Episode 1 Peace of Mind

One in four of us will face a mental health illness

at some point in our lives.

We may know the statistic, but what do we really know

about those who live with challenging conditions

and the working lives of those involved in their care?

This series will bring them together - to tell their stories.

Whitchurch Hospital in north Cardiff is facing its final days

as an ageing institution, built at the start of the last century.

Modern psychiatric services across Wales

aim to treat people where possible in purpose-built units,

or outside in the community.

24-year-old Natalie McCulloch, from the Vale of Glamorgan,

has been under the care of a specialist mental health team

since being sectioned for a severe eating disorder 10 months ago.

I've been diagnosed with anorexia nervosa,

and basically it's an eating disorder, but it goes

far further than food.

It results in weight loss, food restriction,

exercise compulsion, hospitalisation...

I get very emotionally anxious

and tearful - and socially,

I've sort of disengaged with a lot of friends.

I've dropped out of university, out of work,

and I've let go of so many opportunities, just because

so many of them involve food.

So, I've... Probably about...

11, 12, 13, that sort of age, and I guess that's when

your puppy fat gets laid down, and things,

and those changing shapes provoke the feelings of being

overweight, even if they would have sort of slipped away.

The worrying thing was that I'd lost

six stone in six months, and I think it was just that severity...

of how I'd been sort of quite a "bonny" little girl

at the Christmas, and then by the June, I was, well...

emaciated, I suppose. Erm,

and I had to be sort of put into a wheelchair.

People think, "Oh, you know, just eat, you know, just go home and

"have a few good meals - that'll put the weight on and stuff."

If only it was that easy.

Natalie's care team is based at Whitchurch Hospital, although

she isn't being treated here.

The SHED team is a specialist high-risk eating disorder unit,

treating around 40 patients each year.

Well, the types of psychological issues that all eating disorders

have in common is a very severe concern

with either body shape or body weight,

or food intake, or the pattern of eating.

In some senses, the approach to food and eating can become quite rigid,

and obsessional, and they experience

quite high perfectionistic standards, in terms of

achieving their goals with their eating.

But treating Natalie has meant leaving Wales

and a bed for her at a specialist clinic in Marlborough in Wiltshire,

as there are no beds for severely anorexic patients in Wales.

Her care is shared by the team in Whitchurch

and by the unit in Marlborough where Natalie is being

supported to shop and plan for meals,

-then eat on her own - and in company.

-Thank you very much!

Everyone understands that you're in there to go through

some hellish times, and the empathy there is incredible.

That's one thing that touches everyone when they go in,

how understanding everyone is, and how willing people are

to listen to and help other people even if they won't help themselves.

Getting up, someone stands behind the bathroom door,

while you go to the toilet, so you don't try and influence your weight.

Then you go down to your underwear and step on the scales.

I'm always really anxious as I see the numbers go up,

because it's done in points, and you can see it go up and up and up,

and part of you is thinking, "I want it to be higher,"

but then part of me is, "OK, stop now, stop now!"

as I'm seeing it go up. It's very difficult for me

to be excited or elated by reaching my target -

which I think a lot of people can't understand, because

in an ideal world, that is what I'm working towards, thus,

I've reached it, surely I should be happy.

But I think it signals a new part of the journey, and that's really scary.

42-year-old Maddy Read was born in Birmingham,

but moved to Cardiff over 20 years ago. She has lived

with debilitating mental illness all her life.

I believe that I was depressed

from my first memories.

I think I suffered from anxiety, as well as depression,

from early childhood.

I think the two come hand-in-hand

and I was scared of anything and everything.

I was scared of bees, I was scared of wasps,

I was scared of aeroplanes flying over.

Volcanoes, earthquakes.

Big-time - more than that was normal, really.

Maddy made it through college and a music diploma,

but became seriously ill in her early 20s.

I've spent all day, every day,

either just crying, shaking -

physically, severely shaking...

screaming...

or actually paralysed.

I was very suicidal. All the time.

Became obsessed with killing myself.

I wanted it to be right.

