Interview with a health journalist...

I spoke to freelance health journalist and author Natalie Blenford about health journalism in women's national magazines.

What publications have you written health stories for?
Zest, Top Sante, Cosmopolitan, CosmoGIRL!, Bliss, Scarlet

Why are health/fitness stories important to journalism?
The NHS/COI publishes flyers and posters about hot health issues of the day, such as giving up smoking and the importance of eating a low-fat diet (which is currently being advertised all over bus shelters) and GPs should be the first port of call for anyone in need of personalised, professional advice. But journalists can help educate the public about thousands of different health issues, in a range of accessible, non-preachy ways, simply by writing about them in a style and format that is original and interesting.

A first person feature about a woman who survived breast cancer, for example, might encourage readers to self-examine their own breasts regularly and lead to them making healthy lifestyle choices. The impact comes from the detailed, honest and accurate nature of the stories being told – they have much more punch than a flyer you can pick up at your local doctor’s surgery.

Can you give an example of a health feature you have written which has had an impact on you?
I wrote a feature for Cosmopolitan in 2006 headlined “How Normal Are Your Breasts?”. The feature showed the bare breasts of 15 Cosmo readers, all of whom had different sized/shaped breasts from AA cup to E. Working on this feature made me realise there really is no such thing as a normal pair of breasts – everyone is unique, and hence everyone in normal. The feature caused a massive reaction in Cosmo’s readership – the magazine received lots of letters of thanks from readers who now feel happy with themselves, and this was a very gratifying and useful thing to happen.

I was also very moved by the story I wrote for April Cosmopolitan 2009, of Whitney Cerak, a 21-year old student who survived a car-crash and 5 weeks in a coma before waking up to discover she had been the victim of a case of mistaken identity, and her parents thought she had died in the accident. This is billed as a “real-life” story rather than a health feature, but the medical detail heavily influenced the story and her recovery has been miraculous from a health perspective.

How hard is it to work as a freelance in the area of covering health/fitness/beauty?
Not too hard (although as a side point, actually it’s harder now than ever due to budgets being tightened). It takes a while to get established as a trustworthy, accurate writer and it takes time to work out the best methods for finding health stories, case studies and feature ideas that editors want. But actually there are people out there who can help you. All beauty brands, all charitable foundations and all consumer companies such as gym chains have press officers or PR companies who can help you source cast studies or products, and once these people know who you are, they will help you get your job done.

The hardest thing about freelancing (in general) is establishing a daily routine that works for both yourself and your editors; managing your cash-flow, and finding ways to say “yes” to more changes when it’s appropriate, and “no, sorry”, when you are convinced the job is 100% finished but an editor thinks otherwise. You also have to be very self-motivated, organized and an excellent communicator who can talk to all types of people, from pushy PRs to people who’ve survived seriously harrowing experiences. Often you don’t meet case studies face to face, so you need to be good on the phone and able to strike up a rapport with an interviewee, in seconds.

Have you got any tips for aspiring health journalists who want to work in magazines?
Firstly, know your market: there’s a difference between health journalism in Cosmo, let’s say, and Zest. One is a general interest women’s mag; the other is a specialist magazine for people who take an active, daily interest in health and fitness. Consequently, the same ideas won’t necessarily work for both magazines.

It’s vital to know who you are applying to before you write off asking for work experience or freelance work. There’s nothing worse than general letters, and avoid writing clichéd sentences like “I’m passionate about health journalism because I think it can change lives” – it might be true, but it will probably sound simple in a letter or email. Instead, communicate exactly what you can offer the publication in question. Do you know lots of 20-something girls who are keen to be case studies in their magazine? Have you got a good contact in a PR company, who can hook you up with some new facts/stats that would be the basis of a health news story? Are you a first-time marathon runner willing to keep a journal of your progress as you train for this year’s London marathon? Everyone has something unique to offer, and magazines thrive on ideas and creativity, so channel lots of this into any letters you send off.

