Personality disorder: What about recovery?

Exploring the process of recovery from personality disorder, and how this can be achieved, Heather Castillo, author of The Reality of Recovery in Personality Disorder, provides some insight about the concept of recovery in relation to personality disorder.

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Twenty years ago, personality disorder was defined as enduring and inflexible and was usually considered untreatable.   If I had moments of doubt, regarding embarking on a study of this human puzzle, they weren’t many.  The adversity experienced by those who had attracted the diagnosis was too compelling.  The assumption that professionals know best how conditions should be defined, and how services should be configured, was a similarly popular perception at that time.

My subsequent twenty-year journey concerned research with people diagnosed with personality disorder.  Driven by the ideas and needs of service users, our ensuing service developments aimed to build a new model of understanding and progress, one which could even make the old ways obsolete.  The early 2000s proved to be a fertile time for innovation when the Department of Health invested in pilot services which allowed a kind of exploratory latitude that I have not experienced before or since.  This gave us heaven-sent liberty to create a new and very different kind of service and a golden opportunity to extend our research studies.  At this time there was no agreed rationale of recovery for those diagnosed with personality disorder and few researchers had sought the views of service users regarding this.  We wished to continue to explore research methods that incorporated subjective accounts of recovery because we believed that professionals would find little guidance about what might help recovery from a medically-oriented randomized controlled trial.

The concept of recovery essentially arose in the service user movement, however, it was an idea which was soon hijacked by mainstream services becoming a clinical concept concerned with cure.  This was experienced as an unrealistic expectation and a burden to get well.  The word recovery has different meanings suggesting that conceptual clarity is necessary.  First is the traditional concept of recovery as cure which is located within an illness framework.  Second is the personal definition of recovery which has emerged from service user narratives.  These accounts emphasize the understanding of recovery as a process that can still take place in the presence of symptoms and disability.  Recovery is about finding abilities, possibilities, interests and dreams.  This was a crucial concern for our research group members and they set out to define recovery in their own terms.  They believed that the term recovery implied returning to a previous state of being, whereas members were seeking to create a new future, the future they wanted.  Standing on the firm foundations of a clearly defined concept of personal recovery, by 2004 we had established our new service.  I have long believed that, as human beings, thriving is our default setting.  Up to now this had not proven to be the case for our service users, however, the homeliness and peacefulness of the new service and the sense of hope that permeated the air had an effect on all of us.

Living too long with untenable emotions and in a state of chronic hyper-arousal, people with a personality disorder diagnosis frequently adopt dysfunctional behaviors to numb unbearable feelings and to swiftly bring their mood down to a manageable level.  Hurting the body can create temporary calm because of endorphin release.  Such behaviors include self-harm and substance misuse.  This is how people have coped and, for many, they become deeply ingrained coping strategies.  The damaging expression of pain needs containing measures, therefore, to create psychological safety at the new service these self-destructive behaviours needed to be actively challenged.  An Acceptable Behaviour Policy was created in collaboration with service users and administered by them.  If someone broke the rules laid out in this policy there were consequences, and that person would be invited to a community discussion with peers.  During the course of our research 51 (85% of participants) discussed the use of negative coping strategies and 46 (over 76% of participants) reported a dramatic reduction in their use, suggesting that the concept of boundaries had become internalized.

Initially we were engaged in developing healthy attachment in terms of safety and trust, feeling cared for, a sense of belonging, and learning acceptable boundaries.  Next we discovered that only when this was sufficiently consolidated did service users begin to learn to contain their past experiences and build necessary skills to progress.  Meaningful therapy cannot take place, no matter how desperately it is needed, if trust does not exist and if behaviour is chaotic, risky and destructive.  Healing is about integrating experience by making sense of what has happened.  Prior to this stage, reality often proved to be unbearable and making sense out of traumatic experiences and child abuse is a difficult thing to do.  This marked the long process of beginning to re-frame traumatic experience.   However, a focus on a deficit in skills, and all that has gone wrong in the past, can create a sense of hopelessness.  Therefore, the fostering of hope and the building of confidence became vitally important in activating the internal resources necessary to conceive of and pursue dreams and goals.

Supporting recovery is about helping people to build self-esteem and identity and to find valued roles in society.  This began to translate into internal changes concerning sense of self and external achievements in the various domains of social inclusion.  However, despite progress, significant fears and barriers to the concept of recovery were also highlighted in relation to risking what progress had been made.  Because the word recovery could potentially become synonymous with the idea of loss of support, it became essential to further define it in a tenable way.  As a result, the concept of Transitional Recovery was born, meaning that progress would be defined as an ongoing journey of small steps, involving the retention of new-found healthy attachment, and new structures were incorporated into the service to help build confidence with outdoor-well-being pursuits and social inclusion initiatives.

Developments which stemmed from the  unique knowledge of service users, about what would best support them and help them to progress, shows that it is possible to work effectively with a relatively large number of people with a personality disorder diagnosis, well in excess of a hundred at one time, at different stages in their journey of recovery, many of whom had not made progress in other service settings, resulting in significant financial savings to the health, social care and the criminal justice system.

Dr Heather Castillo worked for many years in Mind organisations in Essex, developing advocacy for people with mental health problems. She has worked with service users, training and supporting them to become legitimate researchers in the field of mental health. In 2004 she helped to set up, and became the Chief Executive of The Haven Project, which began as a Department of Health National Innovation Site for the support and treatment of personality disorder. In 2011 she completed a doctorate at Anglia Ruskin University, UK, about the process of recovery in personality disorder. She lives in Essex, UK.

Learn more about The Reality of Recovery in Personality Disorder

Young People and Drugs – What can adoptive parents do?

