‘It’s time to talk! — The importance of conversations to support our mental health and well-being in a psychologically informed environment…’
27.01.2023: As I write this week’s PIE blog in my role as lead for Psychologically Informed Environments (PIE), at the national youth homeless charity; Centrepoint, I am aware that next week is ‘Time to Talk Day’. This is promoted to be the UK’s “biggest mental health conversation” (c.f. https://timetotalkday.co.uk/), a day on which we are encouraged to come together with friends, families, communities and work colleagues to “talk, listen and change lives”. Originally launched in 2014, ‘Time to Talk Day’ was part of the ‘Time to Change’ campaign run by Mind and Rethink Mental Illness, that aimed to end mental health stigma and discrimination. This year’s ‘Time to Talk’ day is happening on Thursday 2nd February 2023, and in Centrepoint, we are offering an open space at lunchtime for our staff, wherever they work in the organisation, to come together remotely to talk with the aim that this will bring people together and improve all of our psychological well-being. Therefore, if you are reading this and work at Centrepoint, please do sign up to our lunchtime ‘Time to Talk’ session next week!
So why is ‘talking’ so important in creating a psychologically informed environment? Psychologists know that ‘it’s good to talk’ — after all, that is the basis of many effective psychological or therapeutic interventions to improve mental health. However, psychologists also recognise that sometimes it can be difficult to talk to others about how we are feeling. Perhaps we do not have the language or vocabulary to describe how we are feeling. Perhaps we struggle to recognise how we are feeling, particularly if we are experiencing high levels of stress or we are disconnected from our emotions because of the use of alcohol or other substances. Perhaps, we come from a non-western culture, wherein mental health issues are less discussed or recognised, and possibly even more stigmatised or understood differently. Perhaps we do not feel we have anyone we can talk to because we do not have any psychologically safe and trusting relationships. All of these issues are common in the homeless young people we support in Centrepoint, which can make identification of mental health issues more complicated and in turn, harder to address in this population.
Nevertheless, that doesn’t mean we should not try to identify and rectify some of these barriers to communicating how we are feeling because psychologists also know that the more conversations about our mental health we have, the more likely we are to get the help and support we need and as a consequence improve our psychological well-being. In my own psychology career, I have witnessed the incredible power that comes from talking about our inner mental state with someone we have a positive relationship with, whether that is within a professional or a personal relationship. Talking can literally change lives and sometimes the hardest part is just starting the conversation in the first place. If we are willing to do this, to create that space in our day to talk to others about how they are feeling, we can be powerful change agents in their lives, even if we are not a psychologist! That other person can feel heard and seen, their emotions can be validated and recognised, and then they can move a step closer towards managing them.
It is important to remember that just like our physical health, wherein it is important we strive to have a healthy diet and do exercise to keep fit and physically well, it is just as important that we take care of our mental health. For many of us the last few years with the COVID-19 pandemic have been challenging. Moreover, with the post pandemic ‘fall-out’ and the ongoing challenges of the cost of living crises and other societal issues such as the lack of affordable housing, rising inflation and lack of public sector resources, they are continuing to be challenging, especially for the homeless young people we support in Centrepoint. We are all living with perhaps more uncertainty now than in any other time in recent history. It is therefore perfectly understandable that this might be having an impact on our mental well-being. It does not make us or the Centrepoint young people we support ‘weak’, rather it should be viewed as a normal response to this ongoing pressure.
Research highlights that one in four people will experience a mental health problem in any given year (McManus et al, 2009; Mind, 2014). In any given week in England (c.f. McManus et al, 2016), 8 in 100 people will experience ‘Mixed Anxiety and Depression’, 6 in 100 people will experience ‘Generalised Anxiety Disorder’, 4 in 100 people will experience ‘Post Traumatic Stress Disorder’ (PTSD), 3 in 100 people will experience ‘Depression’, 2 in 100 people will experience ‘Bi-polar Affective Disorder’, and around 1 in 100 people will experience a ‘Psychotic Illness’. In addition, research (c.f. McManus et al, 2016) has highlighted that over the course of an individual’s lifetime, 1 in 5 people have suicidal thoughts, 1 in 14 people self-harm and 1 in 15 people attempt suicide. It is also known that whilst women are more likely to have suicidal thoughts and make suicide attempts (McManus et al, 2016), men are three times more likely to succeed in taking their own life (Samaritans, 2019).
