Technology is becoming increasingly more important in our daily lives. During both work and in free time, everyone holds a computer, a phone, a tablet or a smartwatch in their hands. In light of these changes, science has begun to question to what extent the relationship between man and technology may influence people’s lifestyle. Moreover, this will allow us to understand how to use technology in ways that promote well-being. In line with the aforementioned statements, psychology and psychiatry are experiencing a real explosion of the use of these technologies to support mental health treatment. You can have a look yourself: go into your device’s app store, type into the search “mental health”, and you will quickly find a lot of possible applications! You can even find them associated with other communication channels, such as photographic or videos platforms, which can enhance the learning process with a multimedia service. Normally, the encounter between different disciplines could lead to a new framework of different perspectives and mutual enrichment, but will this also be possible for technology and mental health? Research has yet to establish to what extent these applications can be utilised to promote the mental well-being of citizens. We need to understand which interventions are effective, for whom they are effective, how we can promote them, who should use them, and what training is required to use them. People with a good level of mental health are more inclined to download applications related to psychological well-being for several reasons. These may be due to curiosity or to the appeal of the app, from the desire to obtain a higher level of mental health, or perhaps to address a discomfort that they find hard to share, and want to manage by themselves. These reasons represent why the preventive field have some many applications. A key example is apps for genome sequences, like FACE2GENE and HELIX, which can help find who is at risk of mental health problems, and start promoting early interventions aimed to delay or stop the onset of a number of mental health disorders linked to genetics. Moreover, apps can be used not only for mental health, but also to monitor other health aspects connected to it. There are lots of apps that promote proper nutrition, physical activity or global health management through the adoption of healthy habits, like MYFITNESSPAL, CAREZONE or CLUE. Primary care physicians are currently considering how to maximise the benefit of the use of these tools in following up patients closely. Applications can also be useful for the early detection of mental distress. They allow us to overcome some traditional limits of psychiatry, such as the difficulties of reaching people who prefer not making contact with the service due to stigma, to the difficulties in reaching otherwise difficult target populations such as people suffering from social phobias or agoraphobia (fear of public places). Moreover, they can be particularly helpful in the engagement of youth who tend to prefer communicating through technology more than face-to-face. From a health organisational point of view, these resources can overcome time constraints and other internal needs, allowing people to obtain monitoring by health professionals. From a diagnosis point of view, apps can help in making an in-depth assessment in line with an ecological paradigm of treatment by supporting the physicians in reading the tests and in identifying which are the most useful diagnostic criteria to choose. Apps can also integrate cognitive-behavioural therapies recognised for the management of different pathologies, such as mood disorders, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder and eating behaviour disorders. They can provide the user with meditation and relaxation exercises, increase personal resources and resilience, and improve cognitive functions. See, for example, MINDFULLNESS APP, HEADSPACE, MOODPATH, MOODNOTES, HAPPIFY. In times like the ones we are living, where Coronavirus is keeping us apart, can we imagine in how many ways apps could be useful? First of all, they can guarantee the person the opportunity to play a real, active role in their own care path, promoting real empowerment, supporting self-monitoring and transferring strategies into everyday life context through exercises and homework directed from the apps. Secondly, the users have also the opportunity to get in contact with health professionals, in real-time, through the in-app messaging, mail services and video media. In this sense, the application becomes an additional resource that facilitates the therapeutic relationship. Furthermore, it is also possible to get into an exchange group with other people who are experiencing the same problem, like TALK LIFE. This fundamental element can potentially allow to extend the person’s support networks in the territory outside the geographical limits of the services. Also, they can also be used by other people, such as family members or caregivers, who can also receive dedicated interventions. Finally, the apps can also be used by health professionals, who can exchange information while keeping the network of services around the users updated in real-time. Moreover, health professionals can use apps for their continuous professional development and learning, and for keeping up-to-date with the latest research. They can also use these apps to take care of their own mental health and wellbeing, and to prevent phenomena such as burn-out. All these implementations are in line with what has already been done in psychiatric rehabilitation. Technology has been used for decades in psychiatry, up to the most recent use of computer programs for cognitive remediation, or virtual reality for exposure to anxiety- or paranoia-provoking situations. At this point, it seems spontaneous to ask whether this relationship between technology and mental health is always so positive, and which are its limits. The first consideration that is worth making is that these strategies remain tied to the commitment of the person, and dependent on the correct and appropriate use of the app. Therefore, it is necessary to guide the subject by providing training with clear information on its content and purpose, even when the app is chosen by the users independently of the advice of health professionals, and perhaps selected based on less important criteria, such as design or aesthetics. Another central problem is the collection of sensitive data that takes place through these tools. The information that you record in the applications requires correct management, which must require the collection of clear information and informed consent, in line with the privacy regulation. These aspects, linked to a strong ethical component, are currently neglected and not properly monitored. Furthermore, app development needs research in usability and the choice of the best methods and platform to deliver the app, ideally with an interactive process of improvement. Research can also use rigorous methods to generate reliable lists from which the health professional can choose which app is more suitable for which users. The absence of criteria that guides the choice of certified software constitutes one of the main elements that discourage clinicians from using this technology in their practice. In this sense, it would also be beneficial to check who manufactured the applications, in order to ensure constant communication between manufacturer and health professionals. There is also a need to improve the personalisation and adaptation to the specific needs of the user, for example, because the app is unable to monitor key processes such as the compliance with medication or other forms of therapy or the correct recording of sleep-wake rhythms. Moreover, the efficacy of these apps in more complex clinical circumstances, such as addictions, chronic and multimorbid diseases, and critical situations of urgency, remains uncertain. Finally, let’s not forget the portion of the population that may not have these tools readily available, or may find them difficult to use. These include the elderly, people with severe cognitive impairments, or people from more disadvantaged socioeconomic backgrounds. In conclusion, it seems clear that technology is now part of the lifestyle of western cultures and beyond, but its role in the management of mental health still needs to be clarified. The apps can represent an innovative tool for the integration of different therapies and the support of both user and health professional, but we need research in order to validate their effectiveness. We shall not forget that technology has yet to replace the most important element of a successful therapy: the human relationship. NOTE FROM THE EDITOR: A massive ‘thank you’ from all of us at the InSPIre the Mind team to the lovely Jessica Zambotti — who works in Psychiatric Rehabilitation and is a master student in Prevention and Early Interventions at the University of Verona in Italy — for this great insight into the ever-evolving relationships between technology, society, and psychiatry. Thanks, Jessica — we look forward to reading more from you soon! Header Image Source: Tianyi Ma on Unsplash

hese past couple of weeks have been an important time for self-reflection. Through my reflective work, I have thought about all the women in my life who have nurtured my own personal growth; who have shared with me their courage and wisdom; who have educated me. In light of the Black Lives Matter movement, there is no better time than now to speak up about the influential work of the black women in all our lives who teach, empower, and inspire us. As a newly qualified junior doctor with a special interest in mental health, I wanted to dedicate this blog post to celebrate the incredible work of the black females who promote positive mental well-being — the women who have been such an important and personal inspiration to myself, and many others. Chidera Eggerue I don’t think many young women today can talk about body positivity, female empowerment and self-love without thinking about the one and only, the incredible, Chidera Eggerue AKA @theslumflower on Twitter and Instagram. Author of “What A Time To Be Alone” — a book that has inspired many (myself included!) to seek love from within — Chidera is a heroine to many females who have truly struggled with body image, depression and self-identity. Adrienne Herbert An international TEDx Speaker, ADIDAS global ambassador, master trainer @fiit, host of her own podcast the ‘Power Hour’ AND wonderful mum, @adrienne_ldn is the epitome of a superwoman. Oh, and she is also a very keen runner, leading the challenge “100k in May” on Strava (a running app), where she inspired thousands to sign up and run 100km in May to improve their mental wellbeing and health. Her podcast, Power Hour, never fails to motivate me. Every week, Adrienne talks with today’s leading coaches, creatives, pro-athletes and modern innovators, to share with her listeners lifestyle tips and advice on how to achieve success. Her love for encouraging others to accomplish their personal passions and ambitions is just so admirable. And on top of everything, all her #goodvibes content on her Instagram profile sure does promise to leave you bursting with everyday positivity! Jessica Katanga Three words to describe Jessica Katanga? Powerful. Wise. Courageous. 5th-year medical student and YouTube blogger, Jessica is a woman who has inspired me from the very first moment I met her. Her YouTube blog explores medicine, lifestyle and education. In her most recent video “Psychology of Activism, Movements and Allyship” Jessica explains the science perfectly — giving an incredibly unique approach and highly informative explanation on the link between cognitive psychology and modern-day activism. Her videos are not only educational, they are also hilarious- and you simply can’t watch her blogs without admiring her humour, humbleness and beauty. Kimberley Wilson Psychologist and creator of “Whole Body Mental Health,” Kimberley is a passionate advocate of evidence-based medicine and her holistic approach to how our lifestyle choices — our nutrition, sleep, exercise —  affects our brain health is truly fascinating. She introduced me to the discipline of nutritional psychiatry in her book, “How to Build A Healthy Brain,” and her educational IGTV videos on her Instagram @foodandpsych certainly quenches my thirst for neuroscience knowledge. From helping me discover the power of self-love, to motivating me to challenge myself; from being a source of daily inspiration, to educating me on the philosophy of holistic whole-body mental health: I have learnt such valuable lessons from each and every one of these brilliant women. Therefore, dear reader, I invite you to take a moment to do the same. The work of our black peers has been overlooked for too long and certainly not enough has been done to shine light on their talents and creativity but now is the time to change that. Reflect on the individuals in your life who have inspired you. Speak out about their work and share it with others. Give credit to those who have nourished you. Continue to show them your support. So, why not start now? Comment below and let’s start the conversation. NOTE FROM THE EDITORS: We want to say ‘thank you’ to Annabel for writing this uplifting piece for InSPIre the Mind, introducing readers to just a few of the amazing black women who use their platform and voice to encourage others to be their best selves. Thank you, Annabel — excited to read and see more of your work soon! Header Image Source: See captions of the images throughout the blog.

