Breaking Taboos

Jane Nathan runs Education4Health, an educational consultancy focussing on mental health. She is a mental health first aid instructor, consultant and trainer for schools, higher education and the corporate sector. Through her work, Jane has helped hundreds of individuals to improve their mental health as well as train many more to help others facing mental illnesses.

I ran a mental health awareness session for a group of sixth form boys at RGS in May 2018 and was interested to discover their thoughts on the subject.

They were asked to complete a short survey and the results were very encouraging:

– Over 80% of the boys thought that mental health issues can be as serious as physical health issues. – 70% thought they knew enough to look after their mental health. – Nearly all respondents knew someone experiencing poor mental health.

I expect if I’d asked these questions ten years ago, we would have seen some very different answers.

The areas of concern for the boys and their peers were depression, anxiety, confidence and self-esteem. This is not at all surprising. From the mid-teens to mid-twenties we see a significant increase in depression and anxiety as well as suicidal thoughts, self-harming and eating disorders. These latter two conditions are more commonly seen in girls and women although it’s by no means exclusive to them. When boys and young men do experience eating disorders, for example – and 10% of those who experience eating disorders are, in fact male – they tend to be very unwell indeed, and this can manifest as early as eight years of age.

Adolescence is the most common time for the first onset of adult mental health conditions and also the time when more severe problems such as psychosis and personality disorders can begin to emerge. However, young adults are also the group who are least likely to recognise they have a problem that might benefit from treatment and men are much less likely to seek help. 50% of mental health problems are established by the age of 14; 75% by the age of 18. This doesn’t mean that if you had the sunniest of childhoods you are immune to mental health problems, but it does show that the foundations of good mental health are laid down early. You can’t go back and change your early years but you can be more aware of your vulnerabilities. And as fathers and grandfathers there is an opportunity to help the next generation coming along.

Mental health problems affect one in ten children and prior to mid-adolescence it manifests itself more commonly as severe behavioural problems, mainly in boys.

There are many key moments across the lifespan when someone may be susceptible to mental health problems. Common causes are: starting a family, changing job, loneliness, money worries, bereavement, long term or severe stress, significant trauma, bullying or abuse.

From school, young adults take their first steps into the wider world. Many RGS students will have gone on to university. From a mental health viewpoint this is good as graduates are known to experience greater wellbeing and mental health than non-graduates. Also, the rate of death by suicide is lower in the university setting than the general population.

However, those who have very high standards, including academic standards, can put themselves under significant pressure, due to perfectionist tendencies. High achievement can therefore come at a significant personal cost.

Being an undergraduate comes with greater challenges than those faced by previous generations. As well as moving away from home for the first time, managing finances and juggling the commitments of study possibly with a part-time job, tuition fees and living costs mean the financial pressures can be a significant burden.

A recent YouGov survey showed that one in four university students are experiencing mental health problems and for them, there is an increased chance of dropping out.

For those that complete their degree there is a greater sense of competition as more graduates vie for graduate jobs. They also begin their working life with unprecedented levels of debt, and financial worries can be a significant contributor to low mood.

A lot of my work is with organisations concerned about mental health in the workplace. Studies such as the StevensonFarmer review and the supporting work carried out by Deloitte have highlighted the cost to business and government by employees being mentally unwell.

It’s thought that 91 million working days are lost each year to mental health conditions at a cost of up to £41bn. It’s not surprising that organisations are sitting up and taking notice. Those organisations who are sufficiently far sighted to invest in a wellbeing strategy find that the return on investment can be as high as £9.98 for each pound spent on such training.

For many adults, the challenges are going to be conditions such as stress and depression. If you have an understanding employer who is putting mental health support in place, the good news is that poor mental health is often preventable and, in many cases, recovery is achievable.

From an employer’s perspective around 15% of people at work have symptoms of an existing mental health condition. This has significant effects on performance, including profitability.

To quote Sir Simon Wessely, past President of The Royal College of Psychiatrists, “You own it!”, meaning that employers can create a positive and supportive workplace culture themselves, free from stigma.

Sources of help for boys and men:

Campaign Against Living Miserably. thecalmzone.net

hello@Ed4Health.co.uk - Ed4Health.co.uk

This autumn the prime minister appointed the first minister for suicide prevention. This is a positive step as the topic needs to be discussed and addressed.

Later in life, just when you think you might put your worries behind you, you may find yourself struggling with anxiety and depression. It affects 22% of men over 65 years old.