Julian Cohen, author of All About Drugs and Young People, is a writer, educator, counsellor and consultant who has specialised in drug and sex education work with children, young people, parents, carers and professionals for nearly 30 years. In this blog post he covers tips and advice for adoptive parents who may be concerned about their child and drugs, and there is a free extract from the book for you to read at the end of the post. 

National Adoption Week is highlighting the fact that over 4,000 children in England are waiting for adoptive parents. A significant number of these children are older, have had particularly distressing childhood experiences and have additional and complex needs. They need adoptive parents who will help them overcome their troubled backgrounds. This means consistently sticking by them through the good times and the bad, helping them to make sense of who they are and to grow up feeling safe and secure.
These children may use a range of drugs not just to have fun but in an attempt to escape from unpleasant feelings they have about themselves, past experiences and anxieties about their futures.
Adoptive parents need to be drug aware and sensitive and relaxed about how they deal with young people’s involvement with drugs. How can they go about doing this? Here are 10 suggestions to help you be prepared.

1. Be aware that we are all drug users and have a lifetime drug career. If we think of drugs as mood altering substances they include alcohol, tobacco, caffeine and medicines, as well as illegal drugs, ‘legal highs’ and other socially taboo substances such as solvents. We all self- medicate throughout our lives. The key is to promote a relatively healthy and safe drug career, rather than a damaging one. Cohen_All-About-Drugs_978-1-84905-427-0_colourjpg-web

2. Be informed – learn about drugs and their use. You don’t need an encyclopedic knowledge but you do need to know something about various drugs, the different ways they are used, possible effects and dangers. At the same time you need to avoid the many myths that often surround discussion of drugs. Read books, look on the internet and talk to other adults and to young people.

3. Be aware of your own use of drugs, both past and current, and your particular feelings about drug use. What messages is your use giving your child, why do you feel as you do and how do your views compare with and other adults you know and with young people?

4. Be realistic. Be clear about what you can expect of children of a particular age, development and background. Drug use can be dangerous but avoid exaggerating the risks. Going over the top about dangers is a sure way of closing down communication with young people. And don’t think that they always will be deterred by risky behaviours. Risk can be attractive to them. Rather than expecting they will never use drugs adopt a harm reduction approach where you can have an honest dialogue with them about what they are up to and help to ensure their safety.

5. Talk with young people and make drug use a normal topic of conversation. Use opportunities that arise from watching TV and films. Don’t rush in and tell them what to feel, think or do. Take it gently and listen to what they have to say. You may sometimes need to bite your tongue and agree to disagree.

6. Know how to assess the risks involved with young people using drugs. Take into account the particular drug they may be using, how much and how often, how they are feeling in themslef and also who they may be using with, when and where. Don’t assume the worst and be aware that heavy, regular drug use is often motivated by a desire to blank out painful emotions.

7. Negotiate sensible, age appropriate drug rules. Rather than impose rules discuss with young people what they think might be best. Start with alcohol, cigarettes, caffeine and medicines. If, what, how much and often, when, where and who with can be discussed. You can consider sanctions for breaking the rules and might also put the spotlight on your own drug use as well as theirs.

8. Educate young people about drugs. Learn together by talking and looking at drug pamphlets, books and the internet. Include learning about basic first aid so they can help other people in any emergency situations. Support their school to deliver relevant drug education.

9. Respond to situations where young people become involved with drugs without panicking, being aggressive or overly draconian. Rather than rushing to act, whenever possible create time to think carefully and find out more before responding.

10. Know where to get help, if needed. The Frank website – – can point you to local drug services that offer information, advice and support for young people and for yourself. They also have a telephone helpline on 0300 123 6600. If you need help or advice also consider talking to your local adoption support groups and workers, other adoptive parents and your family and friends.

Remember, most young people who use drugs, including illegal and other socially taboo substances, do so without getting into serious problems. And many of those who do have problems with drugs will, in time, grow out of it. Supportive parenting can make a huge and positive difference to young people’s drug careers and their lives.

Julian Cohen

Read a free extract from Julian’s book here.

Find out more in Julian’s book All About Drugs & Young People – Essential Information and Advice for Parents and Professionals. Julian can also be contacted via his website

Dyslexia, self-harm and attempted suicide

 Research shows that at least 5% of schoolchildren are likely to have dyslexia.  Children sometimes lack the maturity to ask for help and things can go sour when they’re left to fend for themselves. With the aim to assist both parents and educational practitioners to recognise the emotional turmoil that young dyslexics face in life, Neil Alexander-Passe explains the link between dyslexia, self-harm and attempted suicide. The author’s new book Dyslexia and Mental Health: Helping people identify destructive behaviours and find positive ways to cope is out now.




School – legally enforced torture

If you were forced to attend school in Japan without the aptitude to understand the language nor pens and pencils to record what is required, you might not mind if it were only for one day. However, imagine you were legally forced to go five days a week for eight hours a day for ten or more years. Is this fair? I’m sure you would agree not. Well this is exactly how a dyslexic feels. They lack the skills and tools to understand school, and are marked poorly by the lack of such abilities. Everywhere they turn, they see books, and the ability to read and write are valued above all other skills. You can appreciate that they could feel helpless and lacked of control in their lives.

To make matters worse, most teachers lack the skills and aptitude to recognise a struggling learner in their classrooms. It must be said that dyslexic children begin to develop self-protecting strategies to camouflage themselves from showing up their lack of skills, especially amongst their able-bodied peers. Such strategies can include: hiding in class, being the class clown to cover up for the lack of abilities, being the class helper to avoid writing tasks, forgetting homework on purpose, and calling in sick to avoid lessons when there are spelling tests or they need to give in homework. They develop sensitive antennas for situations that might highlight their difficulties, and quickly put in place back-up plans to avoid trouble.

It should also be recognised that children sometimes lack the maturity to ask for help from teachers, and get bored waiting in a long line for help. Calling out in class is sometimes seen ‘bad behaviour’ but in reality it is the child asking for help, albeit not in the way the teacher would prefer.


