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There was no space in my life to look after me

Sarah is a consultant anaesthetist of over twenty years from Cardiff.

Sarah shares how her mental health was exacerbated by difficulties in her family and how HHP Wales and therapy services have helped her access the help she needed to cope.

Sarah has kindly shared her story in the hope that it will help others reach out for support when they need it.

woman and child walking in a forest

“Things started for me three years ago in January 2018. I had a normal, busy life: happily married with two teenage daughters and I had never suffered with mental health problems before. Life was good but then things started to unravel.

“My mother passed away in January 2018, which was unexpected, but I feel I coped fairly well. I was perhaps a little bit reserved at home and had maybe taken my eye off the ball with my teenage girls.”

Sarah’s family situation took another unprecedented turn when her youngest daughter was diagnosed with anorexia in June 2018.

Sarah explained, “This diagnosis came after a case of depression for my daughter that had been well hidden from the family, but we came together to tackle it.

“I thought I understood eating disorders and I was determined we were going to fight to get my daughter back into good health. But unfortunately, it really took its toll on all of us.

“Initially I struggled on at a very high-stress level at both work and home but by August my daughter was severely unwell, needing 24-hour care with suicidal ideation and anorexia.

“I found I just couldn’t work any longer and I went to see my GP at this point and asked for some anti-depressants. I knew I needed resilience to carry on and I was struggling to sleep, eat and focus. I gave everything to my daughter and our lives were just turned upside down.”

What made you first realise that things weren’t right for you?

“I thought I was just about coping at home but until you have lived with or known someone with anorexia you just do not know what it does to a family. It is incredibly difficult.

“At work, my mind was totally on whether my daughter was safe at all times. I was doing treatments and procedures and I felt things were just getting to be unsafe. I was in a position where I could be dangerous.

“I thought I had to stop and take some time out, initially thinking it would just be a few weeks.”

However, Sarah’s struggles sadly evolved further.

“My daughter took an overdose a month later and luckily she survived but the level of care that she then required prevented my concentration on anything else.

“I continued seeing my GP monthly and while she was supportive, it turned into a horror story of life at home and not about much about myself and how I was dealing with things. I wasn’t concentrating on my mental health and everything was given to my daughter.

“That was the first six months; I saw no way of dealing with it other than increasing my dose of anti-depressants and being at home full-time.”

Did you try to seek help beyond your GP?

“I felt there was no time. There was no space in my life to look after me other than that monthly GP visit; that was all I could do and it didn’t seem right at the time to do anything else.

“I did ask to see Occupational Health because I was hoping to get back to work. We got to a slightly more stable position with my daughter in January 2019.

“I thought I had taken plenty of time away and now I needed to get back at it again.

“I did a fast return to work but there was no way of planning an easy workday as an anaesthetist; it is completely unpredictable.
I was back in and working the best I could. I wasn’t great but I struggled through it thinking this is where I should be.

“I just about coped at home and we grumbled on until my daughter’s second overdose where the world just stopped and the wheels came off again.

“I couldn’t cope with anything. That was a turning point for me and rock bottom for my daughter. She was kept as an inpatient for a few months and I decided to use that time to try and help myself.”

A self-referral to HHP Wales

“A colleague told me about HHP Wales and I phoned them. I had an instant response and was assigned a councillor who I managed to see in a couple of weeks. It was all very efficient and that’s how I started on my route with HHP.”

Sarah contacted HHP Wales over the phone. With the launch of our new website, the quickest way to refer yourself for support is through our referral form.

“HHP Wales were a very useful service and the explanation of the 8 sessions I received was well explained. We discussed a brief mental health history and began the CBT (Cognitive Behavioural Therapy) sessions. The overall experience had both good and bad elements.

“I saw a very nice counsellor and we talked through what was going on but I found that the sessions did turn into discussing my daughter’s problems, rather than directly aiding me in controlling my anxiety or improving my sleep problems.

“It could well have been the place I was in mentally and different things do help at different points in an individual’s mental health journey but I thought I’d done my best and found the sessions more as just a place to talk.”

What happened next?

“After those initial CBT sessions, I was referred for an assessment through my income protection insurance which highlighted how bad things were for me. This was my lowest point.

“Nearly a year on from my first visit to the GP, the psychiatrist undertook a medical assessment and understood my situation very quickly.

