NHS needs £25bn in emergency cash, Theresa May told

NHS leaders are urging Theresa May to give the health service an emergency cash injection of £25bn before 2020 or risk a decline in the quality of care for patients and lengthening delays for treatment.

An influential group representing NHS Trusts says that the care provided by hospitals and GP surgeries will suffer over the next few years unless the prime minister provides an £5bn a year for the next three years – and a further £10bn of capital for modernising equipment and buildings.

NHS Providers is preparing to release its own manifesto next week, calling on the Conservatives and Labour to end what it calls the austerity funding of the health service. Saffron Cordery, the director of policy and strategy , said its analysis showed that there was a “revenue gap” of £4.5bn-£5bn a year in 2017-18 and “each of the subsequent two years as well.”

Hospitals needed that sum, said Cordery, to get rid of their deficits, which are running at £800m-£900m a year, deliver new NHS commitments on cancer and mental health and improve their performance against key waiting time targets.

The NHS also needed a further £10bn for capital spending on building and repairing premises, buying new equipment and moderning how care is provided, she added. That is the sum which a recent report commissioned by the Department of Health said the service needed for those purposes.

May inherited a pledge from David Cameron and George Osborne to provide a £10bn real-terms increase between April 2014 and April 2021. So far in the election campaign, the prime minister has refused to be drawn on how she might fund the health service, telling journalists that they would have to wait for the publication of the party’s manifesto.

A second group, the NHS Confederation, which represents hospitals and ambulance and mental health services, urged May to commit to giving the NHS £8bn-a-year annual budget increases after 2020-21, when the current funding settlement expires. The Department of Health’s budget is due to reach £133.1bn by March 2021.

Niall Dickson, its chief executive, said NHS services were so stretched that it would have to go back to getting at least the 4%-a-year budget increases it enjoyed historically between its creation in 1948 and 2010. After that, the coalition government limited rises to only 1% annually.

“It’s quite unsustainable for the shackles to remain on the health and care system and for society to expect the levels of need that will arrive over the next 10-15 years to be met unless it is willing to fund them,” Dickson said. “If we aren’t ready to put significant extra resources into the NHS then difficult choices will need to be made about things that we are going to do.”

Prof John Appleby, chief economist at the Nuffield Trust thinktank, said that returning to 4% a year rises, which the NHS used to receive regardless of which party was in power, “would require a cash increase of around £8bn in 2021-22.”

While Tory backing for such large sums was unlikely, “this could change if the NHS continues to miss its headline performance targets and the concern the public are starting to express about the NHS continues to rise”, he added.

The two interventions put pressure on May on an issue that some polls show is top of voters’ list of priorities in the general election, even ahead of Brexit.

Jeremy Hunt, the health secretary, has said several times that the NHS budget will need to rise by a significant amount after the current funding schedule ends in March 2021. For example, last October he told the Commons health select committee: “It is a given that over coming decades we will need to put more into the health and social care system … if we want a high quality healthcare service, yes, we need to continue investing more.”

Simon Stevens, the chief executive of NHS, England, has voiced concern that per capita health funding will decline in 2018-19 and 2019-20. It is due to fall from its current level of £2,223 per head this year by £16 next year and £7 in 2019.

Anita Charlesworth, the director of research at the Health Foundation thinktank, said the NHS could no longer make ends meet by holding down pay and reducing investment in equipment and facilities. “Cracks are evident – access to new drugs is being restricted, waiting times have increased and recruitment and retention are growing problems across the NHS. The health service can always be more efficient but it cannot bridge the gap between pressures rising at 4% and funding at 1% for much longer without quality and access suffering”, she said.

A Conservative spokesman said: “A strong NHS needs a strong economy. Only Theresa May and the Conservatives offer the strong and stable leadership we need to secure our growing economy in future and with it funding for the NHS and its dedicated staff.

“We’ve protected and increased the NHS budget and got thousands more staff in hospitals – but we know that progress is on the ballot paper at this election.”

NHS needs £25bn in emergency cash, Theresa May told

A moment that changed me: when the doctor told me I was psychotic | Anonymous

I was sitting in my living room along with a social worker, mental health nurse and my baffled parents the day the doctor told me I was “psychotic”. It felt like a dream. Just a week before, suffering from anxiety and depression, I had taken leave from the training course I was on. A week of shuffling around the house followed.

Like many people, I was determined to “escape” my unhappiness in any way possible, but thankfully lacked the conviction to do anything about it. Soon I became convinced I had committed some sort of sin that I could never articulate: TV programmes and songs fed a narrative in my mind which was impossible to write down now – it simply made no sense. It involved God, the devil, my boss and the professionals around me, all of whom were part of some major conspiracy reminiscent of The Truman Show. These delusions were common signs of psychosis, a condition that can stem from deep depression.

During my own episode of psychosis I was, in medical terms, detached from reality. But that simple message was not what I heard in the stigma-ridden word, psychotic. It conjured up something very different, and very upsetting: serial killers and fictitious villains. Unsurprisingly, this added more weight to my own delusional and self-loathing narrative.

This was a life-changing moment for me. I didn’t realise it then, but I was experiencing for the first time the true impact of misused words. According to the NHS, somebody who is psychotic will “perceive things differently to those around them; this might involve hallucinations and delusions”. But the word with which “psychotic” is so regularly interchanged is “psychopathic”, defined as a “chronic mental disorder with abnormal or violent social behaviour”.

The two are not linked, and they are certainly not the same. Yet a glance through any film review section, in any newspaper or magazine, will probably suggest something different. As the mental health charity Mind states on its website, “lots of people wrongly think that the word ‘psychotic’ means ‘dangerous’”. As I sat in my living room, being told I was psychotic, I interchanged the word with “dangerous” and felt myself spiral deeper into a delusion of guilt. “So I have done something wrong … maybe I am an evil person,” I thought.

I spent 10 days in a psychiatric hospital, silent and shy. Every patient was a character in my “story”, as were the nurses. I said very little and did even less, but my mind was racing. Like many psychotic patients, I was convinced the nurses were out to get me, and that I was being punished for something. My fantasies of having committed a great sin escalated as I was taunted by one patient who believed she was the devil, and offered salvation by another who sang religious songs and walked around the ward with arms outstretched. We were all orbiting “reality” in our own ways.

Like many people who experience any kind of deep depression I lacked hope, but my warped state of mind took that further

It wasn’t until I had taken the right drugs and rebalanced various chemicals in my brain that I began to listen to the professionals who were there to help me. I read up on psychosis and had several sessions with a community mental health nurse. Listening to my reflections on the negative associations of the word “psychotic”, he explained how common my feelings were in his clients. “That’s the media for you,” he said, brimming with frustration.