Regaining control in a world they can’t control

When dyslexics feel that they have no control over their life at home and at school, and feel like failures at everything they try to achieve, they begin to look for ways to feel better.

We all can recognise comfort eating; maybe a chocolate bar when you feel sad – but self-harm goes beyond this. Food, if taken to extremes can give an individual some control in a world they feel is uncontrollable. They are forced to go to school each day; even though they hate it and are taught in ways they can’t learn. Over-eating and becoming obese can protect them from social situations that might require them to read or write (e.g. reading the bus timetable; reading numbers on a bus to meet up with friends; reading the name of the film being shown at the cinema; reading a timetable etc.). They might take the other extreme and think if they didn’t eat they would be so small and thin that no one would recognise and take note of them.

Others see that drugs are a way to escape the harsh world they believe they live in, so sniffing glue or taking drugs will bring a high that allows them a respite/escape even for minutes from the pain they feel at school and home, being socially excluded or by them not having a job.

Self-harm through cutting allows a sense of control in their lives, it also gives an adrenaline high to the body. It allows an individual to regain control of some aspect of their life, however it can become more dangerous in their pursuit of this natural high. Easy to hide at first but harder as time goes by with constant cutting.

In the extreme, the need for an escape through risk-taking can lead to putting one’s life in even more dangerous situations (e.g. playing on train lines, getting into fights), however it is with attempted suicide that can be shocking in young dyslexics from a very young age of seven years old. They want to escape a world they feel excluded from, they also see the pain and anguish they are putting their parents through and want to save them from further pain. Sadly many dyslexics do take their lives but such deaths are unrecorded as they haven’t left a suicide note, as that would require writing, a task they feel is very hard and they want an escape from.

It is interesting to note that some dyslexics get into fights to break bones, especially arms and hands to avoid writing tests. Such calculated lengths to avoid taking tests should be recognised, along with unrecognised dyslexic children forcing themselves to be sick just before a test to avoid being judged badly in front of peers. The lengths some dyslexics go to preserve what self-esteem they have can be remarkable.


What can be done?

  • Schools need to screen and put in place interventions to help dyslexic and other struggling learners.
  • Schools need to provide counsellors for children who experience difficulty learning at school, as the emotional effects of failure can lead to social exclusion, depression and self-harming.
  • Teachers need to recognise the avoidance by children, ask themselves why, and act to question if there is a learning difficulty or another barrier to their learning e.g. avoiding reading and writing.
  • Teachers need to read through secondary behavioural manifestations in pupils and look to understand their primary learning needs. What is bad behaviour covering up? Are they lost in class? Have they missed vital stepping stones to learning? Are they using bad behaviour to cover up for their struggle to understand what is required?
  • Parents need to recognise the signs of self-harm and depression in their children, so that they can refer them to specialist teams for help.
  • Parents need to praise the effort, not the end result, and support their children to focus on strengths not weaknesses.


Neil Alexander-Passe is the Head of Learning Support (SENCO) at Mill Hill School in London, UK, as well as being a special needs teacher and researcher. He has taught in mainstream state, independent and special education sector schools, and also several pupil referral units. He specialises in students with dyslexia, emotional and behavioural difficulties, ADHD and autism. Neil has written extensively on the subject of dyslexia and emotional coping and, being dyslexic himself, brings empathy and an alternative perspective to the field. Find out more about Neil’s work here.

Learn more about Dyslexia and Mental Health here.

Read Neil’s other blog post: The lifelong social and emotional effects of dyslexia

The lifelong social and emotional effects of dyslexia

With the aim to assist both parents and educational practitioners to recognise the emotional turmoil that both young and older dyslexics face in life, Neil Alexander-Passe illustrates the lifelong social and emotional effects of dyslexia. The author’s new book Dyslexia and Mental Health: Helping people identify destructive behaviours and find positive ways to cope is out now.



What is dyslexia?

To most, dyslexia is the difficulty with words, but in truth the term is misleading. The true effects of dyslexia go well beyond having a difficulty with words and spelling, as it also affects the ability to remember names and facts, balance and the ability to tie shoe laces and tying ties, misreading and misunderstanding the relevance of numbers, to write neatly, and to recall facts once learnt (even from two minutes ago).


The young dyslexic

The effects of dyslexia are widespread, and in mainstream education everything the dyslexic has difficulty with is valued highly by teachers and their peers. Can they read fast and write neatly? Well, no. Can they remember spellings for a test? Well, no. Can they recall enough facts to write an essay? Well, no. So a young dyslexic will see their friends and peers perform at ‘normal’ rates and progress smoothly through school, and each year the gap widens. Unless teachers have knowledge of special needs and/or dyslexia, it is unlikely that the young dyslexic will be identified as having learning difficulties or differences.

Studies of teacher training courses and the knowledge-bases of teachers support the argument that most teachers are unqualified to recognise a dyslexic child in their midst. So what happens? The dyslexic child begins to see themselves as ‘abnormal’ and ‘stupid’, which is exactly what they are told, either openly by teachers or by their friends, or indirectly by being put on the ‘stupid’ table with the other ‘slow’ kids. Children know who the clever and not-so-clever ones are very fast, and no matter how teachers dress up mixed-ability classrooms, kids know! In the playground the clever kids mix within their own circles, excluding all the others as misfits.

Each year the dyslexic child falls even further behind their peers, and their common reaction is to give up even trying in class, as no matter how hard they try, they always seem to get the lowest marks. No matter how hard they revise spellings or facts, within minutes or hours such facts or spellings are lost like grains of sand.

Emotionally such failure on a daily or hourly basis is harsh. What can the dyslexic child do in such a hostile environment? Well, many withdraw and develop depressive symptoms to cope, as it’s easier that way.


