 Okay, hi. I think I'm live. I'm not quite sure. I'm not quite sure how I would know. Let's have a look. Okay, hi. I think I'm live. Oh god, I'm playing myself now. That's not good. Okay, so I need to just figure out the tech a moment, so I'm not sharing this yet, and hopefully not many of you will know. But while I figure out the tech, I'm also then going to put it live on Twitter, and then we will make a start. Sorry, I'm disgustingly ill at the moment. I have chest infection from having had a broken ribs. Now what I'm trying to figure out is how I get to that nice screen that actually shows me your questions and stuff. Okay, so I think I can see that now. I just need not to play it. So I'm also going to press go on Twitter because in for a penny, in for a pound. And okay, so we're just going to say I've, so you can see me figuring this out as I go along. This was surprisingly complicated to set up a live chats on YouTube. So yeah, apologies. Okay, so live Q&A, re-mental health now. Send in your questions. So I'm kind of dual sending this. So I'm actually going to put this. Can we turn it around? Yeah. Oh my God, bear with me. Flip camera. There we go. So I used to do this quite a lot broadcasting and then I stopped doing it. And as with anything, when you stop doing it for a while, then you completely forget how to do everything. Okay, so what I'm hoping to do today is to answer a few of your questions. So I asked some of you to send me in some questions. If you had them about mental health, I get questions all the time on email, Twitter, YouTube, you name it. And I figured that what I would do is use live video as a way of kind of having a chance to chat with you. Today I'm really testing it out, but I'll answer the questions I've had. And then if it works well today, then I'll look to do it again in the future. Hopefully you can all hear me okay and stuff. I'm kind of going to rely on you really to let me know if there's any problems. So do leave a comment on Twitter or YouTube if there is any problem. Okay. So the first question I had is from Terry on Twitter who was asking about what is attachment disorder and what can you do to help if someone has it? And I'm going to try and keep the answers relatively brief. Obviously you can go away and look up more information if you need it. But this scenario here is that Terry's grandson has been diagnosed with potential attachment disorder and he wants to know what it is and what he can do to help. So attachment disorder, there are quite a few different types. But very, very briefly, when we are babies, young children, then one of the things that we need to do is to build a secure attachment with an adult figure. That might be a parent or a caregiver of some kind. And what we need is for that adult figure to be like a safe and stable base from which we can explore the world. So this is like Bulby's attachment theory. Now that can sometimes not work as we might like for a range of different reasons. Even it can be neglect, it can be abuse, it can be that there is some form of trauma going on there. There can be all sorts of different things that can mean that that attachment doesn't form in the same way that it might. And we would say then that the child doesn't have this kind of stable base from which to explore the world. Now, in terms of how that impacts, it can impact on our kind of behavioral and emotional and sort of social development as well. And we can see all sorts of different symptoms from that if you like. And that's perhaps what's being picked up in Terry's grandson. Now what Terry wanted to know is what can I do to help? And he said that all he knows to do is just to love his grandson. And actually that's the most important thing you can do. So a child who has got any kind of attachment difficulties, what they need most is love, care, and yeah, your support. They need to know that you unconditionally care for them and you're probably going to need to kind of care out loud. So when I talk about caring out loud, I mean actually making it very, very clear to the kid that you care about them. So don't assume that they actually know that you love them, actually spell it out for them. Write it down, tell them again and again and again. So we often can make the mistake of thinking that because we know that we love someone that they'll know we love them too. But no, spell it out for them and then yeah, just try and be really consistent in your approach as well. So the other thing that can often be missing here is things like boundaries. So being really clear and consistent in your rules, making yourself predictable. So your kid knows how you're going to respond to different situations. The other thing you can do is to help support them with things like emotional regulation here too. And here this just becomes about being emotion coaching is a good approach here. You could look up and this is about having a kind of empathetic way of parenting. So we're going to instead of responding with kind of anger or sadness or anything like that when a kid is inappropriate in terms of how they act. So remember, no feelings or thoughts are inappropriate, but the way that we act might sometimes be inappropriate. So we want to teach that to our kid and we can take difficult moments. So those moments which might be kind of angry outbursts or inappropriate behaviors, we can take those as kind of learning opportunities for that child. And instead of kind of pointing blame at the child, look at the behavior and then think with the child. Well, what caused that? How are you feeling? What caused that? And how might we respond to that differently next time? The other really important thing here is to remember that as a trusted adult in a child's life, we're always a role model. And sometimes that means admitting when we get stuff