A Holistic Approach for Workers, Organisations, and Communities My name is Gillian Brooks, and I am a Senior Lecturer in Marketing at King’s Business School, King’s College London. In recent years, mental health and well-being have emerged as critical aspects of a healthy and productive workplace. As awareness around these issues grows, more organisations are recognising the importance of fostering an environment where employees' mental health is prioritised. This is not just a matter of social responsibility; it's a strategic investment that benefits workers, organisations, and even the broader communities they serve. It is for this reason that focusing on work-life balance makes a profound difference. So to celebrate this year's World Mental Health Day (WMHD), I would like to share with you a holistic approach to addressing wellbeing in the workplace for workers, organisations, and global communities. For employees, mental health challenges such as anxiety, stress, and burnout can have a significant impact on their personal and professional lives . According to the Mental Health Foundation , mental health was the 5th most common reason for sickness absence in 2022, and 857,000 workers suffered from work-related stress, depression, and anxiety in 2023 in the UK alone. When workplaces ignore these issues, the consequences can be severe : reduced productivity, increased absenteeism, and a decline in overall job satisfaction. On the other hand, a workplace that actively supports mental health creates an environment where employees feel safe, valued, and motivated. Implementing mental health initiatives — such as access to counselling, stress management workshops, or mindfulness programs — can reduce stress levels and help employees cope with challenges. Additionally, promoting work-life balance ensures that workers have time to recharge outside of work, fostering resilience and enabling them to bring their best selves to their jobs. And by creating a culture of openness around mental health, companies can help reduce stigma, encouraging workers to seek support when they need it. Looking at Business Benefits Investing in mental health and well-being is not just the right thing to do—it’s also a smart business move. 17.1 million working days were lost due to work-related stress, depression or anxiety in 2023 . And since then, organisations that have prioritised their employees' well-being have seen a range of benefits, including improved productivity, higher engagement, and greater employee retention. This includes: Enhanced Productivity : Employees who feel supported are more likely to be engaged and focused. They have the mental bandwidth to be creative and solve problems efficiently, which contributes to better performance and innovation. By reducing stress and creating a supportive work environment, companies can enhance productivity across the board. Higher Engagement : When workers feel that their well-being is valued, they are more likely to be engaged with their work. Engagement drives commitment, enthusiasm, and a sense of belonging. This, in turn, translates to better teamwork and a more positive workplace culture, where individuals support each other and align with the organisation's goals. Reduced Turnover : High turnover rates can be costly for organisations, both in terms of recruitment expenses and the loss of institutional knowledge. A focus on mental health and well-being helps retain talent by creating a more satisfying work experience. Employees who are healthy and supported are less likely to leave, reducing turnover and maintaining a stable, experienced workforce. Looking at Community Benefits The impact of prioritising mental health and well-being in the workplace extends beyond the office walls. When organisations take care of their employees, it creates a ripple effect that benefits entire communities. In fact, it can promote healthier family dynamics. Employees who maintain a healthy work-life balance and manage their mental health effectively are more present and engaged in their personal lives. This means they can be better parents, partners, and friends, contributing positively to their social circles. The reduced stress levels help them engage more meaningfully with their loved ones, creating stronger, more resilient families. Businesses who take a lead in promoting mental health, help normalise conversations around these issues, not only within the organisation itself but also in the broader community. This can encourage other businesses and local institutions to adopt similar practices, creating a culture where mental health is openly discussed and supported. Communities also thrive when their businesses are strong and stable. By reducing absenteeism and turnover, and by maintaining a productive and motivated workforce, businesses contribute to the economic stability of their communities. According to the Centre for Mental Health , the long-term economic impact of prioritising mental health can actually be seen in more resilient local economies, where businesses are equipped to weather challenges and continue to provide employment opportunities. One of the most effective ways to support mental health and well-being is through a focus on  work-life balance . When employees have time to disconnect from work and enjoy their personal lives, they can recharge, preventing burnout and long-term stress. Here are a few ways organisations can support work-life balance: Flexible Work Arrangements : Remote work, flexible hours, or compressed workweeks can give employees more control over their schedules, allowing them to balance their personal and professional responsibilities. Flexibility helps reduce stress and allows employees to adapt to their unique life circumstances. As noted in a recent article by The Guardian , enhanced rights to request flexible working arrangements have been implemented in the U.K. as of 2024, further emphasising the importance of adapting work environments that support employee well-being. Encouraging Time Off : Promoting the use of vacation days and mental health days allows employees to take the time they need to rest and recover. It’s important for organisations to actively encourage this, ensuring that taking time off is seen as a positive aspect of the workplace culture. A recent study highlighted by Forbes found that 47% of workers feel guilty for taking a vacation, underscoring the need for organisations to foster a culture where taking time off is encouraged and normalised. Creating Boundaries : Encouraging boundaries between work and personal life, such as no email expectations outside of working hours, can help employees fully disengage from work when they are off the clock. This allows them to return to work refreshed and more capable of handling challenges. As highlighted by Sky News , giving workers the right to switch off could not only enhance their well-being but also potentially boost the economy, demonstrating the broader benefits of maintaining work-life boundaries. This incentive that has also been supported by the U.K.'s labour party. To make a meaningful difference, addressing mental health and well-being must become a core part of a company’s culture. This means more than just having policies on paper — it requires a commitment from leadership, managers, and employees to create a supportive environment. Training managers to recognise signs of stress, providing access to mental health resources, and fostering open communication can make a big difference. And involving employees in these efforts can ensure that initiatives are tailored to their needs. Whether through anonymous surveys, focus groups, or simply open conversations, gathering feedback helps create programs that truly resonate and make a difference in the lives of employees. So, let’s remember the power of conversation in shaping a supportive community. This year’s WMHD focus on workplace mental health underscores the need for organisations to prioritise the well-being of their employees, creating environments where everyone feels valued and heard. By checking in with friends, family, and colleagues, we can foster connections that help us navigate life's challenges together. Let’s not confine this important dialogue to just one day; instead, let’s make it a continuous effort to advocate for mental health awareness. Together, we can create a culture that not only acknowledges mental health but actively supports it, benefiting individuals and communities alike.

A Reflection on Robert Frost’s “The Rose Family” What do I have to be to prove that I am a rose? Hello everyone! My name is Isabella Molnar, and I recently completed my Master’s degree at King’s College London. Having had some time to reflect on my past achievements, I began asking myself: What truly defines me? How do I determine my own worth, and is it shaped by external validation, or does it come from within? These reflections led me back to one of my favourite poems “ The Rose Family ” (1928) by Robert Frost (1874–1963). In this article, I will share my personal interpretation of the poem and explore my thoughts on the unconditional nature of human worth. So, let’s begin… “The rose is a rose, And was always a rose. But the theory now goes That the apple’s a rose. And the pear is, and so’s The plum, I suppose. The dear only knows What will next prove a rose.   You, of course, are a rose – But were always a rose.” What is Frost Trying to Tell Us? In his poem, Frost begins by affirming that the rose – often a symbol of beauty – has always been a rose, suggesting that its beauty is timeless. He then extends this metaphor to other fruits in the rose family, implying that they too can be considered roses, though only “the dear” knows what will next be classified a rose. Frost’s direct address to the reader, reassuring them that they are and always have been a rose, introduces the deeper message: human worth (symbolised by the beauty of the rose) is intrinsic ( “belonging to the essential nature of [something]” ) and constant, regardless of external definitions. This hidden message reflects Frost’s style of writing , using nature and simple language to explore important social and philosophical ideas. The poem can be interpreted through both naturalist and idealist philosophical stances, which often intersect in his work. Essentially, naturalism claims that reality is grounded in nature and physical causes, while idealism argues that reality is shaped by our thoughts and mind. So, from a naturalist perspective, we might say that no matter how society tries to redefine or categorise the rose, its natural structure remains unchanged. On the other hand, the idealist perspective suggests that the beauty of the rose is not rooted in physical attributes, but rather in how we perceive it. If society renamed the rose, its essence would remain the same, as beauty exists in our perception. Nevertheless, in my opinion, both perspectives lead to the conclusion that external labels do not alter the beauty of the rose. While Frost’s dualist approach and the crossroad between naturalism and idealism has faced criticism for not taking a definitive philosophical stance, seemingly creating an epistemological dilemma , I view this as a strength, given that poetry is naturally open to diverse interpretations. My personal interpretation is that Frost’s key message is that, much like the rose’s enduring beauty, our intrinsic worth remains constant despite external influences. Indeed, just as the rose remains beautiful despite how it is categorised, we too are worthy, regardless of external labels, societal standards, or judgement. This idea aligns with the transcendental concept of human worth, suggesting that our intrinsic worth is unconditional and thereby not dependent on external validation, such as achievements, social status, or appearance. Our worth consequently does not depend on what society next proves a rose, which is particularly significant considering society’s shifting standards of beauty and worth and the random nature of such judgements, symbolised (and criticised) by the phrase “the dear only knows what will next prove a rose”. The poem exemplifies a recurrent theme in Frost’s poetry: the tension between the individual and society . So, what do I have to be to prove that I am a rose? “The Rose Family” reminds us that we do not need to prove ourselves to anyone as our worth is already within us. Human worth is not tied to external validation; we are all the same and thus all worthy of acceptance and love. Why is This so Important for Mental Health? I believe that the concept of unconditional intrinsic worth is key for mental health. When we tie our self-worth to external validation, we make ourselves vulnerable to a cycle of stress, perfectionism, and dissatisfaction . This reliance on external measures often leads to feelings of worthlessness and inadequacy , making it difficult to find genuine contentment and self-acceptance. Moreover, what society proves valuable, or worthy can shift rapidly, creating an unstable foundation for self-worth that is prone to collapse under pressure. However, when we truly believe that we are all roses – intrinsically and unconditionally worthy – such external pressures lose their power over us. A large body of evidence supports the idea that individuals with a strong sense of self-worth are more resilient and better equipped to cope with stressful life experiences . They are consequently less likely to experience mental health issues , such as anxiety and depression, and are more likely to maintain emotional resilience through life’s ups and downs. Why is This Relevant for Us Today? Although written in the 20th century, this poem is more relevant than ever, as the tension between the individual and society has become even more pronounced in today’s world. Social media, professional pressures, and societal standards constantly bombard us with ideals of success, beauty, and happiness , often making us feel that we must conform to these external standards to be worthy. This creates relentless pressure to adapt, leaving many questioning their own worth when they “fail” to meet these shifting standards. Moreover, societal expectations have become increasingly unrealistic and unattainable, keeping us endlessly chasing an ideal that is perpetually out of reach. Particularly with the rise of social media, comparison culture has made it more and more difficult to feel content with who we are, consequently exacerbating feelings of self-doubt and insecurity .   Perhaps, by embracing the concept of intrinsic worth, we can live our lives for ourselves, rather than constantly seeking approval from others. Frost’s poem captures this mental freedom. The idea that “you, of course, are a rose – but were always a rose.” encourages us to look within for our worth. This shift would allow for a more liberated existence, less impacted by the weight of constant pressure. In this regard, “The Rose Family” is a powerful reminder that our intrinsic worth is constant and unconditional, no matter what the outside world tells us. So, the next time you find yourself doubting your worth, remember: You are, of course, a rose—but you have always been a rose.

Humans are inherently social beings, and our daily interactions with others – whether family, friends, colleagues, or strangers – shape our ability to understand the minds of those around us. I’m Bryony, a cognitive psychologist, and I’m interested in how the brain works and how we think about other people’s minds. In my latest research , my team and I found that people frequently misunderstand those who differ from themselves. In this article, I’ll explore why this happens, the consequences of these misunderstandings, and how we can improve the situation.   Where does it all start? People categorise each other  into different social groups. This helps us to make sense of the busy social world around us, and where we belong in it. One of the ways we categorise people is in terms of whether they are ‘in-group’ to ourselves (i.e., they belong in the same group as us) or whether they are different and therefore part of an ‘out-group’.   You may perceive someone to be different to yourself for many reasons. Perhaps because they hold different political views to you, speak a different language, or perhaps because they are of a different gender-identity (e.g., cisgender vs transgender), or neurotype (e.g., neurotypical vs neurodivergent). It may simply be because you’ve had different life experiences. This social categorisation is not , inherently, a bad thing.     However, we tend to spend more time with the people in the same social group (s ) as us. This allows us to develop a nuanced understanding – or representation – of the individuals within our ‘in-groups’. In other words, spending more time with people similar to us allows us to recognise the diversity within the group . This isn’t the case for out-groups though. Because we spend less time with out-group members, our understanding is often based on limited interactions or second-hand information from media or social networks. If that information is inaccurate or overly simplistic, then our representation of them will be as well. This is important because research  suggests that if we have a poor representation of people, we are more likely to make inaccurate assumptions about them. What did our research find? In our study , we asked 256 people from the US to predict the social and political beliefs of others. First, we asked participants their own view, i.e., how far they agreed or disagreed with statements such as “my own race is not superior to any other race”. We then showed them the responses of other people who had been asked the same question.   If the participant said they strongly agreed  that their own race is not superior, they would be presented with someone who said they strongly disagreed  with this. This would make them “out-group” to the participant.  Now aware that the other person disagreed with them on one belief, we asked participants to predict this other person’s view on a different topic, such as “immigrants are good for society”. The participant might assume that someone who believed in the superiority of their own race, might also be anti-immigration.   Each time, we asked participants how confident they were that their prediction was correct. We found that people were consistently very confident that their predictions were accurate (75% confident) but they were wrong more than 60% of the time. In fact, the more confident they were, the more likely it was that their prediction was wrong.     How does this affect our day-to-day lives? The consequences of this are vast and wide-ranging, manifesting at the individual level and on a societal level. For instance, imagine you are interviewing someone for a job and they suddenly leave the room without explanation. You might assume they are rude or uninterested, leading you to question their suitability as a colleague. However, if your representation of them included the knowledge that they had an anxiety disorder and suffered from panic attacks, you’d probably interpret their behaviour – and the type of mind they have – very differently. A broader range of experiences with diverse individuals allows us to form a more complete understanding of others, making it easier to interpret their actions and intentions accurately. Without that diversity, we may mistakenly assume that everyone’s mind works like ours, or like the other minds we have been exposed to. For instance, children who have experienced abuse or neglect may be more likely to represent other peoples’ minds as ‘nasty’ . That is, they may overestimate the likelihood that others are aggressive, deceitful, and lacking in empathy because of their prior experience . In such children, who may be later diagnosed with Conduct Disorder , their incorrect assumptions about what other peoples’ minds are like may make them more likely to react with suspicion or aggression towards others. Thus, the previous experience one has of others may reduce their ability to understand people who have minds that deviate from what they’re used to. People’s lack of awareness about their proneness to misjudge differential others can have wider impacts at a societal level . For instance, in the UK riots this summer, we saw far-right protesters targeting asylum seekers and Muslims, as well as those who were helping or housing them. The riots were started after an attack on children in Southport , in which the p erpetrator was wrongly identified as a Muslim asylum seeker via social media posts. Thereafter, it is likely that many of the  people comprising the far-right in-group took their understanding of this single ‘asylum seeker’ as wanting to intentionally harm children, and attributed the same intention to all asylum seekers and Muslims. This led to wide-spread violence against swaths of people in the UK, the vast majority of whom had no such intention.   What can we do to help? The good news is, it seems that when people are made aware that their assumptions about other people are incorrect, they do reconsider. In a second study (which is still in progress), we asked participants to complete the same task, but this time told them when their initial prediction was incorrect. Receiving this feedback helped participants to make their predictions more accurate. Further, participants learnt that they were more likely to misunderstand the views of out-group members than in-group members.   If people are aware that they are less able to understand out-group minds, they may become less likely to rely on their initial assumptions, and seek more information. Indeed, having conversations with people who hold different views, beliefs, and experiences could help challenge our incorrect assumptions about each other. This is why it is so critical that people are exposed to people who are different from themselves, and hear their real stories to gain insight into who they are as individuals. This helps us to understand that, like our in-group, the out-group is made up of many people with different personalities, beliefs, desires and emotions. Over time, this helps us to understand how their mind works and, hopefully, makes it likely that we will treat out-groups fairly and with humanity.

