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There can be a lot of pressure around Christmas to socialise more often than usual, to embrace 'the Christmas spirit' and to spend beyond our means to meet the expectations of others.

Mental health charity Mind found that over a quarter of people feel under pressure to achieve the ‘perfect Christmas’.

These factors can affect your mental health, particularly after last year's lockdown, which altered the festive period in ways we've not seen in the UK since the second world war.

This year we may feel obligated to go to parties, to eat and drink more than we want to, spend more money than we have, or feel lonely for not having social opportunities.

All of this can affect our mental health, so let's talk about how we can be affected and what we can do to help ourselves.

Social commitments and anxiety

Anxiety is prevalent in the UK. Around 10 million people are affected by anxiety.

Around Christmas there's a greater expectation to be sociable more than we normally might be.

For those with social anxiety disorder it can be a particularly stressful time.

Over-committing to socialising can leave you exhausted, so remember that it's ok to decline an invitation if you wish to.

The NHS notes that symptoms of social anxiety can range from worrying about events before, during and after them, to panic attacks.

Asking for help can be difficult, but it's good to see your GP who can put you at ease, or seek advice online from organisations like Anxiety UK:

Money matters

Some of us may feel huge pressure in buying elaborate gifts for our loved ones, and probably beyond our means.

It's easy to use a credit card to make it all possible, but facing the pressure of paying off our borrowing can be too much.

Mental health charity Mind found in 2015 that more than a third of the people with mental health problems that they surveyed self-harmed to cope with the pressure of Christmas, with 76% having problems sleeping at that time.

Those with Bipolar Disorder can overspend when experiencing mania, or people with depression can resort to 'comfort spending' on others to help their mood.

If you're worried about money, Mental Health & Money Advice and Mind are available year-round to provide practical advice and support.

Eating at Christmas

For anyone who's faced an eating disorder (ED), Christmas can be a particularly hard time with expectations to indulge in more food than usual.

It's important to eat as much as you feel comfortable with and eat the foods that you know you can.

Talking to a close friend, family member or contacting an organisation like Beat can help you if you need support.

Alternatively, you may be diagnosed with binge eating disorder (BED), and this can be just as challenging.

If you're caring for someone with an eating disorder, try serving food as a buffet, rather than a meal and treat meals as routinely as possible. Once meals are over, attempt to shift the focus away from eating.

Remember, it's ok to enjoy yourself at this time, even if it means eating a little more than usual.

If you need support, help is available online.

Limiting your time on social media

In a 2021 study, 38% of adults think social media is actively harmful.

While social media can be fun for sharing experiences and connecting with friends and family, it can also have negative effects on your mental health.

Comparing yourself unfavourably with others' highlights reels on social platforms is common, and particularly prevalent at Christmas. "Life envy" can be damaging.

If social media's getting too much, there are things you can do to help yourself:

  • Limit your time online.
  • Unfollow or mute accounts.
  • Delete social media apps.

Loneliness, and not just at Christmas

Charity Age UK reported in 2018 that Christmas isn't a time many look forward to.

For 52% of the people surveyed, loneliness has become a 'normal' part of life.

But it's not just older people who experience loneliness. Younger people, too, can face these difficulties.

Lockdowns amid the COVID-19 pandemic increased feelings of loneliness. A 2019 study found that almost 88% of young people surveyed said they experienced loneliness to a certain degree.

So, how can we alleviate loneliness?

The Mental Health Foundation suggests it's a good time to embrace your creativity, to do the things you enjoy doing, or perhaps treat yourself to a gift if you can afford to; and to remember to value yourself, that you are important and are loved.

It can also be helpful, if you can, to go outside and see the world around you.

Seeing life and interacting with people, even just the person serving you at a coffee shop, can help you feel less alone in the world.

At Christmas, perhaps give someone a call, they will more than likely be glad that you did.

We hope our tips help you in what is not always an easy time.

However you choose to spend it, whether surrounded by people or quietly, we wish you a peaceful Christmas.

HHP Wales

Health for Health Professionals 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.

This blog was originally shared on the National Centre for Mental Health website. To read the original post please click here

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An ongoing study of mental health during the pandemic found after the first wave in March 2020, 62% of adults reported feeling anxious or worried due to COVID-19.

The key reasons given for these feelings of anxiety were: becoming ill, being separated from friends and family, and uncertainty about the future and finances.

Mental crisis hotlines operated by the NHS received over three million calls during the pandemic. 

Although the effects of COVID-19 on the mental health of the entire UK population have been serious, health care workers have faced heightened levels of distress caused by the pandemic.

Mental health of NHS employees

Mental health awareness among the general population has improved. Despite this, it remains a taboo subject among the medical profession.

