Knowing when you need extra help is a crucial part of self-care, although it can be difficult.
Learning to recognise when a worsening of symptoms becomes a need for extra help and support is vital for long-term mental health management. However, it can also feel like admitting failure. When your symptoms have improved, a decline in your mental health can feel like it’s your fault — that you have done something wrong which has caused your symptoms to get worse.
Everything feels darker and you are trapped into the “old” pattern of mental illness you thought you had come through.
The logical part of your mind knows this is wrong and nobody is to blame for their mental health problems, but the messed-up parts of your mind constantly tell you the same old myths: it’s your fault, you fucked up, you are doomed to be miserable forever.
You may try to ignore the situation, but it’s important to get help sooner rather than later.
I speak from experience. Over the past 3/4 months, my mental health has declined. This came after a fantastic summer during which I did things that were previously impossible for me (going to jive classes, for example) and felt well enough to stop taking medication after over a decade.
I came up with excuses for not going to my GP: I was stressed out because major renovations had turned my home (and life) upside down. I felt more depressed because I had been hit with one virus after another. These excuses were true, but my assumption that things would go back to normal when the workmen left and I regained my physical health were not.
I wasn’t coping and by delaying getting help, I suffered more and my mental health got worse.
I finally went to my GP on Monday. He is referring me to an organisation which offers counselling, which I believe will be most beneficial for me right now. I told him I would prefer not to go back on antidepressants at the moment, but I would never rule them out as a possible treatment. He was brilliant and accepted my insight into my own mental health — I had been a little wary of feeling pressured to take medication again without trying counselling on its own first, but that turned out not to be an issue.
If you aren’t so lucky and your GP pressures you to try a course of treatment which you feel isn’t right for you, remember you are entitled to a second opinion. However, it’s also worth examining your reluctance to follow the suggested course of treatment — some people resist medication, for instance, because they believe myths perpetuated by the media. Do some research, always asking whether your sources have an agenda which is at odds to your wellbeing, and make an informed decision.
Self-intervention, like self-care, is different for everyone.
For me, self-intervention was about recognising that I needed professional help and would benefit from counselling, which I hope I will receive. For other people, it might mean enlisting the support of family or friends, altering their lifestyle or adopting more self-care strategies. It could mean something entirely different, which I might not consider.
It’s about recognising when your mental health has dipped enough that you need extra strategies in place to prevent it from getting worse.
Ideally, this will lead to an improvement of symptoms, but the initial reason for self-intervention is to stop the situation declining further. The signs that you have reached this point vary depending on your recent mental health history and self-knowledge. Symptoms which may not concern one person, may be very worrying to another.
For example, I wasn’t concerned by a slight increase in my depression, because I know it gets worse in winter. However, while my low mood was normal for me, the increase in anxiety to the point where I was having panic attacks more often is a red flag. For someone else, the increase in depression could be a red flag whereas if they were already regularly experiencing panic attacks (as I did in the past), an increase in their frequency might be considered a small change.
Knowing your red flags is important in managing your mental health.
If you don’t have a high level of self-knowledge and self-awareness, keeping a record of your symptoms is helpful. I try to do this when my mental health problems get worse because whereas I normally have a high degree of self-awareness, this gets skewed by anxiety and depression: I tend to think things are fine until they get so bad I can’t deny it any longer. By keeping notes on my mental health, I could have noticed the worsening of symptoms before things got so bad.
Like so many things related to mental health, this is easier said than done, but keeping even a rudimentary record of symptoms can be useful.
Self-intervention is needed because many mental health symptoms aren’t noticed by other people.
There are plenty of reasons why other people might not recognise your symptoms worsening:
• A lot of symptoms are internal. Negative thinking, headaches, low mood, etc. aren’t always apparent on the outside, especially if they are not expressed.
• It can be difficult to distinguish when an already-present symptom is getting worse. If someone knows you experience a specific symptom, such as feeling nervous around other people, they may think all signs of this are normal for you and can’t tell when it’s worse or better.
• Nobody is with you 100% of the time. Many symptoms are most apparent when you are alone and many may not seem concerning when glimpsed by someone who doesn’t realise how frequent they are. Under-eating or over-eating, for example, are often secretive behaviours and might not worry people who only see you displaying the behaviour over a limited period of time, such as your working hours. They don’t know whether this continues when you get home, or whether these behaviours are balanced out by other ones.
• People might not know if something is a symptom of mental illness. There is a lot of ignorance around mental health and some symptoms might seem unconcerning to people who consider them merely quirks. Some symptoms might be considered normal by some people, such as dismissing a persistently low mood as pessimism or chronic under-eating as a low appetite.
Even if other people do realise your mental health is deteriorating, they might not know how to tell you.
They may assume you already realise or that you would feel uncomfortable if they brought it up. They might tell themselves it’s none of their business or that you might get better without their intervention. These assumptions may or may not be correct — the point is that you cannot rely on someone else to recognise your red flags and tell you to get help.
This means you have to make an effort to recognise your own red flags early, so that you can take action and get the help you need.
It’s better to plan self-intervention before it’s needed.
When you are relatively well, it’s the best time to make decisions abot what to do if your mental health declines. Don’t wait until worsening symptoms cloud your judgement.
I wish I had a clear plan in place. It would have made things easier and enabled me to get help sooner.
I had some vague ideas about what it would take for me to go back to my GP, but nothing written down. There was no list I could refer to, which would probably have convinced me to see the doctor when my symptoms got worse, rather than a few months later. This is something I plan to change.
While so much of self-managing your mental health is about focusing on positive change, having contingency plans is essential. If you have close friends and family members you trust, you can ask them to help. For example, you may ask them to flag up when you are displaying certain symptoms, such as withdrawing from social events. You can also indicate the kinds of treatment you would prefer in various situations, so they can help you get the treatment which is best for you.
I wish my mental health had continued its upward trajectory, but it hasn’t and self-intervention was necessary to prevent my health from deteriorating further. It’s a potent reminder that mental illness is not linear and for many of us, self-care involves preparing for episodes of worse mental health — perhaps for the rest of our lives.