The power of connection

On Thursday, the federal health minister, Ms Sussan Ley, announced a new framework to tackle what has been described the crisis in Australia’s mental health system. Key opinion leaders in this field from the AMA to top academics and researchers have had mixed responses to the announcement. For what it’s worth, this is mine.

I am a consultant psychiatrist working solely in private practice. I run a very busy clinic covering a wide range of clinical sub specialties and many of my patients have been coming for several years. Prior to this, I completed my training in a tertiary teaching hospital, and over 10 years have seen many  patients with all forms of mental illness. I have also worked in rural and indigenous areas and have first hand knowledge of what works.

Regardless of their condition, their social situation, their background, their journey, two things help patients recover. Hope and connection.

When my patients recover they tell me they were grateful I didn’t give up on them. As they became well, they could see at the very time they were most unwell they truly believed things would never get better. So my ability to hold their fears, and reinforce with consistency and kindness that things would improve, were the most therapeutic ingredients to my package of care for them. Connection with a stable consistent provider of healthcare was paramount.

As doctors, we often forget how important we are in the care of our patients. This is particularly true in psychiatry when there are so many other ‘key stakeholders’ in the delivery of care to those with mental illness. We often relinquish our roles, shy away from leadership and stifle our voices when we see care we don’t agree with. It’s almost as if the system can only work if we remain silent. But I find that very hard to do.

For what it’s worth, I have been involved in the care of patients with all forms of mental illness since the era of deinsitutionalisation, firstly as a pharmacist and then as a psychiatrist. I have seen fundamental changes to the care they receive over the past 25 years.  I liken this new round of changes to a homeopathic treatment for the mental health system.

Each time a new strategy or overhaul of care is delivered to great applause, it is as if the policy makers have diluted the pool of patients with mental illness to such a point that they focus on only the smallest fraction of those who need and deserve our care. The very small number of people who have the insight,  and know how to go and seek out some help. They talk about ‘support’ ‘engagement’ ’empowerment’ and ‘resilience’ like they are evidence based measures of successful outcomes. They talk about strengthening partnerships and improving access without any tangible way of assessing what that means. The rest are diluted out and discarded.

For the past 25 years not one single mental health policy has addressed the needs of those with severe and chronic mental illness.

Over 25 years I have seen patients with schizophrenia, bipolar disorder, borderline personality disorder, melancholic depression, anorexia nervosa and many other clinical presentations be moved from pillar to post, often quickly and at the hands of a new government. Every single time this happens the two most valuable aspects of psychiatric care, hope and connection are fundamentally destroyed. The argument that ‘well this approach ain’t working, so let’s replace it’ drives this move to destroy hope and connection.

For the past 25 years not one policy has looked at what we have and tried to improve it, rather than reinvent it.

Let’s be sure of the facts, the ones that are diluted out in the homeopathic process that is labelled mental health reform;

  • Many patients with severe and chronic mental illness require lifelong care and frequent hospitalization.
  • Being hospitalized for mental illness is not a failure of anybody but exactly the appropriate type of evidenced based care a patient needs if acutely unwell, and at risk to themselves or others. And a long hospital stay often means a patient is very unwell, not that the services are incompetent.
  • We have turned our backs on those already in long term and residential care, the very thing policy makers said they would not do when patients were turfed out of asylums. They are still here, with us, deserving of our care just as in any other severe illness, but are firmly entrenched in an overflowing ‘too hard basket’.
  • We already have a mental health system which is failing not because it is hospital based, and the idea of building primary care networks for this group of patients has no merit. Patients with severe and chronic mental illness deserve multidisciplinary care that can be flexible in a ‘step up-step down’ way and can move to provide the care and risk reduction required. The reason this doesn’t work now is not because it is based in the hospital system, but because the services are so poorly run down they can’t offer what the patient needs. Administering ‘care packages’ to these patients, already known to the professionals in the public mental health system will lead to a doubling up and waste of valuable money that could be used to create extra beds and fund more staff.
  • It is not the patient’s fault that they fall through the state government/federal government convenient ‘diffusion of responsibility’ construct.
  • Improving knowledge and awareness of mental illness by providing fact sheets and e-health approaches are good for some but this should not be applied to mentally ill patients in a broad brush way.

