Many of us will be familiar with patients who have recovered from an episode of mental ill-health, who are fearful of coming off medication or of anything that might rock the boat. There is no way that they want to go back to where they were.
So what advice might we give to these patients about staying well? What advice might we give to those who come to us struggling to help them maintain balance.
And equally important, what could we be putting into practice ourselves? To help us care for others more effectively. To keep us buoyant, happy and thriving.
In 2008, the New Economics Foundation (NEF) were commissioned to develop a set of evidence-based actions to improve personal wellbeing. They came up with “five ways to wellbeing: connect, be active, take notice, keep learning and give.”
South London and Maudsley trust (SLAM) took this concept further, developing the “Wheel of Wellbeing”, which adds a 6th element – planet.
I am going to look at each of these in turn and make them relevant to us as clinicians.
This is essentially about being and keeping active; getting our 30 minutes 5 times a week in as little as 10 minute bursts.
It is also about spending less time sedentary. Studies are now suggesting that inactivity causes as many deaths as smoking. As well as being important for many of our patients, this is very relevant to GPs in particular.
In addition, body could reflect how we look after our physical health, how we maintain physiological balance. So healthy eating, reducing alcohol and caffeine, avoiding other toxins such as smoking and drugs and getting good quality sleep.
Studies show that learning new things makes us happy. This could be trying something new or rediscovering an old interest e.g. learning to knit, or play a musical instrument.
On another level, this could also reflect using our mind creatively to change the way we think about some of the obstacles that we face:
“If you don’t like something, change it; if you can’t change it, change the way you think about it. ” Mary Engelbreit.
As we all know too well, this is often far easier said than done. Yet, the beauty and simplicity of the Wheel of wellbeing is that if we follow it, we’re much more like to find the headspace to do this.
In addition, ‘mind’ could mean time for reflection, perhaps on how our current situation matches our purpose and passions. I am not sure how often we do this as doctors. We identify goals for the purpose of appraisal, and climbing the career ladder. But how often do we actually identify what our values, purpose and passions actually are and if we are anywhere near meeting them?
Health psychologist, Kelly McGonigal, suggests in her TED talk “How to make stress your friend” that the best way to make decisions is to “go after what creates meaning in your life and trust yourself to handle the stress that follows.”
This is about giving. As medics we probably feel that we give through the very nature of our job. However, this is also our livelihood.
Giving in this context means giving without any expectation of reward. For example, volunteering or doing something small like helping someone across the road.
Spirit here also reflects a broad interpretation of spirituality. Something that suggests meaning and purpose, or feelings of connectedness and love, or perhaps a transcendent awareness of something bigger than ourselves.
Evidence shows that spiritual practices such as practicing gratitude, being humble, being mindful, listening to music and praying all enhance resilience and are associated with positive physical and mental health.
This is about connecting or reconnecting with people. These may be our friends, our family, our colleagues and, in many cases, our patients. It might also be people that we don’t know.
Having an engaging conversation with someone or laughing when we are feeling fed-up can often be enough to help us shift to a more positive state.
Kelly McGonigal, suggests in her same TED talk “How to make stress your friend” that “human connection is our body’s built-in mechanism to stress resilience” and that “when you choose to reach out to others when under stress, you create resilience”.
In addition, true friends comfort us. They know our history, our strengths and weaknesses and because of these or in spite of these, they choose to stay with us something, which positively influences our self-esteem.
People is also about community. Being part of something positive gives us a sense of belonging. On the flip side, it can also be detrimental. We will all be familiar with having worked in teams or groups which did not work well together. That sense of “swimming with sharks” as one surgeon once so aptly described it.
This is about taking notice. Finding the time to be curious, noticing beautiful sights, commenting on unusual ones. Appreciating our surroundings and the people we are with.
It is also about focussing on the present, rather than the past or the future. Yoga, tai chi and mindfulness are all techniques that can help us achieve this by encouraging us to focus on the now.
We may feel that we are small fry when it comes to this, particularly after Trump’s recent u-turn on the Paris climate deal but there are small changes that we can make every day, such as switching off lights, not driving where possible, that we can all make to help keep our planet sustainable for the future.
Every year, one on four people will experience a mental health condition. We know that mental ill-health in doctors is higher than in other professional groups. Yet, everyone will experience emotional distress.
Emotional distress is normal, and is a part of everyday life. Feeling stressed, anxious or low at times is also normal, as are unhelpful thoughts. It is when these thoughts and feelings become so frequent and / or severe that they prevent us from coping with daily life that they become a problem.
I think that the Wheel of Wellbeing is a useful evidence based tool that we can use with our patients and ourselves to promote positive emotional health, so that we can hopefully prevent that emotional distress from becoming a problem.
Two other excellent evidence-based resources that I have found useful are: