Facing Down Mental Illness

DAVOS – Contrary to common perception, mental illness is a problem that is neither new nor unique to the developed world. What we call schizophrenia and bipolar disorder are recognizable in literature dating back to ancient Greece, and The Anatomy of Melancholy, published in 1621 by the English scholar Robert Burton, remains one of the most astute descriptions of depression. Today, low- and middle-income countries account for most of the morbidity and 75% of the suicides that result from mental illness.

What is new, and encouraging, is the heightened attention now being given to the problem. Last year at Davos, I helped launch a new Global Agenda Council on Mental Health, after a study by the World Economic Forum and Harvard School of Public Health projected that the global economic costs of mental illness over the next two decades would exceed the costs of cancer, diabetes, and respiratory ailments combined. With the stakes so high, the human and economic case for leaders to take mental health seriously is clearly compelling.

As policymakers act, they would be wise to bear in mind that mental disorders are brain disorders. Too many people dismiss mental illnesses as problems of character or lack of will, rather than recognizing them as serious, often fatal, medical disorders. The brain is a bodily organ just like any other. We should no more blame a person for a malfunctioning brain than for a malfunctioning pancreas, liver, or heart. People with brain disorders deserve exactly the same level and quality of medical care as we expect when confronted with disorders of any other part of the body.

Consider depression, the most common mental illness, which must be distinguished from the sadness, disappointment, or frustration we all experience in our lives. William Styron’s 1989 memoir, Darkness Visible, rightly calls “depression” a weak word for a debilitating condition that is marked by hopelessness, helplessness, and dread.

In extreme forms, depression can be so disabling that the thought of getting out of bed or making a phone call becomes overwhelming. Functioning effectively at the workplace can be intensely challenging, which is reflected in the growing recognition of a condition known as “presenteeism,” a variation on “absenteeism”: depressed employees are physically present but mentally absent.

Mental illnesses can often lead to other health problems. Brain disorders like depression and schizophrenia greatly increase the risk of developing chronic ailments, such as cardiovascular and respiratory diseases. People with mental illnesses and substance-abuse issues are at increased risk of infectious diseases like HIV/AIDS.

Furthermore, mental disorders have a profound impact on the outcome of other illnesses. After a heart attack, for example, the prognosis depends on the presence or absence of depression more than on virtually any measure of cardiac function. That is why health-care policymakers should embrace a simple adage: “no health without mental health.”

Indeed, mental illnesses can be as fatal as physical ones. Suicide causes more deaths than homicide. Around 7% of people with major depressive disorder will take their own lives. Globally, more than 800,000 people kill themselves every year. The number of people scarred by a loved one’s death is much greater; every suicide has many victims.

Tackling the problem will require innovative approaches. It is not enough simply to make treatment available. People with psychotic disorders may deny that they are ill, and those suffering from depression may be too consumed by self-loathing to feel worthy of help. Even in the developed world, it is estimated that only about half of all people suffering from depression are diagnosed and treated. According to the World Health Organization, in developing countries, 76-85% of people with severe mental disorders are not treated. We need sensitive ways to identify those at risk and to help those who are most disabled.

Not everybody with a mental illness needs expensive drugs, hospital care, or even direct access to highly trained psychiatrists. We may not have the equivalent of a vaccine for measles or a bed net for malaria, but low-cost, highly effective interventions are possible for most people either at risk for, or already suffering from, a mental illness. In low-resource environments, local residents or family members can be trained to provide brief, effective psychotherapies that treat moderate forms of depression or anxiety. Phone- or Internet-based therapy can be used as well.

That said, it should be acknowledged that treatments for mental illness remain far from infallible. Of those who get help, only about half receive the right treatment, and about half of those receiving treatment regress. The only way to improve these percentages is to deepen our understanding of normal and abnormal brain functioning. We need research to develop better treatments for brain disorders in general, and for mental illnesses in particular.

Fortunately, some important initiatives launched in the last year are moving us in the right direction. In April, the United States National Institutes of Health introduced a ten-year BRAIN Initiative, joining similar efforts in the European Union, Israel, Japan, China, Australia, and Canada. We have also seen unprecedented levels of support from philanthropists. In the US, for example, $650 million was donated recently to the Stanley Center for Psychiatric Research. In the United Kingdom, a new charity, MQ, is awarding funds for research on psychological treatments.

Breakthroughs in biomedical research offer hope that cures for brain disorders will be found. By broadening access to existing treatments and investing in research to develop new therapies, we can aspire to eliminate one of the oldest and most widespread causes of human misery.

Thomas Insel is Director of the United States National Institute of Mental Health.

Copyright: Project Syndicate, 2015.
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