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Poor mental health has the ability to change the way you think Blog by Sarah Green

11 May 2021

Sarah Green is a patient advocate who wants to see better mental health support for people with kidney disease. Here, Manchester-based Sarah, 33, writes a blog on how looking after our mental health is as important as looking after our physical health. Sarah helps run a Facebook support group for young adults with kidney disease:

Despite living with multiple complex health issues including chronic kidney disease and Type 1 diabetes, it's my mental health that worries me the most.

My physical health is difficult to manage and I'm kept alive purely by medical management and my own intervention but it's never skewed my view of reality.

Sarah Green
Sarah Green

A few years ago I experienced a breakdown and psychotic depression. Whilst this period was traumatic for those around me, I don't remember a great deal about it.

The memories I do have are surreal snapshots that I struggle to integrate into my reality. However, it has had a lasting impact on me. Now I know how distorted my thinking can become.

Complex physical health affects our mental health

Whilst this is an extreme example, it's well known that those who live with long term complex health issues, face higher rates of mental health issues, particularly depression and anxiety.

This is perfectly understandable. Keeping yourself alive is hard work and often complex health issues impact our lives in ways that further increase our likelihood of developing mental health issues through things like job loss, relationship breakdowns and changed familial roles.

This year has only added to these issues. The impact of shielding, financial pressures and having much less medical support than we are used to has meant that many of those who were coping well with their illness, have struggled.

Transplant patients who had previously considered themselves physically fit and well have had to deal with suddenly being reclassified as "extremely vulnerable".

World on fire

Those who were already vulnerable now have another threat to their lives added to the list. For those of us who were struggling with anxiety and depression, well frankly it feels like the world is on fire.

In my life, Covid could kill me, my diabetes could kill me, my potassium levels could kill me. Honestly there are so many things that could take me out that some days I'm genuinely not quite sure how I'm still here.

All of these things are treated extremely seriously by medical professionals but my mental health is often overlooked and this confuses me greatly. Poor mental health has the ability to literally change the way you think.

Suicide is the leading cause of death in perfectly healthy under 30's. If poor mental health can convince people that suicide is their best or only option, why aren't we treating it as a health emergency?

Suicide may be an extreme symptom of depression but much more common is a feeling of general ambivalence about whether you live or die. For healthy people, this may not be a major issue but for those with complex health issues it can be lethal.

Ticking time bomb

Fighting to keep yourself alive is tough. Attending dialysis or treatments, sticking to restrictive diet plans or having to do complex maths equations to work out insulin doses is all difficult, time consuming and generally a huge pain in the a**.

If you throw in depression and the complete lack of motivation that comes with it, it gets even harder. Add in ambivalence about living and it's a ticking time bomb.

How many people who don't turn up for dialysis regularly are actually just too mentally tired or unwell to attend? How many people who fail to stick to dietary and fluid restrictions and then face the lethal consequences, just didn't have the energy to care whether they lived or died? How many people who didn't adhere to treatment simply saw an easy way to get off this planet?

We know that the prevalence of mental health issues is higher in those with long term health conditions. We know this, the evidence shows this.

Yet mental health care is consistently and routinely underfunded, under provided and honestly, ignored.

Kidney disease is hard work

Whatever your stage of kidney disease. Whether that's pre-dialysis, on dialysis or post transplant, there are issues that can put pressure on your mental health.

All too often people struggle to access any support for their mental health. Renal psychology services are over-stretched or simply not available.

Even the best treatments will only work if people are mentally well enough to engage with them. The best medical staff in the world can't convince someone to attend dialysis if that person believes the world would be better off without them in it.

Good mental health isn't just something that is nice to have, it's as essential as any medical intervention. People can only be kept alive and well if that is what they want.

Depression is a killer but for those who have to fight to stay alive, that may not be the cause that goes on their death certificate.

Until we address mental health issues within physically ill populations, people will continue to die and we will be left with the question of whether good mental health support could have kept these people alive.

Find out more

For information and support on a wide range of organisations who can help, visit the NHS website.

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