Hello and welcome back to Mind Over Chatter.
The Cambridge University podcast.
I'm James, I'm nick.
And I'm Naomi.
And once again, we're inviting you to join us in our conversations with clever, curious people here in Cambridge.
In this third series, we're talking about health.
And in this episode, we're focusing on mental health.
We're going to cover everything from the.
Prevalence of mental health problems and eating disorders, social media and sedentary behavior.
And video games, including Hellblade.
So who were we talking to in this episode?
We talked to a professor of child and adolescent psychiatry.
Hello, I'm Tamsin Ford
I'm professor of child and adolescent and psychiatry at the Department of Psychiatry.
A professor of health neuroscience.
And a behavioral epidemiologist.
Hello, I'm Esther van Suijs and I'm a mercy program leader at the MRC Epidemiology unit.
As usual, we began by asking our guests to tell us a little about their research.
Yes, well, I and and my group spend our time researching how we can optimize.
The organization and delivery of services and also individual interventions to optimize the mental health of children and young people.
I'm very interested in in perception and learning in the brain and how it might go wrong in mental illness, and I'm I'm very interested, particularly in the the growing field of research that that sees the brain and the the mental processes that it carries out as as being shaped.
Not just by.
What goes on inside the skull?
But as this complex interaction?
Of body, brain and environ.
So my group is particularly interested in trying to understand and change young people's diet and physical activity behavior, and we predominantly focus our attention on educational settings and family settings.
With all our episodes, we always try and you know, set the scene, so to speak in each and give a sort of introduction to each of the episodes.
So obviously with this topic we're talking about mental health.
I'll ask, I'll put this one to Paul to start with.
If you could sort of explain to us what does it mean to have a sort of a mental disorder and how do we classify or who falls into that class of being mentally ill?
Uhm yeah I can see the relief on.
Tangent space there that she didn't get last time.
So that is an incredibly difficult question, and.
You have to remember that.
You know any answer I give is going to annoy and offend somebody.
Uhm, you know there are some people who would completely deny the existence of mental illness and would suggest that actually it's a uh medicalization of an experience that is.
Perfectly understandable as a normal reaction to one's circumstances. I disagree with that. I think there are certain instances in which there are processes that go wrong and require medical intervention, and I.
In psychiatry, we have this profoundly difficult problem that, unlike some other branches of medicine, we don't have very clear markers for when somebody is ill.
We don't have sort of blood readouts and imaging readouts and so.
Forth so the categorization actually boils down to very carefully documenting someone.
Experiences and their reactions to those experiences and then trying to ascertain whether they have particular symptoms.
So are they.
Are they hearing or seeing things that aren't there?
Do they have beliefs that really are?
Possible to comprehend in the context of their their life, so as you can tell, I don't know the answer to your question.
I don't think there's any simple answer and I'm I'm.
I'm blathering a bit, but I think categorization of mental illness is largely down to skilled and detailed history taking.
And trying to ascertain whether somebody has a sort of constellation of symptoms.
And whether those come together in a recognized pattern that we can then say, OK, this person seems to fit into such and such a category, and therefore these are the appropriate steps to take in their in their management.
I'm, I'm sure Tamsin could have given a much more succinct and useful response, so maybe she'd want to chip in there.
I think you did an excellent job.
I think we should apologize less.
We don't have as mental health practitioners.
We don't have blood tests and scans and things you're right yet.
Maybe they will come.
But actually I think there is as much confusion about at what point wheezing.
So you know I end up coughing after every run I do now.
I could go to the GP and say, you know I might end up with an inhaler and he might think I have an exercise induced asthma, but it doesn't get in the way of my life.
I haven't bothered to go and I think there is as much fuzziness.
Particularly in primary care for physical health conditions, I think that one of the problems that mental health has is we use language in a sloppy way.
So we talk about mental health when we think about we're actually thinking about mental illness, and that actually causes a lot of confusion and.
Robs those who are having experiences that they're struggling to deal with with a way of expressing themselves, and I think at the extremes when someone is doing fine or someone is really distressed and unable to function, nobody would query that.
On one side, somebody is doing really well, and they're healthy.
And on the other side, and that somebody is really struggling.
But there is a fuzzy dividing line and I think that comes with the biological makeup of the person.
Some of us temperamentally are much more reactive to things than others.
It comes with the psychological wherewithal.
Of you know what's happened to that?
Individual in the past.
And also their social supports, and that's what makes the difference of being able to cope with the curveballs.
That life throws at you or not.
Tamsin you mentioned here the possible distinction between mental illness and mental ill health, and I know we might also talk about mental disorders.
Can you either piece those apart a little bit or just maybe give us a sense from each of your perspectives?
Which of those we're talking about often?
I think for me, mental health is a spectrum from absolutely thriving and being, you know, really happy and everything going well, which I hope we all experience some of the time.
But let's face it, it's not real life, you know.
There's usually, you know some challenge somewhere.
For most of us.
And we're all going to experience disappointments and bereavements.
And, you know, stressful situation.
And then at the other extreme, I think when something is getting in the way of your ability to cope with your activities of daily living, so it you know anxiety is a normal reaction.
Feeling sad as a normal reaction, psychotic illness isn't.
It's very unusual.
But if you have things that are stopping you working, mucking up your relationships, interfering with their ability to eat, sleep.
Then I think you are shading into disorder, but that it's not a kind of sharp division, but I I think you would find the same if you really examined it.
For many other conditions, you know we talk about.
Uhm, you know stages and grading of cancers.
But actually you know, again, it's not these sharp categories that fit neatly into boxes.
This will be a spectrum of progression from totally benign to aggressively management.
Can I just ask where do you see mental well being fitting in that terms?
I I think it's a really interesting question for me.
I see health as.
A spectrum and I would say well being fits with the thriving and doing really well, but like quality of life, uhm?
You can have a long term mental health condition, but have fairly good well being with it and the same thing.
You can have chronic physical health or a disability, but score highly on well being and quality of life measures.
So it it's not as.
Simple as just being the top end of being mentally healthy.
Yeah, and just.
To follow up, one of the points Tamsin.
Made about, uhm, you know psychiatry in in some ways being like other branches of medicine in that there's often a fantasy that a diagnosis in standard medical practice is a very clear cut one with not.
No need to worry about psychological and social factors, but of course that's completely untrue and.
You know there was a there was very famous paper in the 19 seven.
He's pleading with the profession as a whole to introduce the biopsychosocial model in recognition of the fact that no illness can really be fully comprehend it outside of the social situation in which it's occurring.