Many health care workers have been exposed to high levels of psychological trauma and are therefore at increased risk of negative mental health outcomes.

Previous research has found doctors and medical students are hesitant to disclose a mental health condition and are reluctant to seek help for fear of judgment or professional repercussions.

Studies indicate that healthcare workers have been disproportionately affected by the pandemic in comparison to the general population.

One study shows up to a third of NHS employees report higher levels of distress due to the pandemic. 50% of staff felt their mental health had declined during the first two months of COVID-19 and 45% of doctors surveyed reported experiencing depression, anxiety, or stress relating to or made worse by the pandemic. 

A separate study conducted on medical workers found 40% of respondents reported currently suffering from a broader range of psychological and emotional conditions due to COVID-19.

When being compared to the general population, key workers during the pandemic reported significantly higher levels of PTSD, insomniem depression and anxiety symptoms. 

Key factors impacting NHS staff wellbeing

Understanding who is most at risk

NHS frontline workers who are directly involved in the treatment and diagnosis of COVID-19 were found to be more vulnerable to the negative physical and mental health effects of the pandemic.

Among these are nurses and paramedics. 52% of nurses report being concerned about their mental health due to increased workplace stress during the pandemic. 

Additionally, studies have found minorities, young people, full-time students, people who are unemployed, single parents, those with long-term disabilities, and those with pre-existing mental health problems to be at high risk for struggling to cope with the pandemic. 

We're here for NHS workers in 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.

Useful mental health resources

Learn more

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Alcohol use disorder (AUD) is highly prevalent in the UK adult population, with 4% of people between 16 - 65 years old being alcohol dependant and 24% of adults consuming alcohol in a way that is potentially harmful. 

The Chief Medical Officer's guidelines for both men and women state that in order to keep health risks from alcohol to a low level it is safest not to drink more than 14 units a week on a regular basis.

One unit is 10ml of pure alcohol. Because alcoholic drinks come in different strengths and sizes units are a good way of telling how strong your drink is. 

High levels of stigma regarding alcohol use disorder and anxiety about judgment and potential professional consequences should a problem be detected can affect the willingness of an individual to seek help.

Alcohol support through HHP Wales

Health for Health Professionals Wales (HHP Wales) provides a highly confidential, evidence-based service for staff and students working in the NHS in Wales.

HHP Wales operates in a climate of trust and openness to avoid feelings of fear and shame and strives to offer an opportunity for all NHS Wales staff to receive appropriate mental health and alcohol misuse support.

To shed further light on this important service, two members of the HHP Wales team, Dr Bern Hard and Dr Mohan de Silva, have kindly agreed to discuss the alcohol use disorder service in more detail.

"I think a lot of people worry about confidentiality, stigma and the consequences of disclosing information about alcohol use. 

"The principles that underpin our AUD service are insight and cooperation."

Dr Bern Hard

What is the history of the service?

Dr Mohan:

"The service is an evolvement of the original HHP Wales.

"Prior to the COVID-19 pandemic, HHP Wales was set up for health care professionals who were doctors working in Wales and the service offered structured cognitive behaviour therapy (CBT) to those who would benefit from mental health support.

"Following the pandemic, access to HHP Wales services was expanded to all individuals working for NHS Wales. It was also envisaged that due to the circumstances of COVID-19 there would be an increasing number of health care providers with AUD.

"With this in mind, the original HHP Wales screening questions were expanded to include AUDIT (questions about alcohol consumption and possible alcohol-related problems) to help identify such individuals."

Could you provide a brief overview of the service?

Dr Bern:

“The AUD pathway is really aimed at exploring alcohol use in greater depth when it has been identified as a possible factor during the initial conversation with the HHP Wales Doctor Advisor.

"We screen for AUD using a standardised tool called AUDIT.

"This tool can flag up patients whose use of alcohol may be detrimental to their wellbeing in a number of different ways.

"The AUD assessment allows for a detailed discussion about the patient’s current and past relationship with alcohol, and whether this is impacting negatively on them.

"The assessment aims to establish if the alcohol use is hazardous, actually causing harm or if there is any degree of physical dependence - and if so, how severe is this.

"This allows for us to guide patients towards the most effective strategies to manage the problem.

"Non-dependant use can usually be managed by specialist support and guidance, which we can provide with a referral to a CBT therapist with expertise in working with AUD.

"If patients are using alcohol in such a way that they have come to depend physically on it, then it is more appropriate to advise engagement with a specialist service in their local area. We aim to facilitate this next step where needed.”

If someone was considering using the alcohol use disorder service, what would you like them to know?

Dr Bern

"When treating health care providers, we need to always have an eye on the effects that the patient’s own health could have on their ability to treat their patients safely. 

