R U OK?

Today is R U OK? day. It’s an annual day nominated by the R U OK? suicide prevention charity to think about the people in our lives and consider if they are okay. More than that, it’s a day to take ourselves in hand, try to be brave and open a conversation if we think someone we know is struggling. Of course this is something that should happen every day. But today is a day to revive our intentions to be a good mate to our family, friends, colleagues, anyone we bump up against in our daily lives. It’s a day to understand a bit more about what drives people to consider suicide, and to learn ways that we can safely help them.

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I’d love each one of you my readers to check out the R U OK? website. Just pick one topic and give 5 minutes of your time to taking on some new knowledge, or understanding, or strategy. It really can change and even save a life. It’s that important.

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Some of the topics I think are great are Mates, resources for every day, news stories and information, but I’m sure you’ll find the topic that makes most sense, or means the most to you.

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I’ve been a mental health advocate (at least I think I have been) for a lot longer than I’ve been ill with mental illness. By that I mean that I’ve considered mentally ill people the same as myself just with a condition requiring treatment, and tried to show to others that they don’t need to be feared. As a child I was used to being around mentally unwell patients. One family friend had schizophrenia and another had bipolar disorder. We saw them regularly, saw them better and worse, visited them in hospital and knew they were just people like the rest of us. And they were just the people who had known, obvious, must-be-treated illnesses. Who knows how many people in my acquaintance had depression or anxiety that was more or less invisible. I wouldn’t know. It was never talked about. If they were there, I never knew. Which is a terrible shame.

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So today is about conversations. I want people to have conversations. But first of all I want to tell you why R U OK? as a charity and a question is so important to me.

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When I was depressed or anxious, I felt awful. I was barely dragging myself around, limping from bed to work and from work to bed. My brain was either whizzing or sluggish; it wasn’t very useful. I felt like all of this must be pasted across my face, and that surely someone would notice today that I was struggling and ask me about it. It had to be written on my forehead, I thought, why can no one see it, why is no one wondering what’s wrong with me? I was just dying for someone to see it and come to my aid.

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But nothing happened. I didn’t want to be attention seeking and bring it up myself, I wasn’t one of those people who was always making a fuss. But I was in pain here, it must be obvious. I thought of a hundred ways to bring it up, but I just couldn’t. It was too obvious a way to start a conversation, there was no easy lead in.

“So you’re having tuna for lunch, that’s interesting, did you know that I’m depressed?”

So I dragged myself around, wondering and waiting and hoping that someone would do the hard part for me and bring up so I could let it all pour out. And do you know the funny thing? Having felt so isolated, like no one could see the real me inside, like I was alone in this experience and so on, once I was officially sick and had told people about it, I had several comments along the lines “oh I thought so” and “I figured something was wrong” and “I knew something wasn’t right” and “you didn’t seem like your usual self”. If just one, only one person had actually said that out loud, it would have been such a relief, a balm, a comfort! It probably would have meant that I got help sooner. It could’ve shorten the process, and I would have been so thankful. It would’ve meant such a lot.

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Speak up. If you can see a change, say something. If things seem different, say so. The worst that can happen is that you’re wrong, and they are just having a bad day or week, or are preoccupied. But how can it hurt? At the least, I’m sure they’ll appreciate your concern, the effort that you’ve gone to, your care. It would be a rare person who would take exception to your kind heart.

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The second part is knowing what to say. The reason for this charity’s name is that R U OK? is a powerful question. It might not seem like it, or seem much different to our usual greetings, but it works. We say hello, hi, howdy, how are you going? what’s up? how’s it going? how’s things? alright? and a hundred similar things so many times a day. And we’re programmed to response almost rote: good thanks, hey there, great, how about you? not much, well, yep and so on. So much so that if someone says something different to these, we can accidentally get caught saying good thanks before we’ve even registered that they’ve asked us what’s up?!

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But R U OK? hits a different nerve. It makes us really think about how we are, and it elicits an honest answer.

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So here’s what I want to do. I want you, one day over the next day or two, to count how many greeting encounters you have in one day. I consider one encounter to be one person say hello and/or how are you and the other person responding. Now I know for myself, home most days, there aren’t very many encounters. But for people working in retail there might be many, maybe more than what I’ve allowed for. I really want to know what your number is! Please get involved and let’s see how many times we bump up against each other each day.

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I’ll post the results as early as possible once you’ve had a chance to respond with data from your working life today and tomorrow. If you don’t read this until the weekend, give me your weekend numbers too.

My aim for this poll is to think about how many times we have a typical hi/how are you conversation. The next step after this is to consider what might happen if we changed ONE of these rote conventional habits into an R U OK? conversation. What could U achieve, how could U have an impact on someone else’s life? You already read my tales of mental illness, so you already have a kind heart and I daresay you want to help others too. This is the perfect chance, and I hope to take the baton and run with it.

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So tell me…?

Something that I’ve found out along this journey with me, my head and I is that questions are really important.

It was that question that has become an advocate for helping others with mental health concerns that first triggered my understanding of the need for questions; R U OK?

I’ve always been interested in mental health and I saw this group pushing people to understand and use the question R U Ok? to start talking to others about what’s going on, what’s wrong, what’s troubling you, what’re your concerns? I thought it was a great idea and I bookmarked it in my head to use someday if I saw someone having a hard time.

I wasn’t sure that it would be effective but I planned to give it a go anyway; nothing ventured, nothing gained, right?