“I was offered further sessions with a local psychotherapist which became a real turning point for me. I was at the stage where my depressive symptoms were at their worst and I had been fully supporting my daughter through a year and a half of constant care while experiencing my own problems.

young woman with long dark hair speaking to another woman across a table

“The psychotherapist took a different approach and I was able to explain more about myself and my life. The sessions helped me understand why I thought in certain ways, due to my own upbringing and experiences throughout my career. Everything started to make a lot more sense and we used techniques that really resonated with me.

“I found myself stopping, thinking and working a different way. This connection with the therapist saw me through twelve sessions with my last one taking place in September 2020.”

HHP Wales provide access to mental health support which includes booking appointments with therapists. We offer self-help, guided self-help, peer support and virtual face-to-face therapies with accredited specialists. Find more details of how we can help you here.

How are things for you now?


The tools and support offered through therapy sessions have given Sarah new strategies to help her cope when life gets difficult.

“I returned to work at the start of the COVID-19 crisis in April and even there I noticed how I was so much better at coping than I thought possible.

“Within a few months, I felt more myself than I had done in the past three years. I’ve reduced my medication and everything is looking more positive because I have learnt to deal with things in a different way.

an older blonde woman smiling at a younger blonde woman

“My happiness is dictated to by daughter and the rollercoaster of mental health effects people differently and we are having a dip now. The last few days have been tough, but I am able to look at things more clearly.

“I am keener to look after myself and determined to not go back to where I was before.

“I now work part-time, my workload is more manageable and I have good support in the workplace. I know assistance is there through Occupational Health and HHP Wales should I need it again and that helps me feel supported.”

Do you have any advice to share with staff who feel they are struggling?

“Seek extra help earlier and don’t delay like I did. Occupational Health offered a helpful, positive experience. Speak to your GP, self-refer to HHP Wales and make your own health and well-being a priority.

“Finally, I’d recommend everyone get outside when they can. Getting into the open air and feeling part of nature really helps me feel well. Sleep is important too as everything feels worse when you’re overtired.

a woman walking down a path in a park

“It has been difficult in the last three years to always keep in touch with friends, particularly as people often didn’t know the best thing to say, but I have found my experience has made me see things differently with my relationships. I forgive people, my attitude to people and life has totally changed.

“I have always been a very driven person, but I now think of everyone’s struggles in a kinder way. Some good things have come out of this horrible journey of ours and the way I live my life now is better than before.”

Sarah and her family’s story remind us of the obstacles and difficulties that can cause a change in our mental health when we are forced to face new and unexpected life challenges.

Timing, relationships and accessing effective support through talking therapies, particularly when living with an ongoing difficulty, can impact our mental health on a day-to-day basis.

HHP Wales is here to help if you need us.

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Natalie is a GP trainee living in West Wales. She shares her experience of accessing HHP Wales during the COVID-19 pandemic.

South Wales pharmacist, Geraint Jones, contracted COVID-19 in April 2020. He has kindly shared an insight to his experiences of accessing support through HHP Wales after he was later diagnosed with Long COVID.

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The importance of connecting with nature for our wellbeing

Nature is the theme of this year’s Mental Health Awareness Week and Professor Debbie Cohen, one of the founders of HHP Wales, has kindly shared some thoughts on how important it is for NHS staff to connect with nature.

Hello, my name is Professor Debbie Cohen and I’m an emeritus professor of occupational medicine at Cardiff University, which means I’m retired from the NHS and from Cardiff University, but I’m not fully retired!

Towards the end of my career and since I retired I have built up a 10acre small-holding or a small farm where I breed and manage rare breed animals such as sheep, pigs and goats.

Debbie Cohen in a yellow top and jeans petting one of the goats she keeps on her farm

There is a growing amount of evidence to show that there are many benefits to being outdoors, including positive effects on both physical and mental health.

Engagement with the outdoors and the natural environment can take many forms including gardening/growing, visiting or exercising in green spaces, interacting with wildlife and taking part in conservation work.

A recently completed study by Sustainable Health Care found that across three NHS sites included in the study there was a strong appetite among health staff to take time outdoors, with up to 89% of staff reporting that they would like to spend more time in green space at their site than they currently did (1). 

Staff who said they regularly spent time in their sites’ green spaces during the working day reported significantly higher levels of wellbeing.

The most common way in which staff spent time in green space at work was taking a walk at the site during a break.

A young dark haired woman walking along a path through a park

Something else I’ve also learnt on my journey in my new occupation is how to manage the land, how to think about how to build up my land which had been left fallow for over 10 years.

In the face of climate crisis and loss of biodiversity farming and those concerned with the natural environment have had to think big about how they could regenerate and recreate a system that is more sustainable.

