Making Mental Health “Visible”

By Gina Mohajer

This week, a gentleman on the radio said, “if you break your leg, you can’t walk. If you have a mental health problem, you can’t see it”. I thought this aptly summarised the problems we have with mental health in society and why, more than ever, we need to raise awareness and bring mental health to the forefront of government health policy.

Today, Friday 10^th October, is Mental Health Day and the theme is “Living with Schizophrenia”. It is estimated that around 26 million people worldwide suffer from schizophrenia. However, despite this being a treatable disorder, a staggering 50 percent of sufferers are not receiving the treatment they need, 90 percent of whom live in the developed world. Considering the huge advances in medicine and technology, the amount of money invested in the healthcare system, and our understanding of the detriments of poor mental health – this statistic is shocking and highlights that a great deal more needs to be done.

Today’s awareness raising is to ensure that those living with schizophrenia are no longer stigmatised or marginalised from society – which can augment their condition – but instead get the best possible care, as early as possible, and receive the support they need to manage their illness and help them on their journey to recovery. For more information about schizophrenia and to download the “Living with Schizophrenia” report click here.

Today is also a great opportunity to highlight the importance of mental health and wellbeing more generally and to ensure that although it may not be as “visible” as a physical condition, it is equally important and needs to be treated as thus. We all have a responsibility as individuals to listen and take care of our body and mind, as employers to create a workplace that is fair and where clear policies exists to prioritise staff wellbeing, as practitioners to ensure that patients receive the correct care and treatment and that the government continues to promote mental wellbeing through national guidelines.

One in four adults in Britain will experience a diagnosable mental health problem in any one year; this is a vast number of people and none of us our immune. However, it is essential that we understand that we can through education, self awareness and empowerment make a fundamental difference to improving and protecting not only our own mental health and wellbeing but also of those around us. Through concerted efforts, we have the ability to bring about real positive changes – a belief at the core of the Royal Society for Public Health.

For more information on mental health and training click here

For more information on mental health in the workplace click here

Happiness at Work

The key to tackling mental health problems?

The equation seems simple; a healthy workforce equates to a happy workforce which results in a more productive and successful organisation. This is good for society and the country’s economy. However in reality the picture is bleak, suggesting that this formulae is neither being understood nor utilised.

Unfortunately, poor mental health is not uncommon in today’s society. In Britain, one in four adults will experience a diagnosable mental health problem in any one year, despite the UK being one of the richest countries in the developed world. Whilst wealth does not necessarily lead to happiness, having a good standard of living, access to free healthcare, can certainly improve a society’s wellbeing. However, not so surprisingly, 80 percent of people with a mental health problem believe that their condition is associated to work related problems. Does this imply that employers do not understand the equation mentioned above? Or are they so intent on achieving their outcomes that they choose to ignore it, not realising that the long term affects of poor mental health can be catastrophic for society. 

With one in six working Britons experiencing a mental health issue at any one time, including depression, anxiety or stress - more needs to be done to address these unsettling statistics.

In the run up to Mental Health Awareness Week (12^th – 18^th May) two significant, and timely, documents have been published; a survey by Depression Alliance revealing that a third of people struggle to cope at work due to stress/exhaustion, and a report entitled “Depression in the Workplace in Europe: new insights from business leaders", which makes the argument that employers need to be more responsible for the wellbeing of their employees and the benefits this has on the country’s economy and society as a whole.

At any one time in Britain one worker in six will be experiencing depression, anxiety or problems relating to stress. Among people who describe their mental health as poor, 80% say this is at least in part a result of problems at work

The report, which was published at the end of April, suggests that mental health problems are the leading cause of disability worldwide, affecting 350 million people. More over, depression disproportionally affects adults of working ages and the financial impact on business and the economy is profound. Recent figures, from the London Schools of Economics and Political Science and King’s College London, shows that the annual cost of depression to European businesses is a staggering £77 billion. This is directly a result of lost productivity.

