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Episode Three shownotes 

In the third episode of Louder Than Words we’re looking at changing attitudes to mental health and how that is having an impact on healthcare, education and support for young people. You can find the full transcript later on in the page.

UK health data shows that mental health is a serious challenge and many mental illnesses start young. According to the World Health Organisation around a fifth of children and young adults around the world have a mental health condition.

Big shifts in policy are taking place and we’ll be talking to experts involved in those changes which are influencing how we treat and prevent mental health problems.

Hannah Brock is a mental health nursing student who is learning about new approaches to mental health and the need to put patients at the centre of our thinking.

Professor Wayne Martin from the Essex Autonomy Project is working with frontline professionals and policy makers to understand how to embed personal autonomy into care practices.

Thomas Currid from the School of Health and Social Care understands how attitudes have changed and is making sure students understand the new environment and the options available.

New practical approaches are helping children to understand how they can protect their mental health. Srivati from Breathing Spaces in Schools tells us how the project helps schoolchildren develop mindfulness.

Mindfulness is extremely close to Dr Caroline Barratt’s heart. She is teaching and helping students learn to become aware of what’s going on for them in their own minds and in their own hearts so they can connect with their own sense of value and where they want to go in the world.

Finally we talk to Professor Chris Nicholson about how we can give UK care workers a better toolbox of skills, to be able to cope with complex situations often connected with mental health.

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Professor Wayne Martin

Dr Caroline Barratt

Professor Chris Nicholson

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Each episode of Louder Than Words will look at a key global issue and give you a chance to hear from leading researchers, policy makers, thinkers and campaigners plus those directly affected by the issue.

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Episode Three Transcript

This is Louder than Words – the pod from the University of Essex. I’m Professor Jules Pretty

I’m journalist Martha Dixon - In this episode we’re putting the spotlight on Mental Health.

Jules Pretty 0:20 UK health data shows that many mental illnesses start young. According to the World Health Organisation around a fifth of Children and young adults around the world have a mental ill health condition.

Martha Dixon 0:32 But there are big shifts in policy taking place – including how to treat and prevent problems.

KIDS MEDITATING 0:39 When you’re meditating you can put everything aside and concentrate and think about anything you want so you become calmer.

Jules Pretty 0:50 We’ll be looking at what’s happening on the ground – especially in new teaching and training methods for those who treat people suffering from mental illness.

THOMAS CURRID 0:58 We use mindfulness in practice we look at a lot of other more contemporary therapies as well.

Martha Dixon 1:05 And we’ll learn how philosophy tools developed at the University of Essex are making a big difference for patients and their freedom to choose what happens to them.

Wayne Martin 1:16 Social care in the 21st century should be about the maximisation of autonomy. That’s a new idea – it’s also a philosophical idea- what is it - autonomy is a kind of freedom.

HANNAH TYPING Hannah Brock 1:39 In recent decades there has been a philosophical shift in mental health care. This approach focuses on the individual as a whole, rather than just their diagnosis.

Jules Pretty 01:55 Busy completing her studies to become a mental health nurse – this is Hannah Brock- who’s at the University of Essex.

Hannah Brock 02:02 For example if you have depression and are experiencing

Martha Dixon 02:11 She’ll be treating people with conditions like anxiety, depression and schizophrenia.

Hannah Brock 02:16 I think it’s a really exciting time to be studying Mental Health at the moment because, I think our attitude as a society is changing and we’re not really shying away from those difficult conversations anymore.

ROLE PLAY 02:30 Hannah: Hi Sarah it’s Hannah from the community mental health team. Is now a good time to talk? Sarah: Hi, Yeh, Okay.

Martha Dixon 02:36 Part of Hannah’s studies involve practise role plays with other students.

ROLE PLAY 02:42 Hannah: So we’ve discussed a bit already about your previous medical history and any sort of treatments you’ve had before. Today I really want to hear from you about what you think your main difficulty is.