I didn't want to mess it up, I didn't want to wake up

with a broken neck and not be paralysed for the rest of my life,

where I couldn't kill myself again.

I didn't want to die in pain,

so getting the right way was really important to me,

so I kind of researched it a bit,

and just became obsessed with doing it and how to do it.

I kind of tempted fate by having this cord round my neck...

hanging from the banister,

and my tip-toes would just be on the step.

I'd will myself to push, but...

I never did.

And then I met my husband, Mike.

He was a great support,

and I moved in with him pretty much within weeks.

And he pushed the Community Team and said,

"Look, she's not progressing, she's not doing anything.

"What have you got in mind?"

After four in-patient admissions at Whitchurch for her severe

depression, Maddy was offered the chance to attend the day hospital here.

That was really the most significant thing that helped my recovery.

I had two or three days to go in each week.

I met this lovely lady who took art groups...

and it got me mixing with people, as well.

I had a routine, for the first time.

Get up, go in, see the nurse, do a group, maybe see the doctor.

And come home.

The work Maddy did at the day hospital,

coupled with anti-depressant medication,

meant that she could begin to recover - for the first time.

Two, three, four years ago, I remember waking up and thinking,

"Oh! I don't want to die today. I don't want to kill myself today."

That was fantastic!

Getting well was like being born for the first time.

Dudley Moore! Good Lord, is he "jazz"?

Gosh, it's so dated, it's beautiful!

I could see things, I could communicate with people,

I could... SHE SIGHS

..enjoy, maybe? Nearly?

Get pleasure out of things - that's a better way to say -

get pleasure out of things I thought I'd never get pleasure out of.

Even just observing scenery, or...

you know, anything.

In Flint, 21-year-old Kelly Boylin also knows the pain of mental

health problems from an early age.

I started self-harming when I was ten...

but I didn't really understand at all what I was doing.

I had no idea what self-harm was,

or why people did it,

or...what caused it, or anything like that.

I just knew that I was in pain and wanted to get away from it.

It's horrible. Everybody judges you - your friends, your family.

You're now the person with a mental health problem.

A diagnosis doesn't make me a monster - I'm not dangerous.

I'm just like you, I'm just like everybody else -

I'm a normal human being.

I just find things a bit more difficult sometimes.

A traumatic childhood, which she's still reluctant to talk about,

made her mental health worse, and by the age of 15, she was

placed in a specialist unit for teenagers in Colwyn Bay.

I actually remember the day I got took in

was the last day of my GCSE exams.

I remember saying goodbye to my friends at 3.30 at the gates

and saying, "I hope we all get the results we want."

And then, literally, crossing the road and there being a taxi

waiting for me to take me to this mental health unit

that I knew nothing about,

and didn't know what I would face when I got there.

And I was so, so scared.

It was horrible. I hated every single minute of it.

I think I was just a very angry little girl at the time.

I just fought against the system by carrying on, trying to take my life,

and self-harming and... in a number of ways, really.

Slamming doors, getting angry.

Running away - I did that a number of times, as well.

The opportunity to work with a trained

psychologist at the unit was a turning point for Kelly.

Bronwyn was my care co-ordinator.

But she was also a child psychologist.

She was lovely. She wasn't intimidating or anything like that.

She was just really warm, and asked the questions quite subtly,

so she wasn't in my face and didn't scare me.

She really understood how hard it can be to be that age

and be struggling with

such harrowing things.

She'd see me about once a week,

and we'd talk about how things are getting on at the unit,

what I was finding hard and what I was getting a bit better with.

I finally realised it's kind of now or never.

I had to do something with my life,

and just make people proud of me.

I think I was really fixated on making people proud of me.

So it definitely spurred me on.

We really had a really close connection.

We got on really well and used to be able to have a laugh.

We'd go out for coffee and for walks.

We just got on really, really well.

It felt like she was a massive support network in my life.

Six years later, we're still doing that.

I'd almost call myself her "transitional object".

If you think about teddy bears and their significance for toddlers,

as they move on into school,

or sleeping in their own bed, or anything of that sort.

