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New frontiers in mental health
Kristian Wahlbeck
Prague, 15.9.2016
ROAMERA Road Map for Mental Health
Research in Europe
Funded BY FP7/no282586
Mental health is shaped early in life
Where and how we are born, grow, live, work and age determines our mental health
Cumulative incidence of first DSM-IV disorder by comorbidity and severity
“Generalized“ psychopathology already present at age 13
5Ormel et al., Psychol. Med. 201415.9.2016 New frontiers
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Children who have been maltreated or bullied are much more likely to have mental health problems in adulthood
Great Smoky Mountains Study, Lereya et al Lancet 2015
Risk of mental health problems in adulthood
Normal popu-lation
Maltreated Bullied0.0
1.0
2.0
3.0
4.0
5.0
Odd
s rati
o
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Mental health inequityMental disorders are, generally speaking, twice as common among socio-economically disadvantaged individuals than among those close to the top of the social ladder
Mental health follows a social gradient• poverty and low income• insecure housing• limited education• recent unemployment/loss of social status• high-demand or low-control work• child abuse or neglect• poor neighbourhood conditions• low social support/networks• discrimination
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Mental health determinants & risk factors: Growing evidence base
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Socio-economic determinants (poverty, social exclusion)
Alcohol and illegal drug use
Common for all NCDs Specific for mental health
Early interaction deficitsNeglect, abuse and harsh
upbringingSchool bullying
Work place stressLack of social support &
networksCommunity environment
Grant Agreement no. 282586
Levels of Mental Health
Individual levelFamily level
Societal level
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Mental health systems
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Psychiatric services
Primary care
Prevention of mental disorders
Mental health promotion
Grant Agreement no. 282586
Perspective on Costs
0200400600800
Cost
s in
Billi
ons o
f €
Sources:http://rt.com/news/183052-japan-fukushima-costs-study/ http://www.reuters.com/article/2014/10/15/markets-bonds-euro-idUSL6N0SA3IH20141015 Gustavsson, A., Svensson, M., Jacobi, F., Allgulander, C., Alonso, J., Beghi, E., … Olesen, J. (2011). Cost of disorders of the brain in Europe 2010. European Neuropsychopharmacology, 21(10), 718–79.
Mental health: a field in transition• Deinstitutionalisation• Move from rom residential
services to assissted living• Growing role of primary care• Growing role of for-profit
service providers• Integrated care• Empowerment of service users• UN CRPD and human rights• A shift in focus from late
curative measures to promotion and early prevention
Grant Agreement no. 282586
Supporting Mental
Health For All
Measuring quality across
health services and
systems
How service users and
carers can be empowered
Prevention, protective factors and resilience
Finding how access to
services can be improved
Applying safe, innovative
and effective interventions Addressing
Societal Values and Issues
Using economics to
measure intervention
efficacy
Investigating wider socio-
economic outcomes
The effects of inequality on mental health
Reducing mental health
stigma
Taking a Life Course
Perspective The development of symptoms
across the lifespan
Longitudinal and cohort
datasets and studies
Risk factors and
preventions in childhood and adolescence
Towards Personalised
Medicine
Mechanisms of
psychological disorders
Improving diagnostic strategies
What are the mechanisms
and outcomes of
comorbidity?
Treatment evaluation
needs to be standardised
Building Research
Capacities
Sharing findings and databases
Maintaining inter-
disciplinary research networks
Building a strong
empirical research base
Involving stakeholders in research
Research is needed into…
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ROAMER: Geographic distribution of public mental health publications (weighted by GDP)
Forsman et al. 2015, Eur J Publ Health15.9.2016
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< 100100 – 200 200 - 300300 – 400> 400
Period: 2007-2011
ROAMER: Geographic distribution of randomized clinical trials(weighted by GDP)
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National public and non-profit funding for mental health research in euros for year 2011
Total amount
allocated for mental health
research (M€)
% of health research budget
allocated to mental health
Funding per capita for mental health research (€
/ inhabitant)
GDP allocated to mental health research (%)
Spain 16.8 5.6 0.4 0.0011
Finland 10.2 9.7 1.9 0.0037
France 84.8 4.1 1.3 0.0030
UK 123.4 6.5 2.0 0.0048
ROAMER: National funding for MH research
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Hazo et al, submitted 2016
Grant Agreement no. 282586
High Level Priorities
1. Research into mental disorder prevention, mental health promotion and other interventions in children, adolescents and young people
2. Focus on the development and causal mechanisms of mental health symptoms, syndromes and well-being across the lifespan (including older populations)
3. Developing and maintaining international and interdisciplinary research networks and shared databases
4. ͏ Developing and implementing better interventions using new scientific and technological advances
5. ͏ Reducing stigma and empowering service users and carers in decisions about mental health research
6. ͏ Health and social systems research that addresses quality of care and takes account of socio-cultural and socio-economic contexts and approaches
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NIH/NIDA: A child’s first eight years are critical for substance abuse prevention
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“There is strong evidence that a stable home environment, adequate nutrition, physical and cognitive stimulation, and supportive parenting can lead to good developmental outcomes.”
