Henry Hawkins Lecture 2025 Recordings and Blog by Linda Bryant

Reflecting on the Henry Hawkins Lecture 2025 with Together CEO Linda Bryant

I do not go to the gym or run, I’m a bad swimmer and would probably be considered a dangerous cyclist, but I do spend a lot of time enjoying the outdoors and walking my dogs in whatever direction they drag me.

This year’s Henry Hawkins lecture explored the theme of the impact of good physical wellbeing on our mental health and from my own experience, there are lots of ways, unique to our personal interests and personalities, that can help with our physical health that doesn’t necessarily involve a lot of financial expense or donning full sportswear.

For the event we found ourselves at the fantastic football stadium of Norwich City Football Club – along with celebrating the fabulous services Together and our partners provide across the county of Norfolk, we spent a thought-provoking couple of hours understanding the complex relationship between our physical and mental wellbeing and it was apt to do that in an environment dedicated to football, our ‘national’ sport that is so accessible  – a kick around in a local park or back garden.

Video recording 1 – Opening remarks & welcome Linda Bryant & Councillor Tom Fitzpatrick

Video recording 2 – Opening remarks Lee Watson Norfolk County Council

Resources – Lee Watson Together Henry Hawkins Lecture Oct 25 Presentation Slides

We were fortunate to have with us Dr Claire Carswell, an Advanced Research Fellow with the National Institute for Health and Care Research and a registered mental health nurse based at the University of York in the Mental Health and Addictions Research Group. Her research focuses on the relationship between mental and physical health, with a particular focus on health inequalities among people who experience severe mental distress, 46% of whom have a long-term physical health condition and who are, sadly, likely to have shortened lives as a result. While such statistics are difficult to hear and digest given we are in 2025, Claire’s research is identifying better ways to support people manage their physical health, with the goals of improving care and ultimately helping people to live longer.

Video recording 3 – Claire Carswell, NIHR Advanced Research Fellow, University of York

Resources – Claire Carswell Together Henry Hawkins Lecture Oct 25 Presentation Slides

Video recording 4 – Claire Carswell Questions & Answers

Claire made the case for person-centred care, better co-ordination between physical and mental health services and a more joined up system as well as providing the evidence of the positive impacts of physical activity on improving mental health.

Written responses to Slido questions posed to Claire Carswell

1. Do you have any ideas or patient feedback on how we can improve SMI physical health checks in general practice, given the delivery rates in Norfolk?

The main thing that has come out with our research, in terms of the qualitative work on people’s experiences managing their long-term physical health conditions and SMI, and the co-design process for the DIAMONDS intervention, is that the key to successful engagement is flexibility and a person-centred approach.

We haven’t looked into improving access to physical health checks specifically, but in other NHS trusts, such as Sheffield (and I think there was also a trust in London doing something similar) they have had some success with taking a flexible and assertive approach to physical health checks for people with SMI using health coaches in a dedicated physical health check service. You can read about it here: https://www.england.nhs.uk/long-read/a-dedicated-physical-health-check-service-for-people-with-severe-mental-illness/

2. What’s your view on police forces adopting the right care, the right person, and only responding in crisis cases? Expecting primary care agencies to deliver more.

While I understand the purpose of the policy and the need to ensure people receive care and support from the appropriate professional services, the rollout of this policy hasn’t been supported by building additional capacity in primary care, mental health, and emergency services. Advising that police and primary care collaborate to ensure that police services aren’t responding to mental health crises will only work if primary care services are given the resources to meet these needs.

There have been several news articles and publications raising the concern that the implementation of right care, right person may be resulting in preventable deaths, which has resulted in coroners drafting a prevention of future deaths report (e.g.  https://www.judiciary.uk/prevention-of-future-death-reports/sophie-cotton-prevention-of-future-deaths-report/), as mental health services, primary care and emergency services are not resourced to fill the gap.

3. Could the lower amount of funding for the development of anti-psychotic medication compared to other physical health medication play a role here too?