The challenge here for the NHS is to think about what we can learn from these ideas about sustainability and restoration from the natural environment that we can use to develop and create a more sustainable workforce as well as a more sustainable healthcare system?

Space to breathe: valuing green space at NHS sites for staff wellbeing

We need to think bigger, we need to be bold and learn from others; thinking holistically about organisations in the same way we would think about restoring a natural environment and how we can continually regenerate something that becomes sustainable.

For example, adding nitrogen as a quick fix to soil without caring for what depletes it is not sustainable. We’ve got to get the foundations of the soil right to support healthy growth.

So what can we learn from what has been going on around us?

Why not click on some of the following videos to see what some of my friends and colleagues have been thinking about.

What ideas could you take and use?

Sue Pritchard – Chief Executive of the Food Farming and Countryside Commission

Kim Stoddart – Gardening journalist, writer and editor

https://youtu.be/uTqqA0bXtAI

Apologies if there are issues viewing this video in the blog, it is available here on Youtube.

Dom Higgins – Head of Education and Health at the Wildlife Trust

Thanks and video credits to Ben Harris

1.  Centre for Sustainable Healthcare (2020).  Workplace, Wellbeing and Green Space

Resources

HHP Wales

Health for Health Professionals Wales (HHP Wales) offers access to mental health support for all NHS Wales employees, students and volunteers. 

HHP Wales is a free, confidential service that is supported by Welsh Government funding and administered through Cardiff University.

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Mental health support for NHS Workers in Wales

We are pleased to share that Health for Health Professionals Wales (HHP Wales), a support service for all NHS staff in Wales, has joined the Division of Psychological Medicine and Clinical Neurosciences at Cardiff University.

Funded by Welsh Government and run by Cardiff University, the HHP Wales service will now operate from the Division alongside world-leading mental health research centres such as the National Centre for Mental Health (NCMH, the Neuroscience and Mental Health Research Institute (NMHRI), and the MRC Centre for Neuropsychiatric Genetics and Genomics (MRC CNGG).

Professor Jon Bisson, Director of HHP Wales (pictured below), said:

I am delighted that HHP Wales is now part of the Division of Psychological Medicine and Clinical Neurosciences. We will work closely with research centres such as NCMH to complement its world-leading research endeavours with an excellent clinical service for people working for NHS Wales.

“HHP Wales has expanded significantly during the COVID-19 pandemic, receives very positive feedback from those it supports and I am confident that its new home will facilitate its further development.”

HHP Wales was set up to provide free, confidential mental health support for doctors in Wales. It extended its support to all NHS staff in Wales during the coronavirus pandemic.

Prof Jon Bisson

How you can get support

If you work for the NHS in Wales and would like support, you can refer yourself online.

You will be emailed within 24 hours with the date and time of your telephone appointment with a Dr Advisor who will assess you and signpost you to one or more of the following services:

  • Self-help
  • Peer support
  • Guided self-help
  • Virtual face-to-face psychological therapy
a white man with a beard using a laptop balanced on his lap

How you can volunteer

If you are a health professional in Wales and would like to volunteer for the service, please visit HHP Wales for details.

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HHP Wales Public Advisory Group

Health for Health Professionals Wales (HHP Wales) provides access to free psychological and mental health support to all NHS staff, students and volunteers in Wales.  

We are excited to announce the call for expressions of interest for a chairperson and up to a further six members to establish the HHP Wales Public Advisory Group (PAG).  

The PAG will ensure vital service user involvement in the development of the organisation and they will have a role in: 

  • providing feedback (positive and negative) and proactively identifying service enablers and barriers to the HHP Wales team 
  • informing the strategic direction of the service 
  • supporting the delivery of a co-produced service with a particular focus on accessibility and inclusivity 

The PAG will include, but not be limited to former clients of the service, other NHS staff with lived experience of mental health difficulties who have not used the service and may extend to include other interested members of the public where appropriate.   

The PAG will meet quarterly to discuss the ongoing progress and development of the service and report into HHP Wales as appropriate.    

How to apply

Please provide expressions of interest in the form of a single page letter which should provide information about why you would like to join the PAG and indicates whether you would like to be considered for the position of chairperson, member or both.

Submissions and requests for further information about the PAG can be obtained from Dr Jake Hard.

The cut-off for submissions is Friday the 19 March 2021. 

Email: hardj1@cardiff.ac.uk

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GP trainee shares her experience of accessing mental health support during the pandemic

Natalie is a GP trainee currently living and working in west Wales. She trained in London having struggled with anxiety as a teenager, seeking counselling and other avenues of support at various points in her life.

