Archive for The idea

Mindapples Presents… Working Positively Under Pressure

31 May 2013 · Filed under Handle pressure, Mental health and wellbeing, Stay motivated · Tagged

Why do goals and challenges sometimes motivate and drive us to success, whereas at other times they overwhelm and make us feel stressed?

In this seminar from the Your Mind: A User’s Guide programme we will be looking at how you can manage stress, stay motivated and work positively under pressure.

Taking place on Thursday, July 4th at London Bridge, come along and learn about how your mind works and how to use it effectively, with insights from the latest psychology research.

Working Positively Under Pressure

Stress is our emergency response and is harmful to our health and mental performance in the long term. Effective businesses motivate their staff without creating stress.

Psychological research is teaching us important insights into how our motivation systems work and why external benefits alone are not enough to inspire us to be engaged or effective at work.

Our understanding of stress and pressure is converging on our ability to succeed as the key to avoiding stress and managing challenges effectively. Getting the balance right between our drive to succeed and our ability to do so is now the key to thriving in the modern workplace.

By understanding the psychology of motivation and pressure, we can learn to manage our workload to avoid stress and stay motivated and effective in our work, and build healthy and effective teams that can work positively under pressure.

Event Details

The event will be held at the Exchange in London Bridge, near the foot of the Shard. The 1 hour session will begin at 6.30pm and will be followed by networking drinks and a chance to discuss the content of the Your Mind: A User’s Guide programme.

Eventbrite - Working Positively Under Pressure

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Starting university – why I think mindapples help

9 August 2012 · Filed under Mental health and wellbeing, News, Universities

Starting university, for anyone, can be a big step. The complete change of environment, moving away from home, meeting new people and starting a new university course can be a lot to adjust to. When I first came to university 6 years ago I found that while there were so many new great things to discover and take part in, I also got a bit lost.  I was so preoccupied with meeting new people and making a good impression, joining new clubs, going out to all the student nights and worrying if I would do well enough on my first essay – I forgot to take the time to reflect and think about how I was really doing.

While services such as nightline and counselling are great and absolutely necessary, I think a concept like mindapples would have helped me adjust and take better care of myself – providing a way to set a routine in a new environment. For example, some of my mindapples are “go for a walk”, “have a really nice breakfast” and “call my parents”. If I would have done those things back then on a regular basis, as I do now, I think I would have felt a bit more settled and in control. It would have also given me an opportunity to take the time to check in with myself on a daily basis.

Simple things can help you maintain yourself, whatever they are, and I think having Mindapples for students could really help them adjust better. Not only would it give them a reason to have a think about their wellbeing, but also a positive way to talk about it with their friends making it a completely normal conversation. Not a conversation you only have when you’re not doing too great.

Back in February this year, seven universities had mindapples at their University Mental Health and Wellbeing Day. The success of this and the great responses we received have inspired us to invite more universities to take part in promoting mental wellbeing at the beginning of this academic year. Students are likely to feel more pressure this year than ever before. Faced with increased tuition fees, an unstable job market and lack of guaranteed employment in addition to the usual stresses of moving away from home – we want to empower students and equip them with tools which can help them manage their wellbeing.

If you would like to have mindapples at your university please get in touch at hello@mindapples.org.  If your university has a wellbeing programme please tell us about it, we love hearing about what universities are doing for their students.

We also have brand new trees and toolkits, which are available at our shop www.mindapples.org/shop. Mindapples are offering discounts for universities and schools;  please e-mail us to get a discount code.

 

By Ruta Marcinkus

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A commissioning framework for public health

21 March 2012 · Filed under Mental health and wellbeing · Tagged , , , , , , ,

Last week I was at the Guardian Public Health Dialogue in London, discussing how the new systems for public health will affect the UK. And eating crisps, of course.

For those of you who aren’t familiar with the Government’s plans, in a nutshell the responsibilities for the health of the public are moving into Local Authorities, the controversial new clinical commissioning groups, and a new central body called Public Health England. It was clear from last week’s event that even within the Department of Health and the NHS no-one is quite sure how all this is going to work yet, but it’s a big shift for public health delivery and could shake things up a lot.

I’m pleased to see Local Authorities having an increased role, because as Dr Quentin Sandifer at Camden Council said last week: “Everything that local governments do is public health.” Mental health in particular is deeply connected to social context, inequalities and living conditions, and so too are most of the really intractable social issues in communities today, from long-term worklessness to anti-social behaviour, poor diet, self-harm, drug-taking and alcohol abuse. Beyond the basic public safety responsibilities like protecting us from epidemics, public health in the UK today is really about improving people’s lives, and the best-placed bodies to take a whole-person approach to tackling this are Local Authorities.

I think the key obstacle to doing this well lies with the commissioning system. We hear a lot about the changes to NHS commissioning, but I still believe it is here that the new plans will come unstuck, unless we can shift our approach.

“Comissioning” in public services (still a relatively recent term) usually means paying third-party providers for a contracted service that they deliver on behalf of the State, whether that’s an NHS Trust running a sexual health clinic, or a private sector company delivering hospital IT systems. There is little sense in the UK of the concept of “State philanthropy” found in the US: most commissioning tends to be needs-based, with authorities identifying specific issues and tasking suppliers with solving them. Commissioning something purely because it makes people’s lives better is unusual, particularly in these austere times. The priority is on solving specific problems for specific people – a drug rehabilitation scheme here, an eating disorder support service there.

