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ss triple helix - spring 2023,  'I'm fine...'

'I'm fine...'

honesty about mental illness
  • The author reflects on how various life experiences, professional encounters, and traumas have shaped her resilience through God's grace.
  • The NHS can often be a very unsupportive environment, and faith and medical training on their own are no guarantee that we can survive working there.
  • Finding supportive networks and communities (professional and spiritual) and developing emotional intelligence and self-awareness are vital for our wellbeing.

Rachael Pickering looks back on a mental health journey.

It's a formative memory: I returned from school to find a relative sitting in the dark, still in their dressing gown, crying their heart out. Toddling through to the kitchen, I asked another family member, 'What's wrong?' Her reply was puzzling: 'Oh, nothing, darling. They're absolutely fine!' Hmm. Someone wasn't telling the truth. Why was that?


Growing up, I was shy, but I did like to observe my peers. A numerically-challenged girl would binge eat in the school toilets after every maths class and an awkward kid at church pulled out their eyelashes during youth meetings. Yet curiously, whenever I asked if they were okay, I'd hear 'I'm fine' and the like. Clearly I found, we humans tend to hide our true selves from each other. But there's neither need nor point in hiding from God. Rather, there is every reason to be open and honest with him.

You have searched me, Lord, and you know me. You know when I sit and when I rise; you perceive my thoughts from afar. You discern my going out and my lying down; you are familiar with all my ways. (Psalm 139:1-3)


It was during my undergraduate years that mental illness became personal. After marrying Mark, who now leads our CMF family, I fell pregnant - finding out only when I started to miscarry. Reactive depression kicked in. As a result, I had to rearrange my elective, staying home for a placement in liaison psychiatry. Unexpectedly, I loved it! It is a medical acknowledgement of what Christians know to be true. We are more than our physical bodies. We are mind, body, and soul.

I've generally been well since then, save for a few crises. I was slow to recover from occupationally-acquired pneumonia. An accidentally diagnosed cancer necessitated major surgery. An overseas coup-countercoup head injury pummelled my Broca's area; I regressed to high school French and please forgive me if I call you by the wrong name. And yes, I've joined the ranks of those living with long Covid; the brain fog and depression have been grim, but I'm turning the corner.

The human spirit can endure in sickness, but a crushed spirit who can bear? (Proverbs 18:14)


After medical school and a brief spell of surgical training, I migrated to GP Land. A registrar year in an affluent practice helped me learn that financial security does not necessarily go hand-in-glove with wellness. And a spell as a London locum opened my eyes to the sheer scale of mental distress within our inner cities.

But pretty soon, I was recruited by the Metropolitan Police Service to work as a forensic physician, caring for detainees in London's custody suites. It was a baptism of fire! Day in, day out, I was dealing with extreme deliberate self-harm (DSH), highly distressed people detained for their own protection, and aggressive folk under the influence of multiple substances. To cap it all off, I also had to attend scenes of unexpected death, some more gruesome than others. Many of these people had (obviously or less obviously) died by suicide.

These days, I'm a prison GP. More than half of my consultations are overtly psychiatric, and most of the rest touch on mental distress. Psychosomatic and functional disorders abound. And using consultation model lingo, I take many physical entry tickets for consultations about emotional problems. [1]

The frequent attempt to conceal mental pain increases the burden: it is easier to say 'My tooth is aching' than to say 'My heart is broken'. [2]

And in my humanitarian work with detainees in poorer countries where mental illness is completely taboo, I find it the proverbial 'elephant in the cell'. Everyone ignores it even though it's taking up so much room!

It's 25 years and counting since I got my licence to wield a stethoscope. Mental distress has cropped up almost every day. It is to be expected in doctor-patient consultations. But worryingly, it's increasingly common within peer interactions. Many colleagues have burned out and left the NHS. Some are on slow burn and need a break. And tragically, a few - including people I knew from CMF - have taken their own lives.

Neither Christianity nor medical knowledge exempts us from the risk of mental illness. Even our Great Physician experienced extreme sadness, and he self-prescribed human companionship. And I'm so grateful to the colleagues who have walked alongside me and prayed with me during my struggles.

...[Jesus] plunged into an agonising sorrow. Then he said [to his disciples], 'This sorrow is crushing my life out. Stay here and keep vigil with me.' (Matthew 26:36-38, The Message)


In my private life, too, psychiatry came home to roost. Several friends and family members suffered. And most painfully for Mark and me, our only child was diagnosed as neurodiverse and then developed a mood disorder; I mourned for the idyllic future I'd envisaged for them.

There is a time for everything...a time to weep and a time to laugh, a time to mourn and a time to dance... (Ecclesiastes 3:1-4)


Too anxious to cope with high school, they needed me at home. With sadness, I gave up my job as a high-secure prison GP and tried to settle down to a life of caring and home-schooling. But surprisingly, this career sacrifice enabled me to embark on an amazing professional adventure! Suddenly uncoupled from school term timetables, I was able to take my child around the world. Together we explored my dormant calling to medical mission, which I'd first heard at a CMF student conference. And long story short, I co-founded and started to grow Integritas Healthcare, a Christian faith-inspired organisation with a heart for detainees. [3]

Carry each other's burdens, and in this way you will fulfil the law of Christ. (Galatians 6:2)

support I was pretty clueless at the start of my police career. I wasn't even clear about the difference between highly risky DSH and actual suicidality! Yes, the police had given me forensic training. But there was minimal emotional support and absolutely no additional psychiatric training.

A far better experience was the three years I spent with an all-female team of sexual offence examiners. Although we dealt 24/7 with child and adult victims of sexual assault, the police service did not provide emotional support for us. So, we formed our own support group, and our wonderful clinical lead was a true servant leader.

Now that I, your Lord and Teacher, have washed your feet, you also should wash one another's feet. I have set you an example that you should do as I have done for you. (John 13:14-15)


Some black clouds do indeed have silver linings. Looking back on the various trials of my life to date, I can now thank my Creator for using them to grow me, slowly but surely, into a more resilient creature. A couple of coats of emotional Teflon have armoured me up for work I would have been far too vulnerable to undertake as a younger GP. God prepares and equips each of us in a unique way.

Now may the God of peace...equip you with everything good for doing his will, and may he work in us what is pleasing to him... (Hebrews 13:20-21)


It's been my experience that many providers of NHS offender healthcare have decidedly inadequate psychological and educational support for their staff members. And whilst constructive criticism should inform positive change, seasoned staff with valid concerns have been shoved out into the cold. That said, after several spells of yelling myself hoarse in the 'Great NHS Wilderness', I've finally stumbled into a role within a dynamic, listening NHS Trust.

Wounds from a friend can be trusted, but an enemy multiplies kisses. (Proverbs 27:6)

Other changes are afoot too. I'm giving myself more breathing room. I'm more open about my own mental health. And at work, I'm trying to speak less and listen more. Less cleverness, more emotional intelligence is the order of the day.

The words of the reckless pierce like swords, but the tongue of the wise brings healing. (Proverbs 12:18)

And the NHS is in a dire need of emotional intelligence. Psychological First Aid courses may be all the rage, 4 but we don't need certificates to utilise emotional intelligence about the wellbeing of others and ourselves. And down on the shop floor, we CMF members are in a prime position to lead by example.

  • The author reflects on how various life experiences, professional encounters, and traumas have shaped her resilience through God's grace.
  • The NHS can often be a very unsupportive environment, and faith and medical training on their own are no guarantee that we can survive working there.
  • Finding supportive networks and communities (professional and spiritual) and developing emotional intelligence and self-awareness are vital for our wellbeing.
Accessed 23/02/23
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