Dr. Stella Chan on the Mental Health Impact of COVID-19

Episode 4: Dr. Stella Chan on the Mental Health Impact of COVID-19

 

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Issue Number

4

Publication Date

June 2020

Transcription


Please note transcriptions are auto-generated so may feature mistakes.

Rebekah: [00:00:00] Hello, and welcome to the RSEs Tea & Talk podcast series. A programme inspired by the coffee houses of the 18th century, where great thinkers would come together to discuss ideas and matters of the day. I’m Rebekah Widdowfield and I’m Chief Executive of the RSE, which is the Royal Society of Edinburgh, and is Scotland’s National Academy.

Our mission is to advance learning and make knowledge useful. And as part of that, I’m having a series of conversations with some of Scotland’s leading authorities on a whole range of topics, starting with exploring different perspectives on the coronavirus pandemic. The conversations are all with fellows of the RSE who are keen to share their expertise and experience.

This week I’m speaking about the mental health impacts of COVID-19 with Dr. Stella Chan; reader in clinical psychology at the University of Edinburgh, and a member of the RSE’s Young Academy. So we’re not in a coffee house, we’re both in our own homes, which explains the occasional dip in sound quality. But I’d encourage you to grab yourself a drink of something, sit back and listen to one of Scotland’s leading experts talk about things that matter.

So Stella, the response to the COVID pandemic has understandably been very much about protecting people’s physical health and increasingly though we’re seeing much more attention being paid to people’s mental health. And I wonder if you can tell us from your perspective, what are the key things we should be thinking about in terms of mental health and the impact of the pandemic and our response to it in terms of the lockdown?

Stella: [00:01:35] Well I think that the first thing that we need to always remember is that people respond to the same situation differently. So it’s very difficult to predict on a particular person, how the person’s going to respond to that, whether it’s positive or negative, and it’s important not to make assumptions to people, but that said it’s also important to be vigilant, so to speak and be observant and understanding that this is stressful situation to a lot of people.

I think that if we dissect the question a bit, you know, thinking about what kinds of people, how they may be affected. Of course, the obvious group would be people who are working the frontline in the health and care services, or if they’re key workers or if they have to maintain a lot of interaction with people.

So the threat, the physical health threat is very real and we still see people dying every day. So I think the anxiety is around health and around potentially getting the illness or having to care for people we love. So that is very real. The threat is very real.

But for lots of who do not have direct contact with COVID, so to speak, the impact tends to come from the lockdown itself. So lots of us find ourselves losing the usual routine and structure. Routine and structure is very important to maintain mental health. So we have a certain kind of routine; we normally wake up, we know what we’re doing, where we’re going. But all of a sudden, you know, we have to change the way we live, change the way we work.

And also about isolation although we’re kind of constantly still in touch with other people some way, just like now we’re talking to each other remotely, but it’s not quite the same as going to a workplace or school every day. And you have some kind of face to face interaction.

And I think another group that I’m particularly thinking about other people who are already vulnerable, so people who have a mental health history perhaps, or people already quite isolated in some ways, or people who don’t have very high level digital literacy. So this would be a time that they may find themselves particularly struggling or is particularly challenging for them.

Rebekah: [00:03:41] So I think that’s a really interesting point that, you know, we need to recognise that people – one are in different situations in terms of actually what they’re dealing with, but two, even people in the same situations will respond differently.

Thinking about those three groups, you’ve maybe mentioned those who are vulnerable, those who are sort of in the front line and sort of the more general public if I can put it in that way. What are the ways in which you think we can build resilience both as, as individuals, and as a society?

Stella: [00:04:08] I think as an individual now, one of the psychological theories that I am personally very drawn to, and a lot of my work is based on is compassion theory. So thinking about the relationship with ourselves, our relationship with other people.

So one of the key things within compassion theory is about common humanity; it’s to understand that, you know, sometimes when we suffer, actually it is not just us as a unique human experience. It’s a shared human experience.

