296 - Mental Health

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We have many mentions in the media of mental health and mental wellbeing and that we must recognise the things that affect it. I have long said that physical health is distinct from fitness. I think we measure physical health as a lack of physical illness, perhaps as days lost at work,¹  things we cannot do (or no longer can do). Perhaps we measure mental health in the same way, again as days lost from work or things we cannot do. 


Fitness

Personally, fitness is the speed with which my heart rate returns to some target level, say from an exercise target of 155-160bpm (already above the 220-age figure, but where I generally exercise) to 120bpm. 20-30 minutes on a treadmill will finish (for me) at a heart rate of 170±3 and 3 minutes later it is back below 120. However [2] disagrees with me and says fitness is a combination of endurance, strength, balance and flexibility. My flexibility has always been low and yet is perhaps better now than twenty years ago; I no longer jump at all well, either. 

I think the right question to ask would be "Fit for What?"


Mental health measurement

I suspect all the measurements are self-administered, a comparison of how one feels about oneself, so this is subjective measure. During covid lockdown I do not know how to answer the questions that ascertain mental wellbeing. But then I don't most of the time; these are not questions I can answer. My feelings are very much the same as last time I found this, that in order to answer such questions, there must have been some recent change in the status of something like feeling confident, useful, loved, relaxed, interested, etc.

 The WEMWBS score showed a significant moderate sized negative correlation with mental ill-health, as represented by GHQ-12 score, in the population sample (r = -0.53, p < 0.01) using a Likert score, which persisted when a dichotomous scoring method, (with the four GHQ response categories being scored 0,0,1,1 [37]) was used (p < 0.01) (Figure 4). 

WTF? I'm sorry, even accepting that the above has meaning, the statement is not the correlation of a good measure, that's a weak indicator. I'd suggest that lowering people's expectations would raise their wellbeing measure under these test conditions.


Source [7] offers some simple questions and a test, followed by sensible advice, but the advice doesn't vary with the test response. As with my criticism of the title of the NHS,²  much (almost all) of what I can find on mental health is about treating failure to have that health, not measurement of what it is. If you seach for 'test of mental health' you either find subjective tests ("How do you feel about that?") or all sorts of diagnosis of mental ill-health. There seems to be no equivalent of mental fitness. I don't want to know about a lack of mental health, I want to know what it is that constitutes mental wellness. Again, fit for what? seems to be the right question.

Source [8] —with quite the longest link length I've seen in a long while,  over 800 characters— provides a lot of detail in a military context, demonstrating a battery of tests that might be made to decide whether somneone was fit to return to duty, or indeed what sort of duty they were fit for. I recommend scanning this, perhaps even reading it in full. I liked this bit, from the end discussion: 

the DoD could benefit from an integrated set of population-based measures of psychological fitness variables. This type of database could provide our senior leaders with an ongoing assessment of total force levels of functioning and trends over time, a view of the general population functioning across multiple metrics, and a safeguard against potentially misleading interpretations when looking at single metrics.  It then identifies some examples of population-based metrics, most of which are unavailable to me.


I am disappointed that there appear to be no agreed objective measures of mental health. I will continue to search for these. I'd even be happy with equivalents to the mile-and-a half run (from the Army basic fitness test), which might be to complete a sudoku or a cryptic crossword. I use sudoku to maintain various brain patterns, but I do a ridiculous number per day and per year. ³ 

The Nuffield Foundation encourages all sorts of wellbeing and I found a school-targeted document [10] that separated health into four areas: moving, eating, sleeping and feeling. If your answer to everything is 'there's an app for it, probably' look here [11]. Using these four labels we can reduce moving to that 30 mins elevated heart rate per day we're supposed to do, plus some sensible stretching. There's an awful lot of stuff available on eating, but I might reduce that to eating less meat and more fruit and veg, with question marks still on saturated/unsaturated fats, sugars, and volume. We have very little sugar in the house, no butter or margarine, we don't use salt or MSG. I might add a query over dairy products (choces of alternative milks, such as soya) and breads, where we observe that substituting rice for wheat for a couple of months reduces the waistline. But bread is so convenient. For sleeping, I have practised all sorts of regimes. I have learned how to go to sleep easily (quickly); I know I need 50-60 hours a week, outside which range I'm suffering from something (too much work, being noticeably ill). I try for 55 hours a week. I suspect, from the volume of available material, that many people do not sleep well. I'm afraid I don't recognise that state. For feeling, I'm at a loss; I'm an insensitive bugger and this is the area in which I am currently interested.


