Mental ill health – a national emergency
Mental ill health is a national crisis. Every year one in four people in the UK suffer from a mental health problem, with huge impact on the individual, their family and society. Mental health problems are one of the largest causes of sickness leave from work, accounting for more than 15 million lost working days per year. The total cost of mental health problems to the economy is estimated to be £70-£100bn per year. Suicide is the leading cause of death amongst young people aged 20-34 in the UK. Treatments have not significantly advanced for decades and services are massively stretched meaning that many people do not get the support they need. We urgently need to do better.
Why research is critical
The fundamental problem that limits our ability to treat mental illness is a lack of adequate understanding of the biological and psychological mechanisms underlying these conditions. Until we understand the causes of a disease or disorder it is extremely hard to improve treatment. This was the case in the rest of medicine – treatment for diseases like pneumonia and cancer only progressed once we understood their causes. Our understanding of the fundamental causes of mental health problems such as depression, autism and schizophrenia has lagged behind our understanding of conditions like cancer. There is however now real hope now as research is beginning to uncover some of the key risk factors for mental illness.
Progress in understanding risk
It has long been recognised that both genetic and environmental risk factors (“nature and nurture”) can both influence mental health. Understanding these risk factors provides a key route to understanding the causes of mental health problems. Many mental health problems run in families and we know from a range of different studies that genetics is important in these conditions. Until recently however it proved very difficult to identify the exact genes involved. In the last decade however there has been exponential progress in finding the genes for conditions like autism, schizophrenia and bipolar disorder, with the UK playing a key role in this research. This has been possible through advances in technology (for example DNA sequencing) and major international collaboration. Genetic studies have shown that genes involved in synapses (the connections between nerve cells) as well as genes affecting the brain’s immune system and genetic control are important in these conditions. This means we are now beginning to understand the causes of mental disorders, and to identify new targets for treatments.
We also know that environmental factors – including early life events and influences such as stress can also influence risk for mental ill health. Again considerable progress has been made in understanding the relationship between factors such as birth problems, childhood maltreatment and stress and mental health problems. These areas also offer opportunities for novel interventions to prevent mental disorders, be it through psychological treatments, societal changes or new medications.
The tools to develop new treatments
In order to take forward the promise of this new understanding of risk for mental ill health into better treatments we need to understand how genetic and environmental factors affect the brain. Studying the brain is however difficult due to both its complexity and inaccessibility. Fortunately significant recent advances in neuroscience now make such research possible. In particular, the ability to take peripheral cells (such as a skin sample) from patients and turn them into brain cells in a dish (so called induced pluripotent stem cell technology) means we can directly study the functions of brain cells from patients. Such cells also provide a new way of testing novel treatments. Advances in brain scanning also mean that we have unprecedented means to investigate the structural, functional and chemical changes in the brain associated with mental health problems. The coincidence of these advances in neuroscience with the greater understanding of risk means that this is a time of enormous opportunity for the development of new treatments for mental disorders.
What we need to do next
The UK has great strengths in mental health and neuroscience research, but this is currently distributed across different centres. Mental health research receives only 6% of our national spending on health research, despite the huge burden of these disorders. What we need now is a national strategy to bring together our excellent researchers in these fields and to generate a national programme for mental health research bringing together the diverse expertise that we will be required to make progress. Such a strategy could parallel that recently developed for dementia research, and ideally would benefit from close synergies in the study of these important brain disorders. A national strategy for mental health research, allied with appropriate investment, would also provide a strong message to help tackle the stigma that still exists in association with mental disorders, and would provide a platform against which to support and improve our mental health services. Finally, given the huge unmet need in mental health and the great opportunity for advances in treating a range of brain disorders, a clear national programme of research in this area in the UK will provide an important basis for ongoing industrial investment in the health sector in the UK.