It doesn’t mean that the experience becomes more positive or less negative in any way. But nonetheless, it helps us put things into perspective. So lock down is not only just affecting us here in Scotland. It’s actually affecting a lot of people around the world. So also somehow I feel as though we have been in lockdown for a very long time, but if you actually look at the calendar, it’s just over two months.

So it is just, I think it’s important to think about that – it’s a particular period of time that we’re experiencing this and we’re already easing off the lockdown and it’s affecting everybody. And so putting that into perspective, I think it helped me take a balanced way of viewing things and seeing things.

Another thing that I think that is important is to be flexible and adaptable, and that is always quite important for mental health. It’s about how we deal with change. Interestingly, even positive change is very stressful. Like even if you move into a bigger house or better job, you know, just change itself is actually can be quite challenging and threatening in general.

And now we all have to change. And adapt, and I reckon that like, those of us who are more willing to embrace change may find it easier to adapt. So I would say an attitude of thinking about when things are difficult, when things may be different – how can we make the best of it? I think that will help about resilience.

So two things really, one is putting it into perspective, thinking that it is a shared experience rather than just an isolated personal experience. And the second thing is to be more adaptable to change.

Rebekah: [00:06:08] Thanks so much. And it was really interesting about thinking about that shared human experience and it connects with some of the things Professor Steve Reicher was talking about in the last podcast around the sort of shared identity terms of how we respond to the pandemic and adherence to the guidelines.

I guess there is this question though, while at one level we are all in it together in terms of we’re all experiencing the pandemic in some shape or form. We also know that actually the way that the impacts are playing out; so some people are much more at the sharp end than others. And we can see that most obviously in the sort of mortality rates from people from black and minority ethnic communities or from particular deprived areas and things like that.

So how do we deal with this mental health in that context, where there is such a differentiation in people’s experiences, let alone how they then respond to situations.

Stella: [00:06:52] Do you mean how can we build resilience while it’s actually not equal?

Rebekah: [00:06:56] Yes. I mean, so for someone like me in effect, advising me to, sort of get a bit more of a perspective, think about the sort of shared humanity – is probably good advice. For somebody who’s maybe in a more vulnerable position, if I can put it in those terms, or more at the front edge and the cutting edge of the pandemic, it might feel harder advice to receive.

Stella: [00:07:15] That’s true. Actually, you’ve raised a very good point. Indeed, it is the shared experience in some way, but it’s also there is some kind of health inequality there – if I may put it that way. And I think that actually is still coming back to a sense of compassion. I think that links up to another challenge, a mental health challenge with COVID is a sense of lack of control as well for a lot of us.

So when things are not completely in our control and it kind of creates a lot of anxiety. Anxiety is very much about future-oriented. It’s about not knowing what’s happening and that kind of feeling. So coming back to your point about this being a shared experience, you know, you’re absolutely right. It’s not equal that way.

I think that its important to stay connected with people. So no matter what the situation is, I think there is always some way to stay connected, even though you can’t physically be closer than two meters for most of us. But there’s many ways to connect and there are communities. And one thing that I find when we’re in challenging times, we see the worst in people. And at the same time we see the best in people. I think in a situation like that, we see a lot of creativity, how people do things differently to achieve the same goal. For example, if we want to stay connected and we can’t stay together; you know, I had a walk just now and I saw most of the cafes have now changed their, completely changed the shop, the front bit of that. And it becomes like a hatch. So most of the cafes, now they have a hatch that they sell coffees, and so. And people queueing up every two meters, you know? so that is different from how we normally live, but people still manage to get their coffee and people are chatting with each other while they’re waiting for their coffee.

So that sense of kind of coffee community, so to speak, have kind of started emerging in many communities. And also I’ve seen that a lot of people who traditionally may not be using a lot of digital technology, such as people who are in older age, and they all have now because of the situation have learned to be more digital minded, and digital literate, and these create opportunities as well.

