Wednesday, 22 May 2019

Breakdown: A Clinician's Experience in a Broken System of Emergency Psychiatry

By Lynn Nanos

The police found Owen, twenty-nine years old with untreated bipolar disorder with psychotic features, refusing to get off the road where he impeded traffic. Instead of arresting him, they escorted him to emergency services.

He gets readmitted to emergency services countless times within just a couple of months. His mother, Martha, tells me that he’s not been functioning at his baseline for the last four years. He started college, but now has no employment, no money, no friend, and no home.

Excerpt from Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry:

Owen’s chief demands of me include an apartment, money, food, and a photocopy of the entire Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). His rapid speech, restless body movements, inability to listen and concentrate, verboseness, and expansive affect are like what I previously witnessed. His outer physical appearance is like his appearance the previous times I saw him. However, I observe a more intensified level of torment radiating from his thinking and behaviors. He appears more out of touch with reality than ever before. He is mindlessly repeating my words, a behavior called echolalia.

His agitation increases as I write. He then demands that I read to him everything I write. He says that I’m writing lies about him.

I stop writing. In a brief silence that interrupts his talkativeness, I ask if he hears any voice that may not sound real. He says, “No!”

Fifteen minutes later, he voicelessly utters words for a couple of seconds. This is the first time I see him do this.

The revolving door that Owen and too many patients enter exists due to several combined factors. The nationwide shortage of inpatient beds creates a backlog of patients waiting excessively in emergency departments for placement. The involuntary hold criteria in most states are so restrictive that it is often difficult for patients to get the help they really need. Oftentimes, such laws don’t prevent danger.

For instance, in Massachusetts, a person can be transferred involuntarily to the hospital if he or she is at imminent risk of sustaining physical damage or cannot protect self from basic harm due to poor judgment. But psychotic deterioration is not considered. Nor is the patient’s lack of understanding that treatment is needed considered. When clinicians find that patients do not meet this stringent standard, there is usually no choice but to discharge them back home or to the streets. I propose that civil commitment criteria be revised to do more that reduce danger as it’s unfolding. Laws could be more proactive and preventative if they were expanded.

Breakdown exposes inpatient units discriminating against the most challenging clinical cases. If a patient determined to meet inpatient criteria is prone to violence, doesn’t want any help, has no health insurance, or is expected to present extremely challenging barriers to discharge, her or his wait for an inpatient bed will be longer than average. I boldly propose that consequences against inpatient units that discriminate against the sickest patients be imposed by the government.

The most common reason for treatment noncompliance is the lack of awareness of being ill, referred to as anosognosia. More than half of those with schizophrenia or bipolar disorder have anosognosia. The consequences of lack of treatment might be most pronounced in Massachusetts because it lacks Assisted Outpatient Treatment (AOT). In AOT, courts order outpatient treatment for people with serious mental illness who otherwise would not seek treatment voluntarily. This can include orders to adhere to prescribed medication, attend outpatient appointments, or both.

Despite the controversy of AOT in Massachusetts, where Breakdown is based, I bravely propose that AOT is expanded nation-wide. Despite the growing popularity and decline in controversy of AOT, it is still largely underutilized throughout the country. Extensive research shows that AOT reduces rates of homelessness, violence, hospitalizations, victimization, arrests, and improves self-care. Yet two other states, Connecticut and Maryland, also do not allow AOT. All other states and Washington, DC allow AOT.

About the Author

Lynn Nanos is a Licensed Independent Clinical Social Worker in her eleventh year as a full-time mobile emergency psychiatric clinician in Massachusetts. After graduating from Columbia University with a Master of Science in Social Work, she worked as an inpatient psychiatric social worker for approximately seven years.

She is an active member of the National Shattering Silence Coalition that advocates for the seriously mentally ill population. She serves on its Interdepartmental Serious Mental Illness Coordinating Committee committee and co-chairs its Blog committee.

Lynn can be contacted through her website

Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry is available in print and for Kindle at Amazon (COM | UK) and other sellers, including as an e-book from


Sunday, 19 May 2019

Mental Health Awareness Week Roundup

Hosted by the Mental Health Foundation, Mental Health Awareness Week took place from 13-19 May 2019. The theme this year was Body Image – how we think and feel about our bodies – and I thought it would be good to draw together some of the things we’ve been involved with.

There was a lot going on at work (BPDTS Ltd) through the week, including a number of excellent posts on our corporate blog. There was a company-wide dial-in call on stress, and a lunchtime meet and greet. I also attended a meeting of Mental Health First Aiders.

I was invited to contribute three articles, including one for the main DWP Digital blog.

Fran and I had the privilege of publishing two brilliant guest articles here at Gum on My Shoe.

Our friend and fellow mental health blogger Aimee Wilson posted a series of interviews throughout the week on the subject of body image.

We have some great content lined up here at Gum on My Shoe in coming weeks, including contributions by Lynn Nanos, author of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry; and Katie Maylea, author of In Bloom Not Broken; so keep an eye out for those.

If you fancy working with us, check out the Guest Guidelines on our contact page.


Thursday, 16 May 2019

This Is My Body

By Charlotte Underwood

This is my body.

What I see:

  • Scars
  • Fat
  • Imperfections

What I feel:

  • Fear
  • Vulnerability
  • Disgust

What I know:

  • A body that’s kept me alive for 23 years
  • A body winning against binge eating
  • A body that is mine and no one else’s
  • A strong ass woman

The thing with body positivity and body image is that it’s hard work. Most people can’t stare at a mirror and force themselves to love what they see. Many people have a love/hate relationship with their body. But over time, we can learn to be proud of our bodies and our skin.

When I was a teenager, I literally stopped eating properly and I worked out a lot because I felt like I was being judged for my weight. I felt I wouldn’t be loved as a larger girl. And you know what? I wish I never had to feel like that.

I am learning to look after my body and my mind for myself. I do not let anyone tell me that I should lose a few pounds or sort out my appearance, because it’s not their right. Your body is yours, it’s keeping you alive and that alone is beautiful.

My rule of thumb: If you want tattoos and piercings, get them. If you want to dye your hair do it. If you want to put on makeup and a cute outfit do it. If you want to lose weight or gain weight, do it. Or Don’t. Whatever you need to feel more yourself do it, but only for you.

