The Trick To Life...

...“is not to get too attached to it…”, so the song goes.  (For those who don’t know, it’s the title track from The Hoosiers’ first album).  But that’s not exactly what this post is about (I like to think my style is a little less morbid than that!).  Sadly, I don’t think there is really a ‘trick to life’; I’m pretty sure if there was one, we'd all be using it by now!  Please let me know if you have any bright ideas though…!

So, why have I called this post The Trick To Life?  Well, I think one way to do pretty well in life is to be a well-rounded person.  This may sound a bit clichéd and obvious, but bear with me!  I think one of the tricks society needs to learn to better use to help people do this is good, well-rounded education.  If you’ve read my previous posts, you’ll already know about my views on how mental health should be incorporated into education.  If you haven’t, then I refer you to my post titled Staring at the Sun.  Although mental health is extremely important, it’s not the only thing that I feel strongly about in terms of education.

What made me decide to write about this today was something I read in my local Youth Parliament manifesto.  One of their notions is that “all young people ages 11-18 should be taught basic politics at school”.  I completely agree:  I for one was barely taught a single thing about politics at school, and the outcome is not good.  It’s embarrassing when it comes to election time or some such event and one simply doesn’t know anything about politics!  And how can a young person be expected to make a reasoned judgement when voting  if they don’t know what the key differences are between the parties?  It seems kind of irresponsible to give people the right to vote without giving them the tools they need to vote wisely (tihs seems an appropriate time to mention a dear friend of mine who votes Labour because their colour is red and he adores Arsenal FC!  He was half joking, I hope!).

It’s not just politics that I believe is severely neglected by the education system.  In my discussions about mental health I’ve already expressed my passion for psychological wellbeing, and another hugely important element of that is body image.  I could go on about this all day and will no doubt be writing about it in more detail in later posts.  But in short I think schools have the potential to do massive amounts to help diminish what experts in the field have called a ‘culture of body dissatisfaction’.  Fortunately awareness of this problem is on the up and there are things being done, but there’s still a lot of work to do.

 

 This weaves back in nicely with my post about mental health awareness.  One of the key things I think could be done to improve emotional wellbeing in general is encouragement of exercise (and not just traditional team sports like netball, football and hockey, but more varied activities to really get lots of young people involved). Not only could this help to prevent illnesses such as depression, but it could also help to alleviate negative body image.  Exercising can help you to feel healthy and maintain a healthy body weight without the need for strict dieting.  I have a lot more to say about this, but I think I’ll save it for another day, so please look out for further posts if this interests you!

All in all, I feel that schools should be doing more to encourage wellbeing and life skills as well as academic success.  I understand that there is already a struggle to fit everything into the National Curriculum, and I agree that the academic side is very important, but I can’t help but think that the value of being academically brilliant is hugely decreased if the person has difficulties in other aspect of their life.  I’d like to hear about other people’s thoughts on this, and will leave you with the question of what sorts of things you believe are really important in education.  Debate, discussion and views contrary to my own are welcome!  As always, thanks for reading :)

Give Me Novocaine

Firstly, apologies for this being a couple of days late.  So far I’ve managed to be posting consistently every other Thursday but just didn’t have enough time to write this on Thursday!  Anyway, as always I hope you find this to be a good read…

This post is actually a response to a comment someone made about my previous post, which discussed raising awareness of, and the possible prevention of, mental health problems.  In relation to when people develop mental health problems, this person asked me “It seems that cocktails of pills seem to be the answer to a lot of mental problems, what are your views on that?”  So, I decided to put together a little post about my views on that, and in the process of doing this explain a little bit about the current guidelines for treating mental health problems.  The title Give Me Novocaine comes from a Green Day song with the same title; obviously novocaine isn’t a drug that is used to treat mental health problems, but the song seems to allude to the notion of just taking pills to make everything better, whereas this isn’t always going to work.  Also, I love Green Day and it’s a great song so why not use it?! 

