The indi­vi­dual, their envi­ron­ment, and how they work together

In health promo­tion, the life-stage model is gaining incre­asing importance. How important are life stages in mental health?
Corne­lia Waser: The life-stage model takes into account the diffe­rent circum­s­tances in which people live. The people around us are rele­vant to the model. In early child­hood, this is shaped by diffe­rent people than in youth. If it is the family first, then school beco­mes more important later. But the chal­lenges also change depen­ding on the life stage. To meet these chal­lenges, people need to be empowered in a targe­ted way. 

What are the advan­ta­ges of the life-stage model compared to other approa­ches?
It focu­ses on the right people around us and the rele­vant criti­cal life events. The life-stage model offers a simple struc­ture. The data points to issues that are more likely to crop up than others. Diffe­ren­ces emerge this way. For exam­ple, the issue of mental stress has increased drama­ti­cally amongst young women. The model helps to iden­tify the reasons and the people around them who can do some­thing to support them. 

Life stage and age do not exist in isola­tion. How do diffe­rent factors inter­act with gender or back­ground, for instance?
As we cannot address all factors at the same time, we inves­ti­ga­ted the ques­tion of whether the factors can be placed in a hier­ar­chy. In gene­ral terms, the follo­wing can be concluded: Mental health is much more likely to suffer when seve­ral stress factors come toge­ther. Howe­ver, based on the data, it is not possi­ble to infer a hier­ar­chy. It cannot be said that, for instance, age, gender or socio-econo­mic status are parti­cu­larly important. The latter is rele­vant, at least in many cases: Those who are in a poor socio-econo­mic situa­tions are consis­t­ently disadvantaged. 

Can the effect of socio-econo­mic status on mental health be explai­ned?
A key factor for mental health is the feeling that I can make a difference.

And people in socio-econo­mic­ally disad­van­ta­ged situa­tions lack this feeling?
They have less room for manoeuvre.

But this sense of purpose tends to dimi­nish with the second Porsche.

Corne­lia Waser

Is it a ques­tion of money?
Money plays a role. Let’s take a look at coun­sel­ling services available if you have mental health problems. There is a long waiting period for services funded by health insu­rance. If you do not have the finan­cial means to seek coun­sel­ling else­where, you will have to wait it out. This is where the lack of money has an impact. But in gene­ral, the feeling of being able to make a diffe­rence also opera­tes inde­pendently of the finan­cial aspect. If someone feels that they have a good job where they can make a diffe­rence, even without a lot of money, it has a big effect on mental health. 

What role does the feeling of doing good play – or even of volun­tee­ring or making a dona­tion?
That’s an important factor, again, this feeling of being able to make a diffe­rence. Recipro­city is also important for mental health. If you feel you’ve given some­thing, it’s easier to accept something. 

Am I more satis­fied when the orga­ni­sa­tion I work for does some good?
Yes – we are always looking for a connec­tion to the good, which is easier to find in this kind of activity.

Purpose helps?
It’s very important. But people can also find purpose in making money. Someone might find purpose in being able to afford a Porsche. But this sense of purpose tends to dimi­nish with the second Porsche. Luxury has a less lasting effect on mental health. People who are commit­ted to some­thing commu­nity-based or chari­ta­ble find it easier to see the purpose.

There may not be a hier­ar­chy. But what is the inter­ac­tion between the diffe­rent factors, age, gender, etc.?
They’re getting stron­ger. The more pres­sure there is, the more stress a person needs to be able to manage. As long as ever­y­thing runs smoothly, a person can handle the pres­sure. There are inter­ac­tions, for instance, in adole­s­cence, people deal with exam stress at the same time as the chal­lenges of growing up. In addi­tion to diffe­ren­ces in life-stage-speci­fic chal­lenges, there are gender diffe­ren­ces in what they look like and how they can be tack­led. In addi­tion, expe­ri­ence of deal­ing with chal­lenges grows as you get older. You have more skills to find the balance to make up for this.

Do I need to reduce stress factors or can I increase my resi­li­ence in order to cope with such situa­tions?
It’s both. Each and every one of us can have an influence. But if you’re alre­ady in an envi­ron­ment that’s not right, the opti­ons are limi­ted. That’s why we start with the stages of life in early child­hood. If you start life stron­ger, you have a better chance of maste­ring chal­lenges. For people who cannot build up this resi­li­ence, there’s more demand on the envi­ron­ment to absorb it.

What does the tran­si­tion between life stages look like? Are these parti­cu­larly criti­cal moments?
A clas­sic exam­ple is early paren­thood. A child arri­ves. This is a criti­cal tran­si­tion. The situa­tion is medi­cally chal­len­ging. There’s a lack of sleep. The child turns your whole life upside down. The tran­si­tion from puberty to adult­hood is also a criti­cal moment. The body is adjus­ting. You break away from your parents and you have to build your own rela­ti­onships. Not ever­yone will make this tran­si­tion smoothly. In these situa­tions, it is valuable if a social circle made up of parents and teachers can help. 