And psychological processes that go along with it.
And I think psychiatry is probably been one of the quickest branches to.
To take take up that challenge.
So in many ways.
Uhm, you know the problems we're dealing with are.
Are not unique to psychiatry and some of the criticisms of the diagnostic process.
I do think, ignore or take a very simplistic stance that if you can't find a biological abnormality, then it's not an illness and therefore psychiatry is not a branch of medicine that that really it.
It's a slight caricature, but it's a position that is held.
And I think anybody knows anything about illness and health would recognize the over simplicity.
That and in.
Fact one of the things we can't do is diagnose health.
You know, the definition is that it's a state of complete psychological, social and physical well being, which of course.
Very few of us could actually aspire to.
I'm just gonna jump in here so I'm not going to ask for a diagnosis of health, but I'm going to ask about the scale of the problem so we can think about this context in a physical sort of an A mental capacity.
So eating disorders as well as mental health disorders and do they differentiate?
But if we're thinking about the scale of the problem?
You can read quite often.
I'll say they some say that we're sort of living through a sort.
Of mental health crisis.
Now I don't know if you agree with that, but can we sort of talk about the scale of the problem that we're finding in a wider context?
I can certainly speak for young people and I get a bit rusty with grownups.
But I've been involved in large national surveys of the mental health of children and young people since the turn of the century.
And probably for about the last seven or eight years, there's been increasing sort of concern about the mental health of children and young people in the media talking about a tsunami of referrals.ct, there were big surveys in: and then:
What is much more concerning is the rates of problems or disorder, by which I mean young people who are really struggling with the things you kind of need to do to get on with everyday life in our older teenagers and particularly young women.
Coming out of surveys of Adam.and the last survey in: nt back to see this sample in: In: a big gap in time between the:
Affected so the only adult data I do know is from a panel survey where people come in at the age of 60.
Team and then they they go back every so often and the same people are filling in the same questionnaires and that shows that there are quite.
There's some very different directory and sort of trajectories, so there are some people who are doing consistently well or even very well, absolutely thriving all the way through the pandemic.
Then there are others.
Who have done.
Consistently badly and there's a group where there was an abrupt deterioration, and then they're sort of settling down a bit, but they don't get back to their baseline level, and then there is a group whose mental health is just deteriorated and what seems to.
Be driving that.
Uhm, this is not an experiment, so we can't say it's causal, but it it seems to be financial insecurity, housing, insecurity, job insecurity and coming from more marginalized groups.
So women, ethnic minorities.
Uhm, you know.
So it's the standard risk factors that we know are very bad for.
Your physical and mental.
Health, but they you get these stacking of risk factors on and certain parts of society.
Paul, I know you did a heroic review of the data for the Cambridge Neuroscience talk that we that you spoke.
I don't know if you've got more to say on this.
I mean, I think you you've not just summed it up very beautifully, but you've updated what what I was reading.
I mean, I I was slightly.
I I think the pandemic in some ways has thrown into relief.
Some of the uncertainty in this middle ground that Tamson talked about, which is that blurred area where we're not quite sure whether we want to call it illness or disorder or what.
And and I think one of the striking things about some of the work coming out of.
Pandemic was that.
A very anxious and depressing situation was making people anxious and depressed.
And and I think that there can be a tendency to.
I mean, I know people were criticising some.
Some of the research for medicalizing, a very normal reaction.
And and I think that's a that's a.
That's a fair criticism.
Can I just ask in terms of the UM you were talking about?
The prevalence tamsyn?
So about how many people at one point have a a particular disorder or are not mentally well?
And do you have an idea of what part of that is due to new people developing mental illnesses?
And what part of that is due to the fact that actually because surfaces have been reduced so much over the past few years, actually they're people who are?
Are experiencing mental illnesses for longer than they might have done.
In previous years.
That's a really good question and and I can't.
I don't think we have the data to answer it.
I think we should.
Be gathering that kind of data.
And I think we should hold onto the facts.
So let's take children and young people into sort of emerging adulthood.
You know, late teens, early 20s.
So one in six is a scary number to not be doing very well, but that still means five out of six are doing OK.
Those with existing.
This is sort of at a population level, not a service level.
Those with existing mental health conditions have done really badly.
They are of another high risk.
Group for having consistently poorer mental health throughout.
In these longitudinal surveys.
What we have seen is lots of new presentations of eating disorders.
And particularly again in young people so.
So not only are
They increased so doubled at the end of last year in children and young people, and I don't think it's that different in adults.
It's certainly a very very substantial increase.
But actually the.
Biggest increase has been in emergency and urgent presentations, not in routine presentations.
So you've got.
A combination there of of both new.
You know new development of eating disorders, but also presenting later.
Whether that's because it was harder to get to services or people were worried about going to services because of the risk of catching COVID.
Certainly, and for other referrals, which of course quite a lot come through.
Schools, so when schools were shut, it's not surprising that there was a big drop.e was a reluctance. So in the:
As a deliberate decision, now we're about to start some services interviews with a sample of of those young people and their parents to find out what that was about.
Because we kind of need to know.
And because you know, you pay a heavy developmental price as a young person if you are not functioning for three or four or six months, you know that that's kind of could be a whole academic year at school that you then have to catch up on whilst you're also trying to protect your mental health.
OK, let's pause a moment.
We started this conversation with what turned out to be maybe one of the most difficult questions to answer.
It's a pretty reasonable one, though.
So what does it mean to have a mental?
And it turns out there's no simple answer, particularly because we don't have any clear physical markers that indicate when someone is mentally ill.
It's not as if we can run a blood test or perform a scan of some.
Sort well, not yet at least so as tamson.
And Paul said.
Working out whether someone is mentally unwell.
Is therefore more like piercing together a jigsaw puzzle of various indicators.
Paul described it as putting together a constellation of symptoms and then asking whether those symptoms come together in a recognizable pattern.
Sort of like the Big Dipper of mental health or the Little Dipper Orion's belt.
The key point is that if and when something is getting the way of you going about your daily routines, working, eating, sleeping, watching the repair, shop playing mousetrap.
Then it's more like.
You might have a mental health condition.
Tamsin compared it to the stages.
And gradings of cancers?
There aren't any sharp distinctions between different stages.
Instead it's a spectrum with lots of fuzziness in between.
OK, but where does mental well being?
Fit into the mix.
What we heard was that we should think of health as a spectrum.
So many spectrums like a flag shop during Pride Week.
A spectrum of well being at one end and illness at the other well being corresponds to thriving and enjoying a good quality of life.
