Fit for Duty podcast: Episode 7.

Hello again and thank you for joining us for episode seven of the Fit for Duty podcast by Aetna International. At Aetna, our mission is to help put people on the path to better health, helping to ensure they get the quality care they need. We help people make informed decisions about their health, as well as the health and well being of those they look after — be it employee or loved one. Through this podcast, we explore conditions behind rising global healthcare costs, talking through healthy behaviours and treatment strategies. We also provide employers with actionable information and demonstrate how early intervention, care management, innovations like virtual health, and proactive engagement can help ensure people flourish. Because when we thrive, our professional and personal endeavours thrive too. We hope you find our discussions not only interesting but valuable. Make sure you subscribe to the podcast. And don’t forget, you can follow Aetna International on LinkedIn for all our latest news and articles. 

Today I’m joined by Dr Sneh Khemka, Vice President, Population Health Solutions here at Aetna. With World Mental Health Day just around the corner, we spend 35 to 40 minutes talking about mental health imbalances, and how they affect the whole being. Our conversation takes in the self help evolution, changing recognition and awareness around depression and anxiety globally, how far we’ve come and yet how far we still have to go with eroding mental health stigma. Sneh’s experience in digital healthcare and data analytics means that he shares some intriguing insights on digital innovation in the mental health space and cutting edge science including psychedelics. I asked Sneh about the impact of lockdown, and the global pandemic on our mental well being. And he explains the influence of community, both physical and online, and social connectedness on our overall mental health. We discuss what forward thinking companies are doing in the mental health space, both for healthcare consumers, and from a benefits perspective for employees. If you have any thoughts on today’s topic you can always get in touch with us with your questions and comments by messaging Aetna International through LinkedIn. We’re always keen to hear your feedback and we hope to answer your questions in future podcasts. I hope you enjoyed the episode.

Good morning and welcome to our Fit for Duty podcast. This morning’s discussion will be focusing on mental health and well-being and I’m joined by Dr Sneh Khemka, who’s the Vice President of Population Health Solutions and vHealth here at Aetna. I’m delighted to have you back in the virtual studio again, Sneh. Good morning, could you please introduce yourself for our listeners.

Yes, good morning Lorien and thank you very much for having me back. It’s nice to record another podcast with you. By way of introduction for your listeners who haven’t heard from me before, my name is Sneh. I’m a doctor/surgeon by background. But more recently I diversified into public health and working in the business of healthcare and hence my role with Aetna International. And really what I’ve been doing is helping with big scale infrastructure projects for governments, setting up new healthcare systems, moving into public health provision of health services, changing the way we look at data and analytics to help with the management of population health, and more laterally delivering digital healthcare services in countries like India, Dubai and Thailand. So that’s a bit of what I’ve been up to but it’s quite a wide ranging set of interests that I have Lorien.

It is a wide-ranging set of interests and can we specifically ask about your interest in in digital health care and data analytics. What drives that interest?

Well, it’s the modern face of medicine. So, what the world has realised is that the old adage of data is the new oil. It’s the source of a lot of wealth and in health care that’s extremely relevant, knowing what’s going on with individuals and with populations at very specific level of detail allows us to be able to give much more targeted health interventions. So, for example, if you understand a person and their genes, and if they were to get cancer, then you can give a much more targeted therapy which is more likely to be curative, and with fewer side effects. So, it makes a huge amount of difference. Or at a population level, knowing when there’s an epidemic about to happen. Knowing where coronavirus is rearing its head and being able to clamp down on it. That data is extremely important. And the digital side of things is really the health care, which like many other things has moved from analogue to digital. And where in healthcare you don't need to physically lay hands on a patient, you can deliver a lot of health care remotely — over an app or video, over the telephone. And we’re really keen on that at Aetna International and we’ve been setting up vHealth and virtual health services all over the world to meet the increasing demand in that area.