In answer to the question - what do I think about the use of drugs to treat mental illnesses? - my simple answer is that drugs can be necessary but should not be the first port of call in all cases of mental health problems.  Some illnesses (e.g.: psychotic ones) are more likely to warrant the use of medication.  What I find concerning is GPs’ propensity to administer anti-depressant medication willy-nilly.  (As you may have already noticed in previous posts, I will tend to use the example of depression, firstly because it is the main thing I have a knowledge base in and secondly because it’s such a common illness that needs addressing.)  

My view on this comes from the National Institute for Health and Clinical Excellence (or, aptly abbreviated, NICE) guidelines.  These are formed on the basis of evidence, which basically means that NICE only recommends therapies that evidence suggests are effective.  In terms of common mental health disorders, NICE recommends that a stepped care model should be used (NICE, 2012).  This essentially means that the ‘least intrusive, most effective’ intervention should be provided first.  In other words, if, for instance, a person has mild depression, they will be treated accordingly for this; similarly, a person experiencing severe depression will be treated accordingly for the severity of the problem (see the stepped care image below, from IAPT Programme, 2012).  

  

IAPT stands for Improving Access to Psychological Therapies and is another key element of the NICE guidelines on treating mental health disorders.  By using the stepped care model, we are using resources more efficiently, which means more people can be treated.  In turn, this means that people don’t have to wait so long to be treated.  Let’s take the example of depression: for mild depression, cCBT (computerised Cognitive Behavioural Therapy) and guided self-help are recommended.  This means the patient uses resources at home and has periodical guidance from a professional such as a PWP (Psychological Wellbeing Practitioner).  These are known as low-intensity therapies and are less intrusive for the individual and free up more of the professionals’ time, meaning more people can be treated at once.  For moderate to servere depression, on the other hand, high-intensity therapy is recommended.  This could be in the form of face-to-face CBT.  

 

The important thing to remember here is that these guidelines are all based on the evidence relating to treatment for mental health disorders, which I why I tend to agree with them.  For example, CBT, IPT (Interpersonal Psychotherapy) and BA (Behavioural Activation), all therapies recommended by NICE for depression, have been found to be as effective in treating depression as antidepressant medication (e.g.: Hougaard & Jørgensen, 2007).  These treatments have also been shown to be more effective than medication in prevention depression relapse (Dobson et al., 2008).  Hence, my view that a cocktail of pills is not the answer to mental health problems!

Don’t get me wrong though; I don’t condemn the use of medication altogether.  In depression for example, the severity could be so high that the patient simply won’t be able to engage in CBT or BA.  In these cases, antidepressant medication can be really useful in making the patient feel more able to engage in these.  The guidelines also recommend medication for patients who have not responded to other therapies.   

Another important consideration though is the fact that antidepressant drugs have a slightly delayed effect on cognition (thoughts) compared to behaviour.  As a result, a person who is feeling suicidal may find themselves feeling more able to act on their thoughts before these types of thoughts start to subside or change.  Hence, very careful consideration should be given before prescribing medication to treat depression. 

So, to summarise, my most basic answer to the question “should drugs be used to treat mental health disorders?” is yes, where the evidence base suggests this is effective.  In terms of depression, I think drugs should only be used where this is necessary due to the severity of the illness or non-responsiveness to other, less intrusive therapies.  I think one of the problems is that anyone who is medically qualified (e.g.: GPs) can prescribe anti-depressant medication, even if they do not have specialised knowledge in this area.  Therefore, GPs seem too often to prescribe drugs when a patient presents with mild depression, when they should be referring them into the IAPT service.  This need to change!

As always, thank you for reading and I would be interested to hear about other people’s views on this so please do leave a comment.  Also feel free to suggest a topic for my next post and I’ll see what I can do!  See you in two weeks…

References:

Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J. … Jacobson, N. S.  (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76, 468-477.

Hougaard E. and Jørgensen, M. B. (2007). [Psychological treatment of depression.]. Ugeskr Laeger, 169, 1444-7.

