Practices

A long stretch at home is never neutral time. It teaches two things at once: staying away stops the dread, and staying away is pleasant.

That double lesson is why a few months out is so much harder to undo than a few days. First comes relief, then the slow morning, the screen, the…

Going from talking online to talking in person is not one more step up the same ladder. It is a different ladder, and it deserves rungs of its own.

Those rungs might run from voice notes, to a phone call, to a video call with the camera on, to meeting one person you already know somewhere quiet,…

A group can help a great deal, and it is rarely the place to begin. Being in a room of people is a strong dose, and doses climb rather than start at the top.

Left too early it often ends with someone dropping out, and dropping out gets read as proof they were right about themselves all along. Once there is…

If cutting down has failed over and over, that is information rather than a verdict on you. For some people the workable goal turns out to be none rather than less.

Starting young makes this more likely, and the earlier the heavy use began the harder the road back to casual use tends to be. Nobody enjoys hearing…

When a young person is struggling to launch into adult life, it is usually two things at once: the practical scaffolding, and the social side. Work on one only and the other tends to pull it down.

Calendars, laundry and deadlines are the visible half. The harder half is friendship, saying no, asking for something, being alone in a room full of…

If you have been the one holding someone's schedule, meals and reminders together, do not put all of it down on the day they leave. Pass it over a piece at a time, each with a date on it.

Write out what you are actually doing for them: waking, appointments, repeat prescriptions, food, deadlines, forms. Most families are surprised by…

A bridge year can be a deferred place, a course at the local college, a job, or a stretch of genuinely doing very little. That last one is a real option and not a refusal to choose.

For someone who has just come apart, a fresh demand can restart the same collapse, so a few months with nothing scheduled is sometimes the…

The next step has to be theirs. A job that looks like nothing to you might be the first thing in two years they chose without being pushed, and that is exactly why it holds.

Parents tend to want the step that recovers the lost ground. The young person needs the step they can actually take on Monday. Shifts in a shop, one…

This is not a milestone you pass. The two year old's version goes, then a version comes back at twenty two, and again at fifty two, wearing whatever clothes that stage of life provides.

So think maintenance rather than course completion. When conditions change, a new baby, a new manager, an illness in the family, expect the old…

If reminders, other people's deadlines and a bit of chivvying are what keep you moving, you are allowed to keep them. Inner drive arrives later for some of us, and taking the scaffolding away early does not hurry it along.

Families often pull the supports back on a birthday, as though a certain age should switch on self-direction. What tends to happen is that the only…

Assessing a child's thinking used to mean a referral, a waiting list and a report some months later. Brief cognitive tools an ordinary clinician can run have changed that, and the gap between noticing something and having a plan can now be a session rather than a season.

Learn one of them properly instead of dabbling in three. Know what it measures, what it does not, and how to talk about a score without turning it…

Coming off an antidepressant is a piece of work in itself. Plan it slowly with the prescriber rather than stopping on the day you feel well.

Some, venlafaxine especially, leave the body fast enough that a missed dose is felt within a day: dizziness, strange electrical sensations, a mood…

With the fast acting treatments, the plan for what happens afterwards matters as much as the treatment itself.

Electroconvulsive therapy can shift severe depression quickly, and without something in place afterwards the relapse rate is high, which is why…

Sometimes the honest answer is that there is nothing in your surroundings to feel good about. Changing them counts as treatment, not as running away.

A life with no friends nearby, no work that means anything and a steady drip of criticism will produce low mood in most people, and skills practised…

Finding the dose is a search rather than a calculation. It goes up in small steps until either the effect you want turns up, or the side effects get annoying enough that you come back down a step and settle there.

There is no way to work the right dose out from body weight or from how bad things look, which surprises people who expect medicine to be more exact…

One of the founding figures of biological psychiatry summed the whole business up as some medicine helping some people at some doses some of the time. Knowing that before you start makes the first disappointment much easier to survive.

Most people need more than one adjustment: the dose, then the timing, sometimes the drug itself. Go in expecting the first prescription to be the…

If every step you try keeps not working, however small you make it, that is information rather than failure. A more intensive programme is the next thing to look at, and it should be put to you as an option.

The whole point of shrinking the steps is to find one that moves. When nothing moves at any size, staying in the same weekly arrangement out of…

The strengthened warning on this class covers misuse, addiction, physical dependence and withdrawal. The part most people miss is that dependence builds with ordinary correct use over weeks, with nobody doing anything wrong.

That distinction needs handling gently, because patients hear dependence and hear addict. Physical dependence is the body settling around something…

Walking away from a course or a job that was never going to fit can be the sensible move rather than a failure of nerve. It is also frightening, particularly when other people are paying for it.

Fit does more work here than effort does. The person who cannot survive a rigid nine to five in an open plan office may be excellent somewhere with…

Some people book their first assessment on the day they turn eighteen, because it is the first day they can consent without a parent. If you have been waiting like that, the waiting was not laziness.

Where a family or a community treats mental health care as shameful, a young person can spend a decade struggling with nobody's permission to ask for…