, based upon the semi-autobiographical book by Mary Ward and tells the story of a woman, Virginia Cunningham, who finds herself in a psychiatric hospital, with no idea how she got there. The hospital is organised around a series of wards that reflect a patient’s progress and response to treatment. The Snake Pit is the ward folk go to when they are deemed to be beyond treatment and help. They become the forgotten and invisible population within the hospital system.

It is a fascinating film, and amazingly you can still find it for sale on eBay. It is a film with so many levels of human interaction and behaviours to observe. One of these is the fact that the nurses and doctors offer the patients a ‘therapeutic cigarette’ at the start of any conversation. These days, we would find this totally unacceptable. However, when I trained as a mental health nurse back in 1975, it was a very common part of the way we built and sustained our relationships with service users.

Things really are different now and, despite the unfortunate advice being provided to the Bartley Green School pupils, looking after our children’s and young people’s mental health remains critical. Late last year, NHS England published The Mental health of Children and Young People in England Report 2023. The report found that one in five children and young people in England, aged eight to 25 had experienced a probable mental health problem during 2023. In response, nearly 400 Mental Health Support Teams have been set up to work within schools and colleges. The purpose of these teams is to provide early support to children and young people experiencing common mental health issues.

Some 200 new teams are in development, and due to come in line in early 2025. When this happens over 50% of England’s schoolchildren will be able to access mental health care and support. Of course, 50% is distinctly better than where we are now, but it remains vital that any child or young person experiencing mental health issues should be able to access the help that they, and perhaps their families, might need.

Post-pandemic, the world has become a lot more difficult for children and young people. Many families continue to struggle with the cost-of-living crisis. This gets played out in choices over what family money should be spent on. Nearly three million people used a food bank in the last 12 months. For many children and young people there is the lockdown legacy, where the pandemic isolation and virtual education resulted in limited opportunities for them to socialise and develop self-confidence and resilience.

Additionally, what is happening across the globe - the conflicts in Ukraine, Palestine, Israel and now sadly Yemen - raises everybody’s anxiety, but I guess, even more that of young children. These days, children and young people have much greater access to unfiltered news and it’s all available in almost real time. I guess there will be some young people who will equate the pictures from last Thursday’s jets taking off with their missiles with the Top Gun Maverick film or their latest Ace Combat video game. Other young people, however, might rightly wonder how safe they are from the reach of other people’s warfare.    

Looking after the mental health of children and young people is one of the five clinical areas of the excellent NHS CORE20 +5 approach. The approach was originally focussed on healthcare inequalities being experienced by adults, but it has now been adapted to apply to children and young people. The CORE focus is on the most deprived 20% of the population in terms of the Index of Multiple Deprivation. The seven domains cover all social detriments of health and wellbeing – you can see these here. Tackling these inequalities will take time and effort.

Virginia’s battle to move out of the Snake Pit and receive the treatment she needs is eventually facilitated by a pipe-smoking and kindly psychiatrist, Dr Kik. He believed with the right person-centred support, everyone could recover and live a healthy and worthwhile life. Perhaps thinking about our children’s future, and finding ways to tackle the inequalities they might face, we might all need to be a ‘bit more Dr Kik’ (minus the cigarettes and pipe of course).

Drinking in the first week of 2024

Well, the first week of the New Year has been an interesting one. Unusually for us, these days at least, we stayed up to see in 2024. It was an evening with Jools Holland and friends on the TV, a log fire and plenty of sparkling bubbles to drink the night away. Indeed, that was the last alcohol we’ve had to drink since midnight on the 31st December. We are on day seven of our dry January. It is estimated that 8.5 million others will be doing likewise. Probably a good thing (more of which later), as back in 2022, the cost of alcohol-related problems to the NHS in England was £3.9 billion a year. The cost to society was £21 billion. Staggering sums of money which, if available for other uses, could do much in terms of positively addressing health inequalities. 

As I write this blog, I note that apparently after seven days, with our livers and kidneys working overdrive, any toxins should have mainly left our bodies. As a result, we should be sleeping better, the brain fog should be clearing and our skin should be looking so much younger and healthier. Sadly, after another restless night’s sleep, the face that stares back at me in the mirror tells no lies. I’m thinking my improvement journey might take a little longer.

It is not the only improvement journey I thought might take some time last week. The first of January saw me start in my new Chair’s role at Greater Manchester Mental Health NHS Trust (GMMH). It was strange walking into an office that was mine, yet it didn’t feel mine. All my personal effects were still in boxes and bags, pictures were still to be hung on the walls and the previous occupant’s papers were still sitting on the desk. I didn’t have time last week to sort out my new office, but I will make a start next week. Last week was all about meeting folk with whom I will be working. These were all very positive conversations, and each one filled me with the reassurance that I had made the right move in joining the Trust.

However, there was a consensus that our improvement journey was likely to be more of a marathon than a sprint. All those I met were emphatically committed to being on this journey. There was a shared and well-articulated commitment to ensuring the decisions we took along the way were always service-user centred, clinically-led, managerially-supported, and academically-informed. These seemed to me to be the rubrics upon which to anchor our actions and behaviours.

Fundamentally, GMMH is a people organisation. It is an organisation that is made up of people who, through many different contributions, are there for others when they need help and support. In the clinical setting, the focus must be on the person, and valuing the uniqueness of each individual. We need to approach this in an authentic and genuine way. It is never about being judgemental, and always about trying to better understand how others are experiencing the world. Whatever we think we know, it doesn’t equip us to truly know how others are experiencing a loss, an illness, or some other challenge in their lives.

This approach was a fundamental tenet underpinning my teaching when I worked at the University of Salford. On day one of their student journey, I would tell all the new students in my welcome address that we would help them acquire ‘knowledge’ through our teaching and then help them apply that knowledge through exposure to practice, what I called ‘knowing’. However, it was the space between ‘knowledge’ and ‘knowing’, which I called ‘not knowing’ that was really important in helping others and building and sustaining therapeutic relationships.

We can teach someone the signs and symptoms of depression or anxiety (knowledge). In practice, we can teach people what might be the most effective treatments and therapeutic approaches (knowing). What we can’t teach is how that person might be experiencing their depression or anxiety (not knowing). And that is the space we need to explore, keep in mind, when working with others, and to do so with compassion, and empathy. I also believe that we adopt these approaches with the colleagues we work alongside. We should do so in our interpersonal relationships, but we should also promote the development of an inclusive and supportive organisational culture. Such an organisational culture does take time to develop, but it is achievable. As is successfully completing dry January!

Whilst there are undoubted health benefits to not drinking any alcohol for a month, the biggest benefit comes from breaking the habit of drinking alcohol: as a reward (for a hard day), for comfort (I’m feeling fed up), or for social reasons (being out with my mates). I’m not sure we have made this shift. We have simply exchanged alcoholic gin with 0% alcohol gin; the same with wine and beer. I’m certain we will remain alcohol free until the end of January and perhaps beyond. 

In any case, I’m also sure we will be wanting to change our future relationship with alcohol altogether. We have read the research on the harms alcohol consumption brings (knowledge), and have experienced the impact of alcohol consumption on our health and wellbeing (knowing) - now it’s time to explore a life that is alcohol free, or near alcohol-free (not knowing).