How to rebuild your life after breakdown

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I've had a breakdown – will I ever get back to normal?
How can I start to regain my confidence?
How can I rebuild my relationships?
What sort of help can I get?
What about finances and work?
References
Useful organisations
Further reading

"Since my experience (I don't like breakdown, but can't think of a better word), I have felt an almost obsessive need to set myself goals and challenges. Each challenge successfully completed makes me feel better about myself. Initially, just going off the ward was a challenge, then going shopping, then more shopping (I do endorse retail therapy!), then coping at home, going back to work, then eventually climbing a mountain in Snowdonia, trying scuba diving, swimming a length underwater, studying psychology, and so it goes on… My recovery has been a brilliant experience and life has never been better."

"I went back to work part time and it was impossible – I simply felt inadequate, because I couldn't fit what I wanted or needed to do into the time available... So I was soon off sick again, because I believed I couldn't do my job any more, that I would never be able to cope with it. Eventually, a close friend helped me to see that maybe I wasn't hopeless, and that maybe I should make my own decisions about what I could and couldn't do. Then I simply returned to work, full-time – without permission – and everything was fine."

"The thing that I found vital in my own recovery was finding ways of understanding what I had experienced (and continue to experience on occasions) and accommodating it into my life and view of myself, in a way that made sense to me and allowed me not just to survive, but to thrive."

This booklet is for anyone who has had a breakdown, for their family, friends and for mental health professionals. It offers ideas on self-help, and on how and where to find support or information. It draws on the personal experience of people who have successfully rebuilt their own lives.

I've had a breakdown – will I ever get back to normal?

A breakdown of your mental heath can be a shattering experience, but the good news is that most people do recover. Everyone's experience of breaking down is individual. Some people use mental health services during a breakdown, while others cope with their problems alone or within their circle of family or friends.

In the same way, each person's needs for recovery after a breakdown are different. There is no correct path to recovery that will suit everyone. However, some of the information and ideas here may be useful to you.

Diagnosis
The term 'nervous breakdown' is generally understood to mean a state in which someone becomes unable to cope with everyday life, perhaps following a particular trauma or, perhaps, apparently out of the blue. There are many different forms.

If you saw a GP or psychiatrist during your breakdown, you may have been diagnosed as having some form of mental illness. For some people, this can feel reassuring, as it enables them to find out what has been written about that illness and to join organisations or support groups for people with the same diagnosis. Others feel that being given a 'label' makes them less optimistic about their future. Some are told that they will have this problem for life. Don't be put off by negative opinions from others, even if they are professionals. Nobody can predict your future, and most people can recover, whatever their diagnosis.

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How can I start to regain my confidence?

There are many different paths you might take, and you need to find what is right for you. While some people find that getting back as quickly as possible to their normal routine is the best way forward, others find this impossible and need to take things very slowly. Some people decide that they want to rethink their lives and take a new direction.

"At first, my goal was to get up and get my son to school, then it was to do a cleaning job, then on to voluntary work, then a part-time job. Now, I work full-time, but it's flexible, so I can work from home, if I need to, and have a day off if I don't feel well."

You may find it hard to motivate yourself to do anything at the moment; or you may be pushing yourself too hard to get back to 'normal'. Now is the time to think carefully about how to achieve the right balance between stress and inactivity. Here are some tips, which others have found valuable.

Be kind to yourself
Recovery is rarely a smooth path. If you have a bad day, try to think what you would wish for someone you care about, who felt the way you do, and treat yourself the same way. Don't condemn yourself or feel a failure, just think about what you can learn from what has happened and continue to plan for the future. Watch out for perfectionism, and try to be realistic – set goals that you can achieve.

Do something physical
"I have found gardening brilliant – there's the manual side (working off excess nervousness), the out-in-nature bit, meeting the other gardeners… and, of course, producing some goods."

Tension can accumulate if we are inactive. A regular exercise programme can help. Try aerobics, walking, jogging, dancing, swimming, yoga – or an outdoor activity, such as gardening or fishing. (See The Mind guide to physical activity.)

