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This Padlet was updated on 24/06/2025. It has sources from the course learning materials and additional sources  to enhance your professional development. 

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This Padlet was updated on 24/06/2025. It has sources from the course learning materials and additional sources  to enhance your professional development. 

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In recent years, there has been increasing acknowledgement of the important role mental health plays in achieving global development goals, as illustrated by the inclusion of mental health in the Sustainable Development Goals. Depression is one of the leading causes of disability. Suicide is the fourth leading cause of death among 15-29-year-olds. People with severe mental health conditions die prematurely - as much as two decades early - due to preventable physical conditions.

Despite progress in some countries, people with mental health conditions often experience severe human rights violations, discrimination, and stigma.

Many mental health conditions can be effectively treated at relatively low cost, yet the gap between people needing care and those with access to care remains substantial. Effective treatment coverage remains extremely low.

Increased investment is required on all fronts: for mental health awareness to increase understanding and reduce stigma; for efforts to increase access to quality mental health care and effective treatments; and for research to identify new treatments and improve existing treatments for all mental disorders. In 2019, WHO launched the WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health to ensure access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people.

In 2022, WHO launched the World Mental Health Report: Transforming Mental health for All.

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Wellbeing is how we're doing as individuals, communities and as a nation, and how sustainable that is for the future.

It encompasses the environmental factors that affect us and how we function in society, and the subjective experiences we have throughout our lives.

How to measure
wellbeing?

How to improve
wellbeing?

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What is wellbeing? - What Works Wellbeing

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Wellbeing is how we're doing as individuals, communities and as a nation, and how sustainable that is for the future.

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Mental health and illness has sometime been described as a spectrum. People at one end of the line or spectrum are very well, and those at the other end are very unwell with a serious mental illnes…

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These are examples that trigger the fight or flight response (also known as the acute stress response).

What is Fight or Flight?

The fight or flight response is the body's natural physiological reaction to stressful, frightening, or dangerous events. It is activated by the perception of threat, quickly igniting the sympathetic nervous system and releasing hormones, preparing the body to face a threat or run to safety.

The term "fight-or-flight" is our engrained survival instinct and represents the options our ancient ancestors could choose when dealing with dangerous environments.

Back then, when you faced a hungry saber-tooth tiger, you could only run or fight. Many of the high-arousal situations we face in the modern world are more psychological in nature (e.g., a job interview).

American physiologist Walter Cannon coined the term after realizing that an unconscious and automatic series of fast-acting reactions occurred inside the body to help assemble resources the body needs to manage threatening circumstances.

He also called it the acute stress response. To delve into the history, in Cannon's (1915) book, Bodily changes in pain, hunger, fear, and rage, he noted that when a predator threatened an animal.

For example, their bodies proceeded to release the hormones epinephrine and adrenaline, which triggered the fight or flight response.

Cannon remarked that this process happened unconsciously and automatically and served the function of helping the animal to defend itself in life-threatening situations by prepping the body to run or fight.

What Is Fight, Flight, or Freeze?

In the years since his research, physiologists and psychologists have developed and refined Cannon's work, coming to a better understanding of how people react to threats.

Thus defining what is now called fight, flight, freeze, and fawn:

Fight: facing any perceived threat aggressively.

Flight: running away from danger.

Freeze: unable to move or act against a threat.

Fawn: immediately acting to try to please to avoid any conflict.

Again, when one feels threatened, the body rapidly responds to imminent danger.

The underlying goal of springing into fight, flight, freeze, or fawn, is to decrease, end, or evade the danger to return to a state of calm and control.

Signs

The stress response occurs when the demands of the environment are greater than our perceived ability to cope with them.

The stress level depends on the individual's perception of the event and their ability to cope with the event.

E.g., taking an exam might not be perceived as a stressor by someone who has had good results on their test (they feel they can cope) but might be seen as a stressor by another individual who has failed all their tests (they feel they can't cope this leads to a stress response).

Fight Response

When you feel in danger and believe you can overpower the threat, you are in fight mode. Your brain sends signals throughout your body to rapidly prepare for the physical demands of fighting.

Most signs to tell you are in a fight response include:

Tight jaw or grinding of the teeth

Urge to punch someone or something

Feeling intense anger or killing someone, even yourself

Desire to stomp or kick

Crying

Glaring at people, conserving angrily

Upset stomach, feels like knots or burning

Attacking the source of the danger

Flight Response

This is believing you can defeat the danger by running away. In some cases, running away is the best decision. Take a burning building as an example. Unless you are a firefighter, it is best to get out of there as fast as you can.

