tag:theconversation.com,2011:/uk/topics/mental-health-343/articlesMental health – The Conversation2024-03-28T20:41:08Ztag:theconversation.com,2011:article/2258762024-03-28T20:41:08Z2024-03-28T20:41:08ZSpotting the signs of disordered eating in youth: Tips for parents and caregivers<figure><img src="https://images.theconversation.com/files/584906/original/file-20240327-29-jlr0nd.jpg?ixlib=rb-1.1.0&rect=549%2C76%2C2570%2C1739&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eating disorders are on the rise in youth, with research showing that health-care visits for eating disorders have doubled since before the COVID-19 pandemic.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In the age of social media, youth are constantly bombarded with viral trends and toxic messages that set unrealistic standards about the ideal body image. This has translated into a far too <a href="https://doi.org/10.1371/journal.pgph.0001091">common expression of body shape dissatisfaction</a> in young people.</p>
<p><a href="https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/eating-disorders">Eating disorders</a>, such as anorexia, bulimia, binge-eating disorder, and avoidant/restrictive food intake disorder are serious mental health conditions that affect approximately <a href="https://nied.ca/about-eating-disorders-in-canada/">one million Canadians</a>. These conditions are also on the rise in youth, with research showing that <a href="https://doi.org/10.1016/j.jaac.2024.02.009">health-care visits for eating disorders doubled</a> during the COVID-19 pandemic, compared to before the pandemic. </p>
<p>This is concerning, since there are already <a href="https://doi.org/10.1016%2Fj.jadohealth.2022.12.008">very long wait times</a> for eating disorder programs. </p>
<h2>Impact of eating disorders</h2>
<p>Individuals with eating disorders experience a problematic relationship with food, often accompanied by significant distress about their weight, shape and size. Many experience body image dissatisfaction and restrictive eating. </p>
<p>Eating disorders do not discriminate. They can occur in people of any race/ethnicity, age, socioeconomic class or gender. Youth who do not “fit” the stereotype of an eating disorder, especially <a href="https://nedic.ca/bipoc/">those from Black, Indigenous and racialized backgrounds, may face delayed recognition and diagnosis</a>.</p>
<p>Eating disorders impact every aspect of an individual’s life and contribute to significant distress for the affected individual and their family, including their siblings. <a href="https://www.nationaleatingdisorders.org/health-consequences/">They can have serious and life-threatening complications</a>, such as bradycardia (heart beating too slowly), osteoporosis (bone weakening) and anemia (low red blood cell count). Eating disorders are also associated with a high rate of premature death.</p>
<p>As clinicians and researchers, we have studied and worked with youth and their families struggling with eating disorders or “disordered eating” (the spectrum of unhealthy eating behaviour and patterns). Below we offer a guide for parents and other supportive adults on recognizing the signs of disordered eating in youth and offer practical resources and tips to support them effectively.</p>
<figure class="align-center ">
<img alt="A teen boy sitting at a white table with an empty white plate on it, resting his head on his hand" src="https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584907/original/file-20240327-16-158617.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eating disorders impact every aspect of an individual’s life and contribute to significant distress for the affected individual and their family, including their siblings.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Signs of disordered eating</h2>
<p>Considering the growing concern about the rise in eating disorder behaviour in youth, and the importance of timely recognition and action, the following signs and symptoms of disordered eating are important to look out for:</p>
<p><strong>Behaviours related to disordered eating</strong>:</p>
<ul>
<li><p>Excessive exercise to reduce weight or change body shape</p></li>
<li><p>Going to the bathroom immediately after eating</p></li>
<li><p>Eating in secret</p></li>
<li><p>Restricting foods, such as a specific food group</p></li>
<li><p>A preoccupation with losing weight or maintaining a low body weight</p></li>
<li><p>Frequently weighing themselves because of body image dissatisfaction</p></li>
<li><p>Unusual behaviour around food such as weighing/measuring food or cutting food into tiny pieces, or large consumption of liquids at mealtimes (for calorie dilution and a sensation of fullness)</p></li>
</ul>
<p><strong>Physical signs of disordered eating</strong>:</p>
<ul>
<li><p>Unexplained weight loss or weight fluctuations (up or down)</p></li>
<li><p>Delayed puberty or amenorrhea (missed periods)</p></li>
<li><p>Sensitive or damaged teeth</p></li>
<li><p>Dizziness or fainting</p></li>
<li><p>Feeling cold</p></li>
<li><p>Stomach pain</p></li>
</ul>
<p><strong>Social and psychological signs of disordered eating</strong>:</p>
<ul>
<li><p>Personality changes, such as social withdrawal and increased irritability</p></li>
<li><p>Depression or anxiety</p></li>
<li><p>Fighting with others about food, eating and weight</p></li>
<li><p>Avoidance of food-related social activities like birthdays or sleepovers</p></li>
</ul>
<h2>General recommendations for all parents and caregivers</h2>
<ol>
<li><p>Be on the lookout for sudden or drastic changes in your child’s eating habits, such as extreme dieting, avoiding certain foods, preoccupation with weight, and fears about losing control of overeating. Also, keep an eye out for frequent fluctuations in meal patterns.</p></li>
<li><p>Pay attention to any physical changes you notice in your child, such as unexplained weight loss or gain, persistent fatigue, or changes in mood. These could be signs of underlying issues related to disordered eating.</p></li>
<li><p>Be mindful of withdrawal from social situations that centre on food, such as avoiding gatherings where meals are involved.</p></li>
<li><p>In addition to <a href="https://doi.org/10.1371/journal.pgph.0001091">social media use</a>, parent role modelling <a href="https://doi.org/10.1017/S0007114508892471">can shape children’s attitudes and behaviour toward food and body image</a>. As a result, we recommend that parents ditch the weight-based talk. It is best to avoid commenting on people’s physical appearances, weight, shape and body sizes, including your own and others in your life. Rather, we recommend parents focus on health rather than appearances and empower youth to develop a positive relationship with food and their bodies.</p></li>
</ol>
<figure class="align-center ">
<img alt="A mother comforting an upset teen on a sofa" src="https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584858/original/file-20240327-28-lk1lch.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If you notice some of the signs and symptoms of disordered eating, it is essential to talk with your child.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>The importance of early identification and intervention</h2>
<p>If you notice some of the signs and symptoms of disordered eating, it is essential to talk with your child. Invite them to share their experiences and listen without judgement. Express compassion, kindness and concern about their health and well-being.</p>
<p>If you believe your child’s health is at risk, warmly but firmly tell them that you are worried about them and organize contact with a health-care professional. Make an appointment with your primary care provider and <a href="https://nedic.ca/media/uploaded/PARENTS-CARERS_checklist_for_PCP_-_fillable.pdf">come to your appointment prepared</a> to discuss the type of behaviour you have been seeing.</p>
<p>Previous research suggests that <a href="https://doi.org/10.1002/erv.2745">quickly seeking help may support better recovery from an eating disorder</a>. This awareness motivates both providers and family members into action to quickly identify eating disorder behaviour in youth and to advocate for them to receive comprehensive care from a diverse health-care team including psychologists, physicians, dieticians and social workers.</p>
<p>If you experience a long wait for targeted support in your area, consider also exploring <a href="https://nied.ca/wp-content/uploads/2024/02/Caregiver-Well-Being-Resource-Guide-5.pdf">reputable organizations in your geographical location</a>.</p>
<p>It is important for parents and caregivers to recognize that negative body talk does not mean that your child has an eating disorder. It is, however, something to be mindful of, especially when coupled with the signs of eating disorders provided above.</p>
<p>The National Eating Disorders Information Centre helpline and live chat are available seven days a week. For Helpline call 1-866-NEDIC-20 (toll-free) or live chat at <a href="https://nedic.ca/">nedic.ca</a></p><img src="https://counter.theconversation.com/content/225876/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amelia Austin receives funding from the University of Calgary's O’Brien Institute for Public Health and Cumming School of Medicine.</span></em></p><p class="fine-print"><em><span>Gina Dimitropoulos receives funding from the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation and the UCalgary Research Excellence Chair.</span></em></p><p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, an anonymous donor, and the Canada Research Chairs program.</span></em></p><p class="fine-print"><em><span>Tracy Vaillancourt receives funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, and the Canada First Research Excellence Fund. She is the chair of the COVID-19 Task Force for the Royal Society of Canada. </span></em></p>Parents and other supportive adults can learn to recognize young people’s symptoms of disordered eating, which is a spectrum of unhealthy eating patterns and behaviour.Amelia Austin, Postdoctoral Research Fellow, Mathison Centre for Youth Mental Health and Education, University of CalgaryGina Dimitropoulos, Associate professor, Faculty of Social Work, University of CalgarySheri Madigan, Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryTracy Vaillancourt, Tier 1 Canada Research Chair in School-Based Mental Health and Violence Prevention, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2258272024-03-26T17:02:22Z2024-03-26T17:02:22ZFor people with mental illness, drugs and alcohol can be a key survival strategy. I’ve learned they shouldn’t have to ‘get clean’ to get treatment<figure><img src="https://images.theconversation.com/files/582279/original/file-20240315-20-k4w6kp.jpg?ixlib=rb-1.1.0&rect=43%2C60%2C5708%2C3768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-on-bottles-blurred-person-drinking-1200866920">Ground Picture/Shutterstock</a></span></figcaption></figure><p>A decade ago, while working in a women’s prison, I met a young woman whose story would leave an indelible mark on me. She had endured severe abuse at the hands of men, and I was initially concerned that, as a male social worker, my presence might rekindle her trauma. Yet, through careful and considered engagement, we were able to forge a relationship of trust.</p>
<p>Jenny* confided in me that heroin had become her refuge – the only respite that quieted the relentless storm of her thoughts. But her dependency had brought dire consequences: the removal of her children and her subsequent imprisonment for possession with intent to supply. Even so, Jenny told me that before she was imprisoned: “Heroin was the only thing that helped me to cope.”</p>
<p>While inside, she experienced regular flashbacks and profound anxiety. Her treatment regime included antipsychotic medication Seroquel and heroin replacement Subutex – but Jenny didn’t use them conventionally. “The only way they help is if I grind them together and snort them,” she explained. This method provided her a fleeting, euphoric respite from her psychological torment.</p>
<hr>
<p><em>Across the world, we’re seeing unprecedented levels of mental illness at all ages, from children to the very old – with huge costs to families, communities and economies. <a href="https://theconversation.com/uk/topics/tackling-the-mental-health-crisis-147216?utm_source=TCUK&utm_medium=ArticleTop&utm_campaign=MentalHealthSeries">In this series</a>, we investigate what’s causing this crisis, and report on the latest research to improve people’s mental health at all stages of life.</em></p>
<hr>
<p>It wasn’t Jenny’s drug revelation that struck me most profoundly, but the reaction of some of my prison colleagues. Her unconventional use of the medication was labelled substance abuse, leading to her being ostracised by the prison’s mental health service, which refused to work with her until she “sorted out” her drug issues.</p>
<p>Even though I had known Jenny for a year, it was only when she was about to be released from prison that I really understood how serious her situation was. I was shocked to see her breaking the prison’s rules on purpose because she didn’t want to leave. She started smoking in places she shouldn’t, damaged her own cell and areas everyone used, attacked another prisoner, which was not like her at all, and started using spice and hooch.</p>
<p>Jenny preferred staying in jail over facing life outside, but she was let out all the same. A week after her release, I received news that she had died from a heroin overdose.</p>
<h2>My search for answers</h2>
<blockquote>
<p>Mental health problems are experienced by the majority of drug and alcohol users in community substance use treatment. Death by suicide is also common, with a history of alcohol or drug use being recorded in 54% of all suicides in people experiencing mental health problems. (<a href="https://assets.publishing.service.gov.uk/media/5a75b781ed915d6faf2b5276/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf">Public Health England guide</a>, 2017.)</p>
</blockquote>
<p>Jenny’s tragic story left me with many questions – what were the underlying causes of mental illness? What spurred the spiral into addiction? Why did individuals turn to substance use? – that, even after six years as a mental health social worker working in prisons and psychiatric hospitals, I had neither the knowledge nor experience to answer. Talking to colleagues did not resolve them, so I sought answers by returning to academia alongside my day job.</p>
<p>A postgraduate diploma helped me better understand the theories of mental health from neuroscientific, psychiatric and pharmacological perspectives. But above all, I realised that many of the people I was now encountering in my new role, working in a crisis home treatment team (a community-based team set up to support people experiencing severe mental health issues), would never get better. Rather, they would just keep coming back with a new crisis.</p>
<p>And for a large majority of them (around four in five), substances ranging from highly addictive narcotics to potent, mind-altering chemicals would be a key part of their daily lives in addition to, or as an alternative for, their prescribed psychiatric medication.</p>
<hr>
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<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><em>This article is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.</em></p>
<hr>
<p>Roger was one of many people I met who relied on <a href="https://theconversation.com/what-is-spice-and-why-is-the-drug-so-dangerous-60600">Spice</a>, a synthetic cannabinoid designed to mimic the effects of naturally occurring <a href="https://www.ncbi.nlm.nih.gov/books/NBK563174/#:%7E:text=Delta%2D9%2Dtetrahydrocannabinol%20(also,the%20class%20of%20cannabinoid%20medications.),%20the%20psychoactive%20ingredient%20in%20marijuana.%20Regular%20Spice%20users%20face%20severe%20health%20risks,%20in%20particular%20to%20their%20cognitive%20function,%20and%20an%20increased%20risk%20of%20%5Bpsychotic%20outcomes%5D(https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20341">THC</a>. (In addition to consumption by smoking, there are increasing reports of synthetic cannabinoids being used in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398321/">e-cigarettes or vapes</a>.)</p>
<p>Nonetheless, Roger told me Spice was the “only thing that would help sort my head out”. And, after listening to a lecture from me about the dangers of these substances, he responded:</p>
<blockquote>
<p>I know how much to take – I know when I’ve taken too much or not enough. I use it in doses now. Why would I stop if it’s the only thing that works?</p>
</blockquote>
<p>It was clear that Roger knew much more about the effects of Spice than I did. Interactions like this ignited a desire in me for deeper knowledge – not from books or universities, but directly from people with co-existing mental health and addiction problems.</p>
<p>Perhaps surprisingly, in the UK we don’t know how many people are living in this combined state. Estimates have tended to focus only on people with severe mental health problems and problematic substance use. For example, a <a href="https://www.drugsandalcohol.ie/17764/">2002 Department of Health guide</a> suggested that 8-15% of its patients had a dual diagnosis – while acknowledging that it is difficult to assess exact levels of substance use, both in the general population and among those with mental health problems.</p>
<p>A decade earlier, US research had identified that for <a href="https://psycnet.apa.org/record/2005-09774-007">people with schizophrenia</a>, substance use (non-prescribed drugs) was a significant problem relative to the general population. More recently, a 2023 global review of evidence identified that the prevalence of co-existing mental health and substance use among <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9955022/">children and adolescents treated for psychiatric conditions</a> ranged between 18.3% and 54%.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Painting of Thomas De Quincey" src="https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=644&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=644&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=644&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=810&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=810&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582289/original/file-20240315-24-55mu9.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=810&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Thomas De Quincey, author of Lessons From an English Opium Eater.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Thomas_de_Quincey_by_Sir_John_Watson-Gordon.jpg">National Portrait Gallery via Wikimedia</a></span>
</figcaption>
</figure>
<p>But what I found particularly interesting was an analysis of the writings of Thomas De Quincey from more than 200 years ago. In his 2009 article <a href="https://www.tandfonline.com/doi/abs/10.3109/10826089009056230">Lessons From an English Opium Eater: Thomas De Quincey Reconsidered</a>, leading clinical academic, John Strang, highlighted that issues raised by De Quincey in 1821 remain causes for concern some two centuries later.</p>
<p>De Quincey was arguably the first person to document his own use of substances, in particular opium. His writing shows that he self-medicated to manage pain, including “excruciating rheumatic pains of the head and face”:</p>
<blockquote>
<p>It was not for the purpose of creating pleasure, but of mitigating pain in the severest degree, that I first began to use opium as an article of daily diet … In an hour, oh Heavens! What an upheaving, from its lowest depths, of the inner spirit! </p>
</blockquote>
<p>De Quincey’s use of non-prescribed drugs mirrors that of John, Jenny, Roger and so many other people I have met as a social worker. Clearly, we’ve known about the close relationship between mental illness and substance abuse for hundreds of years, yet are still wrestling with how best to respond.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/guide-to-the-classics-confessions-of-an-english-opium-eater-by-thomas-de-quincey-a-dense-strange-journey-through-addiction-190435">Guide to the classics: Confessions of an English Opium Eater by Thomas De Quincey – a dense, strange journey through addiction</a>
</strong>
</em>
</p>
<hr>
<p>Official guidance almost always advocates for a <a href="https://www.nhsconfed.org/system/files/2022-12/NHS%20Confederation%20parliamentary%20briefing%20-%20No%20wrong%20door%20-%20a%20ten-year%20vision%20for%20mental%20health%20learning%20disability%20and%20autism%20services.pdf">“no wrong door” policy</a>, meaning that those with dual addiction and mental health issues will get help whichever service encounters them first. But from what people with lived experience were telling me, this was not the case.</p>
<p>I sent freedom of information requests to 54 mental health trusts across England, to try to discern any patterns of variation in the way their patients were being measured and treated. Some 90% of the trusts responded, of which a majority (58%) recognised the dual occurrence of mental illness and substance use. However, the estimated prevalence of this dual diagnosis varied widely – from only nine to around 1,200 patients per trust.</p>
<p>What I found most alarming was that less than 30% of the mental health trusts said they have a specialised service for addiction which accepts referrals for dual diagnosis patients. In other words, throughout England, a lot of these patients are not being appropriately supported.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Out-of-focus man holding a syringe in the foreground" src="https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582295/original/file-20240315-22-jay1uw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drug-addict-young-man-syringe-action-599693732">271 Eak Moto/Shutterstock</a></span>
</figcaption>
</figure>
<h2>‘When I say I use heroin, people change’</h2>
<blockquote>
<p>I started using when I was around 18. Things weren’t good in my life at the time, and I got in with a crowd who offered me heroin. It was the most amazing experience; all my worries disappeared better than the antidepressants I had been taking. But the more I used, the more I needed it. Now I use it in stages, just before I go to work and at night.</p>
</blockquote>
<p>Carl had been using heroin for more than ten years when I interviewed him. When I asked if he wanted to stop, he shrugged and said no, explaining:</p>
<blockquote>
<p>I’ve tried so many times – I’ve been on methadone but that was worse, especially coming off it. I know how much to take, and no one knows I use gear – so, no. But, as soon as you tell a professional you take heroin, their whole attitude changes. I’ve seen it many times. I dress quite well and I have a job, but as soon as I say I use heroin, they change. It’s almost as if they don’t see the same person any more.</p>
</blockquote>
<p>Talking to Carl underlined that many users know far more than me about the substances they take and why they take them. Yet as soon as a professional (typically a nurse, social worker or doctor) hears they are taking an illegal substance, or are misusing a legal substance such as alcohol, they are stigmatised and often ostracised from service provision.</p>
<p>Suzanne was homeless and also using heroin, but for different reasons to Carl. I asked why she started using it:</p>
<blockquote>
<p>I’ve had a shit life – it numbs all of that. Now being homeless, it helps me to sleep and keeps me warm, but I only use it in the winter because I need to sleep.</p>
</blockquote>
<p>In summer, Suzanne explained, she would switch to taking “phet” – amphetamines. I asked her why:</p>
<blockquote>
<p>You need to be awake – there are lots of dickheads around. I’ve been beaten and raped in the summer when I was asleep, so you need to be awake more.</p>
</blockquote>
<p>Hearing the stories of people fighting their personal battles with mental health and substance use issues was at once haunting and cathartic for me. It was deeply moving to hear them, time and again, struggling with the most difficult aspect of their condition: the simple decision to ask for help. And sadly, far too often, when they did summon the courage, their requests would go unheard, unheeded, or they would be engulfed by a sprawling system that seemed unable to help.</p>
<p>Dave had been using alcohol for many years and had asked for support on several occasions – only to be passed from service to service:</p>
<blockquote>
<p>I was made redundant and, at 50, was finding it hard to get another job. I wasn’t drinking all of the time then. But as I started to get into more debt and the bailiffs were knocking on the door, I needed a drink to get me through it. It was not until I was charged with drunk driving that I knew I had a problem.</p>
</blockquote>
<p>Dave said he wasn’t shy about asking for help – at least, for a while. But he found himself caught in a downward spiral that led to more drinking, more suffering, and less support:</p>
<blockquote>
<p>So many times I’d stop drinking, but I couldn’t deal with the voices in my head. I’d ask for support, but the waiting lists were so long. The medication the doctor gave me did nothing, so I’d start drinking again, and because I’d start to drink again, mental health services wouldn’t touch me. All they kept saying was: ‘You should stop drinking first.’</p>
</blockquote>
<h2>The biggest barrier to getting support</h2>
<p>To expand my understanding, I also sought the perspectives of a dozen people working on the frontline of mental healthcare – from professionals in NHS mental health and substance use teams, to people working for charitable support groups. Their insights revealed a <a href="https://www.miragenews.com/northern-england-life-ups-death-risk-from-1195801/">frayed and fragmented network of services</a>, with the holes and inefficiencies obvious and crying out for attention and repair. As one nurse explained:</p>
<blockquote>
<p>The stress of trying to get services to help is unbelievable. You’ve got pressure from the person’s family because they are afraid they’ll end up dead. You’ve got pressure from managers to discharge the person. All I’d get is criticism which far outweighed encouragement or support. The stress made me so anxious that I almost gave it all up – and even considered suicide myself.</p>
</blockquote>
<p>Over 80% of the professionals I spoke to called for an integration of mental health and substance use teams, in part because of the huge cuts nationwide in funding to substance use services. One social worker in a substance use service explained the current situation:</p>
<blockquote>
<p>If you get someone with an alcohol addiction, it becomes quite apparent that they use drink as a way of coping with their mental health. But, because of massive waiting lists within mental health services or because they are told they need to stop drinking before [they can be treated], mental health support can’t be offered. So, the person just keeps drinking and eventually disengages from our services as there is no hope for them. We shouldn’t expect someone to stop using a substance that they perceive is helping without offering an alternative treatment.</p>
</blockquote>
<p>For all the professionals I interviewed, the most significant barrier to getting support for someone’s mental health issues was that they used substances and would not receive any treatment until they addressed this. As one mental health nurse told me:</p>