"All health care providers have a duty to ensure that their own ill health does not impact negatively in a professional capacity. 

"The risk of this occurring is increased if we operate in a culture of fear and secrecy.

We at HHP Wales accept that health care providers are human. People first. And all people have problems.

"With help and support we can address those problems together, in a way that fosters wellbeing in the health care provider, in the NHS workforce, and in turn, reduces risk to our own patients.

"Confidentiality needs to be balanced with transparency and sharing of information where it is in the best interest of the patient. 

"Largely speaking, there is no need to share information outside the HHP Wales where the health care patient has good insight into their own health and is prepared to follow the advice of professionals.

"There are cases where insight is lacking, and we do need to share information in order to protect patient safety, but these are rare, and even then the aim is always to support the health care patient to recover."

Could you share any insight into the difference you've seen the service make to your users?

Dr Mohan

"In most cases, the health care professionals leave with deeper insight and benefit immensely from the extra support they receive from the AUD service.

"My experience is that most instances I have dealt with do not require formal detoxification and I'm reassured by the extra steps that they take with our service.

"While some health care professionals worry about confidentiality, they value the opportunity to talk to someone 'anonymously' - I believe this is somewhat easier on the telephone and HHP Wales give them this confidence. 

"I believe the service is an invaluable help to professionals by giving them an opportunity to discuss their problems outside of their employment and giving them a fair amount of confidentiality to discuss their problems openly without being embarrassed."


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A midwife, from south Wales, Amanda is currently on secondment working in clinical governance due to the COVID-19 pandemic.

For this very personal blog, Amanda has requested to remain anonymous. To honour this request, we have changed her name.

The support from HHP Wales changed my life…

We lost my mum suddenly in 2008. I was in the middle of my midwifery degree when she had to be taken to A&E. She lived with severe asthma and Addison’s disease, but I was totally unprepared when she died suddenly in front of us from a cardiac arrest.

Instead of dealing with my grief, I carried on with my intense degree. Partly losing myself in it so as not to deal with her death but also knowing I couldn’t let her down.

In December 2009 I had my little boy and that’s when my problems really started.

After what happened to my mum, I was afraid to bond with him. I wanted to save him from feeling what I had when my mum died.

When he was about seven to eight weeks old, I realised what I was doing and thought, I have to deal with this.

Two years later, I found I couldn’t leave work behind. I was constantly worrying; “Have I done something wrong? What if I go in and something catastrophic happens?”

In 2018, I had my daughter, and going back to work I was told I’d be the allocated scrub nurse for the elective caesarean sections. This role took the pressure off as I felt more in control and more importantly someone’s life wasn’t in my hands.

In December 2019, my worrying only got worse.

I went in for some elective surgery, an umbilical hernia repair. I was worried I was going to die and then found out I had sepsis. I continued to feel unwell and was told I had the flu, which we now think was COVID-19.

I was living with a constant fear of death. I couldn’t leave my children. If I was going out in the car, I was terrified I’d crash. And I found I couldn’t handle hearing alarms as it reminded me of the ones at work and I’d be really anxious.

Woman wearing face mask facetiming man wearing face mask

In March 2020, I was receiving counselling through occupational health.

I’m a severe asthmatic and was moved to work in governance due to the pandemic. It’s actually really helped with my mental state.

I found myself worrying when the COVID numbers started getting better, panicking about life going back to how it was.

The support from HHP Wales changed my life, and I’m not exaggerating.

I was pointed in the direction of HHP Wales and filled in an online referral form, then someone from the service got back in touch with me.

It was recommended that I complete the Spring programme and Professor Jon Bisson took my case on.

Spring was developed by Cardiff University's Traumatic Stress Research Group and Healthcare Learning Company, informed by people with lived experience of PTSD and health professionals working in PTSD.

It is an eight-step online programme that takes users through information about PTSD and typical symptoms, unlocking helpful tools and techniques for symptom management.

Woman's hands typing on a laptop

Therapists guide and support participants through ‘Spring’, encouraging access to the programme and completion of homework.

Before starting the programme, I didn’t know I had PTSD

Through completing Spring, I found ways and means to cope with what I’d experienced. I am able to rationalise my thoughts so much better now.

Obviously, it’s hard work revisiting everything you’ve experienced but I could see how it was helping me process it. And being able to complete it online at my own pace, stopping and starting when I needed to take care of my children was really useful.

Then checking in with Jon every week or two kept me on track and helped me deal with everything that was brought up through the process.

Would you recommend HHP Wales to your colleagues?

Yes, I know of people I work with who would really benefit from this support. People who have seen some really traumatic things as part of their jobs and have no way of dealing with it.

There’s a perception that their managers won’t want to know but I want to reassure them they do and that the support I received was incredible.