See, I’m chatting with my parents and they are miles and miles away. And now, you know, so the connectedness, I think technology make it possible. So I think wherever possible, we should stay connected with people in whatever way we can.

Rebekah: [00:09:30] I mean, I think one of the things that Steve and I were talking about last week as well, was the phrase, social distancing. And certainly his view was that was an unhelpful term in the sense that what we should be doing is physical distancing, but social connecting. And he was pointing out sort of some of the risks of social isolation and the negative health implications of that. I mean, is that view that you would agree with as well, that we should be careful about the words we use and think about how we talk about the pandemic and the importance of words and language and narrative in terms of mental health and wellbeing.

Stella: [00:10:00] Yes, absolutely. I think sometimes that how we call things actually prime the way people perceive it. None of us, humans are not objective and we’re not robots, you know? So yeah, absolutely. To call it social distancing, it does imply some kind of isolation. So, yeah. So I agree with that.

Rebekah: [00:10:19] And then just in terms of thinking about maybe some of the positive things that might come out of the pandemic without wishing to downplay the horrendous impact it’s having on people’s lives, do you think the pandemic is starting to normalise conversations, for example, about the emotional responses to challenging and anxious situations?

And do you think it is either already doing, or it will support a greater openness in talking about mental health and wellbeing?

Stella: [00:10:45] Yes, and no. I think there has been a longstanding issue about people not being able, not feeling comfortable to open up about your emotional responses. And this is, you know, one of the situations in which we are now beginning to recognise the emotional impact and people started talking about that.

So in that sense, it does kind of encourage more discussion, but at the same time, people may think that, you know, the kinds of emotional responses in the face of something like COVID is normal, but it doesn’t necessarily mean that people will translate that aptitude to other kinds of emotional difficulties or mental health difficulties.

What I do think that we have to a certain extent, normalise is about flexible working. There’s one thing that has been – I’ve been pondering a lot about is about a work life balance. You know, as a psychologist of course there’s something that’s very important for me to think about in terms of mental health. It’s very fundamental to be spending time with family, but in modern days, I think because we’re so busy and sometimes it’s not about our choice, it’s about what is possible, what is not possible in our work environment.

So a lot of people may previously have been facing obstacles about flexible working hours or part time or that kind of thing. Now, because of necessity, a lot of companies, a lot of employers, they have to allow their employees to have a flexible working hours arrangement. And I hope that, what I hope is that after this, it becomes like a real life experiment.

So if the experiment works well and we all experience that it is actually quite possible to work remotely. It’s possible to work in flexible hours. And I hope that that will promote and prompt and pull focus on debates and social policy changes, employee rights, so to speak, and the norm. What I think we’re probably normalising is a flexible working arrangement, actually.

Rebekah: [00:12:41] I mean, I guess that points to as well, the connectedness between mental health and wellbeing, and social policy and social policy interventions, which might not be directed at improving people’s mental health and wellbeing, but might have that consequence. Although for some other people, actually it might have the reverse effect.

I mean, thinking about sort of the state’s response to mental health and maybe the state’s responsibilities in terms of mental health and wellbeing. Are there things you think that the state is doing or should be doing that actually support mental health and wellbeing at this particular time?

Stella: [00:13:13] At the moment, I actually see that recently, you know, there begin to be more, for example, on the radio, you begin to hear adverts to advise people that if you have health and mental health needs, the services are still open to them.

And I think that is a very important message because in the beginning, when we were in the crisis, I think one of the challenges would be that people who have mental health difficulties would probably assume that services are closed now, and this is not a priority. And therefore they may not go and seek help.

And now that I think one of the things that is important to emphasise to people that services are now running as normal, lots of services, and they should not delay in seeking help. And I think that is important.

Rebekah: [00:13:59] And just in terms of that, thinking a little bit more about the sort of service provision. I mean, there’s obviously certainly one school of thought that mental health is very much the poor cousin and the poor relation of physical health in terms of the service provision, in terms of access to services, is that a view you’d you’d agree with?