But then, before I had a chance to use it to help another person, someone asked me, and I burst into tears!! Just like that! That is how powerful the question is and how right on target it is to really hit the spot when someone is down, anxious, fearful, despairing etc.

I didn’t think it would work. But I walked into a doctor’s room to get some routine results, she asked ‘are you okay?’ and it turns out I wasn’t, to a severe degree which I had not even realised up until that moment.

When she said, ‘how are you?’, as I walked in the door I said fine. That question is just too automatic and we are too programmed into a standard response that doesn’t really give an answer. We know when we ask it that it’s more for form than for really enquiring into someone’s health. It has become a greeting more than a query. Not to say that it can’t be used as a question; some people can inject that something extra that shows that they genuinely are enquiring about your health, but usually that’s not the case.

But there is something unique, direct and unusual about the question ‘are you okay?’ that hits a nerve, that registers with a person as an actual question and that demonstrates some extra kind of care and interest on behalf of the asker.

Questions are so important in mental health.

We can’t lay open a wound, or show an obvious dislocation, or contusion, or register a positive blood culture, or low blood level as evidence of our condition.

We may not look ill, or sick, or injured to other people.

All the evidence of our ailment is locked inside our heads.

It is literally all in our minds, but not in the way that that saying is usually used, to suggest that it’s a figment of our imagination!

There is nothing imagined or exaggerated or fictitious about any mental illness.

However there is a level of difficulty for anyone treating a mental illness, be it doctors, nurses, psychiatrists, psycholgists, counsellors or any other health professionals.

To diagnose a mental illness, as with any other condition, a set of diagnostic criteria must be met. But none of those criteria are obvious when a patient walks in the door.

The diagnoser (doctor or psychiatrist) must be able to draw out the information that they need to make a diagnosis by asking questions. They need to ask a lot of questions. Questions designed to gather information, to confirm suspicions, to determine signs and symptoms of the condition.

They have to be very skilled in asking questions AND in listening to the answers for clues about what is going on with the patient.

It takes time! Sometimes a lot of time. Sometimes questions are asked over and over. There is a purpose to that; it is to gather the right information so that the right diagnosis is made and the right treatment given. It might seem repetitive but every question fills a useful part of the overall picture. It’s not a sign of incompetence on the part of the person asking the questions; its a part of their professional skill.

Patients most often don’t know what is going on with them. I’m a health professional with a clinical understanding of mental illness but I still didn’t recognise mental illness in myself. I just thought I was stressed at work. The fact that I was constantly obsessing over work all day and night, that I couldn’t sleep, that I was being clingy and petty and being a huge strain on my husband with my concerns and fears and anxiety didn’t occur to me to be an excessive reaction. So I can’t even imagine how patients with no prior knowledge of mental illness feel when they start to suffer from symptoms.

They might be scared, afraid, stressed, anxious, overwhelmed, confused, in denial or fearful of what the diagnosis will mean and what treatment will be prescribed. So the doctor also has to tread carefully around the person’s soft or sore spots but still trod and poke enough to get what they need to do their job.

In any emotional state a person has more difficulty remembering and recalling, trouble giving an accurate history, limited ability in listening and responding, and struggles with taking in information. This is one of the reasons why questions need to be repeated; to be sure that the right answer has been given. It’s also why seeing multiple doctors on different occasions can be useful in building a clearer picture of what is going on.

Often a patient may not be diagnosed immediately, because of these factors. It may be considered in the patient’s best interests to allow them time to go away and calm down, to give more thought to the history of symptoms that they have experienced, and then to bring them back and ask further questions. Of course it isn’t safe for all patients to be sent away; some need to be kept for their own safety, some need to have treatment started immediately. For those who are sent home to return late, maybe the same questions will be asked all over again, and although it seems tedious to the patient, it is all for the purpose of gathering as much information as possible so that the best outcome can be achieved for every patient.

So, questions.

Tell me what’s been going on?

How have you been feeling?

When did this start?

Who have you already seen about this?

What treatments have you tried?

Has anyone in your family experienced any mental illness?

How long have these symptoms been going on for?

How severe are your symptoms?

What symptom is the most difficult for you?

What has brought you here today?

How are you today?

Compared to then, how are you now?

What do you think has triggered these symptoms?

What has happened that might have caused this?

What do you know about your condition?

What do you know about the treatment for this condition?

What’s the worst symptom that you are experiencing?

How are you coping?

Are you experiencing any side effects?

Give me a run down on how the last week has been for you?

How often do you shower?

How often have you been getting out of the house?

Are you finding enjoyment in life?

How has your motivation been?

What have you been getting up to?

Have you been hearing or seeing things that don’t exist?

Has anyone been speaking to you through other objects?

Are you suicidal?

Have you had thoughts of harming yourself or others?

Do you have a plan to harm yourself?

Have you had suicidal thoughts?

Have you had thoughts that are frightening to you?

How has your sleep been?

Tell me what you are afraid of?

Do you ever have periods of great energy when you can achieve a lot? Or when you don’t need sleep?

When are you not anxious? Are there any places where you feel comfortable?

What things make you anxious? What things trigger a panic attack?

There sure are a lot of questions that can be asked!! And this is probably the tip of the iceberg really, these are just the questions that I can remember from the health professionals that I saw. I’m sure there are many others for other mental health disorders.

And yet, the most important question is whichever one you ask to the person that you see struggling. It really doesn’t matter what it is. It can be r u ok?, how ya doing?, what’s up with you?, how are things?, how have you been going lately?.

As long as you take the courageous step of asking and listening, you will be doing the right thing. Go you!!