wrong. So we all have this sometimes where we get frustrated. We might fly off the handle or respond in some way inappropriately to a child, whether that's with anger or sadness or whatever. And actually just saying, hey, sorry about that. I responded that way because I was feeling this way and actually talk it through and say actually next time what I should do instead is X, Y, Z. When you apologize to a child, then you're giving them a really valuable kind of learning experience and it's good role modeling for them too. Okay, sorry, I'm horribly ill, so you're going to have to bear with me kind of sniffing away. Okay, so the next one was I was asked to provide three top tips for promoting positive mental health. Now this is a massive question, massive, massive question. And I was trying to think what would be my top three. So what I always say, to be honest, is to think first about physical health and that our physical health underpins our mental health. So if I was going to give three top tips, I would say eat healthily, try and get good and enough sleep and try and get outside and get some exercise if you can. And that sounds not maybe like the answer you'd be expecting because I specialize in mental health and I spend a lot of time talking about promoting wellbeing and emotional regulation and all that kind of thing. But actually if you're going to do just three things for your mental health, that would be it. Sleep well, eat well, get outside and get some exercise. Most important things you can do. And if you're going to do just one of those, I would say work on sleep first. I'm a big believer in the power of sleep. So just to kind of think about sleep for a moment, when we have a bad night's sleep, everything feels harder. You know, like when you go to work or you're trying to parent or go to school, whatever might be your situation. If you've had a really bad night's sleep, then you find that it's harder to concentrate, you're quicker to get emotional and just everything feels generally more difficult. Conversely, if we've had a good night's sleep, then our brain is working better. We're better at problem solving. Thank you. You're saying you can relate to that. Yeah. And yeah, we're better at problem solving. We feel better. We're more alert. Just everything is generally easier. And so if we can train ourselves to sleep better and to really prioritize sleep, then that makes life just generally easier. We kind of, we start on a, you know, more even playing field. We're kind of promoting our resilience. And the really nice thing about sleep as a way of focusing on our mental health is that it's really, really easy to form new habits. So you might have like years of sleep deprivation behind you. You might be chronically sleep deprived, really, really tired, really, really struggling with sleep. But if you spend literally a few days focusing in on your sleep, then you will find that it makes a really big difference. So someone's just asking about how many hours you suggest. Now this changes massively depending on the individual and also depending on how old you are. So teens and toddlers need more sleep than anyone else. Older people need a bit less sleep. But actually it's really more important to get good quality sleep than good quantity of sleep. So a few hours of good, undisturbed sleep is going to actually generally do more good. And if you get those sleep regular times, you'll find that does more good than getting very, very long stretches of sleep. So some people try and have a sleep deficit during the week and then like binge sleep at the weekend. That's not really so helpful for our body is just consistently getting the same amount of sleep every night. So in order to promote good sleep, really simple stuff. So we're going to have a regular bedtime. Treat yourself like a toddler basically have a regular bedtime. If you go to sleep at the same time every night, you'll fall asleep more easily. You'll fall into a deeper sleep more quickly. Your body will be ready for sleep at that time so you didn't spend ages kind of tossing and turning and trying to get sleep. Have a regular wake up time as well. So set your alarm for the same time every day. This can be really tough when you first change it and you might find that it's difficult to get up and you might want to gradually move it forward. But if you start getting up at the same time every day, even at the weekend, if you can, then you'll find that it's actually really easy to wake up at that time. The other thing you can then do is actually try and move your wake up time slightly further forward to give you a bit of time in the morning to do stuff that you find enjoyable or kind of sets you up well for the day. So that you have, you know, good amount of time for breakfast. I like to do yoga and reading or piano practice in the morning. So actually actually cut back a little bit on the sleep, get up early and do those things that really set me up for feeling less anxious, more able to kind of face the day ahead and doing things I enjoy. I used to get up really early on work. I don't do that anymore. Now I do stuff I enjoy instead. But, you know, it's up to you and where you are in your life and what you need to get done and that kind of thing. My thesis, my PhD thesis was all written at four o'clock in the morning. But yeah, so getting to sleep on time, getting up at the same time each day as well. Having an environment that is conducive of sleep, so having a kind of proper sleep zone. So if you've got a bedroom, then obviously having your bedroom, the right temperature, having comfortable bedding, making sure it's nice and dark, that you're not disturbed, that kind of thing. If you are kind of a student saying you've just got one room, then you might want to zone your room so that you kind of work and carry