Moreover, whilst these figures are very sobering and perhaps even shocking, the research data from which they are drawn is actually likely to be an underestimation of the prevalence of mental health issues as the research sample excluded many vulnerable populations such as those who are homeless, or are already in prison or hospital. Our own Centrepoint research has highlighted that homeless young people are actually at a greater risk of developing mental health issues than their peers of a similar age in the general population (Centrepoint, 2019 — https://centrepoint.org.uk/media/4650/prevalence-of-mental-health-need-report.pdf). For a further discussion of the specific relationship between mental health and homelessness, please see a past PIE blog here: https://drhelenmiles.medium.com/mental-health-homelessness-time-for-a-change-to-break-the-link-8621f6513e7).
Of note, research has also shown that support staff working with the homeless population also show higher than average rates when compared to the general population of mental health issues (c.f. systematic review — Wirth et al, 2019). This can be related to the specific challenges of working in the homeless sector including managing multiple bureaucratic systems (both internally and externally), high caseloads, witnessing traumatic incidents or hearing about trauma from those they support (i.e. ‘vicarious trauma’) and intermittent or low positive outcome rates that can be frustrating and demotivating. Whilst maintaining professional boundaries, deriving ‘meaning’ from our work and working within a supportive team all help to cope with or reduce the potential negative impact on our mental well-being, the fact remains that working in the homeless sector is challenging. As a consequence, a psychologically informed or PIE approach such as offering staff support, training and space for reflective practice is critical in managing staff mental health so that they don’t burn out or develop compassion fatigue, and can continue to support their clients, many of whom as noted above have their own mental health issues.
Therefore recognising that we need to be aware of our mental health, and take steps to manage it are important if we are to work in a psychologically informed manner in the homeless sector. ‘Time to Talk’ day is just one prompt or incentive to encourage us to start to talk about how we are feeling, in order to help ourselves as well as those we support to improve their psychological well-being. Talking about our mental health reduces stigma, and can be the first step to feeling empowered to access any further professional help we might need. However, even if we are not at that stage, just talking to others can make us feel better (assuming of course that the content of the conversation is neutral or positive rather than negative). Even short or informal conversations and quick check-ins with those around us can be helpful and of course, help us to build relationships with others, which also can influence our psychological well-being positively.
We therefore know that talking is important if we are creating or working within a psychologically informed environment or PIE, but the next barrier is often that we might feel anxious or unsure about how to go about starting that first conversation or concerned that if we do start it, what happens next. The good news is that you do not have to be a psychologist to ‘talk’ to others about how they are feeling! After all, most of us do this all the time in our day-to-day lives with family and friends. The willingness to be open and talk to others is actually often the hardest first step! So what do we need to bear in mind when we do have conversations about mental health or psychological well-being with others, such as our work colleagues or the homeless young people we support?
The most important thing is to consider the ‘time and place’. Not everyone wants to talk all the time, and sometimes there are not appropriate places to talk (e.g. in public areas or in front of others we might not feel comfortable with). Perhaps it might be better to have a face-to-face conversation but equally it might be better to have a remote video (e.g. via MS Teams or What’s App) or telephone call with the other person. If your conversation is face to face, can you consider where are you having it (i.e. is it a confidential or private space)? Remember it might be more helpful to have a chat whilst carrying out an activity (e.g. cooking a meal or going for a walk) wherein you are talking ‘side-by-side’ rather than facing each other, as this can feel less intimidating or anxiety provoking. Of course, it is not necessarily about finding the ‘perfect place’ to talk (does such a place even exist?), but just reflecting on what might make that conversation easier for both parties. What is important to remember is that we all need to feel ‘psychologically safe’ to talk to someone, usually within the context of a developing supportive or already established secure relationship. Therefore, considering what will help the other person or ourselves feel comfortable to talk is critical.
