10 tips to stay mentally healthy

Enjoying mental health means having a sense of wellbeing, being able to function during everyday life and feeling confident to rise to a challenge when the opportunity arises. Just like your physical health, there are actions you can take to increase your mental health. Boost your wellbeing and stay mentally healthy by following a few simple steps.

Connect with others. Develop and maintain strong relationships with people around you who will support and enrich your life. The quality of our personal relationships has a great effect on our wellbeing. Putting time and effort into building strong relationships can bring great rewards. 

Take time to enjoy. Set aside time for activities, hobbies and projects you enjoy. Let yourself be spontaneous and creative when the urge takes you. Do a crossword; take a walk in your local park; read a book; sew a quilt; draw pictures with your kids; play with your pets – whatever takes your fancy. 

Participate and share interests. Join a club or group of people who share your interests. Being part of a group of people with a common interest provides a sense of belonging and is good for your mental health. Join a sports club; a band; an evening walking group; a dance class; a theatre or choir group; a book or car club. 

Contribute to your community. Volunteer your time for a cause or issue that you care about. Help out a neighbour, work in a community garden or do something nice for a friend. There are many great ways to contribute that can help you feel good about yourself and your place in the world. An effort to improve the lives of others is sure to improve your life too.

Take care of yourself. Be active and eat well – these help maintain a healthy body. Physical and mental health are closely linked; it’s easier to feel good about life if your body feels good. You don’t have to go to the gym to exercise – gardening, vacuuming, dancing and bushwalking all count. Combine physical activity with a balanced diet to nourish your body and mind and keep you feeling good, inside and out. 

Challenge yourself. Learn a new skill or take on a challenge to meet a goal. You could take on something different at work; commit to a fitness goal or learn to cook a new recipe. Learning improves your mental fitness, while striving to meet your own goals builds skills and confidence and gives you a sense of progress and achievement.

Deal with stress. Be aware of what triggers your stress and how you react. You may be able to avoid some of the triggers and learn to prepare for or manage others. Stress is a part of life and affects people in different ways. It only becomes a problem when it makes you feel uncomfortable or distressed. A balanced lifestyle can help you manage stress better. If you have trouble winding down, you may find that relaxation breathing, yoga or meditation can help. 

Rest and refresh. Get plenty of sleep. Go to bed at a regular time each day and practice good habits to get better sleep. Sleep restores both your mind and body. However, feelings of fatigue can still set in if you feel constantly rushed and overwhelmed when you are awake. Allow yourself some unfocussed time each day to refresh; for example, let your mind wander, daydream orsimply watch the clouds go by for a while. It’s OK to add ‘do nothing’ to your to-do list!

Notice the here and now. Take a moment to notice each of your senses each day. Simply ‘be’ in the moment – feel the sun and wind on your face and notice the air you are breathing. It’s easy to be caught up thinking about the past or planning for the future instead of experiencing the present. Practising mindfulness, by focusing your attention on being in the moment, is a good way to do this. Making a conscious effort to be aware of your inner and outer world is important for your mental health.

Ask for help. This can be as simple as asking a friend to babysit while you have some time out or speaking to your doctor (GP) about where to find a counsellor or community mental health service. The perfect, worry-free life does not exist. Everyone’s life journey has bumpy bits and the people around you can help. If you don’t get the help you need first off, keep asking until you do.

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Educational outcomes

Educational outcomes

Educational outcomes
The Effective Pre-school and Primary Education Project (EPPE) is Europe’s largest longitudinal pre-school effectiveness study and provides a unique insight into the factors that influence resilience (defined here as better than expected educational outcomes) in disadvantaged families.
This demonstrated the crucial role of cognitive and social/behavioural development on
educational attainment. The strongest effect on children’s resilience at age 5 and 10 is their level of self-regulation (independence and concentration) at the start of school.21 The study found that the effects associated with a high quality home learning environment (HLE – providing structure, extensive educational stimulus and activities, a high level of parent/child interaction and the family’s sense of efficacy in supporting their children’s learning) on children’s development were stronger than for other traditional measures of disadvantage such as parental SES, education or income (Sylva et al 2007). [See p. 32 for a further discussion of these issues.] Box 7 gives an example of positive practice from Austria.