That being said.
You can have a long term mental illness, but still have pretty good well being.
Just as you can have a chronic physical condition but still have a good quality.
And what do we learn about the scale of the problem?
How much mental ill health is out there?
Well, one of the key things we heard was that on a national level, there is increasing concern about young people, mental health, those aged between 16 and 24.tal health of young people in: ss, which isn't great, but by:
Is there any chance this deterioration?
And mental health has been caused by the pandemic.
Well, these studies can't prove that the pandemic has caused mental.
Ill health there correlation studies only.
If there's one thing I learned in stats class at school, it's that correlation does not equal causation.
And if there's one thing I learned in stats class at school, it's that wearing a graphical calculator in a holster on your hips so that you can whip it out and calculate a confidence interval at a moment's notice is mega cool. Shout out to Mr. Harpley.
So no, we can't say for certain that this deterioration in the population's mental health is necessarily because of the pandemic.
Another important thing to keep in mind is that we heard the risk factors for poor mental health.
Basically the various things which might make it more likely that you suffer from mental ill health stack or pile up on one another, making mental ill health even more likely if you meet multiple risk factors.
And those risk factors can include things like financial insecurity, housing, insecurity, and job insecurity.
Basically, of any sort.
And being part of a marginalized group such as women and ethnic minorities.
But did I hear that this data has its critics?
Yes, that's right.
Paul pointed out that the medicalization of a normal reaction to a stressful and anxious situation.
In other words, treating the natural anxiety and depression.
Which might result from a global pandemic lockdown and COVID.
In mental ill health.
Has come in for some criticism.
OK, but even if.
We accept that the prevalence of mental health problems in the UK has increased.
Why is that?
Is it because more people are developing mental illnesses or is it because available services to help people have reduced in recent years so we have less capacity to prevent people from becoming unwell?
Or it could be that people are now experiencing mental ill health for longer than they would have because they're not getting.
Created so that the numbers suffering mental ill health at any time are.
Slowly getting bigger.
Well, this is the.
$1,000,000 question isn't it? But unfortunately we can't ask the audience or phone a friend.
We can't even look deep into Chris Tarrant's eyes for the hint of a clue.
No, basically we don't have the data to answer the question, but we should get that data.
Agreed, although when we say we, I'm hoping that doesn't include me personally.
I who wouldn't know where to start.
So even if.
One in six are suffering mental ill health, which is pretty awful.
I guess that means at least five and six aren't.
That's true, I guess.
The glass of mental well being is at least five sixths full.
Yeah, I'm an optimist like that.
But unfortunately there's more to worry about hiding behind those numbers.
For example, we also heard that there's been a big increase in eating disorders.disorders has doubled between: and:
And on top of that, we're also seeing a big increase in emergency presentations of mental illness, which means that people are only seeking help at a much later stage of their illness.
This could be due to COVID.
Maybe they don't want to risk heading into a hospital and possibly catching something.
Or maybe they are reluctant to seek help and feel like they're putting a burden on the health care system at such a difficult.
It might also be that people are aware of how many others are struggling and feel as if they need to stay strong and therefore avoid seeking help until things have already become really bad.
Thinking about young people in particular, Tamson stressed how disruptive mental ill health can be if things got to the point where school is being missed, which might really affect a young person development.
Esther, maybe you could say a bit more from your perspective about what else is going on with children, adolescents and young people, maybe, especially during the pandemic that surrounds their mental health, so they've they.
Presumably there's also their physical health.
There's their diet.
There's what they're doing.
From a day to day perspective, you know, can you say anything about that?
Yeah, so so.
My research particularly concerns physical activity behavior, sedentary behavior and and to a smaller extent, dietary behavior.
So we know from previous Surface Pre pandemic that adolescents between the age of 11 and 18. Actually 80% of them are not sufficiently active.
And what we mean by that is they don't meet the World Health Organization guidelines of engaging in 60 minutes.
Of moderate to vigorous physical activity per day.
And that's a staggering number, which surprisingly hasn't changed much in the past 20 years.
And we also know that children spend a lot of their time being sedentary and over the past 20 years that has changed from spending time in reading and maybe playing musical instruments.
To more screen based activities and particularly obviously in current days, it's around the playing video games and social media, uhm?
We know from a mental health perspective that there are associations, particularly between sedentary behavior or the amount spent.
Amount of time spent using screens and mental health outcomes later in life.
So maybe even within our lessons, if we look at three or four years.
Later, but even we're able to predict mental health in sort of middle adult.
Good, but very interesting.
Quite recent research is showing that it's actually the sedentary behaviors and also the screen based behaviors that are mentally passive.
So where you're just absorbing information you're not actually actively engaging with it.
That tend to be most detrimental to children and adults, mental well being and mental health.
And and so.
But and it's those are activities like TV viewing, but also listening to the radio.
For example, they're not necessarily the screen on screen divide, because actually playing video games is actually quite mentally active and that.
Doesn't seem to show that strong association with mental well being.
Obviously there is a a group of children that have problematic gaming, and we're not talking about that population.
Could I ask?
Yes, I mean, I think that's really interesting.
I'm I'm fascinating to hear.
Does that sort of behavior interact with, say, consumption and things like that?
I mean, are they more likely to be eating when they're reading or or listening to the radio?
Does it sort of?
Is there a sort of, I suppose synergistic?
Is is the wrong word?
Sort of interactive effect.
I think that's a really good question and we don't tend to have the quality data to assess that because it's we don't have simultaneous data of actually what children are doing when they're sedentary, and what they are consuming at that time.
What we might have.
It's data from monitors that such as padama tresoar accelerometers that allow us to assess.
OK, these children are not being active at the time and we then might have a simultaneous diet diary and we know what they're eating, but actually the interesting element is around what they are actually doing when they're being sedentary, and so, but I do think that actually, when you're being mentally active, you will probably have some.
Some sort of physical activity as well.
Not very active, but when you're gaming it's quite difficult to be eating 'cause actually you're using your hands closely.
Similarly, when you're playing a musical instrument when you're watching television, actually it's much easier to consume, so I think it's a really interesting question, and that it.
It could be related to both physical and mental health outcomes.
And you you talked a little bit about the last 20 years and the way in which some of those numbers you told us about have been pretty constant over that period.
Has there been any noticeable change during the pandemic and during the last 18 months or so?
Uhm, so the data format is pretty weak.
For many children schools are a very important source of their physical activity.
So for example here in the UK they they would do their PE there, but there's also after school sports and and other sports activities around school there might be active travel.
