Mental Health Awareness Month has been observed in May since 1949, but making note of it in 2021 hardly feels necessary. After all, for the past year and change most of us have been almost too aware of the declining state of our collective mental health.
Talks of the COVID cloud, re-entry anxiety, and languishing have become almost trendy. They are the most shared articles on social media with captions like "mood" and "I feel seen." Celebrities also leaned into the mental health conversation with new enthusiasm: Kendall Jenner created a Vogue video series about her anxiety, Demi Lovato partnered with therapy app Talkspace, and Prince Harry and Oprah teamed up on a mental health documentary for Apple TV+ to name just a few examples. Of course, this helps to normalize seeking help and for all of us to feel less alone. But, some days, the conversations we have and memes we share can make it feel like we can't possibly need a mental health awareness month, because we have been non-stop aware of our mental health difficulties all year.
Don't get me wrong, as a psychiatrist, I want people to talk openly about their experiences and the idea that the pandemic might have made that easier for people is one of the best outcomes by far. However, there is a difference between mental health and mental illness. And after a year of everyone feeling poorly, we need to start talking about feeling mentally healthy — and what that even looks like.
Let's start with the word health. The World Health Organization defines it as "a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity." In other words, achieving mental "health" is not being absent of a disorder, like anxiety or depression or PTSD, but rather, being able to cope with it and thrive with day-to-day life anyway. The continuum from illness to health is also not static and changes, sometimes quite quickly, with the rest of our life. That simple fact alone should give you hope that you will feel better, though it is hard to predict who will feel better and when. Just as the weight of the pandemic didn't settle on all of our shoulders suddenly and simultaneously, it won't be lifted all at the same time when we can go back to work or are vaccinated. For some, there will be a — poof! — kind of improvement; maybe you've already felt it with the warming weather and loosening of mask regulations. For others, things might even get worse first. All of these reactions are normal; like our physical health, our mental health is fluid and changes over time.
So How Do You Even Know If You Are Mentally "Healthy?"
If it's so normal to chat about mental health struggles, and also so normal to have them, we also need to understand what feeling better looks like, as that is normal, too.
You Check In With Yourself
It is healthy to ask yourself, "how am I doing?" and do it routinely, while you drink your coffee or brush your teeth. We absolutely do not self-assess our emotional and physical state enough and often power through our days without thinking about ourselves or our feelings until they get in the way or we are in a crisis.
Obviously if you answer: Joyful, elated, satisfied, content, happy, or optimistic, these feelings suggest you are doing quite well overall. However, keep in mind, it is more than ok to have emotions besides happiness and still be feeling fine. Contrary to popular belief, feelings and truly letting yourself experience them are actually part of being healthy.
For your own awareness of how you are doing over time, it can help to keep track of your answers, how they change, and if they do, how long that lasts. You can do this easily in a journal or using apps like Daylio or iMoodJournal. You can then use these trends to help you know if you start to feel worse, and make slight adjustments early to stay well.
You Are Practicing Good Sleep Hygiene
Sleep is one of the most important things you can do for self-care. Good sleep makes your workday more functional, your relationships (even the stressful ones!) more tolerable, and your mental health symptoms less triggered.
Ask yourself: Am I sleeping at least 7 hours a night? Do I feel rested in the morning and have energy throughout the day? If you answer yes to these questions, great! One way you can maintain mentally healthy sleep is to practice what is called sleep hygiene. This includes many things but establishing a routine, going to bed and waking up at the same time every day, only sleeping when you are sleepy, and not taking naps, are included. It can also help to have rituals before bed, like when you were a child and took a bath, got into your pajamas, and read a book. Since this is 2021, you can even listen to a celeb read you a bedtime story through apps like Headspace and Calm (and who doesn't want Idris Elba or Matthew McConaughey putting you to bed at night??).
You Actually Enjoy Things You Typically Enjoy
When we feel more mentally healthy, we are more interested in and excited to do things we typically enjoy in our day-to-day life. Depression often makes us isolate and feel uninterested in things, and anxiety simply can make you avoid doing social activities because you think your anxiety might worsen. When you feel good, all of a sudden, you want to do those things you enjoy again. You pick up the book you put down, the television show you stopped liking (and rolled your eyes over), and go back to saying yes to plans with friends and coworkers. You might even notice you are picking up the phone or responding to texts a lot more often, as well. When we are doing better, we have the capacity to find enjoyment in others.
You Set Boundaries (Because Boundaries Are Good for You)
Far too often we frame boundaries like they are used as a last resort when we feel miserable and need to remove things from our schedule because "we just can't even." But, it is actually good and healthy to set boundaries. It means you are asking yourself what you want and what you have the capacity to do, and are valuing your own needs in the conversation.
I always like to quote "you can be a good person with a kind heart and still say no." I like it because there is so much guilt that comes with boundaries, especially for women, but protecting ourselves is key to our mental health. You can say no because you don't want to, and communicate it in a healthy way. You can take breaks and vacations or remove notifications from your phone when you need it and prioritize your wellbeing. Being able to vocalize what you want and take actions to make it happen is a sign of mental health.
You Have Friends You Can Be Vulnerable With….But Don't HAVE to All the Time
Nobody wants to talk about how they are doing mentally all of the time, or to be constantly checked on about their sleeping, eating, or mood, especially when they have a mental health diagnosis. But, social support is a key part of resiliency and sometimes, it is easier to notice mental health changes in others and not yourself.
Having at least one person in your life you can turn to when you feel angry, anxious, sad, or generally not as good as you would like is a good mental health practice. You want to feel like you can be open and honest with them and tell them what is actually going on. Why? Because vulnerability is a strength and is critical when we need it. You might even want to talk to a friend about how you want to be checked on and what you find helpful. Open communication about support can often make the support more helpful when it happens. Being able to ask for what you need from others is also a sign of mental health.
Going to Therapy Can Be a Sign Of Health, Too
There is really no wrong time to talk to someone about your feelings, behaviors, or thought patterns and going to therapy does not have to only occur because there is "something wrong with you." Instead, you can go to learn about yourself and become more emotionally aware. It can actually help you be better at your job or in your relationships, even if you are not actively struggling with them. Therapy can also just help you stay well, just like exercising, and become a part of your overall routine.
Ultimately, it is possible to feel mentally healthy and to recognize when you do. While I can't answer specifically for any one person when they will finally flourish post-pandemic, the point is there are ways to help you get there and help make sure you stay there. Maybe you're there already, and had just forgotten what doing okay looked like.
Jessi Gold, M.D., M.S., is an assistant professor in the department of psychiatry at Washington University in St. Louis.