Natalie’s anxiety came to head in her fifth year of medical school when the stress of working, extra-curricular activities and transitioning into clinical medicine became overwhelming.

She rediscovered her passion for medicine after a year out and moved to west Wales 18 months ago to undertake her training placements on a part-time basis.

Natalie shares her struggle from the start of 2020 when her anxiety flared up, exacerbated by issues in her personal life, cancelled wedding plans due to COVID-19 and working as a junior doctor in the middle of a global pandemic.

At the start of last year, my anxiety increased and I began to realise I needed some help. Over the past 10 years of living with anxiety, I have come to recognise the triggers in my behaviour that highlight for me that I may start to struggle with my mental wellbeing.

Over-thinking, worrying, catastrophising and compulsive behaviour like checking plug switches and shutting doors have become red flags for me.

I noticed I was starting to develop unhelpful thinking styles and behaviours again which told me it was time to reach out for support.

I approached my GP. I had been self-managing my anxiety since moving to Wales but this was my first time seeking help locally.

I was nervous because I was about to enter a placement rotation in the local area and I felt self-conscious as a medical professional seeking help. The GP was excellent and did not make me feel at all judged. She told me about the HHP Wales service, and I have been doing much better since they helped me get set up with a therapist.

Natalie contacted HHP Wales over the phone. With the launch of our new website, the quickest way to refer yourself for support is through our referral form.

white woman in a yellow jumper typing on a laptop

What did you find most helpful about the HHP Wales service?

Moving to a new place and all the challenges and opportunities that come with that can be difficult but the flexibility and convenience of the sessions set up by HHP Wales really helped.

It was coincidental that, due to the pandemic, everything was moving online and when I called HHP Wales for the first time and was given a triage conversation over the phone, an option of an online consultation was ideal for me.

I was offered a set of eight sessions with a therapist based in Cardiff which was great because I could have the sessions from the comfort of my own home.

The flexibility helped alleviate worry as I was mindful that I was about to start in working within psychiatry teams in the local area.

I was very aware I was starting as healthcare professional at same time as starting as a patient and I really wanted to keep my personal/professional identity separate.

The confidentiality reassurances offered by the therapy through HHP Wales meant I never had to worry about anonymity.

I didn’t feel the sessions being online put me at any disadvantage and I feel lucky to have accessed such high-quality face to face therapy, despite living so far away from anyone!

Seeking help for your mental health

It can be a real struggle to know where to start. Over the past decade, I have accessed help through a number of different routes such as Occupational Health, signposting through trade unions and medical organisations.

I experienced first-hand the hesitancy in seeking help through your own hospital or GP’s surgery when you work within the medical field.

If you need someone to talk to, please take that first step and reach out whether it’s through Occupational Health, your GP or through self-referral with a service like HHP Wales.


We are grateful to Natalie for sharing her story with us through a recorded conversation with Dr Thomas Kitchen, Deputy Director of HHP Wales, during the HHP Wales Symposium in December 2020.

Resources

HHP Wales

Health for Health Professionals Wales (HHP Wales) offers access to mental health support for all NHS Wales employees, students and volunteers. 

HHP Wales is a free, confidential service that is supported by Welsh Government funding and administered through Cardiff University.

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Pharmacist shares experience of mental health support during Long COVID recovery

South Wales pharmacist, Geraint Jones, contracted COVID-19 in April 2020. He has kindly shared an insight to his experiences over the last year after he was later diagnosed with Long COVID.

Geraint was living with a multitude of symptoms after his initial COVID infection in April, which became extremely impactful on his day-to-day life, both as a professional and as a person.

Geraint explained: “I was in quite a novel situation at this time as I was diagnosed with Long COVID by a London clinician with experience in treating patients after initial COVID infection.

“There was no guidance on how to support or manage patients presenting with a huge variety of symptoms at this time, so I felt very uncertain on how the illness may impact my life, but also how long it will continue to affect my life.”

Finding support

Health for Health Professionals (HHP Wales) was recommended to Geraint through a friend at Swansea Bay University Health Board.

“After knowing the struggles I’d faced with COVID, and subsequently, Long COVID. I sought support through HHP Wales predominantly out of desperation and not knowing who to turn to for help.”

After initially contacting the service to see what support was available, Geraint was assigned a therapist who would lead him through sessions of Cognitive Behavioural Therapy (CBT).

