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I was thrilled to speak about the relationship between storytelling and mental health with Dr Nihara Krause, founder of stem4. This award-winning charity works to enhance early understanding of mental illness in teenagers and signpost towards prompt action and intervention. In order to carry out this mission, stem4 educates individuals, parents, teachers and communities. Dr Krause founded stem4 because she didn’t feel that schools had any support at the time. Mental health was not a freely discussed topic, even less so than nowadays, and she was very keen for schools to be able to understand and work with mental ill-health as an issue.
I spoke to Dr Krause about the state of our relationship with mental health, how we understand it, and how we are becoming increasingly aware of the issues. We also spoke about the dangers of overdramatising mental ill-health and the importance of portraying stories that carry a message of hope.
What would you say is the state of mental health in society nowadays?
It’s only really recently that people have started to talk about mental health. The state of mental health in society has been incrementally rising since about the 1970s. We’ve all been impacted by a pandemic and by ripples of other circumstantial events that have occurred. If we look at children’s mental ill-health, the latest NHS digital data on 5–16-year-olds we had in 2018 said that 1 in 9 presented with a mental health issue; that’s now risen to 1 in 6. If we include 17–19-year-olds, that number goes up incrementally. We know that something has increased. Whether that is a diagnosable mental ill-health issue or whether it is increased distress as a result of what we’ve gone through is difficult to distinguish.
There are a number of pressures that have arisen in recent years – more family breakdowns, more poverty, greater movement within communities in terms of transition and change – which tend to have a bigger impact on people’s mental health. Mental health lies on a spectrum and most of us fluctuate in and out of good and ill mental health. At the moment, we’re working with a population who are more towards the middle-to-unwell spectrum. There’s a hugely improved way of identifying mental ill-health these days. It wasn’t something that was spoken about or acknowledged, and there was far more stigma surrounding the topic. Similarly, there’s documentation that men would present more with physical problems rather than saying they had mental ill-health issues. There’s a much better system of diagnosis and less stigma nowadays. There are so many good treatments and so many good people who can help make a change.
“There is a form of treatment, bibliotherapy, which is all about reading and what you can learn through reading. It’s healing for people to feel that it’s a shared experience and they’re not alone.”
What are some of the common issues those suffering from mental ill-health face?
I think the biggest worry is how others might perceive you. If you’re a young person you might be worried about how your peer group might see you, if it’ll have an impact on your opportunities, whether that’s at school or at work when you’re older. They’re still the same issues as before, but now they’re slightly less emphasised. There’s also, for men, a cultural element of ‘stiff upper lip’ and ‘men having to be strong’. Because a lot of significant men have come forwards recently, it’s been very helpful and got men talking more and we are moving forwards in terms of progression.
Most young people will present with anxiety and low mood. Whether or not this develops into a disorder is different. It’s important that we separate the emotions from the actual disorders – anxiety is different from an anxiety disorder, and depression is different from a depressive disorder. It’s figuring out where people lie on the spectrum of mental health that is important. In terms of what can cause disorders to develop, there are developmental issues such as growing up (parental mental health and familial relationships) and school (interpersonal issues or school experiences such as being bullied or friendship issues) that can have a huge impact on a young person’s mental health. In a wider context, there could be adverse experiences like relationships or anything else that might happen.
Some mental ill-health conditions are more likely to develop if you have a genetic or biochemical connection that goes with it – if it’s an anxiety disorder, a substance misuse disorder, or an eating disorder. If that individual is vulnerable and is put in a situation that triggers this, then it’s more likely to develop – this isn’t to say that it will develop, but the more adverse experiences a person has, the more likely their mental health is to suffer, particularly if they have a vulnerability to this in the first place. I use a bio-psycho-social model. It means that all our mental health difficulties are a combination of biological, psychological and social factors. It is almost impossible to isolate a single issue or cause behind mental ill-health on an individual or larger basis. Everyone is an individual, exploring how they respond to things, and their responses are affected by the type of person they are.
How can representation in the media help tackle these issues?
If you are creative there’s a huge amount you can do in terms of expression. You’re lucky you can express. Use art, writing, and film, to be able to do that. For a number of young people, particularly those who self-harm or might develop an eating disorder, it’s because expression is so difficult, so they have to look at alternative means of expressing their distress. I think if you’re creative, it’s amazing. Use the gifts you have. If you look at books, for example, there are so many amazing stories that people will relate to. There is even a form of treatment, bibliotherapy, which is all about reading and what you can learn through reading. It’s healing for people to feel that it is a shared experience and they’re not alone. But it needs to be a message of hope alongside all of the pain that might be portrayed and that might be more sensationalised. For young people in particular, you really have to think about it from the eyes of a young person rather than an adult. These are very difficult messages and it’s always a fine balance between what you show versus what you might protect an audience from. You don’t always need to vividly and graphically show these difficulties. Similarly, there’s a whole load of words that are used to report on mental health, like ‘tsunami’. I do think that, whilst it’s important to make the message clear, we also need to think about how the audience hears it. Particularly for young people, those kinds of terms can make it sound really frightening and we don’t want to exaggerate and over-dramatise issues that people might be struggling with.
Moving forwards, what do you think are the next steps to ensure we continue to progress in the right direction?
We have to look at what’s happening in society and respond to these issues and what we, as a community, are being exposed to. I think there needs to be continued discussion, of course, about the fact that people are experiencing these issues, and there needs to be a lot more ongoing support at lots of different levels. I know the government has been trying to support mental health but the available services are only for those who are very severe. I think there needs to be a lot more done at a less severe level in terms of offering support. I think, now, we have to start to talk about it at a community level. We’ve all been impacted by what’s happened and what continues to happen. Perhaps formal treatment isn’t always what people need. We need more research into what’s happening, we need more involvement from people themselves as to what they’ve experienced, we need to start to think about tailoring support that works for people, we need to start to think about more resourcing of those services, and we need to be informed by good clinical research. I know that there is so much research and it’s just sad not to be able to offer that in a way that’s helpful. One thing is sharing, but it’s not enough; you need to also be able to think about how you move forwards and make changes.
My goal with this interview was to empower you to write about mental health accurately and meaningfully. Dr Krause has shared critical information about mental health, our current state as a society, and how stories of hope can help inspire others to help themselves. The bio-psychosocial model that Dr Krause uses, I feel, is key to exploring a fictitious character’s mental ill-health in a meaningful way. If we can grasp this complexity, we can create more three-dimensional characters who are relatable and could even help readers to comprehend and process their own struggles.
There’s a lot of work to be done, but it’s great to see how far we’ve come in the last decade. I hope that this interview has inspired you to express your own experiences through your work and equipped you with some statistics and ways of thinking that will help you to explore mental health in your art purposefully.
Thank you so much to the inspiring team at stem4 and to Dr Krause for taking the time to speak with me.
Find out more about stem4 on their website and donate to help them continue educating society about mental health.
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