Guest Writer – Alan Cox – Men’s Mental Health

Today, as I read and listen to all the conversations around the corona virus pandemic, mostly doom and gloom, I get taken back to a time in my not too distant past when my world seemed to be falling apart. I think about how my thinking at the time led to some serious outcomes that I now believe could have been avoided if I knew what I know now.

At the time, I was running a design agency with some 12 or so staff. For a myriad of reasons, we were struggling to stay afloat and had built up quite large debts with the Inland Revenue and Banks. Some of the reasons were totally outside of my control, including the global financial crisis and the earthquakes that struck in my home town of Christchurch, New Zealand. And some of the reasons were down to me. Inexperience at business, poor decision making, trusting people who should not have been trusted, having my priorities wrong etc.

When all this was happening, it felt like I was living inside a wicked nightmare that was continuously conspiring to kill me. My situation felt hopeless. I could not see past the immediate situation and I fell into a fog of despair. In the end, my brain and body simply gave up. I had a severe mental breakdown. Before this happened to me, I had no idea what a mental breakdown was and how serious it could be. My legs turned to jelly; my speech was slurred, my brain felt dead, I felt numb and had lost all sense of hope.

This Illness then led to my business going into liquidation, calls being made on personal guarantees I’d made on business loans, no income and so on. My nightmare seemed even worst. Ultimately this all led to me trying to end it all, more than once.

Since this time, I have recovered, both mentally and physically. I now have a strong mindset that I believe could have got me through the trials in my past. This mindset isn’t some kind of spiritual or woo-woo way of being; it’s a mindset that has formed through re-conditioning my brain through new learnings and ways of being that I’d like to share with you now.

Being not OK is normal.

Our brains have evolved over many millions of years, and for the vast majority of that evolutionary period, we lived with the genuine fear of predators. Our brains release chemicals in our brain to enable us to fight or flee.

And new thinking suggests that depression and fatigue are evolutionary mechanisms to force us to lie low and not place a burden on the rest of the tribe.

These mechanisms persist today, and it’s our fear of circumstances that cause these very same feelings of not being OK. So accepting that not being OK is entirely normal and that it is part of being a normal human being, was a huge relief for me.

I no longer felt like there was something wrong with me. I was simply being normal for the circumstances I was in and could put this worry to bed. If you’re feeling ‘not OK’, well that’s just you being normal.

Life is not always a forward journey.

Think about team sports, like football, rugby, basketball, and even board games like chess. Winning the game isn’t all about forward moves. All of these games involve backward moves to ultimately win the game. It seems to me that life is no different. Life is painful at times, sometimes really painful.

When going through one of the pain points it’s so hard to see the long view. When I was losing my agency business, I had zero thought that within a couple of years, I’d be heading up a new technology startup. And two years later, when that startup was failing, I couldn’t have imagined that now I’d be doing something even better. I can speak from first-hand experience that every nightmare I’ve gone through has led to personal growth, increased wisdom, and new opportunities. However bleak things might look now, understand that your life will become richer and better a little further down the track.

Things in life can change from moment to moment. And so can you.

We tend to live in our current reality, in business, at work and at home, and when living in this reality, we tend not to look up consider new possibilities or news ways of being.

So when hard times fall upon us, it’s hard to imagine doing something different or being someone different to who you are today. When my agency had failed, and I was in the middle of a crisis, it was hard to imagine the future I am in now.

Humans are incredibly adaptable things and can make all kinds of opportunity come out of any situation. Believe me, I’ve been there and done it multiple times. Try not to look at your future right now through a dirty lens. Instead, trust in your ability to adapt and grow.

Stories are stories, they are not reality.

I used to be terrible at ruminating and playing out all kinds of situations in my head. I’d continuously be thinking through what if this, what if that, even holding full-blown conversations in my head in how I’d respond to people saying things to me. And one day I realised that much of my thinking was based on stories that had no basis in fact.

I now operate a simple rule that says something is not true until I know it to be true. Let me explain. Let’s use an example that most of us could probably relate to. We are driving in our car, and another car cuts across you, and you need to brake hard to avoid contact.

