Community Reporters have been producing stories for a number of years on issue to do with Mental Health and Well Being. This feature aims to compare and contrast the wider views on mental health and wellbeing with the stories produced by Community Reporters. What are local communities and individuals saying about mental health and wellbeing? Where do their concerns lie and what are they doing to tackle the problems they face? Links to the stories highlighted in the report can be found at the end.
Just as we all have physical health, all of us have mental health, and both change throughout our lives. Like our bodies, our minds too can become unwell. One in four of us will be affected by mental illness in any year1, and the World Health Organisation (WHO) forecasts that by 2020, depression could be the second leading contributor to the global burden of disease2. Despite its prevalence, mental health still suffers from a major image problem. More than 40% of countries worldwide have no mental health policy, and across the board it appears we have little idea of how to talk about mental ill health respectfully and responsibly.3
Listening to the voice of communities allows us to become aware of the cultural differences that exist within paradigms such as mental ill health. Despite definitions by mental health authorities, daily understandings of and methods of coping with mental ill health will not be constant across cultures and societies. Causes for mental ill health can be attributed to a range of different sources, just as methods for curing sickness will differ depending on an individual’s worldview, and can include anything from medication to shamanism. It is important we remain mindful of these differences when we discuss mental health since this awareness emphasises how definitions do not move smoothly across all people and places.
2. Awareness, Stigma and Medical Services
The World Health Organisation defines mental health as:
[T]he emotional and spiritual resilience which allows us to enjoy life and survive pain, disappointment and sadness.4
Su from Leeds Wellbeing describes how ‘most of us probably know that remaining well is cyclic, like the seasons, not linear.’5 When it comes to mental health, it is not a straightforward case of being well or being unwell. Mental health lies on a continuum that shifts and changes; one that we are all navigating on a daily basis.
Fig. 1 – The Mental Health Continuum
Mental health problems are common, but nearly nine out of ten people who experience them say they face stigma and discrimination as a result. This can be even worse than the symptoms themselves. The attitudes people have towards those with mental health problems means it is harder for people to work and make friends. People can become isolated, excluded from everyday activities, and can become reluctant to seek help, making recovery slower and more difficult6. Stigma and discrimination are perhaps the two biggest obstacles to a productive dialogue about mental health.
This is something not helped by depictions of mental health issues in the media. Time-to-change.org have reported that 63% of references to mental health in TV soaps and drama were ‘pejorative, flippant or unsympathetic’, with terms used including: ‘crackpot’, ‘a sad little psycho’ and ‘basket case’7. The problem seems largely to be one of communication – how do we talk about mental health?
Action is already being taken by two charities, Rethink Mental Illness and Mind who are leading on England’s biggest programme to challenge mental health stigma and discrimination, ‘Time to Change’. It helps to raise awareness, crucial in ending discrimination since often stigma is a result of people misunderstanding what it means to have a mental illness. Time to Change aims to banish myths of mental illness by presenting the facts. For example:
- Myth: I don’t know anyone with a mental illness.
- Fact: Someone you know or love has experienced a mental illness and talking to you would help.8
Many people are not well informed, and understanding how to recognise mental health problems and effective treatments available needs to be more widespread. Leeds Wellbeing Web reports on the Time to Change Experience coming to Leeds. It took the form of a pop-up space where people could learn the truth about mental health in an engaging and fun way. Time to Change volunteers challenged stereotypes of mental ill health by talking to the public about their lived experiences of mental health problems. In addition to this it highlighted small, everyday things individuals could do to support those they care for who may be suffering.9
Time to Talk Day is also taking place across the country, and World Mental Health Day lands on 10th October. It is a day that aims to involve global education, awareness and advocacy for mental health issues10. This is important in itself, but is perhaps of particular significance for men who suffer with mental ill health. My Time CIC, based in Birmingham, made a film called ‘Talking Men’ to highlight the problems faced by men who suffer from mental health issues and depression11. It presents us with a series of facts, such as:
- The stigma associated with mental health problems is strongly felt by men. Often the only solution in a man’s head is to take his own life.
- Men are less likely to go to their GP or see a counsellor and are more likely to let problems escalate before they seek help.
