The future of wellbeing – prevention, tech, and more

30 Jul 2019 Ryan Miller    Last updated: 30 Jul 2019

Photo by rawpixel.com from Pexels
Photo by rawpixel.com from Pexels

Mental health provision has never been good enough. As our understanding of mental health improves, we need to build a system fit for the future, not the present. Technology will play a part. We need to decide what part that is.

 

In 2017 one in eight people suffered from some sort of mental disorder, according to estimates from the World Health Organisation.

Rates of reported poor mental health are soaring – but increases in reporting do not necessarily mean increases in incidents.

The rise in reports goes hand in hand with our greater understanding of mental ill health, both amongst the general population and at the cutting edge.

Populations around the globe have more awareness of the existence, importance and treatability of mental health. There is a wider understanding of it as a key part of general health and wellbeing.

At the same time, the medical profession has an ever expanding understanding of mental health meaning our ideas of good practice in treatment and self-care evolve over time.

Per Harvey Whiteford, Professor of Population Mental Health at the University of Queensland: “There is no epidemic of mental illness sweeping the world, but there is much more talk about it and more people are being treated.”

Quality of treatment is another matter.

State of treatment

The WHO’s Mental Health Atlas Project aims to collect data on resources around the world. Its first report was published in 2001 and there have been updates in 2005, 2011, 2014 and 2017 – with the latest paper relying on information from 177 of the WHO’s 194 member states, representing 97% of the world’s population.

According to the WHO: “In low-income countries, the rate of mental health workers can be as low as 2 per 100 000 population, compared with more than 70 in high-income countries.

“This is in stark contrast with needs, given that 1 in every 10 person is estimated to need mental health care at any one time.

“Less than half of the 139 countries that have instituted mental health policies and plans, have these aligned with human rights conventions which stress the importance of transition from psychiatric institution to community-based services and the participation of people with mental disorders in decisions concerning them. And all too often, when mental health plans are made, they are not supported by adequate human and financial resources.”

What about us?

The difference in provision between low- and high-income countries is huge. Nevertheless, even a figure of 70 mental health workers per 100,000 population seems quite low when an estimated 10,000 of those people will be suffering from poor mental health at any one time.

Here in Northern Ireland, high-quality care is, if anything, more important. Last year a number of mental health organisations signed a letter which described local mental ill health levels as “catastrophic”. NI has 25% higher rates of poor mental health than England, and as many as one fifth of the population show signs of a possible mental health problem while in the 2017/18 NI Health Survey 26% of people said they had concerns about their own mental health.

However, mental health care is not all about post hoc treatment. If anything, modern thinking tends towards the opposite, and prevention is now seen as hugely important when it comes to improving population mental health.

Prevention is closely related to the concept of resilience – of being able to stay well during the difficult times in our lives.

Preventing poor mental health (such as by improving people’s resilience) is not some passive policy. Quite the opposite. Investment is hugely important.

Early years intervention

Many experts say this starts in childhood, by improving the mental health of kids in primary school.

Some even assert this is not just ideal but essential. Professor Ricardo Araya, from King’s College in London, says: “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.”

Scope spoke previously with Action Mental Health (AMH) about the importance of resilience, how it is something that can be actively improved, and about some of their targeted programmes that are tailored to different population groups – including one for primary school children as young as eight.

One of their key concerns, however, was that there are simply not adequate resources for provision to be readily available wherever it is needed.

Amanda Jones, Operations Manager for Resilience and Wellbeing at AMH, said: "There is a responsibility for this provision to be delivered. It should have statutory funding.”

Where there is a lack of resources, it is important to ask how more can be found. It is also fair to look for novel and innovative solutions, where possible.

Technology

It’s easy to roll your eyes about the World Economic Forum (WEF) and the Davos set.

They can seem like the very definition of out of touch, and their (many, and often utopian) proposed solutions to global problems are notorious for skirting round direct solutions to the wealth inequality that arguably lies behind many of these problems.

A new report released earlier this month is undeniably vulnerable to such an accusation. It is called Empowering 8 Billion Minds - Enabling Better Mental Health for All via the Ethical Adoption of Technologies.

The paper’s Executive Summary is quite remarkable, especially for people who read a lot of these reports and are used to summaries made of key findings and recommendations. It begins with a fictional narrative whereby a young man from India who suffers from periodic depression is able to keep his mental health positive with help from tech interventions:

“Ajay chose a service that used mobile phone and internet technologies to enable him to carefully manage his personal information. Ajay would later develop clinical depression, but he spotted that something wasn’t right early on when the feedback from his mental healthcare app highlighted changes in his sociability. (He was sending fewer messages and leaving his room only to go to campus.) Shortly thereafter, he received a message on his phone inviting him to get in touch with a mental health therapist; the message also offered a choice of channels through which he could get in touch…

“Now back to reality. And today’s reality could not be more different.

“Even in the wealthiest countries, waiting times for expert appointments and counselling extend to months. (One UK study of more than 500 adults found that a quarter of individuals with mental health issues waited more than three months to see an NHS mental health specialist; 6% had waited at least a year.)

“However, an experience such as Ajay’s is not as much of a pipe dream as it might appear. The range of new technologies within the mental healthcare sector (and the rate at which these are being developed) is staggering. These innovations span the whole spectrum of mental health, from self-care (one of the fastest-growing markets for apps) to self-assessment tools (there are hundreds of psychological tests available online) through to developments such as electroencephalogy (EEG), which measure brain activity and offer the promise of early diagnosis.”

This is long-winded rhetoric but, to be fair to WEF, it paints a picture and the report itself has some concrete suggested next steps.

Recommendations

WEF’s report puts “ethical” in the title in a way that could be no more than a wave of a hand, however the report also looks into this in some detail and concerns about misuse are built into the recommendations.

It is completely understandable – in fact, it is plainly sensible – to be wary of the dangers of data in the modern world.

However, tech presents undeniable opportunities. Are we really comfortable suffocating these, or forgoing them entirely, or would we rather aim high? WEF, of course, entertains only the latter.

The paper says tech is already widely used in healthcare and these uses are growing. It notes that tech-based care is “location agnostic” and that good use of data will lead to better outcomes.

“The greater use of new and existing technologies in this space raises a complex web of ethical dilemmas, particularly in the areas of data privacy and individuals’ rights,” says the report, before calling for ethical action in several different ways, while also calling for eight separate actions to drive progress.

These actions include:

  • the creation of a governance structure to ensure ethical use of data
  • the development of regulation that is grounded in human rights law and adaptable to technological change
  • embedding responsible practice into new tech
  • adoption of a “test-and-learn” approach in implementation, with continual assessment and the prompt raising of unintended consequences
  • exploitation of economies of scale only possible with tech
  • agree on unified metrics and make designs with measurement in mind
  • build technology solutions that can be sustained
  • prioritise low-income communities and countries

The benefits

Thinking of mental health in terms of pounds and pence is dismal, fundamentally.

However, we live in a world with many problems, and looking at some of the staggering costs of inaction provides impetus to any call to action.

Per the WHO: “Every US$ 1 invested in scaling up treatment for common mental illnesses such as depression and anxiety leads to a return of US$ 4 in better health and ability to work.

On the contrary, failure to act is costly. According to a recent analysis, which calculated treatment costs and health outcomes in 36 low-, middle- and high-income countries for the 15 years from 2016-2030, low levels of recognition and access to care for depression and another common mental disorder, anxiety, result in a global economic loss of a trillion US dollars every year.

According to the Mental Health Foundation here in the UK: “Untreated mental health problems account for 13% of the total global burden of disease. It is projected that, by 2030, mental health problems (particularly depression) will be the leading cause of mortality and morbidity globally…

“The 2013 Chief Medical Officer’s report estimated that the wider costs of mental health problems to the UK economy are £70–100 billion per year – 4.5% of gross domestic product (GDP).

“However, estimating this figure is very complex and an earlier study carried out by Centre for Mental Health found that, taking into account reduced quality of life, the annual costs in England alone were £105.2 billion.”

When these figures are set beside both the lack of investment in mental health resources – both in prevention and treatment – and also the potential difference that could be made by investing in technology, it seems clear that a far better model, and far better world, is achievable.

Achievable does not mean easy. But those calling for change in how we deal with mental health are in a great position to argue their case.

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