Sarah: I guess my main issue is I feel really low. I can’t stop crying and I feel like I just don’t want to talk to anyone or see anyone. Hannah: Ok yeh, thank you for sharing that. How long have you been experiencing this would you say

Jules Pretty 03:09 Hannah knows there’s been a great shift in treating mental illness in the last 20 to 30 years and she’s now learning how she can prescribe exercise, creative projects, and being in nature.

Hannah Brock 03:20 I think we kind of understand that mental health affects everything, whether that’s relationships, or jobs or our physical health, so when we understand how it affects everything we can better support people and treat them more holistically so that’s what we’ve been learning about at university.

There’s so many more available options and there’s something for everyone I think so whether that’s you want to talk to someone and just talk out any issues you’re having or want to channel that more creatively so you want to do some music or art or if you want to focus on it as a family then you can go to family therapy. There are so many options that I think that’s another reason why it’s such an exciting time to be doing it now because we have that chance to be more creative and we have that chance to explore different options with the patient based on their preferences

Martha Dixon 04:19 Their preferences – this concept is also a key cornerstone in today’s treatments.

Jules Pretty 04:25 This marks another important shift in UK policy on mental illness.

Wayne Martin 04:30 I’d like to say we’re in a slow motion revolution in care context, including mental health care context

Martha Dixon 04:37 Professor Wayne Martin from the University of Essex uses his philosophy research to help this revolution here in the UK.

Wayne Martin 04:45 I direct a project called the Essex Autonomy project, which is a research project and public policy project that focuses on the ideal of self-determination in care settings. Really starting after the war, Nuremberg there was more and more of an emphasis on human rights and self-determination as being important values in care settings. So that’s been a process that’s been changing if you think back before that it was more of a model of doctor knows best – follow doctor’s orders but we think now more of a partnership between care providers and care recipients. And so that’s autonomy. That’s trying to build in the value of autonomy into care settings and to re-regulate care practices in conformity with that kind of ideal

Jules Pretty 05:41 Wayne’s groundbreaking work is about helping decision makers ensure mental health patients are very much involved in their own treatment processes – and they have the free will to make choices.

Wayne Martin 05:52 Some of the ideas that inform care practice and the regulation of care, the adjudication of care, relationships, they are philosophical ideas. There’s a famous Department of Health memo from 2010 that says ‘social care in the 21st century should be about the maximisation of autonomy’. That’s a new idea and it’s also a philosophical idea. What is it, is it autonomy as a kind of freedom. Freedom and philosophy that’s one of the things we worry about. What is freedom? So what does that mean concretely and how does one embed it into new types of care practices. That’s the kind of philosophical angle.

Wayne Martin 06:45 A lot of our practice is as well as the strictly academic side is focused on providing training for professionals. There are a lot of professional roles in British life in one way or another are responsible for ensuring respect for autonomy and human rights in care settings. So one obvious example is judges. There’s a specialist court called The Court of Protection, that’s involved in the regulation of care practices and judges need training. One of the things our team does is we build curricula and we deliver training to judges. But judges is just one example if you think about social workers, or advocates, there’s a special role called Best Interests Assessors in care home settings

Thomas Currid 07:43 Well I’d like to think that we’re definitely holistic Martha

Jules Pretty 07:48 With the increased prevalence of mental illness in the UK, there’s a real need for new and proven methods like autonomy and social treatments to become cornerstones of all training for practitioners.

Martha Dixon 07:59 That’s where Thomas Currid comes in.

Jules Pretty 08:02 He runs the courses for mental health nurses at the University of Essex .

Martha Dixon 08:05 He says he’s adopted a very different approach in recent years- making him part of the revolution in mental health care.

Thomas Currid 08:14 Whilst years ago I do understand mental illness was treated very much in the medical model, the biomedical model. For example it was seen as having some kind of organic, and it does have an organic basis, but also that it was seen as being able to be treated by medicines alone, or even surgery for example. So over the years’ things have improved, because people have thought about this, and thought well hold on a minute what about the social aspect and what about their psychological aspect.

Jules Pretty 08:56 This new teaching approach that includes autonomy and social treatments is something Thomas sees as a great benefit for patients.

