MENTAL HEALTH CHARTER: #TIME4CHANGE
To help you to know how to talk about mental health here is a fact sheet on
symptoms and common language and terminology
Mental Health and Wellbeing
It is important to remember that, like physical health, we all have mental health too.
What is mental wellbeing?
Mental wellbeing describes your mental state - how you are feeling and how well
you can cope with day-to-day life. If you have good mental wellbeing, or good
mental health, you are able to:
• Feel relatively confident in yourself - you value and accept yourself and judge
yourself against realistic standards
• Feel and express a range of emotions, appropriately and proportionately
• Feel engaged with the world around you – you can build and maintain
positive relationships with other people and feel you can contribute to the
community around you
• Live and work productively
• Cope with the stresses of daily living and manage times of change and
Mental health problems and wellbeing
If you experience low mental wellbeing over long period of time, you are more at
risk of developing a mental health problem.
If you already have a mental health problem you are more likely to experience
periods of low mental wellbeing than someone who hasn’t. However, you can still
have sustained periods of good wellbeing where you can manage your life without
Getting help if you are struggling
If you feel persistently down, for a duration of two weeks or more, or feel that you
can no longer cope, it is really important that you don't struggle on alone. Often, just
naming that you're having difficulties can bring a sense of relief and make your
circumstances feel much more manageable.
Many mild mental health difficulties can be resolved simply by talking to a friend,
member of your family or staff. Often mild problems will resolve of their own accord
or respond well to talking therapies.
Signs of mental health problems
It is important to evaluate these in terms of duration and severity of symptoms,
having a cluster of symptoms and the impact it has on social function.
Sleep can have an impact on mental health, as well as being a possible early
indicator of the onset of mental health difficulties.
There are clinically effective self-help apps to address sleep problems and these can
often be more useful than medication. Google ‘sleep hygiene’ for advice on steps to
take to prepare for a good night’s sleep. NHS Choices also provides information and
self-help advice. Your GP can discuss specialist treatment options with you.
Symptoms of depression may include:
• Persistent low mood, often worse in the evening
• Loss of interest in life and a lack of enjoyment of things you'd usually get
• Feeling alone, even when surrounded by people
• Tiredness and a lack of energy
• Feelings of emptiness and worthlessness
• Feeling disconnected and unmotivated
• Loss of interest in sex
• Problems getting off to sleep, early morning waking with an inability to get
back to sleep, problems getting out of bed in the morning
• Failing aspects of training or over-working
• Problems concentrating and remembering things
• Feelings of guilt and despair
• Suicidal thoughts
Bipolar disorder, sometimes referred to as manic depression, is characterised by
extreme mood swings. These can range from extreme highs (mania), to extreme
lows (depression). Mood swings also have associated changes in sleep, energy levels,
rate of speech and the ability to think clearly.
Symptoms of mania may include:
• Feeling very happy, elated or over-joyed
• Talking very quickly
• Feeling full of energy
• Feeling self-important
• Feeling full of great new ideas, schemes or plans
• Inability to concentrate
• Easily irritated or agitated
• Being delusional, perhaps believing things that seem irrational to other
people, having hallucinations and disturbed or illogical thoughts,
• Not feeling the need to sleep
• Not eating
• Poor impulse control and an inability to consider consequences of actions -
for example, spending large amounts of money on unnecessary and often
• Risky or harmful behaviours that are out of character
Please refer to the previous section for a description of possible symptoms
About 8% of the population engages in current, chronic non-suicidal self-injury. Of
these, 80% do so for emotional regulation.
Self-harming behaviours may involve:
• Taking too many tablets
• Cutting yourself
• Burning yourself
• Banging your head, punching walls or throwing yourself against something
• Punching yourself
• Sticking things into your body
• Swallowing things
Incidents of deliberate self-harm are greatest amongst women, LGBT+ people and
those who have experienced physical, emotional or sexual abuse during childhood.
Taking drugs recklessly, engaging in unsafe sex or binge drinking are examples of less
obviously but still serious self-harming behaviours.
Someone who self-harms is usually in a state of heightened emotion, distress and
unbearable inner turmoil. About 3 in 100 who self-harm over more than 15 years will
kill themselves. That's more than 50 times the rate for those that don't self-harm.