Stella: [00:14:15] Yes, absolutely. It has been a longterm problem. You know, the amount of money spent on mental health, both in terms of research and both in terms of clinical services are always behind physical health. For many reasons. One of the reasons is that I think a lot of mental health problems are kind of less visible, so to speak. And traditionally there’s still a lot of attitudes around who’s responsible for that. You know, there’s an unhelpful attitude about people who have mental health problems, they should be responsible for their own mental health. And that is of course something I don’t agree, but there are many, many historical reasons why that is so.

And I think now we have more acknowledgement that there is no health without mental health. So that is a very important message to get across.

Rebekah: [00:15:00] And do you think that that message is important in terms of, as you say, readdressing that balance, but are there things you think we can do to help reset the balance in terms of service provision, if you were advising government in this area, what would you be advising them to do in terms of service provision?

Stella: [00:15:15] I think it’s more, very important for us to think about prevention and early intervention. We do know that from my area of research, for example, I focus on young people’s mental health, because we know that a very vast majority of people who have mental health problems actually have their problems emerge in adolescence.

So lots of times people assume that the problem is kind of with adults, but actually is because some of the early problems, were not recognised even by the person themselves. So if we were able to do something when people are younger, it’s easier to learn the new way of thinking and feeling and relating to themselves, you will have a lot more potential to change the quality of life across, across the lifespan.

So obviously the earlier you tackle the problem, the better. So I think early intervention, investing in early intervention is very, very important. It’s vital. Another thing is to work more closely with schools because in, you know, in society like ours, most of our children would go to school. And that is a perfect opportunity, a perfect place for us to help them build resilience.

It’s also less stigmatised. So a lot of young people, when they have problems, when they have difficulties; they may not feel comfortable to come forward to seek help. Going to a clinic going to a doctor’s surgery is something that is related to stigma. However, we’re trying to fight stigma, but you say if you’re able to have more easy access to help within your normal environment, such a school, and that would be a natural way to tackle that.

So I think more resources put into school. I’ve been talking, I work very closely with schools. I talk a lot with teachers. One of the things strike me is that teachers and schools are very, very keen to develop their mental health strategies, but how much they can do is very much dependent on the resources they have in that school and whether the teachers happen to have some training in the area also. But I’m thinking that actually in the future, if we can work closely with teaching training or if we can assign some specific kind of clinical psychologist hour or, you know, that kind of thing to schools. I just think we have a lot of missed opportunities in school.

Like we have teachers really dedicated and yet they don’t have to support the need. And here we are, you know, we have got lots of mental health professionals wanting to help, but at the same time not quite sure how to work with schools. So I think more connection there, maybe more formal connections that is instigated from the educational authority or the government and the resources that come with that would be very, very helpful.

Rebekah: [00:17:53] I mean, it’s reminding me a little bit, as you speak, Stella about some of the previous conversations that have been held about financial literacy and actually how you prepare kids and young people for the adult world in terms of how they budget. And I know this is a very different area, but it almost seems another sort of tool for life, is actually how you, within the course of the day to day learning environment, which obviously removes any stigma, enable people to grow and develop as citizens and as human beings in a way that they’ll be able to flourish.

Stella: [00:18:19] Exactly. I think when I grew up, for example, you know, we got people coming in, occasionally speakers come in to talk about how to look after yourself in terms of, like hygiene, or in terms of your physical health. And we were taught what to do if you have a cold, you know, but when I grew up at least no one ever come in to talk to me, what do you do if you feel low, what you do if you feel anxious. It’s the sort of thing that we learned in a hard way.

You know, eventually we find our way and fight our way. It shouldn’t be that hard.

Rebekah: [00:18:47] It was interesting. I was thinking I did some resilience training, but not until I was in my thirties, but it was quite simple, but really powerful, simple tools and techniques to sort of help you deal with challenges. And I think that sort of learning is, is, is really, really helpful.