The adult dyslexic

After ‘surviving’ school, maybe without any qualifications to their name, dyslexic young adults are faced with finding a job, or going to college to gain the qualifications they need to start an apprenticeship. They see their peers leave school with 8-10 GCSEs, and all they have is one or two qualifications in unvalued subjects, such as Art or Drama. They see their peers go to university or train up to any career that takes their fancy, but what can the dyslexic do? Do they have a choice? Not with the lack of qualifications they have. Their dreams of being lawyers or doctors are just that, dreams.

Do they either start on a low-level college course to develop their basic skills, take a job in manual labour, or be unemployed – they begin to question their place in society. Can they take their place, or are they excluded from a society that highly values those who can read and write? Once again, they see that withdrawal is a good option to protect their self-esteem, and again depression looms. Many find completing application forms so exhausting that they give up even applying for jobs or benefits, and some even turn to crime to make ends meet.


Dyslexics and their families

Parents of young dyslexics are bemused by their child who can orally seem intelligent but just cannot seem to cope at school. They know they work hard but nothing seems to stick. They know that no matter how long they work at writing an essay, it looks messy and rushed. Compared to their non-dyslexic children, they can see their dyslexic child starting to give up, and beginning to withdraw into a shell-like existence.

The dyslexic child begins to question their place in their family; it is almost like they don’t fit in. They begin to question if they were adopted, and many have been known to write ‘help me’ on signs in their bedroom windows, or even run away from home, as they feel trapped by a family that they don’t feel a part of. What does running away achieve? It manifests their anxiety about fitting in. It says to them that it’s better to leave as they don’t fit in, and that their parents and siblings do not understand them. Many keep a packed bag under their beds, even from an age as young as seven, so when the pressure gets too much, they can flee at a moment’s notice. Where do they go? Anywhere, as it must be better than a home that feels more like a prison.


What can be done?

  • Schools need to train teachers to recognise dyslexics in their classes. Research suggests that 20% of all school-aged children will have a learning difficulty at some point in their education, and dyslexia is the single most common difficulty. Seen severely in 5% of schoolchildren and another 5-10% more mildly, that’s at least one to two dyslexic children in each classroom.
  • Teacher training needs to teach recognition of learning difficulties.
  • All teachers are required by the UK government to be qualified to teach all children with special educational needs in their classrooms, but most lack this ability, so additional training is urgently required for them to ‘differentiate’ their lessons effectively.
  • Schools need to identify early and provide specialist teaching to children with special educational needs.
  • Schools need to provide counsellors for children who experience difficulty learning at school, as the emotional effects of failure can lead to social exclusion, depression and self-harm.
  • Teachers need to recognise the avoidance by children, ask themselves why, and act to question if there is a learning difficulty or another barrier to their learning e.g. avoiding reading and writing.
  • Parents need to praise the effort not the end result, and support their children to focus on strengths not weaknesses.


But don’t some dyslexics survive school and succeed in life?

Whilst it is true that some dyslexics do well in life (e.g. Richard Branson, Keira Knightley, Mollie King, Jamie Oliver, Tom Cruise), researching them you hear the same thing. School was hell and they left as soon as possible. They also highlight that they found something they were good at early on, maybe not school subjects such as English, Maths or Science, but vocational skills such as selling, persuading, acting, cooking, art and design, etc. This allowed them to balance the negativity at school with their ability to out shine their peers outside school. Ongoing research in dyslexia and success has found that each successful dyslexic has a ‘chip on their shoulder’ to prove everyone who ever doubted their ability wrong, to prove that they are not ‘stupid and thick’. They are driven by their school failure and humiliation to do well in life. Even returning to school for their own children is hard for them, they can have symptoms of Post-Traumatic Stress Disorder when seeing small chairs, smelling sickly floor cleaner, or seeing drawings pinned up on walls, as theirs were not deemed good enough for presentation.


Dyslexics, unless diagnosed and helped early on in their school career, will suffer from varying levels of emotional pain. Be it low self-esteem, self-doubt; withdrawal or running away from home. It is important to recognise that secondary bad behaviour is commonly covering up for primary difficulties, but most teachers are just satisfied by mislabelling pupils as troublemakers and try to move such needy pupils to a different teacher.


Neil Alexander-Passe is the Head of Learning Support (SENCO) at Mill Hill School in London, UK, as well as being a special needs teacher and researcher. He has taught in mainstream state, independent and special education sector schools, and also several pupil referral units. He specialises in students with dyslexia, emotional and behavioural difficulties, ADHD and autism. Neil has written extensively on the subject of dyslexia and emotional coping and, being dyslexic himself, brings empathy and an alternative perspective to the field. Find out more about Neil’s work here.

Learn more about Dyslexia and Mental Health here.

Read Neil’s other blog post: Dyslexia, self-harm and attempted suicide

Independent Mental Health Advocacy: A glass half full?

Independent Mental Health Advocacy is all about giving a voice to those whose rights have been compromised. Hot on the heels on the release of their new book Independent Mental Health Advocacy – The Right to be Heard, co-authors Karen Newbigging, June Sadd, and Karen Machin explain the role that IMHAs play within mental health services, and the principles and practice of the role.


The Mental Health Act allows for people to be detained in hospital and, in specific circumstances, treated against their will. Changes made in 2007 extended these powers into the community with Community Treatment Orders, with the safeguard of a new statutory role of Independent Mental Health Advocacy (IMHA).

In researching IMHA across England, we heard about its value and how it had helped people get off a section quicker, or negotiate a change in medication or leave.  For some people, it enabled them to feel valued and built their self-confidence so that they could advocate for themselves. For a small number of people, however, it seemed like IMHA services were maintaining the status quo, giving the appearance of protecting individuals’ rights without really changing their situation.

