Living with Mental Health

(text swooshes)- Thank you very much for everybody for joining me this evening, and really, it's the first day of the Children's Mental Health Week for those of you who don't know. And so it's quite an important week for us to think about the life course of a child and how that affects the life, adulthood for children as well. My talk today will provide you with a taster of what is to come in a series of lectures here at Gresham College. And I particular will talk about understanding what mental health means, how we can best manage it. During the talk, I'm going to show you how common it is as a problem really for society and a global problem as well; what some of the mental health conditions are; introduce you to some of the reasons why people may be at risk of mental health problems; the barriers to management as well; and then different approaches that are suggested to support people with mental health conditions. And most importantly, we'll consider the importance of taking a holistic approach to keeping all of your minds and our minds healthy. But before we start with that, I'd just like to do two things. One thing is I'd like you to just put up your hand if you know anyone who has experienced some sort of mental health condition. So that's most people in the room, I think here. And nearly everybody in the room has put their hand up to say that they know somebody with a mental health condition. So you can see just how common it is. And just take a minute to think about whether there's been a time when you yourself have felt overwhelmed or sad or is your day was just a struggle and it's just too much about it for you. Just think for a moment, how did that actually make you feel. Did you talk to anybody? Did your heart race? Did you just decide to get in your bed and close the door to the world? And just hold that thought throughout this lecture, as people with mental health conditions face that every day. But to many of us, there's a very, very fine balance between feeling all of those feelings that we just talked about and actually having a mental health condition. And there are ways we can prevent it, the ways we can be resilient to some of the stress factors, and we'll talk a little bit about that as well. But before we can go into this, I want you to consider what really is the definition of mental health. So the WHO has stated that the state of, well, mental health is a state of wellbeing that enables people to cope with the stresses of life. And that's what we've just talked about, the stresses of life. It's an integral part of your health and wellbeing that underpins our ability to make decisions. So if it goes off balance, your decision making may off go off balance as well. And important for us when we are building relationships. But the last thing is key here, it's a basic human right. And sometimes we don't actually think about that. We think of many other things as being a human right, but we don't think of mental health being a basic human right. So maybe it's time to reconsider. And then as I said, there's a balance here. We have the mental health conditions or disorders, and there's chronic medical conditions that can affect your mood, your thinking, and your behavior. But it's a balancing act and that's what I've really been trying to show you. The balancing act between poverty, minority status, poor health, genetics, adverse childhood experiences, and we'll talk all about this, with the support networks, the friendships that you have around you, the healthy lifestyle that you may be able to live, the education that you have and knowledge and awareness of the situation and also your ability to access the healthcare and support that you need. But we've just recognized that most of you put your hands up when we said, do you know somebody with a mental health condition? I'm sure if we said, do you know somebody who's actually been on the brink of a mental health condition such as anxiety or depression, actually you might have put two hands up or even more, because actually it's a global problem. It's not just something of the Western world or another part of the world, but it's a global problem and it's a huge, huge problem. One in eight people live with a mental health condition. That's one in eight. So in a room of about 100 people, you'd say about 12 to 13 would have a mental health condition. Now when you think of other illnesses such as diabetes or heart disease or anything else that you really want to talk about, chronic obstructive airways disease, well, think of mental health. That's a lot of people, 12 to 13 people amongst 100. And this picture here really just shows you how common it is in different parts of the world. And as I said, it's not just a phenomenon of the Western world, but it's a phenomenon of the whole world itself. In 2019, the countries who had the most mental health disorders per capita were actually Australia, Iran, and Spain, which was quite unusual to me. Why that is? I'm not totally sure whether it's because of the presence of the mental health disorders or whether it's part of how it's diagnosed or whether it's also how people recognize mental health disorders in those different countries, but that's very, very large. And if you just look here in this slide here, you can actually, what I've tried to show you is, where mental illness sits amongst all the different conditions. So you have COPD, chronic obstructive airways disease or chronic obstructive pulmonary disorder. You have diabetes and diabetes is considered a very common disorder or a illness. But then we have anxiety which is high up there. We have depression, which is also high up there. And depression and anxiety and all of the other mental illnesses is way above the some of those conditions that I just told you about. This data also shows us from a different perspective what the different types of eating disorders are and depression disorders, alcohol disorders, drug abuse disorders, or bipolar disorders. All of these come under the terminology the mental health illness. So we're not just talking about anxiety and depression, we're talking about all of these different types of disorders that you see here. It's something that we don't really mention. We may mention anxiety, we may mention depression, but alcohol use disorders is also mental illness. Drug disorders is also mental illness. And bipolar disorder and all the other ones I've just talked about. Eating disorder is particularly becoming an increasing disorder in this country. We know that in young people particularly and post-pandemic, the number of children and young people with eating disorders has risen continuously. And that's actually very, very troubling. Why is it increasing in our society and do we have the services that we can actually utilize to actually support all of the young people? Unfortunately, as you can see here, this is a slide which is showing you the rise after the pandemic of mental health disorders in this country. You can see that in England and Wales, the number of people showing signs of depression in the over 70s, that's the over 70 year olds, that's the elderly population that we have, doubled considerably, and almost tripled in the 16 to 39 year olds. Let's take a moment to soak that in. So this is only in the last few years we've had a huge, huge increase in the number of people in our country who have actually got mental health disorders of some kind or the another. And we don't know now, with the cost of living crisis going