I mean, just talking about young people or thinking about young people. Cause as you say, that’s obviously being quite an area of focus for you. I mean, do you think there are particular implications of the pandemic for young people both now and into the future?

We’ve talked about early intervention. When might we see issues arise? But are there particular things that the moment that you think are affecting young people in a specific way?

Stella: [00:19:24] Yes. I think the main thing is about a lack of structure because I think school is a very good structure, you know, whether you like the structure or not there is a structure there, but now, you know, almost overnight, very quickly, young people, children and young people find themselves, you know, waking up and then, you know, they have to completely change the way they do schoolwork.

Schoolwork itself is actually, it could be quite a source of stress normally, already, and having to adapt to a different way and a different format of learning again is a big challenge. And we also, I’m also particularly thinking of those young people who are in a critical academic stage in terms of exams. So the uncertainty around, you know, that when exams are canceled, so how are their grades going to be determined?

And this is something very unfamiliar to them and unfamiliar to all. And that uncertainty is, is, is very, very difficult to manage. I’m also thinking about the isolation that it really depends on young people, how their normal – well, how their usual social life is like; how they maintain that friendship group and things like that. We are working with 10 groups of young people, actually young citizen scientists in our project, Project Soothe.

We have been developing wellbeing tools with them. We started before COVID so it’s not a COVID related project. But nonetheless, we have been trying to continue with the project and working with the young people remotely to develop these wellbeing tools. So what we see is differences. You know, some young people continue being very engaged and being able to adapt to this new way of working with us and continue with the project and developing wellbeing tools, they’re very keen.

At the same time, we also see some young people kind of started disengaging a bit, quite understandably because of other pressure. So I reckon this is actually a snapshot of how young people may be dealing with it differently. Another group of, two groups of people I’m thinking of who are probably quite stressed one is a group of parents, you know, we all find ourselves homeschooling on top of everything else, maintaining our own jobs and things like that.

So I’ve heard a lot of parents feeling really tired, really exhausted, and trying to do their best. And also teachers as well, because, you know, in university we have already started changing our teaching learning materials. And I reckon it’s absolutely the same for teachers as well.

We’re launching a new sleep awareness week with some schools in Scotland, this week actually. So we’re working quite closely with schools and teachers, and we know that schools are a doing wonderful job to maintain and try to keep things going. But not without challenges.

Rebekah: [00:22:01] I mean, it’s, it’s interesting actually, in terms of young people, there’s been quite a lot of discussion more recently about generational scarring, but quite often talked about in terms of economic impacts, which are obviously critical in terms of access to the labour market, but maybe less in terms of generational scarring in terms of mental impact.

So the work that you’re doing in that space sounds really important. Can you just say a little bit more about Project Soothe for those who’ve maybe not come across it.

Stella: [00:22:26] Well Project Soothe started in 2015. So it was a very simple concept, really. We wanted to collect images from members of the public – images that make people feel soothed.

And the biggest difference is that in the past, when we did research, we used to create these materials ourselves. But now that it’s really important to recognise that members of the public are co-producers of research. So they’re our genuine partners. So instead of trying to create these soothing images, we ask the general public to help us create a bank of soothing images.

So far we have collected more than 800 images already from more than 30 countries. And they’re absolutely lovely images. They are all freely available, and if anyone wants to look at them, they’re in our online gallery, open 24/7. So if you just Google Project Soothe and you will find our website.

So now we got so many lovely images. And from our research, we have found that by looking at 25 of them is enough to have an immediate, positive mood effect. So people feel better, feel more positive after looking at images. Now, what we don’t know is that whether it has long lasting health benefits. Another thing we don’t know is what is the best format to benefit from these images.

And that’s why we work with young people. Young people are incredibly creative admirably so. I always think that academics are not naturally creative. We’re probably just all a little bit bookish, but anyway, so we recruited 10 teams of young citizen, scientists, their age range from 10 years old onwards.

