Your health

You should see your GP straight away if you are having psychotic experiences. Early treatment of psychosis gives the best chance of recovery.

NHS Choices has some useful information about the kinds of question your GP may ask about psychosis. If they think your psychotic experiences might be caused by mental illness, they will arrange for you to be seen promptly by a specialist.

For people who live in the NHS Greater Glasgow and Clyde area, that is likely to be the “Esteem” team, a service for people with a first episode of psychosis. The team has bases throughout the Greater Glasgow and Clyde area.

Other people may be seen by a Community Mental Health Team (CMHT) in their local area. CMHTs can offer help from the following healthcare professionals:

• A psychiatrist – a qualified medical doctor who has received further training in treating mental health conditions
• A psychologist – a healthcare professional who specialises in the treatment of mental health conditions through talking therapies
• A community mental health nurse – a nurse with specialist training in mental health conditions

The main treatments for psychosis include:

• Medicines – Most people find that antipsychotic medicines (such as risperidone, olanzapine and clozapine) are very helpful. They can reduce or stop hallucinations and help people to think clearly again. They usually take a week or more to start working, and many people take them long-term. However they do have side effects, and it may take some time to find the right drug for you.
• Psychological treatment Cognitive Behavioural Therapy (CBT) for psychosis can be an effective way to tackle unhelpful thoughts and feelings that might be caused by psychosis.
• Family support Behavioural Family Therapy (BFT) is a useful way to help you and your family cope with psychosis, while minimising the stress of living with that condition. It should be available in your area if you live in Greater Glasgow and Clyde.
• Peer support – It’s often helpful to link up with others who have had a similar experience of illness to you. Support in Mind Scotland have particular experience of psychosis. You might also contact the Mental Health Network if you live in Glasgow, or Acumen if you live in Renfrewshire, East Renfrewshire, West Dunbartonshire or Inverclyde.

Find out more about treatments at NHS Choices.

Some people become so ill with psychosis that they’re temporarily unable to make good decisions about their care. If that happens, and there’s a risk to the health and safety of that person or to others, then doctors can use the Mental Health Act in Scotland to ensure people have the right care and treatment. Long-term decisions about care and treatment are made by the Mental Health Tribunal for Scotland, and the Mental Welfare Commission for Scotland works to ensure that peoples’ rights are respected.

Many people who hear voices or see visions are not troubled by them and do not seek help. For those who do, around half will completely recover after just one occasion. Some people do experience on-going difficulties. When we feel stressed or anxious, the way we think about ourselves, other people and the world around us can change. For example, we may become more self critical or fearful. There are close links between emotional distress and psychosis. Anything we can do to help with emotional problems is therefore also likely to help with symptoms of psychosis. Below are some ideas about ways to manage difficult emotions and stress.

Looking After Yourself

Taking time to look after yourself is an important part of recovery.

Think about:

• Eating regularly
• Getting enough sleep
• Getting some exercise. Exercise is good for mental health as well as physical health. Try to get 30 minutes a day of moderate exercise if you can. NHS Choices has some good suggestions to get started if you’re not used to exercising
• Some people find mindfulness or yoga especially helpful. Although not always available through the NHS, there should be classes in your area
• Keeping in touch with people who make you feel good about yourself
• Avoiding too much alcohol or caffeine, including energy drinks
• Avoiding non-prescription drugs. Cannabis, speed (amphetamines), ecstasy, cocaine, mushrooms and so-called “legal highs” can all make your symptoms worse.

Find a Routine  

Everyone needs a reason to get up in the morning so set your alarm. Plan one activity you enjoy and one which gives you satisfaction every day. Try to stick to your plan even if you don’t feel like it at times.

Write down all the things you like doing and people you like to see, and come up with a plan to start doing things and seeing people at your own pace.

If you build up to things at your own pace, over time you’ll be able to do more and more. Your family, friends or your mental health worker can help you make a plan for this.

It may be helpful to keep a diary, recording life events, your mood, your diet and sleep. This can help you recognise patterns in your moods and psychosis, and identify what might trigger it or make it worse. It can also help you identify things that have been helpful, and recognise warning signs that tell you when you are starting to feel worse.

Getting appropriate help

Stay in touch. Make sure that trusted family and friends know how you’re really feeling. It’s important to discuss symptoms, side effects and any other concerns with the clinicians working with you.

Watch out for low mood. Many people experience low mood or depression, either as part of their psychosis or as they recover from psychosis and get back to their usual lives. Let your psychologist, doctor or nurse know about this – they should be able to help. Suicidal thoughts at times are also common, and it’s especially important that you let someone know if that is troubling you.

Since some medicines taken to control psychosis can make you gain weight, it’s really important to know your weight (and BMI), and to eat healthily. Since medicines and weight gain might increase your risk of diabetes or high cholesterol, make sure these are checked by your doctor.

If you are a smoker, do all you can to quit. Stopping smoking will improve your mental health as well as your physical health. The Smokeline service might be able to help.

There are lots of helpful things you can do to help you deal with distressing symptoms. Everyone’s experiences of psychosis are different so not all of these ideas may be useful to you. You could try out some of these ideas as other people have found them helpful.

Hearing Voices

Distraction

Some people are able to get control over their voices by distracting themselves by:

• Humming
• Listening to music
• Talking to or contacting a friend
• Playing computer games or using your phone
• Doing everyday things around the house
• Seeing friends.