As a team, and perhaps particularly because some of us have experience of being sectioned, we were troubled by this finding.  How could an apparently progressive step for human rights be misused or misinterpreted in this way? This led us to reflect on the grassroots nature of advocacy and how its introduction as a statutory duty could have fundamentally, but not necessarily, altered its nature.

Advocacy has a long and honourable tradition in mental health, where the experience of being detained is profoundly disempowering. Limited choices or inadequate support and treatment from mental health services have raised questions about upholding people’s rights and the availability and quality of care.  Incidents that have involved people at specific risk of discrimination have brought this into sharp focus, including the higher rates of detention of African and African-Caribbean people under the Mental Health Act, the poor treatment of people with learning disabilities and, in extreme circumstances, deaths of detained patients following restraint.

The purpose of IMHAs is to provide a safeguard for people detained under the Mental Health Act and to enable individuals to have a greater say in decisions about their care and treatment.  In this book, we explore this type of advocacy drawing on available research, including our own. We take a critical look at IMHA services, considering their foundational roots and the factors that shape how these are provided and that will have a direct bearing on their impact.

The development of IMHA services has to be understood and evaluated in context and the first part of the book is devoted to this. We start by exploring the disputed terrain of mental health and different perspectives on what this means, the origins of advocacy in the survivor movement and the emergence of IMHA services, borne out of the lengthy and contested process of the reform of the1983 Mental Health Act.

Our individual values, experiences and reading of the research on experiences of compulsion raised questions for us about the fundamental purpose of mental health legislation and its value, pointing to much-needed reform.  Although this research reinforces IMHA as an essential safeguard for protecting rights, the interpretation of the legal framework often privileges negative rights (such as refusing treatment), thus overshadowing more substantive rights (the rights to health and civil and social participation). The second part of the book keeps the latter focus in mind, as we discuss how IMHA services should be commissioned and provided, and the skills that IMHAs need to enable an individual to self-advocate, and mental health services to listen.

Access to IMHA services is still problematic and people who might need this form of advocacy the most are often the least likely to have access. We consider how well IMHA services are being commissioned and provided so that they are available and suitable for everyone, such that they take account of prior experiences of discrimination and how these can be reproduced through the mental health system, reinforced by legislation and in advocacy provision.

The relationship between advocates and mental health professionals should be unsettling and can be fraught for various reasons, including a lack of appreciation of the advocacy role and a professional assumption that they are best placed to be the person’s advocate.  Nonetheless, this can also work well, and we identify a framework for understanding such tensions and possibilities for constructive working relations.

It for these reasons that we conclude by looking at the future of advocacy, as a glass half-full/half-empty scenario. This deliberately evokes the paradox described by Peter Campbell (2009:51) that although the right to advocacy is ‘partly recognized, service user influence over its provision is diminishing’. Readers will decide for themselves whether this is a glass half full or half empty!

We have found that the process of coming together and co-writing this book has been a really rich one. We brought different perspectives and experiences to the task and hope that this has resulted in a penetrating analysis of IMHA that both highlight the complexities and suggest some ways in which these can be thought about and addressed. We hope that our book will contribute to shaping future development so that, ultimately, people detained under the Mental Health Act really do have a say, and that their rights, beyond the narrow confines of the Act, are promoted.

Karen Newbigging is a Senior Lecturer at the Health Services Management Centre, University of Birmingham and is active in advocacy research and development. June Sadd, an independent survivor consultant, educator and researcher, draws on her personal experience of the psychiatric system in her work. Karen Machin works freelance in mental health from a perspective of lived experience. Learn more about Independent Mental Health Advocacy – The Right to Be Heard.


How to support grieving college students – Part 2

Between 35% and 48% of college students have lost a family member or close friend within the last two years. Grieving college students can often feel isolated and vulnerable, and may feel that no one else ‘gets’ what they are going through. In the second part of this two-part post, co-author of We Get It, Heather Servaty-Seib talks about the book and how it can be used as a tool to support grieving college students.


We Get It is the product of the power and compassion of 33 resilient grieving young adults who took the risk in sharing their stories with others.  As the authors/editors, David and I were honored to receive their stories and to organize them in a way that we thought would be most useful and helpful to others.  As David noted in the prior blog entry, our primary audience of focus is grieving college students and young adults.  We want them to know, through reading these stories, that they are definitely not alone and that in many cases they will find their own thoughts and concerns in print in the narratives of their grieving peers.

As someone passionate about supporting grieving individuals, and who dedicates the majority of her academic and clinical efforts to encouraging and empowering young people in their grief journeys, I have always wanted to assemble a resource for grieving college students. But, over time, I realized that grieving college students did not want or need a book that I, as a counseling psychologist and professor, would write for them! Rather, what students and young adults need is to hear the stories of their peers and to know that they are not the only ones who feel/felt torn, lost, transformed, newly determined about life, etc. I believe this book will make a true difference, and I am proud of David and every single young adult who contributed to this volume.

In addition to reaching out to grieving individuals, this book was also written to offer guidance to those who want to support grieving college students and young adults, including family members, friends, counselors, professors, or university staff members. Reading the stories included here can provide helpful insights into the unique and dynamic nature of grief. If you are someone who is seeking to be a supportive presence in the life of a grieving young adult, we hope you will consider reading our book and that you will leave wiser and better able to acknowledge, normalize, and facilitate the grief of these young adults.

David and I want to express our sincere appreciation to supportive others who decide to read We Get It. You have taken a significant step in making a difference in improving the experience of grief for young adults. By reading the narratives in this book and considering the reflection questions, we hope that you will be able to offer the high quality support that you wish to provide. We know it will mean a great deal to the grieving college students and/or young adults they seek to support.

