'As a mental health professional, I thought I knew everything about depression... then I had a breakdown'
NHS Director of mental health Mandy Stevens spoke to Bryony Gordon for the latest episode of the Telegraph’s new mental health podcast, Mad World. Here, she tells Eleanor Steafel why her experience of having depression has made her more determined than ever to help others suffering from mental illness.
Six months ago, Mandy Stevens was in the grip of a depressive episode so severe, it was a daily battle for her not to end her life.
Almost overnight, Mandy had gone from being a happy, functioning 45-year-old with a demanding job that she loved – as an NHS director of mental health – to being so wracked with anxiety that she couldn’t leave her bedroom, couldn’t change her clothes, couldn’t even bring herself to clean her teeth. She had spent nearly 30 years on the frontline of mental health care but, within ten days, she became a patient herself.
Mandy went on to spend three months in an acute inpatient ward near her home in east London. There, she was put on antidepressants and antipsychotics, and monitored regularly by the highly trained staff, as she fought a private war in her head, her demons telling her constantly that it would be better for everyone if she no longer existed.
Today, it seems unbelievable that the bubbly woman in front of me was a mental health inpatient just a few weeks ago. Slowly but surely, she says, she is emerging from the fog of depression – she is back living at home, is seeing a psychiatrist regularly, and feels the terrifying blackness that gripped her for three months has almost lifted.
But while she was still in hospital, and at her very lowest ebb, Mandy did something most people in her position would not have considered. In the midst of a particularly bad episode, with tears rolling down her face, Mandy took a selfie. She vowed that when she was better, she would share her story.
“Even though I was so ill and in such a terrible state, I can remember thinking: ‘There’s an important story in there’,” she says. And indeed there was. As soon as she was well enough to leave hospital, Mandy posted the picture on social media, with an accompanying post explaining what she had been through. Her post, entitled “From NHS director to mental health inpatient in 10 days”, went viral, with thousands of people commenting on her bravery in sharing the story.
For Mandy, it was a no-brainer. “How could I keep my own mental illness as a dirty little secret and not talk about it?” she says. “I’ve got 15 years as a clinician, I was a healthcare assistant and then a student and a staff nurse. I’ve worked on the crisis team, I’ve been a community nurse, I’ve had 15 years as a matron before becoming a manager, and now a director.
“Clinically, I know everything there is to know. I’ve now had six months of using services and being at completely the other end of the spectrum.
“I thought I knew everything about mental health, and I’ve proved myself wrong.”
If one in four of us will, at some point, suffer from mental illness in our lives, then you might imagine someone who spends their days caring for dangerously depressed and psychotic people may be more susceptible than most. As Mandy says: “There is no immunity. Mental illness can come out of nowhere and affect anyone at any time.”
But, speaking to her, it’s clear the way she coped with depression was vastly different to the average person.
From the moment she felt her world begin to collapse, she was self-diagnosing, guiding herself through the motions of mental health care as she would one of her patients. “The day I cried to my chief exec in a meeting – totally out of character for me – I went home and did the Beck’s Depression Inventory [a psychometric test]. I scored 21, which is mild to moderate depression.
“I went to see a private psychiatrist a few days later. She said to me: ‘You’re very depressed, you need therapy, here are some antidepressants, come back and see me in a week.
“Over the week, my mood absolutely plummeted. I was tearful and having suicidal thoughts. I knew it was serious when she said to me: ‘Mandy, if you killed yourself, how do you think your family would feel?’ And I said: ‘They’d be upset, but they’d get over it.’
“She said: ‘Mandy, your mum and your family, for the rest of their lives, will miss you every single day.’ I can remember shrugging and looking away.”
Mandy lasted another week at work, stoically getting on with her job, before she knew she could go on no longer. “I remember walking towards my car, thinking: ‘I can’t do this. I’m broken inside.’
“I know so much about mental health, I’d tried cognitive behavioural therapy, I’d tried relaxation, I’d taken the medication, I was doing everything I could.
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“But I felt like I was on a precipice looking into this vortex. I thought: ‘If I get into that car and start driving, I can’t be responsible for my actions, I’m too ill.’ I phoned the crisis response team. They said: ‘Come into hospital, we’ll sort you out a bed’.”
It wasn’t until 12 weeks later that she was well enough to leave hospital, with friends and family left shocked and confused by her rapid and totally unexpected decline. Looking back, Mandy says the depression had probably been brewing for some time, as the pressures of a demanding job began to get on top of her and she unwittingly began to isolate herself socially.
Now very much on the road to recovery, Mandy believes two things saved her from taking her own life: the first is that she understands the process of depression so well that she was able to track her own progress, and since leaving hospital has written herself a “robust recovery plan”.
“I remember one day when I was crying in my room and one of the nurses came in and said: ‘Do you want to talk?’ I’d been doing my own clinical risk assessment, and said: ‘I’ve changed. I’m actively suicidal now.’ I was detained under the Mental Health Act.”
The second reason Mandy believes she is still here is also what spurred her on to share her story, and why she is now determined to campaign for better mental health care throughout the UK. “Unfortunately the NHS is a postcode lottery. East London Foundation Trust is one of only two trusts in the country that is seen as outstanding,” she says. “The nurses here have humbled me completely and reminded me of my pride in my profession.
“I have experienced this outstanding care in my hour of need, and it has been truly remarkable.
“And I am now being supported by a wonderful range of community services provided by the local Trust, the mental health charity Mind and the local council.”
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Mandy believes that in many ways she has been lucky. She had the means to go straight to a private psychiatrist when she initially felt at risk, rather than sit it out on a lengthy NHS waiting list. She also happened to live in an area where mental illness is catered for exponentially better than it is in the rest of the country.
You wouldn’t blame her for steering clear of the mental health world after what she has been through. But, remarkably, the second she is well enough, she is determined to make sure she uses her experience to help others.
“I lost my mind, lost my self esteem, lost my pride, lost my sense of who I am, lost my confidence, lost my job and my income, lost my driving license and my independence,” she says. “But I am slowly picking up the pieces.”
How to listen to Bryony Gordons Mad World podcast
To try out the stress-relieving square breathing Mandy mentions in the podcast, click here. She also recommends a free meditation app called Insight Timer, which is available to download here.