Also, start interviewing people and writing these interviews up – publish them on a blog, and paste the link to the bottom of your email signature. Show editors that you are doing everything you can to get started, and hopefully they will reward you with a commission in the end. And keep working at it – these things don’t happen overnight and tenacity is required if you want to get into magazine journalism in the middle of what’s looking like a rather nasty recession.

Natalie is the author of "Dance Your Way to Fitness" published in 2007 by Collins & Brown in association with Zest Magazine.

Evil weed

I am currently working on a feature about the health risks of cannabis smoking to young people.

We have all heard by now of the risks to mental health associated with the drug. The Government's new FRANK campaign, which coincides with the reclassification of the drug from Class C to Class B, has focussed on psychological risks, such as panic attacks, paranoia and depression .

Although it is an effective campaign, they have overlooked the physical effects smoking cannabis can have on young people's health.

As part of my research for the feature, I have interview the British Lung Foundation, National Treatment Agency, a leading consultant physician in respiratory medicine, Dr Onn Min Kon and the chief executive of the charity Drugscope.

Research has found that smoking a few joints a night could do as much damages to you lungs as a 20-a-day cigarette habit. And these negative health effects are being seen in people much younger than we would expect to present with lung cancer, bronchitis and other respiratory problems. The drug has also been linked with early onset of a particular type of testicular cancer in young males.

My feeling is that the reclassification will do little if not nothing to reduce usage in young people -stats even show that when the reclassification was lowered to C previously, usage decreased slightly. Though there is still more research to be done, the physical damage caused by a nation of under 25s who are experimenting with cannabis, could be a potential timebomb for the health service. As they say...where there's smoke, there's fire.

He's just not that into you...

New research, conducted by the Time to Change campaign, has found that a partner is four time more likely to leave you because of a mental health condition like depression than because of a physical disability.

Attitudes to severe mental illnesses like schizophrenia are even worse. The survey, which asked people about issues that would make them break off a romantic relationship found that 20 per cent of British women wouldn’t stay with someone if they were diagnosed with schizophrenia, yet only per cent of them would break up with someone who became disabled and needed to use a wheelchair.

Dave Stocks, who had a breakdown and gets depression, says: “I think people do feel awkward when they know you have a mental, rather than physical illness. They’re embarrassed, don’t know what to say to you. Some of my mates reacted like that. But Jools, my girlfriend, she’s been great. We’ve been through some tough times together, but even in my darkest days she stood by me. It can be hard though – I told her it might be easier for her if she didn’t tell her friends about my problems, just to make life easier. We both know that mental health conditions are stigmatised, but it hasn’t stopped us. Being able to be open about it has actually helped my recovery. We’re strong and happier now than ever, having been through this together”

Stuart Baker Brown, who has been diagnosed with schizophrenia says: “I have been well for a few years now and made a good recovery, but the stigma attached to having a schizophrenia diagnosis still follows me around. Dating can be hard at the best of times, but it can be even harder when you’re facing outdated attitutdes about mental health conditions. I met one woman, and everything was going well, we planned to meet up for a date. Then she found out about my diagnosis before I had a chance to tell her and that was it – she just didn’t turn up. I later discovered she was worried about her children. She’d assumed I might be dangerous. She was wrong, the idea that someone is going to be a danger just because they have had schizophrenia is a myth. It was really hurtful. I’ve met somebody new now, and she sees the real me, not just the label. Thankfully some people can see through the stigma and see the person”.

Time to Change is England’s most ambitious programme to end the discrimination faced by people with mental health problems, and improve the nation’s wellbeing. Led by Rethink, Mind and Mental Health Media and backed up with £16m from the Big Lottery Fund and £2m from Comic Relief. The campaign has a string of celebrity supporters, such as Alastair Campbell, Stephen Fry, Ruby Wax and Patsy Palmer – all of whom have experienced mental health problems. It also has the backing of Gordon Brown, David Cameron and Nick Clegg.

Cash for recession depression

The Government has allocated an extra £13m to therapy services for people who are suffering from depression because of the impact of the recession on their lives.

The mental health charity Mind welcomed the extra funding and said there had never been a more important time to invest.