In the final chapter of the book, we actually provide a list of suggestions for those who seek to offer support to grieving college students and young adults (e.g., non-grieving peers, parents, counselors). We separated the chapter into general tips for supporters and a few additional specific tips for parents, non-grieving peers, counselors, college personnel and professors, and support group leaders. We provide a brief description of each suggestion followed by quotes from the authors to help illustrate the “lived” experience of each of these ideas. These suggestions are tips that grieving students themselves have offered. Some of these suggestions were reported by many, whereas others were only noted by a few. We encourage you to view these ideas as possibilities and be sure to personally evaluate how well each may or may not fit for you.

Again, although our primary focus is on getting We Get It into the hands of grieving college students and adults, we definitely believe that the book can offer real and practical guidance to family members, friends, counselors, professors, or university staff members. You will truly be amazed by the candor, depth of insight, and eloquence of the 33 young adults who share their stories in We Get It.

Heather L. Servaty-Seib, Ph.D., is a counseling psychologist. She is currently a professor in the Counseling Psychology Doctoral Program in the Department of Educational Studies at Purdue University, US. Dr. Servaty-Seib also maintains a small, grief-focused private practice. She is well-published in the areas of adolescent and young adult grief, social support and grief, and she is a past president of the Association for Death Education and Counseling. Much of her recent scholarship has been focused in the area of student bereavement, with articles published in both The Counselling Psychologist and Death Studies. Dr. Servaty-Seib was heavily involved in implementing a bereavement leave policy for students at Purdue University, an effort which has set a precedent for other campuses. She lives in Lafayette, IN.

Learn more about We Get It.

Read part one of this blog post.

How to support grieving college students – Part 1

Between 35% and 48% of college students have lost a family member or close friend within the last two years. Grieving college students and young adults can often feel isolated and vulnerable, and may feel that no one else ‘gets’ what they are going through. In the first part of this two-part post, co-author of We Get It, David Fajgenbaum says in his own words how he aims to provide guidance and support for bereaved students and young adults.


Losing a loved one at any age is difficult. But there are certain things about college and young adulthood that can make it a particularly difficult time to grieve. We’re often away from home for the first time and/or at college. We’re going through an intense period of personal and professional development. We’re swamped with assignments or work tasks. We’re often geographically far from our ill or grieving loved ones. We’re supposed to have the “best four years of our lives” and be worry free. Despite having other grieving young adults all around us (one out of three college students reports grieving in the last year), we can and often do feel completely alone and believe that there is no one around us who “gets” what we are going through.

We get it. These are some of the reasons that Heather and I have dedicated much of our lives to helping grieving college students and young adults. Heather has published bereavement research, advocated for young adult grievers as the President of the Association for Death Education & Counseling, and helped to establish one of the only student bereavement leave policies in the nation on her campus at Purdue University. I established a peer-led grief support group at Georgetown University after my mom died, grew the organization into a national movement (AMF) that has reached 3,000+ grieving students on 200+ campuses, and helped to propel college student grief to become a priority issue in higher education in the United States.

But four years ago, Heather and I connected over our mutual concern for all of the students not being reached by my nonprofit and not benefiting from Heather’s research and outreach. We had seen the impact that can be made on a griever’s life when they receive the support they desperately need, and we knew there were many more around the world in need of support and of connection with others who “get it.” Some individuals are able to find and connect with those with similar experiences of loss, whereas others are never able.

We assembled a book of autobiographical narratives written by 33 grieving college students and young adults for grieving college students and young adults. We believe these narratives can give readers a voice and the courage to share their grief experiences with others. We have discovered that one of the most powerful experiences for grieving individuals is to hear even a small element of their own experience being expressed by another. We wanted to make this experience possible for all, regardless of their access to others with similar experiences.

This book provides a window into the many grief reactions and mourning approaches of 33 grieving students and young adults. These young adults contributed their stories to this book to make a difference in the lives of future grieving students through sharing their stories–through showing that they “get it.” Rather than providing a prescription for how grief should be done, they genuinely describe the thoughts, feelings, and behaviors they experienced throughout their grief journeys. The power of this book is in the candid, engaging, and heartfelt sharing contained in these stories. We have offered the whole narratives, organized them based on themes, and provided commentary and reflection questions at the end of each chapter to help grievers to keep actively moving forward. We are so grateful for their beautifully-written stories.

If you are a grieving college student or young adult, we hope our book will be helpful for you and that you will find multiple points of connection as you read. This book was also written to offer guidance to those who want to support grieving college students and young adults, including family members, friends, counselors, professors, or university staff members. If you fall into this group, we hope that this book will provide helpful insights into the unique and dynamic nature of grief.

I’d like to close by sharing some of the lessons I’ve learned through my own grieving process and work:

First, helping others through support and community service has been very therapeutic for me , and I’ve heard this from many of our AMF members. The community service component is a particularly helpful way to get guys, like myself, to confront some of their emotions – through actively doing something. Along the same lines, I also get tremendous therapeutic benefit from dedicating my life to fighting cancer. Second, the power of peer support and being able to speak with others who “get it” cannot be underestimated; my support group at Georgetown was my lifeline. Third, we all express our emotions differently, so it is essential that we encourage people struggling with grief to express their emotions in whatever way is most helpful for them. Fourth, even though it has been over 10 years, I still miss my mom and wish that she were still here. But the sadness and intensity has certainly decreased over the years, so that I’m able to integrate my memories and the lessons she taught me to be able to actively move forward.

David C. Fajgenbaum, M.D., MSc, is a Research Assistant Professor of Medicine in the Division of Hematology/Oncology at the University of Pennsylvania and the co-founder of the National Students of AMF Support Network, a non-profit organisation dedicated to supporting college students grieving the illness or death of a loved one. Dr. Fajgenbaum co-founded the organization in 2006 in memory of his mother, Anne Marie Fajgenbaum (AMF). The organization is now a national movement that has supported 3,000+ students on 200+ campuses and raised national awareness about college student grief. AMF now stands for “Actively Moving Forward.” David has been profiled on Forbes Magazine’s 30 Under 30 list, the Today Show, Reader’s Digest, and 40 million bags of Doritos.  David received his BS from Georgetown University, his MSc in Public Health from Oxford University, his MD from the University of Pennsylvania, and his MBA from The Wharton School of Business. Dr. Fajgenbaum lives in Philadelphia, PA.