He’s right. Examples of journalists’ misuse of the word “psychotic” are everywhere. Trainspotting’s Begbie is described as “psychotic” in practically every review I have read; ranging from the Guardian to the Sun (the latter also describes Begbie as “psychopathic”, using the terms interchangeably). On the Huffington Post, you can find a countdown of The Most Psychotic Movie Villains of All Time, featuring everyone from Freddy Krueger to Norman Bates. A website called allthetests.com, billing itself as “an exciting exploration into your personality and IQ”, allows you to partake in a light-hearted quiz entitled Are You a Psychotic Killer?, claiming it will help you decide “whether or not you should be locked away forever to keep you from killing everyone!” Even if, after all this, you look for a definition of the word in the online dictionary Merriam-Webster, the context given is as follows: “the identity of the psychotic murderer known as the Zodiac Killer remains an intriguing puzzle”.

Meanwhile, Dictionary.com unhelpfully lists “psychopath” as a synonym. I have no doubt that I would have spiralled less, and experienced fewer delusions about my own morality and guilt, were it not for the way mental health terminology is misused.

My life has changed a lot since that day. I’ve returned to work and count myself lucky to be among those who love their job. Yet my life today seemed impossibly out of reach two years ago. Like many people who experience any kind of deep depression I lacked hope, but my warped state of mind took that further. Interpreting my psychotic thoughts with hindsight, I was convinced my future would consist of prison, some sort of pact with the devil and a showdown with lots of malevolent nurses.

Unless I’m in for a big surprise, none of this has or will turn out to be a reality. My mind played tricks on me; the truth was that I was going through an episode, and episodes pass. The life and happiness that felt so out of reach was, in reality, waiting for me just the other side of a hospital spell.

I am fortunate to have been free of psychotic episodes since 2014. But for many people these episodes come and go frequently. The misuse of the word is everywhere, and the associations it carries as a result will only help to escalate people’s symptoms. So please remember: psychotic does not mean psychopathic, violent or dangerous: it is about perceiving things differently to everyone else around you. With the help of the media, and the general public, we could all have a positive change in perception.

• Read about psychosis on the Mind website. The NHS explains many aspects on this page

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A moment that changed me: when the doctor told me I was psychotic | Anonymous

Secret Teacher: Class, I wish I"d told you the truth about my mental health

Last year, I quit teaching. I had completed my NQT induction, and despite the years of self-doubt and tears I’d finally come to recognise that I was a competent teacher, and had started to believe my positive feedback.

I had also come to realise, however, that teaching was an unhealthy career choice for me. I am a perfectionist – or now, I hope, a recovering perfectionist – who is prone to anxiety. Unfortunately, I could not reconcile these aspects of my mentality with the never-ending pressures of being a teacher.

My health was poor while I was in the classroom. I was on medication, undergoing therapy and had to twice take time off sick when I couldn’t leave my house without breaking down. As the end of the year approached, I knew I would be leaving teaching.

But as the end of term loomed, I wondered: “What will I tell my students?” I remember standing in front of my lovely class, with whom I had developed an extremely good relationship, trying to find the words to explain why I was leaving them in the middle of their GCSEs.

They were a wonderful bunch – curious, energetic and high-achieving. But many were also anxious and stressed. I saw myself in so many of them. Their perfectionism and ridiculously high standards were a mirror of myself. I stood before them, without having learned to deal with those issues, about to give up on my dream career after two years of mental anguish.

And so, on my last lesson I stopped, looked them in the eye, and said:

Guys, I am leaving because I have never tackled my perfectionism – that same perfectionism that you think will get you A*s and make you happy.

I am leaving because I have not yet learned how to cope with failure or deal with negative emotions. I have not yet worked out how to tackle my faulty thinking. I have achieved so much academically and have a wonderful social life, but I have been suffering with poor mental health. I am anxious and depressed, and so I can’t carry on being your teacher at this moment in time.

But that’s OK. Our lives will go on. I am already receiving help, both through medication and therapy. I’ve talked to my family and my friends and it’s helping. I’m taking small steps to manage my lifestyle, to make sure I’m getting enough sleep. Mindfulness helps. Exercise helps. For me, music helps. There are so many ways you can mend yourself.

I am a not a doctor. I cannot tell you how to recover if you are suffering from poor mental health – not now or in the future. This is just my experience, but I think you should be aware of it.

Mental health issues are not something to be ashamed of. They are not always obvious. They can express themselves in many different ways. I think there is a scale; some mental health issues are life-threatening and totally debilitating. Mine, fortunately, are not. But had I carried on without talking and reaching for help, they may well have become so.

There is little that’s more important than your own health – physical and mental. Look after yourself, look after each other and talk. Build yourself a support network when times are good, just in case things get harder. Work on challenging negative thought patterns and disputing irrational thinking. Research what makes your brain work, investigate mindfulness, work on yourself.

And if you ever find yourself tempted to lie about a natural, normal period of ill health because you are ashamed, stop and think: “What would you tell a class of 15-year-olds? What would your 15-year-old self have benefitted from hearing?” Don’t be ashamed, use your journey to help others.

But I didn’t say that. Of course I didn’t.

I made up a different illness, in the same way I tell friends that I can’t come to their party because I have a migraine, when the truth is that I cannot see past the tears to make it out the front door.

Even in 2017, mental health stigma still exists and few people are brave enough to talk about it out loud to those kids who need to hear it. I certainly wasn’t. I passed up on perhaps the most “teachable moment” of all.

And so, I’m sorry I lied. I’m sorry we are not yet in a time or place where it is acceptable for me to have shown such weakness. I hope you do not suffer from mental health issues, but the reality is that many of you will. And I hope, if you do, you are brave enough to share your story when you can.

Follow us on Twitter via @GuardianTeach. Join the Guardian Teacher Network for lesson resources, comment and job opportunities, direct to your inbox.

Secret Teacher: Class, I wish I"d told you the truth about my mental health

Children struggling to concentrate at school due to lack of sleep, MPs told

Sleep deprivation is a growing problem in schools, with pupils struggling to concentrate in lessons due to lack of sleep, MPs have been told.

Edward Timpson, minister for children and families, highlighted the issue while being questioned by MPs who are investigating the role of education in preventing mental health problems in children and young people.

Lack of sleep has been linked to children’s use of mobile phones and tablets late into the night, MPs sitting on the joint inquiry by the Commons health and education committees were told at Wednesday’s hearing.

Timpson said: “A big issue in schools now is around sleep deprivation. Children are not getting enough sleep and that causes problems concentrating.”

Doctors have previously reported a dramatic increase in children with sleep disorders; NHS data shows hospital attendances in England for under-14s have risen from almost 3,000 in 2005-06 to more than 8,000 in 2015-16.

MPs also raised concerns about the impact of social media on children’s mental health, with reports of widespread cyberbullying, and parents’ inability to protect their children.

Former government mental health champion Natasha Devon said neither teachers nor parents could keep up with the fast-moving technology and suggested schools needed IT experts to help children use social media safely.

“There is a gap in understanding between young people and their parents and teachers and the technology is developing faster than we can measure the psychological impact.

“Last year an extensive report on the impact Facebook had on self-esteem was published but teenagers aren’t on Facebook anymore. They’ve moved on to Instagram and Snapchat.”

