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                                                            MANIC DEPRESSION FELLOWSHIP
                                                                       SELF-HELP GROUP

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    NEWSLETTER
              OCT - NOV 2005

 COMPLEMENTARY EDITION
Thanks again to Jonathan for setting the theme of this
edition and sending me in an article from his wife, Karen,
who is a holistic therapist. It‟s also our first ever
„advertising feature‟ as Karen invites us at the end to use
her services!
This has also given members the opportunity to share
other thought and experiences with complementary
therapies. We stress throughout that these treatments are
„complementary‟ in the sense of being an addition to your           Robert always felt a wave of serenity at the
usual treatment, not an alternative.                                very thought of having his feet massaged.
Thanks also to Dr Hunt on two counts. Firstly for cheering
us up no end by telling us in this edition that having bipolar
can also predispose us to other mental heath problems.
Secondly, I‟d like to thank him for stepping in to talk at the             TURNING POINT
last moment to our October meeting where he spoke about
„The Mental Health Act - Today and Tomorrow.‟                               FOR CARERS
We don‟t have a write-up for his talk here because I want          If you support an adult with a mental health
to devote the next newsletter to that subject as well as           problem in Cambridgeshire or Huntingdon you
rights, advocacy, representation, complaints and so on.            can get information, advocacy and support.
Finally, I feel duty bound to say something about the cuts                  Ring 0845 601 7881
to mental health services. To be honest, I‟m bored already
with the consultation and it hasn‟t even started yet. I have
no doubt it is an open process, but the financial cuts are
too profound to give much scope to distribute them very
differently to what is already proposed. Look at the PCT
website for a consultation document and timetable if you             Cambridge Independent
need to know more (or contact me for more detail).                     Advocacy Service
These are savage and unfair cuts that affect Cambridge
and some other cities disproportionately. The rationale for         Helps to defend and promote rights and
them emanates from Whitehall and the battle on that front            responsibilities. Call them for help in
has much more to win. If you haven‟t done so already, I                 negotiating with mental health
hope you will write to your MP (David Howarth for                                professionals.
Cambridge is fighting hard but getting only fudge from the
Dept of Health). Write to the newspaper, local or national.               Tel: 01223-218500
Write to the Dept of Health. The services are already
spread too thinly to lay back and watch them be cut further.
QUESTION THE DOCTOR                                                Some people use other drugs, for example amphetamines
                                                                   in a similar way to deal with feelings of depression.
People have sometimes asked whether having manic                   Amphetamines do make people feel high and cheerful but
depression means that you can‟t have another mental                depression is usually lurking on the come down from the
health problem as well. On their behalf I asked Dr Neil            drug. These are some of the reasons that misusing both
Hunt, Consultant Psychiatrist, about this and his reply is         legal and illegal substances are such common problems
below. As ever, Dr Hunt gives this advice in good faith but        for those with a bipolar disorder. The reason why smoking
if you have concerns about this issue it is best to consult        tobacco is also much more frequent is less clear, though
the doctor or psychiatrist who knows you best.                     there is clearly a strong smoking culture in psychiatric
                                                                   hospitals – for both staff and patients!
Dr Hunt replied: It seems unfair that because you have
one illness you are actually more likely to have another           Personality disorder is a more controversial area of
illness as well. For example if you have a heart attack you        comorbidity. There used to be a popular idea that those
also have a fair chance of having a stroke. This is also true      with manic depression were very likely to have an unusual
for manic depression, and the word used to describe this           personality - either a very up and down one “cyclothymic”
combining of illnesses is Comorbidity                              or rather obsessional - usually extra tidy, orderly and
                                                                   pernickity. The difficulty here is distinguishing personality
The two most common comorbidities that come with manic             from the illness itself. Many people find that they have
depression are anxiety and substance misuse. Most                  periods of mild depression or hypomania before their
people experience some anxiety and drink alcohol, but              illness really gets started. This would seem to me to be
when these become problems in their own right then they            part of the illness rather than their basic personality. Also
are seen as comorbidities.                                         obsessional symptoms are not uncommon as part of
                                                                   depression. However you certainly do come across both
Anxiety shows itself in many ways from an underlying
                                                                   of these personality types among those with manic
uneasiness and tension to panic attacks and phobias.
                                                                   depression, but you also see as wide a spectrum of other
Sometimes anxiety only appears when depression is
                                                                   personalities as you do in the rest of the population.
prominent and when the depression resolves then so does
the anxiety. However for others the anxiety can be a               Some people have such extreme personalities that they
problem in itself even when the manic depression is well           are sufficient to be a major problem for themselves and to
under control. Anxiety tends to lead people to restrict their      others. It is only when the problems reach a serious level
lives so that they avoid all the situations that seem to be        that it should be called a personality disorder.       The
associated with their fear. The problem is that the more           hallmark of this is that those with personality disorders
