From the Inside Looking Out: An Interview with Mental Health Nurse Grace Blackford
So tell me Grace, what’s your background in the healthcare industry?
Yeah, so I began my journey into the health industry by studying a Bachelor of Nursing at Massey University in Palmerston North. After doing the standard theoretical coursework for a year, I had my first mental health placement in my second year, which was at a rehabilitation centre for people with chronic schizophrenia. It brightened my eyes to see the reality of the world’s mental health issues first hand. I found it very interesting that people can have the same diagnosis (e.g. schizophrenia), but the treatment and way you deal with the illness is entirely different from person to person.
Ever since that point, I knew I wanted to go down the mental health route for my career. The particular reasoning for my decision being that it isn’t like any other area of nursing because it’s so varied. In any other field of nursing or to a degree health in general, it’s a systematic approach. For example, if a patient is admitted to the hospital for a broken bone, the same exact methodology is used to address the situation because we understand exactly how to treat it. Whereas we’re still yet to unlock the golden method for treating the mind, due to the individual specific nature of the illnesses.
In my third year placement, I was working with adolescent children, dealing with a variety of different mental illnesses. It was a respite health centre, which is essentially a resting place for the children, allowing them to take a break away from everyday life. It also gives the normal support workers a break too.
After completing my degree I continued to do postgraduate study in Wellington to attain a Certificate in Mental Health Nursing. I am currently working in the Hawke's Bay Acute Psychiatric Inpatient Unit, and have full intention to pursue my Masters in Mental Health Nursing. Sorry, that was quite the life story! [Laughs].
As a professional working directly in the industry, what do you feel are some of the big misconceptions within the healthcare industry and mental illness itself.
I’d have to say, my biggest pet peeve is how people react when they see someone walking down the street acting odd, and the way they use slang terms for mental health such as ‘schitzo’ or ‘psycho’ to describe their behaviour. Throwing out diagnoses nonchalantly without actually understanding the full meaning of those terms. It does nothing but further increases the stigma associated with mental health when you use those terms to enact a negative connotation.
For example calling someone bipolar when someone is acting hot and cold with their emotions. Even if it’s used simply among friends in a light-hearted manner, you don’t understand the ramifications that may have for other people hearing it, such as third-party bystanders. Imagine the feeling that elicits when parents who have a child with bipolar disorder hear that being thrown around. You’re exiling innocent individuals from being taken seriously or treated in the same manner as any other human being. Using these slang terms in a negative aspect is not helping the situation. People with a mental illness aspire to live a normal life just like you or me, but they have to work harder to achieve this, and it gets even more difficult when the general public interprets them by their illness rather than by their personality.
Another big misconception is people’s perception on medication as a treatment for mental illness. There are particularly two significant opinions on the matter. One is that people will make the assumption that a patient will need to simply take the pills to be healthy, and the other being they don’t need to take any medication at all, they just think it’s as easy as cleaning up your diet, exercising etc. Unfortunately, it’s not that black and white, and so there are situations where medication is essential. Again the most prominent element in this debate is that in reality, it’s entirely individual – some people will need that medication to keep them on a balance that will help push them through. In situations when a patient is acutely elevated, medication can be administered to help get them out of a manic episode.
Also, the majority of people don’t have enough insight to understand that the stigmatised ‘zombie’ like state in which patients get induced into is in most cases used for a short-term period in order to have a long-term gain. If we continue to use bipolar as an example, medication is used to stabilise an individual's mood, and so yes they may become a zombie in comparison to their normal state, but in the long term, they’ll be able to slowly adjust once their body is used to the levels.
It really can’t be said enough about the absolute importance medication plays in mental illness. Majority of patients will be under medicated, with a minority proportion being over medicated. What people see from the outside looking in are the extreme cases where it hasn’t necessarily been beneficial for the individual to take that amount of medication or a particular medication. However, just like any industry you have outliers and people's perception is unfortunately based upon that with regards to mental health.
Dealing with an illness that affects the mind is very difficult. If it were easy, we wouldn’t have these types of stories or issues arising over medication. Much like the news, you typically only hear the bad, you don’t hear the heartfelt stories where medication has enabled an individual to change their life for the better.
What would be your advice to a person that may be dealing with an underlying mental health issue?
First and foremost, I would advise them to go and see someone so that they can give you an opinion on what it may be. Regarding who that person would be, I’d suggest starting with your local GP, as they can lead you in the right direction if the situation warrants the necessity for further action to be taken. In more extreme circumstances, there’s also a local DHB Mental Health Crisis Team (CATT Team) that will come out to see and assess you.
Finally, I think it’s crucial for people to be open about it because we need to reduce the stigma around mental illness. One in every six people in New Zealand experience a mental disorder at some point in their life, so why don’t we hear about it? Communication is key, not only for awareness, but it will also give more resources to that area of health because more people are opening up about it and thus can be treated accordingly. If you merely think about sadness as a temporary feeling, so you don’t bother speaking about it may cause it to build further and create a snowball effect for an even more significant mental episode down the line. Whereas talking about it allows you see it for what it is. See it as a depressive episode, as opposed to being depressed. This generates more hope that it’s something you can change and build from, as opposed to being that depressed person as your life.
Unfortunately, not everyone wants to bring up their issues/emotions, so what are some signs or red flags that others can take notice of to suggest a friend or family member may be having problems in mental health?
- Becoming more withdrawn or isolated (from friends and family etc.). People will generally become more in their own mind, as opposed to operating externally.
- More sick days, or missing practice, not exercising, etc.
- A reduction in self-care – becoming more unhygienic (e.g. not showering, not brushing their teeth, etc.)
- Overeating OR undereating. Essentially any unintentional change in diet.