The MPs heard that some schools try to tackle the problem by confiscating mobile phones for the duration of the day, but Devon – who founded the Self-Esteem Team – said children and young people were able to get round safety measures adults try to impose.

“I went into a boarding school where they removed their phones at the beginning of the day and handed them back at the end for a few hours – they all have two or three phones to circumnavigate that problem.

“There was an example where they gave a teenage boy the Fort Knox of laptops with every single parental control on it and challenged him to find some pornography. He did it in 30 seconds by Googling the Spanish word for pornography. They find ways around the safety measures that we put in.

“What schools need, I think, are experts in this field who are really up to date with the technology.”

Lady Tyler of Enfield, who chairs the Values-Based Child and Adolescent Mental Health System Commission agreed: “The technology is moving on at such a pace that many people, many parents, really don’t feel very well equipped to know what’s going on and how best to support their children.

“If there was that more specialist expertise in schools, I think schools would be very well advised to pass some of that on to parents in simple ways – tips on how to help manage their child’s use of social media and what the pitfalls are.”

She added: “For me what is particularly important to get across is a balance between screen time, physical activity, sleep and all sorts of things that contribute to overall wellbeing.”

Also giving evidence was Lord Layard, emeritus professor of economics at LSE, who is advising the government on a trial of weekly mindfulness classes in 26 schools.

Asked about the effectiveness of mindfulness, he said he believed in it and tried to practise it himself but added: “It’s only a part of the answer to this problem.”

He called for a “radical initiative” to support children with mild to moderate mental health disorders in a school-based setting, so they are seen early on before they become so seriously ill they reach the high thresholds required to be seen by Child and Adolescent Mental Health Services.

“It’s important to realise just how bad a place we are in. We are in a situation where only 25% of children in psychological need are receiving any kind of psychological help. That has to to be changed.”

Children struggling to concentrate at school due to lack of sleep, MPs told

My friend told me not to freeze my eggs and now I"m childless

The dilemma At the age of 35, I was single and childless, so I considered egg freezing. I found a clinic, sorted out transport and worked out costs. But before I went ahead I spoke to a close friend who strongly warned me against the idea. She stated removing eggs from your body and storing them in a freezer was silly. I respected my friend as she had been through many fertility treatments and so I cancelled my appointment.

I am now 40 and after meeting a very special man am struggling to conceive. My gynaecologist asked me why I had not frozen my eggs and I find myself furious with my friend. I am struggling to forgive her for her catastrophic advice.

I am sure she was not deliberately malicious, but I feel she has ruined my chances of ever being a parent. I have not said anything to her yet. How can I move on?

Mariella replies Stop the blame game. I appreciate that you are angry and frustrated. The vagaries of female fertility and its curtailment long before many of us are ready or in need of saying goodbye to the possibility of parenting is an evolutionary frustration.

Once upon a time we were unlikely to live much beyond 50. Today it’s double that and we are better prepared for parenting in our middle years. We mature more slowly, committed relationships start later, careers are rarely consolidated in our 20s – all of which knocks parenthood down the touchline.

Yet here you are suffering a similar fate to many women of our generation – finding the right relationship, but potentially too late to make it a family affair. Dumping responsibility for past choices on to someone else’s shoulders is not the way to solve your problem or your complex feelings around the baby-making issue. I’m startled that not freezing your eggs should be seen by your gynaecologist as a slip-up on your part. I suspect the majority of women, unless experiencing a relatable medical condition, would not have freezing their eggs high on their “to do” list in their mid-30s. Maybe we should. It’s one of a host of options we need to be discussing as our bodies struggle to keep pace with seismic shifts in society.

Your friend may not have displayed great foresight, but that’s easy to judge in hindsight

Blaming your friend for delivering an opinion, based on her own experience, is the last thing you should be focused on. Your anger would be better channelled in tackling your possibilities for conception. There’s a long and ever-increasing list to choose from – IVF, donor eggs, surrogate mothers – if having a baby is your priority. Getting your gynaecologist to show more imagination and make fewer unhelpful comments about choices long past would be a much more constructive occupation.

Then again, friction among friends seems a staple of long-held relationships. Some days I find myself longing for the innocent friendships of yore. In adulthood, refraining from manslaughter let alone maintaining civility with those you’ve “matured” alongside, gets ever harder. Over the decades, girlfriends develop opinions that are intractable, habits that are increasingly annoying and foibles, long suffered, become ever more insufferable. Where once all I asked for in a buddy was the potential for fun, a companion to share the late-night taxi fare with and an open phone line in times of emotional turmoil, now I demand sensitivity, compliance, flexibility, intuition, blind loyalty, political compatibility, back-up when required and free rein when not.

In short the older we get the less tolerant we become of anything less than perfection in those who’ve accompanied us through the years. The better we get to know ourselves the less flexible we are about stepping beyond established boundaries. It’s surely the reason so many of us get stuck in our ways, paused at a particular point, with no hunger to develop, seek new adventures or push ourselves. I’d go so far as to say it’s what makes us old!

I’m wondering how much credit your pal would have been given had she pushed you into egg freezing. Would your life have taken this same turn or a different swerve? It’s illogical to separate the choices we’re happy with from the ones we’d like to retake because they are intrinsically connected. Your imperative to have a baby may have pushed you faster into finding a relationship. The insurance of frozen eggs might have made you dawdle along the way and blinded you to the possibilities of the man you’ve met. That’s why gratitude for the things that turn out right is so much more important than raging against perceived losses.

Your friend may not have displayed great foresight, but that’s easy to judge in hindsight. Here in the present I suggest you take responsibility for your choices, channel anger into positive action and be grateful that you’ve met a great man.

If you have a dilemma, send a brief email to mariella.frostrup@observer.co.uk. Follow her on Twitter @mariellaf1

My friend told me not to freeze my eggs and now I"m childless

Britons "bumped off" EU medical research grant applications, MPs told

British medical researchers are being removed from applications for EU research grants by European colleagues because of Brexit, MPs have been told.

Prof David Lomas, representing UK university hospitals, told MPs that Britain’s position at the forefront of medial advancement was threatened were it no longer able to access the European Research Council, one of the world’s leading funders of scientific research.

“One big issue for most of hospital academics is applying for grant applications, and we’ve seen people bumped off grant applications to the EU,” he told the health select committee.

Applications to the ERC are usually made by consortiums of researchers from a variety of EU countries. Britain has a strong track record of taking the lead in these groupings.

“Previously having a British member would help you in your application to get funding … Nowyou are less than an asset, so we have had academics removed from grant applications,” Lomas said.

He said it was vital for patients that Britain continued to be part of leading edge research and was pressing the government to argue the case for continuing to contribute to the ERC on a pay-as-you-go system.

“If we don’t get the very best people we don’t drive the research and innovation where we punch above our weight. If we can’t attract the very best, we can’t lead in the innovations that will lead to patient benefits.”

Lomas said his own university, University College London, where he is vice-provost of health, and the University of Cambridge were huge beneficiaries of the ERC, as was the UK.

“We raised €760m [£642m] between 2007 and 2013 from the ERC. My own university and Cambridge are neck and neck for bringing more in to any university [than any other] in the EU,” he told the committee.

