In case you do not know, Mental Health Awareness week is coming up and remarkably “Movement for Mental Health” is the theme of the week. With this widespread acceptance of the field now being firmly mainstream, I wanted to reflect on the 20+ year journey I have been working in mental health. Where better to start than my first EVER published research study, a project we started 19 years ago and published in 2007!
How did it all start?
I did my first shift on a psychiatric ward in 2003. I was astonished at what I saw, people sitting all day, moving only to eat or smoke a cigarette. I soon realised that getting people moving who were very unwell in a psychiatric hospital could have a profound impact on their mental health. In 2005, I started working in a 100 bed older adult psychiatric service – it included older adults with schizophrenia, bipolar disorder, severe depression and other conditions. The majority of wards were locked, making it a real challenge to support this group to be more active. I knew from my training in physiotherapy, the importance of movement for the body and function, but had not yet strengthened the link with the Mind.
What was the evidence and public awareness “Movement for Mental Health” 20 years ago?
I think its fair to say that this was a niche area with little robust data or evidence. The limited available research really did hamper the field and very few people took us seriously. Consequently, trying to suggest that Movement should be a core part of the treatment of people with mental illness was met with consternation. There was no mention of physical activity for mental health at Academic conferences. You were considered a bit alternative for holding a view that physical activity could improve mental health!
Our research project in 2005
Back to my first published research study – I knew that the older adults in the 100 bed unit were spending a huge amount of time being sedentary and this was not favourable for their physical health or function. As a newly promoted “Senior” Physiotherapist, I decided to try and do something about this with some colleagues and what we did in this project was quite simple. We recruited 53 older adult inpatients to take part in our project. We provided some educational sessions with the inpatients and nursing staff on the wards (who have a key part in facilitating movement and taking people off the ward). We measured older adults’ physical activity levels with pedometers before and after these educational sessions. Quite simply, we were able to increase the proportion of people meeting recommended walking levels from 21% at the start to 32% at the end.
Simple but effective.
Movement and mental health: where are we now?
The last 20 years have seen seismic changes in the quality and quantity of research in our field. The last 10 years have been particularly exceptional. We have seen many clinical trials showing that exercise works for many mental health conditions from children to older adults. Further, we have undertaken a substantial amount of mechanistic work, to build on our understanding of how movement impacts our mental health. The field has infiltrated (inter)national guidelines, such as the European Guidelines I led or the Lifestyle for Mental Health guidelines we recently published.
This is all enormously pleasing, but what really makes a big difference is the input from major players not in academia. For instance, ASICS returned to its founders’ routes and has set out to explore movement and mental health with robust science that can be used by the public. This includes the Movement for Mind programme, development of the Mind Uplifter to accurately measure how movement changes our Minds and Mind Games the Experiment. Moreover, the Charity Mind has really championed the use of physical activity for mental illness and Red January has really gained pace over the last few years, helping us start our years off in an active way to lift our mood.
Fantastic progress but still LOTS to do!
The collective effort has massively moved the field on. However, despite the thousands of academic papers, many guidelines, we still have huge challenges. The main challenge is not a lack of evidence or acceptability issue, it is how do we implement (and measure) change in the real world? We have increasing burden of poor mental health in society, increased sedentary behaviours levels and people with mental illness cannot easily access supportive physical activity programmes. Moving forwards, I really hope the field can maintain the momentum, develop actionable, evidence-based programmes that can be scaled and implemented to influence people in the real world.
I am really delighted to be in the large crowd supporting the Movement for Mental Health theme of this years Mental Health Awareness Week. Have you got any plans?
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