This post is brought to you by me being 100% wound up by society’s pressures to look perfect. Because I’m not ‘the ideal’. And what do I say that that? It’s my fucking body and it’s pretty damn great. I’ll enjoy it however makes me feel safe, happy and comfortable.

I feel like it’s important to mention:

  • I’ve still made great friends with this body.
  • I got married and found love with this body.
  • I still went on TV/did an ad campaign and photoshoots with this body.

Our body does not have to limit us, fuck what people think.

Please don’t ever feel like you are less of a person because society’s ideals have been thrown down your throat. Beauty ideals are simply an opinion. It doesn’t mean you are not perfectly beautiful and able to live and achieve a great life.

Also remember that when we die, our bodies will degrade but people will remember our actions and kindness.



Originally posted as a thread on Twitter, starting here.


About the Author

Charlotte Underwood is a twenty-three year old from Norfolk, UK. She is a growing mental health advocate and writer who aims to inform and education on mental health. The goal is to be a friend to those in need. She believes no one should feel alone. Charlotte blogs at You can also find her on Twitter and on Facebook.


Wednesday, 15 May 2019

Mona Lisa and Me: My Journey with Body Image

By Jen Evans

When I think about body image, the first thing that occurs to me is that women seem to have to deal with this more than men. But I’ve never chatted with a man about this subject so I don’t know how valid that is. On a daily basis, men and women are confronted with ideas and images about what they ought to look like on magazine covers and in the world of celebrity. In my thinking, all of these images are airbrushed and not realistic.

From the Middle Ages to the Renaissance, a larger woman was considered normal and of noble status because she could afford to feed herself. If we take a look at the Mona Lisa we can see that she’s no Twiggy. She’s full-bodied and buxom. That was what people considered attractive at that time.

Somewhere along the catwalk, I feel we went horribly wrong. Even in the Fifties here in America, women like Marilyn Monroe were more like an hourglass than a Barbie Doll. Maybe it’s because of ladies like Twiggy that the unrealistic body image manifested.

My journey with body image has been challenging. I’ve spent my adult life dealing with an eating disorder called binge eating disorder (BED). Until I was twenty-six I ate whatever I wanted and didn’t have to think about my weight. I was mostly happy with my body at this time. But around twenty-seven I started to use food to deal with complex emotions.

Looking back, a lot had happened to me before I turned twenty-six. I had experienced profound loss, from my parent’s divorce and my father’s abandonment of me, to the death of a beloved friend. And more poignantly, at that exact time in my emotional history I lost the guy I married. He wasn’t who he portrayed himself to be. He was someone else entirely.

At twenty-six I was too young to process all this. So I started to eat. Once I became a plus-sized girl I felt shame for my physical expansion. Also I was body-shamed with nasty stares by both men and women. I’d like to tell you it has gotten easier. But I can’t. I’m still a big girl and I still don’t like it. I body-shame myself all the time and I am not comfortable in my own skin.

There is a movement now where women are advocating for body diversity. It calls for acceptance of “fat” or larger people. I think that’s great. I do. But for me, it’s not simply a question of my weight. It’s not healthy for me to be bigger. I have two bad knees and when I’m big they hurt at times, specifically when going up and down stairs. I don’t like the way I feel when I’m big. I also feel it’s harder to attract a date when I’m heavier.

Really, I just feel bad about myself and that doesn’t help in any sort of way. If I could feel good about myself at whatever weight I was then maybe I wouldn’t think about it day after day as I do now. But it is a constant at this time, and so is my disorder. I’m hoping to truly deal with my food issues this summer. I want to be my best self and that doesn’t include weight, both physically and metaphorically. A healthy me will probably be a more grounded me, and that is what I will achieve.


Monday, 13 May 2019

I Wasn't Disappointed in You When

I wasn’t disappointed in you when your weight went up because you ate all the girl scout cookies. Although maybe it seemed that way when I suggested you throw them away or gift them to someone next time, and lectured you about average daily calories. As though that would fix your relationship with your body.

I wasn’t disappointed in you when you told me you cut yourself. Although maybe it seemed that way when I said remember I’m here. Don’t ever feel you’d be a burden or that I’d be too busy or asleep. As though I can make the demons go away.

I wasn’t disappointed in you when you went back to sleep after our prearranged wake-up call. Although maybe it seemed that way when I started calling a second time or a third to make sure you were up. As though your day starts better in my hands.

I wasn’t disappointed in you when you told me there’s no hope, no job, no friends for you so why bother trying. Although maybe it seemed that way when I pushed suggestions in your face you’d tried a hundred times before. As though my blazing positivity could make a difference this time.

I wasn’t disappointed in you. But maybe you were. And I didn’t honour that. I didn’t allow breathing space for that.

I need to sit with this a while.
Breathe it in. And out again.
Because I’m disappointed in me.
And that’s okay too.


Wednesday, 8 May 2019

Just Be Real. Let Profound Sort Itself Out.

I wrote recently how my blog posts are often inspired by conversations. The inspiration for this one was a recent online chat with a friend. We were discussing an article she was writing for Mental Health Awareness Week on the topic of body image.

“I’m interested to read your piece when it is ready.”

“I’ve only just started. I’m not sure I have anything profound to say.”

“Just be real. Let profound sort itself out.”

If you follow our blog you’ll know I’m a great believer in real, which I might also describe as genuine or honest. In life generally, but especially when it comes to writing. I would much sooner read a possibly-less-than-polished piece from the heart and guts of its writer than something which has been finessed but lacks integrity.

You can read more of what REAL means to me in this article hosted by HastyWords.

On one level, of course, an article, essay, poem, or any other piece of writing is REAL from the moment it’s written down. It exists in physical form, perhaps as words scribbled out on a page (as this one is materialising, word by word, in my Midori Traveler’s Notebook at a table in the lovely Church Gallery coffee shop in Kirkby Stephen) or on a screen.

And that alone can be enough. Bringing something into being is a profound act. It is art, and needs no further validation or justification. To create is to partake in and contribute to something greater than yourself. And if your words are written with integrity, if they are kind in mind and heart, then — oh! — they have the potential to move mountains. To move other hearts than your own. To change lives. Maybe even save a life.

And that’s about as profound as it gets.


Wednesday, 1 May 2019

May I Be Light


May I be light.
May I be thin.
May I be fit.
May I be whole.
May I be patient.

May I love my body.
May I love my food.
May I love my light.


By Fran Houston


Wednesday, 24 April 2019

Secrets of a Successful Blogging Workflow

Fran and I have been blogging since August 2013. Just about everything we do is a joint enterprise, although I look after the website itself and take the lead with the writing. Let’s take a look at how I go about putting one of our blog pieces together.

Focus and Content

We blog about lots of things, but mainly mental health and supportive relationships. We welcome guest contributions: if you’d like to work with us check out our Guest Guidelines.


Most of my ideas come from conversations with Fran or other friends, things we’ve done together, events I’ve attended, or things I’ve seen on social media. Here are a few examples.

Then again, inspiration can come from almost anywhere if you’re paying attention!

I jot ideas down as and when they occur, often whilst traveling to or from work or taking my evening walk, using Google Keep or Trello (my favourite to do list app) on my phone.


We started out rather haphazardly, posting between one and four posts a month and with no clear strategy as to frequency or content. After a time we settled on posting once a week, on a Wednesday, with additional articles going up on a Saturday. I’m proud to say we’ve maintained that posting schedule for several years.


Most of my articles, including this one, start out in Google Keep. This means I can work on them on my phone, my Chromebook, or my PC at home. I write best in coffee shops or at work on my lunch breaks. Mostly I compose on my phone (I have a Bluetooth keyboard and a folding stand, which make it easier to type) but sometimes I choose to write longhand in my Midori Traveler’s Notebook, especially if I am feeling “stuck”. Using a fountain pen on paper helps me get the words down on paper without being tempted to edit as I go. It does mean, of course, that I have to type my notes up later.


Once the article is written, or at least drafted, I move to my home PC. If the piece was drafted in Google Keep, or if it’s a guest piece, I simply copy and paste into a new Word document. If it was drafted by hand I have the unenviable task of typing it up from my scribbled notes! The first thing I do is run three global changes on the document.

  1. Single quote to single quote
  2. Double quote to double quote
  3. Double space to single space

The first two might seem redundant but they ensure all single quotes, apostrophes, and double quotes are nice and “curly”. Once that’s done I can get down to the actual editing.

Titles and Capitalisation

I don’t always use it but the CoShedule Headline Analyzer is very helpful in writing titles that “drive traffic, shares, and search results.” The title of this article (Secrets of a Successful Blogging Workflow) scores 72 out of 100, which is pretty good.

I use another online tool to ensure titles and headings are consistently capitalised.


I like to use my own photos where possible. Other images are sourced from royalty free sites such as Unsplash. Pablo is a brilliant online tool for finding royalty free images (via Unsplash), cropping them and adding text.

Putting It All Together

Our blog is powered by Blogger. Once I have everything ready, I open our site in a browser (there is a Blogger app but I don’t find that useful at all) and open a new post. I paste from the Word document into the HTML window, and add HTML tags by hand. I like to keep things simple and limit myself to the following tags:

  • Headings: eg <h3></h3>
  • Paragraphs: <p></p>
  • Bold: <b></b>
  • Italic: <i></i>
  • Lists: <ul><li></li></ul>
  • Blockquotes: <blockquote></blockquote>

I add links, images, and labels (keywords) using the Blogger interface.


I usually have everything in place in advance and schedule the post for 7:30 a.m. on the relevant day.

Link Testing

I proof read in advance but links in Blogger previews are not active, so once the post has been published I double check all the links are working before I start to share it out on social media. I am usually in a coffee shop at the time (yes, at 7:30 in the morning!) and can correct on my phone if necessary.

Sharing on Social Media

Once I am happy with the post I share it on our social media. I generally start with Twitter and Facebook (my personal account plus either my author page or our joint Gum on My Shoe page). Later in the day I share to the other Facebook page, any relevant Facebook groups, and LinkedIn. I share our latest post on Twitter throughout the week, specifically on the following Sunday (tagging with #SundayBlogShare) and Monday (#MondayBlogs).


I confess I am not as clued up as I could be on the stats side of things. I don’t know how many unique users visit our site, for example, although I keep an eye on the number of pageviews for individual posts and pages, and for our site as a whole (over 202,000 total pageviews at the time of writing).

Our Blog Book

Published by Eliezer Tristan Publishing, our latest book No One is Too Far Away: Notes from a Transatlantic Friendship showcases the very best of our blog posts and articles. It is available in print and for Kindle from Amazon (COM | UK) and in print from Barnes and Noble and other booksellers. Also on Goodreads.

A Blogger’s Toolkit

I use the following more or less routinely in my blogging workflow.


Monday, 22 April 2019

No I'm Not Taking Any Cats Home! A Visit to the Cats Protection Tyneside Adoption Centre With Aimee Wilson

(But I did take home three Teddy Bears, a heap of books, and some beard conditioner.)

On Easter Monday my friend and fellow blogger Aimee Wilson and I went along to the Easter Fayre & Pawsome Afternoon Tea at the Cats Protection Tyneside Adoption Centre in Gateshead.

You can read Aimee’s post about the day here.

Aimee had invited me along as the latest in our line of bloggers’ days out. We’ve previously visited Newcastle’s Life Science Centre, Tynemouth’s Blue Reef Aquarium, and had a day out in Blyth. I always learn a few things or come away with some new ideas. I’m happy to report our latest day out was no exception.

Customer Engagement Advisor Chris Jackson took us on a guided tour. I was very impressed at the facilities and Chris’ knowledge and obvious passion for his job. The Tyneside Adoption Centre is the first purpose-built Cats Protection rehoming facility in the North East. According to their website they have 42 outdoor heated pens, and “work tirelessly to provide support in the local area, with the aim of re-homing unwanted, abandoned or stray cats to suitable homes.” They hope to help a minimum of five hundred cats a year “with the help of our dedicated staff, volunteers and supporter network.”

The staff and volunteers were well represented at the event, running the stalls and taking interested folk to see the cats. The food and tombola were especially popular. We kept going back to the tombola and left with a fine haul. A bit of swapping added to the fun. I gave Aimee a rather nice stag’s head candle holder I won, and Aimee gave me the beard conditioning lotion she ended up with! Two very nice ladies gifted me the teddy bears they won after hearing how my wife Pam collects cuddly toys. (Pam says thank you!) I’m keeping the copy of Stephen Fry’s autobiography The Fry Chronicles for myself.