Responding to Voices

• Sometimes if you talk to the voices, they will go away. You can talk into your phone when speaking to the voices to avoid bringing attention to yourself
• Imagine turning down the volume on the voices, like you would on the TV
• Keep a note of when the voices speak to you and what they say to see if these things are important to you.

Upsetting Ideas or Beliefs

Keep calm

Even though you may think or feel something is real, it may not be. Very often things we believe strongly can turn out to be wrong, so try to remind yourself of this. Try to work out what is different about times when the belief does not feel so strong and write down what you notice.

Keep busy

When you’re busy playing a sport, doing a bit of work, doing the shopping or hanging out with friends, the ideas can feel less upsetting or important.

Keep safe

Try not to act on your beliefs even if you have a very strong urge to, as this can keep your worries going. Talk to someone you trust – a family member, a friend, mental health worker or psychologist. Be aware that simple things like crossing the road can become difficult when you are very distracted.

As a friend, family member or partner, you can have an important role in supporting your loved one. You can help them learn to manage their psychosis and reduce the likelihood of them becoming unwell.

However, it can be difficult to know how best to help. Below are some suggestions that might be useful to you.

Helping with Unusual Experiences

Hearing voices is often very distressing for someone, as the voices are often critical and say unpleasant things. Some people may wish to talk about what the voices are saying, while others prefer to keep this private. 

If the person wishes to speak about their voices, try to understand how they feel, even if you may not agree with their explanation of the voices. You can also try to point out the person’s good points to boost their confidence, as the voices will often try to undermine this. 

It can help to distract the person by starting conversations or getting them involved in day-to-day activities. You could also ask the person what works for them as they may have found other ways to cope with the voices.

When people have unusual ideas or beliefs, it can be difficult to understand where these come from. It is often tempting to try to talk them out of their beliefs but this can sometimes lead to heated conversations. 

Try to keep calm, even if the person is saying things that seem very frightening, and reassure them by showing them you understand how significant their beliefs are to them.

Helping with Problems with Motivation

Psychosis can make it hard for a person to:

• Think straight
• Keep going
• Take an interest in people
• Keep up with things they previously enjoyed.

While this can be frustrating for those trying supporting them, try not to expect the person to do too much too soon. It is important to strike the balance between gentle encouragement and making allowances for their difficulties.  Offer praise for any achievement, however small, and try to find enjoyable or practical things to do together.

What Else Can Help?

Help the person to regain their confidence by encouraging them to do things on their own.

As it can be hard for the person to realise that others in the family may also need support or help, give clear, calm messages about what you would like to happen.

Stick to an everyday routine with regular mealtimes and chores.

Like everyone, the person may need their own time and space, so try to respect this without worrying too much.

As the person can sometimes seem distant or unemotional, show support and acceptance by continuing to spend time with them and involving them in everyday things.

Getting help

Someone who is experiencing a psychotic episode might not be aware of the changes in their thinking and behaviour.  It might often fall to friends or family member to support individuals in accessing help. If someone you know needs help urgently, you have two options:

• Make an urgent appointment with their GP
• Call NHS 24 by dialling 111

How services can help family and friends to support people

Many families find it helpful to meet with a professional who is trained in helping families. The aims of these meetings could include: developing a shared understanding of what is happening, improving family relationships, and finding ways to solve problems together.  Guidelines recommend that everyone diagnosed with psychosis can access family interventions.  These should be available in your area if you live in Greater Glasgow and Clyde.

Even if the person does not want personal information shared with relatives, services can give you general information about the problems people experience, what can help, and what support is available.

While it is important for staff to keep information about the person’s care private, sometimes the people who live with the person or know them well may have ideas or information, which can help in their care.  It is fine to pass this information on to staff if you think it might help.

Look After Yourself

Seeing someone you care about experiencing psychosis can be distressing and confusing. It is important to take care of yourself.

It can be difficult to support your relative and look after yourself at the same time. However, it is very important to make time for yourself to ensure that you do not become overwhelmed by what is happening to the person you care about. 

This might mean taking time out for yourself and doing the things that are important to you, like seeing friends or keeping up with your interests. Keeping to the same routines in your day-to-day life can also reduce tension at home.

You may also find speaking to others in a similar situation useful.

Below are some resources you may find helpful:

• Support in Mind
• GAMH Carers Support
• Carers Link East Dunbartonshire
• Carers of West Dunbartonshire
• East Renfrewshire Carers Centre
• Renfrewshire Carers Centre
• Inverclyde Carers Centre

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site

Early treatment of a psychosis gives the best chance of recovery. 

An early intervention programme, of up to 2 years, is recommended for people aged 16-35 who appear to be experiencing a first episode of psychosis.

Early interventions, for people who experience a first episode psychosis, are known to positively impact on engagement with mental health services, access to family & other psychological interventions and on future education & employment prospects and social & functional recovery.

Early intervention programmes offer different types of support that have been shown to help people recover from psychosis, and usually include practical support, family work, psychological therapy and medication. There would also be a focus on minimalising the effect of psychosis such as feelings of loss, entrapment and humiliation.

What are the potential long-term problems of untreated psychosis?

The risks include suicide, more likely to relapse, greater resistance to treatment, higher incidence of requiring compulsory care, poorer engagement with treatment, higher rates of substance miss-use, and greater distress amongst family members

“The course of schizophrenia is most stormy at onset and early in its manifest course, plateauing thereafter” 

The plateau effect and the critical phase (Birchwood et al, 1998)

What could you expect from an early intervention programme?