on, people's worries about losing jobs, people not being able to pay their bills at all, how much this has further increased. And these are only about the people that we know. This is not actually talking about all the people in this country who haven't actually sought care and who are actually sitting at home struggling because they're too worried to talk about mental health disorders. It's also estimated that worldwide the pandemic led to a 27.6% increase in cases of major depressive disorders, and 25.6% increase in cases of anxiety disorder. So you can see we're not talking about a small number of individuals here. And this doesn't include people who, as I've said before, would come under the banner of stress and not be diagnosed with depression or anxiety. And for stress itself, the World Health Organization has actually named stress a global pandemic. So the question we need to consider now is are we doing enough about it and who should take responsibility for actually improving the health of our nations? One country has actually looked at this in a different way. So the country of Bhutan has actually started thinking about GNH, as they call it, rather than GDP. So we measure our country's progress from our monetary, economic perspective, but actually Bhutan actually thinks about the progress of their country from their happiness perspective. This doesn't mean it's the happiest country in the world, but what this mean is that they thought that it was important enough as a policy to consider a holistic approach to their nation and think of happiness and wellbeing of their nation and measure that and actually have to deliver according to that in their policies. So you can see here that the GNH, it was introduced in about 2008 and it was there to measure the progress of their country. Bhutan felt that the material and the spiritual aspects were just as important aspects of life and they should be intertwined together. But you can see there are also nine domains there. So psychological wellbeing, your physical health itself, you can't untangle the two. And I think often we think of mental health, separate physical health, but actually they're completely intertwined. When you're feeling down, when you don't feel well in yourself, when you can't run around, when you can't take part in activities, it goes, people say, "it gets me down," it makes people feel sad. Time use. How much time do you have in your life to spend on things you want to spend on or with people that you want to spend? What are your living standards? What's your housing environment like? Are you able to exercise outside? Are you able to see the sunshine at all? Community vitality. Now we don't really talk... We talk about community, we talk about the importance of community vitality. What that means is how much are you engaging in your community. Not that you're by yourself, not you're not there as an individual, but you are working with a community, you're giving back to your community, you feel fulfilled in yourself. And also education. Education is key. Awareness, education, feeling that you actually are achieving something in your life and building your self-esteem. So maybe is this something we should consider here as well, as if we have this rise in individuals who have mental health disorders, should we also be thinking of the happiness of our nation? But also there is a parable that people consider, and this is the elephant parable. The reason I'm bringing this up is because understanding mental health is actually very difficult. The brain is very, very complex. We have thousands and thousands and millions of neurons that connect together. We have what we call neurotransmitters that are coming out and actually controlling everything I'm doing here in front of you, whether I smile, whether I move, what I do. So it's a very, very clever organ, but it's a very, very complex organ. And for thousands and thousands of years, people have to some extent understood the body and the mind and talked about the body, the mind and the soul, but understand the mechanisms of how it works and the mechanisms of how some of these disorders works, it's something that we're just learning about. So now we have MRI scans, we have ways of picking up and detecting the neurotransmitters, we have genetics and epigenetics, and we can talk a lot about this in the series coming up. But for today, all I'm trying to say to you is this is a complex area, the brain is very complex, and there's more and more research that is being done to try and untangle this. Now what this parable is trying to say to you is when there's a blind man and he attempts to describe an elephant, each person or each blind person will touch different part of that elephant and they will describe to you totally differently what that feels and what it appears to be. And that seems to be where we're in science at the moment with mental health disorders. There are very many different factors that we're researching and we're finding out about, and the challenges, how do we get them bring all of that information together to make a holistic change to the way we look after our communities. Well, one of the areas that we can think about is risk factors. There are a number of different risk factors that impact on whether we are more likely to develop a mental health disorder or whether we are able to really do that balancing act that I was talking about before. So here we are with the three big buckets, I call them, of mental health conditions and risk factor buckets, really. So the biological risk factors, the psychological risk factors, and then the sociological risk factors. And that's how I just like to bring them to you in the next few minutes. Now genetics. Genetics is always a little bit tricky to talk about, because you never want somebody to feel well, you know, is it in my genes that I'm going to definitely have a mental health disorder, and what can I do about it? And why are we actually talking about genetics here? Well, one thing is that there is a genetic risk with some mental health disorders and that's just known and it's some information that we can use in a positive way. And you're probably saying,"Well, why in a positive way?" Well, we know that anxiety, schizophrenia, bipolar disorder and some major depressions are actually linked to our genetics. So your risk of having an anxiety disorder can go up by about four to six times if you have someone else in your family who actually has anxiety. So that's quite a lot. But what does that mean for that individual? Do they need to know that or don't they need to know that? And the moment we don't screen for individuals, we don't do sequencing for genes. But what would it mean for you in a family if you knew that you had a relative who might have an anxiety disorder? Well, I suppose what it would mean is if you knew that somebody else in your family had anxiety and you started having the feelings that may put you into that category, you might think, "Well, shall I access care? Shall I get more support?", rather than withdrawing yourself and not getting that support. So if we can utilize this in a positive way to help people and support people with the knowledge and awareness, then naturally we can enable them to feel comfortable to go and get the support that they need. But there are also many other groups of individuals who are actually at risk. So yes, we have the individuals with the genetics behind them, but children and young people are particularly at risk. And we'll talk a