When I'm Having a Bad Day Everything Feels Overwhelming

Blog culled from here

Rae Ritche talks about what bad days feel like when living with anxiety

I’ve spent the last couple of weeks questioning the correct length for toe nails. With my feet exposed in sandals, I’ve wondered whether every person I’ve encountered – from family and friends to strangers in shops – has been assessing my ungular choices. 

This kind of behaviour isn’t limited to toe nails. I’ve done it with heel heights and fingernails, even cuticles.  There probably isn’t an aspect of personal appearance, however small, that I haven’t interrogated at some point.  

I believe this behaviour is profoundly connected to my mental health.

When I’m going through a difficult patch, or even a rogue bad day, everything appears overwhelming. I struggle to cope with what’s going on around me or within me. 

I feel I simply don’t know enough about life to function properly, as if everyone except me received a manual on how to be a human. 

I lose confidence in my ability even to do those things that I can usually manage.

At times like this, I grasp at anything with an air of certainty about it. I’ll devour magazine columns, self-help tomes and ‘try this’ tips of all kinds. I want clear instructions. I want to be told what to do.

There’s no shortage of sources out there happy to meet this need.  There’s prescriptive advice available for every aspect of life imaginable.  I know because I’ve read it – read it and believed it (or at least suspended cynicism long enough to give it a go). 

I’ve applied Marie Kondo’s methods to my socks, done a life laundry of my possessions, made it to Inbox Zero and a whole lot of other stuff that doesn’t have a catchy name to accompany it.

I cling to these admonitions as a form of protection, harbouring the vain hope they’ll keep me safe.    If I reorganise the kitchen cabinets in the right way or buy a pair of reusable water bottles or put all my postcards and tickets in a scrapbook then everything will be okay!  All my problems will be solved!

How could I possibly still feel overwhelmed by mental health issues if I’ve sorted out every aspect of my life in accordance with the advice I’ve read?

Of course this is a flawed way of thinking.  Overcoming mental health issues requires more than a few nifty organisational tips.  Life can’t be lived according to a ten step ‘how to’ guide.  But when I’m struggling this logic returns. 

Next time it might be arranging my books by colour or only wearing white shirts for a month.  For now, it’s trying to figure out the right length for toe nails. 

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Awareness on Mental Health at Adherence Counseling Training in Suleja, Niger State

Gede Foundation and Management Sciences for Health (MSH) jointly trained 15 HIV/AIDS Adherence Counsellors and State focal persons in Suleja, Niger State, from 13th to 16th June 2017. Participants were selected from the Federal Capital Territory, Kebbi, Kwara, Niger, Sokoto and Zamfara States.

One of the objectives of the training was to explore the possibility of integrating mental health into routine ART services of Adherence Counsellors and overall health seeking behaviour—a discussion that is now consideredas important following a number of research articles that suggest a link between the two in terms of attaining significant viral suppression.

Dr Cynthia Ticao (Performance Director, Research and Advocacy, Gede Foundation) raised awareness about mental health and explained, at different sessions, the significance of mental health in HIV treatment outcomes especially in terms of treatment engagement and adherence. Results of the recently published research article from the joint study between Gede Foundation and the Institute of Human Virology, Nigeria (IHVN) on the ‘Prevalence of depression, alcohol abuse, and suicidality among people living with HIV-AIDShelped participants to relate more on thedangers of not addressing common mental health disorders (CMDs) in HIV-AIDS management—a position where Adherence Counsellors remain central.

Participants shared experiences related to their work and recognised the need to pay more attention to mental health conditions among the patients’ community especially because it has gained greater coverage nationally and internationally over the last three years, which is reflected in Sustainable Development Targets and also in the National Strategic Framework forHIV-AIDS Services Delivery (2017-2021). 

The training ended with two conclusions, (i) strong realisation for the need to integrate mental health services into HIV-AIDS care and support among participants and, (ii) Gede and MSH to explore possibilities of creating an effective partnership for a sustainable capacity building programme through the treatment and care continuum for HIV- health workers in order to achieve the overall goal of increasing treatment adherence and retention in care for people seeking ART services.