Brexit was also affecting recruitment of high-calibre staff in medical schools, with teaching hospitals in Leeds and Glasgow reporting people pulling out of job offers, he continued. “So we have lost stellar people who would have come otherwise.”

Concern over the right to live and work in the UK after Brexit was already affecting recruitment across the board, said Danny Mortimer, chief executive of NHS Employers.

Giving evidence before the select committee, he said the controversial application process for permanent residency cards involving an 85-page application form had proved counterproductive, and was deterring valuable healthworkers from planning to stay in the UK after Brexit.

Both men were speaking just weeks after the Nursing and Midwifery Council reported a sharp decline in registrations from Europe.

Just 101 nurses and midwives from the EU27 registered to work in the UK in December, down from 1,300 in July, the committee heard. About 5% of nurses and 10% of doctors in the NHS are EU nationals.

Mortimer said EU staff were critical to the smooth running of the the health service. “We cannot believe that the NHS can do without our EU national colleagues,” he said.

One area that could be more heavily impacted than hospitals is social care, with EU nationals plugging the gaps, particularly in rural areas where it was difficult to recruit British staff, MPs heard.

“Some areas it has been very difficult to recruit, rural areas are very difficult to recruit people in social care, so EU [nationals] have come into this area,” said Martin Green, chief executive of Care England.

Britons "bumped off" EU medical research grant applications, MPs told

Boys as well as girls should be told about the evils of FGM

Lynne Featherstone, the Liberal Democrat parliamentarian who was once a home office minister, and Justine Greening, the education secretary, have written to Theresa May asking that she will allow girls’ schools to teach pupils what a bad idea female genital mutilation (FGM) is, so that the poor things will know how they can avoid being so tortured.

I can’t remember when I first heard of FGM – presumably when being told all about strange foreign places and habits, while absorbing the oddities of geography at school or later. The tiresome fact is that while the clitoris exists to make reproduction agreeable so that the species will continue, FGM makes reproduction the exact opposite when its painful removal is deemed necessary by any tribe or group.

I know that it is often older women who do the actual chopping

So there is no harm in warning young girls, but you would think the males ought to be the ones to be lectured on the subject. (I know that in the hot places where the habit comes from, it is often other women, older women, who do the actual chopping – perhaps partly to be sure that lush young girls are not keen to attract all the older chaps.)

I do think that it should be the boys’ schools that make sure the pupils are aware of the awfulness of FGM, so that girls and women will not be in for a bad time at the mercy of boys and men who don’t see the usefulness of the clitoris at all.

There’s no harm in sensible information being available for all, but surely it’s the males that need educating.

What do you think? Have your say below

Boys as well as girls should be told about the evils of FGM

A moment that changed me: my psychiatrist told me I could be one too | Linda Gask

During my years of medical training I was tense and wound up almost all of the time. Then, just before my finals, things got very much worse. I began to draw up a complex revision timetable, which I obsessed over. I was as fearful of failing as I had been with my A-levels, but there was also a terrible sense of unease about what was happening to me, to which I couldn’t put a name.

I convinced myself that the best way to stay in control of my world was to design a kind of map for my mind and contain everything within it by the time the exams arrived. I ruled out lines on sheets of paper to create a chart to govern every waking hour for the next few months. I did not want to acknowledge the obvious parallels with my brother, whose strange behaviour would later be diagnosed as obsessive compulsive disorder.

The idea of studying medicine had come to me quite suddenly around the age of 15. I had discarded my previous ambition of being a biology teacher, and when I received an offer from Edinburgh medical school I had been determined to make the most of it.

But my confidence was in short supply, and I felt out of place in Edinburgh from the start – like many students, I self-medicated with alcohol. As a working-class girl, the first in my family to ever think of going to university, I didn’t share the same background as most of my fellow students. My mother worked in a factory, assembling transistor radios, my father in an amusement park repairing fairground rides, and my relationship with both had been increasingly difficult in the years before I left home. As a result, I felt even more alone.

I also had problems with anxiety which began before my A-levels. I hadn’t made the grades that Edinburgh asked for in their offer, but unexpectedly they had still given me a place. As the tension built during my years at medical school I had a few appointments with a student counsellor, but didn’t find it very helpful. I couldn’t understand what the problem was, although I know now, having had psychotherapy many years later, that it had a great deal to do with unresolved problems with my family from my childhood.

As I prepared for my finals, with my mind map, and my chart of each available hour, there came a point when I couldn’t go on. I can’t remember exactly what happened. I wasn’t sleeping or able to work. Sometimes I didn’t bother to get dressed, and it felt as if everyone in my year knew that I was a complete failure. My head felt like it was splitting open and I was struggling to hold the pieces of my brain together. I finally went to see my GP and he referred me to a psychiatrist who did sessions at the university health centre. With some medication, a lot of tears, and support from him I managed to pass my final examinations.

I had no idea where to go next with my life. I had wanted to specialise in general medicine, but my attempts at getting a training post were unsuccessful, and deep down I knew I didn’t really have the right talent for it. I began to seriously question my ability once again. The real problem was that the specialty for which I seemed to have the most aptitude as a student now seemed closed to me. During my student attachment in psychiatry I had been able to imagine myself without too much difficulty in the world of the people on the psychiatric unit. However, the fact that I could relate only too well to some of the experiences described by the patients also worried me.

I needed to find out if my fears were warranted, and finally plucked up the courage to telephone the psychiatrist I had seen a few months earlier.

“I wanted to thank you,” I said, “and ask if you thought it would be out of the question, after what happened to me this year, for me to train as a psychiatrist?”

“No,” he said warmly, “I don’t think it would be out of the question at all.”

Those few words of encouragement set me off on a very successful career path in psychiatry. It’s not been without problems. I’ve had recurrent episodes of depression, and at times it’s been hard. But I would not have fitted in better anywhere else in medicine, and I think I’ve been a more empathic doctor because I know what it’s like from both sides. I’m determined that medical students who experience mental health problems and worry about the stigma that still exists in medicine should not assume that they are simply “weak”, or that the door into a career in psychiatry is closed to them. It certainly isn’t.

A moment that changed me: my psychiatrist told me I could be one too | Linda Gask

NHS nurse killed himself after losing his job, inquest told

An award-winning nurse who died after setting himself on fire outside Kensington Palace suffered a “mental breakdown” over how his NHS employers handled his dismissal, an inquest heard.

Amin Abdullah, 41, died on 9 February last year close to the London home of the Duke and Duchess of Cambridge after being sacked from Charing Cross hospital where he worked as a charge nurse.

An inquest into his death on Monday heard how he had previously attempted to take his own life and had told a patient in the unit where he was being treated he was going to set himself on fire.

Giving evidence at Westminster coroner’s court, his partner, Terry Skitmore, said Abdullah slipped into a depressive state during a disciplinary investigation which began in September 2015 and after he subsequently lost his job at Imperial College healthcare trust.