out kind of activity in another part of the room and that your bed is very much of sleeping. What we don't want is to associate our bed with wakefulness. And again, if you can't sleep, if you try getting to sleep for kind of 20 minutes, half an hour, then it's better to get up and do something kind of relaxing, reading, coloring, something like that. And then return to bed because again, otherwise we can create this association with wakefulness on our bed, which is less good. The other thing is try and get over the fear of missing out and actually turn off your social media and your mobile and that kind of thing at night. Because if we leave it all running, then we don't go into such a deep sleep because we're kind of, you know, perhaps checking and checking and that can be really tough. Thanks for everyone who's coming and saying hi by the way, I'm sorry I'm not responding to everyone in turn, but I am noticing your things, I'm noticing your hearts. Okay, questions just come up saying your thoughts on dissociative identity disorder, formerly known as multiple personality disorder. Okay, dissociative identity disorder is an interesting one when I have a personal interest in because I had that diagnosis a while ago. So dissociative identity disorder is it's complicated and it can take various different forms. But so yeah, previously known as multiple identity disorder, but this is where someone will essentially upset themselves. So it's not a choice from what is happening in the immediate surroundings as a kind of trauma response. Now this can be that they might then kind of take on a completely different persona. And the two personas or multiple personas might not be aware of each other when they, you know, so I, Puki, am not aware of what my kind of alter ego, if you like, would be doing when I dissociate. So when I dissociate that will be because trauma response has triggered me to dissociate. And that would be when I was very unwell with it, that would be times when I would be at great risk of suicide or self harm. The difficulty for me with that was that I was unable to use things that I'd learned in dialectical behavior therapy. So I was unable to do things like emotional regulation and keep myself safe in the same way. So for me it was a really dangerous thing. I had to put alarms on the door, stop myself leaving the house, make sure that yeah, my husband and family were aware of the danger there. In terms of you saying my thoughts on it, I'm not sure whether you're saying whether it's kind of treatable or whether I think it exists or whatever. In terms of my thoughts of it, I guess, so personally I found it a really distressing disorder. All the different diagnoses that I've had and I've had many, although they now kind of all sit under complex post-traumatic stress disorder. So this is a relatively common symptom of that. For me it was the most distressing symptom or most distressing diagnosis I had because eating disorder, people kind of understand the get depression, people get it, anxiety, people get it, even things like self harm and suicidal ideation, people kind of get it. Dissociative identity disorder, people don't understand and it makes you feel like, well, like you've gone completely mad. Turning up, I had experiences where I would turn up to accident and emergency having self harmed and I would arrive there and I would suddenly be aware of where I was and that I was in pain. And I wouldn't remember how I got there, I wouldn't remember what I'd done, how it happened and yeah, that was really distressing. However, for me, actually learning to recognise when this was in danger of happening and either avoiding things that might trigger those trauma responses or using lots of grounding techniques, so techniques that make you feel like in the here and now. So that might be kind of breathing techniques. I use lots of stuff with the senses in order to try and stay present. Sometimes it would be just picking up the phone and asking a friend to talk to me. Really kind of, yeah, trying to be present in the moment made a huge difference. And then the other thing was about actually beginning to tackle the underlying issues. So again, for me, that was about doing trauma therapy and actually addressing the kind of roots of my trauma. Be different for different people. Dissociative identity disorder is difficult. Okay, so the comment coming up here, that's true. I have the idea it was frustrating even trying to find the proper therapist and psychiatrist. Yeah, I would agree. And I have to be honest, even though it's disorder that I have had a diagnosis of, it's not something I know huge amounts about besides my own experience. So I know some of the detail about how to kind of, yeah, try and deal with it on a day-to-day basis. But it's not an especially common diagnosis. It's not one that people come forward with a lot and actually trying to get the right input and help can be really hard. Particularly because if you are someone who's struggling with dissociative identity disorder, then you are likely having, you know, quite a complex profile. And you might not be in a great position to actually look for appropriate support. So yeah, it's a tricky one. But one of the things I would say is that with dissociative identity disorder and any kind of dissociative type symptoms and also derealisation, which is a related thing where you might feel a bit like Alice in Wonderland. Everything takes on a very kind of surreal kind of quality. Then actually knowing the name for that, being able to go and look it up, being able to realise, oh, this is a symptom that other people have experienced. For me, that was actually incredibly helpful and made me realise, OK, this is a thing. I can learn about it. I can name it. I can begin to understand it. There are things I can do about