Mental Health and Wellbeing in the Workplace. Gill Hasson

between physical and mental health is complex and it is often difficult to determine the direction of causal relationships.

       Professor Dame Carol Black

In the same way that the repression of stressful experiences can become a physical problem, physical health can impact on our mental health.

      Psoriasis – an auto-immune condition affecting a person's skin – is an example of a condition which can impact on mental as well as physical wellbeing. A 2010 study published in the journal Archives of Dermatology found that those living with psoriasis are a third more likely than people without the disease to be depressed or anxious. The physical and psychological impacts can be cyclically linked: the condition can cause emotional distress which can trigger a psoriasis flare and, as a result, cause further distress.

Wellbeing is Subjective

      A myriad of factors influence health and well-being, though many are familiar only to those who experience them.

       Professor Dame Carol Black

      Although there are key aspects to wellbeing – physical, mental and emotional, social and spiritual – wellbeing is subjective; each and every one of us has our own individual thoughts and beliefs about what makes for wellbeing. Our thoughts, ideas, beliefs, and experiences are framed in a narrative – we each have our own story – our own explanation or account of our wellbeing and what may or may not influence it.

For example, one person's account of their experience of depression and anxiety – how they feel, how they manage, and the extent of the impact on their wellbeing – will be different from someone else's experience and account. In another example, a person who is physically unwell or has a physical disability may feel that they have good levels of wellbeing despite illness or disability. Conversely, someone who is perceived as being well and ‘able bodied’ may believe and feel that they are not experiencing wellbeing to any great extent.

      And, when it comes to traumatic experiences, professor of psychiatry at the University of North Carolina, Stephen Porges, suggests that the focus cannot be on the event, but on the individual reaction or response. ‘Much of our society defines trauma by the event when the real critical issue is the individual's reaction. By not accepting that, we end up saying: “If I can survive this and do well, why can't you?” So we start blaming the survivors again.’ Porges says that whatever the size or the intensity of the traumatic event ‘when a person has a reaction or response to trauma, the body interprets the traumatic event as a life threat’.

Who Experiences Mental Ill-health and What Are the Causes?

‘One in four’ is widely cited as the number of people who suffer from a mental health problem. The Health Survey for England found in 2014 that one in four people reported having been diagnosed with at least one mental illness at some point in their lives. A further 18% said they'd experienced an illness but hadn't been diagnosed.

      As with so much of what it means to be human, our levels of mental health and wellbeing are a result of both genetic (nature) and environmental factors (nurture).

      Although no specific genes for depression have been identified, research has shown that if you have a close family member with depression, you are more likely to experience depression yourself. While this might be caused by our biology, (nature) this link could also be because we usually learn behaviour and ways of coping from the people around us as we grow up. (Nurture)

       Mind

      Many factors can contribute to the onset of a mental illness. These include prenatal stress, adverse childhood experiences (ACE), including childhood neglect, abuse, and trauma; stress; bereavement; relationship breakdown; physical and sexual abuse; experiencing stigma or discrimination; unemployment; social isolation and loneliness; poverty, debt, homelessness or poor housing; physical illness or disability.

      Mental ill-health can affect anyone, regardless of gender, age, race, ethnicity, religion, geography, sexual orientation, or other aspects of cultural background or identity. But some people are more vulnerable than others.

For example, 7.7 million adults aged 55+ say they have experienced depression and 7.3 million have suffered with anxiety, according to 2017 YouGov research for the charity Age UK. For people over 55, the death of loved ones, their own ill-health, and financial worries are the most common triggers for mental health problems.

      In their 2016 report Mental Health Problems in People with Learning Disabilities, The National Institute for Health and Care Excellence (NICE) state that mental health problems in people with learning disabilities are more common than in the general population, with a point prevalence of about 30%.

      People from a Black, Asian, and minority ethnic (BAME) background are, according to the UK Mental Health Foundation, generally at higher risk of mental ill-health. They also report that Post Traumatic Stress Disorder (PTSD) is more common in women of black ethnic origin.

      The Mental Health Foundation report that evidence suggests people identifying as LGBT are at higher risk of experiencing poor mental health such as depression, suicidal thoughts, self-harm, and alcohol and substance misuse – compared to heterosexual people, due to a range of factors, including discrimination, isolation, and homophobia.

Whoever we are, whatever our circumstances, and whatever the statistics, what's most important is to recognize that we all have mental health. The spectrum ranges from a positive, healthy state to a poor or extremely poor state of mental health with severe symptoms or conditions. It's also important to know that our mental health can fluctuate, depending on life situations, and on how we manage our mental health.

Defining Mental Ill-health

      Mental illness happens when the way a person thinks and behaves causes significant distress or impairs their ability to function. Mental disorders are usually defined by a combination of how a person thinks, feels, perceives and behaves.

      The WHO state that ‘Mental disorders comprise a broad range of problems, with different symptoms. However, they are generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others.’

      Mental ill-health can develop gradually or be a sudden change in the way you approach your life and the way you think, feel, or react and this can create difficulties in your daily living. As a result, life can become very difficult to cope with. There can be periods where it is transitory, where the feelings, thoughts, and behaviours are not experienced for very long, or are intermittent. At other times it may be a prolonged and protracted episode, and seem as if it will never pass.

Mental health problems can range from problems such as depression and anxiety, eating disorders, and addictive behaviours, to rarer problems such as schizophrenia and bipolar disorder, personality disorders, and PTSD.

      On their website, Mind explain that ‘we all have times when we struggle with our mental health, but when these difficult experiences or feelings go on for a long time and affect our ability to enjoy and live our lives in the way we want to, this is a mental health problem. You might receive a specific diagnosis from your doctor, or just feel more generally that you are experiencing poor mental health.’

Recognizing and Understanding Specific Mental Health Problems

      Stigma and lack of awareness surrounding the spectrum of mental health problems can mean that people are often not aware of the symptoms of even some of the most common disorders like depression and anxiety. A person can be struggling but they, their friends, family, colleagues etc. may not recognize that they have a mental health problem. This can mean the issue doesn't get talked about, support and treatment are not sought, and things can go from bad to worse.

Of course, just as one person can experience