These emotional and physical responses signify you are in flight mode:

Excessively exercising

Feeling fidgety or tense or trapped

Constantly moving legs, feet, and arms

Restless body that will not stop moving

Sensation of numbness in extremities

Dilated eyes, darting eyes

Freeze Response

When one feels neither like fighting nor flighting, freezing is an option. This list of responses lets you know you are in freeze mode:

Pale skin

Sense of dread

Feeling stiff, heavy, cold, numb

Loud, pounding heart

Decreasing in heart rate

Sensing tolerated stress

Fawn Response

One may use the fawn response after unsuccessfully trying to fight, flight, and freeze. The fawn response is typically prominent in people who grew up in abusive families or situations.

If you are an abused child with narcissistic parents, the only hope of survival would probably be agreement and helpfulness.

Over time, you can recognize this by realizing that regardless of how poorly a person treats you, you are more concerned with making them happy than taking care of yourself.

Why it is Important

The fight or flight or freeze or fawn response has been with us since the beginning of time and still plays a crucial role in coping with stress and threats in our environment.

One is more prepared to operate under pressure by priming the body for action. In fact, the stress created by a circumstance can be important, making it more plausible that you will effectively deal with whatever concerns you.

These triggers can help you perform better at your job or school, in a situation where you can use pressure to do well, in cases where your life is in danger, and you need to escape or defend your life.

However, while the fight or flight or freeze or fawn response happens automatically, sometimes it is activated with no real reason or danger; therefore, it is not always accurate.

Inappropriate Responses

Phobias are great examples of this concept and how the fight or flight response might be falsely activated. A person who is afraid of the ocean might experience acute stress if they go on a family cruise or visit the aquarium.

Even though typically these things are enjoyable to most of us, the person in question will experience their body going into alarm mode, with their heartbeat and respiration rate rising. If the response is severe, it can lead to a dangerous panic attack.

This kind of response is not nearly as adaptive in the modern world; in fact, we suffer negative health consequences when faced constantly with psychological threats that we can neither fight nor flee.

How to Cope

Thoroughly understanding your body's natural fight or flight or freeze or fawn response is a way to help cope with these kinds of situations. When you notice that your body becomes tense, there are steps you can take to try to calm and relax your body.

There is no doubt that the fight or flight response has a distinct purpose and function, but everyday situations like work, bills, kids, finances, and health, can be some of the largest, non-threatening stressors. Stress management is key to your overall health.

The stress response, and precisely the fight or flight or freeze or fawn response, is one of the major topics studied in health psychology. Experts in the field are interested in helping people discover ways to combat stress, which sometimes can be unnecessary, to live healthier, more fruitful lives.

By understanding the fight or flight or freeze or fawn trigger more, psychologists are helping people uncover new strategies for dealing with the natural reaction of stress.

When thinking about the fight or flight or freeze or fawn trigger, it is essential to think big picture when you begin to feel yourself starting to get worked up over something that you know is not a genuine threat or danger.

Learning to slow down, be aware of yourself and your surroundings, and conceptualize what is truly happening to help you regain control is vital.

When to Seek Help

When the fight or flight, freeze, or fawn response becomes overly frequent, intense, and activates at the most inappropriate times, this can imply that you are suffering from a range of clinical conditions that include most anxiety disorders.

Again, while the fight or flight or freeze or fawn response has a clear purpose, it should not be activated whenever you do not have to defend your life.

If you feel this could be you, a valuable part of treatment for this kind of anxiety is an improved understanding of the fight or flight or freeze or fawn response's function, purpose, and process (which is what this article is all about).

For example, patients with post-traumatic stress disorder (PTSD) may confuse the heightened physiological arousal as an indicator of a real threat.

Understanding the fight or flight, freeze or fawn response can help them feel safer by implementing relaxation and grounding techniques.

If you are at a point where stress heavily impacts the quality of everyday living, contact your doctor. Medication, therapy, and stress management strategies can help you reach a more stable state of being.

Here is a specific list of symptoms; you should seek help if you experience any of the following:

Constantly feeling "on edge."

Inability to relax.

Persistent fear, nervousness, or worry.

Stress interferes with daily pursuits.

Intense fear of non-threatening situations.

Reaching out for help is always essential. If you are worried about your mental or physical state or both, be sure to make yourself a priority.

A mental health consultant can aid in rooting the underlying causes of these overwhelming feelings.

How Does it Work?

You can possibly think of a time when you encountered the fight or flight or freeze or fawn trigger.

Whether it was a physical danger (finding a predatory animal like a snake on a nature walk) or a psychological danger (asking someone out on a date), you may start breathing faster, you can feel your heartbeat quicken, and your whole body becomes tense - ready to take action if necessary.

Let us get deeper into the science and anatomy of this response. The reaction begins in the amygdala, the section of your brain responsible for fear. The amygdala responds by transmitting signals to the hypothalamus, stimulating the autonomic nervous system (ANS).

