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Learning lessons in mental health care from around the world

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Earlier in July, the journal Nature published a worldwide “call for urgent action” in research into mental health. The article, Grand challenges in global mental health, is based on an international review of “the priorities for research in the next 10 years that will make an impact on the lives of people living with [mental health, substance use and neurological] disorders”.

It is, inevitably, an ambitious undertaking that illustrates above all the burden of ill health worldwide that is linked to the wide range of mental health problems. Depression alone costs some 65 million disability-adjusted life years (DALYs) while alcohol misuse accounts for 23 million and schizophrenia nearly 17 million.

The article is also a reminder that mental health conditions receive a much smaller share of research funds than their prevalence and their impact on people’s lives would merit. The total fund of research into mental health conditions is simply not enough to tackle the level of need that exists.

As a result, the authors set out their 25 top priorities for research into mental health, sorted into six groups. While some of the priorities were specific to the developing world, most are applicable to the UK and address some of the biggest challenges we face in improving mental health across society and in improving the lives of people affected by mental illness.

Some of the most important priorities focus on prevention and early intervention. They include reducing the ‘duration of untreated illness’ which we know for many conditions has a major bearing on both the speed and success of recovery, and tackling key determinants of poor mental health such as child poverty and abuse.

Other priorities focus on improved responses to the needs of people with mental ill health, such as better screening in primary care and improved community care. And there are major workforce issues such as improving mental health knowledge among all health professionals and increasing the role of lay health workers in providing effective treatments.

Global “grand challenges” can seem a long way from the real world of mental health care and support. Yet while they should be first and foremost a reminder of the pressing need for more research funding for mental health, they do point to some of the biggest issues we all face now in improving the quality of care people get in a time of scarcity of resources.

They also serve as a reminder that countries around the world can all learn from each other. While mental health care in the UK is widely regarded as being among the best in the world, we can still learn from the efforts of services in developing nations that are working in much more straitened circumstances, often without the elaborate exclusion criteria that we apply to people and the silos in which we work.

Readers' comments (2)

  • I won't suggest that the above comment should be removed for being unsuitable and offensive. I don't generally support such censorship.But it is staggeringly ill-informed and unhelpful. The glib equation of mental illness with violence is simply false, and panders to the tabloids. People with mental health problems - including schizphrenia - are more likely to be victims of violence than prepetrators. The effect of stopping one schizophrenic from murdering someone would be precisely the same as the effect of stopping a murder by a Welshman, or a taxi driver, or a bald man. We have not closed our mental health institutions, only the 150 yrs old mega-hospitals, and we now have as many people living in residential care and supported accommodation with at least some dignity as we had on the back wards of the old bins. As for locking up peole who haven't committed a crime, in the name of a prediction we can't rely on and a treatment that doesn't exist - need I go on?

    Unsuitable or offensive?

  • Not that I wish to defend the Murdoch press, but… “more likely to be a victim of crime;” also more likely to hang around with other people with mental illness, on wards, day centres, etc. so who are the perpetrators in these cases most likely to be? The article calls for more research, but if there is already research as to who these perpetrators are, perhaps another reader of HSJ would like to signpost it to the rest of us. My impression of tabloid reporting is that they equate violence with psychosis, not anxiety and depression, which as I’m sure we all know make up the majority of mental illness. According to the Mental Health Foundation, about 1% of the population experience schizophrenia, whilst according to Shift, about 5% of homicides are carried out by people with schizophrenia. The Shift statistic is meant to assuage public concerns, but most tabloid readers would probably be alarmed to make the connection that 1% of the population commit 5% of homicides.

    http://www.mentalhealth.org.uk/help-information/mental-health-a-z/S/schizophrenia/

    http://www.shift.org.uk/mediahandbook/whatsthestory/reporting/index.html

    Of course, the vast majority of homicides are caused by one category of our society, men, and the tabloids aren’t clamouring for them to be locked up! But simply trotting out that tired old “mentally ill are most likely to be victims” phrase does less to de-stigmatise mental illness than more to undermine public confidence in statistics.

    As Eysenck quoted Claude Bernard at the beginning of Smoking, Health and Personality, “I do not reject the use of statistics, but I condemn not trying to go beyond them.”

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