Rev Roger Munson – 29 November, 2020
Thank you for the opportunity to share with you some of my long experience working with people who have mental health issues. This is an important day as everyone of us will know of someone who has mental health issues or your own lived experience. The good old statistics show that 20 percent of the population experience mental health issues.
Living in St Kilda in the 80’s I had my first encounter with people who had issues with mental health. It was the time that Jeff Kennet had decided to deinstitutionalise people with mental health issues to have a better life. The problem was that there was no planned support in the community, so it was up to members of the community such as my church to take up the slack.
Assisting people with mental health issues can certainly be daunting and it was no exception for me. I remember one of my first encounters was at a concert in the church. From the side door a Greek man with long black hair, a white suit and sunglasses and an upside down cross came walking in and being a young man educated in the symbols of evil I was very nervous. When I got to know George, I was able to meet a man who was a brilliant classical pianist and artist which helped him cope with his schizophrenia.
After many years of assisting people with mental health issues through my ministry I became an Advocate, and I could use this experience. My first visit to the High Dependency Unit to assist a young woman with a psychiatric treatment order hearing was also a bit daunting. I had been given a personal alarm and was in full view of the staff behind the window at the end. However, having never used on of these before I managed to set it off twice before I worked out you had to keep it upright but this funny moment helped build rapport despite the obvious signs of her paranoid schizophrenia and I worked with her for a few years until she got into the NDIS and had the supports she needed.
Mental health affects all aspects of life.
It is hard to be honest about your mental health issues with an employer. There is a risk you might be pushed out of your job. This can be deliberate or through ignorance. I worked with a man who had anxiety and his employer was working to assist him to thrive in his work yet the result was that the employer believed micro management would be of help but in reality it had the opposite effect making him more anxious resulting in the occasional outburst which then saw his job at greater risk. After realising this I facilitated his transfer to a different job with a different manager who understood his issues and gave him the space to thrive.
It is hard to maintain your housing. If a person is unwell there is a greater risk of homelessness.
This presents in many forms. One is maintaining a place in a suitable condition such as ensuring it is clean and undamaged. One issue that is poorly dealt with is hoarding. When you do not have many positive emotional connections objects can take their place and when this gets out of hand people can be at risk of homelessness.
People can be at risk of losing their loved ones through a marriage collapse due to the difficulties of living and coping with their partner or their children as child and youth protection may consider they are at risk. In my experience children are taken by Child Protection as they fear the impact of a mental health episode on the children.
Overall, the biggest obstacle is getting the treatment you need. Some employers provide a small number of counselling sessions to ensure that personal issues do not impinge on your work. In Canberra there is a shortage of psychiatrists and in the public system they are often Registrars who have little experience and focus more on the drugs a person might need. It is hard to get an appointment and there is a waiting list and if you are reasonably well you may be rejected for an appointment. An appointment with a psychologist is quite expensive and even with a mental health plan people find it hard to afford the co-payment and the few who bulk bill are heavily booked.
There is hope and it is people who take the time to get to know someone, who accept them as they are, and are willing to listen that can provide the best support for someone who may be struggling.
People struggling with mental health and often an associated addiction such as drug use often have inappropriate soothing or self-harming behaviours to help them cope with life.
Johan Hari and other professionals in this area are quite clear about what can help people lessen their symptoms and provide improvement in their everyday living.
It is important for all of us to have positive connections, have a purpose in life and achievements.
We can be the people who provide the positive connection and we can assist people to have self-compassion. Self-compassion is
self -kindness, common humanity, and mindfulness.
An important point here is that we all should practice these things for ourselves and as we listen to people and get to know them, we can hear the need for self-compassion. The practice of self-compassion builds resilience and helps us thrive.
When I work with clients, I use these strategies. I worked with a man who had PTSD through long term neighbourhood harassment. As a man there are those messages that we should be able to cope, we should be able to keep working to help support my family and when he did get back to work I cannot seem to manage the same level of work I was able to do ten years ago and I feel inadequate and find it hard to talk to people as I worry what people will think of me.
Its very easy for all of us to beat ourselves up when things go wrong, when you make a mistake or fail to achieve a goal. Forgiving and nurturing yourself can set the stage for better health, relationships, and general well-being. We can think of what we might advise a friend who might be facing a difficult or stressful situation, then when we find ourselves in a similar situation we can direct those same compassionate responses to ourselves. It is helpful to realise all humans make mistakes and suffer and part of mindfulness work is to think through what happened. We can create a bridge of hope, respect, courage, support, and continuity by using unconditional positive regard to build rapport and a trusting relationship, which enables us to have conversations with people.
With this client I helped him to focus on his strategies to feel good about himself, feeding the birds in his backyard, riding his motorbike in the bush and staying in touch with the people who love and appreciate him.
