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How mental health nurses can help service users cope over Christmas

RCN professional lead for mental health Catherine Gamble outlines strategies for maintaining as ordinary a routine as possible

RCN professional lead for mental health Catherine Gamble outlines strategies nurses can employ to ensure service users maintain as ordinary a routine as possible during the festive season

Christmas TV adverts portray an idealised vision of the festive season: a perfectly cooked turkey, stockings waiting to be filled above a fireplace and everyone enjoying the company of friends and family around a board game. But, for many people with mental health problems, Christmas is the most testing time of the year.


Catherine Gamble: ‘The anticipation 
for Christmas can be overwhelming
for people at their lowest ebb’
Picture: Barney Newman

The festive period can be troubling for people who have long-term mental health conditions. But no two people spend Christmas in the same way, so it would be a generalisation to say there’s a single reason or even a handful of reasons why people may find the season distressing. 

There is a lot of expectation around Christmas. It seems to come earlier every year so that decorations can clash even with Halloween costumes in some shop displays.

The anticipation for Christmas, an event that ‘everyone’ has looked forward to, can be overwhelming for people at their lowest ebb, especially if factors outside their control make it hard for them to get as excited as other people seem to be. 

Unease and loneliness

Spending time with loved ones might bring a sense of relief but, if it involves long distances and public transport, this can also be accompanied by the unease at being far from usual support networks and mental health workers.

‘Mental health nurses have a crucial role to play in helping people cope at a time that can pose a substantial risk to people’s well-being as they try to keep it together’ 

Conversely, the sense of loneliness can be magnified through the Christmas lens. Last year, for example, one in three people contacting Samaritans on Christmas Day did so out of loneliness (Murphy 2018). 

Mental health nurses have a crucial role to play in helping people cope at a time that can pose a substantial risk to people’s well-being as they try to keep it together.

But it’s not just at Christmas that people may need extra support; there’s New Year as well as all the other religious and public holidays.

Risk of suicide

Cavanagh et al (2016) showed that, while suicide risks in the general population are significantly lower during Christmas, they can peak on New Year’s Day. The study concludes that clinical services should be aware of the risk of suicide and the potential need to supervise people more closely over this period.

Nurses should be prepared even if their patients are not religious or have no plans to celebrate holidays. Because of when Christmas falls this year, for example, for most people there will be five non-working days until care services restart.

I have co-produced and run workshops for families and those with lived experience of mental illness to support them though this period, and many of these skills and tips have then been shared with mental health nurses through publication and clinical supervision.

‘We must also have conversations to ensure people know the crisis line numbers and share any concerns they have with care coordinators’ 

Christmas shopping can be a burst of hyperactivity, but nurses can advise patients to make shopping lists or stagger shopping times, and families can be encouraged to discuss making homemade gifts to reduce the pressure on people with low incomes and enable them to feel more giving. 

Renewing prescriptions early

To cope with the unavailability of some services at different times throughout the year, nurses can talk to clients about renewing prescriptions early, making sure they are made out correctly and will last until services next open.

We must also have conversations to ensure people know the crisis line numbers and share any concerns they have with care coordinators.  

‘Service users can also take more practical steps to avoid feeling left out or under pressure’

There are coping strategies to help people maintain as ordinary a routine as possible and let them know what they can do if they need to ask for help. Service users can also take more practical steps to avoid feeling left out or under pressure. They should speak to family members about who plans to visit and when, what activities they can be involved in and maybe even practise conversation topics to handle difficult situations that are likely to arise.

Religious and public holidays are special and fun, but can sometimes be stressful and hard work. However, preparing properly can help people benefit from their positive aspects by strengthening their relationships, celebrating their culture and reaffirming any faith they may have.


References

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