This June we launched the ASPIRE study, aiming to understand how we can use inflammation blood tests to identify people with depression who can be helped by anti-inflammatories. Led by myself at King’s College London, the ASPIRE study (‘Advanced stratification of people with depression based on inflammation’) brings together investigators from 8 countries (Australia, Belgium, France, Germany, Italy, South Africa, The Netherlands, USA), including two associations of people with lived experience of mental health problems. As a psychiatrist dedicated to helping people with depression, the most frustrating aspect of my work is the difficulty in predicting who will respond to which antidepressant strategy. This is particularly relevant to people with “treatment-resistant” depression, who have not improved with two or more standard antidepressants. This study may change this. This is our aspir ation.     At Inspire the Mind, we have often discussed the clear evidence that 20-30% of people with depression , and even more people with depression who are not responding to antidepressants , have increased levels of inflammation in the blood. Inflammation is activated when we face a threat that could lead to infections, such as a physical assault, but it can also be activated by being stressed. Indeed, during depression, the increased inflammation is part of a general activation of the biological stress response system: ultimately, depression is, both psychologically and biologically, a condition of chronic stress.   From a clinical point of view, this activation of the inflammatory system directly affects the brain , making the person more likely to stay depressed (for example, by changing how brain cells and brain areas communicate between themselves) and less likely to respond to antidepressants (for example, by changing the brain chemicals that are the target of antidepressants). As such, dampening this inflammation with anti-inflammatory medications – drugs such ibuprofen, celecoxib or aspirin, used for inflammatory disorders such rheumatoid arthritis – should have beneficial antidepressants effects, by rescuing the brain changes induced by the inflammation.   Indeed, some studies , including ours , have demonstrated that adding an anti-inflammatory medication to an antidepressant improves depressive symptoms in people who had not previously responded to antidepressants – but only if their levels of blood inflammation are measurably high. Other studies in people with low levels of inflammation have shown no such beneficial effects .   And this where ASPIRE steps in to try to address exactly this question: what is the best blood inflammatory biomarker(s) that accurately predict successful response to an anti-inflammatory? And, connected to this question, are there clinical features that accurately predict the response to anti-inflammatories: for example, the type of depressive symptoms a person experience, or physical health abnormalities such as obesity and excessive sugar levels in the blood? Moreover, are there brain changes induced by inflammation that accurately predict the response to anti-inflammatories and that could be measured by taking pictures of the brain via brain scans? We will then put all of this information together in a “decision tool” and test our ability to predict the response to anti-inflammatories using this decision tool in a new clinical trial.   The work is divided across seven work packages. Work Package 1: Systematic Reviews and Meta-Analyses of Inflammation Related Clinical Predictors. We aim to gather a large amount of data by thoroughly reviewing previous research investigating anti-inflammatory medications in depression. We will also perform additional analyses to see how factors like age and sex-at-birth affect treatment response.    Work Package 2: Laboratory Analyses of Inflammation Related Blood-Based Biomarkers.  We will focus on well-known blood-based inflammatory biomarkers, which are biological molecules measured in the blood and used to assess a person’s levels of inflammation. We will re-analyse biomarkers from over 1,200 participants across many clinical trials using anti-inflammatory medications in people with depression.   Work Package 3: Meta-Analysis of Blood-Based Biomarkers. We will combine all the data gathered from work packages 1 and 2, including data from other collaborators, that focus on biomarkers measured in blood and that are related to the immune system and metabolism.   Work Package 4: Meta-Analysis of Inflammation-Related Neuroimaging Markers. We will look at alterations in the brain's structure (structural data) and how different brain regions function and interact with one another (functional data), from clinical trials using anti-inflammatory medications in people with depression.   Work Package 5: Generating a Machine Learning Tool. We will use a machine-learning approach to develop a decision tool that identifies individuals with depression who will respond to an anti-inflammatory and thus benefit from accessing these drugs.   Work Package 6: Feasibility, Proof-of-Concept Study to Test Decision Tool. We will run a 12-week study to see if we can use the decision tool to identify the people with depression who will improve using an anti-inflammatory.   Work Package 7: Views of People with lived experience and Dissemination Findings. The views of people with lived experience (PWLE) are at the core of the ASPIRE project. In this work package, we will explore opinions on the notions of using anti-inflammatories to treat depression. We will also focus on sharing all the research we have done in ASPIRE with the wider public, for awareness and education. And indeed, at the heart of the study are people with lived experience. Alongside playing a crucial role in the conception and design of ASPIRE, the study will amplify the voices of those affected by depression and advocate for better treatments and understanding.   The study aims to change public perception of the role of inflammation in mental health and, in general, on the importance of mind-body interaction in mental disorders.   Further information on the study can be found at www.aspirestudy.org , @aspireresearchstudy on Instagram and @theaspirestudy on X.   Members of ASPIRE Consortium King's College London, UK: Carmine Pariante, Anthony Woods, Caitlin Pentland, Courtney Worrell, Giulia Lombardo, Lea Schmid, Luca Sforzini, Melisa Kose, Naghmeh Nikkheslat, Nicole Mariani, Zuzanna Zajkowska, Valeria Mondelli Amsterdam University Medical Centre, The Netherlands: Brenda Penninx, Femke Lamers, Yuri Milaneschi Cardiff University, UK: Neil Harrison   Charité University, Berlin, Germany: Christian Otte, Julian Hellmann-Regen, Deniz Dogan, Stefan Gold Deakin University,  Australia: Jane Meier, Michael Berk, Olivia Dean Emory University, Atlanta, USA: Andy Miller, Jennifer Felger Foundation FondaMental, Paris, France: Federico Cevoli, Marion Leboyer, Bruno Aouizerate IRCCS Ospedale San Raffaele,  Milan, Italy: Alessandro Mioli, Benedetta Vai, Camilla Monopoli, Francesco Benedetti, Sara Poletti   IRCCS Fatebenefratelli, Brescia, Italy: Floriana De Cillis, Annamaria Cattaneo Libera Virginia Cavaliere Istituto Superiore di Sanità, Rome, Italy: Claudia Delli Colli, Igor Branchi GAMIAN Europe, Brussels, Belgium: Erik Van Der Eyken, Fanni-Laura Mäntylä, Nigel Olisa South African Depression and Anxiety Group (SADAG), Cape Town, South Africa: Cassey Chambers Ofentse Hanyana University of Antwerp, Belgium: Céline Wessa, Livia De Picker, Manuel Morrens, Violette Coppens University of Bristol, UK: Golam Khandaker, Eimar Foley University of Cape Town, South Africa: Dan Stein, Nadia Hoffman, Shuretta Thomas   University of Melbourne, Australia: Ben Harrison, Christopher Davey   University of Muenster, Germany: Bernhard Baune

On the 13th of March, 2023, a one-year and six-month journey of strike action began for junior doctors, involving 11 individual rounds and totalling  44 days  of strikes.   However, on 16th September 2024, these strikes have finally come to an end, with an agreement having been made between the British Medical Association (BMA) and new government.   So, let’s break down why doctors were striking, and what the new deal means.   Junior doctors have voted to accept a pay rise which will average 22% over two years, in a constructive step towards pay restoration.   The pay deal is a positive step forward for doctors, and a particularly positive change for myself and my colleagues, as after 8 years of studying, I am due to graduate as a doctor and start work next year. Why were junior doctors striking? Since 2008, junior doctors have had an approximate  35% decrease  in salary, due to below-inflation pay rises. The image below illustrates the current pay of junior doctors in 2024, and was captioned by the BMA : "The junior doctors operating on your appendix are paid just £66.55 between them. For a potentially life-saving procedure, which lasts about an hour". When a junior doctor with 1 year’s experience is referred to, this means they have already completed 4-7 years of medical training at university, and are in their first year of working as a doctor. The image highlights how a doctor with one year of experience is earning £14.09/hour, which has been compared to a rate  less   than that of a Pret A Manger Barista , whilst a trainee surgeon with 10 years of experience is earning £28/hour.   The BMA posted a photo further highlighting the junior doctor and Pret A Manger barista's similarity in salary, leaving many doctors feeling undervalued due to the years of training they have undergone, and the level of responsibility they hold for people's lives. This salary decrease has taken place on a background of junior doctors experiencing workplace burnout at the highest level ever recorded , high-pressure workloads, inadequate resources , poor support structures, and a cost-of-living crisis. In fact, junior doctors are now facing higher levels  of burnout than during the pandemic, with 63% of doctors feeling ‘at a high or moderate risk of burnout. I have written previously about burnout in the NHS which you can read more about here .   Additionally, 65% of doctors have experienced the feeling of ‘moral distress’ as a result of working in the NHS. Moral distress  refers to the psychological unease felt when professionals identify an ethically correct action to take but are constrained in their ability to take that action.   It is therefore unsurprising that 19,000 doctors were estimated to have left NHS England prematurely between September 2022 and 2023. This equates to 1 in 7 of the NHS doctors in the workforce.   Doctors enter the profession wanting to help people, however when resources don’t allow for this, it is devastating. When you then also feel undervalued due to factors such as a salary decrease, it exacerbates the challenges already faced by doctors.   Therefore, the strike action was called to advocate for pay restoration, and one and a half years on, a new pay deal has been accepted.   What does the new pay deal mean? The pay deal  offers an average of a 22% pay increase over two years, which results in an average 4.05% uplift on existing 2023/24 junior doctor pay. For a first-year doctor, this will result in earning approximately £16.06/hour compared to the previous £14.10/hour. This offer shows progression in the journey to reverse the past decrease, and moves doctors about one third  of the way towards full pay restoration.   The new deal will hopefully provide a renewed sense of optimism for doctors, and a belief that a more positive work environment can be achieved.   What about other healthcare professionals? Some frustration has arisen for other healthcare professionals such as nurses, midwives and physios, some of which similarly underwent strike action last year . After the Royal College of Nursing’s (RCN) negotiations with the prior government, their pay deal was a little more than half  of the new junior doctor deal as a percentage increase.   The leader of the RCN has said “We do not begrudge doctors their pay rise”, “What we ask for is the same fair treatment from government.” The RCN has now opened up communication with its members to understand the views of nursing staff on their current pay, which is yet to be announced.   What other changes are happening alongside the doctor pay deal? The junior doctor pay deal announcement also comes alongside a change to the title of doctors, with junior doctor being removed and replaced by the term resident doctors .   Over the course of the pay dispute, there have been large amounts of misinformation and confusion over the term junior doctor. The previous governments Health Secretary, Victoria Atkins, was accused of belittling Junior Doctors  by calling them “doctors in training” on national television. This may suggest to some that they are not qualified doctors, or are undergraduate students.    However, the definition of a junior doctor is ‘a qualified doctor practicing at any stage between graduation and completion of specialist postgraduate training’. Junior doctors could have a decade of experience working in a field such as neurosurgery, however, have not yet finished training due to the length of time it takes to complete. Therefore, the new term 'resident doctor' will be a positive change to better reflect the skills and responsibilities of these doctors.   Overall, the pay deal is a step towards pay restoration and will hopefully provide positive news to doctors working on the frontline, alongside the change in terminology from junior to resident doctor.

