Mental Health Foundation director of development and delivery Isabella Goldie explains how nurses can protect their own mental health through self-care, mindfulness and taking control
Just as you must put on your own oxygen mask before attending to others, nurses must look after their own mental health in order to care for their patients in the best way possible. Mental Health Awareness Week 2017 took place from 8-14 May. The theme for this year’s national awareness week was ‘thriving not striving’. Instead of examining why so many people in the UK are struggling with mental health problems, a question was posed as to why too few people are thriving with good mental health.
This is not just freedom from mental illness but the ability to think, feel and act in a way that allows them to enjoy their life and deal with its challenges. The new Mental Health Foundation-commissioned report, Surviving or Thriving? The state of the UK’s mental health, shows the need for greater awareness, funding and prevention in society. This, says director of development and delivery Isabella Goldie, begins with nurses.
Can you tell me a bit about your background and how you came to work with the foundation?
Originally, I was a mental health nurse. I worked in a mixture of acute services and then became a community psychiatric nurse (CPN). Later I worked in psychotherapy and then moved into the voluntary sector. Having worked in the community, I was very aware of the lack of services that had any element of empowerment or coproduction.
There was an organisation in Glasgow that offered me a job to help build up community services for the first time. Before we knew it, we had about 150 staff.
So can you tell me some of the top figures from the report? What have you found?
Probably the most alarming figure is that 65% of people have said they have experienced a mental health problem in their lifetime. In our report, respondents were self-reporting, so it was what people felt, as opposed to diagnosis. So 65% is very alarming. We need to dig a lot deeper to think about that, because one in six is the instance of people with mental health problems at any given time in any given week. So it might be 65% who have mental health problems across a lifetime, but they might not all have them for months at a time or frequently.
What other relevant factors did you discover?
The socioeconomic factors are worth focusing on. For people in the lowest income households, 73% have experienced a mental health problem, which is higher than the average. The figure is 69% for households with the highest income. So there’s a clear social gradient.
One area that popped right out is if you’re unemployed. Some 85% of unemployed people have experienced a mental health problem in their lifetime.
Being unemployed does something negative to your mental health. There is a strong stigma attached to it. I think the figure is worrying, but also interesting. The incidence drops to 61% if you’re in work full time, so there’s quite a variation there.
Another area where you have a higher risk of mental health problems is if you’re a lone parent. Parenting can be a particular stressor.
More than half of older people said that they’ve had a lifetime mental health problem and that statistic is pretty shocking – but at the same time, they’re doing much better than young people, 70% of whom have experienced a mental health problem.
For children, the indicators show that the situation is worsening. Chronic disorders, rates of self-harming at school age, and bullying in school have all gone up. There are lots of signs that all is not well.
What did you find out about prevention methods?
Our findings give clarity to the argument that if you work to improve mental health, you do the same things as when you work to prevent mental health problems. So mental health promotion and mental health prevention require similar things. Looking at positive mental health, however, our survey found that only 13% of people said they had high levels of positive mental health.
What about nurses’ own mental health? Do you think it’s true that the lonelier a nurse is, the more likely they are to have poor mental health?
Absolutely. The studies in loneliness show that there’s a strong link between loneliness and mental health problems. The other factor for nurses is the vicarious stress. There have been been small studies, but not enough on vicarious stress. Nurses are listening to people’s difficult lives on a regular basis and they have to be the person that helps them to find a way to navigate through that, whether practical or emotional. Nurses are human and we’re tuned to others’ behaviours and emotions, so it takes its toll.
Can helping patients have a negative effect on nurses if they let themselves become engulfed in their struggles?
The self-management advice is the same for nurses as for anyone else. In our report, we look at five big recommendations for the Government and 10 for individuals. In the 10 for individuals, we conclude that some of the measures that work for physical health also work for mental health and actually the evidence base is incredibly strong for exercise, sleep and diet. If you get that right, you can do a lot of good.
The evidence for omega 3 fatty acids has been pretty strong for managing depression and improving your mental health. So has exercise, particularly high-intensity exercise. So short spurts have been shown to be a really good protector for brain health, to help you think more clearly and have more energy.
Do you think there are things nurses can do at work to help their mental health?
Absolutely. There are apps. A tea break is an ideal amount of time to do something like mindfulness, as is a lunch break. Mindfulness can be very bite sized and a dose of 10 minutes a day can have strong benefits over six to eight weeks. If you work shifts, it’s hard to get the right amount of sleep or to eat well or to fit in an exercise regime. But this lifestyle management is not just about physical health – it’s important for your ability to cope.
I would also stress the importance of peer support. Nurses need to make sure they find a network of support.
So if you are in an isolating job, might there be other people around you in similar isolating jobs? If you’re a practice nurse, for instance, is there a group of practices where you can meet other nurses? Are there any online forums where you can do that? Is there any way to create a network? When I was an individual development worker in the job in the voluntary sector, initially there was only me. That was only for a couple of years and then the team grew quite dramatically. But by embedding myself with other colleagues, I found people who weren’t necessarily in my field, but who were able to offer support.
Another important aspect for any workplace role is the amount of control you have over your work. I’d advise nurses to embrace anything that can lend them more control over their work and engage with decision-making. It might feel like an added level of responsibility and sometimes people don’t want that, to go to meetings and so on, but the more you’re able to control what you do with your day, the better. So I’d urge nurses to be more autonomous in terms of planning their workload.
What changes would you like to see in how the NHS treats mental health?
One of the areas we are lobbying for in this report is a much stronger choice of approaches, which people can receive support from. The report calls for greater screening so that health checks can become ‘100% health’ checks, which include mental health. We should not be separating mental health out and doing something different. When you’re 50 and you get a whole series of health checks from mammograms to bowel cancer strips and all of that, we should be building mental health into that. So school nurse checks, mother and baby checks, pregnancy checks, should all include mental health issues.
Is the current focus on cognitive behavioural therapy (CBT) a good thing?
We’re seeing something interesting with CBT. The online version of it, if there’s moderation and it’s well guided, is actually coming out much better for some people than face-to-face therapy. Other people do better with face-to-face therapy, of course, but we must give options to suit everyone. So already we’re starting to see some choices emerging within CBT.
Interestingly, this is market driven. That’s because companies have decided they could offer it online and set up a service.
We are also seeing more evidence about mindfulness because it’s something the person can do by themselves. They can do it on an app, or on a Kindle, or on a more intense online course. You can also join a group and practise it with other people. There are lots of different ways to do it and people have a choice.