Just what the doctor ordered: advice for looking after your mental health
Looking after our physical and mental health is important during the current Covid-19 pandemic. To offer a range of information and advice to help you support a healthy lifestyle, co-founder of Scalesceugh Hall & Villas, Dr Anita Herdeiro, will be sharing regular articles ('Just what the doctor ordered') over the coming weeks – each focusing on different aspects related to our health and wellness. In her first article, Dr Herdeiro focuses on mental health. So we are now approaching nearly 11 months of lockdowns, wearing masks and where isolation and sticking swabs up our noses and at the back of our throats for Covid-19 testing has become the norm. As a GP, it has been a very challenging, interesting and desperate time over these past few months. Nonetheless, I have also seen amazing acts of kindness, resilience, and a true understanding of how we can care for ourselves, whilst the NHS is under such constraints. I have worked in four counties divided between the south and north of England during this time and I have seen us as clinicians at our most vulnerable. I remember when it all started I had been requested to do a TV appearance on BBC news where I discussed the importance of hand hygiene, mask wearing and reducing risk with distancing. It all felt strange. I did not really know what we were dealing with and little did we know how bad it would get. Many of my patients live isolated with very few neighbours, difficult public transport, few family members locally. They had not minded before lock down as they were always out and about but now this was not the case, and it made them reflect on their current circumstances and locations of where they lived. In this, my first article, I would like to focus on mental health – a very broad topic and one that has had a great strain on its services before the Covid-19 challenges. A study by the Mental Health Foundation in partnership with the universities of Cambridge, Swansea, Strathclyde, Queen’s Belfast and De Montfort has highlighted the impact the current pandemic is having on the mental wellbeing of adults in the UK. Taking place from March - November 2020, the study repeatedly surveyed over 4,000 UK adults and revealed that key indicators of distress – including loneliness, suicidality and not coping well with stress – are worse now than at the start of the pandemic. The study showed that among those surveyed, the extent of loneliness has risen from 10% to 25%; whilst reports of having had suicidal thoughts as a result of the pandemic are up from 8% to 13%. Moreover, the amount who say they are “coping well with the stress of the pandemic” has decreased gradually, from almost three quarters (73%) to 62%. Never has building a strong mind been more important. In the words of Dr Antonis Kousoulis, Director for England and Wales at the Mental Health Foundation: “There is no vaccine to protect our mental health against the consequences of the pandemic. Instead, we need to focus on prevention.” I have been inundated with calls regarding people’s mental health deteriorating. Whether it was something they had already suffered from or something new. Many people were losing loved ones or simply anxious of what was going to happen next with this new virus. I realised although the mental health services were trying their best, they were very stretched and we needed, with the appropriate patients, to offer self-help tools. To empower people to look after themselves. Although we do try to do this anyway, Covid-19 gave a burning platform for people to really engage with social prescribing and self-help tools. We usually advise patients if they experience symptoms of depression for most of the day, every day for more than 2 weeks, you should seek help from a GP. Depression is the most common mental disorder in older people. Symptoms include low mood, reduced enjoyment, lack of energy, low self-esteem, feelings of hopelessness, lack of appetite, weight loss, disrupted sleep patterns and poor concentration. It's particularly important to speak to a GP if you: Have symptoms of depression that are not improving Find your mood affects your work, other interests, and relationships with your family and friends Have thoughts of suicide or self-harm Of course some patients will need to be seen and require medications, however many did not just want to be given a pill, they wanted the tools to help get themselves better. Empowerment is something I have tried very hard to incorporate into Scalesceugh Hall & Villas. When we had looked at other retirement villages, I had hated the concept of someone telling you how to live your life – what activities you would be expected to be involved in and when you should be awake. As I have always said, I think at this stage you have lived long enough to know what good looks like, and we, who are creating such communities, should listen and try and translate that into our development, architecture, facilities and services that we can provide. I have used a lot of social prescribing in my work place in the last year to help people with their mental