Aimee and I got to visit a couple of the cats, which were gorgeous. As tempting as it was, and despite significant “encouragement” (thanks, Aimee!) I managed not to bring any of them home.

I was surprised and delighted to have two excellent conversations about mental health with people I’d never met before. I don’t know why I was surprised. Mental health features in almost all our lives one way or another, and if you initiate a conversation it’s not at all unusual to find someone with a story to share. At the Easter Fayre I found two.

Chris had made a table available for me and Aimee to display our contact cards. (I’d brought plenty of cards along with me, a lesson I’d learned on our first bloggers’ day out!) We were sitting at the table and it was natural to point out to folk that yes they were our cards and to share a little of our respective stories. The conversations flowed from there.

Afterwards, Aimee and I talked about our blogs and our books (High Tide, Low Tide and No One Is Too Far Away in my case; Aimee’s book is called When All Is Said & Typed) and how their value is not measured in pageviews or book sales, but the impact our stories have on individual people’s lives, and the impact other people’s stories have on us. I am grateful for the reminder, and to the two people who shared with me today.

I said I always learn something when I am out with Aimee. What did I learn this time? I learned that cats don’t necessarily want their tummies rubbed when they roll around on their backs. I learned that if you keep trying on a tombola you’ll win something eventually. I learned that Aimee is a really good navigator (I managed to get us lost a couple of times on the way to the event). Oh, and I learned that being cheeky can be an asset!

All in all I had a fabulous time and the event raised over £475 to support the centre’s work.

Cats Protection is the UK’s leading feline welfare charity. Their vision is a world where every cat is treated with kindness and an understanding of its needs. You can contact the Tyneside Adoption Centre on their website, on Facebook, or Twitter.

Aimee Wilson is a 28-year-old mental health blogger who has used her personal experiences to develop a popular online profile. Her blog I’m NOT Disordered has over half a million readers. Aimee’s first book, When All Is Said & Typed, is available at,, and in other regions.


Wednesday, 17 April 2019


By Charlotte Underwood

I hate my body. I just do. I can remember looking into the mirror and hating my body as a child. Even as a teenager, I hated it. As an adult, still not a fan.

I’ve been so many different weights, my body’s changed with age. I’ve worked out, dyed my hair, got tattoos and piercings. But nothing makes me happy.

The thing is, self love is more than a mirror. It’s deeper. Self love is mental.

When you judge someone for their appearance, they remember it. When you call someone fat, they feel it. When you break someone’s confidence, they know it.

My low self-esteem comes from years of being called ‘fat’, ‘obese’, ‘ugly’ and ‘unlovable’, all by people I trusted. I actually didn’t hate how I looked, until someone told me where to look.

That’s important to remember, this whole epidemic of people wanting to change how they look, doing diets, hurting their body’s to be ‘perfect’... is because we created it. We made that. We made people feel this way.

So I don’t care about your personal preference of appearance. I don’t care about your judgement on fat, thin and in between. I don’t care if you have ideals. You. Do. Not. Shame. Someone.

If you don’t find someone attractive, that’s fine, but you don’t need to project that onto them. Let people live, let people be happy, let them enjoy the body that keeps them alive. Not one person has the right to set the standard of ‘the way we should look’.

And my friends, change your body if you want, but only if it’s really because you want, not because you’ve been pushed into it by judgement. Make sure everything you do for you, is for you.

#bodypositive #bodytransformation #bodyconfidence #beauty #lifestyle #wellbeing #wellness #recovery

Originally posted on Instagram.


About the Author

Charlotte Underwood is a twenty-three year old from Norfolk, UK. She is a growing mental health advocate and writer who aims to inform and education on mental health. The goal is to be a friend to those in need. She believes no one should feel alone. Charlotte blogs at You can also find her on Twitter and on Facebook.


Wednesday, 10 April 2019

Sometimes We Need to Ask the Questions

We don’t have the answers to everything, sometimes we just need to ask the questions.” (John Rotter)

The above quotation is taken from an article by John Rotter, Marketing and Communications Assistant at MHFA England. It expresses perfectly why asking questions is such an important aspect of mental health literacy.

This post was inspired by an open letter to me by fellow mental health blogger Aimee Wilson in response to an article I wrote recently about imposter syndrome, self-doubt, and legitimacy. In her letter, Aimee described how important it is to have people she can turn to for support.

Having gone through my mental health journey with my Mum being my main source of support, I think that I now know how essential it is to have the support of another person through your times of struggle and the challenges thrown at you. [....] The difficulty comes in allowing yourself to lean on another person or even to just admit that you need to lean on them!

Something she went on to say caught my attention.

I love that you ask me questions when I’m struggling because it’s much more helpful than you just sitting there and nodding along, pretending to understand.

That meant a lot, not least because Fran and I have long advocated asking questions in the context of caring, supportive relationships. But what kinds of questions are most helpful?

What Do You Need?

Asking your friend what they need is one of the simplest and yet most important questions you can ask. This came up recently in conversation with another mental health blogger, Laura Riordan. We were chatting about how we support friends who live with mental health issues, and Laura said:

Maybe I can just listen instead of making any suggestions. Some people desperately want advice [....] And some just want to be heard.

I agreed wholeheartedly.

Yes, Laura. I’m a believer in not pushing suggestions or advice on people unless they ask for it. What people often need is space to share, safe from judgement. The best thing is simply to ask: what do you need right now?

This is echoed in a line from our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder:

Supporting Fran means paying attention to her needs and not assuming I know best. This can be as simple as asking, “What do you need most right now?”

How Is It For You?

For someone like me with no lived experience to draw on, asking questions helps me understand what my friends are going through. That’s what Aimee was talking about when she said she loves that I ask her questions when she is struggling. On that occasion, we were talking about self-harm. I’d asked how it was that sometimes self-harm expresses itself for her as an overdose, sometimes as cutting, sometimes in other ways. Was there a difference, I wondered, in the kind of situations that led to her taking these different actions, what they represented for her, or the effect on her afterwards? Aimee was a little thrown by the questions. I don’t think she had been asked to think about it in quite that way before, but as she wrote in her open letter it was clearly of value to her:

In asking these questions, you’ve helped me to make a better sense of my self-harm and that, is one of the first steps in changing the behaviour and moving forwards in my recovery.