Let’s take a look at the flawed science underlying conspiracy theories and who is behind them. At the beginning of the COVID-19 pandemic, I published a blog debunking the top 10 most dangerous coronavirus myths, to combat widespread early misunderstanding of the virus. As the pandemic has progressed in the two months since my first blog, it has become clear it provides the perfect environment for false rumours and fake news to flourish. Concrete evidence about the virus has been frustratingly slow to emerge and the advice given by public health organisations and governments has often felt inconsistent and peppered with caveats. With more of us spending time at home and online, many of us feel compelled to conduct research ourselves. The issue is that when people are under heightened stress and they want to resolve uncertainty, they can lose their ability to weigh and judge information effectively. This means we may not be able to discern reliable information from inaccurate or biased information, especially when search engines and social media algorithms are optimised to prioritise content that aligns with our existing values and beliefs. Even our responses to news coverage can be biased, with emotional response being the driving factor in whether a news article will go viral. One study even found that false news reached more people and spread significantly faster than the truth (particularly when politics are involved). “We are all prone to believing information when it is repeated, easy to process and when it aligns with our prior attitudes and world views.” — FULL FACT Conspiracy theories tend to be grounded in unusual coincidences or misunderstood science, and they use highly emotional language to appeal to others. In a time when public mistrust is at an all-time low, it is important to counter false information with clear, high-quality evidence. It is also important that people are made aware that some of the conspiracy theories being pushed into the mainstream media are often backed by hidden agents with ulterior motives. The hysteria generated by many of these conspiracies detracts from very real issues such as how COVID-19 disproportionately affects BAME ethnicities, exacerbates inequality, and is associated with air pollution. In this blog, I address the flawed science underlying some of the most famous COVID-19 conspiracy theories, covering everything from the rumours about the pandemic being created in China or planned by Bill Gates, to its associations with 5G and the hype around hydroxychloroquine. Conspiracy 1: The COVID-19 pandemic was planned. Everything about the COVID-19 pandemic is confusing, starting with how it has been named. The first misunderstanding, which led to the emergence of several different conspiracy theories, is quite a fundamental one. Most people had never heard the term ‘coronavirus’ before the pandemic. Surprisingly, we are already intimately familiar with milder strains of coronaviruses, which we experience in the form of common colds every winter. These seasonal coronaviruses have been documented in humans as far back as 1976. Animals are also highly susceptible to coronaviruses and several strains are known to be carried by cows, pigs, horses, and bats. Due to so many different strains of animal coronaviruses circulating in livestock, vaccines for animal coronaviruses have existed for several years. Many cleaning products are also labeled as designed to kill ‘coronaviruses’ from surfaces. Some people have wrongly assumed that the existence of these cleaning products and vaccines means that somehow manufacturers were warned about the pandemic or that a secret cure for COVID-19 already exists. To break it down: SARS-CoV-2 virus is a brand-new strain of coronavirus that only started circulating in the human population in late 2019. COVID-19 (coronavirus disease 2019) is the name of the disease people develop after being infected with the SARS-CoV-2 coronavirus. SARS-CoV-2 is the only coronavirus strain that caused the COVID-19 pandemic. SARS-CoV-2 is different from other coronavirus strains because it is a brand-new type of coronavirus. SARS-CoV-2 is much more dangerous than the milder coronavirus strains and we are still learning how it transmits and affects the human body. After an earlier coronavirus strain (SARS-CoV) led to the SARS scare in 2003, many organisations started conducting hypothetical ‘pandemic planning’ events to try and prepare for the next contagious disease outbreak. One of the most vocal people with concerns was Bill Gates, who gave a TED talk in 2015 warning us that the world was not prepared for the next pandemic. His TED talk has now been used as proof that he was somehow behind this pandemic, but fortunately, Full Fact, an independent fact-checking charity, has debunked this theory. Research into coronaviruses has been funded for over 20 years: Conspiracy 2: The virus was engineered by humans or it escaped from a laboratory. Rumours that the virus was engineered in a lab have been circulating since January, despite any concrete evidence supporting these claims. These rumours were further fuelled by the Trump administration accusing the Chinese government, and Chinese officials accusing the US army. Unfortunate coincidences, such as the proximity between the Wuhan Institute of Virology laboratory and the Wuhan seafood market, led some people to believe the virus may have escaped from the lab into the market. To clarify any doubts on the possible “non-natural” origin of the virus, a group of infectious disease researchers, from a non-profit medical research organisation in the US, decided to investigate the genetic sequence of the virus. By looking at the DNA sequence they were able to determine, without any doubt, that the virus naturally evolved in animals, with the most likely culprits being bats or pangolins. Another study published in May further confirmed that the virus likely originated in bats and then jumped to pangolins. A worldwide genetic analysis of humans carrying the virus has very strong evidence that the virus jumped to humans in November or December of 2019. While it may seem strange that a bat virus could somehow jump to humans, via pangolins no less, bats regularly fly over human homes and nest in urban areas, while pangolins are consumed as a delicacy or used for medicinal purposes throughout Asia and Africa. As early as 2015, one study found that 3% of Chinese villagers living close to bat caves were carrying antibodies to a similar, less contagious, version of coronavirus, similar to SARS-COV-2. In 2012, six miners in China contracted a pneumonia-like disease and two died, from a mine shaft infested with different bat species and bat coronaviruses. Scientists are now so certain that the origin of the virus is natural, that they teamed up and wrote a statement of support, published in one of the most prestigious medical journals in the world, confirming that the virus jumped from animals to humans. To date, there are now 11 independently published studies (yes — 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 & 11 studies), from around the world that have determined the virus came from animals. Notably, there are no published studies that have been able to contradict these findings or suggest otherwise. Conspiracy 3: 5G caused the COVID-19 pandemic. The theory supporting the association between 5G and COVID-19 emphasises the false link between the first outbreak in Wuhan coinciding with the rollout of 5G in the city. In fact, many cities in China (and throughout the world) had been involved in the 5G rollout prior to the outbreak in Wuhan. Genetic studies have also shown that COVID-19 spread to different countries via air travel. Another incorrect premise of the 5G theory is that 5G weakens the immune system’s cellular defence, making people more vulnerable to COVID-19. Let’s take a look at the science behind this… The electromagnetic spectrum is made up of ionizing and non-ionizing radiation. It is well known that ionizing radiation becomes more dangerous as frequencies increase (such as UVA and UVB rays in sunlight) and that this radiation can damage DNA, and repeated DNA damage over time can lead to cancer (such as too much exposure to X-rays). In contrast, non-ionizing radiation is not powerful enough to penetrate and damage our DNA. 5G technology is non-ionizing radiation and its frequency lies between microwaves and remote controls on the electromagnetic spectrum (see the graph below). Although 5G is higher on the non-ionizing spectrum than 3G and 4G technology, it is still not powerful enough to alter DNA. For those who still believe that the high frequencies of non-ionizing radiation are dangerous, they should logically be much more concerned about lightbulbs, which emit much higher frequencies than 5G (and we all know that lightbulbs are safe). Unfortunately, most people’s fears about mobile phone radiation is based on an early (and now widely discredited) study that used flawed data to find a strong association between radiation and tissue damage. While there is a lack of high-quality research into overall mobile phone safety, even after decades of exposure to mobile phone radiation there has not been a marked increase in the prevalence of brain tumours and cancers, meaning that if there is any risk from mobile phone use it would likely be weak and inconsistent. Ultimately, there is no association between the rollout of the 5G network and COVID-19 outbreaks. In contrast, the negative effect of air pollution on the environment and health of humans is a far more worrying, with far more scientific evidence to back it up. It has also been shown to compound the negative effects of COVID-19. Conspiracy 4: Hydroxychloroquine is a miracle cure for COVID19 Although not a conspiracy theory, the hype around hydroxychloroquine started on March 14 when a Google word document was circulated on Twitter touting the potential use of repurposing the old anti-viral Malaria drug hydroxychloroquine for COVID-19. The document claimed to be written in consultation with prestigious medical schools and scientific institutions, and by March 16 it had gone viral on Twitter. Unfortunately, it was only realised much later that the author of the document was actually a blockchain investor, who had inaccurately claimed to write it in consultation with medical schools and scientists. The global hype around hydroxychloroquine had already been set in motion before the first clinical study testing it on COVID-19 patients was even published, on March 17, with the study only finding a 50% improvement in the extremely small sample size of 14 patients with COVID-19 taking hydroxychloroquine alone. These authors have now been criticised for not randomly assigning patients to treatment groups, their small sample size and lack of a control group (to compare the treatment groups with), meaning that the positive results could quite easily have occurred due to chance. However, by March 19, US President Donald Trump was promoting the