IAPT Programme (2012). Services. Retrieved from  http://www.iapt.nhs.uk/services/services/

NICE (2012). http://publications.nice.org.uk/common-mental-health-disorders-cg123/key-priorities-for-implementation. Common mental health disorders: Identification and pathways to care. Retrieved from http://publications.nice.org.uk/common-mental-health-disorders-cg123/key-priorities-for-implementationhttp://publications.nice.org.uk/common-mental-health-disorders-cg123/key-priorities-for-implementation

Staring at the Sun

So as usual I’ll start with a quick explanation of my title -  Staring at the Sun is a song by Rooster, which (I think!) is about losing out or getting hurt due to being ‘blinded’ by someone – “I’m tired of staring at the sun; can’t stand the way you burn my eyes so I can’t see… You took everything, while I was staring at the sun”.  Anyway, I think it’s quite a clever little lyric and is relevant to today’s blog post, which is partially about society being blinded to certain things.  It also, I realise as I write, gives me a good excuse to sneak in a little picture that captures the literal blinding sunlight phenomenon, which I took on a beach in Ireland a couple of years ago!  Hope you like it.

Anyway, I digress!  The inspiration for this post comes from a recent Mayor’s Debate with Young People in my local area, which I was reading the report for last night (yes that’s right; I read reports about Mayor’s debates in my spare time!).  There were three motions passed that evening, one of which related to mental health and wellbeing in young people.  Specifically ‘there should be more effective and integrated mental health services for young people and their families’.  According to the report, the person supporting this motion drew listeners’ attention to a lack of mental health services tailored directly at young people, to the mental health problems caused by the pressures of growing up on today’s society, and to an overlooking of these as a result of adolescence being viewed as a carefree time.  The opposition, on the other hand, noted that there are already good, well integrated services for young people, but that in fact there should be more investment in health, exercise, youth clubs and general wellbeing for young people.

Now, I’m all for improving mental health services and there do need to be services specifically for young people, but I’m inclined to agree with the latter approach.  We need to invest in preventative strategies to help stop young people developing mental health problems in the first place.  If you haven’t already, by the way, this would be a good time to take a look at my previous post, which is all about simple ways to improve wellbeing and mood.  And from first-hand experience, they really work.  If we can get young people engaging in exercise, in positive social experiences, in healthy eating (NOT dieting!), then I strongly believe we can get young people out of mental health problems.  And in fact I think these strategies would also help to treat the symptoms for some people that have already developed mental health problems, such as mild depression.  As noted in my previous post, evidence suggests that simply doing things is an effective treatment for depression.  Furthermore, using this approach will help young people to avoid the stigma associated with getting therapy or taking medication.  That said, it is also important that we work towards reducing and ultimately eliminating the stigma associated with mental illness.

This brings me nicely on to my next point, which is that in my view there is an urgent need to increase the awareness of mental health problems in society.  This is really where the title for this post becomes relevant, because I feel that society is largely blind to mental health and mental illness.  Ok, so that is a somewhat bold and exaggerated statement, but some serious work needs to be done to open people’s eyes to it.  How many of you were taught about mental health at school?  I would be interested to hear from you if you did, as I certainly didn’t.  Well, I did, but only because I chose to study psychology at A level.  By the way, I’ll just mention that I like to refer to mental health as well as mental illness, because it’s important to see it as a positive thing and not just an uncomfortable topic to avoid. 

Anyway, I think it should be a requirement that mental health and illness is taught to people from a fairly young age, just as physical health and illness are taught in science, P.E., PSHE.  Depression is just as much an illness as cancer, so why shouldn’t people have an awareness that it exists, what it is and how it might be treated?  Please correct me if I’ve got the wrong end of the stick here but as far as I can see, schools aren’t really teaching this sort of thing in this country.  It doesn’t even seem to be on the education agenda; I did a search on the TES website last night to find that the last mention of mental health in any of their publications was July 2011 – nearly a year ago!  I’m kind of incredulous that it’s not being talked about more to be honest.  I also read in a publication by YoungMinds that “The Ofsted report on PSHE (2010) found that mental health and emotional wellbeing is a neglected aspect of the curriculum”.  By the way, I’ve included a link to this report at the end of the post so feel free to take a look for more detail.