It also helped me learn a little more about what my friend lives with and how she handles things.

Getting Real

Asking questions is not a passive activity. A question invites a response, and you may not get back what you anticipated or are comfortable with. In addition to talking with Aimee about self-harm, conversations with Fran and other friends regularly touch on suicide and suicidal thinking. Things can get real very quickly. Depending on the circumstances, you might want or need to ask further questions or take action. If your friend appears to be struggling, be prepared to ask the important questions.

  • Are you feeling suicidal, or thinking of doing something to harm yourself?
  • Do you feel you are safe right now?
  • Do we need to think about how to help you stay safe?

Also ask how your friend would like you to proceed if you become concerned for their safety. Respect their wishes and opinions, but be clear that you will involve other people or support services if necessary. That way you both know where you stand. We have a selection of crisis lines and support organisations on our Resources page.

Care and Understanding

Questions are not always about crisis, suicide, or self-harm, of course. Asking appropriate questions can let your friend know you are aware of their situation and needs. I described a few such situations in my article 5 Must-Read Rules to Help Your Friend with Anxiety and Bipolar Disorder for Bp Magazine.

I may not have a mental health diagnosis but I struggle too at times. I get stressed, uncertain, frustrated, and stuck. It’s happened quite a lot in the past few months. I’m blessed in having friends who are unafraid to hold things up to the light for me, and that includes asking the kind of questions that challenge me to explore what I think I know, my motives, and expectations. It really helps. Here is an example from a recent chat with Aimee:

Aimee: Hi Marty. How are you?

Marty: I’m OK. I was feeling a bit down over the weekend but am doing better today. I was very busy at work and there were train delays but I’m home now.

Aimee: Aw why do you think you were feeling down?

Marty: After feeling “stuck” for a while, as you know, my writing got going again recently. Our day out in Blyth and joint blogging ideas helped, and the Mental Health First Aid conference I went to. All that gave me a boost. I think what’s happened is that energy has run out of steam a bit. Does that make sense?

Aimee: Of course. Totally understand. Well here’s a little assignment for you...

Aimee invited me to contribute to an article she was writing and shared her draft with me. It helped me shift how I’d been feeling and generated some possible new ways forward. Later, I let her know how much I appreciated the support.

Marty: Thank you for asking if I knew why I’d been feeling down, Aimee. It helped me focus on what might have been behind it. Also, thanks for knowing that giving me a “little assignment” would help!

Aimee: Of course! This friendship isn’t just you being here for me when I’m struggling!

Ask Yourself First

It can be helpful to ask questions, but that doesn’t mean bombarding your friend with them all the time. It’s also important not to come across as insincere, patronising, or condescending. These are sure ways to annoy and alienate someone! If you are at all unsure, take a few moments and ask yourself a few questions before proceeding.

  • What do I want to achieve by asking this question?
  • Am I inviting my friend to do something, or to share something with me?
  • Am I prepared for whatever kind of response I get back, be that positive, negative, partial, uncertain, none at all, or my friend asking me a question in return?

Finally, is this question, and my motive for asking it, kind in mind and heart?

Over to You

What is the best, most insightful question you have ever been asked? What kinds of questions do not help you at all? Have you asked someone a question that made a real difference? Are there times you feel questions are inappropriate or unnecessary? We’d love to hear from you.


Wednesday, 3 April 2019

Competition and Collaboration in the Blogging World | A Chat with Marty and Aimee

Following on from our Bloggers About Town visit to Newcastle’s Life Science Centre in January, and a jaunt to the Blue Reef Aquarium at Tynemouth, I met up with fellow mental health blogger Aimee Wilson last weekend in Blyth, Northumberland. This involved an hour long bus ride for me, which made it quite the adventure!

Aimee met me from my bus (“I feel like a celebrity!” “Lmao you’re a VIP!”) and we wandered down to the quayside to look at the boats (pretty sure that blooming big one was a ship, actually!) and a fascinating sculpture, The Spirit of the Staithes by artist Simon Packard.

After taking photos we retired to the Commissioners Quay Inn for lunch. We were soon deep in conversation — and both checking our phones!

Marty: I like that we can both be on our phones and we “get it.”

Aimee: Yeah, everyone else just thinks you’re being rude! That’s why I’m so glad I have a friend who blogs — blogging is such a big part of my life that it makes a big difference to have someone who can…

Marty: Identify?

Aimee: Yes! Someone who I can identify with. Actually, I want to pick your brain about something… So, I got a message off another blogger the other day — Peter McDonnell, you know him I think — saying he’s meeting up with a Police Officer after being inspired by my work with Northumbria Police. I asked where he lived, in case I knew the Officer. He told me — he doesn’t live up here so it’s fine — and asked why it mattered to me.

Marty: Sure I know Peter, he’s a great guy. And why did it matter to you?

Aimee: It’s nothing to do with Peter at all. It’s more to do with whether I knew the Officer he was planning to see.

Marty: Let’s see if I have got this right. Let’s say I’m the Police Officer and I’ve done a post for your blog and then another blogger approaches me wanting to work with me... is that what you mean?

Aimee: Yeah! I think it’s more about my insecurities; like, I’d be worried I wasn’t good enough. You know? Like, maybe my work and my blog weren’t enough for them.

Marty: I can see where you’re coming from.

Aimee: But then I try and look at it like, “well it’s not a competition!”

Marty nods and gives a thumbs up whilst drinking his pint.

Aimee: I mean, on the one hand, we shouldn’t be comparing ourselves to other bloggers. But on the other hand, the comparison can help us to improve what we do. If you see someone’s content you like, you can take inspiration from that and use it to push yourself further.

Marty: Like, when you look at a blog with loads of readers — like yours! —

Aimee: Thanks!

Marty: It makes you ask yourself what you can do to get your blog to the same level.

Aimee: Yeah! I think it’s natural to have some sort of competitiveness — it’s a good thing — but it’s important to not let that get you down and cause you to put too much pressure on yourself.

Marty: And I think it’s important to remember what we’re trying to say through our blogs too.

Aimee: Yeah, like in this case the important thing is to get the message out that the Police are working with mental health services to better their own capabilities when they’re called to attend a mental health crisis. That message is more important than worrying about someone being “better” than you.