There is evidence for these arguments everywhere, it’s just that the whole mess that began after deinstitutionalisation is so large now that nobody wants to talk about it. Patients who left asylums in the late 1980s moved through an era of case management, mobile support teams and crisis assessment and treatment teams. But then these services became so overwhelmed they could no longer deliver assertive outreach to the level they should. With nowhere else to turn, many became ‘frequent flyers’ in our state hospital emergency departments. When they were ready to be discharged from hospital, there was no room at the chronic care units if they needed it. NGO’s that provided wonderful support and consistency such as Richmond Fellowship and St Mary’s House of Welcome suffered massive funding cuts. And rather than improving medical comorbidity in patients with mental illness, mainstreaming psychiatric services into major teaching hospitals has led to more stigma and a sense that patents with mental illness are purely bed blockers.

There is so much devil lying in the detail of this new mental health reform. It is also very disappointing that it was announced without any increase in funding for the public mental health system, and in top of that, Medicare cuts for patients with severe and chronic mental illness. I have many questions about this implementation of primary health networks (PHN’s) and it is hard to ascertain any information. In particular, I wonder who will be staffing these organisations, to what level of acuity can they provide care, and how does a patient and a health professional interface with a PHN? What will be the role of the GP, the one who should be the cornerstone of medical care for all patients? How does the private psychiatry and psychology system fit with this? How long will PHN’s be around for and what happens to the patients after the funding runs out? Allow me to be cynical because I have seen it all before. I work every day with patients with mental illness, I wear all the responsibility and I know how complicated it can be.

So what do I think we need? Well, it’s not that glamorous, and doesn’t contain a lot of rhetoric, so it probably won’t get up. But I reckon after 25 years in this area of medicine I might be onto something. My simple recipe for mental health reform (totally undiluted):

  • Allow psychiatric triage services that exist in all our major hospitals across Australia the resources and staffing to be able to pick up the phone and respond when a patient is in crisis. These clinicians often know the most unwell and vulnerable patients in their network. They have managed them for years. The know what they are doing. And they have a connection with them.
  • Boost the crisis teams and assertive outreach teams, bring back the homeless teams and all the wonderful services that could respond in a timely and safe manner.
  • Look after staff who dedicate their careers to helping some of the most disadvantaged people in our society, so they remain in the system and continue the connection.
  • Have places of haven for those who live with symptoms all the time. Be kind to them.
  • And above all, invest in acute services that know exactly how to manage mental illness and have been doing so for years.

Bring hope and connection back to the forefront of what we are trying to achieve. Not another layer of bureaucracy and more strangers that may come and go in and out of a patient’s life.

Dr Helen Schultz is a consultant psychiatrist and advocate of patients with mental illness. She is also passionate about doctor’s mental health, and attracting doctors to the wonderful profession that is psychiatry. She is the author of How Shrinks Think

Keep talking because people are listening.

Hi all,

Yes I am home, but my head and thoughts are still in Bali, keeping up with supporting those who are stranded, and those home but finding it difficult to cope.

This unmitigated customer service disaster, and it is a disaster, is continuing to make a big impact on ordinary everyday tourists. It is very clear that customer service and communications departments within airlines and insurance companies are struggling to cope. This is no excuse for their behaviour, and big multinational companies, more than any other companies have the finances and resources to outsource this if they are overwhelmed.

After almost two weeks, if a major company cannot streamline its communication it is time to outsource. Even for the selfish reason of protecting their brand.

I have made it home and lodged my formal complaint with the airline carrier that has since cancelled both my flights home. If I did not make the decision to purchase a one way ticket via Kuala Lumpur on Thursday night I would still be in Bali. I would be facing a second week of being stranded, and the very real risk of my patients becoming unwell at home without my care would have caused me fury, anger and sadness. I know that because I have watched the departure details, not on the airlines website, but on the official Bali airport page. I realised about one week ago that because the airlines are not updating their pages regularly, and often doing a ‘cut and paste job’ on information, the Facebook pages and Twitter feeds are out of date and unreliable.

I took my son to his basketball match yesterday and I felt true exhilaration that I was home and I was back doing all the normal stuff. A basketball match. I won’t forget that feeling for a very long time. It has taught me that my life and what it entails is the most important and central part to me. Familiar faces, routines, my own bed, my own home cooked food, all combine to make me feel like I belong. I know that being delayed and not getting back to familiar territory is fertile ground for an exacerbation of anger and helplessness. This is something the airlines and insurance companies seem to miss.

Yes there is the risk of flying into an ash cloud. And yes there is risk in leaving people stranded. Everybody is talking about the latter but the airlines are not listening.

