Which works best?
People with mental health problems rightly seek help, and often approach their GP as part of this. It’s thought that 90% of mental health issues are dealt with in primary care. In a typical GP clinic about 40% of the appointments can have a mental health component , although I feel in practice this is much higher.
If this is the common, and therefore correct approach, this article considers Lifestyle Medicine and Mental Health and asks what’s the point?
Traditional Medicine approach
The traditional approach that is taught is that of the doctor being the expert, and patient passive giver of their story in symptoms. Doctors are taught early on to convert this to a medical story, reach a diagnosis, and the prescribe a treatment, often in the form of a tablet which the patient goes away and takes.
What are the limitations of this?
So far, so good, as long as it all works. But we know there are various holes in this approach. For starter, the doctor doesn’t know everything, myself included. The patient is passive and the understanding of their situation not really involving them. Key elements of the story can get missed, particularly social stressors and historical issues like trauma and abuse. Unfortunately, medical issues are increasingly complex with people having multimorbidity– multiple overlapping issues, along with polypharmacy (multiple medications). It’s increasingly unclear how best to proceed in this situation. Finally tablets have multiple limitations including no effect; – only about 1:7 people will benefit; side effects, limited compliance (regular taking) especially long term conditions, potential long-term side effects; and withdrawal effects when stopping which can be worse that the original symptoms.
Lifestyle Medicine and Mental Health
How does this differ? Firstly, there is an increasing acknowledgement that the current model doesn’t work for patient, or doctors. But what would a different model look like. It needs to acknowledge and hears the patient’s story. Working truly in partnership with the patient, both practioner and patient being expert skills and knowledge of themselves and their knowledge to the table. It respects the autonomy of patients to make changes to their own health and wellbeing via supporting individuals to make Incremental or large-scale Lifestyle Changes (and not just using drugs). Those Lifestyle Changes need to be backed by scientific evidence which give the practioner confidence in their effectiveness. By taking this approach, the root causes of the issues can be identified and addressed.
What are Lifestyle Medicine changes?
The British Society of Lifestyle Medicine identifies six key areas Sleep, Nutrition, Mental Wellbeing (Stress management), movement, healthy relationships & social connection, harmful substance avoidance (alcohol, drug, and smoking). Regarding mental health we can expand this to include Toxins, Adverse Childhood experiences, medical conditions and lack of purpose.
Surely these don’t work.
I use these approaches regularly with patients in General Practice, but have also made a huge number of changes to my own lifestyle to improve my mental health. These include:
Sleep – regular bedtime routine, turn off digital devices at 2000, no caffeine after 1200
Mental wellbeing – daily meditation
Movement – Regular cycling, walking and badminton
Arranging to see friends, diarizing time for this and family
Whole food-based diet – no processed food, no fizzy drinks, drinking at least 2 litres of water per day
Men’s Mind GP
I believe in this so much I’ve devised a course for men with mental health difficulties to learn about themselves, lifestyle medicine so that they can make small incremental changes to improve and support their mental wellbeing. Click here to learn more. Or email me: firstname.lastname@example.org