The ANS comprises the sympathetic and the parasympathetic nervous systems - the fight or flight response is in the former.

The sympathetic system activates and then stimulates the adrenal glands to trigger the release of catecholamines, including adrenaline and noradrenaline.

Acute stress response: Sympathomedullary Pathway

When a stressor is perceived, the hypothalamus activates the sympathetic branch of the autonomic nervous system. This, in turn, causes the adrenal medulla to release adrenaline into the bloodstream. This prepares the body for "fight or flight."

The adrenaline and noradrenaline increase the heart and breathing rates, the blood circulation is redirected to the skeletal muscles, and digestion stops.

When the stressor subsides, the parasympathetic branch of the nervous system is activated, the heart and breathing rate decrease, digestion restarts, and all other functions return to normal.

The Physiological (Bodily) Stress Response

Here is a list of physiological signs and symptoms that can indicate whether or not the fight or flight or freeze or fawn response has kicked in:

Eyes: the pupils dilate. Allowing your eyes to absorb more light improves your eyesight so that more attention can be dedicated to danger. You might notice a "tunnel vision" or realize that your vision becomes "sharper."

Ears: the same concept for the eyes applies to the ears. You will notice that your ears essentially "perk up," and your hearing can become "sharper."

Heart: heart rate increases, and there is a dilation of coronary blood vessels. A faster heart can feed more blood, oxygen, and energy into the body, enhancing your power to run away or fight.

Lungs: breathing quickens and becomes shallower. Again, this quicker breathing takes in more oxygen for your muscles.

Skin: you become pale, and your face gets flushed. Blood vessels in the skin contract, directing more blood where it is needed - the muscles, brain, legs, and arms. Your hands and feet get cold because of this too.

Muscles: your muscles tense up all over the body, becoming primed for action. Because of this, your muscles might shake or tremble, particularly if you are not moving.

Stomach: you may get nausea or "butterflies" - blood is diverted away from the digestive system, which can cause these feelings.

Mind: thoughts begin to race. This quicker thinking can help you evaluate your environment and make rapid decisions if necessary. Hence, it can be challenging to concentrate on anything other than the danger you perceive. You may also feel dizzy or lightheaded if one does not actually run or fight under the trigger.

Pain: your perception of pain temporarily reduces while under the fight or flight or freeze or fawn trigger.

Since everyone's bodies are unique, the specific physiological reactions can vary, depending on how one usually responds to stress. Understandably, after you perceive the danger is gone, it can take between 20 to 60 minutes before your body is in a normal state once again.

The Psychological (Mind) Stress Response

Along with the physiological response, it is entirely possible that one may experience psychological effects too. In the form of nervousness, acute stress tends to increase the intensity of anger or movements when evading danger.

Alternatively, it could simply cause one's mind to blank, making it impossible to think clearly and decide what to act upon next. Several psychological responses can occur anxiety, focus shifts, and attention spurts.

Both physiological and psychological stress causes one's body and mind to move into survival mode.

The Bottom Line

Psychological or physical threats trigger the fight or flight or freeze or fawn response.

It is a built-in defense mechanism implemented by evolution to cause physiological changes, including increased heart rate and heightened senses, enabling you to defend yourself rapidly from a perceived danger.

If you discover yourself experiencing the fight or flight or freeze or fawn response to extreme levels and see that you overreact to non-life-threatening situations, seek a mental health professional to help you uncover underlying causes and strategies to cope.

Now, praise yourself for taking the first step: gaining a deeper understanding of the fight or flight or freeze or fawn response.

References

Cannon, W. B. (1915). Bodily changes in pain, hunger, fear, and rage. New York: Appleton-Century-Crofts.

Kirby, Stephanie. "Fight Flight Freeze: How to Recognize It and What to Do ..." Edited by Aaron Horn, Betterhelp, https://www.betterhelp.com/advice/trauma/fight-flight-freeze-how-to-recognize-it-and-what-to-do-when-it-happens/.

Schauer, M., & Elbert, T. (2010). Dissociation following traumatic stress. Journal of Psychology, 218, 109-127.

What Happens During Fight or Flight Response. (2019, December 09). Retrieved from https://health.clevelandclinic.org/what-happens-to-your-body-during-the-fight-or-flight-response/

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Fight, Flight, Freeze, or Fawn: How We Respond to Threats

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The fight or flight response is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It prepares your body to either confront or flee from the threat by triggering changes like increased heart rate, quickened breathing, and heightened alertness.

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Joe Wicks on the importance of exercise on mental health | Mental Wellbeing Season - BBC

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How do I know if someone has a mental health problem?