Thank you. And so, I know that we spoke a few weeks ago on the topic of heart health. And at the end of our discussion we really started to touch on the role of psychosocial factors, and how important that is on our physical health. So, around the world, the topic of mental health has been demanding a greater and greater share of voice in the health and wellness conversation in recent decades. It’s been described as a health care crisis in itself, and so many health care bodies and government agencies have really been prioritising that mental health prevention and intervention, and that was before the impact of the current pandemic and its consequences of uncertainty, isolation, financial strain, which obviously have led to understandable spikes in anxiety, stress, depression and more. So, today I really wanted to talk to you about that current picture of mental health, and where we go from here. Whether that’s at an individual level for people looking after their own health or for government bodies and health care players.

I’ve got some stats here, as usual, to give some context. So, it’s thought that one in four people will experience a mental illness at least once in their life, and currently around 450 million people are living with mental health disorders, which are among the leading causes of ill health and disability worldwide. More worryingly perhaps is the World Health Organisation  has said that every 40 seconds someone dies by suicide. So, that is 800,000 people who die by suicide every year. And that's more than people doing from war or homicide put together. So, those statistics are really worrying and I really wanted to start with the basics Sneh, please, if I may. What is mental health, and why is good mental health so important to individuals, for the organisations they work for and for society as a whole?

Well, I mean what you’ve just said there Lorien is very interesting on a number of different levels and you've introduced some statistics there which I wasn't aware of, which you're right are pretty startling. So, let's take it back to basics here, mental health arises, the health of your mind. Now if you think of the mind, one of the original neuroscientists that we know of, Ramón y Cajal, a fantastic Spanish neuroscientist. He came up with a definition of the mind. And the mind is the biochemical phenomenon that arises from its organ, the brain. And so, mental health is really about maintaining the right biochemical balance within that organ — the brain — and ensuring that things are kept in balance. And when they’re not in balance, you get mental health problems and disorders. Now, given the complexity of those biochemical interactions in the brain, it is not surprising that imbalances come frequently. But the problem with mental health imbalances, is that unlike physical health imbalances which may affect one organ or one limb or one part of the body, mental health imbalance affects your whole being. It affects who you are, how you live, how you present yourself. And so, it becomes all encompassing. And sometimes it is a small biochemical imbalance that could be modified with non-interventional therapies, such as self-help. But often, it requires someone else to do something about it, either through talking therapies or through medical, drug or surgical interventions. So, the other thing I’d say about mental health is it’s very personal. Unlike physical health, where a broken bone is a broken bone and you've got a fixed treatment pattern for that, mental health is so individual. It depends on a person’s character, on their individual preferences, on their expressions, on where they live, how they live, who they live with. And so, tackling mental health is much more complex and there isn’t a panacea solution that works across the board, unlike with many aspects of physical health. So, all of that having been said, Lorien, I think the revolution that we’ve had in the last 12 to 18 months, accelerated of course in the last six months by COVID, has really been short of nothing but amazing. If you see how people are talking about mental health, especially in the western developed world, it’s quite astounding. You have the royal family here in the UK engaging on a regular basis. You have summits with world business leaders engaging in conversations about mental health, recognition in the workplace, recognition amongst the medical community, and mental health has now emerged as its own discipline. It was always just a subset of overall health and well being, but really now mental health is being dealt with as its own individual category, separately from physical health, and I think it's beginning to receive the attention it deserves. The last comment to make on this point, specifically, is that I think we are in our infancy when it comes to understanding and treating mental health. We’re only 30 years away from fairly barbaric treatments like electroconvulsive therapy and frontal lobectomy, which are really barbaric ways of dealing with mental health issues. And we’ve just beginning to understand how to recognise, how to treat and how to heal people with mental health issues.

Thank you so much for those really fascinating discussion points there — lots of things to that I could dig into but I specifically wanted to ask you more about the symptoms of depression, anxiety and other common disorders. What are those symptoms, what should people be looking out for and aware of?