Author's Note: This story depicts grief and social anxiety, and how taking care of others can sometimes help you take care of yourself. The events are fictional, but I hope you enjoy and that it brings you comfort if you need it. Photo by Simone Dalmeri on Unsplash Sarah sighed as she carefully pulled back a curtain just a smidge; just enough to look outside. She saw the shifting grey, just like the one that hummed inside her like an old box TV set with no signal and knew before the first drop fell that it was going to rain. "Of course," she said, quietly, to no one in particular. In fact, to no one at all. Sarah was 22 and lived alone. Some would say she was lucky not to have to exist alongside a gaggle of roommates, or with her parents. But they wouldn’t know, just by looking at her, that her only family was her Gran, and that she died a year ago, leaving her the house. And leaving her all alone.          Sarah supposed some people would still consider her lucky, having the house all to herself in this economy. They were right, in a way, but again, they weren’t to know that the last time she’d left the house - beyond the front or back doorstep - was to attend her Gran’s funeral. That she hadn’t brushed her teeth in about three weeks. That she could barely get out of bed most days. But how would they know, anyway? She never left the house - she just couldn’t - not with all the noise, and heat, and eyes on her, like laser beams. The one time she tried to go in her garden she couldn’t breathe and had to rush inside before she passed out, because if she did there would be no one to find her for weeks, maybe even months. Sarah sighed, imagining the raindrops falling against the windowpanes covered constantly by heavy curtains. She remembered, for a moment, the game she used to play as a child, how she would pick a raindrop and trace its trail down the window and wait to see if it was the first of the cluster of raindrops that reached the bottom. Sarah almost pulled the curtain back, just to see, but as she moved her hand towards the fabric, anxiety shot through her as though she'd been struck by lightning. It was then that she heard it, a strange scratching at her front door. The anxiety jolted, almost as if there was an aftershock. Sarah stepped away as if on impulse, and sat on her sofa, waiting, desperately, for that sound to go away. Unfortunately for Sarah, the sound continued for what felt like hours. And as the sound continued, the anxiety continued to reverberate through her, her hands and feet buzzing with pins and needles. And still, the scratching sound continued. In moments like this, she always tried to distract herself. What was that trick she read online? Five things she can see, four things she can hear… She tried her best, but she couldn't seem to focus on any other sound that wasn't the scratching at the door - even the fierce rain that roared alongside the wind outside. She tried her best... "All you've got to do is try your best, love," Sarah suddenly heard her Gran's voice, as clear as day. It was something that she always said, especially when Sarah was struggling with things, like her exams or the school football team tryouts. It used to be something she would try and remember, after her Gran died, to help her get out of bed or find something to eat. But lately, she hadn't thought of it so much. She supposed she'd used it to get by so much that it had lost its magical effect. Just the idea of that made Sarah’s chest ache like someone had just punched it. She didn't want to stop remembering her Gran. Louisa Fielding had practically raised her. But on top of being her guardian and pretty much her mum, she was so incredibly kind - always baking enough treats to feed the streets, cheering everyone up during bad weather, and keeping plenty of cash on hand in case she passed someone homeless to offer some food and a night at the hotel. Of course, she also had her wild sense of humour - most of Sarah's memories involving her Gran involved the both of them laughing, or at the very least, smiling. Yes, Louisa Fielding was the best person Sarah ever knew. And the person with the biggest, funniest heart. Until it stopped. Sarah caught her breath as reality caught up with her. She was sat alone and anxious in her dead Gran's house. And there was still that damn scratching noise, going on and on by the front door. "All you've got to do is your best, love." Sarah wondered what her best would be, right now. Not being anxious? But it was that scratching that made her feel anxious in the first place… Alright, Sarah thought. I will. Her hands trembled as she reached to open the door, but she still managed to pull it open despite the wind roaring against it. Whatever Sarah thought would be there, she certainly didn't expect a tiny, soaking wet little bundle of fur. A gasp escaped her lips, and in that time, the bundle of fur rushed inside, as if the noise was inviting it in. Sarah shut the door, still shaking, and turned to see the wet ball of fur sat, dripping on the carpet beneath it. Under the wet, matted grey, Sarah could see two black pupils, looking up at her. They stared at each other for a moment, before the bundle of fur shook itself furiously, sending water everywhere as if it had suddenly started raining inside. "No!", Sarah cried, as she reeled from the cold water; she was soaked, and almost started trembling herself, if she wasn't so distracted by the small, furry dog that had just revealed itself. It turned its head slightly as if trying to decipher what she was saying. It had long, matted black fur, and two ears that stuck up on its head, that Sarah thought, at that moment, almost looked like antennas. "Sorry," Sarah said, quickly, and much quieter. The dog tilted its head back up as she spoke, seemingly understanding. It gave a soft bark, which Sarah thought, for a moment, almost sounded like the dog was saying hello. The absurdity of that thought made Sarah smile, and then the dog started gently wagging its tail. The sight of this made Sarah’s anxiety lessen, just a little, and she realised that the dog was still dripping wet - and so was she. Not that it mattered, really, as she hadn't changed out of these pyjamas in a few days. Weeks, even. But if she was going to dry the dog, she may as well change into a fresh set afterwards. "Shall we get us dry?" Sarah asked the animal who simply wagged its tail as though enthusiastically agreeing with her. *  It had been a few days with the dog before Sarah decided to see if he had an owner. Sure, it seemed happy enough - Sarah even let it sleep on the end of her bed - but she couldn't bear letting it stay if it was someone else's family. She couldn't just take it from someone. She wouldn't. But before she took him to the vet, she needed to make him more presentable. She didn't want anyone to think badly of her - she was anxious enough at the mere prospect of leaving the house as it was. Bathing the scruffy little thing was actually kind of fun. Sarah managed to rub soap into the dog's fur until it decided to shake again, covering her in soap, too. Instead of being frustrated or upset, it made her smile. She finished bathing the dog before jumping in the shower herself to wash off the soap and apply human soap and wash herself too - she was already in there, so she might as well, right? It was only when she was brushing the dog's long, matted fur afterwards, that she realised that was the first shower she'd taken in a while. The first time she'd even had the energy to consider going in the shower, let alone having one. And as the thought entered her mind, the small dog wrinkled slightly before licking her hand and bringing her back to the present. "Good dog," Sarah said, and she started to brush again, counting as she did so, and breathing easier with every new number.   *  Despite the positive steps Sarah had taken today, her hands shook as she went to open the front door. At just the thought of stepping out there - of being around other people - Sarah felt her breathing quicken, her chest hitching faster and faster as the reality of what she was about to do hit her like a slap in the face. As she turned away from the door, she felt a soft pressure against her legs. Sarah looked down to see the dog stretched up and resting its front paws on her legs, as if it was trying its hardest to reach her. It did a gentle, soft bark, before attempting the jump again. Eventually, what the dog was trying to do broke through her anxious thoughts and appeared in her mind: He was trying to leap up at her and into her arms. The dog did a soft bark again - "Pick me up," it seemed to be trying to say, "Pick me up!" So, Sarah obliged. But as soon as she picked the dog up, leaving its lead to dangle like a cord towards the floor, the dog stopped moving. Instead, it curled up in her arms and even nuzzled its nose into the crook of her elbow. Sarah stayed still, not wanting to wake him, and realised she could hear its heart beating, so softly, through its fur. Just listening to it for a few minutes, standing stock-still, was enough to steady her own anxious heartbeat until eventually, she felt okay again, and her anxiety was at bay. Not wanting to disturb the sleeping animal in her arms, Sarah impulsively decided to carry the dog to the vet, just as it was. While anxiety crackled through her as soon as she took a step away from the house, Sarah tried her hardest to just focus on the dog's steady heartbeat as it slept soundly in her arms. And somehow, that helped her keep putting one foot in front of the other, to the sound of the little dog's heart beating. Ba-bump, one step, ba-bump, two steps, ba-bump, three steps… Before she knew it, Sarah found herself at the vet, only slightly drenched in sweat, and she’d walked the whole way there without collapsing, and even without having an anxiety attack. The receptionist at the front desk smiled kindly as Sarah approached. "Do you have an appointment, love?" She asked. Sarah tried to ignore the worry bubbling up inside her as she replied. "Yes, in about 5 minutes," Sarah managed to say, before gesturing to the dog in her arms. "Aw bless," the receptionist said, still smiling. "Tired, is he?" Sarah just nodded. "And a bit scared." "Aw, don’t worry," the receptionist said, talking more to the dog now than to her. "Just do your best in there, alright? That's all you've gotta do." Sarah nodded, grateful, and rushed to sit down before the receptionist saw the tears that sprung into her eyes at her very familiar words.   * It wasn't long before they were called in by a vet with colourful tattoos of a cat and a dog on each arm, angled and etched as if they were greeting each other over the vet’s chest. "Hello," the vet said softly, more than the dog than to Sarah, which put her at ease. "Who do we have here, then?" The dog stirred in her arms and jumped deftly onto the steel examination table. "Um," Sarah said, suddenly realising that she'd never given the poor creature a name, "I..." Anxiety crackled in her chest, and she caught her breath in her throat, making her cough. God, maybe this whole thing was a mistake. "It's alright," said the vet, as if they could sense her anxiety. "It took me weeks to name my last kitten. Let's just start the examination and we can go from there, alright?" Sarah nodded and stepped back, grateful the focus would no longer be on her. The dog sat calmly and didn't object to anything the vet did during the examination and various bits of paperwork on the computer. When they were done, the vet even patted the dog on the head, saying "Good boy." "Boy?" Sarah asked. Gender hadn't crossed her mind either. "Yup," said the vet. "And he's not microchipped either, so unless you'd like us to take care of him until he finds a new home—" "No," Sarah cut the vet off with a quickness that surprised even herself. "He's coming home with me." At that, the dog started wagging its tail, and the vet smiled. "Alright then. Before I let you go, have you had any thoughts of a name for this little lad?" Sarah thought for a moment before a name appeared in her mind, as bright and clear as a summer's day. As loud and joyous as her Gran's laugh - the perfect name. "Lou," said Sarah. "His name is Lou." The dog kept on wagging his tail, quicker now, and licked her cheek as she reached out to pick him up. "Well, he seems to like it. And Lou - that’s a lovely name," said the vet, with a smile. It is, Sarah thought, both there and as she carried Lou home. Just the sound of it made her smile. Lou, Lou, Lou… Sarah would later realise that her trip home was the first time she’d left the house since her Nan’s funeral and she hadn’t focused on her anxiety, or let it consume her. Despite the brisk walk there and back, Sarah collapsed heavily on the sofa as soon as she got through the door. Thankfully, Lou happily jumped on her lap, settling as he rested his head on Sarah’s hand. She couldn't move it now, but she realised that when she could, she felt like she could brush her teeth, or even her hair, especially since Lou was so well groomed - she might as well be too, right? Or at the very least, she would try her best, she thought, shutting her eyes, just for a moment, as she listened to Lou softly breathing in and out, in and out… That's all she had to do - and it didn't seem so difficult now. She was no longer alone, after all. And for the first time in a long time, just as she was about to fall into a peaceful sleep, Sarah realised she might just agree with anyone who called her lucky - yes, because now she had Lou to take care of, and him to take care of her.

My name is Rustom, and I’m a fitness instructor and a music therapist based in Mumbai, India. As part of my work, I conduct fitness and bootcamp training sessions for children and adults in Mumbai. Working with individuals with special needs fell into my lap, when my first Down syndrome student, (whose name is Mihaan) came to my fitness class for children. Down’s syndrome occurs when an individual is born with an extra chromosome , and people with this condition often face developmental challenges . When he joined my class, I decided not to read about the condition to allow myself to go with my own instinct. Along the way, I got to know Mihaan more and more and began to notice and admire his purity and innocence, as well as his outstanding sense of humour. As word of mouth spread, I started working more with special populations. Not only did I see a difference in myself and how I was learning to adjust, but I saw a difference in the other ‘neurotypical’ students as well. Gradually, my class became a mixed bag of every shape, size, and capacity, and I was so proud of it.  In 2022, Mihaan told me he was interested in running the   Tata 10 km Marathon  in Mumbai, which takes place in January each year. We decided to dive into this challenge together, and so our training began. This entire process taught me things I never expected, and completely changed my mindset. As a trainer, my first goal is always to understand and accept the individual nature of the person I train. No two people are the same, so how could the path they take and the progress they make be? Each person is different, but each person is human, and humans have their differences and their flaws - my goal is to honour this and treat them with patience, friendship, and respect, no matter what they’re labelled as. The teaching method that I use is secondary to all this. I’ve never wanted to be labelled as a teacher myself. I’d rather be a friend who can support them and maybe guide them just a bit.    So, we started really slow, with maybe jogging a maximum of four to five stretches of 200 metres. Gradually we increased to walking and jogging two kilometres and, after that, everything just seemed to fall into place.    This journey taught me a lot about running with Mihaan. I am an ex-timing runner- which means finishing a run in a pre-identified timeframe, beginning with each training session as well. But, with Mihaan I had to get ready to adjust my experience to fit his needs and train him to the best of my ability. I had to throw the concept of doing the run within a particular time out of the window for the first time. We would not run continuously, which is the usual strategy when training for a marathon. Occasionally, as we first started, we would not run for stretches of 100 metres. The main goal of this process is to make the run a fun run - not only for Mihaan, but for me as well. I had to be ready to stop at regular intervals - whether it was for patting dogs walking at Mumbai’s world-famous Marine Drive , or talking to people as we went along. Unlike my previous experience as a trainer, I could not plan anything.   And it was so freeing.    To say Mihaan loves talking is an understatement. He talks almost every step of his run. Traditionally, if I was training someone, I would tell them to preserve their energy during practice. I could easily have told him to not talk and to preserve his energy while he runs, but that would just spoil his fun. Because we were talking through the run we could not wear earphones, so we would carry a mini speaker so both of us could enjoy music while we ran.   We would run. We would sing. We would chat. When people saw Mihaan and me running, they’d be envious of the fun we seemed to be having and wanted to join in. Soon, we suddenly had an entourage of people running with us. In the process, he also inspired other specially-abled individuals to participate in the 10 km. He also had the chance to meet athletic superstars Yohan Blake and Katie Moon , and his jovial personality and well-thought-out jokes made them laugh. Today, Mihaan is preparing for his third 10 km marathon. He can now run stretches of more than 1 km. Between his marathons in 2023 and 2024, he dropped a whole hour. But that doesn’t matter, because we still enjoy doing it so much.