Now, more than ever, we need to keep talking. There has been an absolute tragedy in Europe and although people in Bali are not directly affected, as humans we are affected as we see more and more acts of terror across the world. Because these attacks kill and maim tourists we can’t help but relate. I am not trying to make people more anxious, I am acknowledging that many of us will be having these thoughts anyway, and it is best to talk about them. What is imperative right now is to share your feelings, and perhaps minimise how much you watch footage of the tragedy in Paris. It will only serve to increase anxiety. It won’t help.

I feel so sorry for the staff of the airlines and insurance companies on the front line, handling customers who are beyond being polite and reasonable. I hope the companies are looking after their staff’s well being. Staff members did not envisage this happening either. These companies need more than ever to take control and display true leadership. By no means stop calling the airlines, keep talking but think about the language you are using. Some call centre operators are probably on the cusp of going out on stress leave, which is awful for them and may mean longer delays getting through. If you are beyond and completely frustrated, get a note pad and pen and start writing down all of your concerns and interactions. Write down dates, times, names of people you have spoken to and what was communicated. This is your book of power for when you get home and feel more powerful. Keep conversations with call centre operators brief and civil.

Here are some of the ways that may help improve communication in this extremely difficult time;

Communicating in person

  • Keep talking to each other, now is not the time to pitch against each other and take our out your frustrations on each other. If you are feeling very frustrated, take some time out and go for a walk and let other know when you will be back. If others are upset around you, given them permission to have a break. Stay in the moment. Don’t argue around your children as they will be anxious themselves.
  • Organise times to catch up with fellow guests you have met at he resort, in cafes or at the airport. Those who listen when you communicate. Perhaps delay talking about the disturbance until you are all together, and try and do other things such as reading and walking when not with the group. Hearing and thinking about the same thing over and over will lead to burnout and worsen fatigue.

Communicating via social media

  • Just because airline social media channels are not being manned as professionally and pro-actively as desired, don’t stop using them. If you are not receiving replies to your posts, don’t stop sending them. Keep screenshots of communications. If you need to find something to do, check out software such as Hootsuite that can schedule posts. Schedule a pile of posts, tagging who you are trying to communicate with at 5-10 minute intervals. Then leave the software to do its job.
  • Learn about the power of the hashtag. Hashtags are really, really useful. If you don’t know what one is, here is a quick run down. A hashtag is like sticking a ‘post it’ note to a piece of paper. Imagine some ‘post it notes’ in different colours. Pieces of paper with a blue ‘post it’ note contain shopping lists. Red contains information about your favorite hobby. Green for recipes you’d like to make, and so on. Now imagine throwing all the pieces of paper on the floor. Want that recipe for spaghetti bolognese? ( I always crave spag bol when I am travelling) Look for the pieces of paper with…green ‘post it’ notes. Want your tweet or FB post to come up in a search about your predicament? Use a hashtag. Hashtags are not owned by anybody. Sometimes they can be registered as official but anybody can use them. You can use them to search for information. Say if you want to find out more about the ashcloud, enter #ashcloud into the Twitter search engine and all tweets related to the hashtag will come up.
  • Hashtags and ‘@’ signs are different. An ‘@’
  • sign before the official address (called a ‘handle’) will send your tweet to the right person. An example of this would be this tweet I could post on Twitter or enter into Hootsuite to keep sending every 10 minutes;
    • Hi @VirginAustralia, any chance of flying today? #Bali #ashcould  The staff managing the tweet at Virgin will see it as it has been sent to them. Whether or not they read it is up to them, just like if you get your bills out of the letterbox and don’t open them. They kind of still exist, and you still have to pay them, even if you decide to keep the envelope closed. The hashtag means that anybody searching for information about Bali or the ash cloud will see your tweet.
  • As a word of caution though, do not send a tweet containing your personal information or flight number unless you want the general public knowing your movements. And only send urgent information to a handle if you know the handle is checked constantly.

Communicating to the universe

  • Keep the conversation going. Hot topics today are old news tomorrow. Search for a hashtag you like such as #ashcloud or others that official groups like Bali Travel Group recommend. The more traffic on a hashtag, the more it will ‘trend’ and will capture the attention of those whop present the news. Like it or not, that is how things work nowadays.
  • Send out positive stories that will inspire and motivate others to keep going. Positive accounts will spread as well as negative ones. If somebody on a call centre has gone the extra mile (pardon the pun) acknowledge that. Send a thank you note or email when you get home.
  • Keep in touch with everybody at home waiting for you. Let your friends and family know how things are going. If you are heading off to the airport let people know if your flight is on time.

