Why me?

During the month of the Green Ribbon campaign in May the airwaves were full of discussion about mental health in a wonderful feast of publicity. Many of our member organisations organised events to raise awareness. Websites, Twitter feeds and Facebook posts were abuzz with individual stories. New publications were launched; broadcasters and newspapers did mental health features. All of this attention was welcome by those of us who have ploughed the mental health field over the years. The very space that the topic of mental health can garner now across the media marks a huge advancement on times past.

And yet, with all of this publicity, have you noticed that most of the messages centred around what each of us as individuals can do to talk more openly about mental health and look after ourselves better? The Green Ribbon campaign admonishes each of us to ‘say no to stigma’, while the national mental health promotion campaign asks us to ‘look after yourself, look after your mental health’. It strikes me that this talk is all about me – asking me to take action and challenging me to do something about the issue.

Yourmentalhealth.ie has a long list of “things you can do to feel well”, including getting eight hours of sleep each night, exercising, staying connected with friends and family, eating well, and drinking less alcohol, tea and coffee. Similarly, go to Mental Health Ireland’s webpage on the ‘five ways to wellbeing’ and they encourage you to take action – to connect, be active, take notice, keep learning, and give.

It’s all very worthy stuff, well proven to support positive mental wellbeing. And yet, in all of this guidance, is there not something missing? Is there not something beyond ourselves, our individual capacities, that makes a difference also to how well we are in our minds?

The World Health Organisation has long explained that mental health is influenced by environmental factors, or what they call the ‘social determinants’ of mental health. They state that there “is a strong link between the protection of basic civil, political, economic, social, and cultural rights of people and their mental health.” Protection of our rights – the rights to liberty and privacy, to have a say in decisions that affect us personally, to participate in the decisions that organise our society, to work and have an adequate income that covers our needs, to enjoy the best possible mental health that our State can afford, to freedom of expression, to respect for our culture and religious beliefs – all these rights, when realised, can positively promote our mental health and wellbeing. Unprotected, disrespected and unfulfilled, they can hinder our ability to cope with life’s challenges; can impair my individual capacity to look after my mental health.

The WHO’s explanation of the link between these rights and our mental health is worth quoting at length:

“Mental health and mental illnesses [sic] are determined by multiple and interacting social, psychological and biological factors, just as health and illness in general. The clearest evidence for this relates to the risk of mental illnesses, which in the developed and developing world is associated with indicators of poverty, including low levels of education, and in some studies with poor housing and low income. The greater vulnerability of disadvantaged people in each community to mental illnesses [sic] may be explained by such factors as the experience of insecurity and hopelessness, rapid social change, and the risks of violence and physical ill-health.” (WHO (2005) Promoting Mental Health: Concepts, emerging evidence, practice, p.xviii)

While it is possible that a particular individual will be able to rise above their circumstances and develop good mental health regardless of their socioeconomic position, in general across the population of Ireland, the environment that we live in plays a big role in how well we feel. Ultimately, it is the State through its laws, policies and resources that collectively shapes the environment in which my potential for mental health is realised.

For example, studies have proven that simply going for a walk in nature can improve one’s mood. And yet, what are the differences across Ireland in terms of people’s access to such green spaces? Do some of us literally have green space ‘at our doorstep’, in our own backyards, while others live in a concrete jungle with any parkland some distance away?

So too, exercise is shown to improve mental wellbeing. And yet, how many people have free access to a local swimming pool or gym?

So, how about we begin the discussion about what we want in our local communities to support our wellbeing. How about we start building up a picture of that environment that helps us to stay well.

Here’s my shopping list of environmental supports for my mental wellbeing:

• An affordable, good quality swimming pool
• An affordable gym
• Free mindfulness and other meditation classes
• A clean, tidy local area
• An accessible green park where I can walk for half an hour on a daily basis
• Trees that I can look onto from my living room window.
• A work place that doesn’t make unreasonable demands on my inner resources, that allows me the time to look after myself, to spend time with my family and friends, to engage in my hobbies, and that respects my contribution
• A home that is secure, safe and not too far away from work
• An adequate income so that I don’t have to worry about day-to-day expenses
• Public transport links that make it possible for me to get to work, volunteering, and social activities
• Laws that protect me from discrimination and abuse, and a police force that ensures my safety
• Advocacy services that empower me to seek redress when I’ve been treated unfairly

My list is very much in line with that of the authors of the WHO report on mental health promotion:

“There is also consensus among authors that some of the major determinants of mental health are located within social and economic domains and include:

• social inclusion and access to supportive social networks;
• stable and supportive family, social and community environments;
• access to a variety of activities;
• having a valued social position;
• physical and psychological security;
• opportunity for self-determination and control of one’s life; and
• access to meaningful employment, education, income and housing.” (WHO 2005, P.92)

What’s your list? It’s probably different in some ways, similar in others. But I wager that not all of it is down to you alone. I bet that some of what you need for your mental health requires the support of our public agencies and our Government – in other words, our collective action.

My mental health does not exist in a vacuum. Yet what is made invisible in all of the talk about looking after ourselves is the role of society, our national community as reflected in the structures of our State.  There is lots of talk about ‘you’ and ‘me’, but very little mention of ‘us’ as a whole.

For example, where is the discussion of poverty, unemployment and inequality, and their negative impact on people’s mental health? It has long been recognised that people in lower socioeconomic groups have a higher risk of mental health difficulties than those in the upper income brackets. This is as true in Ireland as elsewhere. Our rates of admission for severe mental health difficulties have consistently been higher among those in the lower socioeconomic groups. Provocatively, Richard Pickett and Kate Wilkinson argue in their new book ‘The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing’ that it is not just poverty that gives rise to mental distress, but even greater inequality regardless of wealth per capita. They argue that greater degrees of inequality in a society increase competitiveness which in turn creates greater anxiety and other types of mental distress.

And yet, at what point in the month of May did you see an article in an Irish newspaper about reducing income inequality as a means to promoting our mental health? Poverty. Inequality. These are not issues that can be solved by me, alone, taking action to look after myself. But we will never get to a mentally healthy Ireland without solving them.

There is much we can do to begin to broaden our focus about how to improve Ireland’s mental health, to start talking about ‘us’ and ‘our’ mental health rather than just ‘me’ and ‘mine’. If we truly want to reduce mental distress and increase mental wellbeing, we need more discussion about this type of mental health ‘intervention’ – the collective action to re-shape our society towards one that fosters flourishing and affirms our equal value as human beings. Mental Health Reform has long been advocating for these types of changes through our submissions on implementation of A Vision for Change. If you would like to learn more about the cross-sectoral dimension of our work, see here.