With the increasing drive towards payment by results, it will probably be the simple, easy to shift, highly measurable targets that get priority, because they are easier to commission effectively. Yet when you consider that the biggest cost-savings and radical efficiencies usually come from systemic, multiple-effect interventions, this is an issue that the Government should be taking seriously.

Public health doesn’t really work that way. Many of the most important public health questions in the UK today are simply too complex and interconnected to be tackled in isolation. A targeted intervention can be undermined by other factors such as the closure of key services, or wider social and economic factors. This is a particularly concern for our area, mental health and wellbeing, which  is notoriously difficult to measure and to affect through isolated interventions. With mental health issues costing the UK £77bn a year, and up to 50% of mental health problems seen as preventable by the Department of Health, the opportunity for systemic interventions in this area seems obvious.

Our particular interest at Mindapples is in helping people to take better care of their minds, which could support many areas of public health, just as the 5-a-day campaign has had a systemic effect on our physical health. It seems a no-brainer to me that if everyone in the UK takes better care of their minds, this will help address a great many health and social issues. But there seems to be no way in the current framework to commission this kind of systemic solution to multiple problems. Will public mental health fall through the cracks again?

I think the key to solving this problem lies in the outcomes frameworks.

Two weeks ago I was at a Department of Health meeting looking at the outcome framework for Local Authorities around public health. Whilst there are lots of excellent measures in there, many are too large and complex for any one commission to solve, making it difficult to know how anyone could commission effective interventions. For example, one proposed measure is the number of  hospital admissions for self-harm. The easiest way to commission services against this measure will be to work with people who have already self-harmed and put them through a process to help them recover. (Or, if you’re feeling cynical, to simply discourage people who have self-harmed from coming to A&E at all.) The harder thing to commission is something to reduce self-harm in the community at large, because it involves shifting a complex array of measures for the general population. Many public health issues work like this: simpler to treat than to prevent.

Complex problems require systemic interventions. The best councils are already thinking systemically, but the commissioning frameworks must reinforce this. If we are going to free up commissioners to try systemic, multiple-effect solutions to our most intractable public health problems, we need outcomes frameworks that include not only the symptoms, but the underlying causes of our public health issues. Moreover, by simplifying the objectives for public sector contracts, we can open up greater opportunities for small service providers, community groups and social enterprises, who currently lack the resources to deliver or measure against such weighty outcomes.

We are used to doing this in other areas. For example, we don’t expect Councils to tackle economic growth on their own: we make strategic economic decisions and task Local Authorities to deliver specific, measurable, tactical outcomes, such as offering small business support. So what are the simple things which Local Authorities can do, which collectively will contribute to a step-change in the health of the nation?

For one, we urgently need to start measuring locus of control. Clinical evidence is stacking up to show that if people feel they have control of their lives, they are likely to be mentally and physically healthier, with or without seo services. If we measure this across communities, and particularly amongst users of public services, we can easily start commissioning to promote this. There is similar evidence around self-esteem, education, loneliness, social capital, sense of community, and perceived inequality. We can commission interventions in all these areas, and measure them relatively cheaply too.

The job of Public Health England, in my view, should be to review the evidence base and understand the overall issues facing Britain, and to task commissioners with moving indicators that they can easily measure and effect, but which collectively add up to big change. Their job is to be the national experts in these matters, setting the agenda and driving a national strategy for change in public health, not simply passing the streategic decisions on to local level. Get these measures right, and we can make progress quickly. Get these measures wrong, and we will be stuck with more of the same – or rather less of the same.

Public health, and particularly public mental health, represents a huge opportunity to improve people’s lives and make Britain stronger in today’s tough global economic climate. The sooner we see this, and make plans to do something tangible about it, the better for everyone. It’s time for the Government to lead the way on building the evidence base and deciding the tactics, and free the rest of us up to do what we’re good at: helping people feel better.

Posted by Andy

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Why taking care of our feelings matters

15 March 2012 · Filed under Evidence, Feed your mind, Mental health and wellbeing, Your mind · Tagged , , , ,

“Positive emotions are worth cultivating, not just as end states in themselves but also as a means to achieving psychological growth and improved well-being over time”

- Barbara L. Fredrickson
Broaden-and-Build Theory of Positive Emotions, 2001

According to recent psychological research, the experience of positive emotions such as joy, interest, contentment and love, not only makes us feel good but also helps us develop new skills, build new relationships and become more resilient in the long run.

“Positive affect” – the conscious experience of a positive emotion – allows us to be more creative and open to new opportunities. It makes us more likely to have more flexible thought patterns, be more responsive to new information, and process it in novel ways, compared to when we are experiencing “negative affect” (Isen, 2000). Positive affect allows us to broaden our attention and our cognitive thinking, whereas negative affect – anxiety, depression, or feelings of threat – narrows our attention and prevents us from thinking and acting in a flexible productive way.  We are more open to new experiences and different actions when we are in a positive state than when we are in a negative state.

