Updated: May 23
For many years stigma has existed around mental health; some people have been branded with a ‘mental health’ label and subsequently been subjected to discrimination as a result of derogatory associations.
Thankfully, the tide is turning and awareness of the impact of genetic, environmental, social, financial and lifestyle factors on our mental health, is increasingly recognised. The Prince and Princess of Wales have supported Mental Health Awareness Week for a number of years and in doing so, have helped to raise its profile and encourage an openness and willingness to talk and share.
The World Health Organisation definition of health highlights that ‘health’ requires mental well-being as much as physical well-being. We all need to be mentally healthy. The degree to which we are in good mental health or mental ill health varies between individuals, between different seasons of our lives and depending upon a wide range of factors, some of which are within our control and others which are not.
Understanding more about how we can look after our mental health, needs to be high on the agenda. In 2017 depression was found to be the leading cause of ill health and disability worldwide 2. Although quoted rates of mental illness often vary due to the limitations of population reporting, the trends are consistently on the increase. In the UK, a survey is conducted every seven years looking at population mental health and well being. Publication of the latest survey is awaited, but at the time of the 2014 survey around one in six adults in England were found to have a common mental disorder 3. It is likely the figure is higher, as many people are not included in the survey, including those in prisons or sheltered accommodation.
Given how common mental health disorders are, most people, even if not affected themselves at some point in life, are affected indirectly, through a close contact.
The following questions aim to provide information to give you the confidence needed to support a loved one or to recognise a need for action for yourself. The focus will be on depression, anxiety and stress, as these are most common.
When does feeling depressed or anxious become a disorder?
Life is full of ups and downs. Even those around you who might appear to have it easy, will most likely have their own set of worries or insecurities. Life events, illness, bereavement, job insecurity, financial burdens, moving home and relationships can all rock the boat. Our reactions to such trials vary from person to person. Some will find it comforting to share with loved ones, others would rather not give it air time. Some will shed tears, others might appear unfeeling. Some might shout or seem angry, others might become quieter than normal. Some might experience physical symptoms: heart racing, sweating, numbness, various pains. There is no right or wrong reaction to difficult times in life, we all cope with things in different ways.
Most of the time the strong emotions that we feel are reactive. Something in our lives has led to an emotional response. Take an extreme example, such as the death of a loved one. Most people would be unsurprised to experience in themselves, or witness in someone else, a strong emotional response to this. The type of response, as we’ve already considered, will be variable. It can be the case for some, that they don’t appear to be having what might be deemed a typical emotional response, but instead experience unusual, normally medically unexplainable, physical symptoms. Such is the strong link between our physical and mental wellbeing.
Continuing with this example, in the event of the death of a loved one, how long might you expect to experience this reaction? Well, how long is a piece of string? Again, we are all different. Our relationships differ, the loss for one will be different to another. The bereaved might describe feelings of sadness, frustration, reduced appetite, and not enjoying things as much as usual, all of which are symptoms of depression. They might be experiencing feelings of irritability, being easily tired, struggling to control worries and difficulty sleeping, each of which are symptoms of anxiety.
So, how can we detect when our, or another’s, emotional response is leading to or has become a disorder? Some key questions to help us consider this include:
Are the feelings present most of the day, nearly every day?
Have they been persistent for at least two weeks?
Are the emotions interfering with the ability to do what is needed during the day, eg work, caring for children or eat?
Is there any concern for the safety of anyone?
You do not need to be able to self diagnose or diagnose someone you know. If you feel concerned or answer yes to the above questions, it is always appropriate to seek advice and assessment from a GP or other medical professional.
Going back to our example of the person who is grieving the loss of a loved one. Let’s suppose the answer to the above questions is no. It has been over two weeks since their loss and though the feelings are frequent, there is still some enjoyment in certain things, at various points in the day; they are still able to function and do their job; they’re eating normally and have had no thoughts of wanting to hurt themselves. When symptoms of depression and/or anxiety are being experienced, but you are still able to contend with the day ahead, now is an opportunity to take extra care of your mental health, to prevent any deterioration to the point of disorder.
Stress: performance enhancer or problem?
In the early 20th century, psychologists Robert Yerkes and John Dodson recognised a relationship between pressure and performance; to perform optimally you need a certain amount of pressure4. Without this, there is a risk of boredom, which can lead to under achieving.