little bit about that in a minute. But there's also another lecture coming up in the series about children and anxiety disorders. Older adults, elderly people. People at the other end of their life cycle. When things are changing, that's another group of people who are at risk. People in low income households where there's poverty, they don't have enough money, their housing is poor, they're not able to do all the wonderful things that many of us can do, like going to the theater or going to see friends and visiting museums or even just running around in the park or visiting other places where you can actually get away from some of the stresses of your life. Some of the houses people live in, very cramped, very small, very dark. And all of those things affect the way you balance your brain and all of the neurotransmitters that help us keep balanced in our lives. Ethnic minorities. Ethnic minorities have also been shown to be at higher risk of mental health disorders. And some of this goes with the fact that communities, who are more marginalized or feel marginalized in society, already feel quite stressed or alienated from society. It may be because many individuals from the ethnic minorities actually are doing work which is more stressful and some of it links to poverty as well. So there's a array of reasons and we know since the pandemic as well, many people did lose their loved ones, did lose people who were very close to them and were not able to also visit their close ones who may live abroad. And that also increase the rates of mental health disorders and some of the ethnic minorities. And also other communities who may feel marginalized as well. LGBTQ communities as well, particularly may feel that they can't access care, may feel that people are not enabling them to talk about their lives or what they need from life and sometimes feel a bit alienated from society. All of these are risk factors that add to your stress levels and how you respond to the world around you. And men. A few men in this room, quite a few men in this room and men are actually particularly at risk of mental health disorders. It's known that individuals who are of the male gender don't always talk about their problems, often internalize their problems, hold them into themselves, and the suicide rate is actually hire in men than it is in women. So women may show that they need help in many different ways, but men actually have a high risk of suicidal rates. Now I mentioned a little bit about children being at risk, and the reason I mention this is because it links to adulthood as well. So adverse childhood experiences, this may be something you've heard about or may be something you've not heard about, but adult childhood experiences are those experiences that a child has when they're in the womb or when they're born and in the first few years of life and beyond. And it's what impact they have had from the environment within which they live. So this comes to the social and environmental factors that I was talking about before. Children are very vulnerable to their environment and they encounter traumatic experiences and traumatic events. Their brains are still developing, their brains are small and their brains are growing at an extremely fast rate. In the first five years of life, you're developing networks, your brain is just constantly developing networks, and these may be for sensation, for language, for critical thinking. And that's with 700 to 1,000 neuron connections are being developed per second. So when we talk about adverse child events or experiences, you can imagine what's happening to the child if you are being maltreated in some sort of way. If you've got a chronic childhood stress, this will have an impact on the way your brain develops. And the trauma, we talk a lot about trauma in children, and that trauma that child goes through. And that can actually hinder the development of some parts of your brain. So the ACES affect you physically, emotionally, and can actually put you at risk of abuse later on in life. It can actually make you homeless later on in life and actually put you at risk of mental health disorders later in life as well. And when we talk about adverse child experiences, we're talking about things such as if your parents may have abused you, if they're alcoholics, if they constantly screaming at you as well and they affect your emotions and your behavior. And we need to be tackling this. We need to be tackling this at an early age, and we need to be supporting our children in our society. The reason for that is this is an economic slide and it shows that actually if we could impact on children's adverse experiences when they're children, then we actually could save the country a lot of money, because we'd be preventing problems later on. So the lifelong benefits of supporting our children in this country would be to reduce chronic health conditions later on, depressive disorders later on, even things such as diabetes or cancer, risk taking behaviors such as drug abuse, alcohol abuse. And also it does mean that some children when they become adults, end up getting into the cycle of unemployment, less education in high school, and then the cycle goes on and on and on. So we've talked about the fact that generally mental health has gone up in our society, mental health conditions have gone up. And this is a slide just to show you the children and the impact on children. This is astonishing really to think that our children in our country have mental health conditions that are going up at this rate. That's 2017, which has now moved to 2020. That's quite a lot really. But what are we doing about it? The problem is that in one in six children have a probable mental health disorder. That's probable. Many children do not come to get diagnosed, they don't meet the threshold of diagnosis, but they're suffering inside with it. Many of them can't get help, they don't know where to get health, and sometimes they're just told,"You know, you're feeling a bit sad, just go back to school, get on with it." And then they really just feel constrained and the cycle goes on where they don't tell anybody about what's going on. And as I've said, the number we're seeing here is up since 2017. So how do children, and actually many adults as well, present? Most people don't come saying,"I have a mental health disorder," or "I'm feeling as though I'm ill," or actually know if they've got depression or they've got any other condition at all. But the physical symptoms that you should all look out for are a constant tummy ache. Often they'll say your brain is in your stomach and your feelings from what you're feeling in your brain can often be felt in your stomach. So people talk about irritable bowel syndrome, they talk about, you know,"things aren't just quite right in my stomach,""my bowels don't seem to be working." That's because your bowels are connected to your brain and often there's a connection between the two. So what you feel in your stomach has an effect on your brain. You're feeling tired, constantly tired, like you can't wake up in the morning, you can't really go and do your job as you meant to. You get a fast heartbeat, everything just seems to be pounding. You're anxious, you look outside, and you don't want to meet anybody. You can't breathe. You've got a headache, you've got diarrhea, the opposite side of constipation, you're feeling sick every time you go meet somebody, you just feel sick, you don't want to go meet them. You have no appetite or you feel lightheaded. Just some of this physical symptoms that you should watch out for or watch out for in colleagues or friends who may not be telling you that "I am actually struggling." So I just want to show you this little clip really just to make you understand how it feels for an individual living with a mental health disorder.