The Broaden-and-Build Theory (Fredrickson, 1998, 2001) explains why this might be the case.  A negative emotion such as fear is triggered by a threat signalling for us to escape, or anger which signals us to attack. Negative emotions limit our behavioural options for quick, decisive actions so that we act appropriately to maximise our chances of survival (Tooby & Cosmides, 1990). Positive emotions, on the other hand, signal opportunities for exploration and creativity, allowing us to think and behave in a more flexible way where no threat is present, and broadening our repertoire of thoughts and actions.

Whilst negative emotions help us focus us on a narrow range of immediate options, positive emotions give us the mental space in which to build our personal resources, whether physical, intellectual, social or psychological. Positive affect makes it easier for us to approach new experiences (what is known as “approach behaviour” rather than “avoidance behaviour”), enabling us to engage with the environment and be involved in activities that promote development and growth. Examples of this include increasing our attention and curiosity to learn new things, allowing flexible thinking to finding new creative solutions to problems, or simply being more open to develop our social relationships that can lead to support in the future.

The broaden-and-build theory highlights the benefits of experiencing positive affect, not just for feeling good, but for living and working more effectively. When we feel good, we are more able to learn new skills and build our support networks, helping us cope better and enjoy our lives in the future.

What all this means is that promoting and maintaining positive affect matters much more than just how we feel in the moment. Keep great people in your life and you won’t have to look for cross country moving quotes. Taking care of how we feel can help us boost our development, improving our wellbeing and our health, and enabling us to do more in our lives, and our work.

By Ruta Marcinkus

References:

Fredrickson, B. L. (1998). What good are positive emotions? Review of General Psychology, 2, 300-319.

Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56, 218-226.

Isen, A. M. (2000). Positive affect and decision making. In M. Lewis & J. Haviland- Jones (Eds.), Handbook of Emotions (2nd ed., pp. 417-435).

Tooby, J. & Cosmides, L. (1990). The past explains the present: Emotional adaptations and the structure of ancestral environments. Ethology and Sociobiology, 11, 375-424.

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Happy 4th birthday Mindapples!

29 February 2012 · Filed under The idea

Mindapples is 4 today.

On 29th February 2008, I submitted the original proposal to Social Innovation Camp that led to the creation of the Mindapples campaign, and ultimately the organisation it is today. Yes, that’s right, we are a leap-year baby.

The idea for Mindapples came originally from my conversations with my dear friend, Jo Worsley, who I remember back in 2006 arguing passionately about how stupid it was that our minds were the thing that separated us from animals, and yet we are taught almost nothing about how they work or how to look after them. I have learnt a lot from Jo over the years about how to manage my own mind, and I was acutely aware of how underfunded and unrecognised mental health was in our society. The fact that this issue was so low on our national priority list always struck me as ridiculous, because, as Jo herself put it, we all have mental health.

So when my friend Anna Maybank asked me to submit an idea to the first SI Camp, I wanted to do something in mental health. I’d recently been learning about the development of the 5-a-day campaign, and I wanted to create something equally practical and popular for mental health. And since my focus was on how to harness the power of the social web to create change in the world, my first instinct was to ask the crowd what they thought, and share their wisdom online. So I decided to create a website that asked everybody what the 5-a-day for their mind was, and share their answers with the world.

So, to celebrate our fourth birthday, here is the original email that started all:

From: Andy Gibson
Date: 29 February 2008 14:16
Subject: Idea Submission: Mindapples
To: ideas@sicamp.org

Can’t decide on a name! I’ve registered mindapples.org and stayingsane.org - which do you prefer?

The idea

What is the mental health equivalent of 5-a-day? Mindapples is a simple campaign to promote awareness of mental health and wellbeing for all people, even those who self-identify as “sane”. A public campaign website will invite the general public, celebrities, health professionals and “role models” to submit their own “5-a-day” to stay mentally healthy – from playing the piano to drinking lots of water. Snippits of biography will help to contextualise the suggestions and lend a human tone to the site, whilst users can add their “me too!” votes to any idea to establish a sense of the most popular activities. The human interest for this content could be great, and we should also attract press coverage and interest from prominent organisations and thought leaders. The long-term vision for the campaign would be to attract government, third sector and commercial backing for a popular list of daily activities which can help you stay sane, which could be used by everyone from yoga teachers to bottled water companies to promote the benefits of what they offer. It will put the concept of daily mental wellness firmly into the public consciousness, and encourage everyone to think about the impact their activities have on the state of their minds.

What social need does it address?

Mental health is one of the most socially important and underfunded issues in society today, and directly or indirectly affects the majority of the population. Yet most mental health campaigns focus on providing care and acceptance for people who are officially classified as “mentally ill”. While initiatives in physical health are focussing more and more on prevention and wellbeing, mental health continues to languish in the public imagination as something shameful, that only relates to “sick” people – with all the stigma and isolation that this culture can create. But if you can care for your body by eating an apple or going for a run, what is the equivalent for your mind? By supporting individuals to take care of their day-to-day mental wellbeing through simple activities, we can make mental health an issue which is relevant and important for everyone. If successful this campaign could transform the definition of mental health, break down the social division between “sane” and “insane”, and promote a healthier, safer society.