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Crime

Crime

Crime
Mental health problems make a substantial contribution to offending behaviour and a very high proportion of people in prison (including those on remand) have one or more mental disorders (Singleton et al 1998), so prevention is likely to result in considerable savings. One major longitudinal study found a clear gradient in crime risk between those with conduct disorder, those with ‘some conduct problems’ and those with no problems, confirming that small improvements in emotional adjustment in children can have a significant impact on subsequent crime rates (Ferguson et al 2005; see also Keyes 2006; Scott et al 2001).

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Productivity

Productivity

Productivity
Stress, anxiety and depression combined are the single greatest cause of sickness absence in the United Kingdom. However workplace costs are not confined to the consequences of clinically diagnosed mental illness but extend to less than optimum mental health. Loss of productivity associated with poor mental health (over and above losses associated with sickness absence) is estimated at twice the cost of sickness absence. The evidence that is available suggests that ‘presenteeism’ (functioning at less than optimum capacity while at work) has a significantly larger impact on worker productivity than absenteeism. A recent United Kingdom study estimated costs of £15.1 billion a year in reduced productivity due to ‘presenteeism’. Presenteeism accounts for 1.5 times as much working time lost as absenteeism and costs more to employers because it is more common among higher-paid staff (Sainsbury Centre for Mental Health 2007).
Other studies show that improved wellbeing or positive affect reduces sickness absence and increases performance/productivity:
• Job performance/productivity: wellbeing predicts good job performance (Harter et al 2003; Cropanzano and Wright 1999)
• Job performance/productivity/creativity: assessed by supervisors (Wright and Staw 1999; Lyubomirsky et al 2005)
• Reduced absenteeism (Pelled and Xin 1999; Keyes 2005)
Factors that have been seen as indicators of wellbeing in the workplace, for example effort/reward balance, levels of social support or job control, also have an independent influence on health outcomes (Ferrie 2007). Over 25 years, a study of Finnish men showed that those with a greater effort/reward imbalance had twice the risk of coronary heart disease. High job control is also associated with significantly lower risk of heart disease, as well as with markers of stress response e.g. lower levels of cortisol and blood pressure (Steptoe 2005; Steptoe and Wardle 2005). Evidence from Sweden shows how changing employment conditions towards less job security and control are impacting upon people’s health and wellbeing in a high income country, influencing rates of cardiovascular disease, alcohol misuse and suicide (CSDH 2007 p22). Box 6 gives an example of positive practice from France.

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Health behaviour

Health behaviour

Health behaviour
Mental health also influences physical health through its influence on health behaviour, which is socially patterned and deeply embedded in people’s social, cultural and material circumstances (NICE 2007). The relative contribution of individual characteristics (affect, cognitive and social skills), social context (peers, social networks, relationships) and material factors (income, access to healthy products) is difficult to untangle and interventions to improve health behaviour through improving mental health (in schools for example) often attempt to address all three areas.
Positive mental health is associated with:
• Improved sleep, exercise, diet (Pressman and Cohen 2005; Mental Health Foundation 2006a)
Improving positive mental health reduces:
• Alcohol intake (Graham et al 2005; Petersen et al 1998 ; Mental Health Foundation 2006b)
• Smoking (Graham et al 2005)
• Delinquent activity20 (Windle 2000)
There is some dispute as to whether alcohol misuse precedes, or is a consequence of, mental health problems such as anxiety and depression (Kessler et al 1996; Merikangas et al 1998; Rehm et al, 2003) and in many cases there is likely to be a dynamic interaction.
The marked relationship between socio-economic factors and health behaviour raises a number of questions about the extent to which psychological factors pattern behaviour. A significant context for understanding the link between mental health and behaviour is the extent to which health-damaging behaviours may be survival strategies in the face of multiple problems, anger and despair related to occupational insecurity, poverty, poor housing, exclusion and other indicators of low status. These problems impact on intimate relationships, the care of children and on self care (Rogers and Pilgrim 2003). In the United Kingdom, the 20% - 25% of people who are obese or continue to smoke are concentrated among the 26% of the population living in poverty, measured in terms of low income and multiple deprivation of necessities (Gordon et al 2000). This is also the population with the highest prevalence of anxiety and depression (Melzer et al 2004). Capacity, capability and motivation to choose health are strongly influenced by mental health and wellbeing, making these pathways a feature of the growing interest in positive mental health as a route to achieving behavioural change (Stead et al 2007). Mental health may also be a factor in helping to explain the wider international data which shows that socio-economically disadvantaged conditions are not universally correlated to all forms of health-damaging behaviours (CSDH 2007).

