Wednesday, January 21, 2015

4 things leaders need to know about mental health

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 among the
conditions recognizable in literature stretching back to ancient
Greece. Robert Burton’s 1621 work, ‘The Anatomy of
Melancholy,’ remains one of our most astute descriptions of
depression. Rather than being disorders of the developed world,
most of the morbidity from mental illness and 75% of the
mortality (measured as suicide) are in low- and middle-income
countries.
What is new, and encouraging, is the heightened attention now
being given to mental illnesses. Last year at Davos, I helped to
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 be more than the costs
of cancer, diabetes, and respiratory ailments put together.
When you can’t get up or make a call
Too many people dismiss mental illnesses as problems of
character or lack of will, rather than recognizing these disorders
as serious, often fatal, medical disorders. For anyone who has
not experienced depression, the most common mental illness, it
is important to distinguish the disorder of depression from the
sadness, disappointment, or frustration we all experience in our
lives.
Indeed, when someone develops major depressive disorder, he
or she may no longer experience any of these “normal” feelings.
William Styron’s 1989 classic, ‘Darkness Visible,’ rightly calls
“depression” a wimpy 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. While a person with depression might manage to
get to work, concentrating or functioning in the workplace
becomes intensely challenging. There is growing recognition of
this condition, which is known as “presenteeism,” a variation on
“absenteeism” – it means that depressed employees are present
in body, but absent in mind.
Four things leaders need to know
In the United States, approximately 7% of people suffer an
episode of depression and about one in five people experience
some form of mental illness each year. With prevalence rates so
high, the human and economic case for leaders to take mental
health more seriously is clearly compelling. What do they need
to know?
First, mental disorders are brain disorders. The brain is a bodily
organ just like any other. We should no more blame ourselves or
others 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 they expect
for disorders of any other part of the body.
Second, mental illnesses are tied inextricably to physical illness
beyond the brain. Brain disorders like depression and
schizophrenia greatly increase the risk of developing chronic
diseases such as cardiovascular and respiratory diseases.
People with mental illnesses and substance abuse are at
increased risk of certain infectious diseases such as HIV/AIDS.
Beyond increasing risk, mental illnesses have a profound impact
on outcome. In fact, following a heart attack, the presence of
depression is more important for prognosis than virtually any
measure of cardiac function, except for being in frank heart
failure. That’s why the expression “no health without mental
health” has become an important guide for health care policy.
Third, 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 the thought that they could have
prevented a loved one’s death is much greater, meaning that
every suicide has many victims.
Fourth, effective treatment can be low-cost and low-intensity.
Not everybody with a mental illness needs expensive drugs,
hospital care, or even direct access to highly trained
psychiatrists. In low resource environments, locals or family
members can be trained to provide brief, effective
psychotherapies that treat moderate forms of depression or
anxiety. Even phone- or internet-based therapy can be used to
help recovery. While we don’t have the equivalent of a vaccine
for measles or the bed net for malaria, there are low-cost, highly
effective interventions for most people either at risk for, or
already suffering from, a mental illness.
Today’s treatments are not good enough
Finally, this is an area where policy makers need to do more than
“build it and they will come.” It is not enough simply to make
treatment available. People with psychotic disorders may deny
they are ill and those with 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 with depression
are diagnosed and treated. In the developing world, WHO
estimates that 85% of people with a mental illness are untreated.
We need sensitive ways to identify those at risk and to help
those who are most disabled receive treatment.
That said, it should be acknowledged that treatments for mental
illness remain far from infallible. Of those who get treated, only
about half get the right treatment, and only about half of those
remit. The only way we can hope to improve these percentages
is by understanding more about how the brain works, in its
normal and abnormal modes. Yes, we need to close the gap
between what we know and what we do, ensuring that today’s
treatments are implemented. But for many people, today’s
treatments are not good enough. We need research to develop
better treatments for brain disorders generally, and mental
illnesses specifically.
Fortunately, the launch of some important initiatives this past
year has us moving in this direction. The US National Institutes
of Health launched a 10-year BRAIN Initiative , joining similar
existing or developing efforts in the EU, Israel, Japan, China,
Australia, and Canada. We have also seen unprecedented levels
of support from philanthropists – for example, in the US, $650
million was donated recently to the Stanley Center for
Psychiatric Research, while a new UK-based charity, MQ , began
awarding funds for research on psychological treatments.
Biomedical research gives us hope for cures, for brain disorders
as much as any other part of the body. With better policies for
providing existing evidence-based treatments in the near-term
and research for developing better treatments in the long-term,
we can aspire eventually to consign mental illness to the history
books.

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