Skitmore said Abdullah, who “lived for the job”, was a “caring” and “dedicated nurse” and “struggled to understand what he was being disciplined for”.

The inquest heard how he had written a letter for another colleague caught up in a complaint made by a patient “to show how she could respond”, resulting in him getting embroiled in the issue.

Skitmore said Abdullah, after initial meetings and the investigation, did not hear anything about the disciplinary “for many weeks” and put in a grievance regarding the delays in a bid to get some answers.

On 21 December 2015 he was handed an instant dismissal on the grounds the letter he had written to support his colleague was “untrue”.

Skitmore said the delays in the disciplinary process eventually led to the mental breakdown of his Malaysian-born partner, who grew up in an orphanage and became a British citizen in 2009.

Under questioning, Skitmore said: “The disciplinary and additionally the 10 weeks of ignoring him caused him to have a mental breakdown and caused him to do what he did. I have got to live the rest of my life with that, and I do not want anyone else to go through that.”

Holding up a picture of his partner smiling on holiday in Spain, he described him as the “happiest man in the world”, adding: “Seven months later I’ve got a pot of ashes with candles beside it. They have lost a magnificent nurse and I have lost a magnificent partner.”

Skitmore also revealed in a statement read out by the coroner, Dr Shirley Radcliffe, that Abdullah had told him his mother had killed herself through self-immolation, but that a friend of his partner said she may have jumped in a river.

The inquest heard how on 27 January last year Abdullah was voluntarily admitted to St Charles mental health unit, after attempting to take his own life.

Abdullah had lodged an appeal against his dismissal in January 2016 and a hearing date had been set for 11 February.

The inquest heard how on 8 February Abdullah had been allowed to leave the unit to go to collect a suit ahead of the impending hearing. He had at points during his time in the care of the hospital been placed on observation and had been given 15-minute escorted cigarette breaks because of the risk deemed by staff.

He had also told another patient at one point that he intended to go out the following day and “have sex and set himself on fire” – something he denied when it was later put to him by a doctor.

Consultant psychiatrist Anna Higgitt said the unit took into account things he was saying to people which “varied at times”, when making the decision to extend his unescorted leave to one hour.

She said “a lot of the time he was planning for the future” and had told staff he would find a job somewhere else, and ahead of the hearing had even been out to have a haircut.

“He wanted from the start to have more freedom than we offered. We negotiated and he stuck to what we agreed. Up until he did not come back – he stuck to it really well,” she told the inquest.

The inquest is expected to last three days.

• In the UK, the Samaritans can be contacted on 116 123.
  In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.

NHS nurse killed himself after losing his job, inquest told

Mark Austin admits he told anorexic daughter "starve yourself to death"

The broadcaster Mark Austin has revealed how he struggled to understand his daughter’s anorexia and “failed utterly to grasp that she was seriously mentally ill”.

In a candid account, he admits he thought her “crass, insensitive, selfish and pathetic” and became so frustrated he once told her: “If you really want to starve yourself to death, just get on with it.”

But now the TV presenter hopes to break the taboo around potentially deadly eating disorders and is calling for improved mental health provision to deal with the crisis of more than 850,000 young sufferers, predominantly girls, in the UK.

Austin’s daughter Maddy, now 22, became ill in 2012, losing four stone and changing from a healthy and promising athlete to an “emaciated, ghostlike figure”.

He recalled: “I didn’t understand it at first. Cancer I understand … but this was my daughter wilfully destroying herself by not eating.”

Writing in the Sunday Times magazine, he described how Maddy would lie about how much she had eaten and “explode with rage” when challenged.

“She showered me with contempt. As a father you have to make a decision and I made the wrong one. I decided to go on the attack.”

He said: “I even remember saying, ‘If you really want to starve yourself to death, just get on with it’. And at least once, exasperated and at a loss, I think I actually meant it.”

The newsreader acknowledged that as a father he felt “excluded and hated” and found it hard to talk about issues of body image and weight control.

“I floundered and, in the process, ended up poisoning her against me further,” he said.

Austin described how things hit rock bottom for Maddy after a failed spell at a private inpatient unit on a regime of forced feeding. She resisted the treatment and threatened to kill herself. Maddy’s mother became so worried that when her daughter returned home she took time off work and slept on her bedroom floor so as to monitor her around the clock.

Maddy was eventually “saved” by a local NHS day-patient unit.

She recalled: “Eventually it was a local NHS nurse who really understood me and saw the Maddy without the demons. I was lucky, but mental health treatment should not be a lottery.”

Now her father is urging people to take the illness more seriously and is calling for “walk-in centres on the high street of every town and city in this country, manned by trained counsellors”.

He added: “As a country our response is bordering on the pathetic. It is a mental illness, but, almost uniquely, it is one that kills.”

One in 100 women aged between 15 and 30 are affected by anorexia and it is reckoned that one in five chronic anorexics will die as a result of the condition or because they take their own life.

The Beat youthline can help young people experiencing an eating disorder: 0345 634 7650. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Mark Austin admits he told anorexic daughter "starve yourself to death"

New Year"s Eve partygoers told to beware of fake booze

New Year’s Eve partygoers are being urged to avoid cheap fake booze containing potentially lethal ingredients found in antifreeze.

The warning in the run-up to the UK’s biggest drinking night of the year comes from the Local Government Association (LGA), which represents more than 370 councils in England and Wales. It follows recent council seizures of counterfeit vodka laced with highly dangerous chemicals found in cleaning products and paint solvent.

After a series of raids on suspect premises leading up to New Year’s Eve, council trading standards teams are also warning sellers of illegal alcohol that they face confiscation of their stock, prosecution and being stripped of any relevant licences.

As people stock up on alcohol at home and attend major celebrations in towns and city centres, councils are issuing safety advice to help people avoid harm from dangerous alcohol containing lethal chemicals such as chloroform – which can induce comas – and high levels of methanol which is a key ingredient in antifreeze. Drinking the bogus booze can lead to vomiting, permanent blindness, and kidney or liver problems, and can be fatal in extreme cases.

The LGA is urging shoppers to look out for telltale signs of fake booze. These include unfamiliar names or names mimicking recognised brands, crooked labels, spelling mistakes, and very low prices that seem “too good to be true”. Drinkers being served vodka in pubs and clubs should also smell the drinks as fake vodka will often smell of nail varnish.

“New Year’s Eve is the biggest drinking night of the year but people need to avoid suspiciously cheap, fake alcohol at all costs because it could seriously harm your health, and even kill you,” said Simon Blackburn, a councillor and chair of the LGA’s Safer and Stronger Communities Board.

“Counterfeit alcohol also harms legitimate traders and threatens livelihoods, with the black market trade helping to fund organised criminal gangs. Council trading standards teams have been cracking down on businesses selling fake alcohol and rogue sellers should think twice about stocking these dangerous drinks as we will always seek to prosecute irresponsible traders.”

In a prosecution brought by Halton borough council, a taxi driver had his vehicle seized and was given a suspended sentence after counterfeit vodka was found in his taxi. Twenty-six litres of fake vodka – found to be unfit for human consumption – and 108 bottles of illicit wine were seized following a search of a storage unit.