you try to hide away from the world the more frightening it        have       great difficulty in making and maintaining
becomes. It is only when you are able to face your fears           relationships.                                  /continues
that they will start to subside, but it can be very difficult to
reach this conclusion yourself and turn the tide of fear
back.
One of the best long term treatments for anxiety is through                             LIFELINE
cognitive and behaviour therapy, the aim of which is to
improve your ability to stay calm and to relax and to then            The Cambridge Mental Health Helpline
gradually face the situations and thoughts that provoke                 is available 7-11pm every day on:
your anxiety.      The most effective tablet treatments are
antidepressants but for those with manic depression this                 Call Freephone on: 0808 808 2121
can bring with it the risk of tipping you into mania. Drugs
such as Valium can be useful in the short term but have a
high risk of addiction.
Alcohol is very effective at reducing anxiety and this is one
of the reasons that Manic Depressives are very vulnerable
to drinking excessively. Unfortunately alcohol only works
well in the short term and then tends to make anxiety
                                                                                     LIFECRAFT
worse. One of the reasons for this is that once you get into
the habit of using alcohol to quell your anxiety you tend to         Mental health information service is open
lose the mental ways of calming yourself down. When you                   from 12noon-5pm Mon – Fri
are addicted to alcohol the withdrawal symptoms when you
have not had a drink for a day usually include feeling very
anxious. All this ends up in a vicious circle of increasing                      Tel: 01223-566957
alcohol and anxiety.
/continued. Borderline personality disorder is the              LOOK INTO MY EYES!
personality disorder that can be mistaken for bipolar
disorder. In fact some psychiatrists see it as one version of   Our Smartgroup had a brief thread about hypnosis and
bipolar disorder, or part of the „bipolar spectrum‟. The        depression. One member said: “I tried hypnosis to treat
features of this include instability of mood, though rather     my depression. It didn't work at all for me. I found the
than the persistent mood states of depression or mania          hypnotherapist was going in directions she thought were
there are usually very sudden swings often in response to       right (childhood experiences, sexual experiences), rather
events, particularly if things are going wrong. So they can     then listening to me. I think largely because of this, I didn't
be very excited and fun at a party but then dramatically        really trust her and probably never got properly
change to suicidal despair when they feel slighted by           hypnotised.”
someone. They find it very hard to soothe their emotions
and hate being on their own. They tend to get involved in       “Thinking about it, there were sessions (I got a whole of 10
very intense but short-lived relationships and often find       sessions) that I did feel better for a couple of days
themselves lonely and feeling hurt. You can see that most       afterwards. These were mainly when I did get completely
of these features can occur in bipolar disorder but it is the   relaxed and when I was open for the suggestions of feeling
enduring nature of the personality rather than problems         good, thinking positively, etc. that she made. What I found
being centred on periods of illness that is the difference.     was, that when I was very down, these suggestions didn't
To complicate things further most of those with borderline      seem to be able to win from the negative thinking I had.
personalities do also suffer from more persistent periods of    For me, the counselling I did about half a year later was a
depression and a few also have clear and persistent             much better remedy for my depression. I needed to get rid
episodes of mania.                                              of a lot of sadness and I did an immense amount of crying
                                                                during my counselling, which I couldn't do during the
You can see that the term „Comorbidity‟ is the psychiatrists    hypnosis sessions.”
defence to the incredible complexity of problems that we
face. However it is often useful to try to differentiate        GETTING TIED IN KNOTS
between the problems that are directly related to manic
depression and those, like alcoholism that need to              Jackie‟s experience with Yoga is: I've found yoga, though
recognised and tackled as problems in their own right.          not strictly a complementary therapy, to be very calming
                                                                and sometimes uplifting. If I feel down but managed to drag
                         ~~~~~~~                                myself there anyway. Unfortunately I've had to give it up
Grapefruit – a slight reprise                                   since having tendonitis in shoulder and hip. For this kind of
                                                                effect you need the serious kind of yoga, in the spiritual
It was delightful to hear from Alasdair, a former member        (though not necessarily religious) sense rather than the
from over ten years ago who now helps to run the Waltham        seriously-get-fit sense.
Forest group. Alasdair wrote:
                                                                GOING TO THE DOGS
“Glad to see Cambridge MDF booming. I have just been
reading one your recent newsletters and was amazed to           For one brief moment, I thought Nicky said it was „dogging‟
read that carbamazepine can react with grapefruit juice. I      that she found useful. Actually, it was dog rambling‟ about
have been on this for nearly 10 years now and remember          which she says: “We have a dog rambling group which our
that one of the warning signs that I am beginning to get        support workers run. I find this very therapeutic and it helps
high is the urge to heat whole grapefruits, peeling them        keep my mood stable, We have members that don‟t have
and eating the segments as though they were oranges.            dogs as well and we take it in turns to bring food for
This seemed a very specific sign unlike “being talkative" or    afterwards. We go on different walks all round the villages.
"missing sleep". Perhaps it helps to get carbamazepine out      Sometimes I feel like not going but, because we are all
of body quicker or perhaps it helps increase the blood level    such good friends, it‟s shame to miss out so its
and so increase its calming effect.                             encouraging.