Part II: The effect of Ozempic on people suffering with eating disorders    Trigger warning: The following article contains discussions about eating disorders with explicit descriptions. Some readers may find this distressing.     Ozempic and its derivatives have been all the buzz in the media over the last year, due to their ability to promote weight loss. In my previous article , I explored exactly what these drugs are, how they work, as well as how they have hindered progress within the body positivity movement. In this article, I will focus on how Ozempic and its media prominence can affect those with eating disorders.   The negative impact of Ozempic on eating disorders  According to the NHS , “an eating disorder is a mental health condition where you use the control of food to cope with feelings and other situations”. They can come in the form of eating too little , eating excessive quantities in discrete time periods, or going to great lengths to get rid of any food consumed  – such as self-inducing vomit, exercising excessively, or misusing laxatives.    In people suffering with, in recovery from, or at risk of an eating disorder, having access to a drug which suppresses appetite has the potential to cause significant harm. Especially for eating disorders characterised by a restricted eating pattern, such as anorexia nervosa , the idea of a drug which will help maintain restrictive ‘goals’ is incredibly dangerous. Indeed, there are even reports of doctors prescribing Ozempic for people who are anxious about their weight , without any screening or background checks.     There is not yet any concrete research available on the impact of these weight loss drugs on people with or recovering from eating disorders. As a scientist, research is usually the place I go to, especially when trying to relay evidence on a topic. However, in this case, I can offer some personal opinions on the matter.     In 2020, I suffered with anorexia – as did roughly 60,000 people  in the UK alone. Luckily, due to the support of my friends and family, I was able to quickly come back to a healthy weight, and I would now class myself as fully recovered.     Writing these articles has caused me to wonder how my story might have been different if I had known about Ozempic during that time. At the height of my eating disorder, my mind was constantly preoccupied with thoughts of food and weight . Hearing about Ozempic now, I can see how the media buzz and ongoing discussions of weight loss could have easily fuelled my obsession with food and thinness. The way these drugs are portrayed as offering easy, cosmetic ‘benefits’ only reinforces the harmful belief that being thin is what matters most. From my own experience, I know how quickly this mindset can take over, and it’s concerning to think about the damage it could do, even for those who aren’t using the drug themselves.    An important thing I also learned is that being recovered is not just about being of a healthy weight. It involves a difficult path of learning to navigate food choices without constant anxiety, and separating self-worth from body size. This is why conversations around weight loss and drugs like Ozempic need to be approached with caution. People in recovery may seem outwardly healthy, but they can still be vulnerable to triggers. During my recovery, when I was uncomfortable in my growing body, I would’ve likely jumped at the opportunity to take a drug which made restricting effortless.    This is why it’s crucial to recognize that what may appear as a harmless ‘quick fix’ can have serious consequences. If someone of a clearly healthy weight requested  bariatric surgery , they would be swiftly turned away. So, why should the situation be different when this drug essentially has the same effects? Research shows  that anorexia is one of the deadliest psychiatric illnesses, emphasizing the need to protect these vulnerable groups when discussing and prescribing these drugs.    Two sides of the coin: Ozempic as a treatment for eating disorders?  However, there are some who would also argue that Ozempic and other similar drugs can help people with certain eating disorders. For example, it has been suggested  that for people suffering with binge eating disorder or bulimia nervosa (both of which are characterised by uncontrollable episodes  of eating large quantities of food in a  discrete  amount of time), Ozempic can help to suppress the urge to binge and help to quieten food noise .  However, it should be considered that having an eating disorder does not mean you always fit into one  specific category  of, for example, binge eating or anorexia. Indeed, many go through natural processes of ‘symptom switching’  throughout their eating disorder (whereby they switch  from a disordered eating pattern fitting one disorder to another). For many with binge eating disorder (BED), resisting the binge is the ultimate goal, and being ‘better’ at this restriction due to taking Ozempic may cause them to actually consume very little throughout the day . This may ultimately cause BED to morph into a restricted eating disorder, such as anorexia.     Furthermore, the effects of Ozempic disappear  once people stop taking it.  Research shows  that for BED, the most important thing is to treat the core psychopathology underlying the urge to binge (for example, by reducing impulsivity and compulsivity ). Using Ozempic as a sole treatment for binge eating disorders is unlikely to target these processes, and thus the urge to binge may return if they stop taking it. However, studies have suggested  that when used in combination with psychological approaches such as cognitive behavioural therapy, drugs like Ozempic may help with the treatment process by improving compliance but should still be prescribed with caution.     Clearly, the story surrounding Ozempic is incredibly complex and highlights the need for careful consideration and awareness. The media’s focus on weight loss and cosmetic benefits can have serious implications for those struggling with eating disorders, potentially exacerbating their challenges. It’s essential to approach these narratives thoughtfully and seek out reliable support.  If you are struggling and need support, below are a few helpful organizations that offer both resources and direct assistance:     https://www.beateatingdisorders.org.uk/    https://www.talk-ed.org.uk/    https://www.eatingdisorderhope.com/treatment-for-eating-disorders/international/united-kingdom/u-k-eating-disorder-organizations-charities

The FREED project In September 2024 we will be celebrating the 10th birthday of FREED (first episode rapid early intervention for eating disorders). FREED is a service that provides treatment and care for young people aged 16-25 who are in the early stages of an eating disorder. It is designed to focus on the needs of the individual, taking into consideration their age, life stage and personal circumstances, then tailoring treatment accordingly. Adolescence into emerging adulthood is the peak period of onset for eating disorders and a time of significant neurodevelopmental, educational and social changes for young people. FREED has evolved from a small local innovation in South London, tested in a single-centre study to a multi-award-winning national programme that has been rolled out successfully in eating disorder services all over England. It has also inspired similar programmes internationally. How did the journey start? We started developing FREED at a time when eating disorder services across the UK were struggling with lengthy waiting lists, and young people potentially being hospitalised hundreds of kilometres away from family and friends .  We decided we wanted to do something about this desperate situation by delivering early well-coordinated care for young people presenting to treatment for the first time. In developing FREED, we were inspired by the work of Pat McGorry and colleagues, who had shown that early intervention makes a big difference in the lives of young people with psychosis, with much better outcomes for early intervention than for traditional care up to 10 years later. Pat McGorry is also a pioneer of youth mental health, highlighting the need for making treatments and health services youth-friendly, inclusive, and easily accessible. Finally, we also took on board Jeff Arnett’s concept of emerging adulthood, as a distinct and unique period of development from the late teens through the twenties, characterised by ‘in-betweenness’, (i.e., where the person is no longer an adolescent, but also not yet a fully-fledged adult). The impact and success of FREED "I nearly dropped out of university last year when my illness was at its most aggressive. I can only thank FREED for quite literally saving my life" Research has shown that FREED reduces the duration of untreated illness (time between onset and first evidence-based treatment), improves treatment uptake and dramatically improves clinical outcomes. For example, 60% of young people with anorexia nervosa receiving FREED are fully weight-recovered at 12 months, whereas just under 20% of similar young people (in terms of diagnosis and illness duration) receiving usual treatment were recovered. FREED also reduces the cost to services, by reducing the need for intensive treatments, such as in-patient or day-treatment. Lastly, FREED is highly acceptable to patients and families. The reason why FREED has been so successful seems to be that it hits a double sweet spot.   Firstly, as a model it hits the so-called innovation sweet spot: It is desirable (i.e. it adds value), feasible (i.e. it can be implemented), viable (i.e. it has substantial return on investment, is cost-saving and contributes to long-term growth) and sustainable (i.e. it does not have negative environmental or social impacts). Secondly, at an individual patient level, it also hits a sweet spot, between the person’s emerging motivation for treatment, their strong developmental need for ‘adulting’ and the malleability and less entrenched nature of eating disorder symptoms early in the illness, meaning that key factors for achieving change and recovery are lined up optimally.    The FREED project ‘It is not rocket science’ Some have suggested that FREED is simple "good practice" and that "it is not rocket science". Thank goodness, it is not rocket science: there are no convoluted theories or incomprehensible language needed to understand the principles or practice of FREED. The aim is simply to "get it right the first time", meaning that we intervene speedily, flexibly, and with evidence-based approaches tailored to young people’s personal and developmental needs and their early illness stage. Having said that, whilst FREED is based on a deceptively simple idea, how early intervention is done really matters. There are examples of ambitious early intervention initiatives for eating disorders that have been ineffective and have not been able to show either a shortened duration of illness or improved outcomes. Early intervention creates a win-win situation FREED is designed as a "service within a wider eating disorders service". The reason for this is to avoid the fragmentation, communication issues, potential for duplication of effort, and access hurdles/bureaucratisation that come with multiple separate services. It also means that any cost savings achieved by the introduction of FREED into a team (through reduction of inpatient admissions) can readily be reinvested into the same service, thereby benefitting all service users, including those with long-standing illnesses. “We have no nay-sayers, just operational challenges” On the strength of the evidence supporting it, FREED was adopted in 2020 by the Academic Health Sciences Networks (AHSNs; now the Health Innovation Networks) into their national programme for scaling. With AHSN support and some additional funds from NHS England, we successfully rolled out FREED to all eligible Trusts in England during the pandemic, training hundreds of clinicians. Towards the end of the programme in Autumn 2022/Spring 2023, we interviewed clinicians and AHSN leads from most regions in England about their views on FREED, its implementation and its sustainability. The views of these different stakeholders closely mirrored each other and were uniformly enthusiastic: People fully endorsed the concept of early intervention and FREED, noted the improved patient outcomes and also how empowering FREED is in bringing out the best in clinical teams. Stakeholders also acknowledged that there are operational challenges, for example, in terms of how to deliver early intervention when managing staffing shortages and increased referral numbers. However, stakeholders agreed that these challenges could be and should be overcome. In the words of one AHSN representative: "early intervention is not optional; it is a necessity". Where to next? We are operating in an NHS that has been described by Health Secretary, Wes Streeting, as "broken" . In this context, and given a rise in eating disorders incidence since the pandemic, FREED, whilst embedded into teams across England, remains at risk of being delivered as ‘FREED in name only (FRINO)’. Therefore, appropriate and continued secure funding is needed to support its delivery with fidelity. FREED on its own is an important cornerstone for early intervention in eating disorders, but there is much more that needs doing. The next frontier for early intervention in eating disorders must be brainier and better and to tear down systemic, institutional, and administrative barriers to early intervention. To make intervention even earlier, awareness raising and early detection are important, as there are still far too many people who do not access the help they deserve, especially those from minoritised ethnic groups, those from lower SES backgrounds, those with resource insecurities, and those from minoritised gender and sexual identity groups. There are further inequalities in that the under 18s can self-refer to services whilst young people aged 18+ seen in adult services often have gate-keeping hurdles thrown in their path. These inequalities urgently need to be rectified. But how can we make early intervention 'brainier and better'? This involves developing a much better understanding of the interplay between biological and psychosocial risk factors for eating disorders and how these intersect with risk factors for other mental health disorders. Such knowledge could lead to much more personalised prevention and early intervention of eating disorders that will further improve outcomes. Our large UKRI-funded EDIFY research programme focuses on many of these questions - you can visit our website to learn more EDIFYresearch.co.uk .