So we’ve got primary school. We’ve got secondary schools. We’ve got young people from, forensic services as well. And institutions that look after vulnerable young people. It’s a very diverse group of young people and they learn about Project Soothe. We give them research training as well. So training of social research methods, and it is up to them what they want to do with the images.

And they came up with brilliant ideas. One of these wellbeing tools being developed now is called Soothing Vision. So this young person designed, have picked some of the soothing images, paired them with music and quotes, aspirational quotes from books and literature and made them into short videos.

We’ve got primary school kids have, are developing a game called Soothe and Sort, so to sort the soothing images. So they come with brilliant ideas and we now have 10 wellbeing tools being developed. And now it’s also led by the young people to evaluate the tools. So they are now using robust research methods to evaluate the effects of these wellbeing tools amongst their own peers. We’re really incredibly proud of these young people. And can’t wait to see the outcome of these tools.

Rebekah: [00:25:27] I mean, it sounds a fantastic project. I mean, as you were talking there about sort of the use of music and quotes and images. It was reminding me of other things where the culture is sort of supporting mental wellbeing. And I was thinking particularly of the book of poetry that is being prepared for new junior doctors, for example. So the cultural aspects seem to be really important here.

You’re beginning to talk there about sort of the way you do research and particularly the importance of citizen science and coproduction. I know another thing that’s really important in your work is also about taking a multidisciplinary perspective to issues like depression and other mental health issues. Can you say about why that’s important to the work that you do and what benefits it brings?

Stella: [00:26:07] I think for the multidisciplinary one, I think traditionally the problem with research, if I can call it a problem, it’s actually really an obstacle.

It’s not that we haven’t done research, but because research was done in such a way that individual research studies tend to be informed by a particular theoretical tradition or particular research method. So in the end, we got studies that tell us how thinking style is linked with depression, for example, so cognitive psychology.

Youve’ got another group of research looking at how the brain functions related to depression. You’ve got another group looking at early life experiences or relationships. But what it doesn’t join up is, so how are the brain functions related to the thinking style? As behaviourally seen and observed? And interpersonal relationship?

Of course everything links with each other within a person. And the only way to understand things like depression or anxiety is to look at all of these elements together. And that is why we need to work together. But that is still, I’m still talking about multidisciplinary within academia. But in fact, increasingly I do find that there’s lots of things that we miss as academics.

So one group that we’re increasingly working with are experts by experience. So people who have lived experience of mental health problems in particular, or people who have experience of caring for someone with mental health difficulties. Now, these people are experts of the illness in terms of the understanding, what it’s like to have it. They understand the obstacles that hinder recovery and unless, and until we listen to them and work with them as genuine equal partners, I don’t think we can go very far in terms of designing the right kind of support. You know, the right kinds of support is not only a scientifically robust intervention, it’s not only about some numbers that we can see from statistical analysis – it’s something that has to be meaningful to people. Something that people have to buy in.

So working with people is important. Another thing is that we also need to think about a resilience model. Now, if you want to stay well for the rest of your life, the kind of coping strategies you use have to be relatively easy to use on an everyday basis. So if I say this is a magical intervention, but in order to do that, you have to climb up to the top of a tree and shout to the moon every minute. No one going to do that. So it has to be something that’s easily incorporated into everyday life. Because of that, I think it’s important to work with people like writers, artists, musicians, you know? To think about the kind of thing people do in everyday life. You know, a lot of us read books, so books would be a fantastic way to get mental health messages across.

I’ve been quite involved in Edinburgh International Book Festival, and I talk a lot with artists and authors and I instigated one of the events called writing for resilience, helping people to develop writing skills, to use writing and storytelling as a way to be resilient. And I think, you know, going forward as a society, if we can recognise a bit more of these connections between academic and nonacademic professionals, people, just the general public themselves, with or without lived experience. I think, you know, if mental health problems are everyone’s problem, then we all have a responsibility and we all have a role to play.