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Morbidity

Morbidity

Morbidity
Review level evidence finds almost unanimous support for an association between higher positive affect and health (Pressman and Cohen 2005). Promoting positive mental health benefits physical health by improving:
• Overall health (Benyamini et al 2000)
• Stroke incidence and survival (Ostir et al 2000; 2001)
• Protection from heart disease: absence of positive mental health is a greater risk factor for CVD
than smoking (Keyes 2004). Psycho-social factors (notably mood, social support and isolation)
are on a par with smoking, high blood pressure and raised cholesterol (Bunker et al 2003;
Kubzansky and Kawachi 2000)
• Lowest number of chronic physical diseases by age (Keyes 2007)

Positive affect is particularly associated with improvements in health outcomes subject to motivation or self report bias e.g. pain, limitations in daily living and quality of life. Positive affect may also provide a stress buffering effect that helps people to cope and is associated with lower levels of cortisol and lower blood pressure (biological markers of stress response) at baseline and at three year follow up (Steptoe 2005). Leading risk factors are outlined in Leading risk factors
Among the 10 leading risk factors for the global burden of disease measured in DALYs, as identified in the World Health Report 2002, three were mental/ behavioural (unsafe sex, tobacco use, alcohol use) and three others were significantly affected by mental/ behavioural factors (overweight, blood pressure and cholesterol).
WHO 2003 p. 9 

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Outcomes associated with positive mental health

Mortality

Outcomes associated with positive mental health
Physical health
Mortality
The influence of positive affect on mortality has been widely asserted, with one major study showing an increase in longevity of 7.5 years, (Danner et al 2001; Levy et al 2002), but it is most consistent for older people living in the community. This is not the case for residents of institutions; in these circumstances, low positive affect ‘may reflect a fighting spirit in a situation of lost control’ and so be more protective (Pressman and Cohen 2005). This is an important finding: happiness may be more adaptive in some circumstances than in others (Lyubomirsky et al 2005).

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Outcomes associated with positive mental health

Outcomes associated with positive mental health
Physical health
Mortality

Outcomes associated with positive mental health

The influence of positive affect on mortality has been widely asserted, with one major study showing an increase in longevity of 7.5 years, (Danner et al 2001; Levy et al 2002), but it is most consistent for older people living in the community. This is not the case for residents of institutions; in these circumstances, low positive affect ‘may reflect a fighting spirit in a situation of lost control’ and so be more protective (Pressman and Cohen 2005). This is an important finding: happiness may be more adaptive in some circumstances than in others (Lyubomirsky et al 2005).

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Population approach

Population approach
The benefits of improving the mental health of the whole population are based on a familiar public health model. Just as we know that a small reduction in the overall consumption of alcohol among the whole population results in a reduction in alcohol related harm, so a small improvement in population wide levels of wellbeing will reduce the prevalence of mental illness, as well as bringing the benefits associated with positive mental health:

Population approach

• by reducing the mean number of psychological symptoms in the population,
many more individuals would cross the threshold to become flourishing;
• a small shift in the mean of symptoms or risk factors would result in a decrease in the number of people in both the languishing and mental illness tail of the distribution

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Faculty of Public Health

Faculty of Public Health
The Faculty of Public Health is the standard setting body for specialists in public health in the UK. We support this report because we believe that it says all the right things about empowerment and the promotion of wellbeing. It usefully complements the recent report from the WHO Commission on Social Determinants of Health and helps to fill many of the gaps between mental health and inequalities, including the crucial links between negative health behaviours and poor physical health. We very much welcome its emphasis on promoting wellbeing - the focus on developing resilient individuals, communities and environments being particularly timely during the current global economic crisis.

