Mental illness in the 21st Century –an Increasing Challenge for Europe

Guy Goodwin

University of Oxford

The challenges

• Mental disorders are common

• Some of them, notably depression, areextremely costly both to the individualand society

• Many patients do not receive treatment

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)

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

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%

Productivity90%

Mortality6%

Service costs4%

Totalcost= £ 9 bn

Thomas & Morris Brit J Psychiatry 2003

Depression–costsforadultsinEngland,2000 -continued

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

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

What to do?

• Prevention and health promotion

• Better access to treatment

– Even if diagnosed, often not treated

• Better treatment

– Research

– Development

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_126085

N ew econom icevidence onm entalhealthprom otionand m entalillness

preventionA pril2011

Check reportforfulldetails

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

Better treatment

• Brain science

– Make connections to clinical problems

• Withdrawal of big pharma fromneuroscience

• Priority setting within the science budgetat national and european level

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

ECNP

www.ecnp.eu

www.ecnp.e

European research spend

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?

The Landmark discoveries

• 1947 Lithium– Cade but developed by Schou etc

• 1952 Chlorpromazine– Delay and Denniker

• 1958 Imipramine– Kuhn

• 1970 Clozapine

• 1970 Zimelidine

The Landmark discoveries

• Clinical trials

• Meta-analysis of RCTs

• Effective psychological treatments

• Social psychiatry

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.