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Health Matters: We can learn skills to build resilience in face of adversity

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Dr Neil McNamara.
Dr Neil McNamara.

Dr Neil McNamara on coping with crisis.

Nearly a year ago, as the spectre of Covid began looming, with a little bit of hope and a little bit of fear I started out in a new role as clinical director for mental health services.

Some days this seems like a daunting challenge, with responsibility for highly specialist intensive hospital units as well as community teams dispersed across nine different districts in a landmass famously the size of Belgium.

The perspective is broad. At the core is a need to understand with service planners what “mental health” and “mental illness” mean in our society and how that influences what people expect from us in the NHS.

In another world, I am still a psychiatrist within our rehabilitation team, alongside colleagues from nursing, occupational therapy, pharmacy and psychology backgrounds.

We try together to support back to independence those who have found their ability to work, form relationships and enjoy activity disrupted by severe mental disorder.

Almost always this means psychosis – a frightening and alienating experience where the fabric of reality is frayed and the world can seem a threatening and confusing place.

On the one hand I could say that this is a fortunately rare condition, affecting only around one in 100 people in a lifetime.

But I am uncomfortable reinforcing ideas that further marginalise.

I find it more helpful to reflect on the shared human experience that our senses can often deceive us and our certainty that we are right about things is easily built on shaky foundations.

I like to ask medical students if they have ever had déjà vu. That usually gets the cogs turning about both what unites us and the paths that might lead to truly serious illness.

I walk a tightrope between these responsibilities. I have a duty to advocate for the needs of patients with psychosis who are often poorly understood, robbed of their own voice and frankly forgotten in the well-meaning clamour to raise awareness of other much milder and more common forms of mental distress.

This is a hard thing to say, particularly when many of us are suffering ourselves from the dislocation and isolation of pandemic lockdown.

Ultimately I know we need to balance out the needs of one group, however disenfranchised, against the needs of all.

I am excited by the idea that if we tune in to this need for balance we actually have an opportunity to reimagine how we take care of our collective mental health and wellbeing.

What if instead of thinking about individual groups and services we had a sense that we are connected parts of a whole?

We can all learn skills to build resilience in the face of adversity which will reduce our chance of becoming more seriously unwell.

These skills and the support networks to share them could be built with ingenuity in communities, freeing specialist services to be there whenever called on for those most in need.

Today I have more hope than fear that we can do this together.

• Dr Neil McNamara is NHS Highland’s clinical director for mental health, learning disability and the drug and alcohol recovery service and consultant psychiatrist (rehabilitation).

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