Mental health is in the public eye like never before, and with it, a welcome shift in how we talk about - and with - people with mental health problems. While I have no doubt that stigma is still very prevalent in society, I also see how stigmatising attitudes and comments are being increasingly challenged and questioned. Celebrities are openly disclosing their own experiences with mental health problems, royalty launch campaigns to support people with mental illness, and politicians of all parties are unified in, at the very least, recognising the problem and the need for change. I would argue that now presents a unique time to make a real step change in how we work together to make a positive impact in the mental health for current and future generations.
What changes need to be made? For one, despite the enormous impact of mental disorders, mental health research is under-funded. This is most obviously visible in terms of charitable donations – for every £1 the government puts into research in cancer, the general public put in another £2.75. In mental health, the equivalent figure is less than a penny. The pharmaceutical industry, whose investment is critical in gaining better understanding of underlying biological mechanisms and the development of new drug treatments has significantly pulled out of mental health research over the last two decades.
This gloomy picture does not reflect that our understanding of underlying biology of mental disorders is being transformed by three revolutions. The molecular revolution – in particular genomics – means we are now are able to use genetic data to put together risk scores of people’s likelihood of experiencing a disorder in their lifetime. Our hope is that we will be able to use such scores to say more about which treatments they may benefit from. The neuroscience revolution promises a huge amount because we have increasingly sophisticated ways of understanding how the brain works in illness and in health both in laboratory science and in humans using, for example, multi-modal neuroimaging techniques. Finally, the digital revolution has an enormous potential to transform health, by the effective use of data from many sources. For example, smartphones and wearable devices provide real opportunities to understand aspects of behaviour, cognition and physiology.
The future for research is exciting, but what else can we do in the here and now? First and foremost we need to work in partnership with patients and service users affected by mental health problems. HIV was transformed when people with HIV started demanding that research on new treatments was conducted. In cancer care it’s virtually the norm that people are offered the opportunity to participate in research trials. There is strong evidence that taking part in a trial means one gets better care and better outcomes than not doing so. And if we are to offer better treatments in the future we need people to be willing to take part in trials. It’s vital that we build consensus about what research is most valued by those affected – a process we and many others have already started.
Secondly, the mental health research community is relatively small. We need to encourage the best and brightest scientists – across many disciplines - to join the quest for better understanding of mental health and better treatments for mental disorders. We also need to ensure that existing research centres pull together as much as possible to enhance our efforts.
This is why we have established a National Institute of Health Research (NIHR) Mental Health Translational Research Collaboration (TRC). TRCs have previously been established in rheumatology, dementia and respiratory disease to pool resources between different NIHR infrastructures, making it as easy as possible to establish research studies between centres. The TRC in mental health will start by focussing on a limited number of high priority issues – the first identified is treatment resistant depression. We already have a number of collaborative projects up and running in this field and we will move to increase our capacity to conduct research in this area. The research is badly needed – many people with depression do not respond to psychological treatments or antidepressants. We hope to be able to test new treatments or approaches to treatment in these individuals.
Our research will link up with a newly established NIHR Mental Health BioResource, which will at the same time launch a research platform to identify people who have experienced anxiety and or depression (the GLAD study) inviting people to complete questionnaires, provide samples of DNA and to give permission to be followed up for future research projects.
We hope, by working in partnership with patients, bringing in new talent, and joining up the resources we have already, that we can transform the landscape of mental health research – and by doing so to improve the lives of those affected.
Professor Matthew Hotopf CBE is director of NIHR Maudsley Biomedical Research Centre