<blockquote>
<p>I had one chap who was using cocaine, mainly due to social anxiety. Initially, he’d use it when socialising with friends. But because it gave him confidence and he could talk to people, he started to use it all the time and got himself in debt. I wanted to address the root cause, the social anxiety, so I referred him to our Improving Access to Psychological Therapy service. But I was told he needed to be abstinent from cocaine for three months before they’d accept him. He eventually disengaged, and I haven’t seen him since.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The word HELP spelled out in white powder" src="https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=363&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=363&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=363&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=456&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=456&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582311/original/file-20240315-25-o9e0be.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=456&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/word-help-spelled-out-by-cocaine-2289738709">Runawayphill/Shutterstock</a></span>
</figcaption>
</figure>
<h2>A seismic shift is needed</h2>
<p>In the shadows of our society, hidden behind the walls of our prisons and in the dark corners of our streets, the experiences of Jenny and countless others bear witness to the profound failings of our healthcare system to address co-existing mental health and substance use issues. For those caught in the merciless cycle of addiction and illness, these systemic inefficiencies and administrative blockades do much to intensify their torment.</p>
<p>Their often brutally honest accounts (and the insights of those who try to support them) draw a portrait of a split and underfunded service, collapsing under the weight of its contradictions. The loud calls for integrated mental health and substance addiction treatment become muffled amid the bureaucratic din of funding cuts, lengthy waiting lists and policy neglect.</p>
<p>The evidence overwhelmingly confirms the need for a model of care that is <a href="https://theconversation.com/how-to-solve-our-mental-health-crisis-214776">holistic and integrated</a> – one that shifts the narrative from stigma and isolation to awareness and support.</p>
<p>The economic case for reshaping investment in our mental health and substance misuse services is powerful. The annual cost of mental health problems to the UK economy is a staggering £117.9 billion – equivalent to <a href="https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2022/09/B1482_research-demand-signalling-national-mental-health-programme_september-2022.pdf">5% of its annual GDP</a> – with substance misuse adding a <a href="https://www.gov.uk/government/publications/review-of-drugs-phase-two-report/review-of-drugs-part-two-prevention-treatment-and-recovery#:%7E:text=There's%20a%20strong%20'invest%20to,was%20spent%20on%20drug%20treatment.">further £20 billion</a>.</p>
<p>However, these figures tell only part of the tale. While we know that <a href="https://assets.publishing.service.gov.uk/media/5a75b781ed915d6faf2b5276/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf">70% of people in treatment for drug misuse and 86%</a> of people in treatment for alcohol misuse have a mental health diagnosis, the full financial impact of people with these co-occurring disorders is probably far greater.</p>
<p>This also includes people who often plough through a <a href="https://www.emerald.com/insight/content/doi/10.1108/ADD-11-2017-0021/full/html">punitive and bewildering series of services</a> as they navigate their intersecting problems, encountering barriers at every turn that fail to address their <a href="https://assets.publishing.service.gov.uk/media/5a75b781ed915d6faf2b5276/Co-occurring_mental_health_and_alcohol_drug_use_conditions.pdf">acute health</a> and social care needs. As their distress is amplified, the costs to <a href="https://www.emerald.com/insight/content/doi/10.1108/17570971111197175/full/html">wider society</a> escalate too – as one social worker explained to me:</p>
<blockquote>
<p>I am currently supporting a woman who is struggling with alcohol dependency, a condition that began after she endured significant domestic abuse. The cycle is devastating: her trauma cannot be effectively addressed because of her dependency on alcohol, and she cannot abandon alcohol because it’s the only solace she finds from her emotional torment. Despite several attempts at rehabilitation, none of the programmes have sufficiently tackled the mental health aspects of her trauma. Now, with cirrhosis of the liver, her health is in critical decline. It’s a heart-wrenching situation – a stark reminder of the desperate need for integrated treatment approaches that address both substance dependency and the underlying psychological trauma.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Out-of-focus woman with a glass of alcohol on the table in front of her" src="https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582306/original/file-20240315-20-l7ky73.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/alcohol-addiction-portrait-lonely-desperate-drunk-137241875">Kamira/Shutterstock</a></span>
</figcaption>
</figure>
<h2>‘I might as well be dead’</h2>
<p>In the quiet confines of a West Midlands mental health crisis centre, I’m preparing to meet someone whose story I know only from the clinical notes on my screen. The phrase “is alcohol dependent” is highlighted in bold. Behind those words is another person whose life is unravelling in the silence of a battle fought alone.</p>
<p>John walks into the room, a man living in the grip of two relentless forces – addiction and mental illness. “It was just to stop the noises,” he says of the whisky he uses as medication for his inner turmoil. His hands are trembling. This is the moment of truth – his story is no longer trapped within the clinical pages of a case file. </p>
<p>“I’ve lost everything,” he tells me. “I might as well be dead.” </p>
<p>Then John explains why he’s given up hope:</p>
<blockquote>
<p>I’ve asked for help so many times, but all I get told is that I need to stop drinking before my mental health can be treated. However, alcohol is the only thing that works for me. I’ve gone through detox, but then I had to wait months for counselling. I just can’t cope that long without any support – antidepressants don’t do anything for me. What’s the point?</p>
</blockquote>
<p>Over the past 15 years, I have met countless “Johns”, both during my day job as a mental health social worker and, latterly, in my academic research. This has led me to conclude that the health and social care system in which I work falls catastrophically short. </p>
<p>This is no mere professional critique. It is an impassioned plea for society to rediscover its collective heart; to explore the human stories that lie hidden in statistics such as that, between 2009 and 2019, <a href="https://documents.manchester.ac.uk/display.aspx?DocID=60521">53% of UK suicides</a> were among people with comorbid diagnoses of mental health and substance use.</p>
<p>Instead of viewing people through the limiting lens of labels, we should endeavour to see their humanity. Engaging in conversation, extending empathy and showing compassion are powerful actions. A kind word, an understanding nod or a gesture of support can affirm their dignity and spark a connection that resonates with their innate human spirit. Or as John, whose journey I’ve had the privilege to witness, puts it:</p>
<blockquote>
<p>It’s not about the help offered but the meaning behind it. Knowing you’re seen as a person, not just a problem to be solved – that’s what sticks with you.</p>
</blockquote>
<p><em>*All names in this article have been changed to protect the anonymity of the interviewees.</em></p>
<p><em>If you or anyone you know require expert advice about the issues raised in this article, the NHS provides this <a href="https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/">list of local helplines and support organisations</a>.</em></p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>For you: more from our <a href="https://theconversation.com/uk/topics/insights-series-71218?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insights series</a>:</em></p>
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<li><p><em><a href="https://theconversation.com/insomnia-how-chronic-sleep-problems-can-lead-to-a-spiralling-decline-in-mental-health-224131?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insomnia: how chronic sleep problems can lead to a spiralling decline in mental health
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<p><em>To hear about new Insights articles, join the hundreds of thousands of people who value The Conversation’s evidence-based news. <a href="https://theconversation.com/uk/newsletters/the-daily-newsletter-2?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK"><strong>Subscribe to our newsletter</strong></a>.</em></p><img src="https://counter.theconversation.com/content/225827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon Bratt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This is the moment of truth. John’s story is no longer trapped in the clinical pages of a case file. ‘I’ve lost everything,’ he says. ‘I might as well be dead.’Simon Bratt, Mental Health Social Worker and PhD Candidate, Staffordshire UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2234182024-03-26T12:50:07Z2024-03-26T12:50:07ZMeasuring emotional ‘emptiness’ could help manage this potentially life-threatening experience<figure><img src="https://images.theconversation.com/files/583273/original/file-20240320-26-46trqd.jpg?ixlib=rb-1.1.0&rect=18%2C12%2C4071%2C2287&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/emptiness-metaphorical-view-woman-struggle-trapped-2344696049">GoodIdeas/Shutterstock</a></span></figcaption></figure><p>Imagine a hollowness deep in your chest, a vacant space where feelings should be. Imagine being numb and devoid of all emotion, happy or sad – with any sensations simply passing right through you. You are watching the world go by from behind a screen – so disconnected that you feel a million miles away from people you care about the most. </p>
<p>This is how <a href="https://www.tandfonline.com/doi/full/10.1080/09638237.2021.1922645">hundreds of people</a> have described the existential feeling of emotional “emptiness”. Perhaps some aspects may feel familiar to you. After all, research has repeatedly shown that emptiness is <a href="https://www.tandfonline.com/doi/full/10.1080/09638237.2021.1922645">a common experience</a>, felt by many of us around the world. </p>
<p>For some, emptiness may be a fleeting experience during a time of immense difficulty in our lives, which passes. Following a period of feeling empty, we may be able to sense ourselves returning, feeling gradually more connected to our inner-self, other people, and the world around us.</p>
<p>But for some, emptiness is a chronic, debilitating experience which has been found to be strongly connected to numerous <a href="https://www.researchgate.net/publication/285484794_Emptiness_and_suicidal_behavior_An_exploratory_review">life-limiting</a> mental health difficulties such as depression, anxiety and experiences of hearing voices, including for people who receive a diagnosis of a personality disorder.</p>
<p>Recent developments including <a href="https://discovery.ucl.ac.uk/id/eprint/10156157/">new measurement tools</a>, however, are starting to shine a light on this elusive experience, enabling researchers and mental health professionals to better support people who feel this way.</p>
<h2>What is emptiness?</h2>
<p>In 2022, along with a colleague, I proposed a <a href="https://www.tandfonline.com/doi/full/10.1080/09638237.2021.1922645">formal definition</a> of emptiness as: </p>
<blockquote>
<p>A feeling that one is going through life mechanically, devoid of emotions and purpose, and therefore is empty inside, with emptiness often being bodily felt in the form of a discomfort in the chest. This is coupled with feelings that one is disconnected from others, in some way invisible to others, and unable to contribute to a world that remains the same, but from which one is distant and detached.</p>
</blockquote>
<p>Our research found that while emptiness is experienced by people who have mental health difficulties, it is also felt by those who have never suffered with their mental health before, and who may have never felt the need to seek help from professionals. </p>
<p>Despite this, across all of those who took part in the research, it was found that greater feelings of emptiness were related to poorer mental health and lower satisfaction with life.</p>
<h2>Emptiness and mental health</h2>
<p>People who feel empty often or all the time are more <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/sltb.12949">likely to have self-harmed</a>, <a href="https://guilfordjournals.com/doi/abs/10.1521/pedi_2021_35_510">thought about suicide</a>, or gone on to make an attempt to end their life. </p>
<p>These findings add to <a href="https://journals.lww.com/hrpjournal/abstract/2020/09000/the_feeling_of_emptiness__a_review_of_a_complex.1.aspx">previous research</a> showing that emptiness is related to harmful use of drugs, alcohol, and unsafe sex. Other <a href="https://www.cambridge.org/core/journals/bjpsych-open/article/psychological-emptiness-scale-a-psychometric-evaluation/A47CFA3CA020FFA897ACA030241E29B9">studies show</a> that <a href="https://www.tandfonline.com/doi/full/10.1080/09638237.2021.1922645">feelings of emptiness</a> seem to affect every aspect of a person’s individual and social world. </p>
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Read more:
<a href="https://theconversation.com/many-of-us-feel-empty-understanding-what-it-means-is-important-for-improving-our-mental-health-163035">Many of us feel 'empty' – understanding what it means is important for improving our mental health</a>
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<p>Self-harm, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/cpp.2781">suicide</a> and use of substances or sex can be understood, then, as ways of coping with or distracting from the emotional <a href="https://journals.lww.com/hrpjournal/abstract/2020/09000/the_feeling_of_emptiness__a_review_of_a_complex.1.aspx">pain of feeling empty</a>.</p>
<h2>Measuring emptiness</h2>
<p>Thankfully, research in this much-needed area is progressing. Our 2022 definition has increased the understanding of emptiness among researchers and health professionals, and has led researchers to develop a new way of measuring and tracking it over time.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/582157/original/file-20240315-24-9wiaxx.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C998%2C664&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582157/original/file-20240315-24-9wiaxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582157/original/file-20240315-24-9wiaxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582157/original/file-20240315-24-9wiaxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582157/original/file-20240315-24-9wiaxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582157/original/file-20240315-24-9wiaxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582157/original/file-20240315-24-9wiaxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Emptiness is commonly experienced but there’s been no way to measure it – until now.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/silhouette-depressed-anxiety-person-head-negative-1216075753">tadamichi/Shutterstock</a></span>
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<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/38299317/">Psychological Emptiness Scale</a>, created in 2022 by clinical and social psychologists alongside statisticians, is a questionnaire consisting of 19 items. It asks people questions such as whether they feel emotionally numb, that they are going through the motions, and that they have no direction in life. </p>
<p>This tool is now available for researchers and mental health professionals to use to formally assess a person’s level of emptiness. It allows this complex, existential feeling to be accurately captured and quantified. </p>
<p>This will enable researchers to properly study emptiness, explore questions about how it develops, and how different therapeutic interventions may help people to manage and reduce this feeling.</p>
<p>Emptiness is a commonly experienced and potentially life-threatening feeling. Accurate measurement marks a significant step forward in our ability to identify, understand and provide support to people who feel this way, in the hope of ultimately reducing distress and saving lives.</p><img src="https://counter.theconversation.com/content/223418/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shona Joyce Herron does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For some, emptiness is a chronic, life-limiting issue. But how can we quantify such a complex feeling?Shona Joyce Herron, Senior Clinical Psychologist, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2262802024-03-25T18:23:58Z2024-03-25T18:23:58ZWhat we learned from teaching a course on the science of happiness<figure><img src="https://images.theconversation.com/files/584034/original/file-20240325-22-w4hm2x.jpg?ixlib=rb-1.1.0&rect=35%2C47%2C7899%2C5222&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/black-woman-on-road-enjoying-window-2281799399">PeopleImages.com - Yuri A/Shutterstock</a></span></figcaption></figure><p>When you deliver a university course that makes students happier, everybody wants to know what the secret is. What are your tips? What are your top ten recommendations? These are the most asked questions, as if there is some quick, surefire path to happiness.</p>
<p>The problem is that there are no life-transforming discoveries, because most of what works has already been talked about. Social connection, mindfulness, gratitude letters, acts of kindness, going for a walk in nature, sleep hygiene, limiting social media use. These are some of the 80 or so <a href="https://ggia.berkeley.edu/">psychological interventions</a> which have been shown to work to improve our wellbeing (to a lesser or greater extent).</p>
<p>But if we already know so much about what works, then why are we still fielding requests for top happiness tips?</p>
<p>The data tells us that students and young people today are increasingly unhappy, with national surveys finding wellbeing is lowest among the young <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403847/">in the UK</a> <a href="https://www.hepi.ac.uk/wp-content/uploads/2021/06/SAES_2021_FINAL.pdf">and the US</a> compared to other age groups.</p>
<p>It was for this reason we began teaching the science of happiness course at the University of Bristol in 2019 – to counter some worrying downward trends. During the course, we teach lessons from <a href="https://theconversation.com/why-so-serious-the-untapped-value-of-positive-psychology-61766">positive psychology</a> and create opportunities for students to put these lessons into practice. </p>
<h2>Learning the science of happiness</h2>
<p>We award credit based on engagement — an important component of not only education, but also getting the most out of life — rather than graded assessments. It would be ironic to talk about the problems of performance anxiety and student perfectionism only to then give our students a <a href="https://journals.sagepub.com/doi/abs/10.1177/1469787418819728?journalCode=alha">graded exam</a>. </p>
<p>Course credit without examination? That must be a breeze you might say. However, for many students, turning up on time to over 80% of lectures and tutorials, completing journal entries on a weekly basis and submitting a final group project turned out to be more of a challenge than they predicted. </p>
<p>Around 5% of students fail to meet the course demands each year, and have to complete a reassessment in the summer. Creating consistent positive habits in the face of all of life’s other demands is not a trivial request.</p>
<p>Nevertheless, the science of happiness course is extraordinarily popular. It also appears to be effective. Every year we find increases of around 10-15% on measures of students’ mental wellbeing at the end of the course, compared to a <a href="https://journals.sagepub.com/doi/full/10.1177/2055102921999291">waiting-list control group</a>. </p>
<p>However, we recently published the findings from <a href="https://link.springer.com/article/10.1007/s10734-024-01202-4">a study</a> that followed up with students one to two years after they had taken the science of happiness course, before they graduated. When we looked at the overall trends, students’ initially elevated scores of happiness had largely returned to their original levels.</p>
<figure class="align-center ">
<img alt="Two women hold each other with happy expression on their faces" src="https://images.theconversation.com/files/584035/original/file-20240325-28-yk1ma4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/584035/original/file-20240325-28-yk1ma4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/584035/original/file-20240325-28-yk1ma4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/584035/original/file-20240325-28-yk1ma4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/584035/original/file-20240325-28-yk1ma4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/584035/original/file-20240325-28-yk1ma4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/584035/original/file-20240325-28-yk1ma4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">It’s not easy to maintain this level of happiness.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-friends-holding-each-other-1038614926">Rawpixel.com/Shutterstock</a></span>
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<p>We were not dejected, though. One of the mechanisms we teach on the course is <a href="https://www.verywellmind.com/hedonic-adaptation-4156926">hedonic adaptation</a>: we get used to both good and bad things. Since humans have a brain wired to pay extra <a href="https://journals.sagepub.com/doi/abs/10.1037/1089-2680.5.4.323?journalCode=rgpa">attention to problems</a>, it comes as no surprise that the initial wellbeing boost we created in the course disappeared as students returned to focusing on life’s hassles.</p>
<p>However, we observed that not all students followed this pattern. Approximately half the cohort reported that they continued to regularly practice some of the things they had learnt, such as gratitude or mindfulness, many months or years after completing the course. </p>
<p>Although the students who no longer practised the activities returned to their happiness baselines, on average, those who did keep up with at least some of the recommended activities showed no such drop. They maintained their elevated levels of wellbeing up to two years later.</p>
<p>In many ways, mental health is no different from physical health. Few people expect to see long-lasting muscle gains after one trip to the gym. For the most part, we are begrudgingly aware that there are no shortcuts if you want to remain fit and healthy. You have to stick with the program. </p>
<h2>New habits</h2>
<p>The same applies to our happiness. Unless we keep working at it, the improvements are temporary. Indeed, if we did have to focus on just one top tip it might be to learn how to harness lessons from psychology to <a href="https://jamesclear.com/atomic-habits">build the better habits</a> we need for lasting change. For example, aiming for small incremental changes rather than an unsustainable overhaul of your whole life.</p>
<p>One thing we question is whether the self-care industry may be sending out the wrong message by telling people happiness is all about making yourself feel better. One of us, Bruce Hood, writes <a href="https://www.simonandschuster.co.uk/books/The-Science-of-Happiness/Bruce-Hood/9781398526372">in his new book</a>, that becoming a happier person in the long term is less to do with focusing on ourselves, and much more to do with focusing on others. </p>
<p>Self-care may bring some short term benefits, but enriching the lives of others can offer wellbeing effects that are less susceptible to adaptation over time.</p>
<p>Ultimately, whatever methods or activities we choose to improve our wellbeing, we would do well to remember that happiness is always a work in progress.</p><img src="https://counter.theconversation.com/content/226280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Jelbert receives funding from the Elizabeth Blackwell Institute </span></em></p><p class="fine-print"><em><span>Bruce Hood does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We followed up students years after they took our course to find out whether they still reported better wellbeing.Sarah Jelbert, Lecturer in Psychology, University of BristolBruce Hood, Professor of Developmental Psychology in Society, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2262232024-03-20T22:21:47Z2024-03-20T22:21:47ZElon Musk says ketamine can get you out of a ‘negative frame of mind’. What does the research say?<p>X owner Elon Musk <a href="https://thenightly.com.au/business/cnbc-elon-musk-suggests-his-prescription-ketamine-use-is-good-for-investors-c-14000709?utm_source=sendgrid&utm_medium=email">recently described</a> using small amounts of ketamine “once every other week” to manage the “chemical tides” that cause his depression. He says it’s helpful to get out of a “negative frame of mind”.</p>
<p>This has caused a range of reactions in the media, including on X (formerly Twitter), from strong support for Musk’s choice of treatment, to allegations he has a drug problem.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1770169081510977939"}"></div></p>
<p>But what exactly is ketamine? And what is its role in the treatment of depression?</p>
<h2>It was first used as an anaesthetic</h2>
<p>Ketamine is a <a href="https://doi.org/10.3389/fnhum.2016.00612">dissociative anaesthetic</a> used in surgery and to relieve pain. </p>
<p>At certain doses, people are awake but are disconnected from their bodies. This makes it useful for paramedics, for example, who can continue to talk to injured patients while the drug blocks pain but without affecting the person’s breathing or blood flow. </p>
<p>Ketamine is also used to sedate animals in veterinary practice. </p>
<p>Ketamine is a mixture of two molecules, usually referred to a S-Ketamine and R-Ketamine.</p>
<p>S-Ketamine, or esketamine, is stronger than R-Ketamine and was approved in 2019 in the United States under the drug name Spravato for serious and long-term <a href="https://doi.org/10.1080/14740338.2022.2066651">depression</a> that has not responded to at least two other types of treatments.</p>
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Read more:
<a href="https://theconversation.com/fda-approves-promising-new-drug-called-esketamine-for-treatment-resistant-depression-111966">FDA approves promising new drug, called esketamine, for treatment-resistant depression</a>
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<p>Ketamine is thought to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717708/">change chemicals in the brain</a> that affect mood.
