What is wellbeing?

A typical GP appointment is 7-10 minutes long. Therefore it was no surprise to me that when I started talking to my GP about my blood pressure a couple of months ago and diverted to talk about my lack of energy, I was referred to the “wellbeing worker” linked with the practise. There was a five week wait for an appointment. I sat in the waiting room at the designated time wondering if this was a new name for a practise counsellor, or an offshoot of IAPT linked to physical health, or whether it was a specific scheme designed to get people eating better and doing more exercise. When she invited me in the wellbeing worker introduced herself and said her remit was to work with people about “diet, exercise, smoking, drug use or to improve your wellbeing”. She asked me to rate my wellbeing on a likert scale for six variables.

So I diligently explained that since being rear-ended by a lorry 2 years ago, I have not been able to make a full range of movement with my left shoulder. This meant I had been unable to continue weight lifting. I also had to have 3 teeth removed and then had a very severe ear infection, causing some other health complications I detailed in an earlier blog. I told her that I have had intermittent earache, headaches, and a feeling of being underwater, which are exacerbated by changes in pressure or getting my ears wet so I had stopped swimming. I have also had ripples in my peripheral vision and a general lack of energy and motivation. I explained that the combination has meant that I had stopped my three times a week gym-and-swim habit and reduced to a fairly sedentary lifestyle with occasional longer walks.

I mentioned that been overweight for my whole adult life, and I had drawn some psychological links to the root of this. I explained that I am fairly comfortable with the idea of being overweight but that stress may have contributed to my more recent problems. I was of the opinion that there is clearly a significant physical component to my health issues, as it has transpired I am anaemic and vitamin D deficient as well as having high blood pressure. But I acknowledged that there is also a lifestyle component, as I had reduced activity and gained weight over the preceding months, and I acknowledged a substantial stress component too.

I noticed that the wellbeing worker had not taken any notes beyond “weight” and “exercise”, so I paused and tried to clarify her role. I asked what professional background she came from, expecting to hear she was a nurse, health worker or psychology graduate. “I’m an admin” she said, and explained that she had taken the job during a reorganisation, having been told that it was predominantly administrative. She said she had initially worried about what she would do if told about problems she didn’t know the answer to, but her manager had been reassuring that it wasn’t her job to solve everything and she could report any concerns to the appropriate person.

It turned out that her job was to identify which pathway to put people onto, from a choice of weight management, exercise, smoking cessation, drugs or alcohol and then fill in the paperwork to make it happen. She booked me in for the weight management group, and gave me a referral to the local council run leisure centre for 12 weeks free membership.

Don’t get me wrong, those things are good low-level interventions. The weight management group is friendly and non-shaming, even though it is pitched at a simplistic level, and I completely endorse exercise on prescription schemes for improving physical and psychological wellbeing. But where was the space to actually talk about what was going on my life? The website for the wellbeing service says:

‘Wellbeing’ means feeling happy, healthy and content in life. Our wellbeing can be affected by our physical and mental health, the people around us, the place that we live, the money that we have and how we spend our time. Our Wellbeing Workers can help you to identify and prioritise changes you might want to make to improve your overall health and wellbeing. They offer lots of support to help inform, motivate and empower you [including through] … Support with confidence issues and to improve self esteem

They offer services to reduce social isolation and assistance to address issues such as debt, housing and education (though this branch appears to prioritise people who have an intellectual disability or socio-economic deprivation) but the only mention of mental health or psychology is in relation to the specialist branch of the weight management pathway for people with BMI over 45 and those considering bariatric surgery. There are also leaflets linked from the weight loss section of the website which talk about “finding happiness” (helpful habits) and “mastering your thoughts” (basic CBT intro) and “relaxation and stress relief” (mindfulness, visualisation/anchoring, breathing exercises). But I was never even told these existed, and even when on the website I had to use the search feature to find them, and as far as I could tell there was no connection to the local IAPT service.

Six weeks later the wellbeing worker rang me up again, to see how I was doing. But again, she didn’t really want to know how I was doing psychologically in any meaningful sense. She wanted to know if I had followed the pathways she had offered. She asked me to give the six ratings again. It felt pretty hollow giving more positive scores, as I didn’t feel like the services provided by the wellbeing service were responsible for the changes – I had lost 10lb in weight before I joined the weight management group (and 2lb since), and feel better because I have more iron, more vitamin D, lower blood pressure, more energy and less pain.