Mind's Chief executive Paul Farmer told BBC News: "Redundancy and money worries put strain on family relationships, cause sleepless nights, trigger stress and increase the risk of developing depression.

"When it comes to the scale of the current recession we are in uncharted territory about how many people could be affected.

"We must learn from the mistakes of past recessions where people lost their job, their confidence and their self esteem leaving them unable to return to the workforce."

Paul Corry, from the mental health charity Rethink, said: "One in four of us is going to experience a mental health problem at some point in our lives.

"We know from history that recessions, depressions and economic troubles bring on mental health problems in people."

Shadow Health Secretary Andrew Lansley said: "We welcome this announcement, not least because we called for these measures to be introduced last year.

"Yet again we see that where the Conservatives lead, the government follows."

I wouldn't go as far as agreeing with the Tories, but I do agree that this is a positive move - I recently wrote a feature about the increase in mental health problems that have been a consequence of the credit crunch, and I am glad that this is being acknowledged by the Government.

A cotton bud emergency

As a lot of my recent posts have been about rather serious issues, here is a lighter story, from one of my favourite health-related blogs, Nee Naw.

The blog is written by a London Ambulance Service worker, who deals with incoming emergency calls at the Emergency Operations Centre (or Nee Naw Control, as she calls it).

The most recent post is about a young man who called an ambulance because he had a cottonbud stuck in his ear. You can't make this stuff up.

Dignity in dying?

For several reasons, the issue of assisted dying has cropped up in my working life this week. And it's a subject that I am still chewing over, and finding remarkably difficult to digest.

I work for a Labour MP, who has received a number of requests to sign an Early Day Motion which calls for a debate on the law on assisted dying and assisted.

I think for both my boss, and me on a personal level outside of work, it's hard to make a snap judgement about what changes do need to be made to the law, if any. The Coroners and Justice Bill is currently going through Parliament, and with it comes the opportunity to MPs to: "Modernise the law on assisting suicide to help increase public understanding and reassure people that it applies as much on the internet as it does off-line."

The issue has been in the news this week because of British couple's decision to go to Switzerland to die. Peter and Penelope Duff, who both had terminal cancer, travelled to a Dignitas clinic Switzerland last week to die together.

Mr Duff, 80, a retired wine consultant, and his 70-year-old wife are believed to have been helped to end their lives last Friday with an overdose of barbiturates. They are the first Britons to die at the clinic since the Lord Chief Justice signalled that anyone helping a terminally ill person to organise an assisted suicide abroad would not be prosecuted.

Sarah Wootton, Chief Executive of the UK charity Dignity in Dying said this week:

"This is an extremely sad case of two more terminally ill UK citizens being forced to travel to an unfamiliar country to die. It demonstrates, yet again, that we are currently on a slippery slope which forces people to make difficult and often desperate decisions so that they can take control of the time and manner of their deaths.

"Dignity in Dying campaigns for terminally ill, mentally competent adults to have the choice of an assisted death, subject to strict legal safeguards. Mr and Mrs Duff were both terminally ill and therefore may have been eligible for an assisted death under this sort of legislation. Had they had the option of an assisted death in this country they may still be alive, as their physical ability to travel would not have been a factor.

"It is time for Parliament to fully debate this issue, and there is that opportunity now. The Coroners and Justice Bill is being debated in Parliament at the moment, and within this Bill is the opportunity to modernise the 1961 Suicide Act. Parliament currently has no plans to change the scope of the Suicide Act to allow assisted dying, but surely this case highlights the importance of addressing this issue with urgency to prevent any more people from having to take the decision to travel abroad to die."

Dignity in Dying say that 80% of the British public (ie voters) support a change in the law on assisted dying for terminally ill, mentally competent adults.

There are some complicated issues to consider with this. For example, in terms of modern medicine and healthcare systems, how do we define who is 'terminally ill' and who is not? People can, fortunately, live many years with illnesses such as cancer, AIDS, and various degenerative diseases. We have the technology to give them a far better quality of life than they would have had a decade or so ago.