Cutting can leave you with permanent scarring and is a route for infection. If you
damage nerves and tendons this can lead to a reduction in sensation and function.
Self-harm is not necessarily a sign that you have a mental illness, though often
people will have an underlying clinical depression.
Eating disorders and compulsive exercising
Anorexia Nervosa is a serious mental illness
What are the signs?
You may find that you:
• Think more and more about your weight
• Eat less and less - calorie counting
• Exercise more and more, to burn off calories
• Can’t stop yourself from wanting to lose weight, even when you are well
• safe weight for your age and height
• Smoke more or chew gum to keep your weight down
• Obsessively check your weight, shape or reflection in mirrors
• Withdraw from social situations which may involve eating
• Wearing baggy clothes to hide one's body
• Water loading before being weighed
• Excluding certain food groups and making foods "good" and "bad"
• Avoiding mealtimes, especially at school
• Lose interest in sex
• You take in very few calories every day. You eat "healthily" - fruit, vegetables
and salads - but they don't give your body enough energy.
• You may also exercise, use slimming pills, or smoke more to keep your weight
• You don't want to allow yourself to eat, but you buy food and cook for other
• You still get as hungry as ever, in fact you find you can't stop thinking about
• You become more afraid of putting on weight, and more determined to keep
your weight well below what is normal.
• Your family may be the first to notice your thinness and weight loss.
• You may find yourself not able to tell other people the true amount you are
eating and how much weight you are losing.
• You may also make yourself sick if you eat anything you did not plan to allow
yourself, particularly if you lose control of your eating and find yourself
bingeing. However, this is known as 'anorexia, binge-purge subtype' rather
than bulimia nervosa. Bulimia nervosa sufferers are by definition in the
normal weight range.
People with bulimia attempt to control their weight by severely restricting the
amount of food they eat, then binge eating and purging the food from their body by
making themselves vomit or with the excessive use of laxatives. Such binge-purge
cycles can be triggered by hunger or stress or a way to attempt to regulate
Binge Eating Disorder
This is characterised by binge eating without subsequent purging episodes. It is one
of the most prevalent eating disorders. The binge eating episodes are associated
with three, or more, of the following:
• Eating much more rapidly than normal
• Eating until uncomfortably full
• Eating large amounts of food when not physically hungry
• Eating alone because of feeling embarrassed by the amount being eaten
• Feeling self-disgust, guilty or depressed afterward
• Marked distress regarding binge eating
• Binge eating occurs at least once a week for three months
Some people will binge eat occasionally, without experiencing many of the negative
physical, psychological and social effects of binge eating disorder. This example may
be considered an eating problem (or not), rather than a disorder.
Compulsive exercising, or anorexia athletica, as another way to purge calories can be
as serious as bulimia and anorexia
Signs and symptoms may include:
• Working out with an injury or when unwell
• Feeling seriously guilty or depressed when not able to exercise
• Not taking rest or recovery days
• Working out for hours, beyond what could be considered usual or safe
Serious side effects may include:
• Loss of bone density
• Reproductive problems
• Degenerative arthritis
Substance misuse and addiction
“In rehab you’re an addict; on a stage you’re a tortured genius”
Using and abusing alcohol, drugs or other substances, such as aerosols, is not simply
a ‘choice’, but a complex response, driven by many internal and external factors.
Those who abuse substances have also been shown to demonstrate impaired
inhibitory control – this may be due to drug–induced changes in the brain. This can
result in higher levels of impulsivity and more risky choices. Your attitude about
using/abusing can be critical to what you do, or don’t do about it.
Some anxiety is good for you and will help you to remain alert and perform well.
However, about 1 in 10 people will experience problematic anxiety, that is too
intense or goes on for too long, at some point in their life. Problematic anxiety, if not
addressed, can adversely affect physical and mental health as well as performance in
all domains of life.