MENTAL HEALTH INCLUDED FOR THE FIRST TIME IN THE NATIONAL HIV/AIDS STRATEGIC FRAMEWORK 2017-2021 IN NIGERIA

Gede is delighted to recognise the inclusion of mental health into the National HIV-AIDS Strategic Framework 2017-2021 in Nigeria. The Framework, produced by the National Agency for the Control of AIDS (NACA), represents the input of a wide range of stakeholders including Gede, which worked as the Co Chair of NACA’s Technical Sub Committee regarding the integration of mental health into HIV-AIDS care and support. Gede’s just published (by BMC Public Health https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4467-5) Prevalence Study into depression, suicidality and alcohol use disorder among people living with HIV-AIDS in Nigeria has also played a part in raising awareness about key issues.

The goal of the Strategic Framework is to “fast track the national response towards ending AIDS in Nigeria by 2030” and, importantly, includes a strategic intervention to, “integrate nutritional assessment, counselling and services, mental health, sexual and reproductive health and psychosocial services into routine care for PLHIV”.

NACA is to be congratulated on including mental health into the Strategic Framework as research has shown that mental illnesses such as depression have a significant impact on HIV treatment engagement, adherence and retention and also play a key role in general health seeking behaviour.

TAKE A CHILL PILL

Anonymous Submission

I was having a rough couple of days. I was irritable. I was moody. I was snapping at everyone. My emotions were raw. 

A few days prior, I’d had a session with a clinical psychologist. I thought it went well. During the session, I almost had a panic attack and I thought after it passed, everything would be ok, or at least it would be heading in that direction. Little did I know that it would bring up raw, strong painful emotions to the surface. This was, by the way, not my first session, or my first therapist. The very first one I saw was a little strange. She wanted to clean the “aura" before I sat down and at that time, it was quite hilarious to me. 

Anyway, this new guy seemed to know what he was talking about. He let me talk, he asked me questions, he asked me why I thought people around me reacted to me the way they did - in hindsight. It clicked then that they may have been having issues of their own, but I took it how I took it and that learned behaviour has continued for the most part of my life. He even gave me homework. He asked me to allow whatever I was blocking to come to the surface. I remember shaking my head ‘no’ and then lightheadedness and voice telling me I’m gonna be OK. For once, I felt validated because I’ve always felt different and believed everyone that said I was a little too emotional and for once, I was told I was ‘sub clinically depressed with suicidal tendencies.’

Fast forward to a day after the session I was just stark raving mad. Everything was annoying me. I was called out on a lot of things - which I thought were valid reactions but apparently, I was acting way out of the ordinary. It was hard enough trying to not swear or say something lest I ‘hurt' someone’s feelings, but then I was asked to take a chill pill. This was funny to me because the person who told me to take a chill pill did not know that I had an actual chill pill that usually helps with my non-imagined anxiety. And so I took my chill pill and of course, it did what a chill pill is supposed to do. 

I’m still mad. My emotions are all over the place. Much like a woman who’d just had a baby - I would know this of course because not only did I have the expected all over the place emotions after my baby was born, I also had post-partum depression. That's not a happy feeling, especially when you do not have someone that understands. To people it’s just you acting up and so, like I always say, you put a lid on it… and then one day, as expected, it goes boom. What happens when you don't have a chill pill?

Prevalence Study Dissemination Session

Gede Foundation, in partnership with the Institute of Human Virology, Nigeria (IHVN) embarked on a joint research project in 2015 to find out the prevalence of depression, alcohol use, and suicidality among the HIV population in Abuja. The study was conducted in 3 conveniently-sampled sites—Asokoro District Hospital, Garki Hospital Abuja, and the University of Abuja Teaching Hospital in Gwagwalada. A total of 1,187 respondents participated in the study, making it one of the largest studies done in Nigeria among the HIV population so far.

At the dissemination session, Mr. Godwin Etim (Performance Director for Resource Mobilisation and Partnership Management) moderated and served as master of ceremonies. He read the welcome address of John Minto (Managing Director, Gede Foundation). Dr. Ernest Ekong (IHVN Clinical & Medical Services Director, IHVN) presented a background of how depression and alcohol use could affect the two most important aspects of positive health outcomes, i.e., adherence to medication and productivity. People diagnosed with HIV who also experience clinical depression more likely do not seek help or delay help seeking and tend not to adhere to medication, thus negatively affecting health outcomes.