Sometimes it will seem obvious when someone is going through a hard time, but there is no simple way of knowing if they have a mental health problem. Sometimes you don't need to know. It's more important to respond sensitively to someone who seems troubled than to find out whether or not they have a diagnosis.

Although certain symptoms are common with specific mental health problems, no two people behave the same way when unwell. You may notice changes in their behaviour or mood if you know the person well.

Our A-Z of mental health provides information on various mental health problems.

How can I help?

There are many ways you can help a friend, relative or colleague who has a mental health problem:

Talking about mental health

It can be challenging to know what to do if you are worried about someone. When you know there is an issue, it is essential not to wait. Waiting and hoping they will come to you for help might lose valuable time getting them support.

Talking to someone is often the first step when you know they are having a hard time. This way, you can find out what is troubling them and what you can do to help.

Eight tips for talking about mental health

1. Set time aside with no distractions

It is important to provide an open and non-judgemental space with no distractions.

2. Let them share as much or as little as they want to

Let them lead the discussion at their own pace. Don't pressure them to tell you anything they aren't ready to talk about. Talking can take a lot of trust and courage. You might be the first person they have been able to talk to about this.

3. Don't try to diagnose or second guess their feelings

You probably aren't a medical expert, and while you may be happy to talk and offer support, you aren't a trained counsellor. Try not to make assumptions about what is wrong or jump in too quickly with your own diagnosis or solutions.

4. Keep questions open ended

Say, "Why don't you tell me how you are feeling?" rather than "I can see you are feeling very low". Try to keep your language neutral. Give the person time to answer and try not to grill them with too many questions.

5. Talk about self-care

Discuss ways of de-stressing or practising self-care and ask if they find anything helpful. Exercising, having a healthy diet and getting a good night's sleep can help protect mental health and sustain wellbeing.

6. Listen carefully to what they tell you

Repeat what they have said back to them to ensure you have understood it. You don't have to agree with what they are saying, but by showing you understand how they feel, you are letting them know you respect their feelings.

7. Offer them help in seeking professional support and provide information on ways to do this

You might want to offer to go to the GP with them or help them talk to a friend or family member. Try not to take control and allow them to make decisions.

8. Know your limits

You will have your own limits on the support that you can provide. And it's important to take care of yourself too. Give yourself time to rest and process what they have told you or what's happened. Try to help them create a support network of other friends, relatives and mental health professionals who can help them too.

Remember that If you believe they are in immediate danger or have injuries that need medical attention, you must take urgent action to ensure they are safe. More details on dealing in a crisis can be found below.

If it is a family member or close friend you are concerned about, they might not want to talk to you. Try not to take this personally: talking to someone you love can be difficult as they might be worried they are hurting you. It is important to keep being open and honest and telling them that you care. It may also be helpful to give them information about organisations or people they can reach out to. A list can be found below.

How do I respond in a crisis?

People with mental health problems sometimes experience a crisis, such as feeling suicidal or experiencing their own or a different reality.

You may also feel a sense of crisis, but staying calm is important.

There are some general strategies that you can use to help:

Listen without making judgements and concentrate on their needs at that moment

Ask them what would help them

Reassure and signpost to practical information or resources.

Avoid confrontation

Ask if there is someone they would like you to contact

Encourage them to seek appropriate professional help

If they have hurt themselves, make sure they get the first aid they need

Seeing, hearing or believing things that no one else does can be the symptom of a mental health problem. It can be frightening and upsetting. Gently remind the person who you are and why you are there. Don't reinforce or dismiss their experiences; acknowledge how the symptoms make them feel.

How do I respond if someone is suicidal?

If someone tells you they are feeling suicidal or can't go on, it is very important to encourage them to get help. You or they should contact a GP or NHS 111. They can also contact the Samaritans immediately by calling 116 123 (UK) for free anytime. They could also get help from their friends, family, or mental health services.

You can ask how they feel and let them know you are available to listen. Talking can be a great help to someone who is feeling suicidal, but it may be distressing for you. You need to talk to someone about your feelings; the Samaritans can help you.

If they are planning to take their own life, please encourage them to call 999 (UK) or go to A&E and ask for the contact of the nearest crisis resolution team. These are teams of mental health care professionals who work with people in severe distress.

Useful organisations and resources

The first person to approach is your family doctor. they should be able to advise about treatment and may refer you to another local professional. See our guide on How to talk to your GP about your mental health.

Specialist mental health services

Several specialist services provide various treatments, including counselling and other talking treatments. Often these different services are coordinated by a community mental health team (CMHT), which is usually based either at a hospital or a local community mental health centre. Some teams provide 24-hour services so that you can contact them in a crisis. You should be able to contact your local CMHT through your local social services or social work team.

Samaritans

The Samaritans offer emotional support 24 hours a day, in full confidence. Call 116 123 or email .

