Community is the bedrock of mental health

Words by Julie Bailey. Photos by Andy Hannant

I can’t think of a more restorative environment in which to do an interview about mental health. I’m meeting Dr Tim Fooks, the new High Sheriff of West Sussex, at Sullington Manor Farm, a medieval farm steeped in history and set among the rolling hills of the South Downs National Park.

Tim, a recently retired Pulborough GP of 30-plus years, cuts a dapper figure as he enters the Old Workshop Cafe at the farm and settles down into a corner sofa to start our interview, surrounded by beautiful artwork (there’s an exhibition going on).

He’s clearly enjoying his new role as High Sheriff for 2025-26, proudly sporting the High Sheriff badge on his lapel – and he’s committed to using his tenure as High Sheriff to support initiatives that promote mental health and resilience – and that includes supporting the work of West Sussex Mind.

With over 30 years’ experience as a GP and GP trainer, a number of strategic health roles and a trustee role for children’s charity, Family Support Work, under his belt, Tim is a big advocate for mental health and community.

“Communities are where we get our sense of belonging, understanding and acceptance from,” effuses Tim. “They are part of what allows us to cope with living and when we are struggling, they give us resilience and strength. In short, they keep us well.”

A changing mental health landscape

The High Sheriff says he has witnessed many changes in mental health – and perceptions of mental health – over the last 20 years. He cites the positive move towards a more holistic approach to treating people, which looks at physical and mental health difficulties as a whole, and recognises that medication is only part of the solution.

“The holistic approach is accepted as good medicine now. In my General Practice, I was used to seeing an individual as a whole person and walking alongside them to find solutions. Medication can help deal with specific issues, such as depression, and helps control emotions, for example, but it can’t help someone get back to work or help them make life changes that prevent depression recurring.”

A big step forward was the advent of social prescribing in West Sussex (an approach which connects people to community activities to improve their health and wellbeing), which was introduced to Tim’s surgery in Pulborough in 2018. “When social prescribers were introduced, it was the single most important initiative that enabled me to offer a broad range of support for mild to moderate mental health problems,” says Tim. “It meant we could offer more holistic care and improve outcomes for patients, linking them with their community and reducing social isolation.”

Rising mental health problems

Another marked change has been the increase in mental health problems among people of all ages over the last ten years. There’s a lot of evidence that this started before the pandemic, but it’s widely accepted that the pandemic accelerated this trend, increasing isolation and people’s sense of loneliness “with the most marked effect on children and young people, among whom one in five 8-25 year olds had a probable mental health condition in 2023, rising from approximately one in nine in 2017.” [1]

In fact, this is Tim’s second tenure as High Sheriff of West Sussex. He was appointed as High Sheriff in 2020-21 (the first time a medic was in this role), but this was disrupted by the pandemic, meaning that Tim was unable to fulfill the position in the way he would have wanted. That said, during this period he wrote A Year Like No Other: West Sussex in the Covid 19 Pandemic, a collection of articles about the experiences of the criminal justice system, the emergency services and voluntary sector during the pandemic.

Although Tim recognises that the country’s leaders had to make many exceptional decisions during the pandemic, he says that unfortunately the country’s mental health wasn’t made a priority. “It’s only afterwards that the effect of Covid on people’s mental health and the fallout from that has been acknowledged,” he says.

There has been an increased incidence of mental health problems among all ages in West Sussex, where one in six people in the county have a common mental health problem [2]. While people are generally more aware about mental health – for example, an Ipsos 2024 survey found that 54% of Britons said that mental health was their top health concern, more than cancer or obesity – continuing stigma around the issue means that people still feel ashamed to be open about their mental health.

Stigma is alive and well

It seems a contradiction that public awareness about mental health appears to be at an all-time high (partly due to the pandemic, partly due to increased incidence and experience of mental health), but people who are struggling with their mental health continue to face stigma and discrimination.

Tim quotes Mind’s Public Attitudes to Mental Health survey last year, which showed that some measures of stigma – in terms of people’s knowledge, behaviour and attitudes towards mental health – had fallen to 2009 levels after a decade of continuous improvement.