There would commonly be a range of support/interventions available, nurses or occupational therapists would help you think about what might be most useful to you, psychiatrists would talk to you about medication options, a clinical psychologist can help with talking therapy, whilst a support worker could help you to get you out and about more. 

What about hospital?

Early interventions may sometimes require a short stay in hospital, especially if you are very distressed by their experiences.  There could also be some crisis or assertive outreach interventions.

What can early intervention work help with?

Early intervention work will focus on:

• Helping you try to understand the things that led to your experiences of psychosis
• Exploring ways to help with your recovery
• Working with your family and friends to encourage positive relationships
• Offering practical support with things like housing or finances
• Supporting you to return to work, university or college, or identifying ways to spend your time

Early interventions also means working with your family and friends by:

• Involving them in all aspects of your care, if you feel this would be helpful
• Offering group sessions for support 
• Offering family work
• Offering individual therapy to family members

What happens after such early intervention?

Early intervention results in many people making a full recovery within two years and do not need follow-up from another mental health service, with their care being returned to their GP. 

For others, the recovery process takes longer than two years, and their care is transferred to a local community-based Mental Health Team for further support.

“My memories from the first month of this episode are fairly hazy”

Early Intervention in First Episode Psychosis: A Service User’s Experience

Stephanie Allan; Early Intervention in First Episode Psychosis: A Service User’s Experience, Schizophrenia Bulletin, Volume 43, Issue 2, 1 March 2017, Pages 234–235, https://doi.org/10.1093/schbul/sbv227

Video on Psychosis and how early intervention can help… courtesy of EPUT – Essex Partnership University NHS Foundation Trust 

Be informed! These sites can help you learn more about…

What is psychosis?

Symptoms of psychosis

Maudsley NHS video What is psychosis?

Help for psychosis

Treatments for psychosis

The British Psychological Society has written a report called ‘Understanding Psychosis and Schizophrenia’.  It has lots of information about what it means to have psychosis and what can help.  It has personal stories written by people who have experienced psychosis about what this has been like for them and what has helped.

You can read it here.

Medicines and their side effects

There are published guidelines about the standard of care it is reasonable to expect:

• National Institute for Health and Care Excellence (NICE)

Local and national organisations

• Scottish Recovery Network
• Support in Mind Scotland
• Glasgow Association for Mental Health
• Breathing Space is an NHS helpline that offers emotional support for people experiencing low mood, depression or anxiety. They can be contacted on 0800 83 85 87.  They are open Monday to Thursday between 6pm and 2am and Saturday and Sunday between 6pm and 6am. 
• See Me Scotland can help you find out more about the stigma of mental illness, and what you can do to stop it in Scotland.

• The Mental Health Act in Scotland, Advance Statements, and your legal rights.

NHSGG&C BSL A-Z: Mental Health – Psychosis

Psychosis is a term used to describe a number of unusual experiences:

1. hearing or seeing things that other people can’t hear or see (hallucinations)
2. holding unusual beliefs that people from a similar background would think strange or irrational (this includes delusions and paranoia)
3. being so jumbled in thoughts or speech that other people can’t easily make sense of what you are meaning (thought disorder)
4. experiencing periods of confusion – for example: becoming very distracted and finding it difficult to pay attention or make decisions

Psychosis can happen to anyone, up to 10 per cent of people will at some point in their life hear a voice talking to them when there is no-one there. Lots of things can contribute to a person experiencing psychosis such as stress, physical illnesses, using drugs or alcohol and mental illnesses

NHSGG&C BSL A-Z: Mental Health – Schizophrenia

Schizophrenia is a serious mental illness that affects thinking, emotions and behaviour. It is the most common form of psychosis. Schizophrenia usually affects people for the first time when they reach early adulthood – from their late teens to early thirties. Symptoms include:

• Hallucinations – hearing, smelling, feeling or seeing something that isn’t there.
• Delusions – believing something completely even though others find your ideas strange and can’t work out how you’ve come to believe them.
• Difficulty thinking – you find it hard to concentrate and tend to drift from one idea to another. Other people can find it hard to understand you.
• Feeling controlled – you may feel that your thoughts are vanishing, or that they are not your own, or that your body is being taken over and controlled by someone else.

Other symptoms include:

• Loss of interest, energy and emotions.
• Problems with motivation and organising yourself.

Problems with routine jobs like washing, tidying, or looking after yourself

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde

NHSGG&C BSL A-Z: Mental Health – Anti-Psychotic Medication

Anti-Psychotic Medications are an important part of treatment for psychosis. They may need to be taken for a long time to keep well. There are different types of anti-psychotic medication and they can be taken as tablets, injections or as a liquid

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde

Complex Post Traumatic Stress Disorder (PTSD) is a term used to describe the changes that people experience following multiple or repeated traumatic events. Examples include childhood sexual, physical or emotional abuse, domestic violence, being held hostage and victims of torture or trafficking.  These experiences are interpersonal (caused by a person deliberately harming another person) and become anticipated rather than occurring “out of the blue”, causing a wide range of difficulties including problems in the following areas:

• Difficulties with experiencing and managing feelings including intense anxiety, sadness, suicidal thoughts, anger, eating disorders, self-harm and substance misuse and sexual difficulties.
• Difficulties with changes in consciousness such as nightmares, flashbacks and intrusive thoughts as well as forgetting traumatic events or having episodes of feeling detached from your thoughts or body (dissociation).
• Difficulties with self identity and the way in which you see yourself.  People often describe feeling helplessness, shame, guilt, stigma and a sense of being different to other people.
• Difficulties with relationships including difficulties with trust, assertiveness and in managing relationships with others.
• Difficulties with health (somatisation). People who have experienced repeated traumatic events often have physical health difficulties including chronic pain, migraines, seizures, chronic fatigue or other long-term health problems.
• Difficulties with systems of meaning: Experiencing repeated traumatic events from an early age can interfere with a person’s ability to find meaning in life and can lead to feeling hopeless, helpless, empty, despairing or living with chronic suicidal thoughts.