health - helping them challenge their fears and finding solutions – and I can recommend the following: Mental health apps There are many apps that I have found useful for my patients which can be downloaded on a mobile or tablet: SilverCloud – An eight-week course to help you manage stress, anxiety and depression at your own pace. Catch It – To help you learn to manage negative thoughts and look at problems differently. Be Mindful – An online course to help reduce stress and anxiety using mindfulness-based cognitive therapy. Beat Panic – To help you overcome panic attacks and anxiety wherever you happen to be. distrACT – Provides quick and direct access to information and advice about self-harm and suicidal thoughts. Breathing exercises Studies show that breathing exercises can actually improve cognitive function, encourage positive thought processes, and reduce symptoms of anxiety. The following calming breathing technique from the NHS website takes just a few minutes and can be done anywhere, and so it can easily be adopted as part of your daily routine for maximum benefit. You can do it standing up, sitting in a chair that supports your back, or lying on a bed or yoga mat on the floor. Make yourself as comfortable as possible. Loosen any clothes that restrict your breathing if you can. If you're lying down, place your arms a little bit away from your sides, with the palms up. Let your legs be straight, or bend your knees so your feet are flat on the floor. If you're sitting, place your arms on the chair arms. If you're sitting or standing, place both feet flat on the ground. Whatever position you're in, place your feet roughly hip-width apart. Let your breath flow as deep down into your belly as is comfortable, without forcing it. Try breathing in through your nose and out through your mouth. Breathe in gently and regularly. Some people find it helpful to count steadily from 1 to 5. You may not be able to reach 5 at first. Then, without pausing or holding your breath, let it flow out gently, counting from 1 to 5 again, if you find this helpful. Keep doing this for 3 to 5 minutes. Mindfulness activities and diary keeping Using key mindfulness tools, my patients showed me how they had transformed their life. A diary I found very helpful for mindfulness, and which can be purchased online, was: 'The 6-Minute Diary - 6 Minutes a Day for More Mindfulness, Happiness and Productivity - A Simple and Effective Gratitude Journal and Undated Daily Planner' Using the diary can help encourage positive and powerful habits into everyday life, by using portions of 3 minutes in the morning to focus on the good things in one’s life and develop a good morning routine to set us up well for the day, and 3 minutes in the evening to reflect; focusing on what went well and how to improve. Making sure you have a routine to stick to during the day, with regular meals and bedtimes can really help. Exercise in the home and outdoors Exercising for as little as 20 minutes a day can help lift your mood, so get out in the fresh air when you can. Walking seemed to be very popular choice amongst my patients, along with a reflective diary. For those cold and rainy days when you aren’t able to get outside, you could get your steps in by walking up and down your stairs or around the house, or you could try a variety of other exercises. Many free exercises videos can be found online and on YouTube, including Tai Chi, dance and yoga. My next article will be focusing on the importance of exercise for our wellbeing and will include some additional suggestions of what you can do to get moving. The NHS also offers a wealth of useful information and advice on their website, including a list of charities and organisations that can offer support, such as Anxiety UK, Mind, Mental Health Foundation and Samaritans. You can find the full list and their contact details here. For those who may be struggling with their mental health due to loneliness, we have written a blog providing tips and advice for tackling such feelings which you can read here. The NHS also offer a useful service where you can self-refer. If you live in England and are aged 18 or over, you can access NHS psychological therapies (IAPT) services. A GP can refer you, or you can refer yourself directly. IAPT (Improving Access to Psychological Therapies) services offer: Talking therapies, such as cognitive behavioural therapy (CBT), counselling, other therapies, and guided self-help Help for common mental health problems, like anxiety and depression It has been interesting journey, where many of my patients have benefitted and I have seen such transformations. Of course, there will be times when we need medication and specialist support but it is not to say that self-help cannot be a way of living and works alongside whatever path you choose. There are many self-help tools out there. I think it is finding the time and space in our lives to engage with it and what better time than now! It is important to note, if you experience any suicidal or self-harming thoughts, or feelings of depression or anxiety that are not getting better, it is important you seek medical advice.