Uhm, so we have seen a drop in physical activity during the lockdowns when schools were closed for many children they were able to pick up again on their activity levels when schools returned, but it's very important to recognize that actually schools didn't return to normal.
And particularly in terms of the activities they were offering, so PE was very restricted.
Many schools were not offering after school activities.
And I think that haflett that has left many children in and so the children have gained more weight over that period.
We do have quite a good evidence on that.
They will have lost some of their physical fitness and we know that these are key barriers for children to become more active again.
So actually I think some of the longer term data will demonstrate a steeper decline in physical activity levels than they have been doing for the sort of up until the pandemic.
And can I ask Esther this this idea that's been a reduction in meeting the the sort of target of 60 minutes?
Vigorous exercise today.
Has there been any other?
Factors that might have driven that, such as, has there been a reduction in in the provision that schools make for physical activity or after school clubs or things like that?
Do you mean in general or during the pandemic?
I'm just wondering, in general 'cause there's a sort.
Of it may be completely wrong, but there's a fantasy that schools don't go in for the same levels of sports coaching and teaching that they used to, and I I don't know whether that's true or not.
I'd be curious to know.
But physical activity I talk about physical activity in each general sense, so it's not exercise or sport or PE.
It's any sort of activity, so we include.
Play in the playground.
I'm going for a walk with your family walking the dog.
Those active travel, those sorts of things.
Uhm, actually there's some evidence that the provision of schools actually hasn't changed that much over the sort of past few decades.
There is definitely a sense that due to a refocus of, particularly from the government perspective, on certain core subjects, and for example Ofsted rankings linked to.
That and things like that that it it has.
It has dropped a bit in terms of its standing, so we all know the examples of when it comes towards this time.
For example, children start practicing their Christmas plays and the first thing they that gets dropped for that is the PE lesson.
So it it it does have.
A lower standing than many other subjects.
But when we look at the data so we know for example, that physical activity declines very steeply from childhood into adolescence and then into adulthood when we look at that data more specifically and look at when physical activity changes in terms of the times of the week, we see that most of that change happens outside.
School, so it's before school it's after school and it's at the weekends.
So actually it looks like schools are able to continue to provide a good provision for children, but it's actually those out of school periods.
That is where the drop is most steeply and where we should maybe focus more of our attention.
Any ideas where where that originates from?
Well it's it's.
I think it's just partly down to the increase.
In sort of.
Homework and things that children have to do is partly due to the attraction of uh, like screens and computer.
Games, but it's also partly due to over time, social norms have changed about what is acceptable for children to do, so this this idea.
This bubble wrap that we tend to talk about that we cover our children with that it's dangerous to go outside and play with your.
Uhm, with your friends without actually parental supervision, go to the playground by yourselves.
We're making playgrounds actually less attractive by children by making them safer.
All of these aspects come into play when we think about physical activity outside of the school environment.
And very quickly, if I could just ask a final follow-up question to Tamsin, we've been talking about physical activity.
To what extent is that a sort of intervention which you'd recognize to improve mental health and well being?
Well, I think again that is a very good point.
I mean, you know if you are someone who is naturally sporty.
Actually, you know the friends of mine, I know who are runners if they are injured and can't run, they're like a bear with us or to.
You know, I think.
They're just the frustration is palpable and for them.
You know, and for me, doing yoga is something that I use that I know boost my mental well being and I really miss it when it's.
However, it has to be something you enjoy.
You can't take somebody who is really not very sporty and force them.
You know, I'm sure if people look there would be a.
Type of activity being it dancing or going for a walk.
You know it doesn't have to be elite sport.
And there is a.
There is an evidence based treatment for depression called behavioral activation.
That's not only about uhm doing exercise or doing physical activity, but it is about scheduling and structuring your day and making sure that you do something.
And of course, if you are doing some kind of.
Activity or class.
There is a structure around that.
There's a time you go.
You interact with people.
You do the activity, you get a sense of mastery and all of that plays in, and in fact, there's a trial being led by a colleague of mine from Manchester of the same kind of intervention in.
In adolescents who that you know the peak onset of depression as a mental health condition, you know the kind of you know getting in the way of studying your friendships and your family relationships, etc.
And of course, it's quite hard.
But one of the things that goes when you're depressed is your motivation to do anything, and then you get stuck in a vicious cycle where you feel ghastly.
You don't want to do anything.
You have too much time for things to go spinning around your head, and therefore you're even less inclined to do something.
So I think you know exercise or activity is.
Is one of those areas where body and mind are particularly closely related.
I think just to add to that is that so, as I said before, physical activity is a whole range of activities and it's not just sport or organized activities and there are cold benefits of lots of physical activity happens outside, and we know that being outside and being in green and blue space.
So being in like forests and being near the sea in the ocean, actually it's really beneficial for people mental health anyway, and physical activity usually comes with a social component.
And I don't we don't understand enough about much of physical activity.
Research is interested in the physical.
Changes that happen in your body when you are physically active, but many of these cold benefits I think are critically important for mental well being.
I totally agree.
And you know, we are social animals, so I think one of the things that has been.
Hard and perhaps particularly hard for those in their teens, which is a time when your peer relationships take on particular importance, and it's you know about your identity formation as you kind of work out here, you are in in your peer group that perhaps is a particularly hard time to suddenly have your.
Social life cut off and where actually social media the active.
Kind of keeping in touch and being able to carry on with some communication with your friends may have been an important mitigation.
This is probably the perfect segue here, Paul.
We've just been talking about physical activity, screen time, and mental stimulation.
It would be great to hear about your work with Ninja Theory on the game Hellblade, which was a huge success.
Selling over 1,000,000 copies. It would be great to hear a little bit about how mental health was such a crucial part of the game.
Well, I I mean, just just raise a hand if I.
Go on too much about this, 'cause I'm very enthusiastic about it and I I'm.
I'm very glad that we've heard from Esther before hand, because I I think it's important that we don't get too enthusiastic about video games because of course, they're just one aspect of how we how we spend our leisure time and.
And there are people who have problem gaming who are unhealthy as a consequence.
Both physically and mentally, and I think that's important to have that in the in the conversation.
So Hellblade was a was a game.
I mean it didn't stand first and foremost as a as a representation of mental illness, but it was a game in which the lead character who's a.
An 8th century Pictish warrior suffered from psychotic experiences, by which we mean her reality was different from those around her.
So she saw things and heard things that weren't actually there.
And so I I was contacted by a video game studio when they were starting to make this and and my initial.
Both enthusiastic, but also slightly dubious.
