The following section gives tips and advice for navigating the mental health system, receiving the best care for you, and ensuring your voice and your rights are respected by the medical establishment. Although the contributors are based in the UK and the US, we hope the gist of the advice will apply regardless.

1.Therapy for Anarchists, Class Warriors, and the Rest of Us
Dr. Charlotte Cooper

In the UK, therapy has roots in middle class philanthropy, and is often accused of being an individualistic response to social problems. This is off-putting to people who feel that the wider social context is relevant to our lives. But therapists are a mixed bunch. Some of us see our work as part of a bigger project of social change. Some of us are working class too, a few are anarchists, and many bring other identities and experience into the mix.

Having a caring space in which you are listened to; understanding what's going on and why you feel so awful, working on meaningful and feasible ways to alleviate that pain are all crucial steps for developing well-being. I am obviously biased because I am a shrink, but I think that counselling and psychotherapy (I use them fairly interchangeably) are primo routes to resolving long-term depression, anxiety, and stress. But getting your hands on some quality, politically engaged psychotherapy when you're too depressed, afraid, or anxious to move is another question.

The Holy Grail

The holy grail: Very cheap or free open-ended counselling/psychotherapy in a style that is compatible with you, with someone local who is clued-in about social marginalisation, and has at least some politics and connection to the communities with whom they work.

Open-ended means that you decide when you're ready to finish. Having someone clued-in means not having to educate the therapist in the basics of your life, and where they will have a grasp of the social context in which you exist, and hopefully some desire for social change. A therapist who has some connection to community will be less likely to patronise or judge. Ideally the therapist should have qualifications, be registered and shouldn't have to work for nothing in horrible conditions (the holy grail is also about recognising their profession, despite popular clichés, as it can be hard way to make a living).

The Reality

If you don't have the money you can approach the therapist of your choice and ask for a reduced price and try to negotiate something affordable. Not all therapists have cheaper places, there will probably be a wait, and you might find that their version of affordable is still too expensive for you. You might have to try
a few people, and the process of negotiating can be quite intimidating.

For free therapy, you can see your doctor to be put on a waiting list for a service about which you have little say, and which is likely to be time-limited (six sessions is common). It’s also possible you’ll be channelled into an Improving Access to Psychological Therapies programme. While the service can be helpful for some people, you will be using a service which is still in its early days and has come under a lot of fire for its somewhat sausage factory approach to mental health. Plus you might find yourself being seen by someone who's trained in IAPT, but not as a therapist.

You might also find community counselling agencies, but you might be asked to make a financial contribution, and again there are likely to be waiting lists and restrictions on length of service and types of therapies. In community counselling it's common to be seen by trainees rather than experienced
therapists. It can be hard to shop around for someone you like and the service can be a bit hit and miss.

If you are a student or work for a company that has an Employee Assistance Programme that extends to psychotherapy and counselling, you have a better chance of finding free services, but these will probably fall short of the holy grail for many of the reasons outlined above.

The kinds of services I've mentioned here can be really great, but it's worth knowing their limitations, too. Counselling and psychotherapy are somewhat mystified professions, tainted by the stigma of mental illness, which means it's hard to navigate the system and determine what's best for you. All of this can be really exhausting when all you want is to be in a room with someone who will listen, understand, and help you to feel better. Ask around, try not to be intimidated, ask questions and keep going until you find what you're looking for.

Other Routes

The holy grail of therapy may be out of reach, but there are other things you can do to help shift your depression and anxiety. Here are some suggestions that you can mix up and adapt, in no particular order:

Therapy groups exist, but can be quite hard to find, and may be closed to new members. There are many benefits of doing therapy in a group, not least the sense of collective witnessing and information-sharing. They tend to be cheaper than one-to-one sessions. But you also need a really skilled facilitator
to help a group function well, and bear in mind that class politics and radical ideas might not be at the top of the agenda, or always welcome. A network of radical therapy groups would be a wonderful thing, but does not currently exist in the UK.

Co-counselling is a grassroots movement in which people pair up and share the roles of counsellor and client, taking turns to speak and listen. It's free. It has roots in a form of counselling that I think is somewhat cult-ish, but there is no reason that you shouldn't adapt the format to suit yourself. For more information, visit http://www.co-counselling.org.uk.

Bibliotherapy is a fancy term for reading, specifically reading the kinds of books that might help you feel better. Self-help literature has a bad reputation, often deservedly, but you can still dive in, use the bits that you find useful and discard the rubbish. You can use other types of literature too, you don't have to limit yourself to one genre; look for poetry, novels, comics, political tracts, etc., that move you or provide some hope or strategies for surviving and thriving. Write about them and keep reading and sharing what you've found, ask people for recommendations. Use the library, read and share things online, lend and borrow.

There are different methods of journaling that can help with depression and anxiety. Some people keep journals to remind themselves of what they have, you can also use journals to explore particular episodes of your life, or simply to be in the moment and to reflect on your feelings. You can check out 'therapeutic journaling techniques' to find a method you like.

