The highs and lows of working in mental health settings at Christmas time

by Dr Marianne Trent, Clinical Psychologist

This piece is adapted from Episode 54 of The Aspiring Psychologist Podcast. If you prefer to listen to it you can do here.

Today, we are thinking about Christmas in mental health, what it means for us to be staff members, or team members as well, because it's, very important both of those things. So if you are working in a mental health, service, you might well be part of the, squabbles for whose turn it is to work anyway, who worked last year, but there are also people in teams who like a chance to slip out for a day or two and go to the office and or the hospital wherever you're working. It might be quieter than at your house if you've got a house full but if you dare to say the 'q' word at work the nurses will grumble at you for jinxing it!

Sometimes you can get some more work done, or work your way through, all of the stockpile of surplus foods that have been brought in for the share table. If you've never worked in, a mental health team before, you will not perhaps be aware about the share table. and that can be triggering for people as well. for people that have had eating issues, in the past or currently suddenly that abundance of food and social expectations to eat it can be difficult as well. And that is obviously around for our clients as well. It's always worth having a conversation with them about how they navigate Christmas, and the festive period and, you know, whether they f how what they choose to eat and what other people around them eat, and, and how that feels.

I read something the other day that suggested that, it's not uncommon for many of us to eat a surplus of calories to the tune of 500 or more per day in the run up to Christmas, and the days after it. And apparently that can add up to, an increase of 5lbs by the time the festive period has passed.

And that might be well be triggering for clients that you work with. or, you know, even having that level of food and abundance and pressure can be triggering, and they can feel like a social pressure to eat, or to eat a decent portion. And this is especially problematic for people that, might be anorexic, or, body dysmorphic issues or binge, disorders or bulimia, for example.

So just bear in mind that, you know, it might not just be a tub of Roses, might not always be seen as a good thing, in the services we work with and with the clients we support. Just have an awareness that can be problematic for people. It might be you might be someone you support, might be someone in your team. Some services will see increased demand over the festive period and this can be tricky to staff as well as clients.

Man of us will be taking time off over Christmas. but for people working in, in prisons or secure services, other hospitals, or, you know, in people's homes in community support roles, they might well still be working over Christmas.

If you are, thank you and well done. And hopefully you'll be able to take some time off either in lieu or as annual leave at a later stage because time off is really important. And when we're working in, in difficult challenging roles, sometimes it can feel tricky to take time off, especially if you are carrying a heavy load. So, trying to access supervision before you finish for the year, either with your regular supervisor in person or over the phone or with a more experienced member of the team, can be really advantageous so that you can just feel contained and able to, to relax over your, your break, that you might have from work.

Not everybody celebrates Christmas, even if, you know, for all intents and purposes they've been raised Christian, they might not choose to celebrate Christmas, especially if Christmas has been a difficult or painful time for them in the past. So, exploring with your clients and even with your staff teams about what Christmas and the festive break means for them can be really powerful and can help people feel seen. But trauma can show up at Christmas as well from Christmas has gone by. and that might be because somebody, somebody, has had a painful or difficult experience happen to them in previous Christmases, or maybe because they previously celebrated and shared Christmas with people who were very important to them. But, you know, either through grief and loss or just for reasons outside of their control, those people are no longer, that person is no longer in their lives that can feel, very triggering indeed.

So having a check in with people about what Christmases have been like in the past and what they might be imagined to be like, can be really useful too.

Bearing in mind that lots of services will be grinding to a halt over the festive period, including pharmacies and maybe even psychiatrists. It is important to make sure that your clients have enough medication to get them through until after all the bank holidays. you know, we have busy lives when we're trying to sort out Christmas gifts and, you know, the endless, Christmas jumper days and things. If we've got children in schools, things can easily slip off the to-do list.