That is a contributing factor, although I think that the issue with drug discovery in treating severe mental illness is a bit more complex than just an issue of funding for the development of new drugs. Our understanding of SMI, in terms of its underlying pathophysiology, is very limited and, therefore, a barrier to developing medications that target key pathways. Most psychiatric drugs have been discovered by accident – chlorpromazine, the first antipsychotic, was initially developed to be an antihistamine, lithium’s anti-manic properties was only discovered when a psychiatrist used lithium to increase the water solubility of uric acid, if anything these incidental discoveries of the effects of drugs have been used to develop hypotheses about the potential underlying mechanisms of the conditions, as opposed to an understanding of the mechanisms driving drug discovery.

We also don’t have any animal models to aid in drug discovery for SMI, and no biomarkers across the different conditions to ensure measurement of effect (or again, to understand mechanisms and potential targets). While more funding would be great, we need broader funding to understand these conditions more thoroughly to progress to targeted drug development, instead of relying on building from incidental findings.

There’s a good report from Tufts 2022 that goes through incentivising drug discovery for SMI here:

https://cevr.tuftsmedicalcenter.org/assets/images/TMC_Report.pdf

This was further emphasised by Professor Jonathan Roiser, our second main speaker. Jonathan is Professor of Neuroscience and Mental Health at University College London where he co-directs a research group. For the past 15 years he has led a programme of work that seeks to understand the psychological and brain processes involved in driving symptoms of depression and its treatment, particularly focusing on motivation. In recent years he has directed two studies investigating how physical activity works as an effective treatment for depression, including a large ongoing NHS trial funded by Wellcome.

Video recording 5 – Jonathan Roiser, Professor of Neuroscience and Mental Health, UCL

Resources – Jonathan Roiser Together Henry Hawkins Lecture 2025 Presentation Slides

Video recording 6 – Jonathan Roiser, UCL Questions and Answers

Jonathan focused on the evidence base for physical activity as a treatment for mental health problems, especially depression, with some ideas about how it might work at the biological and psychological levels. It was a fascinating journey into a complex, and often misunderstood area of mental health science and explored the possibilities that pharmacological approaches to treating serious mental distress need to be considered alongside encouraging individuals to engage in different physical activity.

Written responses to Slido questions posed to Jonathan Roiser

For questions and answers at the event attendees could submit those via the Slido app. Those were addressed on the night but there wasn’t time to get to all of them and so they were passed to Jonathan who has taken time to provide written answers to those below:

1. It’s nice to see what we know validated by science! How do we reduce the mis-prescribing of antidepressants by GPs? (given out like sweets)

Personally I am not convinced there is that much mis-prescribing of antidepressants by GPs – I’m sure it happens sometimes, and of course these drugs don’t work for everyone (only around 1/3 of people will get better on the first antidepressant they try, and only around 2/3 of people after multiple antidepressants), but on average they are clearly effective, so it makes sense that GPs will offer them to most patients. There is a massive amount of high-quality evidence from randomised controlled trials – see e.g. Cipriani et al (2018) Lancet – and a GP is only going to prescribe them if there is a clinically important level of anxiety or depression.

While it’s true that the numbers of antidepressant prescriptions made each year has risen quite dramatically over the past 20 years in the UK, that mainly reflects that more people are on long-term treatment (and so receiving multiple prescriptions), as opposed to dramatic increases in the number of people being newly prescribed antidepressants. This increase in long-term treatment reflects the growing understanding that coming off antidepressants is a big risk for relapse, but it is impossible to tell at an individual level who would be at high risk. So, perhaps understandably, GPs take a risk-averse approach and keep people on medication.

Underlying the above points, the fundamental issue that right now we have no way of knowing a) which people are going to respond well to antidepressants, and b) who will be at risk for relapse when they stop. This is one place where I hope that neuroscience will be able to provide important information in future, but studies examining these questions in detail from a neuroscience perspective are only just starting to be conducted.

