Thinking about the ‘worst-case scenario’ isn’t generally a pleasant activity, but it could give you the reassurance you need to proceed with confidence

Planning for a mental health crisis might feel daunting, and it’s important not to get stuck in a negative spiral. But some gentle preparation can be reassuring, helping us to think about what we can do to better support ourselves, or what help we might need from others.

We all have moments when we feel like life is overwhelming, and we need a reset button to start afresh. When you have a mental illness, there can be times when you can find yourself unravelling to the point where you may look to harm yourself, experience suicidal thoughts, or be unsure of whether you are able to keep yourself safe.

Sometimes, when we’re very ill, we can’t express our wants and needs, so having a plan lets the people around us know what to do in times of crisis. Planning before things get rough means you’ll have the right help and support ready to go, which gives you and your loved ones peace of mind.

Planning for difficult times is vital if you live with a long-term mental illness. Your crisis plan should be personalised, so it fits your needs. Here are a few things we can do ourselves to prepare for the future.

Before a crisis hits

Talk to your doctor about treatment options and support in your area, and create a list of what’s available, along with important numbers and opening times for services.

You can also research local or online support groups, and peer support services. People with similar experiences can still offer a different perspective, and can share their insights, as well as advice and coping strategies.

It can also be helpful to put together a box with items you find comforting. Fill it with things that distract your mind from negative thoughts, like your favourite book, movie, and mementoes that remind you of happier times. Together, this prep work will enable you to have support to hand as times get tough.

Make a plan with the people closest to you

When a crisis happens, often loved ones want to do anything in their power to help – but they may be unsure exactly what that is, or what you specifically need. This is why it can be vital to make informal plans with your loved ones, so they clearly understand the next steps and ways they can support you best. Talk it through together, write down what you’ve decided, and ensure everyone has a copy.

The plan should include contact details for your doctor and community support team if you’re too unwell to reach out directly. Let them know what treatments you’d prefer, and which you do not want, which can help them to speak up on your behalf. You should also include how you want them to help you – so add examples of what you will find helpful and what they shouldn’t do, which could be things to say, distractions, activities, etc.

You might want to choose someone you trust to advocate for you to doctors and other professionals, to ensure your needs are met. They can express your views and wishes, and stand up for your rights. It can also be helpful to let your loved ones know what to look out for be

It’s a long road to recovery following emotional abuse, manipulation, and gaslighting, but the following suggestions can help to ease that journey

Over the past couple of years, narcissistic abuse has become a social media buzzword – more and more people are becoming aware of the signs, and working to break free from it. Since 2017, I’ve been helping abuse survivors from all over the world to get back on their feet, regain their mental health, and recover who they were always meant to be.

Every person who walks through my door says something along the lines of, “I don’t know who I am any more.” Or, “I don’t recognise the person looking back at me in the mirror.” Some don’t even see anyone else at all. The complete loss of self, caused by the tactical erosion of identity, is one of the most difficult and heartbreaking consequences of narcissistic abuse.

The good news is that with the right tools, and the right support, you can find your way back to you, and when you do, this connection with yourself will be stronger than you could have ever imagined. So, how do you do it?

1. No contact (no ifs, no buts)

This is the most important rule of abuse recovery. Also, admittedly, one of the most difficult steps to take. If you stay connected, even if it’s keeping their number on your phone, just in case, you will not heal. Period.

Does this mean you’re selfish? Does this mean you’re a bad person? Does this mean you’re turning into a narcissist yourself? No, no, and no. No contact and narcissistic silent treatment are not the same at all. It serves your self-protection.

If no contact isn’t possible due to shared custody or legal proceedings, the contact needs to be highly modified and kept to the absolute minimum, with no personal touches at all, ideally through a neutral third party and/or apps such as OurFamilyWizard (ourfamilywizard.co.uk).

2. Take responsibility for your journey

It’s really easy to feel sorry for ourselves when we’ve experienced such unspeakable horrors and struggle with our mental health as a consequence. Is it fair? Absolutely not. The reality, however, is that we can’t change what has happened. All you can do is change how you feel about it. Can you take full responsibility for yourself and your recovery, make life happen, and feel empowered and in control? The decision is yours. Remember: you are the CEO of this operation!

