Two different approaches can work in tandem to help those with mental disorders.
Key points
Major neuroscientific advances are leading to new treatments for psychiatric disorders.
Public mental health targets social factors that increase risk of developing psychiatric disorders.
Both approaches are important in decreasing disabilities associated with mental illness.
Psychiatric disorders are common and among the most disabling of all medical illnesses. Even disorders with less severe symptoms can lead to substantial disability.
Over the last decade, major progress has been made in elucidating the genetic and neuroscientific underpinnings of psychiatric illnesses. Advances in molecular sciences, cognitive sciences, and neuroimaging are increasingly attracting research-oriented medical students, including those in combined MD-Ph.D. programs, into psychiatry residency training.
New classes of medications are being developed. Evidence-based treatments, including, for example, specific psychotherapies, transcranial magnetic stimulation, and ketamine infusions, are increasing the number of therapeutic tools available to mental health professionals.
Although treatments are available, substantial barriers can interfere with a person’s ability to access treatment. These barriers may include lack of or inadequate health insurance, provider shortages, and/or illness-related symptoms that hinder willingness to seek and follow through with treatments. Implementation research to develop better ways of reaching individuals who would benefit from treatment could lessen the impact of disabilities resulting from mental illnesses.
Public Mental Health
Although reaching individuals already suffering from mental disorders is imperative, there is an additional approach that can decrease harm from mental disorders. This approach involves public mental health.
In addition to biological underpinnings of mental disorders, societal factors can increase the risk of psychiatric illness. These factors may augment biological risks.
As pointed out by Ulrich Reininghaus and colleagues in a recent review in JAMA Psychiatry, “Ethnicity, education level, and socioeconomic status can lead to different risk distributions for subpopulations depending on their position in the social strata.” Public mental health strategies attempt to identify interventions that may decrease these risks and thus reduce the number of individuals who develop mental illness.
Biologic factors may have a stronger influence than predisposing societal factors in the development of some disorders. However, adverse early life experiences can substantially increase the risk of developing certain psychiatric illnesses.
Public mental health approaches can help determine which groups of individuals are most susceptible to specific social adversities that predispose them to various behavioral and cognitive symptoms. As reviewed by James Kirkbride and colleagues in an article in World Psychiatry, specific types of early interventions may be effective at diminishing the later development of certain disorders. Such interventions may involve early recognition and intervention programs, early education programs, and public policies addressing poverty and childhood adversity.
The purpose of this post is not to review the field of public mental health. Rather, it is to encourage a multi-pronged research agenda that works to develop treatments to ameliorate symptoms of mental illnesses and interventions to decrease the development of such disorders. These approaches must be complementary, not competitive.
Note: This article originally appeared on Psychology Today.
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