Society often encourages us to believe, the busier the better. A lack of sleep, juggling many balls or overdoing it, are often greeted with kudos. But, many have experienced the fine tipping point where peak performance gives way to problematic stress.
The health implications of stress go beyond our mental health, negatively affecting several actions in the body including: muscle function; breathing; heart function; gut function; the nervous system and both male and female reproduction. Stress can trigger an inflammatory response which is believed to be one mechanism behind the development of heart diseases 5.
Burnout is considered an occupational phenomenon which results from chronic workplace stress and is characterised by three dimensions, of which the first, fatigue, has to be present:
Feelings of exhaustion or being depleted of energy
Negative or cynical feelings about work
Feelings of inefficiency 6
Typically, the onset of burnout is gradual and therefore it can be possible to miss the early signs. Someone experiencing burnout might describe feelings of being overstretched, not being able to get enough sleep or finding tasks are taking a huge amount of effort to complete. They might feel disheartened, discontent or disillusioned with work, or unsatisfied with their personal accomplishments. Burnout can also lead to negative thoughts, such as not being suitable for the role or not doing good work 6.
Importantly, when problematic stress or burnout occur, the first step to doing something about it, is recognising there might be a problem, what was helpful pressure, may have become a hindrance. Taking action sooner can result in only needing to make minor adjustments. Missing this opportunity, can lead to the need to make more drastic changes in order to regain equilibrium. A key part of of managing stress is prioritising self care. The other pillars of lifestyle medicine guide us where to start.
How can the other pillars of lifestyle medicine help our mental health?
Until fairly recently evidence of the impact of diet on mental health was merely observational. Yet there is now growing strong evidence (SMILE7 and HELFIMED8) of the positive impact of a healthy diet in the treatment of depression. Both of the mentioned studies found a significant improvement in symptoms of depression in those who ate a healthy diet consisting of more fruit and vegetables, wholegrains, fish, nuts and olive oil (consistent with a mediterranean diet) and less saturated fats, refined (white) carbohydrates and processed foods. You can read more about what a healthy diet looks like here.
A healthy diet also helps to maintain a healthy weight, which reduces the risk of physical health problems, such as diabetes and heart disease, as well as facilitating a positive self body image which, in itself, can impact mental health.
There is strong evidence linking physical activity to improved mental health. A study in the US including over 1.2 million people found that those who exercised had over 40% fewer days of poor mental health compared to those who didn’t exercise 9. The study found that this benefit was seen regardless of the type, or intensity, of exercise. The effect was greatest when people exercised for 45 minutes three to five times a week. Exercise releases feel good endorphins, it energises, it improves sleep, enhances learning and thinking and improves overall wellbeing. The benefits of exercise on mental health are well established, as reflected in the most up to date National Guidelines for managing mental disorders 10.
Despite a long list of physical activity health benefits (both relating to physical and mental health), globally one in four adults do not hit the recommended targets and staggeringly over 80% of the world’s adolescent population are insufficiently physically active 11. It is logical that this is a factor in the rising trends of mental health disorders. You can read more about the recommended amount of exercise to target here.
Difficulty sleeping, early morning wakening and oversleeping are all considered symptoms of mental health disorders. However, there is ongoing research recognising that poor sleep is likely to be a causative factor in mental health disorders 12. Regardless of the chicken or egg debate, sleep and mental health are inextricably linked and therefore optimising sleep to achieve adequate rest, is an important part of caring for our mental wellbeing. You can read about top 10 tips to improve sleep here.
The health risks associated with social isolation have been shown to be more detrimental than smoking 15 a day and obesity; it has even been estimated to reduce someones lifespan by 15 years 13. Specifically, loneliness and social isolation is linked to increased rates of mental health disorders and cognitive decline.
When struggling with mental ill health, for some it becomes easier to avoid social interactions altogether. It can be a natural response, in an attempt to avoid feelings of disappointment, letting others down or being bad company. However, this can lead to a vicious cycle, as feeling alone and unconnected is independently detrimental to our mental health. Nurturing social connections and maintaining a purpose in life is an important part of looking after our mental wellbeing.