I strongly believe that simply raising awareness of mental health and mental health provision can go a long way towards preventing mental illness and making treatment of it more efficient.  Yes, we need effective mental health treatment provision, but what use is it if people do not know it’s there?  And what use is knowing it’s there if people don’t recognise the symptoms and therefore don’t know when they or someone they know is experiencing mental illness?  If we simply start helping young people to develop some kind of knowledge base in this field, then we can better equip them to recognise when there is a problem, in some cases to take steps to prevent the problem becoming more severe, and to know when, where and how to seek help.  Further, if mental health and illness becomes part of the syllabus that young people are taught, just as physical and sexual health and illness are, it will become a less uncomfortable topic, more widely understood, and the stigma surrounding it will be reduced (the YoungMinds report I mentioned earlier provides some evidence to support this notion).  More importantly, I really do believe that an increase in awareness would better enable people to take steps to avoid mental health problems developing in the first place or becoming more severe.

So, to summarise, it is my view that mental health should be a compulsory topic in PSHE education and that work needs to be done to increase awareness of mental health and illness in society from a young age.  It is also important to improve provision of strategies such as exercise and general wellbeing, in order to prevent mental illness and decrease the prevalence of this, not just in young people but in society as a whole.  I would be interested to hear about other people’s opinions on this so please do leave a comment if you have any thoughts.  

As always, I’d like to say thank you for taking the time to visit my page and read my blog.  I hope you’ll agree that this is an extremely important issue that impacts on the whole of society and so I’d really appreciate it if you could share this and ask others to share it to really get the message out there.  Thanks again and please do come back in two weeks for my next instalment! 

Links:

http://www.youngminds.org.uk/assets/0000/1410/YoungMinds_response_to_the_PSHE_Review.pdf 

You Could Be Happy

Ok, so as usual I’ll start by explaining the title of my blog: basically, now that I’ve started using song titles & lyrics as blog post names, I’ve set myself an irresistible challenge of naming every post in this fashion!  For those of you who don’t know, You Could Be Happy is a lovely little Snow Patrol song, which I first heard when I watched the second series of Gavin & Stacey.  The couple were going through a rocky patch in their relationship in which Stacey had moved back to Barry while Gavin Stayed in Essex, leaving them miles apart and unsure of their future (ooh check me out getting all dramatic!).  The episode in question ends with each of them on nights out in their respective locations, wondering whether to call each other or not, to the backdrop of Snow Patrol singing “You could be happy, and I won’t know…”  

Anyway, I digress!

The purpose of this post is to sort of sequel my previous post and put together some tips on how to improve your mental wellbeing and become, hopefully, a happier person.  In a way I’m kind of cheating as there are lots of websites out there which list ways to boost serotonin levels, etc., but I like to think I can bring together some bits and bobs from different sources and put my own spin on them to create what I think is the perfect 'recipe for happiness'.

I’ll start by doing the sciencey bit and explaining a little bit about serotonin, for those who don’t know; not because I want to get all scientific on you but because a lot of ways you can improve mood work by boosting serotonin levels, and I think it makes sense to understand why you’re doing things rather than doing them because somebody said it might help improve your mood.  So, serotonin is a neurotransmitter.  A neurotransmitter is basically a cell that transmits signals in the brain.  Serotonin is involved in various functions in the body, one of which is mood regulation.  Hence, boosting serotonin levels in the brain can help improve mood.  With that in mind, here’s a list of some serotonin-boosting tips:

1)    Do stuff!  No matter what it is, just make sure you do things.  Behavioural Activation is a psychological therapy for depression with quite a good evidence base, and it simply involves getting patients doing things.  Typically, this will start with small tasks like housework and build up to something like a dinner out with friends one hasn’t seen in a long time.  Now obviously this post isn’t about treating depression, but if you’re feeling down and want to improve your mental wellbeing then I hope this is a good example to encourage you to get out and about, because it really will help. 