it. And so that was quite positive. There's lots of questions about whether labelling is good or bad or indifferent. And yeah, for me, that label was helpful. And again, you can feel less alone when you find other people who are also going down that road. Mind have got some really great information about dissociative identity disorder and the different kind of treatment options and how to kind of live with it that would be worth looking up. OK, next one. So someone who watched the, I think it was a Horizons programme last night, the BBC programme last night about male suicide. I didn't watch it because I'm really easily triggered. So I have to be careful. And my friend, Steve, who featured in it, Steve Mallon, he sadly lost his son to suicide. He featured in the documentary and I asked for his advice and he said that the documentary was really well put together. They'd had really good safeguards in place, but he knows me well and he just recommended I didn't watch it alone. So I didn't watch it. However, I understand it was a really good thought provoking documentary and certainly it's got lots of people asking questions. So someone who watched that last night asked me the question, why do more men kill themselves than women? Again, OK, why do more men kill themselves than women? Right, first thing to understand here is that many more women make suicide attempts than men. It's just that men are more likely to result in death when they make a suicide attempt. Now there are lots of different theories around that and probably a good thing to do would be to watch the programme last night where I'm sure they explored some of this in some depth. Traditionally, we have considered that men use more lethal means. So the way in which they make attempts on their life, it's more likely to result in death. Less able to be undone if you change your mind, so more instantaneous. So it can be about the methods and it might also be about the point at which you take this action. So a lot more women will be engaging in lower level self-harming activity or have suicidal ideation but also be actively talking with people they trust or seeking help for that. Whereas traditionally we've looked at men and said they're less forthcoming and talking about their emotions and seeking help. I think we have to be a bit careful when we are talking about this because I fear that this is becoming a bit of a self-fulfilling prophecy and we spend a lot of time saying men and boys are not able to talk about their emotions and actually that's quite disempowering for men and boys who increasingly are able to talk about their emotions. Other reasons why more men kill themselves than women. I think this is a really tough one. The other thing here is that we can end up entering this world of looking at data and trends which is important but when we're thinking about suicide actually every story is an individual story and we should be looking on a case by case basis. We should also be unafraid to look at where things have gone wrong and someone has unfortunately taken their own life and think about what we can learn from that. I think it's one of the greatest gifts that we can give to someone who has sadly died if we're able to learn something and kind of take their memory and their legacy forward by hopefully meaning that someone in a similar situation might be more likely to get the help that they need. But yeah we're in a slightly difficult place in the UK maybe worldwide at the moment where we are talking more about mental health, that doesn't mean we're doing it enough but people are actively seeking help and the help's just not necessarily always there. We don't have, we're not able to meet the need at the moment, it's a problem and it's one of the things that myself and many colleagues, people like Natasha, Devin, Steve Malam lots of colleagues, many of you I talk to regularly on YouTube and Twitter and we're looking to try and improve it but it's tough, just yeah kind of a quick thing there I guess if you are struggling with thoughts or feelings of suicide then do contact Helpline Suicide the Samaritans or Childline if you're under 18 are really good ports of call but you can, yeah there is good help available. The other thing I would recommend is writing a Suicide Safety Plan it's something you or someone that you care about has ever sort of struggled with and that's just about thinking at a moment of calm about how you would manage in a moment of crisis and it's really as simple as that and having a safety plan can be life-saving and it can also be a really good way of opening the conversation if you or a loved one are struggling with this too. Look up Alice Cole-King connecting with people for a good template there. Okay then I had a parent who asked how can I stop my child self-harming? It's like really big questions today. How can I stop my child self-harming? Okay so I've made loads of videos written a lot of books on self-harm if you want like a very brief answer then I guess my key thing here is stop, listen, care and actually allow your child to open up don't be afraid of this topic because we can't, you know, we can remove means, we can give consequences actually that's not going to have the impact that we want. This is a child who is clearly in distress for some reason and the self-harm will be meeting a need of some kind. Someone asking am I qualified to discuss these things? I would hope so, yeah. I'm the Vice-Chair of the Children and People's Mental Health Coalition in the UK. I have a PhD in mental health from the Institute of Psychiatry. So yes, yes somewhat and I have kind of personal experience too. That said, obviously always do your research and yeah, look up elsewhere. So how if we want a child to stop self-harming, so self-harm will be meeting a need and so what we need to do