Gwnewch y pethau bychain or “do the little things” is a saying attributed to St David, the patron saint of Wales. But what relevance does the advice of a sixth century monk hold in 2023?
In modern times, doing the little things certainly is important when we consider our mental health. It can make a difference in preventing ill health and sustaining a sense of happiness, as well as in treating mental illness.
A small thing may not have a decisive effect alone, but when many are put together, they can make an overall difference. Avoiding daily alcohol is an example. Having a drink may make you feel relaxed but, over time, regular alcohol will drag down your mood.
Excessive gambling and recreational drugs are also to be avoided. In contrast, regular exercise and making time for relaxation have a positive effect on our mental health.
Doing the small things has a role to play in treating mental illness too. Medication and therapies such as cognitive behavioural therapy have roles to play in helping people to recover from mental illness. However, they are not so effective that they are always enough on their own. They are likely to work best when they happen in the context of a trusting relationship with a doctor.
When patients are surveyed about what they value in a doctor, human qualities consistently outrank technical abilities. Research supports the idea that relationship factors are important in medicine. This applies across the whole of health care, to medication and physiotherapy as much as it does to psychotherapy.
Human interaction may seem a small thing but it can make a difference to how well treatment works. Placebo effects are powerful and they are not just due to fooling yourself that dummy tablets work. The effects of placebo can be due to all of the helpful aspects of a therapeutic relationship.
Suicide is a devastating event, which, in the setting of the UK, is often related to mental illness. However, while it is important to treat people with mental illness to avoid preventable deaths, there are limitations to how effective this can be in reducing the total number of suicides.
Sadly, mental health treatment does not always stop people from taking their own lives. In any case, many suicidal deaths occur without the person ever receiving help. And a proportion of people who take their own life are not mentally ill at all.
Nonetheless, suicide prevention is possible. Actions such as making it harder for people to access the means of taking their own life have repeatedly been shown to reduce suicides. When restrictions were introduced to the number of paracetamol tablets that could be purchased, there was a measurable impact on deaths.
Changes in the rate of unemployment, especially among men, have a predictable effect on suicide rates. When unemployment rises, there is an increase in suicides. When times are better and fewer people are living in poverty, suicide rates drop.
It is not necessary to completely remove access to paracetamol, nor does unemployment have to be abolished. By putting together packages of smaller measures, each of which is known to have a definite but limited effect, major improvements can be achieved. Lives can be saved without seeking one perfect but unrealistic solution.
Having worked in mental health for 42 years, I have seen the announcement of many breakthroughs in treatment. New medications, genetic advances and novel approaches like transcranial magnetic stimulation have all been subject to extravagant claims. None of them has delivered the promised transformation of mental health care.
Approaches that have definite usefulness have been hyped to the point where they crowd out other treatments. That leads to cynicism when they turn out to have limitations. The most recent example is mindfulness. It has a definite role, but it is not for everyone, nor is it for every problem.
The problem with mindfulness
The trouble with looking too hard for the one extraordinary breakthrough is that it takes attention away from properly implementing what we already know works. Those imperfect smaller approaches that have been shown to be beneficial, which, when taken together, can transform people’s lives.
Many of these lie outside the domain of psychiatrists or psychologists. They involve social contact, a meaningful role, places to go and things to do, where people with mental illnesses are not stigmatised or separated from everybody else.
The ordinary actions in life matter. So let’s heed the advice of St David and “do the little things”.