Presenteeism, as identified in the report, can be as detrimental to the organisation and the individual, as much as absenteeism, if not more. In the UK, it is believed that 1.5 times as much work is lost through presenteeism as absenteeism for mental health conditions. This can be attributed to two reasons; firstly, employees with depression also experience cognitive symptoms (difficulty concentrating, indecisiveness and forgetfulness) up to 94% of the time, hindering their performance in the workplace. Secondly, employees are reluctant to take time off work, even when they need to, due to fear of losing their job or demotion, which could compromise their finances. This therefore fuels their stress and can augment and prolong existing mental health conditions. 

In the UK it is argued that 1.5 times as much work is lost through presenteeism as absenteeism for mental health conditions

Time off work or reduced productivity at work can 

affect finances and push people into debt

Having a mental health problem can impact all aspects of our every day life including our relationships with family, friends and colleagues. The Depression Alliance survey which involved 1,200 people, found that 83 percent affected by a mental health problem at work also experienced isolation or loneliness. However, only half of those feeling depressed or lonely confided in a colleague, yet a large proportion who did, reported to have felt better.

Mental health problems can affect any of us, however, in spite of this, there is a widespread lack of awareness, especially in the workplace, of how to recognise the signs and support people. Colleagues and managers may not know how, or feel confident, in supporting someone with a mental health condition, and moreover may not be aware what, if any, the companies policy is on mental health. The report stated that the majority of workplaces (78% in the UK), do not have a formal mental health policy in place and would most likely benefit from reviewing how they deal with depression. Not surprisingly, many employees are reluctant to inform their managers if they know that they have a problem due to fear of facing prejudice or stigmatisation. This of course can escalate feelings of isolation.

Chief Executive of Depression Alliance, Emer O'Neill says, "Depression is the biggest mental health challenge among working-age people and often leads to considerable loneliness and isolation at work. However, many companies aren't properly equipped to manage employees who suffer from depression so providing support to these individuals in the workplace is essential”.

Who’s responsibility is it anyway?

We are all susceptible to experiencing a mental health problem. Research suggests that around 50 percent of our mental health can be attributed to our genetics and environment, but the remaining can be altered by our activities and steps we take in life to protect our mental health. With such a high percentage of mental health problems related to work (it is where we spend the majority of our adult life) more needs to done to protect the mental health and wellbeing of employees. Employers therefore should create a supportive environment that reduces the taboo around mental health, but also implement strategic health and wellbeing plans with the sole intention of protecting their workforce and providing managers and colleagues with the knowledge and tools to deal with mental health appropriately and effectively.   

The Royal Society for Public Health (RSPH) is a strong advocate of improving the health and mental wellbeing of the population, through the creation of health champions and workplace health and wellbeing champions. Our new national Level 2 Award in Mental Wellbeing qualification, seeks to equip people with practical skills they can incorporate in their every day lives to improve and protect mental health. When people have good mental health, they can lead more fulfilling lives, can solve problems and are more productive.

For more information, on the Mental Wellbeing qualification and how it can be adapted for your organisation, please contact Gina Mohajer gmohajer@rsph.org.uk.

Useful Links:

NHS Choices Helpline

http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/mental-health-helplines.aspx

Depression in the Workplace: A report featuring new insights from business leaders

http://targetdepressiondotcom.files.wordpress.com/2014/04/target-report_final.pdf

Mental Health Foundation

http://www.mentalhealth.org.uk/

Photo by Sina Bahrami

Mental Health Warning for Jobless Young

Yesterday news items reported that more than three quarters of a million young people believe they have nothing to live for, with jobless youngsters facing “devastating” symptoms of mental illness, warns a new report.

The Prince's Trust Macquarie Youth Index, reveals that long-term unemployed young people are more than twice as likely as their peers to have been prescribed anti-depressants. One in three (32 per cent) have contemplated suicide, while one in four (24 per cent) have self harmed.

The report which was based on interviews with 2,161 16 to 25 year olds highlights that 40 per cent of jobless young people have faced these symptoms of mental illness – including suicidal thoughts, feelings of self-loathing and panic attacks – as a direct result of unemployment.

Long-term unemployed young people are also more than twice as likely as their peers to believe they have nothing to live for. The Youth Index 2014 full report is downloadable here.