is to think about what need is this meeting for my child and how could that need be otherwise met? So what happens if we just tell someone to stop or if someone just tries to kind of stop cold turkey? Then sometimes we find that they try and maybe they fail and A, they might feel like they can't talk to you about it anymore or B, they try really hard and then they end up turning to a different means and yeah, it doesn't always go well. So instead we need to think right how else can we meet this need and that means having an open conversation about self-harm which can be really tough if you really care about the young person involved. But talk about it. The other thing you can do is get the kid to keep a journal. It might not be a kid, it might be an adult, but keep a journal of when they're self-harming, how it made them feel, what was the kind of reasoning there and then we can think okay, so you often self-harm at this particular time of day or you're doing it because you're feeling in this way and then we can think well how else would we manage to achieve that? So people self-harm for a whole range of different reasons. So for example if someone said to me well I get really really anxious and when I self-harm it helps me to feel calm then we'd be going right okay what are other things that might help you to feel calm? Equally it might be someone who really struggles and you know feels that they need to be punished sometimes people self-harm as a means of punishment and then we'd be thinking okay well let's kind of try and address the root of that or how else might you be able to address this in a different way. So it's really about not saying you've got to stop this it's about saying okay why are you doing this? What's the reason here and how can we meet that in a different way? Generally self-harm is either for coping so I'm trying to cope with difficult thoughts and feelings that I'm having or it's about accessing care so it might be the only way that I can get someone to listen to me or it's a way of getting over the message that I'm really really struggling and it can be about communication so coping communication or care and then again we're just asking ourselves what are the different ways that we might access that? I missed that question that just came up it was about something to do with school counsellors but I missed it. Sorry can you write it again? Sorry I'm sorry it just came up because someone was spamming me about hemorrhoids which it's not asbestos topic unfortunately yeah I can't talk to you about hemorrhoids if you want to send the question about counsellors again then I will try and answer it, apologies for that okay so yeah self-harm don't be afraid to talk about it basically listen okay next one somebody who said their daughter didn't get the GCSE results that's the UK exams which came out today she didn't get the GCSE results she was hoping for and the daughter feels like a failure and this parent said I just need her to know that I really love her and I don't really mind how she did in her exams but she seems to think that I'm judging her based on this okay tough one I would say that it will be quite difficult your daughter is probably had lots of different expectations on herself about today and when we don't live up to our own expectations we're often our own harshest critic it might just take a little while for her to work through those emotions and just making sure that she's safe and that she's able to kind of talk to you about it and try to find some different outlets for those emotions whether they're anger or sadness or anything like that often as a parent we want to go in and rescue and we think right how can I fix this and actually today it's okay for your daughter to actually just you know this is a really tough day and her feelings of anger, frustration, sadness whatever they might be are valid and it's okay for her to feel that way and you might not be able to fix it right away when this has had time to settle then we can think about you know solving and what next and what do we do about that but that needs to come once she's kind of overcome these initial feelings in terms of helping her to understand that you love her regardless of her results and that she has placed more importance on this than you have that's just one of those where you're going to have to perhaps be a bit of a broken record but yeah I mean it's going to be a really difficult day for anyone who didn't get the results that they were hoping for today and it is really important for us to help kids to understand that they are more than their exam results exams are you know they're important for many people they are the stepping stone to whatever we're doing next but actually you know we would hope that any young person would have multiple pillars to their self-esteem and so we would be thinking about the other attributes that they have the other things they enjoy the other things that kind of make them uniquely them but yeah today it might be okay for her to be feeling bad and we might sometimes think about different ways that we can work through those difficult feelings so kind of using music or art getting it out through sport whatever it might be but just finding a way to like work through that frustration and sadness and anger and whatever it might be but yeah just be there listen and let her know that you care okay so someone asking about what about people who want to end their lives can you clarify please whether you're talking about in response to exam results or more generally or what we should do but I get asked a lot about what should we do if someone is suicidal or we think they might be suicidal the most important thing you can do is as I say in my TEDx talk embrace the awkward and talk about suicide so if you're worried that someone might be suicidal