Chair’s Column October 2012

INIMH newsletter launch coincides with World Mental Health Week

J. Lake

Mental illness accounts for about one-third of the world’s disability due to all health problems in adults (Anderson and Jane-Lloplis 2011), reflecting marked societal and personal suffering and enormous socioeconomic costs. The current model of mental health care does not adequately address this crisis on a global level, calling for urgent change in the paradigm and practices of mental health care including basic reforms in education, clinician-training, and research. In spite of increased availability of antidepressants over the past few decades, questionable efficacy, unresolved safety issues and high treatment costs have resulted in an enormous unmet need for treatment of depressed mood, bipolar disorder, anxiety disorders, schizophrenia and other common mental disorders. For example it takes approximately 10 years on average for a depressed person to obtain treatment after symptoms begin however over two-thirds of depressed individuals never receive adequate care. Further, among depressed individuals who eventually find mental health care, it is estimated that fewer than half have access to conventional antidepressants.

Despite the magnitude of the impact of mental illness on health globally, most countries still do not regard mental illness as a high priority. In response to these circumstances the World Health Organization recently called for the integration of mental health services as a priority in global development efforts and invited academic and research institutions, non-governmental organizations and global partnerships to implement more effective strategies (Churchill 2010). As part of this global initiative, WHO in collaboration with the World Federation for Mental Health designates October 10 as World Mental Health Day. This year’s World Mental Health Day focused attention on the prevalence rate of major depressive disorder which is estimated to affect more than 350 million people of all ages and socioeconomic backgrounds. Depression has historically been one of WHO’s top priorities, covered under its Mental Health Gap Action Program which aims to improve mental health services in all countries. The current global economic downturn has resulted in increased rates of depression and other major mental health problems in all world regions due to wide-spread unemployment, loss of income and widespread concerns about the future. The elderly, minorities, low income groups, the uninsured, and residents of rural areas are less likely to receive adequate mental health care and most people with serious mental health problems in the United States receive either no treatment or inadequate treatment for their disorders (Wang et al 2005). In 2009, the last year for which data are available, total costs associated with treating mental illness in the U.S. including outpatient visits, hospitalizations, and ER treatment were approximately $80B, almost matching total treatment costs associated with heart disease and trauma. Heart disease was the only major medical condition for which total treatment costs significantly surpassed costs associated with mental illness. Each year 38.2% of the European Union population (approximately 165 million people) meet criteria for a psychiatric disorder however fewer than one third receive any treatment at all (Wittchen et al 2011). The prevalence of mental illness in EU countries will probably continue to increase due to low treatment rates among the seriously mentally ill, delayed access to care and grossly inadequate treatment. These alarming statistics suggest that the majority of mentally ill individuals in all world regions probably receive inadequate or no care. This problem is made worse by the fact that widely used biomedical and CAM therapies are supported by limited evidence of safety or efficacy. The emerging paradigm of integrative mental health addresses these issues by offering individualized treatments taking into account unique patient needs based on the best available conventional and CAM research findings.

In the context of well described limitations and risks associated with pharmacological treatments and shortcomings of the conventional model of mental health care, the added burden of mental illness caused by the global economic downturn is an invitation to renewed dialog on the range of promising non-conventional treatments as well as new approaches in care delivery. In addition to novel pharmacological therapies, accumulating research evidence is demonstrating efficacy of other treatment modalities for many common mental health problems including psychological interventions, select standardized pharmaceutical-grade natural products, as well as non allopathic whole system approaches such as Traditional Chinese Medicine (TCM), Ayurveda and Tibetan Medicine, meditation, yoga and other mind-body practices. Examples scientifically validated alternative therapies widely used in mental health care include St John’s wort (Hypericum perforatum) and S-adenosyl methionine (SAMe) for depression, adjunctive nutrients such as folic acid, l-tryptophan, n-acetyl cysteine, and SAMe for mood disorders, acupuncture for acute anxiety or depression, mindfulness training for negative symptoms of schizophrenia, anxiety and mood disorders, especially major depressive disorder (J Lake, 2007). In addition to these CAM therapies, lifestyle modifications such as regular exercise, and a healthy diet also offer encouraging evidence for improving overall mental health and reducing relapse risk (Berk, Sarris, Cousan, & Jacka, 2012; Walsh 2011).

In direct response to the urgent unmet need for improved mental health care globally, widely acknowledged limitations of widely used biomedical treatments, inadequacies of the conventional model of care, and growing evidence for select alternative and integrative therapies, in March, 2010, the International Network of Integrative Mental Health (INIMH) was established to advance an agenda for transforming mental health care into a more effective, safer, and more cost-effective paradigm and model of care. Collaborating with mental health professionals around the globe INIMH honors strategic WHO initiatives aimed at improving access to mental health care and providing more effective, more affordable treatments and improved standards of care in all world regions. In recognition of the important work of WHO and the World Federation of Mental Health, INIMH is proud to announce that our first quarterly newsletter is being released to coincide with World Mental Health Week.