Mindfulness is another label for mental wellbeing. Issues raised around this label include sleep again, but also simple things like breathing (is that difficult?), relief of stress, avoidance of stress, meditation. I notice that many people identify worry as something that is bad, but I don't see much about dealing with that. For me, this was established before I left school (1971, not 1993, 2007 or 2014); worrying is an obviously unproductive state, so if you have a worry (and I suppose I ought to write 'when I have a worry', but I'm trying to encourage you to think the same way as I do) the immediate action is to identify that this is happening, to search out with internal questioning exactly what is the cause of the worry and to establish what you can do about that. Having determined what the action is, to make an immediate beginning, since that will directly relieve the level of worry. Where there is no action discerned, this is then deemed to be not a worry, one tells oneself off and moves on. Except that if the worrying continues, you have discovered that there was a failed answer earlier, that in effect part of you demands that an action occur. Fine; either you have been lying to yourself or this is an externalproblem casued by other people; go talk to at least one of the relevant parties. Put up or shut up, indeed.
Again, the Army is good at this: recognise a problem exists, identify it, do the Immmediate Actions.

My take on mindfulness is that it seems to be directed towards a lot of calming down. Whether that is a reduction of stress (anxiety, worry and so on) or also a reduction in aggression (bullying, selfishness) I am unsure. Within a school context, the trend to declare an ethos, or the objectives of an ethos, often includes consideration as a value worthy of encouragement. Some interpret that as being equivalent to manners; I might agree that manners are codified ways of behaviour that might embody some consideration.  To me, consideration is looking at the world as other parties might view it and, having done so, then appreciating why it is that their reactions and behaviour might then differ from your own. Of course, that thinking should then modify or even codify your own behaviour.

I noticed in source [8] that resilience, the abiity to bounce back after some set-back, was a feature sought among the military. This is echoed in [12], which also looks at anxiety, depression and stress as if resilience is a problem not a positive attribute. That is because the term resilience is used (there, in [12]) to describe the cultivation of processes to cope with stress. I found a test of sorts at [13], the bank workers charity, which said I 'need to' work on networking; to which my response is I'm retired and in lockdown. Even that apparent need is a subjective statement, surely. I found several courses, the best of which I thought was the British Army version.  You might enjoy [14] quizzes on adjacent matters. Personally, I feel weak at emotional control, in that it takes me as much as ten minutes to calm down from rage; it takes the lady wife two hours, so all is relative. Emotional intelligence is a term I keep running up against; I suspect I have a very low EQ. 


DJS 20200428


1   [1] An estimated 141.4 million working days were lost because of sickness or injury in the UK in 2018, the equivalent to 4.4 days per worker.

The four most common reasons for sickness absence in 2018 were minor illnesses (including coughs and colds), musculoskeletal problems (including back pain and neck and upper limb problems), “other” conditions (including accidents, poisonings and diabetes), and mental health conditions (including stress, depression and anxiety).

I read the chart as saying 12.4%, an eighth, of days lost can be attributed to mental health. That doesn't in any way measure poor performance that could be attributed to poor mental health.

Edit 20200628: Post-Covid, one can anticipate a change in attitude to Sick Days, to include effective self-isolation. Some of this time will be rescued by working from home (WFH is so close to WTF), but the isolating worker who cannot WFH will need state aid (sick pay). It would be very good if this new attitude extended to being sent home for being below par mentally, too. The problem we have is that we are so very unproductive anbd that we persist in measuring effectiveness by length of the working week. I still say that mostly this reduces to a lack of trust and that this is a systemic management failure and not a worker failure. I asked the wife what she thought WFH stood for; she thought 'What the Fuck Happened?.


2    The National Health Service behaves more as a national failure-of-health service. A health service would do a lot more pro-active work to prevent lack of health. I am not at all saying they do none of this; I am saying that the perception is that the NHS is where you go when your health is failing.  
How do you test "Are you healthy?" I'd guess most of us do this in a negative way, like counting days off work or things that cannot be done. [I want to run a two minute half-mile, but I never have done that; I'd love to do a five minute mile again; I'd love (now) to run a six or even seven minute mile. Are any of those useful tests of 'healthy'?  Compared to other people my age I am well to the right on the distribution curve for most positive attributes; I'm low on flexibility but have always been thus and less so now than forty years ago. Is this healthy?  Further, do we misuse words like fit, well
 and healthy?

If one takes up the question 'fit for what?' and applies it in either of the mental or physical sense, then that questions what you consider (or anyone else considers) is reasonable behaviour. Taking the subjective measure route from the mental health business, one would rapidly ask "What would you like to do?" considered in the previous paragraph, or taking the National Ill-health service attitude, look instead at what one cannot do. And, presumably, compare that to some subjective or objective list.


