Prevention: the new Holy Grail of the treatment of mental illness | Society

FAccording to health experts, more attention should be paid to preventing mental illnesses rather than treating them at the present time by comparing the current approach of treating only heart disease after a long period of time. cardiac arrest.

At the beginning of a new series of Guardian publications on diseases that would affect nearly one billion people worldwide, reputable researchers have said that money and lives could be saved by investing more in maintaining people's health.

They say that the revolution of fitness, food and medicine over the past 50 years has transformed physical health, but that little similar effort has been made to keep people healthy mental.

"Prevention is much less developed in mental disorders than in other areas of medicine," said Ron C Kessler, a professor at Harvard Medical School. "In psychiatry and psychology, it's like if you practiced cardiology of the 1950s, where you expect a heart attack and, once that happens, you know what to do."

"We have to go upstream a bit more."

Mental health still has few resources in relation to physical health and its delay in prevention is several decades old. Some companies are dealing with mental health first aiders, digital advisors and awareness campaigns. Some schools also teach students psychological resilience at an early age and offer advice on the spot. Many people practice the type of mental "training" that therapists think they can help, but overall, only 5% of funding for mental health research is spent on prevention research.

According to the World Health Organization, about one in eight people, or 970 million people, suffered from some mental disorder in 2017, and the number of people seeking treatment is rising.

"No epidemic of mental illness is sweeping the world, but it is being talked about a lot and more people are being treated," said Harvey Whiteford, professor of population mental health at the University of Queensland.

The result is that services are overwhelmed. Only 10 countries, most of them in Western Europe, have more than 20 psychiatrists per 100,000 population. Only five have more than one psychologist per 1,000 people and only two – Turkey and Belgium – have more than one mental health nurse per 1,000 people.

Prevention is fast becoming the buzzword, but it is a delicate subject because mental health issues are still poorly understood.

"There are things we can do, but we know enough about them and they are not part of the health system," says Whiteford. "It's not blood pressure, cholesterol and stopping smoking. Risk factors are child abuse, domestic violence, bullying, genetics. "

A recent article in Lancet Psychiatry has identified the main risk factors that can lead to mental illness. In general chronological order, they include genetics, early traumatic brain injury, child abuse and / or lack of stimulation in childhood, bullying, substance abuse, social adversity, shock and trauma, exposure to domestic and military violence, immigration and social isolation.

The paper written by researchers in Spain, Australia, the United States, Canada and the Netherlands suggests that prevention strategies could include:

• Policy approaches such as reducing inequalities, improving child care and de-stigmatizing mental illness

• Health care initiatives such as genetic risk screening, parental mental illness and developmental delay in young children

• Best educational practices such as fighting bullying, focusing on nutrition and exercise, and teaching children to be aware of their thinking

Most mental illnesses strike first before the age of 25, bringing Ann John, a professor at Swansea University, who advises the Welsh government on the prevention of suicide and self-harm, saying that it would be logical to carry out many prevention activities. to arrive in secondary schools.

She defends an idea called "global approach to the school", which is gaining ground in the United Kingdom, New Zealand and elsewhere. It focuses on coping skills and resilience, and considers positive mental health as a fundamental part of a school's philosophy.

Ricardo Araya, a professor at King's College in London, thinks the work needs to start even sooner. He has participated in trials involving pre-adolescents in Britain, Brazil and Chile, helping to strengthen psychological flexibility. "We help children understand the emotions, the normal reactions, that what you do will have an impact on how you feel, how you interpret events, how you can poison your life by explaining erroneous why these events occur. "

He mentions the work of economist James Heckman, Nobel laureate, who showed that a targeted investment in disadvantaged preschool children reported an annual return of 13% through better results in health, social behavior and employment.

"It has to happen at the age of 10 or you've missed the mark in terms of prevention," says Araya.

Whiteford says encouraging people to avoid too much stress would reduce their "allostatic load," an accumulation of psychological trauma that can eventually lead to depression and post-traumatic stress disorder (PTSD).

"Everyone has a breaking point," he says. "We are all on this continuum of vulnerability, and protecting ourselves from psychological trauma, is like protecting ourselves from too much exposure to the sun."

Foremost, prevention is about changing people's thinking, he says. Shakespeare's Hamlet said, "There is nothing good or bad, but thinking makes it so." It took 400 years for people to understand what he meant.

"In the world of physical health, you are what you eat," Whiteford said. "In the world of mental health, you are what you think."

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