Warning: The following article contains spoilers for the movie ‘Inside Out 2’ In 2015, Pixar’s "Inside Out" captured the hearts of both young and old by creatively depicting the inner workings of 11-year-old Riley’s mind. Now, "Inside Out 2," set two years later, continues Riley’s story as she enters puberty, taking steps to add more emotional complexity. This film has been praised for its innovative portrayal of emotions and mental health, and it is the highest-grossing film of 2024 . In this article, I will explore how "Inside Out 2" tackles complex themes in an accessible manner, helping viewers navigate and understand complicated emotions in a fun and digestible way. The sense of Self and the inner emotional conflict In the first film, we got to know Riley’s core emotions—Joy, Sadness, Fear, Disgust, and Anger—who work together from 'Headquarters' to guide her actions. In the sequel, set during a weekend hockey camp just before she starts high school, Riley's emotional world expands as she enters puberty. Alongside her familiar emotions, new ones make their debut: Anxiety, Ennui (boredom), Envy, Nostalgia, and Embarrassment.   Anxiety takes centre stage in Inside Out 2 . From the moment her erratic and hyper character arrives in Headquarters, she disrupts the balance by imagining worst-case "what-if" scenarios and trying to take control of Riley’s actions. When Joy dismisses her pessimistic approach, Anxiety forces Joy, Sadness, Anger, Fear, and Disgust to the "Back of the Mind," insisting that “Riley’s life needs more sophisticated emotions than all of you.” I’m sure many would agree with me when I say that this portrayal of Anxiety as a dominant force really hits home. I can relate to the idea of anxiety taking over and pushing aside all other emotions, especially when I was a teenager and didn’t yet know how to manage it. One of the film’s standout features is the “Sense of Self,” an object built from memories stored in the Belief System. Initially, Joy has a purely positive Sense of Self (one which repeats the phrase “I’m a good person”) by retaining only positive memories, but once Anxiety takes over, she reshapes it into something dominated by anxious emotions (causing it to state also “I’m not good enough”). This shift leads Riley to make questionable choices, such as abandoning her friends and recklessly trying to impress the hockey coach.   As a teenager, I remember putting immense pressure on myself, thinking that any mistake—whether in exams or social situations—would define my future. In the film, Anxiety views the hockey game as a make-or-break moment for Riley’s future, leading to a pivotal panic attack when things don’t go as planned. The panic attack Like many who’ve seen the film, I found the panic attack scene both incredibly emotional and completely relatable. After Riley is sent to the penalty box during the hockey game, Anxiety spirals out of control, creating a whirlwind of panic at the control panel. Joy enters the chaos and finds Anxiety frozen in the middle, flickering and overwhelmed. It’s hard to put the power of this scene into words, so I’d urge anyone to watch the film in order to truly understand its impact. Finally, Joy manages to pull Anxiety away from the controls, and in a heartbreaking moment, Anxiety says:   “I was just trying to protect her.”   Accepting all emotions and seeing all aspects of yourself honestly The emotions realise that the only way to help Riley through her panic attack is to create a new Sense of Self—one that embraces both positive and negative emotions. This message is key: anxiety isn’t something to eliminate, but to manage. It reminds us that anxiety can be helpful in high-pressure situations and that most of the time, our Anxiety is only trying to help us.   In the first Inside Out film , the key message is the important role that sadness plays in our lives. The sequel sticks to this theme and continues to highlight the value of negative emotions. For example, in one of the final scenes, Anxiety begins to panic and spiral, but the emotions ask her to take a seat and calm down. Once calm, Anxiety then does her ‘job’ by reminding them about Riley’s Spanish test. Reflecting on my own teenage years, especially around exam time, I’ve realised that my anxiety often pushed me to succeed, driving me to take my achievements seriously and stay focused. One of my favourite parts of the movie is how Riley’s new Sense of Self reflects her growth. Instead of only believing “I am a good person,” she accepts a broader range of beliefs: “I make mistakes,” “I need help,” “I’m strong.” This shift is a powerful message about adulthood and self-acceptance. We can be good friends and still make mistakes, be confident but still feel nervous. By accepting all parts of ourselves, we can face life’s ups and downs without panicking when things don’t go perfectly. This message is particularly important for someone going through puberty, where teenagers tend to be incredibly hard on themselves and their newly arising emotions and characteristics.   The film consulted psychologist Dacher Keltner from the University of California, Berkeley, who explained that the ending—where all emotions are accepted—is rooted in research showing that happiness isn’t just about joy. Stress, anger, fear, and even envy play important roles in our well-being. While society has made great strides in accepting mental health disorders, there’s still a misconception that we should only embrace positive emotions. This mindset can be counterproductive, as thinking that something is wrong with us the moment we feel sad or anxious gives those feelings more power.   My only critique to the movie is how easily the other emotions manage to calm Anxiety, which feels more like the typical "happy ending" of a children’s movie than a nuanced portrayal of teenage anxiety. Many who deal with anxiety may wish it were that simple, but in reality, it’s more complex. Still, it’s important to remember that Inside Out 2 is a Disney film, where a happy ending is a prerequisite.   Of course, "Inside Out 2" does not capture the full complexity of the human brain and all its emotions. It is believed that we may have upwards of 25 different emotions , but creating a character for each one would have made the film too chaotic and confusing, not to mention a bit of a storytelling nightmare. Despite these omissions, the movie makes significant strides in helping both children and adults understand emotions and mental health, and importantly gives mental health awareness even more mainstream media representation.