2. Considering comorbidity, your thoughts on exercise triggering hyperarousal in people who also have conditions like say, PTSD?
3. Beyond depression – are there any considerations / any thoughts you have around how physical activity can lead to hyperarousal in say conditions like PTSD?

I’m not sure if these questions were from two different people, but I’m going to respond to them together as they seem to be getting to the same issue. I also want to preface my response by saying that I am not by any means a PTSD expert, and the below answer reflects my understanding of the literature, which I acknowledge may be incomplete.

There is strong evidence, perhaps surprisingly, that engaging in vigorous aerobic exercise is actually associated with fewer hyperarousal symptoms in PTSD (see Harte et al 2015, Evaluation & the Health Professions). One possible explanation for this is that although exercise does place physical stress on the body, and results in short-term increases in certain stress hormones such as cortisol, these impacts are generally limited to the period of exercise itself. In fact, over the longer term cortisol actually reduces with regular exercise; a good explanation can be found here if you are interested: https://lifestylemedicine.stanford.edu/how-exercise-balances-cortisol-levels/. This fits with qualitative research which finds that in the aftermath of exercise, people generally feel less stressed – although of course it’s important to build in periods of restful recovery from exercise! Finally, there is a recent suggestion that exercise could be particularly effective as part of a broader treatment strategy for PTSD, especially in combination with psychological treatments, if timed appropriately, as it can help the re-learning which is an intrinsic part of those treatments (see Crombie et al 2024, Journal of Anxiety Disorders).

4. How does repeated trauma exposure affect long-term mental health neurologically, & what impact does reg. exercise have in moderating these effects?

This is a broad question and a very active research area – multiple PhD dissertations could and have been written on both of these topics! I’ll do my best to answer briefly, and as with the previous answer I want to emphasise that I am not a trauma expert, so my understanding might be incomplete.

In terms of effects of trauma on the brain, it’s important to first define what we mean by “trauma”, as this word has broadened in use over the past decade. In the context of mental health research, trauma is quite an extreme experience – it refers to directly experiencing a situation in which the individual believes that they, or someone else in that same situation, are at a real risk of death, serious injury or sexual violence. This is distinct from the use of the term “trauma” to refer (broadly) to types of adversity (such as poverty, discrimination, or interpersonal conflict), which has become a more common use in recent years.

There are multiple effects of severe trauma on the brain, especially when experienced during development. My colleagues at UCL Eamon McCrory and Essi Viding have been researching this topic for many years, and found clear evidence for changes in the function and even anatomy of the brain circuits that process emotion, motivation and memory. This helps explain why early trauma is such a big risk factor for later mental health problems – their theory is called the “Latent vulnerability hypothesis”, and Eamon wrote a nice explanation of this idea here if you are interested: https://www.eif.org.uk/blog/childhood-adversity-and-the-brain-what-have-we-learnt. Also the institute he directs, the Anna Freud Centre, have put together this great video: https://www.youtube.com/watch?v=xYBUY1kZpf8.

In terms of the second question, there is evidence that exercise can buffer the effects of trauma (both before and after the event) – for example there is a good paper on this topic by Wang et al (2023) European Journal of Psychotraumatology. A review by Dong and Lin (2025) in Frontiers in Psychology explains how these beneficial effects may be caused, in part, by targeting the same brain regions we know are impacted by trauma in the first place, such as the prefrontal cortex, hippocampus and amygdala.

5. Is there any evidence on what causes the underlying inflammation in the first place? Why is it higher in people with depression?

Again, this is a big research topic – as is often the case in mental health, it’s probably partly genetic and partly environmental. Part of the environmental influence is probably stress itself, which is known to be sufficient to trigger immune activation. This may then feed a vicious cycle, as being depressed is also inherently stressful – often the chronic immune activation can resolve when depression lifts, so the two go hand in hand. The other possibility (and we see this a lot with chronic fatigue, long Covid and other post-viral syndromes) is that the brain may still be operating as if there was inflammation, so symptoms such as fatigue or brain fog don’t lift even after the virus has been cleared and inflammation has subsided. This is a big topic of research now (following Covid), which is important as currently there are very limited treatment options.