potential of the drug at press conferences, incorrectly stating it had already been approved by the Food and Drug Administration (FDA) to treat the virus. The FDA then had to release a statement cautioning people against using the drug off-label. Later, when Trump stated he was taking a two-week course of hydroxychloroquine, despite any evidence showing it could prevent COVID-19, there was widespread concern from healthcare professionals about the dangerous example this could set. A recent study confirmed a huge surge in ‘hydroxychloroquine/chloroquine prescription fills, likely due to off-label prescriptions for COVID-19. Hospitals are now having to deal with the additional burden of treating people poisoning themselves after taking the drug, with one man fatally poisoning himself with a fish tank cleaning additive made with the same active ingredient as chloroquine. The bias towards this drug is even derailing clinical trials of COVID-19 treatments. While studies done within cell dishes in labs show that both hydroxychloroquine and chloroquine can inhibit the virus, as with any medicine, studies in humans tend to be much more inconsistent. The largest study of the drug was published in The Lancet on May 22, stating that the drug increased the risk of death in hospitalised COVID-19 patients. This paper has now been famously retracted because of serious concerns about the verification of the data sources, study design, and analysis used. While the verdict on hydroxychloroquine is far from clear, now is not the time for anyone to be taking this drug off-label. Where do conspiracies come from? Ultimately, people get caught up in conspiracy theories for a multitude of reasons. It might simply be that the theory aligns with their pre-existing beliefs and opinions, giving their feelings of anxiety an outlet to focus on. For others, placing the blame on a specific person, country, or organisation, it may give a face to the invisible threat of the virus. They may even simply just provide a form of escapism that distracts from the bleak reality of the situation. The reality is that the energy expended on conspiracy theories would be far more useful if directed at current public health emergencies whose negative effects are being further compounded by COVID-19. As mentioned above, this includes the virus disproportionately affecting BAME ethnicities, how the pandemic exacerbates social inequality and air pollution contributing to COVID-19 fatalities. All of these issues are having a much more immediate and substantial impact on people today and are backed by scientific evidence and consensus. So why do some people still prefer to get wrapped up in conspiracy theories? Professor Colin Klein, who studies conspiracy theories, offered the following explanation: “Conspiracy theories offer an emotionally satisfying narrative, even if it’s not a true narrative.” However, it is important to highlight that, despite the potentially comforting narrative that conspiracy theories may provide, they have dangerous repercussions, such as inciting racism towards Chinese communities, promoting dangerous cures, or normalising acts of vandalism. More generally, believing that the COVID-19 pandemic is a cover-up could have negative health ramifications on an enormous scale if people stop trying to prevent the spread of the virus. Professor Neil Johnson, senior author of a study investigating malicious COVID-19 content said: “The rise of fear and misinformation around COVID-19 has allowed promoters of malicious matter and hate to engage with mainstream audiences around a common topic of interest, and potentially push them toward hateful views.” Even more concerning, is that most people have no idea that some of the agents spreading them are doing so for their agendas. By exploiting the uncertainty surrounding the pandemic these agents attempt to push people towards divisive and politically polarising views, creating distrust in mainstream media and science. This does not mean we should distance ourselves from people with alternate views to us. Instead, we need to counter false claims with clear facts and a compassionate approach. If you find tuning into the breaking news cycle anxiety-inducing, you might want to reduce your consumption of media news coverage. Remember to regularly check for updates from public health organisations local to you, as guidelines are updated according to the best available evidence and are based on current infections and hospital capacities relevant to your area. And, if you need a trustworthy alternative to mainstream media, do look at reputable and independent science websites, such as Science News (which is also non-profit), Nature News, or Science Mag. These websites cover the latest scientific research and events, summarised in everyday language, by writers who are qualified to interpret the results of studies. We need to recognise that conspiracy theories are flourishing due to a climate of fear, mistrust, and lack of knowledge about the virus. Header Image Source: Andre Castelucci

The true character of a society is revealed in how it treats its children” Nelson Mandela, 1997 I was asked to write for this blog last Christmas, when I spoke alongside Professor Carmine Pariante, Editor in Chief of InSPIre the Mind, at the Royal College of Psychiatrists Young People’s Christmas Debate. Despite the rather solemn motion (“This house believes the modern world is toxic for our mental health”), it was a mainly jovial affair in which I waxed lyrical about the harms and benefits of reality television. It is almost impossible now to picture the hundreds of school children sitting in a room- no face masks, less than one metre apart- listening to real-life speakers for whom the words “Teams” and “Zoom” just meant groups of people going fast. How different the modern world looks now. Six months on and my original blog topic (reality television) does not feel right when juxtaposed with my day to day life as a forensic psychiatrist in the time of Corona. Instead, I have decided to write about children — in particular, about the most vulnerable children in society, whose experiences have led them to come into contact with the Criminal Justice System, and for whom COVID has presented new and particularly unwelcome challenges. Last month, during my daily permitted exercise I cycled into a ghostly central London to see the landmarks, and passed the Houses of Parliament. I reminisced about 2018 when I worked at the Parliamentary Office of Science and Technology, funded by the wonderful Wellcome Trust. During this period, I prepared a parliamentary briefing (“POST note”) on the Age of Criminal Responsibility. You can read my POST note here. I usually work with adult offenders, and this was my first foray into child and adolescent forensic psychiatry. The topic and issues therein were deeply intriguing, and I found myself immersed in a world of criminologists, lawyers, police, philosophers, prosecutors, victims groups, charities, neuroscientists, parliamentarians, social workers and psychiatrists, all interested in the complex area of youth offending. The age of criminal responsibility proved to be a highly topical and controversial issue, featuring in the BAFTA-nominated BBC documentary “Responsible Child” which was coincidentally aired the night before the aforementioned Christmas debate. Campaigners and professionals alike have become increasingly outspoken that the UK needs to raise the age of criminal responsibility and to stop criminalising young children. COVID has put youth offending and child detention under the spotlight. So I felt this blog was an opportune moment to share my thoughts and findings. The importance of a good childhood has never been more apparent The most widely adopted human rights treaty in the world is the United Nations Convention on the Rights of the Child (UNCRC), which considers every aspect of a child’s life, ranging from war and torture to education and play. It builds on a UN Declaration on the Rights of the Child which highlights that “the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection”. As a society, we have a duty to ensure all children are kept safe. Without exception. During the current Covid-19 pandemic, ensuring child wellbeing is crucial. There has been mounting concern about the effect that school closures and social distancing are having on children, especially the most vulnerable, and governments are being called to consider the impact of lockdown on children’s physical, emotional and health. For the hundreds of thousands of children deprived of liberty in detention centres around the world, the issues are stark. Not only are they at heightened risk of contracting the infection, but the severely restrictive regimes and removal of education, activities and therapy are likely to cause irreparable damage if not properly addressed. Never has there been greater pressure to reduce the number of children in custody, both in the UK and internationinveally. Long before Covid-19, it was increasingly clear that children who are accused of criminal acts require particular protections. There is a growing body of evidence that these children disproportionately come from disadvantaged and ethnic minority backgrounds, have grown up in care or dysfunctional families, and are frequently the victims of crime themselves. As a psychiatrist, I am particularly interested in the high levels of mental disorder amongst all offenders, but for children in contact with the criminal justice system, the rates are shocking. Almost one in three young offenders has a learning disability, 15% have a neurodevelopmental disorder such as autism spectrum disorder and attention deficit hyperactivity disorder, and a staggering 60–90% have communication difficulties. You can read more about this here. These children’s ability to understand criminal behaviour and navigate complex legal systems is limited at best, and in many cases entirely lacking. Is it right that these children should be criminalised? For time immemorial, legal systems have recognised that young children should not be held criminally responsible. The UNCRC emphasises that some children do not have the capacity to infringe penal law, and those who do should be dealt with in a manner which is appropriate to their emotional maturity. In other words, they should not be criminalised and incarcerated but treated with care and reintegrated into society wherever possible. To ensure very young children are spared the full rigour of the law, the Convention compels member states to set a minimum age for children to be tried in a criminal court, the “minimum age of criminal responsibility”. In 2007 the UN Committee on the Rights of the Child declared that “a minimum age of criminal responsibility below the age of 12 years is considered…not to be internationally acceptable”. It is somewhat surprising, and perhaps shocking to many, that in most of the UK the minimum age of criminal responsibility is currently set at 10 years. The age of the smiling