Well let’s start with depression. So, depression is a big issue, and depression as a category crosses quite a lot of different definitions and there's an ambiguity between the definitions. So, when people talk about being stressed, often they mean they're depressed. When people talk about being a bit under the weather, not quite feeling themselves, about irritability, about those other sorts of minor psychological issues, often they’re referring to what we would clinically call depression. And depression can be mild, it can be moderate and it can be severe. It’s a big issue. The reason I say is, you know, just to talk about other statistics, major depression is really thought to be the second leading cause of disability worldwide. And let me just say that again. Depression is the second leading cause of disability worldwide. Now you would have not normally thought, if someone asks you what are the leading causes, you’d have thought about physical disease but really depression is so impactful. But it's not just how it impacts your mind, it’s how it impacts your body. And it’s a major contributor to the burden of suicide that you refer to, and ischemic heart disease. So, depression causes people not only to commit suicide, but to get heart disease and heart attacks and strokes and things like that. So, the psychosomatic influences that come from depression really are quite significant. And if you were to talk about global health burdens, about 13% of the total global burden of disease is accountable by untreated mental health conditions. So, I’m coming back to your original question here: how do you define it? So, the traditional definitions of depression, you know, go all the way from not quite feeling yourself, being increasingly irritable or agitated, you know, reacting in a bad way to minor stimuli. It can move that into a feeling of anxiety of, sort of a constant distraction, not being able to get on with things, constantly procrastinating, worrying about the future. And then when it manifests a little bit more, it comes into what we would clinically term depression, which is a depressed mood, negative thoughts about your current state, negative thoughts about the future, constant worry, interference in sleep patterns, especially waking up earlier in the morning and not being able to go back to sleep. It manifests in the way that you eat — decreased appetite. And sometimes the other way around, increased appetite, in reaction to a stimulus, i.e. comfort eating. And then it can manifest physically as I mentioned, ischemic heart disease, but also in the way that you interact with other people, in how much activity you take, in your motivation to do things and engage with society, and to work normally. So it's a very broad ranging definition and the reason I’m not going with the usual clinical strict criteria is because definitions are changing, and it encompasses quite a range of symptoms.

It’s very interesting to hear you say that it is changing, and the way we understand mental health is changing. You’ve talked there about the consequences, but in terms of the stimuli, and the contributing factors, I should imagine that they vary by age, by gender, geographic region and also socio-economic status. What are your thoughts on the roles of each of those on our mental well-being?

So, there’s a lot in there so let’s talk about age. There is no doubt that as you get older, you are more prone to mental health conditions. That is a very well-established phenomenon. And it is often people in their 50s and above who will have some sort of major mental health condition. That’s not to say that that doesn’t happen in younger people. There’s often incidences. And the thing is in childhood mental health conditions are much more difficult to recognise and diagnose and therefore go undiagnosed. Gender imbalance: it is thought that men are more prone than women to mental health issues. And that’s really related to how men and women interact with society in slightly different ways, which we’ll come on to later. But that’s a general rule of thumb. Geographically, there is a much higher rate of recognised, and I use that word carefully, recognised mental health issues in the Western world, compared to developing economies, especially across the Middle East and into Asia Pacific regions. Now, I don’t think the incidence of depression or mental health conditions is particularly different in different countries. It is more about how they are recognised, because the stigma around mental health still continues in many economies, and people will not be recognised or will not admit that they have a mental health issue, whereas in countries like the UK or US where it’s become much more common parlance and acceptable talking about these things. The incidence is higher because the rates of diagnosis are higher. But there is also known to be variation with where you live in the world, according to weather patterns and exposure to sunlight. So, in the far north of Europe, especially in the Nordic countries, there is an established evidence based around higher rates of depression and suicide, especially during the very long winter months when there is decreased sunshine. And that’s definitely a factor as well. So, there’s a fair few things that cause variations, but the rule of thumb is that it is about recognition and diagnosis. That will give us true statistics on the impact of mental health around the world.

I'd absolutely like to discuss stigma in a few minutes. But in the meantime, I mean you mentioned there that mental, neurological and substance use disorders account for 13% of the global burden of disease. And yet, countries spend just 2% of their health care budgets on mental health so, Sneh, why the disconnect?