- Men are four times more likely to commit suicide than women.
- One in seven men will develop depression within 6 months of unemployment.
The stigmatising effects of mental health issues can be crippling, and talking about it can be the first important (albeit difficult) step towards raising awareness. Leeds Wellbeing reported on Labour MP Kevan Jones speaking out about his depression in a Commons debate in June 2012 on mental health. He said: “Like a lot of men, you try and deal with it yourself. You don’t talk to people.12”
The ‘Talking Men’ film features also service users of My Time giving accounts of their experiences, as well as asking what we can do to support men with a mental illness.
Here are some of the points they raised:
Fig. 2 – ‘Talking Men’ by My Time CIC
They point out that all GPs are part of a National Programme called IAPT (Improve Access to Psychological Therapies) which supports the frontline NHS in implementing National Institute for Health and Clinical Excellence guidelines for people suffering from depression and anxiety disorders. What is apparent is that more education needs to come out of mental health services13.
Many service users avoid traditional medical services due to negative experiences. One individual describes how he no longer trusts the medical profession since he was forced to take medication. Although in the UK doctors may be prescribing less anti-depressants and conducting more referrals to psychologists or counsellors, tablet medication is still seen by many as the main solution14. A Community Reporter posted arguing for the abolishing of the schizophrenic label since the terminology and ‘treatment’ are both inadequate. The individual writes:
‘My view is that there was, and still is, something fundamentally wrong with psychiatry and its rigid adherence to the medical model with its heavy drugging, damaging treatment and the claims that the schizophrenia label has a scientific basis.15’
Another reporter has expressed the danger of labels and the inability for those labelled to question the theory behind the ‘mystifying terms’. Often, unwillingness to accept labels can be assessed by medical practitioners as ‘your problem’, and this imbalance of power is often damaging to service users 16. Su describes how she too finds biochemical explanations for mental illness to be inadequate, since ‘they don’t ring true to my experience or to those of other people of my acquaintance so labelled’17. In another report she describes how she believes that one of the biggest factors in her remaining reasonably well is to actually have rejected her diagnosis, and to take an active part in negotiating the treatment she receives 18. This sense of empowerment is something described as lacking in mental health services, and particularly with regard to services for minority groups, as described by Henri19.
Overall, many services are not meeting the needs of their patients successfully. People can be reluctant to go to hospital in the first place, but their impression is worsened when it is difficult for them to access services or when institutions do not keep to timed appointments. John Wharton, a district nurse coordinator, speaks about his work in Warrington and comments on the importance of asking service users to evaluate their services as a way to improve them. The patient perspective is crucial, ensuring that the medical profession sees them as individuals and acknowledges their individual journey20.
3. Wellbeing and the Community
Laura B describes how good mental wellbeing is about much more than whether or not you have a mental health problem. She emphasises the importance of ‘feeling good’ and ‘functioning well’, something some people may refer to as ‘happiness’. Although there is no foolproof method of attaining this, Laura B does highlight evidence-based steps that individuals can take to improve and maintain their mental wellbeing:
- Being active
- Mixing with other people
- Learning new skills
- Being aware of yourself and the world
- Giving – doing things for others21
A focus on being active is something also emphasised by Leeds Wellbeing, who reported on the launch of ‘Leeds, Let’s Get Active’ – an initiative aimed at people who may not do much physical activity, enabling them to use Leeds City Council leisure centres for free22.
‘Being aware of yourself and the world’ is something that can also be referred to as mindfulness. Vicky from Leeds Wellbeing also describes how for her, mindfulness involves living in the present – and mindfulness practice helps her achieve this 23. Many Community Reporters have reflected on the importance of being mindful, or of having the time for introspection. Leeds Wellbeing report on a member of the community, Milan, who is a Buddhist practitioner and owns his own allotment. He says his allotment is:
‘therapeutic, good for anxiety and a good kind of contemplation or introspection. I call it environ-mental gardening24.
Judy Turley, Secretary of Leeds and District Allotment Gardeners Federation, shares Milan’s enthusiasm for allotment gardening, describing it as ‘an oasis in the middle of a busy city’. Allotments are not only good for one’s own wellbeing, but they open up the potential for connection with members of the community; individuals can share plots, distribute goods amongst community groups and socialise amidst gardening.
