Do we need to talk to a real person?

I was reminded of the fact that interacting and talking with other people is core to human development, mental health and wellbeing by a BBC Radio 4 podcast, ‘ The Inquiry’, which asked: “what can we do about the world’s mental health problem?” Apparently the global trend of increasing mental health problems means that 1 in 3 of us can expect to have a serious, clinically diagnosed mental health problem in our lifetime. Ironically, this podcast was originally broadcast several months before the devastating effects of the pandemic in November, 2019, which for many people, maybe most, could be said to be traumatic and shocking, i.e. “an emotional response to a terrible event” (American Psychological Association). It is reasonable to assume therefore, that our mental health and general wellbeing is probably even more fragile at this time and so I was keen to hear what possible answers to the question might be offered by the four invited mental health experts.

First, Dr Vikram Patel, Psychiatrist from the Global Centre for Mental Health talked about the extent of the problem and of how, just as every person on the planet at some point in their lives would experience physical illnesses and/or conditions, the same was true of mental health. One trend in mental health data was that conditions such as age-related dementia, schizophrenia and personality disorder presented at a relatively consistent rate. However, rates of depressive and anxiety disorders were escalating regardless of demographic characteristics such as age, gender, location, income and class.

The second expert was Sir Graham Thorneycroft, a psychiatrist who has been recognised for reducing the social stigma of mental health illness and has highlighted the need for individuals to be able to ask for help and understand that it is possible to recover mental health.  He has also found, through his research, that mental health support and awareness training programmes require customising to whichever local population is being targeted. Interestingly, his work has suggested that indirect, i.e. on-line campaigns that tap into celebrity culture such as Prince William’s work can make a difference.

Shekhar Saxena, Director for Mental Health and Substance Addiction for the World Health Organisation, was more tentative about the beneficial effects of on-line interactions via social media. He suggested that the vey human tendency to compare self with others, obviously facilitated and magnified by the on-line world of social media was very often at the expense of one’s own wellbeing and mental health. He also made the point that at this stage we simply didn’t know enough about the qualitative difference between on-line and real life face-to-face interactions upon mental health and wellbeing. WHO makes clear that social function and activity are key to mental health albeit at the same time endorsing the pandemic strategy of enforced social distancing and isolation:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”


“Mental health is fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life.”

The fourth expert was Grace Ryan from London’s Mental Health Centre, who has conducted research across the world and looked at mental health provision and community mental health strategies. She talked about her work in Sierra Leone , Uganda and Zimbabwe where the scale of need and inadequate resources mean that a tiny number of psychiatrists serve the mental health needs of millions. One response that has proven very successful with 86% of recipients claiming beneficial effects, is the ‘community bench’ scheme, for example in Zimbabwe, grandmothers have been trained as lay counsellors and will sit on special benches near hospitals and health centres so that anyone who just wants to talk and open their minds can spend time with them. The idea has been taken up in London and New York where it is referred to as ‘friendship benches’ and is proving equally valuable and innovative. Grace also managed a good re-frame of the increase in mental health problems by suggesting that in a way, it was a measure of human progress that having gone beyond sheer physical survival, dealing with disease and increasing lifespan expectations we could now focus upon mental health and quality of life.

It was an interesting and reasonably balanced piece of radio but I felt dissatisfied as I thought about the different points that had been made.  Clearly, the experts on this podcast were in agreement about the fundamental importance of social strategies and approaches but the question of what form this should take seems to have been avoided.  By this I mean is it acceptable to encourage people, especially the young and those with mental health problems, to interact on-line and conduct their social lives via social media? And what part do real life interactions and relationships play in mental health and wellbeing? It surprises me that so many learned bodies and professions are not more focused upon this matter, for example, The Royal Academy of Psychiatry’s advice to young people with clinically diagnosed mental health conditions during the Pandemic does not appear to make any link between real life interactions and mental health :

It may be difficult to adjust to not being able to get out and about as much as you’d like while you are self-isolating at home. But you may still be able to take part in online or digital versions of some of the activities you would normally do. Search online, or ask friends, classmates or teammates for some ideas. You may also find local organisations or groups that offer online activities for young people that you can join.”

The day after I listened to the podcast I read about Mark Zuckerberg’s new membership of the ‘Hundred Billion’ club, evidence of the commercial gains of creating, supporting and promoting on-line socialisation. He has clearly made a huge financial success out of this modern day phenomenon and by and large it seems this is sanctioned and facilitated by government and many professionals involved in supporting mental health, even if largely by default. I think there needs to be a better balance and that we should be having more conversations about, more funding for and more research about the importance of real-life, face-to-face social interaction as well, even with face coverings and the one/two metre distancing rule. Maybe some members of the one hundred billion club, especially those from the world of social media, might like to finance more ‘community/friendship’ benches and other such projects that facilitate direct interaction and real relationships.

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