And a final word, as a doctor and psychiatrist. Keep talking when you get home and let your GP know if you are not coping. If you are in real trouble in Bali, and very concerned about your health and safety, contact the Australian embassy. If you have a mental illness and have run out of medication, seeing a doctor as soon as you arrive should be your first priority.

Stay safe, keep talking, force the airlines to listen. Don’t talk about compromising safety but about alternative ways you can get home. And educate them that there are very real consequences to your health should you continue to be delayed that go way past inconvenience.

 

 

Disrupted passengers both ways. We’re all in this together.

Today I thought I’d write about those that have had a really difficult time during the recent volcanic eruptions in Bali, disrupting their travel plans. Those who couldn’t get here and those who are stranded in Bali draining every cent that would have been put towards future holidays.
As a psychiatrist, I see first hand the emotional and medical consequences of banking up a sleep debt, rest debt and ‘catch up with family and friends debt’ all the time. So many of us, including me, continue to put off what is immediately beneficial and rewarding. How many times have we thought about how much we enjoy having a coffee with a friend, only to lament about how long it has been between drinks? Finding time for a coffee and a catch us seems insurmountable yet the benefits last longer than the coffee does. Likewise, planning a break from relenting commitments, daily schedules, obligations and structure can often be the only way we cope with it all.

I think about how exhausted I was before heading to Bali. I didn’t even realise until I almost collapsed into the lounge by the pool and couldn’t move. Daily morning yoga was a total struggle; I hadn’t practiced yoga for over 2 years and my busy mind made me lose my balance way before my muscles did. But after about 3 days, I was, surprising to me, completely relaxed. After 5 days, one of the guests, soon to become a friend alerted me to the cancellation of flights and the volcanic disruption occurring all around me. Because, from the resorts in Bali, there is no evidence at all there is an ashcloud.  From that morning on as speculation grew we all succumbed to the lack of daily updates, uncertainty and the very real situation that we wouldn’t be returning home on time.

But what about if it was a week before? What if I hadn’t made it to the yoga mat?

I think if I hadn’t made it to my holiday in the first place I would have needed to have thought of a pretty good plan B by now. I admit I have fallen into the trap of ‘it’ll be OK, just get through this week, this financial quarter, this year’, wishing days away waiting for a break. When we do this we take a toll on our own health, often silent, succumbing to more viral infections, or mildly raised blood pressure, chronic fatigue, and so on. We somehow justify that things will all rectify themselves, once we get on that holiday.

In this current situation, many people just like me have banked up the same amount of debt but unlike me just didn’t get to Bali, or did, but are trying to rationalise the situation by eating into funds for the next holiday. If you are one of these people I am sure you have struggled with the uncertainty, the hope you’ll depart then the disappointment when you don’t and by now are absolutely fed up.

Faced with the certainty of a volcanic eruption, completely at the hands of mother nature, it is time to take charge of some certainty over your predicament. Because, if you were operating on limited reserves like me up until now, it’s time to take back some control.

Some things to try;

  • Sit down with your family and work out what it was that you wanted from the holiday in the first place. ‘Chill out’ I hear you say. Reflect on what it is in your daily life that doesn’t allow you to ‘chill out’. Write it down and save for later. Now is not the time to try and make the most of things. You need a break right now.
  • Negotiate your way into a new holiday, whether it be shorter or to a different destination. I’m not saying to put yourselves in debt, but desperate times call for desperate measures, and I know the airlines are very happy to offload passengers to another destination to get them off the queue. It may be shorter, and it won’t be Bali, but it will be something.
  • If you now have unexpected days at home, use them wisely. Don’t try and overload them but instead spend them doing things you always put off.
  • If you are on an extended stay in Bali, live in the moment. None of us know what next year will bring. There is no reason to believe that this delay due to no fault of your own, means you will never holiday again.

Remember your thinking is probably clouded by your current predicament. It won’t feel like this once you do come back from your holiday or get home. 

The one thing I have seen most in medicine is that none of us know our fate and despite our best plans, sometimes things just happen. As humans we don’t think about this that often, until the inevitable happens. As a word of advice, it might be best to avoid call centres as much as you can. Lip service right now, when you are as frazzled as I am, is not going to help. The operators have to behave a certain way, and we all know, if they just said they didn’t know we would all be happy. I understand that the most frustrating thing right now is not feeling heard or understood.

Take care and find your yoga mat, it is waiting for you.

Dr Helen Schultz is a consultant psychiatrist currently stranded in Bali. She has had the most amazing time and met some fantastic people but it is time to go home. 

Anxiety may follow you home from Bali, even if you didn’t pack it.