Yes, I mean that goes back to what we were saying earlier, that the recognition around mental health has only just started really emerging in the last 12 to 18 months. And I remember when I trained as a doctor some 25 years ago, psychiatry formed one module in my education which probably took off about three or four months of my total six-year undergraduate training. And that’s all I was allocated. And in that psychiatry training, I was trained how to recognise and deal with things like severe psychosis or bipolar disorder or schizophrenia, rather than understanding those things which sit in the non-psychiatric realm and more in the psychological realm around the things we’re talking — stress, depression, anxiety, irritability, lack of appetite, lack of sleep, lack of libido, those sorts of things. And so, doctors traditionally were never trained in this, and the money is spent directly is followed by what doctors recognise and know how to deal with. And so, those stats don’t come as surprising. And I think it’ll probably take at least two to three decades for us to match the need for funding with actual funding, as we change how people are trained and how we deal with mental health issues in the community.

And so we talked about stigma, or rather you mentioned stigma. What are some of the misconceptions that people, including those with mental health issues, have? And how can we convince people that mental disorders are as real as physical? So just continuing on from what you were just saying there.

The second part of your question is the most challenging bit, is how do you get people to recognise, but let’s just talk about stigma for a second. So, stigma still very much exists. And forgive me that I’m going to use some fairly stark language here, but this is what goes on in everyday society. Nobody wants to be labelled as mad or bonkers. And if you have a mental health condition, you fear that’s what's going to happen to you. It is very hard for you to talk about that with your own family, your spouse, your parents, your children. I’m talking about myself here. I’ve had mental health issues in the past like any other human being. And in those periods of mental health problems, you fear how people are going to react. You worry that they’re going to mark you with a badge and dissociate themselves from you and that you will, even if you’re not labelled as being bonkers, you’re labelled as being a depressive or people who you don't wish to associate with in society. And that’s very tough, so if you put on top of that, that when you're depressed you’re much less likely to want to socially interact, you’re much more likely to close in on yourself and ruminate on thoughts and to continue introverted and extroverted behaviour, you get that double whammy. And so, that that will your social or your family circle. When it comes to the workplace, it’s even more. People really do not want to be identified as having mental health issues. Even today, you will never hear of someone going off sick for mental health problems. Even if it may be mental health related. Because there is still that stigma associated with it, and it’s only very brave people who are willing to talk about that openly. Whereas if you went off with an upset tummy or a broken ankle, you’d be quite happy to tell other people that’s what’s afflicting you. So, we’ve still got a long way to come on stigma. And if you go to countries that are still going through their revolution of health care in developing economies. It is really not the done thing to talk about mental health issues. And so, I’m repeating myself here a little bit but we are a long way away from having open non-stigmatised recognition and conversations around mental health and getting there will be one of the ways to tackle the burden of disease that this is causing in society.

You’ve mentioned earlier that obviously mental health conditions are incredibly personal and therefore seeking treatment and your preferences around what’s going to work for you is also incredibly personal. And I have practiced breathwork and meditation and I found that to be very, very helpful. But what do you think that individuals can do to help maintain, prevent or improve their mental health, short of seeking professional help?

So, there’s the physical aspects and then there's the, sort of, concentrating more on the mental health aspects. So, if you think about the physical aspects, making sure you have a balanced lifestyle is so fundamentally important for mental health. Because remember, it’s a biochemical phenomenon, it’s part of how your body is working. And if your body is not working properly, your mind will not work properly. And so, regular exercise, I cannot emphasise the importance of this enough. Getting 30 minutes of exercise every day that leaves you slightly short of breath does wonders for your mental health About maintaining a good serotonin and endorphin balance, the right levels of steroids, cortisol, adrenaline flowing around the body, the right balance of 5-HT. All of these sorts of things. So, regular exercise is one. Two is regular eating. So, if you have unbalanced or imbalanced eating, that will necessitate mental health issues. Not only because it is unbalanced but because you are what you eat, and it causes physical disruption of the biochemicals that circulate around the brain. So, regular eating and healthy eating with a balanced diet, as you know everyone talks about is super, super important. And sleep. Trying to make sure that you get a regular cadence of somewhere between six to eight hours of sleep a night in a regular controlled, darkened, temperature modified environment. If you can achieve it, it is really important and that will help to deal with a lot of the mental health issues. So that’s the stuff that you can do sort of on the physical front. But when it comes to self-help, we have had a revolution around this again. Probably not a revolution, more evolution, Lorien, I'd say. But evolution is coming — people choosing to practice things such as breathing techniques, as you’ve talked about, yoga, Pilates, those sorts of physical exercises really help with mental health. But then moving into meditation and mindfulness. So, mindfulness is a relatively new science but it’s becoming much more widely adopted, and it’s about just living more in the moment, being less concerned about the past and the future, concentrating on where you are. And it only takes 10 to 15 minutes a day of practising active mindfulness, for it to become part of your regular routine. And I’ve certainly done that myself and it’s made me a much more stable individual when it comes to mental health exacerbations. You can then move into, sort of, online self-help tools. So, there’s a plethora of new apps, all the way from Headspace to Calm. And there are lots of others out there. And Aetna International, for our customers, has embarked over the last 12 months on a programme of offering either free or discounted access to these online apps, so that our customers can get access to these things and really engage with their mental health and their mindfulness in a meaningful way. And we’re getting lots of positive feedback from customers who don’t expect that of their insurance company to offer it, but we do and we find that really helps customers. And we recently launched this more involved programme with a company called Wysa, which is free to all our members to use, and has a series of online self-help tools, videos, online chat with qualified psychologists, those sorts of things, which really do help people. So long winded answer Lorien, but there’s a lot that can be done out there.