3  Cool Sudoku gives me 6-10 daily puzzles of different styles (I moved from 6 to 10 during 2019); about 45 minutes total of an early morning. Sudoku Killer from Megafauna supplies me with some 250x5 harder puzzles, at 5-25 minutes each. Sudoku Times from Triniti gave me 30,000 puzzles and will take me the rest of my life to finish (I've about 4000 done so far on each of two gadgets); I can now do the Hard level (3 of 4) with no check marks 80% of the time (and rising) and the Hardest maybe 10% of the time. With checkmarks, a poor performance is over 10 minutes. All of these are on my iPads and I quite often do a puzzle on both gadgets, well separated in time and never repeated even in the same week, so I'm unaware of the repetition.

Outside lockdown I do the Times Cryptic on a Saturday (that's two crosswords, one Jumbo) and would usually to 90% of one of these without aids, once or twice a month needing no aids at all. Plus of course all the other puzzles, but I don't attempt the Listener, the chess, scrabble or the Latin crossword.


4   Mental resilience link

1. negative thoughts vs positive thinking

2. emotional control. 

3. mental rehearsal, positve imagery (seeing yourself achieve

4. anxiety and phsysiological arousal. learnoing to calm down, mostly by breathing techniques

5. Goal setting.


5   EQ test I realised afterwards [13/20] that this was an American test. Also, that I am used to facial expressions used to convey ancillary messages. Third, that this test is very much biased to a norm I do not recognise. As I learned when living in China, facial expressions are something we learn, but what they are and what they mean can be very different. For example, a Chinese will stick its tongue out, gripped between the teeth, in a way that in Britain might be read as cheek, concentration or trying not to laugh; it means they are embarrassed, probably by your western behaviour.

EI test [54/75] says I'm merely OK, with 56 marking the start of 'good'. That suggests I have changed quite a bit in the last ten years. This test was broken down into five subsections, in which I score evenly (10,10,12,12,10). I also got 54 on communication skills. I did far better on the leadership test, 67/75, which said I had low self-confidence (don't agree) and poor emotional intelligence (agree).


[1] https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2018

[2] https://www.everydayhealth.com/fitness/how-fit-are-you-a-fitness-test-for-adults.aspx

[3]  The many pointers I found to this all failed to load, so copy and paste the link:  I was amused/amazed that this stopped when Obama ceased being president. Try this link. https://www.murrieta.k12.ca.us/cms/lib/CA01000508/Centricity/Domain/1245/Presidential_Fitness_Award_Qualifications.pdf

[4] https://www.washburn.edu/student-life/recreation-wellness/employee-wellness/documents/EW-2011-President-Fitness.pdf is the President's Challenge as it ran in the US to the end of August 2016

[5] https://www.ukkinstituutti.fi/filebank/500-ALPHA_FIT_Testers_Manual.pdf

On August 31, 2016, the programs that comprise the President’s Challenge underwent an organizational transition to better serve the American public. New and existing partnerships are providing additional resources for these programs to improve their efficiency, accessibility, and physical activity and nutrition tracking options. As part of the transition, the President’s Challenge office in Bloomington, Indiana, is closed. I really didn't find any replacement, only lots of froth saying it is somewhere now not visible.

[6] https://www.fph.org.uk/policy-campaigns/special-interest-groups/special-interest-groups-list/public-mental-health-special-interest-group/better-mental-health-for-all/measurements-of-mental-health-outcomes-and-key-sources-of-data/ The test itself is at figure 1

[7] https://www.nhs.uk/oneyou/every-mind-matters/your-mind-plan-quiz/?WT.tsrc=Search&WT.mc_id=MentalHealthGeneric&gclid=EAIaIQobChMI06isjv2N6QIVkUDTCh1B7A6jEAAYASAAEgIpEPD_BwE

[8] https://watermark.silverchair.com/milmed-d-10-00073.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAngwggJ0BgkqhkiG9w0BBwagggJlMIICYQIBADCCAloGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMgnP2jkpSr1esOqE2AgEQgIICK_7TC3QXMlqmIIiyL5TZ_c4HgxVBSsRn9gZ19IcoofLcAuuvbMWt4fGSI2qzZDd3RjUGuYPdIYJU1n-7Nt7vPSZMrUfrL2p_XcoCFctV8AFsRNzTq8nsPHxEAN0SsSFw3M_tPVdgLYcTXH6MKHTDN8NPvjBSTu7Rnq-tR4bcxQdrndDpG7VHaQNJfFRxU-hW8S3oZFRakrJlR1OFeMEMZY7d5iaitUQcnWOfsNoyp34TSwe1y7gdJpNhJ5ZZqO9CzI9yXEv4izMnxv_4gQRFfiqoz658UBw6mfv9BFbrmGDTtWOLBePsJ1fd_JuOVN2RnysOjQ78kFygpsrPQGFmGbu80HqokvvRFvVzJncTGTy72bcu4kMr0KFQ1C62JY3PB13ltQDxK73084DEqMkW2DJNRxKhA8KoTGnIKkFmfPs6odk-WxfryKuy6XhbxT7vlnuRr2E9K_6wVJJGuLoyQ6lxDvSkCynjUjUlSoOss6fQjNxzLflrqAscAZ8KgHRrduIkAvW2ToSOvQIbVpMuaP6LsimY5sYRPj8O3PrsMq3-OMNdogga1hya_HAYcGLtavuFP7Q6xtLE3zMxgRBSvD6qbskZAoC2CAdj0q27I5lNKJfjq8HtV55CW0kpz2-k4tNkTs7tdzRB3k138rL8gCJtdv1BCGwbkdr2hUuX3jh7xotYUBvV2tY1NWndLHEmSVtob36skVhpL2_bSS3MSjoAwpsuk_7bm9ZXKw