Separately, Lincolnshire county council’s trading standards officers helped seize 3,570 litres of beers, wines and spirits – most believed to be counterfeit – from 20 premises as part of an operation with police and HMRC.

Drinking industrial-strength isopropanol – which is more commonly found in antifreeze, lotions and cosmetics – can lead to dizziness, vomiting, anaesthesia and even blindness, and can leave someone in a coma. Other substances found in fake bottles of spirits include ethyl acetate, which is normally found in glues, nail polish removers and cigarettes, and can lead to organ damage.

New Year"s Eve partygoers told to beware of fake booze

Do not wash your hands of NHS and social care problems, MPs told

The devolution of power to local authorities and mayors should not be used as an excuse by central government to wash its hands of responsibility of key services such as the NHS and social care, a cross-party committee of MPs has said.

The public accounts committee has also stipulated that the government must ensure taxpayers’ money is well spent by devolved administrations in England. It highlighted a continued failure of central government to define its objectives.

The committee added that the Department for Communities and Local Government (DCLG) must do more to demonstrate the link between devolution and economic growth, as repeatedly trumpeted by the former chancellor George Osborne.

The MPs particularly warn in their report published on Sunday that central government must not “absolve itself of its responsibility to ensure that devolved areas receive adequate funding for sustainable services”.

Sajid Javid, the communities and local government secretary, was forced last week by an outcry over a crisis in social care funding to announce a £240m “adult social care support grant” to be divided by local authorities based on need.

The public accounts committee’s report says: “Ultimately, central government should not devolve problems to local areas without the resources required to manage them. The devolution of health has potentially significant implications for the NHS and local government, and presents both opportunities and risks for clinicians.

“We have heard in our devolution discussions how those in support of the move consider that it will enable local areas to reshape health and social care according to the needs of local people. However, at a time of severe financial pressure on the health service, devolution of health may not offer the answers the department believes it can deliver in the timeframe needed.

“Unless government addresses the rising demand, spiralling costs, the structural issues and ensures that public health is delivering on reducing demand, the NHS will continue to face impossible financial pressures.”

Labour MP Meg Hillier, who chairs the public accounts committee, said her colleagues had repeatedly warned that central government must take responsibility for local services.

She said: “Central government must take responsibility for ensuring devolved areas receive adequate funding to maintain services.

“The point is well-illustrated by the devolution of health and social care. Time and again, our committee has raised concerns about the sustainability of NHS finances. Devolution is not a miracle cure and central government cannot expect to wash its hands of problems to which it has no solutions.”

Do not wash your hands of NHS and social care problems, MPs told

Hospitals in England told to put operations on hold to free up beds

Hospitals in England have been told to put most operations on hold over Christmas to ensure enough beds are free for patients who need emergency treatment.

The health service regulator, NHS Improvement, has asked all hospitals that provide acute care to postpone most of their planned operations in a drive to make more beds available over the winter break.

In a letter to NHS Trusts, the regulator said surgery would have to be rescheduled if hospitals were to reduce their bed occupancy to 85% from 19 December to 16 January, when pressure on the health service is expected to be at its most intense. According to NHS England, hospital bed occupancy currently stands at about 95%.

Many hospitals take steps to wind down the number of operations they perform over the Christmas period, but the letter obtained by the Health Service Journal states that operations may need to be postponed “beyond any current plans”.

It says: “Given the level of risk facing the system, it is clear that having sufficient bed capacity going into Christmas is critical, and we know most organisations will already have this in hand as part of local planning arrangements.

“In preparing for managing winter pressures, it is recommended that all providers pace their elective work by introducing elective breaks where trusts cease most in-patient elective activity and focus on treating emergence activity and non-admitted patients.”

Admissions to hospital emergency departments tend to spike over the winter because of the cold weather and a rise in respiratory infections.

The NHS Providers chief executive, Chris Hopson, told the Health Service Journal that the guidance was “another classic example of how trusts are now caught between a rock and a hard place” of meeting surgical targets while coping with ever rising emergency demands. “Trust chiefs tell us it’s increasingly difficult to deliver both,” he said.

“This guidance does go further than before, for example in specifying a target bed occupancy level as the holiday period starts, but it is in line with the direction of travel over the last few years,” Hopson added.

The letter, dated 9 December, came to light as the Nuffield Trust warned that pressure on beds in NHS England hospitals had become so intense that on any given day last winter the equivalent of more than five extra hospitals’ worth of beds had to be brought into service.

On the busiest day last winter, 26 January, hospitals had to find a record 4,390 extra beds, the equivalent to the capacity of seven hospitals. With the pressure on beds so acute, the Nuffield report said hospital managers would find it harder to deal with emergency patients within four hours of their arrival in A&E departments as targets require.

Beds have come under increasing pressure in the past few years as more people are referred to hospital and medically fit patients are not discharged on time. Delays in discharging patients stand at a record high, up 27% on last year, as do trolley waits, up 54% in the year to October. John Appleby, the Nuffield Trust’s chief economist, said: “It’s a big sign the system isn’t working that efficiently.”

He said the call on hospitals to free up more beds over Christmas showed a “tinge of anxiety” over the levels of bed occupancy in the NHS. “It’s a bit invidious,” he said. “But clearly emergencies must take priority.”

Jon Ashworth, the shadow health secretary, said: “This leaked memo represents a damning indictment of Theresa May’s mismanagement of the NHS. The Tory failure to provide the NHS with the funding it needs means that hospitals are having to close operating theatres over Christmas just to get through the winter.

“This short-term fix is only going to store up problems for next year and leave more and more people stuck on waiting lists when already almost 4 million people are waiting for an operation. Starving the NHS and social care sector of the investment they need simply can’t be allowed to continue.”

A spokesperson for NHS Improvement said: “NHS providers will be doing all they can to make sure their patients are able to receive quality care during the busy Christmas period. A reduction of elective hospital activity in the run-up to Christmas is standard practice, and well rehearsed by NHS providers.

“Many hospital trusts also routinely wind down elective activities in the run-up to the Christmas and new year period, as patients do not wish to be in hospital over the festive period and those who are medically fit for discharge want to return home. This also frees additional capacity.

“Cancellations should be kept to an absolute minimum and, in trusts where elective work does need restricting, then the decisions should always be taken using appropriate clinical reviews to ensure patient needs are met.”

Hospitals in England told to put operations on hold to free up beds

Women with cancer "should be told more about fertility options"

Girls and young women with cancer in the UK are not being given enough information about the options for safeguarding their chances of having children after treatment, fertility experts have said, while describing access to such technologies across the UK as “haphazard”.

“Cancers in young people are largely treatable with good long-term survival [but] one of the most common ill effects of cancer therapy is permanent infertility,” said Melanie Davies, a consultant gynaecologist at University College London Hospitals. “If you ask people who have had cancer who are young: ‘What is the thing that bothers you most?’, top of the list is infertility.”