Absolutely. A you mentioned Wysa there and one of the reasons I like it is because you have the ability to self-help, and to read around the subject to actually arm yourself with various tools and techniques to help your own mental well-being, and you can also then have that professional help as well. But, when should individuals seek professional help? And how can their loved ones and their support networks, including their employer if appropriate, encourage them to seek that help?

(27:58)

Well, before I answer that I mean I just want to talk about things like Wysa and self-help tools. So if you take the average person out on the street, they’re a bit scared of these sorts of apps and things because they don’t know how to engage with them, and they feel it’s going to, you know, it's going to eat up a lot of their time, that you have spent two or three hours a day doing this, and when that’s not the case at all. These are actually really simple things, and they’re 10, 15-minute things that you do every day or every other day or once a week or once a month if you want. And the great thing about it is you engage with it in the way that you find easy to engage with it. And the results are immediate. They are so immediate and so tangible and so real, that once you’ve tried it, it’s difficult to stop using it. And that’s why they’re just so vastly popular these things. That's why so many people download them and use them. So, for those of you who listen to this podcast who have thought about engaging with something like Wysa or Headspace or whatever and haven’t done it — just try it. Give yourself one day this week and give yourself half an hour just to download and try one of these things, you get them through the Aetna International Health Hub portal, and give it a go and see what you think of it. It could make a huge difference for you. But your question Lorien about when do you recognise, when do you need to help you seek professional help — there’s no hard and fast rules, but the rule of thumb here, the guide: suppose your family member you’re concerned about, your spouse or your child or your parent. It’s when you notice them not interacting with you normally, where they are expressing negative thoughts about their current or future situation, where they are expressing or where they’re showing disturbed patterns of sleep — either sleeping a lot or not sleeping enough. Certainly, if they express any intentions of self-harm, including suicidal thoughts, then it absolutely is your responsibility to help to get them professional help to stop them from getting into that state. But really, for families, it’s about recognising when someone is not being themselves. And my advice here is don’t hesitate to seek professional help. And it doesn’t need to come through your traditional hospital or GP. It can come from online resources, some of these health tools that we talked about, they’re really good at picking up when people need more professional help — either medical or psychiatrist related. And these things really will help. And then there are, of course, the charitable help names, such as the Samaritans here in the UK, where people can go to for anonymous but really good experts advice.

So, that brings me on to the subject, or back onto the subject, of COVID-19. So, according to the United Nations, COVID-19, the pandemic has led to psychological distress in populations that is widespread. So, people are distressed because of the impact of physical isolation, many people are afraid of infection, of dying or losing family members. Individuals have been physically distanced from loved ones, from peers, their livelihoods are at risk or people are facing economic turmoil. And there’s also misinformation out there rumours about the virus. A lot of deep uncertainty that is causing distress. So, you know, I wanted to ask you to agree with the UN’s assertion that the pandemic is leading to a long-term upsurge in the number and severity of mental health problems?