Rebekah: [00:29:47] You know this obviously, but one of the things about RSE that makes us different from other national academies is that we cover not just the breadth of academia within our membership, but also people from business, the public sector and third sector.

And that gives us a real advantage, I think in terms of being able to look at challenges and issues from different perspectives, but we’re also very mindful of needing to bring in lived experience. We’ve got the practitioner experience, if you like, but lived experience of people perhaps dealing with some of the challenges we might be looking at; and that’s certainly one of the key things that we’re mindful of as we take forward the work that we’ve set up with the Post COVID Futures Commission – is actually making sure that we are hearing from and bringing in the voices of those people who are experiencing things at the front line, if you like, or at the sharp end.

I mean, one of the things you talked about a little bit earlier, you talked about the images having come from a number of different countries. And I know in other areas that you’ve looked at in your research work is about how mental health varies across different cultures and countries. And I wonder if you could just tell us a little bit more about that and particularly any key differences that there are, for example, between Scotland and other countries across the world, in terms of how we experience mental health and wellbeing, and indeed how we respond to it.

Stella: [00:30:59] I think the first thing is that most of the mental health difficulties are quite universal. So for example, my research is mostly on depression, and we know that depression is a worldwide health challenge. It affects people from poorer countries and wealthier countries. So depression doesn’t really choose.

So it’s everywhere, but how we experience it and particularly how we talk about it is quite different. That leads to one of the issues about how we assess, how we diagnose, it’s also different. So one of my former PhD students, she looked at depression in, inner Mongolia, for example, and I have a PhD student who had been working on looking at mental health problem in Pakistan, for example. And I have an MSc student from Belize and looking at the row of images there. So the overall observation without going into details are that it is a universal thing. So we see depression everywhere. We see anxiety everywhere. But how people talk about that and whether they talk about that, how comfortable they are in talking about that actually really differ both across countries and within countries in terms of different communities.

So we have communities, we have cultural groups that have a stronger tendency to talk about mental health problems in a physical health context. So probably instead of saying that I feel lonely, maybe it’s talking about I’m really, I feel really tired.

Now it’s not only about the way they talk about that. It could well be that is really the way they experience it. So that is where they kind of focus on maybe some of these things about, you know, feeling tired or about relationships. You know, how the attribute being the cause of the difficulties also differ between countries.

Sometimes I think that we also take things for granted. Sometimes we overlook cultural differences, it’s as simple as we have brought Project Soothe to four lower and middle income countries last year. And one of the observations we had while talking to clinicians and practitioners in other countries is that it’s the type of images. So for example, Project Soothe, we were hoping to develop Project Soothe into a more international and universal health intervention because pictures and images transcend the language barrier.

We thought there’s a huge potential there. The same time that what we need to be mindful from focus group that we collected – the information collected; is that for example, in countries that there are certain religious belief, they would not want to see images of certain animals, for example, that the cows are sacred; to be part of that bank of soothing images because they will think that it may be a bit disrespectful.

So those are kind of simple things, but important. And yet we have overlooked it. And I think coming back to your earlier questions, Rebekah is about working with people, it’s about recognising other people’s expertise. And one of these expertise is, is about people understanding their own culture.

So cross cultural studies have to b. Working in partnership with people in the country who know about the country. And I know that RSE, have lots of kinds of funding opportunities particularly including this kind of international collaboration. And that is really important.

Rebekah: [00:34:15] And I think it also takes us back to your first point where you started about that we all respond to the same situation differently. And then if you layer on that cultural differences as well, that means there’s even more nuance in terms of how people respond.

Just coming back to COVID again for a minute. I mean, There’s been a lot of comparison with other countries in terms of the number of cases, in terms of the number of deaths and the death rates. Is there any evidence emerging yet around the impacts in terms of mental health and differences across different countries in terms of how people’s mental health and wellbeing is being impacted by COVID? Or is it a bit too early for that yet?