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Child Poverty Action Group

Child Poverty Action Group
Child Poverty Action Group (CPAG) is a leading charity campaigning for the abolition of child poverty in the UK and for a better deal for low-income families and children. CPAG supports this report because it demonstrates so clearly the damage that inequality does to mental health. This analysis highlights the ‘social recession’ of families being left behind and the harm this causes and it clearly demonstrates that tackling child poverty and boosting fairness must be the watch word of societies which seek to promote good mental health.

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How is borderline personality disorder treated?

How is borderline personality disorder treated?
Borderline personality disorder can be treated with psychotherapy, or “talk” therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional’s care, it is essential for the professionals to coordinate with one another on the treatment plan.
The treatments described below are just some of the options that may be available to a person with borderline personality disorder. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.

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What studies are being done to improve the diagnosis of borderline personality disorder?

What studies are being done to improve the diagnosis of borderline personality disorder?

Recent neuroimaging studies show differences in brain structure and function between people with borderline personality disorder and people who do not have this illness.

Some research suggests that brain areas involved in emotional responses become overactive in people with borderline personality disorder when they perform tasks that they perceive as negative.

People with the disorder also show less activity in areas of the brain that help control emotions and aggressive impulses and allow people to understand the context of a situation. These findings may help explain the unstable and sometimes explosive moods characteristic of borderline personality disorder.
Another study showed that, when looking at emotionally negative pictures, people with borderline personality disorder used different areas of the brain than people without the disorder. Those with the illness tended to use brain areas related to reflexive actions and alertness, which may explain the tendency to act impulsively on emotional cues.
These findings could inform efforts to develop more specific tests to diagnose borderline personality disorder.

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How is borderline personality disorder diagnosed?

How is borderline personality disorder diagnosed?
Unfortunately, borderline personality disorder is often underdiagnosed or misdiagnosed.
A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect borderline personality disorder based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.

The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with borderline personality disorder, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional’s attention.
No single test can diagnose borderline personality disorder. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with borderline personality disorder showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe borderline personality disorder showed a more intense emotional response than people who had less severe borderline personality disorder.

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What are the risk factors for borderline personality disorder?

What are the risk factors for borderline personality disorder?
Research on the possible causes and risk factors for borderline personality disorder is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.
Studies on twins with borderline personality disorder suggest that the illness is strongly inherited.

Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression.
18 Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.
Social or cultural factors may increase the risk for borderline personality disorder. For example, being part of a community or culture in which unstable family relationships are common may increase a person’s risk for the disorder.
Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.

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What illnesses often co-exist with borderline personality disorder?

What illnesses often co-exist with borderline personality disorder?
Borderline personality disorder often occurs with other illnesses. These co-occurring disorders can make it harder to diagnose and treat borderline personality disorder, especially if symptoms of other illnesses overlap with the symptoms of borderline personality disorder.
Women with borderline personality disorder are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, borderline personality disorder is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder.

According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with borderline personality disorder also meet the diagnostic criteria for another mental illness.Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia.

These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat borderline personality disorder and other mental disorders. For more information, see the section, “How is borderline personality disorder treated?”

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When does borderline personality disorder start?

When does borderline personality disorder start?
Borderline personality disorder usually begins during adolescence or early adulthood.1, 9 Some studies suggest that early symptoms of the illness may occur during childhood.
Some people with borderline personality disorder experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment

NOTE : 

Studies
suggest
early
symptoms
may occur
in childhood

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What are the symptoms of borderline personality disorder?

What are the symptoms of borderline personality disorder?
According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:
Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
Recurring suicidal behaviors or threats or self-harming behavior, such as cutting Intense and highly changeable moods, with each episode lasting from a few hours to a few days
Chronic feelings of emptiness and/or boredom Inappropriate, intense anger or problems controlling anger
Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.
Seemingly mundane events may trigger symptoms. For example, people with borderline personality disorder may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face5 and have a stronger reaction to words with negative meanings than people who do not have the disorder.
Suicide and Self-harm
Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with borderline personality disorder have suicidal behaviors,7 and about 4 to 9 percent commit suicide.4, 7 Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with borderline personality disorder. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.7 For more information about DBT, see the section, “How is borderline personality disorder treated?”
Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with borderline personality disorder include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with borderline personality disorder may self-harm to help regulate their emotions, to punish themselves, or to express their pain.8 They do not always see these behaviors as harmful.