 2)    Eat a healthy, balanced diet.  Firstly, this definitely doesn’t mean calorie count and don’t ever eat treats!  I don’t worry too much about calories and I eat something unhealthy every single day, but it’s just about getting the right balance.  High levels of protein are good, as protein contains tryptophan, which basically converts to serotonin in the brain.  This will work best if you consume a small amount of carbohydrate together with the protein.  The way I understand it is that protein essentially helps to boost the levels of serotonin, whilst carbs help to release it.  I’ve also read that it is good to eat a high protein meal followed by a carbohydrate snack two hours later.  Try to eat wholegrain carbs and avoid white ones, as this is much better for digestion and helps prevent the sluggish feeling you sometimes get after eating.  Some good tryptophan-rich foods are oily fish, eggs, poultry, nuts and cottage cheese.  Also, try not to consume too much caffeine.  I limit myself to 2, or 3 at absolute tops, cups a day, and I find I feel more anxious if I consume too much.  Also, remember alcohol is a depressant!

  

3)     EXERCISE!  I cannot emphasise this enough.  Exercise is great for releasing serotonin and another “happy hormone”, dopamine (also a neurotransmitter).  There has also been research to suggest that it is as effective a treatment for depression as antidepressant medication.  I try to exercise most days and I absolutely love it.  Once you get the bug, it really is addictive!  I definitely think that people should see exercise as a way of being healthy and happy rather than a way of losing weight.  Of course, if you get a good balance between exercise and healthy diet you’re going to maintain a healthy weight anyway.  Once you find your sport and learn to love exercise you won’t need to worry so much about your weight and what you’re eating, which is great.  I rarely weigh myself as I know I have a fairly healthy lifestyle, I feel good and I’m happy with how I look.  Even if I’m feeling really tired, sometimes I’ll really make an effort to get on the cross trainer or something for a bit, and I’m always feeling better and more awake afterwards.  It’s amazing!  And exercise doesn’t have to be intense; you could just go for a walk or something.  I also read somewhere that being around nature can improve psychological wellbeing, so going for a walk in the country or on the beach could be the perfect mood-boosting plan.  Also, according to the brain-training website Lumosity, brain performance peaks at three workouts a week, so exercise has a multitude of benefits.

4)   Be with people.  Just appreciate the people around you and spend time with family and friends.  I heard once that a hug a day decreases stress levels!  I also think there’s a lot to be said for really being able to enjoy your own company sometimes, but if you are feeling down then enjoying others’ company is a good place to start!  If I’m feeling down I find being with other people inevitably helps.

5)   Get out in the sun!  The old classic: everyone’s happier when it’s sunny.  That’s because sunlight supresses the production of melatonin, and melatonin supresses serotonin production. Therefore, we want to get as much sunlight as possible to boost serotonin levels (but don’t forget your sunscreen!).  One of the websites I’ve linked below suggests getting out in the sun for at least half an hour in the morning and two hours throughout the day, if possible.  

6)   Be 'mindful'.  Mindfulness is a difficult art to master but it can have amazing effects.  Mindfulness is used as a treatment to prevent depression relapse (it’s very new but has an excellent evidence base so far!), but it’s also great for reducing stress and generally improving mental wellbeing.  It involves focusing on the self and the present moment, in a non-judgemental way.  Importantly, it also involves acknowledging (NOT supressing!), but not elaborating on, thoughts.  Personally, I plan to start attending some mindfulness sessions to improve my ability to manage stress.  I’m no expert on it at the moment but would definitely recommend to anyone looking into it and possibly learning some mindfulness techniques.

So, if you’ve got this far, as always I’d like to thank you for reading.  I’ve said all this not just for the sake of putting a list of things together that are supposedly good for improving wellbeing, but because they’re all things I include (or endeavour to include!) in my own lifestyle and feel really good for it.  I would urge anyone to try and follow at least one or two of these tips to help make you feel good, both physically and mentally.  I truly believe that if you do, “you could be happy”!

Relevant Links: 

Lumosity: http://www.lumosity.com/app/v4/personalization

Wikipedia - serotonin:  http://en.wikipedia.org/wiki/Serotonin

Wikipedia - neurotransmitter: http://en.wikipedia.org/wiki/Neurotransmitter

Serotonin-boosting tips: http://www.marksdailyapple.com/serotonin-boosters/#axzz1tpWPm6Di

http://www.ei-resource.org/articles/mental-and-emotional-problem-articles/easy-and-natural-ways-to-raise-low-serotonin-levels/

http://www.naturalnews.com/020611.html