Your blood boils, you toot your horn, gesticulate and shout WTF! All of this reaction was predicated by a story that you had created that the guy in the car was an idiot and had a blatant disregard for you or your safety. Well, the guy probably isn’t an idiot. He may have a lot on his mind and may not have even seen you. He may actually be a very caring person who was simply distracted and being careless.

The point here is we have a tendency to make up negative stories and then act as though these stories are true. By continuously stopping your story making habit it keeps you grounded and stops your emotions going crazy when they really don’t need to.

It takes a while to break these habits but it does happen. And when it does you’ll notice how much lighter you feel. So think about all the things you’re saying to yourself right now. Will you actually lose your job or business? If you do will it really mean that your partner will leave you because you’re hopeless? If you end up losing your house, will that really be the end of the world? Acknowledging that these are just stories, can give you space to consider outcomes that may not feel so bad.

You may need help and you owe it to yourself and your family to go and get it

Many of us are not great at accepting that we need help. This one is a massive topic on its own which I could write a book on, but there are a couple of simple points I’d like to make now that I know what I know about neuroscience and mental health.

The first thing is that when we are struggling mentally, it is a good idea to find someone who can unpick what you’re going through and help you with strategies to get through it. Your brain is complicated, and people are complicated things.

It takes people with real expertise to be able to help unravel what’s going on and get you feeling better. This isn’t one of these things to tough out, especially if you’re a guy. You may need to try a few different people with different styles before you find one who can help, so don’t give up on the first try.

The second thing is to have an open mind that you may need medication, even if for a short while to get you over the current hump. If you do enough searching on the internet, you’ll find plenty of material stating that antidepressants don’t work and it’s all about things like “Lost Connections” (see the book from Johan Hari).

While much of this sentiment may be true, I believe that in some circumstances, medication helps to lift the cloud just enough to make things like counselling even possible. It did this for me. A good doctor should be able to take you through a robust screening to determine if medication would be helpful.

Over to you…

Yes, we are in a pretty sh*t time right now, and we’d all much rather wave a magic wand and have it all go away. But that ain’t gonna happen.

The burden of life can be hard at times, and that’s the way it is. Life is hard. It twists and turns like a twisty turny thing. But at the end of the day, we must have a belief in ourselves and that good things will come from this. It’s a nasty storm we’re in. All storms pass. And above all the grey clouds is a clear sky. That clear sky is always there regardless of what we see and experience on the ground.

Ride the storm, Kia kaha.

Some big ideas to change the story on mental wellbeing.

There has never been a more critical time for thinking differently about how we deal with mental well-being. Over the past few decades, the western world has seen a consistent alarming rise in mental health problems. In some countries like New Zealand, suicide rates are now the worst they have ever been.

Recent history has shown us that politicians and their advisors are failing to navigate the complex problem of mental health. They are often focusing on short-term over-the-cliff policies that have done little to reverse the trend. The world is changing, and increasingly, our workforce will need healthy minds to function. Now is the time for bold moonshots that place mental well-being centre in the vision for our future.

The World Health Organization defines Mental Health as the state of wellbeing in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution in his/her community. Therefore, it is way more than just the absence of mental disorders.

“Mental illness is not a personal failure. In fact, if there is a failure, it is to be found in the way we have responded to people with mental and brain disorders.” -Dr. Gro Harlem Brundtland, Director-General of WHO

Based on the data gathered by the World Health Organization, approximately one in four people will experience mental ill-health at one point in their lives. Around 450 million people are currently suffering from mental and neurological disorders which place mental health as one of the leading causes of disability and ill-health worldwide.

These statistics serve as a wake-up call for everyone to take necessary actions in promoting mental wellbeing by improving our physical and social environments through the collective efforts of individuals, companies, schools, the government, and society as a whole.

According to Dr Caroline Leaf, a cognitive neuroscientist who is an advocate of mental well-being, 75–98% of mental, physical, and behavioural illnesses come from toxic thinking.