Whatever your age, there are steps you can take to improve your mental health. First is to prioritise it as you would your physical health. Learn to recognise the signs of illness, ensure you get enough sleep, get some exercise, eat well and drink in moderation, limit screen time and learn to talk about your feelings – even if it feels awkward at first.

As we look across society, the scale of the problem is immense. However, if the next generation is as informed as those sixth formers I met with, I’m hopeful that the barriers of limited awareness and stigma will, in time, be broken down. ■

What I Wish I’d Known

Andrew Wells OG 2004

I wish I’d known that depression is an illness of perspective. That it could make me feel like I was a useless failure and that everything was hopeless. That I would stop enjoying the things I’d always loved. That I would feel so numb and detached from everything around me that sometimes it would feel like watching my own life go by from the other side of a glass wall. That it could leave me wondering who I was on some days. That it could make me believe that things would never get better.

I wish I’d known that depression is an illness with physical symptoms. The loss of appetite. The exhaustion. The insomnia. The insomnia-induced exhaustion. The exhaustion-induced insomnia. The inability to move quickly or, some days, much at all. The physical challenge of just getting up the stairs to bed some nights. The physical challenge of just getting out of bed some mornings.

I wish I’d known that depression is an illness with emotional symptoms. That it could make me feel overwhelmed, sometimes by the smallest things that previously I’d never even have thought twice about. That it could leave me feeling lonely in a crowded room. That it could make me cry when I got home, day after day some weeks. That it could simultaneously leave me feeling terrible but also make me mask my symptoms in company. That it could make me feel frustrated, irritable and short-tempered when I didn’t want to.

I wish I’d known that anxiety could hit me with no notice. The feeling of not belonging. The feeling of needing to escape from any social situation. The fear of missing out when I didn’t go to social events. The feeling that nobody would ever involve me in anything again. The thudding heart. The hot flushed feeling. The tingling sensation in my legs. The pain in my arms. The faint feeling. The fear of the faint feeling. The spooling, spiralling thoughts worrying about anything and everything for hours on end (and often at 3.20am).

I wish I’d known that depression and anxiety are really common. That while everybody’s experience of these illnesses is different, there are also wellestablished ways to treat them. That there is lots of information out there on where and how you can get support. That there are great organisations like Mind, the Blurt Foundation and the Samaritans (to name just a few) with really helpful websites. That there are books like Reasons to Stay Alive by Matt Haig and I Had a Black Dog by Matthew Johnstone that could help me to realise that I wasn’t the only one struggling with these illnesses. That J K Rowling’s writing about the dementors in the Harry Potter books would describe depression better than I ever could when I was struggling to explain it to other people.

I wish I’d known that getting help isn’t a sign of weakness. That the scary step of arranging to see a psychologist for talking therapy would turn out to be one of the best things I did. That going onto antidepressants didn’t mean I was a failure. That there were other things I could do that (sometimes) helped things seem a little bit better: mindfulness, fresh air, exercise, gardening, music, colouring, surrounding my desk in ever more pot plants.

I wish I’d known that asking for help from work didn’t mean they would think I was a write-off. That they would be understanding and supportive. That reducing my working hours for a while to give me a bit of extra breathing space and ‘me time’ didn’t mean that I wouldn’t be capable of going back to full time work ever again. That it’s not the end of the world if you get so overwhelmed you cry in your boss’s office. That being ill didn’t mean that I would have to stop being a lawyer. That once I opened up about anxiety and depression, I’d find out that there were many other people in the same boat that I’d never have guessed were struggling.

I wish I’d known that gradually, with therapy, medication, time and a lot of support from family, friends and colleagues, I would start to feel better. That progress would sometimes feel exhausting and impossible, but that it was real and it was worth it. That things would be up and down for a long while, but that the ups would start to outnumber the downs. That I would learn to manage the downs and that the downward spirals would get shorter and easier to spot coming. That I would be able to sleep through the night again. That my friendships would survive. That I would start to enjoy things again.

I wish I’d known that you probably can’t ‘fix’ someone who is unwell and you probably shouldn’t try – just being there for them and with them might be what they really need. That asking someone ‘how are you?’ and really listening to the answer might be the most important thing we can do for someone who is struggling. That when we ask ‘how are you?’ we are really saying ‘I care about you’ and ‘I am still your friend’ and ‘I don’t think you are a freak.’ ■