Moreover, being outdoors in itself is crucial to wellbeing. Leeds Wellbeing have reported research by the University of Essex which shows that ‘exercising outdoors boosts people’s physical and mental health more than going to indoor gyms, even in winter’25. In the same report they describe how The National Trust have also written about exercising outdoors, claiming that ‘just five minutes in the outdoor gym every day can lead to improvements in mood and self-esteem, as well as physical fitness’. They argue the benefits of exercising outdoors are manifold, including:
- Burning up to 20% more calories
- Working harder and improving balance on uneven surfaces
- Vitamin D boost for healthy bones
In his film, ‘All Walks of Life’, community reporter toxthetcr speaks to the service users of a walking group in the North West run by Shap. They describe its benefits as not only including the effects of the environment—the fresh air, exercise and the scenery—but also its social benefits of affording the opportunity to get out of the house, meet new people and socialise26.
Many stories from the Institute of Community Reporters emphasise the importance of community towards one’s wellbeing, particularly in terms of offering support, places to socialise and opportunities to learn new skills. ‘Chat N’ Create’ is a Leeds-based arts group who encourage learning outside of formal educational institutions. milangardening describes how the group has an equal opportunities ethic, is open to everyone and works on a ‘friendly, human scale’27. It allows attendees to participate in creating art for the community and for themselves, as well as offering a confidential counselling service, on-site childcare and learning support. One of the attendees has described the group as providing her with ‘company, creativity and pleasure’.
There is a considerable evidence base, both from the UK and internationally, that demonstrates the benefits of using the arts in health. ‘Arts in Health’ by Dr. R. Staricoff (2004) provided evidence that the arts “can help reduce heart-rate, blood pressure and requests for analgesic medication”28. Places such as Start in Salford are excellent places for people to meet others and engage in creative activities, as reported by kevin29. In all the examples given by the community reporters, the benefits of attending community arts groups are described as threefold: it develops skills, offers the opportunity to socialise and meet like-minded people, and it develops confidence. These benefits are highlighted in kevin’s report about community-focused services, as well as in ges27’s report ‘Singing My Way Well’:
‘Joining a choir is one of the best things I have done for my wellbeing, because I get to sing great, uplifting songs, and get to meet like-minded people.’30
A report on a group named ‘Eccles Forever Young’ by Dennis Parr describes many members noticing a change in confidence31. This group focuses on getting the community to meet together on a regular basis ‘to chat and relax over a cuppa but most importantly have FUN’. A group named ‘Wythenshawe Good Neighbours’ (WGN) is another example of a funded, volunteer-led initiative that works towards helping the community—this time with a focus on reducing the impact of isolation and loneliness amongst the elderly community in Wythenshawe32.
An interview with NHS workers who have experience as health visitors emphasises how residents should be supported to be a part of the solution rather than being thought of as the problem. Hazel Stuteley, a health visitor based in Falmouth, Cornwall, describes setting up the local Beacon Project to counter the lack of a forum for residents to give their opinion. This created the enabling conditions for the community, connecting them with local authorities and essentially empowering them by both giving them a voice and listening to them.33
Being aware of the needs of the local community can lead to all sorts of positive change. One recent example is the construction of Barton Hub in Salford34.
Fig. 3 – Barton Hub, Salford
Barton Hub was built as part of City West Housing Trust’s regeneration project at Barton Village in Eccles, where many of the residents are of non-working ages. It is designed to strengthen community links and improve wellbeing since it will provide a focal point for the community – somewhere where they can go to meet for a coffee, attend a local event and receive support and advice, all under one roof35.
Community Reporter mattbell has drawn attention to another project in Salford that focuses on the community being empowered to make change:
‘Salford is unwell. Roughly 4 people per day in this city will die from preventable diseases. So what do we do about it? Well, Salford Healthy Communities Collaborative believe that the way to change peoples lifestyles is by the community itself making the change and raising awareness36.’
The aim of the Salford HCC is to create local teams of volunteers to help raise awareness of cancer and heart disease specifically. The role of volunteers is something that warrants focusing on because it appears as a key point amidst many of the stories of successful community groups.