When having a conversation about psychological well-being or mental health, we often can feel like we need to ‘respond appropriately’ or ‘solve the issue’ that the other person is sharing. However, the first thing to remember in the conversation is the importance of just asking open-ended questions (e.g. “How does that effect you?” / “What does that feel like?”) then secondly, listening, really listening, to what the other person has to say. When we really listen, we are giving the other person space to express how they are feeling. Be comfortable with the odd silence, we don’t need to immediately jump in — instead the other person might just be preparing what to say next. Really listening not only helps us to understand their experience better, but also can be extremely validating to the other person. Perhaps this is the first time they have opened up about their thoughts and feelings to anyone, or in the past they have had a negative experience when they did (i.e. they or their concerns were minimised, invalidated or too easily dismissed).
Psychologists and therapists know that by simply giving space to another person to speak freely to you, and responding in an empathic and non-judgemental manner is hugely powerful in starting the process of healing (c.f. Person Centred Counselling Approaches; Carl Rogers). We do not have to have all the answers and some things are not easily solved, especially past issues that cannot be changed. Saying, “I really don’t know what to say right now but I can hear you feel like X and I am just really glad you shared this with me” (c.f. Brene Brown) can be surprisingly helpful and connecting if you really don’t know how to respond to someone’s disclosure in that moment.
If you have talked to another person about their mental health issues or psychological well-being, it is also key to not change the way you are treating or responding to them afterwards. No one wants to be judged, avoided, ignored or gossiped about if they share something personal. Of course, we are used to professional confidentiality when working with homeless young people, but this can equally apply when a colleague shares something with us. Consequently, sensitivity is critical not only during any current conversations but also in our future interactions with them. Of course, if someone shares something with us that suggests that they may be at risk (from others, to others or to themselves), we may need to pass that information on to another person to help them access the support they need but this should always be done with their knowledge and consent if possible.
Finally, when having conversations about mental health, it is important to be patient. We know that it takes time for the homeless young people we support to feel able to engage with us and open up about their feelings. Equally, anyone we know in a professional or personal setting might not be ready to talk about what they are going through despite our best attempts to create a psychologically safe space / relationship with them and start the conversation. That is OK, we need to accept this but the fact we have tried to talk to them about how they are feeling can make it easier for them to speak to us and open up more in the future. Many of the clients that I have worked with therapeutically over the years did not always tell me everything straight away. Instead, I always worked with what they were willing to share at that time. Perhaps you can find other ways to show them you care (e.g. sending a text to let them know you are thinking of them, offering to help with practical day-to-day tasks instead) to remind them you are there when they are ready to talk.
Of course, when someone does speak to us about their mental health or psychological well-being, it can be the start of them reaching out for professional help and we can help signpost them to and encourage them to access appropriate support. For example, within Centrepoint, if they are a homeless young person, you can refer them to local statutory mental health services, GP’s or our brilliant internal Health Team (c.f. https://centrepoint.org.uk/what-we-do/health/), who can offer mental health, substance use, healthy relationships, nutrition and dietary advice or psychotherapy interventions as needed. If they are a staff member, we have various options including an Employee Assistance Programme, our Medicare Offer and our PIE Team, who can offer brief time limited support and signposting to other specialist services as needed. Therefore, please do not feel anxious about starting the conversations with those we support or work with (as well as our friends and family!). Even if you cannot make the ‘Time to Talk’ lunchtime session on ‘Time to Talk’ day next Thursday 2nd February, can you create other opportunities to talk within your workplace? Most importantly, I would argue that we should not limit speaking about our mental health and psychological well-being to just one day. It is good to talk, so let’s keep the conversation going the other 364 days, thereby helping to create a psychologically informed and supportive environment all year round…