Mind Infoline

Mind provides information on a range of mental health topics to support people in their own area from 9.00 am to 6.00 pm, Monday to Friday. Call 0300 123 3393 or email .

Rethink Advice and Information Service

Rethink provide specific solution-based guidance: 0300 5000 927 E-mail: .

Anxiety

Anxiety UK runs a helpline staffed by volunteers with personal experience of anxiety from 9:30-5:30, Monday to Friday. Call 08444 775 774.

Citizens Advice

Citizens Advice provides free, independent, confidential advice for various problems and information on your rights and responsibilities.

Step Change

StepChange provides help and information for people dealing with various debt problems. Freephone (including from mobiles) 0800 138 1111 or visit the website on www.stepchange.org.

MindEd

MindEd is a free educational resource on children and young people's mental health for all adults.

If you are feeling like ending your life or feel unable to keep yourself safe, please call 999 or go to A&E and ask for the contact of the nearest crisis resolution team. These are teams of mental health care professionals who work with people in severe distress. If you feel affected by the content you have read, please see our get help page for support.

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How to support someone with a mental health problem

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We all go through tough times and people help us through them. Other times we have been worried about other people's mental health.

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How to Support Someone with Suicidal Thoughts

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How to Support Someone with Suicidal Thoughts

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Worried someone may have suicidal thoughts? Talking to them can help. Find out how you can support someone by listening without judgment, exploring options like NHS or charity support, and find futher sources of support.

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What reasonable adjustments are - Reasonable adjustments at work

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What reasonable adjustments are and when an employer must make them for someone with a disability.

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Being person-centred is about focusing care on the needs of individual. Ensuring that people's preferences, needs and values guide clinical decisions, and providing care that is respectful of and responsive to them.

Health and wellbeing outcomes need to be co-produced by individuals and members of the workforce working in partnership, with evidence suggesting that this provides better patient outcomes and costs less to health and care systems.

Person-centred care framework

Person-centred approaches is a core skills education and training framework that articulates what it means to be person-centred and how to develop and support the workforce to work in this way.

Developed in partnership with Skills for Health and Skills for Care, the Framework aims to distil best practice and to set out core, transferable behaviours, knowledge and skills. It is applicable across services and sectors (e.g. health, social care, local authorities and housing) and across different types of organisations (e.g. public, private and not for profit).

Person-centred Approaches underpins existing dementia, learning disabilities, mental health and end of life care core skills frameworks.

Working together

Bringing together the mental health, dementia, learning disability, and end of life careprogrammes we're identifying the basic competencies and behaviours required by everybody who's involved in ensuring patients and service users stay engaged, healthy and in control of their own choices.

We're working with cross-system partners to build an understanding of the roles and responsibilities of practitioners and citizens and how they work in partnership to enable individuals to manage their own health and wellbeing with the support they need and choose.

The work will model the six principles produced by the People and Communities Board, alongside the New Models of Care Vanguard Sites, for changing the way that health and care relate to people and communities. The six principles require that:

care and support is person-centered: personalised, coordinated, and empowering

services are created in partnership with citizens and communities

focus is on equality and narrowing inequalities

carers are identified, supported and involved

voluntary, community and social enterprise and housing sectors are involved as key partners and enablers

volunteering and social action are recognised as key enablers.

These 'six principles' set out the basis of good person-centred, community focused health and care.

Members of the Health Education England's Patient Advisory Forum (PAF):

We hope to be valued for what and who we are, no matter how broken we may seem from the outside. We want to be offered choice to maintain our independence, dignity and sense of self worth. The challenge for the NHS and all health and care providers is to develop a mindset, which will preserve our freedom to help ourselves in true partnership.

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Being person-centred is about focusing care on the needs of individual. Ensuring that people's preferences, needs and values guide clinical decisions, and providing care that is respectful of and responsive to them.

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Let's talk about person-centred care | Caring with Confidence: The Code in Action | NMC

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The NHS Talking Therapies, for anxiety and depression programme (formerly known as Improving Access to Psychological Therapies, IAPT) was developed to improve the delivery of, and access to, evidence-based, NICE recommended, psychological therapies for depression and anxiety disorders within the NHS.

From small beginnings in 2008, the programme has steadily grown so that nearly 1.2 million people were able to access services in 2021/22. This expansion was the result of training and deploying thousands of new psychological therapists and practitioners, as well as providing additional training modules for existing therapists. Taken together The Five Year Forward View for Mental Health and The NHS Long Term Plan commit the NHS to further expand the NHS Talking Therapies, for anxiety and depression programme so that 1.9 million people per year will be able to access services by the end of 2023/4.

Details of local NHS Talking Therapies, for anxiety and depression services are available on the nhs.uk website: Find an NHS psychological therapies service.