While the exact way ketamine works on the brain is not known, scientists think it changes the amount of the neurotransmitter glutamate and therefore changes symptoms of <a href="https://doi.org/10.3389/fnhum.2016.00612">depression</a>. </p>
<h2>How was it developed?</h2>
<p>Ketamine was first synthesised by chemists at the Parke Davis pharmaceutical company in Michigan in the United States as an anaesthetic. It was tested on a group of prisoners at Jackson Prison in Michigan in 1964 and found to be fast acting with <a href="https://pubs.asahq.org/anesthesiology/article/113/3/678/10426/Taming-the-Ketamine-Tiger">few side effects</a>.</p>
<p>The US Food and Drug Administration <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126726/">approved</a> ketamine as a general anaesthetic in 1970. It is now on the World Health Organization’s core list of essential medicines for health systems worldwide as an <a href="https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02">anaesthetic drug</a>. </p>
<p>In 1994, following patient reports of improved depression symptoms after surgery where ketamine was used as the anaesthetic, researchers began studying the effects of low doses of ketamine on <a href="https://pubmed.ncbi.nlm.nih.gov/8122957/">depression</a>. </p>
<figure class="align-center ">
<img alt="Depressed woman looks down" src="https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/583066/original/file-20240320-16-cf5ntq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Researchers have been investigating ketamine for depression for 30 years.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-attractive-latin-woman-lying-home-1147331690">SB Arts Media/Shutterstock</a></span>
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<p>The first clinical trial results were <a href="https://www.biologicalpsychiatryjournal.com/article/S0006-3223(99)00230-9/abstract">published in 2000</a>. In the trial, seven people were given either intravenous ketamine or a salt solution over two days. Like the earlier case studies, ketamine was found to reduce symptoms of depression quickly, often within hours and the effects lasted up to seven days. </p>
<p>Over the past 20 years, researchers have studied the effects of ketamine on <a href="https://doi.org/10.1016/j.neuropharm.2022.109305">treatment resistant depression, bipolar disorder</a>, <a href="https://theconversation.com/ketamine-can-rapidly-reduce-symptoms-of-ptsd-and-depression-new-study-finds-216077">post-traumatic sress disorder</a> <a href="https://pubmed.ncbi.nlm.nih.gov/34199023/">obsessive-compulsive disorder, eating disorders and for reducing substance use</a>, with generally positive results. </p>
<p>One study in a <a href="https://www.sciencedirect.com/science/article/pii/S0165032723006110">community clinic</a> providing ketamine intravenous therapy for depression and anxiety found the majority of patients reported improved depression symptoms eight weeks after starting regular treatment.</p>
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Read more:
<a href="https://theconversation.com/ketamine-injections-for-depression-a-new-study-shows-promise-but-its-one-of-many-options-209591">Ketamine injections for depression? A new study shows promise, but it's one of many options</a>
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<p>While this might sound like a lot of research, it’s not. A <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00304-8/fulltext">recent review</a> of randomised controlled trials conducted up to April 2023 looking at the effects of ketamine for treating depression found only 49 studies involving a total of 3,299 patients worldwide. In comparison, in 2021 alone, there were 1,489 studies being conducted on <a href="https://www.centerwatch.com/articles/25599-oncology-trials-outpacing-rest-of-the-field-in-complexity-and-duration-study-shows#:%7E:text=The%20number%20of%20investigational%20drugs,genetic%20sequencing%20technologies%2C%20CSDD%20says.">cancer drugs</a>. </p>
<h2>Is ketamine prescribed in Australia?</h2>
<p>Even though the research results on ketamine’s effectiveness are encouraging, scientists still don’t really know how it works. That’s why it’s not readily available from GPs in Australia as a standard depression treatment. Instead, ketamine is mostly used in specialised clinics and research centres. </p>
<p>However, the clinical use of ketamine is increasing. <a href="https://www.tga.gov.au/sites/default/files/auspar-esketamine-hydrochloride-210507-pi.pdf">Spravato nasal spray</a> was <a href="https://www.tga.gov.au/resources/auspmd/spravato">approved</a> by the Australian Therapuetic Goods Administration (TGA) in 2021. It must be administered under the <a href="https://adf.org.au/insights/ketamine-treat-depression/">direct supervision</a> of a health-care professional, usually a psychiatrist. </p>
<p>Spravato <a href="https://www.tga.gov.au/resources/auspmd/spravato">dosage</a> and frequency varies for each person. People usually start with three to six doses over several weeks to see how it works, moving to fortnightly treatment as a maintenance dose. The nasal spray <a href="https://www.unsw.edu.au/newsroom/news/2023/10/why-low-cost-ketamine-is-still-inaccessible-to-many-with-severe-">costs</a> <a href="https://www.medicalrepublic.com.au/esketamine-snubbed-by-pbac-again/17835">between A$600 and $900</a> per dose, which will significantly limit many people’s access to the drug. </p>
<p>Ketamine can be prescribed “off-label” by GPs in Australia who can prescribe schedule 8 drugs. This means it is up to the GP to assess the person and their medication needs. But <a href="https://www.medicalrepublic.com.au/caution-as-esketamine-approved-for-depression/4975#:%7E:text=GPs%20and%20other%20clinicians%20can,8%20drug%20poses%20serious%20risks.">experts in the drug</a> recommend caution because of the lack of research into negative side-effects and longer-term effects. </p>
<h2>What about its illicit use?</h2>
<p>Concern about use and misuse of ketamine is heightened by highly publicised deaths connected to the <a href="https://www.pbs.org/newshour/arts/autopsy-report-shows-actor-matthew-perry-died-from-effects-of-ketamine">drug</a>. </p>
<p>Ketamine has been used as a recreational drug since the 1970s. People report it makes them feel euphoric, trance-like, floating and dreamy. However, the amounts used recreationally are typically higher than those used <a href="https://pubmed.ncbi.nlm.nih.gov/16529526/">to treat depression</a>. </p>
<p>Information about deaths due to ketamine is limited. Those that are reported are <a href="https://journals.sagepub.com/doi/10.1177/02698811211021588">due to accidents or ketamine combined with other drugs</a>. No deaths have been reported in <a href="https://pubmed.ncbi.nlm.nih.gov/36410032/">treatment settings</a>.</p>
<h2>Reducing stigma</h2>
<p>Depression is the third leading cause of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717708/">disability worldwide</a> and effective treatments are needed. </p>
<p>Seeking medical advice about treatment for depression is wiser than taking Musk’s advice on <a href="https://www.washingtonpost.com/wellness/2022/05/04/wellbutrin-elon-musk-antidepressant/">which drugs to use</a>. </p>
<p>However, Musk’s public discussion of his mental health challenges and experiences of treatment has the potential to reduce stigma around depression and help-seeking for mental health conditions. </p>
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Read more:
<a href="https://theconversation.com/ketamine-can-rapidly-reduce-symptoms-of-ptsd-and-depression-new-study-finds-216077">Ketamine can rapidly reduce symptoms of PTSD and depression, new study finds</a>
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<hr>
<p><em>Clarification: this article previously referred to a systematic review looking at oral ketamine to treat depression. The article has been updated to instead cite a review that encompasses other routes of administration as well, such as intravenous and intranasal ketamine.</em></p><img src="https://counter.theconversation.com/content/226223/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julaine Allan receives funding from the Australian Government to conduct research on mental health and substance use interventions, treatments and outcomes. </span></em></p>What exactly is ketamine and what is its role in the treatment of depression?Julaine Allan, Associate Professor, Mental Health and Addiction, Rural Health Research Institute, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2235442024-03-19T19:45:12Z2024-03-19T19:45:12ZHalf of Australians in aged care have depression. Psychological therapy could help<figure><img src="https://images.theconversation.com/files/581494/original/file-20240313-16-lmeqav.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-woman-sitting-on-wheelchair-looking-2033086775">sasirin pamai/Shutterstock</a></span></figcaption></figure><p>While many people maintain positive emotional wellbeing as they age, around half of older Australians living in residential aged care have <a href="https://research.sahmri.org.au/en/publications/the-prevalence-trends-and-determinants-of-mental-health-disorders">significant levels of depression</a>. Symptoms such as low mood, lack of interest or pleasure in life and difficulty sleeping are common. </p>
<p>Rates of depression in aged care appear to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251748/">increasing</a>, and without adequate treatment, symptoms can be enduring and significantly impair older adults’ quality of life. </p>
<p>But only a minority of aged care residents with depression receive services specific to the condition. Less than 3% of Australian aged care residents access <a href="https://static1.squarespace.com/static/5b8c84fc4cde7abe6c3e7d7c/t/637af471f1a9621ed169fc24/1669002355850/Gov+mental+Health+infographic+FINAL_19-10-2022.pdf">Medicare-subsidised mental health services</a>, such as consultations with a psychologist or psychiatrist, each year. </p>
<figure class="align-center ">
<img alt="An infographic showing the percentage of Australian aged care residents with depression (53%)." src="https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=476&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=476&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=476&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=598&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=598&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582461/original/file-20240318-16-8nfghk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=598&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Cochrane Australia</span></span>
</figcaption>
</figure>
<p>Instead, residents are typically prescribed a medication by their GP to manage their mental health, which they often take for several months or years. A <a href="https://www.jamda.com/article/S1525-8610(24)00082-3/abstract">recent study</a> found six in ten Australian aged care residents take antidepressants.</p>
<p>While antidepressant medications may help many people, we lack robust evidence on whether they work for <a href="https://www.jamda.com/article/S1525-8610(11)00306-9/abstract">aged care residents with depression</a>. Researchers <a href="https://academic.oup.com/biomedgerontology/article/77/5/1055/6425112">have described</a> “serious limitations of the current standard of care” in reference to the widespread use of antidepressants to treat frail older people with depression.</p>
<p>Given this, we wanted to find out whether psychological therapies can help manage depression in this group. These treatments address factors contributing to people’s distress and provide them with skills to manage their symptoms and improve their day-to-day lives. But to date researchers, care providers and policy makers haven’t had clear information about their effectiveness for treating depression among older people in residential aged care. </p>
<p>The good news is the <a href="https://www.cochranelibrary.com/web/cochrane/content?templateType=full&urlTitle=/cdsr/doi/10.1002/14651858.CD013059.pub2&doi=10.1002/14651858.CD013059.pub2&type=cdsr&contentLanguage=es">evidence we published today</a> suggests psychological therapies may be an effective approach for people living in aged care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-so-many-australians-taking-antidepressants-221857">Why are so many Australians taking antidepressants?</a>
</strong>
</em>
</p>
<hr>
<h2>We reviewed the evidence</h2>
<p>Our research team searched for randomised controlled trials published over the past 40 years that were designed to test the effectiveness of psychological therapies for depression among aged care residents 65 and over. We identified 19 trials from seven countries, including Australia, involving a total of 873 aged care residents with significant symptoms of depression.</p>
<p>The studies tested several different kinds of psychological therapies, which we classified as cognitive behavioural therapy (CBT), behaviour therapy or reminiscence therapy. </p>
<p>CBT involves teaching practical skills to help people re-frame negative thoughts and beliefs, while behaviour therapy aims to modify behaviour patterns by encouraging people with depression to engage in pleasurable and rewarding activities. Reminiscence therapy supports older people to reflect on positive or shared memories, and helps them find meaning in their life history.</p>
<p>The therapies were delivered by a range of professionals, including psychologists, social workers, occupational therapists and trainee therapists. </p>
<figure class="align-center ">
<img alt="An infographic depicting what the researchers measured in the review." src="https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=486&fit=crop&dpr=1 600w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=486&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=486&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=611&fit=crop&dpr=1 754w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=611&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/582462/original/file-20240318-26-4oweov.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=611&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Cochrane Australia</span></span>
</figcaption>
</figure>
<p>In these studies, psychological therapies were compared to a control group where the older people did not receive psychological therapy. In most studies, this was “usual care” – the care typically provided to aged care residents, which may include access to antidepressants, scheduled activities and help with day-to-day tasks. </p>
<p>In some studies psychological therapy was compared to a situation where the older people received extra social contact, such as visits from a volunteer or joining in a discussion group.</p>
<h2>What we found</h2>
<p>Our results showed psychological therapies may be effective in reducing symptoms of depression for older people in residential aged care, compared with usual care, with effects lasting up to six months. While we didn’t see the same effect beyond six months, only two of the studies in our review followed people for this length of time, so the data was limited.</p>
<p>Our findings suggest these therapies may also improve quality of life and psychological wellbeing. </p>
<p>Psychological therapies mostly included between two and ten sessions, so the interventions were relatively brief. This is positive in terms of the potential feasibility of delivering psychological therapies at scale. The three different therapy types all appeared to be effective, compared to usual care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/too-many-australians-living-in-nursing-homes-take-their-own-lives-92112">Too many Australians living in nursing homes take their own lives</a>
</strong>
</em>
</p>
<hr>
<p>However, we found psychological therapy may not be more effective than extra social contact in reducing symptoms of depression. Older people commonly feel bored, lonely and socially isolated in aged care. The activities on offer are often <a href="https://onlinelibrary.wiley.com/doi/10.1111/jocn.14978">inadequate</a> to meet their needs for stimulation and interest. So identifying ways to increase meaningful engagement day-to-day could improve the mental health and wellbeing of older people in aged care.</p>
<h2>Some limitations</h2>
<p>Many of the studies we found were of relatively poor quality, because of small sample sizes and potential risk of bias, for example. So we need more high-quality research to increase our confidence in the findings.</p>
<p>Many of the studies we reviewed were also old, and important gaps remain. For example, we are yet to understand the effectiveness of psychological therapies for people from diverse cultural or linguistic backgrounds. </p>
<p>Separately, we need better research to evaluate the effectiveness of antidepressants among aged care residents.</p>
<h2>What needs to happen now?</h2>
<p>Depression should not be considered a “normal” experience at this (or any other) stage of life, and those experiencing symptoms should have equal access to a range of effective treatments. The <a href="https://www.royalcommission.gov.au/system/files/2021-03/final-report-volume-2.pdf">royal commission into aged care</a> highlighted that Australians living in aged care don’t receive enough mental health support and called for this issue to be addressed.</p>
<p>While there have been some efforts to provide <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajag.12895">psychological services</a> in residential aged care, the unmet need remains very high, and much more must be done. </p>
<p>The focus now needs to shift to how to implement psychological therapies in aged care, by increasing the competencies of the aged care workforce, training the next generation of psychologists to work in this setting, and funding these programs in a cost-effective way. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-our-residential-aged-care-system-doesnt-care-about-older-peoples-emotional-needs-103336">How our residential aged-care system doesn't care about older people's emotional needs</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/223544/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tanya Davison currently receives research funding from the Medical Research Future Fund (MRFF), Australian Research Council (ARC), and Aged Care Research and Industry Innovation Australia (ARIIA). She is employed as Director of Research Discovery at Silverchain (an Australian in-home care provider) and is a committee member of the Australian Psychological Society (APS) Psychology and Ageing Interest Group. </span></em></p><p class="fine-print"><em><span>Sunil Bhar currently receives research funding from the Medical Research Future Fund (MRFF), Australian Research Council (ARC), National Health and Medical Research Council (NHMRC), Aged Care Research and Industry Innovation Australia (ARIIA), The Ian Potter Foundation (IPF) and Arcare Family Foundation (AFF). He is the Director of the Swinburne Wellbeing Clinic for Older Adults (a free counselling service for aged care residents) and is employed as Professor of Clinical Psychology at Swinburne University. He is a committee member of the Australian Psychological Society (APS) Psychology and Ageing Interest Group.</span></em></p>A new review looks at whether psychological therapies, such as cognitive behavioural therapy, are an effective way to treat older people in aged care with symptoms of depression.Tanya Davison, Adjunct professor, Health & Ageing Research Group, Swinburne University of TechnologySunil Bhar, Professor of Clinical Psychology, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2252852024-03-11T19:13:13Z2024-03-11T19:13:13ZMother’s little helper: interviews with Australian women show a complex relationship with alcohol<figure><img src="https://images.theconversation.com/files/580616/original/file-20240308-16-prhzxy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5751%2C3768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/alcoholism-alcohol-addiction-people-concept-drunk-2187785169">Syda Productions/Shutterstock</a></span></figcaption></figure><p>Men have historically, and still do, <a href="https://pubmed.ncbi.nlm.nih.gov/19686518/">drink more than women</a>. But in recent years there has been an uptick in women’s drinking, particularly among women in their late 30s <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13428">through to their 60s</a>. </p>
<p>This is concerning, as <a href="https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health">no level of alcohol is considered safe</a> for our health, and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395922001189?via%3Dihub">women are especially susceptible</a> to <a href="https://www.sciencedirect.com/science/article/pii/S0376871615016166">alcohol’s long-term health harms</a> (for example, cancer and heart disease). </p>
<p>We’ve also seen the emergence of the “wine mum” <a href="https://theconversation.com/winemom-humour-and-empowerment-or-binge-drinking-and-mental-health-challenges-161338">in popular culture</a> and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12215">greater social acceptance</a> of women’s drinking.</p>
<p><div data-react-class="TiktokEmbed" data-react-props="{"url":"https://vt.tiktok.com/ZSFyYHa68/."}"></div></p>
<p>But women still drink differently to men, and there are some important reasons why – particularly for women who <a href="https://doi.org/10.1016/j.drugpo.2022.103699">juggle both paid work and motherhood</a>.</p>
<p>In 2022, we conducted interviews with 22 Australian working mothers aged 36 to 51, to learn more about their daily lives and the role alcohol played. Most of the women were middle-class professionals. Many were partnered to men, some were single, and all had school-aged children they looked after alongside their jobs.</p>
<p>We’ve <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2024.2314041">recently published</a> two <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2023.2299392">new papers</a> exploring what we found.</p>
<h2>Modern working mothers</h2>
<p>Now, more than ever, <a href="https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-status-families/latest-release">women are entering the workforce</a> and developing careers. At the same time, many also have to meet the demands of having children. While we like to think we’re moving towards a more equal society, women are still expected to do the <a href="https://www.tandfonline.com/doi/full/10.1080/13668803.2015.1080664">majority of childcare and domestic duties</a>.</p>
<p>This means many women are having to do “<a href="https://www.sciencedirect.com/science/article/pii/S0955395922001189?via%3Dihub">double shifts</a>” of paid and unpaid labour, increasing the chance they’re stressed, and limiting how much time they have to relax, unwind, and pursue hobbies. This is where alcohol comes in.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/oh-well-wine-oclock-what-midlife-women-told-us-about-drinking-and-why-its-so-hard-to-stop-188882">'Oh well, wine o’clock': what midlife women told us about drinking – and why it's so hard to stop</a>
</strong>
</em>
</p>
<hr>
<p>Most women we talked to felt <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2024.2314041">over-committed</a> because of their competing roles. Whether they had partners or not, they were often taking on the “default” caregiver role. This involved tasks such as getting kids ready for school, cooking, cleaning, and organising appointments. </p>
<p>At the same time, their jobs could be mentally or emotionally stressful, such as working in health care or project management.</p>
<p>And it wasn’t uncommon for these two worlds to overlap. For example, some women talked about needing to send emails or make calls from home outside work hours, or feeling there was an expectation for them to take time off work to take kids to appointments. </p>
<p>Many women were fatigued, and they felt a sense of guilt at not being able to commit fully to either role. As Mia, a full-time employed, partnered mother said:</p>
<blockquote>
<p>You’ll spend your life feeling compromised, doing a half job as a parent, and a half job as a worker.</p>
</blockquote>
<figure class="align-center ">
<img alt="A woman in the kitchen with two children talking on the phone." src="https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For many women, work and home life overlaps.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/busy-stressed-mother-talking-on-phone-1584282157">Onjira Leibe/Shutterstock</a></span>
</figcaption>
</figure>
<p>When participants talked about drinking alcohol, it was something accessible they could do alongside their home duties. For example, a glass of wine while cooking dinner was almost ubiquitous. Drinking helped women manage busy days, and the amount they drunk was not always something they had the capacity to be mindful of. As Caroline, a full-time employed, separated mother explained:</p>
<blockquote>
<p>We don’t sit down and stand around like the boys do drinking, with the beer cans round our feet. We drink a glass of wine while we cook tea […] while we’re sitting doing the kids’ homework or arguing with them about, ‘where’s your sock? Where’s your library book?’ […] it makes it very easy to think ‘I’ve only had one glass of wine’ when you’ve had three or four, because you’re not mindful of what you’re doing.</p>
</blockquote>
<p>Many of the women we talked to also described feeling under-supported. This included at work, where they felt there wasn’t always enough flexibility to accommodate their parental obligations, and at home, where their partners were not always around to share the workload. </p>
<p>These stresses and pressures meant alcohol became a “prize” or “reward” for getting through the day. And when participants felt particularly stressed or under-supported (which was often), the reward of a drink at the end of the day was all the more important. According to Penelope, a part-time employed, separated mother:</p>
<blockquote>
<p>I think that I reach out to drinking at the end of the day because I’m really quite overwhelmed, or quite exhausted mentally and physically from the day.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
</strong>
</em>
</p>
<hr>
<h2>What about the pandemic?</h2>
<p>Things became even more complicated during the <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2023.2299392">COVID pandemic</a>. Women suddenly took on “triple shifts” – mothering, working and home-schooling – leaving many feeling even more overwhelmed. As Belle, a partnered mother who worked part time, said:</p>
<blockquote>
<p>We were all working and trying to home school, and it was just so awful […] so I guess my girlfriends were going through that too, the ones with kids, and they were all definitely drinking a lot more.</p>
</blockquote>
<figure class="align-center ">
<img alt="A woman at a kitchen bench drinking a glass of red wine." src="https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The chaos of the pandemic left working mothers feeling even more overwhelmed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-beautiful-lonely-young-woman-drinking-1802268634">Gorodenkoff/Shutterstock</a></span>
</figcaption>
</figure>
<p>Alcohol was classified as an “essential service” during lockdowns (bottle shops remained open while many other retail stores closed), and against this backdrop, participants felt it became even more normalised. They talked about seeing media depictions and advertising of alcohol, including online memes that made wine out as a way to cope with the pandemic. Belle said:</p>
<blockquote>
<p>Everyone would send each other little memes of women just drinking, and it definitely became […] a socially acceptable way of getting through that really shit time.</p>
</blockquote>
<p>Hobbies and exercise activities they would previously turn to to relieve stress were often restricted because of the pandemic. As such, alcohol became one of the few things left. Many women we talked to were either drinking more, more often, or felt an increased desire to drink, especially during the height of the pandemic and when they were home-schooling.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-are-drinking-more-during-the-pandemic-and-its-probably-got-a-lot-to-do-with-their-mental-health-139295">Women are drinking more during the pandemic, and it's probably got a lot to do with their mental health</a>
</strong>
</em>
</p>
<hr>
<p>To understand why and how modern working mothers drink alcohol, it’s also important to consider how the alcohol industry targets women, often framing alcohol as a <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2024.2314041#:%7E:text=This%20study%20investigated%20the%20social,meanings%20around%20reward%20and%20relaxation.">symbol of relief and relaxation</a> among busy working mothers. </p>
<p>But it’s equally important to realise being a modern working mother is tough, especially as traditional gender expectations of women as carers persist. Almost 60 years ago, the Rolling Stones sang about “<a href="https://en.wikipedia.org/wiki/Mother%27s_Little_Helper">mother’s little helper</a>” in reference to women using substances to manage everyday life. </p>
<p>Until we see changes in the way women are supported at work and home, alcohol may continue being “mother’s little helper” for many working mothers.</p><img src="https://counter.theconversation.com/content/225285/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maree Patsouras receives funding from an Australian Government Research Training Program Scholarship and the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Cassandra Wright receives salary funding from the Australian Research Council. She also receives funding from the Medical Research Future Fund, Northern Territory Motor Accident Compensation Commission, Music NT and Menzies School of Health Research internal grant scheme.</span></em></p><p class="fine-print"><em><span>Emmanuel Kuntsche receives funding from La Trobe University, the Victorian Health Promotion Foundation (VicHealth), the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), and the University of Bayreuth Centre of International Excellence "Alexander von Humboldt". Emmanuel Kuntsche serves as that Secretary of the Australasian Professional Society on Alcohol and other Drugs (APSAD).</span></em></p><p class="fine-print"><em><span>Gabriel Caluzzi receives funding via the Australian Research Council and the Victorian Health Promotion Foundation.</span></em></p><p class="fine-print"><em><span>Sandra Kuntsche receives funding from the Australian Research Council. </span></em></p>Men and women often drink alcohol differently. This is especially the case for women who juggle both paid work and motherhood.Maree Patsouras, PhD Candidate, Centre for Alcohol Policy Research, La Trobe UniversityCassandra Wright, Senior Research Fellow in Alcohol and other Drugs, Menzies School of Health ResearchEmmanuel Kuntsche, Director of the Centre for Alcohol Policy Research, La Trobe UniversityGabriel Caluzzi, Research Fellow, Centre for Alcohol Policy Research, La Trobe UniversitySandra Kuntsche, Associate Professor Family Therapy and Systemic Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2237072024-03-11T12:25:16Z2024-03-11T12:25:16ZShould people suffering from mental illness be eligible for medically assisted death? Canada plans to legalize that in 2027 – a philosopher explains the core questions<figure><img src="https://images.theconversation.com/files/580759/original/file-20240308-16-9f5ja6.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C2101%2C1409&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In advocates' eyes, expanding access to a medically assisted death helps people protect their autonomy at a crucial time.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-of-a-young-womans-hand-holding-the-hand-of-royalty-free-image/1408213220?phrase=hands+death+love+bed&adppopup=true">Eva HM/iStock via Getty Images Plus</a></span></figcaption></figure><p>Imagine that you have lived with an illness for years. The suffering this illness has caused is devastating – so much that you wish to die. You no longer feel like the person you were before. You have been to see specialists, have tried the best treatments, but nothing works.</p>