What’s new about it?

Rather than focussing on mental sickness and inviting people to discuss their problems, this campaign will promote discussion of mental wellbeing and prevention in a stigma-free, non-judgemental environment. The 5-a-day campaign raised awareness of the importance of individuals taking care of their health, and it did so without mentioning sickness or obesity. By focussing on the positive side of mental health we hope to make the discussion of mental health more socially acceptable, and raise awareness of the simple things that everyone can do to stay mentally healthy. When was the last time someone asked you what you do to stay sane?

What inspired you to come up with your idea in the first place?

I have had direct experience of depression, stress and anxiety, and yet I would self-identify as “sane”. Many people I know have experienced what might be termed “mental illness” and yet they do not fit into what the NHS would classify as the “mentally ill”. I also have experience within my personal life of the impact of more severe mental and emotional problems on people’s ability to function, form relationships and be happy, and have seen just how little support there is for people who fall somewhere between “totally sane” and “totally broken”. Meanwhile I have watched well-known figures like Stephen Fry raise awareness of mental illness by “coming out” as sick, but no-one who is “sane” talking about the practical tools for managing your mind and staying well. When I spoke recently to a colleague about the five-a-day campaign I realised that there is no equivalent for mental health, and that this is the missing piece of the jigsaw – and an excellent way to use the power of advertising and the press to help everyone take better care of themselves and accept mental health as something everyone should consider.

Stage of development

The idea is reasonably well-formed and is already attracting some interest from organisations and individuals. I have a clear plan for how to take it forward, but I need advice from mental health experts and experienced campaigners on how to develop the campaign itself, from identity to tactics. There are various potential individuals interested in helping with the campaign in various ways already, and although the idea itself is basically my own at present, Social Innovation Camp weekend would offer a good opportunity to bring some of these people into the project.

What can we do for you?

  1. Geeks – the first step is to create the basic campaign site, including the beginnings of an identity and content delivery platform
  2. Mentors – after that, I need high-level input from people with a good knowledge of social campaigning and the mental health world
  3. Funders – to give me some initial cash to pay for some design and identity work to develop the campaign brand, some PR/outreach work to attract attention from the press and prominent individuals, and the technical infrastructure to run a high-traffic website.

I am happy to steer the initial development, and if the campaign takes off I would be happy to perform a strategic and representative role to guide and promote the project and establish the organisation, but I don’t have the time to perform an executive role on the project and I would look to hire a campaign director and some interns to push the project forward. I have a clear plan for developing the project though, so I am very happy to put time into carrying that out.

Privacy

Keep it open, but can you put an e-mail address on there for people to contact me if they want to help?

Cheers!
xAx

–
Andy Gibson
Founder and Director
www.sociability.org.uk

As you can see, the idea hasn’t changed much from its original form over the past four years; in fact, it’s remarkable how many of the phrases in this first email I still use today. I wasn’t actually keen to lead the project at first (I was still at School of Everything at the time), so the fact that it has dominated my life for four years since is a cautionary tale for anyone thinking about starting something new. Watch out folks: good ideas take over your life! And as you can also see, I wasn’t even sure if we should call it Mindapples. Just imagine if I’d been persuaded to call it ‘Staying Sane’? I very much doubt we’d be having this conversation right now. Funny how these things turn out.

We didn’t actually get selected for the first SI Camp, and the Government actually published it’s own Five Ways to Wellbeing a few months later, but a lot of people liked the idea, and it seemed to have something other campaigns in this space lacked. So Tessy Britton suggested that I should just post it up as a Surveymonkey site and a blog, and get people sharing their 5-a-days, and thanks to the RSA and some influential bloggers, we soon had over 1000 responses and interest from some very high-level people in the field. My friends Hege Saebjornsen, Lauren Currie, Jenny Reina and many others then helped to grow the project into a full campaign, and since 2010 Esther King and I have been turning that campaign into a growing social business. It’s been a very long, strange journey, and very hard at times, but it’s great to look back and see how much progress we’ve made, and how true we have stayed to my original intentions for the project.

Thanks very much to everyone who’s been involved in taking Mindapples from this innocent little proposal to the growing organisation it is today. As they say, it’s been emotional.

And a very happy 4th birthday to you, Mindapples. May you have many more to come.

Andy

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Why having fun is good for you

16 February 2012 · Filed under Feed your mind, The idea, Your mind · Tagged , , , , , , , ,

We all know that leisure time makes us feel good, but now scientific evidence shows that taking time out and engaging in activities you enjoy really does lead to both psychological and physical wellbeing.

It’s a well-established fact that physically healthy actions such as eating well and getting enough sleep make us feel better, it is much harder to prove that taking the time to do our ‘mindapples’ is good for us too. Recent research carried out by Pressman and colleagues (2009) has examined how leisure activities affect our wellbeing. They defined these as “pleasurable activities that individuals engage in voluntarily when they are free from demands of work and responsibilities”, but we might call them mindapples.