There is also the issue of identifying the 'mental competence' deemed to be necessary to make the decision to be assisted in ending your life. By the time a person with a terminal illness has degenerated to a level where they would consider ending their life, in many cases their mental competence has degenerated along with their physical health, and again it is questionable of whether they can be left to make such a decision.

This issue poses a challenge for the current Government and future ones, as it is nigh on impossible to consider the issue without brining your own personal feelings and experiences along with you. But if the Government can't make decisions on this who can? It is too risky and area not to be regulated by legislation - it poses too much of a risk to the people and families involved to just leave it up to personal choice in each case. And I think it is too much to ask the family members to have to be put in the position of making such decisions. And so, the debate will rumble on...I hope that whatever changes are made to the law, they still convey what is really meant by having dignity at the end of your life.

Work and mental health

As the recession deepens in Britain, a huge rise in the number of people with mental health conditions has been predicted. Stigma and lack of support in the workplace means people are losing jobs or being refused work at the time when they need them most, and recent Government welfare reforms could complicate things further for those in mental distress. Gemma Pritchard reports.

“The mentally ill are an easy target. Despite the fact 1 in 4 people have a mental health condition, only sufferers and their families understand what it’s like, because you can’t see their symptoms or their distress.”

“The Great British public get whipped up into a frenzy about the idea of people unfairly claiming money from the state, which means people with mental health problems become a target – we are classed as workshy and useless. Our illnesses may not be visible at all or take socially unpleasant forms, so we end up being doubly ostracised. There is a huge amount of hostility.

“The paradox is that people with mental health conditions do want to work, but often people won’t employ them, which says a great deal about the insecurity of employers,” says Chris Danes, 47, from Essex.

Chris has Bipolar Disorder (Manic Depression). His condition has meant that 11 years ago he was forced to leave a successful career in teaching as a Deputy Head of a public school, after a serious episode of the illness. Chris is one of millions of people in the UK who have found that a mental health condition has become a massive barrier to their employability and career. Chris has been able to continue to earn a living by writing books from home and doing some media work about his experiences. But Government research shows others are less fortunate, and many people in the UK with psychological problems fall into a benefit trap which is then very difficult for them to get out of.

At the end of last year, the Government announced a package of welfare reforms intended to get people on benefits back in to work. This includes the introduction of the Work Capability Assessment which will push people on benefits onto Jobseeker’s Allowance, placing emphasis on the responsibility of the individual to find work. But a growing body of evidence suggests that employers are not willing to take on people who have experience of a mental health condition, and they are failing to provide staff with adequate mental health support.

As the recession deepens, this problem can only get worse, with unemployment currently around the 2 million mark, and increased anxiety amongst employees about their future. The Conservative party predicted in November that we will see a massive 26 per cent increase in the number of people experiencing mental health problems by 2010 as a direct result of the economic crisis in Britain. And for people already struggling with mental distress, debt will only make their problems worse.

A poll by mental health charity Mind found that 58% of people had to leave a job because of lack mental health support, 31% had been sacked or forced out of a job after disclosing a mental health problem and 26% had been demoted after disclosing a mental health problem. Even more worryingly, 1 in 4 had job offers withdrawn after disclosing a mental health problem, which is illegal under the Disability Discrimination Act. Yet they found themselves powerless to do anything about it.

Over 200,000 people with mental illnesses move from work onto benefits each year. Although one review has found 9 out of 10 people with mental distress still want to work, Government research has shown that less than 4 in 10 employers would be willing to take them on.

Chris has experienced first-hand the gung-ho attitude of employers who are unwilling to accept a mental health condition as a legitimate reason for sick leave.

“When I was ill and off work for six months,” he says, “no-one from the school visited or came for a meeting with me. My ex-wife, herself a doctor, was bombarded with phone calls from my fellow deputy saying ‘he’s just got to get back’. As in many boys’ schools of its time, it was ‘sink or swim’ for the boys and the staff. Thus medical evidence and doctors’ opinions were overridden. I was made to feel that it was a moral failure.”