Stella: [00:34:53] I think it’s too early. I mean, if you look at, if you do a kind of literature search for papers, you of course can find some individual papers, especially from countries who were affected earlier, like China or Italy. So you, you start seeing some papers from scholars, from those countries reporting mental health challenges. But as a whole, if we have to compare between countries it’s too early.

At the same time, I think you just have to be mindful of that unless the study is deliberately set up to do so, just simply by looking at studies in different countries, it’s very difficult to compare because of the way they assess mental health problems, a bit different, the way they do the recruitment difference is almost impossible to do a cross-cultural comparison.

Another thing that we know from our research being difficult is if you use a different measure, and if you want to use the same measure. So if you translate the same measure into different languages, you thought you solved the problem, but actually you don’t because the measure, although it’d be the same, but the content may not be culturally specific enough to pick up the kinds of mental health challenges specific to each cultural group. But if you then allow the comparison to be made between different assessments, then it is very difficult to tease apart. Is that because of the measurement difference or is that genuine difference?

But I think that is important if we are trying to think positively is to think about learning from each other, what works well and what doesn’t. And if we can have some genuine, honest conversations between countries about what are our observations? What works and what doesn’t? That probably would be a more meaningful way to bring everyone together.

Rebekah: [00:36:30] I mean, I noticed that the UK research and innovation has just launched a funding call for projects around mental health and wellbeing. So it would be interesting to see if any of those have a comparative analysis in terms of looking at mental health across different countries.

Just one final question. If I may, Stella – given all your work on mental health and wellbeing and thinking about people’s resilience, would you mind sharing with us how you manage your own mental health and wellbeing?

Stella: [00:36:54] Well, first of all, I don’t always manage very well and I would be the first to admit that there are good days and there are bad days. For me, it’s very important to have something to look forward to; have a sense of purpose. So I always like having a project, a project that is outside work.

So at the moment I have started a new project for myself, it’s called cooking around the world in 80 days. So a couple of years ago, I read the classic book, you know, the novel Around The World In 80 Days. So now I’m using the itinerary and every day I have that imaginary traveling experience. So I know that today’s equivalent to the book, we will be passing Malaysia, for example.

Which is true, actually. So today we’re going past Malaysia. So I look at the encyclopedia and I’m lucky enough to have an old edition of the encyclopedia. So I look at an encyclopedia to try to understand what the country is like. And then I Google it as well. Have a look at what sorts of food do they eat, then I’ll cook something that is either inspired by the country or actually a recipe from the country.

So it’s day 31 now, so I’ve been doing that for a month, just over a month. And it’s really exciting. So every night before I go to bed, I close my eyes thinking, Oh, tomorrow I’ll be in a new country. So I wonder what new experience will I get? So for me, it’s about creating a sense of structure, creating a sense of purpose.

There’s also making use of what I like best, which is eating and cooking. So it’s solved one problem, it’s solved the mental health problem. It doesn’t help with the other health problem when you keep eating, but nonetheless, I’m enjoying it. And that is my coping strategy.

Rebekah: [00:38:31] It’s making me wonder if I should ask whether you do home delivery Stella, because that all sounds very, very attractive, I have to admit.

Stella: [00:38:38] Actually, it may not be a bad idea. I have been thinking about turning it into a book because it just, all the years working a lot with the Book Festival, I always had this dream that one day I may have my own book. So maybe something to think about in the future, maybe working in partnership with a book writer, cookbook writer, and to see if I can turn that into a book.

Another thing that I think for the RSE, maybe if we have Fellows who are chefs, that would be really, really nice to have.

Rebekah: [00:39:05] Well, it sounds like a really fantastic initiative.

Dr. Stella Chan. Thank you for sharing your knowledge, experience and expertise on the mental health impacts of COVID. Thank you.