The references would make a brilliant reading list.

[9] https://www.psycom.net/quizzes  You could have fun showing that you have all sorts of problems you didn't previously have a label for. Or a lot less fun if you decide you really have discovered that you have a problem. Or a problem with an identified label, as if there being a name for something makes a difference.

[10] Developing a whole-school approach to wellbeing - Nuffield ...www.nuffieldhealth.com › downloads › nuffield-health...

[11] https://www.nuffieldhealth.com/article/25-essential-apps-for-a-healthy-mind-and-body

[12] https://wellbeing.foryoubyyou.org.uk/?gclid=EAIaIQobChMIz5ffgP6P6QIVx-d3Ch3EqQTVEAAYBCAAEgLfFvD_BwE

[13] https://www.bwcharity.org.uk/resilience-check

[14] https://www.3smartcubes.com/pages/premium_tests/

DJS is 'fit': [2]

Cardio Step test 12"; answer 60 bpm, substantially off the scale, being excellent for any age. My resting pulse is around 50; lowest each day around 47.

Balance test: one-legged.  20, 50, 50 seconds. Expected, something more like 10 secs. Somewhere around excellent.

Flexibility test; sit and reach. Maybe one inch. That is reaching towards toes when sat down. At best I can manage 6" remaining until the heels; that is better than when I was 40, but still adjudged pretty awful.

Strength Sit-ups for a minute; between 30 and 50, depending whether I'm allowed my ankles held down. It used to be higher. So somewhere between excellent and off the scale.


DJS is 'fit': [3]                 Inset record form from here.

1.5 mile run. Today I ran round the park twice and the first lap was 16:30, which is adequate to good, and good considering I've had 8 days off running. That's 3.5 km, 4:45 per km, 15:18 for 2 miles, only 70% on age-grading, so 1½ miles would have been inside 11:30 and if given warning I'd do that inside 11 minutes, where I used to be under 8 minutes. This week I am aged ⅔ of a century, or just aged.

Sit-ups/press-ups push-ups to failure, around 30 sit-ups to a minute, 30 to 50 as above.  

sit and reach. As above, awful. I found a similar test, 5.3 here, where my hands don't get even close to the wall. A week later, I can do this.

BMI  23.4 from https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/ which says I'd be healthy at 57kg; no I wouldn't, 68kg is my minimum and below that I fall over repeatedly. In the UK I seem to stay steady at 74-74.5 kg. I'd prefer 72.5.

DJS is 'fit': [5]               

5.1.1   no risk, BMI 23.4, so category 5 (top)

5.2.1   (did it again, can exceed 60secs, hi-fit category   5.2.2 easy

5.3.1   hands against the wall when your back is in contact with the wall. Hopeless, severe restriction of range of motion. As sit and reach above, can do this a week later.

5.3.2   I can grip almost my weight, so I still score top 20% for the under 30s. 5.3.3 not good any more, around 25 cm 5.3.4 the weird push-up, maybe just into the top category. 5.3.5 easy, 'cos the feet are held.

5.4   2 km walking? Inside 16 mins for top category? I think so. 9 minutes running on track is 70% of age-graded world record speed, which I should do on any uninjured day. A comfortable walk is half of running speed, so 16 minutes is only hurrying a little bit; an 8 minute km is 7.5 kph; I've done 7kph for an hour within many long walks, on bad surfaces. When at Shiplake we tried out race walking, discovering that a four minute half-mile was quite doable which in turn suggests that a 12 minute 2km would be relatively comfortable at a race-walk. I've just looked up age-grading; a race-walk mile in 10 minutes is 75% on age-grading, suggesting that 13 minutes for 2km would be appropriate at my age. SimilarIy, a 12:50 mile (equivalent to a 16 minute 2km) would be way down, under 60% of age-grading even at my advanced age; easy, then. I thought we were good at that walking thing....



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