Treatment

Complex PTSD is likely to take longer to resolve and you are likely to be referred to a mental health professional to help with your recovery.  Treatment is usually carried out in three phases.  The first phase involves helping you to manage your current symptoms in the here and now and is referred to as developing safety and stabilisation.  If you are still being affected by trauma memories, you may then go on to talk about your experiences in more detail. This phase acknowledges the losses that have occurred as a result of the trauma, including lost opportunities and relationships.  However, it is important to note that improvement is possible without talking in detail about the past if you do not wish to.  Phase three involves helping you to connect with people, places and activities that may help you to continue to feel better.

Caring for somebody

Caring for somebody who has experienced complex traumatic experiences (traumatic experiences which occur repeatedly over time and usually within an interpersonal context for example childhood sexual abuse, domestic violence, as well as victims of persecution, torture and trafficking) can be difficult as they may have a number of concerning difficulties over a long period of time including difficulties managing their emotions, self-harm, depression, eating disorders, difficulties within relationships as well as flashbacks, nightmares and anxiety. Caring for friends or relatives who struggle with their mental health can have a negative impact on your own health and it is important to look after yourself.

There is more information about Complex PTSD

It is normal to experience upsetting and confusing thoughts after a traumatic event, but for most people this will improve naturally over a few weeks.  Most people are unlikely to require access to specialist mental health care.

You should visit your GP if you or someone you know is still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome.

Your GP will want to discuss your symptoms with you in as much detail as possible. They will ask whether you have experienced a traumatic event in the recent or distant past and whether you re-experience the event through flashbacks or nightmares.

Your GP can refer you to mental health specialists if they feel that you would benefit from treatment.

The main treatments for post-traumatic stress disorder (PTSD) are psychological therapy and medication

Traumatic events can be very difficult to come to terms with, but dealing with your feelings and thoughts and seeking professional help has been shown by research to help in the treatment of PTSD. It is possible for PTSD to be treated many years after the traumatic event occurred which means that it is never too late to seek help.

Watchful waiting

If you have mild symptoms of PTSD, or if you have had symptoms for less than four weeks, an approach called watchful waiting may be recommended.

Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse. It is sometimes recommended because 2 in every 3 people who develop problems after a traumatic experience get better within a few weeks without treatment.

If watchful waiting is recommended, you should have a follow-up appointment within one month.

Psychological therapy

If you have PTSD that requires treatment, psychological therapy is usually recommended first. A combination of psychological therapy and medication may be recommended if you have severe or persistent PTSD.

The treatment is carried out by trained mental health professionals who listen to you and help you come up with ways to help you resolve your problems. The main types of psychological therapy used to treat people with PTSD are described below.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) aims to help you manage your problems by changing how you think and behave. Trauma-focused CBT uses a range of psychological treatment techniques to help you come to terms with the traumatic event.

For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail. During this process your therapist helps you cope with any distress you feel, while identifying any unhelpful thoughts.  Your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience. For example, feeling that you are to blame for what happened or fear that it may happen again.

You may also be encouraged to gradually restart any activities you’ve avoided since your experience, such as driving a car if you had an accident.

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) involves making side-to-side eye movements, usually by following the movement of your therapist’s finger, while recalling the traumatic incident. Other methods may include the therapist tapping their finger or playing a tone.

Although it might seem a bit strange at first, there is research evidence to show that it can be effective in resolving some of the most distressing symptoms of PTSD. 

Group therapy

Some people find it helpful to speak about their experiences with others who are experiencing similar difficulties. Group therapy can be used to teach you ways to manage your symptoms and help you understand the condition.

Medication

Antidepressants such as paroxetine, sertraline, mirtazapine, amitriptyline or phenelzine are sometimes used to treat PTSD in adults.  A combination of medication and psychological therapy can be particularly helpful.

Post Traumatic Stress Disorder can make you feel unsafe and in danger even after the threat has passed.  It is difficult to recover if you are still in danger.  It is therefore important to identify areas in your life in which you feel unsafe and, where possible, take steps to manage these. Thinking through the areas of safety below may be helpful:

Emotional safety: Do you feel safe within your emotions?  Are the ways in which you are coping with your feelings safe or unsafe: for example are you numbing or shutting off from your feelings as you fear they will overwhelm you? Are you self-harming or using substances? are you experiencing suicidal thoughts?

Relationship safety:  Are the people around you supportive? Is there anyone who is taking advantage of you emotionally, sexually or financially?  Do you find yourself pushing people away if they come too close? Do you find it difficult to trust people?

Physical safety: Are you looking after yourself physically?  Are you eating regularly, getting enough sleep, attending regular health checks, taking regular exercise?  Are you taking risks with your health?