- A general lack of motivation.
- Anhedonia - an inability to enjoy things.
- Sleeping more OR sleeping less – a change in regular sleeping patterns.
And so what would your advice be to friends/family that may have someone they know dealing with mental illness?
- Know your friends and family’s normal behaviour – so that you can understand irregular activity and act accordingly. Understand their routine. Pay attention to changes in behaviour.
- Be more open about it. Don’t be afraid to check up on people regularly.
- Ask questions, but try and stay away from the generic sentences. ‘Hi, how are you?’ is a loaded question. A person gets asked that regularly each day so they’re not exactly going to open up when hearing it, they’ll be more likely give you a generic response. This loaded question needs to be actually answered more openly. However, if you ask it in a more specific manner by giving it some context, it can help disarm the individual into opening up about what’s really on their mind.
What’s your opinion on drug abuse being perceived as a criminal offence, as opposed to a health issue?
From my perspective, I fully believe that it is a health issue and thus shouldn’t be treated as a criminal offence. Purely because it’s an addiction, you don’t throw people in jail for being an alcoholic or being addicted to cigarettes. Therefore, why do we do it for meth or cannabis addicts?
Furthermore, if someone has an addiction and has committed an offence to fuel that addiction, why throw them in jail where they will come out six months later and commit the same offence. Punishing users in a criminal aspect isn’t correcting the issue, it’s merely delaying society from having those acts being repeated by the same individuals.
I think that addictions to illicit substances should be treated in the same manner as any other addiction, such as alcohol and cigarettes, whereby they receive support with rehabilitation as opposed to living in a cell surrounded by a bad environment.
What do you think is the most significant issue in society that is triggering an onset of mental health problems?
Trauma – from sexual molestation, abusive relationships, etc. People develop hallucinations unknowingly as a coping mechanism, and so this can stem to onset schizophrenia. Poverty is also traumatising. By not being able to educate and have good wellbeing means that people aren’t able to be insightful enough to see the warning signs of their thoughts and actions. People need to be able to recognise the difference between wellness and illness. You don’t know what you don't know.
Do you see trends with the patients you treat?
- Lack of insight
- Lack of judgement
- An inability to make healthy decisions when they’re so impaired. This happens due to the individual not having that insight or sense of judgement to recognise the illness earlier.
How do you think we can further awareness for mental health?
We’ve made good traction in the past few years in regards to trying to educate the public on mental illness. For example, the adverts regarding dealing with depression featuring Sir John Kirwan. This enabled the public to get a better understanding that the illness can affect anyone, regardless of their situation.
I’ve already said this a couple of times, but I can’t stress this enough that one of the best ways to promote mental health awareness is by being open. It’s okay to have a psychotic episode after dealing with an extreme situation. When people are actually talking about what’s happening to them, then it naturally creates awareness.
It would be good to see further public advertising for other areas of mental health, such as bipolar disorder, schizophrenia, etc. Seeing that on TV won’t necessarily decrease the amount of people in society dealing with the illnesses, but it will enable the general population to have a better understanding on how to deal with those who do have it, and it will also less stigmatise the illnesses.
If we were taught more about mental illness in schools we would be able to develop insight and coping strategies at a younger age and thus catch mental illness earlier before it becomes debilitating, which would mean dealing with fewer issues in adult life. Also, if education around mental illness was taught in school, it would further assist in the reduction of the stigma surrounding the topic.
What are some ideas that you think the government could implement to further mental health treatment?
Need more resources, the majority of hospitals are understaffed. Our ward in the Hawke’s Bay hospital is for acute mental illness, meaning that we deal with the most severe cases, but due to a lack of resources, we also put people with addiction, and people who are underage all in the same area. This puts the patient in an environment that's not going to generate the best health outcome, as they are areas that the staff are simply not specialised in.
Whereas, Wellington has an opioid substitute treatment team that deals specifically with that part of addiction. They also have the Rangitahi unit which deals with mental illnesses affecting children and youths.
It all comes down to the allocation of resources. Why is healthcare not more of a priority? I understand that there is a number of factors to take into consideration with regards to how the country is run, but at the same point I can’t help but think why aren’t we looking after our own citizens?
I couldn’t agree more. I really appreciate your time and thoughts on all of these topics, thank you Grace. Lastly, before we finish up this interview, have you got any recommendations on reading or learning material for people that would be interested in delving further into mental health?
For sure, I’d recommend reading the Mental Health Act – while that doesn’t sound exciting, it’s vital as it describes why we need medication, mental health wards etc. It’s also very beneficial to learn as you can use the Mental Health Act to get someone you know the help they need at a much faster pace.
In terms of books, Girl, Interrupted by Susanna Kaysen is a very compelling read which describes her experiences as a young woman in a psychiatric hospital in the 1960s after being diagnosed with borderline personality disorder. It gives you a greater understanding into the mind of someone dealing with a mental illness.
Also, look for movies about mental illness, such as A Beautiful Mind with Russell Crowe. However, like anything, you need to accept that how we deliver care has changed from when a movie was made or when a book was written. But again, it gives a perspective of the illness and the individual. In particular, reading books can allow you to get into the mind of the person when reading their thoughts.
The Mental Health Foundation’s list of recommended helplines is below. All services are available 24/7.
Need to talk? – 1737. Free call or text 1737 to talk to a trained counsellor, anytime.
Lifeline – 0800 543 354 (0800 LIFELINE)
Samaritans – 0800 726 666
Youthline – 0800 376 633. Free text 234 or email firstname.lastname@example.org
Healthline – 0800 611 116
For more detail, visit the Mental Health Foundation’s website: https://www.mentalhealth.org.nz/get-help/in-crisis/