Self-injury awareness day

March 1st marks ‘self-injury awareness day’, a global movement signified by the wearing of an orange ribbon, which aims to increase the awareness of self-injury and challenge many of the misconceptions surrounding this.

What is self-injury? Self-injury, also known as ‘self-harm’ or ‘cutting’, describes how someone intentionally inflicts physical injury to their own body without any suicidal intent. It can take on any form, whether it is cutting, head banging, hair pulling, burning, recreational drug or alcohol abuse, non-lethal drug overdoses or taking excessive risks to personal safety.  It affects people regardless of age, gender or ethnicity, although it is known to be particularly common in younger people.  Due to the shame and self-hatred often associated with self-harm, many sufferers will go to great lengths to hide scars, making it difficult to identify those needing help, and also to estimate how prevalent this is.  Research suggests that at least ten percent of 15-16 year olds have self-harmed at some point in their lives.

Why do people self-injure? Self-injury is recognised as a coping mechanism for overwhelming emotional distress relating to current traumas or difficulties from the past.  The distress might be grief, anger, loneliness, emptiness, anxiety or self-hatred and sufferers may describe how the ‘real pain’ of self-harm numbs their emotional turmoil, and in some cases acts as a way of avoiding attempting suicide. Over time self-injury might become a person’s ordinary response to everyday stressors, sometimes increasing the frequency and severity of injury.

What to do if you are self-harming? GPs are well placed to provide confidential advice and support, put you in touch with local and national self- injury organisations (see below) and check for any underlying depression/ anxiety or eating disorder symptoms. The Student Counselling Service is also somewhere safe and non judgmental to go to.

Is there treatment for self-harm?  Yes there can be, and the aim of treatment may be to both minimise harm from acts of self-injury and to help the sufferer find new coping mechanisms and develop problem-solving skills.  Strategies to minimise harm include recognising triggers for self-injury, learning less dangerous ways/locations for cutting, carrying dressings and understanding the dangers associated with certain medications. However, stopping the self harm is not necessarily the aim of treatment, which may be more directed towards underlying issues.

Talking therapy (e.g. cognitive behavioural therapy/ dialectical behavioural therapy), creative therapy, support networks and the promotion of the development of self-help skills all help in supporting a sufferer to learn new coping mechanisms.  If self-harm is part of an underlying mental health illness, specific treatment for that condition may be warranted.

I am worried that my friend is self-harming?  It is upsetting to discover a friend is self-harming but it is important to provide non-judgmental support and acceptance, acknowledging that they are distressed. Encouraging them to talk to health care professionals or contact a local support group will show them that you care. Asking a person to stop self-harming will not help the situation as you are asking them to take away their coping strategy.

Will I/my friend get better?  There are no quick fixes for self-harm, but by getting a person the right support and treatment, they will start to learn new ways to deal with their emotional distress.

References/ literature available:


  1. Life Signs Self-Injury Fact Sheet for Health Care Workers-
  2. Information resource pack- Bristol Crisis Service for Women –
  3. NHS self injury fact sheet-
  4. MIND- ‘understanding self-harm’-


Support Groups

Self Injury Self Help- support groups for women and men who self-injure in the Bristol area.

TESS- Bristol Crisis Support for Women, text or email support service for girls and women who self-injure- up to age 25., or text 07800472908

MIND- for information sheets/ advice about local resources-



Eating Disorders Awareness Week; 24 February 2014.

Beat, the Eating Disorders Charity, is running a national awareness week called ‘Sock it to Eating Disorders’ this week. It is a light hearted way to bring people together, do a bit of fundraising, and raise the profile of a devastating group of conditions.

As a GP at Students’ Health I deal with such conditions most weeks, and one can become too focussed on the medical aspects, so it’s good to stop and think occasionally about what these illnesses mean to the people who suffer from them, and their friends and families. And nothing brings that home like the Beat “Lasting Memories” page, which reminded me of the immense impact that such a potentially fatal condition can have.

What a long list of lost young people, mainly women, and so many aged around 18-20, like the students I look after every day. The messages left by family and friends are heart breaking, and this online wall of memorials is a sobering reminder of why I and my colleagues spend so much time and energy improving and developing local services for Eating Disorders in Bristol.

We have made it so much easier in the last 2 or 3 years to get help that hopefully such memorials will become rare, and fewer families will be turned upside down by such tragic deaths.