Alcohol can be used in an attempt to cope with feelings of depression, but alcohol itself is linked to depression and therefore in the longterm is not going to help 14. In fact, most harmful behaviours are linked to poor mental health, including smoking, drug use, gambling and excessive internet use. When struggling to cope with mental ill health it is best to avoid these things. You can find out more about where to get help here.
If we briefly think back to the earlier example of a person struggling after the death of a loved one, what lifestyle interventions might help? Maintaining social connections will help them to feel supported, regular exercise will release endorphins and improve sleep quality and focusing on the benefits of healthy diet might improve appetite. When struggling with your mental health you can be supported to find specific areas of your lifestyle, that could help you to feel more like yourself.
Can positive psychology help?
All feelings are valid and being able to share and be heard is important. If you’ve ever felt low or anxious and been told to “pull your socks up” or “think positive”, it might have felt frustrating. But, is there something behind positive thinking?
Having a positive psychology doesn't minimise misery or erase life's challenges, but it does have the ability to amplify happiness 15.
There are two key components of positive psychology. Firstly, choosing to have a positive affect, meaning, you strive for contentment with the past, you aim to be happy in the present and have hope for the future. Of course, feeling content with the past is more challenging for some, for example those who have experienced trauma, but we can all aim for this. Secondly, focusing on your individual strengths and virtues. The modern world might suggest strength is success, wealth, fame, beauty or popularity. True individual strengths and virtues include the following:
Knowing your own strengths can boost confidence, reduce stress and build meaning in life. You can discover your own natural strengths by completing a self assessment here.
Having a positive psychology impacts our health directly by affecting physiological processes, leading to emotional well being and disease prevention. Indirectly, a positive psychology encourages us to make healthy choices.
So, how can we achieve a positive psychology in the midst of trials?
Be present. Today you only need to manage what the day has in store. Try not to allow thoughts to run away with you or to think too far into the future.
Be connected. Prioritise having meaningful connections, in person, with others.
Be purpose driven. Having meaning in life helps us to maintain a positive psychology.
Be realistic. Ambition is good, aim to set realistic goals to achieve the sense of satisfaction and fulfilment that comes with success.
If I see my doctor about my mental health, what can I expect?
Often it takes a lot of courage to take the steps needed to discuss your mental health with a doctor. In fact, it’s not uncommon for people to get as far as the consulting room, to only opt out and discuss a minor ailment instead. So, let’s look at what to expect.
First things first, as we’ve discovered, mental ill health is common and so although it feels huge, your doctor will have had many similar conversations and won’t be overwhelmed, whatever you need to say.
Importantly, confidentiality is a fundamental within every patient-doctor consultation. The only time a doctor has to share something you have said, is when someone is at risk. Almost always, everything you say is kept in total confidence, between you and your doctor.
Your doctor should give you the opportunity to explain how you have been feeling. Many people find there is some benefit simply in getting some of these thoughts, that may have been weighing them down, out in the open.
Once you have shared, your doctor is likely to ask you some questions as part of their assessment. You can expect to be asked about your feelings, but also your appetite and other physical symptoms. They might also ask about life at home and /or work. It is likely you will be asked if you have had, or are experiencing any thoughts or ideas of hurting yourself, as this is not uncommon. If you have, they will explore these with you further and ensure you have support available around the clock.
Sometimes, your doctor may ask you to complete a questionnaire asking you to reflect on how you have been feeling over the last two weeks, this might be during your appointment, or to take home. It is a helpful tool to assess your current mental health and to allow comparison during future follow ups.
Your doctor is then likely to discuss different treatment options available, to allow you to make a shared decision on what approach is best for you. The options will depend on the severity of your symptoms and may include: guided self-help focusing on lifestyle, talking therapies, group exercise, mindfulness and meditation and in the case of more severe symptoms, additionally medications7.
Once you have made a plan together, some follow up should be arranged and you should also be given information about how to get help, if and when needed.
Need help now?
If you recognise mental ill health in yourself there is help available. For many, choosing healthy behaviours is a good way to start taking care of your mental health. Simply, think about what you might do to care for yourself, this will look different for each of us but might include:
Taking a relaxing bath
Switching off and reading a book
Making time for exercise
Cooking a healthy meal
Meeting up with a friend
Doing a good deed to help someone else
Spending time in nature
Keeping a gratitude diary
Going to bed early
In crisis? - if you or someone else is in danger, call 999 or go to A&E now.