actually have that conversation with them you are never going to put the idea into someone's head if it wasn't there already so you can ask you know have you had thoughts of killing yourself and that person might turn around and go my god no what are you thinking about then you can feel kind of deeply reassured and they might come to you another time if those sorts of thoughts or feelings came to them but on the other hand they might turn around and say yes in which case actually this is an awkward conversation but you are there then to help to be there to help them get through the next minute and sometimes that's all that we can do is to help them get through the next minute okay so the clarification there this is suicide in relation to severe mental illness so one thing to say there I guess is that feeling suicidal is something that can happen to anyone so sometimes it is a result of mental illness and it might be that because we are basing such extreme emotional turmoil things like extreme depression and anxiety can cause us to be suicidal but also people can become suicidal as a result of circumstance so no one is immune to mental illness but no one is immune to having thoughts or feelings of suicide and sometimes that can come on very rapidly in response to something and yeah the best thing we can do to help someone stay safe in those circumstances is A to actually ask the question to let them know that we're there for them in that immediate moment and keep them safe in that immediate minute and then our next steps there are then about helping them to seek further support so that might be about going to accent an emergency or your emergency room depending where you are in the world and getting help in that moment or it might be about going to visit your doctor and trying to get the appropriate support in place a good friend is one who listens it's not necessarily one who can fix but you can be there to support and guide and enable the person who you're worried about to take the next steps in terms of accessing the right support that's not always easy you don't always get the right answer first time be prepared to revisit if you're willing to help the person you care about to visit the doctor and you know try and begin that journey of accessing the support they need that can help the other thing you can do is make them aware of things like Samaritans Childline if it's a younger person and other helplines which can help how do you assess when suicidal thoughts are likely to become active attempt okay that's a really good question just only one moment while I cough okay so here we have to become very kind of unsqueamish about asking questions about suicide so we start to actually ask questions have you had thoughts about killing yourself and if the answer is yes then we can look more in depth there well when did you last have those thoughts how often do you have those thoughts we then in terms of working out whether someone is kind of high medium or low risk because lots of people might have frequent thoughts of suicide but they're kind of thoughts of not really wanting to be alive anymore but they haven't really thought about what steps they might take but if you start asking questions about have you made any plans how would you do it, when these kind of questions if somebody is able to give you answers to that and they thought exactly about how they would do it they have made thoughts about what will happen to their belongings or how they would tell people what might happen after they die and they've really thought this stuff through that's when we begin to worry that this is someone who is very high risk obviously another indicator is someone who has made previous attempts so someone who's made a previous attempt is much more likely to make further attempts but we would hope obviously to support someone before they make any attempts it can feel really difficult asking those questions and often people worry that they'll put the thought into someone's head if you ask someone if they've had thoughts of killing themselves and you start asking them questions about how would you do it have you thought about when you would do it and all that kind of thing but actually you're not going to put the thought into someone's head you have to be prepared for the difficult answers that you might get you might find it really distressing personally and you need to make sure you've got the right support in place for yourself but yeah basically if someone has got detailed plans and they've really thought this through that's when we become incredibly concerned and that is when they should be picked up quickly by crisis team if you make that team aware of this person's current state okay final question on my list oh I've got one here from Ellie okay and another one is there a risk assessment that could be used in schools often young people will talk about so it's like great question I'm just trying to see my books are colour coordinated because it means I can find them quickly can I find the book I'm looking for now it's called suicide in schools by Jonathan Singer and now I can't find it no well that's typical isn't it I will send a link through afterwards but okay so Routledge published a book about three or four years ago called suicide in schools by Jonathan Singer it is quite American in its approach so it's quite things about like the legal ramifications and that kind of thing but yeah there is there are risk assessments that you can put in place and yeah so there's very very specific guidance for schools in there it's a really good book it's very thorough a little bit terrifying but yeah I would recommend that and yes you can you can just I would just pick up and use those they are evidence based and the authors are you know absolutely leading in their field and the years