Here at Students’ Health Service we really do want to help you if you have, or think you might have, an eating disorder, so please do come and see any of the GPs, and talk about referral onto First Step, the new Bristol-wide community based service for assessment and therapy. First Step is led by a clinical psychologist, and you can have your appointment in the same building as the GP practice, no need to go to hospital. The average waiting time for an appointment with them is about 3 weeks, not long at all, so don’t hesitate if you are suffering… come and talk to us.

It’s Time to Talk about Mental Health! #TimetoTalk

This weeks blog is a quiz!

Time to stop the stigma surrounding mental ill health. See how much you know in the attached short quiz, via the link below. Scroll to the bottom of the linked page to see the Myth/ Fact quiz.

Then spread the word. It’s OK to talk about mental health!





Smart drugs; how much of a risk are you prepared to take?

“We simply don’t know how chronic drug treatment will affect ‘healthy’ brain function in future years.” So says Professor Barbara Shahakian of the University of Cambridge, on the subject of cognition enhancing medications. The newspapers and their online equivalents have recently been full of stories about using such so called ‘smart drugs’, for example to study for exams, but we know very little about them, or about what effect they might have on us in the long term. Such drugs include both Ritalin, prescribed for ADHD and Modafinil, for narcolepsy.

New figures for drugs used to treat Attention Deficit Hyperactivity Disorder (ADHD) show that prescriptions from GPs have risen 56% in 5 years. The media and certain professionals in the mental health field have been quick to assume that GPs are therefore prescribing them less carefully, and raised concerns that such drugs might be ‘abused’ and ‘diverted or misused’. I have my own theory, which is that as the UK’s psychiatrists have become more confident in diagnosing ADHD (GPs don’t generally diagnose it, as it is such a time consuming process) and they have also relaxed the prescribing of the necessary medications from ‘red’ type (consultant only prescription) to ‘amber type’ (meaning the GP can prescribe with consultant support), this would naturally lead to an increase in numbers of GP prescriptions. GPs are not that easy to hoodwink, and no-one will receive a prescription from our GPs, unless they have a well documented consultant diagnosis. My concern therefore is not the increasing numbers of prescription drugs, but the issue of non-prescribed ‘smart drugs’ being used by students to self medicate with the aim of ‘enhancing’ their academic performance.

Some research suggests up to 1 in 10 UK students uses such drugs, and some have written about their experience online. In Oxford the verdict was that Modafinil made only subtle improvements in concentration, but it did make them poo a lot!

It doesn’t yet seem to be quite clear how these drugs work, but it is generally agreed that they stimulate a part of the brain that changes mental and behavioural reactions. Therefore using them to keep yourself working harder for longer without medical advice seems to be a significant risk with regards to potential long term effects on the brain. A recent study by Dr Nora Volkow and colleagues, based on PET scans, suggested that 400mg Modafinil had effects in brain areas known to be involved in substance abuse and dependence. There is also evidence that it will disrupt sleep patterns in the long term, and the ability to make memories.

It seems to defy logic to use drugs to get through exams/ academic work when all the good evidence- based advice is that for sustainable performance humans do best with regular breaks, planned meals, and quality sleep, and even mindfulness/ exercise.


With all these possible risks, I would strongly encourage you to think hard before taking any non prescribed psychostimulants, or cognition enhancing drugs. There might be short term benefits, but are the risks worth taking?


Camping; a cure for insomnia?

I was fascinated to read a new bit of research published in August, when so many of our students were off camping. Sadly I don’t think festival camping will count, but if you were in the outback, somewhere with minimal night lights and sitting by the camp fire, then well done!


It seems that living by the maxim “up when it’s light and asleep when it’s dark” is based in science… it’s one of the pieces of advice we give our students who suffer from insomnia, along with;


  • Avoid napping in the day
  • Avoid alcohol/ caffeine 4-6 hours before bed time
  • Exercise regularly, but not just before bed
  • Go to bed at the same time and get up at the same time, every day
  • Block out light/ noise as much as possible
  • Don’t use the bedroom as an office or place of work
  • If you cannot sleep having woken in the middle of the night, then after 20mins get up and do a quiet activity, have a bath etc before going back to bed and trying again.


If your insomnia persists then please come and talk to a doctor.

What I like about the camping research is that it is so simple and pares back all the stuff we do to ourselves that stops us sleeping, so that within just a few days of a simple routine being followed sleep returns.


