Trigger Warning: This content contains information and reference to mental illness and suicide. If you or someone you know is affected by mental health issues or the content discussed, please call the Samaritan’s 24 hour hotline on 116 123. The Campaign Against Living Miserably (CALM) offers support to men between 17:00 and 00:00 on 0800 58 58 58.

An introduction

ThisÔÇÖll be a long ride, so letÔÇÖs get to know each other. IÔÇÖm Mike, and IÔÇÖm a writer with bipolar disorder and ADHD. ItÔÇÖs the worst. IÔÇÖm not good at being a person. I suffered abuse as a kid. I get anxious at restaurants when I butter bread in case itÔÇÖs another mundane thing I screw up. I come from a loving but deeply dysfunctional working-class family. My life is a fleeting rollercoaster on the rails of impulse. I have episodes of ecstasy where I make ambitious investments and sleep around, yet somehow never sleep. I also have episodes of depression where colour subsides and death lures. Underlying it all is a chronic inability to direct my focus.

LifeÔÇÖs not great. I stare at neurotypical people doing neurotypical things in equal parts awe and envy. Sustainability seems distant and naive. But IÔÇÖm also an award-winning critic who is still breathing and has heard it all before. Well-intentioned people are going to offer vague and patronising advice. Some of it helps. Barely any of it gets results. IÔÇÖm here to tell you exactly how Cardiff’s mental health systems work and how to navigate them productively. A positive attitude is not enough: this is a long journey that demands proactivity and introspection. You have no choice but to embark.

The diagnosis

You want to reach diagnosis. You may not think you do, but you do. If that diagnosis is ÔÇÿgo homeÔÇÖ, count yourself lucky. IÔÇÖm going to teach you how to get there without private healthcare. YouÔÇÖve probably consulted the university wellbeing service. Maybe youÔÇÖve even seen your GP. What did you tell them? What came of it? I bet either:

1. Wellbeing offered you counselling or CBT, which was nice, but didnÔÇÖt get you where you wanted, and you didnÔÇÖt actually read what they told you to read
2. Your GP prescribed you 5mgs of citalopram (or equivalent) which just made you feel a bit ÔÇÿoffÔÇÖ
3. YouÔÇÖve bottled it up because itÔÇÖs ÔÇÿnot that bad compared to other peopleÔÇÖ

Whatever the case, youÔÇÖre still at the drawing board. You canÔÇÖt quite put your finger on it, but something is wrong. Maybe youÔÇÖre noticing your life isnÔÇÖt as ÔÇÿnormalÔÇÖ as you once thought. Maybe the words ÔÇÿanxietyÔÇÖ and ÔÇÿdepressionÔÇÖ mean something to you. But until you have it in writing from someone better qualified, it will be an invisible enemy that you do not understand. You canÔÇÖt anticipate the manoeuvres of an enemy you only vaguely perceive. ThatÔÇÖs why you want a diagnosis. It personifies the opponent of your progress. Fortunately, getting one isnÔÇÖt all that difficult once you know how it works. The hardest parts ÔÇô waiting times and unreceptive doctors ÔÇô are beyond your control and must simply be survived.

Write it down

Want to kill yourself? CanÔÇÖt breathe in front of others? Whenever you feel like it, make a note of it. DonÔÇÖt get caught up in the details. Just get it down. Put a memo in your phone. DonÔÇÖt do it because itÔÇÖs therapeutic. Do it because itÔÇÖs evidence. The sad state of the NHS means that you do not enjoy the privilege of being a patient. You must overcome the vulnerability a patient approaches a hospital with. You are a lawyer and you are going to court to represent yourself.

The NHS is big. ItÔÇÖs a nebulous, bureaucratic system with finite resources, and the only way to fairly get anything moving is with empirical evidence. How you feel is evidence only to yourself. Build on your feelings in note form. Be honest, confront yourself, develop insight. Above all, provide examples. If youÔÇÖve made plans to kill yourself, write down the methods, the motivations, the protective factors stopping you (or lack thereof). If youÔÇÖre anxious, write of how you couldnÔÇÖt breathe during a social setting and had a panic attack. Transform your pain into symptoms on a page that can be approached methodically.

On writing, Ernest Hemingway famously said, ÔÇÿshow, donÔÇÖt tellÔÇÖ; it is not enough to merely tell your doctor that you have depression. Until you demonstrate it adequately, you will be a hot potato patient and you will get around.

02922518888

HereÔÇÖs exactly what to do: ring Cardiff University Wellbeing on 029 2251 8888. Pick the counselling and wellbeing option. Tell them you need to talk through your problems with someone. They will arrange an appointment for you. Attend it. One thing I hear all the time is ÔÇÿbut I wonÔÇÖt know what to sayÔÇÖ. This is a nonissue. At my first one, I babbled in tears about feeling ÔÇÿwrongÔÇÖ and it was still productive. This is a safe space for developing an emotional and mental vocabulary. Like any skill, it takes practice. You arenÔÇÖt supposed to know whatÔÇÖs wrong or what to say.

Wellbeing is for learning your weaknesses; the GP is for long-term solutions, if necessary.

Tell wellbeing you want to figure this out and document your symptoms to prepare for a GP appointment. YouÔÇÖll have a few sessions, in which time the two of you may develop an idea of what this could be. The UniversityÔÇÖs wellbeing service might be enough for you. If it is, fantastic. If not, ask your counsellor for a letter referring you to the GP. TheyÔÇÖll help you write you one. But keep it for yourself ÔÇô do not give it to the front desk at your local practice, because you wonÔÇÖt get it back.

