Health experts agree that there is not nearly enough attention given to preventing mental illness. Instead, treatment is in place as it arises, which has been compared to only treating heart disease after a cardiac arrest.
Leading researchers feel that substantial money and many lives could be saved by investing more in a proactive approach.
While there has been a fitness, nutrition, and medicine movement over the past 50 years that has transformed physical health, few efforts have been made to bring mental health on a similar path.
“Prevention is much less developed in mental disorders than in other areas of medicine,” said Harvard Medical School professor, Ron C Kessler. “In psychiatry and psychology it is like we are practicing 1950s cardiology, where you wait for a heart attack and once it happens you know what to do.
“We need to go upstream a bit more.”
Mental health has far inferior resources in comparison to physical health and is decades behind when it comes to prevention. Some businesses are taking more progressive approaches, including telehealth counselors, mental health first aiders, and training programs. Some schools are also prioritizing psychological resilience education from a young age, and also offering counselling on site. Self-help apps are even giving individuals mental “fitness” tricks to help train themselves that many therapists believe help. Yet, only 5% of mental health research funding is spent on preventative approaches.
According to the World Health Organization, approximately 970 million individuals (1 in 8 people) suffered from a mental health disorder in 2017. The numbers for people seeking treatment are soaring.
“There is no epidemic of mental illness sweeping the world, but there is much more talk about it and more people are being treated,” says Harvey Whiteford, professor of population mental health at the University of Queensland.
As a result of this heightened awareness, the system is currently overwhelmed. Only 10 countries have more than 20 psychiatrists for every 100,000 people.
Given the system challenges, prevention is quickly emerging as a trend, but it is still extremely tricky given how poorly understood mental illness is.
“There are things we can do, but we don’t know enough about them and they fall outside the health system,” says Whiteford. “It’s not blood pressure, cholesterol and stopping smoking. The risk factors are child abuse, domestic violence, bullying, genetics.”
A recent paper in from the Lancet Psychiatry journal identified key risk factors that may cause mental illness. They concluded that (in chronological order) genetics, early brain trauma, childhood abuse and/or lack of stimulation, bullying, substance abuse, social adversity, shock and trauma, exposure to violence both domestic and military, immigration and social isolation, were all significant risk factors for mental illness.
The paper, which was produced by researchers out of Canada, the US, Australia, Spain and the Netherlands concurred that prevention strategies may include:
- Policy approaches such as improvements in childcare, destigmatizing mental illness, and reducing inequality
- Screening for genetic risks, parental or family mental illness, as well as delayed developmental milestones of young children
- Educating on things such as bullying, teaching young children how to be aware of their thoughts, and emphasising nutrition and exercise
Ricardo Araya, a professor at King’s College London, sees the need to educate children at a young age. “We are helping children to understand emotions, normal responses, that what you do will have an impact on how you feel, how to interpret things that happen, how you can poison your own life by coming to the wrong explanation of why things happen.”
“It has to happen by the age of 10 or you’ve missed the boat in terms of prevention,” Araya says.
Avoiding stress is not the answer, however, says Whiteford. Encouraging people to avoid too much stress would limit their “allostatic load”, a pooling of psychological trauma that can eventually lead to depression and PTSD.
“Everybody 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.”
Prevention is now about changing the way people think. A quote from Shakespeare’s Hamlet so eloquently puts it:
“There is nothing either good or bad, but thinking makes it so.”
It has taken some 400 years for us to really understand what this means.
“In the physical health world, you are what you eat,” Whiteford said. “In the mental health world, you are what you think.”