Environmental safety:  Is the area you live in safe?  Do you feel afraid to go out?  Did the traumatic event/s occur at home and you are constantly reminded of it? Or is the trauma still happening at home or nearby?

A mental health professional can help you identify areas of risk in your life and create a safety plan to manage these. 

Psychoeducation:  Finding out more about the impact that trauma has on the brain can be very helpful.  Understanding that your symptoms are not a sign of “being weak”  but rather your body and your brain trying to process, cope with and heal from what happened can be very powerful. It can be helpful for a mental health professional to help you understand how trauma is affecting you.  There is an information booklet from NHS Inform about how to cope with PTSD.  

Managing nightmares and flashbacks: Understanding why and how nightmares and flashbacks occur can help you feel more in control of your symptoms.  Although they can be intensely powerful and distressing at the time, it is important to remember that they will pass. Identifying your specific triggers can be helpful in making you feel more in control again.  Even if you feel that they occur “out of the blue” there may be subtle cues or reminders of the traumatic event such as a specific feeling or piece of music or smell which set them off.

Grounding: Flashbacks can make you feel as if the danger is still here.   Grounding helps focus your attention on one very specific thing at a time, pulling you back into the here and now.  For example,  smelling a strong, pleasant smell such as peppermint or lavender oil, identifying five things you can hear, touch or see, picking up an object and studying it intently using all your senses to describe it.  Some people find it helpful to make a flashcard to keep with them, reminding them of the current date and time and having a “safe” word or phrase on it. 

Talking or writing about what happened:  Many people find that talking about what happened in a safe environment with a trusted person can help them make sense of what they have been through. This is best done with the guidance of a mental health professional.

Recovery from PTSD can take time.  It is important to look after your physical health in the meantime by ensuring you are eating and drinking regularly and keeping physically active.

Following a traumatic event

Immediately after a traumatic event the most important thing is to ensure that a person is safe from further danger and that their physical needs are taken care of including medical treatment if required. It is important for you to be guided by the person’s wish to talk. If they want to talk, be present and listen to them, providing comfort and consolation. Don’t pressure them to talk if they don’t want to. Encourage them to seek support from friends and family and point them towards information which explains that it is natural and normal to be upset and distressed at this time. Flashbacks, nightmares, an increased sense of threat and avoidance are normal in the early stages and most people will recover without needing further help. Encouraging people to keep to a gentle routine and look after themselves is important. However, if you become concerned that someone’s symptoms are not resolving after a month or that their distress is intense then urge them to seek help through their GP. 

Coping with flashbacks

If you are with somebody whilst they are experiencing a flashback it can be helpful to “ground” them in the here and now.  This means gently bringing them into the present by asking them to use their senses to describe what they can see, hear, or feel in the present moment. Smell is a very powerful way of doing this.  You can encourage the person to keep some favourite perfume or essential oil to hand. You can ask them to state their name, age and the current date and name three things they can see, feel and hear. Alternatively, you could ask them to hold an object such as a stone and describe it in great detail. Find out more about grounding techniques.

Managing a disclosure of other forms of trauma

If somebody discloses a traumatic event to you such as domestic violence or childhood sexual abuse it is important to listen and acknowledge what they are telling you. Hearing accounts of abuse can be distressing and confusing, particularly if it brings up issues for yourself. It is important that the person feels that they have been listened to and believed. Try to focus on them and how they must be feeling rather than your own response and gently encourage them to seek help if they want to. They can do this by contacting their GP in the first instance.

Complex PTSD

Caring for somebody who has experienced complex traumatic experiences (traumatic experiences which occur repeatedly over time and usually within an interpersonal context for example childhood sexual abuse, domestic violence, as well as victims of persecution, torture and trafficking). You can read a description of what Complex PTSD is. It can be difficult as they may have a number of concerning difficulties over a long period of time including difficulties managing their emotions, self harm, depression, eating disorders, difficulties within relationships as well as flashbacks, nightmares and anxiety. Caring for friends or relatives who struggle with their mental health can have a negative impact on your own health and it is important to look after yourself.

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site

Archway Glasgow – provides services and support to men and women aged 13 and over who have experienced rape or sexual assault within the past seven days.

Call: 0141 211 8175

Assist – provides advocacy, information and support to women and men whose partners or ex-partners are appearing in Glasgow’s domestic abuse court. 

Call: 0141 276 7710

Breathing Space – free confidential phoneline you can call when you are feeling stressed or down. 

Call: 0800 83 85 87 

Childline – free national helpline for children in trouble or danger.  It provides a confidential phone and online counselling service for any child 24 hours a day.

Call: 0800 11 11

Combat Stress is a military charity specialising in helping ex-servicemen and women.  If you are serving or have served in the UK armed forces they run a 24 hour helpline.

Call: 0800 138 1619

CRUSE is a UK charity providing support and information for people who have experienced bereavement. They run a support helpline.

Call: 0845 600 2227 (calls costs up to 8p per minute, plus your phone company’s access charge per minute)

Rape Crisis – is a UK charity providing a range of services for people who have experienced abuse, domestic violence and sexual assault. They run a free helpline service every day from 6pm-midnight

Call: 0808 8010302

The Anchor, Glasgow Psychological Trauma Services.  This is a specialist mental health service within NHS Greater Glasgow and Clyde for people experiencing complex PTSD.  Referrals can be made by GPs or other health and social care professionals

Scottish Women’s Aid provide help and support to female survivors of domestic abuse. You can phone the domestic abuse helpline

Call: 0800 027 123

Victim Support provides support and information to victims or witnesses of crime.