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What is borderline personality disorder?

What is borderline personality disorder?

What is borderline personality disorder?
Borderline personality disorder is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III) listed borderline personality disorder as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.
Because some people with severe borderline personality disorder have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders.1 While mental health experts now generally agree that the name “borderline personality disorder” is misleading, a more accurate term does not exist yet.
Most people who have borderline personality disorder suffer from:
Problems with regulating emotions and thoughts Impulsive and reckless behavior Unstable relationships with other people.
People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.
According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have borderline personality disorder in a given year.2
Borderline personality disorder is often viewed as difficult to treat. However, recent research shows that borderline personality disorder can be treated effectively, and that many people with this illness improve over time.

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Implications for the Design of Mental Health Systems Recovery as a concept is by no means fully understood

Implications for the Design of Mental Health Systems Recovery as a concept is by no means fully understood.
Much research, both qualitative and quantitative, still needs to be done. Paramount to the recovery concept are the attempts to understand the experience of recovery from mental illness from those who are experiencing it themselves. Qualitative research would seem particularly important in this regard.
However, it is not too early for system planners to begin to incorporate what we currently think we know about recovery.
For example, most first-person accounts of recovery from catastrophe (including mental illness) recount the critical nature of personal support (recovery assumption #2). The questions of system planners are: Should personal support be provided by the mental health system? And if so, how can this personal support be provided? Should intensive case managers fill this role? What about self-help organizations? Recovery…the Guiding Vision in the 1990s 533 Should they be expanded and asked to perform even more of this function?
If personal support is characterized as support that is trusting and empathic, do human resource development staff members need to train helpers in the interpersonal skills necessary to facilitate this personal relationship? Quality assurance personnel would need to understand the time it takes to develop such a relationship and figure out ways to assess and document this process.
Recovery, as we currently understand it, involves the development of new meaning and purposes in one’s life as one grows beyond the catastrophic effects of mental illness. Does the mental health system help in the search for this new meaning? Does it actively seek to provide opportunities that might trigger the development of new life purposes? Is this the type of service professionals and survivors talk about when the value of “supportive psychotherapy” is mentioned? Is there the support of therapists trained to help persons with mental illness control their lives once again—even without fully controlling their mental illness?
There are a number of possible stimulants to recovery. These may include other consumers who are recovering effectively.
Books, films, and groups may cause serendipitous insights to occur about possible life options. Visiting new places and talking to various people are other ways in which the recovery process might be triggered. Critical to recovery is regaining the belief that there are options from which one can choose—a belief perhaps even more important to recovery than the particular option one initially chooses.
Recovery-oriented mental health systems must structure their settings so that recovery “triggers” are present. Boring day treatment programs and inactive inpatient programs are characterized by a dearth of recovery stimulants. The mental health system must help sow and nurture the seeds of recov- 534 CHANGING TOWARD THE FUTURE ery through creative programming. There is an important caveat to this notion of recovery triggers. At times the information provided through people, places, things, and activities can be overwhelming. Different amounts of information are useful at different times in one’s recovery. At times denial is needed when a recovering person perceives the information as too overwhelming. At particular points in one’s recovery, denial of information prevents the person from becoming overwhelmed. Information can be perceived as a bomb or a blanket—harsh and hostile or warm and welcome. Helpers in the mental health system must allow for this variation in the time frame of information they are providing—and not routinely and simply characterize denial as non-functional.
Similarly, the range of emotions one experiences as one recovers cannot simply be diagnosed as abnormal or pathological.
All recovering people, whether mentally ill or not, experience strong emotions and a wide range of emotions.
Such emotions include depression, guilt, isolation, suspiciousness, and anger. For many persons who are recovering from catastrophes other than mental illness, these intense emotions are seen as a normal part of the recovery process. For persons recovering from mental illness, these emotions are too quickly and routinely considered a part of the illness rather than a part of the recovery. The mental health system must allow these emotions to be experienced in a nonstigmatizing and understanding environment. Helpers must have a better understanding of the recovery concept in order for this recovery- facilitating environment to occur.

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