3. Shift the focus

Shift the focus away from them, and what happened, and onto yourself and your healing. There is a time for reading books about narcissists and victim stories, and engaging in self-help groups, but eventually, you need to start to focus on yourself and begin to learn about things that actually will move you forward.

4. Self-care, self-care, self-care

I cannot stress enough the importance of self-care in finding yourself. This is something that very likely doesn’t come naturally to you. You’ve probably spent your whole life sacrificing yourself, and have always put others’ wellbeing before your own. Now is the time to change that. It’s like you putting your oxygen mask on first on the plane before you help others.

Self-care is whe

What is it, why does it happen, and what signs should I be looking out for? We share everything you need to know about passive suicidal ideation

Passive suicidal ideation is something that many of us experience, but few seriously talk about. Perhaps the thought has crossed your mind, “I wish I could just fall asleep and not wake up,” or “I wish I could die, so I don’t have to deal with this.” These are examples of passive suicidal ideation and, while they are not active plans, and often focus on ways in which someone may die rather than actively cause their own death (such as thoughts of death through an accident or natural causes, rather than suicide), these thoughts can be not only worrying, but can lead to engaging in riskier behaviour without being conscious of it.

Suicidal ideation isn’t an isolated event – it can be a symptom of other mental health issues, such as severe depression, or manic depression for those with a bipolar disorder diagnosis. Here, we’ll explain more about the different types of suicidal ideation, warning signs to look out for, and, crucially, how to then find help.

What’s the difference between passive and active suicidal ideation?

Having suicidal thoughts is a spectrum. For some people, these thoughts may be active: they think about suicide, and may have developed a plan for what they will do. They want to die. For others, it may be passive: they wish they were dead or could die, but do not have any concrete plans.

Neither kind of suicidal ideation should be dismissed. You are still at risk of harm if you have passive suicidal thoughts.

Intent and motivation can change quickly, meaning you may not feel at risk now, but that could change before you realise it or have time to seek help. Studies have suggested that if you experience high levels of depression and suicidality, thoughts of passive and active ideation have the potential to become more severe and dangerous. Experiencing physical illness, a significant decline in your mental health, or an unpredictable event (losing your job, a particularly bad day, fighting with a loved one) could trigger your thoughts to become active.

How many people experience passive suicidal ideation?

Passive suicidal thoughts are more common than many of us realise. Worldwide, around 9% of us will experience suicidal ideation at some point in our lives. Within the past 12 months, that sat at around 2%. One US study found that 4% of adults aged 18 and over have thought about suicide, with those aged 18–25 the most likely to have had such thoughts within the past 12 months.

As of 2020, around 10 in every 100,000 deaths were contributed to suicide in England. For men, that rate was much higher (15.3 per 100,000) compared to women (4.9 per 100,000). Men aged 45–49 have the highest suicide rate (23.8 per 100,000). Worldwide, the World Health Organisation estimates that one in every 100 deaths is a result of suicide.

All this to say, suicide is something that has touched many lives, and it’s something that we need to take seriously.

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If ‘barely getting by’ is where you’re at right now, you could be dwelling in ‘survival mode’

Here’s something that all of us can likely agree on: it can be really tough out there. The shared pressure to do and be more, the waves of bad news that flood our lives, and the personal challenges that we’re forced to face – it’s a wonder we’re able to manage at all. Except, actually, sometimes we aren’t. Sometimes, stress tips us over the edge, and our bodies respond.

“In simple terms, ‘survival mode’ is our body’s automatic response to danger,” counsellor and psychotherapist Belinda Sidhu says. “It’s what has helped us to survive, to get to this point. This response begins in one of the oldest parts of the brain, the limbic system.

“When someone confronts danger, the eyes, ears, or both send information to the amygdala – a part of the brain which can act a bit like an alarm system.