Enthusiastic because I think video games are extraordinarily interesting instances in which you are very participatory, in which you, you, you sort of take the part of a protagonist and you make decisions.
You you advance through the gain, you learn things in a way that's that's very active.
And but also dubious because of course video games, representation of mental illness has not been entirely respectful or or acceptable really.think somebody did a study in:
They looked at how how mental illness?
Had been represented across a host of of best selling games up to that point, and the keywords that came out were things like psychotic and murder and psychopathic and.
And crazy, you know it was just a sort of trope to motivate the villains in the games, really.
But I went along to the studio and I met them and it was very clear that they were doing it in a very honest and respectful way and they immediately wanted to get people with actual experience of mental illness.
Uh, in the discussion.
So we had lots and lots of discussions about how it could be represented in a game.
What might be the sorts of things that.
And it would.
It would work as as a way of of.
Helping the user to understand what it might be like to go through this this quest while at the same time suffering from horrible auditory hallucinations and not being quite sure what's real and what's not.
And being overcome with the darkness, so so it was first and foremost a game.
But it happened to represent mental illness and and I think what came out of that for me was a number of really important lessons about what happens when you.
When you take your your field and you and you put it into a completely different domain, uh, a much more sort of unusual domain for me.
How about you?
What out the audiences?
What did you get from the feedback from audiences that you wouldn't have normally?
You know, spoken to?
Or had the opportunity to interact with?
Yeah, I mean that for me was the the most amazing experience of it all.
But actually on the day it was released there was this very interesting phenomena where it started to sort of catch fire on the Internet and people started discussing it and they were discussing it and mental illness in a very.
Very sort of respectful way.
It was very much.
Uhm, saying or could this be what it's like I?
Knew somebody who?
Heard voices would have been like this for them, it was.
A real sort of empathic thing and also.
You know, if I.
If I write a paper on hallucination.
If I'm lucky.
Maybe 20 people or read it, including my mother.
But this this game sold 1.5 million upwards of 1.5 million copies, so we know that it's reaching a huge audience.
And then we were getting lots and lots of testimonials from people who'd we played it and who were deeply touched by by what it meant to them.
And and some people were saying, well, you know.
I've had, I played voices and I can now show this game to my friends and say look, this is this is what it feels like and and so for me in terms of impact.
It just felt so so gratifying and and touch.
Thing just to see what people were making of it.
I think for psychosis that's particularly important because it's a much less usual experience, and I mean there are a number of people.
If you ask people.
Just in a population, there are a number of people who do hear voices who aren't bothered by it at all.
And if it's not getting in the way of what you need to do in life.
Then I don't think we should.
Be calling it a problem, but true psychosis is a very unusual experience, whereas you know we've all got anxious about things.
We've all felt sad about things, and that's not the same as an anxiety disorder or a depressive disorder, but I think.
It's much more within the bounds of imagination and mental health or poor mental health is still very stigmatized.
So the fact that this game access loads of people and spark.
Not a debate that was empathetic to the people who are suffering from this condition, who are often highly stigmatized and, you know, there is there is a a reduction in life expectancy of 15 to 20 years amongst those with severe mental illness.
You know they are a very, very vulnerable group and I think you know it's just fantastic that this game got out there and reached so many people and help people understand what might be going on for people who experience this condition.
OK, let's pause again for a second.
We need to catch up with the various layers being added to this conversation.
Like one of those layer by layer pancake cakes they made on Bake Off a conversational, shipped torture.
If there ever was one.
We've not only got mental health, but now also physical activity and sedentary behavior.
How all this interacts?
Sedentary behavior, being lots of sitting look up sedentary in the dictionary and there's a picture of me, me sitting.
We know for example that even in pre pandemic times 80% of adolescents aged between 11 and 18 were not sufficiently active.
Means they weren't getting at least 60 minutes of vigorous activity per day.
Not only is this a big number 80%, but it hasn't changed much in the last 20 years.
Instead, children apparently spend quite a lot of their time being said.
Very, very much.
Hoping this isn't because of the terrible example I'm setting.
Is it because they're spending more time looking at screens than 20 years ago?
Well children, screen based activity has definitely increased over that time, but the fact that the activity levels have stayed pretty constant over the same period means that screens can't have led to any.
Decrease in activity levels instead.
They've probably just displaced other forms of already sedentary activities, such as reading books and playing musical instruments.
Although if you've ever seen anyone play something like a bagpipe or a tuba, it sure looks like there's some pretty vigorous activity going on there to me.
Or the drums, especially if you're.
Channeling animal from The Muppets.
But from a mental health perspective, the important thing is not whether or not an activity is active or sedentary, but whether it's mentally active or passive.
So you might.
Be using a screen, but that's not necessarily an issue when it comes to mental health.
If you're really absorbed in the content and are actively engaging with it, think about the difference between how you might read a good book compared to how you might half watch American TV.
So apparently it's the mentally passive activities which are most detrimental to good mental health and well being.
Oh, so as lot of thumbs up.
To video games.
Well, depending on how you play and the game itself, a video game could be very mentally active rather than passive activity.
And how does all of this active or passive activity interact with food?
Do our eating habits change during different activities?
Sorry, said getting a bit sidetracked here, but Paul did ask the question.
Well, on the one hand, it's very clear that our eating habits do change during different activities.
You don't see Serena Williams munching away on a sandwich during a game of tennis.
Or Paula Radcliffe chomping away on a lobster thermidor during a marathon.
The problem is that we don't have good data on.
This on what and how people eat whilst they're doing other things.
We only have some activity data, for example, from pedometers and food Diaries.
Basically a record of what they ate that day, and as Nick so kindly offered pedometer data could be unreliable if there's any chance your subject might have strapped it to there.
Cat not to bring the P word back into this again pedometers, but has any of this changed since the pandemic?
Are people more or less active?
Well, we heard there's.
Been a drop in activity, basically a reduction in the number of people getting their 60 minutes of vigorous exercise each day.
But children this is probably because of school closures, and even when they were open, various restrictions which stopped them putting on the usual program of activities.
So children have gained weight and lost some of their physical fitness.
If I'm anything to go by, these children will have tripled in weights, can no longer fit into any of their pre pandemic clothes and they're barely able to haul their immense bulk out of bed each morning.
They're so unfit, but maybe that's just.
Me no pits, medio and unfortunate.
Sorry guys, data shows that this fitness is harder to get back once it's been lost, which has a knock on effects for later in life.
So apart from thinking about children, levels of physical activity, are there any interventions we could use to help improve children mental health?
