The recent announcement of new funding for mental health research can help to improve existing treatments and develop new ones, says Dr Carmine Pariante in this guest blog.
The UK is extremely good at research into mental health. And now there is better news: the Department of Health recently announced a 5-year funding package for health research of £816 million – the largest ever such investment – of which about £80 million is going to mental health.
You could be forgiven for not knowing either of these facts, because research into mental health problems doesn’t get much publicity, much like anything else connected with mental health. But it’s worth taking a look at what this involves, because it paints a picture that is at odds with some of the popular misconceptions around mental health in general and psychiatrists in particular.
The Royal College of Psychiatrists has already been working hard to show the positive impact of research in psychiatry and psychology, and also where new developments in neuroscience might take us. And I have recently written on how psychiatry and mental health professionals help the society at large. This latest announcement, however, takes this a step further.
So how is this new money going to be spent? Some of it is assigned to two Biomedical Research Centres (BRCs) uniquely focused on mental health and dementia, Oxford Health and the South London and Maudsley (SLaM) NHS Trusts. In addition, there are mental health and dementia research themes within larger BRCs in Bristol, Cambridge, Newcastle upon Tyne, Nottingham and University College London. This is the time to look at what the science of psychiatry and mental health will do in the future. And the future is bright.
Precision is the buzzword in psychiatry now, and for a reason. For too long, doctors and patients have struggled with medications that work only in 50-70% of people, and are prescribed using a ‘trial-and-error’ approach. Efficacy of psychological therapies is probably in the same range, although we know very little about why some patients respond and other don’t. Future research will specifically validate psychological and biological markers for what we call ‘stratification’ (grouping patients together according to how they might respond to specific treatments, rather than guesswork), and matching the right treatment to the underlying pharmacological or psychological problem.
For example, blood tests will be developed to identify patients that require specific combinations of treatments, like adding an anti-inflammatory to an antidepressant or antipsychotic. Also, psychological therapies will be developed to address specific psychological symptoms like negative cognitive biases – a general tendency to see the world as worse than it is – which is associated with depression.
But precise delivery of therapies at an individual level comes from knowledge that requires big data. Very big data. So, the future will use translational informatics to anonymously collect and analyse clinical, psychological and biological data from hundreds of thousands of patients who attend the NHS or register onto online platforms. New ways of working with electronic medical records will lead to the building of large clinical cohorts of cognitively, biologically and genetically well-characterised people.
One such ambition is to collect data on the psychosocial and biological predictors of response to psychological therapies in the almost 500,000 individuals who attend Improving Access to Psychological Therapies services every year. By having access to such a large amount of data, it will also be possible to predict relatively rare events, such as suicide attempts or adverse drug reactions.
Of course, there is no point in improving the delivery of treatments if we do not have new treatments to deliver. Hence the focus of future research on developing a range of novel therapies that tap into hitherto unknown mechanisms, and that will be tested in the largest possible clinical trials. Dr Matthew Patrick, chief executive of SLaM, aims to “involve 50,000 patients in new treatment studies by 2021”, and Professor John Geddes, director of the new Oxford BRC, wants to “drive insights from discovery science into innovative treatments.”
The list of these potential new treatments is enormous. Besides new (or re-purposed) medications targeting novel biological mechanisms across all mental disorders, there will be new psychological therapies for trans-diagnostic psychological symptoms, virtual reality for psychosis and anxiety, novel internet implementations of psychological therapies with proven face-to-face efficacy, novel app-based technological approaches to provide precision monitoring of mental health and neuroimaging-based interventions where patients will be able to change their own brain function.
Dementia will be tackled through a variety of approaches, with an emphasis on early identification and treatment of people before they develop a full-blown cognitive deterioration, and on pharmacological and non-pharmacological interventions to preserve cognitive health in later life.
Finally, and paraphrasing a sentence we have heard many times before, there is no physical health without mental health. In England, 5 million people have a long-term medical condition with a comorbid mental disorder and more than 12% of the costs of long-term conditions are linked to patients’ poor mental health, translating into more than £10 billion in NHS expenditure.
It is not surprising therefore that we will see a renewed emphasis on the interface between mental and physical health. For example, new psychological interventions will be developed to address symptoms like anxiety, depression, pain and fatigue, irrespective of the medical disorder. Additionally, specific interventions will be developed for high-risk groups, such as: patients with autoimmune and rheumatoid disorders, where poor mental health is partially driven by the biochemical changes in the body; patients in the perinatal period, where the impact of poor mental health also extends to the exposed offspring; and patients with diabetes, where poor mental health increases the risk of dementia and affects health management behaviour.
This announcement confirms, if there was a need to, that psychiatry and mental health research are as scientific as the rest of medicine and that we already benefit from revolutionary technical and theoretical developments. The range of scientific approaches available is mind-blowing, and this new funding will allow all of us to build on our strength in order to deliver the brightest possible future for patients.
About the author