This negative pattern of thinking is usually a result of many factors but is commonly attributed to negative life experiences, unhealthy lifestyle, and chaotic environment.

To understand it better, let’s take a look at the three types of environmental factors that can make a person susceptible to mental illness:

1. Physical environmental factors which include:

• poor nutrition
• stress
• sleep deprivation
• vices (substance abuse, alcoholism, smoking)

2. Social, environmental factors which include:

• lack of support system
• chaotic work/home environment
• influence of social media
• social stigma
• inability to meet the standards set by society
• lack of knowledge about mental health

3. Economic factors which include:

• lack of resources, support, and access to mental healthcare
• poverty/unemployment

Given the abovementioned conditions, this article aims to significantly raise the state of mental health in society by suggesting possible ways of investing in mental health to boost the well-being of society as a whole. It also aims to discuss the long term benefits that these advancements can bring to society, business, and economy.

Economics: Place mental wellbeing centre-stage as the future economic advantage

Many countries are profoundly aware of the cost of poor mental health to the economy and society. In the US alone, the cost of mental health amounts to 53 billion dollars less in total income each year, while losses in the UK amount to 35 billion pounds.

Poor mental health affects an individual’s ability to focus, which can lead to an unstable workforce and job losses due to unproductivity and inefficiency. Results of one study by Pinheiro, Ivandic, and Ranzzouk (2017) found that mental disorders such as depression, anxiety, and alcohol disorders are among the leading causes of work losses measured by absenteeism and sick leave rates which results in financial and human capital losses.

Along with the advancement of technology, more and more jobs can and will be done with the help of Artificial Intelligence and robotics, thus minimising the need for manual workers or labourers whose job involves physical work.

This Fourth Industrial Revolution will see a significant shift in the nature of tomorrows workforce and the shift is towards jobs where “unique to human” skills such as compassion, empathy, and sound judgment will be some of the main skills that companies will be looking for as these skills cannot be automated by robots.

High standards of mental well-being are therefore going to be essential to support these roles of the future. A rise in the overall health of a Nation will take years to achieve since there are lots of factors to work on, and if these underdeveloped countries fail to address the mental health needs of their people now, their economy will continue to fall behind. Consequently, countries who invest in building nations with strong mental well-being are more likely to thrive in tomorrow’s economy.

Bold actions:

• Define our vision for what the mental well-being of our Nation will look like 10 years from now.
• Create and implement the overarching strategy that will get us there.
• Set and publish annual targets with corresponding game-plans.
• Publish results annually against targets.

Education: Make mental well-being education a core part of the curriculum

Given that mental health is the number one cost to the economy and society it surely must sound bizarre that there is practically zero curriculum time given to teaching the knowledge and skills that foster positive mental well-being.

Issues in mental well=being often manifest at an early age. For many young children, these issues often begin in their immediate social environment. Experiences of abuse, family discord, negative forms of discipline, and even arguments between parents are some of the factors that can contribute to young children having mental health challenges.

Education is critical, even at this early age, for individuals to make better sense of what is happening to them and be able to reframe their situation to create a more positive outlook and sense of self-worth.

Children and young adults must be able to recognise and understand their feelings and the neurological realities that can help them deal with their emotions in a positive way in order to avoid behavioural problems as they progress in life.

Many behavioural problems can be prevented if children are trained and educated on how to properly respond to negative feelings or deal with trauma (if the child has had traumatic experiences) through art therapy, play therapy, or some cognitive and behavioural interventions.

Schools must start investing in teaching knowledge and skills to prepare their students for their future careers. We’re not talking about ad-hoc mindfulness sessions here. We are talking about at least 2 hours per week learning and practising. Teaching students how to survive and thrive in life must be seen as a core part of the strategy to building a more resilient and capable society.

Bold actions:

• Teach students about matters of the mind including, psychology and neurology
• Teach the students about the concepts of self-care
• Develop programs that encourage students to interact with each other and promote social connection
• Strengthen counselling programs in schools and let children know about the available services
• Organise seminars and meetings that will educate the parents about the significant role they play in enhancing their children’s mental health.