(cellphone beeps)(uneasy music)- [Narrator] I am sad. I feel fat. I'm stressed. I feel ugly. I'm not hungry anymore. I'm so tired all the time. I'm just having a really hard. And I dunno what to do anymore.- So that moved me because the last little bit "I'm fine." And that's what most of us do, we're feeling, but when we press that button, we change what we say. So how do we help people more? But later in life it's also a problem. And later in life, many people don't have the phone to tell people they're not feeling well. Many people, people are isolated. So why is old age a problem? Well, eight to 10% of people over 70 report moderate to severe depression. And just like I said that it's going up in the young people, it's going up in the elderly as well. But why is this happening in our society? Well, there's a number of different factors. When you're old, your brain changes, the brain connections change. Some may have Alzheimer's disorders, and that in itself has been linked to depression as well. You've lost a lot. We talk about loss. The word loss, what does that mean if you are aging? You've lost some of your friends, you've lost some of your relationships with other people, maybe your partner, you may have lost your job because you're too old now to be in a job. How are you keeping active? How are you actually keeping in these strong relationships that's actually prevent you from getting depression or anxiety or some of these other disorders? And isolation. Isolation for our elderly, there's a huge, huge problem. If you're sitting alone in a closed room all the time, you have nobody to see all day, this really, really moves people into the area of depression. And now in addition to this, we have many people who can't pay their bills, people who are worried about their heating. And so at the current time, we've again had this problem I've just shown you with childhood at the other end of the spectrum with individuals who basically have really lived their whole lives being active, doing something, giving something back to society, and then in the pandemic have been shut down, not been able to see people they loved and been pulled back from society, many who are now also having social anxiety and worried about getting back into the world again. And on top of this, we also again have the costing living crisis. So just as we have one end of the spectrum, we also have the other end of the spectrum as well. So here's just a quote from somebody, this is Terry."It was after I lost my son and my husband that I started to feel deserted. A lot of things seem to happen at one time and I didn't want to get up or do anything, but I had to make myself. I lost touch with people. I don't like thinking about that time because it was awful. You don't get over it, you must learn to live with it." But the question is how do you live with it? So stigma, access to care, access to resources, lack of support. These are some of the things that we're seeing as barriers to our care. So I've talked a lot about the burden of the different problems that we're seeing. I've talked about why that matters in different age groups and now I'll just touch on the barriers to care as well. Well, the problem we have is that stigma is a huge problem. Stigma is probably one of the key issues that we are seeing around mental health. We may think we've got better at it, we may talk about it a little bit more. We may have people or advocates for mental health disorders as well. But actually stigma is the work first thing that we must actually try and tackle. When some of you talk about, you know, diabetes or heart disease, it's sometimes a very common thing to talk about at the dinner table or with your friends."I've had this problem, I've been for my treadmill test, I've had a blood test done." You talk about to your boss at work, "Oh I'm sorry, but I'm going to see the doctor because of X, Y, Z." But how many people feel comfortable to talk about the fact that they're going to see the doctor because they're feeling low or because they're worried about a mental health disorder? Probably very, very few. We don't tend to want to talk about it. We hide ourselves away and we hold on to the feelings of trying to make it invisible to somebody else. You also hear people saying,"Well, I don't want to see the doctor because it'll be on my record. If it's on my record, somebody's going to think that they can't give me a job or my partner may want not want to be with me anymore." All these fears that we as society have built up because the word mental health in itself and how it's framed, it's got quite a negative frame to it. So how do we change that? How do we change the narrative and change the word mental health into something that's more about when mental wellness than it is about mental health and mental health disorders? This myth here is something that a lot of people tell us. You can't struggle with your mental health if nothing bad has happened to you. And that's not true at all. We all have brains, we all have neurotransmitters floating around, and that balance I was talking about can actually imbalance in any of us. We all live through the daily grime of work, going to home, meeting people. And sometimes it's tough, and sometimes even if it's not tough, it's still difficult for us to live with. The other areas of stigma that we have to think about is, as a culture in the world, mental health has also marginalized a lot of individuals. Some individuals and some cultures are considered to actually hold an evil person inside them to be demons and to require witchcraft or some other sort of intervention to really pull the evil outside of them. For example, some Pentecostal Christians and Islamic groups believe that mental health problems a result of demonic or jinn possession with exorcism being the only way to cure the ailment. That doesn't say that any of this is wrong. It just means that for some people and some individuals, it makes it quite hard to talk about the problems that they're going through. And how do we help people get the treatment they need along with some of the other alternative interventions that are out there? How do we work together with faith healers? How do we work together with other groups of individuals who are trying to manage some of these people? And part of this bit is because these sorts of words