While men’s fertility can be preserved through freezing sperm samples, for women the options are more complex, involving the freezing of eggs, embryos or even tissue from the ovaries – although the latter is less well established and brings a number of risks, including the possibility of re-implanting cancerous cells.

But experts have raised concerns that patients, and even oncologists, are often unaware of the options, adding that there are huge variations in the availability of the technologies, storage and funding methods around the country, with funding often being granted by commissioners on a case by case basis.

“There is a very sketchy provision – in some places it is quite well organised, in other places it is not,” said Richard Anderson, professor of clinical reproductive science at the University of Edinburgh, who with Davies has co-authored an editorial on the topic, published in the British Medical Journal.

“There is an urgent need to improve information for patients, education for oncologists, and equity of funding, to overcome the barriers to more widespread use of fertility preservation in the UK,” they write.

While guidelines from the National Institute for Health and Care Excellence (Nice) have been issued, provision of fertility preservation remains patchy, they say.

“The Nice recommendation is that women [with cancer] should be aware of this and should be offered oocyte or embryo preservation, including adolescent girls,” said Anderson. “But the issue is that that doesn’t seem to have been established around the country by any means as yet.”

While data on the proportion of women with cancer who undertake fertility preservation is lacking, Davies and Anderson say the need for action is borne out by a number of surveys, together with feedback from both patients and clinicians up and down the country. “Colleagues [are] finding it difficult to get money [and] difficult to provide an adequate and funded service,” said Anderson. According to research from the UK charity Breast Cancer Care, 88% of 176 women under the age of 45 who had breast cancer said they were not referred to a fertility specialist after being diagnosed.

Valerie Peddie, senior charge nurse and fertility specialist at the Aberdeen Centre for Reproductive Medicine, agreed with the criticism. “It is absolutely fair and it is 100% accurate,” she said. “[Having children] is just part of the natural life cycle and they may be denied having children in the future if they are not given the opportunity for discussion.”

It isn’t only cancer patients who need access to information and technologies for fertility preservation, Anderson points out, noting that certain drugs and procedures used to treat conditions ranging from rheumatoid arthritis to sickle cell disease can also affect the fertility of patients. Peddie said: “It is all about quality of life and being afforded the opportunity for discussion and being given sufficient and accurate information regarding the implications, long and short term consequences [on future fertility] of any medical treatments that they might require.”

Stuart Lavery, director of IVF Hammersmith and a consultant in gynaecology, reproductive medicine and surgery, was upbeat about the provision of fertility preservation to patients.

“Our experience is that the NHS has become a lot more responsive to this issue – and we have got so busy now that we have had to set up a dedicated clinic just to see these patients urgently and get them into the system quickly,” he said, adding that the NHS had also become more supportive in funding such procedures.

Despite the progress, Lavery admitted there was room for improvement. “I think what is happening is that the oncology teams are really just finding out what is available in their local areas, and that perhaps the relationships and the referral pathways, that patient pathway, in many places may not be as smooth as it could be.”

Women with cancer "should be told more about fertility options"

NHS patients told to lose weight and quit smoking or face operation delays

Obese people and smokers will be asked to lose weight and give up cigarettes or face delays to routine operations after a health authority’s proposals were approved by NHS England.

Patients with a body mass index (BMI) of at least 30 will be asked to lose weight or face a 12-month delay for elective surgery while smokers will be asked to quit for two months or face a six-month postponement, the Vale of York Clinical Commissioning Group (CCG) announced.

The North Yorkshire CCG ruled out a “blanket” ban and said each patient would be dealt with on a “case-by-case basis” when the plan comes into force in January.

The CCG said: “Smokers and obese patients that need routine surgery, but do not wish to access the support services or fail to meet the criteria will not be denied their operation, but it could mean they have to wait longer than they otherwise would have done.”

Dr Shaun O’Connell, the CCG clinical lead who is also a local GP, said the plans would give patients the “best possible health outcomes in the long term” while helping to protect finances.

O’Connell said: “There is no ban and no blanket policy … decisions about what is in the best interests of their health, will be made on a case-by-case basis.”

The CCG, which serves a population of more than 351,000 in areas including York, Selby and Tadcaster, said there would be exclusions from the plan, which will probably include emergency and bariatric surgery and operations on patients under 18.

This year, NHS England intervened in the policy after the Royal College of Surgeons raised concerns that the proposals went against clinical guidance and made smokers and overweight patients soft targets for financial savings.

But the public body has now approved the plan.

An NHS England spokeswoman said: “Vale of York CCG has made clear its commitment to supporting patients to achieve better health and clinical outcomes by referring them to an established weight loss or stopping smoking programme, where appropriate.

“However, every patient’s case will be considered in the light of their own particular circumstances and on the basis of clinical need.”

NHS patients told to lose weight and quit smoking or face operation delays

Send patients to private sector to avert winter crisis, hospitals told

Hospitals have been told to discharge thousands of patients and pass some scheduled surgery to private organisations to reduce pressure ahead of a potential winter crisis, it was reported.

Leaked memos also revealed that managers have been banned from declaring black alerts, the highest level, when hospital services are unable to cope with demand, the Daily Telegraph said.

The newspaper claimed instructions were sent by NHS England and the regulator NHS Improvement last month to reduce the levels of bed occupancy in hospitals, which are the most crowded they have ever been ahead of winter.

In the three months to the end of September, 89.1% of acute and general beds were full, compared with 87% last year, prompting the order for hospital trusts to take the drastic measures.

The goal is to reduce occupancy levels down to the recommended safe limit of 85% from December 19 to January 16, the Telegraph said.

Dr Mark Porter, chairman of the British Medical Association, said: “This is evidence of an over-stretched healthcare system that the government has failed to properly fund, which must outsource patient care to private providers to cope with predictable patient demand.”

Hospitals have been told to turn to the private sector to “maximise elective activity”, with operations such as knee and hip replacements likely to be among the outsourced procedures to help free up beds for urgent patients.

The measures are likely to have a significant cost to the NHS.

NHS England said plans to pace elective programmes and hospital discharges are put in place every year to maximise bed availability and reduce the possibility of cancelled operations.

A spokeswoman said: “Our ambition to reduce bed occupancy in hospitals over the festive period is about timely discharge and getting people to the most appropriate care setting ahead of the holidays, so there is capacity for early January when we know pressure is greatest.

“This is part of our well-rehearsed winter preparedness every year.”

A spokeswoman for both NHS England and NHS Improvement added there was a lack of a historic national protocol for hospitals when declaring alerts, leading to “a hotchpotch of confusing terminology”.

She said: “This has led to confusion between hospitals, ambulances and the public over what is happening, how to respond or how they can help.

“The new NHS guidelines are for hospitals to use when managing local operational pressures in order to deliver a consistent approach across the country.”

Send patients to private sector to avert winter crisis, hospitals told

"As boys we are told to be brave": men on masculinity and mental health

Efforts have been made to challenge traditional stereotypes, but there is still pressure on men to be strong, independent, stoical, competitive and tough. According to research published by the American Psychological Association, these “masculine traits” have been linked with mental health issues such as depression and substance abuse.

