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

Is premature death a postcode lottery?

A new interactive map, Longer Lives, produced by Public Health England (PHE) demonstrates the variation in premature death across England through a colour code technique. The map which ranks 150 authorities by their premature death rates – that is before the ages of 75 – also allows users to view these areas by five of the most common causes of premature (and preventable) deaths.

These include cancer, heart disease, stroke, lung disease and liver disease. The map further enables users to view the areas which are the most socio-economically deprived.

Interestingly, the map clearly identifies the North of England as having large proportions of premature mortality, where deprivation is more prevalent, compared with the South of England where good health is more evident particularly in affluent areas. However, a few exceptions to this do exist in the South especially in London boroughs, Southwark, Tower Hamlets, Newham, where health is regarded as extremely poor and deprivation seemingly high. 

To view the coloured coded map and see how your area rates click here.

Why such a divide between North and South

The reasons as to why such a variation exists could be due to rates of poverty, obesity levels, alcohol consumption and smoking. Historical factors such as decline of the manufacturing industry in the North, may have increased unemployment and hence poverty in the regions. Other factors may include the social and cultural environment as well as access to education, housing and transport.

Nonetheless, what the map does highlight are areas in which local authorities need to pay particular attention to improve health and tackle health inequalities – it is unacceptable in our modern day society for such a disparity of mortality to exist depending on location.

The RSPH has been working with Well London to provide health improvement training and education to people from the most hard to reach and deprived areas of London, more information can be found here.

Regardless of where we live, all of us can take simple steps to improve our health and even positively influence the people around us to make real and lasting lifestyle changes. Our most popular qualification Understanding Health Improvement Level 2 Award, and Understanding Behaviour Change Level 2 Award provide practical knowledge of the benefits of good health and wellbeing. They examine how we can reduce health inequalities  through basic understanding of the concept of health, building confidence in talking about health and encouraging people in the community to seek health services available to them. For more information please contact Gina Mohajer gmohajer@rsph.org.uk. 

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.   

Combating the myth that creativity 

is linked with mental illness!

The belief that creative people are more likely to suffer from mental illness, is an ancient notion that has transcended through the years and has long been part of our popular culture. The tortured artist or the visionary genius who succumbs to his/her own personal demons, is an image that is perhaps a little too familiar.   However, how legitimate is this concept ? Are creative people really prone to increased mental health issues? Or is being “creative” actually the coping mechanism to improve mental health?

Reverse the stigma

Previous studies, namely recognised as being poor and often subject to bias, have shown a link between creativity and mental illness. This could be a result of artists and writers who kill themselves often becoming high profile news items, and hence distorting the truth.  Artists and writers who live contented and well-balanced lifestyles are likely to attract less attention.

The study

Researchers from Gothenburg University and Uppsaala University in Sweden, sought to distinguish the association between creativity and mental disorder and whether in fact a correlation existed. The study used Swedish health records to identify more than a million people diagnosed with various mental illnesses. They compared the incidence of creative occupations among people with mental illness  against a matched sample of “healthy” people.

The study identified that people in creative professions were significantly less likely than people in other professions, to be diagnosed with schizophrenia, schizoaffective disorder, depression, anxiety disorders, alcohol abuse, drug abuse, ADHD or to have committed suicide.  The only exception to this was writers.  It was found that people who wrote for a living were twice as likely to suffer from schizophrenia and bipolar disorder and more likely to experience depression and anxiety disorder.

The study was however unable to identify how or why, people with certain creative talents or dispositions would be more likely to experience mental health problems.  For example, does being a writer lead to psychiatric problems? Or, do mental health suffers turn to creative pursuits in order to express themselves?

Arts/Culture as a way to improve mental health

Over the past few decades, research has emerged around the positive impact that arts/culture can have on health, particularly mental health. One such cohort study by a Norwegian researcher, Koenraad Cuypers, performed statistical analysis on the health data of 50,797 Norwegians, as part of the Nord-Trodelag Health Study. The evidence derived from the study showed that participation in cultural/creative activities were significantly associated with good health, good satisfaction with life, low anxiety and depression.  Further information on arts and health studies can be found at The Arts Research Monitor by clicking here http://www.artsresearchmonitor.com/articles.php?catUID=6 

  

In the UK, health professionals and creative artists have worked together for over 25 years using the arts to support healthcare and health promotion. Thus, the importance of arts as a way of improving health must not be underestimated. Whether you are watching a concert, visiting an art gallery, painting, singing, dancing or reading – these creative activities have been recognised as effective ways to decrease stress, create community cohesion and improve social interaction as well as providing a sense of relief from everyday life.