6. I am interested in the sense of control engaging in physical activity offers. Have you found any positive correlation with reduction of depression symptoms?

We haven’t investigated this directly, but I do think it could be important. However, it probably doesn’t explain all of the effects of exercise, as some types of activity (e.g. aerobic) seem to be more effective than others (e.g. mild yoga) in depression, and both would probably elicit a sense of greater control or confidence.

7. How do we get GPs to fund physical activity? E.g. gym vouchers, for those who cannot afford it, as part of social prescribing? Wouldn’t cost more than medication

It’s not actually GPs who make these decisions but NHS clinical commissioners, who decide what services are going to be offered in a particular area. Personally I don’t think gym vouchers alone would be effective, because people also need a lot of motivation to actually start exercising. In my view, supervised classes (with a good coach) specifically for mental health is likely to be more effective, as people are more likely to attend. I think this would also be less intimidating for people who are out of shape than starting in the gym by themselves. This would still be a form of social prescribing, and that’s the obvious route for delivering these kinds of interventions, as it is already well integrated into primary care.

8. How can we implement physical activity as a treatment for depression without demeaning those suffering by putting the full weight of their recovery on them?

This is such an important point, which relates to the previous question too. I really see the issue in terms of lowering the barriers to start engaging in physical activity, as opposed to blaming depressed people for not doing exercise. There has been extensive research on perceived barriers to starting physical activity in people with depression, see Glowacki et al (2017), Mental Health and Physical Activity – these include factors such as identity (e.g. feeling too old or not identifying as a “sporty person”), low confidence in having the ability to exercise, having low levels of motivation or energy, lacking time or money, and lack of support/encouragement. So physical activity services specifically for mental health need to be developed with these known barriers in mind – in my view, a supportive and understanding coach or instructor will go a long way in breaking some of these barriers down.

9. In your research, how do you separate depression from similar symptoms, such as burnout?

Symptoms of depression are measured using standardised questionnaires or interviews – for example, in our research we use the PHQ-9, which covers the major symptoms used for diagnosis. Burnout is usually considered (e.g. by the World Health Organisation) as an occupational phenomenon – a state of physical, mental, and emotional exhaustion, usually (but not always) related to long-term stress or pressure at work. Some of the symptoms of burnout do overlap with depression (e.g. fatigue, sleep problems, worthlessness, loss of interest, difficulty concentrating). Because both depression and burnout are defined according to symptoms, there is a lot of overlap and a clinician would not necessarily distinguish between them on that basis; but if the symptoms clearly relate to workplace stress (e.g. if they lift when someone takes a break from work, such as a holiday) then that would usually provide important context.

Our final guest speaker was the wonderful George Egg. Every year, at the Henry Hawkins Lecture, we invite someone from the Arts to give a different learning perspective on our lecture theme. In past years, we have had musicians, poets, even a choir. This evening, we were lucky to have George.

George is a comedian who cooks. He is an award-winning, multi-sell-out, international-touring performer, who delights his audiences with a performance of cooking-with-laughs.

Video recording 7 – George Egg Comedian and Author

Resources – Information on George’s book and future performances

We know how important diet is to our physical and mental wellbeing but for many people cooking healthy foods can be challenging, particularly living on your own or on a tight budget. Armed with his chef’s skills and stand-up experience, George engaged the audience with an alternative, and somewhat surprising way, to make a healthy meal of poached eggs and fish using a wall-paper stripper!

Previous guests of our lecture events have commented on how much they enjoy the time we also take to recognise the contributions people have made to the work of Together. This year was no exception – we recognised and celebrated the incredible commitment and contribution of some recently trained Volunteer Community Champions within Together’s Service User & Lived Experience Engagement project here in Norfolk. It was lovely to share their successes with the audience as they received their certificates and our congratulations.

Video recording 8 – Closing Remarks with Claire Woodcock and Angus Cameron