We need a Grey New Deal

Mental illnesses do not receive the attention they deserve and they are treated as taboo, writes Gerhard Schratt. Taking a cue from the Green New Deal, he proposes a Grey New Deal.

Every day, our grey cells - the brain’s neurons - determine our life, our health and our well-being. WHO’s Mental Health Day is held every October to highlight the importance of mental health. But last October, as in previous years, the media and the general public took little notice. This lack of public concern stands in stark contrast to the outsize significance of mental illnesses.

Around one in two people in Switzerland will suffer from a mental illness at least once in their lives. Most common among these are depression, anxiety disorders and substance abuse1. Taking the years of productive life lost due to illness, disability or premature death - or disability adjusted lost years - as a measure of an illness’s social burden, mental illnesses rank fourth after cancer, cardiovascular and musculoskeletal diseases; in the under-50 age group, they rank first2. Worryingly, between 2006 and 2016 alone, disability adjusted years lost to mental illness increased by nearly 15 percent.

The cost of mental illness to the economy is also immense. While total costs in the EU had already reached just under 800 billion euros in 2010 (some 4 percent of gross domestic product), experts predict this figure to double by 2030 as a result of demographic change3. This means that mental illnesses, together with cardiovascular diseases, top the list of all illness-related economic costs; in the case of mental illnesses, indirect costs such as those caused by absence from work account for a particularly large share.

Pandemic has an impact

It is expected that the seriousness of mental illness will continue to increase in the wake of the COVID-19 pandemic. Indeed, the pandemic itself fans the flames of mental illness: not only can factors associated with COVID-19 - including social isolation, grief, anxiety, increased alcohol consumption and loss of income - trigger mental illness, they are especially liable to exacerbate existing mental illness.

According to a study by the University of Basel on the effects of COVID-19 on mental health, the proportion of respondents with severe depressive symptoms rose from 3 percent before the pandemic to 18 percent in November 20204. Model calculations suggest that the psychosocial consequences of a three-month lockdown would cost the Swiss population alone 1.7 million years of life in the future - even without taking other factors, such as changes in eating and exercise behaviour, into account5.

Research into why society nonetheless treats mental health as a second-order issue reveals a host of reasons. First and foremost, mental illness is still treated as taboo6. The vast majority of psychological issues are kept within the family circle, with the taboo beginning in the workplace, where psychologically induced absences are becoming more prevalent. This is associated with a stigmatisation of those affected, who in turn withdraw, thus closing the vicious circle.

Underfunded according to WHO

This lack of public attention is also reflected in the resources allocated to healthcare. WHO even goes so far as to say that the mental health sector is chronically underfunded. Globally, according to WHO, only 2 percent of all healthcare spending is devoted to mental illness - a vanishingly small proportion when measured against mental illness’s health and financial consequences.

Furthermore, academic and industrial research in the field of mental illness is underdeveloped compared to other sectors, such as cancer research, with the result that urgently needed innovations in prevention, diagnosis and treatment are lacking. The main reason for this is the inherent complexity of the brain, the decoding of which requires extremely long-term research projects. This problem is particularly evident in industrial research, where failures in the development of novel drugs have led to a reduction of neuroscience research.

Dialogue helps break down taboos

How can we counteract this? Inspired by the recently proposed Green New Deal concept for addressing the climate crisis, I propose a Grey New Deal in reference to our grey matter. Provided it specifically involves the full range of stakeholders - the public, patient organisations, academic and industrial research, healthcare providers and policymakers - such a programme could foster dialogue, encourage knowledge sharing and accelerate investment in research and innovation.

The overarching goal must be to ultimately enable better prevention, diagnosis and treatment of mental illness. Only intensive dialogue can help in the urgent task of breaking down the taboos surrounding mental illness and raise awareness of its importance both among the general public and among policymakers. This would for instance allow psychosocial aspects to be better addressed in future health crises like the COVID-19 pandemic.

Under a Grey New Deal, funding would need to be provided to launch multidisciplinary translational research programmes in the field of mental health involving academia, clinicians and industry. Of central importance here is the stepping up of basic neuroscientific research, which has the potential to open up alternative options for future treatment using innovative technologies.

COVID-19 and the vaccines that have been developed against it have shown us how much we can achieve in a relatively short time if we mobilise all social forces and financial resources. The challenge now is to harness this momentum for much-needed innovation in mental health.

References

1 OBSAN Bulletin 5/2017
2 Global health: time for radical change? Lancet 2020. 396: 1129, doi: 10.1016/S0140-6736(20)32131-0
3 Trautmann S, Rehm J, Wittchen HJ: The economic costs of mental disorders. EMBO Reports 2016, 17: 1245, doi: 10.15252/embr.201642951
4 de Quervain D et al.: The Swiss Corona Stress Study: second pandemic wave, November 2020
5 Moser DA, Glaus J, Frangou S, Schechter DS: Years of life lost due to the psychosocial consequences of COVID-19 mitigation strategies based on Swiss data, European Psychiatry 2020, 63: e58, doi: 10.1192/j.eurpsy.2020.56
6 Werner Alfred Selo Stiftung: Stigma psychischer Erkrankungen 2013

Prof. Gerhard Schratt

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