Thomas Currid 09:03 Yes we still use physical for example we will use medication but we also understand that people do have many other domains that are important and it’s these domains that are will enable the person to enjoy life and we’re about ensuring the individual that we care for. We want to them to flourish rather than languish so yes over the years it has definitely there’s been a move from the more biomedical model to the more biopsychosocial model and if you think about many of the approaches that are currently in use we’re now going to other areas such as mindfulness for example. We use mindfulness in practice and we look at a lot of other more contemporary practices as well.

Martha Dixon 10:06 The new landscape for mental illness in the UK includes autonomy for patients and social treatments but what about preventative care before people end up with the NHS?

Jules Pretty 10:18 Figures show the majority of mental health patients develop their conditions when they are young.

Martha Dixon 10:23 Meditation is proven to help children, but it’s falling to charities to provide the service in schools.

Meditation session 10:32 On the tip of your hand to the bottom of your feet my entire body is comfortable

Martha Dixon 10:39 Like this one in Northwold Primary in London

Pupil 10:42 When you’re meditating you can put everything aside and concentrate and think about anything you want so you become calmer. It helps me take a calmer approach, and helps me just calm myself down, take a little breather and it just helps me get on with my work and makes me more peaceful

Srivati. 11:11 My name’s Srivati and I’m part of Breathing Spaces in Schools and what we do is teach mindfulness to pupils and adults in schools. So we’re connected with the London Buddhist Centre which has a secular mindfulness programme also called Breathing Space. But our focus is definitely bringing this life skill to young people. One of the things we’ve learnt through just being young people ourselves and those of us who teach young people is that like us adults they struggle often with the same kind of things. They may get anxiety, quite a lot of them suffer from depression, which is worrying in itself and just having trouble coping with different situations on an ordinary level so those of us adult practitioners of mindfulness we found it helpful for us so wanting to share it with young people.

Pupils 12:05 Meditation has made me calmer during work and when someone annoys me I don’t rush off I just meditate and it all feels better.

It helps me to focus and when you come back from in the playground you can calm down and you’re in a state where you can finish and do your work and continue in a calmer state

Srivati 12:28 I think it is part of the bigger picture of mental health the incidence of depression in people is starting much younger. So the earlier you start to experience depression the more of your life you’re going to be struggling with it. So to have these tools of mindfulness when you’re young is going to be really helpful to offset that repeating.

Jules Pretty 12:58 And this approach is also being embraced by Essex academic Caroline Barratt. She’s a pioneer of a method called contemplative pedagogy.

Caroline Barratt 13:08 So contemplative pedagogy is a way of approaching teaching and learning that really embraces the inner experience of students. So very often in higher education we’re very much focused on teaching students about the world around them. But by bringing in contemplative practices into the classroom and into the way that we teach and help our students learn we can support them to become aware of what’s going on for them in their own minds in their own hearts and connect with their own sense of value and where they want to go in the world.

Martha Dixon 13:41 So Caroline what is taking part in this practise actually mean if you’re at university or college?

Caroline Barratt 13:49 So sometimes it might include something like short mindfulness practice at the start of a class to help students become more focused. For example, we might ask them to spend a few minutes just focusing on their breath to help them calm down and settle as they arrive in the classroom. Or it might include something a more reflective space in which students are really asked to perhaps write about or talk about how they’re being affected by what they’re learning and their experience of that and they might share that with colleagues or they might keep it to themselves.

It’s about introducing students to their own minds. So very often in education we just take it for granted that students have minds that are capable of learning. And we often come across this model where we think of ourselves as teachers and filling up the minds of our students. If you like with new information.

But actually each student will have a very, very different subjective experience of learning. Each student if bringing a very different range of conditions into the classroom with them and so by allowing space with the classroom activities for students to become aware of how they’re being affected by what they’re learning and the things that their mind is doing while they’re trying to learn. I think it’s very empowering. It enables students to notice when they’ve had emotional blocks to learning or perhaps where they’re becoming very distracted and then it gives them tools to help them overcome that. It’s really about developing awareness I think that enables students to then make positive changes and learn more effectively and more deeply and in ways that will help them to see the world more differently.