The appointment

Call your GPÔÇÖs practice the second it opens and go to the next available appointment. Bring the letter you got from wellbeing to the doctor directly, alongside any other symptomatic evidence. You have about fifteen minutes to make a compelling case. Plan your pitch. It is perfectly acceptable to go to your doctor with an agenda. If you think you have depression, or anxiety, or bipolar disorder, say it. Doing so creates a discussion with diagnostic criteria that you can assess together. If you bumble in anxiously with nothing to say but ‘I don’t feel so good’, you will be met with equally vague solutions.

Approach the conversation no differently to how you would if you had tonsillitis. Instead of ‘there are white spots at the back of my throat‘, or, ‘it hurts when I swallow’, provide your mental symptoms. These could be, ‘I’m constantly fatigued’, ‘I have suicidal ideations’, ‘I lose control over basic functions in social settings’. Prepare situational examples for the main ones.

Something inside you stirs when you pick up the phone. That’s your fear that the doctor won’t take you seriously. Unfortunately, doctors are people too. There’s a chance you could be dismissed, talked over, or hurried along during a busy day. During my first NHS consultation, my doctor refused to believe I had suicidal ideations and told me to lie about it at the next assessment because he knew better. Looking back, this was malpractice. But you’d be surprised at how even the strongest people can be coerced into enabling their own mistreatment in an environment as vulnerable as mental healthcare.

This fear comes from within. It’s the phantom of the legitimacy you’re denying yourself. Just because something is illusory, however, does not make it trivial to overcome, especially if you hail from a background of no-nonsense ‘soldier on’ parents. You’ll wonder if they’re right, if you really are just a big baby. But if nothing’s wrong, then tell me: what are you doing here? Nobody seeks mental healthcare for shits and giggles. You’ve come this far for a reason: you have symptoms and you need help. Good doctors will ask probing questions; if a doctor answers them for you, you’re not talking to a doctor at all.

I will make no guarantee that the first professional you see will be kind and understanding. Fortunately, there is more than one doctor in the world. Persist – which you must – and you will find one willing to entertain a constructive dialogue. When you do, ask what your options are. You may be offered medication. Take it if you like (beware; side effects are real and they can be immobilising). IÔÇÖd recommend asking to be referred to your local Community Mental Health Team (CMHT). This is the upper tier of mental healthcare that will investigate your case on an individual basis. You’ll be assigned a psychologist whom you’ll meet with every six to eight weeks or so. This person will monitor you and provide a diagnosis.

ThatÔÇÖs half the battle

You need to be mentally prepared for the truth. HereÔÇÖs a fun thought: what does ÔÇÿdisorderÔÇÖ mean? Mankind may seem developed to you, assuming you’ve avoided the news in the last three years. But evolution is a slow burn. In the grand scheme of human history, we have enjoyed a sliver of peacetime. Our species has barely had enough time to decide what it ought to be, let alone the wealth of time required to psychologically evolve to these standards. Psychopathology, like me at my school prom, is young and woefully unexplored. Terms like ÔÇÿdisorderÔÇÖ describe how productive we are in the way society conventionally understands it. It is by no means an assessment of your capability or value as a human being.

One piece of advice youÔÇÖll get is ÔÇÿbe kind to yourselfÔÇÖ. No; be fair to yourself. Kindness is too forgiving to be applied unconditionally. Everything thatÔÇÖs happening to you is bullshit, but it does not absolve you of accountability. You may have family, you may have friends, you may have lovers. All, in some way, will tell you that everything will be okay, that all wounds heal with time. ItÔÇÖs a comforting phrase and a shallow one. It is action, yours entirely, that will bring you through this difficult process. Self-advocacy and personal responsibility are central to survival.

You will falter. You will miss appointments. You will fail at jobs and relationships you werenÔÇÖt mentally ready for. ItÔÇÖs all a part of the game. This is a delicate balance to strike, and day-to-day life will be the most difficult factor because it isnÔÇÖt designed with you in mind. You are inherently abnormal. You may be mentally incapable of regular structure. That doesnÔÇÖt matter. Set realistic goals and achieve them. It doesnÔÇÖt matter if youÔÇÖre doing it 3am like a nutter. It doesnÔÇÖt matter if you eat a sandwich by its individual parts. It simply needs to be done; no one else can do it for you.

The wait

Waiting times will seem endless. In the interim, others will recommend coping mechanisms. Try them all, even if they seem asinine. These include breathing exercises, rigorous daily routines, ÔÇÿlife hacksÔÇÖ, and so on. Some of these might work for you: if so, great. But no one knows what to say to you if nothing works out, so IÔÇÖll have a go.

This is a formative time in your life. You are cursed with mental and emotional inconsistency and itÔÇÖs too easy to drown in the vortex. Form yourself before it forms you. Give your name meaning. Do you believe strongly in something? Do you love someone? Do you have a passion project that demands your attention before you die? If you have nothing to live for, like I did, find something. ItÔÇÖs not like you have anything better to do. Write your name on a post-it note. Stick it on your wall. Look at it when you are feeling low and remember what you serve at your fullest. Take good care of it; itÔÇÖs the real you.

Rise and shine, pal. ItÔÇÖs time to fight the dread. 029 2251 8888.

If you have any questions, reach out to me at mikegpob@gmail.com. I’m the weirdo in the glasses down here.