Dr. James Aw, Medical Director of the Medcan Clinic Toronto stated that; “Hobbies and interests outside of work are important for health. New experiences and expanding social networks through art and culture is one piece of the armamentarium in achieving optimal health and living well.”

Early 2013 the RSPH will be holding a new programme, "New Horizons," to address an emerging and widening interest in how the arts can positively impact health and wellbeing.  For further information or to register your interest please contact Gina Mohajer.

To conclude

From the Swedish study, although cause and effect was not ascertained, it nevertheless, highlighted the importance of good mental health and ensuring that those who suffer from mental disorders have the appropriate support and information available to them.    

The RSPH has been involved in promoting the benefits of mental health and demonstrating how this can be achieved. Good mental health is integral for all parts of life, not only for the individual but also for the affects it has on family, relationships, work and society as a whole. Thus, it is imperative for mental health to remain at the top of National and Local Government agenda and policy.

To read RSPH full report on Mental Health please click here.

Why talking is good for our well-being

I'm sure we are all familiar with the expression “a problem shared is a problem halved”.  Now recent research affirms that communicating our thoughts and experiences to others, actually stimulates cognitive and neural mechanisms associated with reward and hence makes us feel better.   

The study, “Disclosing information about the self is intrinsically rewarding” was carried out by Harvard neuroscientist Diana Tamir and Harvard colleague Jason Mitchell and focused primarily on brain functionality associated with talking about oneself.  The evidence demonstrated that self disclosure was strongly linked with increased activation in brain regions that form what is known as the mesolimbic dopamine system. 

This system is recognised as the pathway in which dopamine is carried from one area of the brain to another and is responsible for controlling the brain’s pleasure and reward centers.  It is also associated with the functions of movement, preservation and compulsion. 

An MRI scanner was used to monitor the subjects’ brain by picking up changes in neurons activity as well as blood flow.  As a result, the scientists were able to distinguish the part of the brain that was responding to what the subject was talking about.  The experiment found that when people talked about themselves, which included beliefs and opinions, blood flow to region became significantly prominent. 

The study highlights that humans have a tendency to convey information about personal experience, because of the intrinsic value associated with self disclosure.  Whenever we face a problem, sometimes sharing our concerns or just simply relaying a fond memory to someone, can make us feel better and hence have a positive impact on our mental well-being and health.  Moreover, Tamir points out that by openly discussing our beliefs and opinions with others, has the added value of building social bonds and social alliances between people.

Perhaps we shouldn't underestimate the power of a conversation and the benefits of simply taking the time to listen and talk to someone.

Learning to De–Stress! Celebrating National Stress Awareness Day

Today, 2^nd November, is National Stress Awareness Day, aimed at helping people to deal with and avoid stress.

Stress Management has never been more relevant than it is today.  Recent research has emphasised that stress levels have doubled in four years.  Statistics from MIND show that half a million people in the UK experience work-related stress at a level they believe is making them ill and that twelve million adults see their GP with mental health problems each year, much of which is stress related.

As such, this year’s theme is based on “Wellbeing and Resilience at Work”

Why are we more stressed?

With our current economic climate, the increasing number of redundancies and the growing uncertainty of job security, has inevitably lead to a lot of worries.  People are concerned about their financial situations, paying back mortgages or how they will provide for their families.

In the work place, stress can be caused by relationship conflicts between colleagues, greater workload and pressure, which can also lead to depression.  Depression and issues from work are one of the main causes of stress reported by patients when they visit their GP’s.  

National Stress Awareness Day asks whether you have a technique or routine to help you combat tension?

We all know that stress is harmful for our overall health and wellbeing.  It can have a negative impact on our body, the way we feel and can also affect the way we operate and behave.  However, feeling stressed is reversible and we can all take certain steps to ensure we cope with pressure and also learn how to relax and take time out for ourselves.  It could be something as simple as taking a bath, writing a diary, listening to music, doing physical activity.   

MIND have identified Ten Top Tips to tackle stress, as well as guides on how to relax, manage stress and also how to improve your mental wellbeing.

For further information on National Stress Awareness Day and ways to support it, please visit the International Stress Management Association UK