Dr. Cynthia Ticao (Performance Director, Research & Advocacy, Gede Foundation) presented the results of the study. Major depressive episode (MDE) was experienced by 28.2% (n=335) of the participants. Alcohol abuse was reported by 7% (n=35) and 7.8% (n=93) were found to have experienced harmful alcohol use. One hundred and seventy (14.3%) participants thought about committing suicide throughout their lifetime, with 2.9% (n=35) doing so in the 12 months prior to the study. There were 27 participants (2.3%) who attempted suicide at least once in their lifetime.

Attendees at the dissemination session (Dr. Pat Matemilola - HiFass, Dr. Evans Onyekele - Gede Foundation’s Board Chair, Dr. Ernest Ekong - IHVN Director of Clinical Services and Co-Investigator for the project), Ms. Anthonia Ojokojo from the Society for Community Development (SCD), Mr. Samuel Jinadu - Karu Behavioural Unit, Dr. Avese Torbunde - IHVN, Yusuf Abubakar and Egbo Lincoln - Research Assistants) actively participated in the Q&A portion, asking very important questions such as: What next? What direction should organizations working for people living with HIV/AIDs (PLWHAs) follow now that we have evidence of the prevalence of depression, alcohol use, and suicidality among PLWHAs? 

The inclusion of mental health care into the National Strategic Framework on care and support is a big step towards the next impactful step forward. Gede Foundation and IHVN are confident that the study has earned the attention of the national authorities responsible for policies that will affect the lives of millions of PLWHAs in Nigeria.

Ms. Jeremy Boglosa being presented with an award

Dr. Ticao being presented with an award

Board Chair, Dr. Evans shows Founder's award 

Gede Foundation and IHVN are currently restricted from publishing the study as it is being considered for peer reviewed publication. We can certainly meet with your organization to discuss the results if you missed the dissemination session. Please contact us at info@gedefoundation.org.

Mental Health Camps: April Rounds

Written By Zunzika T. Okpo 

Gede Foundation held another round of Mental Health Camps, one on Saturday, April 22nd and the other on Monday, April 24th, 2017 in Mpape and Mararaba, respectively. 

As always, there were new, and older cases that came for follow-up. Perhaps the most satisfying, was a case, that most of our regular readers would be familiar with, of the lady that was chained to a pole in a church for over a year. The lady in question is now doing a lot better and in medical terms, she now ‘stable’ and was able to narrate her story from her own point of view. She claimed that when she was pregnant, 4 years ago, she was diagnosed with high blood pressure. She was overthinking everything as things were not going well for her and her husband.  When it was time for her to have her baby, she was in labour for over a week and throughout this time, she kept hearing voices telling her to leave. She stayed, however, and was able to deliver her baby. After she was discharged, everything went back to normal and she was caring for her newborn. When the baby was a few weeks old, she started getting upset at every little thing. One day, when the baby was 3 months old, she had a fight with her husband, got so angry that she left the house. After she left, she walked for such a long distance that she did not know where she was anymore. All she had with her were the clothes on her back and a handbag containing some money. As she could not find her way home, she ended up sleeping on the streets for sometime. Everything looked confusing to her. She did not know anywhere or anything. She eventually began to beg until she had a moment of lucidity and asked for directions to her house. She had apparently been away home for over a week. She was dirty, disheveled and had her lost her bag, save for the clothes she was wearing. When she eventually got home, her husband asked her to escort him to a church. She obliged. Little did she know that she was going to be chained to a pole for a very long time. That was where she had been from the time her child was 3 months old till he turned 3 this year. Right now, through the BasicNeeds livelihoods support part of the project, she was given money to buy a sewing machine and is back to being a fashion designer. She seems determined to advocate for herself and others, to stay in the support group and to adhere to her medication. 

