How to solve MH technical paper

How to solve MH technical paper

 

We have previously argued that global mental health needs to be solved urgently. Only a combined effort make an impact.

To actually solve mental health, a complete reimagining of the complex societal mental health ecosystem is needed.

The Thrive Foundation proposes to use emerging scientific evidence and cutting-edge innovation to actually solve mental health in our community of 65,000 people. Our approach is to tackle mental health across the life-course of the population, from conception to old age, using a multi-level systems framework of determinants of mental health, as described in Figure 1, below.

 

Diagram of the social determinants of mental health adapted from The Determinants of Health

Figure 1

 

The above framework illustrates the complexity of mental health within a society. Tackling any one of these components is unlikely to achieve radical improvements. The components above can be condensed in three core principles. WHen applied together, we believe that Mental Health can be solved in a society. These principles are:

  • Prevention and Health Promotion: protection and resilience enhancement
  • Perfect Care: innovative treatments and suicide prevention
  • People Power: social justice, democracy, and community empowerment

No one has yet brought the elements together with the intention of solving mental health at national level. This is possible in Guernsey because of its manageable size and structure as a test bed nation, a simplified single-layer bureaucracy, innovative and visionary leadership, the ability to access rapid policy development, and the power to dive deeply into systems for meaningful change.

Below we present the Thrive Foundation principles framework in more detail.

 

  1. Prevention and Health Promotion

Mental illness is largely preventable. Genomics research has demonstrated complex multi-gene influences on health where hereditary (genetic) factors alone only account for a small proportion of illness liability. Genomic science has clarified that environmental influences, probably from before conception, and continuing throughout life, have the strongest effects on health. The vast majority of mental illness is thus caused or triggered by environmental factors like trauma, abuse, poverty, inequality, substance use and toxic stress. Each of these can be systematically reduced using existing science.

Population mental health is normally distributed from thriving to surviving to suffering. Scientists have demonstrated that whole population mental wellbeing can be shifted towards thriving and away from suffering. The normal distribution curve of population health shifts left away from illness towards thriving (Figure 2, below).

 

Prevention: shifting a population towards thriving

Figure 2: Prevention and health promotion can shift a whole population (left arrow) towards thriving (blue area), and also reduce clinical cases and suffering (red area).

 

From a mental healthcare perspective, fewer people cross the illness line to become “clinical cases” who require costly treatment, and incur other costs (unemployment, etc), all of which negatively impact the economy. Based on epidemiologist Prof Geoffrey Rose’s work, the principle of whole population shift has also been demonstrated in such diverse areas as obesity, gambling, smoking, alcohol use, suicide, educational attainment, blood pressure and cholesterol.

Prevention approaches give positive returns on investment. For example, recent research shows that for each dollar invested in prevention, a savings of up to $10 in treatment for alcohol or other substance abuse can be seen (NIDA, 2003). Investing in population health makes human, health, and economic sense.

The more people thriving, the greater the opportunity for self-actualization at national level.

 

Prevention and health promotion

  • 50% of new cases of depression, ⅓ cases of dementia, and up to 60% of drug use can be prevented (Cuijpers, JAMA 2012; The Lancet, 2017; Thompson, 1997);
  • Parenting support interventions have been shown to promote lifelong mental health and wellbeing of the children (Walhbeck, 2016);
  • School programmes have consistently been shown to have positive effects on social and emotional skills and competencies and reduce substance misuse;
  • Workplace reorganisation and increased control over work life improve;
  • Improved mental wellbeing increases productivity and reduces societal costs.

 

  1. Perfect Care

Existing care systems can implement proven systems to radically improve outcomes and reduce risk. Innovative new treatments, like psychedelic-assisted therapies and gene therapies, are held back by outdated and inefficient bureaucracy. To disseminate innovation is much quicker in a smaller health system within a nimble regulatory framework.

Similarly there is strong evidence for developing detection, early intervention and optimal evidence-based care for mental disorders that occur despite prevention efforts. Using whole-system approaches, suicides have been reduced to zero in health systems using “perfect depression care” models.

Health outcomes for people with psychosis are better in developing countries, despite – or because of — the lack of access to modern medicine, and the maintenance of integrated communities. We want to develop community-based peer support and expert patient networks to offer both out-of hospital, crisis support, advocacy, and leadership in transforming their services.

 

Perfect Care

  • “Perfect depression care” and Zero Suicide initiatives have been successfully demonstrated in multiple healthcare systems;
  • Peer support networks enhance recovery, are evidence-based and cost-effective;
  • Psychedelic-assisted therapies show major promise for treatment-resistant depression, post-traumatic stress disorder and addictions;
  • Gene therapies, cross-species translational approaches, AI, robotics, virtual reality and biohacking amongst others will revolutionise care.

 

  1. People Power

Mental health is dependent on structural determinants: mental wellbeing is best achieved in equitable, just and non-violent societies (Patel 2014).

Few Western countries truly harness power of the people within their communities.

Evidence-based approaches including: Asset-Based Community Development (ABCD) approaches, participative democracy, universal basic income, restorative justice, drug regulation and public mental health approaches, not only empower citizens and communities but they also provide impressive returns on investment.

No single ecosystem has attempted to join the dots in the way, scale or time-scale that the Thrive Foundation intends.

 

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