A new era for healthcare

In his 2020 book, Together, Vivek H. Murthy, President Obama’s Surgeon General, spoke of his growing realisation that for all the complex medical challenges facing the United States, it was social connection  and loneliness that came to define his time as the US’s most senior health leader.

Murthy witnessed how the challenges of loneliness and disconnection came to define the health, well-being, and even the politics of a nation.  

“So many of the problems we face as a society — from addiction and violence to disengagement among workers and students to political polarization — are worsened by loneliness and disconnection. Building a more connected world holds the key to solving these and many more of the personal and societal problems confronting us today.”

Here at the UCL Policy Lab, we have been  working with partners from across UCL such as Dr Fran Zanatta and with colleagues overseas to ask how social connection might enhance the health of the nation. 

JB: Your work explores how patients and clinical practitioners can be empowered to act, building relationships that can sustain healthy lives. Can you tell us about how this work came about?

FZ: I was working on a major research programme with young people in east London towards the end of the pandemic. They were interested in mental health, which, by accident, was the discipline that I was moving towards at the time, having previously worked in education.

We designed the project so that every Friday, we invited different artists to engage young people in a variety of methods to think about how they can take action within their community. We invited Citizens UK, an organisation focused on community organising, to run one of the sessions, which blew everything up by moving the discussion from just thinking and feeling, to planning and action. What was meant to be a single session ended up being a whole action that the young people planned themselves. From this one session came action and empowerment for the young people. Witnessing that was incredibly powerful. 

JB: How has this kind of approach developed more broadly in the NHS? Can you give some examples?

FZ: My team’s first project at UCL was with mental health peer support workers. These are individuals with lived experience who have gone through a process of recovery, or management of their challenges, to support others through volunteering or as paid staff members in the NHS.

They were still going through the recovery process, and we organised a series of sessions to enable them to become engaged actively in research. One of their training sessions was with Citizens UK. It was incredible to see them talking about power and how to transform anger from something destructive to something productive. It clicks something into people, and it shifts the capacity for action.

Suddenly people become aware of their own agency. I guess it is an element of awareness, empowerment or “yes, I can do this”. We’re going to be doing some more work this autumn, on peer support workers and power and research. 

JB: Agency, or respect, often feels like it gets lost, even within well-meaning institutions like the NHS. Could approaches like yours offer people the tools to grasp back some of that agency? A sense of freedom when we need it the most?

FZ: It’s about self-advocacy and awareness. A young person I was working with described agency as about having the awareness and knowledge that you have options, the capacity to make choices around your actions, and feeling like if you ask questions or make  a suggestion, that it won’t backfire on you.

There are issues with the processes and systems, but  I think what matters the most is the relationship and the need for all of us to be more person-focused. Because of limited resources, staff have a bigger caseload, and there’s less time for thinking, for feeling and processing those feelings. because there is a lot  of holding that people working in mental health services have to do.

Relationships, and fostering those relationships create space for agency, for intentionality, for dialogue. And that provides the space for healing. 

JB: How much of this approach is about listening and valuing peoples experience?

FZ: In some primary schools there is a designated mental health service, which is something being advocated for quite loudly by Young Minds and the British Association for Counselling and Psychotherapy, and organisations like the Young People and Children Mental Health Coalition. Having someone who you  can go to, even just for a chat, creates the knowledge that you can talk about things even when they’re hard, that there’s someone listening and that it’s okay to not feel great.

One of the primary schools I worked in had a chat bench, which we would sit on and young people could just come up and have a little chat if there was something that was bothering them. It’s nothing complex, but it shifts the internal way of working and the way in which you relate with yourself, with your difficult experiences and with others. Once you’ve experienced it yourself, you’re more likely to replicate it in your relationships and connections with other people. Those little changes are quite crucial. 

JB: It feels like so much of your work is about building community – which again is often lost when all we think about is the immediate crisis – and yet it feels that without this community how can we expect long-term change for patients.

FZ: Working with peer support workers has been quite enlightening because it’s centred around creating relationships. One of these colleagues leads a community cafe where people can drop in and have a chat or take part in activities. It helps to tackle very complex issues such as isolation, loneliness, and  not having a warm space or a cup of coffee or tea. These seemingly small acts of community can be incredibly transformative.

Another programme was an evaluation for a community garden in Essex with a community organisation called Trust Links. They do amazing work. I’ve met a lot of volunteers and so-called service users, the local community members, and it’s just incredible to see how transformative it is because it creates space where people can gather and cultivate, but  it also creates somewhere where you can go to shift the thinking, or address something that you’re struggling with. It becomes a space where you  feel safe to share and get support for the challenges that you’re experiencing.

When talking with young people, what comes up a lot is how sterile and terrifying some of the mental health spaces meant for healing are. When you have a space full of plants produced by people in the community, and there are smiling faces and people who look like you, talk like you, and struggle like you, that shifts  their experience.