4. Volunteering and Self-Advocacy
Dennis Parr reports on how some 4.9 million people over 65 years of age do voluntary work in the UK. 37,000 of these are in Salford completing 137,000 hours of work each week37. 37 Volunteers undoubtedly contribute significantly to communities but, importantly, voluntary work is of benefit to the volunteers themselves. Kimb085 describes the benefits of volunteering as being threefold through benefiting the organisation/company, the community and the volunteers themselves. It allows the volunteer to ‘gain experience, keep busy in a meaningful and productive way, build self-esteem, [...] to meet new friends, [...] to learn about an industry and gain skills’38.
When, in another report, volunteers themselves were asked about what they get out of volunteering, their responses echoed those of Kimb085. Gaining experience was referenced—perhaps getting to do courses via volunteering—and many referred to a sense of achievement or improvement in confidence, alongside the chance to use the skills one already has to benefit other people. Gary Cooper of the Spruce Court Residents’ Association says, ‘Even though I’m retired, it doesn’t mean I’m useless. I can still use my skills’, where another volunteer describes how volunteering, ‘Gives me a sense of achievement, confidence, which I was beginning to have lost’39.
The image below depicts a word cloud of some of their responses:
Fig. 4 – What I Get Out of Volunteering
Community groups involving volunteers are often valuable because of the opportunity for self-advocacy. Self-advocacy is a powerful tool in mental health services because it reaches out to people who are going through similar experiences as well as the general public. aarOnn leads the Ayrshire Support Group and describes that sometimes when someone has questions and wants reliable information, they just need to be able to talk to someone who understands what they’re going through because they themselves have gone through it too 40. One of the members of this support group has said:
‘It was such a relief to share my thoughts with other people who knew where I was coming from and to talk to people that were further down the line so I knew what to expect. It was a big help in my recovery.’41
Vicky describes how although initially hesitant about attending a support group, she has found it incredibly beneficial. She emphasises that this was primarily because the facilitators all have personal experience of mental ill health. She felt that there was no judgement and no ‘us and them’ environment, and has been able to gain a lot of insight from other people’s personal experiences.42
Undoubtedly peer support workers, paid or unpaid, are beneficial to recovery since they are ‘experts by experience’ and counterweigh the inherent power balance in some client/professional relationships. Leeds Wellbeing emphasise that if these support workers are to be truly valued, they should receive adequate personal and practical support, including training 43. Sue Hinder, who runs a Carers Support Service, raises a similar point. She emphasises that a lot of carers get stressed in their roles and so it is important that adequate support for them is provided—which could be something as simple as providing complementary relaxation therapies to give them time away from their duties.44
The Department of Health is committed to improving health in England and addressing barriers that create inequalities in health. Areas that the public have identified as important include:
- Greater emphasis on general wellbeing
- More information and support
- Easier access to services45
These areas for improvement appear to be echoed by stories from the Institute of Community Reporters. Other key points raised by the report include the impact of stigma and lack of awareness about mental health issues, and the invaluable contribution of community groups and volunteers to wellbeing and recovery.
Gaps in the report that could benefit from further research include the following:
- The link between mental ill health and suicide – none of the stories explored this but according to the National Institute for Mental Health (NIMH), 90% of people who die by suicide have depression or other mental disorders. ‘Just as the association between mental illness and crime is too strong, the connection between mental illness and suicide is too weak.46’ Of course it is extremely important and perhaps much easier to focus on wellness and the success of community groups, but the link between mental illness and suicide is prevalent and should be emphasised in order to assist those who may be suffering—sometimes just knowing that other people have these thoughts can be the starting point to recovery.
- Distinguishing between types of mental ill health – no two kinds of mental ill health are the same and knowing how to cope with depression will be in many ways incomparable to knowing how to cope with an eating disorder, as an example. There are as yet no community reports on specific mental illnesses, a consideration that could prove beneficial.
- Mental Health First Aid
- Thu-Huong Ha (2013)
- Mental Health First Aid
- Mental Health First Aid
- Time to Change website
- Mental Health First Aid
- Mental Health First Aid
- Thu-Huong Ha
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