children in the photo above. An age at which they are still in primary school. To put this into context, in mainland Europe, the average minimum age of criminal responsibility is 14 years. In many South American countries it is 16–18 years. Some jurisdictions have two age thresholds- an absolute minimum age below which a child cannot be prosecuted at all, and a higher threshold below which the child is assumed incapable of criminal wrongfulness unless proven otherwise (the rebuttable presumption of doli incapax). This provides a safety-net for those just over the minimum age who are nevertheless developmentally immature in the eyes of the law. In 1998, the government in England and Wales decided to abolish the defence of doli incapax which previously afforded some protection to children over the minimum age of 10 but under the age of 14, leaving English children at great risk of criminalisation than their European counterparts. Until recently, Scotland held the questionable record of the lowest European minimum age of criminal responsibility at 8 years, but the Age of Criminal Responsibility (Scotland) Act 2019 raises it to 12 years, bringing it at least in line with acceptable international levels. There seems to be little appetite to review the minimum age in the rest of the UK, and a Private Members’ Bill seeking to raise the age to 12 years failed to complete its passage through Parliament before the end of the last session in 2019. If the true measure of civilisation can be found in the way a society treats its most vulnerable citizens, what does the age of criminal responsibility say about the government’s attitude to children? A minimum age of criminal responsibility of 10 years runs counter to common sense Successive governments have pledged to improve education and mental health care for children and young people, with a particular focus on poor and marginalised groups. Children’s rights are protected in numerous laws which recognise that they differ from adults in their abilities to make decisions for themselves. For example: Below the age of 18 children cannot vote, sit on a jury, buy alcohol, tobacco or fireworks, or open their own bank account Below the age of 17 children cannot drive a car Below 16 years, children cannot consent to sex, play the lottery or buy a pet Below 14, children are not responsible for wearing their own seatbelt When set against these figures, a minimum age of criminal responsibility of 10 years runs counter to common sense. In theory, a child who is deemed too young to consent to sex themselves could receive a life sentence for committing a grave sexual offence against someone else. This begs the question of how the current minimum age of 10 years was decided upon. At the turn of the twentieth century, the age of criminal responsibility in the UK was 7 years. This was raised to 8 and then 10 years in the 1960’s, but the reasons for deciding the cut-off appear to be arbitrary and not scientifically informed. This was a time when neuroscience was in its infancy and very little was known about brain development. We now know that the adolescent brain goes through a period of almost unrecognisable change between the ages of 10 and 18 years. The neuroscientific support for raising the age of criminal responsibility You can read more about adolescent brain development in a superb book by Sarah Jane Blakemore- Inventing Ourselves- the Secret Life of the Teenage Brain. This paper also summarises the neuroscientific support for raising the age of criminal responsibility, which I outline below. The brain’s white matter, tissue through which the different brain regions connect with each other, is not fully developed in children, and teenagers are particularly poor at planning. Rapid development of the risk and reward areas in the brain (namely, the ventral striatum and amygdala) combined with more gradual development of the more cautious, rational, impulse-controlling area (the pre-frontal cortex) leads to an increase in risk-taking behaviours in youths which they arguably have less control over than adults. The teenage brain, especially a 10-year-old-s brain, doe not look or work like an adult brain. Conventional morality, problem-solving and logical thinking are also not fully achieved in children until their mid-teens, or later for those subjected to adverse childhood experiences. At court, children lack many of the capacities required to participate in their trials (you can read more about what these are here). Children are also prone to false confessions and suggestibility. Treating them in the same way as adults in criminal justice settings is scientifically unjustifiable. While neuroscience suggests that 10 is too young for a child to be deemed criminally responsible, it does not shed a great deal of light on what the cut-off should be. This is where real circumspection is needed as to how we as a society view our children, and whether criminalising children has any benefits. Any child found guilty of a crime is at risk of being institutionalised, in secure care homes or treatment centres as well as Young Offenders Institutions, secure hospitals and prisons. There is evidence that those dealt with the most severely are the least likely to stop offending in the future. Having a lower age of criminal responsibility has been shown not to deter children from offending, and countries with the lowest minimum age, including England and Wales, have not only the highest rates of child detention in penal institutions, but also the poorest outcomes with regards to rehabilitation and reoffending. Having a criminal record is not only stigmatising, but it also leads to children self-identifying as criminals, and having limited access to education and employment. Of course, there are alternatives. The main arguments against raising the age of criminal responsibility are that 10-year-olds know right from wrong (this may be true to an extent, but this is not the same as being criminally responsible) and that something needs to be done with the small number of very, very serious child offenders. Here we can learn from other countries, where welfare laws are predominantly used to manage children who carry out criminal behaviours. In England and Wales, a child can be deprived of their liberty when there is a risk of harm to themselves or others without them having to go down the criminal justice route. Preventative, minimal intervention and restorative models have proven to be successful in reducing reoffending and improving outcomes. Prevention is always better than cure and early intervention should be the priority. As highlighted in the links above, the COVID pandemic has provided a lens through which the harms of criminalising children are magnified. According to Jo Becker, children’s rights advocacy director at Human Rights Watch: “Children should never be detained unless all other options have been exhausted. The threat of Covid-19 makes the release of children all the more urgent.” Reviewing the age of criminal responsibility is now more important than ever. Note from the author: Much of this information is available in the POST note mentioned above, but this blog is entirely my own opinion and does not represent the views of POST or the Wellcome Trust. Header image source: pjcross

Black Lives Matter from a neurodivergent and diaspora perspective: Preston Mitchcum, Board Co-chair of Collective action for safe spaces asked on Twitter: ‘Do you know how angry people must be to go outside for days- by the thousands during a global health pandemic to protest anti-black violence?’ The answer is nuanced, spanning continents, generations, the answer is uncomfortable, painful and still raw for many. We are in the midst of history being made, not only in America but globally, the world is watching, listening and responding to the systemic oppression and at its most extreme the murder of African Americans Like George Floyd and Breonna Taylor and the tidal wave of pain left behind by these injustices that ripple out across the world. Families like Ahmaud Arbery’s, Sean Bell’s and Philando Castile’s are examples of families standing in the gap to make change, ignited through the same catalyst of injustice and loss. Those like myself who exist at the intersections, from the diaspora, those with a disability and neurodivergence can empathise with the waves and ripples of trauma and sheer exhaustion spilling out of America, the injustice and in some cases mirror reflections of local and national struggles; parallel experiences that resonate with us on many levels across modes and languages. I have given myself permission to cry, to double down on the fact that it’s ok to need and seek out nourishing relief for the inner self in testing times, to tell my family I love them, to reach out to friends who have the biggest hearts but struggle with self-care, struggling as we all do in testing times. In times like this, the craft is enduring, surviving, this is the articulated output. The world has become smaller, more joined-up and is better for it. Across the UK at 6pm on 3rd June, all those supporting Black Lives Matter took a knee #TakeTheKnee on their doorstep declaring that #BlackLivesMatter; many of us empathise with African Americans who are enduring this, exhausted but still with so much to do in order to embed long-lasting change, a change that the ancestors would look upon and smile, that kind of change. A change African Americans should not have to embark on alone. How do we transform support into actions? There are many anti-racism focused organisations that can be engaged with globally and online to contribute; the below resource is but one way for people who desire to help embed change, to be allies and begin or deepen anti-racism work, the link/resources have been created by Sarah Sophie Flicker and Alyssa Klein bit.ly/ANTIRACISMRESOURCES, there’s also anti-racist organisation Carry Our Weight and UK focused anti-racism reading lists and recommendations on social media. For those needing support during these challenging times, there are organisations like Black Minds Matter UK that are able to provide support. Those existing at the intersections extend thoughts, love, strength and most importantly action with support and protests online, showing solidarity through using #BlackLivesMatter, #BlackOutTuesday and #TakeTheKnee to protesting in the streets IRL, all over the world; the global majority supports black lives mattering. To quote the poet Dinos Christianopoulos ‘They tried to bury us. They didn’t know we were seeds.’ This is more than a moment. NOTE FROM THE WRITER: Natasha Trotman is a neurodivergent, Inclusive Designer and Researcher; her work examines different ways of experiencing and processing the world. NOTE FROM THE EDITORS: We would like to use this opportunity to say a huge thank you to Natasha for writing this incredibly important piece for us. It was very important for us to address the issues we currently face and Natasha has done so wonderfully — thank you!