So just having an awareness, maybe developing a little checklist for yourself, to make sure you've had the conversation with each of the clients that you support, about whether they have enough medication to get them through because of course it might be damaging for their mental health or for those they live with, if they are not, you know, able to access all the medication that they need. Also, on your checklist would be making sure that you've got updated risk and care plans in place for your clients. There will usually be a crisis or duty service available, but people are going to very much be more up to speed if they're able to read some recent documentation. and it's helpful as part of that risk planning to have, you know, a contingency plan for what a client does if they're feeling like they can't cope.

So, that's all-useful stuff to consider with your clients, ahead of any break. They might find it helpful to do some activity scheduling with you as well to keep them feeling like they've got more options available to them when their usual sources of support might not be available.

So, this year, more than ever, there might be increased pressures, on families and individuals, because of the cost of living crisis. And of course, it might feel even more challenging to heat, homes over the festive break. It might be worth checking in with your local community to see whether there are any warm space initiatives happening, over the festive break, which is where people are heating public spaces, and offering cups of tea, maybe biscuits, some soup, things like that. and just reiterate with your clients, there's absolutely no shame in that and that they might actually benefit from that. And similarly, when I worked, for Argos head office, there was, the Christmas day, people were to be by themselves. There was, a free Christmas meal available and they used to pick people up and drop them off as well if they needed that. So, there might well be services or support, systems near you, specifically support people who are lonely at, at Christmas, or for, you know, for whatever reason are going to find it more challenging to be by themselves.

It might be that you might need to help pave the way for clients to be able to access food banks over the festive period. so having that conversation with people about whether they've got enough food, for the festive break, especially given there's a couple of bank holidays where often supermarkets will be shut with the shortest day of the year in the UK being the 21st of December. We might also notice that people are experiencing, more symptoms of seasonal effective disorder (SAD). And so, you know, just holding that in mind, we can think about the advice of trying to get some daylight, perhaps by going for a stroll, sort of first thing in the morning when you wake up and the sun's coming up and maybe thinking about, getting, if you're working from home, getting, you know, daylight bulbs, for any of the lamps that you might sit by, for much of the day. But having a chat with, your service users about how they notice, their, their mood fluctuate throughout the year, especially in the colder months, can be useful. And not everyone likes Christmas. Not everyone likes a Christmas party. you know, we are, either extrovert, introvert, or I believe ambivert, which is somewhere in between, and we can do both. and, it might not be quite the social frivolity, that you might find it or that others might find it. Just know that you don't want to go to the Christmas party, you don't have to go. and if you find it difficult or if your clients find it difficult or challenging to be around people who might not have been good people to them in the past, we can empower them to, to say no as well.

You get to choose, they get to choose, especially if they're adults. But, when it's difficult to be around people and you feel like you don't have control, that can feel really triggering and really challenging. Hoping you have a nice festive break, whatever you are up to time off when we are working in these demanding jobs can be so important. And being able to, to clock off and know that you are feeling contained and like you've done everything that you potentially could do to try to ensure that the service, and the people that you support within it are going to have the best possible, time off, from the service or from you. if you are working over the festive break, I hope you have some time off at a future time, but also there can be, you know, joyful times about working. I certainly have worked on Christmas morning when I was a home career, and very much felt privileged to be able to spread some warmth and cheer, to people, on Christmas morning. So yes, thank you for being part of my world. Thank you for the important work that you do.

Pause and Reflect Time

1. How does Christmas affect your mental health?

The American Psychological association says 38% of people surveyed agreed that their stress increased during the holiday season, and this can lead to illness, depression, anxiety, substance abuse, etc.

2. Why do people get stressed at Christmas?

Majorly because they find it hard to set boundaries to have more privacy. Christmas is spent with other people, and that stirs pressure and worry. Just be careful to not do more than you can take; your mind matters.

3. How does Christmas affect you and are you working it this year? Let us know in the comments

To check out The Grief Collective Book & Books for Aspiring psychologists click here

To connect with Marianne on socials click here