Learn more about We Get It.

Read part two of this blog post.

Can children be depressed?

It may be hard to believe that children can experience depression at a very young age, but as the NHS explains, “10% of children in Great Britain aged between 5 and 16 have a mental health problem, with 4% of children suffering from an emotional disorder such as anxiety or depression.” Lloyd Jones, author of The Princess and the Fog, shares his personal experience with depression as a child and adult, and explains how he learned to cope through his art.

This content was originally posted on Lloyd’s blog.


‘Depression has been something of a running theme in my illustration work for a long time and The Princess and the Fog is obviously no exception. It is a subject that is very  near and dear to my heart as I’ve personally suffered from depression for most of my life.

I first felt as though I had a tendency towards depression when I was a child. I had only a cursory understanding of what it was – namely that it made you feel tired and sad and disinterested in things much of the time – which I felt described me, but I didn’t really know what it MEANT to be depressed or what one was supposed to do about it. I remember I confided in an adult – a family member, I won’t say whom – for some advice. “I think I’m depressed,” I admitted. “What have you got to be depressed about?” they replied, fairly astounded. And that was the end of the discussion. I suddenly felt as though I hadn’t earned the right to be depressed. I was just a kid. I didn’t have anything to be depressed about. I suddenly felt so embarrassed and so intensely alone. I don’t really remember what happened after that but I know that for a long time I wasn’t able to talk to anybody about it again.

It wasn’t until I was 21, in the second year of my BA, that I was first officially diagnosed with depression and put on fluoxetine. Suddenly I was allowed to be depressed. It was okay to talk about it and there were pamphlets and medicines and all sorts of things I was allowed to know about. I had had some experiences in college with herbal remedies and counselling that only seemed to be taken semi-seriously and didn’t really do much for me but this was the real deal. Depression as a theme started seeping into my illustration work as something I finally understood enough to be able to communicate. Projects like the Short Term Diaries of the first year of my MA gained some popularity as an alternative therapeutic tool, and I seemed to reach a lot of people with my short graphic memoir zine There’s A Hole In My Chest and its follow-up There’s a Hole In Your Chest. I was meeting and communicating to increasingly more people who felt the way I did.


Excerpt from ‘There’s A Hole In My Chest’

For the second year of my MA I wanted to do something different, having felt a bit stifled by the Short Term Diaries towards the end of the project. I liked the responses I got to my Hole in Chest books so I thought it might be a good idea to keep the same theme rolling. Writing and illustrating a picture book had been on my bucket list for a while so I thought I’d give it a try.

When I began writing the story I had to do a lot of research into childhood depression to make sure I tackled the subject responsibly and respectfully, and to make sure I got my facts straight. I discovered after struggling to find much that childhood depression was still a relatively new concept and that up until recently it was believed that children could not become depressed. Suddenly I had a bit more context for the loneliness I had felt as a child. There were hardly any books for children with depression out there. There were dozens of books and pamphlets and cartoons and other media for children living with just about any other mental illness you could think of, but not depression. I realised that if I made one, it could actually be really important to someone. A year and a half of working on it later, and here we are.

If I had had a book like The Princess and the Fog when I was a child, I wonder how different things would have been. If I’d known that I wasn’t the only person out there feeling this way, I can’t help but think I might have felt a lot less isolated and desperate, and  perhaps because of that I would have had a better understanding of how to deal with it. That was the book I tried to create. If The Princess and the Fog helps even one kid out there feel like they don’t need an excuse to be depressed, that there’s somebody else out there who’s been through the same thing and survived, and that they can do the same, then I’ll have done my job and I’ll be happy.

Lloyd Jones lives in the south of England. Lloyd has a first class honours degree in Illustration from the University of Portsmouth, an MA in Sequential Design and Illustration from the University of Brighton and he is currently working on a PGCE FE from the University of Southampton. He has learned to live with his fog, rather than suffer from it. Learn more about The Princess and the Fog

Find out more about depression and anxiety in children here.


Goodreads Book Giveaway

The Princess and the Fog by Lloyd Jones

The Princess and the Fog

by Lloyd Jones

Giveaway ends August 19, 2015.

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Six steps to finding balance in busy lives

It is important to know that life imbalance is one of the biggest causes of stress in the western world; consequently understanding why we experience imbalance in our modern lives, and finding strategies to help you overcome it, is very useful! Teena Clouston shares 6 steps to finding balance in busy lives from her new book Challenging Stress, Burnout and Rust-out.


So what is burnout and rust-out?

Burnout and rust-out are caused by long-term stress; burnout is marked by exhaustion and rust-out by apathy and disengagement. Which of these we experience and when, is variable, dependent on the unique individual and his or her circumstances. Stress and imbalance can be linked to some specific personality traits and thinking patterns that we can unconsciously adopt to manage the daily grind but which, unwittingly, can maintain our state of imbalance and levels of stress.  For example, people who rush around like busy bees, or those that put up with or make excuses for their busyness and overwork are all using different strategies to deal with life conflicts, pressures and time scarcity, but sadly, are failing to diminish stress. Alternatively those that fight back and overcome these pressures seem to be able to live a far more balanced and healthy life because they dare to challenge the status quo and take time to do things they find meaningful or enjoy doing, irrespective of the pressures of work or general over-busyness.