Hi all,

I’m continuing to write and help out where I can, because I feel quite uneasy myself, and really missing home. As a psychiatrist working in private practice I would usually have seen about 15 patients this week by now, and handled a pile of inquiries via phone as well. So having this enforced break in Bali after my flight was cancelled 5 days ago is feeling really surreal, and I am feeling for my patients who have had to move their appointments until I get back.

I have heard that some people have managed to arrive home, but have noticed that the anxiety has followed them there. As a psychiatrist I can understand why, and I know it doesn’t make a lot of sense intuitively. I’m sure these people are hearing lots of comments, which are not helping the situation at all, such as

‘what do you have to be anxious about, you’ve just come home from Bali?’

Returned travelers understandably may have expected to be relieved and grateful when they finally walked in their front door. But instead they may have experienced a range of emotions, good or bad, ranging from mild disappointment to symptoms of trauma and everything else in between.

It is really important to accept it is OK to feel anything you might be feeling when you get home. Only you know and experienced your personal journey to get back in your front door.

As I have been writing about, humans love our structure and certainty. Uncertainty is a fertile breeding ground for anxiety. This structure includes daily routines which work best when they align nicely with our own circadian rhythm, or internal ‘body clock’. When we are on holidays, structure goes out the window in a really beneficial way, and because we don’t have to wake with an alarm clock or fit in with other schedules, we sleep when we want, eat when we want and we feel better for it. However, when we travel home crossing time zones and disrupting sleep (who can sleep on planes at the best of times?) we disrupt our circadian rhythm again, but in a negative way. This has a negative impact on mood and anxiety levels.

It ain’t just post holiday blues, there are known structural connections between the sleep centres and the mood centers in our brain. The good thing is once jet lag or transient sleep disturbance rectifies itself, so should you mood.

But what happens if, on top of all of this, there has been major sadness, disappointment or even illness or loss compounding the situation? What if you have been stranded like I am, annoyed and irritable that I have really no idea what will happen, fed up with comments telling me to enjoy my extended holiday, and then you finally get home? What if, instead of feeling relief and jubilation that you are home, you are teary, on edge and just plain miserable? There may be additional factors, complicating what has already happened with circadian rhythm disturbance that may be making things more difficult for you, including;

  • Nobody at home gets what you have been through. Friends, family and work colleagues only apply what they have seen on the news or have heard from other people, and you can feel they genuinely don’t understand your predicament. This invalidation may make you question your own response, feel deficient in some way, or lead you to holding back or pretending things are fine.
  • You have more FOMO. FOMO, or fear of missing out, may apply if your delays have led to you missing significant events going on for others at home. You may feel inappropriate guilt or anger because this awful unplanned event made you miss something very special to you.
  • As a coping mechanism, and because you felt helpless and uneasy, you may have coped with your extended time in Bali by being somewhat detached from the situation. This is a normal coping mechanism but also occurs when people are anxious. When reality hits you, when you see the credit card bills, or open the mail, all the emotions you may have not experienced while away may come flooding back.
  • If you have been diagnosed with depression or anxiety, you may have inadvertently missed doses of your  prescribed medications due to protracted travel home, or you may have run out while away. These feelings may actually be symptoms of a relapse of your illness and understandable.
  • You are constantly checking FaceBook feeds or news reports as you feel a connection to this situation and you feel inappropriate guilt that you got home. This in an extreme form is akin to ‘survivor guilt’, experienced by those who survive traumatic events and feel guilty that they did. This is complicated when well meaning people remark ‘how lucky were you’ and other things that make people hide their true feelings about their experiences.
  • If your time in Bali was complicated by further adversity, such as illness, theft or violence, you may be re-experiencing the event every time you see more updates, especially if the media at home is sensationalising things. You may feel a need to keep connected to social media as a way of trying to reassure yourself, which is keeping your mind on the past, and not on the healing properties of the present.

So if any of these factors (and I’m sure there are more) sound familiar, first and foremost do NOT beat yourself up for feeling the way you do. I often tell my patients that they feel anxious, depressed, sad, angry, lonely or whatever just because they do. Acknowledging how you feel regardless of whether you feel it is inappropriate or not is your first step to accepting it, then nurturing and healing yourself.