This blog has been written on behalf of the InSPIre the Mind editing team. As a team we want to raise awareness of such a prevalent issue going on in our world and hope that the resources we have found can be of use for our readers. As some of you will know, in light of the ongoing protests and grief around the world following George Floyd’s killing, we have decided not to publish our usual blogs this week. Particularly at this time, our attention must be on the issue of racism, which continues to impact countless lives across the world. These recent events act as yet another reminder of the systemic racism and oppression present in our society. We recognise that total silence at this time is unhelpful and hope that the resources we have listed below can begin to guide those unsure of what they can do to help. Likewise, we must all continue to examine our roles in this problem, our prejudices, and our privilege. We have also just published a fantastic piece written by designer and researcher Natasha Trotman entitled, “Black Lives Matter: Transforming Empathy into Action” which discusses the BLM movement from a neurodivergent and diaspora perspective. Thank you, Natasha, for sharing this with us and providing links to some great resources, some of which are included again here. At InSPIre the Mind, we have a responsibility to use our platform to help highlight and discuss how current societal issues affect mental health and wellbeing. We have spoken with our team and want to take this opportunity to show our support to Black communities and the Black Lives Matter movement. As such, we want to encourage bloggers, writers, poets, and all literary creatives of Black communities to use this platform as a place they can share their work. We hope to amplify Black voices in whatever ways we can; if you are interested in writing a piece for InSPIre the Mind on any topic of your choice linked to mental health, please do not hesitate to get in touch with us at inspirethemind@kcl.ac.uk. WAYS YOU CAN HELP SUPPORTING BLACK CREATORS One fantastic platform for Black writers and online content creators is Black British Bloggers, a network dedicated to elevating Black voices in the UK and supporting the growth of these creative communities. Likewise, UK Black Owned Businesses is a catalogue of Black-owned businesses throughout the United Kingdom which aims to overcome the under-representation of Black-owned businesses by connecting them to potential customers. Black Writers Collective — a network aiming to connect Black writers worldwide and supporting their projects from idea to publication. How to support black publishers and bookshops Opportunities for writers and illustrators of colour DONATE Official George Floyd Memorial Fund — This is the official GoFundMe organised by George Floyd’s family. DONATION LINK (note: this fund is now closed) Black Lives Matter UK — All money raised here will be put towards paying in full for therapy sessions for those in need, connecting black individuals and families with professional mental health services across the United Kingdom. DONATION LINK /// MORE INFO UK Black Lives Matter Fund — This fund organised by BLMUK activists aims to continue supporting and campaigning for black communities in both the UK and across the world. DONATION LINK /// MORE INFO Minnesota Freedom Fund — This fund goes towards paying cash bail for those who cannot afford it, aiming to fight the criminalisation of poverty and the disproportionate harm this causes to communities of colour. DONATION LINK /// MORE INFO Donate Without Money // Stream to Donate - For those of us who want help but are unable to make any donations directly, there are ways you can support raising funds. Here is a playlist of videos that you can stream on YouTube which will be donating all the ad revenue to support the families and protestors who need it. What qualifies as a valid view on a video can be tricky, so first, here are a few pointers regarding efficiently streaming. While watching, ensure any ad blocker you are using is turned off and that you do not skip ads. Also, watching the same video on repeat may mean that your views are not counted; to avoid this, just let the playlist autoplay or watch a couple other videos between streaming the same video. EDUCATIONAL RESOURCES Ways to Help / BLACKLIVESMATTERS — this page provides a comprehensive list of educational resources on anti-racism, how to be an ally, and Black history. Also on the site are some great lists for more places to donate and petitions you can sign. This is an extensive list compiled by Sarah Sophie Flicker, Alyssa Klein (referenced also in Natasha’s blog) of anti-racism resources for white and non-black minorities, including books, articles, podcasts, videos, and films. Black Mental Health Matters — this is another great website containing resources to therapists and hotlines for black African Americans struggling with mental health. Another collection of places to donate, petitions to sign, and information on protests, with an emphasis on Black women and Black people in LGBTQ+ communities. Of course, this list should not be taken as a complete set of resources but rather a helpful starting point. Once again, we hope to make InSPIre the Mind a place where writers of all backgrounds are encouraged to share their work on all things mental health. Thanks for reading — your InSPIre the Mind editors.

The coronavirus pandemic has had a devastating impact on many lives, causing disruption globally. As an 18-year-old student, I would like to share some thoughts on how the pandemic has affected me and other teenagers in a similar position, including the impact on mental health. Schools Closing The opening weeks of 2020 saw news headlines reporting on the threat of coronavirus and its increasingly concerning, rapid spread in China — although initially this seemed distant from our lives here in the UK. Feelings of unease a mongst my peers began in March, when rumours started to spread regarding the potential closure of schools and exams being affected. Gradually, all school celebrations marking the end of our school education, such as prom, were cancelled, which was disappointing in our final year, but of course we understood it was necessary. It was announced by the government that from Friday 20th March, schools were to be closed for the vast majority of students, except to stay open for ‘those of key workers and for children who are the most vulnerable.’ Although schools closing may not seem that significant, the impact on my peers and I in our final year of school was considerable. The guidance and support that our teachers offered was abruptly taken away. We became aware that school was so much more than a place of education; it was our support system. BBC news reported ‘Psychiatrists are warning of a tsunami of mental illness from problems stored up during lockdown,’ including in children resulting from school closure, self-isolation and fear of hospitals. Moving to online lessons was a peculiar adjustment, and although the modern era of advanced technology has enabled our studies and lessons to continue online, the feeling is very different to being physically in a classroom. The side-jokes and funny glances that we used to share with our friends are no more, and it is much harder to communicate through a screen, as we constantly find ourselves interrupting each other as well as the teacher. It has also, unfortunately, made it easier for some to simply ‘not attend’ the online lessons, which may be to the detriment of their education, not to mention their mental health as it reduces an opportunity for social interaction during the day. At present, we are overwhelmed by conflicting reports regarding the safety of reopening schools, especially for years 10 and 12 (that is, children age 14 to 17), as it would benefit them for their upcoming exams next year. Whilst many are keen to return to school to properly progress their education, fears remain about their own and their family’s health, with many suggesting that even if school re-opened, they would choose not to return until the new academic year, if any risk remains. Exams Cancelled On the 18th of March, Gavin Williamson, Secretary of State for Education, announced that ‘all statutory exams in England — SATs, GCSEs and A-levels — will no longer take place this academic year.’ We were stunned. The exams which we had spent the greater proportion of our lives working and studying towards, and which we were convinced would determine our futures, had been cancelled. I found myself at a loss — was I anxious, upset, confused or thankful? In fact, we probably experienced all of the above in quick succession. The uncertainty is frightening, including the fact that our A level grades, normally an objective examination assessment, will instead be based on the judgment of our teachers. I have friends who are devastated that they will not get the chance to prove themselves this summer, and are anxious about their chances of moving on to higher education with this new system in place. The Student Room website carried out an unofficial snap poll involving over 1000 teenagers to find out whether students thought they would be awarded a ‘fair grade this summer’ under the novel system. Sixty-six per cent responded ‘no’ (as of 27th May 2020), suggesting that the majority of teenagers are anxious about the system in place. How Has the Pandemic Affected Mental Health? The Academy of Medical Sciences published a ‘Position Paper’ in The Lancet Psychiatry, in which they outlined the results of two surveys, canvassing opinion of over 3000 individuals. They aimed to develop an understanding of the existing state of individuals’ mental health and to set out ‘immediate priorities and longer-term strategies’ to improve general mental health. It was noted that a majority of the responses came from those with pre-existing mental health conditions, with fears that their existing health problems may worsen. Other common concerns included the effects of social isolation, increased anxiety and stress-levels, and financial difficulties resulting from the coronavirus pandemic. Young Minds quantified the impact of the pandemic on adolescent mental health, carrying out a survey on 2,111 young people. 83% of those surveyed described their mental health as being either ‘much worse’, or ‘a bit worse’. Some vulnerable adolescents are struggling even more that others during this difficult time. One of my friends, tragically, had a close relative pass away from the virus. The lockdown has meant that she has had to process this bereavement without members of her extended family. Another friend, living with a relative with serious health conditions, is having to cope with significantly more stringent restrictions enforced on her family, and for a longer period of time. Seemingly small things, such as going from seeing friends every day to never at all, has been a difficult adjustment for myself and many others. Whilst social media has had its fair share of criticisms, I must say that it has helped my friends and family a lot during this extraordinary time — allowing me to still be there for those I love, even though I cannot physically be with them. Being able to regularly facetime has helped me stay socially connected and share experiences with others in similar circumstances. A positive outlook? These are strange and unprecedented times, and almost everybody has been negatively impacted in some way. However, I believe that we could still try to find ways to make something positive out of this situation, whether it be taking the opportunity to recognise and develop our own resilience, learning how to better ourselves in some small way, or understanding the impact that we all have on each other’s lives. Header Image Source: Unsplash

