‘It Takes Balls to Talk’ founder Alex Cotton MBE on her career and mental health

Last Wednesday, honorary Warwick graduate Alex Cotton MBE – Hon Dsc spoke at the University on the importance of openness in tackling mental health issues, her experiences as an LGBTUA+ person, and how her career has been shaped by hard work and opportunities.  

The talk was part of the Inspiring Women’s Student Series, organised by Warwick Philosophy Careers and Skills. It was conducted in the Maths and Stats building. 

Cotton is a mental health nurse with the Coventry and Warwickshire NHS Trust. Through her experiences in this role she was inspired to found the ‘It Takes Balls to Talk’ movement, which focuses on dismantling harmful attitudes that prevent men from seeking support in times of mental instability. 

The campaign uses sport as a medium to challenge these attitudes, and initially served the Coventry and Warwickshire region alone. However, the successes of the campaign have led to likely expansions across the UK.

The talk began with a screening of a music video: Smalltown Boy by Bronski, which follows a young gay man, and concludes with a homophobic assault. Cotton explained that the video had resonated with her as a young person as she came to terms with her own sexuality. 

She claimed that although there was now more acceptance for the community, the “silent stigma of homophobia” is still an issue to this day. 

In this manner, Cotton used much of the talk to describe the story of her life, imparting wisdom in the process. She initially discussed her experiences of attending Pride marches, facing a homophobic attack, and the fear and eventual relief she felt when coming out to her friends and family, who were ultimately very supportive.  

When she eventually came out to her mother, she was met with unprecedented calmness she said, and claimed that when she asked her mother to tell her father, she simply replied: “I think he already knows”. This led to Cotton’s first “present of experience” of the talk, as she told her audience: “Don’t hold back on having difficult conversations”.  

Don’t hold back on having difficult conversations

– Alex Cotton MBE

She stated that she was “pursuing social change,” and that the university was “behind her” – noting the presence of Pride flags at the University, which she claimed demonstrate its status as an “open organisation”.

“We’re not there yet, but we have made great gains”, she said.

Cotton explained how her mother had been a significant inspiration, teaching her that everybody has the same hierarchy of physical and emotional needs, and promoting “respect for everyone”. 

Having described the course of her early life, Cotton described her earliest involvement with the NHS. She had learnt, she said, that the NHS was a “gay friendly” institution, which drew her to a role as the “non-sterile” staff member in operating theatres.  

After perspective-altering  experience, in which a woman having a Caesarean-section asked her to take her organ donor card in case the worst happened, the course of the rest of her career so far was shaped.

Talking to this patient, she realised that she was better suited to the mental health practice, explaining: “I don’t want to look at the bodies, I want to talk to talk to the people”. 

Having come to this realisation, Cotton moved from the south to Birmingham, and attempted to enroll as a student mental health nurse with the Queen Elizabeth College Hospital. She was initially rejected due to a rash on her hand caused by medical gloves, but her was given a place after she personally visited the course leader. 

Following this, Cotton’s university experience began. She accentuated the importance of finding “what makes you happy” at this time in life, arguing that it is the “best time to try new things.” She also discussed the benefits of finding out what “de-stresses you” as a way of maintaining good mental health – her own outlet being cooking. 

After finishing university, Cotton searched for her ideal career path. However, she faced some disappointment with early interviews, ultimately leading her to posit to the audience: “What’s not for you will pass you by,” stressing the importance of how to “get back up” in difficult circumstances. 

Eventually, Cotton was offered her current role as a community mental health nurse in Coventry and Warwickshire NHS Trust. In this role, she became interested in Cognitive Behavioural Therapy (CBT), which, according to her own description, is “about how you interpret things, teaching people to reframe their thoughts”. 

The community nursing role also led to collaborative work with the police. It was through this experience that she learnt that “75% of men who take their own lives have had no contact with mental health services.” Thus, whilst watching a Coventry City FC football game, she engendered the idea for the ‘It Takes Balls to Talk’ campaign. 

What’s not for you will pass you by

– Alex Cotton MBE

Her idea was supported by Mind, a prominent mental health charity, and the Royal College of Nursing (RCN) union. NHS management were initially sceptical of the idea, but Cotton’s efforts were unrelenting. She argued that “If it’s the right thing to do, do it anyway” regardless of whether others support you. 

She described how the basis of ‘It Takes Balls to Talk’ is not only encouraging men to talk, but also fostering an environment in which we “encourage people to listen”. A framework of “listening mates” is encouraged by the campaign, aiming to give everybody a friend or organisation who they can talk to when they are in need.

Cotton stated that her belief is that “it is not about what you say, it is about how you make them feel,” when dealing with people in need.

She explained her preferred techniques, including positive listening (demonstrating engagement with the patient’s feelings via non-verbal communication) and the ‘Ask Twice’ technique, which is founded on a belief that people will speak more openly on their feelings the second time of asking.

As her talk drew to a close, Alex Cotton discussed her wealth of accolades that she has amassed as a result of her campaign. As aforementioned, she has been awarded an Honorary Doctorate of Sciences by the University, on recommendation from Dr Paul Sutcliffe, who she will be continuing to work with. 

She was also named on the Queen’s Birthday Honours list and was awarded the honour of Member of the British Empire. When she was presented with her award by Prince William, the two discussed the possibility of making her campaign a national effort. 

She expressed her gratitude to the University, which she credited a key in the development of the campaign, and stated: “Warwick has given to me, I want to give back to Warwick”.