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Resistance is not futile


6 steps to achieve a healthy work-life balance

There are several different ideas shared in the book but if I had to choose 6 they would be:

  • Gain some autonomy over your workload
  • Review and adapt your views and attitudes about work so they become congruent with what you really want in life
  • Share your daily responsibilities with others
  • Do something meaningful everyday
  • Live in the moment
  • Walk in nature

These techniques are not a cure-all in terms of work-life or indeed, more general life balance. That’s because, in reality, they all need you to put in a lot of effort in terms of making changes in how you live your life everyday, and that is not easy. For example, if you are going to use mindfulness techniques to try to focus on the moment or cognitive behavioural strategies to change your thinking or attitudes about life balance, then you have to practice that regularly and put some work in every day. That said, you do need to start somewhere and from small moves big things can grow and consequently, with practice, you can really change your sense of balance, your quality of life and ultimately, your well-being; thus practice may not make perfect, as the saying goes,  but it can make life just a little richer and more satisfying.

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Illustrations by Peter Cronin, ARSMA.

Teena J. Clouston is a Reader in Occupational Therapy and Life Balance at the School of Healthcare Sciences at Cardiff University, UK. Over the last ten years, her research interests have become focused on the meaning and experience of lifestyle balance, and her PhD specifically studied the influences of paid work on finding balance in everyday life. Learn more about Challenging Stress, Burnout and Rust-out here.

Teach your Child How to Fight Anxiety

Natasha Daniels is a child therapist  and has worked with young children and their families for over 15 years. Her book, How to Parent Your Anxious Toddler, covers everything parents of an anxious toddler need to know, to help them tackle everyday difficulties and build up their child’s resilience, independence, and coping mechanisms. In this post she shares some advice on helping your child to fight anxious feelings.  

Teach your Child How to Fight Anxiety….and be a Super Hero!
Teaching your child how to fight anxiety can start at a very young age. I have worked with children as young as two and three that were able to learn skills on how to face their fears. So, roll up your sleeves and start arming your child with skills to overcome their anxiety. It is never too early to turn your little one into a superhero!

How to Parent Your Anxious Toddler - cover image


Set the Battle Ground
Have your child name their worries. Sometimes this will just be Mr. Worry, but you can pick something more specific based on your child’s fears (Mr. Bossy, Mr. Bugs, Mr. Scared, Mr. Sick etc.). Tell them that Mr. Scared likes to boss kids around and make them fearful. Have them create a worthy superhero to fight off Mr. Scared. I like to use the child’s name with Super in front of it (Super John, Super Amber, etc.). Have them draw a picture of Mr. Scared and of their superhero. Prompt them to make the superhero look like them in some way.

Dress the Superhero
Children love dress up and there is something transforming when one is dressed as a superhero. Have your child pick out a superhero costume that they can wear when they are a fighting Mr. Scared. A cape and a mask are always good places to start. If they have a particular superhero that they love – have them dress up as that instead.

Give them the back story
Set the stage for your child by giving them their superhero story. Incorporate your child’s fears into the story. Their story might go something like:

There once was a mean, bossy guy named Mr. Scared. Mr. Scared liked to go around bullying kids and making them feel scared. Every time Mr. Scared was able to make a kid feel scared, he would grow bigger. Super John wasn’t going to let Mr. Scared grow any bigger! When Mr. Scared started telling him to be scared of the dark, Super John didn’t listen to him! He knew he could turn on the lights.

Put on Your Game Face
In my house we have a “Brave Face” pose. Whenever anyone is scared to do something – we say, “Brave face!” and we all put our heads up high and proud. Sometimes duck lips are included. Sometimes it is a full superhero pose – arms on hips, chest pushed out. It is a nice way to empower each other and it encourages us to fight through our fears. At the very least, it lightens the mood and makes us all laugh.


Verbally encourage your superhero
Having your child dressed and feeling empowered is only half the battle. Now they will need actual experiences to challenge and fight Mr. Scared. You want to encourage your child’s independence by giving them the least amount of assistance they need during these challenges. First start by giving them verbal support. You can say things like, “Don’t let Mr. Scared win this battle! Where is Super John? Do you need to get your cape on? Show me the Brave face!!”

Give suggestions to your superhero
Give your superhero some suggestions. You can say, “I know it seems dark upstairs, but there is a light switch right there you can turn on.” Or another suggestion might be something like, “We can sing together as you go upstairs so you know I am still right here.”

Offer limited support to your superhero
When your superhero is lacking some any superpowers – it may be time to call in for back up. The main goal is for your child to feel success, so if you have come to the conclusion that Mr. Scared is definitely going to win the battle, get your kiddo’s back! Offer the least amount of intervention as possible. This might be turning the light on for them or walking half way up the stairs with them. Always premise your assistance with something like, “Okay Super John I will make you a deal. I will turn on the light for you if you do the rest” or “I will go up the first flight of stairs, if you go up the rest.” Getting your child to agree on a plan makes it more likely that they will stick with it…sometimes. If that doesn’t work – pleading helps – “Don’t let Mr. Scared win! I know you can beat him!”

Okay, if all else fails, bribe your superhero!
I know that if someone told me to jump off a high dive there would very little that anyone could say to get me to do it. However, if the price was right – I might be encouraged to face my fears and try to do it. When all else fails offer a “challenge prize.” I will often have families set up a “challenge treasure box” that is filled with dollar store toys and prizes. When your child is faced with a particularly hard challenge, you can offer a challenge prize if they try to do it. You want your child to push themselves just slightly out of their comfort zone. If they are able to do this, but don’t fully complete the challenge you can say, “You were amazing! I know that was scary for you, but you went ahead anyway and tried to do it! You get a challenge prize for being so brave!”

Children don’t turn into superheroes overnight, but if you don’t give your child the skills to fight their fears, they have lost the battle before it has even begun.

This post was originally published on Natasha’s blog: 

Find out about Natasha’s book How to Parent Your Anxious Toddler, read reviews or order your copy here