Mental wellbeing - it’s everyone’s business

Medics increasingly stress the negative effects of excess weight, inactivity and unhealthy lifestyles on our physical health, noting the clear links to heart disease, cancer, diabetes and stroke, etc. But Western thought and medicine have for too long separated body and mind and it’s still insufficiently recognised that our physical health has a significant impact on our mental wellbeing.

If we’re feeling low, anxious, depressed or panicky, we may already be taking medication and/or seeing a therapist to help us understand, manage and deal with these difficulties. Although energy levels can be quite low at such times it’s helpful to be aware of and work on improving our physical health and general mental wellbeing, because they interact with each other. Any work we do also helps build resilience and keep low mood and anxiety at bay in the future.

Mental wellbeing isn’t just the absence of obvious problems – it’s a state of ‘wellness’ and feeling alive, thriving rather than simply surviving, incorporating psychological and spiritual dimensions and benefiting from attention to physical health.

What's the problem?

For many years a predominantly biomedical approach to health has contributed to a frequently found belief that healthcare is something someone does to us rather than being something we can influence ourselves. This can encourage passivity, so we end up too easily abdicating responsibility for our health to the professionals.

Recent statistics and research demonstrate that obesity is rising1 and people are generally taking less exercise. (It remains to be seen whether the vestiges of Olympic Games fervour will change this, as policymakers are hoping…) Numerous newspaper reports, magazine articles and tv programmes are devoted to these topics and you only have to walk into a bookshop, down the high street or into the station to see publicity about the latest diet book promising amazing results very quickly. We’re also constantly bombarded with stories of celebs who’ve lost weight eg post childbirth or pre-wedding with this or that diet. There's even one called the OMG diet, capturing the zeitgeist if nothing else...

At the same time recent media reports have focused on the huge rise in NHS (England) antidepressant medication prescriptions, 46.7 million in 2011, a 9.1% increase on the previous year. Also in 2011 15.3m prescriptions were issued for sleep difficulties2, the Mental Health Foundation reckoning that one in ten people are taking this medication. But all medication has side-effects and it’s not normally desirable to rely on it long-term.

Such stories raise an important point. For lasting change healthy lifestyles aren't just a one-off experiment, after which we 'go back to normal': they need to be about permanently changing our lifestyles but in a way we can manage. Faced with the seeming enormity of the challenge we may feel overwhelmed and give up.

Time for a different approach?

Quite often healthy living advice is presented in a bossy manner that may put us off. Is there too much stick and not enough carrot going on? I'd like to argue for an incremental, bit-by-bit approach involving kindness and encouragement (to ourselves and each other). This could achieve more in the long run by strengthening inner resources to nourish and sustain ourselves. Too quickly people get discouraged if not seeing instant results: most of us already know what is and isn’t good to put into our bodies and that we shouldbe exercising, etc, but it’s tricky to fit things into busy schedules and hard to overcome lethargy and lack of motivation accompanying low mood.

Many leaflets from health promotion agencies, GP surgeries etc talk about losing weight, getting enough sleep and exercise etc but don’t usually tell us how, especially if we have difficulty with these. This can result in an initial burst of enthusiasm but then giving up (witness the number of gym subscriptions allowed to lapse in the middle of January…!). Tough though it may be, we need to accept that good habits or at least better ones can't just be temporary. We need to make the changes last, embed them into our lives and change our lifestyles and thinking accordingly. The key is sustainability, keeping going in the face of obstacles and lack of support, but what to do when we don’t feel in the mood and it’s too easy to make excuses?

What can we do?

First, perhaps with a trusted friend, family member or therapist, we can begin to understand the barriers we may have erected to healthy living, for example why we feel the need to smoke, drink too much, shop or comfort eat. With exercise, a significant number of people have been put off gyms and exercise by terrible memories of school days – sadistic games teachers, running up and down hockey and rugby fields in the freezing cold or not feeling any good at team games, not to mention lack of encouragement. So exercise can become associated long term with low self-esteem and failure.

Second, recognise that we don't have to climb the mountain in one go – remember the management training tip about how to eat and elephant? (Answer: a bit at a time...)

Third, we can start to think about what to replace these things with – what interests, motivates and delights us and how else could we get the feeling we’re using the less healthy things to get?

Fourth, it's not only about exercise and diet, important though these are. We also need to recognise, nourish and replenish the emotional and spiritual parts of ourselves, whether it's through music, art, drama, religious observance, meditation, baking, birdwatching or stripping down an engine – a highly individual choice.

Fifth, we need to encourage and be gentle with ourselves, recognising each achievement and step on the way, however small. (I think the CD accompanying the workplace mindfulness training I've recently done is a good example in having at the start and end of each section 'Congratulate yourself for taking this time for mindfulness practice'). In this way we can feel more supported and less alone.

So what does this add up to in practice?

I want to argue for a more thinking, mindful approach to healthy diet and lifestyle and, most importantly, not beating yourself up if you fall short. Instead of perceiving this as a failure, causing many to drop diet and exercise programmes as a lost cause, you could congratulate yourself for noticing what's happened, 'forgive' yourself the lapse and get back on board. This can happen over and over again and gradually, with perseverance, you'll notice changes. After that making further adjustments doesn't feel like such an uphill task. Yes, some people can give up smoking, chocolate or whatever immediately, but we can't all do that so be gentle with yourself.