Other practical strategies to try (once again these are general guides and not specific to all cases);

  • Limit or avoid news updates about what is happening in Bali. It doesn’t help to let your mind wander into what is still happening to others. There is a fine line with feeling connected to others who understand, and perpetuating feelings of helplessness and sadness.
  • Connect to 1-2 friends who truly understand and talk to them. But if you feel overwhelmed by sharing, retreat for a while until you feel stronger.
  • Get your circadian rhythm back on track ASAP. Do not stay up late reading updates. Re-establish your normal daily routine. As bad as you have slept the night before, get up at the same time and go for a very short walk, not for the purpose of counting steps but to get some bright sunlight on your face. This will reset your melatonin levels and ensure your sleep cycle returns to normal as soon as it can. Sneak in a coffee or tea on the walk, it may help with motivation!
  • Connect with good memories and times that did happen. Print our photos of smiles, beautiful scenery, a picture of you in a relaxed happy state. All the reasons why you went to Bali in the first place.
  • If these tips do not work in a couple of days, or if you are having worrying thoughts, see your GP as a matter of urgency. You might be going there anyway, for that often needed dose of Bali-belly remedy. Make sure you tell your GP if you are not coping. Key symptoms to report are sleep disturbance, excessive worry, disturbed concentration, and more seriously thoughts of self harm.

This is not a time to think all the feelings you are having are due to you being weak, ungrateful or any other silly idea that may try and pop into your mind. Be kind to yourself, don’t avoid your feelings or excuse them away. Stay grounded. At home.

 

Dr Helen Schultz is a consultant psychiatrist in Melbourne, Australia, generally reachable by air from Bali. Right now she is stranded in Bali, churning out blogs and missing her son like anything. 

While I wait to get home, home finds me here

I am so amazed and truly inspired by all the people who read my blog yesterday and left such thoughtful comments. Like many of you I am feeling quite helpless as the days drag on and my proposed departure date is further behind me. It is really comforting for me to share my knowledge and try an help, while I am so far away from my patients in Australia, who keep getting moved to new appointment times.

Yesterday I wrote about the importance of keeping your health and safety as key priorities. That includes your mental health. Mindfulness is key here; if ever there is a time to be extremely vigilant about remaining in the present, it is now. Constant distractions and worries about home will only hamper our efforts to stay calm and we all need to be calm.

Once again, I need to impress upon anybody working in customer service and trying to assist us;

We don’t really want to call you or make your day any more stressful than it is. In fact, we would rather leave you alone, but we need to do so as the delays drag on and we search for certainty to combat feelings of despair. So please understand from our point of view that if you continue to provide consistent, clear messages and update when you promise, we will feel reassured and take ourselves out of the queue of calls waiting for you.

If you are experiencing an exacerbation in anxiety or your mood is affected adversely, remember to do what ever you can to stay calm. That may mean avoiding busy places that you may be visiting in order to kill time, or use WiFi. Sensory overload may not be helping inner anxieties, once again check in with your own anxiety and see how much you can withstand. Consider it a finite, valuable resource.

If you have run out of medication or are experiencing symptoms of a relapse of mental illness, it may be a good idea to try and call your GP at home. Although they may not be able to assist you as comprehensively as a visit to a doctor in Bali, you may be able to get some basic advice, and they may be able to reassure you. Likewise, your pharmacist at home may be able to help out. I would imagine that the local hospitals and GP clinics in Bali will currently be overflowing with requests for repeat prescriptions and treatment of acute physical and mental symptoms. I would imagine that they cannot cope too well with the huge demand, and my heart goes out to the doctors and nurses trying to help. If you are already anxious, an extended wait in a crowded emergency department may make things worse. Having said that, if you are feeling unsafe or acutely unwell, you must attend there for care.

So, from a psychiatrist’s perspective, here are some things you can do to boost your mental health reserves. they are not a substitute for specific medical advice, but they might help;