"you're attention seeking," "you're cursed,""you deserve it," "it's all your fault,""you're a freak," "you're violent,""why is that person just being so violent towards me?","you're lazy," "is it contagious?", "you're just weak,""you're weak minded," I don't know how many people have heard people saying that, "You're weak minded. Just get up and get on with it. We get on with it. I get up and do my work. Why can't you do it?" And just watch this little clip to try and bring that stuff to life a bit.- I can't breathe. I have migraines, numbness, weight loss. I live with it every day. The illness that I'm suffering from is an anxiety disorder, and it deserves to be treated like any other illness, but it's not.- Mental health needs to be helped by all of us. We need to help our colleagues, we need to help our friends, but how can we help? So we'll talk a little bit more now about the ways that we can actually support individuals and ourselves keeping us strong in our mental health, but also individuals who are actually suffering as well. And there's a number of different ways, and I think we need to think about all of these not as separate, but actually together. So medication, how would you use medication? Psychotherapy, talking therapy, self-care, lifestyle. How do we reduce stresses such as some of the inequalities I've been talking about in our societies such as poverty and the other impacts of that on people. Social media. We could have a whole talk on social media and the impact of social media on mental health. Community level. What do we do at the community? How do we actually address stigma? What could you all do to address stigma? What could we all do? How could we come advocates to reduce stigma? How can we improve diagnosis and get people through the door? And how can we improve access to care as well? So NICE have also created a number of guidelines around mental health disorders, and actually what I've just said, they match very well. Whereas previously there was a lot of impact and a lot of thinking around what medication could people get, and probably that was often the first place that people went to was you go to a GP, you'd be given some medication and that was considered would do the job. Actually things have shifted quite a bit now. Medication is not the first thing that we necessarily give people. It has its place and we'll talk about that. But actually all of these other additional therapies, interventions also needed. And it's good to see that these are actually being considered by the health service as well. So just take a moment to think about these. This is what really all of us in this room should be thinking about, lifestyle and environment. So this is for you, me, anybody who wants to strengthen our mental health, but also people who have mental health disorders. So the first one on this list is sleep. So I don't know how much sleep all of you have had last night, two hours if you are partying and you're a student to maybe six hours if you are, usually six hours is what a lot of us get, and eight hours if we're really lucky, and 10 if we're really lucky. But the problem is that it's well known that if you sleep at night, you can actually think more clearly, you can actually do what you need to do in your job, you can focus more clearly, but it also does help your mental health. You feel better in yourself, you feel ready for the day, you feel you can do what you need to do. So the first one is all think about how much sleep you're getting. A balanced diet, and the reason I'm talking about a balanced diet, I'll come to in a second, but really your brain is connected to your gut, which is what I said before. And we don't really think about what foods we eat when we're thinking about mental health, but I'll park that for now. Fresh air or green space, well being outside in the sunshine has actually been shown to have a positive effect on your brain and on the release of neurotransmitters, it's actually being outside physically in the air around you, and particularly with sunshine, this has an effect on you. So if you're in a dark place all the time, I was talking about people who are in sometimes some very difficult housing conditions, who are constantly in the dark, that actually has a negative effect on their mood. Physical activity. Physical activity is so important. Now I'm not asking any of you to run a marathon or do a sprint or be an Olympic swimmer, none of that at all. You can do whatever physical activity you want to do from as little as just lifting your arms up and down, just keeping yourself moving, doing a bit of yoga if you want to do yoga, going to the gym, because all that does is it releases the endorphins in your brain, actually keeps you lifted and keeps your positive mood. Social interaction. We underestimate what social interaction and how important it is. I'm not talking about social interaction just as being in a group of people that, mm, yeah, you're with a lot of people in the supermarket. Is that social interaction? No, I'm not talking about that. What I'm talking about is building strong relationships with people. There's a lot of evidence that has shown that having loved ones around you, people who you trust, people who are your close friends, that actually has a a very strong positive effect on your mental health. Interacting with communities, interacting with other people has also been shown to have a very positive effect. So there's two things. One is developing family connections, people you love, and the next is actually connecting with broader people within your community to do activities that are similar to what you like. So that's why I was saying that if you just go to supermarket, but that's not social interaction. What we're talking about is doing like-minded activities with people. So you've all come here today, you all like-minded because you're in this room. Doing something regular is even better. So this is why going to the church, going to other religious institutions seemed to work very well. Brought people together every week, people met people who were like-minded, people had a sense of community and somewhere you could talk and talk about your feelings or what you were going to do in your life. Reduced social media, as I said, this is having a huge negative effect on people. We talked a little bit about eating disorders and what I was trying to allude there was that eating disorders is going up and up and up. That's because people consider body image much more than they probably did before, constantly comparing themselves. Depression, anxiety. Why? Because you're thinking about,"Hmm, has my friend got a better job than me?" You see on Facebook somebody's in a nice place, you see what they're wearing, you think, "Why didn't I buy that?" So you're constantly, constantly comparing yourself every few minutes of the day. I mean, you know, we're here in this room and nobody's got their phone out, which is wonderful. But I'm sure if any of you had a chance, many of you would've got your phone out and maybe just looked at Twitter or looked at Facebook and within a minute you'd be going,"Hmm, are they doing what I'm doing?" And we don't realize the stress that that brings on our brains. And smiling. Smiling has been shown to be a really important activity to do. And when I say activity, it's a small activity but it's a very important activity. So just for one minute, if you are just smile for a minute and it'll lift your mood. It's good to see everybody trying to smile, and a little bit higher would be even better. But smiling has genuinely been shown to actually release hormones as well. And that's why you might also have heard of laughter therapy as well. Just laughing, smiling actually helps to improve our health. So coming back to what I was talking about with regards to the gut. We don't really pay enough attention onto mental health combined with gut health. But increasingly the science of mental health related to gut health is becoming quite interesting. In America, not so much in the UK but in America, you actually have nutrition psychiatrists now who will actually consider what you're actually eating and see how that actually impacts on your mental health. And the reason for this is it's been shown that processed foods actually have a negative effect on your mental health. So a lot of what we will eat when we're