<p>This is many people’s reality, and not only because of physical disorders and disease. Chronic mental illness can be just as crushing. Starting in March 2024, Canada planned to make medical assistance in death, or MAID, available to people with mental illness – <a href="https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html">expanding a program</a> already available to patients with terminal or chronic physical illness. In 2022, more than 13,000 people in Canada died with medical assistance, according to <a href="https://www.canada.ca/content/dam/hc-sc/documents/services/medical-assistance-dying/annual-report-2022/annual-report-2022.pdf">a government report</a>.</p>
<p>In February, however, the government announced <a href="https://www.canada.ca/en/health-canada/news/2024/02/the-government-of-canada-introduces-legislation-to-delay-medical-assistance-in-dying-expansion-by-3-years.html">a three-year delay</a> for the controversial program, saying the health care system needs more time to prepare.</p>
<p>When it is enacted in March 2027, this new provision will make Canada one of the few countries that allow MAID for mental illness. These include <a href="https://doi.org/10.3389/fpsyt.2022.895387">the Netherlands</a> <a href="https://pegasos-association.com/requirements/">and Switzerland</a>. Only a minority of U.S. states, such as Maine and Oregon, <a href="https://deathwithdignity.org/states/">allow any kind of MAID</a>, though many others have debated it – and none allow it for mental illness.</p>
<p>Critics say there are inadequate safeguards and <a href="https://www.cbc.ca/news/opinion/opinion-assisted-dying-maid-legislation-mental-health-1.5452676">a dearth of health care coverage</a> for psychiatric and psychological issues, which could prompt people to view MAID as their only alternative. They also point to the difficulty of predicting whether or not someone’s mental illness will eventually get better.</p>
<p>MAID activists believe that access to this choice for patients with mental illness is morally required. But even people <a href="https://www.cbc.ca/news/politics/medical-assistance-in-dying-mental-illness-delay-1.7098313">not opposed to Canada’s new provision</a> are concerned about whether the system is ready.</p>
<p>As <a href="https://www.gonzaga.edu/college-of-arts-sciences/faculty-listing/detail/kulp">a philosopher</a> who specializes in <a href="https://ecommons.luc.edu/luc_diss/1277/">end of life ethics</a> and physician-assisted death, I research a distinction that is at the heart of this debate. There is a subtle but crucial difference between being acutely suicidal – an experience that may pass – and, after long consideration, desiring death in the face of suffering. </p>
<h2>My body, my decision?</h2>
<p>Plenty of people oppose MAID – often called physician-assisted death – under any circumstances, including terminal physical illness. Some believe it <a href="https://www.cccb.ca/media-release/statement-by-the-canadian-conference-of-catholic-bishops-on-the-non-permissibility-of-euthanasia-and-assisted-suicide-within-canadian-health-organizations-with-a-catholic-identity/">violates the sanctity of human life</a>. </p>
<p>Others have qualms about asking doctors, who are normally concerned about the preservation of human life, <a href="https://www.thepublicdiscourse.com/2019/11/57243/">to participate in ending it</a>. In other words, they emphasize nonmaleficence, the obligation to do no harm – <a href="https://doi.org/10.1159/000509119">one of the core tenets of medical ethics</a>.</p>
<p>Many proponents, on the other hand, base their arguments on two other core tenets: beneficence – the obligation to benefit the patient – and autonomy. <a href="https://doi.org/10.1093/acprof:oso/9780195140279.003.0002">Autonomy arguments</a> usually assume that a government is only justified in restricting citizens’ liberty if exercising that liberty would cause harm to other people.</p>
<p>Advocates of physician-assisted death emphasize that ending one’s own life does not harm other people, suggesting that the government has no business curtailing the patient’s choices. Legalization ensures that citizens can make their own decisions about one of the most personal and value-laden times of life.</p>
<p>In medical ethicists’ view, in order for a person to be considered autonomous, they must be able to act intentionally and with an understanding of the potential consequences of their actions. Additionally, an autonomous person is reasonably free from undue influence – such as family members pressuring them or financial considerations that restrict their choices. </p>
<p>When it comes to physical illness, ethicists who <a href="https://philpapers.org/rec/RIDMAI-2">argue that physician-assisted death is morally permissible</a> view patients as free actors exercising their autonomy if they meet several criteria: they are terminally and chronically ill, have worked with medical professionals over time and have established an unchanging desire to end their suffering.</p>
<h2>Thorny issues</h2>
<p>Experiences of mental illness, however, raise serious questions about patients’ autonomy.</p>
<p>Mental illnesses often limit a person’s ability to govern their own lives free from the effects of their illness. For instance, a patient with <a href="https://theconversation.com/mariah-carey-says-she-has-bipolar-disorder-a-psychiatrist-explains-what-that-is-94893">bipolar I disorder</a> is not fully autonomous during the middle of a manic episode. Were it not for their disease, they would be less likely to engage in the types of behaviors that characterize a manic episode, such as reckless spending or risky sexual encounters.</p>
<p>Yet this is not true for all mental illnesses, or at all times. A person with well-treated bipolar 1 disorder will have periods in which <a href="https://www.samhsa.gov/mental-health/bipolar">their symptoms are under control</a>. In fact, it is in these periods of lucidity when <a href="https://www.nytimes.com/2023/12/27/world/canada/medical-assisted-death-mental-illness.html">some bipolar patients</a> decide their own death would be preferable to the suffering they endure. </p>
<p>Moreover, proponents of <a href="https://www.nytimes.com/2023/04/21/opinion/medical-assistance-dying-mental-illness-maid.html">extending physician-assisted death to mental illness</a> believe that the approval process can protect people who request it when acutely suicidal or who have not yet received adequate treatment.</p>
<p>In Canada’s proposed system, a mentally ill person requesting MAID must have been informed of all reasonable treatment options. They must also demonstrate a sustained desire to receive MAID, including waiting for 90 days after their application. Finally, the patient must have two doctors certify that their suffering is “<a href="https://www.justice.gc.ca/eng/rp-pr/other-autre/ad-am/p1.html">grievous and irremediable</a>” in any way the patient finds acceptable.</p>
<p>One key issue in preparing Canada’s health care system is whether providers have received enough training <a href="https://www.canada.ca/en/health-canada/services/publications/health-system-services/advice-profession-medical-assistance-dying.html#a7">to differentiate someone who is acutely suicidal</a> from someone who is in a frame of mind to make this decision thoughtfully. If someone is experiencing an acute desire to die that may be a symptom of their illness, most ethicists would find MAID morally impermissible. If, however, a mentally ill person <a href="https://www.reuters.com/world/americas/shes-47-anorexic-wants-help-dying-canada-will-soon-allow-it-2023-07-15/">has spent years suffering</a>, has exhausted reasonable treatment and has maintained a desire to die for some time, some ethicists believe MAID is appropriate.</p><img src="https://counter.theconversation.com/content/223707/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maria Kulp does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Assessing a patient’s autonomy can be more difficult when mental illness is the main source of their suffering.Maria Kulp, Associate Professor of Philosophy, Gonzaga UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2245102024-03-07T19:23:53Z2024-03-07T19:23:53ZWorking from home can make us healthier and happier. Employers benefit too. Here’s the evidence if you need any convincing<figure><img src="https://images.theconversation.com/files/580287/original/file-20240306-20-2qvls8.jpg?ixlib=rb-1.1.0&rect=23%2C23%2C7786%2C5187&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-writing-on-her-notebook-3059747/">RF Studio/Pexels</a></span></figcaption></figure><p>Some of us used to imagine a world where the morning commute was a short stroll from your bedroom, the dress code included comfy slippers, and the closest coffee shop was your kitchen. Then working from home became a reality for many during the COVID pandemic, reshaping our work-life balance.</p>
<p>During the early days of the pandemic in 2020, our team was partway through a year-long <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248008">study</a> examining lifestyle and wellbeing in Australian adults. Our findings, captured during the early COVID period, revealed that people working from home slept nearly half an hour more and drank slightly more alcohol. Dietary habits and mental health indicators were unchanged. </p>
<p>Fast forward to today. Many <a href="https://www.abs.gov.au/statistics/labour/earnings-and-working-conditions/characteristics-employment-australia/aug-2023">employees</a> still work from home and <a href="https://melbourneinstitute.unimelb.edu.au/data/taking-the-pulse-of-the-nation-2022/ttpn-11-july-2022">many more want to</a>. The Fair Work Commission is <a href="https://www.smh.com.au/politics/federal/work-from-home-battle-begins-and-the-decision-could-affect-millions-20240221-p5f6kb.html">reviewing</a> whether it needs to create basic rights for flexibility, allowing people to work from home. </p>
<p>While some of the health evidence about working from home is mixed, overall it shows giving workers the flexibility to choose to work from home can be good for their physical and mental health.</p>
<h2>It saves time commuting</h2>
<p>Before the pandemic, the typical Australian spent <a href="https://melbourneinstitute.unimelb.edu.au/__data/assets/pdf_file/0010/3398464/HILDA-Statistical-Report2019.pdf">4.5 hours commuting</a> each week, a grind linked with <a href="https://doi.org/10.1002/hec.3199">poorer mental health</a> and lower scores of how we rate our own health. </p>
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Read more:
<a href="https://theconversation.com/australian-city-workers-average-commute-has-blown-out-to-66-minutes-a-day-how-does-yours-compare-120598">Australian city workers' average commute has blown out to 66 minutes a day. How does yours compare?</a>
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<p>In Australia, the transition to home offices has given us <a href="https://www.nber.org/papers/w30866">about an hour and 18 minutes a week</a> of extra time. </p>
<p>Yet, intriguingly, <a href="https://www.nber.org/papers/w30866">43% of this newfound time is channelled into more work</a>, with a fraction (9%) to caregiving activities and leisure pursuits (33%). So are we optimising this shift? </p>
<h2>We move and snack more when working from home</h2>
<p>With extra time dedicated to leisure when working from home, there is more opportunity to be physically active and less sedentary.</p>
<p>In a <a href="https://doi.org/10.1016/j.jth.2018.03.008">study from the United States</a> of 108,000 people, work-from-home days were more likely to include significant bouts of walking or cycling.</p>
<p>By having more time available, slower yet <a href="https://doi.org/10.1016/j.jtrangeo.2020.102777">active transport options become viable</a> for short trips, such as cycling to the supermarket or walking to pick up children from care. </p>
<p>However, this silver lining is clouded by findings from <a href="https://doi.org/10.1002/1348-9585.12212">Japan</a>, where remote workers reported less movement and more sitting during office hours, hinting at a complex trade-off between work and leisure-time physical activity.</p>
<p>Dietary habits, too, are evolving with working from home. The convenience of proximity to our kitchen pantries has led to an increase in <a href="https://doi.org/10.3390/ijerph182211882">snacking</a>. </p>
<figure class="align-center ">
<img alt="Person gets chip out of packet" src="https://images.theconversation.com/files/580296/original/file-20240306-20-mzwlfv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580296/original/file-20240306-20-mzwlfv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580296/original/file-20240306-20-mzwlfv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580296/original/file-20240306-20-mzwlfv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580296/original/file-20240306-20-mzwlfv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=512&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580296/original/file-20240306-20-mzwlfv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=512&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580296/original/file-20240306-20-mzwlfv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=512&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">We tend to snack more at home.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-takes-out-potato-chips-inside-1732920281">Oleg Krugliak/Shutterstock</a></span>
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<p>However, as we snack more and see a rise in our overall energy intake at home, there’s also a noticeable shift towards a <a href="https://www.mdpi.com/1660-4601/18/22/11882">broader selection</a> of healthier food options. Consumption of vegetables, fruits and dairy has gone up, complemented by a surge in preparing meals at home.</p>
<p>In the office, limited by the constraints of a packed communal fridge or the wait to use the microwave, opting for a less nutritious but quicker takeaway lunch often seems the better choice. </p>
<h2>What about mental health and wellbeing?</h2>
<p>When considering mental health and wellbeing, the results are nuanced. </p>
<p>Generally, when working from home is compulsory, as was common during the early pandemic lockdowns, mental health and wellbeing <a href="https://doi.org/10.3390/ijerph182211882">tend to decline</a>. </p>
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Read more:
<a href="https://theconversation.com/most-of-us-will-recover-our-mental-health-after-lockdown-but-some-will-find-it-harder-to-bounce-back-169029">Most of us will recover our mental health after lockdown. But some will find it harder to bounce back</a>
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<p>Conversely, when people choose to work from home, their mental health and wellbeing often improve. This is especially the case when they’re well supported by colleagues and their organisation, and can manage their isolation level, meaning they have <a href="https://doi.org/10.1111/jomf.12633">flexibility</a> in their work-from-home arrangements. </p>
<p>There are concerns working from home can <a href="https://doi.org/10.1016/j.jss.2022.111552">negatively impact</a> team cohesion and collaboration, feelings of attachment and social ties within the workplace, and opportunities for promotion.</p>
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<img alt="Workers look at a laptop, laughing" src="https://images.theconversation.com/files/580298/original/file-20240306-26-ueqem6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580298/original/file-20240306-26-ueqem6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580298/original/file-20240306-26-ueqem6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580298/original/file-20240306-26-ueqem6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580298/original/file-20240306-26-ueqem6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580298/original/file-20240306-26-ueqem6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580298/original/file-20240306-26-ueqem6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some employers worry staff can’t collaborate as well when working from home.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/three-men-laughing-while-looking-in-the-laptop-inside-room-XkKCui44iM0">Priscilla du Preez/Unsplash</a></span>
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<p>While connecting with colleagues is difficult to replicate remotely, it’s important to note job performance and productivity appear to be stable or, in most cases, <a href="https://doi.org/10.3390/su15054529">improved</a> when working from home. </p>
<p>Additionally, those working full time at home or in a hybrid model report job satisfaction and wellbeing to be stable or improved. They also report a reduction in work-family conflict – this is particularly so for <a href="https://doi.org/10.2139/ssrn.4393288">women</a>.</p>
<h2>Some people need more flexibility than others</h2>
<p>For some people, the flexibility to work from home alleviates some of the structural barriers to working.</p>
<p>Women, especially mothers and caregivers, report <a href="https://doi.org/10.2139/ssrn.4393288">improved wellbeing</a> with the option to work from home. The added flexibility helps to balance paid employment with unpaid caregiving and household duties, which disproportionately <a href="https://doi.org/10.1111/1467-8462.12538">fall on women’s shoulders</a>. </p>
<p>Similarly, workers with disabilities <a href="https://doi.org/10.1007/s10926-020-09936-5">tend to favour working from home</a>, as a solution to overcoming <a href="https://doi.org/10.1111/bjir.12645">transportation and accessibility challenges</a> posed by traditional workplaces. Providing alternative working arrangements allows a greater number of people living with disabilities to engage in paid employment, which is linked to improvements in <a href="https://doi.org/10.1136/jech-2014-204147">mental health</a>.</p>
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Read more:
<a href="https://theconversation.com/working-from-home-has-worked-for-people-with-disability-the-back-to-the-office-push-could-wind-back-gains-209870">Working from home has worked for people with disability. The back-to-the-office push could wind back gains</a>
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<p>Working from home is not a one-size-fits-all approach and appears best positioned as one choice among many to support a better, more inclusive, and flexible work environment. Just as our homes transformed into makeshift offices overnight, our approach to work must evolve, embracing the diversity of needs and lifestyles. </p>
<p>Let’s hope a legacy of COVID will be a healthier, more balanced workforce.</p><img src="https://counter.theconversation.com/content/224510/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carol Maher receives funding from the Medical Research Future Fund, the National Health and Medical Research Council, the National Heart Foundation, the SA Department for Education, Preventive Health SA, the SA Department for Innovation and Skills, Healthway, Hunter New England Local Health District, the Central Adelaide Local Health Network, LeapForward.</span></em></p><p class="fine-print"><em><span>Rachel Curtis receives funding from the Medical Research Future Fund, National Health and Medical Research Council, SA Department for Education, Healthway, Hunter New England Local Health District, and SA Department for Innovation and Skills.</span></em></p><p class="fine-print"><em><span>Ty Ferguson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Fair Work Commission is considering basic rights to work from home. Here’s what the evidence says about the impacts of working from home on physical health and mental wellbeing.Ty Ferguson, Research Associate, University of South AustraliaCarol Maher, Professor, Medical Research Future Fund Emerging Leader, University of South AustraliaRachel Curtis, Research fellow, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2250852024-03-06T19:15:26Z2024-03-06T19:15:26ZNAPLAN testing is about to start. How can you support an anxious child?<figure><img src="https://images.theconversation.com/files/580059/original/file-20240306-22-ri320g.jpg?ixlib=rb-1.1.0&rect=25%2C92%2C5582%2C3598&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/search/child%20worried%20school/?orientation=landscape">Jonas Mohamadi/ Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>From March 13, NAPLAN testing for 2024 <a href="https://www.nap.edu.au/naplan/key-dates">will begin</a>. Over the following two weeks, all Australian students in years 3,5,7 and 9 are expected to sit tests in literacy and numeracy.</p>
<p>Results are then aggregated for schools and other demographics and made public. Students also get their <a href="https://theconversation.com/what-parents-should-and-shouldnt-say-when-talking-to-their-child-about-naplan-results-189636">individual results</a>. </p>
<p>For students in Year 3, this will be their first experience of a formal test. For others, they will be sitting the test among school and <a href="https://www.heraldsun.com.au/subscribe/news/1/?sourceCode=HSWEB_WRE170_a_GGL&dest=https%3A%2F%2Fwww.heraldsun.com.au%2Fvictoria-education%2Fnaplan-scores-reveal-victorias-top-schools%2Fnews-story%2F3f5ba1b091238e8c5dc139ad34740af2&memtype=anonymous&mode=premium&v21=GROUPA-Segment-1-NOSCORE">media hype</a> about the “importance of NAPLAN”. </p>
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Read more:
<a href="https://theconversation.com/how-to-avoid-annoying-your-kids-and-getting-stressed-by-proxy-during-exam-season-200719">How to avoid annoying your kids and getting 'stressed by proxy' during exam season</a>
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<h2>The NAPLAN debate</h2>
<p>Since it was introduced in 2008, NAPLAN has polarised the community. Some education experts see it as <a href="https://lens.monash.edu/@education/2021/05/10/1383196/learning-from-disruption-why-we-should-rethink-the-place-of-naplan-in-our-schools">counterproductive</a> (with too much emphasis on test performance rather than learning). Others emphasise the <a href="https://theconversation.com/five-things-we-wouldnt-know-without-naplan-94286">importance of the data</a> collected, and how this informs teaching practice and school funding.</p>
<p>One of the prevailing concerns relates to the impact on <a href="https://all-learning.org.au/app/uploads/2021/05/Putting-Students-First_final.pdf">student wellbeing</a>. </p>
<p>While many students do not feel any anxiety, one <a href="https://journals.sagepub.com/doi/pdf/10.1177/00049441211061889">2022 study</a> of more than 200 high school students found 48% felt worried about what the test would be like and how they would perform. <a href="https://www.tandfonline.com/doi/pdf/10.1080/02680939.2017.1305451?casa_token=rnwVm0381fsAAAAA:Wbz40LeJsRLw80DTQFnecubaRTDck5AM0H6p4tRu6VjwOyIYSdjRFr8GFBwNCLrwpLOZLjGi4R9U">A 2017 study</a> of more than 100 primary students revealed up to 20% of children had a physical response to the test, such as feeling sick, not sleeping well, headaches or crying.</p>
<p>For parents, the stress and anxiety their child experiences in the lead up to NAPLAN can cause them to worry and even <a href="https://theconversation.com/naplan-results-inform-schools-parents-and-policy-but-too-many-kids-miss-the-tests-altogether-201371">withdraw</a> their child from the assessment.</p>
<p>But test anxiety is not inevitable. Here are some simple things parents and teachers can do to support students, not just for this assessment, but into the future. </p>
<figure class="align-center ">
<img alt="Two young students sit cross legged in a playground, looking at work books." src="https://images.theconversation.com/files/580055/original/file-20240306-30-nvuda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580055/original/file-20240306-30-nvuda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580055/original/file-20240306-30-nvuda.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580055/original/file-20240306-30-nvuda.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580055/original/file-20240306-30-nvuda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580055/original/file-20240306-30-nvuda.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580055/original/file-20240306-30-nvuda.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">NAPLAN tests students progress in reading, writing and maths.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/young-diverse-pupils-studying-lesson-together-while-sitting-in-yard-5896577/">Mary Taylor/ Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/naplan-results-inform-schools-parents-and-policy-but-too-many-kids-miss-the-tests-altogether-201371">NAPLAN results inform schools, parents and policy. But too many kids miss the tests altogether</a>
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</p>
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<h2>1. Talk about the purpose of the test</h2>
<p>NAPLAN is not just about individual student results and whether you are a “good” at maths or “bad” at reading. It’s about informing teaching and learning. </p>
<p>The results help teachers do their jobs by identifying areas of reading, writing and maths that need more attention. This can help individual students, classes or entire schools.</p>
<p>When the results are collected at state and national levels, they also help tell governments where to put more efforts and funding to help support students. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-australian-students-really-falling-behind-it-depends-which-test-you-look-at-218709">Are Australian students really falling behind? It depends which test you look at</a>
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</p>
<hr>
<h2>2. Talk about how the test is a journey (not a destination)</h2>
<p>Children learn from experience. This enables them to predict what might happen in similar future events. </p>
<p>Talk about NAPLAN as “practice” for future tests. So if you sit NAPLAN test in your younger school years this will help you handle other tests in senior school or maybe even university. </p>
<p>Emphasise that sitting the test is not about a particular outcome or result. It’s about embarking on an experience and learning what it is like to do a standardised tests. In this way, NAPLAN can help students build <a href="https://journals.sagepub.com/doi/pdf/10.1177/00049441211061889">resilience</a>. </p>
<figure class="align-center ">
<img alt="A young girl works at a laptop, with bookcases behind her, lined with books." src="https://images.theconversation.com/files/580056/original/file-20240306-28-oxcats.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580056/original/file-20240306-28-oxcats.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580056/original/file-20240306-28-oxcats.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580056/original/file-20240306-28-oxcats.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580056/original/file-20240306-28-oxcats.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580056/original/file-20240306-28-oxcats.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580056/original/file-20240306-28-oxcats.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tests like NAPLAN can help prepare your child for other challenges.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-in-black-long-sleeve-shirt-using-macbook-4A1pj4_vClA">Annie Spratt/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>3. Teach your child to manage anxiety</h2>
<p>Mindfulness-based interventions have been shown to be <a href="https://mentalhealth.bmj.com/content/ebmental/25/3/135.full.pdf">successful</a> in addressing anxiety symptoms in children. </p>
<p>Mindfulness can teach children to recognise anxiety symptoms such as a fast heart beat, shortness of breath or racing thoughts. By encouraging children to focus on the present moment, mindfulness can help children through improved concentration, better emotional regulation and fostering a sense of calm. </p>
<p>Smiling Mind is an Australian app designed to teach children to be mindful in a developmentally appropriate and guided way. The app is free to download and use. You could sit or lie down with your child and do a “body scan” (where you scan your entire body and notice how it feels) or a listening practice (where you pay attention to the sounds around you). </p>
<p>If your child is experiencing significant test anxiety, such as headaches, tummy pains or a racing heart, there may be more to it than just concerns about NAPLAN. For children aged 12–18, <a href="https://headspace.org.au">Headspace</a> – Australia’s mental health foundation for young people – offers a range of services. </p>
<p>For younger children, or if you are still concerned, speak to your child’s teacher, the school counsellor or your GP.</p><img src="https://counter.theconversation.com/content/225085/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Leslie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Next week, Australian schools will begin NAPLAN tests for students in years 3, 5, 7 and 9.Rachel Leslie, Lecturer in Curriculum and Pedagogy with a focus on Educational Psychology, University of Southern QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2246702024-03-06T17:14:59Z2024-03-06T17:14:59ZWhy do young people have such poor mental health? A psychologist explains<figure><img src="https://images.theconversation.com/files/579608/original/file-20240304-22-i8lpd3.jpg?ixlib=rb-1.1.0&rect=67%2C6%2C4339%2C2978&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-man-82004164">spixel/Shutterstock</a></span></figcaption></figure><p>A <a href="https://www.resolutionfoundation.org/publications/weve-only-just-begun/">recent report</a> from think tank the Resolution Foundation has found that 34% of young people aged 18-24 in the UK have symptoms of a common mental disorder – the highest rate of any age group. </p>
<p>Mental health problems among young people are on the rise. An especially stark finding of the report is that 20 years ago, this age group was the least likely to have a common mental disorder.</p>
<p>The big question is why. As a psychologist researching young people’s wellbeing, I believe that young people today face unprecedented pressures to excel academically, professionally and socially. This pressure can manifest in various forms, including academic stress, performance anxiety and fear of failure. </p>
<p>Current societal difficulties, such as the cost of living crisis, will have further exacerbated these issues – as will the lasting impact of isolation and loss of <a href="https://theconversation.com/coming-of-age-in-2020-the-summer-without-exams-or-school-proms-138750">valuable life experiences</a> during the pandemic. </p>
<p>A <a href="https://www.orygen.org.au/About/News-And-Events/2024/Generations-agree-youth-mental-health-is-declining/Youth-mental-health-in-crisis-Public-and-generatio.aspx">new survey</a> from King’s College London and non-profit research group the Orygen Institute shows that a majority of the UK public thinks that young people today have a worse time finding a job and more difficulty affording things than previous generations.</p>
<h2>Markers of success</h2>
<p><a href="https://www.oecd-forum.org/posts/19894-poles-apart-how-technology-globalisation-have-affected-the-global-workforce">Globalisation</a> and <a href="https://www.weforum.org/agenda/2023/05/future-of-jobs-technology-skills-workplace/">technological advancements</a> have transformed the job market, splitting jobs more starkly into high- or low-skilled occupations. This has led to greater emphasis on specialised skills and higher education. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-25-years-of-education-policy-led-us-to-believe-we-can-only-succeed-in-life-with-a-degree-210017">How 25 years of education policy led us to believe we can only succeed in life with a degree</a>
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<p>Educational or career success – or failure – is now more visible than ever. The rise of social media has intensified the need to present a perfect image of success.</p>
<p>Logging into a social media account invariably brings an announcement about someone being promoted, starting a new job, or taking up an exciting opportunity. This can potentially trigger negative feelings, particularly if a young person has been struggling to get a job or even an interview. </p>