We don’t know the long-term data at the moment, because we’re still in the thick of it, so to speak, and the pandemic is still very real and very live around the world. But let me share some things with you that I think stand out here. So, if you look at the UK, there’s a charity here called Mind. And they surveyed about 16,000 people, and they found that 22% of people who had no previous experience of poor mental health said that during lockdown they were having poor or very poor mental health. That’s 22% of 16,000 people. That’s a startling statistic as I read it, suggesting that really the impact of lockdown, caused by COVID, has caused significant mental health issues. And then, that’s further corroborated with another study from Co-SPACE, which is talking about children aged four to 10, and parents and carers, that over a one month period in lockdown, they saw quite a marked increase in emotional difficulties, especially with the children. It was an expression of being unhappy being worried, being clingy, or physical symptoms manifesting as a result of it. So, lockdown has definitely had an impact on people. If you go into the source of more light impacts, people during lockdown definitely had changed sleeping patterns, so often they were sleeping less, they were getting nightmares and facing more stressful situations on a daily basis. But markedly there was also psychosomatic physical health issues, such as increased high blood pressure, cardiovascular disease, related to the mental health impact of lockdown. So, we are seeing it really quite widespread. And one of the statistics coming out of our parent company CVS health care is the use of virtual consultations for mental health. So, for physical health, we saw virtual consultations go up by somewhere between two to 400%. So that was a very marked increase. But for mental health, there was over a 3,000% increase in consultations for mental health conditions. I’ll repeat that — 3,000% across the US. That is an outstandingly large figure, that 3,000% more people are seeking consultations virtually for mental health issues during lockdown. And that in itself, Lorien, tells quite a story.

It does and you’ve obviously touched quite significantly on virtual health care and solutions. So, when it comes to dealing with stigma, what are some of the benefits that virtual health solutions can offer if people are concerned about how their struggles will be perceived? What role can vHealth play in support for that?

So just for the listeners who haven’t really heard of vHealth before, vHealth is a function and a group of businesses that Aetna International has created and owned, that really provides virtual health care. And that ranges all the way from having consultations with a doctor or psychologist or a dietitian over the phone or over video, but all the way into organising blood tests to be taken at your home or your office, for drugs to be delivered to you where you are, for you to get online support and counselling services, for dealing with chronic diseases and, relevant to this conversation, with mental health. So, what does it cause? it means that people can get much better access and much better anonymity, and that's what our customers are looking for. So, access – often the problem with mental health issues is getting yourself down to see the professional, whether that’s the doctor or the psychologist. When I say going down to see them, I mean physically going to an office location to see somebody and organising that. The inertia in doing that first step is often huge, and it means a lot of people don’t access care. Whereas virtual health, vHealth, it is as simple as opening up an app and booking an appointment, and then having a video consultation wherever you happen to be. So, if you want to do that from the comfort of your own bedroom at two in the morning, if that’s the right time for you, you can do that. And often with that non face-to-face, or even telephone-based interaction, it prefers the patient, the customer, with a level of anonymity which they often enjoy. Now, once they’ve had their first consultation or first two consultations, they’re happy to let go some of that anonymity, but for many people that anonymity, to avoid the stigma, is very, very important. And that’s part of the reason I think we saw a 3,000% increase in virtual health conversations and consultations in America for mental health conditions.

And correct me if I'm wrong but I believe that Aetna Inc. is beginning to use artificial intelligence to augment care in a virtual care space as well. So, that’s things like analysing facial expressions to gauge emotion. How do you see the future of technology continuing to evolve in this space to support people with mental health conditions or concerns?

