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Returning to work after Mental Health relapse

Last week, I was off sick. Now I am back at work again. This may seem unremarkable to most people, but for me, a person with severe and enduring mental health problems, it is quite the opposite.


I live with EUPD (Emotionally Unstable Personality Disorder, aka Borderline Personality Disorder/Emotion Intensity Disorder/complex PTSD - those of us who identify with the diagnosis try to promote the less stigmatising names). This causes emotional reactivity, intense and often overwhelming negative emotions and interpersonal difficulties, and is usually accompanied by chronic depression and anxiety.



Recovery vs Relapse


I am 'in recovery' from my mental illnesses. This is also known as 'living well' with mental illness. These terms aim to convey a sense of freedom from symptoms whilst acknowledging that the underlying illness is lifelong and will never go away entirely. What these terms don't manage to convey is the sheer amount of effort and energy that it takes, every single day, to remain symptom free.


I am constantly fighting my own brain. Every thought I have, every piece of information I receive from the environment has to be checked, rechecked and often overridden by conscious thought. I cannot rely on the inputs from my automatic nervous system, which have a tendency to interpret everyday social interaction - an offhand comment, or perhaps a slight frown - as an extreme threat to my safety. Having an emotional processing disorder is profoundly disabling, and the effects are magnified when the situation you are in actually does influence your survival - such as the workplace! This means I spend a lot of time inside my own head, using a Dialectical Behaviour Therapy technique 'wise mind' to try to dissipate the intense negative emotions and bodily sensations that frequently occur when I interact with another human being.


On top of that, I expend a lot of energy using mindfulness techniques to notice my bodily states - for instance whether I am hungry or tired, or whether I should be even if I'm not - and then applying self care principles like sleep hygiene, eating healthily, and getting the right amount of exercise, and avoiding triggers like alcohol or unnecessary social interaction. These may seem like normal, every day things, but anyone who lives with or has experienced mental illness will know the tremendous amount of effort it takes.


This leads to the point I am about to make: Recovery and relapse occur in a loop. The sheer amount of energy it takes to stay well can lead to exhaustion, which can lead to becoming ill again. This does not mean the hard work we do to become and stay well is for nothing. It is no reason not to try again, every single time. It is just part of the process of 'living well' with mental illness.



The Right Employer


Last week, I spiralled from feeling exhausted, to experiencing dissociation (not feeling real) and then to non-eating, suicidal ideation, and an unfortunate mini-relapse of a proudly beaten addiction to self-harm, in just a couple of days. Such is the nature of EUPD.


I took the whole week off work - if you think about it, that's not much longer than for a common cold. Other relapses have in the past ended my employment at previous work places, resulting in periods of time spent on ESA - something which only increases feelings of worthlessness and isolation. Reasons for this happening include various forms of discrimination or stigmatising attitudes from employers - but even fear of these attitudes, or internalised stigma (feeling 'bad' or 'wrong' or 'unworthy' for having a mental illness) can have a huge impact on our ability to disclose our illness or to be transparent about what we need to stay at work. Fear of judgement, of not being understood, or of our employer being dismissive or minimising our experience, or being seen as 'lazy' or 'faking it', are major barriers faced by people living with invisible illnesses.


I want to share with you the importance of finding the right employer. If you are an employer, I want to convey to you the unique assets that someone living with mental illness can bring to your workplace, and the importance of creating an actively mentally healthy workplace. 


I work for an urban farming social enterprise called Growing Better. We all live with, or have lived experience of, chronic mental illness. As everyone's experience is unique to themselves, we undertake training on topics such as MH first aid, suicide alertness, and anti-stigma, in order to build confidence in our ability to provide the right support should the need arise. We self-monitor, let each other know how we are doing and make sure to ask for what we need. We use practices like non-judgemental active listening to really hear what people say - you'd be surprised at the difference this can make, not just at work but in all relationships. Our workplace is person-centred and we make reasonable adjustments when we can, and not just when somebody is becoming ill or returning from absence. For me, being able to do any computer work from home (in bed, with my dog curled up next to me!) massively reduces anxiety and helps prevent exhaustion. Someone else may prefer being around people but with the radio on in the background. Avoiding excess emotional labour (having to put on a 'happy face') is important, as this increases stress and can lead to emotional exhaustion. You could increase flexibility - for instance sharing the workload to help others with what they find difficult, instead of dividing tasks arbitrarily. The little things count too - making each other cups of tea and bringing in biscuits to share!


Mental wellbeing is something that every one of us has, and people living with mental illness are a valuable source of information on this topic. They have to find techniques that work and practice them everyday. At Growing Better, we wish to set an example to other businesses - you don't ever have to compromise on wellbeing to be a successful part of society. In fact, for any society to be successful, the wellbeing of the people within it must be at it's core.


Written by Ashley Ferrari



Further Information


For employees


Returning to work after mental illness:


Mental health workplace support service from Remploy:



For employers

The MIND employers' quide to mentally healthy workplaces:


Recognising, understanding and dealing with the impact of emotional labour in the workplace:


Active listening:


MH Training (Leeds - some of these courses are free!)

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