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21 October 2022

Why we should prioritise mental fitness, not just illness

We can't ignore the links between physical and mental well-being.

By Gosia Bowling

Research has consistently shown us that physical health and mental health are intrinsically linked. The most obvious example is the connection between exercise and mood, which we’ve likely all experienced first-hand. A study of 1.2 million people published in The Lancet Psychiatry found that those who exercised regularly reported 1.5 fewer days of poor mental health per month than those who didn’t.

Physical activity is an essential tool in the tool-box when it comes to mental well-being. According to the Harvard Medical School, exercise can sometimes be as effective as antidepressants in treating depression. And unlike drugs, exercise is low-risk, low-cost, easily accessible, has no side effects and ties in with other mood-boosting factors such as spending time in nature or with other people.

Unfortunately this interconnectedness also has its downsides; those with chronic conditions are more prone to mental health issues, and vice versa. Data from the World Health Survey indicates that people with two or more long-term health conditions are seven times more likely to have depression than people without a long-term condition. Alarmingly, people with severe mental illness have an average life expectancy of up to 15-20 years lower than the general population.

The reasons for this are complex, not least because some drugs used to treat severe mental illness can increase the risk of cardiovascular disease. But there are other factors at play. Let’s take diabetes as an example; this is a very manageable chronic health condition, and those with it can live full, active and healthy lives. But based on the evidence, a diabetic person might be more prone to depression, in which case self-care becomes more difficult. They might lose motivation and start to neglect their diet and exercise routine, forget to take medication, and miss hospital appointments.

With the link between physical and mental health so evident, why is it that the treatment of one is so often isolated from the other? A person’s diabetes and depression would likely be treated separately in a medical context, rather than in one cohesive programme.

At Nuffield Health, we take a more holistic approach by bringing physical and mental health together. Within 94 of our fitness centres across the UK, we host mental health clinics that offer a range of psychological treatments to members.

We also offer free rehabilitation programmes for those living with joint pain and long Covid. Both programmes incorporate a range of physiological and psychological treatment to target ill health in a more integrated way. Alongside reductions in pain and improved mobility, our joint pain participants report a 24 per cent improvement in their mental health. Similarly, our Covid rehabilitation programme has seen participants experience a 39 per cent reduction in breathlessness, alongside a 70 per cent improvement in emotional well-being.

Initiatives like these show the benefit of taking a holistic, “connected health” approach to supporting individuals. Such an approach is also beneficial for society as a whole. The social return on investment of these programmes is significant – this is the estimated amount of money that is put back into the economy based on factors such as reduced burden on the NHS, reduced burden on families, and reduced workplace absence. Savings come out at £3,400 per person for our joint pain programme and £5,900 for our Covid programme.

[See also: Why are Covid-19 cases rising again?]

A more joined-up approach to healthcare can reduce the impact of ill health on society but unfortunately, the UK still has a long way to go in this regard. The government’s upcoming ten-year Mental Health and Wellbeing Plan demonstrates a commitment to mental health and shows how the country is starting to remove perceived stigma and boost national awareness. However, mentions of physical activity are disappointingly sparse.

We need to stop viewing mental and physical health as two separate things. When the government sets out its plan, we want to see physical activity feature as a key contributor to better mental well-being, with more recognition of the interdependency of our mind and body.

This starts with thinking about mental health in terms of prevention, rather than treatment. The current system is set up so that people seek help once they’re already in distress, and language tends to focus on “conditions” and “disorders”. We’ve got a system in which we focus on trying to “fix” people, and we need to work towards one in which we don’t break people in the first place.

To do this, there needs to be a greater focus on fostering healthy environments, whether that be in schools, workplaces or social settings. Exercise can sometimes be as effective as antidepressants at treating depression These are environments that enable people to thrive and reach their full potential, and find a sense of meaning and belonging. They encourage self-care, such as healthy eating and physical activity, and conversations about mental health. Workplaces are a particular issue; the Centre for Mental Health found that mental health issues at work cost UK employers nearly £35bn last year.

A healthy environment starts with the basics: access to healthy food, hydration, regular breaks and opportunities for movement such as cycle-to-work schemes. But it’s also about creating psychologically safe environments that don’t lead to stress and burnout. These are environments that promote well-being through manageable work demands and positive working relationships, and also empower people to talk openly. In our 2022 Healthier Nation Index survey of 8,000 people, two thirds of respondents said they wouldn’t feel comfortable talking about their mental health with their employer. This needs to change; conversations about mental health at work should not only be welcomed but actively encouraged, starting with mandatory emotional literacy training for business leaders.

We’d also like the government to commission more research into the effectiveness of physical activity for enhancing mental health. We’re currently working with Manchester Metropolitan University on our own research, in which we’re testing the combined effectiveness of cognitive behavioural therapy (CBT) and exercise, but there needs to be more extensive work in this area.

So much preventative work has already been done in areas such as smoking, diabetes and heart disease, and now we want to see the same effort and focus given to mental health. There is a real opportunity to create cohesive, all-encompassing prevention and treatment plans that alleviate both physical and mental illness, helping individuals and society in the long term. The government, NHS, charity sector and private sector all need to work together to prioritise mental fitness and not just mental illness.

This advertorial will appear in our Healthcare Spotlight print supplement, published on 28 October 2022.

[See also: General practice is in crisis – and the government is failing to act]