One intervention that was mentioned was behavioral activation, this.
Is a form of cognitive behavioral therapy used to treat depression.
The idea is to increase your contact with positively rewarding activities.
Which for me might be spending time with friends and.
For me, you might be spending time with friends.
So if you notice yourself feeling anxious or depressed, then you turn to this positively rewarding activity, teaching you that your behavior can affect and improve your mood.
Interventions like these are particularly important for helping with depression in adolescence because one of the things you can lose when you become depressed.
Is the motivation to do anything?
Basically, the key point is that we are social animals and that both the body and the mind are closely activated during any activity.
And presumably, that's why social media isn't necessarily all bad.
The active part of social media keeping in touch and interacting with friends and family has been really important in helping adolescents during the pandemic, much more so than mindless passive scrolling through feeds.
Which is a near perfect description of my use of social media.
The latest thing which the algorithm has decided to feed me lengthy videos about cow hoof repair.
That and snippets from its Neil the.
Dog given all the chat about screen time and computer grains, I love that Paul got involved in game development.
Oh yeah, you can really see.
Document how many people might read one of his academic papers about mental health versus how many might play a game which includes an accurate and informative representation of mental ill health.
Well, we know the answer to that second point, at least 1.5 million copies of Hellblade have been sold, whereas Paul tells us that the readership for his papers is approximately 1 his mum. I think he was joking.
Paul argued that the benefits of working with game developers is that the ultimate product can share an accurate depiction with a large audience of what it might be like to live with a particular mental ill.
There's a depiction which players could, for example, share with their friends to help them better understand what they might be going through.
Which is particularly good news, given that mental health hasn't always been represented sensitively by video game developers in the past.
Yeah, that was a shame to hear.
And as our guests reminded us, the stakes are high.
Sadly, people who suffer from severe mental illness live on average 15 to 20 years less than they otherwise would.
So anything we can do to remove the stigma associated with suffering from and seeking treatment for mental ill health can make a real difference.
Both both for.
Tamsin and Esther, I'm curious whether or not you know of how young people talk to one another about their their own health, and 1 anothers Helst.
So is there any data or evidence about the ways that adolescents and young people use, or any of the the media?
They used to talk to one another about their mental or physical health.
That's a really good question.
I don't know of much research in relation to that. Many years ago, Graham Thornicroft, who is now an Emeritus professor from King's College London. He with Vanessa Pinfold, who heads up the pin and engagement and involvement, and.
Organazation they were doing some work in schools and they got the youngsters they were working with, just as a warm up exercise to use all the terms that they knew of for mental health.
There were none that were offered that were positive.
They were all pejorative, and they were all the kind of terms that Paul was listing earlier.
But you know this.
This would have been 20 years ago, Uhm?
As I say, I don't know any research, but anecdotally I think we see two things going on there are.
Horrendous issues with bullying and cyberbullying, which is particularly insidious because you can't get away from it.
You know, we all have our phones next to each other all the time.
If you're bullied at school, at least you go home and at least there are holidays, whereas if it's online, everyone can see it instantly and it follows you wherever you are.
But equally, I think there is more attention in schools to mental health and it gives children a language and I think there are some peer groups where they are, you know my own daughters who are now in their late teens and.
I was very struck by their wisdom actually, in the way they supported each other through school.
So I think we probably see both extremes, and I think we do need some research into this.
I think that anti stigma campaigns have had an effect.
You know there there was.
The time to change campaign which the Royal College of Psychiatrists is very involved with, and I think you know that work hard to shift views and it has, to a certain extent.
But I think we've still got more work to.
Yeah, I I would agree I think so I would be able to comment much on how mental health is discussed around children and young people, but know a bit more about physical activity and dietary behavior.
And I know as part of the school curriculum actually is is part of the national curriculum.
So there are discussions around healthy eating and physical activity.
However, I do think that in many cases they are just tick box exercises.
They are the the the teachers actually offer them and offer them so they think.
Right, uh, uhm black and white manner like you have to eat healthily and you have to be physically active and otherwise you become fat.
That's the perception I've sometimes had from when my children have come home, and interestingly, I was.
I saw the results of some public involvement work for one of the studies that I'm involved in.
Recently, where actually the other lesson says we don't want to hear about physical activity anymore.
'cause we've we've heard so much about it.
And and so I think there is a bit of a risk that by putting so much emphasis on those discussions, we're actually alienating them from what is actually important.
And I think one of the things I always come back to is in to the feet.
I work in sort of physical activity research.
In our field it's very much about physical activity.
Activity is important for your native risk of diabetes or cardiovascular disease or mortality.
When you're 14, that's not really what you're concerned about.
And so, as public health professionals, we might develop these amazing interventions and then try and target the other lessons with talk about their risk of diabetes in 40 years time.
But actually we need to make sure that and, and that's, I think what some of the national curriculum materials relate to as well.
They talk about maybe.
They talk about obesity, but actually most children don't see that that much as a problem, and their parents might not see that as a problem.
But then they refer to diabetes and cardiovascular disease.
Actually, we need to be a lot.
Better at targeting these interventions at the things that matter to the adolescents themselves and I think mental health is really important.
Doing well at school, having friends, being happy with your social life, those sorts of things are what matters to children and other lessons.
Or can I just ask maybe to finish off this little bit?
Has your experience with video games and with Hellblade inspired you in any way to think about?
About other slightly unconventional ways of reaching out to children or adolescents or young people about the experiences of mental ill health.
It has, yeah.
I mean firstly I I think it it's been intoxicating for me to be involved in a medium that so many people are interested in and care about.
So you know, it's just totally unusual for.
Sort of slightly dusty old academic to be doing something that even their own children are quite interested in.
Yeah, and and I think that's really important.
You know, I, I think you know you have to go out and meet people on on a on a ground.
It's of mutual interest, so I've actually consolidated my relationship with the video game company and we are working on a number of projects under an overall umbrella which is.
Going beyond representing mental experience and actually trying to see whether.
Video game design and VR technology can actually help people to change their their experiences by re framing it.
Uhm, altering the ways in which they perhaps, you know, experience their own bodily signals.
There are all sorts of things you can do that bring.
I mean, I suppose.
Change tack slightly.
What video game designers are absolutely brilliant at doing is creating a world that somebody becomes immersed and invested in.
And actually, that has enormously powerful possibilities for good.
Obviously it has possibilities for bad as.
Well, but I.
Think what we're trying to do is harness.
The the positive potential benefits.
So yeah, I mean, it's really inspired me and we're we're working.
We're in quite regular meetings and discussions, developing a series of.