<p>The King’s College London and Orygen Institute survey found that social media is seen as a <a href="https://www.orygen.org.au/About/News-And-Events/2024/Generations-agree-youth-mental-health-is-declining/Youth-mental-health-in-crisis-Public-and-generatio.aspx">key driver</a> in worsening mental health among the young. </p>
<figure class="align-center ">
<img alt="Sad woman looks at phone" src="https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579614/original/file-20240304-22-6kgvy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A survey shows the UK public believes social media to be a significant factor in poor youth mental health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/disappointed-black-woman-checking-cell-phone-2415613023">Antonio Guillem/Shutterstock</a></span>
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<p>The curated nature of social media feeds can create <a href="https://fherehab.com/learning/beauty-standards-mental-health">unrealistic standards</a> of beauty, success and happiness, leading to feelings of insecurity and low self-esteem. <a href="https://www.tandfonline.com/doi/full/10.1080/1047840X.2020.1820214">Increased time online</a> and the pressure to maintain an online identity may also worsen feelings of inadequacy and isolation. </p>
<p>The <a href="https://www.frontiersin.org/articles/10.3389/fhumd.2021.684137/full">pandemic</a> exacerbated these issues by intensifying feelings of social isolation and uncertainty. Organisational closures and physical distancing requirements reduced social contact and support. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653204/">Research studies</a> report mental health deterioration among children and teenagers as a result of COVID control measures, especially among those with preexisting vulnerabilities, such as socioeconomic disadvantage, neurodiversity or disability. </p>
<p>A high proportion of young people in the UK believe that many areas are <a href="https://www.orygen.org.au/About/News-And-Events/2024/Generations-agree-youth-mental-health-is-declining/Youth-mental-health-in-crisis-Public-and-generatio.aspx">worse for them</a> compared to when their parents were their age; 78% think they are less able to afford things and 76% think mental health has worsened. This has the potential to lead to a sense of hopelessness.</p>
<p>If young people view their future as <a href="https://link.springer.com/article/10.1007/s41811-023-00165-1">gloomy</a> and feel they can do nothing to change their prospects, they are less likely to engage in tasks and activities that can improve their situation. </p>
<h2>Mental health awareness</h2>
<p>The King’s College and Orygen Institute survey found that 47% of people think mental health problems were <a href="https://www.kcl.ac.uk/policy-institute/assets/youth-mental-health-in-crisis.pdf">just as common</a> among young people in the past; they just weren’t identified as such. </p>
<p>Over the past two decades, there has been a growing awareness and acceptance of mental health issues, leading to greater visibility and discourse. This has helped reduce stigma and improve access to resources. But it has also created new challenges for young people navigating their mental health.</p>
<p><a href="https://www.mind.org.uk/about-us/our-strategy/doing-more-for-young-people/facts-and-figures-about-young-people-and-mental-health/">Increased awareness</a> has empowered young people to seek help and speak out about their struggles. </p>
<p>On the other hand, the way mental health is discussed has created a sense of pressure to find ways to be mentally healthy and resilient, with a person <a href="https://www.bps.org.uk/psychologist/mental-health-awareness-time-re-focus">individually responsible</a> for their own mental wellbeing. This pressure may be particularly challenging for young people who are struggling with difficult circumstances and associated mental health issues, leading to feelings of shame and self-blame.</p>
<p>All these factors are intertwined and difficult to isolate, meaning there is no simple solution. But my advice to everyone, not just young people, is, try to play an active part in each area of your life when you can, push yourself outside of your comfort zone, and make sure you celebrate the small wins.</p><img src="https://counter.theconversation.com/content/224670/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiorentina Sterkaj does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>I believe that young people today face unprecedented pressures to excel academically, professionally and socially.Fiorentina Sterkaj, Director of the Department of Psychological Sciences, School of Psychology, University of East LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2239982024-03-06T07:24:34Z2024-03-06T07:24:34ZThe frantic pace of modern life is damaging our sense of time, but nature can help us heal – new study<figure><img src="https://images.theconversation.com/files/579623/original/file-20240304-24-boijcu.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C2995%2C1989&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Huge beech tree with large branches in the enchanted forest in the Basque Country, Alava, Spain.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/es/image-photo/huge-beech-tree-large-branches-enchanted-2378469361">José Miguel Sánchez/Shutterstock</a></span></figcaption></figure><blockquote>
<p><em>“How did it get so late so soon?”</em> ― Dr. Seuss</p>
</blockquote>
<p>In an increasingly competitive world, time is of the essence. Notions of productivity and timeliness have accelerated contemporary lifestyles to a dizzying, sometimes overwhelming pace, and <a href="https://theconversation.com/technology-is-stealing-your-time-in-ways-you-may-not-realise-heres-what-you-can-do-about-it-216863">our dependence on technology is doing little to help</a>. As the clock grows to dominate the tempo of life, time itself seems to be increasingly fleeting. This is particularly true in large cities, where hours, days, and even weeks can sometimes seem to fly by in an instant. </p>
<p>Indeed, an increasing number of people report constantly feeling <a href="https://www.sciencedirect.com/science/article/pii/S2352250X18300411">short of time</a>. Such feelings of “time scarcity” emerge from how time is both used and perceived by people. Long working hours inevitably limit the time that people have available for other activities, but leading fast-paced lifestyles while packed into noisy, dynamic and crowded urban environments is mentally exhausting, and this can also influence how we perceive time.</p>
<p>In a recent <a href="https://doi.org/10.1002/pan3.10601">publication</a>, I propose that nature experiences offer a potential solution to the increasingly widespread feelings of time scarcity caused by contemporary urban lifestyles. This emerges from the unique nature of human time perception, which is highly subjective, and moulded by the experiences and environments in which we immerse ourselves.</p>
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Leer más:
<a href="https://theconversation.com/technology-is-stealing-your-time-in-ways-you-may-not-realise-heres-what-you-can-do-about-it-216863">Technology is stealing your time in ways you may not realise – here’s what you can do about it</a>
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<hr>
<h2>Human sense of time</h2>
<p>Human time perception — our sense of time — is made up of three key dimensions. One of these is <strong>temporal succession</strong>, meaning the way we perceive the order and overlap of different events. For instance, pressing a light switch and the light turning on may seem like simultaneous events, but we have the capacity to perceive the order in which they happen, and this helps us to make sense of the world around us.</p>
<p>Another dimension is <strong>temporal duration</strong>, or how we perceive and estimate the duration of an event. An afternoon spent in the tax office, for example, can seem to last forever, while the same amount of time spent in the company of friends can seem short and swift. Popular expressions such as “time stood still” or “time flies when you’re having fun” reflect our nuanced perception of temporal duration.</p>
<p>The third dimension is called <strong>temporal perspective</strong>, and it refers to the way we regard the past, present and future. Humans have a unique capacity to mentally “time travel” and focus on representations of the past, present and future. Most people have a natural tendency towards certain perspectives, either dwelling on the past or focusing on the future, but maintaining a balanced and dynamic time perspective is <a href="https://link.springer.com/chapter/10.1007/978-3-319-07368-2_26">a sign of psychological wellbeing</a>.</p>
<p>Together, these dimensions help humans make sense of time. However, the way we perceive them can be profoundly influenced by our own characteristics, what goes on around us, and what we do during a given period of time. Our perception of time changes hugely when, for example, work captures our attention, when we are stuck in traffic, or when we find ourselves in the dentist’s chair undergoing a painful procedure. </p>
<p>In contrast, nature experiences can be mentally, physically and emotionally restorative, and this is reflected in our perception of time.</p>
<h2>How nature experiences help regulate human time perception</h2>
<p>Evidence from psychological experiments suggests that there are at least two ways natural surroundings can have a positive impact on human time perception. </p>
<p>One of these is expanding our perception of <strong>temporal duration</strong>. For example, one <a href="https://www.sciencedirect.com/science/article/pii/S0272494417301081">study</a> reports that when people are inquired how long they have been walking in natural or urban settings, they tend to overestimate the time spent strolling in nature, but not in the city. In other words, time feels longer when we are immersed in natural settings in comparison to urban environments.</p>
<p>The other way nature experiences can influence our time perception is by promoting a shift in perspective. In one <a href="https://doi.org/10.1080/08098131.2019.1642374">experiment</a>, participants spent a short period of silence either indoors or outdoors, and were later asked how this experience influenced their <strong>temporal orientation</strong> towards the past, present and future. People who experienced the natural setting reported feeling more focused on the present, and less on the past. </p>
<p>Other studies have provided similar evidence suggesting nature experiences can help us shift our perspective on time, and induce a more positive outlook of the present moment.</p>
<p>While there is plenty of evidence that nature experiences have various physical and mental benefits, the idea that such experiences can help people uplift their relationship with time is new, and provides a unique perspective on the importance of nature for human well-being. </p>
<p>Further enhancing our understanding of how nature benefits human sense of time can help us design cities and other urban environments in healthier and more sustainable ways.</p><img src="https://counter.theconversation.com/content/223998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ricardo A. Correia has received funding from the Academy of Finland (grant #348352) and the KONE Foundation (grant #202101976).</span></em></p>Feelings of “time scarcity” are on the rise, but research shows that natural surroundings can help us to slow down.Ricardo Correia, Assistant professor, University of TurkuLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2240572024-03-04T20:58:06Z2024-03-04T20:58:06ZMAID and mental health: Does ending the suffering of mental illness mean supporting death or supporting better lives?<p>Recent headlines have <a href="https://nationalpost.com/news/canada/psychiatrists-clash-deadline-maid-mental-illness">highlighted debates</a> among federal parties over the proposal to <a href="https://www.canada.ca/en/health-canada/news/2024/02/the-government-of-canada-introduces-legislation-to-delay-medical-assistance-in-dying-expansion-by-3-years.html">extend Medical Assistance in Dying</a> (MAID) to people suffering solely with mental illness. </p>
<p>Proponents of <a href="https://psychiatry.utoronto.ca/news/discussing-medical-assistance-dying-and-mental-illness-canada">expanding Bill C-7 to mental illness claim</a> that delays to do so are based on stigma and stereotypes promoting the belief that a mental disorder renders someone incapable of making a rational choice to die. Those that advocate for delaying an expansion suggest that more work is needed to <a href="https://doi.org/10.1097/yco.0000000000000298">ensure appropriate safeguards</a> are in place to distinguish requests for MAID from illness-induced suicidal ideation. </p>
<p>The recent announcement that including mental illness in MAID will be <a href="https://www.cbc.ca/news/politics/liberals-delay-expanding-maid-1.7101560">delayed until 2027</a> gives provincial and territorial health-care systems more time to prepare for implementation. </p>
<h2>Putting access to MAID in context</h2>
<p>People living with long-term mental illness should have the option to consider MAID, like others facing chronic, debilitating illnesses. However, access to MAID is a small part of a larger conversation we ought to be having about how the health-care system can provide supports and services that empower people with mental health disorders to navigate the long journey of mental illness with dignity and resilience. Extending support to the families that care for them should be considered key. </p>
<p><a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">As the Centre for Addiction and Mental Health (CAMH) reports</a>, mental illness is the leading cause of disability in Canada, and wait lists for services are far too long. For each person with a debilitating mental illness, there are family members — biological, legal or chosen — doing their best to provide support and care. But who supports these families as they navigate the challenges of persistent mental illness? </p>
<p>Despite decades of research demonstrating the <a href="https://doi.org/10.7870/cjcmh-2015-009">importance of family caregivers</a> for supporting people with severe mental illness, and the <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/Caregiving_MHCC_Family_Caregivers_Guidelines_ENG_0.pdf">beneficial outcomes</a> for all family members when families are supported, vital support services have <a href="https://www.fraserinstitute.org/sites/default/files/mental-health-care-how-is-canada-doing.pdf">declined throughout Canada</a>. Families that are racialized, poor or newcomers are <a href="https://doi.org/10.1177/0840470420933911">getting even less support</a> in a depleted family support service system. </p>
<p>Examples of evidence-based family-focused supports that would help include <a href="https://doi.org/10.1111/j.1752-0606.2011.00256.x">family psychoeducation</a>, <a href="https://doi.org/10.1111/hsc.12689">peer support</a>, and <a href="https://doi.org/10.1177/07067437231197263">community-based, culturally-acceptable services</a> that focus on whole families.</p>
<h2>Supporting patients and families</h2>
<p>In addition to asking health-care systems to prepare to end the suffering of mental illness by facilitating death, we should be asking legislators and policymakers to build a health-care system that supports better lives for people with mental disorders and their families. </p>
<p>Families manage mental illness <a href="https://www.ctvnews.ca/health/relatives-of-people-with-serious-mental-illness-often-bear-brunt-of-stigma-study-1.6374892">out of sight</a> of these leaders and society at large; their suffering is seen as a <a href="https://tspace.library.utoronto.ca/bitstream/1807/94700/1/Caregiving%20under%20siege_Williams.pdf">personal matter</a> that is no one else’s business. But the numbers tell us that ending suffering from mental illness is everyone’s business. It requires <a href="https://cmha.ca/brochure/social-support/">networks of support</a> for those who have been diagnosed and caregivers. Ignoring the families that support individuals with mental illness has <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/Caregiving_MHCC_Family_Caregivers_Guidelines_ENG_0.pdf">ramifications for everyone’s health</a>. </p>
<p>My research exploring the experiences of Ontario families affected by mental illness has shown there are <a href="http://familyguidetomentalhealth.com/port/harmful-practices/">gaps in the system</a> when it comes to family support. Conversations with families reveal that, whether one is a caregiver or someone who has been diagnosed, those living with mental illness often feel <a href="http://familyguidetomentalhealth.com/port/stigma-isolation/">isolated, alone and overwhelmed</a>. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/bO_jmSo4VfA?wmode=transparent&start=8" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In a video from the Family Caregiving Project, family members describe difficult interactions with the health-care system.</span></figcaption>
</figure>
<p>Family members who <a href="https://tspace.library.utoronto.ca/bitstream/1807/94700/1/Caregiving%20under%20siege_Williams.pdf">don’t fall into the definition of “traditional family”</a> often report challenges throughout the care process. Families that are part of marginalized or lower-income groups face additional <a href="https://doi.org/10.1177/0840470420933911">challenges to getting help and support</a>, often due to financial barriers, language and cultural barriers, or other social determinants that correspond to inequities in access to health care. </p>
<p>The failure to build proper supports and services that meet the needs of families could worsen an already growing mental health crisis. If the family is stressed, that <a href="https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=c8ae98f27c37c9ca253832a6f7a479f3d322b502">stress will impact everyone within it</a>, caregivers and people struggling with a mental illness alike. This is suffering that can last for decades. The well-being of whole families affected by mental illness must be recognized as an issue of urgent concern.</p>
<h2>Caring for people with long-term mental illness</h2>
<p>Education and training are needed to ensure health professionals have the information they need to better support families. At the same time, more work must be done to promote the general public’s understanding of mental illness and reduce stigma, so people don’t feel ashamed about asking for help. </p>
<p>My work with the Family Caregiving Project to develop <a href="http://familyguidetomentalhealth.com/family-caregiving-project/">free online educational resources</a> is a start. These resources help health-care professionals, educators and community groups better understand and discuss the experiences of families struggling with mental health issues. </p>
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Read more:
<a href="https://theconversation.com/medical-assistance-in-dying-for-mental-illness-ignores-safeguards-for-vulnerable-people-156012">Medical assistance in dying for mental illness ignores safeguards for vulnerable people</a>
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<p>But Canada’s families require government support as well. We need to ensure that our health-care system provides necessary services for families. Last year, we called on the Ontario government to fund targeted support for families living with serious and persistent mental illnesses, <a href="https://www.change.org/p/family-day-includes-families-affected-by-mental-illness-they-need-your-help-0cc2c044-c4bf-4de2-a722-ef5eae4f2d05">collecting nearly 1,500 signatures from people who agree family support needs to be a priority</a>. </p>
<p>Living with a recurrent mental illness and having hopes rise and fall when treatments fail is a source of profound suffering for families all over Canada. People diagnosed with mental illness need to be part of the dialogue surrounding MAID eligibility because long-term mental illness can be devastating. At the same time, we have a health-care system that is focused on the short term of crisis and hospitalization, with little thought or investment for the months and years over which individuals and their families must find ways to carry on. </p>
<p>We need to offer more than assistance to death. We need to offer adequate resources and services that will get people help when needed, and support the mental health and well-being of all family members over the long term.</p><img src="https://counter.theconversation.com/content/224057/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charmaine C. Williams receives funding from the Social Sciences and Humanities Research Council (SSHRC). In the past she has received funding from the Canadian Institutes of Health Research (CIHR), the International Development Research Council (IDRC), the Ontario HIV Treatment Network, and the Ministry of Health and Long-Term Care.</span></em></p>In addition to asking health-care systems to prepare to end suffering of mental illness through Medical Assistance in Dying (MAID), we must ask policymakers to support better lives for families.Charmaine C. Williams, Dean and Professor of Social Work, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2228542024-02-29T21:48:23Z2024-02-29T21:48:23ZBetter sleep is a protective factor against dementia<figure><img src="https://images.theconversation.com/files/573581/original/file-20240117-23-vqzz7m.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6720%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lack of sleep, or poor quality sleep, is one of the risk factors for developing Alzheimer's disease. Fortunately, there are ways to improve sleep.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Dementia is a progressive loss of cognitive abilities, such as memory, that is significant enough to have an impact on a person’s daily activities. </p>
<p>It can be caused by a number of different diseases, including <a href="https://alzheimer.ca/en/about-dementia/what-alzheimers-disease">Alzheimer’s</a>, which is the most common form. Dementia is caused by a loss of neurons over a long period of time. Since, by the time symptoms appear, many changes in the brain have already occurred, many scientists are focusing on studying the risk and protective factors for dementia. </p>
<p>A risk factor, or conversely, a protective factor, is a condition or behaviour that increases or reduces the risk of developing a disease, but does not guarantee either outcome. Some risk factors for Alzheimer’s disease and dementia, such as age or genetics, are not modifiable, but there are several other factors we can influence, <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">specifically lifestyle habits and their impact on our overall health</a>.</p>
<p>These risk factors include depression, lack of physical activity, social isolation, high blood pressure, obesity, diabetes, excessive alcohol consumption and smoking, as well as poor sleep.</p>
<p>We have been focusing our research on the question of sleep for over 10 years, particularly in the context of the <a href="https://www.nhlbi.nih.gov/science/framingham-heart-study-fhs">Framingham Heart Study</a>. In this large community-based cohort study, ongoing since the 1940s, the health of surviving participants has been monitored to the present day. As researchers in sleep medicine and epidemiology, we have expertise in researching the role of sleep and sleep disorders in cognitive and psychiatric brain aging. </p>
<p>As part of our research, we monitored and analyzed the sleep of people aged 60 and over to see who did — or did not — develop dementia. </p>
<h2>Sleep as a risk or protective factor against dementia</h2>
<p>Sleep appears to play an essential role in a number of brain functions, such as memory. Good quality sleep <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2793873">could therefore play a vital role in preventing dementia</a>.</p>
<p>Sleep is important for maintaining <a href="https://www.science.org/doi/10.1126/science.1241224">good connections in the brain</a>. Recently, research has revealed that sleep seems to have a function similar to that of a garbage truck for the brain: <a href="https://doi.org/10.1016/j.mad.2023.111899">deep sleep could be crucial for eliminating metabolic waste from the brain</a>, including clearing certain proteins, such as those known to accumulate in the brains of people with Alzheimer’s disease. </p>
<p>However, the links between deep sleep and dementia still have to be clarified.</p>
<h2>What is deep sleep?</h2>
<p>During a night’s sleep, we go through several <a href="http://ceams-carsm.ca/en/a-propos-du-sommeil/">sleep stages</a> that succeed one another and are repeated. </p>
<p>NREM sleep (non-rapid eye movement sleep) is divided into light NREM sleep (NREM1 stage), NREM sleep (NREM2 stage) and deep NREM sleep, also called slow-wave sleep (NREM3 stage). The latter is associated with several restorative functions. Next, REM sleep (rapid eye movement sleep) is the stage generally associated with the most vivid dreams. An adult generally spends around 15 to 20 per cent of each night in deep sleep, if we add up all the periods of NREM3 sleep. </p>
<p>Several sleep changes are common in adults, such as going to bed and waking up earlier, sleeping for shorter periods of time and less deeply, and waking up more frequently during the night.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=279&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=279&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=279&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=350&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=350&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=350&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sleep stages, and the role of deep sleep for brain health.</span>
<span class="attribution"><span class="source">(Andrée-Ann Baril)</span></span>
</figcaption>
</figure>
<h2>Loss of deep sleep linked to dementia</h2>
<p>Participants in the <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2810957">Framingham Heart Study</a> were assessed using a sleep recording — known as polysomnography — on two occasions, approximately five years apart, in 1995-1998 and again in 2001-2003. </p>
<p>Many people showed a reduction in their deep slow-wave sleep over the years, as is to be expected with aging. Conversely, the amount of deep sleep in some people remained stable or even increased. </p>
<p>Our team of researchers from the Framingham Heart Study followed 346 participants aged 60 and over for a further 17 years to observe who developed dementia and who did not. </p>
<p>Progressive loss of deep sleep over time was associated with an increased risk of dementia, whatever the cause, and particularly Alzheimer’s type dementia. These results were independent of many other risk factors for dementia.</p>
<p>Although our results do not prove that loss of deep sleep causes dementia, they do suggest that it could be a risk factor in the elderly. Other aspects of sleep may also be important, such as its duration and quality. </p>
<h2>Strategies to improve deep sleep</h2>
<p>Knowing the impact of a lack of deep sleep on cognitive health, what strategies can be used to improve it? </p>
<p>First and foremost, if you’re experiencing sleep problems, it’s worth talking to your doctor. Many sleep disorders are underdiagnosed and treatable, particularly through behavioural (i.e. non-medicinal) approaches. </p>
<p>Adopting good sleep habits can help, such as going to bed and getting up at consistent times or avoiding bright or blue light in bed, like that of screens. </p>
<p>You can also avoid caffeine, limit your alcohol intake, maintain a healthy weight, be physically active during the day, and sleep in a comfortable, dark and quiet environment.</p>
<p>The role of deep sleep in preventing dementia remains to be explored and studied. Encouraging sleep with good lifestyle habits could have the potential to help us age in a healthier way.</p><img src="https://counter.theconversation.com/content/222854/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrée-Ann Baril received funding from the Sleep Research Society Foundation, the Alzheimer Society of Canada, the Canadian Institutes of Health Research, Banting Postdoctoral Fellowships, the Fondation de l'Hôpital du Sacré-Coeur de Montréal, the Université de Montréal and speaking fees from Eisai.</span></em></p><p class="fine-print"><em><span>Matthew Pase received funding from the National Health and Medical Research Council of Australia, National Institute on Aging, Dementia Australia, Alzheimer's Association, National Heart Foundation of Australia, Australian Research Council, Stroke Foundation, Brain Foundation, Alzheimer's Drug Discovery Foundation, Rebecca L Cooper Medical Research Foundation, and Bethlehem Griffiths Research Foundation.</span></em></p>Sleep appears to play an essential role in a number of brain functions, such as memory. So good quality sleep could play a vital role in preventing dementia.Andrée-Ann Baril, Professeure-chercheure adjointe au Département de médecine, Université de MontréalMatthew Pase, Associate Professor of Neurology and Epidemiology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2221942024-02-29T17:37:25Z2024-02-29T17:37:25ZBeing excluded or truant from school leads to mental health problems – and vice versa<figure><img src="https://images.theconversation.com/files/577410/original/file-20240222-19-dlxx0m.jpg?ixlib=rb-1.1.0&rect=7%2C3%2C2488%2C1837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/toned-photo-sad-teenager-sit-on-760921072">Sabphoto/Shutterstock</a></span></figcaption></figure><p>In the aftermath of the pandemic there has been a <a href="https://theconversation.com/school-absence-rates-have-rocketed-the-whole-educational-experience-needs-to-change-222187">substantial increase</a> in the number of students who are absent from school in the UK, and children are reporting <a href="https://www.theguardian.com/society/2023/aug/15/number-children-mental-health-crisis-record-high-england">higher levels</a> of mental ill health than ever before. </p>
<p>Research has previously shown that <a href="https://www.tandfonline.com/doi/full/10.1080/13632752.2014.945741">exclusion</a> (a child being removed from school) and <a href="https://acamh.onlinelibrary.wiley.com/doi/10.1111/camh.12322">truancy</a> are linked with poor mental health. </p>
<p>Now, I have <a href="https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/camh.12681">carried out research</a> with colleagues to examine whether mental health leads to exclusion and truancy, or whether exclusion and truancy are in fact contributing to poor mental health in children and adolescents. </p>
<p>We found that the connection goes both ways. Children who struggled with their mental health were more likely to later be excluded from school and to truant. And we also found evidence that exclusion and truancy could increase their mental health difficulties.</p>
<h2>A vicious cycle</h2>
<p>Missing out on school <a href="https://educationhub.blog.gov.uk/2023/09/28/what-are-ghost-children-and-why-is-school-attendance-important/">is detrimental</a> not only to children’s educational achievement but also to their wellbeing and overall development. These children miss out on important formative interactions with their peers and teachers. </p>
<p>Being excluded from school can have a long-term – even life-long – impact. Research suggests that children who have been excluded are <a href="https://www.ippr.org/articles/making-the-difference">more likely</a> to be unemployed and to go to prison, as well as to have mental health difficulties. </p>
<p>In <a href="https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/camh.12681">our study</a> we used nationally representative data from more than 15,000 children born in the UK <a href="https://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/">between 2000 and 2002</a>. The survey collected extensive information on participants during their childhood and teenage years, including information on behavioural problems, such as aggressive behaviour, and emotional problems involving symptoms of anxiety and depression. It also included information on children’s experience of school exclusion and truancy.</p>
<p>Our analyses revealed that mental health difficulties in primary school left children more vulnerable to exclusion and truancy later when entering secondary school. More specifically, increases in emotional problems heightened a child’s chances of being excluded in their early adolescent years, and their chances of being truant from school.</p>
<figure class="align-center ">
<img alt="Young school children in uniform walking away from camera" src="https://images.theconversation.com/files/577416/original/file-20240222-28-5dkfbe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577416/original/file-20240222-28-5dkfbe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577416/original/file-20240222-28-5dkfbe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577416/original/file-20240222-28-5dkfbe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577416/original/file-20240222-28-5dkfbe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577416/original/file-20240222-28-5dkfbe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577416/original/file-20240222-28-5dkfbe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mental ill-health in primary school is linked to exclusion later on.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-diverse-kindergarten-students-walking-together-659275150">Rawpixel.com/Shutterstock</a></span>
</figcaption>
</figure>
<p>Primary school children with worsening behavioural problems were also more at risk of being excluded when they reached secondary school. But, we found no evidence that behavioural problems increased children’s probability of truancy.</p>
<p>In our study, we also discovered that truancy and exclusion may in turn be exacerbating mental health problems. We showed that some of these detrimental effects differed according to the child’s gender. And while some affected mental health only in the short-term, others had a longer lasting impact.</p>
<p>For example, boys – but not girls – who had been excluded in secondary school went on to have higher levels of depression and anxiety, with effects lasting even into late adolescence after they had left school. Both boys and girls who had been excluded also went on to have worse behavioural problems in early adolescence but not later in adolescence. Truants went on to have greater long-term emotional problems, and short-term their conduct problems were also higher.</p>
<h2>Changing the pattern</h2>
<p>Our study very clearly demonstrates a cycle of disadvantage, where children who were struggling with their mental health went on to be truant or be excluded, but at the same time truancy and being excluded further exacerbated their problems, sometimes into late adolescence.</p>
<p>This new knowledge emphasises the need for prevention and intervention for child mental health problems. This could reduce the number of vulnerable children missing out on educational opportunities and also reduce further damage to their mental health. </p>
<p>School-based social and emotional learning programmes may have an <a href="https://srcd.onlinelibrary.wiley.com/doi/10.1111/cdev.12864">important role to play</a> as these have shown success in reducing both behavioural and emotional problems. <a href="https://committees.parliament.uk/publications/41590/documents/205047/default/">Sports-based programmes</a> may be another promising avenue for keeping children connected to school. More awareness of child mental health is also vital, even as young as primary school age. Many children may <a href="https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017">slip through the net</a>: they need better and early access to mental health services.</p>
<p>It is interesting that school exclusion was found to increase emotional symptoms in boys, but not in girls, in both early and late adolescence. These symptoms generally increase much more in girls during this <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0021-843X.112.2.179">developmental period</a>. Additional focus might be needed on finding alternatives to excluding boys from school.</p>
<p>It is particularly poignant that despite behavioural problems not leading to truancy, these types of problems increased following truancy. Children’s bond with their school seems key to reversing this trend. </p>
<p>Programmes that focus on transforming the school environment by developing student commitment to learning and creating a sense of belonging in the school, as these can <a href="https://bmjopen.bmj.com/content/10/5/e031589">reduce truancy</a>, could make a significant difference here. And later mental health problems may also be avoided.</p><img src="https://counter.theconversation.com/content/222194/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aase Villadsen receives funding from UK Economic and Social Research Council</span></em></p>Being excluded from school can have a life-long impact.Aase Villadsen, Senior Research Fellow, Institute of Education, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2235332024-02-29T13:38:58Z2024-02-29T13:38:58ZHow teens benefit from being able to read ‘disturbing’ books that some want to ban<figure><img src="https://images.theconversation.com/files/578696/original/file-20240228-24-s5xddp.jpg?ixlib=rb-1.1.0&rect=47%2C59%2C7892%2C5190&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young readers report becoming more thoughtful after reading stories that feature characters who face complex challenges.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/student-choosing-a-book-on-library-royalty-free-image/959761242?phrase=teens+books&adppopup=true">FG Trade via Getty Images</a></span></figcaption></figure><p>Should we worry, as <a href="https://pen.org/report/book-bans-pressure-to-censor/">massive book-banning efforts</a> imply, that young people will be harmed by certain kinds of books? For over a decade and through hundreds of interviews, my colleague, literacy professor <a href="https://www.albany.edu/education/faculty/peter-johnston">Peter Johnston</a>, and I have <a href="https://www.tcpress.com/teens-choosing-to-read-9780807768686">studied</a> how adolescents experience reading when they have unfettered access to young adult literature. Our findings suggest that many are helped rather than harmed by such reading.</p>
<p>For one study, we spent a year in a public middle school in a small, mid-Atlantic town, observing and talking to eighth grade students whose teachers, rather than assigning the “classics” or traditional academic texts, <a href="https://doi.org/10.1002/rrq.46">let students choose what to read</a> and gave them time to read daily in class. To support student engagement, they made available hundreds of contemporary books that are relevant to the students’ lives. The books included many of the <a href="https://docs.google.com/spreadsheets/d/1a6v7R7pidO7TIwRZTIh9T6c0--QNNVufcUUrDcz2GJM/edit#gid=9827573720">titles currently being challenged</a>, according to PEN America, which is a nonprofit that advocates against censorship, among other things. The titles include Ellen Hopkins’ “<a href="https://www.simonandschuster.net/books/Identical/Ellen-Hopkins/9781416950066">Identical</a>,” Jay Asher’s “<a href="https://penguinrandomhousehighereducation.com/book/?isbn=9780451478290">Thirteen Reasons Why</a>,” Patricia McCormick’s “<a href="https://www.encyclopedia.com/arts/educational-magazines/sold">Sold</a>,” and others that were banned because of themes of sex and violence.</p>
<p>We were interested in what the students perceived to be the consequences of reading young adult literature. They tended to read books they described <a href="https://doi.org/10.1080/09500782.2024.2317944">as “disturbing</a>.” At the end of the school year, we interviewed 71 of the students about changes in their reading and relationships with peers and family. </p>
<p>We also asked open-ended questions about how, if at all, they had changed as people since the beginning of the year. Beyond reading substantially more than they had previously, they reported positive changes in their social, emotional and intellectual lives that they attributed to reading, the kinds of books they read and the conversations those books provoked.</p>
<p>Here are six ways students told us they had been changed by reading and talking about edgy young adult books. </p>
<h2>1. They became more empathetic</h2>
<p>The students chose mostly fiction, with characters whose life circumstances in many cases differed from their own, including those associated with race, gender, sexuality, culture, language, mental health and household income. Because fiction <a href="https://doi.org/10.1016/j.tics.2016.06.002">provides windows into the minds of others</a>, it has the <a href="https://www.science.org/doi/10.1126/science.1239918">potential to improve empathy</a>, which becomes <a href="https://doi.org/10.1371/journal.pone.0055341">more probable when readers get emotionally involved in stories</a>.</p>
<p>This is consistent with what the students reported. As one student explained after reading a book about a bullied character, “Like when you see people … you think, well, they don’t have problems or whatever, but then some of the ones I’ve read, you can just understand people better.”</p>
<h2>2. They improved relationships</h2>
<p>The books contained stark realities about humanity. For instance, some books dealt with how children and teens might be exploited by adults or how mental illness might radically affect a person’s behavior.</p>
<p>Students shared that as they read, they were encountering some of this information for the first time. Their initial instinct, they said, was to find someone else who had read the book and talk about it. </p>
<p>Consequently, students who rarely talked to each other came together over books. In the process, they learned about each other, became friends or at least developed greater appreciation for each other. They also talked to family members, including parents, some of whom they convinced to read the books. </p>
<p>Relationships in books made teens rethink their own relationships. “Her mom was all rude to her,” one student recalled about a character. “It kind of had me feeling bad, ‘cause I was rude to my aunt, and my situation could have been worse.” </p>
<p>Students shared that reading about characters in dire circumstances changed how they thought about their own families. For instance, several admitted that reading a book about a girl their age who was abducted and abused by an adult male made them more likely to listen to their parents’ advice about safety. Others reading that same book reported becoming more protective of siblings.</p>
<h2>3. They became more thoughtful</h2>
<p>Reading about the decisions characters made gave the teens a chance to see the potential consequences of their own future choices.</p>
<p>Some described positive characters as role models. Others described using characters who made questionable decisions as cautionary tales and tools of self-reflection. </p>
<p>Statements such as one student’s comment that “I have changed because I think more about things before I do them” were common and were related to problems teens were already facing or could see on the horizon. These problems included toxic relationships, substance abuse, gang-related activity and risky sexual behaviors. </p>
<h2>4. They were happier</h2>
<p>Despite the fact that many students chose books with serious and unsettling content, students claimed reading made them feel better.</p>
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<img alt="A girl lies on her back on a bench reading a book that she is holding." src="https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578709/original/file-20240228-26-6snxit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Teens say reading books can boost their mood.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenage-girl-reading-book-outdoors-royalty-free-image/1223187399?phrase=teens+books&adppopup=true">Westend61 via Getty Images</a></span>
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<p>Some explicitly attested to the pleasure of reading. “It’s the happiest I’ll get,” one student stated about the time she spent with the books.</p>
<p>More frequently, students described how mental trips through books helped them reconsider their own worries compared with characters with much harder lives.</p>
<p>“You do get an appreciation for what you do have, and, like, for being thankful for the happiness and joy in your life,” one explained. “Some of those books, it’s crazy what’s in there.”</p>
<h2>5. Books helped students heal</h2>
<p>Some students reported that books helped them heal from depression and grief.</p>
<p>“When I was younger, I lost my best friend,” one student shared after reading about a character whose mother died. “It was really hard for me, but books like that really take me back and help me remember her but without getting really upset.” </p>
<p>Many pointed to good feelings they got from meaningful book conversations with peers. That is not surprising given the link between <a href="https://doi.org/10.1007/s10902-007-9083-0">positive social relationships and young people’s happiness</a>.</p>
<h2>6. They became better readers</h2>
<p>Some of the books were difficult for students to read, but they persisted even though they had to work harder to understand them. Other research has found that this persistence is <a href="https://doi.org/10.1080/00220973.2010.481503">related to the interest</a> that students had in the subjects of the books.</p>
<p>Students reported rereading large chunks of books or even entire books to clear up confusion about storylines, and asking teachers and peers for help with problems such as unfamiliar vocabulary. Their scores on <a href="https://doi.org/10.1002/rrq.46">end-of-year reading tests improved</a>, whereas scores for other students remained flat. That is not surprising, since the students in our study <a href="https://doi.org/10.1002/rrq.404">read so much</a>. Also, they read mainly fiction, <a href="https://doi.org/10.1002/berj.3498">which is correlated with better reading skills</a> compared with other genres.</p>
<p>Students said they started visiting public libraries and bookstores. Declarations like “I’m a bookworm now” suggested they began viewing themselves as readers. They also reported larger changes. “I think I got smarter,” one student remarked. </p>
<p>The positive transformations reported by students we interviewed cannot be generalized, but experimentally controlled studies yield related findings. For instance, <a href="https://doi.org/10.1016/j.learninstruc.2019.101216">adolescents who read and talk to each other</a> about stories with social themes report greater motivation to read, greater use of reading strategies, such as rereading what they don’t understand, and insight into human nature than those who do not.</p>
<p>Our research left us reflecting on why we want young people to read in the first place. Do we want them to reap the social, emotional, moral and academic benefits that reading confers? If so, preserving their access to relevant books – even the “disturbing” ones – matters a lot.</p><img src="https://counter.theconversation.com/content/223533/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gay Ivey does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Amid calls to ban certain books from libraries and schools, research shows that students benefit when they have the ability to choose which materials they want to read.Gay Ivey, Professor of Literacy, University of North Carolina – GreensboroLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2238952024-02-28T13:12:00Z2024-02-28T13:12:00ZSleep and circadian rhythm problems linked with poor mental health – new research<figure><img src="https://images.theconversation.com/files/577905/original/file-20240226-17-7n74le.jpg?ixlib=rb-1.1.0&rect=48%2C8%2C5435%2C3604&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The more severe sleep and circadian disruptions are, the worse a person's mood may be.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-cant-sleep-night-because-her-172728239">Ground Picture/ Shutterstock</a></span></figcaption></figure><p>Every cell in the body has a circadian rhythm. This rhythm follows a near 24-hour cycle that is synchronised to day and night. These <a href="https://www.ncbi.nlm.nih.gov/books/NBK519507/#:%7E:text=The%20regulation%20of%20sleep%20is,light%20changes%20in%20our%20environment">circadian rhythms</a> are critical for health and wellbeing.</p>
<p>But our circadian rhythm can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142605/">become disrupted</a> when our lifestyle does not correspond with this natural day-and-night cycle – for example, if we work night shifts or experience jet lag. Factors such as ageing, genetics and certain medical conditions (such as <a href="https://pubmed.ncbi.nlm.nih.gov/37565922/">autoimmune diseases</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338075/">Alzheimer’s disease</a>) are also linked with long-term circadian rhythm disruptions.</p>
<p>Sleep and circadian rhythm disturbances can also predict the onset and relapse of certain <a href="https://cms.wellcome.org/sites/default/files/2022-07/MH-Sleep-Report-Wellcome-07.2022.pdf">mental health disorders</a> – including depression, anxiety, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505194/">bipolar disorder and schizophrenia</a>. The more severe the sleep and circadian disruptions are, the worse a person’s mood, risk of relapse and mental health treatment outcomes are.</p>
<p>But despite evidence showing this link, why it exists remains largely unknown. This is what research conducted by myself and my colleagues sought to understand.</p>
<p>We found that sleep and circadian rhythm disruptions appear to <a href="https://www.pnas.org/doi/10.1073/pnas.2214756121">trigger or worsen a range of mental disorders</a> – including bipolar disorder and depression. We also uncovered some of the specific biological mechanisms which may underpin this link.</p>
<p>Our review assessed all research published in the past ten years on different mental disorders – including depression, anxiety and psychosis. We mainly focused on adolescents and young adults. </p>
<p>We found that the majority of young people diagnosed with a mental health condition also had sleep problems – such as insomnia (trouble falling asleep and staying asleep), delayed sleep timing and worsened daytime alertness. We also found that one-third of people with bipolar disorder (and other mental disorders) had a disrupted circadian rhythm, where they go to sleep and wake up later than usual.</p>
<p>Our study also pinpointed some of the mechanisms that may explain the link between sleep problems and mental health disorders. Among these mechanisms are an increased vulnerability at the genetic or molecular level to circadian rhythm disruption. </p>
<p>We also found that some participants experienced changes in their brain activity caused by chemical signalling problems that can affect sleep and mood levels. Inappropriate light exposure (such as getting too little natural daylight or too much artificial light at night) and eating too late in the evening or at night may also trigger sleep and circadian rhythm problems. </p>
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<img alt="A young man uses his laptop at night while sitting on his bed." src="https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577906/original/file-20240226-20-bm4d01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Getting too much artificial light at night may be one of the mechanisms behind circadian rhythm disruption.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-teen-front-laptop-computer-on-226752055">junpinzon/ Shutterstock</a></span>
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<p>Importantly, we showed that most studies to date have only looked at the effect of sleep on mood or the effects of circadian disruption on mood separately. Both were rarely studied in conjunction, as assessing sleep is far more common (and easier) than assessing circadian rhythms. This is one of the current key research limitations that needs to be addressed in future studies. </p>
<h2>Circadian misalignment</h2>
<p><a href="https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health">One in seven</a> ten to 19-year-olds experience a mental disorder worldwide. <a href="https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health">Depression and anxiety</a> are among the leading causes of illness and disability among adolescents, with suicide being the fourth leading cause of death among 15 to 29-year-olds. Moreover, not addressing adolescent mental disorders can cause these problems to extend into adulthood.</p>
<p>Adolescence is not only a particularly vulnerable time for developing mental disorders – it’s also a time when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10136689/#:%7E:text=Indeed%2C%20insomnia%20during%20adolescence%20is,particular%20life%20period%20%5B17%5D">sleep and circadian rhythms change</a>. Adolescents often sleep later, due to a delay in their circadian rhythm caused by their development, but have to wake up early due to school. As a consequence, they often experience shorter sleep than needed, which can further <a href="https://www.nature.com/articles/s44159-022-00074-8#:%7E:text=A%20meta%2Danalytic%20review%20of,depression%2C%20negative%20affect%20and%20anxiety">worsen their mental health</a>.</p>
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<a href="https://theconversation.com/investigating-insomnia-our-research-shows-how-chronic-sleep-problems-can-lead-to-a-spiralling-decline-in-mental-health-224131">Investigating insomnia: our research shows how chronic sleep problems can lead to a spiralling decline in mental health</a>
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<p>Our review highlights how important it is to pay attention to circadian rhythm disruptions in young people – especially when it comes to risk of certain mental health problems. Our review also highlights the need to consider sleep and circadian problems when someone experiences mental health problems. By addressing such problems, it may be possible to improve one’s mental health and quality of life.</p>
<h2>Sleep and circadian interventions</h2>
<p>At the moment, treatments for sleep problems (such as insomnia) involve <a href="https://academic.oup.com/sleep/article/43/9/zsaa034/5777024">cognitive behavioural therapy</a> and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00683-9/fulltext">sleep restriction</a>. These focus on improving sleep – while mental health problems due to circadian rhythm disruption are not directly addressed.</p>
<p>Our review highlighted treatments that may help improve mood and sleep quality and align circadian rhythms. This included timing medication intake, exposure to natural daylight (and reducing nighttime light) as well as eating and being physically active during the day. More research will be needed, however, to better understand the benefits of these treatments in real-world settings.</p><img src="https://counter.theconversation.com/content/223895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Chellappa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Depression, bipolar disorder and anxiety have all been linked to problems with sleep and a disrupted circadian rhythm.Sarah Chellappa, Associate Professor, Cognitive and Affective Neuroscience, University of SouthamptonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2238242024-02-26T20:01:36Z2024-02-26T20:01:36ZPink Shirt Day must become a call to meaningful action against bullying<figure><img src="https://images.theconversation.com/files/577459/original/file-20240222-20-4iqxbx.jpg?ixlib=rb-1.1.0&rect=0%2C44%2C5000%2C3270&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The calls to action haven’t resulted in much change. We need to do better. The stakes are enormous.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As the last few days of February draw near, we will soon be called to think about bullying on <a href="https://www.pinkshirtday.ca/">Pink Shirt Day</a> on the last Wednesday of the month. Pink Shirt Day was started by Grade 12 Nova Scotia students David Shepherd and Travis Price who wanted to show their solidarity for a victim of bullying who was targeted, in part, for wearing a pink shirt.</p>
<p>This initial show of solidarity has been a recognized day of action in Canada since 2007, and was adopted in New Zealand in 2009.</p>
<p>This means that we’ve had over 15 Pink Shirt Days. What have they done beyond raising awareness? Sadly, the answer is not much. Research shows that <a href="https://www.canada.ca/en/public-health/services/publications/science-research-data/youth-findings-health-behaviour-school-aged-children-study.html#ch10">the number of youth who report being a victim of bullying hasn’t changed at all</a>. The calls to action haven’t resulted in much change. We need to do better. The stakes are enormous.</p>
<h2>Impacts of bullying</h2>
<p>First the bad news: Bullying is <a href="https://doi.org/10.1007/s12144-023-05083-1">notoriously difficult to prevent or reduce</a>. Bullying is too often viewed as a rite of passage — the ability to overcome harassment and bad peer interactions. And it’s true that <a href="https://www.tandfonline.com/doi/abs/10.1080/016502598384388">some stress is helpful in forging stronger social and emotional skills</a>. </p>
<p>The same thing is true for bones that benefit from stressful exercise. But too much stress causes a bone to break, leaving behind a permanent weakness. The same is true for too much social and emotional stress. </p>
<p>Children are suffering decades-long negative <a href="https://doi.org/10.1073/pnas.1323641111">physical</a> and <a href="https://doi.org/10.1002/da.22270">mental health</a> outcomes because of stress caused by bullying. It changes the way the body reads its own <a href="https://doi.org/10.1016/j.bbi.2017.08.025">DNA in response</a> to stress <a href="https://doi.org/10.1017/S0033291715000653">well into one’s 50s</a>. </p>
<p>These effects are actually worse for children in <a href="https://doi.org/10.1017/S0954579423001384">classes that otherwise have low levels of bullying</a>. Those lone victims heartbreakingly feel even more isolated and to blame for their sole victimization. And for some, it can tragically result in <a href="https://www.amandatoddlegacy.org/">taking their own lives</a>. </p>
<h2>Why people bully</h2>
<p>Bullying, appears to be, at least in part, <a href="https://doi.org/10.1007/s10648-022-09703-3">an evolutionary adaptation</a> that can offer its users important benefits. <a href="https://doi.org/10.1002/ab.21418">First up</a> are material benefits like the best spot on the playground, lunch money or a coveted scholarship. Even more appealing are the strong, consistent, <a href="https://doi.org/10.1007/s10802-013-9759-3">longitudinal</a> and <a href="https://doi.org/10.1177/0165025416679743">cross-cultural ties</a> between bullying and popularity. Bullying leads to gains in popularity and, sadly, <a href="https://doi.org/10.1080/15388220.2020.1850462https://doi.org/10.1080/15388220.2020.1850462">popularity tends to lead to bullying</a>. </p>
<p>Perhaps most salient of all, for both boys and girls, and both younger and older adolescents, bullying is associated with <a href="https://doi.org/10.1177/1474704915613909">increased dating and sexual opportunities</a>. Material benefits, popularity and sex are difficult motives to fight against. It gets even harder when we recognize that bullies are <a href="https://doi.org/10.1007/s10648-022-09703-3">not socially unintelligent, they do not have lower self-esteem and they may not even lack emotional empathy</a>. </p>
<p>They are often simply <a href="https://doi.org/10.1007/s12144-019-00182-4">individuals who willingly choose to use power for their own benefit and to the detriment of others</a>. And unfortunately, they get plenty of examples from adults about how bullying can <a href="https://www.thestar.com/opinion/contributors/vladimir-putin-is-a-classic-schoolyard-bully-who-must-be-stopped-not-appeased/article_4a333027-003d-5b2e-b070-199dbbc9ce06.html">get you what you want with few consequences</a> so long as you’re powerful, rich or famous.</p>
<p>So if bullying is really so awful why has Pink Shirt Day not led to meaningful change?</p>
<h2>Tackling bullying</h2>
<p>Bullying is a facultative adaptation — that means it depends on the costs and benefits an environment affords. So even if it has a biological basis, its expression depends on the environmental context. And we know that <a href="https://doi.org/10.1007/s00038-009-5413-9">different cultures</a>, <a href="https://doi.org/10.1007/s10802-014-9949-7">different classrooms</a> and <a href="https://doi.org/10.1080/17405629.2021.1926231">different peers</a> can all change the equation of bullying so that its costs start to outweigh its benefits. </p>
<p>Critically, while data indicates bullies gain popularity and dominance, <a href="https://doi.org/10.1016/j.dr.2023.101073">the same data shows that they lose out on being liked</a> and on being sought out as a friend. People respect and fear a bully’s ability to violently wield power, but they don’t like it. </p>
<p><a href="https://doi.org/10.1177/082957359801300205">While bullying is hard to catch and harder to punish</a>, we can look at changing the carrot instead of the stick. If <a href="https://doi.org/10.1177/0165025411407457">peers stop rewarding bullies</a>, and if adults create environments that <a href="https://doi.org/10.1111/jora.12243">foster prosocial co-operation rather than selfish competition</a>, we can make bullying less appealing.</p>
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<a href="https://theconversation.com/bullying-wont-be-curbed-until-we-figure-out-what-fuels-it-128031">Bullying won't be curbed until we figure out what fuels it</a>
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<p>Doing so is hard. It requires real work from youth, teachers, schools, parents, governments and the general public. We can’t expect youth to stop rewarding bullying if we continue to reward bullies as adults. We can’t expect youth to <a href="https://doi.org/10.1016/j.appdev.2013.10.004">stand up to the most popular kids on their own</a>. </p>
<p>We need to find the right ways to encourage the positive uses of power. Bullying may be an evolutionary adaptation, but it’s not genetically determined, so we should not accept it as an inevitable rite of passage. </p>
<p>This Pink Shirt Day, do more than just think about bullying. Think about how you can get involved and make a positive difference. Talk to your children, talk to their schools, talk to teachers that you know, stand up to bullies in your workplace. Pink Shirt Day started as a gesture of solidarity, as a means of taking back some of the power from bullies. </p>
<p>If we can view Pink Shirt Day as a call to action, instead of just another reminder, we can start changing things so that bullying becomes associated with another evolutionary term — extinction.</p><img src="https://counter.theconversation.com/content/223824/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tony Volk does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Canada has marked Pink Shirt Day since 2007, but meaningful progress in tackling bullying requires solidarity from youth, teachers, schools, parents, governments and the general public.Tony Volk, Professor, Child and Youth Studies, Brock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2236882024-02-22T17:26:30Z2024-02-22T17:26:30ZHow to choose a trustworthy mental health app in a market bloated with options<figure><img src="https://images.theconversation.com/files/576000/original/file-20240215-28-7gauhc.jpg?ixlib=rb-1.1.0&rect=17%2C52%2C5766%2C3564&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mental-health-application-concept-close-smartphone-1962853882">myboys.me/Shutterstock</a></span></figcaption></figure><p>I like to start my day with a bowl of cereal. It’s quick, light and, if I make the right choice, good for me. I also have the freedom to make a less healthy choice – but when I go to the supermarket and look over the array of options in front of me, I need only look at the back of the box to understand what I’ll be eating and, most importantly, whether the ingredients are nutritious.</p>
<p>Today’s <a href="https://www2.deloitte.com/xe/en/insights/industry/technology/technology-media-and-telecom-predictions/2022/mental-health-app-market.html">vast market in mental health apps</a> feels similar to choosing cereal. With the <a href="https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2022/10/10/hidden-waits-force-more-than-three-quarters-of-mental-health-patients-to-seek-help-from-emergency-services">waiting lists for NHS mental health services</a> being months long, apps appear to have the potential to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533203/">ease pressure and are relatively cheap</a>. Their accessibility and light-touch approach suggests that people in need of support will be able to manage their own mental health.</p>
<p>But increasingly, we’re seeing <a href="https://www.wsj.com/articles/the-failed-promise-of-online-mental-health-treatment-11671390353">reports that</a>, for all their promise, <a href="https://www.psychologytoday.com/gb/blog/digital-well-being/202206/the-promise-and-perils-mental-health-apps">mental health apps might not be all</a> they’re made out to be. With questions being asked about <a href="https://www.theguardian.com/society/2024/feb/04/they-thought-they-were-doing-good-but-it-made-people-worse-why-mental-health-apps-are-under-scrutiny">the need for regulation</a>, is it possible that these apps are <a href="https://www.telegraph.co.uk/news/2024/01/15/online-therapy-dangerous-mental-health/">doing more harm than good</a>?</p>
<p>The frustrating answer is: we don’t yet have enough information to say one way or another.</p>
<h2>Unlikely to cause damage, but may not support wellbeing</h2>
<p>It’s unlikely that most apps are actively damaging people’s mental health, although some encourage behaviour that is unlikely to support wellbeing. </p>
<p>To get around the problem of responsibility, <a href="https://www.psychologytoday.com/gb/blog/artificial-intelligence-and-mental-health/202402/wellness-is-not-healthcare">many apps categorise themselves as wellness</a> rather than therapy. They cannot offer advice that needs to be regulated, but they can point to services that might offer more help. This approach also reduces their responsibility for monitoring problems such as someone <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921471/">reporting they are going to self-harm</a>. </p>
<p>Apps are also different from face-to-face therapy as they are generally designed to be used in short, ten-minute bursts that are accessible as and when they’re needed. </p>
<p>There’s certainly a lot of choice. App stores are bloated with options offering different levels and types of support. Unfortunately, hardly any offer extensive evidence of their effectiveness – in terms of controlled trials and in-depth analysis rather than user reviews – and even if they did, the app store would not tell you that before you downloaded.</p>
<p>This leaves potential users in a situation where they don’t know what they’re getting, and it could be stopping them from accessing actual evidence-based care. </p>
<p><a href="https://www.rsph.org.uk/static/uploaded/b215d040-2753-410e-a39eb30ad3c8b708.pdf">Effective interventions</a> should always be based on evidence, but they also require the user to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8726056/">engage with them over a period of time</a>. While they are easy to download, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074985/">apps are also easy to ignore</a>. There are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929738/">numerous examples of trials</a> using app-based interventions in which participants download but never actually open the app, or which have a very steep drop-off in engagement after a few sessions.</p>
<p>It’s clear to me that these apps are more than a passing fad. When the National Institute for Care and Excellence (Nice) made the decision to <a href="https://www.nice.org.uk/news/article/eight-digitally-enabled-therapies-to-treat-depression-and-anxiety-in-adults-conditionally-recommended-by-nice">approve eight online interventions</a> in March 2023, I (cautiously) welcomed the idea. <a href="https://www.nhsconfed.org/publications/maximising-potential-digital-mental-health">Digital therapies have the potential</a> to offer additional support for people in need and provide a welcome bridge between sessions of therapy.</p>
<p>Importantly, these eight apps will be scientifically assessed for how and where apps can be effective in the real world, laying the foundations for the rest of the market to follow.</p>
<h2>Four principles for mental health apps</h2>
<p>More than anything, people need to know what they are getting, and we need to see greater transparency from providers. This is likely to increase their market share, so it really is in their interests. </p>
<p>In 2019, <a href="https://faculty.sites.uci.edu/schuellerlab/stephen-schueller-phd/">Stephen Schueller</a> and I <a href="https://pubmed.ncbi.nlm.nih.gov/31045497/">set out four principles</a> that all mental health apps should work towards, in order to provide the most transparent possible offering to their users. What personal information is collected, and how is it used? Were target users involved in the design of the app? How much should you use it, and is it safe? Are there measurable benefits to using the app?</p>
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<p>My view in 2019 was that formal regulation wasn’t necessarily needed. Anyone making false claims on an app can be reported to advertising standards authorities, and anyone providing actual therapy already operates within a regulated market – although it’s always worth reminding those seeking therapy to do their due diligence and find the therapist that is right for them. </p>
<p>My view about regulation hasn’t changed, but this isn’t to say that no changes are needed. While set up as libertarian havens, app stores such as Google Play and Apple’s App Store need to adopt some rules for the way that health apps are marketed. </p>
<p>By tightening up what’s considered a “health” app and setting out clear rules like those I’ve listed, mental health app consumers should have greater confidence that the app they’re downloading has the power to help them. Essentially, consumers need to be able to choose their mental health apps as easily as I can make a choice about my cereal.</p><img src="https://counter.theconversation.com/content/223688/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:til.wykes@kcl.ac.uk">til.wykes@kcl.ac.uk</a> has received government research grants to investigate the benefit of digital therapies</span></em></p>Have mental health apps lived up to their promise to offer tailored support in a challenging public health context? The answer is mixed.Til Wykes, Professor of Clinical Psychology and Rehabilitation at the Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2196132024-02-18T22:46:53Z2024-02-18T22:46:53ZNZ is bound by international mental health agreements – statistics for Māori show we’re failing to uphold them<p>Aotearoa New Zealand ranks among the highest in youth suicide rates among <a href="https://www.oecd.org/els/family/CO_4_4_Teenage-Suicide.pdf">OECD countries</a> – and it is Māori youth at the <a href="https://theconversation.com/maori-suicide-rates-remain-too-high-involving-whanau-more-in-coronial-inquiries-should-be-a-priority-217254">forefront of this national crisis</a>. </p>
<p><a href="https://www.tewhatuora.govt.nz/our-health-system/data-and-statistics/suicide-web-tool">Recent statistics</a> show the number of suspected self-inflicted deaths for Māori males is nearly double the rate for non-Māori males. The rate for Māori females is around 1.8 times higher than the rate for non-Māori females. </p>
<p>The alarming discrepancy is most notable in the 15-24 age group, where the rate for Māori is about 2.6 times higher than for non-Māori.</p>
<p>Despite these concerning figures, there is no express right to health in New Zealand law, creating a gap in accountability. And by failing to ensure the health and wellbeing of young Māori, Aotearoa New Zealand is falling short of its international obligations.</p>
<h2>Progress and retreat</h2>
<p>Over the past five years, the government has taken some steps to tackle the country’s mental health crisis. But the priorities of the new government could threaten this already limited progress.</p>
<p>In 2019, NZ$2 billion was <a href="https://www.beehive.govt.nz/release/taking-mental-health-seriously">injected into the mental health system</a> by the then Labour government. And the <a href="https://www.mhwc.govt.nz/">Mental Health Commission</a> was established in 2021 with the aim of contributing to better and equitable mental health and wellbeing outcomes for all people. </p>
<p>Te Aka Whai Ora, the Māori Health Authority, was established under the <a href="https://www.legislation.govt.nz/act/public/2022/0030/latest/LMS575405.html">Pae Ora (Healthy Futures) Act 2022</a>. But while the new coalition government has announced the country’s first ever <a href="https://www.beehive.govt.nz/minister/biography/matt-doocey">minister for mental health</a>, it has also announced plans to <a href="https://www.rnz.co.nz/news/political/507330/reti-confirms-transfer-of-decision-making-to-regions-is-among-health-priorities">scrap the authority</a>.</p>
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Read more:
<a href="https://theconversation.com/have-you-been-feeling-your-spirit-was-sad-culture-is-key-when-assessing-indigenous-australians-mental-health-119463">'Have you been feeling your spirit was sad?' Culture is key when assessing Indigenous Australians' mental health</a>
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<p>The <a href="https://www.platform.org.nz/assets/WorkDetail/Cross-Party-Report-Under-One-Umbrella-MHAC-Web-Accessible-FINALv.pdf">Under One Umbrella</a> report, published by the cross-party <a href="https://www.mhwc.govt.nz/news-and-resources/priority-on-youth-mental-health-strikes-a-chord/">Mental Health and Addiction Wellbeing Group</a>, presents a comprehensive, integrated approach to mental health, alcohol and addiction for young people. Significantly, it advocates for a holistic “all-of-government” approach. </p>
<p>Submissions from a <a href="https://www.health.govt.nz/our-work/mental-health-and-addiction/mental-health-legislation/repealing-and-replacing-mental-health-act">recent review</a> of the Mental Health Act show strong support for the new legislation to uphold rights in alignment with international conventions, with more focus on tangata whaiora (someone seeking health) and whānau (extended family). </p>
<p>Although these initiatives and pending legislative reform represent a step in the right direction, the statistics related to <a href="https://www.unicef.org.nz/media-releases/poor-mental-health-in-children-and-young-people-cannot-be-ignored-unicef">youth mental health</a> are still cause for concern. </p>
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<h2>International responsibilities to ensure health</h2>
<p>One strategy to address the national mental health crisis for Māori youth would be to embed the human right to health in local policy and law. This would also bring Aotearoa New Zealand’s legislation into line with its international obligations. </p>
<p>In 1946, the <a href="https://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1">World Health Organization</a> adopted a broad definition of health:</p>
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<p>Health is a state of complete physical, mental, cultural and social wellbeing and not merely the absence of disease or infirmity. </p>
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<p>Over the course of the next two decades, health was conceived as a human right (in the <a href="https://www.un.org/en/about-us/universal-declaration-of-human-rights">Universal Declaration of Human Rights</a> and later in the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-economic-social-and-cultural-rights">International Covenant on Economic Social and Cultural Rights</a>). </p>
<p>The <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/international-convention-elimination-all-forms-racial">International Convention on the Elimination of Racial Discrimination</a> also obliged countries to eliminate race discrimination in public health and medical care. </p>
<p>For children, the right to health is further recognised in the <a href="https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child">Convention on the Rights of the Child 1989</a>. And, specifically for Indigenous communities, in the <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">United Nations Declaration on the Rights of Indigenous Peoples 2007</a>. </p>
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<a href="https://theconversation.com/equity-in-health-care-improves-peoples-health-114910">Equity in health care improves people's health</a>
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<p>It is well established within <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">international law</a> that the right to health for Indigenous children and youth is linked to their distinct cultural, social and customary practices. </p>
<p>And various UN groups have <a href="https://www.ohchr.org/en/resources/educators/human-rights-education-training/e-general-comment-no-14-right-highest-attainable-standard-health-article-12-2000">repeatedly</a> <a href="https://documents-dds-ny.un.org/doc/UNDOC/GEN/G16/177/09/PDF/G1617709.pdf?OpenElement">emphasised</a> that Indigenous people have the right to receive culturally appropriate healthcare services that respect their traditional practices and medicines. </p>
<p>These groups have also urged countries to provide Indigenous communities with the necessary resources to design, deliver and control their own healthcare services. </p>
<h2>The need for a legal framework</h2>
<p><a href="https://www.justice.govt.nz/justice-sector-policy/constitutional-issues-and-human-rights/human-rights/international-human-rights/">Aotearoa New Zealand is bound</a> by these international agreements, and the rights and obligations that flow from them. Yet the right to health <a href="https://tikatangata.org.nz/human-rights-in-aotearoa/right-to-health">does not appear in our laws</a>, which leaves a void in accountability and enforcement. </p>
<p>This hinders the implementation of effective health policies for tamariki and rangatahi Māori (children and young people), particularly as it limits the legal avenues available for recourse when the system fails. </p>
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Read more:
<a href="https://theconversation.com/its-despair-not-depression-thats-responsible-for-indigenous-suicide-108497">It's despair, not depression, that's responsible for Indigenous suicide</a>
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<p>The disparities in mental health outcomes point to an immediate national challenge facing Aotearoa New Zealand, which is to formulate an effective mental healthcare framework. </p>
<p>The most appropriate starting point is to include the right to health in national policy and legislation. This would align New Zealand’s national policies and laws with international norms. </p>
<p>It would also mandate the government to take active steps to ensure that the highest attainable standards of mental health and wellbeing for tamariki and rangtahi Māori are met.</p><img src="https://counter.theconversation.com/content/219613/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is no express right to health in New Zealand law. But international agreements protecting Indigenous rights to health and wellbeing set the standard New Zealand should follow.Claire Breen, Professor of Law, University of WaikatoRobert Joseph, Associate Professor of Law, University of WaikatoThilini Karunaratne, PhD candidate/ Lawyer, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190872024-02-16T13:18:51Z2024-02-16T13:18:51ZA Bronx school district offers lessons in boosting student mental health<figure><img src="https://images.theconversation.com/files/575680/original/file-20240214-30-zch8fe.jpg?ixlib=rb-1.1.0&rect=25%2C42%2C5640%2C3745&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Building a sense of community is critical for students to thrive.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/happy-female-teacher-talking-with-junior-high-royalty-free-image/1439953744?phrase=students+speaking&adppopup=true">Maskot / Getty Images</a></span></figcaption></figure><p>If you are an educator or a parent, you have likely already seen many ways in which “<a href="https://www.psychologytoday.com/us/blog/stressful-lives/202302/the-kids-are-not-alright">the kids are not alright</a>.” </p>
<p><a href="https://doi.org/10.1177/23328584221084722">Mounting evidence</a> shows that the mental health of American youth has been declining for at least a decade. During the pandemic, it took an even sharper downturn. The Centers for Disease Control and Prevention reports that in 2021 – the most recent data available – 42% of high school students experienced persistent feelings of sadness or hopelessness and <a href="https://www.cdc.gov/healthyyouth/data/yrbs/yrbs_data_summary_and_trends.htm">22% seriously considered suicide</a>. This is a significant increase from 10 years earlier, when 28% of students reported persistent feelings of sadness or loneliness and 16% considered attempting suicide.</p>
<p>The isolation of pandemic stay-at-home orders and the trauma of losing loved ones <a href="https://www.aft.org/press-release/educators-say-covid-19-has-greatly-exacerbated-grief-support-crisis-schools">contributed to declines in well-being</a>. Schools have an important role to play in addressing this crisis.</p>
<p>As <a href="https://scholar.google.com/citations?user=gUZyPcUAAAAJ&hl=en">researchers in education</a>, my co-author, <a href="https://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Javaid+E.+Siddiqi%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en">Javaid Siddiqi</a> and I interviewed educators working in <a href="https://link.springer.com/book/10.1007/978-3-031-43237-8#toc">school districts that faced extreme adversity</a> during the pandemic but <a href="https://doi.org/10.1007/978-3-031-43237-8">still found success in supporting their students</a>.</p>
<p>One district in particular stood out for the challenges it faced. At the time of our study in 2020, Bronx Community School District 7 in New York City was not just in the <a href="https://www.cityandstateny.com/politics/2019/12/ny-has-the-richest-poorest-smallest-most-unequal-congressional-districts/176658/">poorest congressional district in the nation</a>, but it also experienced one of the <a href="https://covid.cdc.gov/covid-data-tracker/#deaths-landing_">highest death rates per capita from COVID-19</a>. </p>
<p>Despite these obstacles – all of which were outside of their control – educators told us they found ways to be there for their students and support their mental health.</p>
<p>In the course of our research, three strategies became apparent. The lessons show promise not just in this section of New York City, but for the rest of the country as well.</p>
<h2>1. Connect to community</h2>
<p>In 2023, U.S. Surgeon General Vivek Murthy raised alarm about the essential need for social connection within communities to heal America’s “<a href="https://www.hhs.gov/about/news/2023/05/03/new-surgeon-general-advisory-raises-alarm-about-devastating-impact-epidemic-loneliness-isolation-united-states.html">epidemic of loneliness</a>.” Schools, in particular, have a history of being hubs for connection. In the pandemic, that was especially apparent when they became <a href="https://ethics.harvard.edu/schools-during-covid-19">centers of information</a>, offering academic support and internet access as well as food and nutrition, even when classes were remote.</p>
<p>Across the country, educators quickly realized that psychologically isolated students also needed social connection, and they responded with innovation. They developed <a href="https://www.youtube.com/watch?v=pK5hMspzTaM&ab_channel=AlexaSorden">bedtime story videos</a> for families, online cooking lessons that invited community members into their homes, and socially distanced dance classes on school athletic fields.</p>
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<p>In Bronx CSD 7, a <a href="https://www.nychealthandhospitals.org/pressrelease/mental-health-services-expanded-for-students-in-areas-hardest-hit-by-covid-19/">partnership with a nearby hospital</a> increased access to much-needed mental health services for students and educators.</p>
<p>Community connections help educators understand child and family needs and allow community members to trust schools as a <a href="https://www.wsj.com/articles/a-bronx-school-works-to-help-students-thrive-during-the-coronavirus-pandemic-11590249600">source of support</a>. They also bring community assets, such as free clinics, food pantries, housing programs and mental health resources, into schools where families can more easily access them.</p>
<p>With emergency educational funding from the pandemic <a href="https://www.axios.com/2023/02/02/funding-cliff-student-mental-health">expiring on Sept. 30, 2024</a>, <a href="https://www.ascd.org/books/the-six-priorities?variant=122022">school-community partnerships</a> will be essential for continuing mental health services in schools to support psychological recovery.</p>
<h2>2. Give students a seat at the table</h2>
<p>Relationships within schools are also important for improving and maintaining mental health. Research shows that when school leaders involve students in decision-making, it encourages them to develop leadership skills and <a href="https://doi.org/10.1111/josh.12960">increases the overall well-being of the community</a>, as indicated by civic engagement and health outcomes.</p>
<p>In Bronx CSD 7, students are part of the Superintendent’s Advisory Council. This meant that during the pandemic they were able to bring to light the challenges of engaging in online learning all day without a break. Unlike a regular school day, where students would move between classes and chat with teachers and friends in the hallways, the online school day went from one class period to another with no built-in opportunities to take breaks, socialize and refocus. Experts were quickly recommending that online school days be <a href="https://transcendeducation.org/why-distance-learning-should-not-replicate-school/">restructured to meet student needs</a>. But students knew this first.</p>
<p>When youth are empowered to share their stories, they not only strengthen their school community, but they also serve as trusted messengers for their peers. During the pandemic, students around the country created <a href="https://www.npr.org/2020/06/17/877498373/coronavirus-racism-and-kindness-how-nyc-middle-schoolers-built-a-winning-podcast">youth-led podcasts</a> to learn from each other. They also <a href="https://time.com/6071300/kids-pandemic/">documented their experiences</a>, processing psychological upheaval, communicating their needs and supporting each other. Education researchers have referred to these empowering connection activities as “<a href="https://doi.org/10.1080/10665684.2021.1992603">cultural assets</a>” because they not only support young people, but they also help teachers approach students in more culturally sensitive ways.</p>
<h2>3.Think developmentally</h2>
<p>Since the end of the pandemic, school districts across the country have been dedicating resources and time to recovering “<a href="https://www.nber.org/papers/w29497">lost learning</a>,” the phrase used to describe the test score declines attributed to school closures and emergency online learning. But some students experienced another equally devastating decline that’s gotten less attention – their social and emotional development. </p>
<p>To soften the impact of social isolation, educators in Bronx CSD 7 intentionally dedicated time during remote learning to social interactions. They provided informal connection spaces during the school day, played video games with their students and encouraged them to eat lunch together online. Research shows that young people who communicated more often with friends were <a href="https://doi.org/10.1002/icd.2305">less impacted by the social isolation of the pandemic</a>. The experience of Bronx CSD 7 shows that schools could play an instrumental role in nurturing this force for mental well-being. </p>
<p>Every district faced its own complex challenges during the pandemic, and educators across the country have supported their students, communities and each other in the recovery process. As school leaders consider ways to recover lost academic opportunities and learning, it is equally important to help students stabilize their mental health and boost their overall well-being.</p><img src="https://counter.theconversation.com/content/219087/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Faiza Jamil does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Giving students a voice in decision-making helps foster well-being, research has found.Faiza Jamil, Associate Professor of Education, Clemson UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2199542024-02-15T13:33:39Z2024-02-15T13:33:39Z‘It is hijacking my brain’ – a team of experts found ways to help young people addicted to social media to cut the craving<figure><img src="https://images.theconversation.com/files/571020/original/file-20240124-29-hrfn7d.jpg?ixlib=rb-1.1.0&rect=44%2C0%2C4975%2C3180&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some young people spend hours a day on social media.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/side-view-of-milenial-men-and-women-using-royalty-free-image/1467270207?phrase=social+media+addiction+young+people+negative">ViewApart/iStock via Getty Images Plus</a></span></figcaption></figure><p>Many people have compared the <a href="https://www.cbsnews.com/news/facebook-addictive-as-cigarettes-former-executive-says/">addictive nature of social media to cigarettes</a>. Checking your likes, they say, is the new smoke break. Others say the unease over social media is just the next round of <a href="https://www.theatlantic.com/podcasts/archive/2023/06/stop-comparing-social-media-to-big-tobacco/674267/">moral panic about new technologies</a>. </p>
<p>We are a pair <a href="https://www.colorado.edu/atlas/annie-margaret">of researchers</a> <a href="https://dl.acm.org/profile/99659691909/publications?Role=author">who investigate</a> how social media affects the mental health of young people. More than 75% of teens check their phone hourly, and half say they feel like <a href="https://www.commonsensemedia.org/press-releases/new-report-finds-teens-feel-addicted-to-their-phones-causing-tension-at-home">they’re addicted to their devices</a>. </p>
<p>Here are some of the things they’ve told us:</p>
<p>“TikTok has me in a chokehold.” </p>
<p>“I would 1,000% say I am addicted.”</p>
<p>“I feel completely aware that it is hijacking my brain, but I can’t put it down. This leaves me feeling ashamed.”</p>
<p>Maybe you’ve had similar feelings yourself, no matter your age. Although it’s true social technologies offer clear benefits – unlike smoking – many people still feel uncomfortable with how much time they spend online and often wonder if they’re addicted.</p>
<p>Years of investigation have led our team to this conclusion: Perhaps a better approach is to view your media consumption as a diet. Just as there are many ways to have a healthy diet, there are also a variety of ways to develop healthy and personalized social media habits. </p>
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<figcaption><span class="caption">Having an online presence is becoming a replacement for an in-person presence.</span></figcaption>
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<h2>The search for answers</h2>
<p>A deluge of research on social media usage that began in the early 2010s shows negative impacts in areas related to <a href="https://theconversation.com/mounting-research-documents-the-harmful-effects-of-social-media-use-on-mental-health-including-body-image-and-development-of-eating-disorders-206170">body image, eating disorders</a> and <a href="https://doi.org/10.1016/j.copsyc.2020.04.002">social comparison</a>. </p>
<p>Conversely, other studies point to the mental health benefits of social media, including <a href="https://www.hsph.harvard.edu/news/features/social-media-positive-mental-health/">social well-being</a>, <a href="https://www.pewresearch.org/internet/2018/11/28/teens-social-media-habits-and-experiences/">strong friendships and exposure to diverse perspectives</a>.</p>
<p>Still other studies <a href="https://doi.org/10.1371/journal.pone.0293467">show conflicting results</a>. In fact, <a href="https://doi.org/10.1016/j.copsyc.2021.08.017">inconclusive or mixed results</a> seem to be a recurring pattern when researching this subject.</p>
<p>The inconsistencies in these studies highlight the very hard problem of characterizing healthy interaction between two complex systems – social media technologies and human behavioral psychology. </p>
<p>One issue is that the stress, anxiety and challenges to self-esteem experienced by users may vary from moment to moment, depending on what they are viewing. Consider that not all time spent on social media is equal. For example, messaging distant friends for one hour a day will likely leave you feeling more fulfilled than spending 30 minutes a day <a href="https://www.health.com/mind-body/what-is-doomscrolling">doomscrolling</a>, which refers to an excessive amount of time consuming negative media.</p>
<p>That’s why researchers are trying to distinguish between the active and passive use of social media. “Active use” refers to social exchanges, like sending messages or posting content, while “passive use” is strictly the consumption of social media content without participation, contribution or <a href="https://doi.org/10.1111/sipr.12033">engagement with others</a>. </p>
<p>But even this distinction is too simplistic and <a href="https://doi.org/10.1177/14614448211065425">has come under scrutiny</a>. Some active behaviors, such as trolling on Reddit, are likely unhealthy for everyone involved. And some passive behaviors, like consuming educational videos, are beneficial. </p>
<p>Because healthy media consumption varies considerably from person to person, our research takes a different approach and focuses on users developing personal agency with respect to their media consumption. </p>
<h2>A four-week intervention</h2>
<p>More than 500 college students with a wide range of social media habits have participated in our <a href="https://www.postinternetproject.org/prism">ongoing study</a>. The students begin by reflecting on their current relationship with social media and then set goals for the changes they want to make. This might include spending less time mindlessly scrolling, curating their feed on an app or not sleeping with the phone in the bedroom. </p>
<p>For four weeks, participants report their success in adhering to their goals. They also reflect on their feelings and experiences through journaling and completing standard psychological surveys that capture <a href="https://hub.salford.ac.uk/psytech/2021/08/10/bergen-social-media-addiction-scale/">social media addiction</a> and other mental health outcomes. </p>
<p>Our initial analysis indicates that the four-week intervention significantly reduces social media addiction for those who started with <a href="https://doi.org/10.1371/journal.pone.0169839">problematic</a> or <a href="https://doi.org/10.1556/2006.2021.00025">clinical</a> levels of <a href="https://hub.salford.ac.uk/psytech/2021/08/10/bergen-social-media-addiction-scale/">social media addiction</a>. </p>
<p>Problematic social media addiction is associated with a host of negative effects including moodiness, anxiety and an excessive amount of time and energy spent on or thinking about social media. People with clinical social media addiction levels experience those same effects but to a great degree, with their habit patterns around social media resembling that of an addict.</p>
<p>Those with problematic social media addiction scores at the start of the intervention showed a mean reduction of 26%, and scores for participants who began with clinical social media addiction scores fell by 35%. These reductions brought both groups into a healthy range of social media use by the conclusion of the intervention. </p>
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<p>At the end of the four weeks, participants reported positive changes in their relationships with social media with statements like the following:</p>