rushing around, we're going to work actually will have a very a big negative effect on our mental health. Actually food's, particularly the Mediterranean diet, has been shown to actually being quite positive on your mental health. And this is because your gut has a strong connection with your central nervous system. And a healthy gut means a healthy brain. And if you have the microbes in your gut may release some neurotransmitters that actually may also have an impact on your brain as well. The science is still looking into this, but already, as I said, there is an established community within the US you are recognizing this. And this isn't so off the wall as you might think, because it's the truth, because you are connected, but also secondly, it's not so way off the wall, because for centuries and centuries, the doctors particularly in East, in India, have actually been talking to us about what we should and we shouldn't eat and how that affects your mental health. And this has been there for many, many years. It's just now that we're trying to find the evidence for this to prove it. But why is that important for us? It's because social prescribing has now become part of the NHS. So maybe it's taken a bit of a while for us in the NHS to catch up, but it's now here. What this means is that rather than prescribing only medicines, actually community activities are also prescribed. So going out to do gardening, going for other social activities, art therapy, activities such as that, walking therapy, they've all now started to be prescribed within the NHS. So you can see what I've done is I haven't started this talk with the medications, I've started it with the activities that all of us here can do and everybody in society could do to actually help our mental health. Creative expression is really important. Participating in activities where you can paint, where you can do pottery, where you can just not feel so lonely and isolated by yourselves. And as I mentioned, art therapy and singing. Now the beauty of singing is you smile, you're active, you're physically active, you're bringing air into your lungs at the same time as being with a community. So one activity you might want to go is join a choir and do some singing. Mindfulness as well. Mindfulness is really come from, again, from meditation as years and years of meditation in different countries, the Buddhist community, the Indian community have been doing mindfulness for a long time but called meditation. But that was quite accessible to many people. So what's happened is that we've tried to make it more accessible to individuals by bringing it under the term mindfulness. And there's now lots of apps that you can actually access and you can do this at home, just get an app, you know, spend a few minutes trying to think about the world, about you, why you are actually here in this world. Take a moment to focus on your thoughts and your feelings, what's going on. It sounds quite difficult to do and there's an art but you have to do it regularly to have an effect. There's been an increasing number of studies around this, but some of the studies have shown you have to feel that you want to do it first and you have to do it regularly and then it will have an impact on anxiety, depression and stress. Access to care. So one thing that I'm not going to spend a lot of time talking about is access to care, but one of the problems as we talked about stigma, we've talked about other therapies such as talking therapy or other interventions such as social prescribing. But you have to get somebody to get through the door. And the problem is is that how do you get the person through the door, and when they get there, if they feel the doors are shut, they're going to walk away again. We know that our referral rates are going up, we know that our waiting lists are going up, and actually this has become tougher and tougher for people to get the support they need. These are just some of the quotes that we have."I had to wait six to seven months to be referred to a community team. The only way to get help was to present to A&E, which was a traumatic experience in itself. No one should have to go through that." And here's another,"Signposting just leads to signposting at times and you just go from one signpost to another signpost to another signpost." And this is really what puts people off. So one of the fundamental actions that we have to take is how do we keep ourselves well, but how do also improve the access for people who need it. And we are tackling this in a number of different ways. There are a number of different initiatives. You'll see that the budget has gone up to try and actually help with more mental health services, but it's still not enough. There's introduction of counselors in schools so that children don't have to go to their GP but can actually get help in schools itself. And now there are some cafes, distress cafes or other cafes. When we say cafes it's really a place in the community, which community members will hold a really sort of round table discussions with people, walk-in centers where they can let people come, talk about their problems and then signpost people to the GP or to other people that they need to go through. So we can all do that for each other as well as supporting access to the healthcare services. So just coming briefly to psychotherapy, talking therapies. I've talked a lot about alternative types of therapies such as community activities, but talking therapies is one actual fundamental therapy that has been proven to work, and this is such as cognitive behavioral therapy. And what that really means is you talk to somebody, you talk about the problems, you identify the issues that you're having and you talk about coping strategies, and then you try and reframe your negative thoughts. Talking therapies have been shown to be very effective. Now what we all do every day is talk to our friends and you could could say, well, we all should be doing more of that, and maybe that's what's happening in the world that we're in. We are not actually talking as much as we probably did in the past with the like-minded people that I've mentioned. And we now have cognitive behavioral therapy, which is a formal way of doing that with trained experts to take us through that journey to try and tackle some of the problems and challenges that we are facing. Medication. I left this to the end and I know that in the series coming up more people will be talking about medications and it's difficult in a short talk like this one to talk about medications, which are going to be needed for each type of mental health disorder, because they're so different depending on each one. But medications are important, and it's important we don't forget that they have a place, and they have a place because you can't go and do the activities I've talked about. You can't really go and engage with all the art therapy, the singing, or the walks that I've talked about if actually you really can't get out of bed. You can't engage with talking therapy sometimes, again, if you can't get out of bed. So at times you do need this sort of medication to help you to then be able to do the next step. So, the medications that I'm talking about have an effect on these different neurotransmitters. And again, I'm just highlighting some of them here. You have heard of serotonin, dopamine, adrenaline, noradrenaline, lots and lots of words. But ultimately, they are neurotransmitters that help stabilize your mood. And that's what the