Anorexia nervosa  (AN) is a serious eating disorder  affecting the body and brain, with significant implications for physical and mental health. The defining characteristics of AN are excessive weight loss and malnutrition. This condition is caused by extreme dietary restriction, a distorted body image and, in many cases, excessive exercise. In addition to the visible effects, this disorder significantly impacts brain structure and function. While I have not been diagnosed with an eating disorder, I have observed its detrimental effects  on my immediate family members. Given my background in medicine and neuroscience, I am aware of the mounting evidence indicating that numerous psychiatric disorders have substantial biological foundations. This knowledge can transform how we approach treatment, allowing us to develop more targeted and effective interventions. I believe that improved treatments for AN are forthcoming and that research in this field will ultimately facilitate patients' recovery and enhance their quality of life. Recently, I was involved in a study entitled "Dynamic Structural Brain Changes in Anorexia Nervosa: A Replication Study, Mega-analysis, and Virtual Histology Approach" . We used structural magnetic resonance imaging to explore how AN affects the brain and how proper treatment can reverse these changes. The Study: Who Was Involved and What Did They Do? One of the key factors in understanding how AN affects the brain and vice-versa is examining brain volume changes in individuals with AN. Previous research had shown mixed results , as some studies indicated reductions in some brain structures in acutely underweight patients, while others showed increases or no differences. Additionally, the biological mechanisms driving these changes were even more unclear. Our new study aimed to clarify these changes by examining the brains of a large group of people with AN. By comparing brain scans of individuals with AN, those who had recovered, and healthy controls, we hoped to improve our understanding of the brain's response to this disorder. Significant Findings: Reductions and Recoveries Our research revealed that those suffering from this disorder experience a strong reduction in both grey and white matter volumes throughout the whole brain. Grey matter is crucial for processing information in the brain, while white matter connects different brain regions, facilitating communication. Interestingly, even though the reductions were widespread, some brain regions were less affected than others, or even not affected at all. And, importantly, these reductions were not permanent. Upon partial weight restoration, rapid increases in these brain structures were observed. This suggests that the brain can partially recover with appropriate weight gain. For those who had fully recovered from AN, their brains looked similar to healthy controls, indicating that full recovery of grey and white matter volumes is possible with sustained weight restoration. This finding offers hope, highlighting the brain's remarkable resilience and capacity for recovery. The Brain's Battle: Who gets the resources? To understand why some regions seem immune to the drastic brain volume reduction in the acute state of anorexia, we employed a “virtual histology” approach. This method links differences in brain volume to the typical location of specific brain cells, and their corresponding function and role. This showed that regions with big and well-integrated neurons are the most affected. Furthermore, this implies that AN primarily impacts brain areas that are energetically demanding and highly interconnected. Conversely, regions of the brain less affected by AN were associated with other cell types, such as astrocytes and microglia. This suggests that these cells might be more resilient to the effects of AN, possibly due to different energy requirements or protective mechanisms. This finding is significant because it highlights the impact of AN on the brain's most energetically demanding and interconnected regions. These areas play crucial roles in cognitive functions, emotional regulation, and overall brain health. Understanding how AN disrupts these connections can help inform treatment strategies aimed at restoring normal brain function. What Does This Mean for Patients? For those suffering from anorexia nervosa, these findings help explain some of the cognitive and emotional difficulties they face. Reduced brain volume can affect everything from decision-making to emotional regulation, making daily life even more challenging. Understanding these brain changes is crucial because it highlights the importance of treating anorexia as a serious mental health disorder, not just an issue of weight and body image. And on the other hand, this emphasises the seriousness of the disorder. Early intervention is crucial because it can help the brain start healing sooner, improving the chances of full recovery. What Does This Mean for Health Care Professionals? Refeeding and nutritional support are already key components of anorexia treatment. This study suggests that restoring proper nutrition might also help reverse some brain volume loss. Healthcare providers must ensure patients receive early and sustained intervention. Secondly, Cognitive Behavioural Therapy (CBT) has been effective in treating anorexia by addressing distorted thoughts and behaviours. Understanding the specific brain areas affected could lead to more tailored CBT approaches that focus on improving cognitive functions related to these regions. While anorexia nervosa remains a challenging disorder to treat, this research offers hope. By shedding light on the brain changes involved, we reveal possibilities for more effective treatments . For patients, understanding that their struggles have a biological basis can be validating, and help encourage them to stick with their treatment plans. A Message to Those Struggling If you or someone you know is dealing with anorexia nervosa, know that you are not alone. Advances in research are continually improving our understanding of this disorder, leading to better treatments and support. It's important to seek help and adhere to treatment plans designed by healthcare professionals. Your brain, like your body, can heal with the right support and care . Support for eating disorders: UK’s Eating Disorder Charity (BEAT) FREED: First Episode Rapid Early Intervention for Eating Disorders

At some point in life, we all feel some unnecessary jitters. It might manifest in stuttered words during a presentation or a hammering heart in an unfamiliar crowd. Often, we confuse these nerves with an actual disorder. However, the difference between introverts and the socially anxious lies in the persistent dread of socialization: being a homebody who thrives in ‘me-time’, versus having a panic attack at the thought of attending a party, distinguishes the two. Whether it’s a full-blown disorder, or a random disturbance that pops up every once in a while, there’s a way to tackle these difficulties. Cognitive Behaviour Therapy (CBT), a type of talking therapy, is widely used to deal with debilitating social anxiety. The core philosophy behind CBT lies in relearning & rewiring our thoughts. It usually involves identifying maladaptive beliefs, and then restructuring or eliminating them. Some of these ingrained thought processes, targeted by CBT,  are called Cognitive Biases. Cognitive Biases are subjective, irrational & far from reality. They are skewed due to our faulty perceptions and can cloud sensible decision-making. Indeed, certain unconscious biases make us more susceptible to social anxiety.  Psychoeducation is a transformative tool that CBT employs to substitute distorted beliefs with informed rationale. It demystifies the how’s & whys of our inner workings and provides invaluable insights that guide us to reevaluate & regulate our emotions and actions. As a writer & mental health counsellor, the mere knowledge of cognitive biases helped me minimize my own anxiety around social situations. This allowed me to recognize, analyse and offset my triggers.  Here are a few biases that may be exacerbating your social anxiety. Biases of Attention Remember when you tried to go on a diet or cut your carbs intake? And suddenly all you could see was people devouring pizzas and pasta. This is called Attention Bias . Our moods, affiliations and needs determine what we focus on. As a result, we can become so engrossed in our current train of thought that all irrelevant stimuli are blatantly ignored. For instance, a low mood might make you notice more depressing news than positive developments. For the socially anxious this bias augments their fears. Since our attention span is limited & highly skewed, situational anxiety makes us attend more threatening stimuli. It becomes hard to detach from social threats or divert towards positivity. Since we become selective in picking cues of positive interactions; our attention is solely oriented towards disapproval from others. For instance, while giving a speech, a socially anxious person might hyperfocus more on the frowns in a crowd rather than their pleased expressions, awaiting criticism and ignoring praise. Biases of Memory How we remember an event is based on its intensity, importance, prevalence and emotions attached to it. As much as we like to pride ourselves on our recall prowess, people rarely remember the exact replicas of reality. Each snippet is tinged with our personal preferences. There are multiple biases based on the selective nature of our memory recall. Confirmation Bias - This bias refers to our tendency to seek & believe information that confirms our pre-existing beliefs. This takes us farther from facts and leans towards vague or false assertions. For instance, believing a dog breed is more violent than others because it barked at you once, and then looking for evidence that perpetuates your theory while ignoring other breeds that statistically attack more people. Or a person with a fear of rejection might enter every situation certain of getting rejected.  Recency Bias - A fresh memory is far more prominent in our mind and affects us more deeply than the older ones. We are quick to build long-lasting beliefs based on a single recent incident & let it overshadow all our past experiences. For instance, if a person is recently mocked over their outfit, they’d ignore all the times when they were praised for their fashion sense in the past. For the socially anxious these memory distortions play highly against their favour. They tend to remember more negative events than positive ones. They barely recall pleasing social interactions & events and if they do, these memories are blurry at best. This further makes them apprehensive of future social interactions. Biases of Interpretation How one perceives the world depends on the intricate balance of their beliefs. In turn, their perception dictates their feelings & emotions around any situation. More often than not, there is no big bad threat around us. Yet, with an anxious mind, we feel perturbed in ambiguous social situations. We find it much easier & more believable to infer such moments as negative. To an anxious person, two colleagues whispering and giggling over a meme might seem like they are laughing at their expense. A partner’s frown over a soggy breadstick might feel directed to them as contempt. With social anxiety, we tend to misinterpret social cues and others’ actions. This further fuels the anxiety. Biases of Imagery All of us have a solid mental picture of ourselves. The adjectives we use to describe our persona sum up our self-image & self-concept. A positive perspective can amp up our self-esteem while a negative view diminishes our self-worth. The socially anxious often find it hard to imagine themselves in a favourable light. An impaired vision of one's traits, capabilities, and goals intensifies their social anxiety. They fail to see themselves as relevant, fun or worthy individuals and thus expect rejection & abandonment. Tackling Cognitive Biases While we can’t completely escape these biases, their effect on our social anxiety can be mitigated . Take some time to see what ticks you off, and analyse when and why it happens. Diving into the root cause can help you gain a clear sense of self. Learning why certain situations make you uneasy can let you know how to counteract them with reason. Understanding these cognitive biases makes it easier to rationalise & neutralise them.  Recognizing these biases and reorganizing your thought process is the first step. Usually, psychoeducation is paired with professional help and gradual exposure to anxiety-inducing situations. Rewiring your beliefs to align with a more positive outlook can allow you to self-soothe in the throes of social anxiety. Take a look at life & others with an impartial lens and you’ll be able to see beyond these cognitive biases. To read more about cognitive biases in anxiety you can read Inspire The Mind’s previous blog .