The Prince’s Trust is now calling for urgent support from government, health agencies and employers to fund its vital work with long-term unemployed young people battling mental health issues. With more support, the youth charity can help more young people build their self-esteem and move into work.

Martina Milburn, Chief Executive of youth charity The Prince’s Trust, said:

“Unemployment is proven to cause devastating, long-lasting mental health problems among young people. Thousands wake up every day believing that life isn’t worth living, after struggling for years in the dole queue.

“More than 430,000 young people are facing long-term unemployment, and it is these young people that urgently need our help. If we fail to act, there is a real danger that these young people will become hopeless, as well as jobless.”

The charity's sixth annual Youth Index, which gauges young people’s wellbeing across a range of areas from family life to physical health, highlights that unemployed young people are significantly less likely to ask for help if they are struggling to cope. Three quarters of long-term unemployed young people (72 per cent) do not have someone to confide in.

Shirley Cramer CBE, Chief Executive of the Royal Society for Public Health, said:

“This research proves that unemployment is a public health issue. It is one that must be tackled urgently and it is essential that youth unemployment is added to the public health agenda. Unemployed young people are struggling in many aspects of their lives, from their mental health and wellbeing to their relationships and their qualifications and we must act quickly to end this.”

In response to these findings, The Prince's Trust is increasing support for the UK's most vulnerable young people through its Get Started programme which aims to inspire and motivate the long-term unemployed.

This year, The Prince’s Trust will support 58,000 disadvantaged young people, helping them turn their lives around. Three in four young people supported by The Prince’s Trust move into work, education or training.

For more information about The Prince’s Trust visit www.princes-trust.org.uk/youthindex or follow The Trust on Facebook or Twitter www.facebook.com/princes-trust / www.twitter.com/princestrust

For more information please contact:

Sophie Rawlings on 020 7543 1284 / 07766 144488 or at sophie.rawlings@princes-trust.org.uk
Annabel Douthwaite on 020 7543 1318 / 07841 877181 or atannabel.douthwaite@princes-trust.org.uk

Can a stressful job be harmful to our health?

A certain amount of stress/pressure can “supposedly” be beneficial to us, by making us more productive. However, too much stress over a long period of time can have negative impacts on our health. A recent study from Spain sought to examine what these negative effects were and to what extent could stress increase the risk of developing cardiovascular diseases and coronary heart problems. 

The research was carried out by the insurance company Ibermutuamur, and two universities in Spain and the findings were published in the peer reviewed Scandinavian Journal of Public Health.

The purpose of the study was to determine whether a correlation exists between stress (from work) and abnormal levels of fat (lipids) in the blood. Worryingly, high levels of bad cholesterol known as LDL cholesterol – caused by fat in the blood - can block arteries which in turn may lead to coronary heart disease and other cardiovascular diseases.

Just over 90,000 people took part in the study which was conducted through questionnaires. Participants were asked questions relating to how they felt they coped in their job: “During the last year, have you frequently felt that you cannot cope with your usual job?". Participants who answered "yes" were considered to have job stress.

The questionnaire also included eleven questions relating to anxiety and depression symptoms, such as "Have you felt keyed up, on edge?" and "Have you had difficulty relaxing?” The researchers took fasting blood samples from participants measuring levels of total cholesterol, and then examined whether abnormal lipid levels were linked to job stress. The study did take into account age, sex, smoking, obesity, alcohol consumption and also type of job (blue or white collar occupation).

Results

Around 8,000 (9%) of participants are reported to have job stress; in addition these individuals also reported higher levels of anxiety and depression symptoms, and were found to have a 10% increase in abnormal lipid levels and higher levels of LDL cholesterol, than those who did not consider their job stressful.

Although these findings have been regarded as generally strong in understanding the relationship between stress and bad cholesterol, what the study did not take into account is that, individuals who suffer from stress or poor mental health, may indulge in high risk behaviour as a coping mechanism. This could increase their risk of developing higher levels of “bad” cholesterol as they may be more accustomed to unhealthier diets and/or consume higher levels of alcohol. Therefore, rather than the stress itself, these other “risky behaviours” may play a fundamental role in causing peoples “bad” cholesterol to rise.