The major mental health charities in the UK, which include MIND, Rethink and the Sainsbury Centre, have battled workplace discrimination for many years. Julia Lamb, spokesperson for MIND says: “There remains a long-term stigma and discrimination around people with mental health issues.

“In the workplace, this can translate as anything from problems applying for jobs in the first place, being turned away from jobs, and even cases where people who have been made a job offer disclose a diagnosis and then have the offer withdrawn. There are off course long-term problems too, such as if they get the right support when they are in a job. It can be a massive barrier.

“Of course, there are people who are lucky enough to have employers who are willing to make adjustments to help them and take their needs in to account, for example if someone is taking medication which makes them slow in the morning, an employer could say they can start work a bit later.

“Generally though, there is a lack of awareness in the workplace about mental distress and people don’t get the support they need. This can put a lot of stress on people, and they may have to take time off sick from work. The problem is the longer they are away from work, the harder it is for them to return and get back into it, because they lose their confidence. There are also incidents where people have been off sick for so long that they get sacked.”

MIND are supportive of the Government’s ‘fit note’ scheme, but remain cautious of how it should be implemented. The idea is that instead of ‘sick notes’ people will be assessed for ‘fit notes’, where their doctor will liase with their employer to tell them what they are capable of doing at work. This should raise retentions rates, with people working at a reduced capacity until they are well enough. The idea has caused a lot of noise and even outrage, but MIND say they are for anything that supports people who want to remain in employment.

“It is more complex than that though,” says Julia. “In some cases, it might have been their job which caused the problem in the first place. There are also concerns over whether GPs will have the ability to say what people are capable of- mental health problems aren’t as tangible as physical health conditions – someone may be physically capable of working a 40 hour week, but psychologically can’t cope with the stress. GPs aren’t psychologists or occupational health experts, and for this to work they will need a lot of training and a great deal of sensitivity when making their assessments.”

Dr Jed Boardman, from the Royal College of Psychiatrists adds: “The Welfare Reform Bill is seemingly designed to combat the workshy, currently in the unreformed benefits system.

But it encompasses a large number of people with a range of mental health problems, many of whom want to work and with the right kind of support could be helped in to work.

“It is crucial that the systems to support people in to work are fair, adequately resourced, and based on evidence of what works for people with mental health problems. As psychiatrists, a key role of ours is to help in the recovery of people with mental health problems and help break down the barriers to social discrimination.”

The Government at present remain optimistic about the benefits of the new welfare reforms and argue that we are in a good position to provide people with the support they need, both in and out of the workplace. Public Health Minister, Phil Hope MP, says: “We are building stronger links between the NHS and employment services, to give people integrated support if their depression is linked to unemployment.

“Our programme for expanding psychological therapies has set up 35 new services in 35 PCTs this year and training more than 1,100 people to deliver cognitive behavioural therapy. More services will come on stream over the next two years.

“We are also piloting Employment Advisors in 12 of the 35 new talking therapy services. This will test whether integrated services like this can help prevent people losing their jobs and help people return to work as soon as possible.”

Despite this, there is no question amongst mental health professionals that these new reforms will provide significant challenges for them and their medical colleagues.

Professor Sally Hardy, Head of Mental Health & Learning Disabilities at City University says: “Mental health care professionals, working from a recovery approach, aim to support and enable survivors to regain their sense of self worth and their place in the world, but at a level that feels right for each individual. Using such a person-centred approach can work well alongside the ‘Fit Note’ scheme, as long as it is focusing on what people can achieve rather than on what they cannot offer.

“However, training GP’s to work with people to identify their strengths is a new technique for the consulting rooms that will take more time than many GP’s are able to offer. Many people experience their GP as hardly someone they can collaborate with and share knowledge, but rather as a one-sided diagnostic procedure. The new fitness scheme will certainly take some getting used to, but if implemented with adequate resources could prove beneficial to mental health care sufferers and survivors seeking employment opportunities, as they offer some valuable insights into what it means to be vulnerable and human in a tough world.”