I worked with a woman who has bipolar and OCD and six children with a disability and assisted her to get the help she needed. She could cope with life as her OCD meant she was organised, but systems undermined her. She was trying to study to get ahead but the NDIS think she does not need respite or after school care for her kids so she can study or do a workplace placement. She should be looking after her kids despite this being in contradiction to the NDIS act.
I worked with a man with bipolar who shared his exploits as a businessman but in the end his mental health meant he lost his marriage and he lost his business and psychiatrists in the system did not want to deal with him and he is also trying to manage other complicating health conditions and a divorce settlement. As a businessman he was very good with detail and had trusted associates who could support and mentor him. On his own he is overwhelmed by anxiety, only trusts a few people which means he has to try and stay on top of the above challenges. He tries to advance but his health stops him from succeeding. In order to help him it’s about self-compassion,` ` in that he has to accept that he is like many others in his situation and needs people who can hear his needs and desired outcomes and can put in place people who can build rapport and trust and make progress.
As an advocate it is very easy to be frustrated with people who make decisions that self-sabotage. This can lead to compassion fatigue and you can see in in so many people who try to help others but become disillusioned and cynical. One woman I have worked with for years has major depression and a dramatic experience 4 years ago has meant she has struggled to get resolution. She is very fixated on restoring the status quo but as her advocate I know this will not happen and her depression is getting worse. I have been able to get some movement with her and the system by breaking the tasks down into small jobs that she can manage with support. Also talking to her about strategies to manage her depression and reframing her expectations through thinking about what would be the worst-case scenario or a better alternative and would this be ok. This has meant some minor issues have been identified and put to one side to focus on the bigger picture.
A male client with ADHD is very good at escalating and the result was being barred from getting help from psychiatrists to get the drugs he needed and being barred from disability job providers and from university. This man has a few close friends but is estranged from his family and lives on his own. This man has his goals but seems unable to motivate himself to see these through. Working with him I assisted him to stay calm in his interactions and with me in attendance to support him as well appointments were able to go smoothly. He was able to finally meet with a psychiatrist to get his medication for ADHD. One of the facts I discovered, from one of the psychologists was that he was not being seen as the psychiatrists were afraid of him and our first meeting was on the other side of a glass window but this has changed in subsequent visits after the first meeting went well. He is now working with a job agency and with his medications, in place, is now able to manage these appointments and get himself to the doctors as needed.
I worked with a young man who had cerebral palsy which caused him great pain. He also had mental health issues, in part, caused by his inability to get the help he needed. To cope with the physical and mental anguish he used heroin and alcohol. The pain clinic wanted him to stop using heroin but to use methadone he also had to stop drinking so felt trapped in a catch 22 situation. He also believed that Heroin did not cause him any issues whereas Methadone did. Eventually, access to some counselling to assist him to make a plan to cope with a change of routine and to reduce the pain through mindfulness strategies, like having a dog and a compatible flat mate meant he was able to move off the heroin and access Fentanyl patches to better manage his pain. This has seen a move into better accommodation and enjoying activities and treatments through also entering the NDIS to assist him to have a better life.
One of the lessons I have learnt in life is not to pretend to be someone you are not. As a Minister having a public persona, which is not who you are, is not good for your mental health and can be the path to burnout. It was important not to pretend to be a perfect Christian and to challenge unrealistic expectations such as being available 24 hours a day.
As a counsellor I know too many counsellors distance themselves from their clients to make a dispassionate diagnosis and end up disillusioned and burn out.
When you are real, genuine, and honest you create the circumstance to make a meaningful connection with people and this creates a benefit for both. As a counsellor myself I know that most people are assisted to deal with their issues because of experiencing unconditional positive regard from the person they are talking to. This fosters, rapport and trust and acceptance, which is very healing. Just to have felt that you have been heard is a very powerful healer in and of itself. As an advocate enabling a person to be heard is also a powerful way of allowing that person to let go of the past and move on.
Working with people with mental health issues is challenging and rewarding but it is important to be kind to yourself. It is important to remember that you can only continue to help others if you nurture yourself by looking after your physical, mental, social, and spiritual self. Remember, when the oxygen mask falls put it on yourself first before you help someone else. Take delight in life and in others and enjoy the meeting of people, new and old, and reconnect with the places you frequent and discover other places you have never been.
To conclude a quote from Stephanie Dowrick from her book “Choosing Happiness”
Whatever our background, culture, or race, what rewards us most powerfully and consistently are the most deceptively simple abilities of all, the ability to be kind, to be happy. To live enthusiastically and creatively, to appreciate and understand experiences different from our own, and to find meaning even in unwelcome and difficult situations.