Good sleep habits are vital for our wellbeing, health and mood. If you are suffering, then please come and see us.

A student’s account of depression

I’m sick of waking up every morning and just being unbelievably tired, I never get to not feel tired, especially now. And it’s so frustrating because when I’m not tired, or when I’m working well then I’m actually pretty good, but when I’m not I’m just awful, and I can’t work and it’s horrible. I literally have very briefly seen how good I can be, and that’s always in my head somewhere being chased around and held down by being suicidal and being always tired and self-hatred and guilt and regret. I don’t know how to get it out, or bring it to the forefront or anything. I think suicide is different now, it’s not actively wanting to die, it’s wanting to not exist, because existence is 90% tiredness and guilt and regret and hate, and trying and failing to cover all of that up. 
I tried to meditate this morning and for a couple of minutes actually felt alright, it was like I had picked up and wrenched my life around out of this horrible black river of depression, and slowly scraped all of what I wanted out of that river, and piled it up into an island, and that island is what I clung to before, and it was a horrible island, it was self-harm and video game addictions and drinking and promiscuity, but it wasn’t death, which I think is what the river is, or at least it wasn’t suicide, for as long as you were on the island. And eventually you’d get sucked back into the river; because the island would get washed away, and you’d have to gather it all back up again, with more of the same. And medication helps, I think that in this played out river- metaphor, the medication doesn’t teach you to swim, it just gives you something to hold onto to stay afloat whilst you teach yourself.
Anyway, in this meditative state I was in, I’d made a fire on that island, and that fire was everything that I’d ever hated about me, and me paying for having been who I’d been, and it was awesome. I don’t really know how to describe a somewhat spiritual thing, and I know this is tangential, but it’s like writing down one of your dreams, so excuse the self-indulgence for a second. I’d made this fire, and on the fire I’d put everything, I’d put all the stuff that I’d done to stay here, it was weird, it was like putting events on the fire but they were like pictures of the events, so I put pictures of me cutting myself, and me crying, and pictures of me isolating myself from my family, so many pictures of all of that, and they were all things I did to survive. And then this fire was growing, and it wasn’t really a fire, it was me, and it was the person that I wanted to be, and it was taking all the bad stuff that I’d done to get to where I am, and burning it, not in a sense of burning it away, just in a sense of it was what was fuelling the fire, it was still there on the fire. And my dissertation was on there, and all the times that I’ve beaten myself up when I’ve been an idiot in social situations were on there, and the fire was quite big now. 
Slowly out of the fire, and this is quite weird, all the people that I care about and want to protect came out of this fire, and they were standing round the fire, on this island in the middle of a river of black suicidal thoughts and death, and I was the fire, I was making myself better by having been through all the stuff that I’ve been through, and they were slightly warming themselves by the fire, like I’d made this fire so that they could be warm, and so that I could be warm too. But it was a really surreal feeling, because there were hundreds of people, and they were all sort of standing around this fire, with the people who I’m closest to standing nearest and then everyone else taking a slight back step, and they were shifting, and in the front row of this circle were my family and my friends from home and university people, although I’m not sure how much to read into that. But everyone was standing around this fire which I’d made, and I think in this dream/whatever, I was supposed to think that the benefits of me getting better and giving myself wholly to this fire, was that it didn’t just warm me, it could warm other people, and then once I thought that, everyone sort of lit up, not like a light bulb, but as in, if you imagine people standing in front of a fire they were lit in this flickering light, and it made no sense because obviously the people in the front would cast shadows but there were no shadows. 
And then everyone really gradually started smiling, not sympathetic smiles, just like a compilation of all the smiles that I’d ever made them smile, and it was only really small, like a little twitch in the corner of their lip, but it was there. And it made me want to carry on, and it made me think that I wanted to carry on with that fire, despite how awful it has been, and how awful it still is, because it’s not just warming me, it’s warming other people too, or at least preventing them from heading into the river. And that was the other thing too, it made me think that in my life if I could ever stop people from going into that river, then I should, and I will, that’s what I want to do with my life. And at the end of it all, I was crying, in real life, because I hate it like 99.99% of the time, I hate having to make a fire, and not just jumping into the river and giving it all up, but then sometimes it is worth it, having a fire, not just for your sakes, but for other people.
And I think in some sense, and this whole thing sounds massively martyr-y, and I hope you don’t judge me for that, it’s genuinely not like that, I think it’s something that I’d thought before, I’ve probably mentioned it before, that if you can’t find a reason to live for yourself then you should find it in others. I thought that first when I tried to kill myself, but couldn’t because I thought I heard mum coming home. That was when I was first like “if it weren’t for other people I would almost certainly be dead right now”. And that’s okay, I think.

But yeah, I’m actually semi-smiling right now, because I think in thinking of that fire thing a couple of hours ago, that’s what I’ll think about now, when I feel myself heading down that path, because, and this is huge, and that’s why I’m smiling, I felt myself coming down this breakdown path when I started writing this, but now, I’m actually okay, that is the first and only time that I’ve ever managed to avoid a breakdown, and it’s just because I typed out this fire thing. So even if you don’t read it, then it’s served a huge purpose for me, and really great. So thank you for reading this.


This account was written by a student who wanted others to know that they are not alone, and that they too can get help from Students’ Health and the Counselling Service. Just give us a call or pop by if you are feeling down and would like help.


I’d rather admit I like Justin Bieber

Obviously an extreme example, but apparently us blokes would rather own up to liking the irritating pint-sized pop prince than admitting we’re feeling down. We’d rather admit to being a bad driver, not liking football and having problems getting an erection.  All rather than opening up and saying, “I feel crap”. Are we stuck with some weird macho ideal, of ‘manning-up’, ‘zipping up the mansuit’ or ‘growing a pair’? Maybe the bravest thing is admitting things aren’t quite right…

This week (10 – 16 June) is Men’s Mental Health Week, and the Men’s Health Forum is challenging men to talk about feeling crap before acting on it. Men and women experience mental health problems in roughly equal numbers, yet men are much less likely to be diagnosed and treated for it.  The consequences can be fatal –3 in 4 suicides are by men and 73% of people who go missing are men.  In the UK, over 4500 men kill themselves each year and two-thirds of drink-related deaths are male. More men hang themselves than die on the roads.

Martin Tod, chief executive of the Men’s Health Forum, reckons: “If all men could talk about how they were feeling with confidence, I don’t think we’d be looking at horrific figures like these. Whatever the problem, your GP has heard it before. And these days there are telephone and online options too. Don’t bottle it up.”

For online information check out

The best place to start though? Probably with your GP; not with JB.

Like the ad used to say, ‘it’s good to talk’…


A. Bloke Esq.

‘Safeguarding adults’; what does that mean?

Every adult has a right to respect dignity, privacy, equity and a life free from abuse. That is the firmly held belief of all those who work here at Students’ Health Service, and we see our role partly as being here to protect ‘vulnerable adults’. Many of us hear that phrase and think of adults with learning disabilities, say, but it also encompasses any adult who, because of mental ill health, emotional disturbance, physical disability, cultural or social isolation, may lack the resources to protect themselves against significant harm or exploitation. So it can, unfortunately, describe some of the students we look after, and even someone you might know, though you may not have considered them ‘vulnerable’ before.

If you are worried about someone, that they may be being abused or exploited, or if you are worried about yourself, then we are here to help you. The whole team receives training in supporting adults with safeguarding issues, and we can engage other services to help us if we need to. Examples of abuse include physical violence in a relationship, sexual abuse, including where someone is pressurised to consent, not just where consent was withheld, psychological abuse through intimidation or hostility, and financial abuse such as theft, and misuse of benefits. We are also aware of occasional cases of racial and discriminatory abuse, and are able to offer support in these situations too.

Abusers can be someone the vulnerable adult knows well, or a person in a position of authority above them. Whatever the situation we can ensure confidentiality and sharing of information on a need to know basis, and we will not disclose personal information inappropriately.

If you suspect abuse, please report it. If you would like our support then please talk to any one of our clinical team, and we will ensure you are cared for with the respect and dignity that everyone deserves.


Other support;


Hate crime unit;

Domestic abuse;


 Honour based violence;

Online resources for medical matters

For someone who never went to medical school Dr Google seems to be an incredibly popular and sought after ‘specialist’.  A significant number of people will turn to the internet for information and advice before seeking professional help, and this is a good idea in the right context. There are some fantastic resources out there, and so I thought it might be helpful to list a few of them, to improve the quality of the results our patients are getting when they go online, and to save time for those who get drawn into elaborate and complex searches featuring more and more worrying symptoms and diagnoses!