Make stuff, develop public conversations about depression and mental health more generally in the groups and communities you are a part of; try and think about ways in which organisations and activists can be accountable to people's well-being. Get politically active around this stuff, refuse to suffer in isolation and silence, challenge the stigma associated with mental health .

Encourage experimental ways of developing therapy. Alternative means of therapy can be imagined, customised or put into practice. I think that counselling and psychotherapy will remain a remedy for the elite unless we intervene and demand and create services that more readily address our lives and needs and dreams for social transformation.

Finally...

Keep going, make it moment-by-moment if you're really struggling. Tell someone. Muster some hope if you can, and use whatever tools are available. The world needs you. •

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2. Striving and Thriving: Mental Health on the Radical Left
Tina Phillips

I am a person with lived experience with mental illness, diagnosed bipolar since I was fourteen years old, as well as a mental health professional. It is estimated that one half of all people will develop mental illness in their lifetime. Currently 50 million people (1 in 5) have a diagnosed mental illness in America (not to mention all those who are undiagnosed). Despite such prevalence, mental illnesses comes with a lot of stigma. As activists we need to fight such stigma. The best way to do that is to talk about it. As a fellow social worker and shame and resiliency researcher, Brené Brown says, “Shame
needs three things to grow exponentially in our lives: secrecy, silence, and judgment.” As people with mental illness we need to tell people our stories and help normalize it. It takes courage and bravery to put ourselves out there, but it is necessary. We all need to become mental health advocates who combat
social stigma if we want this situation to get better.

Politically, a life-long commitment to social justice can be a serious undertaking and means a literal struggle. It comes with many personal as well as political sacrifices that have both psychological and emotional consequences. Of course there are positive mental and emotional benefits of being an activist, but the commitment to the movement comes with both rewards and challenges. Mental illness is biological, genetic, environmental, and socio-cultural. However, I believe if we lived in a truly socialist society we could see a drastic reduction in mental illness and could even prevent it. Furthermore, we know capitalism creates social alienation and enormous amounts of interpersonal, relational, and social stress on individuals and families. Not only must we work hard, often at jobs with low pay and long hours, we have many other responsibilities on top of it. We have families, partners and children that we need to help take care of. We have to do chores, feed ourselves and others, and run errands. There is so much to do; we often neglect our own health.

All we can do in the immediate is try to manage the stress, by finding coping skills and decompressing activities. The coping skills can include art, exercise, sleep/naps, socializing with friends and family, eating a slow cooked meal, reading a book, yoga, meditation, relaxation techniques, deep breathing, focusing activities, taking a long walk or hike or going swimming, among other things.

It can be very challenging to overcome the pressures of everyday life, let alone those of being part of an activist movement and community. It is important as an activist that one takes care of oneself and that our community supports us. Burnout is common and all too often we feel our hard work brings too little
tangible results. This can lead to disappointment and frustration.

We have to celebrate every victory and recognize people’s efforts. Appreciation of others is so important in creating self-esteem and maintaining long-term commitment. We can also stave off burnout by taking breaks from our activism and supporting each other through hard times.

So what is to be done? Our mental health system is far from perfect, too overburdened and too expensive for most people. That is part of why we work as left radicals to change this system into one that works for all people. Unfortunately, in the meantime we have to deal with how things are now.

One thing I advocate is therapy, but it is often cost prohibitive. If one cannot find low cost/sliding scale/income-based therapy, I always recommend workbooks. They teach people step-by-step about the condition which they may have and offer a variety of techniques such as mindfulness to cope with emotional stress and improve overall quality of life. Most therapists would teach these techniques in therapy but you can learn them on your own for a fraction of the cost. And if one technique or workbook doesn't work for you, try another.

Another thing therapists provide is the time and space devoted solely to you and a time to talk/vent and be listened to. You can't find this in a book. But you can find this in other people—friends, family, co-workers, and comrades alike. Find some trusted individuals who are willing to hear you out, provide
empathy (not just sympathy), and validation (telling you what you are feeling and thinking is real). Just providing a sounding board of unconditional support can make a world of difference.

I always recommend the rule of threes. Find three reliable people you can go to in a crisis or when something happens that brings you down. Tell your story to those three people, three different times. At the end, you will have released and expressed those feelings and thoughts, will most likely feel better, and hopefully have come up with some solutions. Of course there is one thing a therapist can provide others can't—and that is education, training, and experience in treating and healing major trauma and
psychiatric challenges. There really is no substitute for this. So if you need this, try your best to get it. Oftentimes the expense paid to get this is worth the necessary sacrifices.

Another avenue to increase mental health is using medication. There is much debate about the use of psychotropic medication. As someone who has bipolar disorder, I know my medication saves my life, both literally and quality-wise. Every individual has to make their own choice whether to try medication and see if it helps. Not everyone has to take medication long term, but some do. I have to take mine the rest of my life, but I am glad there is something out there that profoundly helps me.