What are NHS Talking Therapies, for anxiety and depression services?

NHS Talking Therapies, for anxiety and depression services are characterised by three key principles:

1. All psychological therapies offered are evidence-based and delivered at the appropriate dose: where NICE recommended therapies are matched to the mental health problem, and the intensity and duration of delivery is designed to optimise clinical outcomes.

2. All within the clinical workforce are appropriately trained and supervised: high-quality care is provided by clinicians who are trained to an agreed level of competence and accredited in the specific therapies they deliver, and they receive weekly outcomes focused supervision from senior clinical practitioners with the relevant competences to support continual improvement.

3. Routine outcome monitoring via standardised measures is used on a session-by-session basis, so that the person having therapy and the clinician offering it have up-to-date information on the person's progress. The outcomes of all NHS Talking Therapies, for anxiety and depression services are published so that the sector can learn from variation in outcomes and public transparency about the benefits and limitations of the services is maintained. This helps guide the course of each person's treatment and provides a resource for service improvement, transparency, and public accountability.

Services are delivered using a stepped-care model, which works according to the principle that people should be offered the least intrusive intervention appropriate for their needs first.

For more information on how the services work, please see the NHS Talking Therapies, for anxiety and depression manual.

Who are NHS Talking Therapies, for anxiety and depression services for?

NHS Talking Therapies, for anxiety and depression services provide NICE recommended psychological interventions for adults and older adults with anxiety disorders and/or depression. This can be standalone or in the context of a long term physical health condition where this can be managed effectively in a uni-professional service. Evidence-based therapies are delivered by trained clinicians, with or without concurrent pharmacological treatment.

NHS Talking Therapies, for anxiety and depression services provide treatment for people with the following common mental health problems:

agoraphobia

body dysmorphic disorder (BDD)

depression

generalised anxiety disorder

health anxiety (hypochondriasis)

mixed depression and anxiety (the term for sub-syndromal depression and anxiety, rather than both depression and anxiety)

obsessive-compulsive disorder (OCD)

panic disorder

Post-traumatic Stress Disorder (PTSD)

social anxiety disorder

specific phobias (such as heights, flying, spiders etc.).

In addition to evidence-based talking therapies for the common mental health problems listed above, NHS Talking Therapies, for anxiety and depression services also provide employment advice in many areas of England, to support people to reach their employment goals.

Aligned with the Long Term Plan and the Advancing mental health equalities strategy, NHS Talking Therapies, for anxiety and depression services are working to reduce health inequalities, ensuring services meet the needs of all in the population that they serve. Our work on advancing equalities focuses on improving access, outcomes and experiences for specific populations and under-represented groups.

How are NHS Talking Therapies, for anxiety and depression services accessed?

Referral pathways have been specifically developed to promote access and equality. They include:

1. self-referral into every service (find an NHS psychological therapies service - www.nhs.uk)

2. community or voluntary service referral

3. primary care referral

4. secondary care referral (including both mental health and physical health care services).

What does NHS Talking Therapies, for anxiety and depression involve?

All talking therapies involve the patient and therapist, or practitioner, working as a team to understand problems, overcome current difficulties and achieve identified goals. Therapy involves talking, but usually also involves doing practical exercises and tasks both in and outside of sessions. It is an active process, and the therapist or practitioner will regularly check in with the patient to ensure progress.

Talking therapies are provided in different ways, including:

using a self-help workbook or website with the support of a therapist

one-to-one in person, over the phone or through video consultation

in a group.

If a patients first language is not English, talking therapies can be delivered in their chosen language through multi-lingual therapists or confidential translators. NHS Talking Therapies, for anxiety and depression are also available in British Sign Language (BSL) through SignHealth.

What types of therapy are offered in NHS Talking Therapies, for anxiety and depression services?

The following are the NICE recommended talking therapy options for depression, anxiety and post-traumatic stress conditions:

Depression:

Guided self-help based on cognitive behavioural therapy principles

Anxiety which can include disorders such as panic, phobias, obsessive compulsive disorder, and generalised anxiety disorder:

Guided self-help based on cognitive behavioural therapy principles. This is not advised for social anxiety disorder or post-traumatic stress disorder

Post-traumatic stress disorder:

Trauma focused Cognitive behavioural therapy (Tf CBT)

Social anxiety disorder:

Cognitive behavioural therapy (CBT)

How are NHS Talking Therapies, for anxiety and depression services delivered?

Services should offer a choice of in-person or remotely delivered therapies. Most of the in-person therapy is provided in local settings that are as easy for people to access such as GP practices, physical health clinics, community settings and voluntary organisations. In recent years, expedited by the pandemic, more people are opting to have therapy remotely (via video platform, telephone or text talk). Alongside these options, services are also offering digital treatment (digitally enabled therapies, DET), provided via the internet. Such platforms encourage learning through patient self-study, reinforced and supported by a suitably trained therapist. As well as maximising the geographic reach of the NHS Talking Therapies, for anxiety and depression programme, delivering treatment via digital platforms means that treatment can be accessed anywhere and at any time. It can also help promote access to treatment for people who may be less likely to engage with more traditional face-to-face therapy appointments. Other people prefer in person therapy and can choose this. It is a matter of choice.

How are NHS Talking Therapies, for anxiety and depression services commissioned?

Services are commissioned by local integrated care boards (ICBs) and are overseen by NHS England on a regional and national basis.NHS Talking Therapies, for anxiety and depression services will also work closely with community mental health services for people with severe mental health problems (also referred to as severe mental illness) to ensure people are able to receive support from the right service for their needs.

NHS Talking Therapy for Anxiety and Depression services need to develop strong relationships with professionals across a broad range of mental and physical health care pathways, as well as social care, to ensure that people with needs that are either not appropriate or are too complex for NHS Talking Therapy for Anxiety and Depression services receive the necessary care in the right place.

Patient and public participation is an essential part of the NHS Talking Therapies, for anxiety and depression programme. The knowledge and expertise of those using services is key to driving all aspects of our programmes development.

Psychological therapies for severe mental health problems (adults and older adults)

Psychological therapies for people with severe mental health problems (also referred to as severe mental illness) are a key part of the new integrated offer for adults and older adults, as set out in the NHS Long Term Plan. Severe Mental Health problems include psychosis, bipolar disorder, 'personality disorder' and eating disorders. All areas of the country are seeking to increase availability of these therapies as part of a wider transformation of adult and older adult community mental health services. For more information on community mental health services please see our community mental health services page.

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NHS Talking Therapies, for anxiety and depression

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The NHS Talking Therapies, for anxiety and depression programme (formerly known as Improving Access to Psychological Therapies, IAPT) was developed to improve the delivery of, and access to, evidence-based, NICE recommended, psychological therapies for depression and anxiety disorders within the NHS.

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Is workplace stigma around mental health struggles changing?

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Employers are saying they’re more open than ever to helping employees with mental-health issues. But are workers happier speaking up?

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This content discusses discrimination or discriminatory violence (such as homophobia, racism, sexism and ableism), which some people may find triggering.

Summary

how stigma and discrimination affect people with mental health problems

why people with mental health problems are discriminated against

what you can do about stigma and discrimination

what you can do if you are being discriminated against.

Mental health problems are common, affecting thousands of us in the UK. Despite this, there is still a strong stigma (negative attitude) around mental health. People with mental health problems can also experience discrimination (negative treatment) in all aspects of their lives.

This stigma and discrimination make many people's problems worse. It can come from society, employers, the media, and even our friends and family. You may even experience internalised stigma, where you come to believe the negative messages or stereotypes about yourself.

How do stigma and discrimination affect people with mental health problems?

Nearly nine out of ten people with mental health problems say that stigma and discrimination have a negative effect on their lives.

We know that people with mental health problems are among the least likely of any group with a long-term health condition or disability to:

find work

be in a steady, long-term relationship

live in decent housing

be socially included in mainstream society

Stigma and discrimination can also make someone's mental health problems worse and delay or stop them from getting help. Social isolation, poor housing, unemployment and poverty are all linked to mental ill health. So stigma and discrimination can trap people in a cycle of illness.

You may face more than one type of stigma: for example, you may also be stigmatised because of your race, gender, sexuality or disability. This can make life even harder.

Why are people with mental health problems discriminated against?

There are many reasons for this discrimination, including:

stereotypes. Society can have stereotyped views about mental ill health. Some people believe people with mental health problems are dangerous when in fact, they are at a higher risk of being attacked or harming themselves than hurting other people

the media. Media reports often link mental ill health with violence or portray people with mental health problems as dangerous, criminal, evil, or very disabled and unable to live normal, fulfilled lives

What can I do about stigma and discrimination?

Challenge stigma

Time to Change campaigned to change the way people think and act about mental health problems. The campaign has now closed, but there is still plenty of useful information on their website about challenging stigma and discrimination when you see, hear or experience it.

They have tips for talking to someone about their mental health, which can be as simple as asking someone if they're sure if they tell you they're feeling fine. Showing someone that there's no shame or stigma in talking about how they feel could make a huge difference.

They also have resources for your workplace or school if you want to help others understand mental health and challenge stigma.

In Scotland, the anti-stigma organisation See Me has ideas on challenging stigma and discrimination. They also have resources and activities you could use at work.