Marty: I think so, yes. I do get your concern, though. This is your work. You have worked hard to network and grow connections with individual people and with organisations, like with Northumbria Police. You don’t want someone else taking advantage of your hard work. But Peter isn’t doing that, he has been inspired by your work to do something similar in his own area.

Aimee: Definitely! It’s a compliment, really.

Marty: It is, yes. Bottom line, working with other bloggers to counter stigma is more important than worrying about someone picking up on your good ideas and doing their own thing with them.

Aimee: I’m thinking this would make a good blog post. Feel free to shoot me down but what about if we did it like a script layout?

Marty: Works for me!

And that’s what we did! Aimee checked in with Peter McDonnell, the mental health blogger who’d asked her about working with the Police. She wanted to make sure he was ok with us using the feelings that came up for her as the inspiration for this article. She also wanted him to know how much she appreciated the respect he’d shown by letting her know he intended to do the police piece. Peter was very generous about it and gave permission for us to mention him by name. He also said this, which Aimee found really helpful:

I think if your police friend started working with other bloggers after he’d already worked with you, it’d be because he had a nice experience with you, a blogger, and wanted to do it again, with the next blogger that gave him an opportunity.

Thank you, Peter.


Aimee Wilson is a 28-year-old mental health blogger who has used her personal experiences to develop a popular online profile. Her blog I’m NOT Disordered has close to half a million readers. Aimee’s first book, When All Is Said & Typed, is available at,, and in other regions.

Peter McDonnell, 36, is an author, woodworker and mental health advocate from Basingstoke, Hampshire, UK. You can find him and his website at


Wednesday, 27 March 2019

Just Because You're Paranoid: How to Notice Gaslighting in Bipolar Disorder

By Beth Gadwa

Foreword by Julie A. Fast

I recently posted a note on Facebook that included a link to one of my Bp Magazine videos called Bipolar Disorder Paranoia and Keeping Your Relationships Strong. I made the point that I had to take responsibility over my own paranoia and not take it out on others. I have ruined many relationships in the past due to my untreated paranoid thinking and actions. Right under this post, bipolar disorder advocate and writer Beth Gadwa left a comment that truly opened my mind to the other side of the situation. She wrote:

Julie, please be aware that people with bipolar are also sometimes victimized and exploited in relationships. A good strategy is to “check in” with a neutral third party, such as a close friend or family member to try to determine if you are symptomatic. Being bipolar does not mean being a doormat, or turning a blind eye to infidelity or abuse. But it does absolutely mean we have to check ourselves, and pause and reflect before we act.

Wow, she was so correct! What if someone is telling YOU that you have paranoia or that you are manic for their own nefarious reasons! What if you are actually stable and someone is using your bipolar against you! What a thought! I knew I wanted to hear more. I told Martin Baker about it and as always he said, “Let’s do a post for Gum on My Shoe. This is an important topic.”

Here is the OTHER side of the symptoms story from Beth Gadwa. Thank heavens for open minds and hearts. This is how we learn. My mind was opened and expanded from her comment and I hope her stories below help you just as much as they helped me!


Julie A. Fast
Bestselling mental health author, speaker and coach |

Just Because You’re Paranoid: How to Notice Gaslighting in Bipolar Disorder

by Beth Gadwa

Julie Fast wrote a great post about the dangers of bipolar paranoia and how it can undermine core relationships. I had one question in response: What do we do in real situations of abuse, infidelity, or gaslighting when someone is using our symptoms against us in order to control a situation? In my experience, both personally and professionally, neurodiverse people are at increased risk for violence and exploitation. Yes, it is important that we know our own symptoms and work hard to not take them out on others, but it’s equally important that we don’t just blindly accept the words and accusations of others when it comes to our brains.

Julie suggested that I share my own experiences. Here are two stories, both everyday situations that could happen to anyone. I tell them with the hope that we can learn from Julie’s work and at the same time, trust our own experiences in order to protect our brains from those who are out to harm.

#1. “Chicken Wars”

My friend Teri was visiting me from Ohio, with the thought that she might move to Portland permanently. One evening I noticed she was eating takeout fried chicken in the guest room. I asked if she could eat her meal in the common area, because the greasy chicken crumbs could stain the bedding and get into the carpet, attracting vermin.

She immediately became defensive, and told me I could not tell her what to do. I did not raise my voice, but reminded her she was a guest and had been staying at the apartment for over two weeks for free. She grew more agitated. She called me manic and accused me of starting the argument because I was bipolar. I was taken aback and hurt by her words.

To me, this was a normal roommate squabble that had nothing to do with mental health. I wasn’t experiencing any mania symptoms (sleeplessness, racing thoughts) so I didn’t feel the issue was mania or hypomania. I was simply protecting my home. Because of her response to my honest feelings, I felt I couldn’t express any negative opinion in the future without it being labeled symptomatic. We eventually talked through the situation, but it had an effect on our friendship. I have noticed over time that I have become more conflict-averse, which isn’t always a good thing.

#2. “You’d Have to Be Crazy to Break up with Me”

In 2014, I was casually dating a person I met online. At first Kevin was charming, but he grew increasingly controlling and possessive. We had been dating for about three months when he announced plans to throw a reception at a fancy hotel in “our” honor, and asked me to invite my friends too.

This made me uncomfortable. I didn’t know how to exit gracefully, so I told him I didn’t want to see him anymore. He flipped out — started yelling, said that I was manic and didn’t know what I was talking about. In his mind, I didn’t “really” want to break up with him. It must be my diagnosis.

What I did next was check in with my good friend Kasey. She has known me for almost 20 years and reassured me that I didn’t seem to be manic. Kasey had only met the guy once, but she told me to watch out — his behavior fit the classic pattern of abusers and narcissists.

She was right.

The same day, Kevin had also called my sister (whom he had never met — he found her work number online) to “warn” her about my mental health. This creeped me out! Checking in with a trusted source helped me take care of myself and protect myself from a person who was out to harm.

How Can You Protect Yourself?

Relationships fail for a variety of reasons, but being told that having a negative opinion or wanting to leave was due to my mental health was not someone trying to help me. It was someone trying to control me. I focus greatly on my health and work hard to present the most stable self possible. And yet, gaslighting happened. For this reason, I believe it is essential not to have a “single point of failure” in your care network. This means that you check in with yourself and someone you trust, separate from the person who is making the accusation that your bipolar is a problem.