Source: NIH/NIDA 2016
Evidence based public mental healthConsentious use of critically appraisedmethods to promote mental health, prevent mental health problems and provide services.
Public mental health interventionsare typically complex, and a larger variety of evaluation methods are needed thanIn a clinical context
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World Psychiatry 2015;14:36-42
Grant Agreement no. 282586
High Level Priorities
1. Research into mental disorder prevention, mental health promotion and other interventions in children, adolescents and young people
For example: • Performing and sustain long-term prospective cohort studies
on the determinants of mental health and well-being and to study risk and protective factors for mental disorders
• Determining what the social and biological factors underlie risk or resilience factors for mental disorders across the life span
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Mental health promotion
• MHP aims to strengthen mental health and wellbeing in the population
• Mental health is dependent on structural determinants: mental wellbeing is best achieved in equitable, just and non-violent societies (Patel 2014)
• New evidence shows that mental health promotion is effective • Parenting support• Socio-emotional learning programmes in schools• Work-life interventions to improve stress coping skills• Social activities for elderly people
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Effective public mental health interventionsParenting support interventions have been shown to promote life-long mental health and well-being of the offspring.
School programmes have consistently been shown to have positive moderate to strong effects on social and emotional skills and competences
Workplace reorganisation and increased control over work life improve mental wellbeing, increase productivity and reduce costs
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Intergenerational transmission ofmental healthproblems canbe stopped
Risk of mental disorders in the offspring of parents with mental disorders is reduced by 40% by preventive interventions
Siegenthaler et al. JAACAP 2012
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40 % of mental disorders can be prevented in high-risk families
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Effect of interventions on the risk in the child of the mental disorder diagnosed in the parent. Siegenthaler et al. JAACAP 2012
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Income-to-needs ratio = poverty line = 1Internalizingproblems
Norwegian Mother and Child Cohort Study (MoBa), N=75296 (Zachrisson & Dearing, 2014)15.9.2016
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Evidence-based school interventions
• Anti-bullying programmes• Whole-school approach• Teacher training programmes
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Primary prevention of mental disorders and suicide• More than 30 randomized trials have demonstrated that preventive
interventions can reduce the incidence of new episodes of major depressive disorder by about 25% and by as much as 50% when preventive interventions are offered in stepped-care format
Cuijpers, JAMA 2012• There is strong evidence that CBT interventions are effective for
preventing depression during the perinatal periodSockol, J Aff Dis 2015
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Grant Agreement no. 282586
High Level Priorities
5. Reducing stigma and empowering service users and carers in decisions about mental health research
For example:Studying the role of stigma in the wider context of inequalities (health inequalities, etc.) and implementing interventions to assess the place of stigma in public services
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Mental health has moved into the political sphere• Importance of mental health for people’s wellbeing and productivity has
widely been acknowledged
• Increased interest in mental health promotion and prevention of mental disorders
• The translation from rhetoric to practice needs to be done: The EU Joint Action for Mental Health and Wellbeing was a common vehicle of the EU Commission and the Member States for moving towards action
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www.mentalhealthandwellbeing.eu
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• Going upstream: Structural determinants of mental health
PovertyGender inequalityWar and conflictsSocial exclusionIncome inequality
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Company performance and workplace wellbeing: indices by country
Source: Eurofound Third European Company Survey 201515.9.2016
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Gap between evidence and practice
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Social determinants of mental health
Mental health promotion
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Social determinants of mental health
Mental health promotion
Mental Health in All Policies
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http://ec.europa.eu/health/ph_determinants/life_style/mental/docs/consensus_depression_en.pdf
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EU Joint Action for mental health and well-being 2013-2016Based on the European Pact for Mental Health and Well-being
Mental health promotion in schoolsWorkplace mental health promotionPrevention of depression and suicidesCommunity care and deinstitutionalisationMental health in all policies
• Identifies best practices for cross-sectoral work and whole-of-government practices across Europe
www.mentalhealthandwellbeing.eu
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A tool for Mental Health in All Policies: Mental health impact assessment
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How does the proposed development/policy impact on…
• social determinants of mental health
• equity• people’s control• people’s participation• resilience and communtiy
assets• social inclusion?
Successful mental health actions build on intersectoral collaboration
Thanks!