<p>“I feel as though my connections have strengthened with my friends because when I now communicate with them, it is to have an actual conversation, rather than to pass the time responding to Snapchats.”</p>
<p>“I find (social media) a lot less appealing in a lot of ways and haven’t really felt the urge to post something in a long time. I think I am … using it for fun or connectedness instead of distraction.”</p>
<p>“This challenge has positively changed how I view social media, and social approval.”</p>
<h2>Positive change takes time</h2>
<p>Much like any behavior change, adopting healthier media consumption habits requires time, dedication and self-reflection. While our research focuses on college students, we believe a similar four-week process focused on agency and reflection can lead to profound improvements in overall well-being <a href="https://www.postinternetproject.org/prism">for people of all ages</a>.</p>
<p>That said, there are <a href="https://www.commonsense.org/education/digital-citizenship">practical steps you can take right now</a> to reduce your dependence on social media. This includes turning off notifications, removing or limiting apps that you find harmful, curating your social media feed by unfollowing certain accounts, <a href="https://www.theverge.com/23637672/grayscale-iphone-android-pixel-samsung-galaxy-how-to">setting your phone to grayscale to reduce the appeal</a>, and reserving phone-free time. You can get started right now by taking a free, psychologically validated survey to <a href="https://hub.salford.ac.uk/psytech/2021/08/10/bergen-social-media-addiction-scale/">assess your level of addiction</a>. </p>
<p>If you can’t eat gluten, you probably don’t keep wheat-based bread in the kitchen. A truly healthy diet requires learning which foods make you feel your best and finding joy in eating certain foods in moderation. Similarly, our research shows that spending some time setting goals and engaging in self-reflection can change your relationship with social media – for the better.</p><img src="https://counter.theconversation.com/content/219954/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Annie Margaret founded a non-profit called Post-Internet Project that aims to empower youth, educators, parents, and communities with a holistic understanding of the digital landscape, fostering emotional resilience, mindfulness, and compassionate leadership in the face of evolving technologies.</span></em></p><p class="fine-print"><em><span>Nicholas Hunkins is a data science consultant with Post-Internet Project, a non-profit organization founded by Annie Margaret that focuses on empowering youth to develop intentional engagement with modern technologies.</span></em></p>You can free yourself from some of the time you spend online in as little as four weeks.Annie Margaret, Teaching Assistant Professor of Creative Technology & Design, ATLAS Institute, University of Colorado BoulderNicholas Hunkins, Researcher in Data Science, University of Colorado BoulderLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2220202024-02-14T16:56:03Z2024-02-14T16:56:03ZFinding joy in the little things really can benefit your wellbeing – a scientist explains<figure><img src="https://images.theconversation.com/files/575327/original/file-20240213-20-lilmse.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4969%2C3218&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Finding joy in the little things can be an investment in your long-term wellbeing.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-drinking-coffee-looking-through-555829774">Suzana Marinkovic/ Shutterstock</a></span></figcaption></figure><p>Find joy in the little things. This piece of folk advice has been around for aeons, and is one that many of us try to live by. But is there actually any real benefit to this practice? </p>
<p>According to research, yes, there is indeed some benefit to savouring fleeting moments of joy – also known as “<a href="https://www.penguinrandomhouse.com/books/709567/microjoys-by-cyndie-spiegel/">micro-joys</a>”. Whether that’s relishing a cup of coffee, performing an act of kindness or enjoying a funny video, finding joy in the little things not only has many temporary benefits, but research shows it can also be an investment in <a href="https://psycnet.apa.org/record/2000-03082-001">long-term wellbeing</a>.</p>
<p>On a physiological level, engaging in micro-joys can improve our <a href="https://www.sciencedirect.com/science/article/pii/S0301051110002516?casa_token=He3Viq5dECAAAAAA:1gxJgvBTVUatQwIqmsLB8s1Xs74dlga7Gp1DJBnoY_4GGlf6HXDMXfTrJ_D0v-ZyG7E9Ha8E">vagal tone</a>. This is important, as the vagus nerve is responsible for our body’s autopilot system, which regulates the processes we don’t have to think about – such as our heart rate, digestion and breathing. The vagus nerve is also linked to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859128/">mood and anxiety disorders, and regulating stress</a>, so the more stimulated it is the better off you may be.</p>
<p>On a social level, positive emotions can improve relationships and potentially lead to <a href="https://journals.sagepub.com/doi/full/10.1177/0146167218771324?casa_token=XDVaoG_HIBMAAAAA%3AUWojYZzqvyOykckVs1bKNIzUY6-Ym_p_dJcPnh-kEuIwdfwd726V2Uezha41Ot-Wl_ICwHetIm8">positivity resonance</a> – a momentary connection between people that enhances <a href="https://pubmed.ncbi.nlm.nih.gov/35099204/">health, increases life-span</a> and <a href="https://psycnet.apa.org/record/2023-46821-001">meaning in life</a>. </p>
<p>Experiencing positive emotions not only boosts momentary happiness, but it also helps us to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122271/">develop qualities</a> such as optimism and resilience, which can help protect against distress and poor mental health in the future. </p>
<p>The critical question then arises of how many micro-joys we need to experience daily in order to see these kinds of benefits. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898419/">Some studies</a> suggest a magic number: five positive emotions to one negative emotion for optimal wellbeing. So for every one negative emotion you experience in a day (such as sadness, anger and frustration), you would need to have five positive emotions (such as joy, hope or optimism) to balance things out and live a good life.</p>
<p>However, not all experts agree with this ratio – with some <a href="https://europepmc.org/article/med/23855896">criticising the algorithm</a> used to develop it. Nevertheless, most research seems to agree that the <a href="https://pubmed.ncbi.nlm.nih.gov/23855895/">more positive emotions</a> you experience per day, the better. </p>
<p>So, embracing micro-joys may indeed serve as a foundational strategy for improving overall wellbeing. Even engaging in just a few daily micro-joys can not only contribute to momentary happiness, it also helps develop our <a href="https://psycnet.apa.org/record/2000-03444-003">self-regulation</a>. This is our ability to manage impulses in order to achieve a goal or establish a habit. </p>
<figure class="align-center ">
<img alt="A group of business people laugh around a table." src="https://images.theconversation.com/files/575330/original/file-20240213-24-sv68rd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575330/original/file-20240213-24-sv68rd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575330/original/file-20240213-24-sv68rd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575330/original/file-20240213-24-sv68rd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575330/original/file-20240213-24-sv68rd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575330/original/file-20240213-24-sv68rd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575330/original/file-20240213-24-sv68rd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Don’t be afraid to celebrate even fleeting moments of joy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/indian-woman-laughing-funny-joke-eating-1206996136">fizkes/ Shutterstock</a></span>
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<p>Better self-regulation has a ripple effect on <a href="https://link.springer.com/chapter/10.1007/0-306-47149-3_9">various aspects of our lives</a> – such as preventing addiction or self-defeating behaviours (including procrastination, blame and perfectionism). Making time to do even just small, personal tasks such as making lists, tracking daily budgets and even working on your posture each day can help <a href="https://journals.sagepub.com/doi/10.1111/j.1467-8721.2007.00534.x">strengthen your self-regulation</a> and ward off against failures.</p>
<h2>Finding micro-joy</h2>
<p>If you’re keen to see whether practising micro-joys will benefit you, there are a few key things to know.</p>
<p>First, research suggests that some people’s genetics may make them more likely to benefit from micro-joys than others. Studies show that people who are highly sensitive to their environment may <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jopy.12218?casa_token=iSQUHKyZM5wAAAAA%3ADXwoFYHT1GM8Yn7bOQMNIE1DJ9kKAKtm1D3-pDlerj7BsLEREhReBtkpfCMx-wO3S7xA1b0ZQWeY_Q4">disproportionately benefit</a> from engaging in positive activities, such as micro-joys. So if you’re someone who tends to be acutely aware of the subtleties around you or find you become deeply emotional when engaging with art or music, you may find micro-joys to be highly effective for your wellbeing. </p>
<p>Another key aspect of micro-joys is the fact that they centre on cultivating moments of pure joy – not happiness. This is important, as studies have found that the pursuit of happiness can be counterproductive, potentially leading to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160511/">diminished wellbeing</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/21910542/">heightened loneliness</a>. While happiness is a state that people aim to achieve, joy encompasses the processes that may result in happiness. </p>
<p>Celebrating fleeting moments of joy can be so good for us because these moments champion the journey of infusing our lives with greater enjoyment and focus on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533095/">prioritising positivity</a> – rather than focusing on whether we’re happy or not. </p>
<p>Here are a few ways you can practice finding joy in the little things: </p>
<ol>
<li><p><strong>Change your routine.</strong> Trying adding a 10-minute burst of joy into your normal morning, afternoon or evening routine which can give you a moment of delight to look forward to. For example, savouring a cup of tea. </p></li>
<li><p><strong>Look out for moments of humour.</strong> Humour can be a great way to find joy each day. But if you find it hard to see joy in your day, try to imagine how your favourite comedian might hilariously interpret the events of your day.</p></li>
<li><p><strong>Be spontaneous.</strong> Challenge your routine by introducing spontaneity into your day – even if you’re typically a meticulous planner. Embrace the unexpected – even if just for a rejuvenating, five-minute break to call a friend you haven’t spoken with in a while.</p></li>
<li><p><strong>Pursue moments of connection</strong> and shared laughter with strangers, neighbour or acquaintances. Strengthening these social bonds can add a joy to your day.</p></li>
<li><p><strong>Pause and appreciate.</strong> Taking regular breaks to savour the simple act of being alive throughout your day can bring a renewed sense of mindfulness and gratitude that result in joy. For example, listen to the birds singing, or allow yourself to laugh out loud when someone says something funny. </p></li>
</ol>
<p>Engaging in small moments of joy daily holds the potential to elevate both short- and long-term wellbeing for many – though for some the impact of these activities will be more subtle than for others.</p><img src="https://counter.theconversation.com/content/222020/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jolanta Burke does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Enjoying a cup of coffee or performing an act of kindness are some examples of the everyday ‘micro-joys’ that can boost your wellbeing.Jolanta Burke, Senior Lecturer, Centre for Positive Health Sciences, RCSI University of Medicine and Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183062024-02-14T16:55:05Z2024-02-14T16:55:05ZNew study reveals four critical barriers to building healthier Canadian cities<p>Many streets around the globe are becoming increasingly inhospitable to children and the elderly due to compounding traffic and road safety concerns which <a href="https://doi.org/10.1080/15568318.2020.1858376">deter these groups from active transport, like walking or cycling</a>. The recent emphasis on designing cities that cater to the well-being of individuals from ages <a href="https://www.880cities.org/">eight to 80 isn’t just a catchy phrase, but a vital requirement to accommodate evolving demographic realities</a>.</p>
<p>Similarly, the concept of the <a href="https://doi.org/10.1007/s11524-023-00749-4">15-minute city</a> has garnered significant attention in recent years — <a href="https://theconversation.com/forget-the-conspiracies-15-minute-cities-will-free-us-to-improve-our-mental-health-and-wellbeing-200823">despite baseless conspiracies accusing local authorities of plotting to limit residents to a small radius around their homes</a>. </p>
<p>The 15-minute city is all about accessibility, time efficiency and expanding options for everyone, not just the most well-off. Achieving this goal, and designing healthier spaces, begins with a comprehensive understanding of how urban environments impact our health and well-being — along with a realistic look at the current barriers to healthier urban design. </p>
<p>Our <a href="https://www.medrxiv.org/content/10.1101/2023.12.05.23299446v1">recent research</a> — conducted with the help of research assistants Shanzey Ali and Agnes Fung and the City of Regina and Saskatchewan Health Authority and currently awaiting peer review — set out to understand these barriers.</p>
<h2>Designing better spaces</h2>
<p>Research shows that the layout of streets, access to grocery stores, choice of construction materials in dwelling design, and the distribution of public services <a href="https://doi.org/10.1016/S0140-6736(16)30066-6">all play pivotal roles in influencing our health and well-being</a>. </p>
<p>Neighbourhoods with accessible public and community spaces and social events have been shown to improve mental health, increase happiness, and offer a <a href="https://doi.org/10.1111/issj.12472">sense of belonging and community</a>. At the same time, readily accessible grocery stores, community gardens and farmers’ markets have been shown to <a href="https://doi.org/10.3390/ijerph18041943">enhance mental, social and physical health</a>. </p>
<p>So, how do we create built environments that are more beneficial? This is where urban planning comes in as municipal policy-makers develop and implement policies, which can alter the structure, use and regulations of public spaces in cities.</p>
<p>The intricate dance between urban planning and health has <a href="https://doi.org/10.1177/1078087406296390">deep historical roots</a>. The <a href="https://www.bbvaopenmind.com/en/science/leading-figures/john-snow-the-origin-new-medicine-time-of-cholera/">early use of sanitation and segregated zoning to control infectious disease outbreaks in the 19th century</a> is well established <a href="https://doi.org/10.1016/S0140-6736(16)30066-6">and these efforts continue to this day</a>. </p>
<p>Meanwhile, global agencies like the World Health Organization (WHO) and the United Nations (UN) have championed the integration of health and equity into urban governance. Indeed, the <a href="https://sdgs.un.org/goals/goal11">UN Sustainable Development Goal 11</a> aims for inclusive, resilient, safe and sustainable cities. Accordingly, cities are well positioned to safeguard population health and reduce health inequities in a changing climate.</p>
<h2>Day-to-day challenges</h2>
<p>So, why are we not seeing more urban design policies focused on residents’ health and well-being? Our findings shed light on four key issues.</p>
<p><strong>1 – A lack of shared understanding of health equity</strong></p>
<p>Policy makers lacked a shared understanding of health and equity which highlights the complexity of addressing health inequities and implementing effective policies. While the importance of physical and mental health was widely acknowledged, a glaring gap exists in the recognition of the <a href="https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1">social dimension of health</a>. </p>
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Read more:
<a href="https://theconversation.com/it-is-not-just-heat-waves-climate-change-is-also-a-crisis-of-disconnection-210594">It is not just heat waves — climate change is also a crisis of disconnection</a>
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<p>Policy-makers often struggled to find common ground on what constitutes health and equity, which hindered meaningful action. As one policy-maker noted: “I don’t think our (design) standards have ever really been looked at from that health perspective.”</p>
<p><strong>2 – The evidence is usually inaccessible</strong></p>
<p>While policy-makers acknowledged evidence (data) as an essential building block of policy making, they explained there are significant barriers to accessing it. Administrative roadblocks, such as a lack of co-ordination between, and within, provincial and municipal governments, can prevent access to crucial data needed for policy making. </p>
<p>Financial barriers, such as paywalls, can lock access to scientific studies. Meanwhile, technical barriers — including the use of jargon and overly-technical language by the academic community — can interfere with the accessibility of academic literature. </p>
<figure class="align-center ">
<img alt="A large building stands in the background with a field and flower beds in the foregound." src="https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575443/original/file-20240213-20-uh97si.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Legislative Assembly of Saskatchewan in the City of Regina, Sask. A lack of inter- and intra-governmental communication can inhibit free access to vital evidence and data across provincial and municipal governments.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>As one policy-maker put it: “There’s a lot of academic acumen that’s used and terminology, and it can be overwhelming, and nobody wants to walk out of a room and feel stupid.” As a result, sometimes the best approach is also not well understood by the municipal actors, creating greater need for knowledge translation and accessible research. </p>
<p><strong>3 – Government structures are fragmented</strong></p>
<p><a href="https://doi.org/10.1002/hpm.2846">A fragmented governance structure, marked by silo-ing, is another stumbling block</a>. This lack of co-ordination among different branches and divisions within a municipality can result in missed opportunities for collaboration. Differences in the use of terminology can exacerbate the problem, causing confusion and impeding cross-sectoral work. </p>
<p>Conflicts between the objectives of various divisions, such as those between active transportation planners and traffic engineers, underscore the challenges posed by siloed governance. As one policy-maker noted: “There were lots of policies that we seem to put in place that very much favour the movement of vehicles over the movement of pedestrians, cyclists”.</p>
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Read more:
<a href="https://theconversation.com/how-arctic-landscapes-and-canadian-cityscapes-share-a-similar-pattern-213707">How Arctic landscapes and Canadian cityscapes share a similar pattern</a>
</strong>
</em>
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<p>Adding complexity to the mix is the <a href="https://doi.org/10.1177/1078087416684380">limited legal power of local governments in Canada</a>. Deemed “creatures of the province,” municipalities can only exercise powers delegated to them by provincial governments – meaning municipal powers can be modified or revoked theoretically at will. </p>
<p>The ambiguity surrounding the roles and responsibilities of municipalities versus the provincial government creates tension and incurs costs, as municipalities grapple with disagreements over whose jurisdiction certain issues fall under. Most often, this results in funding decisions that impact healthy urban design. </p>
<p><strong>4 – Political ideologies get in the way</strong></p>
<p>Beyond bureaucratic challenges, differing political ideologies present a formidable barrier.</p>
<p>The integration of health in urban design is rooted in the idea of collectivism, which aims to maximize benefits to the community as a whole. While the current favouring of car-centric roads in most areas reflects a libertarian individualism at odds with collective ideals in urban design.</p>
<p>This imbalance is especially striking when one considers the <a href="https://thediscourse.ca/scarborough/full-cost-commute">considerably higher costs to society of driving over walking or biking</a>.</p>
<p>Policy-makers noted that these political ideologies permeate public perception, resulting in resistance to policies perceived as infringing on individual liberties — while policies benefiting only a minority face opposition if they entail personal drawbacks. </p>
<p>We found this issue was exemplified by a fierce resistance to proposals for safer conditions for sex workers by those who wanted them to remain in out-of-sight areas.</p>
<h2>Overcoming these barriers</h2>
<p>The journey towards creating healthier and more equitable cities is riddled with challenges. From a lack of shared understanding, to inaccessible evidence, fragmented governance and legal limitations of municipalities and differing political ideologies, the barriers are multifaceted. However, understanding these challenges is the first step towards meaningful change. </p>
<p>By fostering collaboration, restructuring governance, empowering local governments, and promoting a collective mindset, we can pave the way for more effective integration of health into urban policies that truly support the well-being of communities at large.</p><img src="https://counter.theconversation.com/content/218306/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Akram Mahani holds funding from SHRF (Saskatchewan Health Research Foundation) and CIHR (Canadian Institutes of Health Research). This project was funded by SHRF Align program. </span></em></p><p class="fine-print"><em><span>Nazeem Muhajarine receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. He is affiliated with the Saskatchewan Population Health and Evaluation Research Unit and is a fellow of the Canadian Academy of Health Sciences. </span></em></p><p class="fine-print"><em><span>Joonsoo Sean Lyeo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Canada’s cities must be planned around resident
health and well-being, our research reveals the key barriers to developing truly healthy cities.Akram Mahani, Assistant Professor at Johnson Shoyama Graduate School of Public Policy, University of ReginaJoonsoo Sean Lyeo, Research Associate, Dalla Lana School of Public Health, University of TorontoNazeem Muhajarine, Professor, Department of Community Health and Epidemiology and Director, Saskatchewan Population Health and Evaluation Research Unit, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2221872024-02-14T12:21:03Z2024-02-14T12:21:03ZSchool absence rates have rocketed – the whole educational experience needs to change<figure><img src="https://images.theconversation.com/files/574414/original/file-20240208-22-ypx67.jpg?ixlib=rb-1.1.0&rect=0%2C166%2C7940%2C5130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/schoolchildren-classmates-kids-pupils-students-going-2037583226">Inside Creative House/Shutterstock</a></span></figcaption></figure><p>More than <a href="https://www.centreforsocialjustice.org.uk/newsroom/severe-absence-from-school">140,000 pupils</a> in the UK are absent from from school more than 50% of the time: more than double the number from before the pandemic. </p>
<p>Not being in school matters – and not only because pupils miss out on learning. Teachers play an important role monitoring the welfare of their students, and if young people are on the streets rather than at school they are also <a href="https://www.scie.org.uk/safeguarding/children/education/missing">more at risk of harm and exploitation</a>.</p>
<p>Absence rates have prompted <a href="https://committees.parliament.uk/committee/203/education-committee/news/198876/school-absence-crisis-education-committee-publishes-govts-response-to-report/">increasing concern</a> from the government. Up until now, measures to tackle absence have focused on <a href="https://educationhub.blog.gov.uk/2023/05/11/fines-for-parents-for-taking-children-out-of-school-what-you-need-to-know/">blaming parents and issuing fines</a>: more than a third of a million so far. </p>
<p>More recently, the government has acknowledged the role played by inadequate support for special needs and disability as well as the impact of mental health on pupil attendance. They have responded by increasing the number of “<a href="https://assets.publishing.service.gov.uk/media/6569af115936bb000d31682f/Expectations_for_schools_joining_attendance_hubs.pdf">attendance hubs</a>”: collaborative groups led by senior teachers in schools that have good attendance with the aim of sharing effective strategies with others. </p>
<p>But very little attention has been paid to what is actually happening in schools. Education needs to be more aligned with healthy child development, children’s interests, and the importance of relationships for wellbeing. </p>
<p>Children and teenagers are naturally curious and keen to discover the world around them. They want to be active participants in their own learning. And <a href="https://link.springer.com/chapter/10.1007/978-90-481-9667-8_3">self-determination</a> – being able to make your own decisions rather than being controlled by others – is one of the major pillars of wellbeing. </p>
<h2>Exam factories</h2>
<p>But pupils in many schools have very little in the way of agency. They are told what to do and how to do it. Teachers feel pressure to <a href="https://theconversation.com/most-secondary-schools-dont-have-to-teach-the-national-curriculum-it-should-be-revised-and-restored-or-discarded-214806">“teach to the test”</a>, leaving pupils few options to follow their interests, let alone passions. As teenagers get older, the more <a href="https://innovateinstructionignitelearning.com/wp-content/uploads/2020/04/Bored-Out-of-Their-Minds-Harvard-Graduate-School-of-Education-1.pdf">bored and disengaged</a> they may become in school.</p>
<p>One way of getting students back to school and engaged in learning is to give them more of a voice and increased choice in what they learn. Schools need a broader curriculum that promotes learning about the world because it is fascinating, not just to pass exams. But this will not happen while exam results and league tables dominate education.</p>
<figure class="align-center ">
<img alt="Mother trying to encourage daughter to walk to school" src="https://images.theconversation.com/files/574438/original/file-20240208-28-wtqcii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574438/original/file-20240208-28-wtqcii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574438/original/file-20240208-28-wtqcii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574438/original/file-20240208-28-wtqcii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574438/original/file-20240208-28-wtqcii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574438/original/file-20240208-28-wtqcii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574438/original/file-20240208-28-wtqcii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many children are reluctant to go to school.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhappy-girl-holding-moms-hand-doesnt-1595176540">Ground Picture/Shutterstock</a></span>
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<p>What’s more, schools appear to be <a href="https://cypmhc.org.uk/school-behaviour-policies-are-ineffective-in-creating-change-according-to-findings-from-a-new-survey/">increasingly resorting</a> to punitive approaches to <a href="https://cypmhc.org.uk/publications/behaviour-and-mental-health-in-schools-report/">manage student behaviour</a>. </p>
<p>Students may face discipline for not having the right equipment, being late, talking out of turn or in the corridor and uniform infringements. At <a href="https://www.bbc.co.uk/news/uk-england-cambridgeshire-66734164">St Ivo’s Academy</a> in Cambridgeshire parents have set up their <a href="https://stivoparentsforum.org/">own forum</a> to express concerns, especially about how discipline is affecting their children’s mental health.</p>
<p>Anxiety, depression and other negative emotions impede learning. Young people need to feel safe to focus well. Many do not. The organisation <a href="https://notfineinschool.co.uk/">Not Fine in School</a> supports families whose children are experiencing “barriers” to attendance. Their Facebook group has 37,000 members. It illustrates the many ways pupils can be scared, confused, embarrassed and sometimes panic-stricken in school. </p>
<p>As <a href="https://notfineinschool.co.uk/home/f/learning-from-lived-experience">one mother writes</a> on the Not Fine in School site: </p>
<blockquote>
<p>These past three years have been the hardest thing I have ever had to go through. Watching my vibrant, charismatic, full of life child, become a shadow of himself has been heartbreaking.</p>
</blockquote>
<p>Instead, schools should be promoting the positive. Among other things, this means welcoming students, being kind, showing interest and taking account of their context. </p>
<h2>Doing things differently</h2>
<p>Conversations with children should identify and acknowledge the qualities they are developing and the progress they are making, rather than pointing out deficits and negatives. It also means students feeling they belong, that they <a href="https://pubmed.ncbi.nlm.nih.gov/31407358/">matter</a>, and that they are valued and included. </p>
<p>Positive emotions and mental health are strengthened by <a href="https://psycnet.apa.org/record/2012-32884-000">free play and playfulness</a>. However, experiences that might enhance this in state schools, such as art, music, drama, dance and opportunities to have fun together, are <a href="https://www.forbes.com/sites/nickmorrison/2019/04/09/how-the-arts-are-being-squeezed-out-of-schools/?sh=2191b75baaf4">under threat</a> in state schools. </p>
<p>It does not have to be this way. <a href="https://globalestonian.com/en/news/knowledge-and-skills-estonian-children-rank-first-europe-and-among-best-world">Estonia</a> has one of the best education systems in Europe: teachers have high autonomy in how they lead classes and children feel happy and safe in school. The school system in England <a href="https://www.thetimes.co.uk/article/times-education-commission-how-estonia-does-it-lessons-from-europe-s-best-school-system-qm7xt7n9s">could learn</a> from the independence headteachers are granted to set the curriculum, a focus on wellbeing and no schedule of school inspections. </p>
<p>When policies and practices in state education aim to bring out the best in every child and prepare them to be active citizens of the future, maybe kids will actually want to come to school. </p>
<p>When <a href="https://www.education.gov.au/student-resilience-and-wellbeing/resources/scoping-study-approaches-student-wellbeing-final-report">wellbeing is at the core</a> of a school’s endeavours, children will have better mental health and resilience, greater engagement with their learning and better results.</p><img src="https://counter.theconversation.com/content/222187/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sue Roffey is affiliated with several advisory boards for mental health and wellbeing in schools and is a member of the Labour Party . </span></em></p>Education needs to be more aligned with healthy child development, children’s interests, and the importance of relationships for wellbeing.Sue Roffey, Honorary Associate Professor, Department of Clinical, Educational and Health Psychology, UCLLicensed as Creative Commons – attribution, no derivatives.