Who is responsible for our mental health?

Who is responsible for our mental health?

26th September 2024

Summary On September 26th, One Question launched its place-based approach to addressing the mental health crisis, understanding what keeps us mentally healthy and how that might differ by gender, age, socio-economic background, culture, and disability. The project questions whether society's expectation of a 70-year-old institution to serve a 21st-century society is unsustainable and explores whether a shared societal responsibility to address the causes of mental illness can create the systems, structures, environments and behaviours to stop people from reaching the point of crisis.

Piloting in Bristol, One Question hosted a conversation in the city asking: "Who is responsible for our mental health?" It invited perspectives from business, policy, education, technology, healthcare and community to answer this one question through different lenses, examining what causes uncertainty, illness, crisis and suicide ideation.

The place-based approach to addressing mental health crisis in the UK is not exploring clinical diagnosis or treating those in crisis; But to understand and activate a shared responsibility to prevent it.

This report summarises the conversation, divided into five sections, highlighting common threads and a new set of hypotheses to inform the next phase of our project.

The report starts with the definition of mental health and the path from mental wellness to uncertainty and ‘feeling stuck,’ mental illness, crisis and suicide ideation. And the difference between a clinical diagnosis and an individual experience.

The importance of the language used to talk about mental health and how, increasingly, by adopting clinical language, it can define how we feel rather than understand how we feel.

Whether the role of education is to teach self-worth, selfawareness, and internal validation that we can carry into adulthood, alongside a traditional curriculum, introducing metrics of success that award internal value, not just external value. (Cont..)

The value of technology versus its negative impact on society at every age, the importance of how it is commercially adopted and the role society plays in regulating it.

The expectation of businesses, big and small, to ensure that organisations and their leaders develop systems and structures that support positive mental health by prioritising people and profit.

The value of our communities. The often underrated importance of connection and a sense of belonging or ‘scaffolding’ to support individual and collective mental health.

The report concludes with a set of work streams that will connect the dots between business, institutions, and the community and act as the foundation for short-term priorities and longer-term policy shifts to address the rise of mental illness in the city.

How do we define mental health?

Sarah Parsonage, founder of One Question, opened the conversation by outlining the project and the context of the discussion on addressing the underlying causes of mental illness from different perspectives with a focus on prevention, not solutions on how to treat symptons or to triage crises.

Sarah invited Talk Club's co-founder Gavin Thorpe to ask their two questions: 'How are you today, on a scale from 1 to 10?' He explained that scoring how we feel daily allows us to centre ourselves - which is especially valuable in children.

Gavin explained that adults often default to that 'safe' number – one that's not too high to be unbelievable but not too low to incite questions. He then acknowledged how we each had a decision to make, "Should I tell the truth?" which set the tone for the conversation - one grounded in honesty.

The first perspective on our One Question was through the healthcare lens, reinforcing that the conversation was to discuss routes to prevention. Sarah was joined by Dr Natasha Ward, a GP and Clinical Mental Health Lead for the region, and Emma Brech, CEO of Bristol Mind, to differentiate between mental health, illness and crisis.

As outlined by Dr Ward, being mentally well is a state of ‘feeling at ease’, not about how happy we feel – something that she sees as a common misconception. Feelings of mental illness can manifest as physical symptoms, atypical behaviours and a wider mood disturbance. A diagnosis of clinical depression by the NHS is defined as experiencing five or more of ten key symptoms for two weeks, while a diagnosis of anxiety requires a reported experience of five symptoms for five months. It was acknowledged that anxiety is something we all experience and, in some circumstances, can be a strength; therefore, under the DSM-5 and NHS guidelines, diagnoses are time-defined to determine the difference between normal low moods versus illness.

James Scroggs, Chairman of suicide prevention charity, “Campaign Against Living Miserably”, expressed concern that such diagnoses were time-dependent. Evidence states that once suicidal ideation emerges in someone, the step between imagination and volition could be temporally short - indeed, too short to conform to a clinical diagnosis.

Dr Ward went on to highlight the importance of our environment on mental illness, be it our individual environments or the broader social infrastructure.