Well you’ve taken us into a really interesting area here. So, artificial intelligence is beginning to come through and I’ve seen a few companies out there who are really advancing the space. So, what they can do is over a telephone they can recognise the way your voice pattern is, to see fairly accurately whether you have a mild, moderate or severe mental health issue. Facial recognition, as you mentioned, the way that people have facial expressions how their eyes move, how they intake breath, the flushing in their cheeks. All of these sorts of things or other parameters which can be measured. And when you’ve got artificial intelligence with the right algorithms behind it, they are actually increasingly of great diagnostic value. It’s still probably a few years before we get the science right behind it and we really take into full clinical applicability, but I’ve seen the green shoots of innovation really coming through. And then on the therapeutic side virtual reality, I think, will become much more of a part of our armoury of tools in dealing with mental health issues. So, a lot of companies have had very forward-thinking investment into virtual reality where people are immersed into a part of a virtual reality experience that makes them feel much more connected to the therapy they’re getting. And so that can be about putting them into familiar surroundings, into things which stimulate part of the brain, into environments where parts of your brain stimulated which will really increase your serotonin activities. And there’s some new cusps about how therapies delivered through virtual reality. So, those are my two sort of future predictions. But if I just veer away from AI and virtual reality to really talk about cutting edge, there is now increased science into the use of psychedelics. Now it sounds a bit weird and a bit left of field to talk about it, but cannabis has become a little bit more mainstream now, THC, in dealing with physical issues such as epilepsy. And now there’s a huge body of evidence that’s coming out by the use of psilocybin, which is the active compound in magic mushrooms, to deal with mental health conditions. And so early studies have shown that a micro dose, which is about 20 to 25mg, of psilocybin in a controlled environment, over a period of three or four days can reset depressed people. So, people who have burnt out, depressives who’ve had a lot of conventional medicines but continue to be chronically depressed — they found by giving them these micro doses of psilocybin, they can reset the limbic system, and take them off all therapy, and keep them depression free for up to 12 months after one course of therapy. And so I see a lot of excitement coming through in advanced therapies around psychedelics, which is very leading edge at the moment, but I think will become part of the common narrative in mental health in the next five to 10 years’ time.

That’s incredible, isn't it? And actually looking at the other side of the coin as well, so just again bringing the conversation back to our current situation where we’re living through this mental health crisis. And I mean looking at some of those methods of treatment you’ve just discussed, they have to be very carefully managed and the governance around that at government-level, health care institution-level is going to have to be significant. When we talk about coping mechanisms for people, I am going to refer to a piece of research that was recently conducted by DrinkAware and Opinium in the UK. And they have stated that UK businesses have furloughed around a fifth of their workforce, on average, so just under half, that’s 45.8%, of working adults who’ve been working from home since the lockdown came into effect. Of those, one in four people say that they are drinking more as a coping mechanism. So there is naturally going to be some uncertainty, some reticence around some of the treatment methods that you’ve just mentioned and what is defined as careful, prescribed treatment and what is described as potentially an unhealthy behaviour. And with drinking to cope — I mean, what is the impact of people drinking a greater amount of alcohol on a daily basis, when they wouldn't [ordinarily] do so, at an individual or at a population level with regards to overall mental health and well-being as a picture?

Well, alcohol and really substance misuse, by which I mean non-balanced, non-prescribed, non-controlled use of substances, can become a problem. So let’s talk about alcohol. Having recommended allowances, but within moderation — if you’re having a glass or two of wine a day and not binge drinking, it's probably not going to have any effect on your mental health status. It may make you feel a little bit more happy and relaxed in an evening. But if that becomes unbalanced drinking and you are binge drinking on a regular basis or you’re significantly increasing your alcohol intake, that is very closely tied with mental health conditions. So that doesn’t surprise me at all. And during lockdown, everyone started drinking a bit more, some people started drinking a lot more and there’s some people that will have it. And, you know, for those who drink out there you know if you have a big night, and you're drunk, not only do you get a hangover the next day, but you feel depressed. And that’s because alcohol does cause a biochemical imbalance in the brain, which leads to feelings of depression. But if you talk about things like cannabis. So, if it’s imbalanced, so cannabis can be good for people in the right formulations and taken the right way, it can help with chronic pain, epilepsy, all sorts of things. But if you get imbalanced, and you’re smoking high potency cannabis, or skunk, on regular basis that can lead to severe psychiatric disorders, such as psychosis. And so, imbalance is always wrong. So, it’s about getting things right. You don’t need to go become a teetotaller and abstain completely, but having balance will bring good results and imbalance will cause mental health problems.

And, of course, with mental health problems, they don’t just affect individuals. They affect families, their communities, the organisations that they work for. How does poor mental health affect business operations and what can organisations do in terms of employee assistance programmes to really support their people?