As a bipolar life coach, I advise my clients to stay in close touch with a broad support network of family and friends. That way if there is conflict that feels confusing, you have a neutral third party to evaluate the situation.

If you’re a friend or caregiver, be alert for symptoms as Julie suggests, but please don’t use them as a weapon. Work together with us if you worry that we are symptomatic and it is affecting our decisions. That makes us a part of a team. We need you!


About the Author

Beth Gadwa is a Certified Professional Coach with over eighteen years’ experience managing bipolar disorder. She splits her time between Portland, Oregon, and Western Massachusetts, where her partner Erik resides.

Learn more about her practice at


Saturday, 23 March 2019

Kind in Mind and Heart

I was chatting to my friend Roiben the other day about coasters. Not the boats, the little place mats you put your coffee mug on. I asked if she had any particular kind in mind. She showed me some lovely ones on Etsy, but it was something about that phrase that caught my attention.

Kind in mind

It got me thinking about all the times we’re not kind in mind. Not kind-minded at all, towards others and ourselves. Often we imagine our intentions are kindly, but under the surface there’s some self-serving ego element at work.

It’s something I’ve been working with quite a bit lately, with the help of friends unafraid to hold things up to the light for me.

Kind in mind gives me a new reference against which to assess my motivations.

Kind in mind and heart takes things a step further.

“Is this kind in mind and heart?” I ask myself, as I contemplate some new course of action or intervention. I am not always going to get it right, but it’s already helping.

Maybe it can work for you too.

Incidentally, my favourite coaster is one Fran bought me, shown here with my favourite mug.


Wednesday, 20 March 2019

A Heap of "S" Words and an Aitch: Stigma, Suicide, Self-Harm - and Hope

By Martin Baker and Aimee Wilson

My good friend and fellow mental health blogger Aimee Wilson recently enrolled on an online course at Future Learn, titled Understanding Suicide and Suicide Prevention Strategies in a Global Context. It took me about thirty seconds to decide to join her! This is from the course description:

On this course, you will gain a broader understanding of suicide as a worldwide issue. You will analyse global suicide rates and patterns and explore common risk factors. You will explore the social and cultural factors that can influence suicidal behaviour. You will also look at suicide prevention strategies and learn how these can be enforced in communities.

Having a study buddy is great because — as Fran and I have found many times — you have someone to share ideas and perspectives with, and to talk through any issues that come up. This is especially valuable with something as complex and important as suicidality.

As with other Future Learn courses there is an online forum where students can connect, answer or ask questions, and post comments. One of the modules, Introducing Stigma, invited us to “share examples from mental health settings that help clarify the meaning of the terms [stigma, stereotypes, and discrimination].” I posted the following to the discussion area, drawing on conversations Fran and I have had over the years:

My best friend who lives with bipolar disorder has lived with suicidal ideation for most of her adult life. [....] In her case, the perceived stigma surrounding suicide (how she would be viewed by her community after any attempt at taking her life, whatever the outcome might be) is one of the factors which in her case is protective. The stigma helps to turn her away from that edge. This is something I don’t think I have seen reported elsewhere. Not exactly a good aspect of stigma, but worth noting.

I mentioned this to Aimee on Twitter, where we have been tweeting our progress on the course. She hadn’t heard that particular point being made before either. It made sense to her, although her personal experience with stigma was different:

For me, the stigma means I find it hard to ask for help when I am feeling that way.

I replied that the impact of stigma wasn’t simple for Fran either.

Yes, and that [aspect] is also present for Fran. So it’s all very mixed up and confused/overlapping. (We go into this in our book HTLT in some detail). I guess the different aspects affect people in different ways, and not always “logically”.

Here is the key passage, from chapter 7 of High Tide, Low Tide, “The ‘S’ Word: Being There When Your Friend Is Suicidal”.

The stigma surrounding mental illness is unhelpful and dangerous to the extent it makes people less likely to seek help, or speak to someone about what they are going through. Yet paradoxically, it can be protective to some degree. As Fran sees it, the taint of suicide would follow her even in death. She would be remembered not for her successes — her career, her books, her caring relationships, or the courage she has displayed through decades of illness — but as a failure. Whether or not she survived, she would always be “Fran Houston, that woman who tried to kill herself.” As much as she despises it, the shame of suicide helps to keep her away from the edge.

Aimee and I had chance to discuss this further in person. The idea that stigma could have a protective effect gave her a perspective she’d not had before. I asked if she would share what it meant to her:

Having experienced recovery from Borderline Personality Disorder (BPD), I’ve learnt that it isn’t linear. Recovery is still a rollercoaster; it’s just that you tend to actually stay on the track a lot more! So, it feels like my recovery is constantly being tested by challenges in life and it means that I’m always looking for new inspiration and new reasons to stay on that track. Hearing Fran’s thought process around suicide was really enlightening and I have definitely added it to my arsenal of inspirations I can call on when things get difficult.

And that’s why it is so important to keep the dialogue open about such “difficult” topics as stigma, suicide, suicidal thinking (also known as suicidal ideation), and self-harm. (That’s a heap of “S” words, right there!) All too often these are hidden away or talked about only in terms of statistics and strategies (another two!). Exploring trends, causes, and effects on a societal level is important, but behind every statistic is an individual with his or her personal story, experiences, insights, and potential. That can too easily be lost. As Fran’s experience of stigma shows, things are not always as simple or clear-cut as they might appear.

No one is saying stigma is a good thing. It is overwhelmingly unhelpful, unhealthy, and damaging to both individuals and society at large. But the fact that it may, under some circumstances at least, help someone step back from the edge of self-harm or suicide deserves to be acknowledged and considered alongside other factors.

When it comes to something as complex as suicidality and self-harm, the best approach is to start from the individual person’s perspective, experiences and needs. And if we cannot guess what those are — and we cannot — we need to be prepared to ask the questions.

What are you going through right now?
What helps?
What doesn’t help?
What do you need?

Sharing our stories in a spirit of openness allows us to learn from others, expand our understanding, and can bring hope. What more valuable work can there be?

How do you feel about the topics discussed in this article? Please feel free to share in the comment section below.