They proposed that these everyday activities are more than just something we enjoy doing, but also have a beneficial effect for coping and restoration, particularly at times of stress. Taking time out to relax with a cup of tea or spending time in nature can serve as a “breather”, a chance to take a break and distract oneself from demands and concerns that occupy the mind. Leisure activities can also act as “restorers”, helping us cope with stress by replenishing our resources, for example through spending time with loved ones who make us feel cared for and more able to cope. They based this on previous research showing that common categories of social, physical, nature-related, reflective and creative activities were found to be restorative (Jansen & Sadovsky, 2004), categories that we often find in the mindapples suggestions.

Pressman and colleagues investigated the effects by measuring how much time participants were able to spend time doing the activities they enjoyed and compared it to their self-reported psychological wellbeing, as well as blood pressure, stress hormone levels (cortisol) and other physiological factors.

What they found was that individuals that spent more time engaging in enjoyable activities did in fact have greater psychological and physical wellbeing. This included greater experience of positive emotion (positive affect), life satisfaction and engagement, lower depression scores, greater social support, lower blood pressure and cortisol levels, and better perceived physical function.

Another particularly interesting aspect showed that engaging in leisure activities can act as a “stress buffer”. Individuals with greater stress levels (i.e. had recently experienced stressful life events) who took the time to engage in these activities showed lower levels of negative moods and depression and higher positive affect, than individuals who experienced stress but did not spend time on enjoyable activities. This shows that “breathers” or “restorers” promote positive wellbeing and restoration by providing the individual with necessary resources to cope with stress.

So, while it might not be as easy to measure as getting enough sleep or eating vitamin C, it seems you really can take care of yourself by simply remembering to spend time doing the things you enjoy.

Getting 5-a-day for your mind can be good for your mental wellbeing, your physical health, and act as a buffer for coping with stress. And who knows you might even have fun. So, have you had your mindapples?

By Ruta Marcinkus

References:

Pressman, S. D., Matthews, K. A., Cohen, S., Martire, L. M., Scheier, M., Baum, A. & Schulz, R. (2009) Association of Enjoyable Leisure Activities With Psychological and Physical Well-Being. Psychosomatic Medicine, 71, 725-732.

Jansen, D.A., von Sadovszky, V. (2004) Restorative activities of community-dwelling elders. West J Nurs Res, 26, 381-399.

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The best of the 2011 Mental Health Congress

30 November 2011 · Filed under Mental health and wellbeing

Today Team Mindapples are at the Mental Health Congress, running our now-famous tree pop-up and listening to a range of specialists from the mental health care and policy communities speak about the future of the sector in the UK. Here are a few of the key points that I felt were most interesting from the plenary sessions today.

Bruce Calderwood, Director of Mental Health Policy at the Department of Health, kicked off the day with a policy overview. The Mental Health Strategy is a good document and the intention to take an integrated approach to put mental health on an equal platform with physical health is encouraging. The part that particularly interests us at Mindapples is the first objective of the strategy, “More people will have good mental health”. There is a lot in this strand, mostly focussed on supporting people to stay mentally healthy at key life stages (childhood, education, work, life, and old age). What was striking though is that there was no reference to direct mental health promotion campaigning, beyond a cursory reference to the usual “5 Ways to Wellbeing”. For the sixth objective, reducing stigma, the Department and Comic Relief have pledged over £20 million pounds to the Time to Change campaign (our clients for much of our public engagement work). I would like to see the equivalent funding committed to promoting good mental health in the wider population. I think this is the area of greatest potential impact for improving mental health in the UK, and I’d like to see it given the same level of Central Government support as other parts of the strategy.

Jenny Hyatt from Big White Wall popped up with the first question, which was about ‘e-mental health’. Do we need a strategy specifically for how digital tools can be used in mental health care? Bruce said this was an area that needs more work, and I agree. What I’d add to that is that we need to think much more broadly than simply electronic service delivery, into the role of digital in reshaping our models of care, joining up clinical and non-clinical services, and particularly in connecting people together within and outside the care system. ‘e-health’ doesn’t just have to mean transactional services.

The next panel was on healthcare service commissioning, not directly my area but it was interesting listening to the themes that emerged, particularly in the Q&As afterwards. There was a lot of talk about change, and barriers to innovation, with St Mungos making the point that if commissioners are being told specifically how to commission for care pathways, local innovation becomes very difficult. A commissioner from Croydon, now part of Mindapples amalgamated NHS partners ‘NHS South East London’ also raised concerns that the economies of scale gained from amalgamating local NHS commissioners is offset by the barriers thsi creates to localisation. The most significant point for me though was made by the ever-vigilant Michele from CoolTanArts, who pinpointed that the rhetoric around patient control and choice, so central in recovery, wasn’t being backed up with a clear plan for patient involvement and choice in the care and commissioning process. The message back, sadly, was that in a decentralised system without common commissioning pathways, service users were going to need to “stamp their feet and kick up a fuss” to be heard.

I had to skip the presentation by Peter Finn at the Audit Commission (sorry Peter) on benchmarking measurements, but I did speak to him over breakfast and he asked me what key measurement we should add to the national standards to help us measure the quality of care. My answer was locus of control, measuring how far our public services give users a sense that they are in control of their care and conditions, rather than feeling powerless in the face of external events. My reasoning for this is that an external locus of control has been linked with significant negative mental and physical health issues, whilst feeling empowered and in control of our fate is excellent for our mental health. Control is very much a subjective phenomenon, but it strikes me as very strange that no-one in our public services (and indeed in our workplaces) seems to be measuring this simple and vital factor in people’s health and wellbeing. And it would be very cheap to measure.