So, although it might sound a little bit trite,

I've allowed Kelly to "hang on" in a way.

She's in that very difficult 18-to-25-year-old group

that finds the movement from, maybe,

children's services into adults' services quite difficult.

What if you suddenly find that,

because it probably will happen - these things are always swings and roundabouts...

the times when the bad days,

for whatever reason, outweigh the good again.

How will you cope with that?

I really feel I'm here to make a difference, somehow,

and I want to make that happen.

I don't know exactly what that is.

I find it really, really helpful,

on the mental health side of things,

to have somebody around me that's quite a lot older than me,

that has a lot of experience.

-I think it's really important.

-Luckily, somebody had spotted it.

In Marlborough, Natalie is facing a difficult task.

Her recovery means daily challenges, such as shopping for food

with the help of a specialist nurse.

Erm, I don't think I'll be able to do it, to be honest.

Especially cos they've got the calories all over there... and I'm just thinking,

I don't know what I can have without putting on too much weight.

But then I know that I'm here to put on weight.

I want to choose what I want, because, otherwise,

it's giving in to the anorexia, and I've done that for so many years.

But that is terrifying.

I know they're having crisps,

fruits and a sandwich on the ward,

so I guess I could follow that...

It does give you a guide, though.

Can I just steal that around you, sorry? Thank you.

OK, so what else do I get in this, then?

-If I grab a bottle of water and a pack of crisps?

-Yeah.

And then some fruits.

I'm always really conscious about what people are thinking about what I've eaten,

I love Worcester sauce.

-Hands-down decision.

-And then fruits.

They're onions - that's not good.

And especially, like going out and choosing meals

when you don't know what's in the food...

how many calories are in so-and-so.

This feels so weird.

And a lot of places now put calories on the menu.

Some supermarkets even have them

in front of the cake when you're choosing them.

For someone like me, that is horrific,

as being able to choose something you actually want

is really difficult.

Natalie's team from the Whitchurch Hospital Eating Disorders Unit

has come to Marlborough to discuss her future.

Natalie remains sectioned under the Mental Health Act, but she has

found a flat in Cardiff and wants to live there independently.

Basically, Natalie's been progressing quite well

with the treatment plan set for her.

She's been completing meals...

no problems with that.

Natalie has progressed really significantly recently.

Having a very focussed determination now to recover.

Personally, I'm very optimistic

about how she will be able to continue

this hard work in order to achieve the goals she has in mind.

Ending treatment abruptly at the hospital in Marlborough

would not be good for Natalie.

So the staff will discuss allowing her to share her time

between her flat in Cardiff and the unit in Wiltshire.

Some of the key points would be thinking about planning your meals

at home, thinking about shopping and what the facilities are.

Getting used to shopping in particular places,

and what they have available.

Then, preparing those meals and having some support around that.

I thought that was really positive, actually.

I'm always really anxious before I go in,

just because it's sort of feeding back on your progress,

and about planning for the next couple of months.

I can override those anorexic thoughts

and hopefully then they'll get quieter.

It's like anything, I suppose.

If you don't listen to it, it will eventually give up,

and I hope that will be the same with the anorexia.

Natalie still has much work to do, though.

Preparing food and eating independently

will be a key part of her recovery.

How long does this take to cook, chicken?

About 20 minutes?

So that will have to go on first.

I'd probably cook that one with onions.

OK?

One of the key issues that makes it difficult for people with anorexia

to eat, generally,

is a sense of guilt around eating.

That's very difficult to manage

when they're eating on their own,

but is even more pronounced if they're eating in company,

and therefore they feel other people are aware of what they're eating...

and maybe having thoughts that are quite critical

about them and how much they're eating.

Do you think that looks even? What do you think?

-I don't know.

-It looks a hell of a lot.

Do you think there's more on that one?

Maybe. Does it matter, though?

Hmm, no. No.

No, probably not.

-OK.

-OK?

Recovering from mental illness is a daily challenge,

and maintaining wellbeing can often feel like hard work.

For me, when I was unwell,

then I wouldn't dream of putting any kind of make up on.

I would always be clean and tidy, but there was no motivation,

and what's the point anyway?

Everything was pointless.

It's only when you're well, for me,

that you think of making it even better.

I suppose that's a way of putting it, by doing your hair nice

or having a haircut or putting some make-up on.

It aids what you've already got.

But you have to be well enough to want to do it.

Somebody noticed that if I'm feeling not so good,

I would tend to wear darker, plain clothes.

It's not something I'm aware of or do consciously,

but I guess it probably does reflect on how I'm feeling that day.

Cos, I mean, for me, there's quite a lot of actual motivation

and thought planning in what I wear.

So, if I can't function very well,

if my thought processes aren't very good

and my concentration isn't good,

then it probably reflects on what I'm wearing.

I am a person who likes to be a bit individual,

likes to make, certainly, the best of what I have.

It's just something I enjoy doing, really, make the best of myself.

I love the compliments, if I get any,

and I love to give compliments too.

But it would be the ultimate compliment to me

for people to like me for who I was, rather than,

"Oh, I like that jacket."

Cos, at the moment, I think,

"Well, nobody would like me for who I am...

"because I've got nothing to offer."

Kelly made a good recovery

from mental health problems during adolescence,

until she received shattering news three years ago.

I remember being out shopping with my friend.

I got a phone call from my mum telling me that I had to go home

because something had happened to one of the family members.

She sat us both down...

and I remember her bursting into tears and...

..just saying that this wasn't a joke

and that I had to take this seriously

and that she never wanted to have to tell me this,

but that my middle sister, Kimberly,

had committed suicide during the night.

It just felt like something out of a film, just not real.

I couldn't believe it, because Kim was such a strong-willed person

and so dedicated to what she was doing and...

She wanted to open up her own law firm

and she had so much going for her, that I literally couldn't believe it,

and I actually didn't believe it for about two years after her death.

I come here about once a week

and I think it's still important for me to come here,

so I feel that Kim knows that I still care about her, you know,

I still want to come and commemorate her memory and remember her.

But I don't always bring flowers. I tend to bring little fairies

because she used to have a collection of fairies on her bedside table

and different things like that.

And sister plaques and little poems and things.

I just bring something different.

It's...

These last three years has to be the worst three years of my life,

because...

my sister's not here and I still can't accept that sometimes

and, for the first two years of when she was gone,

I continuously tried to join her.

I felt that she deserved to be here more than me

and, somehow, magically, if I ended it all,

then someone would bring her back

and she'd be able to live the life that she deserved to live.

Well, I set up a campaign in Kim's memory

because, before Kim took her life,

she'd been on a waiting list for mental health services for two years

and she still hadn't been seen by anybody

by the time she had committed suicide.

So, in her memory, I set up a campaign called Kim's Voice

which is fighting for better mental health services in the UK

and I think it's a really good outlet for my grief,

it's a really good way for me to reach out and let other people know

not just how I'm feeling, but actually how a lot of people,

when they lose people to suicide, feel.

If I could help one person through this campaign,

then something good would have come out of Kim's death

and the rest is just a bonus.

I hope she'd be proud of me.

But I guess...

That's one of the hardest things to accept, that you'll never know.

But I hope she'd be proud of me. People tell me that she is.

So, I hope she is.

Natalie's move back to Cardiff

is a chance for her to live independently for the first time.

It used to be a constant thing on my mind, you know,

"Where would I find to live, I need somewhere to live..."

But I was anxious about whether I'd be able to cope,

whether I'd like it, whether the area was going to be good,

whether I was going to feel safe there, that's a big thing for me.

This is my apron, which is very honest.

The idea that I only have a kitchen because it came with the house.

Cooking the easy way, ping!

That's pretty much my level of cooking skill at the moment.

I didn't want to be placed just anywhere,

I wanted somewhere that was actually going to be good for me

and good for my recovery, allow me to practise all the skills

and not put me back into an awkward position, I guess.

You know, they mentioned hostels and that wasn't for me,

I didn't want to go into a hostel.