  • Use psychological and behavioural strategies such as distraction and relaxation techniques. Believe me, they work. Anything that can bring baseline levels of anxiety or depression to a more manageable state should be your first priority.
  • Exercise is extremely therapeutic. Nature walks are much better than trying to walk along crowded roads. Walk along the shore and feel the water on your feet. Cover up, and focus on your breathing. Leave the FitBit behind (I drowned mine in the pool, oops) this is not about steps or fitness. It is about the very beneficial mental health benefits of exercise. Walk as slow as you need to and as far as you need to until you notice your thoughts calm down.
  • Try and only focus on real concerns immediately affecting you, not the ‘what if’s’. Believe me, I have a huge list of ‘what if’s’, as a mother with a son back home in Oz that I was meant to get home to 4 days ago. This is what I am doing, you may find it useful as well.
    • Pull out a piece of paper and pen. Place all of your most important concerns in a column down the left hand side.
    • On the right hand side, allocate each concern to somebody to manage. You may be able to delegate some tasks related to home to someone at home. It will seem better when you notice that a lot of the tasks, such as getting someone to water the garden, pick up the pets, check the mail, contact your employer for updates, cancel or postpone appointments waiting for you can actually done by one person at home in a short space of time.
    • Authorise someone at home to speak on your behalf and this may cut down on your need to call from Indonesia. The time you free up can then be used to work on your relaxation strategies. And seeing a list with items ticked off is extremely therapeutic.
  • For all your fears, worries, what if’s, try visualisation work. Every time an anxious irrational fear pops into your mind, rather that fight or ignore it, put it somewhere – visually. Whether it be in a suitcase or an elaborate parcel made with banana leaves and decorated with frangipanis… you get the idea. Use your imagination to take the heat or the fear out of the worry. Let the worry know you have acknowledged it, but it is not that useful right now, so you will put it away for later. If you fight it, it will get louder and scare you more. The more you feel in control of your worries, the less they can hurt you.
  • If you are looking for medication substitutes, I would strongly advise against purchasing herbal preparations, or products with ingredients you don’t recognise. Any preparation, ‘natural’ or not has the capacity to interfere with your prescribed medication, and may cause a whole new set of symptoms. Avoid health related discussions on chat rooms,  or calling on Dr Google. If you are really desperate, once again a call to your pharmacist in Australia may help, if they have a list of ALL your medications, not just psychiatry medications.
  • It may be tempting to pass the day away with a few extra cocktails, under the proviso that you ‘deserve’ them. I am not trying to be a party pooper here, but if you already feel anxious or depressed, a big night on the Bintangs will make everything a whole lot worse tomorrow. And tomorrow might be the day you get that call you can fly home, so you need to be prepared to cope with a crowded airport, different route home, different airline (breathe, visualise….). Everything in moderation. Including social media.

I’ll endeavor to write daily whilst I am stranded here, and when I get home. Notice I say ‘when’ not ‘if’. Make a conscious decision to only say things to yourself that help you feel grounded, calm, and ready for whatever tomorrow may bring.

Best wishes,

Helen

Dr Helen Schultz has found herself stranded in Bali after booking a well-needed holiday, and writing her first book, How Shrinks Think. She is now spending her time practicing what she writes about, and writing. At any other time, she would consider this her dream life. 

 

 

Grounded by an #ashcloud? How to keep yourself grounded while you wait to get home

After 8 wonderful nights relaxing in Bali, I too have joined the long list of travellers trying to make it home to Australia. It has been 7 days since flights have departed and arrived without disruption. I am witnessing and experiencing first hand how it is to deal with airlines, hotels, insurance companies and generally anybody you don’t wish to bother unless you are actually in need and trying to find a solution to a problem.

I am struggling with trying to be present in the moment and at the same time managing professional and personal issues at home, things I would be doing as part of my usual life if my plane departed on schedule on the weekend. Meanwhile, around me I notice people struggling with the same thing. We all meet again at breakfast, at the pool, share stories about what we have read or heard and try and connect to feel we aren’t alone in this. One common theme is evident,

Now, just like any other time, past or present, we can’t predict the future, and that really makes people very anxious.

In our day to days lives we are often reassured that we can control a great deal of what happens, and most of the time we do a pretty adequate job of it. That’s because humans are hard wired to work best with habit, routine, and structure. We learn how to function by recognising what has worked in the past. Such as booking a holiday, turning up at the airport, arriving at the destination, leaving the accommodation and heading home. We can often leave our comfort zones and relax on a holiday because we know what will happen when its over. When there is any disruption to this, feelings ranging from unease to panic begin to emerge. This is understandable, even in those not predisposed to anxiety. For those who are, this change in routine and dealing with uncertainty can trigger every vulnerability.

It is OK to feel uneasy. Comments like ‘just enjoy the extra few days break’ might be annoying and make you more anxious if you are experiencing financial or health concerns due to being away longer than you have budgeted for.