Ian Hulatt from the Royal College of Nursing was up next after the break, and he talked in detail about how mental health nursing has changed over the past decades. We now have a generation of nurses who were trained in a very different way from the old-fashioned, coercive world of the asylums, but mental health nursing still has an image problem, and the RCN is doing a lot of work on this. My personal experience of mental health nurses has been that they are universally very caring people who struggle every day to both care for and respect the views of some very troubled and troubling patients. It was encouraging to hear Ian talk about the importance of good health and wellbeing in the care process too, although of course crises do happen.

Some stats for you now, shared from Department of Health figures by Chris Naylor of the Kings Fund. 30% of the UK population have a long-term health condition, of whome around 30% have a mental health problem. 20% of us have mental health problems, of whom around 46% have long-term conditions. Which is a complicated way of saying that long-term conditions and mental health problems go hand-in-hand, and the cost of this ‘co-morbidity’ is huge, both in human terms to the quality of people’s lives, and also in the financial impact of increased service use and costs. Generally, for example (US data now), long-term patients with depression cost around twice as much to treat as those without depression. The Kings Fund estimates that £1 in every £8 spent on long-term conditions goes on treating related mental health issues. To be less mercenary about it, people with bipolar disorder and schizophrenia die 10-25 years earlier than the rest of the population, and far more from “unrelated” physical health conditions than from suicide. So improving the mental health of long-term conditions patients should clearly be a top priority for the NHS. Their top suggestions include adding a psychological component to existing physical care services, and improving the mental health support in Primary Care (something we’re obviously keen on given our ongoing GPs pilot work). So, if anyone out there wants to speak to us about how Mindapples might be used to support the treatment of long-term conditions, please do get in touch.

I was most encouraged by Chris’s point that, although we have physical health co-morbidity mentioned in the Mental Health Strategy,  what we also need is to place mental health at the heart of our physical health strategies. I’ve met so people in the NHS and local government who are really aware that many physical health issues, particularly public health problems, are deeply connected to low-level mental health issues – and yet public health in the UK remains siloed, with “alcohol” in one corner, “obseity” in another, “smoking” over there. Recognising the common thread of mental health problems running across so many of our health and social issues feels like an obvious and overdue policy focus, so anything that places mental health promotion at the heart of policymaking for physical health gets my vote.

And on the lifestyle point, next speaker Geraldine Strathdee made an impassioned point about the patronising attitudes we take to patients around lifestyle, and that we should never prescribe medication to patients without first giving them full information about lifestyle changes and other health considerations, to help them make informed choices. As she puts it, we wouldn’t ever prescribe medication for diabetes without also talking through information on diet and nutrition. Giving patients more information and choice about taking care of their minds – nice one Geraldine, I’m a fan. And obviously I think Mindapples could have a key role to play alongside Weightwatchers, free gym passes, sports groups and other parts of the personalised care plans that assist people to get and stay well. I asked Geraldine and Chris this question: given what we know about the value of integrating mental and phyiscal health care and of patients making more informed lifestyle decisions, was there enough emphasis in current policy on education and engagement, to ensure patients and the public know what they can do to look after themselves and are educated about their health needs? Chris felt that this was absolutely central to the Government’s new strategy, because we can’t have a deregulated and decentralised market for healthcare provision without having educated and empowered ‘customers’. However, he also felt that this element had been sidelined for the timebeing because structural concerns are dominating the debate at the moment. Geraldine’s argument was actually that there isn’t enough that policymakers can do, and it’s up to the staff on the frontline to do what we know needs doing – and if we want to create a mass movement to promote this information, we absolutely can. Inspiring and pragmatic stuff, but having tried to do just that for three years now, I can tell you that a bit more support from Central Government would definitely help!

Last up was Prof Neil Greenberg from the Kings Centre for Military Health Research. The key point I took from this is that the biggest issues faced by armed forces members being referred to mental health services are “adjustment disorders” – the struggle to reintegrate back into civilian life. This issue has been well-documented, and is a perfect example of how much our mental health is a product, in part, of our relationship to society, with people struggling to adjust to what might on the surface appear to be a less traumatic and difficult situation. Our friends at Big White Wall are doing a lot to support veterans now, and I had a good discussion with someone working on this at the Department of Health about how Mindapples might get involved in supporting our armed forces to manage their mental health more effectively during and after service. So lots to think about there too.