Reduce your stress level

• If you tend to put too much pressure on yourself, learn to slow things down. Develop a realistic schedule of daily activities that includes time for work, sleep, relationships and fun. (See the Mind guide to managing stress.)
• Pace yourself and take mini-breaks. The following simple routine can help. Sit down and get comfortable; slowly, take a deep breath in, hold it, and then exhale very gently. At the same time, let your shoulder muscles droop, smile, and say something positive such as, 'I am r-e-l-a-x-e-d'. (See The Mind guide to relaxation.)
• Use a daily 'things to do' list.
• Find a form of regular relaxation that you enjoy, such as taking a quiet stroll, soaking in a hot bath, watching the sun set, or listening to calming music. Create a quiet and restful corner in your house, where you can sit comfortably to read or meditate.
• Be sure to get sufficient rest at night.
• A messy environment can add to stress, so try to keep things tidy, clean and comfortable.
• Healthier living helps. What you eat and drink can have an effect on your mood. Excessive caffeine and sugar increase nervousness. Over-use of alcohol and tobacco won't help either, though it may not be the best time to try to give up smoking. Try to eat simple, natural foods, such as brown rice or other whole grains, fruit and vegetables, rather than 'junk' food.

Find your own coping strategy
"What is most important for me has been learning to understand how stress affects me, and also getting to grips with the triggers which cause my relapses."
 
Many people have found that they can help themselves recover by getting to know more about their problems and creating a personal strategy to overcome them. One helpful technique is to keep a mood diary. This enable you to keep track of changes in emotions, to learn what triggers them and what helps most. It can also help to note down improvements and changes you would like to make.

"The course of each person's life after breakdown is very different. I find the standard health promotion stuff – exercise, diet, relaxation – a little too 'worthy' perhaps."

What works for one person does not necessarily work for another. Try different things, and don't accept others' ideas if they don't suit you.

You could express your feelings in drawing, painting, music or writing. Many people find that it's easier to express feelings in a poem, which can be as structured or free-flowing as you like. It's just for you; you don't have to share it with anyone else. There may be a class, where you can learn a new creative skill.

An important part of recovering from a breakdown, for many people, is to find a meaning in what has happened. Meditation of some kind can help with this, and reading inspirational books has been of value to many. If you belong to a faith community, this is the time to ask for help and advice from your minister or from other members of your religious community.

Different cultures and religious groups have different understandings of a mental breakdown and you may find help and support within your particular spiritual tradition and community.

Explore complementary therapies
Many have found help for their recovery from a wide range of complementary therapies. Therapies that have been found useful for recovering from a breakdown include aromatherapy, reflexology, massage, spiritual healing, herbal medicine, homeopathy, acupuncture, shiatsu, colour therapy, crystal healing and Bach flower remedies. Some of these therapies can be used for your own self-help.

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How can I rebuild my relationships?

Relationships may have been under strain during your breakdown. Apologise for any hurts you may have caused others, and try to forgive and let go of any hurts others may have caused you. Then let time do the healing. Think through whether a problem you are having with another person is really your problem or theirs. If it is yours, deal with it calmly and firmly; if it's theirs, there's not much you can do.

"The social exclusion is the toughest part. Learning to like yourself is the first step towards getting the most from other people and yourself. Everyone is different, but we all need a bit of love and kindness sometimes, to get by."

If you have friends or family who understand you, try to enlist their support for your recovery.
A regular, friendly chat with someone, however brief, can be important healing medicine.

You may sometimes find it easier to talk to someone who is not involved with your life and who does not expect support from you in return.
A counsellor or therapist can help you see things in a different light (see Talking treatments, below). You have a right to feel good about yourself, rather than worrying about other people's attitudes to you.

Nobody will be able to help you with all your needs. You need to find out who you can turn to for certain things. Helping others (when you feel able to do this) can take your mind off your own difficulties and remind you that you, too, have something to offer.