Join our network

If you want to do more campaigning around mental health issues, you could join OPEN, our experience network. It's an online community of people we ask to inform us what we do, through anything from quick feedback on a social media post to participating in a research project. We want to hear from people with a range of mental health experiences, whether yours is good, bad or something in between.

I'm being discriminated against - what can I do?

The Equality Act 2010 protects you from discrimination and lets you challenge it. It makes it illegal to discriminate against people with mental health problems when you:

are at work, applying for a job, or leaving one

use services such as hotels, restaurants, public transport, hospitals, local councils and places of worship

deal with organisations carrying out public functions such as tax collection or law enforcement

buy or rent a property

To be protected, you need to show your mental health problem is a disability. You may not think of yourself as disabled, but the Equality Act could still protect you if you fit its definition of disability. You need to show you have a long-term mental health problem that makes your everyday life substantially difficult. Mind has more information on what this could mean for you.

There are different ways you can experience discrimination, including:

direct discrimination: if you're treated worse than others because of your mental health problem

indirect discrimination: if a person or organisation has arrangements in place that put you at an unfair disadvantage

discrimination arising from your disability: if you're treated badly because of something that happens because of your mental health problem, for example, if you're given a warning at work for taking time off for medical appointments

harassment: if you're intimidated, offended or humiliated

victimisation: if you're treated badly because you've made a complaint

There are different things you can do if you're experiencing discrimination. In general, it's best to try these steps to resolve things.

1. Talk to someone informally. Speak to the person or organisation who has discriminated against you. This can be a quick and easy way to resolve things.

2. Make a formal complaint. You can make a formal complaint if an informal conversation doesn't resolve things. Try to do it in writing if possible. Give a clear account of what went wrong and what you'd like to happen, such as an apology, explanation or better service in future. Your complaint should be properly investigated, and you should be told the outcome.

3. Complain to the ombudsman. If your formal complaint doesn't change things, you can take your complaint to an ombudsman. Mind has more information on which ombudsman to contact in England and Wales and how they work. There are different ombudsmen for Scotland and Northern Ireland.

4. Make a legal challenge. If you're not able to resolve things through the ombudsman, you may want to make a legal challenge.

You don't have to take any of these steps on your own. You can ask a friend or relative for help or help from a professional advocate.

Further resources and information

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How stigma and discrimination affect people with mental health problems; why people with mental health problems are discriminated against; what you can do about stigma and discrimination; and what you can do if you are being discriminated against.

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In most cases when people are treated in hospital or another mental health facility, they have agreed or volunteered to be there. But there are cases when a person can be detained, also known as sectioned, under the Mental Health Act (1983) and treated without their agreement.

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National mental health charity: information, services & a strong voice for everyone affected by mental illness - challenging attitudes and changing lives.

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Why is Mental Health First Aid Important at Work

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Having mental health first aiders in modern workplaces is crucial for creating a supportive and empathetic environment for all individuals.

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Easily create surveys and polls to collect customer feedback, measure employee satisfaction, and organize team events.

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Suicide Awareness and Prevention | P13026 | Burton and South Derbyshire College

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The course is aimed at anybody who wants to expand their knowledge of suicide awareness and prevention.  The course will provide a general understanding and in-depth knowledge of suicide awareness and prevention. Learners should be able to recognise the effects of suicide and suicidal thoughts on the affected individual, their loved ones and on wider society.  They will also understand how to recognise suicidal behaviour in children, young people and adults and how to support individuals.  

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Children and Young People’s Mental Health | Level 2 | P15897 | Burton and South Derbyshire College

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10% of children and young people (aged 5-16 years) have a clinically diagnosable mental health problem, yet 70% who experience mental health problems have not had the support they need.
This qualification will increase your knowledge and awareness of children and young people’s mental health. By completing the qualification, you will develop knowledge of mental health in children and young people which would support progression onto further qualifications and into relevant employment in the health and social care or education sector.
In this qualification, the term ‘children and young people’ refers to an age range of 5-18 years old.

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Did you know that one in four British adults experiences at least one diagnosable mental health problem each year?

The most common is mixed anxiety and depression, but there are so many other issues which have a huge impact on a person's life and the people around them.

This course is designed to help those who work around people with mental health problems to understand each condition fully. It would also be beneficial to anyone who has seen someone experience mental health problems and would like to find out more about the meaning, causes, effects, symptoms and management of the condition.

This is an online course. You will receive your welcome email with further details within 48 hours of enrolment. Once you have enrolled, you will be asked to provide a copy of an official form of ID, such as passport, before receiving your login details.

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Awareness of Mental Health Problems | Level 2 | P15900

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Did you know that one in four British adults experiences at least one diagnosable mental health problem each year? The most common is mixed anxiety and depression, but there are so many other issues which have a huge impact on a person's life and the people around them.