Health: Close the treatment gap

A study done by the World Health Organization found that 41% of countries do not have a mental health policy and the average mental health budget is only 2% of the total health budget. This is one of the reasons why there is a massive gap between the numbers of individuals with mental health conditions and the actual number of individuals who receive proper care and intervention.

If you have an obvious physical problem such as heart trouble or pneumonia, you’ll receive full treatment until you are fully recovered. Mental health is the opposite with most people receiving either no care or the bare minimum needed to get them out of the system. Even patients who have recently attempted suicide and have an obvious need for ongoing psychological intervention cannot get it unless they can afford to pay for it themselves, and few can afford this.

Given that mental health is the highest cost to industry and society, how can it make any sense for it to be dealt with the way it currently is.

Bold actions:

• Implement statutes that give mental health an equal standing in the health system.
• Encourage more people to MH practitioner roles by lowering or eliminating course fees.
• Augment the MH workforce with higher numbers of lower-tier practitioners trained in CBT and talking therapies.
• Impart training to novel providers such as online therapeutic tools which can easily be accessed by the public.
• Integrate behavioural health services into primary or community-based care.

Business: Make business accountable for the wellbeing of its people

A study led by the World Health Organization estimates that depression and anxiety disorders cost the global economy US$ 1 trillion each year in lost productivity, and the global societal impact is expected to rise to $6 trillion by 2030.

It is no question that employees serve as the backbone of any organisation. However, most businesses worldwide fail to recognise the cost of not putting employee wellbeing as their top priority which causes a massive decline in the global economy.

The issue we are currently facing is that there is practically zero accountability for how organisations care for their people. Governments are more interested in collecting taxes and ensuring compliance than ensuring their national workforce is well looked after.

Governments need to create a ‘pull’ in the system, which will raise the bar for workplace well-being. A mechanism is needed for measuring and reporting on well-being that creates a natural competitive tension between organisations. Imagine thinking about considering two alternate job offers and finding that one organisation has considerably better well-being for their people, which job would you take?

A competitive tension will see poor performers struggle to get the people they need. So they will need to up their game or go out of business.

Bold actions:

• Implement policies to ensure well-being data is collected from the industry.
• Create a safe and reliable system for employees to report on well-being measures for their employers.
• Provide feedback loops to employers and access to services that proactively help employers improve their practices.
• Make the well-being scores of all organisations easy to access for the general public.

Community: Work to irradicate social isolation

The World Health Organization identified stigma and discrimination towards mentally ill individuals as the “single most important barrier to overcome in the community.”

The first step towards eliminating marginalisation, stigmatisation, and discrimination of persons with mental illness is to truly understand what’s going on inside the world of individuals battling with it, and it can be done by making a conscious effort to reach out to these people.

This is one of our roles as a responsible member of society. We need to care more and be willing to go the extra mile to help people overcome feelings of loneliness and isolation.

Big changes that take place in the macro often start with small positive actions in the micro. As part of a community, we all have a significant role to play in providing emotional support to the people around us, including our friends, families, and neighbours.

We must start promoting social responsibility by increasing our awareness and sensitivity to the needs of others. A simple gesture of smiling or simply asking people how they are doing can make a huge difference in their overall mental well-being. We have to understand how our simple actions can affect society as a whole.

The Role of Media

With the development of technology, the media has a wider reach and are able to connect to the general public. TV and radio ads can be effectively used to create awareness about mental illness and mental health.

The media can participate in mental health campaigns through creating programs, films, and documentaries that will open the eyes of the viewers and listeners about the reality of mental health issues worldwide. In addition, fostering a positive attitude towards mental health can be done by tapping celebrities and media influencers to act as ambassadors and role models in spreading awareness and taking positive action towards eradicating social isolation and promoting social connectedness.

We all have a part to play in creating an environment where people can openly express themselves and feel a sense of belongingness and significance which are important factors in maintaining our mental and emotional wellbeing.

It’s about time that we speak up about issues that truly matter and take the necessary steps in building a better world for the present and future generations. Our simple actions of caring for others will create a ripple effect that can make a big difference in the lives of many people. Let’s all help close the gap and end the stigma. Let us use our voice to speak up.