Joel Wong, who led the research team at Indiana University Bloomington, said: “In general, individuals who conformed strongly to masculine norms tended to have poorer mental health and less favourable attitudes toward seeking psychological help, although the results differed depending on specific types of masculine norms.”

The research collated results of more than 70 US-based studies involving more than 19,000 men over 11 years. It focused on the relationship between mental health and conformity to 11 masculine norms. They included a desire to win, need for emotional control, and risk-taking.

The traits most closely linked to mental health problems were playboy behaviour or sexual promiscuity, Wong said.

We asked a group to talk about their own experiences of mental health and what they thought of this new analysis.

Daniel Briggs, 44, from Stockton-on-Tees: ‘The pressure to be manly stopped me getting help earlier’

Depression feels like there’s a fog surrounding me. It is closing in and I cannot see what’s in front of me. It’s all-consuming and nothing else matters. I can see the fog building but I am powerless to stop it.

I experienced depression for about a decade before accepting what was going on. As a man it’s definitely much harder to talk about your emotions. It was my wife who made me go to the doctor. I had been behaving erratically: talking about killing myself, disappearing off for hours and leaving her worried sick. I was eventually diagnosed with clinical depression.

I used to work in a shipyard. Among those I worked with there was an old-fashioned view of being a man

Daniel

The pressure to uphold the traditional idea of masculinity stopped me getting help earlier. I come from the north and used to work in a shipyard. Among those I worked with there was an old-fashioned view of being a man – we don’t talk about our feelings. If you get upset about anything other than football you are considered a “sissy”. When people say, “How are you doing?”, if you say “A bit crap” the classic response was: “Could be worse.”

It was the same with older members of my family, who’d say, “Just get on with it”. Don’t complain or talk about what’s going on with you. It took me a long time to open up. Even going to a counsellor was difficult; talking about feelings was something women did.

But talking was exactly what I needed to do, and I am now training to be a counsellor. I lost a lot of friends, especially male ones, opening up about my depression. There’s a huge stigma around it. Doing counselling and getting involved with local charities, people have said talking to me made them feel better. I’ve had men thank me because it made them realise they are not alone. Men need to accept that talking is good and that the hardest part is showing emotion. Walking around with a smile on your face, telling jokes – that’s the easy part. But talking about life and your feelings, rather than how your football team did or how many pints you drank on Saturday night, is much harder.

Photograph: Peter Macdiarmid/Getty Images

Chama Kay, 25, from London: ‘My African parents wanted me to understand: you keep this to yourself’

I have suffered from poor mental health since I was about 16; I remember this vividly because I began to self-harm. It was also around this time that people started saying to me, “You need to talk to someone”. It took three years, two failed relationships and one botched suicide attempt for me to finally take this advice.

Looking back now, aged 25, I can see why, like many men, I found accessing mental healthcare so difficult. Masculine ideals of self-reliance, stoicism, sexual promiscuity and dominance over women do not lend themselves to emotional vulnerability. But it’s important to realise that this is not a mindset that suddenly appears. Rather, it’s instilled into men from a young age. I have personally lost count of the times I have heard parents of young boys admonish their own or other people’s sons for being “too sensitive” or “soft”. So acknowledging and addressing how we raise boys is vital here.

We must not dismiss the role culture plays in how men view and approach mental health. When I was diagnosed with borderline personality disorder there was one clear message my African parents wanted me to understand: you keep this to yourself. For years I was discouraged from getting help and actually felt guilty when I did. For many black communities taboos around mental health undoubtedly exist. But more than this, there is the awareness within these communities that structural racism means black boys, as well as black girls, are already at a societal disadvantage. Higher unemployment rates, longer prison sentences, lack of representation in media, politics and business and numerous other statistics will attest to this. The fear that poor mental health will simply be another stigma for black men to have to fight, coupled with many preexisting taboos, makes for a very tough battle for many.

With all this in mind, I often ask myself what can be done to help. I do not believe any man wants to feel emotionally closed off, lonely and isolated and I know they don’t want to be taking their own lives at the rate they are. By looking at the most sacred commandment of alpha masculinity, I believe it is possible to start to allow many men to address what they truly value, ask whether they are living according to their own standards and hopefully in this way begin to form a healthier relationship with their mental health.

Robert Smith, 50, from Brighton: ‘It’s not about gender or masculine traits – it’s about how much empathy you have’

Over the years I’ve had bouts of depression and anxiety. I’ve experienced severe sleep problems and suicidal thoughts. With years of psychotherapy I now know that all these are symptoms of complex post-traumatic stress disorder (PTSD). This is like PTSD but instead of being caused by a single traumatic event with flashbacks, it is caused by chronic or long-term exposure to emotional trauma.

My mental health has been helped almost exclusively by strong friendships and professional relationships with women and their empathy towards me. Had I been sexist, I can’t see how these important relationships would have developed. So I imagine there is a correlation with sexism and poor mental health, but I doubt that “masculinity” is the cause of poor mental health, rather that classical masculinity, which involves objectifying others, is non-empathetic and perhaps indicates other issues. I would imagine there is a similar correlation with racists and poor mental health. So I would consider the key factor to be one that is not exclusive to men, but affects all people who severely lack empathy and isolate themselves as a result.

In the past I’ve maybe found it harder as a man to talk to people about mental health, but not nowadays. I used to find it harder, because to talk, you need a support network but with severe mental health problems you can scare people off and have no support. Now I have this and I have different people to talk to. But to have empathetic friends, it really helps to be empathetic too, so you can share problems.

Tom Ogier, 31, from London: ‘I’ve only quite recently felt comfortable talking about vulnerability’

It can be very hard to admit vulnerability. Perhaps being a fairly big guy it’s easy to appear manly, to play that role, but the traits of “manliness” leave so little space for other important elements of our humanity. Traits that society might portray as more “feminine,” such as compassion, understanding and care, are essential, and sources of great strength.

Men feel they aren’t allowed to open up, even to themselves, for fear of being seen as weak or unattractive.
From boyhood we are told to be brave and ambitious, overcoming obstacles on sports fields, battlefields, boardrooms. But we don’t see many of the mental challenges we face in this way. They are seen as weaknesses that shouldn’t be there, rather than parts of everyone’s lives.

We will all face grief, loss, and relationship issues, and these challenges take their toll, so we’d do well to seek to equip ourselves with understanding.

Photograph: Rob Mattingley/Getty Images

Being a man: it’s hard to know where to start

Thomas

There’s a Leonard Cohen line I often think of, when he went on stage and couldn’t perform for some reason. He said he didn’t feel strong enough because “somehow the male and female parts of me refuse to encounter one another tonight”. I like the idea of acknowledging that both need to combine in an individual for a person to function. The same is true of society. By balancing notions of strength which tend to be thought of in a binary way, as either feminine or masculine, people might be much healthier. A world without sexism would be better for everyone. Not only would women be respected, but men might be better able to appreciate more feminine traits and strengths, in others and in themselves.

"As boys we are told to be brave": men on masculinity and mental health