Caroline Barratt 15:45 In a way it’s a new thing but historically university education was very open to these ways of teaching and learning when it first developed but over time we’ve become more technically focused because if you like and I think the contemplative aspect of learning have somewhat been lost.

Jules Pretty 16:14 Caroline has established a new organisation of educators – spreading the word that good mental health equals good learning.

Caroline Barratt 16:21 I’ve now set-up a network called the Contemplative Pedagogy Network that’s connecting UK educators although it now also has a global audience I wanted to connect with educators that were interested in exploring these ways of teaching and learning because it felt really novel to me and very unknown.

Now we have quite a strong network of educators working in lots of different fields and asking questions like ‘well how do we apply this in economics? how do we apply this in maths? how do we apply this in sociology?’ right across the board and that’s a really interesting inspiration for me.

Martha Dixon 17:02 this type of mental health practice is become more widespread in the UK but often those on the frontline of helping people with mental illness, don’t have this kind of support or extensive training to draw on they’re also often on low pay.

Children’s care home workers chatting 17:20 … she’s going to need a lot of structure routine and a lot more staff attention as well which might be an issue for us ….

Jules Pretty 17:31 These workers in a children’s home are talking about the complex needs of the young people they care for. Chris Nicholson from the University of Essex is here to help with guidance.

Children’s care home workers chatting to Chris Nicholson 17:45 .. yeh, so my sense is this is autism quite high on the spectrum. High its higher functioning, yeh though she is reflective.

Martha Dixon 17:57 Chris wants all care workers in this country to have a better toolbox, to be able to cope with complex situations often connected with mental health.

Chris Nicholson 18:10 Very good and then theres a whole range of different skills that practitions need to have one of the problems in the, let’s say, if I speak very broadly the social care sector including all of these therapeutic and mental health services not just adult elderly care, which is often thought of as social care but much more broadly and we’ve got a real problem in that sector which is that we’ve seen it now through coronavirus and the impact on key workers. We’ve seen some of the problems that they’re not, they’re not given enough training they’re not paid enough they’re not given enough kudos. And in the UK you don’t even have to have a degree to go into that work. It’s as though human nature and working with other human beings is simple work and it’s, it’s far from simple unfortunately. If you’re living in Sweden or some of the other European countries, you would be taking a degree to go into that field and it’s very much more respected and facilitated.

Jules Pretty 19:05 Chris has set up one of the first degree course to give care workers the skills they need. He’s encouraging other to follow.

Chris Nicholson 19:14 So in this country it’s very very disparate. There’s not enough training and therefore people do actually need knowledge. So there should be a syllabus that might include human development, it might include psychoanalytic process and concepts. It may include therapies at work or one-to-one in groups, it certainly needs to include organisational dynamics. Very important. And one of the key things, skills, is to do observation and there are two elements of observation. One of them is the observation of the other and that is your clients and your colleagues and learning to observe and think about that. The other observation is of yourself and that’s what we call reflective practice. So these components need to be built in to any kind of training and uniquely one of the courses that we developed in our Department of Psychosocial and Psychoanalytic Studies is a course called therapeutic communication and therapeutic organisation which is an FdA designed around people that work full time. So it’s quite unique in that sense. And um that really brought into the university. A lot of students who are working in social care and in these quite complex settings, who would never before had an opportunity to do a degree. So it’s been a really wonderful thing and of course then we teach these students and that’s been something I’ve been doing for many, many years. And we learn an incredible amount from them because in a way they’re bringing live material from the sector into the seminar room every week and so it’s fascinating not only for them to apply the psychoanalytic ideas to their work, which they find has great efficacy but also for us to learn a lot more about what’s happening in the sector now. So that that’s a real problem that sector is not well provide for by government in terms of education and training.

Martha Dixon 21:11 We do hope you’ve enjoyed Louder Than Words- the podcast from the University of Essex.

Jules Pretty 21:17 In this episode we’ve heard how mental health needs are becoming more recognised in every part of UK society. From young children – to university students – and to those who care for others will mental health conditions.

Thank you for listening. This was the Louder Than Words podcast from the Centre for Public and Policy Engagement at the University of Essex. You’ll find links to the contributors, their work and books on the centres website.