Self Help Resources

There are individual self-help guides from Get Self help about PTSD and Flashbacks

NHSGG&C BSL A-Z: Mental Health – Post Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder which you may develop after being involved in, or witnessing, traumatic events. A traumatic event is one where you are in danger, your life is threatened, or where you see other people dying or being injured.  Examples of traumatic events include road traffic accidents, assaults and sexual assaults, being involved in a natural disaster such as an earthquake, witnessing or experiencing war, torture or being held hostage.

It is usual for a traumatic event to cause upset and distress.  Most people will recover with the support and care offered by family and friends and by using the ways of coping that they would normally use to deal with stress.  However, some people will experience distress that is more intense and longer lasting and may result in Post Traumatic Stress Disorder (PTSD). Symptoms of PTSD include nightmares relating to the event, avoidance of things that may remind the person of the trauma, flashbacks, feeling on edge and always on the lookout for danger and negative changes in mood and thought.

NHSGG&C BSL A-Z: Mental Health – Trauma

The situations we find traumatic can vary from person to person. There are many different harmful or life-threatening events that might cause someone to develop PTSD. A traumatic event is one where you see that you are in danger, your life is threatened, or where you see other people dying or being injured.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde

When you or someone you know has a phobia, the anxiety can feel so intense that you may fear coming into contact with the thing that makes you feel anxious. You may find that you either avoid situations that you fear or you become extremely anxious in them. When someone has a phobia of something, they often notice changes to their thoughts (for example, noticing frightening thoughts such as “this is extremely dangerous”), their emotions (for example, feeling extremely anxious), and their behaviours (for example, taking precautions to avoid coming into contact with the feared thing).The fear is often so strong that it can impact on your day to day life.

If you have a phobia, you may also experience anxiety if you believe that you may come into contact with the feared situation or object. In some cases, you may find that you experience anxiety even when thinking about the thing that you are scared of. For example, if you have a phobia of spiders (arachnophobia), you may feel anxious when you come into contact with a spider, when you see a photo of a spider or when you think about a spider. You may also have thoughts that pop into your mind about spiders without trying to think about spiders. These are sometimes called “Intrusive thoughts”. Sometimes, your anxiety might lead to the experience of panic attacks. In addition, you may experience a number of unpleasant physical symptoms such as:

• Racing heart rate
• A sensation of a “thumping heart” (palpitations)
• Difficulty breathing or fast breathing
• Feeling sick or nauseous
• Dizziness or feeling lightheaded
• Trembling or shaking
• Sweating
• Dry mouth
• Chest feels tight or painful
• Confusion
• “Butterflies” in the stomach
• Feeling restless
• Tingling or numbness in toes and/or fingers
• A sudden need to use the toilet.

If you do not often come into contact with the animal, object place or situation that is the source of your phobia, it may not have as much impact on your day to day life. However, if you have agoraphobia (extreme fear of open or public places), it may seem much more difficult to live your life day to day. People who have a phobia can often also experience other mental health difficulties such as other anxiety disorders and depression.

There are two types of phobias. These are specific and complex phobias.

A Specific Phobia is a fear of a single object, situation or activity. These phobias often develop when a person is a child or an adolescent. For many people, these phobias can lessen as they grow older.

There are many different types of specific phobias. Some of the most common ones are:

• Animals (such as dogs, insects, snakes, and rodents)
• The environment (such as heights, water, and darkness)
• Situations (such as flying, visiting the dentist, medical interventions, and tunnels)
• Body-based phobias (such as blood, vomit, choking, injections, and injury).

A Complex Phobia is one that involves multiple anxieties. These phobias, therefore, tend to have more of an impact on a person’s day to day life. They also tend to develop when someone is an adult. Common complex phobias include:

• Agoraphobia: This is a fear of situations such as open spaces, travelling alone, busy environments and public environments.   If you experience Agoraphobia, you may find that you fear going into situations where it would be difficult to leave or escape to somewhere safe, such as your home. This can lead to someone with Agoraphobia avoiding a lot of situations which can include leaving their house, using public transport, being in lifts or going to busy shops.  Often people who experience Agoraphobia can find it difficult to seek help and support as they find it difficult to visit their GP surgery or to leave their home for appointments.
• Social Phobia: If you have a Social Phobia, you may have a fear of situations that are social or involve some kind of performance, such as a party or public speaking. A lot of people can find social situations difficult and they may feel shy or awkward.  That is a very normal way to feel.  If you have a Social Phobia, there will be a more intense feeling of fear or dread, and you may find that you often try to avoid these situations.  If you experience Social Phobia, you may worry that the way you act may seem unacceptable or embarrassing to others, or you may be worried about being judged negatively.  Sometimes people who experience Social Phobia can find it very difficult to seek support as they find it difficult to phone or meet people who might be able to help them.

There is now a lot of research which has helped us to understand what can help someone who is experiencing a phobia.  There is also evidence that many phobias can be successfully treated. Sometimes, a person will decide that they do not want to or feel unable to address their phobia. These individuals may take a lot of care to ensure that they avoid the situation or object that they fear. 

Without treatment, people can develop what we call “safety behaviours”, such as avoiding drawing attention to themselves, planning ways to escape feared situations, or avoiding the feared situation or object.  While these behaviours are understandable and may make you feel that you are keeping yourself safe, these behaviours actually help to maintain the phobia and can make it worse over time.  Often, treatments focus on helping the person to understand their phobia, reduce their use of their safety behaviours and learn more helpful ways of coping with their anxiety. This is done in a way and at a pace that is agreed with the person experiencing the phobia.

