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Moving mental health beyond awareness into action

UCL Faculty of Brain Sciences in conversation with Professor Anthony David, UCL Institute of Mental Health, Division of Psychiatry, UCL Brain Sciences caught up to get his thoughts this Mental Health Awareness Week 2021 – and ask him about what he sees as the priorities.

He is calling for a longer-term approach to supporting mental health that goes beyond just awareness. As we mark Mental Health Awareness Week from 10th May, Professor David says that awareness is just the starting point. Research has to ask and answer the hard questions – and universities have a key role to play in sharing learning to guide the progress.

Q: Do you believe that awareness of mental health issues has improved over the years?

A: Awareness of mental health and well-being has exploded over the last 5 years. From celebrities to the royal family and the general public, we are seeing more people bravely sharing their battles with poor mental health. So, I would argue that we have actually come a long way when it comes to awareness, but that we now need to move on from awareness – to action.

Q: Can you tell us what kind of action you are now advocating?

A: There are three pivotal areas where these actions need to take place. The first is upping Government funding into research and support. The second is directing philanthropic donations and time into meaningful action, and the third is changing perceptions of the practice. And by this, I mean taking mental health science, research and medicine seriously.

Q: What are your thoughts on the funding support physical health receives versus mental health?

A: If we compare the funding given by Governments over the decades for mental health research, it pales into insignificance when we look at the money invested in physical health. This is a well acknowledged mismatch. But I also see the mismatch applying to people’s readiness to put their hands in their pockets to help support health causes. The public is much more likely to fund areas such as cancer, for example, than raising funds or giving support to mental health research.

Q: Can you tell us about the spectrum of mental illness and why understanding the variations is important?

A: All of a sudden, everyone is talking about mental health. But what does it actually mean? Mental health is on a spectrum that can span poor mental well-being to serious mental illness. These are different – but connected. Mental health and mental illness poles are on a continuum, so it raises the question of when do you decide the moment good health passes into ill health? We do need to clarify what we are talking about. So while we have learned that there are many wellbeing enhancing activities such as communing with nature, physical exercise, singing in a choir, being creative, helping others – any of which may stave off mental illness – for those struggling with a mental disorder, advice to partake more in such activities fails to hit the spot. There is a danger that such disorder is trivialised. We don’t expect fresh air to cure cancer so why would it cure depression or schizophrenia?

Q: Do you believe there is still a stigma about mental health issues?

A: Yes, there is a stigma that still surrounds mental health that remains a challenge despite all our awareness campaigning. We are more open about talking through mental health and illness, which is good. But why is it that mental health lags so far behind physical health in terms of government funding and charitable donations? Perhaps it is a moral question. There is still a feeling in some quarters that poor mental health is potentially the person’s fault. Some experiencing poor mental health feel the implied stigma of moral weakness. There is a perceived sense of a frailty of mind and spirit, and therefore it is something to be ashamed of. Some may also feel that they are expected to pull themselves out of it. This is not something you’d ever say to someone with cancer or someone who has broken their leg!

Q: In what ways do you think that the pandemic is affecting mental health?

A: There are two ways to examine the impact of the pandemic on mental health. The first is to look at the affect that lockdowns and the fear of the virus might have on depression and anxiety levels. The other is to look at the impact on neurological health – effects on the brain – of the actual virus or the body’s immune response to it. Research based on electronic medical records from the US and around the world has shown an increase in various types of stroke as well as the whole gamut of mental disorders following COVID-19, rates that are higher than those following influenza in previous years. There is increasing evidence to indicate that some people are taking a while to recover from COVID-19. And these ‘Long Covid’ sufferers are affected mentally as well as physically. COVID-19 does not just cause pneumonia and inflammation of the lungs, it can cause inflammation of, and damage to, the brain. We know that anything that affects the brain, can affect the mind too. Our group along with many other experts in mental health research in the UK are currently conducting surveillance to monitor the neuropsychiatric and psychological effects of COVID-19.

No aspect of our bodies or our lives is immune to the coronavirus pandemic. This is certainly the case for mental health, with some experts warning about an impending wave of mental health problems, although it’s too early to know for sure what the long-term mental health effects of COVID-19 may be. We should not be overly pessimistic. We have an extraordinary ability to overcome challenges to our bodies and minds.

Q: What sort of legacy do you think the lockdowns will have had on mental health?

A: The lockdowns will have had an impact on mental wellbeing. The effect on mental health of the crisis we are going through is quite immediate, in terms of the fear created by the pandemic, concern about infections and losses suffered – as well as the loneliness and isolation of lockdown. These elements all take a toll. However, I should emphasise that it is not all doom and gloom. Human beings are quite resilient, and many may have risen to the challenge. There are also those who have been released from the helter-skelter of daily life and from the fear of missing out, dubbed FOMO. Many have been able to re-evaluate their lives and step off the ‘hamster wheel’, change their careers and lifestyles to take the pressure off.

This re-examining of the meaning of their lives has enabled some to make long-term changes for the better – and some will have been able to make a contribution to the pandemic cause and found meaning through that. A few studies describe the phenomenon of post-traumatic growth – which I’ve seen first-hand: colleagues who, while pushed to their limit, find they have never felt more vital or fulfilled.

There is also evidence to suggest that ‘suffering together’ can make the journey through difficult times less painful than knowing you are the only one suffering. Knowing that others are in the same dark place can genuinely help minimise the impact felt by an individual. This is why sharing experiences is so important, since it can lessen the feeling of being alone.

Q: How connected do you think mental health is to physical health?

A: As we look at mental health awareness, another question we must ask ourselves is should we be separating mental and physical health? Most people agree that our minds arise out of and are entirely dependent on our bodies. A person is unlikely to feel in good mental health if they are in poor physical health and vice versa.

As we move through and hopefully beyond the pandemic and consider the interventions that are needed to manage the physical health of patients by looking at preventative measures such as vaccines and treatments for the infected, equally we should be aware of and consider the actions that should be taken now to prevent poor mental health and support those riding the ‘Long Covid’ wave.

Q: Can you tell us about the University Mental Health Charter?

A: Universities have an important role to play in sharing learning to guide progress.

University research must ask and answer the hard questions. Universities are also communities subject to their own stresses and challenges. It’s right that universities should be concerned about the health of students and staff. Mentally well students turn into better students. So, we must turn this awareness into action for our students and staff.

I am proud of the work that UCL, particularly the Student Support and Wellbeing group, is doing in this regard. We are going to be in the first wave of applications for a ‘Chartermark’ which will be awarded through the University Mental Health Charter in the UK. The University Mental Health Charter is the ‘brainchild’ of Student Minds and Universities UK and has been piloted but is about to be rolled out more widely. I am delighted to be leading efforts which will be gathering information on all the initiatives we are making to enhance mental health to put in our application. No doubt there will be areas where we need to do even more but highlighting those through the application process is the whole point.

This is our challenge this Mental Health Awareness Week, to turn our awareness of the issues into actions to meet the challenges ahead.

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