I will be giving a talk this afternoon about positive mental health promotion and preventative care, so I’m hoping to raise some of the points above with the audience then. I’ll post a few points from the Day Two sessions tomorrow too, and in the meantime please do leave us comments if you have any thoughts on any of this. It’s the only way we’ll learn…

**Addendum: Day Two has been very clinincal so I won’t be posting a summary of all the sessions. But, we’ve just been to an excellent couple of presentations this afternoon about involving young people in creating their own mental health interventions, so here are a few extra notes from them.**

Elise Leclerc from the Mental Health Foundation’s youth projects team presented some great impact findings from their work to engage young people in the design and delivery of services. We also heard from MAC-UK about their great work with young people at risk of mental health issues and offending. Here are a few stats from their presentation:

  • Serious youth violence much a public health issue as much as a justice one
  • 1 in 3 young people who offend have an unmet mental health need at the time of offence
  • Clinical depression is far more likely to present as aggression in young men; aggression which leads to violence
  • The evidence suggests that once young people are in the justice system, their mental health needs remain unmet

Young people who are at risk of mental health issues, and of offending, often have complex, multi-level needs, and the evidence from all these presentations is that the best way to help them involves engaging them in activities and services which they have chosen and helped to create. It’s also worth saying that fear of violence contributes significantly to the anxiety levels in young people, so it isn’t so much about stopping young people from being violent, it’s about keeping them safe.

The undoubted highlight though was Stella Charman of Right Here, who is the only person I’ve heard over these past two days (apart from us) who is talking about the central value of ENGAGEMENT. They have a lot of evidence of the clinical value of engaging young people in therapeutic activities that they actually enjoy, like rockclimbing and music production. She really knew the value of understanding what people actually WANT to do, as a route to encouraging people to participate in services and seek help. Mindapples won a Cabinet Office award in early 2011 for an idea to visualise insights data about what people say THEY think is good for their health and wellbeing. There is a huge volume of insights data being collected through Mindapples site (50,000+ suggestions and counting), and from service co-design and co-delivery projects across the country. If we were selling a product like Coca Cola, we would begin by seeking to understand what consumers value and desire, and we think all this data would be incredibly useful for understanding how to commission services that will actually engage people – and yet we’ve had very little interest from public commissioners in finding out what their “consumers” actually want.

The best quote of the whole conference for me was from Stella, who summed up our attitude to mental health services in the UK. “The therapeutic value of a perfectly-planned, fully evidence-based UNATTENDED intervention is ZERO.” Exactly. Thank you, Right Here, now let’s get engagement on the policy map for 2012!

Posted by Andy

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The Future of Mindapples Web Apps?

4 October 2011 · Filed under News, The idea

Today and tomorrow, Mindapples is very proud to be at the Future of Web Apps London conference, rubbing shoulders with some of the most interesting folks in the international tech scene. Thanks very much to Carsonified for featuring us as one of the sponsors and letting us bring our Mindapples Tree to their conference.

Mindapples has been very much an offline business for a while now, running engagement events and taking our tree and applecards on tour to talk to people all around the UK about the health of their minds. We took this approach because we want to prove Mindapples works for everyone, even people who don’t have access to or interest in new technology. We actually started as a digital campaign though, and we’re hoping FOWA will be the springboard for us to get back to our digital roots.

Back in 2008, Mindapples was just a surveymonkey page and this humble little blog. Now we’ve got a great little Ruby on Rails site built by our friends at Unboxed Consulting, but we know we’re still novices when it comes to digital campaigning. There’s so much more we can do, and we’re inspired by projects like It Gets Better, Invisible Children and KaBoom! who have used digital tools to reach millions of people.

So, folks of FOWA and the wider community, we’d like your help. What do you think we should do digitally to get the Mindapples word out to millions of people? Specifically, what do you think we should build or do on the web and with mobile tools to deliver the following objectives:

  1. Get 1 million people to share the 5-a-day for their minds and think positively about their mental health?
  2. Bring people back to http://www.mindapples.org regularly to get tips and inspiration about the health of their minds?
  3. Promote our services and the many other products and tools out there that people can use to increase their mental wellbeing?

We’d like to hear what you think will work best for our campaign, so please reply here, post your thoughts on your own blogs and link back to us, tweet us at @mindapples, or drop us a line privately on hello@mindapples.org.

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Nudge vs. #bigsociety?

31 January 2011 · Filed under Mental health and wellbeing, The idea · Tagged , , , , , ,

Happy New Year folks, I hope you had a lovely mindapple-filled winter break. Last week I attended the launch of the Health Equalities Alliance and their inaugural debate Nudge or fudge – can a gentle push really tackle health inequalities? It was the first time I’ve had the chance to quiz members of the Cabinet Office’s Behavioural Insight Team about their recent emphasis on ‘nudge’ social marketing techniques, and it’s given me much food for thought.

Nudge, for the uninitiated, refers to a set of techniques described in the book of the same name by Richard Thayler and Cass Sunstein, about the unconscious influences which “nudge” us make choices in everything from the food we eat to the directions we walk. Anyone designing an environment in which people make choices is a “choice architect” and witting or unwittingly creates factors which influence decision-making – and which can therefore be altered to nudge people to make choices which are better for them.

This is nothing particularly new. The techniques are drawn from the same psychological stock as 20th Century advertising, PR and sales theory and are well-evidenced. The Coalition though sees these tools as pivotal to delivering mass behaviour change in high cost areas – such as public health – at a low cost. When you consider that a recent Scandinavian study (citation appreciated if anyone can find it) suggested the health service contributes only 15% of the overall health of the population, you can understand why nudge theory is so appealing to an indebted Government facing rising demands on an already over-stretched NHS.

