Mental health week: case studies

Mental health can sometimes be side-lined when discussing health and safety due to being ‘invisible’ when compared to visceral injuries such as broken limbs. This is especially true in a more male-dominated space such as the ports industry, where men may be less inclined to open and share the burden of depression or anxiety.

Just because someone doesn’t mention mental health, that doesn’t mean that it’s not there. As part of Ports Mental Health Week, PSS is sharing share two case studies of people working in and around the ports sector, to demonstrate some of the signs of poor mental health and how to cope with it. Names have been changed to protect their identities.

Dave has suffered from depression for approximately half his life. Since his mid-teens, he has occasionally been hit by what he describes as “the wall”; a wave of depression that appears suddenly and stops him in his tracks.

“Your family and friends assume you’ll grow out of it,” said Dave. “That when you hit your twenties, you’ll magically be cured. But it didn’t happen that way.”

The depression waxed and waned over several years, however, during his early twenties it became a source of shame to Dave. He began to drink heavily although and his reasoning was that it both freed him of inhibitions on nights out, and dampened emotions that he preferred to bury. Neither of which, he admits, were particularly good for him in the long run.

He would also bury himself in work, volunteering for night shifts to the extent that it was common for him to go weeks without seeing friends or during the winter months, even seeing the sun. However, his efforts to ignore his problems culminated in destructive behaviour that he describes as amounting to a “slow suicide”.

“One day, I woke up with a hangover and this intense feeling of shame and disgust at myself,” admits Dave. “I just thought, I can’t go on like this.”

With the encouragement of his then girlfriend, Dave began to open up about his inner most thoughts.

“I felt stupid to be honest. Like airing all this dirty laundry to someone I wanted to respect me. But it was like a dam. Take away a few bricks and the water just forces its way out. That’s how it was for me.”

Through the support of his partner, Dave realised that he needed to talk to a professional about his thoughts, and he referred himself to the local mental healthcare services run by the NHS. He has also completely cut out alcohol and taken up cycling to lengthen a life he believes has been drastically shortened by his actions. Following a course of Cognitive Behavioural Therapy, Dave still occasionally has moments of depression but has since learned to not be ashamed of his condition.

“It is part of me but doesn’t define me,” he concludes.

Alcohol dependence can be a signifier of underlying mental health issues which, as Dave experienced, can be a downward spiral. Alcohol is a depressant and influences neurotransmitters such as Gamma Aminobutyric Acid (GABA), which is the main inhibitor in the brain and operates to prevent the high amounts of neuron activity from causing epilepsy. As such, alcohol stimulates GABA into dampening further neural activity, which is why a single drink can lead to an immediate reduction in anxiety.

However, the problem comes when people become alcohol dependent, causing GABA to work harder and harder to provide the same feelings of relaxation. The higher the alcohol intake, the more damage it does to your body, and the more the brain adapts to a new ‘normal’. This leads to the heightened feelings of tension, anxiety, and possible further depression.

Anyone who finds themself in this situation is encouraged that to seek medical help as cutting alcohol out completely can also be extremely dangerous. Professional therapy is recommended as the brain begins to ‘relearn’ how to process emotions without alcohol.

Bill is on the opposite end of his ports career. He has over forty years of port work under his belt, having begun working in his teens in the Seventies. He freely admits that the culture back then was almost oppressively macho.

“You didn’t talk to anyone about problems,” said Bill. “You left your home problems at the gates of the port and got on with it.”

For years, Bill accepted this as part of working at a port and was fortunate enough to not have depression or anxiety. However, as he got promoted into more demanding roles, the pressures of responsibility began to weigh heavily on him, and he experienced what can be described as the first signs of depression.

“It started with a change in working conditions that led to more demands on my time and the volume of work increased with more financial pressure to succeed,” said Bill. “I started thinking that I couldn’t function mentally. Being riddled with self-doubt and unable to make the right decisions due to total lack of confidence and a loss of self-esteem.”

His years of experience, knowledge and commitment were, according to Bill, of no consequence, and he felt he had to adapt to the changes or be out of a job.

“The feelings of depression and doubt were allowed to fester away, and I was struggling to find a way to put things right, then I decided the only answer was to take my own life and only that way, I would rid myself of all the pain I was feeling.” 

That was the moment Bill realised he needed to get help. He didn’t mind hurting himself but for the sake of his children and grandchildren, he believed taking time off work and getting some therapy was the best course of action. Bill also believed in the power of exercise.

“Simply getting out of the house and going for a walk was enough to improve my mood, by thinking things over rationally without the constant pressure of work. It made life easier to bear.”

Sometime later, Bill was able to return to work. He believes that the industry is changing for the better and states that he is seeing far more newcomers talk about their feelings then he ever did back in the Seventies. He encourages everyone to be open and honest about feelings of stress, anxiety, depression, and inadequacy, as if not treated, they can crush you under their weight.

Physical activity is an under-rated tool in the arsenal tackling mental health. The chemistry behind why physical activity is beneficial for depression and anxiety is still a subject of research. One leading theory suggests that increased blood flow to the brain triggers the release of a protein known for encouraging the growth of new brain cells. Since the hippocampus can be smaller in those suffering from depression, the protein is thought to help regulate mood.

It can be difficult to tear yourself away from work, especially on the dockside where constant vigilance is necessary for the health and safety of others. However, when you find time, going for a thirty-minute walk can improve your blood circulation and lead to better sleep, weight reduction, and an increased interest in sex. In addition to these benefits, a Harvard University study found that just three hours a week of moderate exercise, such as walking, could reduce the odds of incident depression. Both Dave and Bill found that exercise helped them to stabilise their thoughts and process their emotions.

Everyone experiences mental health differently and these two examples can differ greatly from even the vast majority of cases. However, the more people share their experiences, the greater the chances of friends and family noticing the warning signs and encouraging those suffering to seek help.

Port Skills and Safety will continue to highlight strategies from the Health and Safety Executive (HSE) and healthcare professionals for dealing with work-related stress and mental health. The HSE offer Stress Talking Toolkits designed to help managers understand and prevent workplace stress. The Working Minds campaign helps raise awareness and encourages the identification of the early warning signs of declining mental health. The NHS also has a range of tools available via the own mental health resource toolkit, offering workforce planning, recruitment, and day-to-day management assistance.

Please note that the advice and information included in this article is neither an endorsement of behaviour nor healthcare advice. Individuals suffering from depression, stress, or anxiety, are urged to seek immediate professional support.