Cooking without a doubt nourishes your psychological well-being; it soothes the soul and the mind” — Chef Zipora Einav For some people cooking is a boring routine, it requires time and effort and, sometimes, the tiredness takes over and they turn straight to takeaways and food deliveries for dinner. However, for others cooking is not only a way to cuddle family and friends by providing a bountiful feast, but also a moment of creativity, learning new skills, relaxing of the mind, and, if everything goes well, the satisfaction of creating a flavourful dish. This has become even more important at these times of social isolation. As an Italian (scientist), I grew up in a culture where the kitchen and dining room are the core of the house, and where food is the main topic of discussion for everyone. When I think about my grandmother, “la nonna” as we say in Italian, I often picture her in the kitchen cooking something new and delicious while listening to the radio. The kitchen was her studio and she was the lead artist. She was from Emilia Romagna, a region of Italy, home of fresh pasta such as tortellini, cappelletti, tagliatelle and lasagne. Ever since I was little she used to call me and my siblings in to the kitchen to help her out and to give us all her secret tips for making a great homemade fresh pasta that will make your day (I am sorry, I can’t reveal them.. It’s a family secret!). I used to love eating homemade meals, especially desserts, rather than preparing them by myself. I know, I know, I have been spoiled by my nonna and mum, but who could blame me? My culinary experience started with baking cakes. Before I knew it, the kitchen became my own world and time seemed to stop while I was getting lost in my baking for hours during my adolescence days. Slowly, cooking became a combination of creativity, mindfulness, a sense of control, and a way to reminisce on childhood memories. I soon realised that cooking for myself and others can have a huge benefit to my mental well-being. While cooking, I needed to be focused, weighing the ingredients precisely, stiring regularly, adjusting the seasoning, monitoring the process, and enjoying the beautiful sights and transitioning smells it unleashes. The entire experience helped clearing my mind from everyday life problems, without forgetting that a treat is coming at the end. In 2016 I moved to London. From that moment on, cooking has not only been a help for my mental health but has also allowed me to reproduce the smells and flavors of my home. Be it a cake, lasagne or a roast, the smell and process of baking and cooking brings the same sense of comfort as a hug from my mum, and it brings me back to when I would, impatiently, and with eyes full of admiration, look at my nonna cooking. Regardless of our education, origins, relationship status, social standing, age or sex, everyone has an every-day relationship with food, whether it is needing it, loving it, avoiding it, sharing it or craving it. It is something that we all have in common and that binds us together. I found myself writing this blog during the COVID-19 pandemic, with the lack of flour and yeast, and while looking at the many pictures of homemade food on social media: it’s been difficult to not notice that many of us have found cooking and baking of great help to get past this difficult period. Thanks to the possibility of sharing home cooking pictures online and participating in online challenges, allowing us to share what we have made in a symbolic way, cooking is also helping us to connect with our friends and family. So, why is everyone baking and cooking during this pandemic? Is it because we have more time, or is it also because it is helping our mental health? In recent years, cooking has been used to help people relieve stress, and in the therapeutic pathway for mental health conditions such as depression or anxiety. A study published in the Journal of Positive Psychology found that activities like cooking can make people more enthusiastic about things the following day. In fact, cooking therapy (together with other art therapies) has a powerful mind-body impact, since it stimulates all our five senses (touch, sight, hearing, smell and taste). ““Cooking is like painting or writing a song. Just as there are only so many notes or colours, there are only so many flavours — it’s how you combine them that sets you apart”” — CHEF WOLFGANG PUCK As discussed a few years ago in The Wall Street Journal, therapists and psychologists believe that cooking and baking are part of a type of therapy identified as “behavioral activation”. This therapeutic intervention has been used to overcome depression by focusing on activities which increase goal-oriented behaviors, reducing the tendency to procrastinate. Cooking classes, in fact, are now recommended by therapists as additional help to treat depression and anxiety, as well as eating disorders, attention deficit hyperactivity disorder and addictions. Culinary therapy involves the whole task, from cultivating a garden and planning grocery lists to preparing meals, and the process has been shown to relieve stress, improve focus, and develop social skills and sensory awareness. A recent example is a participant from a famous UK TV show: John Whaite. He is a baker and winner of The Great British Bake Off 2012. But what you may not know is that he was diagnosed with bipolar disorder in 2005. John shared how baking helped him in stabilising his mood by providing easy tasks to focus on, in an interview with the BBC. He said: “When I’m in the kitchen, measuring the amount of sugar, flour or butter I need for a recipe or cracking the exact number of eggs. I am in control.” — JOHN WHAITE For an individual suffering from a psychiatric condition, the sense of control is very important, and it gives the feeling of regaining themselves. It is a milestone in the therapeutic pathway. Cooking can also have highly positive effects in connecting you to people, and creating a sense of community which helps you to feel like you’re providing a useful and appreciated service, as the culinary art therapist Michal AviShai said during an interview with the Huffington Post. Finally, in addition to the benefits of the process of cooking, the food itself activates the hormone system that helps to regulate our mood and an overall sense of well-being, as explained in our previous blog by Rachel Kelly. Food stimulates the production of different hormones such as dopamine, the brain’s “pleasure chemical” that rewards your choice to eat a pizza. Other hormones that are regulated by food intake are ghrelin, a hormone produced mainly in the stomach in order to stimulate the appetite, with possible link with mood disorders; and cortisol, which tends to increase blood sugar levels when we are hungry, and it has been associated with the response to stress. We can conclude that cooking has at least 5 benefits: 1. It gives a reward at the end 2. It helps the brain to stay healthy 3. It activates creativity that makes you feel good 4. It is an altruistic gesture when cooking for others 5. It saves money (!) So, if you think this could be helpful for you but you’re not sure where to start, don’t be scared. The skill of cooking takes practice and all professionals as well as good home cooks have had years of practice to refine their technique. Start small, use beginner’s cookbooks or online videos to help you. Plus, you don’t have to be the best chef to get the positive effects of cooking. Don’t underestimate yourself, you might be able to make your favourite dish in no time! Header Image Source: Pexels

For many of us living longer is a blessing, an achievement of our modern society. After every sunset we wake up wiser, more experienced, but ultimately older. At the beginning of the coronavirus pandemic in Stockholm I worked in an old age psychiatry community-based unit, but now I have moved into an inpatient geriatric ward (in reality it was a inpatient psychiatric ward transformed during the corona crisis into an inpatient geriatric ward). The average age of our patients is above 70 years and many of them, when not in hospital, live at home with help from social workers or in different forms of nursing/care homes. During these pandemic times, people like our patients are way too often referred to as “people at risk”, or “older and with underlying conditions”. But for me they are wonderful people with amazing life stories. For me, coming from an ex-communist country, all these stories are from another world, like letters to my grandparents. I am just the postwoman. My patients’ stories are from the other side of the wall, stories from a country without wars for the last 200 years. Most of the patients referred to our unit suffer with anxiety and/or depression and some of them had previously attempted suicide or have a high suicide risk. In pandemic times, the recommendations are that people over the age of 70 should follow strict social distancing. They should isolate at home and no visits are permitted to care homes for unnecessary medical visits. We say “NO” to many of our medical visits at our outpatient unit or at home. Face to face visits are very rare and reserved for psychiatric emergencies. All other evaluations are done over the phone or very rarely by video-calls. The circumstances in which we deliver care are new for medical staff and for the patients. Humans are creative and adaptable. At the beginning of the pandemic I called as many patients as possible, even patients that in other conditions I would have assumed are in a stable situation. I worried that their anxiety, depression, and/or feelings of loneliness will worsen, that they will start drinking more alcohol or that they will avoid seeking medical help for other life threatening medical conditions. At the beginning, the mediatic cover of the coronavirus pandemic was very intense for me, as for many others. My worries at times were probably disproportionate, but it was a new situation for all of us and it took me some time until my worries calibrated to a new normal. COVID-19 news coming from Italy and Spain about how medical staff needed to make difficult ethical decisions on who will benefit the most from an intensive care treatment was overwhelming. And it didn’t take long before many of my patients started to receive news of a relative, or a friend, or a friend of a friend, who died because of the infection or that was in hospital battling pneumonia. CollectivelyCounting is brought to you by First Fortnight, Ireland's Mental Health Festival, in collaboration with poet Stephen James Smith and director Cra... “Collectively Counting” by Stephen James Smith summarize the anxiety from the beginning. Many of the questions are still unanswered. Inevitably, the first part of the conversation with our patients was about the pressure we were all exposed to. Many of the voices were composed, acknowledging that “it is a very difficult situation” and praising our work. But I could hear some very anxious and trebling voices at the other end of the phone who described the whole situation as a “holocaust” or ‘’ättestupa”. Some of them cleaned their houses and prepared for the worst-case scenario, while others turned off the television and other media channels and tried to do something else to distract. Somehow the second part of the conversation was about medicines… if you are talking with a doctor you need to ask something about medicines. I received questions about the use of vitamin D, anti-inflammatory treatment as ibuprofen and medication for high blood pressure. Honestly, I lacked the competence in answering these questions. As the link between psychiatric medication and coronavirus infection were not making the headlines, no patient has yet asked me about the use of their medication for depression, anxiety or bipolar disorder and the risk for infection with coronavirus COVID 19. But for us as professionals it is an everyday question. Polypharmacy (concomitant use of several medications) is common among elderly and we constantly try to reduce the amount of medication. Other questions are related to side effect of specific drugs on the immune system, kidney function or the impact on the muscle of respiration. There is a lack of evidence on the direct relationship between medication for psychiatric use and coronavirus. Everyone does their best to respect the recommendations and adapt to their new life in the best possible way. But for many of our patients who were already suffering from loneliness, the measures of self-isolation are almost unbearable. “Loneliness epidemic” made the headlines in our media, and in 2018 the UK government launched their “loneliness strategy”. Loneliness is defined as “situation experienced by the individual as one where there is an unpleasant or inadmissible lack of (quality of) certain relationships. […] Thus, loneliness is seen to involve the manner in which the person perceives, experiences, and evaluates his or her isolation and lack of communication with other people”. In European countries, loneliness increases with age. Around 16.9% of the people over the age of 80 feels lonely almost all the time. The prevalence is higher in Eastern European countries and lowest in Nordic countries. It is unbearable not to hug and have a close contact with their family, or not to take a walk and a cup a coffee with their friends. To communicate through videocall is not that easy, sometimes it even requires several hours of preparations. Very few of them got worse, more anxious, depressed or even suicidal during the pandemic, but together with their family and carers we found solutions, including, if needed, breaching the “No physical visits” recommendation. But surprisingly, for me, many of them had resources to adapt to the new normal. Sometimes I could hear happy voices, telling me how they succeeded to use these complicated techniques. It was like a personal development. I realised that getting older is a process, a journey, and all of us, including myself, are in different stages of this process. Probably understanding the beauty and the meaning of this journey is the way in which we come to terms with the unknown, the death, the grief of losing someone dear, but also with the happiness and gratitude about life. The anxiety from the beginning has diminished, as good news from survivors and scientists are reaching out. We all try to continue living our meaningful and extraordinary life regardless of the pandemic. Tony Luciani’s “A Life Divided.” photography from SLRLounge