The problem though, as many of the panel observed, is that you can’t nudge people out of poverty. To put it more broadly, choice architecture works brilliantly when you have a choice, but is therefore more likely to benefit the wealthier classes with more options than those who cannot afford better food, or who are subjected to abuse or poor living and working conditions. I am skeptical about the capacity of nudge thinking alone to deliver health equalities or even widespread population health improvements, at least beyond the priviledged minority. It must be blended with real progress on the critical social factors that create poor health, and not a substitute for them. I also welcomed the assessment of Phil Coppard, Chief Executive of Barnsley Council, that dividing public health into individual behaviours like smoking, diet and exercise misses the underlying truth that “this is actually about low level mental health”. Nudging people to act differently may alleviate the symptoms, but leave the sickness untouched.

I believe that nudge thinking has an important role to play in improving the design of public systems and spaces, by making designers think more carefullyabout the implicit choice architecture embedded in their creations. For example, my council landlords require me to sort recycling into several piles and take it out into the street, but if I want to send anything to landfill they will collect it daily direct from my door. Then they put up leaflets about the importance of recycling. This is patently absurd, and if nudge thinking can be used to review and correct the nudges that send people in the wrong directions, this is a good thing.

However, I also believe there is a tension between the implicit paternalism nudge thinking and the “empowerment” rhetoric of the Big Society (and more on my personal thoughts on that project over here). Dr Samantha Callan from the Centre for Social Justice cited one example of nudge in action, that of placing a bus stop outside a care home so that if Alzheimer patients ran away from their carers, they would simply wait outside for a bus until they could be collected. So far, so economically efficient. But as one audience member observed, perhaps this is manipulating patients to stay indoors rather than helping them spend more time outside rather than cooped up indoors all day. Sometimes we do things unconsciously for good reasons, even if the result isn’t as effective as we would like. Moreover, nudging people in one direction rather than another still leaves them vulnerable to being nudged back again, and when you consider that for every pound spent on nudge public health marketing there will be ten spent on getting the public to eat Pringles, the economics of this whole nudge thing start to look flawed. Nudge is powerful, but unless it builds conscious agency and involves individuals in the decision-making process, it can only disempower the people it serves.

How can we be trusted to run our communities, deliver public services and control local planning decisions when we cannot also be trusted to make informed decisions about feeding ourselves or raising our children? We cannot be nudged into taking more informed responsibility for our life choices. So are the people who are to be subconsciously manipulated into living healthier lives the same people who the Government is championing as having the power and skills to lead this country into a new era of citizen-led society? Or will we be nudging one part of the population whilst empowering another?

With this in mind, my question to the panel was “have we abandoned learning?” Dr Ronny Cheung from the Cabinet Office (who took more than his fair share of flak from the audience as the only official nudge apologist present) spoke of nudge as more effective at scale than “giving information” – but giving information is simply old-fashioned broadcast style education. There are so many more sophisticated tools for creating learning than giving information, and if we fail to employ any of them in tackling public health issues, we are effectively giving up on having an informed public who are responsible for their own destinies. We need to engage the public in making conscious choices and building personal habits based on knowledge, to empower individuals not only to manage themselves better, but also to resist being nudged in one direction or another. And if we are to capture the support of the current Government, we also need to do it at scale, and cheaply.

This is where I think Mindapples comes in. We want to build people’s conscious awareness of the connection between what they do and how they feel, and help all of us learn from each other what we each want and need to be mentally healthy. I’m sure we’ll be nudging people along the way, but everything we do will always be about helping individuals make conscious, informed choices about what they need, and getting the support they deserve to meet those needs. And we think we can use digital tools, peer recommendations and the skills and networks of our community to do this at scale, and for low cost. When you consider Mr Coppard’s observations about the root causes of many public health issues, an effective and empowering intervention in public mental health could have huge positive implications for public health in general.

Of course, education on its own is not enough. Professor Richard Parish of the Royal Society of Public Health summarised it well last week: “we haven’t abandoned education, but whether education results in behaviour change depends on social factors.” Mindapples and its like can go some way towards helping people get what they need from society, but there is still much that the Government must do to create the opportunities for people to thrive, and the social and cultural context in which good things are easier to do.

Right now though, we seem to be in the strange position of pushing subconsious behaviour change techniques to a passive, unaware population with one hand, whilst the other lifts citizens up to run our communities, take vital decisions and run public services. Is the pragmatic paternalism of nudge politics actually in direct conflict with the lofty aspirations of the Big Society?

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Mindapples in action: Brixton Market, Oct 2010

15 December 2010 · Filed under Communities, News, Promotions, Take action, The idea

In October 2010, Mindapples teamed up with NHS Lambeth and the nice people at Spacemakers and Transition Town Brixton, to install a pop-up Mindapples Tree in Brixton Village Market and talk to complete strangers about the health of their minds. We had no plan, no permission, and no idea what would happen. So, we asked The People Speak to come down and film the day and make a little video of what happened. Here’s the result…

Thanks to Hektor and Rick for the brilliant video, and to Esther, Jenny and Sahar for collecting Mindapples on the day! If you’d like Mindapples to come to your town, please e-mail pleasedomenext@mindapples.org.

Posted by Andy

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