Mental health: United we stand, divided we fall

Mental health is never far from the headlines these days and this is as it should be. One in four of us will suffer from some form of mental ill health in any given year. Mental illness affects people across the lifespan from children to the elderly, and the burden imposed on individuals and society is immense.

It is widely acknowledged that we need more investment in care provision, and research into the causes and prevention of mental ill health and into the development of new treatment approaches. It is also clear that current investment is miniscule in proportion to the magnitude of the problem and the burdens mental ill health imposes. The scale of the challenge is evident from the reports of the Schizophrenia Commission in 2012  and the Mental Health Taskforce to the NHS in England earlier this year.

Given all this, I was delighted when Cardiff University decided to initiate a blog devoted to constructive debate about issues relating to mental health and illness. We need new thinking about care and treatment, causes and prevention. We also need to hear from a wide constituency including those with direct or indirect personal experience of mental illness (virtually all of us), health care professionals and academics.

I am an academic psychiatrist and have spent my professional life caring for patients with severe mental illnesses such as schizophrenia and bipolar disorder, and researching the causes of psychiatric disorders and dementia. Also, like most of you, I have encountered mental illness and dementia in my personal life. So, when I was asked to write the first post for this new blog and set the scene, I was happy to accept.

Many of you will know that mental illness can be a controversial area. Stories in the media often give the impression that there are widely held fundamental disagreements about whether mental illnesses are disorders of the brain or mind, caused by nature or nurture, and whether they should be treated by drugs of psychological approaches. These polarisations may make good copy but I sincerely hope that we can move away from them in this new blog. There are two reasons for this.

First, they are profoundly misleading. They assume, implausibly, that mind and brain are separate independent entities rather than different aspects of the same thing. They also fly in the face of a large body of evidence indicating the importance of genes and altered brain states in contributing to disorders of mental health and equally compelling lines of evidence that psychological and social adversity impact on mental health. There is also strong evidence that drugs, psychological therapies and social interventions can be effective and often work better in combination than when given separately. While it might not be apparent from the extreme views frequently expressed in the mass media, most mental health workers, researchers, and those with personal experience of mental illness recognize that mental health disorders reflect a complex interplay of social, psychological and biological factors, and that the relative balance of these varies from person to person. Providing treatment consists in working out for each individual the optimal combination of social care, psychological therapy and drugs as well as management of any concurrent physical illness, and is delivered by a multidisciplinary team of nurses, psychologists, social workers, occupational therapists and doctors (both psychiatrists and GPs).

The second reason I hope we can move away from these polarisations is that, not only do they misrepresent the evidence and the views of the majority, but also they misleadingly suggest that there is widespread disagreement among mental health workers about how mental illness should be treated and researched. How can we expect the government to support and pay for better services, or funders to support much needed research, or those with mental health problems to participate in research, if the mental health professions appear to be so divided? How can we expect to recruit the brightest and best to work in this area when sometimes we appear to be at war with ourselves? Surely, if we wish to bring much needed resources and innovation into mental health, we need to present a coherent and unified case for greater investment and a positive image of the many exciting possibilities for progress whether in genomics, neuroscience, social sciences, psychological treatments, early intervention, public health measures and so on. Most of us are trying to do this but we risk the message getting drowned out by the noises offstage.

While understanding mental illness and developing better approaches to treatment and prevention represents one of the greatest challenges we face, there are grounds for optimism. Many voices are calling for change; the need to integrate social, psychological and biological approaches to both treatment and research is widely acknowledged; and new research approaches are making this increasingly tractable. What we need to do now is share ideas and work together to make this happen.

Professor Mike Owen receives funding from MRC, Wellcome Trust, EU.