Approximately two years ago, the science writer Marta Zaraska contacted me as she was interested in kindness and stress. She was curious to know if every-day acts of kindness could lower her stress levels. So, I measured her cortisol levels — the main hormone involved with stress, which is easily detectable in the saliva — every day for one week. On some days (I did not know which one) she engaged with some random acts of kindness to people she knew or to strangers. This story immediately came back to me when I found out that this year’s Mental Health Awareness Week had kindness as its core theme. This annual occasion is UK’s national week to raise awareness of mental health and mental health problems, and to inspire action to promote the message of good mental health for all. We all need some kindness at these difficult times of the pandemic. And yes, I will tell you what happens to Marta’s cortisol, at the end of this blog. Is kindness beneficial to the kind person? For those of you who wonder why such a serious clinical academic as myself (hahaha!) should spend time studying such an ethereal topic as “kindness” (even if my artistic collaboration with Marta is not a study by any stretch of imagination), it is probably important to highlight that the effects of altruism and kindness on mental health — the mental health of the giver, not of the receiver — have been the subject of large and methodologically-sound studies for decades. And the results of these studies have been amazingly consistent: helping others leads to increased well-being, no matter if this altruistic behaviour is expressed through volunteering, charitable donations, or acts of kindness to individuals that we do or do not know personally. For example, a study in 2015 asked to more than 70 volunteers to engage in “prosocial behaviours” (i.e., acts of kindness) when interacting with strangers or acquaintances, doing things such as holding open a door, helping with schoolwork and asking someone if they need help. They found that the days with more prosocial behaviours were associated with higher levels of “positive affect” (i.e., happiness) and better overall mental health. But, you may wonder, it is easy to be kind at normal times, when we don’t have to worry about our own survival. What if we are struggling — like most of us are now, at the times of coronavirus, isolated by the lockdown and worried about own health, and the health of those we love? Well, it turns out that kindness is really beneficial to kind people especially if they are struggling. In another large study on more that 2,200 people, those who were struggling with a range of problems — studying, saving money, controlling their tempers, losing weight or finding employment — were more motivated to address their problem after being offered the opportunity to help (by giving advice) others struggling with the same issue. Yes, those who gave advice improved in their motivation, and experienced a boost in confidence. This was a randomized, controlled, double-blind study, the highest standard of evidence in science. In yet another, even more telling (and touching) study, individuals who were providing full-time home-care to a spouse, because of illness or disability, were asked to record how much time they were spending helping, and also what were their emotions during the same time period, at random moments during the day (so-called “ecological momentary assessment”, or EMA, method). These people were struggling caregivers to spouses who had severe, chronic illnesses, such as dementia, cancer or stroke. The amazing finding: the time spent helping predicted greater levels of positive affect in the caregivers, especially among those caregivers who perceived themselves as “interdependent” with the (care-recipient) spouse. Interdependency was defined as “feeling that they shared a common fate”… but I would call it “being in love with each other”. Many more studies on kindness and mental health are summarised in this year Mental Health Awareness Week webpage dedicate to this topic. So, is the pandemic making all of us kinder? Well, judging from headlines, yes. Newspapers and magazines are all telling us stories of kindness during the pandemic, from Elle to the New York Times to The Guardian. And let’s welcome these nice, heart-warming stories, since the news that we are receiving also speak of countries stealing personal protective equipment from each other, and of an increase in fraudulent activities exploiting the most vulnerable in this situation. And of course, the choice of the Mental Health Act Foundation for this week highlights the need to celebrate kindness because of its singular ability to unlock our shared humanity. So, how can we all benefit from this “epidemic of kindness”? This week is also a “call for action” to do more acts of kindness — for our own mental wellbeing as much as for the wellbeing of those we are kind to. The dedicated list of acts of kindness suggested by the Mental Health Foundation is endless, from making a cup of tea for someone you live with, to sending a motivational text to a friend in difficulties, from donating to food banks, to offering to skill-share with a friend via video call. This week, I have spent hours on a video call with two friends to teach them how to make sourdough bread (yes I know, it is a little bit of a stereotype at the moment, but I like it!) How about Marta’s cortisol? So, I am not going to give away too many details — you can read them in her book which should be out soon. But guess what: her cortisol levels did drop (i.e., she was less stressed) during the “days of kindness”. Of course, this was not a research study, it was only an artistic collaboration. But yet, I like to think that, together, Marta and I have stumbled on something real. That somehow, while she was busy being kind, her body and her brain knew that she was doing something good — not only for others, but also, and foremost, for her. This blog was originally published on King’s College London, as part of Mental Health Awareness Week. Hosted by the Mental Health Foundation, Mental Health Awareness Week takes place from 18–24 May 2020. The theme is kindness. Header image source: Simon Ray on Unsplash

Slow down…take a deep breath…downward-facing dog…namaste. Gurus, fitness stars and health professionals are recommending yoga as the ultimate stress-buster and ab-building solution…but are we willing to go beyond the matching lycra sets and hamstring stretches to discover the mental health benefits of yoga? Several studies have reported the benefits of yoga for anxiety, depression and stress but we often oversimplify it — yoga is not just beautiful handstands and tree poses, nor is it a physical practice that will magically change our life. Yoga philosophy teaches that individuals must understand and accept themselves deeply to bring lasting change. As a researcher in the mind-body interaction myself, I have always been interested in how psychology explores the mind-body connection that yoga is based on. In fact, the mind and the body are one, it is our perception that makes us believe that they are separate. Could yoga then be used as a tool to improve mental health? I started practicing the physical aspect of yoga, asana, 15 years ago, with my mother and her teacher. I quickly branched out, experimenting with different styles and even dipped my toes in different meditation practices. In recent years I have felt a pull to dive deeper into the roots of yoga and after much research and studying on my own, I embarked on an intensive teacher training programme in November last year. I studied in the oldest yoga school in the world, located in an ashram on a small island in India. You can see me graduating in the picture below: What is yoga philosophy? Yoga is intimately related to the Samkhya philosophy, one of the oldest philosophy systems in India. Samkhya is rooted in the duality of the unchanging consciousness and the changing world: nature, the body, the fluctuations of the human mind. The changing world has three forces: tamas (inertia and decay), rajas (desire and aggression) and sattva (balance and knowledge). A core aim of yoga is to develop more sattva in our lives, through becoming more self-aware. Moving away from the intricacies of an ancient philosophical text, this duality can simply be interpreted as recognizing who we truly are and the temporary states that we associate with our identity: emotions and thoughts that arise, sensations in our bodies, stories we tell ourselves. When learning yoga, we start with physical practices, asanas, to strengthen the muscles (bringing awareness to our frequently neglected physical body) and move to more subtle practices, such as pranayama (breathwork) and meditation (bringing awareness to our minds). Once the body is prepared and the breath has been balanced, we can start learning how to work with our minds (or should I say, make peace with our restless minds?). Isn’t this too new-agey? Ok, stay with me. Being present, accepting discomfort, and knowing that feelings are transient are essential requisites to good mental health.If you become aware of each of your inhales and exhales, can you ruminate on the past? When you hold an intense balancing pose for 30 seconds, can you worry about the future without losing your balance? When you go through rounds of sun salutations and your body gets sweaty and your heart is pounding, but you don’t stop, aren’t you creating resilience? When you try to meditate, don’t you recognize the thoughts and emotions that come up and accept them? To me, this is where yoga and mental health come together on the mat — and I can then take these learnings off the mat into my life, along with the other teachings from yoga philosophy. So can I just stretch and breathe any issues away? No, yoga cannot cure any conditions, physical or mental, and should not be used for spiritual bypassing (a tendency to use spiritual teachings to ignore unresolved emotional issues). Instead, yoga invites us to self-study (get to know thyself, warts and all!), to understand how erratic our thoughts are and ultimately encourages us to take the reins of our minds. It invites us to face both the darkness and light that co-exist in us. After all, yoga means “to unite”. How can you unite parts of yourself that you unaware of? Why shouldn’t I just go straight into my meditation cushion then? I invite you to sit in meditation for 5 minutes without moving at all — you will experience the power that a restless and tense body have in disturbing the mind. The physical practice, asana, has an immense value in expanding the body, creating space and releasing tension so that the body does not get in the way of the work we want to do on our minds. What if I just do the yoga classes at my studio, can I get all these benefits? An ancient yoga text suggests that you can achieve pure bliss, samadhi, by physical practice alone: simply perform the posture below for 12 years (yes, 12 years!) while you meditate and follow a strict diet. Alternatively, you can do the daily hard work that Patanjali, one of the fathers of yoga, described as the eight-limb path of yoga. This path helps us lead balanced lives by providing a moral code, hygiene, physical and meditation practices, self-study and lifestyle guidelines to ultimately achieve this pure bliss called samadhi. Sama-what? Samadhi can be loosely translated as standing within oneself, a blissful state of being. It is a state that is transiently experienced by all of us when we hug a loved one or reach the summit of a mountain; we feel that we are completely at peace and in the immerse in the moment. When we are in the present moment, we are in a complete union of mind, body, soul, spirit and emotions, a step closer to samadhi. I believe that yoga can empower each and every one of us to do something compassionate for ourselves. Create space in our body and our mind, be comfortable being in silence with our thoughts and watch what comes up, with no judgment. That is a step closer to better mental wellbeing. In conclusion… Please see one of my all-time favourite free resources, that I keep going back to again and again — Yoga with Adriene. You can also read a fantastic blog on relaxing our bodies and minds with some basic yoga postures here. After practicing yoga for many years and becoming a certified teacher, the more certain I am that there is so much I still don’t know. For now, I will keep practicing my long inhales and exhales, learn to move with discomfort in my body and accept that everything, everything, is transient in this life. I might not be able to do a handstand yet, but I have made peace with my monkey mind. Header image is Carolina’s own photo from a Hatha Yoga class in Sideman, Bali.