of research behind the books so suicide in schools by Jonathan Singer is where I would go for that and then someone saying here saying that they get really horrible panic attacks and do I have any tips for that sorry to hear that first of all Ellie so panic attacks are really horrible they are something which affects different people in different ways and no matter how many times you have them so I struggle with them although I don't get them half as much now as I used to far less than half as much so panic attacks are really horrible and every time you have one you kind of feel like you're going to die but in terms of tips so there are kind of different bits here so one is about trying to understand what's triggering the panic attacks and thinking about whether there's anything we can do to change the situation that we're less likely to have the panic attacks now that might be what is really helpful here is if you can keep a journal and actually note when they're happening and then you might be able to see whether there's any pattern if it's when you're around certain people in certain situations or other kind of triggers it might be certain times a day and if we can see the pattern there then we can begin to think about whether there are ways, whether we should be avoiding certain situations whether we can do something to make the situation more manageable the other thing is that we can't avoid everything and so we might want to think about okay well I generally find that you know Wednesday afternoons I often get really panicky there because I don't know I have to be in a certain place and it makes me feel really anxious so I might want to be thinking about what other steps I can take before that to make sure that I'm as calm as possible the other thing that you can do is think about how you would manage as and when a panic attack is happening or you can feel it coming on so I found really helpful and many people do too, learning to understand my body and its responses better so you can pick up early when you feel panic beginning to rise so you try and hopefully stop it before it turns into a full blown attack and then it's about actually just learning a few strategies for calming and being able to turn to those as you feel the panic rising and so the key thing here is that it's no good trying to put stuff into practice when you're in the middle of a panic attack, you've got to practice it so things like mindfulness someone just shared that idea mindfulness using cognitive behavioural therapy so you can look up CBT if you've not already received it you can address kind of faulty thinking and different thinking and behaviour links and address that but yeah so kind of things like mindfulness breathing exercises, I've got a video on box breathing you might find helpful things like colouring or using different means of getting out how we're feeling can really help there's endless different things we can try but it really depends on you and what works for you so it will be about practicing those things at times of calm so that as and when we find that a difficult situation arises and we feel ourselves going into panic we can quickly begin to use those different methods that we found helpful so whether that's mindfulness you might like a mindfulness app like the calm app on your phone for example whether that is singing playing piano, colouring in listening to music whatever it might be and then the other thing is about during a panic attack now when you're actually in the middle of a panic attack there'll be very little you can do but if you care about someone who has panic attacks I think there are a few important things to know one is talk to the person who has the panic attacks and talk to them in times of calm and ask them what they find helpful during a panic attack so some people find it helpful to be held other people don't want anyone anywhere near them so different people find different things helpful for me I always found that having eye contact with someone having someone gently reassuring me and talking to me would help me to stay grounded and help me work through the panic the other thing I needed so my panic attacks were related and that's true for many people being reminded during a panic attack that it's going to pass so our anxiety has gone up through the roof but our body can't stay up here for ages and it will begin to come down so knowing that it will pass having come onto someone kind of sit with us and reminding us look you feel right now like you're going to die but it is going to pass you've got through every panic attack up till now and the feeling will pass and the other thing is being reminded that I'm safe and again that's true for many people so often panic can be triggered by a whole variety of different things that might be a phobic response it might be a kind of trauma trigger but often the thing that's making us panic isn't anything to do with a danger that is present right here, right now but it's about a danger that's happened in the past or something that isn't actually it's a perceived danger but isn't actually going to do us harm so being reminded that we are safe can again also be really helpful but yeah, key thing here is to try and think in times of calm about how to manage those times of panic and anxiety and then yeah also the kind of the journaling and trying to understand what the triggers are and also noting what's worked well so you can try and do that again and then a really nice comment thank you Pukie, love your work especially your recent vlog oh and we wanted to a collaborative video yeah for sure, drop me a line about that so I'm relatively easy to find my name's a bit of a Google work but if you drop me an email I'm always happy to collaborate with people yeah on various different things really keen to work with as