So, there’s a multi-faceted answer to what you’re saying. The role of employers in making sure that they have a happy, healthy workforce is only going to increase as time goes on. So, in some economies, such as the US, the employer is the one who funds your health care and your health care is inherently linked with your employment. And so in most US employers take the health care of their employees extremely seriously, and will do lots of stuff in ways of programmes, apps, services, access, that sort of stuff to help people with mental health and physical health. In countries like the UK, Western Europe they're often national health systems which pick up that burden. And so, the employer is less engaged in that. But increasingly the trend and the demand from employees, is to have the employer providing more access to mental health services. And part of that recognition is because we know that a happy workforce is a more productive workforce which makes for a better company which makes for better results and happy to shareholders and, you know, growth and all those sorts of things. And so, it’s not just a moral responsibility but it's also a financial and business responsibility to invest in the health and especially the mental health of your employees. I’d say if you look over towards more developing economies that realisation is only just starting to filter through and the investment from employers in this is in some places non-existent, in some places, a tick box exercise, but in other places beginning to emerge as a real theme.

But what I want to talk about actually Lorien is about the community. Because the one thing that we do know is that the community and how you live, where you live and how you support within in that community is extremely important for your mental health. So, no matter what your level of affluence — it doesn’t matter if you’re particularly rich and have a high socioeconomic group or poor and from a lower socioeconomic group — it is true that people in neighbourhoods with a higher level of social cohesion and social bonding, experience lower rates of mental health problems. And that if you are lonely and if you are socially isolated, that is significantly worse for stress and mental health issues as well as physical health issues. So, society plays a huge role, social cohesion, being not isolated from a social level makes a big difference. And that relates to online communities as well. So, it doesn't just have to be physical. In the world of COVID where we have to be physically distanced for non-transmission reasons, online interactions can foster a sense of connection. But those interactions need to be involved, informatic and, sort of, mentally stimulating. There’s hours of endlessly passively scrolling through Instagram and Facebook and TikTok, and you know doing that an hour before you go to sleep, is not good for you. Passive interaction with social media does not foster a sense of online community in fact it alienates. Whereas, if you get online interactions that are with groups of people that involve talking, information sharing, learning, with an agenda or an outcome, that can really foster a sense of community. And I would encourage employers to think about that. One of the things that we’ve done at Aetna international which has been hugely successful is a regular two weekly “Let’s get talking” session, where we go to an online platform, and we don't talk about work. Employees from all across the organisation talk about social and other factors, and that “Let’s get talking” has a positive online community which keeps us sewn together. And I would encourage other employers to emulate what we’ve done for our own staff. It’s very, very powerful.

It is incredibly powerful, and I think that that is a really nice way to bring this conversation to a close. If you could just give me your final, sort of, closing thoughts on that power and how we can tap into these support networks that we have in our friends, our families and also the organisations that we work for, and how that can support our mental well-being.

Well the first thing is recognition. So, we’re going through the revolution around the recognition of mental health issues. For those listening to this, use maybe this podcast as an opportunity to ask yourself some questions about your own mental health status, to interrogate yourself, to understand where you are on your happiness levels, and if you need to address something. And if you do, there are lots and lots of ways of reaching out. If you’re a member of Aetna International, you have access to a lot of tools and services and so we would encourage you to use those. But Lorien, thank you for your time in this fascinating conversation and thank you to the listeners who have engaged with the podcast.

Wonderful. Thank you so much, Sneh, and I’ll speak to you again in a few weeks when we tackle musculoskeletal conditions for World Spine Day. Thank you so much.

Thank you.

Join us for episode eight of the Fit for Duty podcast, when we'll be discussing the world’s largest cause of disability — musculoskeletal disorders, including low back pain. For those who don’t know us, Aetna International is a global health and wellness benefits provider, but we’re more than just an insurance safety net. Our skill lies in delivering the tools, services and resources that help drive health care costs down and people’s physical and mental health and well-being up. That’s something that’s important to our corporate clients and self-funded members alike. That’s why we currently serve almost 900,000 members around the world, from Shanghai to Seattle. Ultimately, we believe that when people thrive, their work and personal endeavours thrive to. For more information about us, you can visit aetnainternational.com.