Nonetheless, what this research highlights is that stress (too much of it) and poor mental health is detrimental for our wellbeing and for society as a whole. Whether it causes our cholesterol to rise or whether it causes us to indulge in health risk behaviour – the message remains clear that improving ones mental health should be paramount in order to tackle many of the other health related problems that exist in today’s society.

What can you do?

The RSPH believe that we all have a responsibility to ourselves and to others, to help prevent, protect and promote good mental health practices. As such a one day programme on Mental Health and Wellbeing has been developed, to provide people with practical skills and knowledge to understand the measures they can take to improve not only their own mental health, but also help the wider community. Click here to download the report on Mental Health in the New Public Health System and click here to find out more about our programme.   

The Seven Golden Rules for a Healthy Life

If we follow these simple steps, can we really reduce our risk of heart disease?

Cardiovascular disease (CVD) still remains the biggest killer in the UK.  In 2010, around 180,000 people died from CVD and 80,000 of these deaths were from coronary heart disease (CHD).  Although over the past decade, there has been a decline in death rates from heart disease in England, there still remains regional and socioeconomic differences in both incidence and case fatality, along with behaviour inequalities.

In 2010, the American Heart Association (AHA) proposed seven factors to help people understand the most effective ways of avoiding CVD and lowering the risk of developing cancer. 

The findings came from a long term study carried out by researchers from Northwestern University (Chicago), the University of Minnesota, and a number of other US research institutions; their findings were published in the peer-reviewed journal Circulation.  The cohort study followed 13,253 white and African American participants for between 17 and 19 years, to establish if maintaining ideal levels of the seven health factors could reduce heart disease and lower the risk of cancer. 

The Seven Simple Steps

• 1      Not smoking (never smoking or quitting more than 12 months ago
• 2      Maintaining a healthy body weight (that is a healthy Body Max Index (BMI)
• 3      Eating Healthily (diets rich in nutrition, fruits and vegetables)
• 4      Physical Activity (at least 75 minutes per week of vigorous physical activity, or 150 minutes per week of moderate or moderate plus vigorous activity
• 5      Having low cholesterol levels
• 6      Healthy blood sugar rates
• 7      Healthy blood pressure

The Findings

From the study, researchers found that the health benefits were higher among people who met the ideal levels for each of the seven factors.  For example, people who achieved ideal levels for six of more factors had a 51% reduced cancer risk and those who met the ideal levels of four factors had a 33% reduced rate of developing cancer.

While the findings have been welcomed, it is worth noting that smoking appeared responsible for the majority of the associations seen between the seven factors and cancer risk. This once again exemplifies how smoking has a direct correlation with your heart, blood pressure, circulation and individual risk of lung cancer.

What more can be done?

As highlighted above, CVD and CHD continues to be a major health concern in the UK, with health issues being more prevalent among low income earners. Those from lower socioeconomic groups are more likely to have poorer diets, lead sedentary lifestyles, suffer from mental health issues and partake in health risk behaviour, including smoking and alcohol abuse. These factors have a major impact on heart disease.

Type 2 diabetes and obesity are also some of the main contributors leading to CVD.  In England alone, a quarter of adults are obese and the prevalence of diabetes in the UK is around 5% for women and 6% for men.  The financial cost to society can also be detrimental.  The statistics reveal that in 2009, CVD cost the UK economy £19 billion – putting further strain on the health care system.

Although the AHA’s seven steps to improving health helps people to understand where to make the changes in their life (healthy eating, exercising), the problem is how to make these changes?  For most people, breaking old habits and changing behaviour can seem like an impossible task, and for some, change is not always welcomed. How do we engage with people and offer advice on sensitive issues that could potentially save their lives?

The RSPH, having recognised the fundamental importance of behaviour change to improve health, has developed a qualification in Understanding Behaviour Change, Level 2 Award, to provide an understanding of communication styles and practical skills to help individuals implement lifestyle changes. The one day programme will also aim to give learners knowledge and confidence to offer brief advice and engage in brief interventions.  Sometimes, having the right conversation with someone can have far reaching positive affects.   For further information on the qualification please click here or contact Gina Mohajer.

