Christmas with a mental health problem

Christmas is a time that brings people together – but it can also serve to underline the social isolation of some. Adults with mental health problems face negative perceptions at the best of times but at Christmas their difficulties are thrown into sharp relief.

Alisha* is a community psychiatric nurse at a statutory CMHT unit in London comprising two approved social workers, two nurses and an ASW manager. Each staff member has a caseload of between 15 and 20 adults.

Forensic cases

The unit handles forensic cases – those whose illness has led to contact with the criminal justice system. Alisha’s clients include five men under 25, four of whom will spend at least some time at home with their families next week. But others who are in hospital or who live in hostels will have limited access, if any, to family. In fact, a quarter of the unit’s clients have nobody to spend Christmas with. “Often, their families don’t want anything to do with them,” says Alisha.

Fortunately, for some, the voluntary sector has stepped in. A local housing association and a church-based charity have accepted applications to provide Christmas dinner and, it is hoped, a relaxing afternoon for certain clients. But these services aren’t for everyone, Alisha says: “I can’t see Ezra*, who is a Rastafarian, enjoying a traditional English Christmas lunch. He’d only enjoy an authentic Jamaican party.”

Avoiding contact

Other clients avoid contact with family at this time of year. “One of my women won’t go home because she’ll have to do all the work for her partner and his friends, the cooking and so on. It’ll be much easier for her to stay in her supported housing scheme where there are staff to do the dinner.”

Some of Alisha’s cases involve more complex considerations: “A young man we’ve had for a few years once stabbed his mother. But this year he’s going home. He’s now stable and his mother is keen to have him on Christmas Day. Obviously we’ve had to do a lot of talking and planning for this.”

Family stigma

One worry for the team is what happens when family members turn on their clients. “What they don’t need is a negative comments. Dad telling them they’re a waste of space, that sort of thing. They have to cope with enough stigma as it is. So you want them to have contact, but you’ve got to recognise that things can go wrong.”

The team gives support to mothers with mental health problems whose children have been removed from their care. “Christmas is particularly hard for them,” says Alisha. But there are also cases where the child has not been subject to a care order but has gone to live with relatives. “Often the child will stay with mum over Christmas and the strain of looking after the child causes a relapse,” she says.

Rise in crises

Does the team see more crises at this time of year? “There is more loneliness at this time of year than any other,” says Alisha. “So, yes, there is often more self-harm, abuse of drugs and alcohol. But it’s worse when we have a ‘four-day Christmas’ when Christmas Day fell on a Saturday as it did in 2004. That takes more planning because there are then four days will little or no cover and clients lack the skills to negotiate this.”

In a crisis the only option available to mentally ill people in this period is to go to A&E, unless home treatment services are available.

Alisha feels that day centres, which are now extinct in many areas, would have had an important role to play at this time of year. “I understand why they are shutting but if there were good centres, well organised with constructive activities, that would alleviate the strain on statutory and voluntary services at this time of year.”

But then there are no easy answers: for every client a different solution seems to be needed.

* Not her real name

See the website of Together UK, a charity offering services for all people using mental health services, including forensic services