The amygdala interprets those images and sounds. When it perceives danger, it instantly sends a distress signal to the hypothalamus – which functions a bit like a control centre communicating with the rest of the body through our nervous system – and controls hormone release. This can lead to that fight/flight/freeze response.

“This response can absolutely be helpful and aid in our survival if, for example, we’re crossing the road and a car turns a corner unexpectedly. Yet, it’s not so helpful if we’re experiencing it when a stressful email pops up. However, the unfortunate element of the amygdala is that it cannot differentiate between the two ‘dangers’, and which may be an actual threat to our survival.”

As Belinda explains, stress is a very normal part of life – and it can even help motivate us, in small doses – but, over time, it can reach a tipping point where it begins to detrimentally affect your life, making it almost impossible for you to concentrate on anything else. At this point, you could enter ‘survival mode’.

“When we go into ‘survival mode’ – or experience the fight/flight/freeze responses – we may notice a number of physical, emotional, and behavioural signs,” Belinda explains. As she sees it, these include…

Physical signs: Aches and pains, trouble sleeping, muscle tension, or jaw clenching. You may find yourself grinding your teeth in your sleep and waking up with a sore jaw. Stomach or digestive problems, bloating, high blood pressure, or headaches.

Emotional signs: Being more emotional than usual – maybe more irritable, getting angry or frustrated at things that wouldn’t usually cause you anger, feeling overwhelmed, or on edge.

Behavioural signs: You may have trouble keeping track of things, making decisions, solving problems, concentrating or getting your work done. You might find yourself procrastinating and avoiding your responsibilities. You may be ‘self-prescribing’ – drinking more alcohol than usual, or using substances such as recreation

We all struggle from time to time. So why does reaching out for help feel so scary? We share more about how to ask for help

Why does asking for help feel so hard? Despite our growing understanding of mental and emotional health and wellbeing, many of us struggle to speak out and ask for help when we need it the most.

According to the latest figures from the United Nations, nearly one billion of us worldwide are experiencing some form of mental disorder. For teens, that is around one in seven. With ill mental health becoming more and more recognised, why aren't we asking for help sooner?

Why do we find it so hard to ask for help?

While accessing help can be a struggle, many of us find it hard to even ask for help. This can be due to a wide range of reasons. Some people worry that they will be a bother or an inconvenience to friends, family or loved ones, or add extra stress and worry to those around them if they admit they need help. Others may be hesitant to speak up out of fear of being judged, seen as weak or ‘less than’ others who aren't outwardly struggling. Some of us may hold back from asking for help out of fear of rejection or not receiving the help we are looking for, so we convince ourselves it is better not to ask, rather than to ask and still not get help.

Counselling Directory member, Psychotherapist and Clinical Supervisor Fe Robinson explains more. “It can feel very difficult to reach out and ask for support. You may feel vulnerable or uncertain, or asking may simply be too much right now. You may not feel there is anyone there that can be a support for you, or you may fear rejection. You may simply want to talk about how to improve relationships and get the support you need. In all of these situations, counselling can be a useful aide.”

Does asking for help actually work?

While asking for help isn’t always successful on the first try, we can still gain so much. By asking for help, we can:

• Stop ourselves from feeling stuck. The longer we wait to ask for help, the more stressed, anxious and overwhelmed we can feel. Speaking up can help us to regain the ability to move forward and see positive changes in the areas we most need them.
• Feel connected with others. When we need to ask for help - either that’s due to mental health, emotional wellbeing, or another reason - we can often feel lonely and isolated. Seeking advice, asking for help, or just sharing what is worrying us allows us to share our burden, connect with others who may be experiencing similar feelings, and dispel the fear that may have built up about admitting something is wrong.
• Gain an outside perspective. Sometimes, talking things through with a loved one is enough to help us see a problem in a new light. Other times, it can help us to recognise when we may need more help in the form of talk therapy, group therapy, peer support, or medication.

How do I ask for emotional help?

Asking for emotional support can feel tough. How do you start the conversation? Who should you turn to first? What do you say? It’s important to remember that everyone deserves to feel supported emotionally. When we feel too overwhelmed, we can ri