I, I think it's really interesting to hear your experience.
I in my field of research, we tend to sort of go the researcher route of developing an intervention and then trying to deliver it and evaluate it.
Uhm, but we cannot compete with these gaming industries and so everything we do looks very amateuristic.
Even if we do develop collaborations with, I don't know app developers of gaming developers.
We don't tend to have the amount of money.
That's actually required to develop something that is.
Really engaging and really sort of does what you are talking about, and so I think actually the reverse is actually a really effective strategy to really capitalize on the potential of some of these medians.
Yeah, I completely agree.
I mean, I I I've often thought that I as a in designing cognitive tasks to engage people.
Language or memory or learning what I've been trying to do the whole time is develop small gains that they will then play and I will be able to assess how well local.
But of course there's such bad game because.
Boring, you know you have to pay people.
To play them.
As you go into a video game design studio and they're working with the same raw material, they're challenging people cognition.
They're setting puzzles.
They're getting them to learn and update, but they do it so brilliantly and they do it with such sort of extraordinary panache.
So I I feel incredibly fortunate that the the studio I'm working with, Ninja.
Theory in Cambridge actually want to use their skills to do some something scientifically based and potentially beneficial.
So extraordinary, that privilege.
Sorry and a huge potential because you can create a world in which people are not only immersed, but they feel safe so you know you can start to help people deal with anxieties.
For example, if there are particular situations.
Say for example you have a teenager.
These were drawing because they find going into school or going to a social event so challenging you can.
You could potentially break that down into a number of steps and.
Game and and very gradually exposed them.
Come to what they fear and give them a sense of mastery in a way that is.
Perhaps easier and more fun than you know, actually making them work through a hierarchy like that in reality.
And also I mean get getting back to some points the testers made.
You know the new VR technology is offering some very interesting ways of actually being physically active.
There are certain games that you can get with.
The Oculus quest that.
You know they'll.
They'll raise your pulse 80, or you know 20 or 30 beats a minute.
And you're physically very mostly with arms, but I I'm.
Sure there are other.
Opportunities for the future where people will engage in an enjoyable physical activity that's actually a game rather than a sort of chore.
I think that that's a really interesting area in physical activity promotion.
We have tried to look into that, but we also discovered quite quickly that things like, uh, we fit for exam.
Ron Paul actually people figure out very quickly how to do that, expending the least.
Amount of energy possible?
Yeah, yeah, I think I think that's a great point.
Because naturally, you know, our brains are so well geared to doing things with the least possible effort, yes.
That you're you are.
Always fighting against that natural tendency.
And children and all the lessons are the best.
Of that, we might.
Be able to tell us.
Oh wait, no no, no.
I need to like keep going 'cause it's good for my physical activity and my health, but children and other lessons will figure it out within a couple of days.
Yeah I was.
I was reminded by a school friend, he said.
Her kids had pedometers when they were at primary school, and they very quickly worked out that if they sat on a chair and kick their legs about, they could do the number of steps without leaving.
And it hadn't even.
Occurred to me that you know.
That kids would do that.
Well, they put it on the cat or something at home.
Yeah, I'm I'm just going to jump it back in and go back to sort of what Esther was highlighting earlier about the the link between physical and mental.
Health and thinking about the spaces and I don't know if this is a sort of way of rounding it up, but Tamsin working on the Cambridge hospital 'cause we haven't really talked so much about treatment side of it and it sort of almost feels like a perfect fit.
The idea of like thinking about the mental and the physical health.
Yes, well, it's a really, really exciting option.
So the for those who may not have heard of this and.
However, we are campaigning to build a new children hospital at the East of England as the only region which doesn't have a dedicated children hospital, and it's a partnership between Cambridge University Hospitals so addenbrookes primarily.
And also Cambridgeshire and Peterborough NHS Trust which is a mental health try.
Fast and the university and the idea is that it will be to use the jargon a whole new way so it be integrated physical and healthcare so it will just be healthcare and but also there will be a Research Institute on site and so you know we'll be working very hard.
To keep children out of hospital because we know that children recover faster and better when they're at home.
But there will always be some children who do need to come into hospital, however briefly, for their treatment.
And the wards will be split by age, so there will be a floor for teenagers and there'll be a floor for children.
And at one end of the spectrum, they will be particularly geared to high risk physical health problems, and at the other end of the spectrum you know the very severely.
Psychologically distressed children, but actually in there will be space that could flex either way depending on who happens to need to be in hospital.
The idea is that there will be joint training upskilling of staff.
He come from a mental health or physical health background and.
And you know the Co location is really important, but I think we're aiming to go a step further than that, which I'm not sure that there are many places, if any, in the world where there is such an integration and the idea is that it will be seamless both.
Mental and physical health within the hospital, hospital and community and and also research, feeding into service evaluation and quality improvement.
Brilliant I I just concur with what Tamsin suggests.
I think this is so inspiring to be working hard at putting everything onto this into the same space.
And, you know, it's acknowledging the importance of.
Physical effects on mental health and mental effects on physical health as well.
And so, for example, where the situation we're in at the moment, we have superb services for young people with eating disorders.
Not every area has its own inpatient unit.
We have a really good inpatient unit and we can take young people from quite a distance if they need to come 'cause there's not a local bed.
Dead, but should somebody be so unwell that their blood chemistry is deranged and?
Their physical health.
Is at risk at the moment.
They have to be put in an ambulance and sent to their physical health wards in ambrox 3 miles away and their psychological treatment stops.
Probably at the point they need it most.
Which is going to slow down their recovery, whereas if they could have.
Both treatments seamlessly together at the same place with, you know, the ability to very closely monitor physical health.
You know, eating disorders are the mental health condition with the highest mortality, and there you know, people do recover from them, but actually the.
And mortality rate is frightening.
And you know by the point people need to be in hospital.
They are really, really pretty unwell and they do need that close physical health monitoring, but also the intense psychological support that an inpatient admission can offer.
Yeah, I mean I, I think that's a great point and a good illustration of just the importance of this.
You know on the on the wards.
In Addenbrookes there maybe two or three people in total who are young people with an eating disorder who've had to be transferred because maybe their potassium goes right down, which is very very dangerous.
They're just uprooted from the service that they really need psychologically, and then they may be lying in a bed between somebody who's.
Had a you know he's got severe chest infection and somebody else who's got their diabetes and they're just.
They're just taking out of place there.
And although the the psychiatry service within ADDENBROOKES and also the eating disorder service do try to to keep up the input, it's it's impossible to do it when they're when they're on a general ward like that.