If you would like to access treatment for your phobia, the first place you would normally visit is your GP surgery.  Your GP should explain all of your options to you and your views should be considered before choosing any treatment.  There are three main treatments that are most frequently recommended:

• Self-help materials;
• Psychological or talking therapies; and
• Medication.

 Self-help Material

There are individual self help courses and materials that you may find online or that your GP may direct you to. These can help you to better understand your phobia.  These materials also often recommend ways to manage or cope with phobias.  As a result, the aim of these materials is to help you to take the first steps towards managing your phobia.  Your GP may also refer you to self-help groups where you can learn more about phobias with other individuals who are experiencing phobias.  There are a lot of resources available that can explain phobias and describe ways of managing them. 

Psychological or Talking Therapies

Talking therapies can help people with phobias. A healthcare professional will often meet with you for one hour each 1-2 weeks to help you to develop ways of coping with and managing your phobia.  The talking therapy shown to have the best effectiveness with phobias is Cognitive Behavioural Therapy (CBT). CBT involves helping you to look at and challenge some of your thoughts which may be making you feel anxious and fearful of the specific situation or object. Therapy can also help you to learn new ways of dealing with the phobia. Your GP might refer you to a Cognitive Behavioural Therapist, a Mental Health Practitioner, or a Clinical Psychologist to help you with this.  You can read more about Cognitive Behavioural Therapy.

Medication

If you prefer not to try talking therapies or self-help materials, or if you continue to struggle with your phobia, your GP may discuss medication options with you.  Antidepressant medications are commonly used when people experience depression.  However, sometimes they also help to reduce the symptoms of phobias, particularly agoraphobia and social phobia, even if you are not depressed. Sometimes GPs will prescribe these to help with phobias.  It is important to remember that these do not work straight away and can often take two to four weeks before people notice a change.  If you visit your GP to discuss your phobia, they may also recommend benzodiazepines such as Diazepam. These often reduce symptoms of phobias and anxiety.  However, they are addictive, can make you feel drowsy, and can stop being as effective after a few weeks.  As a result, they are not a useful long term treatment for phobias.

If you or someone you know is living with a phobia, you may notice an impact on their day to day life.  A phobia can make it very difficult for a person to live their life the way they used to or the way that they would like to.  If you have a phobia, you may experience significant distress and anxiety when you come into contact with the object or situation that you fear.  You may also experience anxiety if you believe that you may come into contact with the feared situation or object.  In some cases, you may find that you experience anxiety even when thinking about the source of your phobia. 

Sometimes, the impact that a phobia can have on a person’s life can depend on the type of phobia.  If you do not often come into contact with the animal, object place or situation that is the source of your Specific Phobia, it may not have as much impact on your day to day life.  However, if you have a Complex Phobia such as agoraphobia or social phobia, it may seem much more difficult to live your life day to day.

Witnessing someone close to you living with a phobia can be very difficult to see.  It can be hard to know how to support a family member or a friend with any type of anxiety disorder.  It can also be difficult to see the impact it might have on their daily life, including a possible effect on their work or how they interact with other people.

If you are trying to care for or support someone with a phobia, it is important to be supportive and sympathetic to what they are going through.  Sometimes you might find it difficult to understand why they are so afraid of the source of their fear. It may not make sense to you.  However, it is important to remember that their fear and anxiety is real.  Individuals who experience phobias can find it distressing if they believe others do not understand them or do not take their difficulties seriously.

When reading about phobias, you may learn that avoiding situations or objects can make a phobia worse over time.  Sometimes, this might lead you to want to push your family member or friend to face their phobia.  It is important to remember not to put pressure on the person who is experiencing the phobia to do any more than they feel ready to do.  It can be very distressing for the person to be forced to do more than they feel comfortable doing.  Instead, it might be helpful to ask your family member or friend if there is anything you can do to help.  This might be things such as talking to them calmly about how they are feeling or doing slow, calming breathing exercises with them.

You may also find that you can support your friend or family member by encouraging them to seek treatment for their phobia.  This might mean supporting them to visit their GP or a therapist, or providing them with some information that you have found about phobias.  Remember, it will be up to the person with the phobia to decide when they feel ready to seek help from services.

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site.

If you would like further information on phobias, you might find the following websites helpful. 

NHS Choices website provides further information on phobias including symptoms, causes and treatments, as well as the real life stories of people who have experienced a phobia.

Centre of Clinical Interventions also has some self-help workbooks that you can work through yourself

MIND also provides a booklet which gives information about phobias, including how to support someone experiencing a phobia.

Anxiety UK, No Panic and Triumph over Phobia are other online resources developed to help and support individuals who experience phobias and other anxiety disorders.

GP surgeries also often offer leaflets or booklets on a number of mental health difficulties including phobias.  They sometimes also offer information on treatments such as psychological therapy.

Acknowledgements

Understanding Phobias (2014) © Mind. This information is published in full at mind.org.uk

Phobias – what, who, why and how to help? (2008) © British Psychological Society

A phobia is a type of anxiety disorder. It is an extreme form of fear or anxiety triggered by a particular situation (such as going outside) or object (such as spiders), even when there is no danger. For example, you may know that it is safe to be out on a balcony but feel terrified to go out on it or even enjoy the view from behind the windows inside the building. Likewise, you may know that a spider isn’t poisonous or that it won’t bite you, but this still doesn’t reduce your anxiety.