If your living or working situation has contributed to your breakdown (a stressful relationship, problems with work or unsuitable housing, for instance) consider whether anything needs to change. However, try to put major changes on hold until you have had plenty of time to think and talk it over with someone not involved in your daily life, such as a counsellor.

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What sort of help can I get?

Care planning
If you have been in contact with specialist mental health services during your breakdown, you should have been provided with a care plan, under the Care Programme Approach (CPA).

Your care plan should be written down and you should have a copy. If a family member or friend is caring for you, they should also be involved in creating it. The plan should specify what help you can expect from health services and from social services. If you don't have one, or you're unhappy with it, contact your local mental health advocacy project, Citizens Advice Bureau (CAB), or Mind. (See Useful organisations, further down.)

Your GP can refer you to the local community mental health team (CMHT) for an initial assessment of your needs. This is a multidisciplinary team made up from health and social services professionals, including a psychologist, psychiatrist, social worker, occupational therapist, counsellor or community support worker. While they all have individual professional responsibilities, they are jointly responsible for supporting people with mental health problems, and their carers, in the community.

Your local social services and voluntary agencies usually operate a range of services, including housing services, community centres for service-users and carers, welfare rights advice and employment schemes. They also provide practical support, which may include access to meals-on-wheels, laundry services, counselling, home helps and befriending schemes. Social services can make their own assessment of your needs, and those of your carer, if asked. You can also approach voluntary organisations, such as local Mind associations, directly yourself. (For more information about community care services, consult the Mind website, whose details appear under Useful organisations, further down.)

Talking treatments
Some GP practices have a counselling service available or can refer you to a local counsellor. Counselling usually takes place once a week, and focuses on helping you find better solutions to your problems. Psychotherapy is sometimes available on the NHS. It is more intensive, and tends to look deeper into the underlying causes of difficulties. You may be referred to a counsellor or psychologist who may offer cognitive behaviour therapy as a short-term, practical therapy for finding the links between feelings, thoughts and behaviour, and developing new coping strategies. You can also find your own counsellor or therapist, privately, who may be able to offer you reduced rates.

Medication
If you are on medication following your breakdown, or are offered medication by your doctor, it's your right to ask questions about this.

It's a common experience that making your own decisions about medication is better than being pressurised into taking medication that you are unsure about. If your doctor is very insistent that you take medication that you find unpleasant or unhelpful, do seek other advice, from Mind or your Patient Advice and Liason Service (PALS). You can find your local PALS by asking your local hospital, clinic, GP surgery or health centre, or NHS Direct. Find out as much as you can about the medication offered to you, and the alternatives, including combinations of complementary therapies, talking treatments and support groups. (See Further reading, further down, for details.)

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What about finances and work?

Benefits
It's important that you get good advice on what benefits you, and anyone caring for you, may be entitled to during your period of recovery. You could contact the Benefits Enquiry Line, a local CAB, your GP, CMHT, social services department or local library, for more information on benefits and employment schemes.

Getting advice or training
For many people, work is important to recovery, whether this means returning to their current job, finding a new job or training course, or finding interesting and worthwhile voluntary work. If you have been a patient of a psychiatric hospital, there may be a rehabilitation service where you can get advice and help on how to get into work again.

This might include courses on regaining your confidence and social skills, interview techniques, and skills training. Other potential sources of support and advice about work include CMHTs, Mind or other mental health charities, your Jobcentre or Jobcentre Plus, or local CAB. There may be a local employment support project, which can help you get back into work. You will need advice on how your benefits will be affected by returning to work. The Government's New Deal for Disabled People is an attempt to make returning to work easier for people who have experienced health problems or disability. (For more information about getting back to work, see The Mind guide to surviving working life.)

Voluntary or part-time work
Doing part-time or voluntary work may be a useful way to get started again, if you feel you need to take things slowly or want to change direction. Getting back to previous work is important for many people, but may present some problems, at first. Flexible working arrangements can be very helpful but, for some, this is not possible or desirable. Some people find that getting back to their normal way of life, quickly, actually helps them recover.

"I found that when I was told in hospital ‘these things take time' it was the most pessimistic and devastating statement I could have heard. Time was the one thing I did not have, as I needed to get back for my kids. I made a quick recovery (in hospital for one week only) and I think it was mainly because I refused to take any drugs… I love my job and I was aware that all the time I was in hospital I was putting it at risk. I managed to get back to work after a total of seven weeks off and worked one day a week less for 10 weeks. I actually felt much better once I was back to my normal hours."

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References

Benefits for people with mental health problems (Mind 2003)
Community care factsheets 1-5 (Mind 2002)
In good faith: a resource guide for mental and spiritual wellbeing (Mental Health Foundation 2000)
Recovery: an alien concept R. Coleman (Handsell 1999)
Strategies for living (Mental Health Foundation 2000)
Wanting to work (Depression Alliance 1998)
Working with voices R. Coleman, M. Smith (Handsell 1997)

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Useful organisations

Benefits Enquiry Line
tel. 0800 882 200
web: www.direct.gov.uk/DisabledPeople/FinancialSupport/

Employment Opportunities for People with Disabilities
123 Minories, London EC3N 1NT
tel. 020 7481 2727
web: www.opportunities.org.uk

Hearing Voices Network
91 Oldham Street, Manchester M4 1LW
helpline (voice hearers only): 0161 834 3033
web: www.hearing-voices.org 12

Maca (The Mental After Care Association)
1st floor, Lincoln House, 296–302 High Holborn, London WC1V 7JH
tel. 020 7061 3400
web: www.maca.org.uk

Manic Depression Fellowship
Castle Works, 21 St George's Road, London SE1 6ES
tel. 020 7793 2600
web: www.mdf.org.uk

Rethink Severe Mental Illness (formerly NSF)
28 Castle Street, Kingston upon Thames KT1 1SS
advice line: 020 8974 6814
web: www.rethink.org

Richmond Fellowship and Workschemes
80 Holloway Road, London N7 8JG
tel. 020 7697 3300
web: www.richmondfellowship.org.uk
Support for people with mental health problems seeking work

UKAN (UK Advocacy Network)
14–18 West Bar Green, Sheffield S1 2DA
tel. 0114 272 8171
Help in locating a local advocacy service

United Kingdom Council for Psychotherapy (UKCP)
167–169 Great Portland Street, London W1W 5PF
tel. 020 7436 3002
web: www.psychotherapy.org.uk
Information about finding a therapist

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Further reading

The bipolar disorder survival guide D. J. Miklowitz (Guilford 2002)
A can of madness J. Pegler (Chipmunka Publishing 2002)
The day the voices stopped K. Steele, C. Berman (Basic Books 2002)
A head full of blue: a memoir N. Johnstone (Bloomsbury 2003)
How to look after yourself (Mind 2004)
Inside out (Manic Depression Fellowship 1995)
Making sense of antidepressants (Mind 2004)
Making sense of antipsychotics (major tranquillisers) (Mind 2003)
Making sense of cognitive behaviour therapy (Mind 2004)
Making sense of herbal remedies (Mind 2004)
Making sense of homeopathy (Mind 2004)
Making sense of lithium (Mind 2004)
Making sense of minor tranquillisers (Mind 2003)
The Mind guide to food and mood (Mind 2004)
The Mind guide to managing stress (Mind 2003)
The Mind guide to physical activity (Mind 2004)
The Mind guide to relaxation (Mind 2004)
The Mind guide to surviving working life (Mind 2003)
The noonday demon: anatomy of depression A. Solomon (Random House 2001)
Sheila's book: a shared journey through madness S. Harvey (Somerset Virtual College/Mind Taunton 2003)
Stopovers on my way home from Mars M. O'Hagan (Survivors Speak Out 1983)
Sunbathing in the rain: a cheerful book about depression G. Lewis (Flamingo 2003)
The world is full of laughter D. Sen (Chipmunka Publishing 2002)

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This booklet was written by Jan Wallcraft
First published by Mind 2000.
Revised edition © Mind 2004.
ISBN 1-903567-00-9

No reproduction without permission.