For further information on heart disease visit the British Heart Foundation here

International Women’s Day 2013

– Celebrating achievement and looking at what more can be done

Every year International Women’s Day is celebrated on the 8^th March. This monumental day seeks to highlight the extent to which equal rights of women have progressed, as well as emphasising the economic, political and social achievements women have and continue to make.

Each year there is a thought provoking theme, to not only celebrate achievements, but to also raise awareness of the issues and discrimination women still experience in the 21st Century. This year the United Nations (UN) core campaign is to end violence against women “A promise is a promise: Time for action to end violence against women”.

Ban Ki-moon, United Nations Secretary said “Violence against women is always a violation of human rights; it is a crime; and it is always unacceptable.  Let us take this issue with the deadly seriousness that it deserves”.

Violence against women continues to be a huge problem in society and can have serious adverse physical and mental affects on the individual and their families.  In the UK, the cost to society totals around £20.1 Billion, which includes human and emotional cost, cost to public services and cost in lost economic output. 

How widespread is the abuse?

The British Crime Survey 2006/2007 established that every year 1.5 million women experience at least one incident of domestic violence abuse, which is nearly 30,000 women a week. Over a lifetime, it is argued that one in four women in the UK will experience domestic violence.

Anyone can be targets of violent domestic abuse, married or unmarried couples, opposite or same sex partners, however, figures show that approximately 77% of the victims are predominantly women. This could be due to a whole range of factors, including cultural differences (i.e. men considering themselves too superior or 50% of men believing that domestic violence is a private affair), life experiences, psychological and emotional issues.

The Home Office Statistical Bulletin: Crime in England and Wales 2006/2007 highlighted that 2000 women are raped a week, resulting in 100,000 every year, and half of these rapes are committed by a current or former partner.

Lesley Abdela, Journalist at the Guardian “Stop looking the other way” wrote that, “Violence against women is a pandemic more extensive than HIV/Aids. It is the main cause of death and disability globally for women aged 15 to 44 – rape and gross bodily violence cause more death and permanent disability than cancer, motor vehicle accidents, war and malaria combined”.

Worryingly, Lesley comments that between one and two women are killed each week by a current or ex partner, and that this number is actually 20% higher than the number of youngsters knifed to death in London or in British cities. 

The affects

Domestic violence against women can have serious implications. As well as the damaging physical health problems that can arise from abuse, there are also notable adverse affects to an individual’s mental and emotional wellbeing; these include post-traumatic stress disorders, depression and anxiety. Moreover, many women turn to taking drugs, alcohol, smoking or overeating as a response to and a way of dealing with the abuse. Statistics reveal that abused women are 15 times more likely to misuse alcohol and 9 times more likely to take drugs than women generally. This can lead to greater physical and emotional problems.

As mentioned above, there is a large economic cost to society as women who are abused often take time off work. Statistics from the Home Office Statistical Bulletin, states that each year one in ten victims of partner abuse takes time off work as a result of the abuse.

Then and now

Until 1990, it was legal for a man to rape his wife.  The idea that domestic violence is a “private family affair” is still widely believed and is one that needs immediate eroding.  Domestic violence is a crime, and if ignored can lead to greater problems for the victim, their families and society as a whole.

International Women’s Day, is a fantastic opportunity for everyone around the world to acknowledge the great achievements of women and the contributions they have made socially, politically and economically, but it also an opportunity to make evident the problems women continue to face world wide.  Through the media, policy makers and the government, we can help to reduce and end domestic abuse and to also ensure a strong support network system is in place to offer advice and guidance to those who have suffered.

For more information on International Womens Day click here

For further information on violence against women click here 

Visit the Women's Health website here 

  

Can mobile apps help people lose 

weight...and keep it off?

Many of us may be well accustomed to using health and fitness mobile apps that have the sole purpose of counting calories and measuring activity levels, to help us lose weight. With the majority of people now using Androids and iPhones, downloading apps to our mobile phones is easy and hugely popular. As a result, tracking what we consume on a daily basis has never been so simple. 