If you are based in England you can find your local urgent NHS mental health helpline for all ages here.
If you’re worried about the mental health of a child Young Minds offer free and confidential online and telephone support.
A charity called Mental Health Innovations offer a free mental health support service. You can text "SHOUT" to 85258 to be connected to an anonymous volunteer.
You can book an appointment with your local GP.
Sometimes GP appointments can feel rushed. If you would like time to discuss your mental health you can book a One5 Health GP appointment today. Alternatively, for a holistic health check, including mental health review, book a full Well Woman or Well Man check today and gain a lifestyle plan personalised to your results.
Constitution of the World Health Organization (no date) World Health Organization. World Health Organization. Available at: https://www.who.int/about/governance/constitution (Accessed: December 29, 2022).
“Depression: Let's talk" says who, as depression tops list of causes of ill health (no date) World Health Organization. World Health Organization. Available at: https://www.who.int/news/item/30-03-2017--depression-let-s-talk-says-who-as-depression-tops-list-of-causes-of-ill-health (Accessed: December 29, 2022).
Digital, N.H.S. (2016) Adult psychiatric morbidity survey: Mental Health and Wellbeing, England, 2014, GOV.UK. GOV.UK. Available at: https://www.gov.uk/government/statistics/adult-psychiatric-morbidity-survey-mental-health-and-wellbeing-england-2014 (Accessed: December 29, 2022).
Yerkes–Dodson Law (2022) Wikipedia. Wikimedia Foundation. Available at: https://en.wikipedia.org/wiki/Yerkes%E2%80%93Dodson_law (Accessed: January 10, 2023)
Sidossis, L.S. and Kales, S.N. (2022) Textbook of Lifestyle Medicine. Hoboken, NJ, USA: Wiley Blackwell.
Burn-out an "Occupational phenomenon": International Classification of Diseases (2019) World Health Organization. World Health Organization. Available at: https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases (Accessed: January 10, 2023).
Jacka, F.N. et al. (2017) “A randomised controlled trial of dietary improvement for adults with major depression (the ‘smiles’ trial),” BMC Medicine, 15(1). Available at: https://doi.org/10.1186/s12916-017-0791-y.
Parletta, N. et al. (2017) “A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED),” Nutritional Neuroscience, 22(7), pp. 474–487. Available at: https://doi.org/10.1080/1028415x.2017.1411320.
Chekroud, S.R. et al. (2018) “Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: A cross-sectional study,” The Lancet Psychiatry, 5(9), pp. 739–746. Available at: https://doi.org/10.1016/s2215-0366(18)30227-x.
NICE (2022) Recommendations: Depression in adults: Treatment and management: Guidance, NICE. Available at: https://www.nice.org.uk/guidance/ng222/chapter/Recommendations#treatment-for-a-new-episode-of-more-severe-depression (Accessed: December 29, 2022).
Physical activity (2022) World Health Organization. World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/physical-activity (Accessed: December 29, 2022).
Harvey, A.G. et al. (2011) “Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms,” Clinical Psychology Review, 31(2), pp. 225–235. Available at: https://doi.org/10.1016/j.cpr.2010.04.003.
Holt-Lunstad, J. et al. (2015) “Loneliness and social isolation as risk factors for mortality,” Perspectives on Psychological Science, 10(2), pp. 227–237. Available at: https://doi.org/10.1177/1745691614568352.
Awaworyi Churchill, S. and Farrell, L. (2017) “Alcohol and depression: Evidence from the 2014 health survey for england,” Drug and Alcohol Dependence, 180, pp. 86–92. Available at: https://doi.org/10.1016/j.drugalcdep.2017.08.006.
Kelly, J. and Shull, J. (2019) The Lifestyle Medicine Board Review Manual. 2nd edn. Chesterfield: American College of Lifestyle Medicine.
Serenity prayer (2022) Wikipedia. Wikimedia Foundation. Available at: https://en.wikipedia.org/wiki/Serenity_Prayer (Accessed: January 10, 2023).
Bible gateway passage: Proverbs 17:21-23 - new international version (no date) Bible Gateway. Available at: https://www.biblegateway.com/passage/?search=Proverbs+17%3A21-23&version=NIV (Accessed: January 17, 2023