From the new cases, there was a 56 year old woman who talks to herself and has visual and auditory hallucinations. She has been a patient of a behavioural unit for over 30 years but relapses regularly which renders her unstable. She also tends to wander off. Another lady in her 20s has disorientation, usually sudden and lasts over a week. At the time the Psychiatrist saw her, she presented with poor memory and could not even recall where she was serving her NYSC (National Youth Service Corps). She has a form of epilepsy which is characterised by sudden disorientation instead of a series of seizures. An elderly lady, in her 80s, has had wandering tendencies, poor memory, poor sleep and unresponsive to people for over 30 years. She laughs to herself, and also talks to herself. She was diagnosed with schizophrenia and placed on medication. Interestingly, an 11 year old also presented with the same complaints and has been this way for 2 years. 

A man in his 70s started forgetting things and became very aggressive about 10 years ago. This behaviour continued, coupled with visual hallucinations and wandering tendencies. 

It is encouraging to note that the message is getting across; support groups have been formed for our older users and even the new ones. They can support themselves emotionally, financially, if need be and in any way they see fit. 

Please come back for more updates on our work in the field! 

As The Pendulum Swings: Nkechi's Story

Nkechi at first glance is pure perfection; the definition of beauty and brains. I was unprepared for the story she was about to narrate to me during our Skype talk. 

“It started suddenly when I was in college. I was happier than usual, I felt I could do anything. Of course, the fact that parents tell us we can do anything and be anything we want, did not help in this case. Being in the media department, I had so many projects I thought I could do - all at the same time. I wanted to write several scripts, I wanted to do photography, because, obviously, the photographer had no clue what he was doing and that was irritating me (he was a professional). I also wanted to anchor another show apart from my own. Because these things obviously fell through, I went on another spiral. I decided to go for a drink with a few friends. What started innocently (or so I thought) quickly turned sour. I went and tried to play ‘bartender’. The drinks were taking forever and I could do it just as well, right? It was cute at first but after my third try, I was given a warning. I left my friends and told them I wanted to go swimming. They were all tipsy and no one really paid me any mind and so I left. I went to a hotel in Abuja and jumped into the pool. It was at that moment that I felt at one with the water. I loved it. I couldn’t possibly drown could I? I was, after all, the queen of the sea. Did I mention that I cannot swim? It took a while for me to be fished out of the water and taken to the hospital. As I sobered up, I started thinking the people in white coats were out to get me. I had to leave. There was work to be done. I wanted to repaint my apartment that I shared with my then boyfriend. I wanted new furniture, but before that, I needed to stop at a store to buy new clothes because this hospital gown just wouldn’t do. I also needed a phone as my telepathic messages to my boyfriend were not going through. So much for being queen of the sea. Where were my special powers? I had too much work to do. Sleep was a waste and it seemed like that is what they wanted me to do at this place with the weird people in white. I somehow managed to slip out. They hadn’t called anyone as I had lost my phone and now I was wondering aimlessly, not quite sure where I was. Eventually, I got home to find a worried and upset boyfriend. I was excited to tell him about my adventures (those I could recall) but he didn’t find it as exciting. I was apparently telling him about so many things I wanted to do but had so little time. I kept jumping from idea to idea till he just left for work. I stayed home re-arranging everything, literally everything. I tried to make several dishes because I just had to. This went on for a while and eventually, my exhaustion caught up with me.

It seemed like a lightbulb had been turned on in my head and I was watching my life as one would a movie. Had I done these things they said I did? How could I be failing my classes? Who sanctioned tattoos all over my back? One of them was a man’s name with ‘forever’ after the name. I was a big girl but I lost weight. I couldn’t bathe, I couldn’t get out of bed. I probably reeked. I hadn't combed my hair in a long time. I kept telling myself that I was just a waste of space. How could I have allowed myself sink so low? To my family, I was a disgrace. That was the first time I decided it really was not worth it. Everyone’s lives would be far better off without me. I decided my 23rd year was going to be my last and so I slashed my wrists. I bandaged it later on and then tried deeper when I was left alone and once again I landed in the hospital. My mother was wailing, asking me what she had done to deserve such a daughter. My father was seething and you could see the disappointment in his face. After my boyfriend explained what had been going on the past couple of months, the doctor suggested I see a psychiatrist. Upon hearing psychiatrist, he ran faster than Usain Bolt; ran right out of my life. It’s comforting to know my twin brother was by my side for the psychiatrist visits and eventual diagnosis. I’ve since left Nigeria and I try to stay out of the limelight. I am married with kids now and that’s not something you want your kids to be associated with. Perhaps with time, I will tell them about my struggles. I now know when my mania or depression is about to hit and I take my medications regularly, I exercise and eat healthy too. My diagnosis is Bipolar Disorder and I’ve learned that once you accept it and do what is necessary, you will be OK. This is just one of the times I have fallen off the wagon. However, it was the defining moment for me.”