medication's doing, helping you to stabilize your mood, just like you would if you had diabetes, you would take insulin. The same way the medication helps us to stabilize ourselves. And lastly but not least, one of the things we must think about is supporting a loved one or a friend. Sometimes very difficult for us to do, but you must think about how can you listen to somebody who has a mental health condition or they may not have told they have. How can you support them? Don't minimize their feelings. Talk about self care to them just as I've talked to you. Offer them some help in actually taking the first steps to get the support that they need. And know your limits. We can't all take it too far. We can do so much, but sometimes we have to hand it over to somebody who's more of an expert than ourselves. So just to finish off with, mental health is something that needs to be considered in a holistic way. It's about our mind and our body and the connection between both. We shouldn't be separating the mind from the body. We should be thinking of it all together. And just to leave you with a poem I wrote myself for somebody that I know, They look at me as though I'm dead, but I'm here and still alive. They pity me with words I'm told and can't look me in the eyes. You think because I don't come to work, I've lost my soul inside. You take me by the hand and say,"There, there, we're all so kind." But no one really hears me, my voice that hides within. No one wishes to truly listen to the darkness deep inside. You make decisions for me not asking me my thoughts. You wonder why I talk no more when you make me feel so small. You call it mental health. Please give it another name. I'm not mental, I'm just me, a person struggling with my life. Thank you very much.(audience applauds)- Thank you very much, Monica. Just before I open the floor to some questions, I've got one question from online, just quite an interesting one. You've talked a lot about the rising incidents of disease, expressed largely in percentages on your growth. How are we confident that the real numbers have gone up and it's just not a greater clinical presentation rather than a true increase in number?- So a lot of the stats which I presented with you are from national statistics. So there's surveys done nationally across the country. Some of them are from studies that have been done looking at the diagnosed disorders. And so that's the people have been diagnosed and these are the numbers that have gone up. You're right, it's difficult always. And I think they alluded to that at the beginning that it's actually sometimes difficult. Is it that people now are going through the door and actually getting a diagnosis, or is it that the true numbers have gone up? But actually we're working on the same sort of model, which is how many people were diagnosed before and how many people have been diagnosed now. But actually what what concerns me is that if that figure's gone up, I actually think there's a lot more people who aren't actually even getting a diagnosis, which is probably even higher than it was before.- Thank you. Questions from the floor. Anyone? So, the other thing that strikes me with quite a lot of what you've demonstrated is the vast amount of things that are influenced directly by government policy. So whether that's poverty or financial management or, for example, access to childcare at an early age, we are asking us to help ourselves and to provide a greater individual support or family support. But actually there's a hell of a lot that society could do. How do you feel we are reacting to this crisis?- I find it a personal worry because I think the problem is that we don't integrate the systems well enough. And I think the problem is that we at the moment don't actually have integrated policies that actually would support. So you read some of the policies that are out there and they do talk about housing, they do talk about inequalities, and the social determinants of health and how that actually impacts on mental health. But actually the strategies that are at play in place, often it's isolation, it's housing talking to housing, or it's health talking to health, or education talking to... And what we really need is all of these cross-sector policies to come together and actually think holistically how we do this. The challenges that each one has its own goals really that don't come around mental health. So I think we actually need to think much more about a holistic, integrated mental health policy for the country that will bring together all of these different factors. They're all there, but they sort of need to be put together as a joint policy together to think about it in that integrated way.- I have a question back here.- [Attendee] Yeah, thank you, professor, for that really stimulating talk. I think at the beginning you mentioned that good mental health was a basic human rights. So I'm just curious to know who should we hold in account? Should we be holding the government to account in this rise of mental health problems, is it the NHS we need to be holding to account, or is it just taking more personal responsibility?- The answer is obviously everybody. (chuckles) It's not going to be one or the other. I've just tried to allude to it. It's all it's an integrated problem. Mental health... And this is what I'm trying to say really from this talk is that mental health is about us, our body, how our body function, how our brain functions and how we relate to people. And we don't always think of it in that sort of way. We just separate everything. So yes, it is a human right, but who gives us a human right? It is government. It is government who gives us our human rights, isn't it? And that's why I put in the slide about Bhutan and what Bhutan is doing. How do we get our policy makers to actually think, how do we improve the mental health of their nation? And that comes back to what Martin was saying about, you know, housing, health and equality, all the factors that I've brought up need tackling. And I think accountability to the government is really important. How are they going to sort of reduce this increasing mental health, particularly for our young children who were born in a very, very difficult time and potentially have had an adverse experience from the pandemic and cost of living crisis. Now, what's going to happen to them as they get older and how are we going to put in policies to give them a better childhood and adolescence, that's going to actually protect our children from adulthood as well. But it's like an onion ring. So there's a policy and then there's local communities and there's local communities in our areas, we need to be thinking as well of what can we put in place. Where does local authorities spend its money? Does it spend its money on giving green space? Does it spend its money on activities for children, new sons, for children, care for the elderly, giving them activities so they can actually easily get out of their homes. And then, of course, it comes then down to the individual and how do we as individuals change the way we live? But it also is one thing I didn't talk about in this talk'cause I didn't have time as employers. So you know, we see many employers now as well having a wellbeing agenda in their employment policies. But are they actually acting that out or are they actually making their employees overwork, sleep very little and not be as functional as they probably could be as well? So we're all accountable, but the question is how we actually activate that accountability. And actually the media as well, advocacy, how do we create an advocacy campaign that's strong enough to not scare people to talk about mental health.