Director of Public Health Annual Report 2023: Mental health matters

Good mental health in adults can be promoted by a variety of things, many of which also have a direct impact on our physical health. These include how active we are, what we eat, how much sleep we get, and whether or not we smoke.

As with children and young people, our mental health as adults can be supported by having a social network of friends, by contact with nature and involvement with arts and music.

The job we do also impacts our mental health and research has found that good quality work or volunteering can promote good mental health. Evidence suggests that adults can further enhance their mental health by learning a new skill or adopting the practice of mindfulness (a technique which involves paying attention to your thoughts, feelings and the world around you in the present moment).

Physical activity is important for good mental health and more active lifestyles have been linked to a lower risk of mental health disorders. For example, research found that just 15 minutes of vigorous exercise each day lowered the risk of depression by 26% in adults who were not usually very active. Another study showed that, for adults aged from their twenties to age 50, every additional physical activity session each week reduced their chance of depression by 6%.

Physical activity has also been shown to improve the symptoms of common mental disorders such as depression, anxiety and distress in the general population, in people with diagnosed mental disorders, and in people living with chronic health conditions.

For good mental and physical health, adults should try to be physically active every day. The more time we spend being physically active, the better the health benefits – but any activity is better than none.

From time to time, everyone has problems getting to sleep, waking in the night or very early in the morning. However, getting enough sleep is crucial to protect both our physical and mental wellbeing.

Not getting enough sleep affects our abilities to problem solve, make decisions and our overall mood. Regular sleep disturbances that last more than a month could be insomnia. Insomnia is often a symptom of common mental health conditions such as anxiety and can be a risk factor for developing other mental health disorders.

There are actions we can take to promote better sleep, including physical activity, cutting back on caffeine and alcohol, and keeping regular sleeping hours.

A healthy diet has been associated with a lower risk of depression. Unfortunately, the relationship between diet and mental health is not simple as some physical health conditions that are linked to a poor diet (such as diabetes and obesity) are associated with worse mental health. When our mood is low, we are experiencing stress, or are low on sleep, we might also turn to “comfort foods”. Overall, however, the evidence supports the idea that having a good diet is likely to help our mental health and wellbeing.

It is better for both our physical and mental health to never start smoking. Where people do smoke, there is strong evidence that quitting smoking results in reduced anxiety and depression, and better mood and quality of life.

Whilst smokers may associate the act of smoking with reduced anxiety and irritability, these positive sensations occur when cravings for nicotine are relieved: the negative feelings are often created by smoking itself.

More people with mental health conditions smoke, compared to the general population, and can find it harder to stop. However, free support is available to quit smoking.

Our mental health as adults can be supported by having a strong social network, known as “social connectedness”. This includes having a common bond and closeness with others, a shared sense of identity, feeling cared for and accepted.

As well as promoting our mental health, research suggests that social connectedness is important to the recovery of people with mental health difficulties.

Loneliness can be linked to worsening mental health. Mental health conditions can also increase someone’s loneliness by reducing their ability to mix with people and leading them to withdraw. Loneliness is particularly associated with specific events in our lives such as moving away from a family home, parenting young children, physical health issues, relationship breakdown, and bereavement.

We can reduce loneliness and increase our social network through participation in social activities such as joining group activities or volunteering.

Learning as an adult has been shown to have a range of benefits linked to better mental health. It can give people a sense of purpose, provide a greater sense of wellbeing, and increase satisfaction with life.

Participation in further education has also been linked to improved wellbeing for adults with moderate to severe mental health conditions.

Being around nature can promote our mental health and reduce levels of depression, anxiety and fatigue. This includes contact with the natural environment through ‘green spaces’ such as parks and woodlands and ‘blue spaces’ in the form of rivers and lakes.

One study found that health and wellbeing were consistently higher for adults who spent 120 minutes or more per week in nature, and this persisted into older age.

Access to a good quality natural environment varies greatly depending on where we live. The most economically deprived areas often have less available public green and blue space, meaning people in those communities have fewer opportunities to reap the benefits.

Participation in art-based activities – particularly singing, music making and dance – can improve wellbeing and quality of life in adults.

There is also some evidence that art can support the prevention and treatment of mental health conditions. For example, a review of the research into the role of visual arts on wellbeing outcomes for working age adults (16-64 years) with a diagnosed mental health condition found a consistently positive effect.

Being in employment and having a ‘good’ job (in which people are treated fairly, are included in decision making, have a secure and consistent income and feel appropriately rewarded for their efforts) supports and protects good mental health.

People who are unemployed are between four and ten times more likely to report depression or anxiety. Indeed, in January 2021, 4 in 10 unemployed people in the UK had poor mental health compared to nearly 3 in 10 in employment.

Support for unemployed people to overcome the negative impacts of losing a job, and to help them re-enter work, can help promote mental health.

The relationship between employment and mental health is, however, complex. Mental health conditions such as stress, anxiety and depression are the leading cause of lost working days in the UK. People with mental health disorders can also find it difficult to find and maintain work, often as a result of negative perceptions about mental health from employers.

There is mixed evidence regarding the impact of the gig economy on mental health. The flexibility can be positive, helping people with mental health conditions stay in, or return to, work. The gig economy can also impact negatively on people’s mental health as there is frequently less financial security, lower decision-making and greater stress and strain.

Adults who engage in regular volunteering activities experience higher levels of mental wellbeing than those who have never volunteered. There is evidence that acts of kindness and giving improve mental wellbeing by creating purpose, self-worth and a sense of reward.

Volunteering also often offers an opportunity to connect with others, further strengthening the positive benefits.

The practice of mindfulness involves paying attention to your thoughts, feelings and the world around you in the present moment. Research has found that mindfulness can improve and protect mental health and can play a role in reducing anxiety, depression and stress.

Whilst mindfulness-based interventions can be a clinically effective treatment, the practice may not work for everybody in every setting. For example, a recent trial in schools did not improve mental health as students did not engage with it.

Many activities that incorporate mindfulness approaches are, however, extremely popular with adults with positive results. For example, yoga combines physical activity with elements of mindfulness and can protect against depression.

Physical activity has also been shown to improve the symptoms of common mental disorders such as depression, anxiety and distress in the general population, in people with diagnosed mental disorders, and in people living with chronic health conditions.

For good mental and physical health, adults should try to be physically active every day. The more time we spend being physically active, the better the health benefits – but any activity is better than none.