I once asked one of the research psychiatrists at               AN ATOM OF MEDICINE HELPS…
Addenbrooke‟s why mental patients all smoked so heavily,
                                                                Linda found homeopathy useful, saying: “I have had a
he said it was because nicotine helped get psychiatric
                                                                homeopath since 1994. The practitioner that I had in Essex
drugs out of the body more quickly, but doctors did not
                                                                helped me get through my divorce and gave me Lithium in
want patients to know this. Presumably if a heavy smoker
                                                                homoeopathic potency. I take one tablet per week. It is
suddenly gives up there could be a problem if his correct
                                                                said to boost the effects of my usual Lithium dose
dose had been worked out based on how rapidly drugs
                                                                and counteract side effects.
stayed in his brain when he was smoking. If he gives up
smoking and continues with same prescription he could           I use homoeopathy for physical symptoms eg. arthritis, with
end up having too high a level.”                                good result.”
               „ADVERTISING FEATURE!‟                              swings. Reflexologists say that the bottom of your foot is
                                                                   covered with points that correspond to various body
COMPLEMENTARY THERAPY                                              systems and parts. Massaging these points, either by
                                                                   stroking them or applying pressure, releases tension and
Hi! My name is Karen I am married to Jonathan who                  blockages that prevent the flow of energy and stimulates
suffers with MD. I am a holistic therapist and have recently       the circulation of blood.
set up my own business - Eden Holistic Therapies. I first
became aware of the benefits of holistic or complementary          Indian Head massage is a massage of the head,
therapies such as massage and aromatherapy when I was              shoulders, upper arms, neck and face. The massage is
suffering from depression and anxiety myself. I found that         undertaken seated and fully clothed. It is excellent at
regular aromatherapy massage started to help lift my mood          relieving stress and tension. It can help anxiety, stress,
and my anxiety began to decrease. However, it was not              depression and insomnia. It is wonderfully relaxing
until Jonathan was in hospital and I realised that                 especially if you are not comfortable with taking your
massaging his hands or feet helped relax him and calm              clothes of.
him at a time when he was unwell and extremely stressed.
                                                                   These therapies are relatively safe and have few side
It was at this point that I decided to change my career and
                                                                   effects for most people. Complementary therapies can be
train in complementary therapies.
                                                                   helpful, however, some do require a level of commitment
The term “complementary therapy” is generally used to              and finding the right therapy can be time consuming and
indicate therapies which differ from orthodox western              costly as it is such a personal choice. In addition using
medicine, and which may be used to complement or                   complementary therapies can be expensive. The average
support traditional western medicine. Some therapies /             cost in Cambridge ranges from £28 - £45 per hour
therapists would also say it can sometimes replace
                                                                   There are many different complementary therapies
traditional medicine, however, I would strongly disagree
                                                                   available on the market. Therapists often advertise in the
that it can replace other treatments but is there to
                                                                   yellow pages, in health food shops and online. Always
complement them and work alongside traditional medicine.
                                                                   ensure that they are fully qualified and insured to treat you.
So I am not advocating that you stop your current
                                                                   You have a right to ask to see their qualifications and
medication, if you are on one.
                                                                   insurance. A good therapist will provide a consultation
The complementary therapies that I offer are                       prior to treatment and they may require a letter of
Aromatherapy, Reflexology, Swedish body massage and                clearance from your doctor.
Indian Head massage. Massage can reduce stress,
                                                                   If you would like to have a treatment with me you can call
tension, anxiety, insomnia and improve mood. Massage
                                                                   to make an appointment on 01223 211535 or 07739
can also help people to recognise tension at an early stage
                                                                   721955. I have a treatment room at my house and parking
and avoid it. Clinical field trials evaluating the efficiency of
                                                                   is available. The treatments cost £18 for half and hour and
massage on mental health have been carried out and
                                                                   £30 for an hours treatment, consultation is included in the
provide evidence that massage can help to reduce levels
                                                                   cost.
of anxiety, stress and depression. Massage methods are
                                                                                        ~~~~~~~~~~~~~
simple and an effective means of affecting the nervous
system and can be used to reduce side effects of                   TAI CHI
medications and in some cases has help to enable a                 Originally a martial art, Tai Chi involves a series of slow
reduction in the dosage of medication.                             physical movements with breath and mind control. It
An aromatherapy massage is one of the best ways you can            always looks very graceful and calming and also has a
treat yourself. It is pampering and nurturing, in addition to      spiritual side in Chinese philosophy. Like yoga, it‟s
very satisfying. Massage and aromatherapy go hand in               become very popular and there are many courses. You
hand in treating nervous system ailments such as                   will find details advertised in many health food shops and
depression. Some good uplifting essential oils include:            in the library.
Bergamot, Cypress, Lemongrass and Rosemary. Some
good soothing essential oils include: Chamomile,                   EXERCISE
Geranium, Jasmine, Lavender, Neroli, Rose, Patchouli,              Straightforward physical exercise is one of the best ways to
Sandalwood and Ylang Ylang. Please note that these oils            attack depression. You may remember the stories of
must not be applied directly to the skin. They can be used         Charles Dickens walking 20 miles a day when he was
in oil burners, a few drops can be added to a bath or they         depressed. No special equipment. No cost!
can be added to massage oil and rubbed into the skin.
                                                                   Cambridge City Council runs an attractive range of sports
Reflexology is a form of foot massage to treat the whole           activities for mental health service users at a low price. It
body. It can aid relaxation, relieve stress and restore            includes swimming, football, yoga and much more. To find
energy. It can help reduce the side effects of psychotropic        out details, ring Lucy Howe on 01223 457547.
medication and moderate the highs and low of mood
FINDING AND USING YOUR THERAPIST
As Karen says, there are numerous ways to find lists of
therapists. Don‟t be afraid to speak to several therapists
before you settle on one you want to treat you – and don‟t
be afraid to change if it doesn‟t feel right.
There‟s nothing to beat a recommendation from someone
else - so do ask around.
Find someone you feel at ease with. In many cases they
will be working in your personal space - and even in your
home sometimes - so make sure you get good „vibes‟ and
that you are happy to have them around.
                                                                        Make sure the therapist is someone with whom you
Most therapies are not regulated but some have a body                   feel fully at ease.
that sets training standards and certifies achievement of
that standard. For those therapies you might get on better
with accredited person and don‟t be afraid to ask to see the
certificate.                                                       MORE DOGGY DEEDS