Further Information

If you would like to know more about courses offered by Future Learn you can find all the information on their website. There is no enrolment charge and most courses are free to access throughout the duration of the course and for 14 days afterwards. You can upgrade for unlimited access plus a Certificate of Achievement or Statement of Participation. For the course Aimee and I are taking the upgrade cost is £52 (GBP).

Aimee Wilson is a 28-year-old mental health blogger who has used her personal experiences to develop a popular online profile. Her blog I’m NOT Disordered has close to half a million readers. Aimee’s first book, When All Is Said & Typed, is available at,, and in other regions.


Sunday, 17 March 2019

When She

By Aimee Wilson


When she fought, he won

When she stole, he caught her

When she looked, he hid

When she bent, he broke her

When she hurt, he caused it

When she ran, he gave chase

When she saw, he missed it

When she heard, he ignored


But when she died, they revived her
When she cut, they mended
When she swallowed, they treat
When she cried, they soothed
When she ran, they caught
When she lost hope, they showed her the way


She won back what he’d taken

She mended what he had broke

She stabilized what he had moved

She finished what he had started

She lived



About the Author

Aimee Wilson is a 28-year-old mental health blogger who has used her personal experiences to develop a popular online profile. Aimee was diagnosed with Borderline Personality Disorder in 2009, and after over 60 attempts on her life was admitted to a long-term, specialist psychiatric hospital almost 200 miles from home. It was during her two-and-a-half-year stay in hospital that Aimee began her blog: I’m NOT Disordered.

Originally it was meant as an outlet for pent-up frustrations from inpatient life, and a means to document her journey through the trauma therapy that eventually led her into recovery in 2014. The blog has developed into a platform for others to tell their stories and to give their own message to the world — whatever it may be.

Aimee’s blog now has close to half a million readers. Its popularity has resulted in three newspaper (in print) appearances, two online newspapers, BBC1 national news, ITV local news, interviews on BBC Radio 5 Live and Metro Radio; as well as a TV appearance on MADE. Aimee has had the opportunity to work with such organisations as North Tyneside and Wear NHS Foundation Trust, Northumbria Police, Time to Change, Cygnet Healthcare; and with individuals who range from friends, family and colleagues, to well-known people in the mental health industry.

Her first book, When All Is Said & Typed, is available at,, and in other regions. You can follow Aimee’s blog and read more about her at


Wednesday, 13 March 2019

Open Hands. Open Arms. Open Heart.

This important principle reminds us not to hold too tightly to people, relationships, and situations. Healthy things grow, and to grow is to change.

In the time we have known each other Fran has moved from mania to depression and out again. She has grown in self-awareness, and developed tools for looking after herself. I have learned a great deal about what it is like for someone living with illness, and how to respond to Fran’s needs and the needs of others. At times Fran needs me close beside her, at other times she needs space to grow independently.

“Open hands” recognises that change is natural, healthy, and necessary. It gives us permission to grow without feeling guilty or restricted. Imagine holding a small bird in the palm of your hand. It feels safe, protected, and cared for, but it is free to move, to grow, and even to fly away.

“Open arms” reminds us that, no matter what happens, we will always welcome each other back as friends.

“Open heart” connects our friendship to our wider network of relationships with other friends, family, and the people we encounter in our lives.”


Excerpted from chapter 1, “The Caring Friendship: Key Skills and Attitudes,” of our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder. Available at: | | | | | | | | Barnes & Noble


Sunday, 10 March 2019

My Mental Health Talk for International Women’s Day

Last week I was proud to speak at an event organised for International Women’s Day by the Women in Digital network where I work.

I’d been invited to take part by my friend and colleague Lisa Overall. We agreed on a topic for my talk — how to support a friend who lives with mental illness — based on an article I wrote originally for No Stigmas, “a global non-profit movement utilizing peer-to-peer connections to promote mental wellness and prevent suicide.” The article was subsequently published at The Mighty.

I had given the talk once before, at a Talking FreELY event in 2017, but it is a topic which resonates with many (at The Mighty my article has been “liked” more than 1,200 times) and I was confident it would work for this new audience. The room was filling nicely by the time I arrived. I’d estimate there were close to sixty people there as the event got underway. (It is possible the promise of cake had something to do with the turnout!)

After introductions, things got off to a great start with a presentation on women and mental health by Lois White who leads the mental health awareness team at BPDTS. Like me, Lois is a Mental Health First Aider, and equally passionate about the work we are doing within the company.

After her talk Lois introduced me and took charge of the projector, anticipating almost all of my “next slide, please” moments. (Thank you!) I’ve done a number of public readings and talks in the past few years, but I still get nervous. Fortunately, once I am up there I find myself calming down and easing into things.

I had the script for my talk on my Kindle to keep me on track and on schedule, but I found myself ad-libbing freely. It’s hard to know when you are in front of an audience but it seemed to go well. There were even a few laughs in appropriate places. Lisa told me later I’d had the room in the palm of my hand, so I guess I did okay!

I received some very positive feedback afterwards, which is testament to the relevance of the key message I wanted to get across: that no one is too far away to be cared for or to care; and that with some basic tech and a little imagination we can be there for our friends and loved ones, whether they live on the other side of town or an ocean away.

In the interval I got chatting with a few of the other attendees including Andy Heath who was photographing the event. I couldn’t attend all the sessions but I’m glad I stayed for the next two speakers, who shared what has influenced and motivated their life and career journeys. The message to follow what interests you most and where your passion lies rather than “chasing grades” resonated strongly for me, as did their commitment to remaining open to new challenges and opportunities.

In case anyone is wondering, I didn’t have Fran with me on live video link (maybe next time!) but she messaged me before and after my talk and was very much with me as I shared our story. I even sneaked in a mention or two (or was it three?) of our book. I still feel self-conscious doing that, but a friend told me something this week that really struck home:

You were wondering where you are in the mental health community ... you are a writer, and an adamant and steadfast supporter.

She’s right (thanks, Jen!) As I wrote recently, I have been struggling a lot with my self-confidence of late, unsure in particular of my role and place within the mental health community. My talk, the positive responses to it, and the other speakers at the event helped me reconnect with the idea that I have a voice and a message worth sharing.

For that, and much else, I am grateful for the opportunity to take part. Thank you.

Photo credit: Andy Heath, with permission.