“My experience with HHP Wales has only been positive. Having used CBT in the past, I loosely understood what I was to expect, but also my therapist gave me very useful tips to get the most out of the sessions and then implement this into my day-to-day life.

“The strategies we spoke through were very simple and never used too much mental ability (which I appreciated as some days I was completely lacking in this).

“I naturally felt comfortable when discussing any personal issues with the therapist, which is a skill in itself but also making me feel at ease throughout at a time and date to suit my varying physical symptoms.

“The sessions were always based around what I, or my therapist, felt I would benefit from having understood my needs through conversation and assessment.”

Would you recommend HHP Wales to others?

“Definitely! I’d never heard of HHP Wales before October (2020), and to be honest, I had quite low expectations due to not knowing much about them or the service that they provide. I don’t think I could have got it more wrong!” 

Geraint contacted HHP Wales via e-mail. With the launch of our new website, the quickest way to refer yourself for support is through our referral form.

Geraint continued: “I received an answer in less than a few hours with a telephone appointment for the next day, essentially a triage appointment to understand why I felt like I needed support.

“I spoke with Nicola, a Dr Advisor, who recommended a course of CBT and sent me the details of my assigned therapist to make initial contact. 

“Within a week, I was introducing myself to my therapist and starting the sessions – I’ve not known a service with such a quick turnaround time and handover between colleagues. 

“I cannot thank the HHP Wales team enough for guiding me through some very difficult times when nobody else understood my worries and concerns.”

Helping to investigate Long COVID

Geraint recently gave evidence as part of an All Party Parliamentary Group about Long COVID.

He had been a part of a small focus group with a senior research associate of the Cambridge Institute who was interested in speaking with men living with Long COVID.

Dr. Nisreen Alwan M.B.E. was part of the focus groups where the attendees would talk about their lived experiences and the lack of support out there for everyone affected.

Geraint said: “A few weeks later, Dr. Alwan got in touch and asked if I’d like to be a part of the All Party Parliamentary Group (APPG) debate led by Layla Moran, Lib Dem MP for Oxford West & Abingdon.”

The aim of the debate was to help gather evidence to submit to MPs about the incidence of Long COVID and how it continues to affect those who have survived the acute infection.

Geraint giving evidence as part of the Long COVID debate

“This was live-streamed via March For Change’s social media accounts, with MPs attending virtually, but also some decided to attend personally at the House of Commons,” Geraint explained.

He continued: “I honestly believe that the support I received from HHP, and gaining an understanding of how to live with a long-term health condition, gave me the confidence to speak at such a debate.

“I used my learned coping mechanisms to help guide me through the preparation and conversation, highlighting the importance of managing strategies when living with an illness.” 

Is there anything you’d like to highlight to anyone considering getting in touch with HHP Wales?

“Prior to contracting COVID, I was fit, well, and would like to think that I was quite resilient; unfortunately, COVID completely changed my physical and mental health.

“The support I received from HHP Wales invaluable at an uncertain time when no other support was available.

“This has been a complete eye-opener to what support is available for healthcare professionals and I would definitely (and already have!) recommended HHP Wales to colleagues.” 

Resources

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HHP Wales first annual symposium

Thank you to everyone who joined us for our first annual symposium on 11 December 2020. 

We were pleased to bring together the team involved in running the Health for Health Professionals Wales (HHP Wales) service with a wider audience interested and involved in mental health support across Wales and the UK.

As well as briefly reviewing the services on offer via HHP Wales, we heard from NHS colleagues who have received support through us.

We cannot thank Sarah and Natalie enough for taking the time to share their experiences, of what led them to the service and how they found the support they received.

Professor Neil Greenberg gave a fascinating talk around the concepts of moral injury and Dr Julie Highfield led us on a reflection of practical strategies to manage grief and loss.

As our first symposium took place online due to the restrictions of the COVID-19 pandemic we have been able to make a recording available.

Watch it on Youtube

  • Welcome – Jon Bisson
  • Opening address from the Chief Medical Officer for Wales – Frank Atherton
  • HHP Wales: Past, present and future – Debbie Cohen and Jake Hard
  • Moral injury: What is it and what to do about it? – Neil Greenberg
  • Reflecting on a lived experience – Sarah, Natalie and Thomas Kitchen
  • Making sense of our grief and loss – Julie Highfield
  • Q&A and close

HHP Wales

Health for Health Professionals Wales (HHP Wales) offers access to mental health support for all NHS Wales employees, students and volunteers. 

HHP Wales is a free, confidential service that is supported by Welsh Government funding and administered through Cardiff University.