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Mental illness in the 21st Century –an Increasing Challenge for Europe
Guy Goodwin
University of Oxford
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The challenges
• Mental disorders are common
• Some of them, notably depression, areextremely costly both to the individualand society
• Many patients do not receive treatment
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ECNP/EBC Report 2011
Size and Burden of Mental Disorders and otherDisorders of the Brain in Europe 2010
Hans-Ulrich Wittchen on behalf of the study group
Institute of Clinical Psychology und PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS)
Technische Universität Dresden, Germany
This presentation summarizes and extends the findings reported in EuropeanNeuropsychopharmacology, 2011 (September issue)
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12-month prevalence (no. persons affected)
14.0
7.0
6.9
5.4
5.0
4.9
3.4
3.0
2.0
1.3
1.2
1.0
0.9
0.7
0 2 4 6 8 10 12 14
Anxiety disorders
Insomnia
Unipolar depression
Dementia
ADHD/Hypercin. dis.
Somatoform disorders
Alcohol dependence
Conduct dis.
PTSD
Personality dis.
Psychotic disorder
Cannabis dependence
Eating disorder
OCD
Mental Disorders by prevalence (and estimated
number of persons affected in millions)
(2.9m)
(1.5m)
(1.4m)
(5.0m)
(4.3m)
(7.7m)
(2.1m)
(14.6m)
(20.4m)
(3.3m)
(6.3m)
(30.3m)
(29.1m)
(29.1m)
Note:For many disorders, the 12-monthprevalence refers to different agesranges (like dementias to subjectsaged 60+). Thus the estimatednumber of persons refers to differentreference populations
0,6% in total
1.2% in total
0.4% in total
Overall:164.8 milion of
the total 510million EUpopulation
Health DisabilityMorbidity
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0%
20%
40%
60%
80%
100%
Prevalence ofm entalhealthproblem s–w orking age population(UK)
Severe mental illness(schizophrenia, bipolar disorder,serious depression) 1%-2%
Symptoms (sleep problems, fatigue,worry, but no disorder 17%
Common mental disorders:symptoms that reach threshold fordiagnosis 17%
Symptom-free 64%
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Productivity90%
Mortality6%
Service costs4%
Totalcost= £ 9 bn
Thomas & Morris Brit J Psychiatry 2003
Depression–costsforadultsinEngland,2000 -continued
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GB - disability benefits, 2007
22%
40%
6%8%
18%
6%
Other Mental and Behavioural Disorders
Nervous System Circulatory and Respiratory System
Musculoskeletal System Injury, Poisoning, External Causes
Department of Work and Pensions, 2007
€ 3.9 billion per annum
Plus reduced tax receipts €14 billion
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0
2000
4000
6000
8000
10000
N odepression Subthreshold depression M ajordepression
0 1 2 3
Simon et al, Gen Hosp Psychiatry, 2005
0 0 01 1 122 233 3
Number of reported diabetescomplications
Costsofhealthservice use by diabetespatients,by depressionseverity
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What to do?
• Prevention and health promotion
• Better access to treatment
– Even if diagnosed, often not treated
• Better treatment
– Research
– Development
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http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_126085
N ew econom icevidence onm entalhealthprom otionand m entalillness
preventionA pril2011
Check reportforfulldetails
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Economic pay-offs per £1investment
NHS
Otherpublicsector
Non-publicsector
Total
Early identification and intervention as soon as mental disorder arises
Early interventionforconductdisorder 1.08 1.78 5.03 7.89
H ealthvisitorinterventionstoreduce postnataldepression
0.40 - 0.40 0.80
Early interventionfordepressionindiabetes 0.19 0 0.14 0.33
Early interventionformedically unexplained symptoms 1.01 0 0.74 1.75
Early diagnosisand treatmentofdepressionatwork 0.51 - 4.52 5.03
Early detectionofpsychosis 2.62 0.79 6.85 10.27
Early interventioninpsychosis 9 .68 0.27 8.02 17.9 7
Screening foralcoholmisuse 2.24 0.9 3 8.57 11.75
Suicide training coursesprovided toallG Ps 0.08 0.05 43.86 43.9 9
Suicide preventionthroughbridge safety barriers 1.75 1.31 51.39 54.45
Promotion of mental health and prevention of mental disorder
Preventionofconductdisorderthroughsocialandemotionallearning programmes
9 .42 17.02 57.29 83.73
School-based interventionstoreduce bullying 0 0 14.35 14.35
W orkplace healthpromotionprogrammes - - 9 .69 9 .69
Addressing social determinants and consequences of mental disorder
Debtadvice services 0.34 0.58 2.63 3.55
B efriending forolderadults 0.44 - - 0.44
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Better treatment
• Brain science
– Make connections to clinical problems
• Withdrawal of big pharma fromneuroscience
• Priority setting within the science budgetat national and european level
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ECNP
www.ecnp.eu
www.ecnp.e
A four point plan
• Increase investment
• Increase research
• More rational regulations
• Empower patients
David Nutt and Guy GoodwinEuropean Neuropsychopharmacology (2011) 21,495–499
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ECNP
www.ecnp.eu
www.ecnp.e
European research spend
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Conclusions
• Mental disorders are common anddisabling, affecting adults of workingage
• The costs are largely indirect – notservices, drugs
• Can we improve the delivery of effectivetreatments
• How will we get innovation in preventionand treatment?
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The Landmark discoveries
• 1947 Lithium– Cade but developed by Schou etc
• 1952 Chlorpromazine– Delay and Denniker
• 1958 Imipramine– Kuhn
• 1970 Clozapine
• 1970 Zimelidine
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The Landmark discoveries
• Clinical trials
• Meta-analysis of RCTs
• Effective psychological treatments
• Social psychiatry
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Recommendations from the meeting
Work on ways to increase investment.
Enhance research.
•Hosting a network for psychopharmacology research: ‘the medicine chest’.
•Developing ‘open-source’ databases for compounds that companies are no longerworking to develop. This might include an ‘eBay-like’ option for other companies tobid for unwanted compounds.
•Set up and/or recognise special centres of excellence in central nervous system(CNS) experimental research and brain imaging where sophisticated early phasetrials can be conducted, experience accumulated, new researchers trained andskilled employment positions provided.
•Work with US colleagues on initiatives in the same arena, such as the new NationalInstitute of Health (NIH) translational medicine institute.
•Create access to clinical trial databases to allow individual patient data meta-analyses to answer critical questions relevant to patient selection and trial design.
Review the regulatory process
Empower patients: work with patient organisations, particularly in relation tostigma, trial outcome measures and funding sources.