• Think about what you eat and drink (eat mindfully, see below), perhaps keeping a record. As you increase your awareness (a lot of eating and drinking is done on automatic pilot) you can make some changes. Many of us already know what's good (proteins, whole grains, most fruit and vegetables etc) and what's not (anything with additives, sugar, processed fat or all of these eg cakes, biscuits, pies, ready meals, takeaways, crisps, chips, puddings, sugary drinks, sweets and chocolate). But rather than immediately trying to cut them out altogether, try making small changes at first. There’s often something that’s less painful to cut down on or cut out than others. Buy organic if you can as it tastes better and is arguably safer because of the avoidance of pesticides and artificial fertilisers. Yes, it's more expensive but you may be making savings elsewhere if cutting down or cutting out sweets, chocolate, cigarettes or magazines.

• Cut down on caffeine, found in tea, coffee, chocolate and colas, as it can contribute to anxiety and feeling jittery. As a substitute herbal teas or decaffeinated versions may not appeal to you at first but persevere till you find something you like. It’s surprising how quickly you can teach yourself to like something…

• Exercise isn’t just about the gym, though gyms are good for helping us build up to a helpful routine, besides contact with others. There’s much more variety these days, so if you don’t like one thing, try something else, eg swimming, power walking, zumba or spin. Ideally you need to combine cardiovascular with strength and resistance work eg weights. We need to exercise energetically (enough to sweat) for half an hour at least three times a week, so strolling through a park won’t do it. But first things first: if you’ve not been used to doing much exercise at all, this is a good start. If gyms don’t appeal but exercising alone feels lonely consider buddying up with people you already know or one of the personal training schemes which are made cheaper by doing it in small groups. Gyms often do special offers and local authority leisure centres are economical so money doesn’t have to be a barrier to exercise.

• Everyone knows smoking and drinking aren’t good for us but they can easily get to be long term props and ingrained habits, with unhelpful consequences. Smoking cessation programmes are free on the NHS and people do report feeling much better, health-wise and financially, for cutting down or giving up altogether.

With drinking, while experts disagree about safe alcohol limits, all agree it’s good to avoid binge drinking and to have several alcohol-free days a week. As many wines are now high in alcohol (13%+) it’s worth seeking out lower alcohol alternatives eg under 12% – they don’t have to flavourless. It’s also worth thinking of ways to socialise that don’t have to involve the pub.

• Sleep can often be affected at times of stress, anxiety and depression but, while the usual tips in health leaflets and magazines are helpful, mostly concentrating on 'sleep hygiene' (no caffeine or exercise after a certain time, etc) they can be limited and not reach the hypervigilant parts of our minds that need reaching. Besides identifying and writing down what's really worrying us and preventing 'switching off', a recent article by a self-declared ilong term nsomniac gave food for thought, literally. Having gone down numerous avenues looking for solutions, an analysis of her diet and eating habits by a nutritionist suggested clear links to insomnia. Who would have thought that chewing gum ('with all its additives, sweeteners and chemicals') would be in the frame3?

• Think about yoga, tai chi or quigong to help calm a buzzing mind as well as benefit physical health.

• Learning mindfulness can be very helpful and evidence suggests it helps with anxiety, depression and other problems. Rapidly gaining popularity, mindfulness meditation is about cultivating the capacity to live in the present, without judgement, analysis or self-criticism. Recognising that we spend much of our time living in the past or projecting into the future, making plans, analysing and judging, etc, it uses a number of techniques and exercises to help us bring our minds into the present so we have more choices how we react and behave. Eating mindfully is regarded by a growing number of people as preferable to dieting, encouraging reflection on our eating habits and impulses, hence our choices, more sustainable than the gimmicks underpinning some diet regimes. Courses are run in a variety of settings from the NHS to Buddhist centres, so it's worth checking locally.

• Stay connected: underpinning wellbeing is the need for contact with others, including family, friends and colleagues. Even if you don’t feel like it try to talk to someone new every day, eg at the bus stop, in the café queue or in the supermarket. You'll feel the benefit and feel less lonely if that’s something you’re experiencing. True, not everyone will welcome your approach but many will and you could even make their day…

• Still on connections and combating loneliness – tap into your local community. This could be the local library or bookshop (many offer a range of activities and events), joining a local campaign or local support group. Especially in cities people can feel isolated, with an increasing number of us living alone, separated from family members and friends. It helps to get to know our neighbours, and not just when the water supply fails.

• Help others: focusing on other people can produce a 'virtuous circle' as well as taking us out of ourselves, helping us get things in perspective and providing a break from our own problems. For Mental Health Awareness Week (May 2012) the Mental Health Foundation ran a campaign called 'Doing good does you good'. This outlined the mental wellbeing effects of altruism, from volunteering and mentoring to giving up your seat on the bus or making someone a cup of tea.

• Read up about it: although they may not be enough on their own, it's helpful to check out self-help books and handouts (single downloads from websites are usually free of charge) from reputable mental health organisations such as the Mental Health Foundation, Royal College of Psychiatrists and MIND. They cover a wide range of topics eg guidance on food and mood and How to stop worrying (MIND). (It doesn't have to be books either – the MHF does useful podcasts). You don't have to spend money on books: many public libraries now offer bibliotherapy, commonly branded Books on Prescription, either as part of their own service or in partnership with the local NHS. So if you haven't set foot in your local library for years it might be time to try it again. You'll find a lot's changed.

• Think about what nourishes your soul – we spend so much time in front of computer or mobile screens that we often lack connections with the natural world. Our spare time can be slanted towards stimulating rather than relaxing recreational activities so perhaps it's time to redress the balance. We could nourish our minds daily by visiting a garden or beach or being close to water, even if it's just the fountain in the local park.

So, try out some of these things, give them a chance to work and keep going... you'll find it's worth the effort...

1 Bupa Health Pulse Poll (December 2011) showed two thirds of adults in Britain are overweight and almost half of obese adults in Britain think they are of normal weight.

2 The Guardian, 21 August 2012.

3 My dream diet (Hannah Betts, London Evening Standard, 3 July 2012).