There is no doubt that we need to talk more about mental health issues, and in doing so promote increased inclusivity so that people feel safe opening up, seeking help, and speaking out. It is with some enthusiasm, therefore, that in this issue of Education UAE, we speak to Dr Lynda Hyland, Senior Lecturer in Psychology and Head of the Careers and Employability Department at Middlesex University Dubai. We began by asking about mdxMindset, monthly wellness talks that were launched in October 2022.
Lynda: We are delighted to have launched mdxMindset Talks, a new Middlesex University Dubai Wellness Office initiative. These monthly talks will be open to students and staff at our university, and to the wider community. We will invite a range of key stakeholders, who have a lot to say about wellness issues, to engage in dialogue on various topics from social anxiety to conflict and mental health. This forum to discuss under-addressed issues is an essential step towards increasing awareness, signposting support, and destigmatising a range of mental health challenges that can be faced by anyone. We also hope to have the opportunity to debunk some myths about mental illness and create an informed and active learning community.
EdUAE: Young people seem to have more mental health challenges today than ever before -why do you think this is and how do we combat it?
Lynda: During adolescence and early adulthood, ‘fitting in’ with one’s peer group greatly matters. Young people try to form their identity and shape who they are in relation to the world around them. This can be a tumultuous experience, and it is neither new nor unique to the current generation of adolescents. However, over the last few years, young people have navigated this journey towards adulthood in markedly different circumstances than previous generations.
Youth mental health difficulties are on the rise. The World Health Organisation (WHO) notes that one in seven adolescents experience mental disorders, including anxiety and depression, and several recent international studies show that the pandemic has exacerbated this.
The mental health burden of the pandemic (in part due to isolation, interrupted social and educational opportunities, and fear of the unknown) has been most manifest among young people, with an additional negative impact on those with preexisting mental health difficulties (WHO, 2022).
The adolescent experience is also affected by social media. Although the opportunities to maintain connections with peers through social media were helpful during the pandemic, overuse of social media has several negative consequences. Cyberbullying, social comparison, and the formation of unhealthy sleep and eating schedules are some adverse outcomes documented in the academic literature.
Educators and families can work to combat the rise in mental health challenges. Recognising these problems is an essential first step, as is talking about them openly. Creating safe spaces for young people to share their thoughts and experiences regarding mental health issues and fostering strong social support networks can make a huge difference. At Middlesex University Dubai, we offer a suite of supports under our ‘Mental Health Matters’ initiative. This includes mental health counsellor support and student-led group discussions on various wellbeing topics. Embedding these supports within the university creates a culture of openness in which students can reach out for help when needed.
We hope that mdxMindset Talks will be an important contributor to enhancing mental health literacy in the UAE
EdUAE: Do you believe that mental health ‘stigma’ is a thing of the past in the UAE or is there still work to be done in society at large?
Lynda: While great strides have been made to destigmatise mental illness, it remains a problem. Studies show that mental illness stigma still exists in the wider population and even among healthcare providers. Worryingly, this poses a real barrier to seeking and receiving mental health support when needed. Tackling this is challenging but improving people’s knowledge and beliefs about mental health issues – their ‘mental health literacy’ – can reduce stigma.
The UAE has a National Policy for the Promotion of Mental Health, in which stigma towards mental illness is identified as a critical challenge.
This policy also states that increasing community knowledge about mental health issues is a vital part of the multi-sectoral strategy to promote mental health. We hope that mdxMindset Talks will be an important contributor to enhancing mental health literacy in the UAE.
EdUAE: Would you agree that mental health problems beset us all one way or another, and it is more of a bell curve than a cut-and-dried diagnosis? Given that, what symptoms should people look out for in order to know when it is time to reach out and seek help?
Lynda: Approximately one in eight people (around one billion) live with a mental disorder (WHO, 2022). This figure is jarring, but it is likely to underestimate the real picture, as not everyone experiencing mental health difficulties will receive a formal diagnosis.
Additionally, this figure shows a snapshot of a given time; the lifetime prevalence of mental illness is much greater. Given the huge numbers, it is highly likely that we (or those close to us) will experience mental illness at some point in our lifetime. The things to look out for vary according to the specific mental health challenge being faced, but can include changes to behaviour, irritability/anger, neglecting responsibilities, and reporting physical symptoms such as headaches or stomach aches (American Psychological Association, 2022). Of course, these can occur in the absence of mental health difficulties, so the important thing is to stay connected with others and keep an eye on the duration and frequency of these symptoms.
Acting before the issue becomes debilitating will result in better outcomes. When people experience significant distress in social, occupational, or other areas of functioning, there is a problem that must be addressed immediately.
Studies show that mental illness stigma still exists in the wider population and even among healthcare providers
EdUAE: How effective and cost-effective are school-based mental health treatments for special needs schoolchildren?
Lynda: Early intervention is important and can result in much better outcomes than intervention at a later stage. We know there are consequences of failing to tackle child and adolescent mental health issues, which can continue to impact the person into adulthood, limiting health, social, educational, and occupational outcomes. Intervening early is more effective, in terms of outcomes for the person and in terms of the cost. It is crucial to invest early to achieve these benefits.