Signs and symptoms of anxiety
• Fast or irregular heart beat (palpitations)
• Blushing or looking pale
• Dry mouth
• Short of breath
• Pressure of speech or breathy speech
• Gastrointestinal disturbance - nausea, vomiting, abdominal cramps,
• Increased frequency of passing urine
• Physical pains with no obvious cause
• Muscle tension
• Tingling in hands and feet and possibly lips
• Sleep disturbance
• Low tolerance for stressors - outbursts of anger, road rage or avoidance of
• Difficulties concentrating
• Poor memory, forgetfulness, difficulty recalling names or numbers
• Feeling worried
This is intense anxiety that is unpredictable and sudden in onset. The experience can
be very frightening and people can think they are about to die. Of all the patients
who present to A and E with severe chest pain, thinking they are having a heart
attack, 25% are actually having a panic attack.
Generalised Anxiety Disorder
This is where symptoms of anxiety are experienced much of the time in most or all
Learning to relax
This can help to alleviate symptoms of anxiety and tension and something like
guided meditation apps or yoga classes can be really useful ways of developing the
more specialised skills required. It is important to use these practices regularly and
not just in times of crisis, if they are to be of most benefit.
There are a number of useful self-help books, based on cognitive behavioural
therapy principles, on the market.
Cognitive Behavioural Therapy
Cognitive behavioural therapy (CBT) is the most widely-used therapy for anxiety
disorders. Research has shown it to be effective in the treatment of panic disorder,
phobias, social anxiety disorder, and generalised anxiety disorder, as well as a
number of other conditions.
Cognitive behavioural therapy addresses negative patterns and distortions in the
way we look at the world and ourselves. As the name suggests, this involves two
main components: Cognitive therapy examines how negative thoughts,
or cognitions, contribute to anxiety. Behaviour therapy examines how you behave
and react in situations that trigger anxiety.
The basic premise of cognitive behavioural therapy is that our thoughts—not
external events—affect the way we feel. In other words, it’s not the situation you’re
in that determines how you feel, but your perception of the situation.
Medication can be an important aspect of treatment for some people with anxiety.
Although originally approved for the treatment of depression, the newer Selective
Serotonin Re-uptake Inhibitors are also useful for treating anxiety. They usually take
4 to 6 weeks to work and may need to be continued for some months after
symptoms have resolved.
Common tranquillisers, like diazepam, are very effective at treating anxiety but they
are also very addictive and so only for very short-term use of less than four weeks
duration. They must also never be used in panic disorder because of possible
Beta-blockers, such as propranolol, do not treat the anxiety itself but can effectively
treat some of the physical symptoms of anxiety, including a rapid heartbeat,
palpitations and a tremor (shaking) by blocking the effects of the stress hormones
adrenalin and noradrenalin. They are short-acting and can be used just before
anticipated anxiety-provoking situations such as auditions. They are contraindicated
in asthmatics and those with low blood pressure.
As with any mental health symptoms, it is advisable to have a discussion with your
GP to exclude any underlying medical causes for your symptoms. For example,
thyroid disease or certain vitamin deficiencies can make you feel anxious or
If you, or someone you know is at imminent risk of harming themselves or others, go
straight to your local Accident and Emergency department. You can call 999 and ask
for assistance. Some areas have mental health crisis intervention teams or urgent
assessment centres – contact details will be available online or through your local A
and E department
See your GP if you are struggling with mental health problems, but not in immediate
danger. They will be able to discuss treatment options with you. Medication is not
always necessary, but individuals can often benefit from a psychological therapy,
such as Cognitive Behavioural Therapy(CBT), alongside any self-help resources you
might use. Your GP can refer you to other services and assess you to exclude any
underlying medical health condition that may be giving rise to your mental health
If you have a college counselor or a mental health professional you see regularly,
contact them and make them aware of the situation as they may be able to offer
increased support to help you to manage over the crisis or sign-post other services
Delivers specialist health support and medical advice to help over-come work-relate
health problems for professional and student performing artists, plus crew
Call 020 7404 8444
Mind Info Line
Call 0300 123 3393 or text 86463
Lines are open 9am to 6pm, Monday to Friday (except bank holidays)
Provides information on a range of topics including:
• Types of mental health problems
• Where to get help
• Medication and other therapeutic treatments
The info line can also signpost other sources of support in your area
Mind has free webinars and resources that show you simple, inexpensive and
practical ways to mental wellbeing. You can find the information on their website
If you are feeling distressed and would like to talk to someone, you could call the
Samaritans 24 hour service on