A Moment to Celebrate
Let’s take a moment to celebrate. Thirty years ago, there were essentially no serious mental illnesses that we knew how to treat in any meaningful way. Now, there are at least a dozen major illnesses that are either curable or effectively remittable for most people. Even with the illnesses we still struggle to treat, we are starting to show progress, with promising research underway all over the world. We can look forward to a day not far in the future when real cures will be possible for many conditions.
Untreated mental illness will impose a tremendous cost to the world economy over the next 20 years. Particularly worth reading is the blog post by Dr. Thomas Insel, Director of the National Institute of Mental Health. The World Economic Forum created the chart below to show the burden of mental illness in terms of Disability-Adjusted Life Years (DALY). DALY is an economic statistic that’s a useful comparative tool, but it doesn’t begin to measure the complete impact of mental illness on individuals and families.
However, I want to focus on the good news: we have the knowledge to effectively treat many of the most costly diseases on this chart.
Here are some of the illnesses that we know how to effectively treat:
- Unipolar depression can be effectively treated for most people who have moderate to severe symptoms. There are multiple psychosocial treatments (cognitive behavioral therapy, or CBT, is the most well-researched) and medications that have been shown to be effective, although it may take several tries with different interventions (or combinations) to find an effective treatment for a particular individual. In addition, behavioral interventions have also been shown to prevent full onset of clinical depression for about one-third of high-risk individuals.
- Recent onset schizophrenia can be remitted with a treatment approach that combines careful medication management with cognitive therapy, family support, and social engagement. In addition, there is a growing body of evidence that early psychosocial treatment can prevent schizophrenia in individuals who are experiencing early symptoms. Take a moment to feel good about this fact. We can prevent the full onset of this terrible disease for a significant fraction of young people who are currently developing psychosis. Only a decade ago, that would have seemed like an impossible idea to most people.
- With the right psychosocial treatment, panic attacks can be entirely remitted for most people. Selective serotonin reuptake inhibitors (SSRIs) can help a significant number of those who do not benefit or cannot participate in CBT.
A number of other conditions can be effectively treated. Object phobias, for example, can be entirely extinguished for most people with the right treatment. We have had less success with the other conditions on this chart, although we are making progress on each of them. The field of treatment for bipolar disorder, including my organization, The Felton Institute, is just bubbling with great new ideas and promising preliminary studies.
It is easy to make a counterargument. Few mental illnesses can be cured outright. An unacceptably high number of individuals with any condition will not respond even to those effective treatments we have available. We should keep in mind how far we have to go, but we should focus on the fact that state-of-the-art treatment, delivered with rigor and with a recovery orientation, can transform lives.
The bad news is — although we have made great strides in the last thirty years — we have made much less progress in making these treatments available to those who need them.
What do you think are the top ways we can improve access?
The Felton Institute’s program Prevention and Recovery in Early Psychosis (PREP) won the 2014 National Council Award of Excellence for Inspiring Hope through Science to Service.