So I was left feeling that it was a service that I was glad existed, but it seemed to tackle symptoms in isolation to their causes, and didn’t seem to connect physical and mental health. I’m guessing that is because public health is still local authority commissioned, whilst mental health is within the NHS. Wouldn’t it be nice if there was a single point of entry to this kind of wellbeing service and IAPT? Surely that would reduce stigma and mean that both symptoms and cause could be addressed, and patients would be able to tackle the interwoven issues of mental and physical health together.

 

Trauma and the return of hope

I wanted to write something about the recent traumatic events including the Manchester arena bomb, the London Bridge incident, the Grenfell Tower fire. These are very painful and raw events that have been quite distressing to learn about, and I am aware that we still don’t have the full picture. I also wanted to touch on the reaction to these tragedies including the One Love concert, and to give my reaction to the election results. I hope it doesn’t seem disrespectful to connect the two, but to me they represent both the fear and sadness of recent events, and the compassion and hope that have followed them. I should warn you now that the second half of this blog is less psychological and more political than usual. That probably isn’t surprising when I am writing about the election, but I know that type of content is not for everyone so I’ve marked where you might want to skip to the end.

Barring 9/11 I can’t remember a month in my lifetime with more traumatic events. The Manchester bomb killed predominantly young people and parents, and felt very close to home for me. The idea that innocent young people and families going to a concert could be the target for terrorists was unbelievably horrific, and the ages of the victims made the story identify with people of all life stages around the country who could imagine it being their child, grandchild, sibling, friend or parent who was affected. This wasn’t some far away event in another country, where people speak another language or have different culture or appearance that can let us abstract the horror away from ourselves.

The impact of the explosion was felt in ripples that spread far wider than just those who tragically died or were injured in the blast, to those who lost friends, relatives and loved ones, and wider again to those at the concert who witnessed the horrific scenes and felt scared by the situation, the emergency services and NHS staff who responded to it, and those who were peripherally involved in the aftermath of helping people find ways home or places to stay, or in looking for people who were missing. As well as the terrible loss of life, and lasting physical injuries, psychologically these events will have changed the course of people’s lives in various ways and to various degrees.

The same was true of those involved in the events on London Bridge and Borough Market. These were ordinary Londoners and tourists going about their daily life. On another day, or with another roll of the dice this could be any one of us or people that we know. Again, the ripples spread far and wide.

And now we have another unspeakably awful tragedy, where the Grenfell Tower fire has killed and injured large numbers of people representing the full spectrum of age and cultural diversity. What they had in common was living in a tower block built by the council in the 1970s. Preliminary commentary suggests that the decorative and insulating cladding used in a refurbishment of the block was highly flammable and caused the fire to spread rapidly and the compartmentalisation system to fail. If that is true, and it was cost-cutting and a delay in updating the fire regulations that was to blame, then that is unforgivable and needs to lead to legal consequences for those responsible, as well as learning that prevents similar tragedies occurring in the future. I can understand the level of anger that is being expressed by the local residents whose concerns were ignored, and by those who feel that the balance of power in the current political situation means that the lives of people with below average income are given little value compared to the profits of the rich.

Here too the psychological consequences will ripple out widely beyond the horrendous loss of life and physical injuries to those who were bereaved, traumatised by what they witnessed, those who tried to raise the alarm but couldn’t reach everybody, the emergency services who responded so admirably against insurmountable adversity and those more peripherally involved. There will be complex feelings for those who survived when others perished, and I can’t begin to imagine how it must feel for the person whose flat the fire started in. If it is true that a faulty washing machine started the blaze, they must be wondering whether there were any choices they could have made differently that would have prevented or reduced the terrible outcomes that followed. Likewise those on lower floors or adjacent buildings who escaped early on and had to watch others jumping from windows, throwing out children, or being trapped too high to do either. I can’t begin to imagine how that will impact upon them over time, as it was overwhelming to even watch on the limited TV coverage.

