We are in the midst of a devastating mental health crisis. In the United States, 20% of the population (over 50 million people) are suffering from a mental illness. According to the World Health Organization (WHO), 264 million people are suffering from mental illness globally. Mental illness tends to be chronic, putting those who are suffering at high risk for relapse over the course of their lives. And one of the most common mental illnesses – depression – is considered the number one cause of disability worldwide, with symptoms such as low energy, poor concentration and severely hampered work functioning. In the most extreme cases, mental illness represents one of the biggest risk factors for suicide.
This problem is not going away and is almost certainly being exacerbated by the Covid-19 pandemic. People are facing severe stressors including catching or persistent fear of catching the virus, unemployment, threat of losing one’s life or the lives of loved ones and disconnection from enjoyable activities and social interaction. Any one of these factors alone could increase risk of mental illness, but taken together it is a perfect storm bombarding us physically and emotionally. In fact, research suggests that as many as 40% of adults are experiencing mental illness during the pandemic, with young adults, racial and ethnic minorities, essential workers and unpaid adult caregivers experiencing the most severe outcomes including increased suicidality.
There is evidence that traditional treatments such as psychotherapy and pharmacotherapy do exist for most mental illnesses and often have significant efficacy in reducing symptoms. For example, one meta-analytic review of 198 studies including 15,118 patients found that seven different psychotherapies for depression demonstrated moderate to high efficacy in reducing depressive symptoms as compared to control groups. Similarly, medication for depression has superior effects to placebo controls across studies.
And yet there are limitations to traditional treatments. Even our most empirically-supported treatments do not guarantee recovery, as many people either do not get better or experience relapse. Further, traditional treatments can be expensive for those who are uninsured and not all insurance plans provide adequate mental health benefits. Access to care can be limited, with people not able to travel to see a provider. Additionally, the stigma of mental illness is severe, with people not wanting to seek care for fear of being labeled as “crazy” and being discriminated against at work or in their social network. As a result, evidence suggests that only half of the people in the country who struggle with mental illness receive care.
Also, how we conceptualize “mental health” is changing. Evidence suggests that one does not need to have full-blown mental illness to see reduction in functioning. Even subclinical symptoms of mental illness such as negative mood and anxiety can substantially reduce overall quality of life and functioning. In addition, “positive psychology” approaches suggest that mental health is not simply the absence of mental illness but also the existence of life satisfaction. In effect, being mentally healthy is not just about surviving but also thriving.
Overall, in order to better address the mental health crisis we need to provide solutions that 1) improve treatment outcomes, 2) increase access to care and 3) take a more holistic approach to understanding and managing mental health. One method that has been considered and researched has been the utilization of alternative and complementary treatments. Interventions such as massage, diet therapy and acupuncture have all been proposed as possibly useful in improving both access to care and outcomes.
Perhaps one of the most promising “alternative” therapies for treating mental illness and improving overall quality of life is exercise. Treatment outcome studies have shown the efficacy of exercise as an intervention for mental illness. For example one review of 12 studies found that exercise interventions had comparable efficacy to established treatments, and better efficacy than control groups for treatment of anxiety. Further, with the exception of severe disability, exercise – in contrast to more expensive and complex forms of treatment – is relatively easy to implement and is readily accessible. And studies consistently show that people who exercise tend to demonstrate improved overall quality of life.
And yet, as promising as exercise appears to be, there is so much more potential for exercise to be harnessed as a potent method of addressing the ongoing mental health crisis. When I talked with Jake Luhrs – founder of YourLife Gym, he talked to me about what could very well be an important piece of the puzzle – the “mental health gym.”
For Luhrs personally, the creation of a “mental health gym” was a natural evolution. Luhrs has described struggling with depression, suicidality and substance abuse in his life and found that exercise was helpful in the expression and management of his emotions. “I got to push all my anger out on the weights and I started to sweat. I would sweat out the alcohol,” Luhrs told me. “My endorphins would open up and … I’d start to feel again.” Luhrs, who is also the founder of the mental health non-profit HeartSupport, saw an opportunity to create a community that valued a more holistic approach to health and well-being. As such, in addition to more conventional physical exercise training equipment and sessions, YourLife offers “mental health” training in the form of mental health training packages, mindfulness classes and mental health seminars.
The concept of a “mental health gym” could improve upon the already powerful benefits of exercise in combatting the mental health crisis. Overall, while exercise alone might improve mental health, we do not know how exercise that integrates mental health interventions may bolster outcomes. As an example, research has begun to examine the efficacy of integrated interventions that include both exercise and cognitive-behavioral therapy for improving mental health in young men. An integrated mental health gym offers a perfect setting to examine these types of interventions in a real world setting.
Also, mental health gyms have the potential to increase access to care on two levels. First, it’s simply another place where people may have the opportunity to think about and access interventions. Estimates suggest that over 62 million people in the country have gym memberships. For those that have memberships, they most likely encounter staff more than they encounter medical professionals on a regular basis. The opportunity to talk with staff at a mental health gym who specialize in mental health issues and coping techniques provides yet another chance of having access to mental health care.
Another way that mental health gyms can increase access to care is by striking directly at the heart of the stigma of mental illness. In general, people who struggle with mental illness may be seen as “weak” or “defective.” In contrast, gyms are seen as places where people embrace strength and well-being. Having a mental health gym that equates mental and physical fitness as valuable goals challenges those stereotypes of mental illness. And an individual who may be initially hesitant to seek mental health care may be more likely to do so at a facility that they see as synonymous with strength and well-being rather than weakness (e.g. doctor’s office).
And finally, a mental health gym represents a real world elevation of mental health to being as important as physical health in our society. Thus, when we are considering a more holistic approach to the mental health crisis, a facility that values physical exercise, mental exercise and other health behaviors such as nutrition can become an ongoing reminder that we need to consider our more general well-being in combatting the mental health crisis.
So welcome to the dawn of a new age in the fight against mental illness.
Welcome to the mental health gym!
Photo credit: Delaney Van on Unsplash
