70 years on… no health without mental health

We now have evidence that suggests that nearly two in three of us will experience a mental health problem in the course of our lives. And one in six of us is managing fluctuating levels of distress each week.

If it’s not you, it’s your colleague, sibling or neighbour. This means that mental health problems exist in our lives, families, workplaces and communities, impacting everyone.

Even for the small minority living with high levels of positive mentalhealth, days of low mood or stressful tasks at work or struggles with a change in our circumstances will be familiar. None of us will lead a long life without having felt limited by our mental health at some point, for a shorter or longer period. This is why at the MentalHealth Foundation, we have always believed in nurturing and protecting everyone’s mental health.

Mental health is a personal experience

However, despite these universal statements, it remains a fact that mentalhealth is affected by a range of social and environmental factors that interact with our own susceptibility and family circumstances. This makes the experience of a mental health problem very personal to each of us.

In mental health, perhaps more than in any other area of health, we face the contradiction of being ultimately the experts of our own mental health, but also being limited by our understanding of our own experiences. This can be compounded if we don’t talk about mental health. We may go for years bottling up our emotions and ignoring serious symptoms.

If we belong to a certain community (as defined by our ethnic or socioeconomic background), we – more often than not – may ignore or underestimate the determinants and impact of mental health problems in another community. If we narrowly follow one political narrative and its social take on mentalhealth inequalities, we may systematically forget the factors related to a different one.

How we see our lives

Mental health is a big part of our identity and it affects many of the aspects of our day to day lives: our relationships, our work, our education. We know that kids with mentalhealth problems have worse educational outcomes, adults with high levels of stress are less productive at work and people who are experiencing a mentalhealth problem are more likely to feel or be lonely and isolated.

When it comes to our mental health, we are on a spectrum. It’s not just a simple yes/no diagnosis. Our mood, stress levels, wellbeing and how we act fluctuates depending on the circumstances in our lives. And this is the case even for those who live with a diagnosis of a long term mentalhealth problem. Our wellbeing can move between a point of struggling to a point of thriving. On a fundamental level this personal experience is about our quality of life.

So it makes sense to do as much as we can to protect our mental health. Getting better sleep, practicing mindfulness, drinking less and exercising more are all helpful. Also, crucially, caring and doing things for others is important. Working on our relationships with family, letting go of old grudges, building positive and lasting friendships, reaching out to someone who may be lonely and being altruistic and engaging in acts of kindness and volunteering. If we stay open minded we can move from a very individualistic perspective on mentalhealth to a collective, societal view.

Mental health problems and legal rights

Of course, protecting mentalhealth is not – and should not be – just down to us as individuals. It can be incredibly difficult to work on ways of protecting your mental health if you are in a position of struggling with your wellbeing. For this reason, the Equality Act 2010 – and similar legislation in several countries around the world – includes diagnosed long-term mentalhealth problems as disabilities. In general terms in public health, considering mental illness diagnoses as disabilities has been a fundamental progressive step in giving people certain rights.

In a similarly important milestone, in the mid-1990s, the “Global Burden of Disease” initiative (the most comprehensive effort to record health statistics and identify trends) reframed how it measured the outcome of a health condition beyond the traditional focus of how many people die because of a condition, towards a focus on the years of productive life lost due to disability. This brought a revolution in research. Mental health went from being almost invisible in global public health statistics to topping global surveys on the conditions causing the biggest impact on people’s lives.

The historical marginalisation of mental health though, in terms of how much is being invested in research, understanding and services addressing problems, has been persistent. This is partly why we have decided to focus on prevention. Yes, prevention should sit alongside well resourced clinical services treating people in need. But a focus on prevention is the only way to address the scale of the mentalhealth challenge we face.

How we see our health

To have a better chance of addressing this challenge in our societies, we need to understand an important fact: that the healthier we are mentally, chances are that we will be healthier physically as well. But remember; mental health is a very personal experience.

Similarly, for our “quality of life” we now tend to dig deeper to understand the uniquely personal perceptions that represent the way that individuals feel about their health status. Quality of Life is used as a tool to understand the dimensions of our health status and all such assessments now also contain at least one simple global question about overall health, which allows people to decide for themselves how their health is. In fact, even when a detailed assessment of Quality of Life is thought to be unnecessary, an assessment of overall health status can be an extremely useful gauge of a person’s wellbeing.

However, it is again important to note that these subjective perceptions of wellbeing do not exist in a vacuum, but have a complex relationship with our socioeconomic situation (e.g. our income, savings and quality of housing), our environment (e.g. how safe we feel in our neighbourhood and the mood of our close friends and family), and our physical health (especially our levels of activity, any addictions and our diet).

Physical health and mental health

This relationship between mental and physical health is one of extremely high importance. We know that mental and physical health interact in several direct and indirect ways.

For example, mental health problems sometimes affect our ability to make decisions, which can affect our ability to access good information on our health (e.g. we know smoking and lack of physical activity are more common among people experiencing mentalhealth problems).

Further, mental and physical health interact upon each other via indirect routes, such as employment. Poor mental health may lead to loss of productivity, then loss of wages, hence reducing access to healthier foods. Or stress at work can lead to lack of sleep which has negative physical health results.

Another important route of interaction is through our relationships and social interactions. People experiencing mental health problems are more likely to feel, and indeed be, lonely or socially isolated. Both loneliness and social isolation strongly impact our physical health and have been found to be linked with increased risk of early death.

These relationships in which one health problem increases the risk for another one, in public health, is usually called a mediation factor. Such mediation analyses have revealed that approximately 1 in 20 of all physical health problems we may currently experience, are a direct or indirect result of a past or current mental health problem.

Building good mental health across society

Unfortunately perhaps, when it comes to mental health, there is no single vaccine that can protect us against distress or mentalhealth problems, nor is there the concept of “herd immunity” (i.e. the notion that where there is a sufficiently high proportion of individuals immune to a condition then the whole population is protected).

But if we invest more energy and attention to the fact that mentalhealth is actually a mediator of all good health in a community, then we can make great strides towards applying the education, resilience and policies needed to protect everyone’s mental health.

If we can keep convincingly building the evidence that helps both to protect and to reduce risk for poor mental health, then we can be proud that we will make progress that will be on a par with some of the great advances we have achieved in improving population health.

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