Find out what the potential therapist knows about mental           Jackie says that the Pets-as-therapy idea works for us, too.
health and what s/he expects to be able to achieve through         “On a couple of occasions as an inpatient I've seen people
treating you. If it sounds too good to be true, it probably is.    bringing in dogs - just because they were visitors with
                                                                   dogs, or visitors bringing patients dogs to see them. The
If you invite the therapist into your home take the same           whole ward seemed to rise about four points on its
precautions as you would with any other stranger.                  collective mood chart! I dare say there were a few people
                                                                   who didn't like dogs but almost everybody (including half
We sometimes hear horror stories of therapists who say to          the nurses) were all over the animal thoroughly enjoying
patients after a few weeks “Now this treatment is beginning        the novelty and friendliness of the dog. After all, people on
to work for you, you might want to reduce your mental              psychiatric wards are very short on hugs etc.
health medication”. This is the time to show them door. It
sticks in the throat to say so, but the shrink you love to hate    DON’T GET MAD - GET EVEN (TEMPERED)
with 7yrs+ training might be a better judge of that than
someone with a correspondence course in nostril massage            I‟m never sure where to position Assertiveness Training in
from Wilburton Academy.                                            all of this. It‟s not a medical therapy so I‟ll include it here.
                                                                   Many people with mental health problems have a struggle
If it feels good, it probably is good. Some treatments can         when it comes to sorting out emotionally charged issues
harm, though. However „natural‟ their basis, some                  with other people. Assertiveness won‟t mean that you win
aromatherapy treatments and herbs can be detrimental. A            all of the arguments – but it will keep you cooler while you
particular herb to watch for is St John‟s Wort. Research           try.
shows it to be useful for depression but it can sometimes
provoke a high in folk like us. It also has funny interactions     Many further education centres offer courses and the gains
with some other treatments.„                                       can be surprisingly quick.
„Natural‟ doesn‟t mean safe or harmless. Belladonna,
arsenic, hemlock and cyanide are all „natural‟!                    SOOTHING THE SAVAGE BREAST