Someone with a phobia may even feel this extreme anxiety just by thinking or talking about the particular situation or object

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde.

Around 1 in 10 women will experience postnatal depression after having a baby. However depression and anxiety are equally as common during pregnancy. Most women recover with help from their GP, health visitor and midwife, and with support from family and friends. However severe depression requires additional help from mental health services.

The symptoms of postnatal depression are similar to those in depression at other times. These include low mood, sleep and appetite problems, poor motivation and pessimistic or negative thinking.

Two in 1000 women will experience postpartum psychosis. The symptoms of this illness can come on quite rapidly, often within the first few days or weeks after delivery, and can include high mood (mania), depression, confusion, hallucinations (odd experiences) and delusions (unusual beliefs). Admission to a Mother & Baby Unit (MBU) is advised for most women, accompanied by their baby. Women usually make a full recovery but treatment is urgently necessary if symptoms of postpartum psychosis develop.

The following advice on how it feels to be unwell and what was, and what was not, helpful, is from a member of the Maternal Mental Health Scotland (MMHS) change agents, people with lived experience of Post Natal Depression (PND). This member had PND after having their daughter two years previously. They were also diagnosed with anxiety & depression which was noted as potentially sparked from suffering from PND.

“What does it feel like to be unwell – uncontrollable, lonely, crazy, low, tired, lack of energy. The only way I could describe it, is to say how low and crazy I felt. I felt when everything went right and my baby was “settled” I had a great day but as soon as we had an unsettled day, the smallest thing would set me off into a downer of a mood that I felt I couldn’t shift. It felt like someone was controlling my mind and body and I was in a deep hole I couldn’t get out of. Horrendous and sad feeling. I had so much support and amazing family around me yet I pushed them all away and wanted no one.

“What was helpful ” – speaking to people I wasn’t close to. Finding a really helpful & understanding doctor who would take the time out and listen to my true feelings and understand the severity. Speaking to other mums who were going through the same & also advising my family on my feelings.

“What was not helpful ” – the first doctor I got tried to put it down to baby blues when I KNEW there was something wrong. I was told that having PND, it isn’t that common you would pick the problem up by yourself. I was in tears and broke down explaining that I isn’t want my baby anymore, I wanted to get in my car and drive as far away as possible and never come back, I wanted a different life.”

For patients

Mental health in pregnancy and the postnatal period

• SIGN Guidelines: Patient Information
• RCPsych: Mental health information on perinatal disorders
• Action on Postpartum Psychosis: Insider Guides

For professionals

Resources for healthcare staff

• Maternal Mental Health Scotland
• NSPCC Scotland & Maternal Mental Health Scotland: Getting It Right for Mothers and Babies-Closing the gaps in community perinatal mental health services
• LSE & Maternal Mental Health Alliance: Costs of perinatal mental health problems
• Everyone’s Business: Maternal Mental Health

Involvement of partners and significant others

We will ask for your consent before sharing any information with friends, family members and carers.

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site

A carer is someone who looks after a partner, relative or friend who cannot manage without help because of illness, frailty or disability. They may or may not live together.

If you would benefit from support in your caring role, local carers services can help. They can provide you with help and support regarding a number of issues including access to respite, short breaks, information and advice on a wide range of topics, emotional support and access to carers support groups. To find information about your local carers service anywhere in Scotland please contact

The Carers Information Line

Telephone: 0141 353 6504

Email: info@glasgowcarersinformation.org.uk

Support for young people

• YoungMinds is a leading UK charity committed to improving the emotional well being and mental health of children and young people.
• Baby Buddy, urgent access to mental health services – available 24 hours per day
• Working hours: Your GP can refer you to the local Community Mental Health Team (CMHT) or Crisis Intervention Team
• Out of hours: Call NHS 24 on 111
• Bluebell PND service Glasgow – 0141 221 1535
• Crossreach
• Home Start Glasgow North – 0141 9482289, email info@homestartglasgownorth.org.uk
• NHSGGC Perinatal Mental Health Service

Your Midwife, GP and Health Visitor can offer support and advice.

Postnatal depression (PND) affects around 10% of mothers. This is much more serious than the period post birth known as ‘baby blues’ which usually lasts between one to three days. PND can develop slowly and may not be noticeable until several weeks after the baby’s birth, or may continue on from the baby blues period. The symptoms of postnatal depression are similar to those in depression at other times. These include low mood, sleep and appetite problems, poor motivation and pessimistic or negative thinking. It can have a significant impact on the health and wellbeing of the mother and the child.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde.

NHSGG&C BSL A-Z: Mental Health – Post-Partum Psychosis

It is a severe episode of mental illness which begins suddenly in the days or weeks after having a baby. Symptoms vary and can change rapidly. They can include high mood (mania), depression, confusion, unusual experiences and strange thoughts. Postpartum psychosis is a psychiatric emergency. You should seek help as quickly as possible.

Postpartum psychosis can happen to any woman. It often occurs ‘out of the blue’ to women who have not been ill before. It can be a frightening experience for women, their partners, friends and family. Women usually recover fully after an episode of postpartum psychosis.

It is much less common than Baby Blues or Postnatal Depression. It occurs in about 1 in every 1000 women (0.1%) who have a baby

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde