The mental health of the nation has certainly been tested due to the events of the past couple of years in the form of an ongoing Covid-19 pandemic.
It’s no exaggeration to state that within a few months in 2020, the world changed. It got smaller somehow, with New Zealanders being asked to either stay in their homes or at least stay in the country.
And so, it came to be that my first big mental health research project, after moving from physical education to psychological medicine in 2019, was investigating the psychological outcomes of the pandemic.
While we are still working on the data, we know that psychological distress increased but not as much as was perhaps anticipated, and there were silver linings to be had. We could also identify which sections of the society were most vulnerable, such as essential workers and people living with mental illness.
This work continues, and we are currently investigating the effect of cumulative lockdowns on mental health in order to influence how things are done in the future.
My time so far as a mental health researcher has been relatively short. In the early days, I became preoccupied with the question “what even is mental health?” Like most people, I had an idea of what mental health was, but it was quickly apparent that even the most fundamental question of what mental health is did not have a straightforward answer.
With a topic as important as mental health, we need to understand it in order to protect, enhance, or treat it. The best way to understand something is to research it. To observe, to listen and, in turn, to respond.
As a result, I decided to produce a podcast series, mainly as an excuse to ask experts the seemingly simple questions, including “what is mental health?”
The World Health Organisation defines mental health as “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. I’m curious about what this means in the context of Aotearoa New Zealand.
As put by one of my first guests on the podcast, mental health is ethereal. It is less tangible than physical health, although some manifestations of it can be very tangible when it comes to the impact on whanau, communities and wider society.
Mental health as a continuum
Mental health is usually associated with poor mental health or mental illness. This in itself is not accurate; mental health is a neutral term, not a negative one. And yet this link persists.
Mental health has been described as sitting on a continuum. At one end would be high psychological wellbeing, or what positive psychology advocate Marty Seligman would call “flourishing”. On the other end would be mental illness, including depression, anxiety, psychoses and personality disorders. But even this doesn’t completely fit the bill. For example, someone living with a mental illness can still experience psychological wellbeing.
Mental health is dynamic
Mental health fluctuates. You might wake up on the wrong side of the bed but feel right as rain by lunchtime. Different seasons bring about changes. Happiness levels tend to increase in the summer, and seasonal affective disorders rise in the winter, both of which have been linked to the amount of sun. Mental health also changes across the lifespan, from the turbulence and unrest associated with adolescence to the dementias that increase with old age.
Mental health is also dynamic in the sense that it is culture specific. Trying to define what mental health is without acknowledging the cultural context is impossible, as highlighted in the New Zealand book Collaborative and Indigenous Mental Health Therapy by Wiremu NiaNia, Allister Bush and David Epston.
The right tools for the job: Numbers and narratives
The title of the podcast — One in Four — is an intentional misnomer based on the often repeated statement that one in four people will experience or be at risk of some form of mental distress, suffer from a mental illness, or experience difficulty.
I eventually traced this statistic back to an article by the World Health Organisation in 2001. This article cited two sources for the statistic, one from Brazil and one from New Zealand, neither of which actually report 25%, or one in four.
As we have seen, our definitions of mental illness change, and that’s before we account for the psychological fallout of large-scale events such as pandemics. So even if one in four is correct at a given point in time, it will no doubt change.
There is a need to go beyond the numbers and raise the importance of stories within research. Last year, I cycled the length of Aotearoa.
As I did so, I talked to New Zealanders about how they perceive and talk about mental health. I was blown away by the openness of people to offer their stories and opinions, in a way that surveys struggle to capture.
We need good population level statistics, in the form of epidemiological research. But we also need stories. Numbers and narratives should be stablemates, not living in separate barns. They combine for a deeper, richer understanding of mental health.
I had an interview for a job last year in which one of the professors asked me about my innovative approaches to research.
My response was not innovative at all. “Simply listen.”
- Dr Matthew Jenkins is a senior research fellow in the department of psychological medicine at the University of Otago, Wellington. He is also the host of One in Four, a podcast about mental health.
