Dr Lucy Foulkes on how mental health is misunderstood

Dr Foulkes completed her PhD (2011-2015) at UCL and her postdoc (2015-2017) at UCL’s Institute of Cognitive Neuroscience. Her research focuses on mental health and social cognition, particularly in adolescence. She is the author of the new book Losing Our Minds: What Mental Illness Really Is And What It Isn't (Penguin Random House, 2021).
 

Why do you think mental health has become more prominent in public discussion in recent years?

In 2007, a charity campaign called Time To Change was launched, with a goal to end discrimination and stigma relating to mental illness. Since then there have been many other campaigns to increase awareness – primarily to promote the idea that mental disorders are prevalent, and that we should talk more about our experience of them. These campaigns have had a knock-on effect in schools, universities, workplaces, homes, everywhere: everyone is now getting the message that we should talk more about mental health, and that this is a universal good.

To what extent do you think mental disorders are on the rise, and why might this be?

There is evidence that rates of some mental disorders are higher now than they used to be. Suicide rates have increased. Rates of self-harm have increased, particularly among adolescent girls. However, when you look at the actual data – with the exception of self-harm, I would say – these increases aren’t as extreme as we are led to believe. I look at this in a lot of detail in Losing Our Minds. For example, one study found that in 1999, 9.7% of 5-15 year olds had a diagnosable mental disorder; in 2017 it was 11.2% (mid-pandemic, in July 2020, this figure was 16.0%).

One possible explanation for the rise is that people really are more susceptible to mental illness and distress now, either because life today is more difficult and stressful than in the past, or because people don’t cope as well as they used to, or both. But there are two other possible explanations.

One is the simple fact that talking about mental health problems more creates the impression that things are worse, when really nothing has changed: we are just more likely to admit and seek help for our distress now (which is a good thing!). The final possibility is that people are now interpreting milder or more transient experiences as mental health problems or disorders, things that wouldn’t previously have received that label, and perhaps shouldn’t. I suspect all these things are happening in parallel, making it very difficult to really answer the question of why rates seem to be rising. And bear in mind these rises, and this discussion, was all going on before 2020. The arrival of Covid-19, which has led to a surge of speculation about an impending mental health crisis, has only complicated the picture.

In your recent book you argue that we need to rethink the conversation about mental health. What are we getting wrong?

The public conversation encourages us to talk more about our mental health, and broadly this is a good thing. There are still far too many people in distress and crisis who aren’t able to talk about it and who aren’t getting help. Thousands of people kill themselves in this country every year. So we do need to keep on talking about this, but in Losing Our Minds I suggest that we need to re-calibrate a bit, because there have been some collateral damage from the current drive for openness.

The issue is partly to do with terminology. These campaigns encourage us to talk about our mental health by giving us labels for our mental health problems, such as social anxiety, PTSD and depression. But there is a lot of misunderstanding about what these terms actually mean, and how messy the topic of mental illness is, and this has led to confusion.

Every symptom of mental health lies on a continuum across the population. It’s a spectrum: there is no black-and-white distinction in nature that separates people with a disorder from people without a disorder. On top of this, some psychologists argue the terms ‘illness’ and ‘disorder’ are never helpful. But this information isn’t really in the public domain. We’ve pumped out these terms and statistics into the public consciousness without the necessary detail. A lot of people have absorbed these terms and become worried that they have these disorders, or have taken them on as part of their identity in a way that I suspect is unhelpful. And all the while, the people who are in extreme distress are still stigmatised and misunderstood. The issue really is the shallowness of the current conversation. As we move forward, we need to focus on depth and nuance.

Oh, and we also need to better fund services, so that help is actually available when people need it. It’s meaningless to encourage people to speak up and seek help if, when they try, they’re faced with huge waiting lists or locked doors. In fact, pushing people to seek help when there’s nothing there might even be actively harmful. So yes let’s keep talking, but let’s figure out what’s actually helpful for people in distress, across the spectrum of health and illness.

How can we navigate the problem that you highlight of ordinary distress being medicalised?

The first solution is to provide better information about the complexity of mental health and illness, such as the fact that all symptoms lie on a spectrum. We also need to promote the idea that a lot of psychological pain is actually pretty normal, part and parcel of being alive. That’s not to say we ignore it. We need to take this pain seriously and encourage help seeking, without being compelled to pathologise all negative experiences. That can add unnecessary stress and fear, while devaluing the experience of those who are more unwell. This is key, actually: if we took people’s distress seriously, they would feel less compelled to label their pain as a disorder in order to be heard. Lastly, we need to give more as a voice to people who are seriously unwell – so we really understand what, for example, the experience of PTSD or OCD looks like.

This year’s theme for Mental Health Awareness Week is nature. In what ways do you think having access to nature can affect our mental health?

There’s plenty of evidence that being outside in nature can be beneficial for mental health. I’m not an expert in this area, but I think everyone should be encouraged to figure out what is useful for them – whether that’s how they look after themselves after a stressful day, or how they find meaning and value if they have a long-term mental disorder. Everyone is different, but spending time in nature should be an option in everyone’s toolkit to support their mental health.

How can we best support those suffering from mental illness?

On a national (and international) level, we need to fund support services so that people in distress can access help, and access it quickly. On a more personal level, we all have a responsibility to educate ourselves a bit about what mental health problems are. No one escapes serious mental illness in their lifetime: even if it doesn’t directly get you, it will likely happen to someone you love and care about. It would help a great deal if we all had a better understanding of what these disorders really are, and were aware of the nuance involved. This is what motivated me to write the book: I wanted to map out what we know and don’t know about these disorders, to improve the depth of public understanding.

Lastly, one of the things that mental health campaigns have got right is to encourage us to talk. When you’re suffering, it helps to not go through that alone. But we also need to learn how to be better listeners, so that when people do talk, they feel heard. There is a concept called active listening – asking open questions, reflecting back what people have said – which we could all do more. I think if people in distress really felt listened to, in personal conversations but also in society at large, that could make a meaningful difference.