It‟s always best to let your psychiatrist and/or GP know           A number of people mention the power of music to adjust
what you are doing. If nothing else, they‟ll realise that your     the mood. Recent research confirms objectively the power
cataracts and nerve damage are because you went                    of music to reduce stress levels.
sunbathing or under the light box after taking the St John‟s
                                                                   The message that comes across is not to put on something
Wort!
                                                                   too quiet and slow when you are getting high. You brain
For all of this caution, you are allowed to enjoy it! After all,   will just get bored and ignore it. Something mid-paced and
you‟re paying. There is no doubt in my mind that properly          attractive will be more likely to attract the attention and
administered therapies and activities can give you a helpful       bring you back down a notch.
and worthwhile addition to your existing treatment.
                                                                   Bach has something for all moods for me and I love
In some cases such as yoga and Tai Chi there is the                orchestral songs for soprano by Mahler and Strauss. You
added appeal of a spiritual sense that can give an extra           might prefer something a few decades more recent!
dimension of inner settlement.
           Improving Social Recovery in Early Psychosis Research Project
People who have episodes of distressing or unusual experiences or beliefs often recover from the worst of these experiences,
but may continue to have difficulties in maintaining social contacts and activities or in returning to or taking up employment or
educational opportunities.

We think people can be helped to make a better social recovery by working with a therapist using a therapy called:

                                Social recovery oriented cognitive behaviour therapy (SRCBT).

The aims of SRCBT are: to carefully identify activities and occupations which are meaningful for the person; to understand any
barriers people may have to undertaking the activity the person wants to do; and to help people prepare for work or leisure
activities by practicing in safe and low stress environments. The study aims to see if working with a therapist helps to improve
social recovery and to reduce symptoms of hopelessness and anxiety if present. CBT tries to help you to understand what you
are experiencing and feeling, cope with it differently, and feel less worried when you are trying to do new things. SRCBT
involves weekly or fortnightly meetings with a therapist for up to nine months.

As it is a randomised control trail, you will have a 50/50 chance of receiving SRCBT or treatment as usual.

         We are approaching people who have had a first episode of psychosis or bipolar disorder within the last eight
         years, who are unemployed and not in full time education and are in relative remission of positive symptoms.

Please contact if you are interested or would like to discuss the project:
Carolyn Crane. Research Nurse. Department of Psychiatry, Box 189, Addenbrooke’s Hospital,
Cambridge, CB2 2QQ. (01223 767034)