- [Attendee] You know, within society at the moment, people move away and the support that should be there is no longer there. I mean, from where I come from, the West Indies, we were very much sort of, what shall I say, the relationships, people lived within the village as it were or the city. So you had support there for you. I'm sure there were mental health problems then, but I think the support there helped. I don't know if you-- No, I completely agree. And that's why when I spent a bit of time talking about relationships and trust, that's sort of what I was talking about is that when you are in a community where people are going in and out and people have trust with each other and people are looking after each other, that can help you from some of the stresses in life. Yes, there may be other stresses that you have to also encounter, but it also helps with you some of the stresses. So that community feel, that family feel is something that research has actually been shown to be beneficial. And it's that connection with loved ones and not just one loved one, but a broader number of people around you. Doesn't mean you have to be living with them, but it means you need to have access to people. And it doesn't have to be somebody you're blood related to, but it's how do you develop those close relationships with people around you. So yes, having that is very important.- [Attendee] First question actually, which was asking about accountability, because some of the issues I think that we are facing, especially in communities, is people are moving apart. But this is a political process. This is about local councils, this is about the lack of funding, this is about people not being able to afford their rent. And it seems to me that we need to take a stand politically as well as doing all the lovely things that you've described that can promote good mental health.- Yeah.- I'd like a comment about that.- No, no, so in my other work that I do, I do a lot of work around homelessness and people living in temporary accommodation and adverse childhood events as well, and the impact on them. And I'm a pediatrician myself, so I see all of the other issues that children feel. So completely, I mean, with the other hat on I have, we've been working quite hard at writing policy briefs, getting the evidence on the impact on individuals as well, and actually taking that to the government as well to try and influence what government does about it. So I completely agree. We have to provide the evidence to the government to show that something needs to be done and there has to be an accountability there. And that's what we're trying to do with some of our other work.- [Attendee] It was just the observation, the start of your presentation, you said "the stresses of life." And I always think about that word in a different context, because life that you mentioned or that country that was taking the stand. And I thought that was brilliant. I've got to Google that later. The word was vitality.- Yes.- [Attendee] But you said the stresses of life, but I think the life in the UK is more of a commercial way of living rather than a vitality. Because the commercial way of... And that's how people spend time, you know? Because I'm thinking about statistics with their children, and I think we've got these young, clean, impressionable minds and they're innocent and they're full of life, full of vitality, but that vitality isn't reflected in the way that they spend time because they have to achieve. And I'm thinking, well, how much, I'm 47, how long does that mindset stay with an individual? You know, in the first 10 years of life, in the first 20 years of life, and, you know? Mental health problems, I think, that will go with monetary aspirations or the imposed monetary aspirations, you know, to get a roof over here, think like what that's, you know, that piece of clay, assembly of clay and glass is 400,000. It's 40 years of my life. And it's that kind of thing. So governmental issues, you know, NHS, let's have these people good mental health so they can start work longer and pay more tax. But a person and get mental health might not want to do that. So there's other questions to be asked. To summarize it, should the expression of "stresses of life" be dismissed and say how we spend our time commercially in Western Europe, in the UK or in other places like that, should that be changed?- And that's really why we're trying to work at changing the framing of it. So training... If we start thinking about mental wellness and mental wellbeing, then you try start changing society and you start thinking, how do you create a society where we have better mental wellness? And then you start talk about rather than negative stresses, you start thinking of it, how do we make it the vitality? We start thinking, well, actually we would have a community with more vitality, if the children could run around, if they had time to sing and talk, if they had the family connections, if they had time to sit down with their family and actually think about life and what beautiful things, and also not chase after all of these monetary aspects, which Bhutan has tried to say, let's not think about that. Let's think about the vitality. So that is why we are trying to reframe this whole narrative, if we possibly can. How you change a whole of society, though, that really has all this ingrained is a very hard thing.- [Attendee] Is there a danger of lumping all mental health into one big sort of bucket in a way that you never would do with physical health? And that there obviously are conditions that are very situational, you know, if you haven't got access to open spaces and you've had traumatic experiences, but are others like bipolar, which very largely have a chemical inheritor root. The situation. And sometimes it does seem that the services treat you as if it's just a generic problem that, you know, as CBT will solve everything.- I think you're right. I think what's happened is it's mental health disorder and physical disorder, and that's how it's being considered. And just as you rightly say, less attention's been given to actually these are all very different things. And I think that the challenge is, because we don't yet know enough about the science behind the different disorders that I've mentioned. So whereas under physical health, you've got cancer, you've got diabetes, you've got something else. We know the science behind them. So in a way, they've become their own entity because we know that. Because we're so far behind with mental health, there's not been much money that's gone into research, there's not been much that's gone into policy, we seem to be... It's the most important thing, yet it seems to be so far behind everything else that I think as time goes on, and we'll see what the genetics are, what they neurotransmitters are, how they're different, you'll suddenly see them becoming their own identity. But I think we are a bit far behind with that. But I agree with you. I understand where you're coming from is that we are not treating all the disorders as a significant disorder in themselves because it becomes such a generic term.- Well, thank you very much. Thank you for all your questions, and I hope you'll join me in thanking Monica Lakhanpaul for an excellent lecture. Thank you very much.(audience applauds)