I needed somewhere with my own kitchen,

because I wanted to be able to cook.

One of the biggest parts of my journey is to get that independence.

So, yeah, I placed a lot of hope on this place.

The period of transition from the inpatient unit

to living in the community is a very difficult time,

and that's why we aim to focus a lot of intensive support

around that period.

With time, that will be tapered away

and she will be offered a range of psychological therapies

and dietician advice in order to maintain her weight.

It's like the golden carrot,

the final discharge is the end of the road, a long road.

It's not the end of the recovery, I don't believe that for one second.

I think I'd be naive if I thought it was.

The hard work is yet to come.

For me, this time, it feels really good

to have gone through the procedure properly, to not have bolted.

My GP saved my life when he sectioned me,

and I never thought I'd say that.

I've really enjoyed going out for meals now.

And really quite empowering just to be able to look at a menu

and choose what I wanted,

as opposed to choose what I think I ought to have.

And last weekend, I went out with friends for a meal,

but I actually really like looking...

I look forward to going out for meals,

mostly if someone else is paying.

So, please...

1998, take one.

Action!

Maddy considers paid work to be a crucial part of her recovery,

offering some financial independence and a structure to her day.

From the early age of school,

I never believed I could do a job, ever. Any job.

Any job posed a problem and that's with me throughout my life, really.

I fell into TV extra work.

I'm a supporting artist, known as SAs.

Because my husband knew an agent, and I phoned,

and there's no audition, there's no interview,

and that's kind of suited me.

I love going out, new places, new people,

so it's almost like a social thing.

I like the fact of being part of a team,

I do like the fact of, you know,

I've been on Casualty or Doctor Who or, you know, the big shows,

so that's all great.

It stops me being at home, moping, thinking I'm useless.

And action!

I love my TV work, but it's not nine to five.

You know, I can go for months where I don't get anything

and then a block of crazy weeks where there's loads, but...

So, I suppose I'd feel normal and recovered

if I had a proper job, but...

That's a challenge in itself.

I can't see a normal, proper job that wouldn't scare me to death.

So, I'm kind of...

Knowing what I want, and knowing what I should be doing,

but too scared to do it.

For me, now... Yes, I'm the best I've ever been.

Yes, I still get bad days.

Yes, I still have issues

with concentration and motivation, particularly, sometimes focus.

And I accept that's always going to be a bit harder for me

than maybe other people.

But recovery, for me, I suppose,

is being able to get where you want to be and not have...

..mental health issues that will hinder that.

Kelly is working hard to maintain her mental wellbeing,

but knows that she needs time to think and grieve for her sister.

Me and Kim had a massive, massive love for horses.

My parents had a few horses and we used to go riding regularly.

So, I guess when I'm riding,

it's really the one place that I feel Kim around still

and I feel like I kind of connect with her.

So, that's really important to me.

I think having a sense of freedom is really, really important,

and this, horse riding, is definitely my sense of freedom.

And, I guess, it's an escapism for me,

via my post-traumatic stress disorder,

the memories, the flashbacks...

It's the one place where I...

where I feel safe and at home.

I feel I'm kind of half way recovered, really.

I still think I've got a lot of work to do,

and that's mostly around the post-traumatic stress disorder,

but I've really done well, self-harm-wise,

and especially with my eating and things like that,

I've come a long way...

And, as well, I've not overdosed in a very, very long time.

I've not tried to take my life in quite a while,

so, I think that's really important for me to recognise as well,

for my recovery,

is how long I've gone without doing these damaging things.

Those who have been brave enough

to share their stories during this series

face the prejudice and fear many of us feel about the mentally ill

every day.

The aim for psychiatric services in today's Wales

is to place those with challenging mental conditions

at the heart of any decisions about treatment in the right environment.

Changing attitudes will take time,

but the era of treating people in asylums is over

as professionals and patients now look for a more modern approach.

Many of the mentally ill

are now being treated alongside the physically ill,

in purpose-built units,

helping break down barriers and reduce stigma

against some of the most marginalised people in our society.

Subtitles by Red Bee Media Ltd