One can define this as our 'scaffolding' that supports our mental health—family, community, a sense of purpose, connection, or belonging, and the broader impact of societal forces at play; these include disenfranchised communities, rapid technology innovation, cultural evolution, the pressure of a cost-of-living crisis, or the move to hybrid working—all of which challenge our mental health.

Our 'scaffolding' sustains a continuity of care and allows us to feel at ease, with a strong sense of agency, enabling us to thrive. However, not everyone has the same support system: as Emma Brech asked, "How do we reach those who don't have the same privileges or scaffolding?"

“How do we reach those who don’t have the same privileges or scaffolding?

Emma Brech, Bristol Mind.

Has awareness redefined mental health?

In the last decade, awareness and increasing conversations about mental health have been successful in reducing, if not removing, the stigma of mental illness and suicide. But in the same conversation, have we also redefined what it means?

Today, when talking about mental health, we presuppose it relates to degrees of mental illness, such that instead of reflecting on how we feel, we self-diagnose using medicalised terms instead of emotions.

Dr Ward raises the concern that the challenge of clinical language is that a diagnosis labels an individual and can create a self-fulfilling prophecy.

For example, instead of teaching us to observe our emotions and behaviour, we can often act out our diagnosis. By labeling someone as anxious, do we make them anxious? Whereas, by acknowledging that we feel anxious, can we change our behaviour to mitigate the anxiety?

Ben Akers, co-founder of Talk Club, shared how using the term 'mental fitness' could steer the conversation towards a more positive environment, using the metaphor that we go to the gym to sustain our fitness. Yet, we often only seek support for our mental health at a point of illness or crisis.

We dance around the words for mental health and adopt clinical language or catch-all phrases that differ from the individual to an institution, to an organisation, to policy, identifying that language is part of the problem and the solution.

"There are no positive, acceptable, singular words we can use."

Ben Anderson, Feeling Social

Education or Connection The conversation moved on to the responsibility of the education system from school children to university students, hosted by James Scroggs and supported by University of Bristol student Sophia Hunt-Davis and recent graduate Robert Edgar, alongside Sarah Garlick, Head of Wellbeing at the University of the West of England, and Vik Verma, the interim Director of Education, Inclusion and Skills for Bristol City Council.

Robert and Sophia shared their own experience of mental health challenges and the impact of a friend’s suicide. Each had a different understanding of the support they received from Bristol University. It evidenced the institutional systems and structures in place to respond to mental illness versus the impact of others' illnesses on us.

Whilst schools and universities have evolved their 'well-being' support in the last two decades, the expectations on institutions today continue to grow, especially post-pandemic.

Arguably, the legacy services established in 2005 are no longer fit for purpose. Robert pointed out that just calling a number when in need does nothing to instil trust between the University and its students in the way a face-to-face approach might.

Universal to the conversation was the sense that with the overwhelming rise of crises, no one institution can address or support the impact of mental illness alone. Responsibility is shared and cyclical - a theme of the day. Teachers and lecturers are no more trained to triage crises than they are to control students' desire to drink or have unprotected sex, but there is, of course, a duty of care in prevention. As Sarah Garlick outlined, there is a fine line between supporting the emotional health of students and educating them to further their academic careers.

However, Sophia explained, there is a disconnect between those who manage the institutions and those who live and work in them. Often, the ‘University’ is an unknowable entity in the student's eyes, while, as Robert said, "[mental illness is] an issue that keeps recurring and recurring; it's not going away."

"[Mental illness is] an issue that keeps recurring and recurring; it's not going away."

Robert Edgar, Bristol University Graduate.

Vik Verma posited that the structure of academia itself does not prioritise mental health. While we create the curriculum, we are not including wellbeing enough—something supported by James Scroggs, who said that fitting into the world after going through education is often extremely difficult, as we are not taught how to 'fit in'. This is especially true when discussing the systemic inequity in the school system and the impact of poverty, special educational needs or cultural prejudices on the mental illness of young children, something that continues through education into the workforce.

While our perceptions of university degrees, qualifications, and the rote stepping stones of a traditional education system are changing, ultimately, we still measure success through arbitrary metrics. They reinforce the idea that we prioritise external validation over internal value. For many, this continues throughout their adult life.

The Commercialisation of Dopamine Richie Jones, founder of e-commerce technology company VVast, and Ben Cosh, CEO of Spicy Minds, a new-to-market AI-led app, joined Sarah to discuss technology's responsibility to support positive mental health.

Sarah explained the two axes of the same conversation: the tension between the desire for consumption fueled by technology and the personal validation it brings, plus the value of the same technology in better understanding mental health and mental illness, albeit not without ethical concerns.

Richie explained how selling products is inherently linked to dopamine manipulation due to the rush of endorphins received after pressing 'buy now’. This has contributed to skyrocketing mass consumption rates in the online shopping boom. Richie explained that all brands have a moral responsibility to become more aware of the impact of weaponising dopamine for economic gain, not just on the individual but also on the climate.

At the other end of the spectrum, the same technology used to manipulate human behaviour and sell more things to more people is the foundation of the Spicy Minds app. It offers support for people struggling with their mental health – Ben shared an example of its use for parents who are seeking help for their children at any given moment, given the extensive NHS waitlists for neurodivergence diagnoses. He posed the question, why is our mental health worse than ever when in the past – during times of war and political unrest – it should have been far worse?

This fed into the next part of the conversation, with Ben suggesting that the technological boom has been playing into humans' innate need for validation. This, to him, seemed notable in children's lives, as they've grown up with greater screen time, so their dopamine-seeking behaviours are used for instant gratification from the algorithms they interact with.

Returning to the focus on how many organisations operating in the for-profit sector have commodified our dopamineseeking behaviours, Ben Cosh cemented the idea that, like Richie, we need to lead by example—especially in shaping new policy: "The Evolution of regulation is slower than that of technology." So, it is our responsibility to build a healthier relationship with social media.

Ben’s AI tool—a digital therapeutic companion named Rowan, which navigates uncertainty about how to support mental illness or neurodivergence in children—is a prime example of technology for good, but there are serious ethical considerations, especially in light of the everincreasing adoption of AI. Limiting young people's access to technology and teaching them positive habits from an early age can only improve their mental fitness.

“The evolution of regulation is slow than that of technology.”

Ben Cosh, Spicy Minds

Business is not the answer.

It is one answer.

Fiona Smith, Senior Business Partner at Burges Salmon, Dominic Borel and Ben Harvey, co-founders of Bianchis Restaurant Group, and Catherine Ridd, HR Director of Triodos Bank, joined Sarah to explore the business' responsibility for our mental health. Starting with the more philosophical argument of responsibility.

Sarah shared that it is not the responsbility of a business to triage or treat mental illness. However, she was equally passionate about the fact that all organisations play a fundamental role in protecting our mental health.

"Businesses are perfectly positioned to support their employees and, in turn, the wider community in mental health."

But it must start with a systems change, not with knee-jerk solutions to moments of crisis but with leaders' behaviour change to develop new structures and systems that support healthier working environments.

Dominic and Catherine believed that weakening relationships between employees and managers contribute to the loneliness epidemic. The hybrid working model has reinforced this: for some, it offers greater flexibility; for others, it breeds a sense of isolation, loneliness and ultimately disconnection. Both agreed that we must strengthen the social connection between people, instilling a shared understanding of values inside any organisation.

However, a business's finite resources must also be considered; some guests suggested a disconnect between expectations of what companies should provide and what they can realistically give. Whilst a one-size-fitsall approach to mental health is not working, a bespoke approach may also be unrealistic.

The conversation went on to dissect the generational tension facing the business world. The new workforce is looking to their employers to support their mental fitness, while the old guard of leaders has never known any difference, and therein lies generational tension. With the rise of awareness of mental health and the uncertainty of language, we have created a one-size-fits-all response, leaving organisations navigating a minefield of the difference between uncertainty, illness and crisis.

As Dominic pointed out, the challenges of running a small, family-owned business means you walk the fine line between business and morals, with little if any wider support. The responsibility of a duty of care to your people includes sustaining a profitable business, which is often overlooked.

It is a finely tight rope between the importance of employment in providing purpose and connection and, as Alex Pearn pointed out, the balance of autonomy and support to sustain those who are mentally healthy and those who aren't. James Scroggs highlighted earlier in the discussion, it can change hour to hour or day to day often due to factors outside of work.

Fiona added that since the pandemic and the unfolding crises across the UK, many of us have defaulted to withdrawing into ourselves and our bubbles at moments of overwhelm. Staying isolated in our echo chambers limits growth, while non-financial wealth contributes to overall health. This acted as the perfect segue to the community's responsibility.

"It is the business' responsibility not to have an environment that makes people unwell."

Catherine Ridd, HR Director, Triodos Bank

Ben Harvey, co-founder of Bianchis Group, shared that during the long period of isolation in the midst of the pandemic, the team behind the restaurant group provided meals for 400 people as part of the Caring in Bristols, “Cheers Drive” Highlighting that in supporting our communities, finding connection and purpose during uncertain times often serves to support our own mental health, Siona Mclenagahn, a social worker and surf coach, built on the importance of community through water, advocating for nature as a vital resource for mental health. “Access to clean water and air is a human right, and our connection to nature, like water, calms us.” As has become more commonly known, cold water immersion positively impacts stress, circulation, and mental health, something the NHS has integrated since 2014.

Siona shared her pilot for understanding the effects of Blue Space Health on the well-being of women who have experienced domestic and sexual trauma. It sought to offer three surf therapy sessions once a week for women who had experienced domestic abuse. It created a 43% increase in optimism for the future, usefulness, relaxation, and feeling closer to others from the start of the pilot to the end.

Referencing Claire Goodwin-Fee earlier in the conversation, Siona suggested that we have been taught from a young age the importance of eating five a day for our physical health. It is time to promote the importance of the same autonomy for our mental health.

Conclusion Written by Sarah Parsonage

In a recent conversation on the One Question podcast, Chris Martin, CEO of The Mix Charity, said, "Let's not forget that this is not a world of sovereign individuals. We are pack animals. As a group, we thrive, and as isolated individuals, we fall."

It is clear from this conversation that there is no one answer to understanding or preventing mental illness or crisis, nor is it the responsibility of any one organisation, institution or individual.

But collectively, by joining the dots between our education system, the NHS, our businesses and our communities, we can create new systems and structures, instil personal agency, and strengthen our communities, fostering greater connection, a healthier workforce and more profitable businesses.

While we may have a history of passing the ball of responsibility, unless we can address the numerous challenges collectively, we will continue to cause the problem at one end of the spectrum whilst trying to fix it at the other.

We will continue to sink the boat whilst rushing to empty out the water.

Over the next few months, One Question will work with regional businesses, big and small, policymakers, charities, and institutions to understand and activate what keeps the city of Bristol and the surrounding area mentally healthy.

We will use our research to connect the dots across society, developing eight different work streams as outlined in the next page, working with a local steering group and our national advisory board to prioritise short-term projects and campaigns and longer-term policy shifts, measuring the impact on the individual, on business and the wider community.

We will also continue to ask questions and curate conversations. Whilst historically conversation is often seen as a luxury, taking time out of the constant busyness of the day-to-day, this was yet another example of the importance of forming connections, a sense of belonging, and developing new ideas to find a different set of answers.

Thank you for joining this conversation; I am passionate about the next phase.

Sarah

Work Streams Supported by our longitudinal research, over the next three months and three years, One Question will develop and activate a series of projects as identified by the below eight work streams, connecting the dots between businesses, institutions, and the community to achieve longer-term behaviour change, system change, and shift policy. One Question will work with the national advisory board and a regional steering group to activate and measure the impact of each work stream.

To find out more, join our steering board or be involved in the initiative, please email conversations@onequestion.live

Research

Technology

Community, Connection and Conversation

Learning

Policy

Language

Self-worth and Personal Agency

Social Media

Coming February 2025...

Thank you