many different people as possible as long as we have yeah similar aims in mind so promoting well-being and yeah making the world a little bit better for children and adolescents with mental health issues yeah I'm happy to collaborate okay final question on my list unless anyone has any more to send through was about how can you tell if a kid is just on a diet and how can you tell when it's something you should be worried about when we're going into the realms of eating disorder I have very very kind of broad rules of thumb here so one is if you didn't know about the diet and you can substitute here you know self harm or whatever behaviour it might be if you didn't know about that particular behaviour would you be otherwise worried about this person so if you're worried about is this a diet or is it an eating disorder if you just lose the diet for a moment would you be otherwise worried do they seem you know have their behaviour changed do they seem withdrawn do they seem so they seem down you know are there other are there other signs there that something might be wrong so if you remove this specific behaviour would you be otherwise worried next one is is this someone who is driving their behaviour or is the behaviour driving them so essentially has it become an obsession and this can be exercises often a question here is this young person healthily exercising or is this become an obsession if they are unable to ever kind of take any time away from it then that's a problem so the diet versus eating disorder question okay if someone is on a diet and they never ever take a break from it so it's someone's birthday and they don't even you know they won't wouldn't even kind of entertain the idea of eating a slice of cake potentially an issue if it's exercise and they're going on holiday and their first question is going to be right how am I going to get my gym you know is there a gym there so can I get my exercise in every day or how else might I get that in then again that might be an issue okay so some people can't eat cake yeah true I'm also gluten intolerant which doesn't help so but you kind of get the gist I guess is that you're if someone is unable to make any exceptions to this behaviour then that's when we know that there is an issue there the other thing is that this person especially with the diet versus eating disorder so dieting is something that you know many many people do and most people kind of take it and leave it and they are not kind of so perfectionist about it someone with an eating disorder will often be very very driven to to diet in the kind of you know they'll be very perfectionist about it they won't take a day off from it they will probably be doing it to more extremes than other people so yeah so those are the things we're saying so if you took away the behaviour would you be always worried about that person can they take a break from it and are they being really kind of perfectionist about it and if they're kind of yeah doing it to more extremes then we would be more concerned someone made a comment there saying about the links between diet and mental health more broadly and that's true so so that was the question about how can you tell the difference between eating disorder and diet but yeah just just briefly more broadly so A, a good healthy varied diet is one of the kind of key underpinnings to good physical health and good physical health underpins good mental health and there's kind of two way links here between good sleep good diet and getting exercise and we kind of see two way links there between the mental health and the physical health there so A it's a meaning if our physical health isn't good that can have a negative impact on our mental health but equally poor mental health can make it harder to have good diet, good exercise and good sleep losing my words now but then the other thing is that diet can also be indicative of other issues not just an eating disorder so when we see changes in diet if someone is eating significantly more or significantly less than they used to it might not be related to an eating disorder it can be for example a symptom of depression so depression will often have a big impact on our sleep and a big impact on our diet makes us eat more or less than we used to and yeah it might not be linked to eating disorder thoughts and feelings okay very last question now because I struggling to find my words and also feeling a little bit rough but yeah so the last question was um it's just completely gone, I saw it there had a really good question come in it's completely gone from my head what was it sorry whoever sent the question if you send it one more time I will answer it in which case I will love and leave you hopefully helpful, what I'll do for future ones is I will again I'll let you know when I'm going to go live this time I did it just on the spur of the moment kind of because I wanted to test out the tech and I didn't want loads and loads of people watching in but if you find this opportunity to kind of interact and ask questions helpful and I will make the timings available ahead we could also look at doing specific topics um if you want to do that so let me know what you'd find helpful by either tweeting me if you're watching on Twitter or leaving a comment on the video if you're watching on YouTube and yeah and the other thing I will do as well is as like today is to take some questions in advance so if you've got a question then do let me know thanks ever so much for everyone who has watched some of you have stayed for the whole time which is quite incredible and yeah thanks for bearing with me while I kind of got the hang of the tech and stuff and yeah hopefully we'll do this again and yeah see you all soon hopefully so thank you signing off now bye bye thank you yeah watch me now figure out the tech