Yet, everywhere there is tragedy, we see good people come out to try to help. From the emergency services and NHS staff, to those running charities and organisations to help those affected to those doing practical things on the ground because they happened to be there and felt compelled to do something. The One Love Manchester concert had the highest viewing figures of the year and the fundraising for Manchester victims and charities has topped £11 million. Likewise the fundraising for victims and organisations that can provide support in relation to the London incidents and the Grenfell fire have been astronomical (last figures I read suggested there had been donations of over £1.5 million in 24 hours to causes related to the fire). Overall, following these tragedies we have seen an outpouring of love and kindness on an unprecedented scale.

So perhaps in that context it is not quite as surprising as the political commentators think that the election results suggest the tide is turning against austerity. Public sector workers with frozen pay are those who have been responding to these crises, killing and arresting the terrorists and identifying their networks, fighting the fires and patching up the injured. That means that the public have remembered what heroes they are, and look in a different light at the cuts to the public sector that are preventing them from doing an effective job and mean we are not rewarding them adequately for the essential work that they do. We have also been roused into action to prevent further victims. We can no longer ignore the fact that the NHS and fire service are warning of their inability to provide sufficient cover to meet the need with budgets cut to the bone. Hospitals are struggling to sustain staffing, let alone recruit, without nursing bursaries and international staff. Children are being harmed and dying because of insufficient social care services, and people with disabilities and health problems are suffering and dying because of cuts to their benefits and support packages.

In short, as events have awakened our empathy it has become clear that the government’s policies are without compassion, and are all about protecting big business and the super-wealthy. They are making the rich richer and the poor poorer, and the vulnerable are dying as a result. Tough talk about immigrants and scroungers has been used to justify a lack of public spending coupled with policies that harm the most vulnerable in society – yet the sudden change away from austerity when their electoral majority was lost confirms that these were idealogical rather than economic choices. The negative focus on blaming disadvantaged groups in society has turned the spotlight away from much bigger abuses of the system by international corporations who manage to pay little or no UK tax, and who exploit staff on zero hours contracts, or even force them to work for their benefits through work fare schemes. The wealthiest in society are able to pay accountants and lawyers to help them avoid tax the most, and to hide income in off-shore schemes for tax avoidance purposes.

So at a time when compassion is so needed, and so evident in response to terrible events, there has been a political shift. It hasn’t happened in isolation – we have seen increasing unpredictability in public voting over the last year. I can only make sense of this in terms of a desire for radical change. Young people and those who have felt disempowered and disenfranchised by a political system that seemed to occupy only the middle-right and work only to sustain the vested interests of those who are already wealthy and powerful have been voting for the option that they think will upset the establishment. Sadly, the only options for rebellion available last year were to vote for Brexit and for Trump, or to not vote at all. But this year, as the government has moved the Overton window further right since the Brexit vote, clear blue water has emerged between the parties. And to the surprise of many, the Labour Party has moved left from their centrist policies and candidates of the last decade. Somehow a genuine socialist candidate has been voted into leadership in the form of Jeremy Corbyn, and despite all the efforts of the press and his own party, he has stuck in there stubbornly, growing support from the ground up, and now he seems to have popular support and the potential to be a future Prime Minister.

[If you aren’t a fan of politics, feel free to skip to the last paragraph now, because the second half of this blog is about the election results and what they might mean].

Corbyn might be an unlikely leader following past templates, as he does not use glib press-friendly soundbites. But he is a man who has stuck to his principles throughout his political career, and has been a voice of reason and negotiation when others have been shouting. From day one he has been an authentic voice in a world of spin. Although he was damned for it at the time, he acknowledged the complexity of the issues and did not ally himself fully with either of the polarised sides of the Brexit debate (though he said on balance he would prefer to remain). He has subsequently been able to make a positive campaign in a time in which the fashion is to blame and ridicule. In the words of Michelle Obama that I like so much “when they go low, we go high“. It doesn’t mean not being outraged or angry. It means choosing to focus on how we can solve problems, rather than on denigrating opponents. Corbyn was not only an underdog that would upset the establishment but an opportunity to say enough to austerity. That message has connected with people whilst Theresa May was curiously defensive and robotic, repeating the same soundbites over and over again and refusing to engage in the debate.