Children with additional needs in the classroom who require support should receive it. It is essential, though, that the right investments are made, and to recognise that some school-based prevention programmes have shown mixed results. While some have demonstrated positive outcomes, others fail to impact mental health. This variability may, at least in part, be due to the methodological limitations of the studies assessing effectiveness, with researchers pointing towards the need for improved data from better-designed studies.
Regardless of the location of the intervention (school, clinic, community settings), the important thing is that treatments are evidence-based, and they offer feasible, cost-effective improvements that can extend into the medium- to long-term.
A study involving data from 1.2 million people in the US showed a significant association between exercise and mental health (Chekroud et al., 2018).
EdUAE: Does exercising actually help mental health?
Lynda: Exercise is one of the best things we can do to support our mental health. This is evident across many studies in countries worldwide. A study involving data from 1.2 million people in the US showed a significant association between exercise and mental health (Chekroud et al., 2018).
This was particularly evident in the case of team sports, cycling, and aerobic and gym activities, but all exercise types were associated with lower mental health burdens.
Even after matching across physical characteristics and demographics, those who exercised over the previous month noted 43% fewer days of poor mental health. Interestingly, the positive outcomes were strongest for those who exercised 3-5 times per week, for 30-60 minutes per session. Exercising more frequently and for longer durations did not show positive effects. Exercising more than 23 times per month or for more than 90 minutes at a time displayed negative associations with mental health. So, it seems you can have too much of a good thing! The take-home message here is that you don’t need to be in the gym 24-7 or do high-intensity cardiovascular exercise; even walking can improve our mood, release endorphins, and protect our mental health.
EdUAE: How can someone support a friend who has mental health issues?
Lynda: In our increasingly busy lives, it can be hard to see beyond our own challenges and notice that others may be struggling. Take the time to check in with your loved ones. If you identify that a friend might need support, ask questions, offer them a listening ear, and reassure them that you care. Let them speak and resist the temptation to jump in with well-intentioned ‘solutions’. Know that telling someone to ‘cheer up’ is not helpful. Instead, validate their emotions. Avoid judgement and be present for them. Know your limits and signpost them to appropriate professional support if needed.
It can be hard for parents to identify that their child is experiencing mental health challenges
EdUAE: What should parents look out for in their children to ensure they act in a timely and understanding manner if a mental health issue arises? And how do they start a conversation with a young person about the possibility they may be struggling?
Lynda: It can be hard for parents to identify that their child is experiencing mental health challenges, particularly when differentiating possible signs of distress from the often-expected adolescent emotional rollercoaster. The American Psychological Association (2022) notes some key signs to watch out for, including changes in eating and sleeping habits, and in social behaviours (e.g., a previously socially active teenager who no longer wants to leave their room).
If parents suspect their child is experiencing a mental health difficulty, UK-based NHS guidelines (2020) say that parents should take it seriously and talk to the child. However, even after identifying a potential problem, it can be hard for parents to start a conversation on this issue. They might be afraid that they will say the wrong thing or worsen the situation.
Create opportunities to talk (e.g., while doing chores such as preparing food or walking the dog). Ask open-ended questions. Let your child know you are there for them and, like supporting a friend in distress, validate their feelings. Broaching these subjects is easier in families where communication is already open, and emotions are more commonly discussed. If your child does not want to talk to you about what they are going through, let them know you are there for them when they are ready. In the meantime, encourage them to talk to someone they trust (e.g., a good friend or family member) and if you think your child needs professional support, be prepared to reach out for this.
EdUAE: What do we need to do as a society to take the next step in combatting mental health problems?
Lynda: We must inform ourselves and recognise that mental health problems can impact us all. If we really want to combat this issue, we must do our bit to address structural factors that make some people more at risk of mental illness. Issues like inequality, poverty, and discrimination all contribute to mental health. Become an ally for those with mental illness by normalising the conversation about mental health issues, using supportive language, and speaking up when others do not or cannot. Education about mental health issues has the power to change the harmful narrative that has allowed stigma to pervade despite the advances in treatment and outcomes for those with mental health problems.
EdUAE: Finally, as someone who has suffered from depression at times throughout my life, I have found that one of my best ‘weapons’, when the fog descends, is to say to myself: “Right, this is me now, it’s not who I am, but at this moment in time I’m in deep trouble, so just be at one with it and accept it, and wait to see what tomorrow brings.” So, is it important to be honest with yourself when going through difficult times; not finding excuses or kidding yourself that you’ve just got the ‘blues’?
Lynda: Good question! While every situation is different, kidding oneself will only work in the short term, if at all. It does not allow you to address the issue and reduces the likelihood that others will be able to support you when you need it most. Honesty can help. Being kind to oneself and acknowledging that today is bad, but tomorrow may be better, can be a powerful resource. The approach you mention, recognising the present-moment experience without judgement, is a key feature of mindfulness, which has shown effectiveness in improving psychological wellbeing. What is most important here is that you have developed a strategy that works for you and that you can tap into when needed.
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Dr Lynda Hyland Senior Lecturer Psychology, Head of the Careers and Employability Department at Middlesex University Dubai, Lynda Hyland is a chartered member of the British Psychological Society and a member of the American Psychological Association, She holds an M.Sc. in Health Psychology from University College London.