Global Mental Health

“The burden of mental disorders is enormous, under-appreciated, and under-resourced, said epidemiologist Hans-Ulrich Wittchen at a panel on global mental health at the International Neuroethics Society (INS) annual meeting yesterday.

Wittchen was joined on the panel by epidemiologist Dana March and in-coming INS president and Dana Alliance member Judy Illes for a discussion that focused on the discrepancy between mental health disease burden and investment in prevention research, and ways to improve treatment research and access to care.

Moderator John Pickard oversees the audience Q&A with panelists Dana March, Judy Illes, and Hans-Ulrich Wittchen. Photo credit: Gillian Hue

Moderator John Pickard oversees the audience Q&A with panelists Dana March, Judy Illes, and Hans-Ulrich Wittchen. Photo credit: Gillian Hue

Neuropsychiatric illnesses (neurological and substance use disorders) comprise 13 percent of global burden of disease, surpassing cardiovascular conditions and cancer, said March, a member of the Working Group of the Global Challenges in Mental Health Initiatives. Many of the costs are hidden indirect or low-direct costs as a result of psychosocial consequences, such as sick leave, premature disability, and dropping out of school, added Wittchen.

These psychosocial consequences can be a result of cumulative problems due to untreated conditions and lack of access to care. Based on his three-year 2011 study, “Size and Burden of Mental Disorders and Other Disorders of the Brain in Europe,” Wittchen cited some discouraging facts about healthcare access and care in the 30 European countries he studied:

  • Only 30-52 percent (by country) had contact with any health professional
  • Only 8 to 16 percent (by country) had contact with the mental health sector
  • Treatment was more common when complications developed

Referencing a combination of studies such as the Global Challenges, Size and Burden, and Roadmap for Mental Health Research in Europe [see video about the study below], the panelists highlighted several priorities to improve mental healthcare in the next decade.

On the research side, Wittchen proposed increased funding for basic and clinical research, a bigger emphasis on international and interdisciplinary research collaboration, and more encouragement and support for big pharma to develop new psychiatric drugs [see our 2013 Cerebrum article by Society for Neuroscience President Steven Hyman on why big pharma has increasingly abandoned this research].

But while we wait for research to catch up to health needs, what can be done in the near-term for patient access to care?

Wittchen advocated for expanding mental health training to all healthcare professionals, so that patients feel comfortable disclosing issues at regular check-ups. He believes this approach will help to lessen the stigma of asking for help.

Telepsychiatry (online access to care and patient apps) were also mentioned, with March acknowledging its “enormous potential.” Earlier in the evening March noted the higher prevalence of neuropsychiatric illness in low and middle income countries, and perhaps this sort of technology could help to reach larger populations in under-resourced settings. Apps are already being used at the University of British Columbia for neurodegenerative diseases like Alzheimer’s, said Illes.

Decriminalization of disease, when possible, was championed by Illes as “low hanging fruit” to improve patient care. In the case of fetal alcohol syndrome, mothers could be penalized for seeking help, she said. Women may not be aware of the harm to the fetus, or drinking may be used as part of a culturally rooted ritual in certain places, she explained. Illes emphasized the importance of developing and improving community-based preventions that are culturally sensitive.

These are just a few of the recommendations the panel made over the course of the discussion. I encourage you to read the reports linked throughout this blog for more information.

— Ann L. Whitman

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