Yes, medications are often over-prescribed and developed by big pharmaceutical companies, which are profit-motivated. Yes, doctors can sometimes be pushers because they are getting kick-backs. That is why finding a good doctor to prescribe the right medication is important. This would often be a psychiatrist, who usually does not come cheap. If you can, try to find a lower cost psychiatrist, but
if you can't, a general practitioner can prescribe many of the same medications. The caution is they are not trained as well in psychiatric conditions and would not be able to monitor you as well as a psychiatrist could.

Another option that could help and is often more affordable, is herbal remedies and Eastern/alternative medicine. There are many helpful remedies out there worth looking into from vitamins, supplements, teas, essential oils, to acupuncture, acupressure, bio-feedback etc. As well as looking at changes in
diet, sleep, and exercise.

Individuals also need social support. If you're in a radical left organization, develop internal systems to provide this support. We need to be able to turn to each other in times of need. This prevents burnout and can be a powerful source of intervention in times of crisis. We need to get more involved in people's
lives, pay more attention, and be willing to have sometimes uncomfortable conversations with people. We need to focus most on compassion, understanding, and empathy.

Another possible strategy radical left organizations can implement is conflict-management, non-violent communication, and peer counseling. If our organizations used these techniques and taught these skills to all of their members they would be better served by doing so. Learning how to communicate
assertively and not passively, passive-aggressively, or aggressively is very important for any individual or organization. Our success is wrapped up in our ability to resolve conflicts and reconcile differences. No one gets through this life on their own—we are all interdependent social beings. So let’s live our radical values in the here and now and transform ourselves and our organizations to serve each other’s needs.

Our organizations can become a model going forward for society and be a source of strength to make
us more effective activists. Indeed this can be a protective factor for those with many risk factors for self-harm, homelessness, and suicide. We can be the difference and we are responsible for implementing these suggestions now. •

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3. Dealing with Mental Health Services:
Advice from an Anarchist Mental Health Worker

Medical professionals can be hit or miss. If you've talked to your personal doctor about mental health difficulties and feel he/she is being dismissive or isn't taking you seriously, you have the right to ask to be referred to specialist mental health services for an assessment. The nature of mental health problems are such that it can seem difficult to assert yourself and it can be easy to feel disempowered. This is especially so when dealing with people who might appear to be in positions of authority, like psychiatrists, social workers, or community based mental health workers.

If you feel the need to approach mental health services, have asked your doctor for a referral, or in some other way you come to their attention, the following points might help you to get the most out of it. Remember that service providers are human beings like the rest of us. You are their equal, and your time is as valuable as theirs. You should expect to be treated as an equal, with respect and dignity.

Try and be as clear as possible when talking about your problems. You should get the most help and the most benefit if those you are asking for help under stand what's wrong and what sort of help you feel you need. If there are specific things that have helped you in the past (a certain medication, talking therapies, group work etc.), make this known, and try and think about other things that you feel would help.

Also make sure things are explained clearly to you, in a way you understand. If a course of medication is suggested, ask questions about it, and try and make sure that potential negative side effects are explained as well as hoped-for positive effects. If you are given a diagnosis, try and ensure that the
symptoms, characteristics, prognosis and implications are clearly explained.

If you feel that social circumstances (poverty, threat of eviction, isolation, substance use issues, etc.) are contributing to your mental ill-health, make this known. Services have a duty to support you with these problems if your mental health is such that you can't do it yourself. Being given anti-depressants and sent back to the root problems that caused the depression, for example, is not good enough.

Remember that you have the right to complain. If you disagree with any decision, diagnosis, course of action or treatment plan or you feel you're not being listened to or taken seriously, talk to the people involved and let them know, if you feel confident doing so. A trusted friend or family member, or an advocacy worker can help you here, too. If you're still unhappy, you can make a formal complaint, you can ask for a second opinion, or you can request a change of doctor. Health boards have a duty to publish complaints procedures, and copies should be available at local community mental health team
resource centres, and normally online as well.

You should be at the centre of any decision making. Do your best to make sure that your views are taken into account. Taking someone else (again, a friend or family member, or an advocacy worker) who understands your situation along to appointments can help with this.

Remember that nothing can be imposed on you against your will unless you are subject to mental health legislation, and certain steps have been taken allowing decisions to be made by professionals. Even in this situation, you do still have certain legal rights, which should be clearly explained, and you should still be at the centre of decision making as much as this is possible.

If you find yourself subject to mental health legislation (detained in hospital, given medical treatment against your will etc.), make sure, as best you can, that the process is explained clearly in a way that you understand, including what your rights are. Service providers and those responsible for the compulsory
measures have a legal duty to explain this to you. Again, having someone else who is on your side (a friend, family member or advocacy worker) can help. If you are unhappy, you are entitled to free legal advice and representation, and in most cases have the right to appeal.

Remember that mental health service providers are there to help you. Anything they do should benefit you, and should be intended to get the best outcome possible for you. If you are unhappy at any point, you can seek advice and support from friends, family, other service users and independent advocacy
and mental health organisations.