How well prepared is the Swiss health­care system to support people with mental health problems at diffe­rent stages of life?
We have certain gaps in the health­care system. But it’s not the only thing that’s rele­vant. It is the whole system in which we operate. For child­ren and young people it is their school, their foot­ball coach, their uncle, for the working popu­la­tion, it’s their place of work, the neigh­bours. Those affec­ted must be able to move healt­hily within this envi­ron­ment. This is precis­ely where they would need support first. 

And how is the situa­tion in a crisis?
There are fewer and fewer family doctors. They would be important as the first point of cont­act. Today you have to go straight to the hospi­tal emer­gency depart­ment. This is not very suita­ble for mental health problems. Nobody knows you there either. If someone has mental health problems and is convin­ced that there is no one available for them to cont­act anyway, they tend to seek help much too late. Gene­ral networ­king also has poten­tial. Who can an employer cont­act and who can a GP consult if they are stuck? A big problem is that these networ­king acti­vi­ties are not paid for. 

Are there no approa­ches to promote this?
There are initial projects at muni­ci­pal level that promote networ­king measu­res for older people or young children.

Most, inclu­ding young people, are doing well.

Corne­lia Waser

Should asso­cia­ti­ons become more invol­ved in this area?
Yes. This kind of networ­king project is often made possi­ble with support from asso­cia­ti­ons. Acces­si­ble projects offe­red in the muni­ci­pa­lity are also important. The storytel­ling café is a typi­cal exam­ple. A mode­ra­ted, rela­xed round table discus­sion. A lot of volun­tee­ring makes this possi­ble and it appeals to many. Those who take part can exch­ange ideas and all have their say. That can make a huge difference. 

What is the poten­tial of arti­fi­cial intel­li­gence, or AI? Could AI play the role of the coun­ter­part at a storytel­ling café, for instance?
The storytel­ling café is all about storytel­ling and reflec­tion. I don’t need AI for that. A substi­tute would be simply to write down the story.

Does the storytel­ling café cease to exist?
The other aspect in addi­tion to storytel­ling is ‘feeling’. Being with people can do us palpa­ble good. AI can’t do that. But it can, for instance, encou­rage us to sit down and start writing in the first place. AI has poten­tial here. But I don’t see that for the commu­nal aspect.

Do you see poten­tial in preven­tion, diagno­sis or the early detec­tion of problems?
I could imagine the use of AI in self-diagno­sis. I fill out a ques­ti­on­n­aire and receive tips. That’s another step. AI would provide support. This must, of course, be imple­men­ted carefully.

Can AI also have nega­tive effects, such as making us feel replaceable?
This feeling proba­bly affects only a few people. There’s still a great need for coun­sel­ling roles at the moment. We are expe­ri­en­cing a shortage of skil­led workers. But there will certainly be tasks that can be replaced. 

AI has been descri­bed as a radi­cal change around the world. Are such deve­lo­p­ments unsett­ling?
So many things are chan­ging around the world that we have no control over. This trig­gers a feeling of power­less­ness. That is stressful.

The pande­mic was an event like this. Does it still have an impact?
The pande­mic unsett­led people. Some found secu­rity only in conspi­racy theo­ries. Commu­ni­ties on social media have inten­si­fied this. It’s still having an effect.

How do you curr­ently rate the mental health of the popu­la­tion in Switz­er­land?
Even though we often talk about the nega­ti­ves, the majo­rity are doing very well over­all. Most, inclu­ding young people, are doing well. The propor­tion of people who are doing well also increa­ses from stage to stage of life. Only at the end, when we are depen­dent on support, does it decrease again. But there are indi­vi­dual groups, such as young women, in which cases of mental stress have increased. This is also reflec­ted in the long waiting times for coun­sel­ling services and the increase in disa­bi­lity insu­rance due to physi­cal illnesses. That’s tangi­ble. We need to tackle that. 

Where do you see room for impro­ve­ment?
Skil­led workers can’t be found over­night. We need acces­si­ble measures.

What like?
With early detec­tion, we oursel­ves or those around us can iden­tify proble­ma­tic deve­lo­p­ments. Then we need acces­si­ble sources of help. If we are always commu­ni­ca­ting that care is over­whel­med, there are many people who feel put off by that and don’t even try to get help. I see poten­tial in acces­si­ble tele­phone coun­sel­ling services. They are curr­ently being over­whel­med. Nobody wants to fund acces­si­ble services. But this is actually where we need to expand.

Have people become less reluc­tant to seek help from a coun­sel­ling hotline?
If someone can’t get an appoint­ment with a psycho­lo­gist, they call a coun­sel­ling hotline. Parti­cu­larly in old age, there is a noti­ceable lack of oppor­tu­ni­ties for inter­ac­tion. Toge­ther with a foun­da­tion, we are support­ing a project that offers services for older people.

So acces­si­ble services can have a big impact?
Some­ti­mes it doesn’t take much. Simple things can help people out of a crisis. It is important that not only the indi­vi­dual and the envi­ron­ment that surrounds them are decisive. Both and how they work toge­ther are important. Simple messa­ges can help. A nice neigh­bour who smiles at you can help.

Conver­sely, does this mean that simple things can lead to crisis?
No. A neigh­bour who passes by without saying hello doesn’t throw you straight into a crisis.