However, how effective are these calorie counting apps? Can technology really aid us in reaching our ideal weight, or is it just a fad, a fashion accessory that will be forgotten with the next diet fix?  Furthermore, as with all successful weight loss, does it come down to our own behaviour and self motivation to bring about healthy changes to our life?

A recent study from the Northwestern University Feinberg School of Medicine, identified as the first of its kind, sought to examine the relationship between technology and the impact it had on weight. The study will be published in the Archives of Internal Medicine. 

The Study and Findings

The Northwestern technology research incorporated behaviour change techniques, including self monitoring, goal setting, feedback and social support.

The research examined a cohort of sixty nine overweight and obese men who were an average age of fifty eight. All participants were offered health education classes on nutrition, exercise and behaviour change; every two weeks during the first six months and once monthly for the remainder of the year. 

Each participant received personalised weekly calorie and activity goals to help them lose weight and all participants were encouraged to attend nutrition and health classes. The participants were divided into two groups. One half recorded their activity and diet on paper, whilst the other half used the Northwestern technology mobile device, to transmit their data to a behaviour coach, who monitored and provided feedback twice a month. 

From the evidence, it was found that those who used the mobile device and attended eighty percent of the nutrition classes lost fifteen pounds and maintained this for one year. The weight loss for those who used the mobile app but who did not attend any classes lost almost nine pounds. The group who attended classes but did not use the mobile app, did not loose any weight. 

The lead investigator of the study and Professor at the University, Bonnie Spring, found the results to be positive and argued that mobile devises could have a significant role to play in making people more health aware; "The app is important because it helps people regulate their behaviour, which is really hard to do....Most of us have no idea how many calories we consume and how much physical activity we get. The app gives you feedback on this and helps you make smart decisions in the moment." 

However, Spring also emphasised that weight loss only occurred when people attended health education classes and engaged in regular exercise. The app alone would not be effective.

"The 'widget' is critical but it is not magical by itself," Spring added. "People need all the tools at their disposal." 

Should we all be downloading apps?

Diets usually fail because we end up eliminating certain food groups – and in the long term this is not sustainable. The difference between “diet fads” and calorie counting mobile apps, is that the latter can help set achievable and realistic goals, whilst simultaneously tracking our calorie intake and activity levels. 

It is often the case that we do not realise how many calories certain foods contain, and so, we are ignorant to all the hidden fats/sugars.  Thus, these quick and easy food tracking devices empower us to make sensible and more informed decisions that govern our health and weight. 

A frequent user of a calorie counting mobile app, Koorosh Ashrafi, PhD Research Scientist at BTG International group company, says; “I’ve lost 10 kilos over the past 6 months, and you learn balance is the key.  I’ve lived quite a sedentary lifestyle because of the pressure of work and studying, and I was still consuming the same amount of calories as 10 years ago when I was training as a rugby player.  Although I am a firm believer of everything in moderation, having a device at the tip of your fingertips, really does educate you about food and its content”

Nelly Araujo, Development Administrator at RSPH, and previous user of the mobile app says; “The goal setting was a motivational tool for me, but I found doing the mobile exercise with my partner, is what also drove me to make healthy changes – because we could support and encourage each other”

Bringing about behaviour changes in our life is no easy task.  We have to want to do it and it helps if we have the right tools at our disposal along with a good support network.

Spring believes that one of the big challenges in treating obesity is the need to provide behavioural treatment in a healthcare system where professionals don’t often have the time and training to support people with unhealthy diets or mental problems.

The RSPH is a strong advocator of the benefits of making healthier behavioural changes, but acknowledges that for many this can be challenging. The RSPH Level 2 Awards in Understanding Behaviour Change, is a qualification aimed at helping learners, health trainers and anyone working within the community to engage with individuals to develop strategies to undergo behaviour change and to offer brief advice and interventions to support individuals in improving their health and wellbeing.  Please click here for further information on the qualification, or contact Gina Mohajer.