                                          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

MEETING 12th SEPTEMBER 2005 – Research                               the benefits it had. Interviewing a service user who
                                                                     identifies with you being like them can often mean that you
It was good to have at our meeting, Iliana Rokkou, who is            get to the „real‟ issues that they might not tell professionals.
responsible for promoting research by service users and              That can mean that you identify better hand more
carers. Together with Jeannette from the group (and an               appropriate help.
experienced service user researcher), Iliana spoke of
opportunities to join in research activities. I feel particularly    There are opportunities all the time for both service users
pleased about this as it offers us an opportunity not just to        and carers to be involved and if, as I hope you will, some
„take‟ from mental health services but contribute ourselves          members of the group want to be involved, give your
– and thereby increase our own self-respect and feel we              details to Iliana Rokkou on 01480 398777 or by email to:
are making a difference. It can also help to develop new             iliana.rokkou@cambsmh.nhs.uk
skills. The intention is for researchers to be paid and
reimbursed expenses.
                                                                                             Lynda Smith
Service users and carers can contribute by identifying
areas for research (I somehow don‟t think the ethics                    It was sad to hear of Lynda‟s death on 16 th
committee will allow us to do drug trials, though!), by                 September at age 58 from injuries sustained a
ensuring research is appropriate and respectful to service
                                                                        few days earlier in a car accident.
users, by actually carrying out research and by helping to
interpret and identify findings.
                                                                        Lynda was a staunch supporter of the group
You don‟t need to be a boffin, as training will be given. The           and I particularly remember the lavish care she
intention is to use, understandable, accessible language                would put into our Christmas parties in her
                                                                        unique way.
Iliana gave us some examples where service users had
conducted one-to-one interviews, given mental health
professionals feedback about treatments and researched                  Our thoughts and best wishes go to her four
the long-term value of the MDF self-management course.                  grown up children and to those who were lucky
                                                                        to have her as a true friend.
Jeannette also gave examples of conducting research and
                                                                                     CAMBRIDGE

                                                     MANIC DEPRESSION FELLOWSHIP
                                                                                SELF-HELP GROUP


                               MAKE SURE YOU RETAIN THIS PAGE FOR REFERENCE

MEETINGS OCTOBER 2005 TO JANUARY 2006

There are links to maps on our website or just ask and I can send one.
---------------------------------------------------------------------------------------------------------------------------
Meetings at Hilltop, Primrose Street, Cambridge
We have small groups („punters‟ and carers in separate groups if attendance justifies). Hilltop car park is at the end
of Greens Road, down a little slope. Come for refreshments at 7.30pm for a 7.45pm start.

                                       November 28th, (No meeting December 26th), January 23rd
---------------------------------------------------------------------------------------------------------------------------
Meetings at St Matthew‟s Parish Hall, St Matthew‟s Road, Cambridge
There is usually a guest speaker or group discussion on a relevant topic. There is street parking around the area but
watch out for double yellows and residents‟ bays in some places. Come for refreshments and informal chat at
7.30pm for an 8pm start.

November 14th – Sarah Bye and Sandra Greatrex from RFET (formerly QEST) will discuss with us ways to access
employment, training, education and voluntary work.

December 12th – Carolyn Crane, Research Nurse, and Dorothy O'Connor, Therapist will tell us about the “Improving
Social Recovery” research project – and how we can participate.

January 9th 2006 – To be arranged

               CONTACTS                           Phil                       Jeannette                      Viv
              (A)=Ansaphone                   0845 434 9780                01223-563269                0845 434 9780
                  at times                         (A)                          (A)                         (A)
     Preferred times                     7pm-9pm weekdays              7pm-9.30pm weekdays         7pm-9pm weekdays
                                         10am-9pm weekends                                         10am-9pm weekends
     New Members                                       *
     Ring for a chat                                   *                            *                              * (Carers)
       Correspondence to: Phil Alsop, Secretary, 6 Beechwood Ave, Melbourn, Cambs SG8 6BH.
       E-mail: mdf(AT)mdfcambridge.org.uk               Website: www.mdfcambridge.org.uk


      We are a local group of the national MDF The Bipolar Organisation, Castle Works, 21 St George‟s Road, London SE1 6ES
      Tel: 08456 340 540. Fax 020 7793 2639. E-mail: mdf(AT)mdf.org.uk Registered Charity Number 293340

       ** STOP PRESS - STOP PRESS - STOP PRESS - STOP PRESS - STOP PRESS - STOP PRESS **
       Our e-mail circle for „punters‟ has been such a success that we are now opening a similar e-mail group for
       carers. Carers of an adult in Cambridgeshire with any mental health problem are invite to join in this friendly
       group to share information and support.
       To find our more, or to ask for an invitation, contact: cambscarers-owner@smartgroups.com

				
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