Neuroscience holds the key to understanding the brain – and to developing more effective treatments for people with mental health disorders. But if we are to translate the many neuroscience discoveries into better brain health and well-being for people globally, we will also need strategies and official recommendations on how these findings can be implemented. In a paper published in The Lancet Psychiatry, we suggest some ways that evidence from neuroscience can be used to improve global mental health. Mental health issues are found across the world and in every population. According to the World Health Organisation, around a third of the adult population worldwide suffers from a mental disorder such as depression, anxiety and schizophrenia. But treatments for depression and methods for preventing suicide, for example, are not evenly spread. There is also clearly a gap between mental health research and services. So it is important to find treatments for mental health disorders that can be delivered in culturally diverse low and middle-income countries, where there are challenges of poverty, stigma and a lack of clinicians with specialist training in mental health.
The roots of resilience
Neuroscience can help us understand the underlying molecular factors behind mental disorders, as well as where and how to focus research and treatment. We know that some people have a greater ability to successfully overcome a stressful challenge, for example. Take war and conflict. The same experience may still lead to a good outcome for someone who is more resilient, whereas a less resilient person may develop post-traumatic stress disorder. Understanding the neurobiology of resilience and finding effective ways to instill this resilience and cognitive reserve in others could help us tackle particular disorders. Known methods of prevention and treatments can also be modified for use in other countries. For example, treating depression, reducing stigma and promoting positive factors for good brain health such as education and exercise, could have a marked impact on suicide in developing countries. Translational neuroscience is also providing new ways of looking at conditions such as schizophrenia. Schizophrenia can cause cognitive problems to memory and motor skills, for example – and the reason that patients with schizophrenia may not be able to return to work, or have a good quality of life at home, may primarily be due to this cognitive impairment. This is because anti-psychotic medications already treat psychotic symptoms. This new approach led to the US Food and Drug Administration (FDA) to accept cognition as a target for treatment in schizophrenia, where previously only psychiatric symptoms such as psychosis were the main focus.
Currently we know that early detection, and early effective treatment, of mental health problems is important for determining the functionality, quality of life and well-being of patients. This accords with what has been known for some time in regard to physical illness such as cancer. Yet there are rarely systems in place for early detection of mental health problems – and people continue to experience illness for many years before it is diagnosed and treated. Getting this right is still an issue in the developed world, but an even more pressing one in low and middle-income countries.
Learning from each other
Tackling global mental health is not a one-way thing, but an exchange: knowledge from low and middle-income countries can also inform what we know about the effects on the brain of social and financial deprivation across a range of populations – going beyond research only on populations in developed countries or those with strong research histories – and may also give an insight into both the mechanisms and mitigating factors for mental disorders. In addition, learning to adapt clinical trials of pharmacological and psychological treatments to include different cultural and environmental factors and meaningful measures within this context would be greatly beneficial. This could also inform a new methodology for developed countries, where there has recently been considerable discussion as to how we can improve drug discovery and clinical trials. When it comes to treatment, another important recommendation for promoting a closer relationship between global mental health and neuroscience is to incorporate neuroscience predictors, for example findings in genetics, and endpoints, such as cognition, into trials in low and middle-income countries.
The Research Domain Criteria framework was developed to find new ways of classifying mental disorders based on behavioural and neurobiological measures. Behaviour can be objectively observed and measured and has a neurobiological basis. For example, excessive impulsive behaviour can lead to problems for people whether they have a diagnosis of attention deficit hyperactivity disorder, mania, or substance abuse. Therefore a treatment for impulsivity would be useful for people with a range of disorders. Modern approaches of genetics, neuroscience and behavioural science can be used to better understand mental illness. And these can all work across populations.
Ethical considerations are also crucial to an understanding of global mental health, since groups who are especially at risk of mental health disorders include people living in poverty and those exposed to war and conflict. A particular consideration of the Presidential Commission for the Study of Bioethical Issues and the Human Brain Project, has been mental health inequities, which increases the likelihood of experiencing disability and premature mortality, stigma, discrimination and social exclusion. Bringing together neuroscientific and global mental health strengths in both research and treatment could lead to real gains in improving mental well-being, quality of life and how well people function with their disorder. At present, while early detection and early effective treatment for physical health problems is becoming the norm in developed and developing countries, there isn’t the same parity of access to treatment for those with mental health problems – especially in developing countries. Improving equality of access to early detection and effective treatments for those with mental health problems will ensure justice in flourishing societies throughout the world.
This article first appeared The Conversation, 29 January 2015.