“Our mental health literacy has deteriorated,” says Tim. “This results in avoidance, anxiety and sometimes negative behaviours to those with mental illness – which ultimately leads to increased isolation and worsening mental health for those affected. That’s why the anti-stigma work that West Sussex Mind is doing is so important. I’m proud to support an organisation that doesn’t just provide practical support to different groups but also campaigns to increase awareness and understanding.”

A culture of self-reliance

This unwillingness to seek help due to shame, and worry about what other people think, is particularly marked in rural communities, which face distinct challenges when it comes to mental health, says Tim.

“There is a strong culture of self-reliance among agricultural communities, where people are reluctant to ask for help. If they get a physical injury that means they can’t work, that’s inconvenient, but for some, if they have a mental health problem that stops them working, that’s plain unacceptable, and they don’t want to ask for help.”

Having worked for over 30 years among farming communities in West Sussex, Tim highlights the financial stress that farmers are under currently, due to factors beyond their control, and says that agricultural communities need specific support and to feel understood by those who occupy the same space.

“We need to ensure that those in leadership positions in the agricultural community – for example, faith leaders, community and voluntary groups, such as the Farming Community Network – have better knowledge and understanding of mental health through training and become champions for mental wellbeing,” Tim points out.

Men on the margins

But the farming community isn’t alone in finding it hard to ask for help. Men also find it difficult to come forward for support, which can have devastating consequences. This is illustrated by the statistics around suicide, which show that, despite men reporting fewer mental health problems than women, death by suicide in England and Wales is three times more common among men than women – with the rate in West Sussex being higher than the average in England (11.5 suicides per 100,000 people in West Sussex between 2020 and 2022 vs 10.4 per 100,000 in England over the same period) [3].

Tim says that we need to change attitudes to mental health among men and welcomes West Sussex Mind’s commitment in its new strategy 2025-2030 to reduce stigma among men and reach more males through all its services.

“Men identify themselves as self-reliant and resilient,” says Tim. “If they injure their leg in a football match, that can be a source of pride, but if they have a mental breakdown, that’s not okay. The fact that they are unfamiliar with mental health conditions, and the support that is available, can result in them trying to find relief through the use of alcohol or drugs – but that is not the answer.”

However, the community – and connection with other men – can provide a solution. Take Men’s Sheds. What started as a movement in Australia in the early 1990s to improve the wellbeing of older men through crafting and woodwork has grown to a worldwide network with 1,100 sheds in the UK, including around 20 men’s sheds in West Sussex.

Men and rural communities (and specifically men in rural communities) are just two of the groups Tim identifies as needing tailored solutions for their mental health and greater education to overcome stigma.

Communities can play a vital role in responding to vulnerable groups to help them address specific issues and find support, as in the example of Men’s Sheds.

Communities sustain wellbeing

So how does the High Sheriff look after his own mental health? Firstly, he says that over his 62 years, he has developed a good level of self-knowledge and self-awareness. “I recognise that my own mental health fluctuates and goes in cycles and that this is normal for me. I get periods of what Churchill called the ‘black dog’, where I tend to see things very negatively. But for me, I know that it’s a phase and it will improve again in a few weeks.”

He also highlights exercise (he likes to walk on the Downs and play tennis), music (he plays cello in an ensemble), his faith and supportive relationships with his friends and family as things that sustain his wellbeing. And when he was a practising GP, he was part of a learning group of GPs, who shared their professional journey and problem solved together – which, Tim says, he needed “to stay well professionally.”

"All of these are examples of communities that I have created and chosen and that support my wellbeing,” concludes Tim. “As humans, we are designed to be together – and we flourish and are at our most effective when we come together in communities.”

With thanks to Gail at Sullington Manor Farm for hosting our interview and photo shoot

References

[1] NHS Digital, Mental Health of Children and Young People in England, 2023

[2] West Sussex Public Mental Health Needs Assessment 2024, West Sussex County Council: Public Mental Health Needs Assessment 2024 - West Sussex JSNA Website

[3] West Sussex Moderngov