This year's theme for mental health awareness week is Nature — and with good reason. "Our research on the mental health impacts of the pandemic showed going for walks outside was one of our top coping strategies and 45% of us reported being in green spaces had been vital for our mental health." (Mark Rowland, Chief Executive, Mental Health Foundation). In honour of this week, we interviewed one of our co-founders, James McGann to learn more about his experience with mental health and how he connected with nature during the lockdown. 

Anxiety is definitely the challenge for me. It's something that for years I did not recognise but just assumed it was a standard way that everyone's mind works. An active inner voice that projects into the future and 'predicts' things that are going to go wrong. Thankfully the predictions are almost always a waste of time, but my mind still likes to consistently come up with them. Mostly it turns on after an activating event, like a disagreement with someone close to me or something not going to plan. I suppose Covid has been an activating event for billions of people's anxiety, including my own. If I meditate, exercise, journal, or do some form of self-care, it will generally turn off. I've worked to become more aware of my anxiety and proactively intertwine those self-care exercises into my day to stop anxiety being something that's part of my week. 

The last twelve months have seen the world thrown into a washing machine, and we're still dealing with the dramatic changes. How has the past year been for you?

After four months of full lockdown, Dublin opened up a little this week. But like everyone else around the world, there have been some really hard times. During lockdown, I found myself running through all of these disaster scenarios in my head: what if I get Covid and pass it on to my parents; what if the economy keeps tanking and we can't grow the business. The list was endless and with nothing to break up days and weeks, I was forced to look at what actions I could take each day to enable my positive mental health. Little things like making sure my phone is in a different room at night; always getting at least 7 hours sleep; tracking meditations and runs. I also started recording my protein intake, as I realised that with my mostly vegetarian diet I was not getting enough protein and it was giving me headaches. I wouldn't have done any of those things if it was not for lockdown. During lockdown if I let those little actions start slipping, my mental health would start acting up quite quickly, in a matter of three or four days. So I found that I had to stay on top of it during lockdown more than ever before.

How did you engage with nature during lockdown and how do you feel this impacted your mental health? 

Living in Ireland makes engaging with nature difficult for half of the year. In January, it was dark from 4 o'clock in the afternoon, raining most days and everything was shut. We couldn't travel more than 5km. January this year was really hard for everyone. Thankfully we are through that phase now, and I've never appreciated nature this much. I'm in my mid-30s and never in my life have I properly noticed Spring before. It's pretty funny. Since March I've been trying go for a few walks during the week and I found myself looking out for nature springing into life. Previously, I'd just go for walks while listening to a podcast or replying to Whatsapp messages. This year, because of lockdown, I found myself tracking which trees had leaves, where the daffodils were popping up, what the local swans were up to. I had never appreciated any of it before. During lockdown, seeing that nature goes on, no matter what the current Covid headline is, really helped me access that positive place in my mind. 

We hope that James' story helps to open up conversations around mental health, and encourages others to connect with nature to support their mental health.

One of Frankie Health's founders shares his experience with mental health and how he connected with nature during lockdown. 

Even before Covid-19, anxiety was recorded as the most prevalent mental health disorder. According to a health poll conducted in April 2020, the Coronavirus pandemic is increasing worry and anxiety for people across the globe. In fact, 45% of respondents feel that stress related to coronavirus has had a negative impact on their mental health. 53% of respondents expressed worry and fear that a family member could fall seriously ill from the coronavirus.

The coronavirus pandemic affecting anxiety

A global pandemic is a time where people are surrounded by unknowns and, understandably, feeling fearful of what is yet to come. In the period between February 16 and March 15, the number of prescriptions for anti-anxiety medications increased by 34%. Without access to face-to-face mental health therapy, people have turned to unhealthy quick-fixes. Individuals suffering from anxiety are in need of long-term support that is accessible, affordable and scalable.

The coronavirus pandemic and mental healthcare

According to a report by Business Insider, a third of the world population has been in some form of coronavirus lockdown. Millions of people are unable to travel to see their therapist. According to the Medical Group Management Association, 55% of practices have experienced a drop in revenue during the coronavirus pandemic. With people unable to leave their homes, mental health practices have been forced to stop conducting face-to-face therapy. Whilst it’s accepted that mental health practices are an essential service, the full potential of a digitised marketplace – for therapists and employees – is yet to be fully explored. 

How effective is online therapy at reducing anxiety?

Online therapy offers an accessible and scalable solution to get mental health support to millions of people. One of the main concerns is tracking how effective online therapy is at treating anxiety, versus traditional, face-to-face therapy. There are over a thousand research studies qualifying the effectiveness of online therapy for participants against a group of participants receiving face-to-face therapy. The changes in participants anxiety levels are tracked against a clinically proven scale, such as the Generalized Anxiety Disorder-7 (GAD-7). A study by the American Psychological Association found that online therapy is more effective than traditional therapy at reducing anxiety. 

How can digital self-care reduce anxiety?

Anxiety frequently surfaces for employees outside of their 60-minute therapy appointment. Digital self-care provides employees with support outside any predefined time slots. It’s accessible at any time, from anywhere. Self-care exercises offer tools to help employees develop a practice of self-awareness and resilience. There are many forms of self-care that can be tailored based on the employee's needs. The three most common forms of digital self-care are proven to effectively reduce anxiety. 

What's the future of mental healthcare for anxiety?

Covid-19 has resulted in a rapid change in the mental health industry. Firstly, the pandemic increased anxiety, thus increasing the need for therapy and regular, reliable support. Secondly, it decreased immediate supply, as many therapists weren't set up for remote work. 

The 2020 global pandemic has forced the therapy industry to find and create solutions for remote care – a need that has previously been easy to postpone. There’s no way to know if Covid-19 had never hit, how long it would have taken for online therapy to become the primary medium of therapy. But we do know that the need for online therapy en masse will call for tech solutions that could be revolutionary across countries and communities most in need. On a global scale, there is already a scarcity of qualified therapists. According to the WHO, developing countries can have as little as 1 psychiatrist to 100,000 people. This shortage affects developed countries too, 65% of non-metropolitan counties in the US have no psychiatrists.

As we enter the next generation of mental health treatment, discoveries in medical technology extend towards data-driven developments. In the context of online therapy, combining industry and technological advances enables personalisation, effectiveness and, perhaps most importantly, accessibility. If innovation and technology are able to support therapists to move online securely and quickly, therapy will be more attainable than ever before. 

The pandemic is increasing worry and anxiety across the globe.

iCBT definition:
Internet-based cognitive behavioural therapy (iCBT) is when traditional forms of cognitive behavioural therapy (CBT) are delivered digitally, using online exercises or worksheets. 

CBT exercises are traditionally conducted through tangible worksheets, they can be easily and effectively digitised, without losing any in-person value. The University of Cambridge completed a meta analysis of 12 trials that successfully measured the effectiveness of iCBT to reduce the symptoms of anxiety. The analysis found iCBT to be highly successful in reducing the symptoms of anxiety. The Canadian Agency for Drugs and Technologies in Health found that iCBT reduced the symptoms of anxiety by 50% from baseline. 

How does iCBT support positive mental health?

CBT has become an increasingly popular form of therapy in recent years. Cognitive behavioural therapy encourages awareness of unhealthy or negative thought patterns. With traditional exercises and worksheets used in CBT being transferred into online versions, iCBT enables employees to reflect on thoughts and feelings in a time and place that is most convenient for them. By digitising CBT and making it accessible at home, employees are able to incorporate iCBT to their daily routine and proactively develop positive mental health. 

How does iCBT support therapists?
When therapists work with online platforms offering iCBT, they are able to offer round-the-clock care for their clients without committing to direct interaction. iCBT enables the therapist to weave CBT exercises into the clients daily routines. 

Analysis found iCBT to be highly successful in reducing the symptoms of anxiety.

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Anxiety and the Coronavirus Pandemic

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