Three ways to address the mental health crisis: better funding, better understanding, better medication

PhD programs have always been tough. In my postgraduate days, ‘second-year blues’ was rampant: the process seemed to have taken an age already, but there was still such a long haul ahead. What seems to have changed is that too many students now perceive the stress as intolerable and do not pull through the process.

Following on from the insightful personal perspectives on mental health in the lab shared recently by Edward Wickstead, and before that by Aidan Seeley and Niamh McKerr, I want to explore some of the underlying systemic failings that are contributing to this growing problem – including those close to home among the scientific community.

Follow the money

The stigma around mental illness identified in the earlier blogs in this series clearly plays a huge part. It makes many people reluctant to admit that they are ill. It can also blind some of those around them who would otherwise be in a position to help – or else limit their response to little more than the “sock school of psychiatry” (“Just pull them up when feeling low”: Lewis Wolpert).

But while there are welcome signs that this attitude is dying out, such stigma clearly also affects decision making when it comes to finding better treatments at the other end of the spectrum: ie for serious psychiatric disorders. Comparison of the income of UK charities reveals that those funding basic research of mental illness and its treatment is negligible compared to the funding of research into illnesses such as cancer or heart disease.

These facts would suggest that funders, government and indeed we the general public are far more eager to find cures for illnesses that are typically life-threatening than for illnesses that are regarded as mainly affecting patients’ quality of life. But that prejudice seriously underestimates the risk of premature death arising from mental illness. The latest data from the Office for National Statistics shows that the number of deaths in the UK attributed to self-harm was twice that caused by road traffic accidents, with the incidence in under 25 year-olds increasing dramatically.

Psychology or biology?

Unfortunately, the stigma attached to mental illness is not confined to the lay community. Several studies have revealed that even some psychiatrists and clinical psychologists regard mental illness as mainly a psychological, rather than biological, problem. This distinction reveals a bizarre view of brain function because it implies that our thoughts and moods are not explained by brain architecture and biology. If that were the case, then we research pharmacologists are all wasting our time.

It further implies that, whereas patients are not to blame for illnesses with a biological explanation, that is not necessarily the case for illnesses that are regarded as psychological (eg Miresco & Kirmayer, 2006). The recent interest in social and environmental factors as causes of depression similarly risks losing sight of the fact that the harm imposed by these influences must arise from maladaptive changes in brain function.

The case for medication

There are two further problems, which pharmacologists (and the British Pharmacological Society) are well qualified to address head-on. One is the stigma associated with taking medication for psychiatric disorders. No diabetic would hesitate to take insulin every day for a lifetime, but there is little enthusiasm for taking antidepressants for prolonged periods, despite evidence that this would be advisable in some patients.

The other problem is a widespread lack of confidence in medicines that are prescribed for psychiatric disorders, especially antidepressants. For instance, a recent study which confirmed their efficacy (Cipriani et al., 2018) was greeted with scepticism on social media.

It is well known that antidepressants do not help all patients, but they are not unique in that respect. Statins do not invariably reduce plasma cholesterol and analgesics do not relieve all types of pain. Nevertheless, that does not seem to be an impediment to their prescription, and they quite clearly do help many people. So there is a concrete challenge here for us pharmacologists: we need to find a reliable way of better identifying the subgroup of patients who will benefit from taking antidepressants (and treatments for other psychiatric disorders) and, as is now the case, to ensure that they are prescribed appropriately.

What can pharmacologists do to help?

So, while experts in other fields focus on identifying and solving the problems that lead to postgraduates succumbing to the stress of their research, we pharmacologists can help by:

1. challenging the stigma attached to mental illness and its treatment
2. intensifying the research effort to find out how to best to treat it (which will depend on more support from the general public)
3. doing far more to convince everyone that the drugs we develop really do work, at least for some patients

To get involved with the British Pharmacological Society’s Early Career Pharmacologists Advisory Group’s work on mental health, please contact getinvolved@bps.ac.uk.

Comments

If you are a British Pharmacological Society member, please sign in to post comments.