It's not the same as having a dedicated team of skilled professionals around you 24/7.
More or less.
Yeah, Esther, are you?
You ever in the position of thinking about what treatment might look like for either mental or physical ill health or poor diets, for example?
Or are you most concerned about preventative measures which avoid getting young people to the point where they need to access something like?
You know this shared mental and physical whole health space that Thompson is talking about.
Yes, so my research is very much rooted in public health and so I am mostly concerned.
Well, actually only.
Turned up with that.
That may not be the correct phrase, but I I think about prevention of physical and mental ill health.
Uhm, so that might be.
I don't know diabetes or obesity or mental health disorders, so actually.
I I do not engage actively with research that is about treat.
And so even when I think about things like childhood obesity, all of my work is around preventing childhood obesity and doesn't necessarily focus on when children are obese what?
What do we do to help them on the correct trajectory again to grow into a normal weight?
And do you feel that some some of these issues you're talking about?
So physical activity?
For example, the diet that children and young people might be enjoying, inverted commas.
Is this sufficiently high up the public health agenda from your perspective.
So yes and no, there's a lot of attention for childhood obesity now in terms of childhood obesity that if we if you look at their childhood obesity plan for from the government that focuses predominantly on eating behaviors and it's predominantly.
On primary school children.
And so there's this whole group of secondary aged children or adolescents that is not completely ignored but largely ignored.
I think they are very much perceived as almost like a lost, not a lost generation, but a lost period.
because actually you can't do much with them.
They do what they want anyway.
And then in terms of physical activity, I think that is largely ignored, partly because actually we don't have very strong evidence for its relationship with childhood obesity.
Uh, but I also think because it's quite difficult to change and the the the strategies the government wants to take are not the ones that work best for physical activity.
But I think it's usually important to focus on physical activity because it has such a wide range of benefits and it may not be directly.
The most important thing for childhood obesity, but it definitely contributes to it, but it has many other benefits including social and mental well being benefits and benefits beyond obesity.
There are or physical health.
So for example, some we know in children some of the blood markers.
Or, for example, precursors of type 2 diabetes.
Actually, they are affected by children physical activity levels.
So, uh, no, I don't think it's high enough on the agenda, and we're working very hard to.
You know to provide the evidence that will actually increase the.
The importance of it.
1 caveat I need to put with that and we don't know what impact.
We've this is hard, but one of the things that really struck me during the pandemic.
Throughout the pandemic, one of the only reasons you were allowed to go out was to be physically active.
So this has really put physical activity at this, so this was like it was up there with going to.
Work if you couldn't work from home.
Actually getting shopping that physical activity was sort of elevated in status.
How that has impacted the population view of physical activity and how important it is, we don't know where we're starting some research about.
Not that, but uh, so I think it it will change over the next few years.
'cause you could almost sort of say that it might have had more of an impact than say like a national or sporting event or some like that in terms of engaging the public in physical activity.
Yes, and also lots of people actually took that opportunity and went out as a family and went out on family walks.
And actually, there's lots of anecdotal evidence that people have really enjoyed that.
Now we don't know how that anecdotal evidence will actually translate into population, physical activity levels, and whether that will maintain.
But I think.
It it, it was really interesting to observe that happening.
You think so.
In the context of the conversation, we've just had, do you think people perceived that hour of physical activity as being beneficial only to their physical health?
Or did they see that as something which was also helping them cope with the mental strains?
And difficulties of of lock down.
So I I think both I think that's a very good question.
I think many people.
I think people obviously responded differently to the situation of the lockdown, but I think many people did see the opportunity to go outside.
Be outside, get some fresh Air's. See some greenery actually was helping them cope with the situation of the lockdown and and so, although there will have been a group.
Of people that will have particularly used it to improve or maintain their physical health, I think for a lot of people who may not have been as active before.
Actually it was a way of coping with the the first of lockdown.
I wonder to what extent as well.
It's illustrates the old adage that you know if you want to increase the extent to which people value something, you just limit their access to it a bit.
And then the idea you know, sort of like.
Some exercise type in a prison.
I imagine where you just think this is my time.
Finally I can do this.
OK, so I guess we've reached the end of the conversation.
I notice the guests had more to say about the stigma surrounding mental ill health.
In particular, we heard that we really need more research into bullying and cyberbullying.
Again, I hope they're not expecting.
Me to do it.
Anecdotally, we know that cyberbullying is especially insidious, as there's no escape, it's insane.
Taneous and there on your phone, which you probably have with you 24/7.
And as well as hearing about the need for campaigns which try to reduce stigma around mental ill health, we also heard about the need for a more nuanced understanding of the risks.
Also heard that although we know there is a link between people physical activity earlier in life and for example the risk that they might suffer from diabetes later in life, highlighting this to adolescents isn't a great way to get them to change their behavior.
Yeah, it turns out that adolescents aren't really thinking much about whether or not they might suffer from diabetes.
40 years in the future.
Hold, I thought.
When I was a teenager I was worried about what might happen 40 years in the future, but less about diabetes and more about whether or not I turn into the teacher from the Browning.
Version and what are this about?
A new Cambridge?
Oh yeah, that sounds both exciting and worthwhile. Like a birthday party at COP 26 or doing the vacuuming with a new Dyson. Assuming you're over 30.
The idea of the Cambridge Children Hospital is that wards will be split by age but not by mental and physical.
Ill health instead.
Physical and mental health care will be integrated with the effects of physical health on mental health and mental health on physical health being considered at the same time in the same place Tamsin described this as treating the whole child.
Which makes me think of Cheerios.
This new hospital configuration would help.
For example, the treatment of eating disorders as otherwise in more traditional medical settings.
The physical treatment might mean that the psychological treatment gets put on hold.
Which is crucially important to avoid as eating disorders are some of the mental health disorders with the highest.
30 rates and by the time that people are in hospital they are often already really ill.
Well, that concludes another episode of Mind over Chatter.
Stay tuned for our next episode on dementia.
Before then, please spread the mind over chatter word.
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A huge thanks once again to our guests.
Paul Fletcher, Tamsin forward and Esther Vance loose.
And finally a.
Big thank you to the sickeningly talented Carlow lad for our music.
And to the.
Equally talented, Alec Sadler for artwork.
See next time.
Well, that's the end for now.
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Thanks also to Annie's weight and Charlotte Zemel for production support. This season we'll be hearing more from Annie in another episode.
Music was by the extremely talented Carlo Lad and artwork by the equally talented Alex Sadler.
See you next time, bye.