People with anxiety disorders often fear the worst. They fear things that will probably never happen. This distortion in thinking is purely a symptom of anxiety and not a character fault. If you are prone to anxiety, or even if you aren’t but feeling anxious right now, here are some practical strategies that can help;

  • Reassure yourself that you will get through this, and no matter how inconvenient or stressful this may be, making rash decisions that could put your health or life at risk are not sensible. Remember to remain somewhere where you feel safe. When people are prone to panic or are distracted they can be impaired in decision making, and may be more prone to accidents or adversity. Remember to be safe crossing roads, entering areas you don’t know and so on.
  • Connect with as much home or certainty as you can. If that means a phone call or Skype chat to someone at home then make that a priority at a frequency that reassures you. Choose a person who will listen and help, rather than friends who may be there for the gossip and drama. Set up a small list of close friends on Facebook that you can contact rather than filter through all the noise on your feeds. Chose who you want to support you right now. Nominate a spokesperson at home who can call airlines, your employer etc on your behalf.
  • Where are your FOMO levels? ‘FOMO’, or fear of missing out, is a real phenomenon and is pretty rife right now, as we learn that social media channels, including unsolicited ones are updated faster than traditional means of communication. This is good and not so good. Certainly, as a group we can force airlines and insurance companies to respond to concerns faster than as an individual trying to call through on a landline. And we can feel falsely reassured by refreshing our social media feeds or listening out for notifications on an almost habitual basis. It is a typical conditioned response. You feel anxious, you press ‘refresh’, anxiety levels drop, there is nothing there, so you search more frequently and on wider platforms. Before you know it, you have spent hours staring at mindless information, in the fear of missing a notification from your airline or travel agency, and feel worse than before. Be very strict about checking for updates and stick to it. Checking your phone constantly, driven by a need to know something, will keep you completely focused on the problem.
  • Be specific about where you will look for information.  As the days go by there are more groups and information making it to our Google searches.  However, what is happening is many of the unsolicited groups and even the official sites are being drowned out by hearsay and personal experiences that may do no more than increase panic. Remember, Facebook pages are often set up by people who are generous with their time as moderators but really don’t sign up or are remunerated to deal with an influx of posts, filtering through for what is genuine or not.
  • Remember you are in one of the most tranquil places in the world, rife with ways to relax. Take this test to see how much you need to use what is here right now with you. Turn on you timer on your phone and set it for 5 minutes. That’s 300 seconds. Press start and lie back and close your eyes. Check how many times you had to resist checking emails or Facebook for updates. Feel how difficult it is to resist the urge. If you have not made it to 300 seconds, or have felt very uncomfortable after that time, you need to embrace some practical ways to help. Focus on the horizon, or where the waves are breaking out in the ocean. Watch the leaves on the trees sway in the wind. Pick up a handful of sand and see how long you can hold onto it before the grains fall to the beach. Come back to the present.
  • If you are a parent and have children with you think about the language you are using to describe your situation. If you are irritable or anxious, or need to have a conversation about your predicament, do it away from the children who will pick up on your anxiety.

Finally, the type of customer service large international companies can offer right now is on display. But now might not be the time to vent anger as it is most likely to make you very anxious, and the call centre operators very defensive. Don’t worry, I have had my fair share of difficult phone calls, when I am able to get through. Just think about what you will achieve right now, and what can wait till a very comprehensive letter of complaint when you get home.

Some tips for major companies when handling calls;

  • Assume everybody you talk to on the phone is calling because something has happened to them and they will be anxious and irritable. The best way to diffuse that is to provide clear directions and allow them to express their concerns.
  • If you broadcast that you will post an update at a certain time then do so. Even if you think it might change, do it anyway. If passengers need certainty, and all they have is a time for the next update then adhere to that.
  • Instead of delivering bad news all the time, educate passengers about what you will do when the ash cloud dissipates. Details such as the number of planes that will be dispatched to fetch stranded passengers, how the priority situation works if you need to get home due to medical emergency and so on. Pretty much every passenger is with you that we don’t want to fly if it is dangerous. there is no argument there. If you truly don’t know the answer, there is a lot of comfort in saying ‘we don’t know’.
  • Employ professional social media strategists to run your Twitter, Facebook and Instagram accounts. Irritated passengers can see right through comments that come across as patronising. Last week I was told “enjoy the pool, it is raining in Melbourne anyway”, which is no comfort to me when I have obligations at home. Social media is a powerful way of delivering effective communication as it happens, use it as such and the amount of negative comments should dissipate, hopefully as quick as this ash cloud does.

Remember, the ash cloud will pass. Don’t buy into fear mongering or shared anxiety of others. Home will be waiting for us. What we can do when there is not much else to do, is let go of what we cannot control. Continue to remain as resilient as you can using the resources around you. Stick together as couples and families, or if alone, remain connected to loved ones at home. We are all in the same boat.

Dr Helen Schultz, when not stuck in Bali, is working as a psychiatrist in Melbourne, Australia. She is now actively putting into place what she advises patients to do – mindfulness, relaxation and reading books. Oh, and waiting for travel updates.