In recent weeks, many of my patients have asked me about how to manage stress and take care of their mental health during the coronavirus pandemic. Between social distancing, working from home, and school or daycare closures, many people’s routines have been upended. As a clinical psychologist and researcher who studies how stress impacts mental health, I’ve come up with a few suggestions that I shared with my patients on how to manage stress in this time. Most of these are from a cognitive-behavioral therapy (CBT) perspective. I’ve also included some suggestions from colleagues — one specializes in family and couples relationships, and one is a psychologist experiencing the pandemic from one of the earliest hit countries. Daily Routines — If you are suddenly working from home, caring for kids who are no longer in school, or have reduced work hours, your daily routine may have gone out the window. Routines are predictable and give structure to our days: alarm rings, start the coffee, hop in the shower, breakfast, get ready for the commute, and so on. Once that’s gone, it can be easy to feel unanchored. So, try to create a new daily routine for yourself. Perhaps you’re not commuting anymore, shuttling kids to the school bus stop, or managing after-work social or school activities. Are there other ways you can structure your day? Maybe without the commute, you have time for a little exercise or a leisurely breakfast in the morning. Maybe at lunchtime you have time to take a walk. Try to plan out your day or week with a similar daily structure. In CBT, this is consistent with behavioral activation, the idea that our activities or behaviors have a big impact on our moods. When we do something we enjoy, are good at, or that feels meaningful, we usually have a lift in mood. If we avoid activities or isolate ourselves, it tends to worsen our mood. To make use of this, in CBT we use “activity scheduling” to map out specific activities that we know will bring us enjoyment or a sense of mastery, slotting those activities into our days at specific times. Maybe I know that I always get a good laugh when I talk on the phone with my brother, so I set aside 20 minutes at lunchtime to call him. Maybe I am really great at organizing things and know that I’ll feel accomplished afterwards, so I set aside an hour in the evening to work on organizing my closet. Maybe exercise gives me a boost in energy, so I schedule in time for a jog or a yoga video online. Jot down a list of things that you know make you feel good, have meaning to you, or you’re good at. Then see if you can block off little chunks of time throughout your week to do those things. 2. Social Distancing and Social Connection — Connecting with other people is important for mental health. It gives us emotional support, helps us feel part of something larger than ourselves, and gives us a space to decompress and share our experiences and feelings. Maybe you’re used to chatting with coworkers, meeting up with friends for a drink after work, or seeing your neighbour at the gym. With people working from home, and restaurants, bars, movie theatres and gyms shutting their doors, many of our social connections are being cut off. This can mean less emotional support and a loss of belongingness and connectedness. If you are feeling cut off from others, see if you can maintain those ties even from six feet apart! Try calling or texting a friend, or emailing a coworker to see how they’re doing. Having virtual hangouts, group chats or Skype happy hours with friends is another way to stay connected. See if a few friends want to Facetime over afternoon coffee or a beer after work from their living rooms, instead of the local café or pub. Also, keep in touch with friends or relatives who are older, immunocompromised, or live alone — they will feel supported knowing that someone is keeping an eye out for them, and it will help them to feel less isolated too. 3. Managing Relationships — In addition to changes in daily routines and social connections, the pandemic may have caused changes in our relationships at home. For those who live with a partner, children, or roommates, you are suddenly seeing a lot more of each other. This is an adjustment and can put strain on relationships. Heather Pederson, Ph.D., a board-certified couple and family psychologist, says that one approach is to see the relationship with your loved one as a means of self-care, using that connection for comfort. This can include doing things together as a team (even simple things, like planning grocery lists), and looking at your partner or family member as a resource. Some couples or families might need to work on negotiating responsibilities, e.g., for new cleaning, childcare, or cooking routines due to social distancing. Dr. Pederson emphasizes that this doesn’t always happen naturally, and family members might need to check in with each other to keep the balance of responsibility, which she likens to an always-shifting teeter-totter. What about those moments when we’re worn thin and anger starts to bubble up? Pederson says that “anger is a protective emotion.” It’s telling you that somewhere, you have a need that’s not being met. She encourages people to get curious, to try to figure out what’s underneath the anger and what needs aren’t being met? Then communicate that to your family member. If conflict gets too heated to work out alone, Dr. Pederson suggests looking for a therapist trained in Emotionally Focused Couple Therapy (EFCT). 4. Dealing With Uncertainty — Uncertainty can be scary. Most of us have not dealt with a pandemic of this scale before, nor had our lives so directly affected. It’s hard to know what to expect. And it is totally normal to feel anxious or stressed in the face of these changes. However, there is a line between a normal level of pandemic-related anxiety, and anxiety at a level that’s interfering with your functioning. If you are having blips of anxiety related to the pandemic that are relatively minor, try using some acceptance-based coping skills. Remind yourself of what’s in your control, and what isn’t. Then be ready to release what’s not in your control — things like how public health officials are responding to the pandemic, or schools and businesses closing. Instead, focus instead on what you are able to control — practicing handwashing and social distancing, setting your daily routine, checking on loved ones. Another technique is practicing mindfulness. This is a skill that focuses on shifting your awareness away from anxiety-producing thoughts, and into a more neutral space, focusing on your breath, movements, or an object. Moving away from the tangle of thoughts that can bring anxiety and fear. There are some free mindfulness meditation audio tracks online, including a 20-minute breathing exercise from mindfulness meditation leader Dr. Jon Kabat-Zinn at the UMass School of Medicine. If you are having more severe anxiety that’s affecting your functioning, it’s best to contact a mental health professional for help. 5. Adapting — Sooyeon Suh, Ph.D. is a clinical psychologist at Sungshin Women’s University in South Korea, one of the countries first affected by the pandemic. Living through the pandemic over the past weeks, she has seen a few patterns play out. For instance, she mentions that some people might be too ambitious at the start — making elaborate meals every night, starting a difficult new exercise routine, setting out to write a novel, etc. She says it’s important to manage expectations so that you don’t burn out. If you try to do too much, you may just end up exhausting yourself. She says that a doable routine is key if you are going to maintain it long-term. Similarly, she says that expectations may need to change for those who are trying to work from home and parent or home-school at the same time (for instance, your kids might get more screentime than usual). She said there is also a tendency for people’s sleep schedules to shift, or to engage in snacking or boredom eating. She emphasizes that it’s important to keep a regular routine for meals, bedtime, and waking up at the same time in the morning. Overall, she says that a key step in coping with these changes over the course of weeks to months is to acknowledge that change is difficult, to adjust expectations of yourself and others, and to give yourself credit for doing what you can in this difficult time. I hope that these suggestions were useful. Stay safe and take care of yourself and others, physically and emotionally! A version of this article was originally posted on Dr. Hantsoo’s website. NOTE FROM THE EDITORS: We would like to say a big thank you to Dr Liisa Hantsoo for allowing us to share this wonderful blog with our readers on InSPIre the Mind. Liisa works at the Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine. She has previously written another great blog for us on stress early in life and the effect it can have on our gut. Thank you, Liisa! Header Image Source: USC News/Getty Images