Nkechi now lives in the US with her husband and two kids. Edited by Zunzika T. Okpo with Nkechi’s permission. 

Concealing an Illness – Stigma, Shame or Privacy Right?

Written by Ekaette Udoekong

The disclosure of one’s health status comes with a lot of sensitivity. There are various factors to consider, such as confidentiality and the right to privacy. It is not enough to dwell on good intentions and invade another’s right to privacy. Although informed consent is sought prior to the treatment of some illnesses, situations arise in which some of these ethics are ignored.

In February 2017, a close friend passed away. He was young but ill, very ill. Nobody, not even family members or friends, knew what he was suffering from. At first, he was aggressive when he was asked to seek medical attention and adamantly refused to talk of any sickness even when it was obvious his health was deteriorating. What is the phobia of hospital called? Nosocomephobia! This might not have been Michael’s reason for refusing to seek medical attention. May be it was shame or stigma but Michael was not even diagnosed of any condition because he did not accept that he was sick. Or maybe he had the right not to go to the hospital because it was his life and could deal with it his way!  

There are a number of reasons why people do not disclose their health status. The most popular among them is stigma, pity, anxiety and concerns of family and close friends. Strangely, Michael might have had the right not to disclose his status to anyone but what if he had a communicable disease (depending on form of transmission) that needed him to be isolated and treated, do we, his family and friends not have a right to be disease free? 

I remember telling Michael that he needed the help of a Psychiatrist or a Counsellor. He responded calmly that he was not sick and he definitely did not have a mental health disorder. Months past, family and friends watched Michael go out and come in, gradually losing weight. Later on, he could not even leave his bed and perhaps the time came that he thought was appropriate to seek medical attention - only then did he agree to be taken to a hospital. The Doctor said he was physically sick and was also very depressed because of what he suffered from.  In situations such as these, how could family member manage his refusal to seek medical help? Should rights be considered first when handling health status disclosures or offering care to the sick? For us at Gede, we work to lessen the suffering of individuals/communities that are underserved and stigmatized because of their health conditions, and this calls for action within the civil society organization especially those providing health services,  to integrate elements of mental health to their overall service delivery. This may not have saved Michael but it may help someone else who is in a similar situation.

Gede Presents Results of Prevalence Study Project

Yesterday, 19th April 2017, Gede was invited by NACA’s Treatment Care and Support Technical Working Group to share its findings on the recent Prevalence Study Project with People living with HIV-AIDS. Dr Cynthia Ticao presented the study design and key findings from the 3 conditions under the study—depression, alcohol abuse and suicidality.

These results had remained one of the catalysts driving the integration of mental health services into treatment, care and support for PLHIV in Nigeria for more than a year.

The meeting that was attended by representatives from WHO, PEPFAR, CDC, IHVN, NACA, MSH, CRS and others from the Federal Ministry of Health, reorganized the significance of this integration and considered as key in enhancing adherence to HIV treatment. It will be worth mentioning that the 2 important aspects of this advocacy had been achieved, namely: i) mental health in the National Strategic Framework (2017-2022), and, ii) inclusion into the recent Country’s Global Fund Grant application for 2018. 

Maiden Yoga At Gede Foundation

Do you want to destress, relax and rejuvenate? Join us at Gede Foundation, 13 Danube Street, every Friday between 4 and 5pm for only N2000. The instructor, Basant Ram is very experienced and has a desire to impart the benefits of yoga to others. He has pursued a career in Yoga and finished a course as Yoga Master. 

The Foundation held its maiden session on Thursday last week, April 13th. Please see pictures below and join us this week!! Call us on 080-5840-4610 for reservations as places are limited. 

See you April 21st at 4pm!