Corbyn’s politics roused a new generation of political campaigners (Momentum) who fought a savvy campaign on social media, where it is said a budget of just £2000 reached more voters than over a million pounds spent by the Conservative party. Over 12 million voters saw a facebook post started by a Momentum member in the week before the election. Partly as a result of this, 622,000 people registered to vote for the first time. This image of Facebook reactions to a live stream of the Prime Minister made me smile:

It is obvious to anyone that knows me or anyone who reads what I write that I identify as being on the left of the political spectrum. I was alienated by Labour’s move to the centre, and have become a lifetime member of the Green Party, despite being pragmatic enough to recognise that whilst we have a first past the post voting system the UK will be a two party political system. So I have been quite interested in the rise of the left within the Labour Party, and a fan of Corbyn as an individual politician for some time (I wrote about Corbyn on this blog a year ago).

So, unsurprisingly, I saw the election outcome as a great result. I was afraid that the Tories would get a landslide victory and use it to push through ever more austerity, and channelling of wealth to the super rich. So to see them lose their majority was a brilliant outcome. I’m delighted, and the more I have thought about it the more I think a hung parliament is about the best possible result.

First off the Tories have lost the mandate for their hard right, hard Brexit plans. And young people have been engaged in politics. Hopefully we can prevent repugnant policies like the dementia tax and fox hunting and cuts to education because the majority is so slender and these policies haven’t played well with the public. But I like that brexit will be a Tory problem to resolve, because when it gets messy they will have nobody else to blame. There is a stronger position to oppose boundary changes and to press for electoral reform. Maybe we can improve the terrible cuts to benefits and the regime of sanctions whilst their focus is on damage limitation and Brexit. And the next election might be one in which change is possible.

I don’t think it is a panacea. After so many cycles of hope and disappointment in recent politics, I’m cynical about whether this is the beginning of a sea change, and worried there is still a lot of conservative thinking about the economy and UKIP influenced blaming of foreigners around. I’d like to believe that things will get better from here, but I don’t think we should expect too much too soon. Some of the optimistic predictions of having a Corbyn government by the end of the year, and reaching a point at which the populace don’t want to go through with Brexit by the two year deadline seem just too good to be true. However, I am optimistic about the long game, because of what the analysis about voting patterns shows. Corbyn’s support is younger and more educated than that of his opponents. That is supported by this chart from the Financial Times:

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You can see that over 65s were 35 points more conservative than the UK average, whilst under 45 year olds are more prone to voting progressively. That split by age is a relatively new thing and it has been much more marked over the last two elections. Then I think about what the five year interval between elections means to the population. With half a million older people dying every year, and half a million younger ones becoming eligible to vote, surely over time that will tip things in a positive direction. The only question is whether the tendency of people to swing right as they get older will continue as the current population ages and/or whether the Tories can start to market successfully to these new voters.

I’ve been trying to understand the reason for these demographic shifts, to judge whether the current middle aged moderates are the retired conservatives of the future. From what I have read I’m not sure that the fade from red to blue is inevitable. I think a lot of us who will be entering the top half of that graph soon age-wise grew up under Thatcher and have much more reticence for those kind of policies than the current over 65s who grew up during and soon after the war. We are also more educated (and education is associated with more progressive values) as well as growing up in a more socially liberal world, with greater exposure to diversity. As this article puts it “When my parents first voted in the 1960s, homosexuality was illegal, abortion was largely illegal, the death penalty was still in force and openly racist attitudes were widely acceptable. Now, the death penalty is a distant memory, abortion rights are firmly entrenched, gay marriage is legal” and (perhaps with the exception of the Brexit effect and islamophobia) racism isn’t socially acceptable. Environmental issues are really embedded in the values of young people, and the scientific consensus for climate change and the need to preserve our limited resources has become overwhelming over the last decade or two. Every school has recycling bins and anti bullying policies, every home has energy efficient light-bulbs and lots of products market their green credentials. There is an increased focus on making healthy choices for ourselves and our planet. Anyone under 40 is also growing up immersed in social media, and with the perspectives of the whole world available to them immediately, rather than just the opinion of the local community and the newspapers. The media barons have less influence, and the circulation of the tabloids is decreasing (and there is increased coverage of celebrity “news” within them, and less coverage of the more serious topics).

So I’m optimistic. Despite all of the things in the world that are upsetting people and setting them against each other, I think the march of time takes us towards an increasing prevalence of progressive values. I hope by the time my children are voters the world will be a nicer place, and the Overton window will have moved back to the left.