There’s definitely fear they won’t get the support from their managers and peers, but I want them to know it’s there, they just need to ask.

I’m in a much better place than last year and I know without a doubt that’s due to the support from Jon and the Spring programme. I cannot thank him and the service enough.

We’d like to thank Amanda for sharing such an honest account of her experiences.

HHP Wales

Health for Health Professionals 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.

Read more

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In today’s fast-paced society our workplaces, schools, communities, and daily routines often become packed.

These busy schedules make it difficult to maintain healthy sleeping patterns.

Sleep plays a large role in both our physical and mental health. Despite spending a third of our lives asleep, sleep deprivation is incredibly common.

Around 1 in 3 of us will experience occasional sleep problems at some point in our lives and 1 in 10 people will be affected by ongoing sleep problems.

The importance of sleep

Sleep plays a significant role in healing and repairing blood vessels, maintaining a healthy weight and balanced hormones, and helps control sugar levels.

Sleep also affects our moods, behaviour, learning capacity, and how we interact with others.

Not getting enough sleep can limit our ability to deal with negative situations and alter our decision-making processes. 

Five factors that could be affecting your sleep

1. Mental and physical health

Lack of sleep is correlated with mental health issues – problems with sleep can be both a contributing factor and a side effect of poor mental health.

Sleep problems are common in individuals who experience mental health difficulties such as depression, ADHD and anxiety.

However, it is difficult to determine exact cause and effect relationships between sleep and mental health, and research into the topic is ongoing.

Studies have shown improved quality of sleep is associated with improvements in mental health and well-being.

Poor physical health can also cause your sleep to suffer. 18% of adults said that a physical health condition or disability had negatively affected their sleep.

2. Relationships and lifestyle

A fast-paced lifestyle with constant use of technology can make it difficult to switch off at night and busy social schedules can get in the way of getting enough hours of sleep.

Caffeine and alcohol usage before bed can result in poor sleep.

The relationship between sleep and social relationships has not been fully defined but sleep quality and relationships have been shown to have a correlation.

In one study, a stable relationship history was shown to be associated with improved sleep quality and continuity. Furthermore a separate study suggests quality and presence of social relationships, especially our closest relationships play a role in sleep quality.

3. School

School is a factor that can often limit a child’s sleep, the early start times require adolescents to wake up earlier than their body clock would prefer. 

Children and adolescents who achieve a recommended sleep duration may be better able to manage their emotions and report better quality of life and wellbeing.

4. Work

High work demands, job strain, level of control people have over their job, work pressure, workplace bullying, and an imbalance between effort and reward are all workplace factors that could negatively impact your sleep.

37% of working adults report their work reduces the amount of control they feel they have over their sleep.

5. Environment

Environments that are noisy and bright are linked to a lack of sleep.

Bedrooms should be kept cool, quiet, and dark to ensure good sleep.

Screen time usage before sleeping is linked to unhealthy sleeping habits and bad sleep and LED light, in particular, can lead to poor sleep.

Sleep and COVID-19

An additional factor that has been negatively impacting sleep is COVID-19. The pandemic has resulted in worsening sleep for UK adults.

Over 25% of UK adults reported COVID-19 has negatively affected how well they sleep.

Fixing your sleep

Although bad sleep is incredibly common, the principles and practices of developing a healthy relationship with sleep are simple.

  1. Reduce stress.
    • Stress can have major impacts on sleep, practicing relaxation techniques such as breathing exercises or progressive muscle relaxation can help reduce the impacts of stress.
  2. Protect your sleep from lifestyle and environmental factors which could upset your sleep pattern.
    • Consider reducing the intensity of aritifical light in your home and spending a couple of hours before bed without technology like your phone, laptop, or television.
    • Create a time to wind down before bed.
    • Avoid drinking alcohol or caffeine before bed.
  3. Make your bedroom more sleep-friendly
  4. Personalise your sleep by determining how much sleep you require and what times work best for you to go to bed and wake up.
    • Try keeping a sleep diary for 10 days to see what works best for you.
  5. Maintain a regular bedtime and sleep pattern.
    • It is particularly important to get up at a similar time each day, even on weekends. This will help train your body clock to regular sleep and wake times.
    • To increase your chances of getting a good sleep try to avoid napping throughout the day. If you must nap, try to keep it short (around 20 minutes).

Learn more

The National Centre for Mental Health (NCMH) offers further information about the relationship between sleep and mental health.

Episode 5 of NCMH podcast Piece of Mind: Mental Health & Psychiatry discusses sleep and if it is a cause of mental health problems or a symptom.

Listen here.


HHP Wales

Health for Health Professionals Wales (HHP Wales) offers access to free 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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