Bold actions:

• Invest in promoting community engagement through media.
• Create resources such as websites and flyers to encourage local action at the community level.
• Provide budget and assistance for local working groups that foster community engagement.

Technology: Invest in technologies that can support mental wellbeing at scale

Many studies tend to focus on the negative effects of technology on people’s mental health, such as computer addiction and isolation. However, on a more positive note, modern technology has found to be useful in providing an avenue for certain mental health interventions.

Benefits of Telepsychiatry

One of the problems in the treatment of mental health is the limited number of mental health professionals. Even with massive investment, there will never be enough psychologists or therapists to go around. This is where the use of technology can potentially come in to bridge the gap.

Telemedicine (also referred to as telehealth or e-health), is a term coined in the 1970s, which literally means “healing at a distance.” This signifies the use of telecommunications technology to improve patient outcomes by increasing access to care and medical information (World Health Organization), Telepsychiatry (a subset of Telemedicine) provides services that include psychiatric evaluations, therapy (individual therapy, group therapy, family therapy), patient education and medication management (American Psychiatric Association).

Aside from breaking the barriers of distance, Telepsychiatry helps in reducing mental healthcare costs and reducing barriers to treatment because these services are readily accessible. According to the American Psychiatric Association, Telepsychiatry has been found especially effective in treating PTSD, depression, and ADHD.

Use of mobile phones

The use of mobile technology in supporting mental health care delivery has proven that these treatments are feasible and acceptable based on several studies. A study by Kauer, Reid, Crooke, Khor, Hearps, Jorm, Sanci, and Patton (2012) found that the use of smartphone apps such as behavioural activation apps, mindfulness apps, and mobile CBT apps have been effective in reducing depressive symptoms of its users.

Bold actions:

• Implement incentives to invest in well-being technology development, such as focussed R&D tax credits.
• Include proven technologies on the list of things doctors can prescribe patients with costs wholly or partially met by the government.
• Train doctors and healthcare providers in the use of technologies to support or even replace medication.

Cities: Urban design needs to put mental well-being first

One of the factors that can positively or negatively affect our mental health is our physical surroundings. The images we are often exposed to and the environment we live in have a significant impact on the way we perceive the world around us and how we view life in general.

According to a research done by The Center for Urban Design and Mental Health in the UK, there is a 40% higher risk of depression, over 20% more anxiety, and double the risk of schizophrenia, loneliness, isolation and stress in cities as compared to rural areas.

One of the most common risk factors for mental health in cities is urban design. Over the past decades, urban designs are built to maximise returns on investment and are not specifically designed to build social connection.

Edward Wilson’s Biophilia theory emphasises that humans have an innate tendency to seek connections with nature and other forms of life. When people are given access to natural settings, they are more likely to integrate relaxation and social interaction in their daily routine which results to lower mental distress, stress reduction, and improved social and cognitive functioning. Therefore, the urban development of tomorrow must be designed with social integration in mind by creating prosocial and green spaces in the neighbourhood.

Likewise, putting active spaces like outdoor gyms, bike lanes, and jogging areas in the neighbourhood can help improve the mental health of individuals since physical exercise and movement promotes positive changes in the brain, including neural growth and reduced inflammation. It also helps the brain release feel-good hormones such as endorphins and creates new activity patterns that promote feelings of calm and wellbeing.

Lastly, architects and urban planners should think of integrating a safe space in designing neighbourhoods. With proper lighting and surveillance, pedestrian lanes, and ramps for PWD, people will feel more safe and confident to move around. This will likely result in a significant decrease in feelings of anxiety because people’s safety needs are being met.

Bold actions:

• Include mental-wellbeing as a key consideration in planning regulations.
• Provide incentives to developers who prioritise wellbeing in urban planning.

In conclusion, a large part of our mental health problem comes down to some pretty basic problems that have evolved over many years, and it will take years to fix it. But fix it we must. Those countries that put mental wellbeing centre-stage today will be tomorrows winners.