First off, a safe and reliable place to start for all medical queries;

Next up, for info on local services, how the NHS can help, conditions, and health costs;

And for travel advice

Lastly for mental health advice and support;  or

which is an award-winning online mental wellbeing service. It offers the first online pathway for mental health and wellbeing, placing people at the centre of their own care.  It enables people to access well governed, safe therapeutic services through self-referral from the comfort of their own homes.


The NHS has also realised the need for a reliable single source of credible and safe online resources and has recently launched its Health Apps Library, at last month’s NHS Healthcare Innovation Expo in London.

Here at SHS we are particularly interested in the ‘Patient Access’ App, as we already have the online facility allowing our patients to book appointments and re order repeat prescriptions via the internet, but it would be brilliant to have a phone app too, making it potentially even simpler. We will be looking into how to adopt this app, but it is something that the local health community may need to fund, so watch this space.

The Sound Doctor App; An Audio app which enables patients to listen to information about their long term conditions and therefore help them look after themselves more easily and get the best out of life.Leading doctors, nurses, patients and other relevant health professionals have been interviewed to provide a really comprehensive look at a number of long term conditions.All the information is presented in short chapters of between 3 and 5 minutes each with several interviewees in each chapter.

ActiveMe App; Developed by NHS experts in CFS/ME, activity record charts are widely used to help patients and
practitioners work together to develop a daily baseline of energy use before increasing it in regular steps
to enable you to achieve your goals.Fast, easy, portable and discreet, ActiveME can help you balance your activities.

Type 1 Diabetes (Alcohol guide) App; Having type 1 diabetes means that it is important to know how to keep safe when having alcohol. This guide aims to help you find out what to do to keep safe and how alcohol can affect your body.This App has been designed based on ideas and suggestions provided during the qualitative interviewing of young people with type 1 diabetes aged between 18 and 21. It has been developed in collaboration with the Poole Hospital Diabetes Centre in the UK for use by their patients.

PillManager App; helps you manage your medications, never forget them, and also helps with re ordering them too.

These are just a few to get you thinking.

See our website for loads more Useful Links


Eating Disorders Awareness Week 11th Feb 2013

Student-Run-Self-Help (SRSH) is a national charity that aims to support students suffering from eating disorders by providing a safe space for students to talk within student-run group sessions. We are driven by young people’s personal experiences of living with mental health issues and aim to provide a confidential, non-judgmental, welcoming environment for those who need support.

“I know I owe my recovery to having amazing people to talk to, people who really understood. Through SRSH my ambition is to ensure that all students have someone to talk to, someone who understands!” (Nicola Byrom, the founding director of SRSH)

In Bristol, we run sessions every alternate Monday in the Just Ask office on the 4th floor of the Student Union from 6.30-7.30pm. We welcome both sufferers and their friends/family. We bring together people who understand each other’s problems and although we know it can be difficult to talk, in a group setting everyone is there to help each other on the road to recovery.

Eating disorder awareness week is the 11-15th February and we feel this is a great opportunity to try and increase students understanding of what an eating disorder is, and what they may be able to do to help friends who may be suffering. This quote provided by a student recovering from an eating disorder simply re-enforces how important it is to talk.

‘ After years of treatment, medication and therapy, the one thing that actually enabled me to overcome this isolating, life-destroying illness, was talking to friends and family. When I started to let others in and shared every little step I made, it made the long road seem much shorter, easier almost, and certainly there was no turning back. There are people out there, lots of them willing to help, and the SRSH team are some of them, and if you are prepared to accept it, recovery is possible.’

We will be running a campaign called “Something Worth Talking About” in the foyer of the Students’ Health Service, Hampton House, on Monday 11th February where people will have the opportunity to learn more about the facts and fiction of eating disorders through various interactive activities.

There will also be a “How to Save a Life” workshop on 21st February at 5.30pm (Venue: MR6 Large, in the Students’ Union) for friends of sufferers. This workshop provides support and invaluable advice for the friends of sufferers. SRSH ran one last term, and with the feedback from attendees, decided it was so successful that it would be repeated.

Although the SRSH team provide a space for sufferers to talk, they are not professionals, and students are encouraged to seek care and advice from the University of Bristol’s Students’ Health Service and Student Counselling.

For more information on the national charity visit:

Find us on Facebook:

Or visit our union webpage: