Last weekend mental health professionals and researchers from many different disciplines and nations gathered in Dubai for the 13th Emirates Society Mental Health International Congress. The need for gatherings such as this has never been greater. Globally, mental health is emerging as “the” major public health concern of the 21st century.
Despite remaining widely under-reported, mental health issues have reached epidemic proportions across the globe. The World Health Organisation estimated that 1.1 billion people worldwide were experiencing a mental health issue in 2016. The economic burden associated with mental illness is the largest of any health issue and is projected to cost us $6 trillion per year by 2030.
Data for the UAE shows a similar pattern, with three of the country's leading causes of health-related disability being mental health conditions. Major depressive disorder occupies the top spot, with anxiety disorders and addiction ranked fifth and seventh, respectively.
Modern medicine has made immense strides in the battle against diseases such as smallpox, polio and rubella. Average life expectancy has increased in most nations, to the degree that some social scientists now believe that the world’s first 150-year-old person has already been born. But, while many of us are living longer than ever before, mental health issues are on the rise – and who wants to live unhappily ever after?
Our relative lack of progress in tackling mental illness becomes particularly evident when compared with the success we have achieved in treating physical conditions. Some of our most pressing physical health issues – such as cardiovascular disease and diabetes – are also complicated by pre-existing or concurrent mental health issues. For example, the rate of depression among people with type-2 diabetes is twice as high as that found in the general population, and when depression accompanies diabetes, there tends to be poorer glycaemic control, poorer self-care and, consequently, poorer outcomes.
At the sharper end of the morbidity-mortality spectrum, suicide is now the leading cause of death for British men under the age of 50. In the US, meanwhile, more people commit suicide than are murdered or killed in combat.
Although mental health is a growing issue, it is not a new one. The earliest known medical manuscript devoted entirely to depression, A Treatise on Melancholia, was written by Ishaq ibn Imran, an Iraqi-Arab physician working in 10th-century Tunisia. Some of his ideas for treating depression might sound odd to our ears, for example, in one section of the work he advocates drinking breast milk as a cure. But, then, perhaps some of our current interventions – electroconvulsive therapy, for example – will sound equally bizarre to future generations.
Last week’s conference, however, reflected progress and a real change in the way we view mental health issues. For a long time, biological, psychological and social perspectives have remained separate and sometimes even been antagonistic to one another. This event, however, was billed as exploring “The Power of 3P: Psychiatry, Psychology and Philosophy”. This more holistic, interdisciplinary approach was reflected in the conference content, with professionals from diverse backgrounds gathered to share their views.
Another significant shift in the mental health arena, also reflected at the conference, is a greater emphasis on early detection and prevention. Several presentations focused on acceptance and commitment therapy (ACT).
ACT is a mindfulness-based approach to mental health issues that shows promise as a universal prevention programme – something we participate in before we ever experience a mental health issue, in the hope that we never do. A study published in 2017 in the journal Child and Adolescent Psychiatry and Mental Health, trialled ACT in a school setting and reported promising preliminary results. Other, similar, prevention-orientated studies are now under way.
Meanwhile, Jigar Jogia, an associate professor of psychology at Zayed University in Dubai, presented work using machine learning to look at brain imaging data from people living with depression, with a view to developing tools that can help detect mood disorders early. As with many physical complaints, catching things early can be a deciding factor with mental health issues too. For some conditions, early intervention can make the difference between a quick and lasting recovery or a lifetime of complications.
We are making progress in the area of mental health. The greater focus on early detection, early intervention and prevention is extremely positive. A broader discussion, looking beyond biology, has also helped professionals and the public to develop a greater appreciation of the psychological, social and spiritual factors that can help keep people mentally well. We may never find a catch-all “cure” for depression, but we are getting closer to developing interventions and fashioning societies where these experiences will become less frequent and less long-lasting.
Dr Justin Thomas is a professor of psychology at Zayed University